目的:本研究的目的是检查发生压力性损伤的危重患者的临床特征和危险因素,并确定与建议的急性皮肤衰竭(ASF)危险因素相关的经验证的不可避免的压力性损伤的比例。
方法:回顾性病例对照比较研究。
方法:样本包括在重症监护病房住院的成年危重患者,例如外科,创伤,心血管外科,心脏,神经,以及中西部大型学术/教学医疗保健系统中5家急性护理医院的医疗重症监护和相应的渐进式护理单位。包括发生医院获得性压力损伤(HAPI)的参与者和没有HAPI的患者(对照)。
方法:从电子健康记录中获得了先前使用HAPI进行研究的数据的二次分析以及不使用HAPI的对照样品的匹配数据。进行描述性和多变量逻辑回归分析。
结果:样本包括475名参与者;165名经历了HAPI并作为案例,而其余310则充当控件。急性生理学和慢性健康评估(APACHEII)平均评分(23.8,8.7%;P<.001),死亡率(n=45,27.3%;P=0.002),肝病病史(n=28,17%;P<.001),1个月内意外损失10磅或更多(n=20,12%;P=0.002)在HAPI组中较高。多变量逻辑回归分析确定了呼吸衰竭的参与者(比值比[OR]=3.00;95%置信区间[CI],1.27-7.08;P=.012),肾功能衰竭(OR=7.48;95%CI,3.49-16.01;P<.001),心力衰竭(OR=4.50;95%CI,1.76-11.51;P=0.002),严重贫血(OR=10.89;95%CI,3.59-33.00;P<.001),任何类型的脓毒症(OR=3.15;95%CI,1.44-6.90;P=.004),和水分记录(OR=11.89;95%CI,5.27-26.81;P<.001)更有可能开发出HAPI。不可避免的HAPI之间没有差异,可避免的HAPI,或根据建议的ASF危险因素确定对照组.
结论:本研究提供了有关可避免和不可避免的HAPI和ASF的重要信息。关键临床特征和危险因素,比如病人的敏锐度,器官衰竭,组织灌注,脓毒症,和以前的压力伤害史,与可避免和不可避免的HAPI开发相关。此外,我们无法支持不可避免的HAPI与建议的ASF风险因素之间的关系.HAPI的不可避免性取决于适当干预措施的记录,而不一定取决于临床风险因素的识别。
OBJECTIVE: The purpose of this study was to examine clinical characteristics and risk factors for critically ill patients who develop pressure injuries and identify the proportion of validated unavoidable pressure injuries associated with the proposed risk factors for acute skin failure (ASF).
METHODS: Retrospective
case-control comparative study.
METHODS: The sample comprised adult critically ill participants hospitalized in critical care units such as surgical, trauma, cardiovascular surgical, cardiac, neuro, and medical intensive care and corresponding progressive care units in 5 acute care hospitals within a large Midwestern academic/teaching healthcare system. Participants who developed hospital-acquired pressure injuries (HAPIs) and patients without HAPIs (controls) were included.
METHODS: A secondary analysis of data from a previous study with HAPIs and matching data for the control sample without HAPIs were obtained from the electronic health record. Descriptive and multivariate logistic regression analyses were conducted.
RESULTS: The sample comprised 475 participants; 165 experienced a HAPI and acted as cases, whereas the remaining 310 acted as controls. Acute Physiology and Chronic Health Evaluation (APACHE II) mean score (23.8, 8.7%; P < .001), mortality (n = 45, 27.3%; P = .002), history of liver disease (n = 28, 17%; P < .001), and unintentional loss of 10 lb or more in 1 month (n = 20, 12%; P = .002) were higher in the HAPI group. Multivariate logistic regression analysis identified participants with respiratory failure (odds ratio [OR] = 3.00; 95% confidence interval [CI], 1.27-7.08; P = .012), renal failure (OR = 7.48; 95% CI, 3.49-16.01; P < .001), cardiac failure (OR = 4.50; 95% CI, 1.76-11.51; P = .002), severe anemia (OR = 10.89; 95% CI, 3.59-33.00; P < .001), any type of sepsis (OR = 3.15; 95% CI, 1.44-6.90; P = .004), and moisture documentation (OR = 11.89; 95% CI, 5.27-26.81; P <.001) were more likely to develop a HAPI. No differences between unavoidable HAPI, avoidable HAPI, or the control group were identified based on the proposed ASF risk factors.
CONCLUSIONS: This study provides important information regarding avoidable and unavoidable HAPIs and ASF. Key clinical characteristics and risk factors, such as patient acuity, organ failure, tissue perfusion, sepsis, and history of prior pressure injury, are associated with avoidable and unavoidable HAPI development. In addition, we were unable to support a relationship between unavoidable HAPIs and the proposed risk factors for ASF. Unavoidability of HAPIs rests with the documentation of appropriate interventions and not necessarily with the identification of clinical risk factors.