Malnutrition is independently associated with skin tears in hospital inpatient setting—Findings of a 6‐year point prevalence audit

Abstract

Skin tears cause pain, increased length of stay, increased costs, and reduced quality of life. Minimal research reports the association between skin tears, and malnutrition using robust measures of nutritional status. This study aimed to articulate the association between malnutrition and skin tears in hospital inpatients using a yearly point prevalence of inpatients included in the Queensland Patient Safety Bedside Audit, malnutrition audits and skin tear audits conducted at a metropolitan tertiary hospital between 2010 and 2015. Patients were excluded if admitted to mental health wards or were <18 years. A total of 2197 inpatients were included, with a median age of 71 years. The overall prevalence of skin tears was 8.1%. Malnutrition prevalence was 33.5%. Univariate analysis demonstrated associations between age (P ˂ .001), body mass index (BMI) (P < .001) and malnutrition (P ˂ .001) but not gender (P = .319). Binomial logistic regression analysis modelling demonstrated that malnutrition diagnosed using the Subjective Global Assessment was independently associated with skin tear incidence (odds ratio, OR: 1.63; 95% confidence interval, CI: 1.13-2.36) and multiple skin tears (OR 2.48 [95% CI 1.37-4.50]). BMI was not independently associated with skin tears or multiple skin tears. This study demonstrated independent associations between malnutrition and skin tear prevalence and multiple skin tears. It also demonstrated the limitations of BMI as a nutritional assessment measure.

Nutritional Considerations of Cardiovascular Diseases and Treatments

“…Increased nutritional risk is frequently found among hospitalized or institutionalized patients. 1,2 Prevalence of increased nutritional risk varies from 20% to 30% in large case registries, to significantly higher proportions, in dependence of type of studied population. Malnutrition was found to be connected with prolonged hospital stay, increased rate of hospitalizations, readmissions, increased prevalence of treatment-related complications, increased prevalence of hospital infections, and mortality.…”

“…116,117 According to ESPEN guidelines on definitions and terminology of clinical nutrition, chronic DRM is commonly described in patients with chronic HF defining it as nonintentional and non-edematous weight loss >7.5% of the premorbid normal weight. 1 Patients with terminal HF are the most complex population with multiple comorbidities and multiple organ dysfunction affecting appetite, intestinal absorption, aerobic metabolism, immunocompetency, neurohormonal axis, as well as protein and enzyme production at cell level. 69,72,118 Whether alone or in combination, micronutrient supplementation improves outcomes of patients with HF by ameliorating symptoms, work capacity, and left ventricular ejection fraction, thus increasing the quality of life.…”

“…This results in no guidelines on nutritional risk treatment in patients with CVD and chronic diseases in general, except those undergoing thoracic surgery (ESPEN guidelines). 1 However, although many clinicians are not aware of nutritional treatment importance, these interventions have high cost-benefit potential and are mostly easy to implement in everyday clinical work.…”

ISTAP classification for skin tears: Validation for Brazilian Portuguese

“…Skin tears (STs) are acute traumatic wounds caused by shear, friction, and/or brute force, including the removal of adhesives, resulting in the rupture of skin layers, dermis and epidermis, or even between them and the underlying tissues . STs are associated with factors such as extremes of age (neonatal and elderly), dehydration, malnutrition (decrease in albumin serum level), pharmacological therapy (corticoids and anticoagulants), mobility impairment, and mechanical factors associated with basic care being, in many cases, underreported.…”

“…9 A higher value was found in a study conducted in Denmark, with a prevalence of 11.4% in 202 patients admitted at a hospital of the same level. 10 Among studies performed in long-term care facilities for the elderly, the ST prevalence found was of 3% in Belgium, 11 4.6% in Denmark, 12 11.6% in Brazil, 13 and 14.7% in Canada. 14 Some studies have indicated associations between ST occurrence and low scores in the Braden scale.…”