Prevalence and Diagnosis of Pressure Ulcers of COVID-19 ICU Patients Weiying
1 Lu ,
1Donald
Carly Rothman,
2 DO ,
Ona Bloom,
1,3,4 PhD ,
Susan Maltser,
3 DO
and Barbara Zucker School of Medicine at Hofstra/Northwell, 2Children's Hospital Colorado, Dept. of Physical Medicine and Rehabilitation, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 4The Feinstein Institutes for Medical Research, Northwell Health
Background
Methods
• In addition to patients with spinal cord injuries or geriatric patients, patients in an intensive care unit (ICU) are particularly prone to developing pressure ulcers. • Jiricka et al. (1995) found that 25% of patients developed a pressure ulcer greater than stage II severity during their ICU stay. If pressure ulcers of stage I severity were included, the percentage of patients who developed a pressure ulcer increased to 56% (Jiricka et al., 1995) • More recently, Fife et al. (2001) found that the incidence of pressure ulcers (stage II or higher severity) was 12.4% in ICU patients. • In another study, the incidence of pressure ulcers (stage II or higher) was 7.9% among 594 surgical ICU patients (Weststrate et al., 1998).
• Retrospective collection of data from medical charts of COVID-19 patients who were admitted to acute rehabilitation at Glen Cove Hospital. Data was collected from electronic health records (Allscripts and Sunrise). • Patients were admitted sequentially for inpatient rehabilitation after acute hospitalization for COVID-19 (April 2020 – April 2021). • For comparison, historical data was extracted from Uniform Data System (UDS) for 2019, prior to the COVID-19 pandemic.
Results
p-value: 0.021
p-value: 0.116
Table 1. Comparing rates of ICU and acute rehab stay in pressure ulcer vs. non pressure ulcer COVID-19 patients.
Non-Pressure Ulcer Patients
Pressure Ulcer Patients
Figure 2. COVID-19 patients with vs. without pressure ulcers. Figure 5. Ventilation and tracheostomy rates in COVID-19 patients /+ pressure ulcers in acute rehabilitation after hospitalization.
Conclusions
Sacrum (right)
Figure 1. Stages of pressure sores.
Figure 3. Relative Frequencies and locations of the pressure ulcers.
Resources
Image Credit: Alila Medical Media
Hypothesis COVID-19 patients will have more pressure ulcers, and of greater severity, than typical inpatient rehabilitation patients prior to the COVID-19 pandemic.
• N=36/128 (28.2%) of COVID-19 patients developed at least one pressure ulcer. • In contrast, UDS data from Glen Cove Hospital in 2019 showed 1.7% patients admitted for acute inpatient rehab had pressure ulcers. • Typical pressure ulcer placement: feet, heels, buttocks • Atypical pressure ulcer placement: face
Figure 4. Clinical differences between COVID-19 patients with pressure ulcers vs. without pressure ulcers.
1. Fife, C. et. al. (2001). Incidence of pressure ulcers in a neurologic intensive care unit. Critical Care Medicine, 29(2), 283–290. https://doi.org/10.1097/00003246-200102000-00011 2. Jiricka, M. K, et al.. (1995). Pressure ulcer risk factors in an ICU population. American Journal of Critical Care: An Official Publication, American Association of Critical-Care Nurses, 4(5), 361– 367. 3. Weststrate, J. T., et al. (1998). The clinical relevance of the Waterlow pressure sore risk scale in the ICU. Intensive Care Medicine, 24(8), 815–820. https://doi.org/10.1007/s001340050671