University Hospital Carl Gustav Carus, Dresden University Department for Quality and Medical Risk Management.
Dtsch Arztebl Int. 2013 Aug;110(33-34):550-6. doi: 10.3238/arztebl.2013.0550. Epub 2013 Aug 19.
The incidence of decubitus ulcers is an established quality indicator for external quality assurance in the inpatient setting. Epidemiologic analyses of the frequency of, and risk factors for, decubitus ulcers in routine care are lacking.
We analyzed routine decubitus-ulcer documentation data relating to all inpatients of the University Hospital of Dresden, Germany, from 2007 to 2011 (n = 246 162 patients). The prevalence and incidence of decubitus ulcers and demographic and illness-related risk factors for them were determined with the use of descriptive techniques and logistic regression models. The effort-to-benefit ratio of documenting decubitus ulcers in various care scenarios was calculated in terms of the number of additional patients to be documented for each patient with incident decubitus ulcer.
The prevalence of decubitus ulcers was 1.21%, and their incidence during inpatient treatment was 0.78%, with significant differences across clinical care units (range of ward-specific incidences: 0.0% to 12.7%). Predictors for the development of a new decubitus ulcer during a hospital stay included higher age (odds ratio [OR] 1.03 per year, 95% confidence interval [CI] 1.02-1.03), longer hospital stay (OR 1.03 per day, 95% CI 1.031-1.033), treatment in an intensive care unit (OR 2.88, 95% CI 2.58-3.22), and transfer to the hospital from a residential nursing-care facility (OR 6.05, 95% CI 5.13-7.11). The patient's sex and the severity of disease were not correlated with the incidence of decubitus ulcers. The effort-to-benefit ratio could be improved if wards with a low incidence of decubitus ulcers (<0.5%) either entirely discontinued the current hospital-wide procedure for documenting decubitus ulcers (with one new ulcer for every 645 patients) or continued it only for patients aged 65 or older (with one new ulcer for every 902 patients).
There are major differences between clinical care units in the risk of decubitus ulcers. Epidemiological analysis of routine quality management data is useful to assess the benefit of measures taken in medical care. Continuing evaluation is essential.
压疮的发生率是住院患者外部质量保证的既定质量指标。常规护理中压疮的频率和危险因素的流行病学分析尚缺乏。
我们分析了德国德累斯顿大学医院 2007 年至 2011 年期间所有住院患者的常规压疮记录数据（n=246162 例患者）。采用描述性技术和逻辑回归模型确定压疮的患病率和发生率，以及人口统计学和与疾病相关的压疮危险因素。计算在不同护理场景中记录压疮的投入-效益比，即每例新发压疮患者需额外记录的患者人数。
压疮的患病率为 1.21%，住院期间的发病率为 0.78%，不同临床护理单元之间存在显著差异（特定病房发病率范围：0.0%-12.7%）。住院期间发生新压疮的预测因素包括年龄较大（每增加 1 岁，比值比[OR]为 1.03，95%置信区间[CI]为 1.02-1.03）、住院时间较长（OR 为 1.03 天，95%CI 为 1.031-1.033）、入住重症监护病房（OR 为 2.88，95%CI 为 2.58-3.22）以及从疗养院转入医院（OR 为 6.05，95%CI 为 5.13-7.11）。患者的性别和疾病严重程度与压疮的发生率无关。如果发病率较低（<0.5%）的病房完全停止目前全院范围的压疮记录程序（每出现 1 例新溃疡需记录 645 例患者），或者仅对 65 岁及以上的患者继续进行该程序（每出现 1 例新溃疡需记录 902 例患者），则投入-效益比可以得到改善。
临床护理单元之间压疮的风险存在显著差异。对常规质量管理数据进行流行病学分析有助于评估医疗保健措施的获益。持续评估至关重要。
