Occurrence and predictors of pressure ulcers during primary in-patient spinal cord injury rehabilitation

Abstract

Study design: Multicenter prospective cohort study. Objectives: To determine the occurrence and predictors for pressure ulcers in patients with spinal cord injury (SCI) during primary in-patient rehabilitation. Setting: Eight Dutch rehabilitation centres with specialized SCI units. Methods: The occurrence, location and stage of pressure ulcers were registered between admission and start of functional rehabilitation (called acute rehabilitation phase) and between start of functional rehabilitation and discharge. Possible risk factors for the occurrence of pressure ulcers during functional rehabilitation (personal and lesion characteristics, complications and functional independence) were measured at the start of functional rehabilitation and were entered as predictors in univariate and multivariate logistic regression analysis with pressure ulcers during functional rehabilitation as the dependent variable. Results: Data for 193 patients (86%) were available. The occurrence of pressure ulcers, including stage 1, was 36.5% during acute rehabilitation phase and 39.4% during functional rehabilitation. Most pressure ulcers were located at the sacrum (43%), followed by heel (19%) and ischium (15%). The significant risk factors for pressure ulcers during functional rehabilitation were motor completeness of the lesion, tetraplegia, pressure ulcer during acute rehabilitation phase, pneumonia and/or pulmonary disease, low score on the Functional Independence Measure (FIM) self-care, continence, transfers, locomotion and total FIM motor score. Having had a pressure ulcer during acute rehabilitation phase was the strongest risk factor. Conclusion: The occurrence of pressure ulcers was comparable with other studies. A few significant risk factors were found, of which having had a pressure ulcer during acute rehabilitation phase being the strongest predictor.

Hospital-acquired pressure ulcers in spinal cord injured patients: time to occur, time until closure and risk factors

“…21 Several studies have tried to give an overview about the circumstances when HAPUs occur 1,3 by doing retrospective analysis over periods of 3 months or divide occurrences in different rehabilitation phases. By knowing and confirming the influence of length of stay, 4,5 our daily-based observations put perspective about the influence of time on the development of HAPU.…”

“…1,3 However, studies in non-SCI patients showed that HAPUs occurred relatively early after admission, varying from 6.2% within 2 days of admission 9 to 12.4% within 7 days on admission to an intensive care unit. 10 On average, less severe HAPUs occurred earlier than severe HAPUs on intensive care units.…”

“…[1][2][3] Although many in-patient prevention concepts have been developed, being admitted to a hospital or rehabilitation centre is still a risk factor for hospital-acquired pressure ulcers (HAPUs). 4 HAPUs are associated with high hospital costs because of prolonged hospital stay 5 and need for additional materials and nursing time.…”

Secondary complications and associated injuries in traumatic and non-traumatic spinal cord injury patients

“…Previous studies have investigated complications following SCI and their risk factors. They have illustrated the association between subject and lesion characteristics and the occurrence of complications (8,9).…”

Analysis of the factor infulencing functional outcomes in patients with spinal cord injury

“…Проценат декубиталних улкуса је био 36.5% са најчешћом локализацијом на сакруму (43%), петама (19%) и исхијуму (15%). Резултати осталих студија који су се бавили локализацијом декубиталних улкуса наводе: сакрум, исхијум и пете [107][108][109]. Овакви резултати су у корелацији са нашим резултатима.…”