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

The original version of this article unfortunately contained a mistake

Interrelación economía y salud

Los servicios de salud han incidido favorablemente en la reducción de la tasa de mortalidad y en los índices de discapacidad. Así, en el último siglo la tasa de mortalidad se ha reducido veinte veces, y ello se ha debido, en buena medida, a determinados avances sanitarios ligados tanto a ciertas vacunas y medicamentos como a las prácticas médicas. Debe señalarse que no todos los éxitos de mejora del estado de salud poblacional se deben a los avances sanitarios ya que es muy importante el propio desarrollo económico, innovaciones agrarias o tecnológicas, la educación de la población así como los hábitos y estilo de vida. Para ello se analiza la interrelación entre renta y salud, economía y salud, se realiza una evaluación económica aplicada a la tecnología sanitaria tomando como base los criterios de efectividad, eficiencia y eficacia.Health services have had a positive effect in reducing the mortality rate and in the rates of disability. Thus, in the last century, the mortality rate has been reduced, and this was largely due to certain health advances linked both to certain vaccines and medications such as to medical practices. It should be noted that not all the successes in improving the status of population health are due to the health advances because it is very important the own economic development, agricultural or technological innovations, the education of the population, as well as the lifestyle and habits. We analyze the interrelationship between income and health, economy and health, it's an economic evaluation applied to health technology on the basis of the criteria of effectiveness and effectiveness

Gestión de la asistencia pública sanitaria: los costes por servicios

Los modelos de gestión basados en los costes por servicio final suponen un paso muy importante, aportando a los gerentes una información necesaria sobre la distribución de los recursos, el lugar y el ritmo al que se consumen. Permiten reforzar y consolidar el control del gasto, ya que al conocer el volumen de los diferentes productos que se prevé consumir en períodos determinados permite negociar los precios con los que se adquieren los materiales, con lo que se produce rebajas significativas.The management models based on final service costs represent a very important step, providing managers with the necessary information on the distribution of resources, the place and the pace at which they are consumed. They allow us to strengthen and consolidate control of spending. If we know the volume of different products expected to spend at certain times, we can negotiate prices with which materials are acquired, producing significant reductions

Gestión de la asistencia pública sanitaria: los costes por servicios

Los modelos de gestión basados en los costes por servicio final suponen un paso muy importante, aportando a los gerentes una información necesaria sobre la distribución de los recursos, el lugar y el ritmo al que se consumen. Permiten reforzar y consolidar el control del gasto, ya que al conocer el volumen de los diferentes productos que se prevé consumir en períodos determinados permite negociar los precios con los que se adquieren los materiales, con lo que se produce rebajas significativas.The management models based on final service costs represent a very important step, providing managers with the necessary information on the distribution of resources, the place and the pace at which they are consumed. They allow us to strengthen and consolidate control of spending. If we know the volume of different products expected to spend at certain times, we can negotiate prices with which materials are acquired, producing significant reductions

Interrelación economía y salud

Los servicios de salud han incidido favorablemente en la reducción de la tasa de mortalidad y en los índices de discapacidad. Así, en el último siglo la tasa de mortalidad se ha reducido veinte veces, y ello se ha debido, en buena medida, a determinados avances sanitarios ligados tanto a ciertas vacunas y medicamentos como a las prácticas médicas. Debe señalarse que no todos los éxitos de mejora del estado de salud poblacional se deben a los avances sanitarios ya que es muy importante el propio desarrollo económico, innovaciones agrarias o tecnológicas, la educación de la población así como los hábitos y estilo de vida. Para ello se analiza la interrelación entre renta y salud, economía y salud, se realiza una evaluación económica aplicada a la tecnología sanitaria tomando como base los criterios de efectividad, eficiencia y eficacia.Health services have had a positive effect in reducing the mortality rate and in the rates of disability. Thus, in the last century, the mortality rate has been reduced, and this was largely due to certain health advances linked both to certain vaccines and medications such as to medical practices. It should be noted that not all the successes in improving the status of population health are due to the health advances because it is very important the own economic development, agricultural or technological innovations, the education of the population, as well as the lifestyle and habits. We analyze the interrelationship between income and health, economy and health, it's an economic evaluation applied to health technology on the basis of the criteria of effectiveness and effectiveness

Risk of recurrence after discontinuing anticoagulation in patients with COVID-19- associated venous thromboembolism: a prospective multicentre cohort studyResearch in context

Background: The clinical relevance of recurrent venous thromboembolism (VTE) after discontinuing anticoagulation in patients with COVID-19-associated VTE remains uncertain. We estimated the incidence rates and mortality of VTE recurrences developing after discontinuing anticoagulation in patients with COVID-19-associated VTE. Methods: A prospective, multicenter, non-interventional study was conducted between March 25, 2020, and July 26, 2023, including patients who had discontinued anticoagulation after at least 3 months of therapy. All patients from the registry were analyzed during the study period to verify inclusion criteria. Patients with superficial vein thrombosis, those who did not receive at least 3 months of anticoagulant therapy, and those who were followed for less than 15 days after discontinuing anticoagulation were excluded. Outcomes were: 1) Incidence rates of symptomatic VTE recurrences, and 2) fatal PE. The rate of VTE recurrences was defined as the number of patients with recurrent VTE divided by the patient-years at risk of recurrent VTE during the period when anticoagulation was discontinued. Findings: Among 1106 patients with COVID-19-associated VTE (age 62.3 ± 14.4 years; 62.9% male) followed-up for 12.5 months (p25-75, 6.3–20.1) after discontinuing anticoagulation, there were 38 VTE recurrences (3.5%, 95% confidence interval [CI]: 2.5–4.7%), with a rate of 3.1 per 100 patient-years (95% CI: 2.2–4.2). No patient died of recurrent PE (0%, 95% CI: 0–7.6%). Subgroup analyses showed that patients with diagnosis in 2021–2022 (vs. 2020) (Hazard ratio [HR] 2.86; 95% CI 1.45–5.68) or those with isolated deep vein thrombosis (vs. pulmonary embolism) (HR 2.31; 95% CI 1.19–4.49) had significantly higher rates of VTE recurrences. Interpretation: In patients with COVID-19-associated VTE who discontinued anticoagulation after at least 3 months of treatment, the incidence rate of recurrent VTE and the case-fatality rate was low. Therefore, it conceivable that long-term anticoagulation may not be required for many patients with COVID-19-associated VTE, although further research is needed to confirm these findings. Funding: Sanofi and Rovi, Sanofi Spain

Risk of recurrence after discontinuing anticoagulation in patients with COVID-19- associated venous thromboembolism: a prospective multicentre cohort studyResearch in context

Summary: Background: The clinical relevance of recurrent venous thromboembolism (VTE) after discontinuing anticoagulation in patients with COVID-19-associated VTE remains uncertain. We estimated the incidence rates and mortality of VTE recurrences developing after discontinuing anticoagulation in patients with COVID-19-associated VTE. Methods: A prospective, multicenter, non-interventional study was conducted between March 25, 2020, and July 26, 2023, including patients who had discontinued anticoagulation after at least 3 months of therapy. All patients from the registry were analyzed during the study period to verify inclusion criteria. Patients with superficial vein thrombosis, those who did not receive at least 3 months of anticoagulant therapy, and those who were followed for less than 15 days after discontinuing anticoagulation were excluded. Outcomes were: 1) Incidence rates of symptomatic VTE recurrences, and 2) fatal PE. The rate of VTE recurrences was defined as the number of patients with recurrent VTE divided by the patient-years at risk of recurrent VTE during the period when anticoagulation was discontinued. Findings: Among 1106 patients with COVID-19-associated VTE (age 62.3 ± 14.4 years; 62.9% male) followed-up for 12.5 months (p25-75, 6.3–20.1) after discontinuing anticoagulation, there were 38 VTE recurrences (3.5%, 95% confidence interval [CI]: 2.5–4.7%), with a rate of 3.1 per 100 patient-years (95% CI: 2.2–4.2). No patient died of recurrent PE (0%, 95% CI: 0–7.6%). Subgroup analyses showed that patients with diagnosis in 2021–2022 (vs. 2020) (Hazard ratio [HR] 2.86; 95% CI 1.45–5.68) or those with isolated deep vein thrombosis (vs. pulmonary embolism) (HR 2.31; 95% CI 1.19–4.49) had significantly higher rates of VTE recurrences. Interpretation: In patients with COVID-19-associated VTE who discontinued anticoagulation after at least 3 months of treatment, the incidence rate of recurrent VTE and the case-fatality rate was low. Therefore, it conceivable that long-term anticoagulation may not be required for many patients with COVID-19-associated VTE, although further research is needed to confirm these findings. Funding: Sanofi and Rovi, Sanofi Spain

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