scholarly journals Comparing Risk Profiles in Critical Care Patients With Stage 2 and Deep Tissue Pressure Injuries: Exploratory Retrospective Cohort Study (Preprint)

2021 ◽  
Author(s):  
Jenny Alderden ◽  
Linda Amoafo ◽  
Yue Zhang ◽  
Caroline Fife ◽  
David Yap ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Critical Care ◽  
Cohort Study ◽  
Length Of Stay ◽  
Retrospective Cohort ◽  
Deep Tissue ◽  
Risk Profiles ◽  
Pressure Injury ◽  
Critical Care Patients

BACKGROUND Understanding hospital-acquired pressure injury (HAPrI) etiology is essential for developing effective preventive interventions. Pressure injuries are classified based on the degree of visible tissue damage; the two most commonly identified HAPrI stages in critical care patients are stage 2 and deep tissue injury (DTI). Some experts speculate that stage 2 and DTI have different etiologies, with stage 2 injuries formed from the “outside in” as a result of tissue deformation, decreased perfusion, and subsequent ischemia caused by external pressure and/or shear forces, whereas DTI emerges from the “inside out” due to inadequate perfusion to the deeper tissues causing tissue ischemia. OBJECTIVE The purpose of this study was to compare risk profiles of intensive care unit (ICU) patients who developed stage 2 injuries versus DTIs. METHODS This was a retrospective cohort study to compare the risk profiles of patients in the ICU with stage 2 injuries and DTIs using electronic health record data. Eligible patients were admitted to the surgical or cardiovascular ICU at an academic medical center in the United States between 2014 and 2018. Anatomic locations were examined, and differences in anatomic patterns were compared using the <i>χ<sup>2</sup></i> test. Risk profile variables included demographic characteristics, Braden Scale scores, vasopressor infusions, hypotension, surgical factors, length of stay, BMI, laboratory values, diabetes, Charlson Comorbidity Index, and the levels of sedation or agitation. The distributions of potential risk variables between patients with stage 2 injuries and DTIs were summarized and compared. A logistic regression model with the least absolute shrinkage and selection operator method was developed to identify the critical risk factors for distinguishing stage 2 and DTI patients. RESULTS A total of 244 patients developed a stage 2 injury or DTI during the study period. Of those, 38 patients with medical device–related pressure injury were excluded. The final study sample consisted of 206 patients (n=146 stage 2 and n=60 DTI). Compared with DTIs, stage 2 HAPrIs were more likely to be located on a bony prominence (n=206, <i>χ</i><sup>2</sup><sub>1</sub>=8.43, <i>P</i>=.03). The multivariate model showed that patients who developed stage 2 HAPrIs had a longer length of stay in the ICU than those with DTIs (odds ratio [OR] 1.001, 95% CI 1-1.002, <i>P</i>=.03) but were less likely than patients with DTIs to experience a diastolic blood pressure &lt;50 mmHg (OR 0.179, 95% CI 0.072-0.416, <i>P</i>&lt;.001) or receive an epinephrine infusion (OR 0.316, 95% CI 0.079-0.525, <i>P</i>=.008). CONCLUSIONS Stage 2 injuries and DTIs have different risk factors and different anatomic patterns. Patients who developed DTIs were more likely to experience low diastolic blood pressure and receive epinephrine, a potent vasopressor. Stage 2 injuries were more likely to occur on the bony prominences, whereas DTIs commonly occurred on the fleshy parts of the body such as the buttock.

scholarly journals Comparing Risk Profiles in Critical Care Patients With Stage 2 and Deep Tissue Pressure Injuries: Exploratory Retrospective Cohort Study

10.2196/29757 ◽  
2021 ◽  
Vol 4 (2) ◽  
pp. e29757
Author(s):  
Jenny Alderden ◽  
Linda Amoafo ◽  
Yue Zhang ◽  
Caroline Fife ◽  
David Yap ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Critical Care ◽  
Cohort Study ◽  
Length Of Stay ◽  
Retrospective Cohort ◽  
Deep Tissue ◽  
Risk Profiles ◽  
Pressure Injury ◽  
Critical Care Patients

Background Understanding hospital-acquired pressure injury (HAPrI) etiology is essential for developing effective preventive interventions. Pressure injuries are classified based on the degree of visible tissue damage; the two most commonly identified HAPrI stages in critical care patients are stage 2 and deep tissue injury (DTI). Some experts speculate that stage 2 and DTI have different etiologies, with stage 2 injuries formed from the “outside in” as a result of tissue deformation, decreased perfusion, and subsequent ischemia caused by external pressure and/or shear forces, whereas DTI emerges from the “inside out” due to inadequate perfusion to the deeper tissues causing tissue ischemia. Objective The purpose of this study was to compare risk profiles of intensive care unit (ICU) patients who developed stage 2 injuries versus DTIs. Methods This was a retrospective cohort study to compare the risk profiles of patients in the ICU with stage 2 injuries and DTIs using electronic health record data. Eligible patients were admitted to the surgical or cardiovascular ICU at an academic medical center in the United States between 2014 and 2018. Anatomic locations were examined, and differences in anatomic patterns were compared using the χ2 test. Risk profile variables included demographic characteristics, Braden Scale scores, vasopressor infusions, hypotension, surgical factors, length of stay, BMI, laboratory values, diabetes, Charlson Comorbidity Index, and the levels of sedation or agitation. The distributions of potential risk variables between patients with stage 2 injuries and DTIs were summarized and compared. A logistic regression model with the least absolute shrinkage and selection operator method was developed to identify the critical risk factors for distinguishing stage 2 and DTI patients. Results A total of 244 patients developed a stage 2 injury or DTI during the study period. Of those, 38 patients with medical device–related pressure injury were excluded. The final study sample consisted of 206 patients (n=146 stage 2 and n=60 DTI). Compared with DTIs, stage 2 HAPrIs were more likely to be located on a bony prominence (n=206, χ21=8.43, P=.03). The multivariate model showed that patients who developed stage 2 HAPrIs had a longer length of stay in the ICU than those with DTIs (odds ratio [OR] 1.001, 95% CI 1-1.002, P=.03) but were less likely than patients with DTIs to experience a diastolic blood pressure <50 mmHg (OR 0.179, 95% CI 0.072-0.416, P<.001) or receive an epinephrine infusion (OR 0.316, 95% CI 0.079-0.525, P=.008). Conclusions Stage 2 injuries and DTIs have different risk factors and different anatomic patterns. Patients who developed DTIs were more likely to experience low diastolic blood pressure and receive epinephrine, a potent vasopressor. Stage 2 injuries were more likely to occur on the bony prominences, whereas DTIs commonly occurred on the fleshy parts of the body such as the buttock.

Outcomes Associated With Stage 2 Pressure Injuries Among Surgical Critical Care Patients: A Retrospective Cohort Study

2019 ◽  
Vol 39 (4) ◽  
pp. 13-19 ◽  
Author(s):  
Jenny Alderden ◽  
Yunchuan Lucy Zhao ◽  
Donna Thomas ◽  
Ryan Butcher ◽  
Brenda Gulliver ◽  
...  
Keyword(s):  
Critical Care ◽  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Surgical Critical Care ◽  
Critical Care Patients

Identifying Risk Factors for Pressure Injury in Adult Critical Care Patients

2020 ◽  
Vol 29 (3) ◽  
pp. 204-213 ◽  
Author(s):  
Jill Cox ◽  
Marilyn Schallom ◽  
Christy Jung
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Critical Care ◽  
Intensive Care ◽  
Decision Tree ◽  
Scale Score ◽  
Critically Ill Patients ◽  
Braden Scale ◽  
Pressure Injury ◽  
Critical Care Patients

Background Critically ill patients have a variety of unique risk factors for pressure injury. Identification of these risk factors is essential to prevent pressure injury in this population. Objective To identify factors predicting the development of pressure injury in critical care patients using a large data set from the PhysioNet MIMIC-III (Medical Information Mart for Intensive Care) clinical database. Methods Data for 1460 patients were extracted from the database. Variables that were significant in bivariate analyses were used in a final logistic regression model. A final set of significant variables from the logistic regression was used to develop a decision tree model. Results In regression analysis, cardiovascular disease, peripheral vascular disease, pneumonia or influenza, cardiovascular surgery, hemodialysis, norepinephrine administration, hypotension, septic shock, moderate to severe malnutrition, sex, age, and Braden Scale score on admission to the intensive care unit were all predictive of pressure injury. Decision tree analysis revealed that patients who received norepinephrine, were older than 65 years, had a length of stay of 10 days or less, and had a Braden Scale score of 15 or less had a 63.6% risk of pressure injury. Conclusion Determining pressure injury risk in critically ill patients is complex and challenging. One common pathophysiological factor is impaired tissue oxygenation and perfusion, which may be nonmodifiable. Improved risk quantification is needed and may be realized in the near future by leveraging the clinical information available in the electronic medical record through the power of predictive analytics.

scholarly journals Cardiovascular risk factor documentation and management in primary care electronic medical records among people with schizophrenia in Ontario, Canada: retrospective cohort study

BMJ Open ◽  
2020 ◽  
Vol 10 (10) ◽  
pp. e038013
Author(s):  
Braden O’Neill ◽  
Sumeet Kalia ◽  
Babak Aliarzadeh ◽  
Frank Sullivan ◽  
Rahim Moineddin ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Cardiovascular Disease ◽  
Primary Care ◽  
Cohort Study ◽  
Cardiovascular Risk ◽  
Electronic Medical Records ◽  
Medical Records ◽  
Retrospective Cohort ◽  
Increased Risk

ObjectivesIn order to address the substantial increased risk of cardiovascular disease among people with schizophrenia, it is necessary to identify the factors responsible for some of that increased risk. We analysed the extent to which these risk factors were documented in primary care electronic medical records (EMR), and compared their documentation by patient and provider characteristics.DesignRetrospective cohort study.SettingEMR database of the University of Toronto Practice-Based Research Network Data Safe Haven.Participants197 129 adults between 40 and 75 years of age; 4882 with schizophrenia and 192 427 without.Primary and secondary outcome measuresDocumentation of cardiovascular disease risk factors (age, sex, smoking history, presence of diabetes, blood pressure, whether a patient is currently on medication to reduce blood pressure, total cholesterol and high-density lipoprotein cholesterol).ResultsDocumentation of cardiovascular risk factors was more complete among people with schizophrenia (74.5% of whom had blood pressure documented at least once in the last 2 years vs 67.3% of those without, p>0.0001). Smoking status was not documented in 19.8% of those with schizophrenia and 20.8% of those without (p=0.0843). Factors associated with improved documentation included older patients (OR for ages 70–75 vs 45–49=3.51, 95% CI 3.26 to 3.78), male patients (OR=1.39, 95% CI 1.33 to 1.45), patients cared for by a female provider (OR=1.52, 95% CI 1.12 to 2.07) and increased number of encounters (OR for ≥10 visits vs 3–5 visits=1.53, 95% CI 1.46 to 1.60).ConclusionsDocumentation of cardiovascular risk factors was better among people with schizophrenia than without, although overall documentation was inadequate. Efforts to improve documentation of risk factors are warranted in order to facilitate improved management.

scholarly journals EP.WE.573Outcomes of Emergency Laparotomies during the COVID-19 Pandemic - A retrospective cohort study

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Nader Habib Bedwani ◽  
William English ◽  
Christopher Smith ◽  
Shailendra Singh ◽  
Paul Vulliamy ◽  
...  
Keyword(s):  
Critical Care ◽  
Cohort Study ◽  
Respiratory Failure ◽  
Length Of Stay ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Emergency Laparotomy ◽  
Platelet Counts ◽  
Critical Care Admission ◽  
Grade 3

Abstract Aims A better understanding of patient monitoring and outcomes is required following emergency laparotomy. We aimed to evaluate recovery following emergency laparotomy during the ‘first wave’ of the COVID-19 pandemic and assess for COVID-19-associated coagulopathy in this group. Methods We performed a single-centre, retrospective cohort study on adult patients undergoing emergency laparotomy from 23rdMarch – 16thMay 2020 comparing patients with or without suspected or confirmed SARS-CoV-2. Main outcome measures included; 30-day mortality, post-operative respiratory failure, ARDS and other complications, critical care admission and length of stay (CCLOS) and total length of stay (LOS). Laboratory results were collected for three days post-operatively including platelet counts and clotting screen. Results 33 patients undergoing 36 emergency laparotomies were included, of which 9 had confirmed or suspected COVID-19. Patients with COVID-19 were more likely to have severe complications (Clavien-Dindo grade ≥3) (9/9 vs 5/24; p &lt; 0.001), post-operative respiratory failure (9/9 vs 2/24; p &lt; 0.001), ARDS (3/9 vs 0/24; p = 0.015) and need for critical care stay (9/9 vs 12/24; p = 0.012) with a longer LOS and CCLOS (17 vs 7 days; p = 0.004 and 6 vs 1 day; p &lt; 0.001 respectively). Platelet counts were consistently lower on all peri-operative days and patients had a higher incidence of coagulopathy (7/11 vs 3/17; p = 0.020). Conclusions Emergency laparotomy is associated with increased post-operative morbidity in patients with confirmed or suspected COVID-19 with increased respiratory complications and critical care stay. Post-operative patients with COVID-19 show mildly reduced platelet counts and deranged clotting that may be part of a COVID-19-associated coagulopathy.

Pressure Injury Risk Factors in Critical Care Patients

2018 ◽  
Vol 31 (7) ◽  
pp. 328-334 ◽  
Author(s):  
Jill Cox ◽  
Sharon Roche ◽  
Virginia Murphy
Keyword(s):  
Risk Factors ◽  
Critical Care ◽  
Injury Risk ◽  
Pressure Injury ◽  
Injury Risk Factors ◽  
Critical Care Patients

scholarly journals Risk Factors for Hospital-Acquired Pressure Injury in Surgical Critical Care Patients

2020 ◽  
Vol 29 (6) ◽  
pp. e128-e134
Author(s):  
Jenny Alderden ◽  
Linda J. Cowan ◽  
Jonathan B. Dimas ◽  
Danli Chen ◽  
Yue Zhang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Critical Care ◽  
Odds Ratio ◽  
Academic Medical Center ◽  
Skin Irritation ◽  
Surgical Critical Care ◽  
Pressure Injury ◽  
Hospital Acquired ◽  
Critical Care Patients

Background Hospital-acquired pressure injuries disproportionately affect critical care patients. Although risk factors such as moisture, illness severity, and inadequate perfusion have been recognized, nursing skin assessment data remain unexamined in relation to the risk for hospital-acquired pressure injuries. Objective To identify factors associated with hospital-acquired pressure injuries among surgical critical care patients. The specific aim was to analyze data obtained from routine nursing skin assessments alongside other potential risk factors identified in the literature. Methods This retrospective cohort study included 5101 surgical critical care patients at a level I trauma center and academic medical center. Multivariate logistic regression using the least absolute shrinkage and selection operator method identified important predictors with parsimonious representation. Use of specialty pressure redistribution beds was included in the model as a known predictive factor because specialty beds are a common preventive intervention. Results Independent risk factors identified by logistic regression were skin irritation (rash or diffuse, nonlocalized redness) (odds ratio, 1.788; 95% CI, 1.404-2.274; P &lt; .001), minimum Braden Scale score (odds ratio, 0.858; 95% CI, 0.818-0.899; P &lt; .001), and duration of intensive care unit stay before the hospital-acquired pressure injury developed (odds ratio, 1.003; 95% CI, 1.003-1.004; P &lt; .001). Conclusions The strongest predictor was irritated skin, a potentially modifiable risk factor. Irritated skin should be treated and closely monitored, and the cause should be eliminated to allow the skin to heal.

Sign in / Sign up

Export Citation Format

Share Document