(660) Strain on the System: COVID-19 Diagnosis Associated With Increased Incidence of Pressure Ulcers

Introduction: Pressure ulcers (PUs) are caused by sustained, localized pressure on tissue and pose a significant medical burden, affecting over 3 million adults annually in the United States (US). COVID-19 infection is associated with pro-inflammatory cytokine release within the skin and can directly damage epithelial cells, which can exacerbate the skin’s susceptibility to external damage. We hypothesized that a COVID-19 diagnosis would increase the incidence of new PUs in hospitalized patients in the US.

Methods: Discharge data from the National Inpatient Sample, Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality database between 2017-2020 was analyzed. Starting in April each year, ICD-10 codes from Centers for Medicare & Medicaid Services were utilized to identify adult patient discharges with a new PU diagnosis and the presence or absence of new COVID-19 positive (COVIDpos) diagnosis at the same admission. Data was evaluated using z-test via STATA/MP 18 & HCUP statistical software.

Results: The incidence of PU in COVIDpos discharges in 2020 was significantly higher than in COVID negative (COVIDneg) discharges (2.97 per 100 COVIDpos vs 2.21 per 100 COVIDneg, p< 0.01). During the COV19 peak in May 2020, there was a 147% increase in the incidence of PUs of COVIDpos discharges compared to COVIDneg discharges (p < 0.01). The percent increase in overall PU incidence from 2017 to 2018 and from 2018 to 2019 was 1.33% and 0.99%, respectively, while 2020 showed a 5.3% increase from 2019 in incidence of PUs for all discharges (p < 0.01). COVIDneg patients did not have a statistically significant increase in PUs in the post-COVID era. (2.15 per 100 discharges pre-COVID vs. 2.21 per 100 COVIDneg discharges, p = 0.08).

Conclusions: Hospitalized patients with COVID-19 diagnosis had increased incidence of new PUs. COVIDpos patients accounted for the majority of increased incidence of PUs in discharged patients in the post-COVID era. Further research should evaluate if the higher incidence persists in COVIDpos patients beyond 2020 following introduction of vaccine and hospital development of robust COVID19 protocols.