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Hip fracture and pressure ulcers - the Pan-European Pressure Ulcer Study: intrinsic anc extrinsic factors
Sophiahemmet Högskola.
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2008 (Engelska)Ingår i: International Wound Journal, ISSN 1742-481X, Vol. 5, nr 2, s. 315-28Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Pressure ulcers (PU) in patients with hip fracture remain a problem. Incidence of between 8.8% and 55% have been reported. There are few studies focusing on the specific patient-, surgery- and care-related risk indicators in this group. The aims of the study were: - to investigate prevalence and incidence of PU upon arrival and at discharge from hospital and to identify potential intrinsic and extrinsic risk factors for development of PU in patients admitted for hip fracture surgery, - to illuminate potential differences in patient logistics, surgery, PU prevalence and incidence and care between Northern and Southern Europe. Consecutive patients with hip fracture in six countries, Sweden, Finland, UK (North) and Spain, Italy and Portugal (South), were included. The patients were followed from Accident and Emergency Department and until discharge or 7 days. Prevalence, PU at discharge and incidence were investigated, and intrinsic and extrinsic risk indicators, including waiting time for surgery and duration of surgery were recorded. Of the 635 patients, 10% had PU upon arrival and 22% at discharge (26% North and 16% South). The majority of ulcers were grade 1 and none was grade 4. Cervical fractures were more common in the North and trochanteric in the South. Waiting time for surgery and duration of surgery were significantly longer in the South. Traction was more common in the South and perioperative warming in the North. Risk factors of statistical significance correlated to PU at discharge were age >or=71 (P = 0.020), dehydration (P = 0.005), moist skin (P = 0.004) and total Braden score (P = 0.050) as well as subscores for friction (P = 0.020), nutrition (P = 0.020) and sensory perception (P = 0.040). Comorbid conditions of statistical significance for development of PU were diabetes (P = 0.005) and pulmonary disease (P = 0.006). Waiting time for surgery, duration of surgery, warming or non warming perioperatively, type of anaesthesia, traction and type of fracture were not significantly correlated with development of PU.

Ort, förlag, år, upplaga, sidor
2008. Vol. 5, nr 2, s. 315-28
Nationell ämneskategori
Omvårdnad
Identifikatorer
URN: urn:nbn:se:shh:diva-102DOI: 10.1111/j.1742-481X.2008.00452.xPubMedID: 18494637OAI: oai:DiVA.org:shh-102DiVA, id: diva2:301171
Tillgänglig från: 2010-03-02 Skapad: 2010-02-25 Senast uppdaterad: 2014-09-12Bibliografiskt granskad
Ingår i avhandling
1. Pressure ulcers - role of the nurse to improve patient safety: prevalence, risk factors, classification and documentation in patients undergoing hip surgery
Öppna denna publikation i ny flik eller fönster >>Pressure ulcers - role of the nurse to improve patient safety: prevalence, risk factors, classification and documentation in patients undergoing hip surgery
2012 (Engelska)Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
Abstract [en]

Pressure ulcer is a common complication in hip fracture surgery and convalescence. Earlier prevalence studies have demonstrated a lower prevalence in Southern Europe than in Northern Europe. In patients with hip fractures, specific risk factors for developing pressure ulcers, apart from those included in standardised risk assessment are not fully understood. Correct classification of Category I pressure ulcers is a prerequisite for planning preventive measures. It is also mandatory for the reliability of prevalence studies. Until now subjective tests such as finger-press test and visual assessment have been utilised in clinical practice. An objective method has hitherto been lacking. Planning and delivering good nursing care to patients who are at risk of, or already have, manifest pressure ulcers should be built on proper documentation. Degree of documentation of pressure ulcer prevalence and risk factors in patients with hip fractures versus elective hip replacement surgery has hitherto not been investigated. Scrutiny of medical records for these diagnoses and identification of potential differences should therefore be of interest.Aim: - To investigate prevalence and incidence of pressure ulcers upon arrival and at discharge from hospital, and to identify potential intrinsic and extrinsic risk factors for the development of pressure ulcers in patients admitted for hip fracture surgery. To establish the inter-rater reliability between blanching and non-blanching erythema, assessed by two independent assessors. The secondary purpose was to investigate potential correlations between risk factors and pressure ulcers. - To explore if a non-invasive objective method could differentiate between blanching/nonblanching erythema in the sacral area of patients undergoing hip fracture surgery. - To investigate the degree of documentation regarding risk assessment, preventive measures taken, prevalence and severity of pressure ulcers, in patients undergoing surgery for hip fractures or elective hip replacements at admission and during hospital care at an orthopaedic unit.Results: The prevalence of pressure ulcers in Southern Europe was lower compared to Northern Europe. Specific risk factors such as dehydration (p=.005), moist skin (p=.004), pulmonary disease (p=.006) and diabetes (p=.005) were identified. The finger-press test and visual assessment of Category I pressure ulcers were both unreliable methods with low interrater reliability. The proportion of patients with persistent discoloration differed significantly between the assessors from Day 1 to Day 5 (p = .013). Reflectance spectrophotometer used was proven to deliver high precision regarding classification of non-blanchable erythema (Category I pressure ulcers). Documentation of pressure ulcers, risk assessment, body mass index and prevention at admittance was unsatisfactory in patients undergoing hip surgery.

Ort, förlag, år, upplaga, sidor
Stockholm: Karolinska Institutet, 2012. s. 91
Nyckelord
Hip fracture, Pressure ulcers, Classification, Reflectance spectrophotometer, Nursing documentation
Nationell ämneskategori
Omvårdnad
Identifikatorer
urn:nbn:se:shh:diva-1201 (URN)978-91-7457-690-0 (ISBN)
Disputation
2012-03-30, Erforssalen, Sophiahemmet Högskola, Valhallavägen 91, Ingång R, Stockholm, 14:00
Opponent
Handledare
Tillgänglig från: 2012-11-29 Skapad: 2012-11-29 Senast uppdaterad: 2016-06-09Bibliografiskt granskad

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