What can increase the risk of pressure injury following stroke?
- Agnes Ogugua
- Nov 10, 2020
- 2 min read
Dysphagia, immobility and diet acceptance: main factors associated with increased risk of pressure injury in hospitalized patients post-stroke
Stroke is considered the second leading cause of death in the world and is among the leading causes of hospitalization and mortality in Brazil. And the incidence of stroke increases with age, from middle aged, to older adults, to the elderly population.
Patients who are hospitalized following stroke are usually bedridden and typically present with altered mental status, physical inadequacy, and with that, the risk of pressure injury increases due to limited ability to relieve pressure to bony prominences. Pressure injuries have a number of etiologies, including pressure and friction, impaired mobility, malnourishment, and underlying chronic disease.
Patients hospitalized after stroke may also present with dysphagia, which affects 37-78% of all stroke patients. Early detection of dysphagia can prevent malnutrition. Anemia is also an independent factor associated with prolonged length of stay and increased risk of pressure injury.
The objective of the study was to determine the predisposing factors for pressure injury in patients hospitalized after stroke. This was a 7-day longitudinal study in which motility, nutrition, and presence of dysphagia were assessed. The nutrition evaluation was based on anthropometric, biochemical, and dietary determinants. Pressure injury risk was assessed using the Braden Scale, where scores were either mild risk (15 or higher), moderate risk (13-14) and high risk (12 or lower).
The results showed that bedridden stroke patients had a greater risk of pressure injury development compared to patients who were ambulatory. Patients who presented with dysphagia also had an increased risk of pressure injury. Patients with good and average diet acceptance had lower risk of pressure injury than those with low diet acceptance. Diet acceptance was defined as either good (>75%), average (25-75%), or low (<25%). Those with high risk of pressure injury were found to have lower BMIs compared to those with moderate risk of pressure injury. And hemoglobin and hematocrit were found to be lower in patients who had a high risk of pressure injury compared to patients who had low risk. Moreover, the risk of pressure injury increased with length of hospital stay, which may be related to the improvement of swallowing ability and diet acceptance as hospitalization continued.
It could be concluded that risk factors such as immobility, dysphagia, low diet acceptance, nutrition risk, and anemia are associated with greater risk of pressure injury.
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