Development and validation of a nomogram for pressure injury risk prediction in stroke patients: a retrospective cohort study

Predictions ARE TOTALLY FUCKING USELESS! Create protocols that prevent this problem! You're so blitheringly stupid you need to be fired immediately!

 Development and validation of a nomogram for pressure injury risk prediction in stroke patients: a retrospective cohort study

Tang Haiyan¹Zhong Quanzhen¹Liao Tingting¹Fu Qing¹Xie Yulei²Lv Zewei¹Zhou Mijuan^1*Huang Bo^3*

• ¹Rehabilitation Department of Zigong First People’s Hospital, Zigong, Sichuan, China
• ²Rehabilitation Department, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, China
• ³Otolaryngology, Zigong First People's Hospital, Zigong, Sichuan, China

Study design: Retrospective cohort study.

Objective: This study aimed to identify independent risk factors for pressure injury (PI) during the post-stroke recovery phase, develop and validate a nomogram prediction model to facilitate the identification of high-risk individuals for PI, and establish a theoretical framework for optimizing clinical intervention strategies.

Methods: Retrospective clinical data were collected from 284 hospitalized stroke patients in the recovery phase (including 85 PI cases) at the Affiliated Hospital of North Sichuan Medical College between January 2018 and December 2022. Participants were randomly allocated into training (70%) and internal validation (30%) cohorts. An external validation cohort comprising 60 stroke patients (30 PI cases) from Zigong First People’s Hospital (January 2023–January 2024) was additionally analyzed. Univariate analysis and LASSO regression were utilized to screen independent PU risk factors, followed by nomogram construction. Model performance was evaluated using the C-index, calibration curves, and Decision Curve Analysis (DCA). Comparative analyses were conducted against the Braden scale (Model 2) and a combined model incorporating the Braden scale (Model 3).

Results: Independent risk factors for PI in post-stroke recovery patients included hemorrhagic stroke subtype, advanced age, hypoalbuminemia, elevated leukocyte counts, and low Activities of Daily Living (ADL) scores. The nomogram model incorporating these five predictors demonstrated AUC values of 0.902 (training cohort), 0.935 (internal validation), and 0.936 (external validation), exceeding the predictive capacity of individual variables: stroke type (AUC = 0.642), age (AUC = 0.756), albumin level (AUC = 0.754), leukocyte count (AUC = 0.712), and ADL score (AUC = 0.839). Calibration curves indicated strong concordance between predicted and observed outcomes, while DCA confirmed substantial clinical net benefit. The Braden scale (AUC = 0.817) exhibited inferior predictive performance compared to our model, and the combined model (AUC = 0.901) showed no significant improvement, underscoring the parsimony and clinical utility of the proposed nomogram.

Conclusion: The nomogram developed in this study for predicting PIs in stroke recovery patients demonstrates high accuracy and discrimination, facilitating the early identification of high-risk individuals and aiding in the formulation of personalized intervention strategies.

Beware of the toilet: The risk for a deep tissue injury during toilet sitting

I just had to put this one out there, is your doctor warning you about this? Maybe get your doctor to write a prescription for this?

TILT Toilet Incline Lift Only$1049

Beware of the toilet: The risk for a deep tissue injury during toilet sitting

Author links open overlay panelMaayanLustig^aAyeletLevy^aKaraKopplin^bZehavaOvadia-Blechman^cAmitGefenPh.D.(Professor in Biomedical Engineering)^a

https://doi.org/10.1016/j.jtv.2017.04.005Get rights and content

Highlights

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Prolonged sitting on toilet seats involves a potential risk for pressure injuries.

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The potential risk for pressure injuries is affected by the toilet seat design.

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Specialized toilet seat cushions are able to reduce the tissue injury risk.

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Narrow/inclined seats increase tissue loads based on simulations and hemodynamics.

Abstract

A pressure injury (PrI) compromises quality of life and can be life-threatening. The fundamental cause of PrIs is sustained deformations in weight-bearing soft tissues, e.g., during prolonged sitting on inadequate surfaces such as a toilet seat. In nursing homes and geriatric facilities, patients need assistance using the restroom, and patients being left on the toilet for tens-of-minutes is a real-world scenario, unfortunately. Nevertheless, there are no published studies regarding sustained tissue loads during toilet sitting and their effects on tissue physiology. Here, the biomechanical and microcirculatory responses of the buttock tissues to toilet sitting were investigated using finite element modeling and cutaneous hemodynamic measurements, to explore the potential etiology of PrIs occurring on the toilet. We found that prolonged sitting on toilet seats involves a potential risk for PrI development, the extent of which is affected by the seat design. Additionally, we found that specialized toilet seat cushions are able to reduce this risk, by lowering instantaneous tissue exposures to internal stresses (by up to 88%) and maintaining reduced interface pressures. Furthermore, hemodynamic variables were altered during the toilet sitting; in particular, tcPO₂ was decreased by 49% ± 7% (44 ± 2[mmHg] to 22 ± 4[mmHg]) during sitting. The current study confirms that investing in expensive PrI prevention (PIP) products is likely to be ineffective for an immobilized patient who is left to sit on a bare toilet seat for long times. This argument highlights the need for a holistic-care approach, employing PIP devices that span across the entire environment where bodyweight forces apply to tissues.