Pattern of presentation of pressure ulcers in traumatic spinal cord injured patients in University College Hospital, Ibadan

Abstract

The neurosurgery division in University College Hospital (U.C.H.) admits approximately one traumatic spinal cord injured (SCI) patient per week, most of whom stay a minimum of 42 days on admission. A common complication in these patients is the development of pressure ulcers, which contributes to a longer hospital stay and increased hospital expenses. The purpose of this study was to investigate the pattern of presentation of pressure ulcers in patients on admission and to propose policies or protocols to reduce the incidence. It is a prospective study of traumatic SCI patients managed on the neurosurgery ward from January 2003 to June 2004. The data was analysed using descriptive statistics. Sixty-seven patients were studied. The average hospital stay was 73 days. Thirteen (20%) of the patients were admitted with pressure ulcers, 32 (47·7%) developed it after admission. As much as 87·5% of pressure ulcers seen in the course of this study which occurred on admission in U.C.H. was in the first week of admission, 6·25% in the second week and the remaining 6·25% in the third week. Pressure ulcers were distributed as follows; 69% (42) in the sacral region, 18% (11) trochanteric, 5% (3) scalp, 1·5% (1) ankle, 1·5% (1) ischial tuberosity, the remaining 5% in other sites. Preventive measures for pressure ulcers consisted of basic skin care, pressure dispersion using fenestrated foams and alternating weight-bearing sites by regular turning. Pressure ulcers are commonest in the sacral and gluteal regions and tend to occur within the first week of admission in the neurosurgical wards.

Pressure ulcers in people with spinal cord injury in developing nations

“…13,54 In purely economic terms, PUs are very expensive. 17,56,60 Cost estimates for PU care in all-comers have been reported as high as $9000 Canadian a month for community dwellers with high grade ulcers, $130 000 American per hospital admission for hospital-acquired ulcers in the United States and up to 4% of the National Health Service Expenditure in the UK annually. [60][61][62] Although such estimates are difficult to extrapolate to developing world settings, it has been reported that PUs account for one-fourth of the cost of caring for SCI patients in Nigeria.…”

“…[60][61][62] Although such estimates are difficult to extrapolate to developing world settings, it has been reported that PUs account for one-fourth of the cost of caring for SCI patients in Nigeria. 17 Although imperfect, these cost estimates certainly highlight the financial toll of PUs.…”

“…Moreover, patient turning often requires more than one attendee. Numerous authors have thus highlighted the necessity of increasing the ratio of nurses-to-patients 15,17,64 or even the establishment of dedicated 'turning teams'. 26 In places such as Nigeria and Turkey with low nurse-to-patient ratios, the burden of many basic patient care activities, such as repositioning, often falls on family members and friends.…”

“…In a Nigerian teaching hospital, for example, a single nurse is responsible for seven SCI patients. 17 If a patient is to be turned every 2 h, with seven patients assigned to one nurse and several minutes dedicated to each turning maneuver, effective repositioning alone could consume a third or more of a nurse's time. Moreover, patient turning often requires more than one attendee.…”

Spinal cord and spine trauma in a large teaching hospital in Ghana

“…As noted in other publications, there was a male preponderance. 1,4,6,10,11 The number of males with SCI in the period was more than three times that of the females. The male, being more risk taking, is prone to injury in general compared with the females.…”