Pre-existing Pressure Injuries Offer Clinical Clues

Jun 04, 2019

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Article in Critical Care Nurse finds pressure injuries present upon ICU admission can identify patients who may require additional care and longer hospital stays

ALISO VIEJO, Calif. – June 4, 2019 – Pre-existing pressure injuries cannot replace sophisticated systems for scoring the severity of illness in critically ill patients, but their presence does quickly identify patients at greater risk for longer hospital stays and increased mortality.

New research finds that pressure injuries present upon admission to the intensive care unit (ICU) can serve as a predictive clinical marker for longer hospitalization and increased odds of mortality, especially when other data aren’t available.

Pressure Injuries at Intensive Care Unit Admission as a Prognostic Indicator of Patient Outcomes” reports the results of a retrospective analysis of ICU admissions from 2010 to 2012 at Baystate Medical Center, Springfield, Massachusetts. The article is published in the June issue of Critical Care Nurse (CCN).

Many hospitals use the Acute Physiology and Chronic Health Education (APACHE) and Mortality Prediction Model, which automatically extracts information from a patient’s electronic medical record, except for the patient’s diagnosis at admission. However, the APACHE score is not available immediately since it relies on information such as vital signs and laboratory test results obtained during the first 24 hours of a patient’s ICU stay.

In contrast, a clinical marker present at admission could be used to quickly and objectively identify patients who may require additional care and longer hospital stays.

“Our results show that pressure injuries can be a quick, unambiguous way to alert critical care nurses and intensivists to newly admitted patients who will be challenging in the ICU, so we can make more informed decisions faster,” said co-author William T. McGee, MD, MHA, an intensivist at Baystate. “This study underscores the importance of a thorough skin examination upon admission to the ICU.”

The researchers analyzed admissions of adult patients to Baystate’s 24-bed medical-surgical ICU over a 17-month period. They limited the assessment to the 2,723 patients with first-time ICU admission who had APACHE severity scores. Of these, 180 had a pressure injury at admission.

The statistical analysis revealed that pressure injuries were associated with significantly longer hospital lengths of stay, regardless of mortality outcome. Patients with pressure injuries at admission had a longer mean length of stay of 3.1 days. They were not associated with mortality after adjusting for the APACHE score but may serve as a marker for increased risk of mortality if an APACHE score is not available.

Among patients with pressure injuries at admission, mechanical ventilation and dialysis were more common, as was the overall severity of illness. They also were more likely to show evidence of prior long-term care or physical rehabilitation. Readmission to the ICU during the same hospitalization occurred more frequently for patients with pressure injuries.

As the American Association of Critical-Care Nurses’ bimonthly clinical practice journal for high-acuity and critical care nurses, CCN is a trusted source of information related to the bedside care of critically and acutely ill patients.

Access the article abstract and full-text PDF by visiting the CCN website at

About Critical Care Nurse: Critical Care Nurse (CCN), a bimonthly clinical practice journal published by the American Association of Critical-Care Nurses, provides current, relevant and useful information about the bedside care of critically and acutely ill patients. The award-winning journal also offers columns on traditional and emerging issues across the spectrum of critical care, keeping critical care nurses informed on topics that affect their practice in high-acuity, progressive and critical care settings. CCN enjoys a circulation of more than 120,000 and can be accessed at

About the American Association of Critical-Care Nurses: Founded in 1969 with 400 members, the American Association of Critical-Care Nurses (AACN) is now the world’s largest specialty nursing organization. In 2019, AACN celebrates 50 years of acute and critical care nursing excellence, serving more than 120,000 members and over 200 chapters in the United States. The organization remains committed to its vision of creating a healthcare system driven by the needs of patients and their families in which acute and critical care nurses make their optimal contribution. During its 50th anniversary year, AACN continues to salute and celebrate all that nurses have accomplished over the last half century, while honoring their past, present and future impact on the evolution of high-acuity and critical care nursing.

American Association of Critical-Care Nurses, 101 Columbia, Aliso Viejo, CA 92656-4109; 949-362-2000;;;