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Ambulance referral of more than 2 hours could result in a high prevalence of medical-device-related pressure injuries (MDRPIs) with characteristics different from some inpatient settings: a descriptive observational study

BMC Emergency Medicine volume 23, Article number: 44 (2023) Cite this article

A Correction to this article was published on 23 May 2023

This article has been updated

Abstract

Background

Medical device-related pressure injuries(MDRPI) are prevalent and attracting more attention. During ambulance transfer, the shear force caused by braking and acceleration; extensive medical equipment crowed in a narrow space add external risk factors for MDRPIs. However, there is insufficient research on the relationship between MDRPIs and ambulance transfers. This study aims to clarify the prevalence and characteristics of MDRPI during ambulance transfer.

Method

A descriptive observational study was conducted with convenience sampling. Before starting the study, six PI specialist nurses certified by the Chinese Nursing Association trained emergency department nurses for three MDRPI and Braden Scale sessions, one hour for each session. Data and images of PIs and MDRPIs are uploaded via the OA system by emergency department nurses and reviewed by these six specialist nurses. The information collection begins on 1 July 2022 and ends on 1 August 2022. Demographic and clinical characteristics and a list of medical devices were collected by emergency nurses using a screening form developed by researchers.

Results

One hundred one referrals were eventually included. The mean age of participants was (58.3 ± 11.69) years, predominantly male (67.32%, n = 68), with a mean BMI of 22.48 ± 2.2. The mean referral time among participants was 2.26 ± 0.26 h, the mean BRADEN score was 15.32 ± 2.06, 53.46% (n = 54) of participants were conscious, 73.26% (n = 74) were in the supine position, 23.76% (n = 24) were in the semi-recumbent position, and only 3 (2.9%) were in the lateral position. Eight participants presented with MDRPIs, and all MDRPIs are stage 1. Patients with spinal injuries are most prone to MDRPIs (n = 6). The jaw is the area most prone to MDRPIs, caused by the cervical collar (40%, n = 4), followed by the heel (30%, n = 3) and nose bridge (20%, n = 2) caused by the respiratory devices and spinal board.

Conclusion

MDRPIs are more prevalent during long ambulance referrals than in some inpatient settings. The characteristics and related high-risk devices are also different. The prevention of MDRPIs during ambulance referrals deserves more research.

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Background

As a vital measure of nursing quality and patient safety in healthcare facilities [1], medical device-related pressure injuries(MDRPI) are prevalent and attracting more attention [2,3,4,5].

During ambulance transfer, the shear force caused by braking and acceleration [6] and extensive medical equipment crowed in a narrow space add external risk factors for MDRPIs [3, 7]. Some studies explored the relationship between pressure injuries (PI) and ambulance transfers [3, 7]. However, as a specific type of PI identified by the European Pressure Ulcer Advisory Panel (EPUAP) (2019), MDRPI and other PI have different etiologies, its influenced by more medical factors [8]. Research on the prevalence and characteristics of MDRPI in various healthcare settings is necessary [4, 9, 10]. In addition, although the EPUAP stresses the importance of managing MDRPI, no guideline mentions the management of MDRPI during ambulance referrals; the research gap still exists.

China’s emergency medical services system was established in the 1980s [11]. Since then, hospital medical staff have escorted patients by ambulance from primary hospitals to better or unique hospitals for treatment [11, 12]. However, as a vast developing country, emergency services are inequitable, and ambulance transfers can take longer in remote areas [13]. Undoubtedly, with the continuous upgrading of infrastructure in recent years and the establishment of mechanisms such as trauma centers and chest pain centers, there has been a significant reduction in patient transfer times [14, 15]. However, transfers by ambulances from the surrounding counties to the city still take 1½ hours, transfers from more remote villages can take 2–3 h, and to the provincial capital can take even longer, which is long enough for the occurrence of MDRPI [9, 16, 17]. Considering the delays caused by the handover and the uncertainty of traffic conditions, the time patients spend in ambulances could be much longer. However, during the literature search, we found many Chinese studies on pressure injuries in inpatients and emergency department period [10, 18,19,20], but fail to find out a study on MDRPI in ambulance transfers, and there are differences in the PIs prevalence with some international studies. We hypothesize that several MDRPI occurs during ambulance transfers that are incorrectly identified as occurring in the emergency department period and lead to statistical errors. In addition, even worldwide, studies related to MDRPIs during long-distance referrals in ambulance settings are insufficient and lack detailed evidence (e.g., gender, age, total device days) for guiding clinical MDRPIs prevention [1, 9].

Clarifying the prevalence and characteristics of MDRPI during the ambulance transfer is necessary to improve the quality of care, which is the aim of this study.

Method

Study design and setting

The study was approved by the Ethics Committee of Guangyuan Central Hospital and conducted there, the largest referral, medical, and teaching center in the region, which was certificated with the national trauma center, chest pain center, and stroke center in 2016, 2018, and 2019 separately. It has a general hospital and a maternity and pediatric hospital, each with separate emergency departments, with a total of over 2000 referrals per year.

A descriptive observational study was conducted with convenience sampling. All MDRPIs and PIs will be confirmed with the referring medical staff to clarify whether they occurred during or before the referral period. Inclusion criteria were: Admitted to hospital by ambulance; Age > 18 years; Transfer time > 2 h. Exclusion criteria were as follows: MDRPIs or PIs occurring before ambulance referrals; having coagulation disorders (Tends to form petechiae and affect the judgment of MDRPIS); being pregnant; Receiving radiotherapy or chemotherapy within three months; Having dermatitis or burns in MDRPI or PI area; incomplete information. The study was guided by the Sex and Gender Equity in Research (SAGER) guidelines. All patients or legal guardians were informed of the study’s purpose, informed consent was obtained before the start, and all data were de-identified. As no previous studies were found on the prevalence of MDRPI in patients transported by ambulance, the pressure injuries incidence (5.2%) in patients transported by ambulance was selected to measure the sample size [3], a minimum sample size of 76 would be required (z = 1.96, P = 0.052, d = 0.05).

Data collection

Before the study, six PI specialist nurses certified by the Chinese Nursing Association trained emergency department nurses for three MDRPI and Braden Scale sessions, one hour for each session. The grading of PI and determination of MDRPI is based on [21]; PIs met the criteria “From the use of a device designed and applied for diagnostic or therapeutic purposes. The resulting pressure injury is generally consistent with the pattern or shape of the device” and will be considered MDRPIs; the others will be regarded as other PIs. After training sessions, nurses took an exam with 5 PIs photos and five relevant knowledge questions, correctly answered five questions, and judged all photos with the grade and type of PIs that would be regarded as having adequate knowledge. Data and images of PIs and MDRPIs are uploaded via the OA system (an electronic information system widely used in Chinese hospitals) by emergency department nurses within 1 h of the patient’s arrival and reviewed by these six specialist nurses in 24 h. The information collection begins on 1 July 2022 and ends on 1 August 2022. All PIs and MDRPIs have been treated with body repositioning and decompression dressing timely as they are identified.

Demographic and clinical characteristics and a list of medical devices were collected by emergency nurses using a screening form developed by researchers after consulting the six PI specialist nurses. Gender, age, Body Mass Index (BMI), diagnosis, history of hypertension, and history of diabetes, were collected as demographic information. Clinical characteristics include state of consciousness, Braden scores, transfer time, body position, area of MDRPIs, Medical devices that cause MDRPI, stage of MDRPIs, other PIs, area of other PIs, PI prevention measures, and area of prevention measures.

Data analysis

Data were entered by SPSS (version 24.0, IBM Corp.). Continuous variables are expressed as mean ± standard deviation (SD); categorical variables are expressed as frequencies and percentages.

Results

During the data collection, 311 admissions were made by ambulance referral, of which 210 were excluded for not meeting the requirements or not agreeing to participate, and 101 were eventually included (Table 1).

Demographic characteristics

The mean age of participants was (58.3 ± 11.69) years, predominantly male (67.32%, n = 68), with a mean BMI of 22.48 ± 2.2, 51.48% (n = 52) with a history of hypertension and 53.46% (n = 54) with a history of diabetes mellitus.

Clinical characteristics

The mean referral time among participants was 2.26 ± 0.26 h, the mean BRADEN score was 15.32 ± 2.06, 53.46% (n = 54) of participants were conscious, 73.26% (n = 74) were in the supine position, 23.76% (n = 24) were in the semi-recumbent position, and only 3 (2.9%) were in the lateral position.

Prevalence and characteristics of MDRPI

Eight participants presented with MDRPIs (n = 10), of which two participants with spinal injuries presented with two MDRPIs and the rest with one, and all MDRPIs are stage 1. Patients with spinal injuries are most prone to MDRPIs (n = 6). The jaw is the area most prone to MDRPIs, caused by the cervical collar (40%, n = 4), followed by the heel (30%, n = 3) and nose bridge (20%, n = 2), caused by the respiratory devices and spinal board (Table 2). The detailed characteristics of MDRPI cases are shown in Table 3.

Table 1 Demographic and clinical characteristics
Full size table
Table 2 Prevalence and characteristics of MDRPI
Full size table
Table 3 Detailed characteristics of MDRPI cases
Full size table

Discussion

The results showed that the prevalence and characteristics of MDRPIs during long-term transfers differed from the in-hospital setting. The prevalence of MDRPI in the sample was 7.92%, which is even higher than that in some ICUs, which have been considered the most affected area for MDRPI [1, 4, 9, 22].

For prevalence, eight participants were identified with MDRPIs (n = 10), of which two participants with spinal injuries presented with two MDRPIs and the rest all with one. Patients with spinal injuries are most prone to MDRPIs [23, 24]. The prevalence was 57.14% (4/7), higher than the 20.1% prevalence during hospitalization reported by Ham et al. For those patients, cervical collars are most likely to cause MDRPIs, consistent with Ham et al. However, we also identified spinal boards as a kind of device closely related to MDRPIs (n = 3). In addition, patients with spinal injuries were most likely to have MDRPIs on the jaw and heel in this study, while Ham et al. reported on the back and elbow.

As to devices, ECG and blood pressure cuffs were used at 100%, and IV tubes were used at 96.03%, yet these devices did not cause MDRPIs in long-distance referrals as in ICUs [4, 22]. Similarly, nasal oxygen (57.42% utilization), no re-breathing mask (13.86% utilization), and endotracheal intubation (12.87% utilization) were found to be prone to cause MDRPI in the hospital setting, but not in this study [8, 9, 16]. However, cervical collars and spinal boards were used at 8.91%, leading to four MDRPIs and three MDRPIs, respectively. In addition, this study identified several devices whose association with MDRPIs needed to be adequately studied, e.g., the simple respirator, with a 2.97% utilization rate, caused one case of MDRPIs, which has never been identified before [1, 9]. This device is only an adjunct to the resuscitation process in hospitalized patients and lasts for a short period. However, due to the unevenness of emergency medical resources, some ambulances are not equipped with ventilators, and medical staff can only use simple respirators for extended periods [13]. To prevent MDRPI, it is vital to choose the right size of equipment [8, 25], but for ambulances, narrow spaces make this more challenging to achieve. To cope with unexpected situations, ambulances can only be loaded with kinds of equipment rather than multiple sizes of a device. Case 7 with BMI 28 had a stage I pressure injury on the left elbow caused by a slim stretcher’s handrail, such carriers-induced PIs have not been reported before, but they occur in real situations [1, 9], furthermore, due to the lack of definition of this PI in the guidelines it was not included as researchers failed to make a consensus whether this pressure injury was an MDRPI.

Except for MDRPIs, the prevalence of other PIs was 4.95% (5/101). Considering that only PIs occurring during ambulance referrals were included in this study, the incidence of PIs we found was higher than in a similar study in Australia (Fulbrook et al., 2019). In addition to differences in healthcare resources and economic levels, most PIs or MDRPIs that occur during referral are stage I and often miss reported because nurses believe they will recover quickly [26]. In many cases, ambulance staff is only responsible for the patient’s safety during the referral process. This responsibility handover also confused medical staff and created difficulties in preventing and counting MDRPIs and PIs [7]. In addition, some patients with low BRADEN scores were not received PI prevention, and some patients had only their sacrum protected. The causes of this are complex. [5, 27]. The eight cases presenting MDRPIs showed significant differences in BRADEN scores. Even though MDRPI is defined as a type of PI, it has an entirely different etiology and characteristics, and the ability of the BRADEN score to accurately indicate the risk of MDRPI deserves further study [4].

Limitation

Firstly this study was conducted in two emergency departments in one city, and if it could be undertaken in more cities, it would undoubtedly increase external validity. Secondly, it could be better if the six PI specialist nurses could re-confirm the judgment of MDRPIs by direct skin inspection rather than photo review. Thirdly, China was experiencing a high temperature during the study period, which may have impacted the referral prevalence of different diseases and may cause a sampling bias.

Conclusion

MDRPIs are more prevalent during long ambulance referrals than in some inpatient settings. The characteristics and related high-risk devices are also different. The prevention of MDRPIs during ambulance referrals deserves more research.

Data availability

The datasets generated and analyzed during the current study are not publicly available due to ethical concerns but are available from the corresponding author on reasonable requests.

Change history

Abbreviations

EPUAP:

European Pressure Ulcer Advisory Panel

MDRPI:

medical-devices-related pressure injuries

PI:

pressure injuries

BMI:

Body Mass Index

HTN:

hypertension

DM:

diabetes mellitus

TBI:

traumatic brain injury

AECOPD:

acute exacerbation of chronic obstructive pulmonary disease

L-thigh:

left-thigh

References

  1. Jackson D, Sarki AM, Betteridge R, Brooke J. Medical device-related pressure ulcers: a systematic review and meta-analysis. Int J Nurs Stud. 2019;92:109–20. https://doi.org/10.1016/j.ijnurstu.2019.02.006.

    Article  PubMed  Google Scholar 

  2. Dugaret E, Videau MN, Faure I, Gabinski C, Bourdel-Marchasson I, Salles N. Prevalence and incidence rates of pressure ulcers in an Emergency Department. Int Wound J. 2014;11:386–91. https://doi.org/10.1111/j.1742-481X.2012.01103.x.

    Article  PubMed  Google Scholar 

  3. Fulbrook P, Miles S, Coyer F. Prevalence of pressure injury in adults presenting to the emergency department by ambulance. Australian Crit Care: Official J Confederation Australian Crit Care Nurses. 2019;32(6):509–14. https://doi.org/10.1016/j.aucc.2018.10.002.

    Article  Google Scholar 

  4. Saleh MYN, Ibrahim EIM. Prevalence, severity, and characteristics of medical device related pressure injuries in adult intensive care patients: A prospective observational study. International Wound Journal 2022: iwj.13845. https://doi.org/10.1111/iwj.13845.

  5. Tan JJM, Cheng MTM, Hassan NB, He H, Wang W. Nurses’ perception and experiences towards medical device-related pressure injuries: a qualitative study. J Clin Nurs. 2020;29(13–14):2455–65. https://doi.org/10.1111/jocn.15262.

    Article  PubMed  Google Scholar 

  6. Cubit K, McNally B, Lopez V. Taking the pressure off in the Emergency Department: evaluation of the prophylactic application of a low shear, soft silicon sacral dressing on high risk medical patients. Int Wound J. 2013;10(5):579–84. https://doi.org/10.1111/j.1742-481X.2012.01025.x.

    Article  PubMed  Google Scholar 

  7. Mäkinen M, Haavisto E, Lindström V, Brolin K, Castrén M. Finnish and swedish prehospital emergency care providers’ knowledge and attitudes towards pressure ulcer prevention. Int Emerg Nurs. 2021;55:100873. https://doi.org/10.1016/j.ienj.2020.100873.

    Article  PubMed  Google Scholar 

  8. Gefen A, Alves P, Ciprandi G, Coyer F, Milne CT, Ousey K, Ohura N, Waters N, Worsley P. Device-related pressure ulcers: SECURE prevention. Second edition. J Wound Care. 2022;31:1–S72. https://doi.org/10.12968/jowc.2022.31.Sup3a.S1.

    Article  Google Scholar 

  9. Galetto SGdaS, do Nascimento ERP, Hermida PMV, de Malfussi LBH. Medical device-related pressure injuries: an integrative literature review. Revista Brasileira Enfermagem. 2019;72(2):505–12. https://doi.org/10.1590/0034-7167-2018-0530.

    Article  Google Scholar 

  10. Wei M, Yang D, Chen L, Wu L, Jiang Q, Niu N, Yang T. The prevalence and prevention of pressure ulcers: a multicenter study of nine nursing homes in eastern China. J Tissue Viability. 2021;30(1):133–6. https://doi.org/10.1016/j.jtv.2020.07.005.

    Article  PubMed  Google Scholar 

  11. Hung KKC, Cheung CSK, Rainer TH, Graham CA. EMS systems in China. Resuscitation. 2009;80(7):732–5. https://doi.org/10.1016/j.resuscitation.2009.04.016.

    Article  PubMed  Google Scholar 

  12. Xiao Y, Chen X, Li Q, Jia P, Li L, Chen Z. Towards healthy China 2030: modeling health care accessibility with patient referral. Soc Sci Med. 2021;276:113834. https://doi.org/10.1016/j.socscimed.2021.113834.

    Article  PubMed  Google Scholar 

  13. Yan K, Jiang Y, Qiu J, Zhong X, Wang Y, Deng J, Lian J, Wang T, Cao C. The equity of China’s emergency medical services from 2010–2014. Int J Equity Health 2017, 16(1): 10. https://doi.org/10.1186/s12939-016-0507-5.

  14. Lau KK, Yu EL, Lee MF, Ho SH, Ng PM, Leung CS. Ambulance use affects timely emergency treatment of acute ischaemic stroke. Hong Kong Medical Journal = Xianggang Yi Xue Za Zhi. 2018;24:335–9. https://doi.org/10.12809/hkmj177025.

    Article  CAS  PubMed  Google Scholar 

  15. Shi X, Bao J, Zhang H, Wang H, Wang Y, Li L, Hou P. Emergency medicine in China: a review of the history of progress and current and future challenges after 40 years of reform. Am J Emerg Med. 2020;38:662–9. https://doi.org/10.1016/j.ajem.2019.11.008.

    Article  PubMed  Google Scholar 

  16. Duerst KJ, Clark AW, Hudson DGB, Struwe LA. Preventing Medical Device-Related Pressure Injuries Due to Noninvasive Ventilation Masks and Nasal Cannulas. Critical Care Nurse 2022, 42(5): 14–21. https://doi.org/10.4037/ccn2022783.

  17. Gefen A, Alves P, Ciprandi G, Coyer F, Milne CT, Ousey K, Ohura N, Waters N, Worsley P. Device-related pressure ulcers: SECURE prevention. J Wound Care. 2020;29:1–52. https://doi.org/10.12968/jowc.2020.29.Sup2a.S1.

    Article  Google Scholar 

  18. Gong X, Chen HL, Shen JH, Zhu BF. Hypotension at emergency department admission and hospital-acquired pressure ulcers in older patients: prospective study. J Wound Care. 2019;28(8):527–31. https://doi.org/10.12968/jowc.2019.28.8.527.

    Article  PubMed  Google Scholar 

  19. Jiang M, Ma Y, Guo S, Jin L, Lv L, Han L, An N. Using machine Learning Technologies in pressure Injury Management: systematic review. JMIR Med Inf. 2021;9:e25704. https://doi.org/10.2196/25704.

    Article  Google Scholar 

  20. Zhang Y-B, He L, Gou L, Pei J-H, Nan R-L, Chen H-X, Wang X-L, Du Y-H, Yan H, Dou X-M. Knowledge, attitude, and practice of nurses in intensive care unit on preventing medical device-related pressure injury: a cross-sectional study in western China. Int Wound J. 2021;18(6):777–86. https://doi.org/10.1111/iwj.13581.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Edsberg LE, Black JM, Goldberg M, McNichol L, Moore L, Sieggreen M. Revised national pressure Ulcer Advisory Panel pressure Injury Staging System. J Wound Ostomy Cont Nurs. 2016;43(6):585–97. https://doi.org/10.1097/WON.0000000000000281.

    Article  Google Scholar 

  22. Coyer F, Cook JL, Doubrovsky A, Vann A, McNamara G. Exploring medical device-related pressure injuries in a single intensive care setting: a longitudinal point prevalence study. Intensive and Critical Care Nursing. 2022;68:103155. https://doi.org/10.1016/j.iccn.2021.103155.

    Article  PubMed  Google Scholar 

  23. Ham WH, Schoonhoven L, Schuurmans MJ, Leenen LP. Pressure ulcers in trauma patients with suspected spine injury: a prospective cohort study with emphasis on device-related pressure ulcers. Int Wound J 2017, 14(1): 104–11. https://doi.org/10.1111/iwj.12568.

  24. Kupfer M, Kucer BT, Kupfer H, Formal CS. Persons with chronic spinal cord injuries in the Emergency Department: a review of a Unique Population. J Emerg Med. 2018;55(2):206–12. https://doi.org/10.1016/j.jemermed.2018.04.029.

    Article  PubMed  Google Scholar 

  25. Kim JY, Lee YJ, Korean Association of Wound Ostomy Continence Nurses. Medical device-related pressure ulcer (MDRPU) in acute care hospitals and its perceived importance and prevention performance by clinical nurses. Int Wound J. 2019;16(Suppl 1):51–61. https://doi.org/10.1111/iwj.13023.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Crunden EA, Worsley PR, Coleman SB, Schoonhoven L. Barriers and facilitators to reporting medical device-related pressure ulcers: a qualitative exploration of international practice. Int J Nurs Stud. 2022;135:104326. https://doi.org/10.1016/j.ijnurstu.2022.104326.

    Article  PubMed  Google Scholar 

  27. Grešš Halász B, Bérešová A, Tkáčová Ľ, Magurová D, Lizáková Ľ. Nurses’ knowledge and attitudes towards Prevention of pressure ulcers. Int J Environ Res Public Health. 2021;18(4):1705. https://doi.org/10.3390/ijerph18041705.

    Article  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Guanyuan Central Hospital, Guanyuan, Sichuan, China

    Zhenyu Luo, Linhe Yang, Shuyan Zhong & Lihua Bai

  2. The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China

    Sihui Liu

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Contributions

ZYL: conception, data acquisition, design, the analytical plan, and manuscript drafting. SHL: data acquisition, critical revision of the manuscript. LHY, SYZ, and LHB: critical manuscript revision and approval of the final version to be published.

Corresponding author

Correspondence to Zhenyu Luo.

Ethics declarations

Ethics approval and consent to participate

The study was guided by the Sex and Gender Equity in Research (SAGER) guidelines and approved by the Ethics Committee of Guangyuan Central Hospital. All participants or their legal guardians were informed of the study’s purpose and provided their informed consent before the study started, and all data were de-identified. All PIs and MDRPIs have been treated timely as they are identified. No impact or risk generate for the patients throughout the study.

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Not applicable.

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The authors declare no competing interests.

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Luo, Z., Liu, S., Yang, L. et al. Ambulance referral of more than 2 hours could result in a high prevalence of medical-device-related pressure injuries (MDRPIs) with characteristics different from some inpatient settings: a descriptive observational study. BMC Emerg Med 23, 44 (2023). https://doi.org/10.1186/s12873-023-00815-9

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BMC Emergency Medicine

ISSN: 1471-227X

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