Predictors of Pressure Ulcers in patients with Vascular Disease

Purpose:
The purposes of this research study are to identify predictors of hospital acquiring pressure ulcers and presence of decubitus ulcer documentation at admission during hospitalization in patients admitted to a vascular nursing floor with a primary diagnosis of vascular disease.

Background/Significance:
Individuals with a peripheral vascular disease (PVD) have a three-fold increase in mortality compared to those without PVD, and are more likely to develop pressure ulcers (PU). Although PU risk factors are well known in the general population, little research is available in patients admitted with PVD medical or surgical diagnosis.

Methods:
This study was a retrospective medical records review using a cohort design of all patients treated for PVD on one unit from 11/1/08 - 12/31/09. Variables collected were determined by review of general and lower extremity PU risk in contemporary literature and also those available by electronic medical record review. Data were collected by 8 RN's after training by the principal investigator, and by administrative database extraction. Data were analyzed using descriptive and comparative statistics.

Results:
In 849 admissions, mean age was 68.6 years for patients without PU and 69 .1 years for patients with PU, 575 (67.7%) were male and 704 were Caucasian. Mean right ankle brachial indexes (ABI) for patients without and with PU were 0.90 and 0.70, respectively. Common diagnoses were aneurysms/embolisms, (43.2%)and atherosclerosis (31.2%). Overall, 18.9% of admissions had a PU; 11.8% were hospital acquired. On multivariable analyses, 9 factors were associated with hospital acquired PU: lower right ABI and Braden score, had an ICU stay, low and high hematocrit values, female gender, non-white status, atherosclerosis diagnosis, and higher BUN and body mass index, concordance index, 0.854.

Conclusions and Implications for Practice:
The rate of hospital acquired PU was higher than desired in patients with PVD. Routine assessment of 9 factors while hospitalized and implementation of interventions (when the risk is elevated)may decrease the risk of hospital acquired PU.