Predictive Factors for Pressure Ulcers in an Older Adult Population Hospitalized for Hip Fractures: A Prognostic Cohort Study

Abstract

Background: Older adult patients with fragility hip fractures constitute a population at high risk for complications, in particular pressure ulcers. The aim was to evaluate the incidence of pressure ulcers and potential predictive factors.

Methods and findings: A prospective multicentric prognostic cohort study in orthopedic wards in three Italian public hospitals. Participants were all consecutive patients 65 years of age or older diagnosed with a fragility hip fracture. Outcomes were incidence of pressure ulcers. The exposure variables were grouped into three macro areas in order to facilitate reading: "intrinsic" variables, "extrinsic" variables and variables linked to the organization of patient care. One thousand eighty-three older adult patients with fragility hip fractures were enrolled from October 1st, 2013 to January 31st, 2015, and pressure ulcers developed in 22.7%. At multivariate analysis, the following were found to be risk factors: age> 80 years (odds ratio (OR) 1.03; p = 0.015), the length of time a urinary catheter was used (OR 1.013; p<0.001), the length of time pain was present (OR 1.008; p = 0.008), the absence of side rails on the bed (OR 1.668; p = 0.026) and the use of a foam position valve (OR 1.025; p<0.001). Instead, the protective factors were the presence of a caregiver for at least half a day daily (OR 0.994; p = 0.012) and the number of positionings during the postoperative period (OR 0.897; p = 0.008).

Conclusions: The study allowed the identification of the patients most at risk for developing pressure ulcers, and the construction of a pragmatic predictive model using significant risk or protective factors in order to reduce the number of pressure ulcers.

Fig 1. Flow Diagram of older adults.

Fig 2. ROC Curve of the Predictive Model of Pressure Ulcers in Patients with Hip Fractures.