Characteristics of Recurrent Pressure Ulcers in Veterans With Spinal Cord Injury

Abstract

Background/Objective: To describe characteristics of recurrent pressure ulcers (PrUs) in veterans with spinal cord injury (SCI). Design: Descriptive, cohort study. Settings and Participants: Twenty-four veterans with SCI from 6 SCI centers in the Department of Veterans Affairs. Methods: Data from a prospective study evaluating PrUs were analyzed for 24 veterans with 29 recurrent PrUs during 9 months. Additional retrospective medical record data were analyzed for 15 veterans who received inpatient treatment. Results: Participants were male, 50% non-Hispanic white, with paraplegia (63%), complete SCI (83%), a mean age of 56 years, and mean time since SCI of 21 years. Most PrUs recurred (63%, n ¼ 15 patients) in the same location as the most recent ulcer and at the ischial tuberosities (63%). Mean time to recurrence was 16.6 weeks. PrUs were stage III (28%, n ¼ 8) or IV (45%, n ¼ 13) with undermining (48%), necrotic slough (50%), and minimal exudate. One third were (n ¼ 9) larger than 16 cm 2. Mean Bates-Jensen Wound Assessment Tool Score was 33.63. Inpatient medical record data (n ¼ 15) showed 73% with documentation indicating infection treated with antibiotics (53%, n ¼ 8 patients), osteomyelitis (47%, n ¼ 7), and/or cellulitis (13%, n ¼ 2) noted. Plastic surgery consultation was obtained for 67% with surgery as an option for 73% (1 without consultation). Scheduled repositioning was documented for 21%. Conclusions: Most PrUs were severe, located at the same anatomic site, and recurred within 4 months, suggesting that the recurrent ulcers were more likely incomplete healing of the initial PrUs. This sample of veterans with SCI provides early data on recurrent PrU characteristics.

Risk Profile Characteristics Associated With Outcomes of Hospital-Acquired Pressure Ulcers: A Retrospective Review

“…(Critical Care Nurse. 2011;31 [4]: [30][31][32][33][34][35][36][37][38][39][40][41][42][43] 2008, the Centers for Medicare and Medicaid Services implemented a 0% complication rate for a number of clinical diagnoses, one of which is a stage III or IV pressure ulcer acquired during a hospitalization. 12 Consequently, hospitals are not reimbursed for the care, services, or resources associated with such a HAPU.…”

Interdisciplinary development of an ergonomic prone mobility cart

“…Pressure ulcers frequently occur in the setting of spinal cord injury (SCI) [1][2][3] and can decrease quality of life, lengthen hospitalization, increase care requirements, and lead to subsequent medical complications [4][5][6][7]. A key component of managing pressure ulcers is reducing pressure in the region of the wound [8], which can involve decreased or eliminated sitting time in ischial and sacral ulcers; however, prolonged bedrest can lead to deconditioning, respiratory compromise, and significant psychosocial impact [5].…”

A computational, tissue-realistic model of pressure ulcer formation in individuals with spinal cord injury

“…They are a significant source of morbidity in both hospitalized patients and communitydwelling individuals with impaired mobility. PUs are especially common in individuals with spinal cord injury (SCI), occurring in up to 80% of this population at some point during their lifetime [2]. Spinal cord injury is a condition associated with decreased functional mobility, acutely increased oxidative activity in leukocytes, and chronic elevation of systemic inflammatory markers [3][4][5].…”