The demographics of suspected deep tissue injury in the United States: an analysis of the International Pressure Ulcer Prevalence Survey 2006-2009.

OBJECTIVE: Suspected deep tissue injury (sDTI) was identified in 2001 and added as a staging definition by the National Pressure Ulcer Advisory Panel in 2007. Clinical data on sDTI are sparse. This article reports the overall prevalence data and describes the demographics of subjects with sDTI from the International Pressure Ulcer Prevalence survey 2006-2009. METHODS: Participating healthcare facilities performed prevalence surveys in their facility during a pre-determined 24-hour period within a pre-selected 2- to 3-day window. All generated data was incorporated into the database, even if specific data fields were absent. RESULTS: Approximately 79,000 to 92,000 patients were surveyed each year from 2006 to 2009. The overall and nosocomial pressure ulcer (PrU) prevalence decreased by approximately 1% in 2009 (P < .001), after remaining fairly constant in the years 2006-2008. The proportion of ulcers identified as sDTI has increased 3 fold, to 9% of all observed ulcers in 2009 and is more prevalent than either Stage III or IV ulcers. Over the same period, the proportion of Stage I and II ulcers have decreased, and the proportion of Stage III and IV ulcers has remained nearly constant. Patients with sDTIs are older than patients with Stage III, IV, and Unstageable ulcers. The anatomic location of sDTIs are more commonly found at the heel (41%), the sacrum (19%), or the buttocks (13%). Compared with other staged ulcers, sDTIs are significantly more prevalent at the heel (P < .001) and the ankle and foot (P < .001) and less prevalent at the sacrum and coccyx (P < .001) and at the buttocks and ischial tuberosities (P < 0.001). CONCLUSION: The survey data indicate that a decrease in overall prevalence of PrUs, as well as hospital-acquired PrUs, may have occurred in 2009. Suspected deep tissue injuries have become more commonly identified, which may be secondary to education of staging definitions.

Continuous lateral rotation therapy for acute hypoxemic respiratory failure: the effect of timing.

Previous studies have indicated a positive impact of continuous lateral rotational therapy on nosocomial pneumonia, but have shown mixed results in decreasing length of stay or ventilator days. The objective of the study was to determine if the use of a continuous lateral rotational therapy protocol would decrease mortality and morbidity, mean ventilator days, and/or intensive care unit and hospital length of stay in patients with a pulmonary diagnosis. The study also analyzed the effect of the lag time to the initiation of therapy. Prospectively enrolled subjects receiving continuous lateral rotational therapy based on predetermined indications were compared with retrospectively identified control subjects who met the same inclusion criteria from a similar time period in the previous year. Early initiation of continuous lateral rotational therapy resulted in significant decreases in ventilator days and intensive care unit length of stay. The therapeutic benefit of continuous lateral rotational therapy may be enhanced with early identification and treatment of appropriate patients.

Body mass index, weight, and pressure ulcer prevalence: an analysis of the 2006-2007 International Pressure Ulcer Prevalence Surveys.

To assess the relationships among pressure ulcer prevalence, body mass index (BMI), and weight, this report analyzed the US data from the 2006 and 2007 International Pressure Ulcer Prevalence Surveys. Findings indicated an overall reduction in pressure ulcer prevalence from 2004 and 2005 to 2006 and 2007; there was a higher prevalence of pressure ulcers in patients with low BMI and patients with both low and high weights. One in 10 patients were extremely obese.

Results of nine international pressure ulcer prevalence surveys: 1989 to 2005.

Pressure ulcers continue to be a significant problem for patients and healthcare facilities. Since 1989, results from the International Pressure Ulcer Prevalence surveys--observational, cross-sectional cohort studies--conducted by Hill-Rom, Batesville, Ind, have been used to document aggregate prevalence rates and provide acute care, long-term acute care, and long-term care facilities with internal and external benchmarks of process improvement. During each of the nine surveys conducted between 1989 and 2005, clinical teams in participating facilities predominantly in the US (some facilities in Canada, Saudi Arabia, and Australia participated after 2003) assessed admitted patients on assigned study dates. For this study, trends using all records (n = 447,930; average, 49,770 per year) were reviewed. The majority of facilities in each survey year were in the US (99% overall). Overall and nosocomial pressure ulcer prevalence rates ranged from 9.2% and 5.6% in 1989 to 15.5% and 10% in 2003 and 2004, respectively. The highest prevalence was documented in long-term acute care (27.3% overall, 8.5% nosocomial). Most commonly, ulcers were located at the sacrum (28%), heels (23.6%), and buttocks (17.2%). Ulcers were more commonly assessed as Stage I and Stage II (>70%). However, in patients with dark skin tone (2004 and 2005 data, n = 162,296), 13% of identified ulcers were Stage I compared to 32% in patients with medium and 38% in patients with light skin tone. Using the most complete data sets (2003, 2004, and 2005), more severe pressure ulcer prevalence (Stage III+) was not found to be age-related. Approximately 48% of all patients who had pressure ulcers and 48% of patients with nosocomial pressure ulcers were assessed at mild or no risk (Braden scale score >14). Prevalence within the Braden Score risk categories aligned with risk for developing pressure ulcers. Despite increased attention to the pressure ulcer problem, prevalence rates from the last five survey years are relatively unchanged.

Analytical and clinical validation of the 25 OH vitamin D assay for the LIAISON automated analyzer.

OBJECTIVE: Methods to assess serum 25 OH vitamin D have improved in accuracy, precision, and ease of use. We describe the analytical and clinical validation of an automated, antibody- and microparticle-based, chemiluminescent immunoassay method for the determination of 25 OH vitamin D. DESIGN AND METHODS: The LIAISON 25 OH Vitamin D assay is a rapid automated method with first results available in 40 min, and a subsequent throughput of 180 samples per hour. Assay performance characteristics of precision and recovery were determined according to the National Committee for Clinical Laboratory Standards (NCCLS) protocols. Analytical and functional sensitivity were determined according to standard protocols. Samples for method comparison studies were obtained from routine clinical samples submitted for 25 OH Vitamin D determination or from apparently healthy normal volunteers. RESULTS: The detection limit for this assay was <2.0 nmol/L across three lots of materials. Functional sensitivity (inter-assay imprecision <20%) was 17.5 nmol/L. Total imprecision (CV) was <15% at 42.5-137.5 nmol/L. Mean (SD) recovery was 101% (13%). The assay was linear on dilution. Comparison with radioimmunoassay (RIA) yielded acceptable correlation (r = 0.88) and clinical equivalence in the range from 37.5 to 150 nmol/L. CONCLUSIONS: The LIAISON 25 OH Vitamin D assay is a rapid, accurate, and precise tool for the measurement of 25 OH vitamin D.

Analytical and clinical validation of a radioimmunoassay for the measurement of 1,25 dihydroxy vitamin D.

OBJECTIVES: The analytical and clinical validation of the DiaSorin 1,25 dihydroxyvitamin D RIA is described. DESIGN AND METHODS: The analytical parameters assessed included analytical sensitivity, dilution linearity, intra- and inter-assay precision, recovery, specificity, and interference studies. Where appropriate, assessments were performed according to NCCLS guidelines. The clinical validation assessed normal individuals and end-stage renal disease patients. RESULTS: The analytical sensitivity of the assay is < 2.0 pg/mL or < 4.8 pM. The assay is specific for both 1,25 dihydroxyvitamin D2 and D3. Recovery ranged from 97% to 108% for spiked samples. Intra-assay precision, as %CV, ranged from 7% to 11%, while inter-assay precision was 12% to 15%. No interference was observed from bilirubin, cholesterol, hemoglobin, or triglycerides. Clinical validation demonstrated complete discrimination between normal and ESRD populations. CONCLUSIONS: These data demonstrate that the DiaSorin 1,25 (OH)(2) vitamin D RIA is a robust, accurate, and precise tool for the assessment of 1,25 (OH)(2) vitamin D.