Abstract
Objectives
Although largely preventable, pressure injury is a major concern in individuals in
permanent residential aged care (PRAC). Our study aimed to identify predictors and
develop a prognostic model for risk of hospitalization with pressure injury (PI) using
integrated Australian aged and health care data.
Design
National retrospective cohort study.
Setting and Participants
Individuals ≥65 years old (N = 206,540) who entered 1797 PRAC facilities between January
1, 2009, and December 31, 2016.
Methods
PI, ascertained from hospitalization records, within 365 days of PRAC entry was the
outcome of interest. Individual, medication, facility, system, and health care–related
factors were examined as predictors. Prognostic models were developed using elastic
nets penalized regression and Fine and Gray models. Area under the receiver operating
characteristics curve (AUC) assessed model discrimination out-of-sample.
Results
Within 365 days of PRAC entry, 4.3% (n = 8802) of individuals had a hospitalization
with PI. The strongest predictors for PI risk include history of PIs [sub-distribution
hazard ratio (sHR) 2.41; 95% CI 1.77–3.29]; numbers of prior hospitalizations (having
≥5 hospitalizations, sHR 1.95; 95% CI 1.74–2.19); history of traumatic amputation
of toe, ankle, foot and leg (sHR 1.72; 95% CI 1.44–2.05); and history of skin disease
(sHR 1.54; 95% CI 1.45–1.65). Lower care needs at PRAC entry with respect to mobility,
complex health care, and medication assistance were associated with lower risk of
PI. The risk prediction model had an AUC of 0.74 (95% CI 0.72–0.75).
Conclusions and Implications
Our prognostic model for risk of hospitalization with PI performed moderately well
and can be used by health and aged care providers to implement risk-based prevention
plans at PRAC entry.
Keywords
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Article info
Publication history
Published online: January 02, 2023
Publication stage
In Press Corrected ProofFootnotes
MI is supported by The Hospital Research Foundation Mid-Career Fellowship (MCF-27–2019) and National Health and Medical Research Council (NHMRC) Investigator Grant (GNT119378). JKS is supported by an NHMRC Early Career Fellowship (GNT1156439).
The authors declare no conflicts of interest.
Identification
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© 2022 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
