Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Earliest known record of a hypercarnivorous dasyurid (Marsupialia), from newly discovered carbonates beyond the Riversleigh world Heritage area, north Queensland

Whollydooleya tomnpatrichorum gen. et sp. nov. is a new, highly specialised hypercarnivorous dasyuromorphian from a new mid-Cenozoic limestone deposit southwest of the Riversleigh World Heritage Area in northwestern Queensland. Dental dimensions suggest it may have weighed at least twice as much as the living Tasmanian devil (Sarcophilus harrisii). Although known only from a lower molar, it exhibits a plethora of carnivorous adaptations including a hypertrophied protoconid, tiny metaconid and a battery of vertical carnassial blades between most of the major cusps, most of which incorporate carnassial notches to immobilise materials being sheared. It is unique among dasyuromorphians in having a massive entoconid that closes the entire lingual side of the talonid. Comparison with previously known thylacinid and dasyurid hypercarnivores suggests its relationships are closer to dasyurids than thylacinids in the main because of the very large entoconid, a cusp that is relatively small to absent in all known thylacinids but commonly small to large in dasyurids. However, the extent of enlargement of the entoconid suggests that it is not closely related to previously known Cenozoic hypercarnivorous dasyurids in the genera Dasyurus, Glaucodon, Sarcophilus or any of the other previously described Cenozoic dasyurids. Although the early late Miocene Ganbulanyi djadjinguli is only known from an upper molar, the reduced area of its protocone suggests a correspondingly reduced rather than hypertrophied entoconid in its as-yet-unknown lower molars. Reconsideration of the structure of the talonid in species of Sarcophilus even suggests that within that Quaternary lineage, the entoconid may have been entirely lost, with the posteriorly displaced metaconid taking its functional place as an occlusal counterpart for the blades of the protocone. The large size of the new species signals the earliest indication within the dasyurid radiation of a late Cenozoic trend towards gigantism that became evident in many lineages of Australian marsupials. While the age is uncertain, on the basis of associated taxa such as species of Ekaltadeta, it is probably either mid or late Miocene in age. Geological features of the deposit suggest it was formed within a pool in a cave environment that periodically underwent desiccation. Some grains suggest an aeolian as well as an alluvial and pluvial origin for the deposit. This may relate to current understanding about environmental change that took place in the region following the mid Miocene climate oscillation

Current status of species-level representation in faunas from selected fossil localities in the Riversleigh World Heritage Area, northwestern Queensland

Current lists of species-level representation in faunas from 80 Cenozoic fossil localities at the Riversleigh World Heritage Area have been compiled by review of recorded occurrences of taxa obtained from both published and unpublished sources. More than 290 species-level taxa are represented, comprising mammals, amphibians, reptiles, birds, fishes, molluscs and crustaceans. The data are presented for the purpose of ongoing palaeoecological and biochronological studies

Current status of species-level representation in faunas from selected fossil localities in the Riversleigh World Heritage Area, northwestern Queensland

Current lists of species-level representation in faunas from 80 Cenozoic fossil localities at the Riversleigh World Heritage Area have been compiled by review of recorded occurrences of taxa obtained from both published and unpublished sources. More than 290 species-level taxa are represented, comprising mammals, amphibians, reptiles, birds, fishes, molluscs and crustaceans. The data are presented for the purpose of ongoing palaeoecological and biochronological studies