Network analysis of Root Causes of Hospital-Acquired Pressure Injuries in Hospitalized Patients

Network analysis of Root Causes of Hospital-Acquired Pressure Injuries in Hospitalized Patients | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Network analysis of Root Causes of Hospital-Acquired Pressure Injuries in Hospitalized Patients Meirong Chen, Xuan Jiang, Xiuling Shang, Xiaohuan Chen, Rongjin Lin, and 5 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7852909/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 9 You are reading this latest preprint version Abstract Objective The objective of this study was to identify core factors and bridging nodes associated with hospital-acquired pressure injuries (HAPI) and to compare network structures across departments. Methods A secondary analysis was conducted on 4,770 HAPI cases from 159 hospitals in Fujian Province (2016–2025). Root causes were categorized into seven dimensions: patient, nurse, environment, equipment/materials, system, procedure, and caregiver. Network analysis identified central and bridging nodes, assessed stability, and compared departmental structures. Results The median patient age was 69 years, and 69.0% were male. Most cases occurred in internal medicine (30.5%), surgery (26.1%), and ICU (22.9%). The sacrococcygeal region was the most common site (56.6%), with Stage II injuries predominating (68.6%). "Improper use of pressure-relieving devices" was the most central node, followed by "caregiver knowledge deficits," "inappropriate skin care protocols," "ineffective daily monitoring," and "insufficient nurse knowledge." Key bridging nodes were "inadequate unit-based training" and "absence of standardized skin care protocol," which connected multiple dimensions. The network was stable (CS = 0.595), with no overall structural differences across departments. Conclusion HAPI arises from multidimensional interactions, with nurse-related factors being dominant. Deficiencies in training and standardized protocols are critical bridging factors, highlighting them as primary targets for prevention. Hospital-acquired Pressure Injury Root Cause Analysis Network Analysis Central Node Bridging Variable Figures Figure 1 Figure 2 Figure 3 1. Background Hospital-Acquired Pressure Injury (HAPI) is a localized tissue damage caused by sustained pressure or pressure in combination with shear forces that occurs within 24 hours of admission to the hospital and is commonly seen in bony prominences, but can also occur in other areas of the body [ 1 ]. Advanced age, limited activity, inadequate tissue perfusion, use of vasoactive drugs, diabetes mellitus, and prolonged surgery or intensive care treatment are common risk factors [ 2 , 3 ]. The prevalence of HAPI varies widely, ranging from 12.8% to 26.6% across countries and disease types [ 4 , 5 ]. According to the Global Burden of Disease Study 2021, the health burden of pressure injuries increased markedly between 1990 and 2021. Reported cases rose to 646,000, deaths climbed from 16,600 to 37,000, and disability-adjusted life-years (DALYs) increased from 409,000 to 804,000 [ 6 ]. Although the standardized prevalence rate has decreased slightly in some countries, the rising absolute numbers highlight HAPI as a growing global public health challenge [ 7 ]. As a largely preventable adverse event, it demands coordinated action in policy, prevention, and resource allocation. Defining the root causes of HAPI is the prerequisite and key to developing effective prevention and control strategies. However, most of the current discussions on the risk factors for the development of pressure injuries are focused on the patient level, with the main focus on the influence of different age, voluntary mobility, disease factors, and therapeutic measures on the development of HAPI [ 2 , 3 ]. Most risk factors are avoidable and preventable [ 8 ]. Yet not all bedridden patients develop HAPI [ 9 ], and the extent of injury differs substantially among individuals. This variability suggests that patient-level risks alone cannot fully explain HAPI occurrence [ 10 ]. International guidelines for prevention and treatment were introduced in 2014 [ 11 ] and updated in 2019 [ 12 ], but implementation remains suboptimal. Surveys indicate that only about half of nurses report adequate adherence [ 13 , 14 ]. Barriers include gaps in knowledge and skills, limited organizational resources, insufficient institutional support, and poorly designed care processes [ 15 ]. These findings suggest that HAPI arises from a complex interplay of patient, provider, and system-level factors. To develop effective and sustainable prevention and control strategies, there is an urgent need to comprehensively identify the root causes of HAPI through multidimensional analysis. However, there is a lack of in-depth identification of the core influencing factors of HAPI and a comprehensive understanding of the interactions between multiple dimensions. Network analysis offers a powerful approach to capture these multidimensional interactions by quantifying the relative influence of factors within the system and identifying nodes that bridge domains [ 16 ]. Such analysis may uncover leverage points for prevention strategies. To address this gap, we analyzed ten years of real-world data from the Fujian Provincial Nursing Quality Control Center. We examined HAPI determinants across seven dimensions: patient, nurse, caregiver, environment, equipment/materials, system, and procedure. Our objectives were to a) identify the core factors associated with HAPI; b) detect bridging nodes within the multidimensional network; and c) compare network structures across hospital departments. This work aims to provide evidence-based targets for more precise and systematic HAPI prevention strategies. 2. Methods 2.1. Database This study used secondary data from the Fujian Provincial Data Platform for Nursing Quality (FJDNQ), a multicenter database established in June 2016 and managed by the Fujian Provincial Nursing Quality Control Center. The platform collects information on nursing adverse events and nursing-sensitive indicators, including pressure injuries, from 159 secondary and tertiary hospitals across Fujian Province. Participation is voluntary and subject to strict eligibility criteria. The database currently includes only Level II and above hospitals; Level I hospitals, which primarily provide community-based primary care, are not yet covered. In contrast, Level II hospitals serve as regional or county centers offering general medical care, referrals, teaching, and research, while Level III hospitals function as provincial or national referral centers with more advanced resources and specialized staff. To ensure data accuracy and consistency, the platform has implemented standardized quality control measures: (1) Strict access criteria: participating hospitals are required to complete standardized training and pass a qualification assessment; (2) Annual training: participating hospitals are required to designate 1–2 data reporting nurses to receive annual training from the Provincial Nursing Quality Control Center; (3) Standardized materials: operation manuals, video tutorials and FAQs are provided; (4) Technical support: online consultation and support are available for data reporters; (5) On-site auditing: annual random sampling is conducted to verify data integrity and concordance with clinical records. 2.2 Data collection HAPI data of hospitalized patients who met the inclusion criteria between 2016 and 2025 were extracted from the FJDNQ database to ensure the completeness and representativeness of the data. Two researchers independently reviewed all HAPI records. Inclusion criteria were (1) Pressure injuries occurring 24 hours after the hospital admission and (2) Age ≥ 18 years. Exclusion criteria: was records with > 50% missing data. 2.3 Variables 2.3.1 Dependent variable The outcome was the occurrence of a HAPI. According to international guidelines, pressure injuries are classified into six categories [ 11 ]: (1) intact skin with localized indelible erythema (stage 1); (2) partial dermal loss with dermal exposure (stage 2); (3) total skin loss (stage 3); (4) total skin and tissue loss (stage 4); and (5) total skin and tissue loss concealed by putrefied flesh or charred scabs (nonstageable pressure injury); and (6) intact or nonintact skin with localized purplish or dark purple discoloration, or congestive blisters (deep tissue injury). For this study, a HAPI was defined as a new Stage I or higher injury occurring ≥ 24 hours after admission. Injuries present at admission were excluded. If multiple Stage I or higher injuries occurred during one hospitalization, they were counted as a single case, staged according to the most severe lesion. 2.3.2 Independent variables Event-level information included sex, age, department, nursing level, time of onset, stage, location, and Braden score. An expert panel under the supervision of the Provincial Nursing Quality Control Center conducted a root cause analysis [ 17 ], following a structured framework across seven dimensions: (1) Patient : disease impact; poor skin condition; non-cooperation with turning; refusal of assessment and treatment; poor mobility, poor autonomy, age factor: age > 70 years; sensory deficits: impaired neurological function; impact of passive position; others. (2) Nurse irregular assessment; inadequate shift handover; inadequate implementation of precautions; lack of knowledge of pressure injury protection; inadequate safety education; improper use of pressure-relieving devices; other. (3) Environment bed linen is damp and uneven; fracture immobilization; other. (4) Equipment/materials inadequate decompression of support surfaces; lack of decompression tools and dressings; others. (5) System unreasonable system for reporting pressure injuries; unreasonable mechanism for daily supervision of pressure injuries; inadequate departmental training on pressure injuries; other. (6) Procedure no standardized skin care process; unreasonable standardized skin care process; others. (7) Caregiver lack of knowledge about preventing pressure injuries; not cooperating with regular turning; incorrect skin care operation; others. 2.4 Ethics statement This study involved secondary analysis of anonymized data from the Fujian Provincial Data Platform for Nursing Quality. As all data were de-identified and could not be traced back to individual patients, ethical approval was not required. An application for exemption was submitted in accordance with the Administrative Measures for Ethical Review of Life Science and Medical Research Involving Humans, and, after confirmation by the institutional research office, the exemption was granted. 2.5 Model introduction The network model is used to describe the complex nonlinear interaction between individual nodes, identify the core performance, core and bridging components in the network, in this study, bootnet package (version 1.6) is used to network structure, calculate connection weights; test the stability and accuracy of the network by nonparametric bootstrap method (1000 times), estimate the 95% of edge weights confidence intervals; calculate the stability coefficients associated with the centrality index and the bridge centrality index. qgraph package (version 1.9.8): for network visualization. networktools package (version 1.5.1): for bridge analysis via the "bridge" function. Identify key bridging nodes connecting different node dimensions, calculate bridge strength and expected impact of bridges. 2.6 Model interpretation The nodes of the same dimension are of the same color, and are connected to each other by lines called "edges". Edges represent the strength of association between nodes, and the thickness of edges reflects the degree of association between nodes (i.e., weight value). The thicker the edges, the stronger the association, the blue edges represent positive associations, and the pink edges represent negative associations. To explore the effect of covariates on the network structure, this study adopts the node wise logistic regression estimation based Ising Model ("Ising Model") using LASSO regularization and EBIC to select the optimal parameters. The model is particularly suitable for: the case where the data type is a dichotomous variable. 2.7 Data description Data were entered using Excel 2019 and analyzed using SPSS 25.0 software. Normally distributed continuous variables were described using mean ± standard deviation, while skewed continuous variables were described using median and interquartile range. Categorical variables were described using frequency and percentage. The chi-square test was used to compare sociodemographic characteristics, patient, nurse, caregiver, environment, equipment/materials, system, and procedure among patients with in-hospital pressure injuries of varying severity. All tests were two-tailed; P < 0.05 was considered statistically significant. 3. Results 3.1 General information From 2016 to 2025, a total of 5,759 HAPI cases were reported in 159 secondary and tertiary hospitals in Fujian Province. After excluding patients younger than 18 years and records with > 50% missing data, 4,770 cases were included. The median age was 69.0 years (IQR: 56.0,80.0); predominantly male 3,290 cases (69.0%).By department, 30.5% occurred in internal medicine, 26.1% in surgery, 22.9% in ICU, 1.6% in emergency, 4.1% in the operating room, and 14.3% in other units. The sacrococcygeal region was the most common site (56.6%). The median Braden score was 11 (IQR, 9–13). Most injuries were Stage II (68.6%), followed by Stage I (18.7%), Stage III (9.2%), Stage IV (1.2%), unstageable (1.3%), and deep tissue injury (1.0%) (Table 1 ). Table 1 General information Incidence rates in different departments Descriptive and differential analysis Grouping Variable Total ICU ( n = 1096) Surgery ( n = 1244) Internal medicine ( n = 1455) Emergency room ( n = 74) Operating room ( n = 197) Others ( n = 684) Statistics P Year of patient admission 2016 300(6.29) 52(4.74) 94(7.44) 107(7.35) 4(5.41) 7(3.55) 36(5.26) χ 2 = 108.82 < 0.001 2017 377(7.90) 106(9.67) 94(7.44) 113(7.77) 9(12.16) 20(10.15) 35(5.12) 2018 551(11.55) 148(13.50) 146(11.55) 171(11.75) 5(6.76) 35(17.77) 46(6.73) 2019 708(14.84) 173(15.78) 186(14.72) 220(15.12) 10(13.51) 23(11.68) 96(14.04) 2020 627(13.14) 128(11.68) 147(11.63) 179(12.30) 12(16.22) 32(16.24) 129(18.86) 2021 540(11.32) 125(11.41) 164(12.97) 154(10.58) 8(10.81) 19(9.64) 70(10.23) 2022 496(10.40) 126(11.50) 127(10.05) 134(9.21) 7(9.46) 20(10.15) 82(11.99) 2023 492(10.31) 92(8.39) 131(10.36) 155(10.65) 7(9.46) 20(10.15) 87(12.72) 2024 519(10.88) 110(10.04) 136(10.76) 160(11.00) 9(12.16) 20(10.15) 84(12.28) 2025 160(3.35) 36(3.28) 39(3.09) 62(4.26) 3(4.05) 1(0.51) 19(2.78) Gender Male 3290(68.97) 820(74.82) 814(64.40) 1007(69.21) 52(70.27) 129(65.48) 468(68.42) χ 2 = 31.168 < 0.001 Female 1480(31.03) 276(25.18) 450(35.60) 448(30.79) 22(29.73) 68(34.52) 216(31.58) Age 69.0(56.0,80.0) 64.0(51.0,77.0) 69.0(57.0,80.0) 74.0(64.0,82.0) 68.0(52.0,81.0) 56.0(45.0,66.0) 68.0(56.0,80.0) H = 275.60 < 0.001# Level of care Superior 1411(29.58) 940(85.77) 100(7.91) 141(9.69) 27(36.49) 52(26.40) 151(22.08) — < 0.001* Grade I 2336(48.97) 125(11.41) 722(57.12) 957(65.77) 34(45.95) 113(57.36) 385(56.29) Grade Ⅱ 979(20.52) 24(2.19) 431(34.10) 340(23.37) 11(14.86) 30(15.23) 143(20.91) Grade Ⅲ 44(0.92) 7(0.64) 11(0.87) 17(1.17) 2(2.70) 2(1.02) 5(0.73) Caregiving situation Unaccompanied 1541(32.31) 919(83.85) 143(11.31) 152(10.45) 31(41.89) 117(59.39) 179(26.17) χ 2 = 1985.1 < 0.001 Accompanied 3229(67.69) 177(16.15) 1121(88.69) 1303(89.55) 43(58.11) 80(40.61) 505(73.83) Types of pressure injuries New cases brought in from outside the hospital 299(6.27) 19(1.73) 72(5.70) 103(7.08) 3(4.05) 3(1.52) 99(14.47) χ 2 = 140.00 < 0.001 Pressure injury occurred in the knee 4355(91.30) 1048(95.62) 1158(91.61) 1327(91.20) 69(93.24) 193(97.97) 560(81.87) Other departments bring pressure injuries 116(2.43) 29(2.65) 34(2.69) 25(1.72) 2(2.70) 1(0.51) 25(3.65) Pressure injury classification Phase I 892(18.70) 251(22.90) 240(18.99) 220(15.12) 17(22.97) 65(32.99) 99(14.47) — < 0.001* Phase Ⅱ 3272(68.60) 714(65.15) 863(68.28) 1056(72.58) 47(63.51) 121(61.42) 471(68.86) Phase Ⅲ 439(9.20) 94(8.58) 121(9.57) 148(10.17) 5(6.76) 7(3.55) 64(9.36) Phase Ⅳ 57(1.19) 16(1.46) 16(1.27) 16(1.10) 1(1.35) 0(0.00) 8(1.17) Phase Ⅴ 63(1.32) 12(1.09) 8(0.63) 10(0.69) 3(4.05) 3(1.52) 27(3.95) Phase Ⅵ 47(0.99) 9(0.82) 16(1.27) 5(0.34) 1(1.35) 1(0.51) 15(2.19) Braden score 11.0(9.0,13.0) 10.0(9.0,11.0) 12.0(10.0,14.0) 11.0(9.0,13.0) 11.0(9.0,12.0) 11.0(10.0,13.0) 12.0(10.0,14.0) H = 269.13 < 0.001# Event classification Grade I 314(6.58) 56(5.11) 84(6.65) 78(5.36) 4(5.41) 30(15.23) 62(9.06) χ 2 = 112.76 < 0.001 Grade Ⅱ 1985(41.61) 442(40.33) 542(42.88) 666(45.77) 18(24.32) 60(30.46) 257(37.57) Grade Ⅲ 2180(45.70) 542(49.45) 567(44.86) 640(43.99) 49(66.22) 97(49.24) 285(41.67) Grade Ⅳ 291(6.10) 56(5.11) 71(5.62) 71(4.88) 3(4.05) 10(5.08) 80(11.70) Sacrococcygeal region 2700(56.60) 598(54.56) 779(61.63) 877(60.27) 42(56.76) 62(31.47) 342(50.00) χ 2 = 85.639 < 0.001 Heel 476(9.98) 114(10.40) 127(10.05) 144(9.90) 7(9.46) 12(6.09) 72(10.53) χ 2 = 3.800 0.579 Occipital bone 130(2.73) 69(6.30) 24(1.90) 5(0.34) 3(4.05) 10(5.08) 19(2.78) χ 2 = 91.694 < 0.001 Inner and outer ankles 141(2.96) 28(2.55) 38(3.01) 52(3.57) 1(1.35) 3(1.52) 19(2.78) χ 2 = 4.713 0.452 Scapula 72(1.51) 11(1.00) 16(1.27) 29(1.99) 3(4.05) 6(3.05) 7(1.02) χ 2 = 12.118 0.033 Ischial tuberosity 99(2.08) 7(0.64) 34(2.69) 45(3.09) 2(2.70) 1(0.51) 10(1.46) χ 2 = 24.682 < 0.001 Trochanter 114(2.39) 5(0.46) 32(2.53) 52(3.57) 4(5.41) 3(1.52) 18(2.63) χ 2 = 30.110 < 0.001 Others 1593(33.40) 384(35.04) 359(28.40) 452(31.07) 22(29.73) 133(67.51) 243(35.53) χ 2 = 123.98 < 0.001 Note: “#” indicates the rank-sum test; “*” indicates Fisher's exact probability test. 3.2 Network analysis 3.2.1 Network structure The estimated network model of HAPI root causes (Fig. 1 ) included 26 variables, with 233 nonzero edges out of 650 possible connections (35.9%). The strongest association was between “ineffective reporting system (Sy1)” and “ineffective daily monitoring mechanism (Sy2)” (edge weight = 1.67). Other strong associations were between “non-adherence to repositioning (P3)” and “treatment refusal (P4)” (1.65), and between “lack of knowledge about prevention (RN4)” and “inadequate unit-based training (Sy3)” (1.38) (Table 2 ). Table 2 Network-estimated edge weight matrix CG1 CG2 RN1 RN2 RN3 RN4 RN5 RN6 P1 P2 P3 P4 P5 P6 P7 P8 P9 En1 En2 EM1 EM2 Sy1 Sy2 Sy3 Pr1 Pr2 CG1 — CG2 1.38 — RN1 0.00 -0.23 — RN2 0.07 0.00 0.80 — RN3 0.00 0.00 0.67 0.73 — RN4 0.80 0.00 0.11 0.48 0.92 — RN5 1.16 1.15 0.21 0.63 0.86 0.00 — RN6 0.84 -0.29 0.20 0.07 0.67 0.98 -0.21 — P1 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.17 — P2 0.00 0.73 0.00 0.13 0.00 0.00 0.00 0.07 1.13 — P3 0.41 0.08 0.00 0.00 0.00 0.00 0.51 0.00 0.63 0.13 — P4 0.25 0.29 0.00 0.00 0.00 0.00 0.13 0.00 0.00 0.00 1.65 — P5 0.00 0.00 0.05 0.00 0.08 0.00 0.00 0.42 0.32 0.37 0.00 0.00 — P6 0.00 0.00 0.22 0.00 0.00 0.00 0.00 0.00 0.21 0.09 0.20 0.00 1.07 — P7 0.21 0.14 0.00 0.00 0.00 0.00 0.24 0.00 0.00 0.00 0.00 0.00 0.00 0.00 — P8 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.48 -0.09 0.00 0.94 0.38 0.08 — P9 0.00 0.00 0.24 0.00 0.00 -0.19 0.00 0.00 0.24 0.12 0.31 0.00 0.75 0.89 0.49 0.62 — En1 0.00 0.57 0.00 0.08 0.00 0.11 0.10 0.12 0.00 1.10 0.00 0.00 0.00 0.00 0.08 0.00 0.16 — En2 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.36 0.00 0.00 0.64 0.00 0.00 0.00 0.00 — EM1 0.00 0.00 0.35 0.00 0.22 0.04 0.00 0.57 0.00 0.15 0.00 0.00 0.20 0.06 0.00 0.28 0.13 0.30 0.29 — EM2 0.00 0.18 0.12 0.10 0.29 0.00 0.00 0.49 0.00 0.12 0.07 0.00 0.09 0.00 0.00 0.00 0.22 0.41 0.00 0.58 — Sy1 0.00 0.00 0.00 0.00 0.00 0.83 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 — Sy2 0.00 0.00 0.11 0.32 0.00 0.58 0.00 0.91 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.19 0.00 0.00 0.00 1.67 — Sy3 0.56 0.00 0.65 0.10 0.00 1.38 0.00 0.61 0.00 0.00 0.00 0.00 0.04 0.00 0.14 0.00 0.17 0.25 0.00 0.00 0.13 0.00 0.98 — Pr1 -0.28 0.25 0.56 0.14 0.00 0.00 0.34 0.00 0.00 0.00 0.27 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.36 0.61 1.40 0.57 0.17 — Pr2 -0.74 0.00 0.58 0.00 0.29 0.00 0.53 -0.27 0.00 0.00 0.00 0.00 0.00 0.21 0.00 0.00 0.32 0.47 0.00 0.20 0.65 0.61 1.12 0.33 0.18 — Note: See Fig. 1 for node label explanations. The three strongest edges in pressure injuries are indicated by underlined numbers. 3.2.2 Central and bridging nodes The most central node was “improper use of pressure-relieving devices (RN6),” followed by “caregiver lack of prevention knowledge (CG1),” “inappropriate standardized skin care protocol (Pr2),” “ineffective daily monitoring mechanism (Sy2),” and “nurse lack of knowledge of prevention (RN4).” Sy2 showed the highest expected influence. Within each dimension, the most influential nodes were: passive positioning (P9) for patients, improper use of pressure-relieving devices (RN6) for nurses, damp or uneven bedding (En1) for environment, shortage of decompression devices and dressings (EM2) for equipment/materials, ineffective monitoring mechanism (Sy2) for system, inappropriate skin care protocol (Pr2) for procedures, and caregiver lack of prevention knowledge (CG1). The main bridging node was “inadequate unit-based training (Sy3),” followed by “absence of standardized skin care protocol (Pr1)” and “inappropriate standardized skin care protocol (Pr2)” (Fig. 2 ). 3.2.3 Network stability and accuracy Bootstrapping with 1,000 samples showed narrow 95% confidence intervals for most edge weights, closely approximating the original estimates, indicating high accuracy. The correlation stability (CS) coefficient for both expected influence and bridging expected influence was 0.595, exceeding the 0.5 threshold, confirming strong stability (Fig. 3 ). 3.2.4 Network comparison Network structures and centrality indices were compared across departments using 1,000 permutation tests (Table 3 ). No significant differences were observed overall (P > 0.1). However, a significant difference was found between ICU and internal medicine networks (P = 0.03), with 38 differing edges (P < 0.05). The most pronounced difference was between “caregiver lack of prevention knowledge (CG1)” and “incorrect skin care practices (CG2)” (P = 0.01, E = 2.422) (Table 4 ). Table 3 Comparison of network results for each department Comparison of differences between edges Node centrality comparison Test statistic M p-value Test statistic S p-value ICU vs Surgery 2.48 0.119 1.70 0.693 ICU vs Internal medicine 2.42 0.030 9.45 0.287 ICU vs Operating room 1.70 0.594 21.35 0.485 ICU vs Others 1.98 0.455 0.47 0.960 Surgery vs Internal medicine 1.29 0.722 7.75 0.109 Surgery vs Operating room 2.78 0.119 23.05 0.436 Surgery vs Others 2.02 0.257 2.18 0.941 Internal medicine vs Operating room 2.71 0.089 30.79 0.119 Internal medicine vsOthers 1.98 0.267 9.92 0.733 Operating room vs Others 2.02 0.495 20.87 0.188 Table 4 Differences between ICU and internal medicine networks Var1 Var2 p-value Test statistic E CG1 CG2 0.010 2.422 CG1 RN4 0.010 0.881 CG2 RN5 0.010 0.737 RN4 RN5 0.010 0.227 CG1 RN6 0.010 1.186 RN5 P2 0.010 0.268 RN5 P4 0.010 1.091 P3 P4 0.010 1.414 CG1 P5 0.010 0.118 CG2 P5 0.010 0.104 RN5 P5 0.010 0.097 CG2 P6 0.010 0.054 RN5 P6 0.010 0.135 P3 P6 0.010 0.490 P5 P6 0.010 0.667 RN5 P8 0.010 0.224 CG2 EM1 0.010 0.190 RN5 EM1 0.010 0.249 P6 EM1 0.010 0.225 CG1 Sy2 0.010 0.662 CG2 Sy2 0.010 0.353 CG1 Sy3 0.010 0.980 Sy2 Sy3 0.010 1.116 CG2 P8 0.020 0.184 P2 En1 0.020 0.589 EM2 Sy3 0.020 0.364 CG1 RN3 0.030 0.128 CG2 P2 0.030 0.516 P1 P5 0.030 0.577 P5 P7 0.030 0.108 P8 EM1 0.030 0.451 EM2 Sy2 0.030 0.259 EM1 Sy3 0.030 0.274 P5 P9 0.040 0.383 P9 EM1 0.040 0.345 RN1 P6 0.050 0.388 P5 P8 0.050 0.457 RN5 P9 0.050 0.135 4. Discussions To the best of our knowledge, this study is the first to examine the network structure of HAPI using multidimensional real-world data from the Fujian Provincial Nursing Quality Control Center, covering 4,770 cases over ten years. The findings demonstrate that HAPI arises not from a single factor but from the interplay of patient, nurse, environment, equipment, system, process, and caregiver domains. The network highlighted five central nodes—improper use of pressure-relieving devices (RN6), caregiver lack of prevention knowledge (CG1), inappropriate skin care protocols (Pr2), ineffective daily monitoring (Sy2), and insufficient nurse knowledge (RN4). Inadequate unit-based training (Sy3) emerged as a key bridging node, linking multiple dimensions and facilitating cross-domain propagation of risk. Nurse-related factors were the most influential within the network, surpassing patient-level factors in centrality and bridging roles. Improper use of pressure-relieving devices (RN6) was the most important node, while lack of dressings and decompression equipment (EM2) was the core factor in the equipment/materials domain. These results underscore the central role of appropriate use of prophylactic dressings and decompression tools in preventing HAPI. This is consistent with previous studies [ 18 ], the guidelines state that patients who do not use prophylactic dressings have a higher incidence of HAPI [ 12 ]. Beeckman and Hahnel et al. have also found high-quality evidence for prophylactic dressings [ 19 , 20 ], that the use of dressings facilitates cell migration and matrix formation while accelerating wound healing by promoting autolytic debridement [ 21 ], and that the scientific use of anti-pressure injury care appliances significantly reduces the incidence of HAPIs [ 12 , 22 , 23 ], and that PIs may occur even when patient self-factors are favorable if anti-pressure injury nursing appliances are not used properly [ 24 ]. A qualitative study of nurses' perceptions of the use of prophylactic dressings [ 25 ] showed that nurses overestimated the effectiveness of dressings as a preventive strategy for HAPI, which made it easy for them to neglect the detailed daily assessment of the skin condition underneath the dressings, which could lead to the rapid deterioration of subtle injuries that would otherwise go unnoticed. However, in China, limited financial support restricts routine use of prophylactic dressings, leaving high-risk patients without timely preventive interventions. These gaps emphasize the need for improved resource allocation, policy support, and standardized practice in the use of preventive devices. Training deficiencies were another critical finding. Inadequate unit-based education (Sy3) acted as a central bridging node. The survey showed [ 26 ] that 40.0% of nurses lacked knowledge of pressure injury prevention, and 60.0% of nurses reported that they did not adequately implement pressure injury prevention in their critically ill patients. Prevention training is of little value if it does not enhance knowledge or if the knowledge gained does not influence behavior and practice. A study showed [ 27 ] that entries such as nurses should maintain dietary intake appropriate to the patient's protein-calorie needs during illness and keep skin clean and dry were correct 90% of the time, but nutritional optimization was carried out in fewer than two-fifths of patients, and the percentage of patients who underwent moisture management was slightly more than one-fifth. Studies have shown that innovative HAPI education approaches such as the use of case-supported education mapping education [ 28 ], competency-based education [ 29 ], multimedia education[ 30 ] or virtual simulation education [ 31 – 33 ], have a positive role in advancing clinical practice. The absence of standardized skin care protocols (Pr1) was another significant bridging factor. Despite the existence of several HAPI clinical practice guidelines [ 34 ], their implementation in daily clinical care remains low [ 14 ]. Several randomized controlled trials have shown [ 35 , 36 ] that a multifaceted protocol based on clinical guidelines, including elements of risk assessment, skin assessment, repositioning, skin care, and nutrition, can reduce the incidence of HAPI and the time to its development. However the results of a qualitative study [ 25 ], nurses tend to rely on intuition rather than research evidence and are more likely to seek guidance from senior colleagues than consult hospital guidelines (relying on tacit knowledge). There are also many barriers to maintaining the practice of guidelines in the clinic; guidelines often involve multiple complex steps and lack formatting into something that can be directly applied by clinical nurses, resulting in less adherence to standardized procedures. Checklists help provide a simplified tool for complex procedures or practices, translating clinical practice guidelines into evidence-based care at the bedside, successfully preventing ventilator-associated pneumonia and catheter-associated bloodstream infections [ 37 , 38 ]. The Standardized Pressure Injury Prevention Protocol (SPIPP) [ 39 ] is a list of bedside precautions based on the 2019 Pressure Injury Prevention Guidelines, which encompasses all four domains of the best practices framework: assessing risk factors, skin assessment and prevention of incontinence dermatitis and eczema, stress reduction, nutrition, and other quality improvement clustering strategies.SPIPP 2.0, in checklist form, simplifies the complex process of implementing HAPI prevention into a series of key steps, each with a continuous quality improvement intervention. However, clinical translational research using SPIPP 2.0 evidence-based guidelines for early PI prevention has not been reported. In the future, evidence-based evidence can be translated based on implementation science, which is expected to make the complex HAPI prevention and control process clear and implementable, thereby improving implementation quality and safety. In addition, this study found that although there was no significant difference in department centrality, the synergistic effect of lack of knowledge and malpractice of chaperones may be a key driver of the difference in risk of HAPI between ICUs and internal medicine departments, this may be because the study results were influenced by the flexible visitation policies for caregivers entering the ICU, where chaperones have no access to both immediate education on scenarios and lack of knowledge on PIs. Scenario-based education and lack of visualization of the mechanisms of PI occurrence and skin care essentials are also the primary barriers to subsequent malpractice [ 40 ], which suggests that "knowledge-operation" miscoupling after an interdepartmental handover will increase the risk of PI occurrence [ 41 , 42 ], and providing structured PI prevention education to chaperones at the ICU transfer node is a powerful risk-reduction initiative [ 43 ], to compensate for the educational disconnect that occurs with the unaccompanied care system. This study has several limitations. First, data collection in this study relied on voluntary reporting. HAPI has been included in the National Healthcare Safety Nursing Specialty Quality Control Work Improvement Objectives, which is one of the most important indicators of safety and quality of care in hospitals, but there may still be underreporting. Second, the root cause analysis was organized and filled out by the head nurse of the unit in which the person involved in the incident was located, which may lead to inconsistency in the classification of patient information accompanied by a certain subjective attributional bias due to the differences in work experience and professional background of those who filled it out. Third, the data in this study came from a multicenter sample in a particular province, which may not be fully representative of the overall situation of healthcare organizations across the country, despite covering different levels and types of hospitals. In the future, the data can be analyzed in conjunction with nationwide data to improve the extrapolation and persuasiveness of the results. 5. Conclusions This study, the first to apply network analysis to hospital-acquired pressure injuries using multidimensional real-world data, demonstrated that HAPI is the result of interactions across patient, nurse, environment, equipment, system, process, and caregiver domains. Five core nodes were identified: improper use of pressure-relieving devices, caregiver lack of prevention knowledge, inappropriate skin care protocols, ineffective daily monitoring, and insufficient nurse knowledge. Inadequate unit-based training emerged as the most influential bridging factor, linking multiple domains and propagating risk across the network. These findings underscore the central role of nurse- and caregiver-related factors in HAPI occurrence. Future interventions should focus on strengthening guideline-based practice, standardizing care processes, enhancing training and education, and improving caregiver engagement to reduce HAPI incidence and achieve consistent quality of care. Declarations Funding This study was supported by Joint Funds for the Open Research Projects of the Fujian Provincial Key Laboratory for Research on Difficult and Critical Diseases (No. KLKF202401). The funding agency had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Competing interests None. Ethics approval and consent to participate This study was conducted in accordance with the ethical principles outlined in the Declaration of Helsinki. The need for formal ethical approval was waived by the Ethics Committee of Fujian Provincial Hospital, as the study protocol met the criteria for exemption. Written informed consent was obtained from all participants after the nature and purpose of the study had been fully explained. Consent for publication: All authors mentioned above have granted final approval for the submitted version. Clinical Trial Number Not applicable. Data avaliability The datasets used and analysed during the current study are available from the corresponding author on reasonable request. However, their availability is subject to approval by the Fujian Provincial Data Platform for Nursing Quality, as they contain sensitive patient information. Materials availability Not applicable. Code availability None. Author contributors: MRC: Methodology, Writing-Original draft preparation, Project administration XHC: Project administration HL, TTW: Conceptualization, Methodology XJ, TTW: Writing-Original draft preparation, Writing - Review & Editing RJL, MY, YL, HWX: Investigation, data analysis and interpretation XLS: Funding Acquisition Declaration of interests ☒ The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. References Puyk KF, Tuck MM, Reeves JA, Digby RL, Shea HE, Bucknall TK. 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Guidelines for Family-Centered Care in the Neonatal, Pediatric, and Adult ICU. Crit Care Med. 2017;45:103–28. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 11 Dec, 2025 Reviewers agreed at journal 04 Dec, 2025 Reviews received at journal 01 Dec, 2025 Reviewers agreed at journal 01 Dec, 2025 Reviewers invited by journal 27 Nov, 2025 Editor invited by journal 03 Nov, 2025 Editor assigned by journal 22 Oct, 2025 Submission checks completed at journal 22 Oct, 2025 First submitted to journal 13 Oct, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7852909","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":552312516,"identity":"7eb2dc3c-c3c1-4d5a-bc3a-543a10f83c6c","order_by":0,"name":"Meirong Chen","email":"","orcid":"","institution":"Fujian Medical University","correspondingAuthor":false,"prefix":"","firstName":"Meirong","middleName":"","lastName":"Chen","suffix":""},{"id":552312517,"identity":"e2db9333-b3fa-4204-aa0a-2e0111bce1f1","order_by":1,"name":"Xuan Jiang","email":"","orcid":"","institution":"Fujian Medical 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14:24:47","extension":"html","order_by":13,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":216146,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7852909/v1/311b68a0324784c75d265b9d.html"},{"id":97264795,"identity":"acf6c0e7-cdea-4997-bea2-4b74cc51fd2d","added_by":"auto","created_at":"2025-12-02 14:24:43","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":325043,"visible":true,"origin":"","legend":"\u003cp\u003eEstimated network structure for all pressure ulcer patients (n=4,770)\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7852909/v1/04ab0b2f2b71ac7ba1d9678b.png"},{"id":97264800,"identity":"c181baf3-224e-4e15-b7aa-e2d86180d018","added_by":"auto","created_at":"2025-12-02 14:24:44","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":135551,"visible":true,"origin":"","legend":"\u003cp\u003eThe centrality metrics (expected influence and strength) and bridging centrality metrics (bridging strength and bridging expected influence) of each node in the network (n=4770).\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-7852909/v1/b4db1e0001b3173777bf9e26.png"},{"id":97264791,"identity":"8ee3940e-81a2-4be2-865e-ed977c188b55","added_by":"auto","created_at":"2025-12-02 14:24:42","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":120262,"visible":true,"origin":"","legend":"\u003cp\u003eNetwork Stability Analysis Chart\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-7852909/v1/18f6151f89b3432db65cc47d.png"},{"id":97372711,"identity":"582633a1-55ab-41f6-8291-fc9d0e6d8979","added_by":"auto","created_at":"2025-12-03 16:32:58","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1819730,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7852909/v1/0ed554c3-5da5-4a0e-b53f-f72ec0d5a545.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Network analysis of Root Causes of Hospital-Acquired Pressure Injuries in Hospitalized Patients","fulltext":[{"header":"1. Background","content":"\u003cp\u003eHospital-Acquired Pressure Injury (HAPI) is a localized tissue damage caused by sustained pressure or pressure in combination with shear forces that occurs within 24 hours of admission to the hospital and is commonly seen in bony prominences, but can also occur in other areas of the body [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Advanced age, limited activity, inadequate tissue perfusion, use of vasoactive drugs, diabetes mellitus, and prolonged surgery or intensive care treatment are common risk factors [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. The prevalence of HAPI varies widely, ranging from 12.8% to 26.6% across countries and disease types [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. According to the Global Burden of Disease Study 2021, the health burden of pressure injuries increased markedly between 1990 and 2021. Reported cases rose to 646,000, deaths climbed from 16,600 to 37,000, and disability-adjusted life-years (DALYs) increased from 409,000 to 804,000 [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Although the standardized prevalence rate has decreased slightly in some countries, the rising absolute numbers highlight HAPI as a growing global public health challenge [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. As a largely preventable adverse event, it demands coordinated action in policy, prevention, and resource allocation.\u003c/p\u003e\u003cp\u003eDefining the root causes of HAPI is the prerequisite and key to developing effective prevention and control strategies. However, most of the current discussions on the risk factors for the development of pressure injuries are focused on the patient level, with the main focus on the influence of different age, voluntary mobility, disease factors, and therapeutic measures on the development of HAPI [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Most risk factors are avoidable and preventable [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Yet not all bedridden patients develop HAPI [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e], and the extent of injury differs substantially among individuals. This variability suggests that patient-level risks alone cannot fully explain HAPI occurrence [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. International guidelines for prevention and treatment were introduced in 2014 [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e] and updated in 2019 [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e], but implementation remains suboptimal. Surveys indicate that only about half of nurses report adequate adherence [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Barriers include gaps in knowledge and skills, limited organizational resources, insufficient institutional support, and poorly designed care processes [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThese findings suggest that HAPI arises from a complex interplay of patient, provider, and system-level factors. To develop effective and sustainable prevention and control strategies, there is an urgent need to comprehensively identify the root causes of HAPI through multidimensional analysis. However, there is a lack of in-depth identification of the core influencing factors of HAPI and a comprehensive understanding of the interactions between multiple dimensions. Network analysis offers a powerful approach to capture these multidimensional interactions by quantifying the relative influence of factors within the system and identifying nodes that bridge domains [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Such analysis may uncover leverage points for prevention strategies.\u003c/p\u003e\u003cp\u003eTo address this gap, we analyzed ten years of real-world data from the Fujian Provincial Nursing Quality Control Center. We examined HAPI determinants across seven dimensions: patient, nurse, caregiver, environment, equipment/materials, system, and procedure. Our objectives were to a) identify the core factors associated with HAPI; b) detect bridging nodes within the multidimensional network; and c) compare network structures across hospital departments. This work aims to provide evidence-based targets for more precise and systematic HAPI prevention strategies.\u003c/p\u003e"},{"header":"2. Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003e2.1. Database\u003c/h2\u003e\u003cp\u003eThis study used secondary data from the Fujian Provincial Data Platform for Nursing Quality (FJDNQ), a multicenter database established in June 2016 and managed by the Fujian Provincial Nursing Quality Control Center. The platform collects information on nursing adverse events and nursing-sensitive indicators, including pressure injuries, from 159 secondary and tertiary hospitals across Fujian Province. Participation is voluntary and subject to strict eligibility criteria. The database currently includes only Level II and above hospitals; Level I hospitals, which primarily provide community-based primary care, are not yet covered. In contrast, Level II hospitals serve as regional or county centers offering general medical care, referrals, teaching, and research, while Level III hospitals function as provincial or national referral centers with more advanced resources and specialized staff.\u003c/p\u003e\u003cp\u003eTo ensure data accuracy and consistency, the platform has implemented standardized quality control measures:\u003c/p\u003e\u003cp\u003e(1) Strict access criteria: participating hospitals are required to complete standardized training and pass a qualification assessment;\u003c/p\u003e\u003cp\u003e(2) Annual training: participating hospitals are required to designate 1\u0026ndash;2 data reporting nurses to receive annual training from the Provincial Nursing Quality Control Center;\u003c/p\u003e\u003cp\u003e (3) Standardized materials: operation manuals, video tutorials and FAQs are provided;\u003c/p\u003e\u003cp\u003e(4) Technical support: online consultation and support are available for data reporters;\u003c/p\u003e\u003cp\u003e(5) On-site auditing: annual random sampling is conducted to verify data integrity and concordance with clinical records.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\u003ch2\u003e2.2 Data collection\u003c/h2\u003e\u003cp\u003eHAPI data of hospitalized patients who met the inclusion criteria between 2016 and 2025 were extracted from the FJDNQ database to ensure the completeness and representativeness of the data. Two researchers independently reviewed all HAPI records. Inclusion criteria were (1) Pressure injuries occurring 24 hours after the hospital admission and (2) Age\u0026thinsp;\u0026ge;\u0026thinsp;18 years. Exclusion criteria: was records with \u0026gt;\u0026thinsp;50% missing data.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\u003ch2\u003e2.3 Variables\u003c/h2\u003e\u003cdiv id=\"Sec6\" class=\"Section3\"\u003e\u003ch2\u003e2.3.1 Dependent variable\u003c/h2\u003e\u003cp\u003eThe outcome was the occurrence of a HAPI. According to international guidelines, pressure injuries are classified into six categories [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]: (1) intact skin with localized indelible erythema (stage 1); (2) partial dermal loss with dermal exposure (stage 2); (3) total skin loss (stage 3); (4) total skin and tissue loss (stage 4); and (5) total skin and tissue loss concealed by putrefied flesh or charred scabs (nonstageable pressure injury); and (6) intact or nonintact skin with localized purplish or dark purple discoloration, or congestive blisters (deep tissue injury).\u003c/p\u003e\u003cp\u003eFor this study, a HAPI was defined as a new Stage I or higher injury occurring\u0026thinsp;\u0026ge;\u0026thinsp;24 hours after admission. Injuries present at admission were excluded. If multiple Stage I or higher injuries occurred during one hospitalization, they were counted as a single case, staged according to the most severe lesion.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec7\" class=\"Section3\"\u003e\u003ch2\u003e2.3.2 Independent variables\u003c/h2\u003e\u003cp\u003eEvent-level information included sex, age, department, nursing level, time of onset, stage, location, and Braden score. An expert panel under the supervision of the Provincial Nursing Quality Control Center conducted a root cause analysis [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e], following a structured framework across seven dimensions:\u003c/p\u003e\u003cp\u003e\u003cb\u003e(1) Patient\u003c/b\u003e: disease impact; poor skin condition; non-cooperation with turning; refusal of assessment and treatment; poor mobility, poor autonomy, age factor: age\u0026thinsp;\u0026gt;\u0026thinsp;70 years; sensory deficits: impaired neurological function; impact of passive position; others.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003e(2) Nurse\u003c/strong\u003e\u003cp\u003eirregular assessment; inadequate shift handover; inadequate implementation of precautions; lack of knowledge of pressure injury protection; inadequate safety education; improper use of pressure-relieving devices; other.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003e(3) Environment\u003c/strong\u003e\u003cp\u003ebed linen is damp and uneven; fracture immobilization; other.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003e(4) Equipment/materials\u003c/strong\u003e\u003cp\u003einadequate decompression of support surfaces; lack of decompression tools and dressings; others.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003e(5) System\u003c/strong\u003e\u003cp\u003eunreasonable system for reporting pressure injuries; unreasonable mechanism for daily supervision of pressure injuries; inadequate departmental training on pressure injuries; other.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003e(6) Procedure\u003c/strong\u003e\u003cp\u003eno standardized skin care process; unreasonable standardized skin care process; others.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003e(7) Caregiver\u003c/strong\u003e\u003cp\u003elack of knowledge about preventing pressure injuries; not cooperating with regular turning; incorrect skin care operation; others.\u003c/p\u003e\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003e2.4 Ethics statement\u003c/h2\u003e\u003cp\u003eThis study involved secondary analysis of anonymized data from the Fujian Provincial Data Platform for Nursing Quality. As all data were de-identified and could not be traced back to individual patients, ethical approval was not required. An application for exemption was submitted in accordance with the Administrative Measures for Ethical Review of Life Science and Medical Research Involving Humans, and, after confirmation by the institutional research office, the exemption was granted.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\u003ch2\u003e2.5 Model introduction\u003c/h2\u003e\u003cp\u003eThe network model is used to describe the complex nonlinear interaction between individual nodes, identify the core performance, core and bridging components in the network, in this study, bootnet package (version 1.6) is used to network structure, calculate connection weights; test the stability and accuracy of the network by nonparametric bootstrap method (1000 times), estimate the 95% of edge weights confidence intervals; calculate the stability coefficients associated with the centrality index and the bridge centrality index. qgraph package (version 1.9.8): for network visualization. networktools package (version 1.5.1): for bridge analysis via the \"bridge\" function. Identify key bridging nodes connecting different node dimensions, calculate bridge strength and expected impact of bridges.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\u003ch2\u003e2.6 Model interpretation\u003c/h2\u003e\u003cp\u003eThe nodes of the same dimension are of the same color, and are connected to each other by lines called \"edges\". Edges represent the strength of association between nodes, and the thickness of edges reflects the degree of association between nodes (i.e., weight value). The thicker the edges, the stronger the association, the blue edges represent positive associations, and the pink edges represent negative associations. To explore the effect of covariates on the network structure, this study adopts the node wise logistic regression estimation based Ising Model (\"Ising Model\") using LASSO regularization and EBIC to select the optimal parameters. The model is particularly suitable for: the case where the data type is a dichotomous variable.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003e2.7 Data description\u003c/h2\u003e\u003cp\u003eData were entered using Excel 2019 and analyzed using SPSS 25.0 software. Normally distributed continuous variables were described using mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation, while skewed continuous variables were described using median and interquartile range. Categorical variables were described using frequency and percentage. The chi-square test was used to compare sociodemographic characteristics, patient, nurse, caregiver, environment, equipment/materials, system, and procedure among patients with in-hospital pressure injuries of varying severity. All tests were two-tailed; P\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e\u003c/div\u003e"},{"header":"3. Results","content":"\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003e3.1 General information\u003c/h2\u003e\u003cp\u003eFrom 2016 to 2025, a total of 5,759 HAPI cases were reported in 159 secondary and tertiary hospitals in Fujian Province. After excluding patients younger than 18 years and records with \u0026gt;\u0026thinsp;50% missing data, 4,770 cases were included. The median age was 69.0 years (IQR: 56.0,80.0); predominantly male 3,290 cases (69.0%).By department, 30.5% occurred in internal medicine, 26.1% in surgery, 22.9% in ICU, 1.6% in emergency, 4.1% in the operating room, and 14.3% in other units. The sacrococcygeal region was the most common site (56.6%). The median Braden score was 11 (IQR, 9\u0026ndash;13). Most injuries were Stage II (68.6%), followed by Stage I (18.7%), Stage III (9.2%), Stage IV (1.2%), unstageable (1.3%), and deep tissue injury (1.0%) (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eGeneral information Incidence rates in different departments Descriptive and differential analysis\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"10\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"6\" nameend=\"c8\" namest=\"c3\"\u003e\u003cp\u003eGrouping\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eICU\u003c/p\u003e\u003cp\u003e(\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;1096)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eSurgery\u003c/p\u003e\u003cp\u003e(\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;1244)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eInternal medicine\u003c/p\u003e\u003cp\u003e(\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;1455)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eEmergency room\u003c/p\u003e\u003cp\u003e(\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;74)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eOperating room\u003c/p\u003e\u003cp\u003e(\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;197)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eOthers\u003c/p\u003e\u003cp\u003e(\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;684)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eStatistics\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYear of patient admission\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2016\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e300(6.29)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e52(4.74)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e94(7.44)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e107(7.35)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e4(5.41)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e7(3.55)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e36(5.26)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cem\u003eχ\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;108.82\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2017\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e377(7.90)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e106(9.67)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e94(7.44)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e113(7.77)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e9(12.16)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e20(10.15)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e35(5.12)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2018\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e551(11.55)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e148(13.50)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e146(11.55)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e171(11.75)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e5(6.76)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e35(17.77)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e46(6.73)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2019\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e708(14.84)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e173(15.78)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e186(14.72)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e220(15.12)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e10(13.51)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e23(11.68)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e96(14.04)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2020\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e627(13.14)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e128(11.68)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e147(11.63)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e179(12.30)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e12(16.22)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e32(16.24)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e129(18.86)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2021\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e540(11.32)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e125(11.41)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e164(12.97)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e154(10.58)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e8(10.81)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e19(9.64)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e70(10.23)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2022\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e496(10.40)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e126(11.50)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e127(10.05)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e134(9.21)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e7(9.46)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e20(10.15)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e82(11.99)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2023\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e492(10.31)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e92(8.39)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e131(10.36)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e155(10.65)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e7(9.46)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e20(10.15)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e87(12.72)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2024\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e519(10.88)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e110(10.04)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e136(10.76)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e160(11.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e9(12.16)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e20(10.15)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e84(12.28)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2025\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e160(3.35)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e36(3.28)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e39(3.09)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e62(4.26)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3(4.05)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1(0.51)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e19(2.78)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGender\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3290(68.97)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e820(74.82)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e814(64.40)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1007(69.21)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e52(70.27)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e129(65.48)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e468(68.42)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cem\u003eχ\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;31.168\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1480(31.03)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e276(25.18)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e450(35.60)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e448(30.79)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e22(29.73)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e68(34.52)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e216(31.58)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e69.0(56.0,80.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e64.0(51.0,77.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e69.0(57.0,80.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e74.0(64.0,82.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e68.0(52.0,81.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e56.0(45.0,66.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e68.0(56.0,80.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cem\u003eH\u003c/em\u003e\u0026thinsp;=\u0026thinsp;275.60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001#\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLevel of care\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSuperior\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1411(29.58)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e940(85.77)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e100(7.91)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e141(9.69)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e27(36.49)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e52(26.40)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e151(22.08)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGrade I\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2336(48.97)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e125(11.41)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e722(57.12)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e957(65.77)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e34(45.95)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e113(57.36)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e385(56.29)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGrade Ⅱ\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e979(20.52)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e24(2.19)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e431(34.10)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e340(23.37)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e11(14.86)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e30(15.23)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e143(20.91)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGrade Ⅲ\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e44(0.92)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7(0.64)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e11(0.87)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e17(1.17)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2(2.70)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e2(1.02)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e5(0.73)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCaregiving situation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUnaccompanied\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1541(32.31)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e919(83.85)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e143(11.31)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e152(10.45)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e31(41.89)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e117(59.39)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e179(26.17)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cem\u003eχ\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;1985.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAccompanied\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3229(67.69)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e177(16.15)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1121(88.69)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1303(89.55)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e43(58.11)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e80(40.61)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e505(73.83)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTypes of pressure injuries\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNew cases brought in from outside the hospital\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e299(6.27)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e19(1.73)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e72(5.70)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e103(7.08)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3(4.05)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e3(1.52)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e99(14.47)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cem\u003eχ\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;140.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePressure injury occurred in the knee\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4355(91.30)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1048(95.62)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1158(91.61)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1327(91.20)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e69(93.24)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e193(97.97)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e560(81.87)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOther departments bring pressure injuries\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e116(2.43)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e29(2.65)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e34(2.69)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e25(1.72)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2(2.70)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1(0.51)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e25(3.65)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePressure injury classification\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePhase I\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e892(18.70)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e251(22.90)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e240(18.99)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e220(15.12)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e17(22.97)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e65(32.99)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e99(14.47)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePhase Ⅱ\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3272(68.60)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e714(65.15)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e863(68.28)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1056(72.58)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e47(63.51)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e121(61.42)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e471(68.86)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePhase Ⅲ\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e439(9.20)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e94(8.58)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e121(9.57)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e148(10.17)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e5(6.76)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e7(3.55)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e64(9.36)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePhase Ⅳ\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e57(1.19)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e16(1.46)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e16(1.27)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e16(1.10)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1(1.35)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0(0.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e8(1.17)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePhase Ⅴ\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e63(1.32)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e12(1.09)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e8(0.63)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e10(0.69)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3(4.05)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e3(1.52)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e27(3.95)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePhase Ⅵ\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e47(0.99)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e9(0.82)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e16(1.27)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5(0.34)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1(1.35)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1(0.51)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e15(2.19)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBraden score\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e11.0(9.0,13.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10.0(9.0,11.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e12.0(10.0,14.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e11.0(9.0,13.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e11.0(9.0,12.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e11.0(10.0,13.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e12.0(10.0,14.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cem\u003eH\u003c/em\u003e\u0026thinsp;=\u0026thinsp;269.13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001#\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEvent classification\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGrade I\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e314(6.58)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e56(5.11)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e84(6.65)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e78(5.36)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e4(5.41)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e30(15.23)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e62(9.06)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cem\u003eχ\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;112.76\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGrade Ⅱ\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1985(41.61)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e442(40.33)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e542(42.88)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e666(45.77)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e18(24.32)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e60(30.46)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e257(37.57)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGrade Ⅲ\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2180(45.70)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e542(49.45)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e567(44.86)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e640(43.99)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e49(66.22)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e97(49.24)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e285(41.67)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGrade Ⅳ\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e291(6.10)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e56(5.11)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e71(5.62)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e71(4.88)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3(4.05)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e10(5.08)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e80(11.70)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSacrococcygeal region\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2700(56.60)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e598(54.56)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e779(61.63)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e877(60.27)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e42(56.76)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e62(31.47)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e342(50.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cem\u003eχ\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;85.639\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHeel\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e476(9.98)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e114(10.40)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e127(10.05)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e144(9.90)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e7(9.46)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e12(6.09)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e72(10.53)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cem\u003eχ\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;3.800\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e0.579\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOccipital bone\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e130(2.73)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e69(6.30)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e24(1.90)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5(0.34)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3(4.05)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e10(5.08)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e19(2.78)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cem\u003eχ\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;91.694\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eInner and outer ankles\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e141(2.96)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e28(2.55)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e38(3.01)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e52(3.57)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1(1.35)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e3(1.52)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e19(2.78)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cem\u003eχ\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;4.713\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e0.452\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eScapula\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e72(1.51)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11(1.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e16(1.27)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e29(1.99)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3(4.05)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e6(3.05)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e7(1.02)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cem\u003eχ\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;12.118\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e0.033\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIschial tuberosity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e99(2.08)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7(0.64)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e34(2.69)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e45(3.09)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2(2.70)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1(0.51)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e10(1.46)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cem\u003eχ\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;24.682\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTrochanter\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e114(2.39)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5(0.46)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e32(2.53)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e52(3.57)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e4(5.41)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e3(1.52)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e18(2.63)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cem\u003eχ\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;30.110\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOthers\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1593(33.40)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e384(35.04)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e359(28.40)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e452(31.07)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e22(29.73)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e133(67.51)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e243(35.53)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cem\u003eχ\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;123.98\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"10\"\u003eNote: \u0026ldquo;#\u0026rdquo; indicates the rank-sum test; \u0026ldquo;*\u0026rdquo; indicates Fisher's exact probability test.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\u003ch2\u003e3.2 Network analysis\u003c/h2\u003e\u003cdiv id=\"Sec15\" class=\"Section3\"\u003e\u003ch2\u003e3.2.1 Network structure\u003c/h2\u003e\u003cp\u003eThe estimated network model of HAPI root causes (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e) included 26 variables, with 233 nonzero edges out of 650 possible connections (35.9%). The strongest association was between \u0026ldquo;ineffective reporting system (Sy1)\u0026rdquo; and \u0026ldquo;ineffective daily monitoring mechanism (Sy2)\u0026rdquo; (edge weight\u0026thinsp;=\u0026thinsp;1.67). Other strong associations were between \u0026ldquo;non-adherence to repositioning (P3)\u0026rdquo; and \u0026ldquo;treatment refusal (P4)\u0026rdquo; (1.65), and between \u0026ldquo;lack of knowledge about prevention (RN4)\u0026rdquo; and \u0026ldquo;inadequate unit-based training (Sy3)\u0026rdquo; (1.38) (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eNetwork-estimated edge weight matrix\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"27\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c13\" colnum=\"13\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c14\" colnum=\"14\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c15\" colnum=\"15\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c16\" colnum=\"16\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c17\" colnum=\"17\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c18\" colnum=\"18\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c19\" colnum=\"19\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c20\" colnum=\"20\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c21\" colnum=\"21\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c22\" colnum=\"22\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c23\" colnum=\"23\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c24\" colnum=\"24\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c25\" colnum=\"25\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c26\" colnum=\"26\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c27\" colnum=\"27\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCG1\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eCG2\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eRN1\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eRN2\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eRN3\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eRN4\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003eRN5\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\"\u003e\u003cp\u003eRN6\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c10\"\u003e\u003cp\u003eP1\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c11\"\u003e\u003cp\u003eP2\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c12\"\u003e\u003cp\u003eP3\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c13\"\u003e\u003cp\u003eP4\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c14\"\u003e\u003cp\u003eP5\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c15\"\u003e\u003cp\u003eP6\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c16\"\u003e\u003cp\u003eP7\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c17\"\u003e\u003cp\u003eP8\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c18\"\u003e\u003cp\u003eP9\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c19\"\u003e\u003cp\u003eEn1\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c20\"\u003e\u003cp\u003eEn2\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c21\"\u003e\u003cp\u003eEM1\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c22\"\u003e\u003cp\u003eEM2\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c23\"\u003e\u003cp\u003eSy1\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c24\"\u003e\u003cp\u003eSy2\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c25\"\u003e\u003cp\u003eSy3\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c26\"\u003e\u003cp\u003ePr1\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c27\"\u003e\u003cp\u003ePr2\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" 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align=\"left\" colname=\"c22\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c23\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c24\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c25\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c26\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c27\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEM2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.29\u003c/p\u003e\u003c/td\u003e\u003ctd 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align=\"left\" colname=\"c18\"\u003e\u003cp\u003e0.22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c19\"\u003e\u003cp\u003e0.41\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c20\"\u003e\u003cp\u003e0.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c21\"\u003e\u003cp\u003e0.58\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c22\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c23\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c24\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c25\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c26\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c27\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSy1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" 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colname=\"c2\"\u003e\u003cp\u003e0.56\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.65\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e1.38\u003c/span\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.61\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e0.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e0.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e0.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e0.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e0.04\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c15\"\u003e\u003cp\u003e0.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c16\"\u003e\u003cp\u003e0.14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c17\"\u003e\u003cp\u003e0.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c18\"\u003e\u003cp\u003e0.17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c19\"\u003e\u003cp\u003e0.25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c20\"\u003e\u003cp\u003e0.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c21\"\u003e\u003cp\u003e0.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c22\"\u003e\u003cp\u003e0.13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c23\"\u003e\u003cp\u003e0.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c24\"\u003e\u003cp\u003e0.98\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c25\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c26\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c27\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePr1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.28\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.56\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e0.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e0.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e0.27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e0.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e0.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c15\"\u003e\u003cp\u003e0.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c16\"\u003e\u003cp\u003e0.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c17\"\u003e\u003cp\u003e0.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c18\"\u003e\u003cp\u003e0.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c19\"\u003e\u003cp\u003e0.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c20\"\u003e\u003cp\u003e0.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c21\"\u003e\u003cp\u003e0.36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c22\"\u003e\u003cp\u003e0.61\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c23\"\u003e\u003cp\u003e1.40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c24\"\u003e\u003cp\u003e0.57\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c25\"\u003e\u003cp\u003e0.17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c26\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c27\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePr2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.74\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.58\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.53\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e-0.27\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e0.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e0.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e0.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e0.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e0.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c15\"\u003e\u003cp\u003e0.21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c16\"\u003e\u003cp\u003e0.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c17\"\u003e\u003cp\u003e0.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c18\"\u003e\u003cp\u003e0.32\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c19\"\u003e\u003cp\u003e0.47\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c20\"\u003e\u003cp\u003e0.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c21\"\u003e\u003cp\u003e0.20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c22\"\u003e\u003cp\u003e0.65\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c23\"\u003e\u003cp\u003e0.61\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c24\"\u003e\u003cp\u003e1.12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c25\"\u003e\u003cp\u003e0.33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c26\"\u003e\u003cp\u003e0.18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c27\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"27\"\u003eNote: See Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e for node label explanations. The three strongest edges in pressure injuries are indicated by underlined numbers.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec16\" class=\"Section3\"\u003e\u003ch2\u003e3.2.2 Central and bridging nodes\u003c/h2\u003e\u003cp\u003eThe most central node was \u0026ldquo;improper use of pressure-relieving devices (RN6),\u0026rdquo; followed by \u0026ldquo;caregiver lack of prevention knowledge (CG1),\u0026rdquo; \u0026ldquo;inappropriate standardized skin care protocol (Pr2),\u0026rdquo; \u0026ldquo;ineffective daily monitoring mechanism (Sy2),\u0026rdquo; and \u0026ldquo;nurse lack of knowledge of prevention (RN4).\u0026rdquo; Sy2 showed the highest expected influence. Within each dimension, the most influential nodes were: passive positioning (P9) for patients, improper use of pressure-relieving devices (RN6) for nurses, damp or uneven bedding (En1) for environment, shortage of decompression devices and dressings (EM2) for equipment/materials, ineffective monitoring mechanism (Sy2) for system, inappropriate skin care protocol (Pr2) for procedures, and caregiver lack of prevention knowledge (CG1).\u003c/p\u003e\u003cp\u003eThe main bridging node was \u0026ldquo;inadequate unit-based training (Sy3),\u0026rdquo; followed by \u0026ldquo;absence of standardized skin care protocol (Pr1)\u0026rdquo; and \u0026ldquo;inappropriate standardized skin care protocol (Pr2)\u0026rdquo; (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec17\" class=\"Section3\"\u003e\u003ch2\u003e3.2.3 Network stability and accuracy\u003c/h2\u003e\u003cp\u003eBootstrapping with 1,000 samples showed narrow 95% confidence intervals for most edge weights, closely approximating the original estimates, indicating high accuracy. The correlation stability (CS) coefficient for both expected influence and bridging expected influence was 0.595, exceeding the 0.5 threshold, confirming strong stability (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec18\" class=\"Section3\"\u003e\u003ch2\u003e3.2.4 Network comparison\u003c/h2\u003e\u003cp\u003eNetwork structures and centrality indices were compared across departments using 1,000 permutation tests (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). No significant differences were observed overall (P\u0026thinsp;\u0026gt;\u0026thinsp;0.1). However, a significant difference was found between ICU and internal medicine networks (P\u0026thinsp;=\u0026thinsp;0.03), with 38 differing edges (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). The most pronounced difference was between \u0026ldquo;caregiver lack of prevention knowledge (CG1)\u0026rdquo; and \u0026ldquo;incorrect skin care practices (CG2)\u0026rdquo; (P\u0026thinsp;=\u0026thinsp;0.01, E\u0026thinsp;=\u0026thinsp;2.422) (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eComparison of network results for each department\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eComparison of differences between edges\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003eNode centrality comparison\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTest statistic M\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ep-value\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eTest statistic S\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003ep-value\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eICU vs Surgery\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.48\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.119\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.70\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.693\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eICU vs Internal medicine\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.42\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.030\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e9.45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.287\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eICU vs Operating room\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.70\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.594\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e21.35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.485\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eICU vs Others\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.98\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.455\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.47\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.960\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSurgery vs Internal medicine\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.722\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e7.75\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.109\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSurgery vs Operating room\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.78\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.119\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e23.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.436\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSurgery vs Others\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.02\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.257\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.941\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eInternal medicine vs Operating room\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.71\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.089\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e30.79\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.119\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eInternal medicine vsOthers\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.98\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.267\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e9.92\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.733\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOperating room vs Others\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.02\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.495\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e20.87\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.188\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDifferences between ICU and internal medicine networks\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVar1\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eVar2\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ep-value\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eTest statistic E\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCG1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCG2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.010\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2.422\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCG1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRN4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.010\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.881\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCG2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRN5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.010\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.737\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRN4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRN5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.010\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.227\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCG1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRN6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.010\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.186\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRN5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eP2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.010\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.268\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRN5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eP4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.010\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.091\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eP3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eP4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.010\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.414\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCG1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eP5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.010\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.118\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCG2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eP5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.010\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.104\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRN5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eP5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.010\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.097\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCG2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eP6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.010\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.054\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRN5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eP6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.010\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.135\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eP3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eP6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.010\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.490\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eP5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eP6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.010\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.667\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRN5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eP8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.010\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.224\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCG2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEM1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.010\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.190\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRN5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEM1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.010\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.249\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eP6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEM1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.010\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.225\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCG1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSy2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.010\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.662\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCG2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSy2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.010\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.353\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCG1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSy3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.010\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.980\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSy2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSy3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.010\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.116\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCG2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eP8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.020\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.184\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eP2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEn1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.020\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.589\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEM2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSy3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.020\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.364\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCG1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRN3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.030\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.128\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCG2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eP2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.030\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.516\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eP1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eP5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.030\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.577\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eP5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eP7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.030\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.108\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eP8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEM1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.030\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.451\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEM2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSy2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.030\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.259\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEM1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSy3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.030\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.274\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eP5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eP9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.040\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.383\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eP9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEM1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.040\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.345\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRN1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eP6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.050\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.388\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eP5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eP8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.050\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.457\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRN5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eP9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.050\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.135\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"4. Discussions","content":"\u003cp\u003eTo the best of our knowledge, this study is the first to examine the network structure of HAPI using multidimensional real-world data from the Fujian Provincial Nursing Quality Control Center, covering 4,770 cases over ten years. The findings demonstrate that HAPI arises not from a single factor but from the interplay of patient, nurse, environment, equipment, system, process, and caregiver domains. The network highlighted five central nodes\u0026mdash;improper use of pressure-relieving devices (RN6), caregiver lack of prevention knowledge (CG1), inappropriate skin care protocols (Pr2), ineffective daily monitoring (Sy2), and insufficient nurse knowledge (RN4). Inadequate unit-based training (Sy3) emerged as a key bridging node, linking multiple dimensions and facilitating cross-domain propagation of risk.\u003c/p\u003e\u003cp\u003eNurse-related factors were the most influential within the network, surpassing patient-level factors in centrality and bridging roles. Improper use of pressure-relieving devices (RN6) was the most important node, while lack of dressings and decompression equipment (EM2) was the core factor in the equipment/materials domain. These results underscore the central role of appropriate use of prophylactic dressings and decompression tools in preventing HAPI. This is consistent with previous studies [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e], the guidelines state that patients who do not use prophylactic dressings have a higher incidence of HAPI [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Beeckman and Hahnel et al. have also found high-quality evidence for prophylactic dressings [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e], that the use of dressings facilitates cell migration and matrix formation while accelerating wound healing by promoting autolytic debridement [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e], and that the scientific use of anti-pressure injury care appliances significantly reduces the incidence of HAPIs [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e], and that PIs may occur even when patient self-factors are favorable if anti-pressure injury nursing appliances are not used properly [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. A qualitative study of nurses' perceptions of the use of prophylactic dressings [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e] showed that nurses overestimated the effectiveness of dressings as a preventive strategy for HAPI, which made it easy for them to neglect the detailed daily assessment of the skin condition underneath the dressings, which could lead to the rapid deterioration of subtle injuries that would otherwise go unnoticed. However, in China, limited financial support restricts routine use of prophylactic dressings, leaving high-risk patients without timely preventive interventions. These gaps emphasize the need for improved resource allocation, policy support, and standardized practice in the use of preventive devices.\u003c/p\u003e\u003cp\u003eTraining deficiencies were another critical finding. Inadequate unit-based education (Sy3) acted as a central bridging node. The survey showed [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e] that 40.0% of nurses lacked knowledge of pressure injury prevention, and 60.0% of nurses reported that they did not adequately implement pressure injury prevention in their critically ill patients. Prevention training is of little value if it does not enhance knowledge or if the knowledge gained does not influence behavior and practice. A study showed [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e] that entries such as nurses should maintain dietary intake appropriate to the patient's protein-calorie needs during illness and keep skin clean and dry were correct 90% of the time, but nutritional optimization was carried out in fewer than two-fifths of patients, and the percentage of patients who underwent moisture management was slightly more than one-fifth. Studies have shown that innovative HAPI education approaches such as the use of case-supported education mapping education [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e], competency-based education [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e], multimedia education[\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e] or virtual simulation education [\u003cspan additionalcitationids=\"CR32\" citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e], have a positive role in advancing clinical practice.\u003c/p\u003e\u003cp\u003eThe absence of standardized skin care protocols (Pr1) was another significant bridging factor. Despite the existence of several HAPI clinical practice guidelines [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e], their implementation in daily clinical care remains low [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Several randomized controlled trials have shown [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e] that a multifaceted protocol based on clinical guidelines, including elements of risk assessment, skin assessment, repositioning, skin care, and nutrition, can reduce the incidence of HAPI and the time to its development. However the results of a qualitative study [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e], nurses tend to rely on intuition rather than research evidence and are more likely to seek guidance from senior colleagues than consult hospital guidelines (relying on tacit knowledge). There are also many barriers to maintaining the practice of guidelines in the clinic; guidelines often involve multiple complex steps and lack formatting into something that can be directly applied by clinical nurses, resulting in less adherence to standardized procedures. Checklists help provide a simplified tool for complex procedures or practices, translating clinical practice guidelines into evidence-based care at the bedside, successfully preventing ventilator-associated pneumonia and catheter-associated bloodstream infections [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. The Standardized Pressure Injury Prevention Protocol (SPIPP) [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e] is a list of bedside precautions based on the 2019 Pressure Injury Prevention Guidelines, which encompasses all four domains of the best practices framework: assessing risk factors, skin assessment and prevention of incontinence dermatitis and eczema, stress reduction, nutrition, and other quality improvement clustering strategies.SPIPP 2.0, in checklist form, simplifies the complex process of implementing HAPI prevention into a series of key steps, each with a continuous quality improvement intervention. However, clinical translational research using SPIPP 2.0 evidence-based guidelines for early PI prevention has not been reported. In the future, evidence-based evidence can be translated based on implementation science, which is expected to make the complex HAPI prevention and control process clear and implementable, thereby improving implementation quality and safety.\u003c/p\u003e\u003cp\u003eIn addition, this study found that although there was no significant difference in department centrality, the synergistic effect of lack of knowledge and malpractice of chaperones may be a key driver of the difference in risk of HAPI between ICUs and internal medicine departments, this may be because the study results were influenced by the flexible visitation policies for caregivers entering the ICU, where chaperones have no access to both immediate education on scenarios and lack of knowledge on PIs. Scenario-based education and lack of visualization of the mechanisms of PI occurrence and skin care essentials are also the primary barriers to subsequent malpractice [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e], which suggests that \"knowledge-operation\" miscoupling after an interdepartmental handover will increase the risk of PI occurrence [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e], and providing structured PI prevention education to chaperones at the ICU transfer node is a powerful risk-reduction initiative [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e], to compensate for the educational disconnect that occurs with the unaccompanied care system.\u003c/p\u003e\u003cp\u003eThis study has several limitations. First, data collection in this study relied on voluntary reporting. HAPI has been included in the National Healthcare Safety Nursing Specialty Quality Control Work Improvement Objectives, which is one of the most important indicators of safety and quality of care in hospitals, but there may still be underreporting. Second, the root cause analysis was organized and filled out by the head nurse of the unit in which the person involved in the incident was located, which may lead to inconsistency in the classification of patient information accompanied by a certain subjective attributional bias due to the differences in work experience and professional background of those who filled it out. Third, the data in this study came from a multicenter sample in a particular province, which may not be fully representative of the overall situation of healthcare organizations across the country, despite covering different levels and types of hospitals. In the future, the data can be analyzed in conjunction with nationwide data to improve the extrapolation and persuasiveness of the results.\u003c/p\u003e"},{"header":"5. Conclusions","content":"\u003cp\u003eThis study, the first to apply network analysis to hospital-acquired pressure injuries using multidimensional real-world data, demonstrated that HAPI is the result of interactions across patient, nurse, environment, equipment, system, process, and caregiver domains. Five core nodes were identified: improper use of pressure-relieving devices, caregiver lack of prevention knowledge, inappropriate skin care protocols, ineffective daily monitoring, and insufficient nurse knowledge. Inadequate unit-based training emerged as the most influential bridging factor, linking multiple domains and propagating risk across the network. These findings underscore the central role of nurse- and caregiver-related factors in HAPI occurrence. Future interventions should focus on strengthening guideline-based practice, standardizing care processes, enhancing training and education, and improving caregiver engagement to reduce HAPI incidence and achieve consistent quality of care.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was supported by Joint Funds for the Open Research Projects of the Fujian Provincial Key Laboratory for Research on Difficult and Critical Diseases (No. KLKF202401). The funding agency had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone.\u003c/p\u003e\n\u003cp\u003eEthics approval and consent to participate\u003c/p\u003e\n\u003cp\u003eThis study was conducted in accordance with the ethical principles outlined in the Declaration of Helsinki. The need for formal ethical approval was waived by the Ethics Committee of Fujian Provincial Hospital, as the study protocol met the criteria for exemption. Written informed consent was obtained from all participants after the nature and purpose of the study had been fully explained.\u003c/p\u003e\n\u003cp\u003eConsent for publication:\u003c/p\u003e\n\u003cp\u003eAll authors mentioned above have granted final approval for the submitted version.\u003c/p\u003e\n\u003cp\u003eClinical Trial Number\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003eData avaliability\u003c/p\u003e\n\u003cp\u003eThe datasets used and analysed during the current study are available from the corresponding author on reasonable request. However, their availability is subject to approval by the Fujian Provincial Data Platform for Nursing Quality, as they contain sensitive patient information.\u003c/p\u003e\n\u003cp\u003eMaterials availability\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003eCode availability\u003c/p\u003e\n\u003cp\u003eNone.\u003c/p\u003e\n\u003cp\u003eAuthor contributors:\u003c/p\u003e\n\u003cp\u003eMRC: Methodology, Writing-Original draft preparation, Project administration\u003c/p\u003e\n\u003cp\u003eXHC: Project administration\u003c/p\u003e\n\u003cp\u003eHL, TTW: Conceptualization, Methodology\u003c/p\u003e\n\u003cp\u003eXJ, TTW: Writing-Original draft preparation, Writing - Review \u0026amp; Editing\u003c/p\u003e\n\u003cp\u003eRJL, MY, YL, HWX: Investigation, data analysis and interpretation\u003c/p\u003e\n\u003cp\u003eXLS: Funding Acquisition\u003c/p\u003e\n\u003cp\u003eDeclaration of interests\u003c/p\u003e\n\u003cp\u003e☒ The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003ePuyk KF, Tuck MM, Reeves JA, Digby RL, Shea HE, Bucknall TK. 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WHS guidelines for the treatment of pressure ulcers-2023 update. Wound Repair Regen. 2024;32:6\u0026ndash;33.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGillespie BM, Chaboyer WP, McInnes E, Kent B, Whitty JA, Thalib L. Repositioning for pressure ulcer prevention in adults. Cochrane Database Syst Rev. 2014;2014:CD009958.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWang Xinran F, Jingjing Y, Li. Interpretation of Nursing Measures in the Process Quality Control Toolkit for Preventing Pressure Injuries in Adult ICU Patients [J]. China Health Qual Manage 2025,32(01):61\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBarab\u0026aacute;si A-L, Gulbahce N, Loscalzo J. Network medicine: a network-based approach to human disease. Nat Rev Genet. 2011;12:56\u0026ndash;68.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMcMahon J, McInnes E, Wan CS, Straiton N, Lam L, Rodgers J, et al. 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The effect of case-supported concept map education on nursing students\u0026rsquo; knowledge of and attitudes toward pressure injury prevention. J Tissue Viability. 2025;34:100848.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAquino C, Owen A, Predicce A, Poe S, Kozachik S. Increasing Competence in Pressure Injury Prevention Using Competency-Based Education in Adult Intensive Care Unit. J Nurs Care Qual. 2019;34:312\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHenry M. Nursing Education Program for Hospital-Acquired Pressure Injury Prevention in Adult Acute Care Setting: A Quality Improvement Project. J Wound Ostomy Cont Nurs. 2019;46:161\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHou M, Lu Y, Liu Y, Luo W, Xue H, Yuan H, et al. The impact of virtual reality applied in nurse education on students\u0026rsquo; clinical thinking: A systematic review. Nurse Educ Today. 2025;146:106553.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eJung SY, Moon KJ. Pressure Ulcer Management Virtual Reality Simulation (PU-VRSim) for Novice Nurses: Mixed Methods Study. JMIR Serious Games. 2024;12:e53165.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLin M-Y, Huang M-Z, Lai P-C. Effect of virtual reality training on clinical skills of nursing students: A systematic review and meta-analysis of randomized controlled trials. Nurse Educ Pract. 2024;81:104182.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGillespie BM, Latimer S, Walker RM, McInnes E, Moore Z, Eskes AM, et al. The quality and clinical applicability of recommendations in pressure injury guidelines: A systematic review of clinical practice guidelines. Int J Nurs Stud. 2021;115:103857.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCao S, Gu M, Feng M, Jia Y, Zhao Y, Chen S, et al. Implementation of evidence in preventing medical device-related pressure injury in ICU patients using the i-PARIHS framework. J Nurs Manag. 2022;30:318\u0026ndash;27.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eChaboyer W, Latimer S, Priyadarshani U, Harbeck E, Patton D, Sim J, et al. The effect of pressure injury prevention care bundles on pressure injuries in hospital patients: A complex intervention systematic review and meta-analysis. Int J Nurs Stud. 2024;155:104768.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBerenholtz SM, Pham JC, Thompson DA, Needham DM, Lubomski LH, Hyzy RC, et al. Collaborative cohort study of an intervention to reduce ventilator-associated pneumonia in the intensive care unit. Infect Control Hosp Epidemiol. 2011;32:305\u0026ndash;14.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePronovost PJ, Goeschel CA, Colantuoni E, Watson S, Lubomski LH, Berenholtz SM, et al. Sustaining reductions in catheter related bloodstream infections in Michigan intensive care units: observational study. BMJ. 2010;340:c309.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePittman J, Black JM, de Jesus A, Padula WV. The Standardized Pressure Injury Prevention Protocol (SPIPP) Checklist 2.0: Content validation. J Adv Nurs. 2024;80:2584\u0026ndash;91.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGarc\u0026iacute;a-S\u0026aacute;nchez FJ, Mart\u0026iacute;nez-Vizca\u0026iacute;no V, Rodr\u0026iacute;guez-Mart\u0026iacute;n B. Barriers and facilitators for caregiver involvement in the home care of people with pressure injuries: A qualitative study. PLoS ONE. 2019;14:e0226359.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eJafari M, Nassehi A, Rafiei H, Taqavi S, Karimi Y, Bardsiri TI, et al. Pressure Injury Prevention Knowledge Among Family Caregivers of Patients Needing Home Care. Home Healthc Now. 2021;39:203\u0026ndash;10.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSim W, Clara Michelle THS, Lim NQBI, Loh V, Chua CWX, Er J, et al. Why do pressure injuries still occur? A multicenter qualitative study of nurses and caregivers. JAAD Int. 2024;17:29\u0026ndash;36.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDavidson JE, Aslakson RA, Long AC, Puntillo KA, Kross EK, Hart J, et al. Guidelines for Family-Centered Care in the Neonatal, Pediatric, and Adult ICU. Crit Care Med. 2017;45:103\u0026ndash;28.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-nursing","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurs","sideBox":"Learn more about [BMC Nursing](http://bmcnurs.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurs/default.aspx","title":"BMC Nursing","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Hospital-acquired Pressure Injury, Root Cause Analysis, Network Analysis, Central Node, Bridging Variable","lastPublishedDoi":"10.21203/rs.3.rs-7852909/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7852909/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjective\u003c/h2\u003e\u003cp\u003eThe objective of this study was to identify core factors and bridging nodes associated with hospital-acquired pressure injuries (HAPI) and to compare network structures across departments.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eA secondary analysis was conducted on 4,770 HAPI cases from 159 hospitals in Fujian Province (2016\u0026ndash;2025). Root causes were categorized into seven dimensions: patient, nurse, environment, equipment/materials, system, procedure, and caregiver. Network analysis identified central and bridging nodes, assessed stability, and compared departmental structures.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eThe median patient age was 69 years, and 69.0% were male. Most cases occurred in internal medicine (30.5%), surgery (26.1%), and ICU (22.9%). The sacrococcygeal region was the most common site (56.6%), with Stage II injuries predominating (68.6%). \"Improper use of pressure-relieving devices\" was the most central node, followed by \"caregiver knowledge deficits,\" \"inappropriate skin care protocols,\" \"ineffective daily monitoring,\" and \"insufficient nurse knowledge.\" Key bridging nodes were \"inadequate unit-based training\" and \"absence of standardized skin care protocol,\" which connected multiple dimensions. The network was stable (CS\u0026thinsp;=\u0026thinsp;0.595), with no overall structural differences across departments.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eHAPI arises from multidimensional interactions, with nurse-related factors being dominant. Deficiencies in training and standardized protocols are critical bridging factors, highlighting them as primary targets for prevention.\u003c/p\u003e","manuscriptTitle":"Network analysis of Root Causes of Hospital-Acquired Pressure Injuries in Hospitalized Patients","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-02 14:24:23","doi":"10.21203/rs.3.rs-7852909/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2025-12-11T11:22:46+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"135275586994625899830251266508934841215","date":"2025-12-04T14:04:43+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-01T15:52:33+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"162941595000336839603650618462698586698","date":"2025-12-01T15:18:57+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-11-27T11:32:15+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-11-03T08:40:17+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-10-22T12:30:45+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-10-22T12:29:35+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Nursing","date":"2025-10-14T01:10:25+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-nursing","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurs","sideBox":"Learn more about [BMC Nursing](http://bmcnurs.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurs/default.aspx","title":"BMC Nursing","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"3faebbc0-9838-494f-9f65-9c6f851435b7","owner":[],"postedDate":"December 2nd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-12-02T14:24:23+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-02 14:24:23","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7852909","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7852909","identity":"rs-7852909","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}