Prevention of Pressure Ulcers Among People With Spinal Cord Injury: A Systematic Review

Abstract

Although there is no clear optimal positioning or turning frequency in bed, the evidence suggests avoiding the 90° lateral position because of high pressures and PU risk over the trochanters. During sitting, pressures are linearly redistributed from the sitting area during recline and tilt; however, reclining carries with it an increased risk of shear forces on this skin. The evidence does not support conclusive guidelines on positioning or repositioning techniques for PU prevention in bed or during sitting. We conclude that PU risk is highly individualized, with the SCI population at a higher risk, which demands flexible PU prevention strategies for bed/seated positioning and pressure relief maneuvers. Education has and will remain our most powerful ally to thwart this pervasive public health problem.

Effectiveness of a multi‐layer foam dressing in preventing sacral pressure ulcers for the early acute care of patients with a traumatic spinal cord injury: comparison with the use of a gel mattress

“…This could partly explain the increased occurrence of sacral PUs in complete tetraplegic patients with the use of the multi‐layer dressings. Results of this study thus reinforce the importance of meticulous preventive care, which is considered as the key factor for PU prevention, and cannot be replaced by any kind of dressing .…”

Advancing SCI health care to avert rehospitalization

“…A recently completed systematic review, for example, clearly indicates that a flexible and individualized program of pressure relief strategies that is re-evaluated and modified often is likely the best preventive strategy. 5 Further, an expanded armamentarium for lower urinary symptom management and UTI prevention might include Vitamin C, cranberry, Methenamine, cyclic prophylactic low-dose antibiotics, probiotics, and various intravesical instillations. Broadly speaking, evidence to date does not support these therapeutics, however evidence consists mainly of small non-randomized trials-hardly the level at which we can easily dismiss the benefits that many with SCI report.…”

“…The systematic review mentioned above points to the discordance between hospital-acquired pressure ulcers being considered "never events" despite evidence that guidelines for pressure ulcer prevention cannot be adhered to at all times. 5 And, with hospitals now at financial risk for catheter-associated UTIs, hospitals' primary preventive strategies include early removal of indwelling catheters. While this strategy is an effective one for many hospitalized patients, it is already proving detrimental for some with SCI whose indwelling catheters are being removed early in acute care with little regard to adequate bladder emptying.…”

“…In the systematic review mentioned above, one clear finding was that pressure relief strategies need to be individualized and flexible, given changing situations and circumstances. 5 Providers care deeply about their patients and their patient outcomes. When adverse events lead to rehospitalization, providers rightfully note the lack of social support, lack of attendant care, inaccessible homes, bad neighborhoods, the vagaries of third party payment, patient noncompliance, and the like.…”

Reply to: Effectiveness of a multi‐layer foam dressing in preventing sacral pressure ulcers in the early acute care of patients with a traumatic spinal cord injury: comparison with the use of a gel mattress by Gefen and Santamaria

“…Reply to: Effectiveness of a multi-layer foam dressing in preventing sacral pressure ulcers in the early acute care of patients with a traumatic spinal cord injury: comparison with the use of a gel mattress by Gefen and Santamaria Dear Editors, Evidence-based recommendations in terms of the acute management of spinal cord injury (SCI) are well established (1)(2)(3). Nevertheless, medical complications, such as pressure ulcers (PU), still occur during the acute phase following an SCI, which signifies that current gold-standard measures in terms of PU prevention (1,2) remain deficient.…”