Perneger T V, Héliot C, Raë A C, Borst F, Gaspoz J M
Institute of Social and Preventive Medicine, University of Geneva, Switzerland.
Arch Intern Med. 1998 Sep 28;158(17):1940-5. doi: 10.1001/archinte.158.17.1940.
Pressure ulcers are a frequent complication of bed rest. We examined risk factors for hospital-acquired pressure ulcers, the use of preventive devices, and the impact of case-mix adjustments on between-ward comparisons.
We conducted 3 cross-sectional surveys in a teaching hospital of 2373 patients who had no pressure ulcer on admission. We assessed the presence of pressure ulcer, dates of admission and ulcer occurrence, hospital ward, patient age and sex, appetite and route of nutrition, surgery during stay, hospitalization for fracture, comorbidities, use of low-pressure devices (special mattresses, cushions, and pressure-reducing beds), and the Norton Pressure Ulcer Prediction score (physical condition, mental condition, activity, mobility, and incontinence).
Two hundred forty-seven new pressure ulcers occurred (5.7 per 1000 person-days). In multivariate analysis, the risk for pressure ulcer increased with age (risk gradient across 5 categories was 1:4.5; P<.001) and Norton score (across 5 categories, risk gradient was 30-fold; P<.001); other risk factors (all relative risks, 1.5-1.8; P<.002) were hospitalization for fracture, surgical intervention, reduced appetite, and nasogastric tube or intravenous nutrition. Adjustment for case mix substantially modified differences between hospital wards. Use of preventive devices was associated with Norton score, but not all high-risk patients benefited.
Pressure ulcers were seen in every 10th hospitalized adult. Patient age and Norton score were the strongest risk factors for pressure ulcers. Use of preventive devices was suboptimal. Adjustment for case mix is essential if pressure ulcer incidence is to be used as an indicator of quality of care.
压疮是卧床休息常见的并发症。我们研究了医院获得性压疮的危险因素、预防设备的使用情况以及病例组合调整对病房间比较的影响。
我们在一家教学医院对2373例入院时无压疮的患者进行了3次横断面调查。我们评估了压疮的存在情况、入院日期和压疮发生日期、医院病房、患者年龄和性别、食欲和营养途径、住院期间的手术情况、因骨折住院情况、合并症、低压设备（特殊床垫、靠垫和减压床）的使用情况以及诺顿压疮预测评分（身体状况、精神状况、活动能力、移动能力和失禁情况）。
共发生247例新的压疮（每1000人日5.7例）。多因素分析显示，压疮风险随年龄增加（5个类别间的风险梯度为1:4.5；P<0.001）和诺顿评分增加（5个类别间，风险梯度为30倍；P<0.001）；其他危险因素（所有相对风险为1.5 - 1.8；P<0.002）包括因骨折住院、手术干预、食欲减退以及鼻胃管或静脉营养。病例组合调整显著改变了医院病房之间的差异。预防设备的使用与诺顿评分相关，但并非所有高危患者都从中受益。
每10名住院成人中就有1例出现压疮。患者年龄和诺顿评分是压疮的最强危险因素。预防设备的使用并不理想。如果将压疮发生率用作护理质量指标，病例组合调整至关重要。
