References
Characteristics of COVID-19 patients who developed pressure injuries: a scoping review
Abstract
Objective:
To describe the characteristics of patients with COVID-19 who developed pressure injuries (PIs), the characteristics of PIs experienced, and the incidence and prevalence of PIs among the patients with COVID-19. PIs are associated with increased morbidity, mortality and healthcare expense. PIs have been reported among patients who have contracted COVID-19. Understanding the characteristics of COVID-19 patients, and how PIs are prevented and managed, may inform care and optimise the outcomes for COVID-19-positive patients.
Method:
A scoping review was conducted. All study designs, including grey literature, published in the English language from December 2019 to March 2021, reporting on patients with COVID-19 and PIs, were included.
Results:
In total, 27 publications (n=4820 patients) were included in the review. The reported incidence rate of PIs was 7.3–77.0%. The causative factors noted were: prone positioning (28.5%); medical devices (21.4%); and medical devices used during prone positioning (14.2%). The most common PI sites were the cheeks (18.7%). PIs occurred on average at 14.7 days post-acute care admission. Of the PIs where staging information was specified (67.7%), the most common was Stage 2/II (45.2%). PI risk may intensify on account of the intrinsic mechanism of COVID-19-associated intensive care treatment.
Conclusion:
PI prevention and management should be prioritised for patients with COVID-19, given the reported high prevalence of PIs and exacerbated risk arising from the use of prone position and medical devices. Further research is required to understand the association between COVID-19 and PIs, and to guide effective prevention and treatment approaches.
Pressure injuries (PIs) are associated with significant morbidity, mortality and healthcare expense.1 Patients can experience pain, reduced mobilisation, loss of independence, low self-esteem, social isolation, wound infection and sepsis.2,3 A systematic review and meta-analysis indicates the global prevalence of PIs to be as high as 12.8% in hospitalised adults, with an incidence of 5.4 PIs per 1000 patient days.4 Mortality rates are higher among patients with PIs (9.1%) than those with no PI (1.8%).5 The possible consequence of the underlying mechanisms of COVID-19 infection on the skin and association with PI development was reported early in the pandemic.6,7,8,9 For example, two case reports described multiple facial PIs experienced during mechanical ventilation and prone positioning,6,7 and several case series subsequently emerged documenting patients with COVID-19 with facial PIs,10 sacral PIs,8,9 and skin and mucosal PIs at anatomical locations on the face, urethra and buttocks.11
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