Eshetie Tesfahun C, Moldovan Max, Caughey Gillian E, Lang Catherine, Sluggett Janet K, Khadka Jyoti, Whitehead Craig, Crotty Maria, Corlis Megan, Visvanathan Renuka, Wesselingh Steve, Inacio Maria C
Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, SA, Australia; UniSA Clinical & Health Sciences, University of South Australia, Adelaide, SA, Australia.
Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, SA, Australia.
J Am Med Dir Assoc. 2023 Mar;24(3):299-306.e9. doi: 10.1016/j.jamda.2022.12.009. Epub 2023 Jan 3.
Although largely preventable, pressure injury is a major concern in individuals in permanent residential aged care (PRAC). Our study aimed to identify predictors and develop a prognostic model for risk of hospitalization with pressure injury (PI) using integrated Australian aged and health care data.
National retrospective cohort study.
Individuals ≥65 years old (N = 206,540) who entered 1797 PRAC facilities between January 1, 2009, and December 31, 2016.
PI, ascertained from hospitalization records, within 365 days of PRAC entry was the outcome of interest. Individual, medication, facility, system, and health care-related factors were examined as predictors. Prognostic models were developed using elastic nets penalized regression and Fine and Gray models. Area under the receiver operating characteristics curve (AUC) assessed model discrimination out-of-sample.
Within 365 days of PRAC entry, 4.3% (n = 8802) of individuals had a hospitalization with PI. The strongest predictors for PI risk include history of PIs [sub-distribution hazard ratio (sHR) 2.41; 95% CI 1.77-3.29]; numbers of prior hospitalizations (having ≥5 hospitalizations, sHR 1.95; 95% CI 1.74-2.19); history of traumatic amputation of toe, ankle, foot and leg (sHR 1.72; 95% CI 1.44-2.05); and history of skin disease (sHR 1.54; 95% CI 1.45-1.65). Lower care needs at PRAC entry with respect to mobility, complex health care, and medication assistance were associated with lower risk of PI. The risk prediction model had an AUC of 0.74 (95% CI 0.72-0.75).
Our prognostic model for risk of hospitalization with PI performed moderately well and can be used by health and aged care providers to implement risk-based prevention plans at PRAC entry.
尽管压疮在很大程度上是可预防的，但它仍是永久性居住型老年护理机构（PRAC）中老年人的一个主要问题。我们的研究旨在利用澳大利亚综合的老年和医疗保健数据，确定压疮（PI）住院风险的预测因素并建立预后模型。
全国性回顾性队列研究。
2009年1月1日至2016年12月31日期间进入1797家PRAC机构的65岁及以上个体（N = 206,540）。
从住院记录中确定的在进入PRAC机构后365天内发生的压疮是感兴趣的结局。将个体、药物、机构、系统和医疗保健相关因素作为预测因素进行检查。使用弹性网惩罚回归和Fine and Gray模型建立预后模型。受试者工作特征曲线下面积（AUC）评估模型的样本外判别能力。
在进入PRAC机构后的365天内，4.3%（n = 8802）的个体因压疮住院。压疮风险的最强预测因素包括压疮病史[亚分布风险比（sHR）2.41；95%置信区间1.77 - 3.29]；既往住院次数（住院≥5次，sHR 1.95；95%置信区间1.74 - 2.19）；脚趾、脚踝、足部和腿部创伤性截肢病史（sHR 1.72；95%置信区间1.44 - 2.05）；以及皮肤病史（sHR 1.54；95%置信区间1.45 - 1.65）。进入PRAC机构时在活动能力、复杂医疗保健和药物辅助方面较低的护理需求与较低的压疮风险相关。风险预测模型的AUC为0.74（95%置信区间0.72 - 0.75）。
我们的压疮住院风险预后模型表现中等良好，健康和老年护理提供者可使用该模型在个体进入PRAC机构时实施基于风险的预防计划。
