{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T07:02:18Z","timestamp":1780038138874,"version":"3.53.1"},"reference-count":24,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T00:00:00Z","timestamp":1780012800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Rehabil. Sci."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Pressure injuries (PIs) are widely recognized as indicators of patient safety and quality of care in acute hospitals, yet their burden in rehabilitation settings remains underexplored. Patients admitted to rehabilitation often present with high clinical complexity and functional dependency, potentially increasing PI-related risks.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This multicenter retrospective cohort study was conducted across 15 inpatient rehabilitation facilities of the Fondazione Don Gnocchi network in Italy. All adult patients admitted for full-time rehabilitation between March 23 and April 23, 2024, were included, excluding those with stays shorter than 5 days. Data extracted from medical records included demographic and clinical characteristics, functional status (Barthel index), PI risk (Braden Scale), presence and characteristics of PIs at admission, incident PIs during hospitalization, healing outcomes, length of stay, and discharge destination. Prevalence and cumulative incidence were estimated, and cause-specific Cox regression models were applied to evaluate the association between PIs and time to routine discharge.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 1,013 patients, 175 had at least one PI at admission, corresponding to a prevalence of 17.3% [95% confidence interval (CI): 15.0%\u201319.8%]. Most lesions were stage 1\u20132 and primarily located at the sacrum and heels. Patients with PIs were older, more functionally dependent, and had higher rates of neurological comorbidities, dysphagia, incontinence, and medical device use. During rehabilitation, patients with PIs at admission showed a higher cumulative incidence of new PIs than those without (14.3% vs. 4.2%). Overall, 41.5% of lesions present at admission healed during hospitalization, with substantially lower healing rates for advanced-stage injuries. In multivariable analysis, the presence of PIs at admission was independently associated with prolonged time to routine discharge (adjusted hazard ratio 0.67, 95% CI: 0.54\u20130.83).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Pressure injuries are highly prevalent at admission to rehabilitation and are associated with poorer clinical outcomes and increased resource utilization. These findings support the need for integrated preventive and management strategies spanning acute and rehabilitation care pathways.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fresc.2026.1808329","type":"journal-article","created":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T06:09:57Z","timestamp":1780034997000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Pressure injuries beyond acute care hospitals: a multicenter cohort study across rehabilitation settings"],"prefix":"10.3389","volume":"7","author":[{"given":"Luciana","family":"Bevilacqua","sequence":"first","affiliation":[{"name":"IRCCS Fondazione Don Carlo Gnocchi","place":["Milan, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lorenzo","family":"Brambilla","sequence":"additional","affiliation":[{"name":"IRCCS Fondazione Don Carlo Gnocchi","place":["Milan, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guya","family":"Devalle","sequence":"additional","affiliation":[{"name":"IRCCS Fondazione Don Carlo Gnocchi","place":["Milan, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Letizia","family":"Oreni","sequence":"additional","affiliation":[{"name":"IRCCS Fondazione Don Carlo Gnocchi","place":["Milan, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Romina","family":"Puce","sequence":"additional","affiliation":[{"name":"IRCCS Fondazione Don Carlo Gnocchi","place":["Milan, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Davide","family":"Bertoletti","sequence":"additional","affiliation":[{"name":"IRCCS Fondazione Don Carlo Gnocchi","place":["Milan, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luca","family":"Donati","sequence":"additional","affiliation":[{"name":"IRCCS Fondazione Don Carlo Gnocchi","place":["Milan, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna Pia","family":"Barberio","sequence":"additional","affiliation":[{"name":"IRCCS Fondazione Don Carlo Gnocchi","place":["Milan, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristina","family":"Messa","sequence":"additional","affiliation":[{"name":"IRCCS Fondazione Don Carlo Gnocchi","place":["Milan, Italy"]},{"name":"School of Medicine and Surgery, University of Milano-Bicocca","place":["Milan, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,5,29]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"710","DOI":"10.12968\/jowc.2019.28.11.710","article-title":"The prevalence of pressure ulcers in Europe: what does the European data tell us\u2014a systematic review","volume":"28","author":"Moore","year":"2019","journal-title":"J Wound Care"},{"key":"B2","doi-asserted-by":"publisher","first-page":"S20","DOI":"10.12968\/jowc.2020.29.Sup3.S20","article-title":"Prevalence of pressure ulcers in hospitalised patients: a cross-sectional study","volume":"29","author":"Olivo","year":"2020","journal-title":"J Wound Care"},{"key":"B3","doi-asserted-by":"publisher","first-page":"103546","DOI":"10.1016\/j.ijnurstu.2020.103546","article-title":"Global prevalence and incidence of pressure injuries in hospitalised adult patients: a systematic review and meta-analysis","volume":"105","author":"Li","year":"2020","journal-title":"Int J Nurs Stud"},{"key":"B4","doi-asserted-by":"publisher","first-page":"847","DOI":"10.1111\/iwj.13110","article-title":"Spasticity and dementia increase the risk of pressure ulcers","volume":"16","author":"Jaul","year":"2019","journal-title":"Int Wound J"},{"key":"B5","doi-asserted-by":"publisher","first-page":"128","DOI":"10.1097\/01.ASW.0000912008.97430.b4","article-title":"Cross-setting comparison of risk factors for pressure injuries acquired in post-acute care","volume":"36","author":"Barch","year":"2023","journal-title":"Adv Skin Wound Care"},{"key":"B6","doi-asserted-by":"publisher","first-page":"634","DOI":"10.1111\/iwj.13071","article-title":"The national cost of hospital-acquired pressure injuries in the United States","volume":"16","author":"Padula","year":"2019","journal-title":"Int Wound J"},{"key":"B7","first-page":"22","article-title":"Pressure ulcers, hospital complications, and disease severity: impact on hospital costs and length of stay","volume":"12","author":"Allman","year":"1999","journal-title":"Adv Wound Care"},{"key":"B8","year":""},{"key":"B9","doi-asserted-by":"publisher","first-page":"E6","DOI":"10.1097\/ASW.0000000000000272","article-title":"Cost of illness of pressure injuries in the inpatient area of a socio-health center in Spain","volume":"38","author":"Ramos-S\u00e1nchez","year":"2025","journal-title":"Adv Skin Wound Care"},{"key":"B10","doi-asserted-by":"publisher","first-page":"1130","DOI":"10.3390\/jpm12071130","article-title":"Pressure injuries and management after spinal cord injury","volume":"12","author":"Vecin","year":"2022","journal-title":"J Pers Med"},{"key":"B11","doi-asserted-by":"publisher","first-page":"207","DOI":"10.1097\/PHM.0b013e3182a92b9c","article-title":"Impact of pressure ulcers on outcomes in inpatient rehabilitation facilities","volume":"93","author":"Wang","year":"2014","journal-title":"Am J Phys Med Rehabil"},{"key":"B12","doi-asserted-by":"publisher","first-page":"893","DOI":"10.1016\/j.jaad.2018.12.068","article-title":"Pressure ulcers: prevention and management","volume":"81","author":"Mervis","year":"2019","journal-title":"J Am Acad Dermatol"},{"key":"B13","first-page":"446","article-title":"Nutritional status and evolution of pressure sores in geriatric patients","volume":"9","author":"Donini","year":"2005","journal-title":"J Nutr Health Aging"},{"key":"B14","doi-asserted-by":"publisher","first-page":"4","DOI":"10.4103\/0970-0358.155260","article-title":"Pressure ulcers: current understanding and newer modalities of treatment","volume":"48","author":"Bhattacharya","year":"2015","journal-title":"Indian J Plast Surg"},{"key":"B15","doi-asserted-by":"publisher","first-page":"102796","DOI":"10.1016\/j.jiph.2025.102796","article-title":"Healthcare-associated infection and antimicrobial use among residents of long-term care facilities in Italy: preliminary results of a point prevalence survey","volume":"18","author":"Brambilla","year":"2025","journal-title":"J Infect Public Health"},{"key":"B16","doi-asserted-by":"publisher","first-page":"103712","DOI":"10.1016\/j.gerinurse.2025.103712","article-title":"Risk of sacral pressure injuries in rehabilitation hospital patients: mediation by comorbidities index scores and length of stay in hospitals and moderation by age cohort","volume":"67","author":"Yin","year":"2026","journal-title":"Geriatr Nurs (Minneap)"},{"key":"B17","doi-asserted-by":"publisher","first-page":"32","DOI":"10.3928\/00989134-20240110-05","article-title":"Sacral ulcer development risk among older adult patients in North Texas rehabilitation hospitals: role of comorbidities, lifestyle, and personal factors","volume":"50","author":"Yin","year":"2024","journal-title":"J Gerontol Nurs"},{"key":"B18","doi-asserted-by":"publisher","first-page":"1754","DOI":"10.1016\/j.ijnurstu.2015.06.006","article-title":"The cost of prevention and treatment of pressure ulcers: a systematic review","volume":"52","author":"Demarr\u00e9","year":"2015","journal-title":"Int J Nurs Stud"},{"key":"B19","doi-asserted-by":"publisher","first-page":"1514","DOI":"10.1016\/j.apmr.2018.03.007","article-title":"Mandated quality of care metrics for medicare patients: examining new or worsened pressure ulcers and rehabilitation outcomes in US inpatient rehabilitation facilities","volume":"99","author":"DiVita","year":"2018","journal-title":"Arch Phys Med Rehabil"},{"key":"B20","doi-asserted-by":"publisher","first-page":"1087","DOI":"10.1111\/iwj.13147","article-title":"Effectiveness on hospital-acquired pressure ulcer prevention: a systematic review","volume":"16","author":"Gaspar","year":"2019","journal-title":"Int Wound J"},{"key":"B21","doi-asserted-by":"publisher","first-page":"380","DOI":"10.1111\/j.1365-2702.2011.03915.x","article-title":"Pressure ulcers in older hospitalized patients and their impact on length of stay: a retrospective observational study","volume":"21","author":"Theisen","year":"2012","journal-title":"J Clin Nurs"},{"key":"B22","doi-asserted-by":"publisher","first-page":"93","DOI":"10.1093\/gerona\/60.1.93","article-title":"A prospective study of the pressure ulcer scale for healing (PUSH)","volume":"60","author":"Gardner","year":"2005","journal-title":"J Gerontol A Biol Sci Med Sci"},{"key":"B23","doi-asserted-by":"publisher","first-page":"M795","DOI":"10.1093\/gerona\/56.12.M795","article-title":"An instrument to measure healing in pressure ulcers: development and validation of the pressure ulcer scale for healing (PUSH)","volume":"56","author":"Stotts","year":"2001","journal-title":"J Gerontol A Biol Sci Med Sci"},{"key":"B24","doi-asserted-by":"publisher","first-page":"1134","DOI":"10.1111\/jan.12898","article-title":"Evaluation of the internal and external responsiveness of the Pressure Ulcer Scale for Healing (PUSH) tool","volume":"72","author":"Choi","year":"2016","journal-title":"J Adv Nurs"}],"container-title":["Frontiers in Rehabilitation Sciences"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fresc.2026.1808329\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T06:09:59Z","timestamp":1780034999000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fresc.2026.1808329\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,29]]},"references-count":24,"alternative-id":["10.3389\/fresc.2026.1808329"],"URL":"https:\/\/doi.org\/10.3389\/fresc.2026.1808329","relation":{},"ISSN":["2673-6861"],"issn-type":[{"value":"2673-6861","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,29]]},"article-number":"1808329"}}