Baumgarten Mona, Margolis David J, Orwig Denise L, Shardell Michelle D, Hawkes William G, Langenberg Patricia, Palmer Mary H, Jones Patricia S, McArdle Patrick F, Sterling Robert, Kinosian Bruce P, Rich Shayna E, Sowinski Janice, Magaziner Jay
Department of Epidemiology and Preventive Medicine, University of Maryland School ofMedicine, 660W. Redwood Street, Suite 200, Baltimore, MD 21201, USA.
J Am Geriatr Soc. 2009 May;57(5):863-70. doi: 10.1111/j.1532-5415.2009.02245.x.
To identify care settings associated with greater pressure ulcer risk in elderly patients with hip fracture in the postfracture period.
Prospective cohort study.
Nine hospitals that participate in the Baltimore Hip Studies network and 105 postacute facilities to which patients from these hospitals were discharged.
Hip fracture patients aged 65 and older who underwent surgery for hip fracture.
A full-body skin examination was conducted at baseline (as soon as possible after hospital admission) and repeated on alternating days for 21 days. Patients were deemed to have an acquired pressure ulcer (APU) if they developed one or more new stage 2 or higher pressure ulcers after hospital admission.
In 658 study participants, the APU cumulative incidence at 32 days after initial hospital admission was 36.1% (standard error 2.5%). The adjusted APU incidence rate was highest during the initial acute hospital stay (relative risk (RR)=2.2, 95% confidence interval (CI)=1.3-3.7) and during re-admission to the acute hospital (RR=2.2, 95% CI=1.1-4.2). The relative risks in rehabilitation and nursing home settings were 1.4 (95% CI=0.8-2.3) and 1.3 (95% CI=0.8-2.1), respectively.
Approximately one-third of hip fracture patients developed an APU during the study period. The rate was highest in the acute setting, a finding that is significant in light of Medicare's policy of not reimbursing hospitals for the treatment of hospital-APUs. Hip fracture patients constitute an important group to target for pressure ulcer prevention in hospitals.
确定骨折后老年髋部骨折患者中与较高压疮风险相关的护理环境。
前瞻性队列研究。
参与巴尔的摩髋部研究网络的9家医院以及这些医院患者出院后前往的105家急性后期护理机构。
65岁及以上接受髋部骨折手术的髋部骨折患者。
在基线时（入院后尽快）进行全身皮肤检查，并在21天内每隔一天重复检查一次。如果患者在入院后出现一个或多个新的2期或更高阶段的压疮，则被视为患有获得性压疮（APU）。
在658名研究参与者中，首次入院后32天的APU累积发病率为36.1%（标准误差2.5%）。调整后的APU发病率在最初的急性住院期间最高（相对风险（RR）=2.2，95%置信区间（CI）=1.3 - 3.7）以及再次入住急性医院期间（RR = 2.2，95% CI = 1.1 - 4.2）。康复和疗养院环境中的相对风险分别为1.4（95% CI = 0.8 - 2.3）和1.3（95% CI = 0.8 - 2.1）。
在研究期间，约三分之一的髋部骨折患者发生了APU。急性环境中的发生率最高，鉴于医疗保险不报销医院治疗医院获得性压疮的政策，这一发现具有重要意义。髋部骨折患者是医院预防压疮的重要目标群体。
