Investigation of Unavoidable Pressure Injuries in the Actively Dying Stage.

Abstract:

Background: Although most pressure injuries (PIs) are healable with appropriate assessment, preventive intervention, and treatment, nursing professionals recognize that some PIs are unavoidable. Research investigating unavoidable PIs is limited because there are few clear means of determining whether these injuries are unavoidable.

Objective: To clarify the reality of unavoidable PIs by analyzing the state of PIs and blood test results in patients who were actively dying.

Methods: From 2018 to 2023, 904 hospitalized patients at the author's medical center developed PIs. Of these patients, 710 survived and were discharged (survival group). Of the 194 patients who died after developing a PI, 111 died more than 8 days after onset (end-of-life group), and 83 patients died within 7 days of onset (actively dying group). The researcher analyzed patients' age, weight, and height, as well as various blood work parameters at the time of PI occurrence in the survival, end-of-life, and actively dying patient groups.

Results: Approximately half of patients with PIs in the actively dying stage had cancer. Total protein, albumin, and blood urea nitrogen were significantly lower among the actively dying patients compared with those who survived. Aspartate transferase, alanine aminotransferase, white blood cell count, and C-reactive protein were all significantly higher among patients in the actively dying versus the surviving group.

Conclusions: It is difficult to determine whether a PI is unavoidable. However, the author believes that clinical symptoms and blood test data can help make that decision.