Patient Mortality Linked to Hospital Bedsores

Researchers at the University of California, Los Angeles (UCLA; USA) conducted a retrospective secondary analysis of the US national Medicare Patient Safety Monitoring System (MPSMS) database to determine the national and state incidence levels of newly hospital-acquired PUs in Medicare beneficiaries, and to describe the clinical and demographic characteristics and outcomes of these individuals. In all, data regarding 51,842 randomly selected beneficiaries discharged from the hospital between January 1, 2006, and December 31, 2007, were reviewed.

The results showed that 2,313 (4.5%) developed at least one new PU during their hospitalization. The mortality risk-adjusted odds ratios were 2.81 for in-hospital mortality, 1.69 for mortality within 30 days after discharge, and 1.33 for readmission within 30 days. The hospital risk-adjusted main length of stay was 4.8 days for individuals who did not develop PUs, and 11.2 days for those with hospital-acquired PUs. The Northeast region in general and the state of Missouri in particular, had the highest incidence rates (4.6% and 5.9%, respectively).

The study found that 4.5% of the patients tracked acquired a PU during their stay in the hospital. The majority of these bedsores were found on the tailbone or sacrum, followed by the hip, buttocks, and heels. The study also revealed that of the nearly 3,000 individuals who entered the hospital with a PU, 16.7% developed at least one new bedsore on a different part of their body during their hospitalization. Individuals at the highest risk were those with existing chronic conditions, such as congestive heart failure (CHF), pulmonary disease, cardiovascular disease (CVD), diabetes, and obesity, as well as those on steroids. The study was published in the September 2012 issue of the Journal of the American Geriatrics Society.

“When individuals enter the hospital with the risk conditions that we've identified, it should send up an immediate warning signal that appropriate steps should be taken to minimize the chance of pressure ulcers occurring,” said lead author Courtney Lyder, RN, DN, GNP, dean of the UCLA School of Nursing. “It is incumbent upon hospitals to identify individuals at high risk for these ulcers and implement preventive interventions immediately upon admission.”

PUs are localized injuries to the skin and/or underlying tissue (usually over a bony prominence) as a result of pressure, or pressure in combination with shear and friction. Most commonly this will be the sacrum, coccyx, heels, or the hips, but other sites such as the elbows, knees, ankles, or the back of the cranium can be affected. The cause of PUs is the pressure applied to soft tissues, so that blood flow is completely or partially obstructed. Shear, which pulls on blood vessels that feed the skin, is also a cause. PUs most commonly develop in persons who are not moving about or confined to wheelchairs.

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