A Survey Of Pressure Injury Prevalence And Clinical Features In A Tertiary Level A Hospital:2009-2018

Background:The prevalence of pressure injury(PI)has increased exponentially over the last two decades although health care providers have been struggling to ensure providing adequate care.PI has been bringing heavy financial burden to family and society.The prevalence rate of PI changes dynamic and is a sensitive indicator to reflect the quality of international PI prevention.However,current surveys on the prevalence of PI in China mainly focused on the cross-sectional study of point prevalence.Less attention has been paid to dynamic data of PI in China.Objectives:This study aimed to describe the time trend and demographic characteristics of PI inpatients,to analyze the characteristics of PI wounds,and to explore influencing factors of the wounds prognosis of PI so as to provide reference for monitoring and evaluating prevention and treatment effects of PI and improving the wounds prognosis of PI.Methods:A retrospective analysis was performed on data of PI cases from the pressure injury reporting system of inpatients in a tertiary hospital in Nanjing from 2009 to2018.The time trend of pressure injury in recent ten years were described with estimating average percent change(EAPC).The demographic characteristics and wound characteristics of pressure injury were described by the number of cases and composition ratio.The ordinal logistic regression model was used to analyze theinfluencing factors of the wounds prognosis of PI.Results:1.Epidemiological characteristics of PI in 2009-2018The total PI prevalence rate was 0.588%(5804/986404).From 2009 to 2018,PI prevalence increased from 0.185% to 1.000%(EAPC=22.462%),the standardized prevalence of PI increased from 0.212% to 0.935%(EAPC=11.686%).The prevalence of hospital acquired PI was 0.128%(1260/986404).The main departments with hospital acquired pressure injuries happened frequently were intensive care unit,cardiovascular medicine department and digestive system department.There were4544 preexisting PI cases,mainly occurred in families,other medical institutions and nursing homes.PI prevalence was 0.805% in males and 0.384% in females,respectively.PI prevalence was 0.123%,0.292%,0.429%,0.972%,2.938% and8.616% in 18-39,40-59,60-69,70-79,80-89 and over 90 years-old groups,respectively.The Charlson comorbidity index of PI patients was 1-13,and the medain of admission Braden score was 12.PI patients were mainly patients with respiratory diseases(23.67%),neurological diseases(20.28%)and tumors(13.03%).2.Wound characteristics of pressure injuryThe sacrum(49.49%)and foot(22.02%)were more commonly affected.Stage II(40.85%)and stage III(25.75%)pressure injuries were the most common.A total of60.13% of PI wounds had PI-related pain.38.10% of PI wounds documented exudate.10.35% of PI wounds had odour.The medical device related pressure injuries tend to occur in head(14.88%)and foot(26.98%)regions,and their wounds were smaller and shallower than that of general PI(all P <0.05).Of the 3209 PI wounds assessed,only23.00% were healed.3.Influencing factors on the outcome of pressure injury woundsMultivariate ordinal logistic regression analysis showed that Charlson Comorbidity Index(?7vs?3: OR=4.121,95% CI=2.502-6.794),Braden scores(?9vs?16: OR=2.321,95%CI=1.758-3.065),wound depth(?0.5cm vs ?0.1cm: OR=4.754,95% CI=3.071-7.367),turning schedule(OR=11.531,95% CI=8.224-16.167),usage of medical relieving device(OR=6.147,95% CI=3.991-9.478),dressing(OR=0.774,95% CI=0.623-0.962)and regular dressing changing(OR=1.426,95%CI=1.178-1.726)were the influencing factors of PI wounds prognosis.Conclusion:The PI prevalence in this hospital has increased rapidly in the past ten years.The majority of pressure injury patients were male and elder.Patients with respiratory disease,neurological disease,tumor,low Braden score and high Charlson Comorbidity Index were more affected.Stage II and stage III pressure injuries were the most common.The sacrum and foot regions were more affected.Charlson Comorbidity Index,Braden score at admission,wound depth,turning schedule,usage of medical relieving device,dressing and regular dressing changes were influencing factors of PI healing.The results of this study provided basis for the formulating and implementing the prevention and nursing measures of PI.