Risk factors for community-acquired pressure injuries: Findings from a large-scale Asian case-control study.
This study identifies multiple risk factors for community-acquired pressure injuries, including unemployment and poor nutrition, emphasizing the need for targeted prevention strategies.
Where it sits
this study against the rest of the eloralintide corpusSummary and findings
This study identified risk factors for community-acquired pressure injuries among adults admitted to an acute care hospital, analyzing data from 52,480 admissions between January 2021 and June 2022. Key findings included associations with unemployment, poor nutrition, and lower serum albumin levels. No therapeutic claims are made.
Abstract
<h4>Background</h4>Pressure injuries, also known as pressure ulcers, remain a major global health problem, causing significant clinical, economic, and psychosocial burdens despite advances in prevention and treatment. While most research has focused on hospital-acquired cases, community-acquired pressure injuries are increasingly recognised, with prevalence in some settings exceeding hospital-acquired rates. Evidence from Asian healthcare systems is limited, yet region-specific factors such as ageing populations, caregiver dependence, and variable access to wound care highlight the urgent need for contextualised prevention strategies.<h4>Objective</h4>To identify the risk factors associated with pressure injuries that developed in the community among adults admitted to an acute care hospital.<h4>Design</h4>Retrospective, unmatched case-control study.<h4>Setting</h4>Acute tertiary hospital.<h4>Participants</h4>Electronic medical records from January 2021 to June 2022, which include 52,480 admissions (5772 cases and 46,708 controls).<h4>Methods</h4>The study was conducted using electronic medical records from January 2021 to June 2022. The cases were adults with community-acquired pressure injuries documented within 24 h of admission; controls had no pressure injuries on admission. Descriptive statistics and effect sizes were used to summarise the relationships between the risk factors and community-acquired pressure injuries. Statistically significant predictors were identified and included in the multivariable logistic regression, and interaction terms were tested for potential effect modification.<h4>Results</h4>Among 52,480 admissions, 5772 were cases and 46,708 were controls. The most common site of injury was the sacrum/coccyx (51%). On univariate analysis, cases were older, more likely to be unemployed, and had greater functional limitations. Moist skin and diaper use were more prevalent, along with poorer nutritional and inflammatory profiles, including lower serum albumin levels and higher C-reactive protein levels.Independent predictors included unemployment, poor or inadequate nutrition, lower serum albumin, functional dependence, moist skin, hypertension, and a history of peptic ulcer disease. A significant interaction between albumin and sex indicated a modest sex-based difference in the association between albumin and pressure injury risk.<h4>Conclusion</h4>Community-acquired pressure injury risk is multifactorial, involving sociodemographic, functional, nutritional, and microclimate factors. Moisture exposure and mobility limitation were key predictors. A modest sex-based difference in the association between albumin and pressure injury risk was observed. Prevention strategies that integrate nutritional support, mobility optimisation, and moisture management may reduce the incidence of community-onset pressure injuries in ageing populations.<h4>Registration</h4>Not registered.
Background
Pressure injuries are a significant health issue, particularly in community settings, yet most research has focused on hospital-acquired cases. This study addresses the gap in knowledge regarding community-acquired pressure injuries, especially in Asian healthcare contexts, where unique factors may influence their prevalence. Understanding these risk factors is essential for developing targeted prevention strategies.
Methods
This was a retrospective, unmatched case-control study utilizing electronic medical records from January 2021 to June 2022, involving 52,480 admissions (5772 cases and 46,708 controls). Cases were defined as adults with community-acquired pressure injuries documented within 24 hours of admission, while controls had no injuries on admission. The study employed descriptive statistics and multivariable logistic regression to identify significant predictors.
Results
Among the 52,480 admissions, 5772 were identified as cases of community-acquired pressure injuries. The most common site of injury was the sacrum/coccyx, accounting for 51% of cases. Significant predictors included unemployment, poor nutrition, lower serum albumin levels, functional dependence, moist skin, hypertension, and a history of peptic ulcer disease. The study reported a significant interaction between albumin and sex, indicating a modest difference in risk association.
Interpretation
The findings align with existing literature that highlights the multifactorial nature of pressure injury risk, particularly in community settings. While the statistical significance of the associations is noted, the clinical significance of some predictors, such as the modest interaction between albumin and sex, may be limited. The retrospective design and reliance on medical records introduce potential confounds that could affect the conclusions drawn.
Key findings
- 5772 cases of community-acquired pressure injuries identified from 52,480 admissions.
- 51% of injuries occurred at the sacrum/coccyx site.
- Lower serum albumin levels were associated with increased risk of pressure injuries.
- Independent predictors included unemployment, poor nutrition, and functional dependence.
- A significant interaction between albumin and sex was noted.
Limitations
- Retrospective design may introduce bias.
- Relies on electronic medical records, which can have inaccuracies.
- Not registered, indicating potential methodological limitations.
- Single-site study may limit generalizability.
- No follow-up data reported.