Journal_1_2014_final_WEB

Figure 3: Rate of PU at different
localizations separated for patients
with PU as principal (left) or additional
(right) diagnosis and for the years
2005 (upper part) and 2011
(lower part) with increasing age.
femur, heart failure and pneumonia are
the most frequent diagnoses coded with
the additional diagnosis of pressure ulcer
(Table 3). These patterns of comorbidity
did not change in the period from 2005
to 2011.
Discussion
Data from the DRG-statistic of the years
2005 to 2011 present a good overview
about the problem of pressure ulcers handled
in acute hospitals in Germany.
There is an increase in absolute numbers
of PU which in part is explained by
the aging population. After age-adjustment
the incidence rates per 100.000 inhabitants
of PU as principal diagnosis did
not increase. There is a variety of possible
interpretations that could be discussed.
One could hypothesize, that burden of PU in out of hospital
care in general remained unchanged. One can also
hypothesize, that the overall strategies in prevention of PU
failed as the rates did not decrease. We did not see a shift
towards patients suffering from lower grades of PU, thus
it can be excluded that there is trend to earlier hospitalization
of affected patients. The opposite is true as the rate
of patients admissed with PU grade 4 increased disproportionally.
This might be in indicator for an increasing
burden of PU in non-hospital settings.
The rates of PU as additional diagnosis per 100.000
inhabitants still increased after age-adjustment. Thus more
PUs were documented in the hospitals. Again there is a
variety of interpretations. As these PUs do not necessarily
developed during the period of hospitalization they could
have been acquired before hospitalization. As all hospitals
are forced to increase their awareness after publication
of the National Expert-Standard for PU Prophylaxis just
more PUs could have been documented without affecting
Table 3: Top five of the additional diagnosis coded in patients
with the principal diagnosis PU.
Order Code PU was the principal diagnosis Rate (%)
1 R15 Faecal incontinence 40,8
2 B962 Escherichia coli 32,8
3 I100 Essential Hypertension 30,4
4 R32 Urinal incontinence 26,0
5 B956 Staphylococcus aureus 22,3
the true number of PUs. An over documentation of each
discoloured skin area as PU grade 1 (or grade 0 after the
change in coding 2009) should have increased the rate of
this grade. Our data showed a dysproportional increase in
PU grade II (or grade 1 after the change in coding 2009),
which suggests that objective findings were documented.
All in all, our data do not support the results presented
from Kottner et al. 2009 who analysed the results of seven
point pressure ulcer prevalence studies conducted in 225
12
EWMA Journal 2014 vol 14 no 1