title: Predictive Factors for Pressure Ulcers in an Older Adult Population Hospitalized for Hip Fractures: A Prognostic Cohort Study.
abstract: BACKGROUND
  Older adult patients with fragility hip fractures constitute a population at high risk for complications, in particular pressure ulcers. The aim was to evaluate the incidence of pressure ulcers and potential predictive factors.
  
  
  RESULTS
  A prospective multicentric prognostic cohort study in orthopedic wards in three Italian public hospitals. Participants were all consecutive patients 65 years of age or older diagnosed with a fragility hip fracture. Outcomes were incidence of pressure ulcers. The exposure variables were grouped into three macro areas in order to facilitate reading: "intrinsic" variables, "extrinsic" variables and variables linked to the organization of patient care. One thousand eighty-three older adult patients with fragility hip fractures were enrolled from October 1st, 2013 to January 31st, 2015, and pressure ulcers developed in 22.7%. At multivariate analysis, the following were found to be risk factors: age> 80 years (odds ratio (OR) 1.03; p = 0.015), the length of time a urinary catheter was used (OR 1.013; p<0.001), the length of time pain was present (OR 1.008; p = 0.008), the absence of side rails on the bed (OR 1.668; p = 0.026) and the use of a foam position valve (OR 1.025; p<0.001). Instead, the protective factors were the presence of a caregiver for at least half a day daily (OR 0.994; p = 0.012) and the number of positionings during the postoperative period (OR 0.897; p = 0.008).
  
  
  CONCLUSIONS
  The study allowed the identification of the patients most at risk for developing pressure ulcers, and the construction of a pragmatic predictive model using significant risk or protective factors in order to reduce the number of pressure ulcers.
authors.affiliation: Dipartimento Scienze Mediche e Chirurgiche, Università di Bologna, Bologna, Italy.
authors.forename: Paolo
authors.identifier: http://orcid.org/0000-0003-1629-3410
authors.initials: P
authors.lastname: Chiari
authors.affiliation: Centro ricerca professioni sanitarie, Istituto Ortopedico Rizzoli, Bologna, Italy.
authors.forename: Cristiana
authors.initials: C
authors.lastname: Forni
authors.affiliation: Ricerca & EBP, Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, Italy.
authors.forename: Monica
authors.initials: M
authors.lastname: Guberti
authors.affiliation: Centro Studi EBN, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
authors.forename: Domenica
authors.initials: D
authors.lastname: Gazineo
authors.affiliation: Ricerca & EBP, Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, Italy.
authors.forename: Sabrina
authors.initials: S
authors.lastname: Ronzoni
authors.affiliation: Centro ricerca professioni sanitarie, Istituto Ortopedico Rizzoli, Bologna, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: D'Alessandro
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D005260:Female; D006620:Hip Fractures / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D006760:Hospitalization; D006801:Humans; D015994:Incidence; D007558:Italy; D008297:Male; D016017:Odds Ratio; D009985:Orthopedics; D003668:Pressure Ulcer / Q000453:epidemiology* / Q000209:etiology; D011379:Prognosis; D012372:ROC Curve; D012307:Risk Factors