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Overview :
Berkowitz et al identified factors associated with healing of
pressure ulcers in residents of long term care facilities. This can help
identify patients who will need more intensive intervention, resulting in better
allocation of resources. The authors are from the Beford Veterans Administration
in Beford, Massachusetts.
Parameters identified as affecting pressure ulcer
healing:
(1) ulcer
stage
(2) age of
the patient
(3)
rehabilitation services
(4)
immobility
(5)
incontinence (I could not find if this was incontinence for urine and/or stool.
I am using any incontinence in the implementation.)
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Clinical
Features of the Pressure Ulceration |
Ulcer
Stage |
|
erythematous skin |
1 |
|
ulcer of the superficial layer of broken or blistered
skin |
2 |
|
ulcer involving the subcutaneous tissue |
3 |
|
ulcer extending into muscle or to bone |
4 |
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Stage 4 ulcer with no treatment plan documented |
5 |
Rehabilitation services available:
(1) physical therapy
(2) occupational therapy
(3) corrective therapy
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Favorable
Factors |
Odds
Ratio |
95%
CI |
|
age >= 75 years of age |
1.5 |
1.1 to 2.0 |
|
rehabilitation services (per number received) |
1.3 |
1.1 to 1.6 |
|
Stage 2 relative to Stage 4/5 |
5.2 |
3.5 to 7.7 |
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Stage 3 relative to Stage 4/5 |
1.5 |
1.0 to 2.3 |
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Unfavorable
Factors |
Odds
Ratio |
95%
CI |
|
immobility |
0.3 |
0.1 to 0.5 |
|
incontinence |
0.7 |
0.4 to 1.0 |
Rates found in specific situations:
(1) all
favorable with no unfavorable factors (75 year old, Stage 2 ulcer, mobile,
continent, with 1 rehabilitative service): 94% ulcer healing at 6 months
(2) no
favorable with both unfavorable factors (70 years old, Stage 4 ulcer, immobile,
incontinent, no rehabilitation services): 24% ulcer healing at 6 months
In the implementation I assigned simple points (0-1 for age,
0-2 for rehabilitation services, 0-2 for ulcer Stage, 0 to –1 for mobility, 0 to
–1 for incontinence) and summated them to give a simple score.
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