• Jenny Alderden, Yunchuan Lucy Zhao, Yingying Zhang, Donna Thomas, Ryan Butcher, Yue Zhang, and Mollie Rebecca Cummins.
• Jenny Alderden is an assistant professor, School of Nursing, Boise State University, Boise, Idaho, and an adjunct assistant professor, College of Nursing, University of Utah, Salt Lake City, Utah. Yunchuan (Lucy) Zhao is an assistant professor, School of Nursing, Boise State University. Yingying Zhang and Yue Zhang are biostatisticians, Study Design and Biostatistics Center, Center for Clinical and Translational Science, University of Utah. Donna Thomas is director of wound nursing, University of Utah Hospital, Salt Lake City, Utah. Ryan Butcher is a senior data architect, Biomedical Informatics Team, Center for Clinical and Translational Science, University of Utah. Mollie Rebecca Cummins is a professor, College of Nursing, University of Utah. jennyalderden@boisestate.edu.
• Am. J. Crit. Care. 2018 Nov 1; 27 (6): 471-476.

BackgroundApproximately half of hospital-acquired pressure injuries identified among critical care patients are stage 1. Although stage 1 injuries are common, outcomes associated with them among critical care patients have not been examined.ObjectivesTo examine the outcomes of stage 1 pressure injuries among critical care patients and to identify factors associated with worsening of pressure injuries.MethodsElectronic health records were used to determine which surgical critical care patients at a level I trauma center and academic medical center had stage 1 pressure injuries. Competing risk survival analysis was used to identify factors associated with worsening of pressure injuries.ResultsReview of 6377 patient records indicated that 259 patients (4.1%) experienced stage 1 injuries. The injuries persisted until discharge from the hospital in 92 patients (35.5%), worsened into injuries of stage 2 or greater in 84 (32.4%), and healed in 83 (32.0%). Patients whose pressure injuries worsened were more likely to be older (subdistribution hazard ratio [SHR], 1.02; 95% CI, 1.01-1.03; P = .002), or to have higher levels of serum lactate (SHR, 1.06; 95% CI, 1.02-1.10; P = .007), lower levels of hemoglobin (SHR, 0.82; 95% CI, 0.71-0.96; P = .01), or decreased oxygen saturation by pulse oximetry (< 90%; SHR, 1.50; 95% CI, 1.00-2.25; P = .05).ConclusionsStage 1 pressure injuries worsen in about one-third of patients (32.4%). Nurses should consider maximal treatment for patients who are older or who experience alterations in oxygen delivery or perfusion.©2018 American Association of Critical-Care Nurses.

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