Assessment of Risk Factors Associated With Hospital-Acquired Pressure Injuries and Impact on Health Care Utilization and Cost Outcomes in US Hospitals

Dreyfus, Jill; Gayle, Julie; Trueman, Paul; Delhougne, G.; Siddiqui, Aamir

doi:10.1177/1062860617746741

Cited by 50 publications

(61 citation statements)

References 20 publications

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“…Incorrect diagnosis leading to an inappropriate care pathway will to lead to financial and patient-related cost. Management of PUs in all health-care systems is costly, [34][35][36][37][38] and associated with higher mortality. [39][40] Complications in the diabetic foot are among the most serious and costly in patients with diabetes.…”

Section: Cost Of Misdiagnosismentioning

confidence: 99%

Identifying and treating foot ulcers in patients with diabetes: saving feet, legs and lives

et al. 2018

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This is a working document that addresses general principles and provides guidance designed to minimise the likelihood of misdiagnosis and inappropriate management of PUs and DFUs. It should be read and implemented in conjunction with local guidelines. It brings theory and practice together, and offers areas of reflection that allow the reader to review the information and then decide where and how to use it to underpin their own clinical area. The consensus will inform and enable opportunities for practice change.

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Section: Cost Of Misdiagnosismentioning

confidence: 99%

Identifying and treating foot ulcers in patients with diabetes: saving feet, legs and lives

et al. 2018

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“…It is well‐recognised that pressure ulcers are a significant cause of morbidity and lead to a lower quality of life for both patients and their carers . In the United States, patients with hospital‐acquired pressure ulcers (HAPU) had a longer length of stay, higher total hospitalisation costs, and greater odds of readmissions compared with patients with no HAPU . Similarly, in Singapore, patients with HAPU had higher hospitalisation costs and lengths of hospitalisation…”

Section: Introductionmentioning

confidence: 99%

“…3,4 In the United States, patients with hospital-acquired pressure ulcers (HAPU) had a longer length of stay, higher total hospitalisation costs, and greater odds of readmissions compared with patients with no HAPU. 5 Similarly, in Singapore, patients with HAPU had higher hospitalisation costs and lengths of hospitalisation. 6 It is well recognised that HAPU is avoidable.…”

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confidence: 98%

A prediction tool for hospital‐acquired pressure ulcers among surgical patients: Surgical pressure ulcer risk score

Aloweni

Ang

Fook‐Chong

et al. 2018

International Wound Journal

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Surgical patients are prone to developing hospital‐acquired pressure ulcers (HAPU). Therefore, a better prediction tool is needed to predict risk using preoperative data. This study aimed to determine, from previously published HAPU risk factors, which factors are significant among our surgical population and to develop a prediction tool that identifies pressure ulcer risk before the operation. A literature review was first performed to elicit all the published HAPU risk factors before conducting a retrospective case‐control study using medical records. The known HAPU risks were compared between patients with HAPU and without HAPU who underwent operations during the same period (July 2015‐December 2016). A total of 80 HAPU cases and 189 controls were analysed. Multivariate logistic regression analyses identified eight significant risk factors: age ≥ 75 years, female gender, American Society of Anaesthesiologists ≥ 3, body mass index < 23, preoperative Braden score ≤ 14, anaemia, respiratory disease, and hypertension. The model had bootstrap‐corrected c‐statistic 0.78 indicating good discrimination. A cut‐off score of ≥6 is strongly predictive, with a positive predictive value of 73.2% (confidence interval [CI]: 59.7%‐84.2%) and a negative predictive value of 80.7% (CI: 74.3%‐86.1%). SPURS contributes to the preoperative identification of pressure ulcer risk that could help nurses implement preventive measures earlier.

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“…The management of pressure ulcers is an extremely important clinical, social and economic problem 1 , 2 , 3 . It is upsetting that despite the enormous technological advances in medicine that have taken place over the last decades, there is still unsatisfactory effective, affordable, and versatile method of treatment for every patient with pressure ulcers (without many contraindications and limitations).…”

Section: Introductionmentioning

confidence: 99%

Effect of laser therapy on expression of angio- and fibrogenic factors, and cytokine concentrations during the healing process of human pressure ulcers

et al. 2018

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Objective: To evaluate the effect of laser irradiation at different wavelengths on the expression of selected growth factors and inflammatory mediators at particular stages of the wound healing process.Methods: Sixty-seven patients were recruited, treated, and analyzed (group A - 940 nm: 17 patients; group B - 808 nm: 18 patients; group C - 658 nm: 16 patients; group D - sham therapy: 17 patients). Patients received a basic treatment, including repositioning and mobilization, air pressure mattress and bed support surfaces, wound cleansing and drug therapy. Additionally, patients received laser therapy once a day, 5 times a week for 1 month in use of a semiconductor lasers (GaAlAs) which emitted a continuous radiation emission at separate wavelengths of 940 nm (group A), 808 nm (group B) and 658 nm (group C). In group D (sham therapy), laser therapy was applied in the same manner, but the device was off during each session (only the applicator was switched on to scan pressure ulcers using none coherent red visible light).Results: The positive changes in the measured serum (IL-2, IL-6 and TNF-α) and wound tissue (TNF-α, VEGF and TGFβ1) parameters appeared to be connected only with the wavelength of 658 nm. The significant change in pro-inflammatory mediator levels [interleukin 2 (IL-2) with p=0.008 and interleukin 6 (IL-6) with p=0.016] was noticed after two weeks of laser therapy. In the other groups, the inflammation was also reduced, but the process was not as marked as in group C. Similarly, in the case of tumor necrosis factor (TNF-α) concentration, where after two weeks of treatment with irradiation at a wavelength of 658 nm, a rapid suppression was observed (p=0.001), whereas in the other groups, these results were much slower and not as obvious. Interestingly, again in the case of group C, the change in TNF-α concentration in wound tissue was most intensive (≈75% reduction), whereas the changes in other groups were not as obvious (≈50% reduction). After irradiation (658 nm), the VEGF expression increased significantly within the first two weeks, and then it decreased and maintained a stable level. In contrast, the TGFβ1 activity remained level, but always higher in comparison to other groupsConclusions: The effective healing of pressure ulcers is connected with laser irradiation at a wavelength of 658 nm. We believe that this effect is related to the inhibition of inflammatory processes in the wound and stimulation of angiogenesis and fibroblast proliferation at this specific radiation (based both on concentration of interleukins and TNF-α serum level and VEGF, TGFβ1, TNF-α activities in wound biopsies). Laser therapy at wavelengths of 940 and 808 nm does not significantly affect the above-mentioned repair processes, which explains its low effectiveness in the treatment of pressure ulcers.

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Assessment of Risk Factors Associated With Hospital-Acquired Pressure Injuries and Impact on Health Care Utilization and Cost Outcomes in US Hospitals

Cited by 50 publications

References 20 publications

Identifying and treating foot ulcers in patients with diabetes: saving feet, legs and lives

Identifying and treating foot ulcers in patients with diabetes: saving feet, legs and lives

A prediction tool for hospital‐acquired pressure ulcers among surgical patients: Surgical pressure ulcer risk score

Effect of laser therapy on expression of angio- and fibrogenic factors, and cytokine concentrations during the healing process of human pressure ulcers

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