Pre-existing pressure injuries cannot replace sophisticated systems for scoring the severity of illness in critically ill patients, but their presence does quickly identify patients at greater risk for longer hospital stays and increased mortality, said the American Association of Critical-Care Nurses (AACN) in a news release.
AACN pointed to new research, published in the June issue of Critical Care Nurse, that finds that pressure injuries present upon admission to the intensive care unit (ICU) can serve as a predictive clinical marker for longer hospitalization and increased odds of mortality, especially when other data aren’t available. “Pressure Injuries at Intensive Care Unit Admission as a Prognostic Indicator of Patient Outcomes” reports the results of a retrospective analysis of ICU admissions from 2010 to 2012 at Baystate Medical Center, Springfield, MA.
Many hospitals use the Acute Physiology and Chronic Health Education (APACHE) and Mortality Prediction Model, which automatically extracts information from a patient’s electronic medical record, except for the patient’s diagnosis at admission. However, the APACHE score is not available immediately since it relies on information such as vital signs and laboratory test results obtained during the first 24 hours of a patient’s ICU stay.
In contrast, a clinical marker present at admission could be used to quickly and objectively identify patients who may require additional care and longer hospital stays.
“Our results show that pressure injuries can be a quick, unambiguous way to alert critical care nurses and intensivists to newly admitted patients who will be challenging in the ICU, so we can make more informed decisions faster,” said co-author William T. McGee, MD, MHA, an intensivist at Baystate. “This study underscores the importance of a thorough skin examination upon admission to the ICU.”
The researchers analyzed admissions of adult patients to Baystate’s 24-bed medical-surgical ICU over a 17-month period. They limited the assessment to the 2,723 patients with first-time ICU admission who had APACHE severity scores. Of these, 180 had a pressure injury at admission.
The statistical analysis revealed that pressure injuries were associated with significantly longer hospital lengths of stay, regardless of mortality outcome. Patients with pressure injuries at admission had a longer mean length of stay of 3.1 days. They were not associated with mortality after adjusting for the APACHE score but may serve as a marker for increased risk of mortality if an APACHE score is not available.
Among patients with pressure injuries at admission, mechanical ventilation and dialysis were more common, as was the overall severity of illness. They also were more likely to show evidence of prior long-term care or physical rehabilitation. Readmission to the ICU during the same hospitalization occurred more frequently for patients with pressure injuries.
