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. 2009 May;57(5):863-70.
doi: 10.1111/j.1532-5415.2009.02245.x.

Pressure ulcers in elderly patients with hip fracture across the continuum of care

Mona Baumgarten  1 , David J Margolis, Denise L Orwig, Michelle D Shardell, William G Hawkes, Patricia Langenberg, Mary H Palmer, Patricia S Jones, Patrick F McArdle, Robert Sterling, Bruce P Kinosian, Shayna E Rich, Janice Sowinski, Jay Magaziner
Affiliations

Pressure ulcers in elderly patients with hip fracture across the continuum of care

Mona Baumgarten et al. J Am Geriatr Soc. 2009 May.

Abstract

Objectives: To identify care settings associated with greater pressure ulcer risk in elderly patients with hip fracture in the postfracture period.

Design: Prospective cohort study.

Setting: Nine hospitals that participate in the Baltimore Hip Studies network and 105 postacute facilities to which patients from these hospitals were discharged.

Participants: Hip fracture patients aged 65 and older who underwent surgery for hip fracture.

Measurements: A full-body skin examination was conducted at baseline (as soon as possible after hospital admission) and repeated on alternating days for 21 days. Patients were deemed to have an acquired pressure ulcer (APU) if they developed one or more new stage 2 or higher pressure ulcers after hospital admission.

Results: In 658 study participants, the APU cumulative incidence at 32 days after initial hospital admission was 36.1% (standard error 2.5%). The adjusted APU incidence rate was highest during the initial acute hospital stay (relative risk (RR)=2.2, 95% confidence interval (CI)=1.3-3.7) and during re-admission to the acute hospital (RR=2.2, 95% CI=1.1-4.2). The relative risks in rehabilitation and nursing home settings were 1.4 (95% CI=0.8-2.3) and 1.3 (95% CI=0.8-2.1), respectively.

Conclusion: Approximately one-third of hip fracture patients developed an APU during the study period. The rate was highest in the acute setting, a finding that is significant in light of Medicare's policy of not reimbursing hospitals for the treatment of hospital-APUs. Hip fracture patients constitute an important group to target for pressure ulcer prevention in hospitals.

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Conflict of interest statement

Conflict of Interest: The editor in chief has reviewed the conflict of interest checklist provided by the authors and has determined that the authors have no financial or any other kind of personal conflicts with this paper.

Figures

Figure 1
Figure 1
Identification, Screening, and Enrollment of Study Participants * 146 discharged from hospital before contact could be made, and 51 because patient, proxy, or physician could not be found or refused eligibility screening
Figure 2
Figure 2
Cumulative Incidence (and 95% Confidence Limits) of Acquired Pressure Ulcers, by Days Since Initial Hospital Admission
See this image and copyright information in PMC

References

    1. Black J, Baharestani M, Cuddigan J, et al. National Pressure Ulcer Advisory Panel's updated pressure ulcer staging system. Dermatol Nurs. 2007;19:343–349. - PubMed
    1. Roghmann MC, Siddiqui A, Plaisance K, et al. MRSA colonization and the risk of MRSA bacteraemia in hospitalized patients with chronic ulcers. J Hosp Infect. 2001;47:98–103. - PubMed
    1. Spilsbury K, Nelson A, Cullum N, et al. Pressure ulcers and their treatment and effects on quality of life: hospital inpatient perspectives. J Adv Nurs. 2007;57:494–504. - PubMed
    1. Allman RM, Goode PS, Burst N, et al. Pressure ulcers, hospital complications, and disease severity: impact on hospital costs and length of stay. Adv Wound Care. 1999;12:22–30. - PubMed
    1. Kumar RN, Gupchup GV, Dodd MA, et al. Direct health care costs of 4 common skin ulcers in New Mexico Medicaid fee-for-service patients. Adv Skin Wound Care. 2004;17:143–149. - PubMed

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