title: Pressure-redistributing support surface use and pressure ulcer incidence in elderly hip fracture patients.
abstract: OBJECTIVE
  To evaluate the association between pressure-redistributing support surface (PRSS) use and incident pressure ulcers in older adults with hip fracture.
  
  
  METHODS
  Secondary analysis of data from prospective cohort with assessments performed as soon as possible after hospital admission and on alternating days for 21 days.
  
  
  METHODS
  Nine hospitals in the Baltimore Hip Studies network and 105 postacute facilities to which participants were discharged.
  
  
  METHODS
  Six hundred fifty-eight people aged 65 and older who underwent surgery for hip fracture.
  
  
  METHODS
  Full-body examination for pressure ulcers; bedbound status; and PRSS use, recorded as none, powered (alternating pressure mattresses, low-air-loss mattresses, and alternating pressure overlays), or nonpowered (high-density foam, static air, or gel-filled mattresses or pressure-redistributing overlays except for alternating pressure overlays).
  
  
  RESULTS
  Incident pressure ulcers (IPUs), Stage 2 or higher, were observed at 4.2% (195/4,638) of visits after no PRSS use, 4.5% (28/623) of visits after powered PRSS use, and 3.6% (54/1,496) of visits after nonpowered PRSS use. The rate of IPU per person-day of follow-up did not differ significantly between participants using powered PRSSs and those not using PRSSs. The rate also did not differ significantly between participants using nonpowered PRSSs and those not using PRSSs, except in the subset of bedbound participants (incidence rate ratio=0.3, 95% confidence interval=0.1-0.7).
  
  
  CONCLUSIONS
  PRSS use was not associated with a lower IPU rate. Clinical guidelines may need revision for the limited effect of PRSS use, and it may be appropriate to target PRSS use to bedbound patients at risk of pressure ulcers.
authors.affiliation: Department of Epidemiology and Public Health, School of Medicine, University of Maryland, Baltimore, Maryland 21201, USA.
authors.forename: Shayna E
authors.initials: SE
authors.lastname: Rich
authors.forename: Michelle
authors.initials: M
authors.lastname: Shardell
authors.forename: William G
authors.initials: WG
authors.lastname: Hawkes
authors.forename: David J
authors.initials: DJ
authors.lastname: Margolis
authors.forename: Sania
authors.initials: S
authors.lastname: Amr
authors.forename: Ram
authors.initials: R
authors.lastname: Miller
authors.forename: Mona
authors.initials: M
authors.lastname: Baumgarten
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000706:statistics & numerical data; D015142:Baltimore; D001513:Beds / Q000592:standards* / Q000706:statistics & numerical data*; D015331:Cohort Studies; D015897:Comorbidity; D003430:Cross-Sectional Studies; D005260:Female; D006620:Hip Fractures / Q000453:epidemiology*; D006786:Hospitals, Urban; D006801:Humans; D015994:Incidence; D008297:Male; D003668:Pressure Ulcer / Q000453:epidemiology* / Q000517:prevention & control*; D011446:Prospective Studies; D012047:Rehabilitation Centers; D012189:Retrospective Studies; D018570:Risk Assessment; D014600:Utilization Review / Q000706:statistics & numerical data