Table 1. Principal Characteristics and Variables of the Patients.
| Variables | Patients without pressure ulcers (n.837) | Patients with pressure ulcers (n.246) | All patients (n. 1083) | p* |
|---|---|---|---|---|
| Intrinsic variables: | ||||
| • Average age | 83.7 (7.8) | 85.6 (6.9) | 84.1 (7.6) | 0.001 |
| • Female gender | 75.4% | 74.4% | 75.2% | Ns |
| • Patients without pain at arrival in the ER (NRS or PAINAD score) | 37.4% | 34.6% | 36.8% | Ns |
| • Average pain at arrival in the ER (NRS or PAINAD score) | 4.8 (2.5) | 5.0 (2.5) | 4.8 (2.5) | Ns |
| • Femoral neck fracture (vs. trochanteric) | 50.3% | 56.6% | 51.7% | Ns |
| • Other fractures at presentation | 6.6% | 9.8% | 7.3% | Ns |
| • Average prefracture Activity Daily Living (ADL) | 1.5 (2.0) | 1.8 (2.1) | 1.6 (2.1) | Ns |
| • Average risk of developing pressure ulcers (Braden score) | 15.7 (2.2) | 14.9 (2.4) | 15.5 (2.2) | <0.0005 |
| • Average comorbidity (Charlson score) | 1.9 (1.8) | 2.0 (1.7) | 2.0 (1.8) | Ns |
| • Long-term cortisone therapy | 12.8% | 12.8% | 12.8% | Ns |
| • Constitutionally very thin (vs. normal or obese) | 17.1% | 25.5% | 19.0% | 0.004 |
| • Patients coming from nursing homes (vs. home) | 8.6% | 9.8% | 8.9% | Ns |
| • Patients never disoriented during hospitalization | 41.2% | 35.8% | 40.0% | Ns |
| • Average percentage of days of disorientation | 22.3 (36.0) | 29.1 (40.7) | 23.9 (37.2) | 0.012 |
| • Average Hblevel at presentation | 12.3 (1.7) | 12.2 (1.7) | 12.3 (1.7) | Ns |
| Extrinsic or patient care variables: | ||||
| • Patients positioned on a gurney in the ER having a mattress <6cm | 28.1% | 24.7% | 27.3% | Ns |
| • Osteosynthesis surgery with an intramedullary nail (vs. arthro- or endoprothesis) | 54.2% | 60.0% | 55.5% | Ns |
| • Average length of surgery (minutes) | 59 (26) | 58 (25) | 59 (25) | Ns |
| • Postoperative hospitalization in the intensive care unit | 2.7% | 5.7% | 3.4% | 0.025 |
| • PhT | 92.6% | 74.0% | 88.4% | <0.0005 |
| • Average daily preoperative positioning | 2.3 (2.2) | 1.9 (2.0) | 2.2 (2.2) | 0.022 |
| • Average daily postoperative positioning | 5.6 (2.2) | 5.0 (2.5) | 5.5 (2.3) | 0.001 |
| • Average number of days until drain removal | 1.26 (0.68) | 1.36 (0.59) | 1.28 (0.66) | Ns |
| • Patients never without diapers | 20.8% | 26.8% | 22.2% | 0.045 |
| • Average percentage of days with a diaper | 37.8 (36.4) | 37.5 (35.4) | 37.7 (36.2) | Ns |
| • Patients without a urinary catheter | 3.6% | 2.8% | 3.4% | Ns |
| • Average percentage of days with a urinary catheter | 53.3 (38.7) | 71.6 (36.1) | 57.4 (38.9) | <0.0005 |
| • No use of restraints | 15.8% | 25.2% | 17.9% | 0.001 |
| • Average percentage of days with restraints (bed rails) | 67.4 (37.5) | 62.3 (41.3) | 66.3 (38.4) | Ns |
| • Fractured limb without immobilization | 23.4% | 21.1% | 22.9% | Ns |
| • Average percentage of days with a foam valve under the operated limb | 15.3 (21.7) | 34.6 (36.0) | 19.7 (26.9) | <0.0005 |
| • Patients without an anti-decubitus mattress | 30.2% | 33.3% | 30.9% | Ns |
| • Foam anti-decubitus mattress | 8.8% | 11.4% | 9.4 | Ns |
| • Anti-decubitus mattress with a motor | 60.3% | 55.7% | 59.3% | Ns |
| • Patients without heel drains | 38.6% | 38.6% | 38.6% | Ns |
| • Average percentage of days with a heel drain | 74.7 (35.4) | 67.8 (39.6) | 73.1 (36.5) | 0.009 |
| • Average percentage of a decrease in Hb with respect to the initial values | 24.2 (11.4) | 20.0 (12.1) | 23.2 (11.7) | <0.0005 |
| • Incidence of fever | 74.8% | 63.4% | 72.2% | <0.0005 |
| • Patients without pain during hospitalization | 21.3% | 30.9% | 23.5% | 0,002 |
| • Average percentage of days with pain ≥ 4 (NRS) | 27.5 (26.3) | 35.4 (35.2) | 29.3 (28.8) | <0.0005 |
| Organizational variables: | ||||
| • Average number of hours from the occurrence of the fracture to arrival in the ER | 21 (56) | 29 (136) | 23 (82) | 0.027 |
| • Hospitalization in orthogeriatrics | 43.0% | 10.7% | 53.7% | 0.018 |
| • Transfer to another hospital before arriving at our ER | 34.1% | 42.7% | 36.0% | 0.013 |
| • Average wait time in the ER (hours) | 1:35 (1:20) | 1:30 (0:50) | 1:35 (1:15) | Ns |
| • Average wait time from arrival in the ER to surgery (hours) | 39 (29) | 42 (27) | 40 (28) | Ns |
| • Operated on within 24 hours | 28.4% | 27.5% | 28.2% | Ns |
| • Operated on within 48 hours | 75.3% | 72,1% | 74,6% | Ns |
| • Patients without a caregiver | 11.8% | 7.3% | 10.8% | 0.045 |
| • Average percentage of days with a partial caregiver | 55.6 (41.7) | 58.3 (42.3) | 56.2 (41.8) | Ns |
| • Average number of days from surgery to the start of PhT | 1.5 (1.4) | 1.8 (1.6) | 1.6 (1.4) | 0.035 |
Description of the principal characteristics and variables of the patients with respect to the development of pressure ulcers. The data are reported as median (± SD) or percentages. Missing data: preoperative positionings: 132; days of beginning physiotherapy treatment (PhT): 118; pain at arrival in the Emergency Room (ER): 85; daily postoperative positioning: 72; hours of wait time from the occurrence of the fracture to the arrival in the ER: 63; day of drain removal: 59; Hemoglobin (Hb) values at presentation and perentage of Hb loss: 57; risk of developing pressure ulcers (Braden score): 49; hours of wait time from arrival in the ER to surgery: 37; hours of wait time in the ER: 35; length of surgery: 31; type of surgery (osteosynthesis vs. arthro- or endoprothesis):28; prefracture pressure ulcers: 18; guerney mattress in the ER < 6cm: 13; constitution: 12; cortisone therapy: 4; days with pain: 2.
*The p value is dervied from the comparison of the patients with and without pressure ulcers with respect to that variable, utilizing Fisher’s exact test, the Pearson Chi-square test, the t test or the Mann-Whitney test where appropriate.
NS: Not Significant.