Validation of a Model for Predicting Pressure Injury Risk in Patients With Vascular Diseases.

PURPOSE: The purpose of this study was to validate a 10-factor model of risk factors for hospital-acquired pressure injury (HAPI) risk in patients with vascular disease. SUBJECTS AND SETTING: Medical reviews identified 800 patients from a 1063 admissions to a 1400 bed quarternary care hospital in the midwestern United States. DESIGN: Retrospective review of medical records. METHODS: Medical records of consecutive patients treated during an 18-month period on a medical-surgical vascular progressive care unit were reviewed. Ten previously identified risk factors for HAPI-(1) lower right ankle-brachial index, (2) low Braden Scale for Pressure Sore Risk score, (3) cared for in intensive care unit, (4) low serum hematocrit values, (4) elevated serum hematocrit levels (5) female gender, (6) nonwhite individual, (7) atherosclerosis, (8) diabetes mellitus, (9) elevated blood urea nitrogen levels, and (10) high body mass index-were compared to determine their ability to predict development of HAPI. Logistic regression model was used to validate the model. RESULTS: One hundred forty-six (16.1%) out of 800 patients developed an HAPI. The 10-factor risk model produced a concordance index of predicted to actual risk of 0.851, and the likelihood of developing an HAPI based on the model was significant (P < .001). CONCLUSIONS: A 10-factor model of HAPI risk was developed for patients with vascular disease. Routine assessment of risk factors is crucial in planning individualized interventions to diminish the risk of HAPI occurrences.

Do patient and nurse outcome differences exist between 2 negative pressure wound therapy systems?

PURPOSE: We prospectively compared the effectiveness of foam- and gauze-based negative pressure wound therapy (NPWT) systems on wound healing, pain, cost, and hospital length of stay. We also compare ease of use and time in performing dressing changes reported by nurses. DESIGN: Randomized, controlled clinical trial comparing foam- and gauze-based NPWT systems. SUBJECTS AND SETTING: Eleven adult subjects with physician orders for NPWT participated in the study. Subjects were middle-aged, white, and male. METHODS: Six subjects were randomly allocated to foam-based and 5 to gauze-based NPWT systems. Wound healing rates and pain at the first dressing change were measured using a centimeter ruler and a visual analog scale, respectively. Wound care costs were tabulated from a checklist of supplies used and nurse perceptions were measured by responses to Likert-type surveys. Relationships between NPWT system and selected variables were measured using Wilcoxon rank sum tests. RESULTS: Median wound healing rates did not differ significantly between foam-based and gauze-based NPWT systems when measured in centimeters at first dressing change for length (10.6 vs 16.5, P = .58), width (2.7 vs 4.2, P = .41), depth (2.2 vs 2.5, P = .78), and tunneling and undermining (both 0 vs 0, P = .82 and .79, respectively). No differences were detected in pain rating at first dressing change (3.2 vs 2.4, P = .77), cost of wound care ($510.18 vs $333.54 P = .86), or hospital length of stay (26.33 vs 14.8 days; P = .58), respectively. There were no differences in nurses' experiences in ease of performing dressing changes and mean time to perform the first dressing change for foam- or gauze-based NPWT systems: 32.3 vs 38.8 minutes; P = .52, respectively. CONCLUSIONS: In a pilot study comparing the effectiveness of foam- and gauze-based NPWT systems, no statistically significant differences were found in patient wound healing, pain, length of stay, or cost of wound care. Nursing time and perceptions about the ease of preparing and completing dressing changes did not differ between systems. Additional research is needed to more definitively determine any differences in wound healing or nurse satisfaction using gauze- versus foam-based NPWT systems.