Prospective study of pressure ulcer risk in spinal cord injury patients

Abstract

Sixty men with spinal cord injury who had developed pressure ulcers in the past but whose skin was intact when they joined the study were followed for 2 years, or until a pressure ulcer developed. Forty of the men were contacted every 4-6 weeks to answer questions about their skin care practices and to provide a 24 hour urine sample. The others were only contacted at the beginning and the end of the study to answer a questionnaire and to provide a urine sample. Changes in skin collagen metabolism were monitored by measuring urinary excretion of a metabolite, glucosyl-galactosyl hydroxylysine (glu-gal Hyl), corrected for creati nine excretion. Sustained increases in levels of glu-gal Hyl excretion were detected at least 2 months and as much as 5 months in advance of overt clinical signs of ulcer development. Increased excretion of glu-gal Hyl was significantly associated (p < 0.05) with the development of a pressure ulcer. An increase in the urinary excretion of glu-gal Hyl is an indication of increased degradation of skin collagen. Body mass index (weight/height 2 ) of 33% of subjects with pressure ulcers, and 12% of those without, was at least one standard deviation below the mean of all subjects. Thirty-six percent of those who smoked developed ulcers, while only 26% of the nonsmokers did. The majority of the subjects who developed ulcers had injury levels above T6. Present age and time since injury were similar among those subjects who developed ulcers and those who did not. Subjects who developed ulcers were more likely to be unemployed, not attending school, and to have had a greater number of ulcers previously. There was no statistically significant difference between subjects who developed a pressure ulcer and those who did not with regard to beliefs about risk or severity of pressure ulcers and about the relative importance of various pressure ulcer prevention strategies. The data indicate that biochemical indicators, such as urinary excretion of glu-gal Hyl, and specific behavioral factors can be used to identify subjects at risk for developing pressure ulcers in time to institute vigorous preventative procedures to avoid skin breakdown.

The Tetrafigap Survey on the long-term outcome of tetraplegic spinal cord injured persons: Part III. Medical complications and associated factors

“…On the one hand, this is due to the fragility of skin around scars but, and on the other hand, more especially because it is a risk factor of a relapse, whatever the level of the lesion. 35,63,64 In this study, the rate increases from factor 3 to 4 and for Berkley, 63 a factor of 4. This vulnerability may be linked to more severe impairments, to maladjusted behaviour, 28,65,66 to low socioeconomic and educational status: low level of education, unemployment.…”

Pressure ulcer risk factors in persons with SCI: part I: acute and rehabilitation stages

“…[22][23][24][25][26][27] In one study, the population was not SCI exclusive, 10 and three other studies focused on SCI patients with PU. [28][29][30] Three studies were descriptive, without any PU-related factors.…”

Risk factors for pressure ulceration in a resource constrained spinal injury service

“…Previous reports have identified delayed presentation, low serum proteins, premorbid medical condition such as diabetes, and completeness of the spinal cord injury as risk factors for pressure ulceration. [3][4][5][6][7][8][9][10][11] The organisation of healthcare in Nigeria is the responsibility of three tiers of the government. The federal government has the overall responsibility for the university teaching hospitals teachings in hospitals and the three National Orthopaedic Hospitals, which are involved in the management of major trauma such as spinal injury.…”