Risk Factors for Pressure Ulcer Development in Non-Critical Aeromedical Evacuation Trauma Patients

Abstract

Background: The military in-flight care environment is unique. Non-critical Aeromedical Evacuation (AE) trauma patients are at risk for developing pressure ulcers (PUs) in-flight. This study examines the incidence of in-flight PU development and analyzes factors that may contribute to them. Methods: This study employed a retrospective case-control cohort analysis of electronic data from January 1, 2008 through December 31, 2012 comparing non-critical AE trauma patients who did and did not develop PUs within three days post-flight. The Department of Defense Trauma Registry identified 15 PU patients. Using the Aeromedical Evacuation Registry (AER), PU patients were matched four-to-one with non-PU patients (n=60) that had been flown within plus or minus one year of the event to control for changes in practice over time. Independent variables examined included demographics, diagnoses, care requirements, flight information, and the number of AE crew. Results: The mean age for the PU patients was 26.20 (SD=8.10); non-PU patients 26.98 (SD=8.16), with a range of 15-54 years old. Age was not significantly different (t(73) = .740, p > .05) between the PU and non-PU patients. All of the PU patients were male (n=15, 100%) and 96% (n=57) of the non-PU patients were male. Fisher’s exact test was conducted for a between group comparison, which was not significant (p = 1.00). The PU incidence rate was calculated as .02 (<1%) based on 73,377 patients discharged during the time period. A binomial Firth conditional logistic regression was performed in the face of PUs as a rare event (n=15; incidence rate <1%). The regression showed statistical significance in two of the 12 variables used in the model, namely the use of intravenous (IV) therapy (p = .04) and pulse oximetry (p = .01). Conclusion: As PUs are a Nurse Sensitive Quality Indicator, a PU incidence rate of <1% illustrates the outstanding quality of care that is being conducted in the U.S. Air Force Aeromedical Evacuation System. Identification of the risk factors that lead to PUs can help mitigate future PU development on the quest to zero PUs.