Abstract
Objective
Assess the utility of the admission Spinal Cord Injury Pressure Ulcer Scale (SCIPUS),
Braden Scale, and the FIM for identifying individuals at risk for developing pressure
injury during inpatient spinal cord injury (SCI) rehabilitation.
Design
Retrospective cohort.
Setting
Two tertiary rehabilitation centers.
Participants
Individuals (N=754) participating in inpatient SCI rehabilitation.
Interventions
Not applicable.
Main Outcome Measures
Logistic regression analysis was performed to determine the utility of the SCIPUS,
Braden Scale, and FIM for identifying individuals at risk for developing pressure
injury (PI) during inpatient SCI rehabilitation. Sensitivity, specificity, positive predictive
value, negative predictive value, false negative rate, odds ratio, likelihood ratio,
and area under the curve (AUC) are reported.
Results
The SCIPUS total score and its individual items did not demonstrate acceptable accuracy
(AUC≥0.7) whereas the Braden Scale (0.73) and the FIM score (0.74) did. Once items
were dichotomized into high and low risk categories, 1 Braden item (friction and shear),
5 FIM items (bathing, toileting, bed/chair transfer, tub/shower transfer, toilet transfer),
the FIM transfers subscale, FIM Motor subscale, and the FIM instrument as a whole,
maintained AUCs ≥0.7 and negative predictive values ≥0.95. The FIM bed/chair transfer
score demonstrated the highest likelihood ratio (2.62) and overall was the most promising
measure for determining PI risk.
Conclusion
Study findings suggest that a simple measure of mobility, admission FIM bed/chair
transfer score of 1 (total assist), can identify at-risk individuals with greater
accuracy than both an SCI specific instrument (SCIPUS) and a PI specific instrument
(Braden). The FIM bed/chair transfer score can be readily determined at rehabilitation
admission with minimal administrative and clinical burden.
List of abbreviations:
AUC (area under the curve), IRGLM (Institute of Rehabilitation Gingras-Lindsay-de-Montréal), OR (odds ratio), PI (pressure injury), REB (research ethics board), SCI (spinal cord injury), SCIPUS (Spinal Cord Injury Pressure Ulcer Scale), TRI-UHN (Toronto Rehabilitation Institute--University Health Network)Keywords
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Article info
Publication history
Published online: May 01, 2019
Footnotes
Related data was previously published in Archives of Physical Medicine and Rehabilitation.
Flett HM, Scovil CY, Delparte JJ, Burns AS, Guy K. Predicting pressure ulcer risk during inpatient SCI rehabilitation: comparison of the FIM Motor scale, SCIPUS and Braden risk assessment tools. The 4th ISCoS and ASIA Joint Scientific Meeting. May 14-16 2015, Montreal, Canada.
Flett HM, Delparte JJ, Scovil CY, Guy K, Burns AS. Correlations between Functional Independence Measure and pressure ulcer risk during inpatient spinal cord injury rehabilitation.
Delparte JJ, Scovil CY, Flett HM, Higgins J, Laramee MT, Burns AS. Psychometric properties of the Spinal Cord Injury Pressure Ulcer Scale (SCIPUS) for pressure ulcer risk assessment during inpatient rehabilitation. Arch Phys Med Rehabil 2015;96:1980-5.
Supported by the Rick Hansen Institute, and Ontario Neurotrauma Foundation, and Alberta Paraplegic Association (grant nos. 2010-RHI-ONF-BPI-832 and 2015-RHI-BPI-996).
Identification
Copyright
Crown Copyright © 2019 Published by Elsevier Inc. on behalf of the American Congress of Rehabilitation Medicine
