Journal_1_2014_final_WEB

hospital found a significant decrease when nonblanchable
erythema were excluded 8 . Prevalence
rates decreased from 6.4 % (year 2001) to 3.9 %
(year 2007) (p=0.015).
Thus we analyzed prevalence of PU based
on the federal statistic. With the introduction
of Diagnosis Related Groups (DRGs) in 2005
for reimbursement this is the most valid data
base for principal and additional diagnoses for
hospitalized patients in Germany. We aimed to
determine changes in prevalence, localization of
PU and comorbidity of the affected patients in
the period from 2005 to 2011.
Methods
The national statistic (DRG-statistic) published
by the Federal Statistical Office includes
data from all hospitals in Germany that use the
DRG-system. These hospitals treat almost 99 %
of all patients in Germany and they are legally obliged to
deliver extensive data on hospital treatment, including demographic
data, diagnoses, comorbidities, complications,
and procedures to the “Institute for the Hospital Remuneration
System” which uses the data for yearly adaptation
of the German DRG-system and transmits them to the
Federal Statistical Office 9,10 . Only some private clinics do
not participate in this system.
For 2005 to 2011 all diagnosis were coded with the
International Statistical Classification of Diseases and Related
Health Problems 10th Revision (ICD-10), which was
adapted for Germany by the German Institute for Medical
Documentation and Information (DIMDI) as ICD-10
German Modification (ICD-10-GM) version 2005 to version
2011. Pressure ulcers were coded as L89.- given all 5
digits of the code (Table 1). This code implies information
regarding the grade of the pressure ulcers (depicting the
depth) and the variety of localizations. As shown in Table 1
coding changed from 2009 to 2010.
Statistics
Age-adjusted prevalences and tables for gender and age
distribution of pressure ulcers separately for the principal
diagnosis and for additional diagnoses were provided from
the Federal Statistical Office. These data count pressure
ulcers not inpatient cases. According to its definition, each
principal diagnosis represents a single case. But, each case
could suffer from several pressure ulcers which have to be
coded. As consequence, inpatient cases could be included
Table 1: Description of pressure ulcer coding in the German version
of ICD-10 in the years 2005 to 2011.
2005 -2009 2010-2011
Fourth digit defines the grade of the pressure ulcers
L89.1- L89.0- PU Grade1
L89.2- L89.1- PU Grade2
L89.3- L89.2- PU Grade3
L89.4- L89.3- PU Grade4
L89.9- L89.9- unknown Grade
Fifth digit defines the localisation of the pressure ulcers (example grade 1)
L89.10 L89.0 PU Grade1: Head
L89.11 L89.01 PU Grade1: Upper Limb
L89.12 L89.02 PU Grade1: Spinous Process
L89.13 L89.03 PU Grade1: Iliac Crest
L89.14 L89.04 PU Grade1: Sacrum
L89.15 L89.05 PU Grade1: Ischium
L89.16 L89.06 PU Grade1: Great Trochanter
L89.17 L89.07 PU Grade1: Heel
L89.18 L89.08 PU Grade1: Other Localisation at Lower Limb
L89.19 L89.09 PU Grade1: Not Defined Localisation
Figure 1: Total number of patients hospitalized with the principal
diagnosis L89 separated by grade 1 to 4.
severalfold in the statistic on additional diagnoses. Therefore,
the distribution of patients with at least one pressure
ulcer as additional diagnoses was provided by the federal
Statistical Office additionally. Last, a single inpatient case
could be count in the statistics on principal and additional
diagnoses in parallel.
Calculations were done using Microsoft ® Excel 2003
and Microsoft ® Access 2003.
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EWMA Journal 2014 vol 14 no 1