Oral presentation in the next EWMA Congress in Copenhague

1. Clinical impact of pressure ulcers in patients
admitted to a rehabilitation unit of an
Intermediate Care Hospital
Santaeugenia S, Álvaro M, García M, Monterde A,
Gutiérrez A, Alventosa AM, Mas MA
Department of Geriatric Medicine and Palliative Care
Badalona Serveis Assistencials
Catalonia, Spain, EU

2. There is evidence of the usefulness of inpatient
rehabilitation units specially designed to manage
complex problems of older patients after acute illness
Pressure ulcers (PU) are frequent in these patients, due
to functional loss associated with acute illness in
vulnerable patients
The aim of this study was to assess the effect of pressure
ulcers during the rehabilitation process
Introduction
Bachmann S et al. Inpatient rehabilitation specifically designed for geriatric patients: systematic
review and meta-analysis of randomised controlled trials. BMJ 2010;340:c1718

3. A pilot study was performed during the period from
January 2010 to December 2011 in several geriatric
rehabilitation units of our Intermediate Care hospital
Method (I)
Main clinical outcomes were analyzed based on the
presence of pressure ulcers at admission
• Functional gain
• Length of Stay
• Acute rehospitalisation
• Discharge Long Term Care Unit

4. Description of the intervention:
• Provided by a multidisciplinary care team
(Medical, Nursing, Physiotherapy, Occupational
Therapy, Social Worker)
• Treatment of post acute conditions
• Comprehensive Geriatric Assessment
(multidimensional assessment followed by an
individualized care plan)
• Rehabilitation
Method (II)

5. N 668 patients
Results (I): characteristics at admission
Age 82 (9)
Gender female 68%
Referred from: acute care 87% / Community 13%
Charlson Co morbidity Index 2 (2)
Main diagnostic group: - Orthopedic 46%
- Medical 30%
- Stroke 18%
- Surgical 6%
Presence of pressure ulcers at admission 16%
Variables are % except Age and Charlson CI: mean (SD)

6. Variables are % except Barthel Index Granger version at admission: mean (standard deviation)
Results (II): characteristics based on PU at admission
PU No PU p
value
Barthel Index at admission* 33 (25) 44 (25) <0.05
Malnutrition at admission* 23% 16% <0.05
Cognitive Impairment 27% 23.5% 0.249

7. Results (III): PU at admission based on diagnostic group
% PU at
admission
Surgical* 37
Medical 16
Orthopedic 15
Stroke 11
P<0.05

8. Variables are mean (standard deviation), except mortality %
Results (IV): outcomes based on PU at admission
PU No PU p
value
Length of Stay* 70 (42) days 59 (37) days < 0.05
Barthel Index at discharge* 53 (34) 69 (33) < 0.05
Mortality 8% 5% 0.1

9. Variables are %
Results (V): destination based on PU at admission
Pressure
ulcers
No
pressure
ulcers
Acute Care 8% 6%
Long Term Care 14% 6%
Home* 69% 82%
p< 0.05

10. Pressure ulcers are frequent at admission in our
rehabilitation units, specially in surgical patients
Several factors at admission, as functional status or
malnutrition seemed related with PU presence
Conclusions (I)

11. Pressure ulcers have a negative impact both in the
clinical evolution and outcomes of patients of our
rehabilitation units
• Worst functional outcome at discharge
• Higher Length of Stay in the rehabilitation unit
• Lower destination home (due to higher destination
Long Term Care)
Conclusions (II)

12. In our experience it would be necessary to improve the
prevention of pressure ulcers in acute units, specially in
surgical departments
More research is needed to find strategies for good
management of pressure ulcers, allowing better inpatient
clinical evolution in rehabilitation units
Conclusions (III)

13. Thank you
Contact Dr. Miquel A. Mas
(Badalona Serveis Assistencials)
mmas7@bsa.cat