Journal_1_2014_final_WEB

Science, Practice and Education
Prevalence of Pressure Ulcers
in Hospitalized Patients
in Germany – Trends from 2005 to 2011
Summary
Objective: Based on the data of hospitalized people
in Germany we aimed to determine changes
in prevalence, localization of pressure ulcer (PU)
and comorbidity of the affected patients in the
period from 2005 to 2011.
Patients and Methods: Age-adjusted prevalence
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. Hospitals 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 Diagnosis Related Group System.
Results: Total number of cases hospitalized with
the principal diagnosis PU increased from 9,941
in 2005 to 12,581 in 2011 (increase of 26.5 %)
with a disproportional increase of PU grade
4 (from 46 % in 2005 to 59 % in 2001). Total
number of cases hospitalized having the additional
diagnosis PU increased from 239,760 in 2005 to
412,029 in 2011 (increase of 71.8 %) with a disproportional
of PU grade 2 (from 39 % to 47 %).
Age adjusted population based data per 100,000
inhabitants show no increase in cases with the
principal diagnosis, but cases with the additional
diagnosis does. Comparing the distribution of
PU localisation there are no relevant differences
between 2005 and 2011 with the exception of
a decrease of PUs of rare localisation (head, upper
extremity, vertebral spin) and not specified
localizations (principal diagnosis: from 25.8 % to
16.5 %, additional diagnosis from 29.1 % 18.0 %).
Patterns of comorbidity did not change in the
period from 2005 to 2011. Urinary and faecal
incontinence play a major role in those with the
principal diagnosis PU whereas fracture of femur,
heart failure and pneumonia are the most frequent
diagnoses coded with the additional diagnosis of
PU.
Conclusion: In Germany the rate of cases hospitalized
with the principal diagnosis PU did not
increase whereas the rate of PU documented in
hospitalized patients increased from 2005 to 2011.
Heidi Heinhold 1
Journalist
Andreas Westerfellhaus 2
Introduction
Pressure ulcer is a generally preventable complication
of immobility 1,2,3,4 . The awareness for
prevention of pressure ulcers (PU) and for early
detection increased in the last decades 5,6 . The
impact of these changes in awareness and in prevention
on the prevalence of PU is unclear. Data
from the National Center for Health Statistics
and the Washington State Department of Health
for the 14-year period from 1987 through 2000
found no evidence that the guidelines for the prevention
of PU have been effective in decreasing
pressure ulcer formation in the United States 4 .
As a limitation of their findings they stated that
they could not exclude a more thorough man-
ner of reporting pressure ulcer counteracting a
decrease in the absolute number of PU. It could
also be accounted for by changing demongraphics
in that, the incidence of chronic disease is increasing
along with increased age profile and thus one
would expect a similar increase in PU, but this did
not happen. So the guidelines might be effective
in decreasing PU in absolute terms. The same is
reported for Canada in a more recent study based
on the Annual Pressure Ulcer Prevalence Census
1994-2008 7 . In contrast to the somewhat constant
prevalence and incidence of PE in these countries,
an analysis of seven cross-sectional studies
reporting point PU prevalence in 225 German
Knut Kröger 3
1 for the Deutsche
Dekubitus Liga e.V.,
2 for the Deutsche
Pflegerat e.V.,
3 for the Initiative
Chronische Wunde e.V.,
Correspondence:
knut.kroeger@
helios-kliniken.de
Conflict of interest: none
EWMA Journal 2014 vol 14 no 1 9