Risk Factor For Pressure Sores In

Hozpitalized Acute Ischemic Stroke

Patient
Xiaoling Liao,MD,PhD, Yi ju, MD, PhD, Gaifen Liu, Phd, Xingquan zao, MD,PhD, Yilong wang, MD PhD, Yong jun
wang, MD.

Preceptors:
dr. Sofiati Dian, Sp.S (K), M.Kes, PhD

Presented by: Fitriya Mediana

Background
 Acute ischemic stroke patients are a group at high risk
for pressure sores.

 It is important to identify risk factors for pressure sores

in acute ischemic stroke patients in order to facilitate
early adoption of appropriate preventive and
treatment measures.
Introduction (1)
 Pressure sores, also termed pressure ulcers and
bedsores, refer to localized injury to the skin and/or soft
tissue caused by long-term or strong pressure (including
shear force and/or abrasion with pressure)
 Stroke patients are a group at high risk for pressure

sores.
 Pressure sores are not only painful, they restrict

patients’ movement, and may lead to infection and poor

nutrition
Introduction (2)
 As well as affecting stroke prognosis, pressure sores
may also increase intensive nursing time, length of
hospitalization, and medical expenditures.
 Acute ischemic stroke patients aged >18 years who

presented at the hospital within 14 days after the

onset of symptoms were eligible for this study.
Critical Appritial

Risk Factor For Pressure Sores

In Hozpitalized Acute Ischemic
Stroke Patient
Critical Appritial
1. Were the two groups similar and recruited from the
same population? yes
Data were derived from the China National Stroke
Registry. Acute ischemic stroke patients aged >18 years
who presented at the hospital within 14 days after the
onset of symptoms were eligible for this study
2. Were the exposures measured similarly to assign people
to both exposed and unexposed groups?NO
In this journal, it is not explained whether the exposure
(pressure sores) was measured in the same way in both
exposed and unexposed groups.

3. Was the exposure measured in a valid and reliable way?

un clear.
In this journal, there is no mention of the same stroke
criteria in patients with pressure sores whether in those
patients a repeat stroke or the first stroke in patients with
pressure sores.
4. Were confounding factors identified? no
not all the confounding factors in this journal are
identified as diabetic neuropathic and limited mobility.
Increased glucose at admition is not related to pressure
sores, the effect of diabetes mellitus which causes
pressure sores are those who have diabetic neuropathic.

5. Were strategies to deal with confounding factors stated?

Yes, confounding factors were identified as risk factors
such as BMI, blood glucose at admission, hemoglobin
after admission. Univarian and multivariate analyzes were
carried out.
Results A R T IC L E IN P R E S S
Table 1. Baseline data of acute ischemic stroke patients with and without pressure sores during hospitalization

Cases (n = 12,415, %) No pressure Pressure sore P value

sore group (n = 12,318, % ) group (n = 97, %)

Mean NIHSS at admission 4 (2-9) 4 (2-9) 18 (9-25) .0001

(interquartile range)
Mean mRS at admission (3-5 points) 635 (5.1) 609 ( 4 . 9 ) 26 (26.8) .0001
Mean length of hospitalization 14 (11-20) 14 (11-20) 20 (9-34) < .0 0 0 1
(interquartile range)
Mean age (interquartile range) 67 (57-75) 67 (57-75) 75 (68-80) .001
Sex (male) 7658 (61.6%) 7613 (61.8) 45 (46.4) .001
Marital status (married) 11089 (89.8) 11016 (89.9) 73 (75.3) .0001
Hypertension 7909 (63.7) 7843 (63.7) 66 (68.0) .372
Diabetes mellitus 2677 (21.6) 2640 (21.4) 37 (38.1) .0001
Dyslipidemia 1390 (11.2) 1382 (11.2) 8 (8.2) .355
Peripheral vascular disease 77 (0.6) 72 ( 0 . 6 ) 5 (5.2) .0001
Coronary heart disease 1792 (14.4) 1769 (14.4) 23 (23.7) .009
Atrial fibrillation/atrial flutter 918 (7.4) 901 ( 7 . 3 ) 17 (17.5) .0001
History of TIA or stroke 4234 (34.1) 4177 (33.9) 57 (58.8) .001
Current smoker 4934 (39.8) 4910 (39.9) 24 (24.7) .0024
Heavy drinker 1171 (9.4) 1169 (9.5) 2 (2.1) .013
BMI ( 24) 6815 (60.9) 6763 (60.8) 52 (69.3) .321
(25-30) 3788 (33.8) 3768 (33.9) 20 (26.7)
( 30) 592 (5.3) 589 ( 5 . 3 ) 3 (4.0)
Blood glucose at admission (mmol/L) 6.77 § 2.36 6.76 § 2.35 7.69 § 3.27 .0001
Hemoglobin after admission (g/L) 137.05 §
19.28 137.14 § 19.21 126.49 §
2 3 .6 5 .0 0 0 1

Abbreviations: BMI, body mass index; mRS, modified

Rankin Scale; NIHSS, NIH Stroke Scale/Score; TIA,
transient ischemic attack.
Results
Table 2. Results of univariate analysis of the occurrence of pressure sores among hospitalized acute ischemic stroke p a t i e n t s
(n = 1 2 , 4 1 5 )
OR 95% CI P value
Age (each increment of 5 years) 1 .3 8 (1.25-1.52) < .0 0 0 1
Sex-female 1 .8 7 (1.25-2.79) .002
Unmarried 2 .9 3 (1.84-4.66) < .0 0 0 1
NIHSS at admission (each increment of 3 points) 1 .3 4 (1.32-1.46) < .0 0 0 1
mRS at admission (3-5 points) 7 .0 4 1 (4.46-11.12) < .0 0 0 1
Hypertension 1 .2 2 (0.79-1.86) .37
Diabetes mellitus 2 .2 6 (1.50-3.41) .0001
Dyslipidemia 0 .7 1 (0.34-1.45) .36
BMI ( 30) 0 .6 6 (0.21-2.22) .490
Peripheral vascular disease 9 .2 4 (3.65-23.41) < .0 0 0 1
Coronary heart disease 1 .8 5 (1.16-2.97) .01
Atrial fibrillation/atrial flutter 2 .6 9 (1.59-4.57) .0002
History of TIA or stroke 2 .7 8 (1.85-4.17) < .0 0 0 1
Current smoker 0 .5 0 (0.31-0.79) .003
Heavy drinker* 0 .2 0 (0.049-0.82) .912
Hemoglobin (each incremental reduction of 10 units) 1 .2 6 (1.15-1.34) < .0 0 0 1
Elevated glucose at admission 0 .8 9 1 (0.851-0.932) < .0 0 0 1
Abbreviations: BMI, body mass index; CI, confidence interval; mRS, modified Rankin Scale; NIHSS, NIH Stroke Scale/Score; OR, adds
ratio; TIA, transient ischemic attack.
* H e a v y Drinker: > = 5 s t a n d a r d alcohol intake per day and more than 5 drinks per w e e k .
Results
A R T IC L E IN P R E S S
Table 3. Results of multivariate logistic regression analysis of the risk factors for the occurrence of pressure sores in acute ischemic
stroke patients during hospitalization

OR value 95% C I P value

Age (each increment of 5 years) 1 .1 5 6 (1.03-1.98) .0136
Unmarried status 1 .9 5 3 (1.103-3.458) .02
NIHSS at admission (each increment of 3 points) 1 .3 4 (1.26-1.43) < .0 0 0 1
mRS at admission (3-5 points) 2 .1 0 1 (1.19-3.72) .01
Diabetes mellitus 2 .4 4 5 (1.45-4.11) .0008
Hemoglobin at admission (each incremental reduction of 10 units) 1 .1 8 (1.06-1.31) .003
Peripheral vascular disease 7 .4 9 (2.63-21.40) .0002
Abbreviations: BMI, body mass index; CI, confidence interval; mRS, modified Rankin Scale; NIHSS, NIH Stroke Scale/Score; OR, adds
ratio; TIA, transient ischemic attack.
6. Were the groups/participants free of the outcome at
the start of the study (or at the moment of exposure)? Un
Clear
In this journal it is not stated whether the patient under
study has been free from pressure sores, so previously
the patient did not have pressure sores.
7.Were the outcomes measured in a valid and reliable way?
No
This journal does not explain how to observe or examine the
occurrence of pressure sores on patients treated for 14 days or
who meet the inclusion criteria, this journal only records the
patient's medical records. Data were derived from CNSR, a
nationwide prospective registry of 21,902 consecutive patients
with a diagnosis of ischemic stroke, intracerebral hemorrhage, or
transient ischemic attack (TIA) from 132 hospitals in China
between September 2007 and August 2008.
8. Was the follow up time reported and sufficient to be
long enough for outcomes to occur? No,

because in this journal the assessment is carried out on

stroke patients treated and pressure sores only occur
within 14 days of treatment. While pressure sores occur
due to strong pressure in a shorter period of time or
with lower pressure in a long period of time. While in
this journal there is no mention of the amount of
pressure that causes pressure sores in patients within a
period of 14 days, resulting in low incidence of pressure
sores in China.
9. Was follow up complete, and if not, were the reasons to
loss to follow up described and explored? NO
because this journal only collected data from medical
records of stroke patients who were treated for 14 days
and did not follow up on patients who fulfilled the
study's inclusion criteria.

10. Were strategies to address incomplete follow up

utilized? Not applicable
because this journal is only collecting data based on
medical records and does not follow the object of the
research
11. Was appropriate statistical analysis used?
Data were derived from CNSR, a nationwide prospective
registry of 21,902 consecutive patients with a diagnosis
of ischemic stroke, intracerebral hemorrhage, or
transient ischemic attack (TIA) from 132 hospitals in
China between September 2007 and August 2008.
Univariate analysis was first performed to find factors
correlated with pressure sores during hospitalization, and
binary logistic regression was then used to perform multivariate
analysis to identify independent risk factors for pressure sores.
12. Did the study address a clearly focused issue? No
this journal only sees the presence of pressure sores during
treatment without regard to when these sores develop. the
assessment was not detailed on the days of hospitalization
where the pressure wound developed, and the study was
not fearful because there was no explanation for stroke
patients for both stroke and first stroke.
13. Was the cohort recruited in an acceptable way? Yes
the observed population still fulfills the requirements of
the cohort population, and what is observed is past risk
factors obtained through the recording of complete data.
 Data were derived from the China National Stroke
Registry. Acute ischemic stroke patients aged >18 years
who presented at the hospital within 14 days after the
onset of symptoms were eligible for this study.

13. What are the results of this study?

The results of this study indicated that age (each
increment of 5 years), being unmarried, NIHSS at
admission (each increment of 3 points), mRS at admission
(3-5 points),diabetes mellitus, hemoglobin at admission
(each incremental reduction of 10 units), and history of
peripheral vascular disease are risk factors for pressure
sores during hospitalization for acute ischemic stroke.
14. How precise are the results?the results are
This journal is doubtful even though in the pressures
literature it is stated that the risk factor for pressure
sores is the same as the results of the journal, but
because in this journal it is not mentioned that
decubitus occurs in the first stroke or repeat stroke,
heating is carried out in a short vulnerable time, ie 14
days treatment and It does not explain how
observations or examinations made on the pressure that
occurred and not all confounding factors are anticipated
by researchers.
15. Do you believe the results?
No because Data collection on factors influencing the
occurrence of pressure sores may be inadequate.
Researchers only look for pressure injuries at all times
during treatment without regard to when the wound
develops.

16. Can the results be applied to the local population?

Can’tell
THANK YOU