Campbell Karen E, Woodbury Gail, Labate Terri, LeMesurier Anne, Houghton Pamela E
London Health Sciences Center, University Hospital, London, Ontario, Canada.
Ostomy Wound Manage. 2010 Aug;56(8):32-9.
People undergoing orthopedic surgery receive care at many points along the healthcare continuum. Although heel pressure ulcer (HPU) incidence in the orthopedic population has been reported to be 13.3%, information is limited. The purpose of this prospective observational study was to evaluate: 1) the cumulative incidence of HPUs in orthopedic patients across the continuum of care, and 2) the outcome of HPUs once they occurred. Of the 72 study participants (average age 76 +/- 16 years, 60% women, 53% required surgery for hip fractures), 57 were recruited consecutively upon admission to a rehabilitation center from one of two acute care facilities and 15 were assessed upon admission to one of the acute care sites and at discharge to the home. All but two study participants were followed-up in the community 1 month after discharge from the acute care or rehabilitation facility. Medical charts were reviewed and study participants underwent a bedside assessment, with direct examination of both heels and staging of the ulcer at admission and discharge. The cumulative incidence of HPUs was 17% (95% CI 8%-26%). All ulcers were identified upon admission to the rehabilitation center; 41% of HPUs were either suspected deep tissue injury (sDTI) or unstageable. Both of the Stage I and two of the five Stage II ulcers were resolved at the time of follow-up; three of the five sDTI or unstageable ulcers were unresolved. HPUs occurred in 17% of people undergoing orthopedic procedures. All ulcers occurred in acute care and severe ulcers persisted while patients received rehabilitation and community care. This is the first study to follow orthopedic patients across the continuum of care.
接受骨科手术的患者在医疗保健连续过程中的多个环节接受护理。尽管据报道骨科患者中足跟压疮（HPU）的发生率为13.3%，但相关信息有限。这项前瞻性观察性研究的目的是评估：1）骨科患者在整个护理过程中HPU的累积发生率，以及2）HPU发生后的结局。在72名研究参与者中（平均年龄76±16岁，60%为女性，53%因髋部骨折需要手术），57名是从两家急性护理机构之一入院到康复中心时连续招募的，15名是在入院到其中一家急性护理机构时以及出院回家时进行评估的。除两名研究参与者外，所有参与者在从急性护理或康复机构出院1个月后在社区接受随访。查阅了病历，研究参与者接受了床边评估，在入院和出院时对双足跟进行直接检查并对溃疡进行分期。HPU的累积发生率为17%（95%CI 8%-26%）。所有溃疡均在康复中心入院时被发现；41%的HPU为疑似深部组织损伤（sDTI）或无法分期。随访时，1期溃疡中的2个以及5期II期溃疡中的2个已愈合；5个sDTI或无法分期的溃疡中有3个未愈合。17%接受骨科手术的患者发生了HPU。所有溃疡均发生在急性护理期间，严重溃疡在患者接受康复和社区护理时持续存在。这是第一项对骨科患者在整个护理过程中进行随访的研究。
