Chandler H Moser, Chakra Budhathoki, Sarah J Allgood, Elliott R Haut, Michael J Brenner, Vinciya Pandian
{"title":"Global predictors of tracheostomy-related pressure injury in the COVID-19 era: A study of secondary data.","authors":"Chandler H Moser, Chakra Budhathoki, Sarah J Allgood, Elliott R Haut, Michael J Brenner, Vinciya Pandian","doi":"10.1016/j.iccn.2024.103720","DOIUrl":null,"url":null,"abstract":"<p><strong>Objectives: </strong>To determine the incidence and risk factors of tracheostomy-related pressure injuries (TRPI) and examine the COVID-19 pandemic's impact on TRPI incidence.</p><p><strong>Design: </strong>Secondary analysis of Global Tracheostomy Collaborative database and a multi-center hospital system's electronic medical records.</p><p><strong>Setting: </strong>27 hospitals, primarily in the United States, United Kingdom, and Australasia.</p><p><strong>Patients: </strong>6,400 adults and 2,405 pediatric patients hospitalized with tracheostomy between 1 January 2019 and 31 December 2021.</p><p><strong>Measurement: </strong>TRPI as a binary outcome, reported as odds ratios.</p><p><strong>Results: </strong>TRPI incidence was 4.69 % in adults and 5.65 % in children. For adults, associated risks were female sex (OR: 0.64), severe obesity (OR: 2.62), ICU admission (OR: 2.05), cuffed tracheostomy (OR: 1.49), fenestrated tracheostomy (OR: 15.37), percutaneous insertion (OR: 2.03) and COVID-19 infection (OR: 1.66). For children, associated risks were diabetes mellitus (OR: 4.31) and ICU admission (OR: 2.68). TRPI odds increased rapidly in the first 60 days of stay. Age was positively associated with TRPI in adults (OR: 1.014) and children (OR: 1.060). Black patients had higher TRPI incidence than white patients; no moderating effects of race were found. Hospital cluster effects (adults ICC: 0.227; children ICC: 0.138) indicated unmeasured hospital-level factors played a significant role.</p><p><strong>Conclusions: </strong>Increasing age and length of stay up to 60 days are TRPI risk factors. Other risks for adults were female sex, severe obesity, cuffed/fenestrated tracheostomy, percutaneous insertion, and COVID-19; for children, diabetes mellitus and FlexTend devices were risks. Admission during the COVID-19 pandemic had contrasting effects for adults and children. Additional research is needed on unmeasured hospital-level factors.</p><p><strong>Implications for clinical practice: </strong>These findings can guide targeted interventions to reduce TRPI incidence and inform tracheostomy care during public health crises. Hospital benchmarking of tracheostomy-related pressure injuries is needed.</p>","PeriodicalId":94043,"journal":{"name":"Intensive & critical care nursing","volume":null,"pages":null},"PeriodicalIF":0.0000,"publicationDate":"2024-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Intensive & critical care nursing","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1016/j.iccn.2024.103720","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0
Abstract
Objectives: To determine the incidence and risk factors of tracheostomy-related pressure injuries (TRPI) and examine the COVID-19 pandemic's impact on TRPI incidence.
Design: Secondary analysis of Global Tracheostomy Collaborative database and a multi-center hospital system's electronic medical records.
Setting: 27 hospitals, primarily in the United States, United Kingdom, and Australasia.
Patients: 6,400 adults and 2,405 pediatric patients hospitalized with tracheostomy between 1 January 2019 and 31 December 2021.
Measurement: TRPI as a binary outcome, reported as odds ratios.
Results: TRPI incidence was 4.69 % in adults and 5.65 % in children. For adults, associated risks were female sex (OR: 0.64), severe obesity (OR: 2.62), ICU admission (OR: 2.05), cuffed tracheostomy (OR: 1.49), fenestrated tracheostomy (OR: 15.37), percutaneous insertion (OR: 2.03) and COVID-19 infection (OR: 1.66). For children, associated risks were diabetes mellitus (OR: 4.31) and ICU admission (OR: 2.68). TRPI odds increased rapidly in the first 60 days of stay. Age was positively associated with TRPI in adults (OR: 1.014) and children (OR: 1.060). Black patients had higher TRPI incidence than white patients; no moderating effects of race were found. Hospital cluster effects (adults ICC: 0.227; children ICC: 0.138) indicated unmeasured hospital-level factors played a significant role.
Conclusions: Increasing age and length of stay up to 60 days are TRPI risk factors. Other risks for adults were female sex, severe obesity, cuffed/fenestrated tracheostomy, percutaneous insertion, and COVID-19; for children, diabetes mellitus and FlexTend devices were risks. Admission during the COVID-19 pandemic had contrasting effects for adults and children. Additional research is needed on unmeasured hospital-level factors.
Implications for clinical practice: These findings can guide targeted interventions to reduce TRPI incidence and inform tracheostomy care during public health crises. Hospital benchmarking of tracheostomy-related pressure injuries is needed.
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