Clinical-epidemiological profile of patients with pressure injuries in the hospital context

1. Escola Bahiana de Medicina e Saúde Pública − Curso de Especialização em Enfermagem em Estomaterapia − Salvador (BA), Brazil. 2. Universidade Federal de Sergipe − Departamento de Enfermagem − Lagarto (SE), Brazil. 3. Universidade Federal de Sergipe − Departamento de Enfermagem da − Programa de Pós-Graduação em Enfermagem − Aracaju (SE), Brazil. 4. Escola Bahiana de Medicina e Saúde Pública – Curso de Graduação em Enfermagem – Salvador (BA), Brazil. *Correspondence author: lidi_lima88@hotmail.com Received: Jul. 06, 2020 | Accepted: Oct. 08, 2020 ABSTRACT Objective: describe the clinical-epidemiological profile of patients with pressure injuries admitted to a university hospital. Method: descriptive study with 122 patients with pressure injuries admitted to a university hospital between January 2018 and December 2019. Data were collected from patients’ medical records and from the Serviço Assistencial de Cuidados com a Pele (Skin Care Assistance Service) database. Descriptive statistics were used for data analysis. Results: pressure injuries predominated among adults and the elderly, browns, who studied up to elementary school and had no partner. There was a similarity between the sexes. The patients had, mainly, infectious disease, one or more comorbidities, nutritional alteration, mixed incontinence and used nutritional therapy, but did not present dermatitis associated with incontinence and smoking history.Most patients were classified as high risk of pressure injury. The study totaled 237 lesions, most of which were acquired before admission, not classifiable, located in the sacrococcygeal region, treated topically with hydrogel with alginate and hydrocolloid, and not healed at the time of hospital discharge. Conclusion: the study described important aspects of the characterization of pressure injuries, as well as the people affected by this serious health problem, which can optimize prevention and treatment actions.


INTRODUCTION
In general, PI results from a complex combination of risk factors intrinsic and extrinsic to the patient. The deficit in mobility, activity and perfusion are the most frequent predictors in the development of these lesions, as well as the presence of an area of unbleachable hyperemia in the skin (PI stage 1). Other factors can also be mentioned: nutrition, general health, hematological changes, age, skin moisture, body temperature, immunity, use of vasoactive drugs, sedation and comorbidities (e.g. diabetis mellitus and vascular disease) 3 .
As a consequence of the PI, there is an increase in the length of hospital stay and the rate of morbidity and mortality, which results in a considerable increase in health care costs related to the human, material and physical resources of the health system 4,5 .
PI are classified in stages according to the layer of skin that has been affected. Stage 1 PI refers to a defined area of unbleachable hyperemia in the skin; in stage 2 PI there is exposure of the dermis; stage 3 PI reaches the subcutaneous tissue; stage 4 PI affects the deeper tissues, such as fascia, muscle, tendon, ligament, cartilage or bone; in the nonclassifiable stage, a necrosis layer covers the wound bed, and it is not possible to classify it; the deep tissue PI is an area of dark red, brown or purple discoloration, persistent and that does not whiten. PI can also occur in the mucous membrane and/or in association with a medical device 2 .
When assessing a patient's risk of developing PI, several known risk factors should be considered. To guide this assessment, there are specific and scientifically proven predictive instruments, such as the Braden Scale. The patient is classified as risk-free or with low, moderate or high risk, according to the score obtained in the subscales: sensory perception, humidity, activity, mobility, nutrition and friction/shear 6 .

RESULTS
In this research, there were 122 patients, with a mean age of 54 ± 24 years and a predominance of adults (43.3%) and elderly (45.1%). Men and women had an equal participation in the study (50.0% each). Most participants studied up to elementary school (47.5%), declared that they did not have a partner (59.0%) and were of brown color (95.9%) ( Table 1).

DISCUSSION
In the present study, a greater number of injuries were identified in elderly people, which corroborates the literature 3,7,8 .This fact may be related to the physiological changes inherent to aging, such as decreased skin turgor and elasticity; presence of comorbidities, such as hypertension and stroke, more frequent in this age group; and also the use of medications, such as painkillers, antihypertensives and anticoagulants 9,10 .
In the elderly, the involvement of chronic noncommunicable diseases can not only affect the perceptual capacity, blood circulation, oxygenation, mobility, level of consciousness, levels of electrolytes and proteins, but also increase the probability of complications resulting from the long period of hospital stay, including risk of PI. Therefore, the importance of meeting the needs and maintaining the functional capacity of this population in order to prevent complications 9 .
In this study, there was no difference in the number of patients according to sex for the occurrence of PI. A study conducted with patients hospitalized for external causes shows a higher incidence of males 7,9 . However, research carried out in the Intensive Care Unit of a general hospital indicates a predominance of females 11  Even with hygiene care, the appearance of incontinenceassociated dermatitis (IAD) is possible, which is an independent risk factor for PI, especially in the regions mentioned above and in the elderly population 17,19 . It should be noted that one of the challenges for nursing professionals is to recognize IAD, which in many situations is confused with PI in its early stages 20 .
Regarding the risk of PI, assessed according to the Braden In this context, when selecting a coverage, the characteristics of the lesion and its anatomical location must be analyzed, in addition to the specific functions of each product, its availability and the cost-benefit ratio 23 .
It can be highlighted as limitations of the study: (1) difficulty in accessing the medical records of the research participants, which made it impossible to consider the totality of data related to clinical variables; (2) how the data were recorded in the SACP database, which did not allow the use of a cross-sectional approach; (3) unicentric study. Therefore, it is recommended to carry out multicenter studies on the subject.
Despite the limitations, the study allowed to know important aspects of PI, as well as the people who are affected by this serious health problem. Despite the findings reflecting a local reality, it is believed that they can guide the decision making of care teams and managers regarding the prevention and treatment of PI, in addition to assisting in the prediction of human, physical, material and care costs in various scenarios in the health sector.

CONCLUSION
PI affected mainly adults and the elderly with infectious diseases, comorbidities, nutritional changes, some type of incontinence and were classified as having high risk of PI.
The lesions, mostly, were located in the sacrococcygeal region, were in an unclassifiable stage, were treated with hydrogel with alginate and hydrocolloid and were not healed at the time of hospital discharge.
Because they are a multifactorial condition and can reach different body topographies, PIs should always be investigated, prevented and treated early and regularly during hospitalization. For this, it is essential to form a multidisciplinary work team, known generically as the Skin Commission, with a focus on defining the institutional standards and protocols for the prevention and treatment of PI, as well as supporting the care teams in clinical practice.