Pressure-redistributing support surface use and pressure ulcer incidence in elderly hip fracture patients

Abstract

Objectives: To evaluate the association between pressure-redistributing support surface (PRSS) use and incident pressure ulcers in older adults with hip fracture.

Design: Secondary analysis of data from prospective cohort with assessments performed as soon as possible after hospital admission and on alternating days for 21 days.

Setting: Nine hospitals in the Baltimore Hip Studies network and 105 postacute facilities to which participants were discharged.

Participants: Six hundred fifty-eight people aged 65 and older who underwent surgery for hip fracture.

Measurements: Full-body examination for pressure ulcers; bedbound status; and PRSS use, recorded as none, powered (alternating pressure mattresses, low-air-loss mattresses, and alternating pressure overlays), or nonpowered (high-density foam, static air, or gel-filled mattresses or pressure-redistributing overlays except for alternating pressure overlays).

Results: Incident pressure ulcers (IPUs), Stage 2 or higher, were observed at 4.2% (195/4,638) of visits after no PRSS use, 4.5% (28/623) of visits after powered PRSS use, and 3.6% (54/1,496) of visits after nonpowered PRSS use. The rate of IPU per person-day of follow-up did not differ significantly between participants using powered PRSSs and those not using PRSSs. The rate also did not differ significantly between participants using nonpowered PRSSs and those not using PRSSs, except in the subset of bedbound participants (incidence rate ratio=0.3, 95% confidence interval=0.1-0.7).

Conclusion: PRSS use was not associated with a lower IPU rate. Clinical guidelines may need revision for the limited effect of PRSS use, and it may be appropriate to target PRSS use to bedbound patients at risk of pressure ulcers.

Figure 1

Proportion of study visits with an incident pressure ulcer Stage 2 or higher (IPU) at the following visit, according to type of support surface in use at a given visit. P = .47 for the association between type of support surface in use at a given visit and IPU at the following visit as derived from chi-square, indicating 10 significant difference. PRSS = pressure-redistributing support surface; n = number of person-visits at which each type of support surface was used.