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Vol. 216. Issue 9.
Pages 461-514 (December 2016)
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Vol. 216. Issue 9.
Pages 461-514 (December 2016)
Original article
DOI: 10.1016/j.rceng.2016.07.002
Pressure ulcers in patients hospitalized in internal medicine: Associated factors and mortality
Úlceras por presión en pacientes ingresados en Medicina Interna: factores asociados y mortalidad
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J. Díez-Manglanoa,b,c,
Corresponding author
jdiez@aragon.es

Corresponding author.
, C. Fernández-Jiméneza, M.P. Lambán-Arandaa, M.C. Landa-Santestebana, S. Isasi de Isasmendi-Péreza, P. Moreno-Garcíaa, E. Bejarano-Telloa, J. Barranco-Usóna, E. Munilla-Lópeza, E. del Corral-Beamontea,b,c, IMPIMI researchers study
a Servicio de Medicina Interna, Hospital Royo Villanova, Zaragoza, Spain
b Grupo de Investigación en Comorbilidad y Pluripatología de Aragón, Instituto Aragonés de Ciencias de la Salud, Zaragoza, Spain
c Departamento de Medicina, Dermatología y Psiquiatría, Universidad de Zaragoza, Spain
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Tables (3)
Table 1. Characteristics of the included patients.
Table 2. Factors associated with the presence of pressure ulcers.
Table 3. Factors associated with mortality in the multivariate analysis (Cox regression).
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Abstract
Objective

To determine the prevalence of pressure ulcers in patients hospitalized in internal medicine and the clinical factors and risk of death associated with its presence.

Patients and methods

Prospective cohort study with patients hospitalized in internal medicine. We recorded the age, sex, presence of pressure ulcers, degree of ulceration, Barthel index, Norton scale, major diagnostic category, length of hospital stay and weight of the diagnosis-related groups. We compared the clinical characteristics of the patients with or without ulcers and analyzed the mortality after 3 years based on the presence of ulcers.

Results

The study included 699 patients, 100 of whom (14.3%) had pressure ulcers (27 with grade I, 17 with grade II, 21 with grade III, 25 with grade IV and 10 with unknown grade). The Barthel index (OR 0.985; 95% CI 0.972–0.998; p=.022) and Norton scale (OR 0.873; 95% CI 0.780–0.997; p=.018) are independently associated with ulcers. Twenty-three percent of the patients with ulcers died during hospitalization, 68% died within a year, and 83% died within 3 years. The presence of pressure ulcers was independently associated with mortality (HR, 1.531; 95% CI 1.140–2.056; p=.005).

Conclusions

Pressure ulcers are common in patients hospitalized in internal medicine, and their presence is associated with higher short, medium and long-term mortality.

Keywords:
Pressure ulcers
Mortality
Internal medicine
Resumen
Objetivo

Determinar la prevalencia de las úlceras por presión en pacientes hospitalizados en Medicina Interna y los factores clínicos y riesgo de muerte asociados a su presencia.

Pacientes y métodos

Estudio prospectivo de cohortes con pacientes ingresados en Medicina Interna. Se recogieron la edad, sexo, presencia de úlceras por presión, grado de la úlcera, índice de Barthel, escala de Norton, categoría diagnóstica mayor, duración de la estancia hospitalaria y peso del grupo relacionado de diagnóstico. Se compararon las características clínicas de los pacientes con o sin úlceras y se analizó la mortalidad al cabo de 3 años en función de la presencia de úlceras.

Resultados

Se incluyeron 699 pacientes, de los que 100 (14,3%) presentaron úlceras por presión (27 de grado I, 17 de grado II, 21 de grado III, 25 de grado IV y 10 de grado no conocido). El índice de Barthel (OR 0,985 IC95% 0,972-0,998; p=0,022) y la escala de Norton (OR 0,873 IC95% 0,780–0,997; p=0,018) se asociaron de forma independiente con las úlceras. Durante el ingreso fallecieron el 23% de los pacientes con úlceras, al cabo de un año el 68% y a los 3 años el 83%. La presencia de úlceras por presión se asoció de forma independiente con la mortalidad (HR 1,531, IC95% 1,140–2,056, p=0,005).

Conclusiones

Las úlceras por presión son frecuentes en los pacientes hospitalizados en Medicina Interna y su presencia se asocia con mayor mortalidad a corto, medio y largo plazo.

Palabras clave:
Úlceras por presión
Mortalidad
Medicina Interna

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