NUTRITIONAL STATUS AMONG PATIENTS WITH HIP FRACTUREIN RELATION TO PRESSURE ULCERS

Abstract

Background and Aims: Patients with a hip fracture often have a poor nutritional status which is associated with increased risk of complications, morbidity and mortality. The aim of this study was to investigate the effects of an improved care intervention in relation to nutritional status and pressure ulcers. An intervention of best practices for patients with hip fracture was introduced, using the available resources effectively and efficiently with a not too complicated or expensive intervention.

Methods: A quasi-experimental study of 478 patients consecutively included between April 1st 2003 and March 31st 2004. A new evidence based clinical pathway was introduced on October 1st 2003. The results from the first 210 patients in the control group and the last 210 patients in the intervention group are presented in this article.

Results: The total number of patients with a hospital acquired pressure ulcer was in the intervention group, 19 patients, and in the control group 39 patients (p=0.007). No patient younger than 65 years developed a pressure ulcer. There were no statistical significant differences between the groups with respect to blood biochemical variables at inclusion. Patients in the control group had higher arm muscle circumference (AMC) (p=0.05), calf circumference (CC) (p=0.038) and body mass index (BMI) (p=0.043) values. Abnormal anthropometrical tests of BMI, triceps skin fold (TSF) < 10th percentile and AMC < 10th percentile were found in 12 patients in the control group and in 4 patients in the intervention group. None of the four patients in the intervention group developed pressure ulcers. However two of the 12patients in the control group were affected.

Conclusions: It is possible to reduce the development of hospital acquired pressure ulcers among elderly patients with a hip fracture even though they have poor prefracture nutritional status. The results in this study indicate the value of the new clinical pathway, as the number of patients who have developed pressure ulcers during their stay in hospital has been reduced by 50%.