Wound care challenges in children and adults with spina bifida: An open-cohort study

Abstract

Skin breakdown is a frequent concern for individuals with spina bifida. We explored wound incidence in patients with spina bifida and how it varies across a person's life span and functional neurologic level. We examined the settings in which skin breakdown most commonly occurred, looking for evidence of chronic, non-healing wounds. We also sought to develop criteria to improve wound monitoring. We identified reported wound episodes in an open-cohort study over a 13-year period, examining the hospital and outpatient clinical records of spina bifida patients at Children's National Medical Center (CNMC). Current age, age at wound presentation, sex, weight, functional neurologic level, wound location, setting in which the wound was acquired, the development of a chronic wound, and presence of a shunt were recorded. Of the 376 patients in our clinical population, 123 (average age: 18.8 years, range: infancy-56 years) developed a total of 375 wounds; the majority of patients who developed one wound went on to develop one or more additional wounds, and 20 patients developed chronic wounds. Our data suggest that age bracket (adolescents), wheelchair use, and bare feet, as well as possibly obesity and reduced executive functioning, are key risk factors for wound development. These findings have led to a focused effort to increase wound education and prevention. In addition we report on our early experience using a wound care specialist to champion this initiative.

Factors Associated With Pressure Ulcers in Individuals With Spina Bifida

“…Pressure ulcers were more common in individuals with a higher level of lesions in the study, which is consistent with the findings of Ottolini et al 13 In general, higher lesion levels are generally associated with higher degrees of paralysis and sensory loss, which may explain the higher rates of pressure ulcers. Wheelchair use was also associated with ulcers, which is not surprising because prolonged sitting and immobility may predispose to pressure ulcers.…”

“…Ulcer recurrences were previously found in 53% of individuals with SB. 13 We also did not distinguish between factors related to multiple ulcers. We expect that future studies with more (longitudinal) data will address these issues better.…”

“…After neurological surgeries, we found that ulcers were more likely to occur in the shunted group. 13 Bladder incontinence was another factor associated with ulcers, whereas bowel incontinence was not. Work by others has suggested that urinary incontinence may be a more accurate predictor than fecal incontinence in individuals with spinal cord injury, 22,23 and it has been well demonstrated that incontinence and moisture are strongly associated with pressure ulcers.…”

“…A recent cohort study over a 13-year period found that age, wheelchair use, bare feet, obesity, and reduced executive functioning are key risk factors for wound development. 13 Another small questionnaire-based study of 87 adults with myelomeningocele showed a higher prevalence of pressure ulcers in individuals with memory deficits, Chiari II malformation, and sensory deficit. 14 For young adults with myelomeningocele, the number of ulcers has also been found to be associated with motor and educational level.…”

Reflections on Health of Young Adults with Spina Bifida: The Contradictory Path towards Well-Being in Daily Life

“…Often the individuals have a diminished bladder-and/or bowel function that calls for strict adherence to routines for emptying bladder and bowel but also for preventive measures to support a smooth stool and avoid constipation and hygienic handle of urine catheters to avoid urinary tract infections. Most individuals with SB have a diminished bodily sensation and therefore are not able to feel when the skin is at risk for pressure sores [6]. Such sores primarily develop on the individuals' but and feet and are therefore not easy to notice or inspect for the individuals themselves.…”