Treatment approaches of stage III and IV pressure injury in people with spinal cord injury: A scoping review

Fähndrich, Carina; Gemperli, Armin; Baumberger, Michael; Bechtiger, Marco; Roth, Bianca; Schaefer, Dirk J.; Wettstein, Reto; Scheel‐Sailer, Anke

doi:10.1080/10790268.2022.2108645

Cited by 3 publications

(5 citation statements)

References 29 publications

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“…This clinic integrates a plastic surgery team from a nearby university hospital and is specialized in the treatment of PI in patients with SCI using the Basel Decubitus Approach. The Basel Decubitus Approach [26][27][28]34] is based on six main principles: pressure relief (1); debridement (2); treatment of risk factors and comorbidities, (3) such as anemia, renal failure, uncontrolled diabetes, and spasticity; wound conditioning (4), flap surgery (5); and prevention of early postsurgical complications and PI recurrence (6). Some interventions, such as nutritional and psychological counseling, have redefined and integrated into the Basel Decubitus Approach [25,29,30].…”

Section: Settingmentioning

confidence: 99%

“…Internationally, it is accepted that stage III/IV PIs require flap reconstruction [17,19,22], postsurgical immobilization, and antibiotic therapy [23]. Because complications during early postsurgical treatment occur more often in patients with a high-risk profile, individual risk analyses are recommended, such as malnutrition screening, as well as the diagnosis and treatment of comorbidities [19,[24][25][26].…”

Section: Introductionmentioning

confidence: 99%

“…The Basel Decubitus Approach is a set of principles for the treatment of PIs that has been developed over the past few decades. It includes different therapeutic elements, such as pressure relief; debridement; treatment of risk factors, such as anemia, renal failure, uncontrolled diabetes, and spasticity; flap surgery; prevention of early postsurgical complications and PI recurrence; transfer training; and re-evaluation of assistive devices [21,[25][26][27][28][29]. Due to the complexity of this treatment approach, its implementation and adherence in the clinical setting have been difficult [18,21,26,28,30].…”

Section: Introductionmentioning

confidence: 99%

“…It includes different therapeutic elements, such as pressure relief; debridement; treatment of risk factors, such as anemia, renal failure, uncontrolled diabetes, and spasticity; flap surgery; prevention of early postsurgical complications and PI recurrence; transfer training; and re-evaluation of assistive devices [21,[25][26][27][28][29]. Due to the complexity of this treatment approach, its implementation and adherence in the clinical setting have been difficult [18,21,26,28,30]. We hypothesized that a CDSS would support process management, thus increasing adherence to the Basel Decubitus Approach and improving the quality of treatment for patients with SCI and stage III and IV PIs by reducing complications, shortening the length of stay, and improving secondary prevention strategies [31].…”

Section: Introductionmentioning

confidence: 99%

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Effect of a computerized decision support system on the treatment approach of stage III or IV pressure injury in patients with spinal cord injury: a feasibility study

Scheel‐Sailer

Koligi

Lampart

et al. 2023

BMC Health Serv Res

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Background Stage III and IV pressure injuries (PIs) in patients with spinal cord injury (SCI) require complex interdisciplinary and interprofessional treatment approaches that are difficult to implement. Practical aspects, such as information exchange and coordination, remain challenging. We investigated whether a computerized decision support system (CDSS) could increase treatment adherence and improve clinical outcomes and interprofessional collaboration. Method In this feasibility study, a core team developed the initial treatment process and adapted it based on several discussions with clinical experts and information technologists. The CDSS followed the Basel Decubitus Approach and was used in a clinic specializing in SCI. Thirty patients with SCI admitted for stage III/IV PI between July 2016 and May 2017 were randomly allocated to standard or CDSS-supported care. Between-group differences in treatment adherence, complication rates, length of stay, and costs were analyzed using descriptive statistics. The use of the CDSS and potential barriers and facilitators were evaluated through interprofessional focus groups, transcribed verbatim, and thematically analyzed (30 participants). Results No differences in SCI characteristics, comorbidities, or PI characteristics (localization: ischium [number (n) = 19 PI, 63%], sacrum [n = 10 PI, 33%], recurrent PI [n = 21, 70%]) were found between the two groups. Furthermore, no statistically significant differences were observed in treatment adherence, frequency of major (20% vs. 13% between CDSS and control group) and minor (33% vs 27%) complications, and length of stay (98 [±28] vs 81 [±23] days). Healthcare professionals found the CDSS to be helpful for visualizing the treatment process. However, the high workload and difficulties in the information technology processes, such as missing reminders, slow computer performance and data processing, and poor accessibility, hindered the effective implementation of the CDSS. Conclusion The implementation of the CDSS to support the treatment of stage III/IV PI in patients with SCI was feasible and included definitions of milestones, interventions, and outcomes. However, to assess the impact of the CDSS, a longer observation period is required. Further, the technical difficulties must be addressed, and solid integration of the CDSS into the clinical information system is necessary. Trial Registration This quality improvement project received a declaration of no objection from the Ethics Committee of Northwest and Central Switzerland (EKNZ UBE-16/003), and ethical approval was received for the focus groups (EKNZ Req-2017-00860).

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Section: Settingmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Effect of a computerized decision support system on the treatment approach of stage III or IV pressure injury in patients with spinal cord injury: a feasibility study

Scheel‐Sailer

Koligi

Lampart

et al. 2023

BMC Health Serv Res

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“…Therefore, treatment and management of PI require complex interdisciplinary approach, encompassing reduction of pressure on the skin, necrotic tissue debridement, wound cleansing, managing bacterial load and colonization, and wound dressing selection. [10][11][12] For deep PI (grade III and IV) surgical intervention includes fasciocutaneous and occasionally musculocutaneous flaps, skin grafts, and rarely direct closure. 13 However, complications after PI surgery are frequent, prolonging patient isolation from social and work environments, and substantially inflating healthcare costs.…”

Section: Introductionmentioning

confidence: 99%

Advancements in cell-based therapies for the treatment of pressure injuries: A systematic review of interventional studies

Camesi,

Wettstein,

Valido

et al. 2023

J Tissue Eng

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The high recurrence and complications associated with severe pressure injuries (PI) necessitate the exploration of advanced treatments, such as cell-based therapies, to facilitate wound healing. Such techniques harness the ability of different cell types to promote angiogenesis, re-epithelialization of the skin, and tissue regeneration. This systematic review explores the efficacy of cell-based therapies and tissue engineering in treating deep PI. We searched for interventional studies using cells in the treatment of PI in adults in four online libraries (PubMed, Embase, Ovid Medline, and Cochrane; latest search 10th June 2023). We found one randomized clinical trial (RCT), two non-RCT, and three pre-post studies, comprising 481 study participants with PI (253 intervention/228 controls). The risk of bias was categorized as moderate due to minimal bias in outcome measurements, or high owing to unclear patient randomization methods, as assessed by the ROBINS-I, NIH, and RoB-2 tools. Four cell types were identified in the context of cell-based therapies of PI: bone marrow mononuclear stem cells (BM-MNCs, n = 2); hematopoietic derived stem cells (HSC, n = 1); macrophages and activated macrophage suspensions (AMS, n = 2); and cryopreserved placental membrane containing viable cells (vCPM, n = 1). Wound healing outcomes were observed in patients undergoing cell-based therapies, including complete wound closure (AMS, vCPM; n = 142), faster healing rate (BM-MNCs, AMS; n = 146), improved granulation tissue formation (HSC, n = 3) and shorter hospitalization time (BM-MNCs; n = 108) compared to standard of care, with no adverse reactions. PI healing rate decreased only in one study with BM-MNC therapy, compared to control ( n = 86). Based on the available data, though with limited evidence, it seems that macrophage deployment showed the most favorable outcomes. The results indicate that cell-based therapies offer a potential avenue for enhancing wound healing and tissue repair in PI; however, more extensive research is needed in this domain.

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Risk factors of major complications after flap surgery in the treatment of stage III and IV pressure injury in people with spinal cord injury/disorder: a retrospective cohort study

Fähndrich,

Gemperli,

Baumberger

et al. 2023

Spinal Cord

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Study design Retrospective cohort study. Objectives To identify risk factors associated with major complications after flap surgery in people with spinal cord injury or disorder (SCI/D) and stage III and IV pressure injury (PI). Setting Swiss hospital specialized in the treatment of people with SCI/D using the Basel Decubitus Approach. Methods We examined 60 risk factors for major postoperative complications in PIs over sacrum/coccyx, ischium or trochanter between 01/2016 and 12/2021. We performed descriptive analysis and computed global p-values using likelihood ratio tests adjusted for clustering of PIs in individuals. Results We included 220 PI treatment procedure from 149 individuals. The study population consisted of 163 (74%) men, 133 (60%) traumatic SCI, 136 (58%) stage IV PI, 198 (90%) individuals with paraplegia, 93 (42%) with osteomyelitis, and 85 (39%) with recurrent PI. Major complications 42 (19%) occurred more often in individuals with stage IV PI (p < 0.01), individuals without osteomyelitis (p < 0.03), and individuals with pathological blood concentrations of cystatin c (p < 0.028), calcium (p < 0.048), and vitamin B12 (p < 0.0049) as well as normal blood concentrations of HbA1c (p < 0.033). Immobilization (p < 0.0089) and hospital stay (p < 0.0001) of individuals with major complications was longer. Conclusion In the Basel Decubitus Approach, stage IV PI, absence of osteomyelitis, reduced vitamin B12 and calcium, elevated cystatin c, and normal HbA1c should be addressed to reduce major complications.

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Treatment approaches of stage III and IV pressure injury in people with spinal cord injury: A scoping review

Cited by 3 publications

References 29 publications

Effect of a computerized decision support system on the treatment approach of stage III or IV pressure injury in patients with spinal cord injury: a feasibility study

Effect of a computerized decision support system on the treatment approach of stage III or IV pressure injury in patients with spinal cord injury: a feasibility study

Advancements in cell-based therapies for the treatment of pressure injuries: A systematic review of interventional studies

Risk factors of major complications after flap surgery in the treatment of stage III and IV pressure injury in people with spinal cord injury/disorder: a retrospective cohort study

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