Stephen Sprigle, PhD, PT, is Professor, Rehabilitation Engineering and Applied Research Lab, Georgia Institute of Technology, in Atlanta, Georgia. Douglas McNair, MD, PhD, is Senior Advisor, Global Health - Analytics Innovation, Bill and Melinda Gates Foundation, in Seattle, Washington. Sharon Sonenblum, PhD, is Principal Research Engineer, Rehabilitation Engineering and Applied Research Lab, Georgia Institute of Technology, in Atlanta, Georgia. The authors have disclosed no financial relationships related to this article. Submitted August 30, 2019; accepted in revised form October 1, 2019.
Adv Skin Wound Care. 2020 Mar;33(3):146-154. doi: 10.1097/01.ASW.0000653152.36482.7d.
To assess pressure ulcer (PU) risk in persons with mobility impairments using a large data set to identify demographic, laboratory, hemodynamic, and pharmacologic risk factors.
The cohort of interest was persons with disabilities who have mobility impairments and are diagnostically at risk of PUs. To define this cohort, diagnoses that qualify patients for skin protection wheelchair cushions were used. Data were obtained from the Cerner Health Facts data warehouse. Two cohorts were defined: persons with and without a history of PUs. Analysis included descriptive statistics and multivariate logistic regression modeling. Variables retained in the model were identified using LASSO, gradient boosting, and Bayesian model averaging.
The resulting cohorts included more than 87,000 persons with a history of PUs and more than 1.1 million persons who did not have a PU. The data revealed seven disability groups with the greatest prevalence of PUs: those with Alzheimer disease, cerebral palsy, hemiplegia, multiple sclerosis, paraplegia/quadriplegia, Parkinson disease, and spina bifida. Ulcers in the pelvic region accounted for 82% of PUs. Persons with disabilities who were male or black had a greater prevalence of PUs. Physiologic risk factors included the presence of kidney or renal disease, decreased serum albumin, and increased serum C-reactive protein.
The results indicate that, although persons with disabilities can exhibit a wide functional range, they remain at risk of PUs and should be evaluated for proper preventive measures, including support surfaces and wheelchair cushions.
使用大型数据集评估行动障碍者的压疮（PU）风险，以确定人口统计学、实验室、血液动力学和药理学危险因素。
本研究的兴趣队列为具有行动障碍且有 PU 风险诊断的残疾人群体。为了定义这一队列，使用了符合皮肤保护轮椅垫条件的诊断标准。数据来自 Cerner Health Facts 数据仓库。定义了两个队列：有和无 PU 病史的患者。分析包括描述性统计和多变量逻辑回归建模。使用 LASSO、梯度提升和贝叶斯模型平均法识别保留在模型中的变量。
结果队列包括 87000 多名有 PU 病史的患者和 110 多万名无 PU 病史的患者。数据显示，有七种残疾群体的 PU 患病率最高：患有阿尔茨海默病、脑瘫、偏瘫、多发性硬化症、截瘫/四肢瘫痪、帕金森病和脊柱裂的患者。骨盆区域的溃疡占所有 PU 的 82%。男性或黑人残疾患者的 PU 患病率更高。生理危险因素包括肾脏或肾脏疾病、血清白蛋白降低和血清 C 反应蛋白升高。
结果表明，尽管残疾患者的功能范围很广，但他们仍然存在 PU 风险，应评估适当的预防措施，包括支撑面和轮椅垫。
