Patterns of Co-Occurring Pressure Injuries: A Data-Driven Study Using Real-World Clinical Records

Objective: This study aimed to investigate patterns and risk factors associated with co-occurring pressure injuries (PrIs) using real-world clinical data. Approach: This retrospective cohort study analyzed electronic health records (EHRs) of adult patients with PrIs from 2015 to 2023 across five hospitals within a large U.S. health care system. An EHR-based phenotype-a set of algorithmic rules using structured clinical data-was developed and validated to identify patients with co-occurring PrIs, enabling classification of all patients in the study cohort into either single-occurring or co-occurring PrI groups. The accuracy of the co-occurring PrI phenotype was assessed through chart review. Univariate analyses and binary logistic regression were employed to identify risk factors associated with co-occurring PrIs. All findings are reported in accordance with the STROBE checklist. Results: Among 18,195 patients with at least one PrI record, 4,415 (24.3%) had co-occurring PrIs. The phenotype demonstrated high accuracy (accuracy = 0.96). Pattern analysis showed a direct association between the number of PrIs and severe-stage injuries. Logistic regression revealed that severe PrIs (odds ratio [OR] 3.47; 95% confidence interval [CI]: 3.23-3.74) were most strongly associated with co-occurring PrIs, followed by Black or African American race (OR: 1.45; 95% CI: 1.14-1.84) and spinal cord injury (OR: 1.32; 95% CI: 1.14-1.52). Innovation: This study introduces a validated EHR-based phenotype for identifying co-occurring PrIs. It reveals a direct link between co-occurring PrIs and injury severity, as well as unique risk factors associated with co-occurring PrIs. Conclusions: Co-occurring PrIs are prevalent and strongly associated with severe PrIs. This study also revealed distinct occurrence patterns, with injury severity increasing as the number of co-occurring PrIs rises. The findings from this study emphasize the need for targeted risk assessment and prevention efforts for co-occurring PrIs.