• William T McGee, Brian H Nathanson, Elizabeth Lederman, and Thomas L Higgins.
• William T. McGee is an intensivist in the Division of Critical Care, Department of Medicine, Baystate Medical Center, Springfield, Massachusetts; Brian H. Nathanson is Chief Executive Officer of OptiStatim, LLC, Longmeadow, Massachusetts; Elizabeth Lederman is APACHE data coordinator, Baystate Medical Center, Springfield, Massachusetts; Thomas L. Higgins is Chief Medical Officer at The Center for Case Management, Natick, Massachusetts, and Professor of Medicine at the University of Massachusetts School of Medicine-Baystate, Springfield, Massachusetts.
• Crit Care Nurse. 2019 Jun 1; 39 (3): 44-50.

BackgroundPressure injuries, also known as pressure ulcers, are a serious complication of immobility. Patients should be thoroughly examined for pressure injuries when admitted to the intensive care unit to optimize treatment. Whether community-acquired pressure injuries correlate with poor hospital outcomes among critically ill patients is understudied.ObjectivesTo determine whether pressure injuries present upon admission to the intensive care unit can serve as a predictive marker for longer hospitalization and increased mortality.MethodsThis study retrospectively analyzed admissions of adult patients to a 24-bed medical-surgical intensive care unit in a large level I trauma center in the northeast United States from 2010 to 2012. The association of pressure injuries with mortality and length of stay was assessed, using multivariable logistic regression and generalized linear models, adjusted for age, comorbidities, Acute Physiology and Chronic Health Evaluation III score, and other patient characteristics.ResultsAmong 2723 patients, 180 (6.6%) had a pressure injury at admission. Patients with a pressure injury had longer mean unadjusted stay (15.6 vs 10.5 days; P < .001) and higher in-hospital mortality rate (32.2% vs 18.3%; P < .001) than did patients without a pressure injury at admission. After multivariable adjustment, pressure injuries were associated with a mean increase in length of stay of 3.1 days (95% CI 1.5-4.7; P < .001). Pressure injuries were not associated with mortality after adjusting for the Acute Physiology and Chronic Health Evaluation III score, but they may serve as a marker for increased risk of mortality if an Acute Physiology and Chronic Health Evaluation III score is unavailable.ConclusionPressure injuries present at admission to the intensive care unit are an objective, easy-to-identify finding associated with longer stays. Pressure injuries might have a modest association with higher risk of mortality.©2019 American Association of Critical-Care Nurses.

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