Dissertation
FACTORS ASSOCIATED WITH INCREASED RISK OF ADVERSE OUTCOMES IN PATIENTS WITH PRESSURE ULCERS DURING HOSPITALIZATION
Doctor of Philosophy (PhD), Washington State University
01/2016
Handle:
https://hdl.handle.net/2376/112171
Abstract
Pressure ulcers (PrUs) are a significant threat to hospitalized patients, occurring in 4.5% of hospitalized patients overall and 8-12% of ICU patients. Patients with a PrU experience prolonged hospital stays, increased pain and suffering, increased risk of infection, greater healthcare costs, and decreased quality or life. However, it is not known what factors are associated with adverse outcomes in patients hospitalized with a PrU or if there are differences between patients with a pressure ulcer present on admission (POA) or hospital acquired pressure ulcer (HAPU). The purpose of this study was to identify factors associated with adverse outcomes in patients with pressure ulcers (PrUs).
Using the Comprehensive Hospital Abstract Reporting System (CHARS), all hospital records of patients discharged with a PrU in the state of Washington between 2009 and 2013 were analyzed. Of the 10,275 records of hospitalized patients in which status of the PrU could be determined at admission, 9667 patients had a PrU POA; 608 had a HAPU. The mean age of the HAPU and POA cohort was 65 and 72, respectively. The most common primary diagnosis upon admission for both cohorts was septicemia. The relationship between demographic factors and Elixhauser comorbid conditions and adverse outcomes (in-hospital death, prolonged length of stay, discharge not home and 30-day re-hospitalization) was analyzed using binomial logistic regression. Fully adjusted models demonstrated the odds for prolonged LOS was 8 times greater in the HAPU cohort as compared to the POA cohort. The odds for in-hospital death were 5.46 times greater for non-White/non-Hispanic patients in the HAPU cohort compared to other races (OR = 5.46, 95% CI = 2.44, 12.20, p < .001). The most common factor associated with adverse outcomes in the HAPU cohort was deep PrU. In the POA cohort, deep PrU, heart failure, and weight loss were common statistically significant independent factors associated with adverse outcomes.
Further research is needed to confirm the relationship between race/ethnicity and in-hospital death in HAPU patients. Results challenge the current paradigm of PrU risk assessment and prevention. Targeted delivery of PrU prevention for patients at risk for adverse outcomes may be more efficacious.
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Details
- Title
- FACTORS ASSOCIATED WITH INCREASED RISK OF ADVERSE OUTCOMES IN PATIENTS WITH PRESSURE ULCERS DURING HOSPITALIZATION
- Creators
- Ruth Ann Bryant
- Contributors
- Kenneth B. Daratha (Advisor)Cynthia F. Corbett (Committee Member)Gail Oneal (Committee Member)
- Awarding Institution
- Washington State University
- Academic Unit
- College of Nursing
- Theses and Dissertations
- Doctor of Philosophy (PhD), Washington State University
- Number of pages
- 163
- Identifiers
- 99900581631501842
- Language
- English
- Resource Type
- Dissertation