Pressure ulcers in elderly patients with hip fracture across the continuum of care.
OBJECTIVE
To identify care settings associated with greater pressure ulcer risk in elderly patients with hip fracture in the postfracture period.


METHODS
Prospective cohort study.


METHODS
Nine hospitals that participate in the Baltimore Hip Studies network and 105 postacute facilities to which patients from these hospitals were discharged.


METHODS
Hip fracture patients aged 65 and older who underwent surgery for hip fracture.


METHODS
A full-body skin examination was conducted at baseline (as soon as possible after hospital admission) and repeated on alternating days for 21 days. Patients were deemed to have an acquired pressure ulcer (APU) if they developed one or more new stage 2 or higher pressure ulcers after hospital admission.


RESULTS
In 658 study participants, the APU cumulative incidence at 32 days after initial hospital admission was 36.1% (standard error 2.5%). The adjusted APU incidence rate was highest during the initial acute hospital stay (relative risk (RR)=2.2, 95% confidence interval (CI)=1.3-3.7) and during re-admission to the acute hospital (RR=2.2, 95% CI=1.1-4.2). The relative risks in rehabilitation and nursing home settings were 1.4 (95% CI=0.8-2.3) and 1.3 (95% CI=0.8-2.1), respectively.


CONCLUSIONS
Approximately one-third of hip fracture patients developed an APU during the study period. The rate was highest in the acute setting, a finding that is significant in light of Medicare's policy of not reimbursing hospitals for the treatment of hospital-APUs. Hip fracture patients constitute an important group to target for pressure ulcer prevention in hospitals.
Baumgarten
Mona
M
Department of Epidemiology and Preventive Medicine, University of Maryland School ofMedicine, 660W. Redwood Street, Suite 200, Baltimore, MD 21201, USA. mbaumgar@epi.umaryland.edu
Margolis
David J
DJ
Orwig
Denise L
DL
Shardell
Michelle D
MD
Hawkes
William G
WG
Langenberg
Patricia
P
Palmer
Mary H
MH
Jones
Patricia S
PS
McArdle
Patrick F
PF
Sterling
Robert
R
Kinosian
Bruce P
BP
Rich
Shayna E
SE
Sowinski
Janice
J
Magaziner
Jay
J
D000368:Aged; D000369:Aged, 80 and over; D015142:Baltimore / Q000453:epidemiology; D003266:Continuity of Patient Care; D005260:Female; D006620:Hip Fractures / Q000150:complications* / Q000601:surgery; D006801:Humans; D015994:Incidence; D008297:Male; D003668:Pressure Ulcer / Q000453:epidemiology*; D011446:Prospective Studies; D012307:Risk Factors