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

Socioeconomic inequalities predicting hospital readmission of patient with congestive herath failure

Premessa Poche indagini hanno valutato il ruolo delle diseguaglianze socio-economiche nell’assistenza ospedaliera dedicata ai pazienti cardiopatici nei paesi europei di radice latina. I soggetti affetti da scompenso cardiaco richiedono assistenza ospedaliera e frequentemente ricoveri ripetuti. I fattori predittivi delle nuove ammissioni dei soggetti con scompenso cardiaco dopo un primo ricovero comprendono sia parametri clinici che socio-economici. Il SSN fornisce un supporto alle classi di popolazione svantaggiate consentendo di minimizzare le conseguenze della deprivazione sociale. In un Dipartimento di Cardiologia è stata condotta un’indagine tra predittori clinici e socio-ambientale di riammissione ospedaliera in pazienti con scompenso cardiaco. Metodi Pazienti: 290 soggetti ricoverati consecutivamente in una unità cardiologica dedicata allo scompenso cardiaco sono stati valutati in relazione ai parametri clinici e socio-ambientali. 210 soggetti (128 uomini, 82 donne, età media 69 -/+ 14) sono stati presi in considerazione in un’indagine che ha richiesto di rendere disponibili il consenso informato, le caratteristiche del follow-up e la disponibilità degli aspetti clinici e socio-economici. Procedure. Sono stati valutati parametri demografici (età, sesso) clinici (cause dello scompenso, compromissione funzionale secondo la classificazione NYHA, frazione di eiezione ventricolare, precedente ricovero per scompenso, durata della degenza, comorbilità, trattamento farmacologico) e socio-ambientali (occupazione, risorse finanziarie, abitazione, caregiver, case-manager,visite di follow-up). Le informazioni sono state assunte dalle cartelle cliniche dei pazienti ricoverati e da interviste con pazienti e familiari realizzate da infermieri addestrati allo scopo. Analisi dei dati Un’analisi descrittiva è stata condotta sui dati ottenuti facendo riferimento alle medie e DS dei parametri registrate su due gruppi separati di pazienti, ricoverati una sola volta o soggetti a ricoveri ripetuti. Al fine di confrontare le caratteristiche dei pazienti è stata realizzata un’analisi uni variata usando un T test per le misure continue ed un test chi quadro per le variabili discrete. Un modello di regressione logistica multipla è stato applicato per verificare le associazioni indipendenti fra i parametri verificati ed i ricoveri ripetuti, prendendo in considerazione solo le misure che risultavano significative all’analisi uni variata. Risultati Nei 24 mesi di follow-up dopo la dimissione della prima degenza 98 pazienti (46%) furono nuovamente ricoverati in ospedale. Sei variabili furono identificate come fattori predittivi significativi per la riammissione nell’Unità cardiologica e quindi analizzati attraverso un’analisi multivariata con regressione logistica. Tali variabili includevano sia aspetti clinici che socio-economici. Fra i primi sono da citare il precedente ricovero per scompenso cardiaco (OR 3,82; 95% LC; 1,66-6,22), durata di degenza > 14 giorni (OR 3,9; 95% LC; 3,4-6,8) e ipertensione arteriosa (OR 2,2; 95%LC; 1,1-3,8); fra i secondi la mancata occupazione (OR 2,61; 95% LC; 1.18-5,1), la carenza di follow up (OR 5,12; 95% LC; 2,1-12,4) e la mancanza del case-manager (OR 3,9; 95% LC; 3,4-6,3). Non è stato riconosciuto un valore predittivo per i parametri funzionali cardiaci, le risorse finanziarie e il vivere da solo. Conclusioni Alcuni parametri predittivi indipendenti sottolineano l’importanza di fattori clinici o socio-ambientali nel peggioramento dello scompenso cardiaco e nel conseguente ripetersi dei ricoveri ospedalieri. Un ruolo significativo è stato riscontrato nell’attività del case-manager e nella frequenza dei follow-up; questi aspetti inducono ad orientare gli interventi mirati a ridurre il ripetersi dei ricoveri potenziando il supporto fornito dall’attività infermieristica territoriale e dal controllo periodico ambulatoriale

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

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 (Intensive Care Medicine, (2021), 47, 2, (160-169), 10.1007/s00134-020-06234-9)

The original version of this article unfortunately contained a mistake. The members of the ESICM Trials Group Collaborators were not shown in the article but only in the ESM. The full list of collaborators is shown below. The original article has been corrected