Outcomes associated with stage 1 pressure injuries: A retrospective cohort study

Background Approximately half of hospital-acquired pressure injuries identified among critical care patients are stage 1. Although stage 1 injuries are common, outcomes associated with them among critical care patients have not been examined. Objectives To examine the outcomes of stage 1 pressure injuries among critical care patients and to identify factors associated with worsening of pressure injuries. Methods Electronic health records were used to determine which surgical critical care patients at a level I trauma center and academic medical center had stage 1 pressure injuries. Competing risk survival analysis was used to identify factors associated with worsening of pressure injuries. Results Review of 6377 patient records indicated that 259 patients (4.1%) experienced stage 1 injuries. The injuries persisted until discharge from the hospital in 92 patients (35.5%), worsened into injuries of stage 2 or greater in 84 (32.4%), and healed in 83 (32.0%). Patients whose pressure injuries worsened were more likely to be older (subdistribution hazard ratio [SHR], 1.02; 95% CI, 1.01-1.03; P = .002), or to have higher levels of serum lactate (SHR, 1.06; 95% CI, 1.02-1.10; P = .007), lower levels of hemoglobin (SHR, 0.82; 95% CI, 0.71-0.96; P = .01), or decreased oxygen saturation by pulse oximetry (> 90%; SHR, 1.50; 95% CI, 1.00-2.25; P = .05). Conclusions Stage 1 pressure injuries worsen in about one-third of patients (32.4%). Nurses should consider maximal treatment for patients who are older or who experience alterations in oxygen delivery or perfusion.