Outcomes after Stroke in Patients with Previous Pressure Ulcer: A Nationwide Matched Retrospective Cohort Study.
BACKGROUND
Factors associated with poststroke adverse events were not completely understood. The purpose of this study was to investigate whether stroke patients with previous pressure ulcers had more adverse events after stroke.


METHODS
Using the claims data from Taiwan's National Health Insurance Research Database, we conducted a retrospective cohort study matched by propensity score. Three thousand two first-ever stroke patients with previous pressure ulcer and 3002 first-ever stroke patients without pressure ulcer were investigated between 2002 and 2009. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) of complications and 30-day mortality after stroke associated with previous pressure ulcer were calculated in the multivariate logistic regressions.


RESULTS
Patients with pressure ulcer had significantly higher risk than control for poststroke urinary tract infection (OR: 1.56, 95% CI: 1.38-1.78), pneumonia (OR: 1.35, 95% CI: 1.16-1.58), gastrointestinal bleeding (OR: 1.31, 95% CI: 1.04-1.66), and epilepsy (OR: 1.84, 95% CI: 1.83-1.85). Stroke patients with pressure ulcer had increased 30-day poststroke mortality (OR: 2.01, 95% CI: 1.55-2.61), particularly in those treated with debridement (OR: 2.87, 95% CI: 1.85-4.44) or high quantity of antibiotics (OR: 4.01, 95% CI: 2.10-7.66). Pressure ulcer was associated with poststroke mortality in both genders and patients aged 60 years or older.


CONCLUSIONS
This study showed increased poststroke complications and mortality in patients with previous pressure ulcer, which suggests the urgent need for monitoring stroke patients for pressure ulcer history.
Department of Anesthesiology, Taichung Veterans General Hospital, Taichung, Taiwan.
Shang-Yi
SY
Lee
Department of Dermatology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.
Chia-Lun
CL
Chou
Neurosurgery Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.
Sanford P C
SP
Hsu
School of Chinese Medicine for Post-Baccalaureate, I-Shou University, Kaohsiung, Taiwan; Ph.D. Program for Clinical Drug Discovery from Botanical Herbs, Taipei Medical University, Taipei, Taiwan.
Chun-Chuan
CC
Shih
Department of Surgery, China Medical University Hospital, Taichung, Taiwan; Department of Surgery, University of Illinois, Chicago, Illinois.
Chun-Chieh
CC
Yeh
Department of Anesthesiology, Taichung Veterans General Hospital, Taichung, Taiwan.
Chih-Jen
CJ
Hung
School of Medicine, Taipei Medical University, Taipei, Taiwan; Department of Anaesthesiology, Taipei Medical University Hospital, Taipei, Taiwan; Health Policy Research Center, Taipei Medical University Hospital, Taipei, Taiwan.
Ta-Liang
TL
Chen
School of Medicine, Taipei Medical University, Taipei, Taiwan; Department of Anaesthesiology, Taipei Medical University Hospital, Taipei, Taiwan; Health Policy Research Center, Taipei Medical University Hospital, Taipei, Taiwan; School of Chinese Medicine, China Medical University, Taichung, Taiwan. Electronic address: ccliao@tmu.edu.tw.
Chien-Chang
CC
Liao
D000367:Age Factors; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D015897:Comorbidity; D016001:Confidence Intervals; D003646:Debridement; D004827:Epilepsy / Q000453:epidemiology; D006471:Gastrointestinal Hemorrhage / Q000453:epidemiology; D006801:Humans; D016017:Odds Ratio; D011014:Pneumonia / Q000453:epidemiology; D003668:Pressure Ulcer / Q000453:epidemiology*; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology* / Q000628:therapy; D013624:Taiwan / Q000453:epidemiology; D016896:Treatment Outcome; D014552:Urinary Tract Infections / Q000453:epidemiology
D000900:Anti-Bacterial Agents
Complications; mortality; outcomes; pressure ulcer; stroke