Abstract
Objective
To identify the long-term clinical, individual, and social risk factors for the development
of pressure ulcers (PUs) in traumatic spinal cord–injured persons with tetraplegia
(TSCIt).
Design
Cohort survey with self-applied questionnaires in 1995 and 2006.
Setting
Thirty-five French-speaking European physical medicine and rehabilitation centers
participating in the Tetrafigap surveys.
Participants
Tetraplegic adults (N=1641) were surveyed after an initial posttraumatic period of
at least 2 years. Eleven years later, a follow-up was done for 1327 TSCIt, among whom
221 had died and 547 could be surveyed again.
Interventions
Not applicable.
Main Outcome Measures
The proportion of PUs documented at the various defined time points, relative to the
medical and social situations of the TSCIt, by using univariate analyses followed
by logistic regression.
Results
Of the participants, 73.4% presented with a PU during at least 1 period after their
injury. Four factors had an effect on the occurrence of PUs in the long-term. Protective
features for this population were incomplete motor impairment (odds ratio, 0.5) and
the ability to walk (odds ratio, 0.2), whereas a strong predictive factor was the
development of a PU during the initial posttrauma phase (odds ratio, 2.7). Finally,
a significant situational factor was the lack of a social network (odds ratio, 3.1).
Conclusions
We believe that the highlighting of a motor incomplete feature of SCI (protective
against the development of a PU) and of a medical risk factor, an early PU (which
served as a definitive marker of the trajectory of TSCIt), together with a social
situational factor, indicates the crucial role of initial management and long-term
follow-up.
Keywords
List of abbreviations:
AIS (American Spinal Injury Association Impairment Scale), PU (pressure ulcer), RF (risk factor), SCI (spinal cord injury), TSCIt (traumatic spinal cord–injured persons with tetraplegia)To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Archives of Physical Medicine and RehabilitationAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- International classification of functioning, disability and health: ICF.World Health Organization, Geneva2001
- Secondary impairments after spinal cord injury: a population-based study.Am J Phys Med Rehabil. 2000; 79: 526-535
- Etiology and incidence of rehospitalization after traumatic spinal cord injury: a multicenter analysis.Arch Phys Med Rehabil. 2004; 85: 1757-1763
- International perspectives on spinal cord injury.World Health Organization, Geneva2013
- The Rick Hansen Spinal Cord Injury Registry (RHSCIR): a national patient-registry.Spinal Cord. 2012; 50: 22-27
- History, implementation, and current status of the National Spinal Cord Injury Database.Arch Phys Med Rehabil. 1999; 80: 1365-1371
- Overview of the National Spinal Cord Injury Statistical Center Database.J Spinal Cord Med. 2002; 25: 335-338
- PU prevalence in people with spinal cord injury: age-period-duration effects.Arch Phys Med Rehabil. 2005; 86: 1208-1213
- Sepsis of the hip due to pressure ulcer in spinal cord injured patients: advocacy for a one stage procedure.Spinal Cord. 2015; 53: 226-231
- Major risk factors for PUs in the spinal cord disabled: a literature review.Spinal Cord. 1996; 34: 255-263
- Prevention and treatment of pressure ulcers: clinical practice guideline.NPUAP, Washington (DC)2009
- Toward standardized reporting for a cohort study on functioning: the Swiss Spinal Cord Injury Cohort Study.J Rehabil Med. 2016; 48: 189-196
- Health conditions in people with spinal cord injury: contemporary evidence from a population-based community survey in Switzerland.J Rehabil Med. 2016; 48: 197-209
- Complications following spinal cord injury: occurrence and risk factors in a longitudinal study during and after inpatient rehabilitation.J Rehabil Med. 2007; 39: 393-398
- Predictors of pressure ulcer recurrence in veterans with spinal cord injury.J Spinal Cord Med. 2008; 31: 551-559
- Incidence, prevalence and epidemiology of spinal cord injury: what learns a worldwide literature survey?.Spinal Cord. 2006; 44: 523-529
- Epidemiology of traumatic spinal cord injury: trends and future implications.Spinal Cord. 2012; 50: 365-372
- The Tetrafigap Survey on the long-term outcome of tetraplegic spinal cord injured individuals. Part I: protocol and methodology.Spinal Cord. 1998; 36: 117-124
- Predictive factors of long-term mortality of persons with tetraplegic spinal cord injury: an 11-year French prospective study.Spinal Cord. 2011; 49: 728-735
- PU risk factors in persons with SCI. Part I: acute and rehabilitation stages.Spinal Cord. 2009; 47: 99-107
- Skin ulcers after spinal cord injury: relationship to life adjustment.Spinal Cord. 1998; 36: 51-56
- Occurrence and predictors of PUs during primary in-patient spinal cord injury rehabilitation.Spinal Cord. 2011; 49: 106-112
- The Tetrafigap Survey on the long-term outcome of tetraplegic spinal cord injured persons. Part III: medical complications and associated factors.Spinal Cord. 2002; 40: 457-467
- PU risk factors in persons with spinal cord injury part 2: the chronic stage.Spinal Cord. 2009; 47: 651-661
- Medical complications during acute rehabilitation following spinal cord injury: current experience of the Model Systems.Arch Phys Med Rehabil. 1999; 80: 1397-1401
- Prevalence, location, grade of PUs and association with specific patient characteristics in adult spinal cord injury patients during the hospital stay: a prospective cohort study.Spinal Cord. 2013; 51: 828-833
- Patterns of morbidity and rehospitalisation following spinal cord injury.Spinal Cord. 2004; 42: 359-367
- Rehospitalization in the first year of traumatic spinal cord injury after discharge from medical rehabilitation.Arch Phys Med Rehabil. 2013; 94: S87-S97
- PU risk in spinal cord injury: predictors of ulcer status over 3 years.Arch Phys Med Rehabil. 2000; 81: 465-471
- An analysis of the diverse factors concerned with the development of pressure ulcers in spinal cord injured patients.Paraplegia. 1991; 29: 261-267
- PUs in community-resident persons with spinal cord injury: prevalence and risk factors.Arch Phys Med Rehabil. 1993; 74: 1172-1177
- Long-term medical complications after traumatic spinal cord injury: a regional model systems analysis.Arch Phys Med Rehabil. 1999; 80: 1402-1410
- Patient risk factors for pressure ulcer development: systematic review.Int J Nurs Stud. 2013; 50: 974-1003
- A systematic review of risk factors for the development and recurrence of pressure ulcers in people with spinal cord injuries.Spinal Cord. 2013; 51: 522-527
- Aging with spinal cord injury: cross-sectional and longitudinal effects.Spinal Cord. 2001; 39: 301-309
- Spinal cord injury medicine. 4. Community reintegration after spinal cord injury.Arch Phys Med Rehabil. 2007; 88: S71-S75
- Evaluating your PU prevention plan: a problem-solving worksheet for people with spinal cord injury and their health care providers.Arch Phys Med Rehabil. 2015; 96: 2089-2090
- Prevalence and incidence of pressure sores in acute spinal cord injuries.Paraplegia. 1981; 19: 235-247
- Sir Ludwig Guttmann Lecture: trends in spinal cord injury rehabilitation outcomes from model systems in the United States: 1973-2006.Spinal Cord. 2007; 45: 713-721
- Networks for SCI healthcare professionals.Spinal Cord. 2014; 52: 577
- Spinal injury centres (SICs) for acute traumatic spinal cord injury.Cochrane Database Syst Rev. 2004; : CD004442
- Patterns of recurrent pressure ulcers after spinal cord injury: identification of risk and protective factors 5 or more years after onset.Arch Phys Med Rehabil. 2004; 85: 1257-1264
Article info
Publication history
Published online: January 24, 2017
Footnotes
Disclosures: none.
Identification
Copyright
© 2017 by the American Congress of Rehabilitation Medicine
