Scoping Review of Wounds in Hospitalized Adults with COVID-19 over the First 3 Years of the Pandemic.

Abstract

Objective: To synthesize the literature on skin failure and pressure injuries (PIs) among hospitalized patients with COVID-19.

Data sources: An electronic literature search using relevant keywords and controlled vocabulary was conducted in March 2023 on MEDLINE/PubMed, EMBASE, and CINAHL. Manual citation searches of included articles and gray literature, including the Wound, Ostomy, and Continence Nurses Society website were performed. Articles published in English between 2020 and April 2023 were considered.

Study selection: Articles were included if they reported on hospitalized adults who were COVID-19 positive with wounds that were not present upon admission. A total of 31 articles met these criteria.

Data extraction: Covidence was used to extract article data, including publication information; study aims and design; participant characteristics; wound characteristics, location, and diagnosis; care setting; clinical outcomes; and clinical and research implications.

Data synthesis: Of the 31 studies, 27 reported new onset skin lesions during hospitalization. Wounds were classified as PIs, skin failure, livedo racemosea, and/or, retiform purpura, and were associated with microvascular thrombosisthrombotic vasculopathy. Most PIs were associated with prone positioning, and affected patients often had multiple comorbidities including hypertension, diabetes mellitus, end-stage renal disease, heart disease, and chronic obstructive pulmonary disorder. Four articles highlighted an increased risk of new onset wounds, and three emphasized the importance of distinguishing deep tissue PIs from ischemic-related lesions in patients with COVID-19.

Conclusions: The evidence suggests an increased risk of ischemic lesions and PIs in patients with COVID-19 infection. This phenomenon may have inflated the numbers of PIs reported during the pandemic and adversely affected nursing quality measures in acute care environments.