A Retrospective Analysis of Deep Tissue Pressure Injury Prevalence and Incidence Using a Large-scale Wound Care Database in Long-term Care Settings Across North America.

Abstract

Objective: Deep tissue pressure injuries (DTPIs) are a severe form of pressure injuries (PIs) that originate in deeper skin layers and are associated with high morbidity and health care costs, particularly in the elderly population in long-term care. The Centers for Medicare and Medicaid Services have prioritized DTPI prevention as a quality measure for skilled nursing facilities (SNFs). Early detection through regular skin inspection and risk assessment is critical. Digital wound care solutions (DWCS) support standardized wound evaluation through images and documentation. This study used DWCS data set from more than 2 million residents and 100,000 DTPIs to explore prevalence and incidence in SNFs (2019-2023).

Methods: A retrospective study was conducted to extract DTPI cases from 3,920,280 wound assessments of 937,363 residents across SNFs. DTPI prevalence was subcategorized by age and sex. Chi-squared tests and post hoc Bonferroni correction assessed associations between residents' characteristics and DTPI distribution. The data set included 204,706 unique DTPI wounds from 120,689 residents across 4053 SNFs using DWCS.

Results: Annual DTPI prevalence ranged from 5.17% in 2019 to 7.16% in 2021, and then stabilized at 6.2% in 2022-2023. Older patients (81 to 90 y) and females exhibited higher DTPI rates. Incidence rose from 4.94 per 100,000 in 2019 to 6.76 in 2021, followed by a decline in 2022 and a slight rebound to 6.11 in 2023.

Conclusions: The rise in DTPI incidence during 2020-2021 may reflect health care strain from the COVID-19 pandemic, whereas stabilization in 2022-2023 suggests improvements in prevention. DWCS are valuable tools for monitoring and advancing DTPI research.