重症监护病房入院时的压力性损伤作为患者预后的预测指标

Pressure Injuries at Intensive Care Unit Admission as a Prognostic Indicator of Patient Outcomes.

作者信息

McGee William T, Nathanson Brian H, Lederman Elizabeth, Higgins Thomas L

机构信息

William T. McGee is an intensivist in the Division of Critical Care, Department of Medicine, Baystate Medical Center, Springfield, Massachusetts; Brian H. Nathanson is Chief Executive Officer of OptiStatim, LLC, Longmeadow, Massachusetts; Elizabeth Lederman is APACHE data coordinator, Baystate Medical Center, Springfield, Massachusetts; Thomas L. Higgins is Chief Medical Officer at The Center for Case Management, Natick, Massachusetts, and Professor of Medicine at the University of Massachusetts School of Medicine-Baystate, Springfield, Massachusetts.

出版信息

Crit Care Nurse. 2019 Jun;39(3):44-50. doi: 10.4037/ccn2019530.

DOI:10.4037/ccn2019530

PMID:31154330

Abstract

BACKGROUND

Pressure injuries, also known as pressure ulcers, are a serious complication of immobility. Patients should be thoroughly examined for pressure injuries when admitted to the intensive care unit to optimize treatment. Whether community-acquired pressure injuries correlate with poor hospital outcomes among critically ill patients is understudied.

OBJECTIVES

To determine whether pressure injuries present upon admission to the intensive care unit can serve as a predictive marker for longer hospitalization and increased mortality.

METHODS

This study retrospectively analyzed admissions of adult patients to a 24-bed medical-surgical intensive care unit in a large level I trauma center in the northeast United States from 2010 to 2012. The association of pressure injuries with mortality and length of stay was assessed, using multivariable logistic regression and generalized linear models, adjusted for age, comorbidities, Acute Physiology and Chronic Health Evaluation III score, and other patient characteristics.

RESULTS

Among 2723 patients, 180 (6.6%) had a pressure injury at admission. Patients with a pressure injury had longer mean unadjusted stay (15.6 vs 10.5 days; < .001) and higher in-hospital mortality rate (32.2% vs 18.3%; < .001) than did patients without a pressure injury at admission. After multivariable adjustment, pressure injuries were associated with a mean increase in length of stay of 3.1 days (95% CI 1.5-4.7; < .001). Pressure injuries were not associated with mortality after adjusting for the Acute Physiology and Chronic Health Evaluation III score, but they may serve as a marker for increased risk of mortality if an Acute Physiology and Chronic Health Evaluation III score is unavailable.

CONCLUSION

Pressure injuries present at admission to the intensive care unit are an objective, easy-to-identify finding associated with longer stays. Pressure injuries might have a modest association with higher risk of mortality.

摘要

背景

压疮，也称为压力性溃疡，是活动受限的严重并发症。患者入住重症监护病房时应全面检查是否存在压疮，以优化治疗。社区获得性压疮与危重症患者不良医院结局之间的相关性研究较少。

目的

确定入住重症监护病房时存在的压疮是否可作为住院时间延长和死亡率增加的预测指标。

方法

本研究回顾性分析了2010年至2012年美国东北部一家拥有24张床位的内科-外科重症监护病房成年患者的入院情况。采用多变量逻辑回归和广义线性模型评估压疮与死亡率和住院时间的关联，并对年龄、合并症、急性生理与慢性健康状况评价III评分及其他患者特征进行了校正。

结果

在2723例患者中，180例（6.6%）入院时存在压疮。入院时存在压疮的患者平均未校正住院时间更长（15.6天对10.5天；P<0.001），院内死亡率更高（32.2%对18.3%；P<0.001）。多变量校正后，压疮与平均住院时间延长3.1天相关（95%CI 1.5 - 4.7；P<0.001）。校正急性生理与慢性健康状况评价III评分后，压疮与死亡率无关，但如果无法获得急性生理与慢性健康状况评价III评分，压疮可能作为死亡率增加风险的标志物。