Pressure ulcer risk factors in persons with SCI: part I: acute and rehabilitation stages

Gélis, Anthony; Dupeyron, Arnaud; Legros, Patrick; Benaïm, Charles; Pélissier, J.; Fattal, Charles

doi:10.1038/sc.2008.107

Cited by 61 publications

(47 citation statements)

References 46 publications

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“…Contrary to the risk factors found in the acute stage of SCI patients' care, 9 the risk factors for chronic SCI patients are quite numerous and depend for the major part on the socio-demographic, medical, neurological, cutaneous or behavioral characteristics of the patients. The results from the epidemiological studies are similar for most of the risk factors found in our review.…”

Section: Discussionmentioning

confidence: 95%

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Pressure ulcer risk factors in persons with spinal cord injury Part 2: the chronic stage

Gélis

Dupeyron

Legros³

et al. 2009

Spinal Cord

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111

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Introduction: Pressure ulcers (PUs) are a common complication following spinal cord injury (SCI). Prevalence for persons in the chronic SCI stage varies between 15 and 30%. The risk assessment scales used nowadays were designed on pathophysiological concepts and are not SCI-specific. Recently, an epidemiological approach to PU risk factors has been proposed for designing an SCI-specific assessment tool. The first results seem quite disappointing, probably because of the level of evidence of the risk factors used. Objective: To determine PU risk factors correlated to the chronic stage of SCI. Materials and methods: Systematic review of the literature. Results: There are several PU risk factors for chronic SCI stage: socio-demographics, neurological, medical or behavioral. The level of evidence varies: it is quite high for the socio-demographics and neurological factors and low for behavioral factors. Discussion and conclusion: Behavioral risk factors (relieving the pressure, careful skin monitoring, smoking) are probably the ones for which a preventive strategy can be established. It is important to develop specific assessment tools for these behavioral risk factors to determine their relevance and evaluate the effect of therapeutic educational programs on persons with SCI.

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Section: Discussionmentioning

confidence: 95%

“…9 The risk factors for acute SCI patients are essentially linked to the care management and duration of hospitalization stays. Clinical factors do not seem to have an effect.…”

mentioning

confidence: 99%

Pressure ulcer risk factors in persons with spinal cord injury Part 2: the chronic stage

Gélis

Dupeyron

Legros³

et al. 2009

Spinal Cord

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111

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“…10 A recent review found no studies on risk factors for pressure ulcers during the initial rehabilitation phase in a homogeneous SCI population. 11 Two rehabilitation studies were identified in this review, but both studies included patients in initial rehabilitation as well as re-hospitalized patients. The occurrence and risk factors for pressure ulcers during initial in-patient rehabilitation of SCI patients is therefore still unclear.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2010

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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.

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“…7 Despite the implementation of these strategies, PUs were still not eradicated. Studies in the United States and Europe identified risk factors for PUs in SCI; [8][9][10][11] however, the identification of risk factors for the local context is lacking.…”

Section: Introductionmentioning

confidence: 99%

Prevalence of secondary medical complications and risk factors for pressure ulcers after traumatic spinal cord injury during acute care in South Africa

Joseph

Wikmar

2015

Spinal Cord

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Study Design: Prospective, population-based cohort study. Objectives: To determine the prevalence of selected complications following traumatic spinal cord injury during acute care and to identify the risk factors for pressure ulcers. Setting: The only tertiary academic (Groote Schuur) hospital in the catchment region providing specialised acute care. Methods: A descriptive, observational study of an inception cohort. Secondary complications were predefined and consisted of pressure ulcers, pulmonary complications (pneumonia and atelectasis), urinary tract infections, autonomic dysreflexia, deep vein thrombosis, pulmonary embolism, postural hypotension, neuropathic pain and spasticity. Possible risk factors for pressure ulcers included variables concerning demographic and injury characteristics and complications. Both univariate and multivariate logistic regression analyses were used. Results: Data of 141 patients (97%) were analysed. In total, 71 (50.3%) patients had one or more complication. The most common was pressure ulcers (n = 42; 29.8%), followed by pulmonary complications (n = 33; 23.4%) and urinary tract infections (n = 24; 17%). Significant risk factors were gun-shot injury, motor completeness (American Spinal Injury Association Impairment Scale (AIS) A│B), vertebral injury, no spinal surgery, pulmonary complications, urinary tract infection and level of consciousness. In the final multivariate model that correctly predicted 81.6% of subjects, motor completeness and vertebral injury remained significant independent factors, whereas having a urinary tract infection was associated with an increased risk (odds ratio: 2.86), but not significant at the 5% level. Conclusion: Pressure ulcers and pulmonary complications were prevalent during specialised acute phase. The occurrence of pressure ulcers, despite protocols in place, is worrisome. To prevent pressure ulcers, special attention seems necessary for persons with motor complete lesions and those with vertebral injuries.

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Pressure ulcer risk factors in persons with SCI: part I: acute and rehabilitation stages

Cited by 61 publications

References 46 publications

Pressure ulcer risk factors in persons with spinal cord injury Part 2: the chronic stage

Pressure ulcer risk factors in persons with spinal cord injury Part 2: the chronic stage

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

Prevalence of secondary medical complications and risk factors for pressure ulcers after traumatic spinal cord injury during acute care in South Africa

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