JMIR Publications

ABSTRACT

Background:

Understanding hospital-acquired pressure injury (HAPrI) etiology is essential for developing effective preventive interventions. Pressure injuries (PrI) are classified based on the degree of visible tissue damage; the two most commonly identified HAPrI stages in critical care patients are stage 2 and deep tissue injury (DTI). Some experts speculate stage 2 and those considered a DTI have different etiology, with stage 2 being formed from the "outside-in" as a result of tissue deformation, decreased perfusion, and subsequent ischemia caused by external pressure and/or shear forces, whereas the DTI emerges from the "inside-out" due to inadequate perfusion to the deeper tissues causing tissue ischemia.

Objective:

The purpose of this short report is to compare risk profiles of ICU patients who developed stage 2 versus DTI HAPrIs.

Methods:

This was a retrospective cohort study of ICU patients' risk factor profiles comparing stage 2 and DTI HAPrI using electronic health record (EHR) data. Eligible patients were admitted to the surgical ICU or cardiovascular ICU at an academic medical center in the United States between 2014 and 2018. Risk profile variables included demographic characteristics, Braden Scale scores, vasopressor infusions, hypotension, surgical factors, length of stay, body mass index, laboratory values, diabetes, Charleston Comorbidity Index, and the levels of sedation or agitation. The distributions of potential risk variables between patients with stage 2 and DTI HAPrI were summarized and compared. A logistic regression model with the Least Absolute Shrinkage and Selection Operator (LASSO) was developed to identify the critical risk factors for distinguishing stage 2 and DTI patients

Results:

A total of 244 patients developed a stage 2 or DTI HAPrI during the study period. Of those, 38 patients with medical device-related PrI were excluded. The final study sample consisted 206 patients (n=146 stage 2, and n=60 DTI). The multivariate model showed patients who developed Stage 2 HAPrI had longer length of stay in the ICU than those with DTI (OR= 1.001, 95% CI= 1-1.002, P=0.03) but were less likely than patients with DTI to experience a diastolic blood pressure <50mmHg (OR= 0.179, 95% CI= 0.072-0.416, P=<0.001) or receive an epinephrine infusion (OR= 0.316, 95% CI= 0.079-0.525, P=0.008).

Conclusions:

In this exploratory study, surgical and cardiovascular critical care patients with DTI PrIs were more likely than patients with stage 2 to experience low diastolic blood pressure and receive epinephrine, a potent vasopressor. Future research is needed to elucidate etiologic differences between stages, which will lead to identifying effective preventive interventions Clinical Trial: N/A