Pressure Injuries in Critically Ill Patients With Ischaemic Stroke: Prevalence, Risk Factors and Clinical Outcomes

BACKGROUND: Pressure injuries pose a significant challenge in intensive care units. Patients with stroke are at a high risk of developing pressure injuries due to neurological impairments and prolonged immobility. Knowledge gaps exist regarding pressure injury epidemiology in critically ill ischaemic stroke patients. AIM: To determine the prevalence and risk factors of pressure injuries in critically ill patients with ischaemic stroke, and evaluate their association with clinical outcomes. STUDY DESIGN: We analysed data from the MIMIC-IV (Medical Information Mart for Intensive Care IV) database on critically ill adult patients with ischaemic stroke admitted to intensive care units. Patients were identified using International Classification of Diseases codes. Pressure injuries were assessed using nursing documentation and diagnostic coding and were classified into one of six stages according to standard definitions. Risk factors were identified using Boruta and logistic regression analyses. The primary outcomes were in-hospital mortality and post-discharge care requirements. RESULTS: Of 4499 critically ill ischaemic stroke patients with a median age of 72 years, 700 (15.6%) developed pressure injuries. Stage two injuries were the most common, followed by stage one. Patients with pressure injuries were older and had longer stays in the intensive care unit. They also exhibited higher illness severity scores than patients without pressure injuries. Independent risk factors included increasing age, a longer ICU length of stay, lower Glasgow Coma Scale and Braden scores, low albumin levels, malnutrition, diabetes, sepsis, a history of falls and the use of renal replacement therapy. After adjusting for confounders, pressure injuries were not significantly associated with in-hospital mortality but were strongly associated with increased post-discharge care requirements. CONCLUSIONS: Pressure injuries affect approximately one in six critically ill patients with ischaemic stroke, which are caused by multiple stroke and critical care-related risk factors. RELEVANCE TO CLINICAL PRACTICE: The relatively high prevalence and multifactorial risk profile of pressure injuries necessitate early, targeted prevention strategies for critically ill patients with ischaemic stroke. Discharge planning must anticipate the increased nursing care needs of patients who develop pressure injuries during their hospitalisation.