Surveillance for Pressure Injuries on Admission to Inpatient Rehabilitation Hospitals During the COVID-19 Pandemic.
Jamila A Kendall, Jack K Haberl, Caitlin Hartsgrove and 4 others
PMID 34252395WHAT IT FOUND
Patients arriving at rehab in early 2020 had more pressure injuries (35.6% vs 20.7%) and more severe wounds than those arriving just before the pandemic.
The risk tracked with how long they stayed in acute care and how complex their case was, not with a positive coronavirus test.
Key findings
01During the early pandemic period, 35.6% of patients arrived at inpatient rehab with a hospital-acquired pressure injury, compared with 20.7% in the pre-pandemic period.
02Among patients with a pressure injury on admission, a greater share had the most severe wounds (stage 4, deep tissue injury, or unstageable) during the pandemic period (28.6%) than before it (10.6%).
03Within the pandemic cohort, a positive coronavirus test was not linked to arriving with a pressure injury; longer acute-care stay and higher case-mix index were.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
Only four rehab hospitals in one system in the Northeast, so the picture may not match other facilities. The pandemic group was smaller (357) than the pre-pandemic group (687), and the hospitals ran at half capacity early on, a factor the model could not adjust for. Severity was scored by each patient's single worst wound, so someone with two stage 3 injuries counted as less severe than someone with one stage 4, which may understate true burden. The two periods differed in age, length of stay, and diagnosis mix, so the rise in injuries cannot be pinned on the pandemic alone. This is a chart review, not a controlled comparison; the authors could not measure what skin checks or prevention actually happened in the acute hospitals.
Declared interests
The supplied text contains no funding statement or author conflict-of-interest declaration. The only supplier named is StataCorp, which makes the statistical software used for the analysis.
The easy way to misread this
Do not conclude that coronavirus infection caused the rise in pressure injuries. Within the pandemic cohort, positive and negative patients had essentially the same injury rate (35.4% versus 35.7%), and a positive test was not associated with arriving with an injury. The signal tracked with length of acute stay and case complexity, which the authors themselves attribute to an overwhelmed acute-care system, not to the virus.