Spinal cord injury and development of pressure injury during acute rehabilitation in Norway: a national retrospective cross-sectional study

Incidence of pressure injuries in patients with spinal cord injury: A systematic review and meta-analysis

OBJECTIVE

To systematically evaluate the incidence of pressure injuries (PIs) in patients with spinal cord injury (SCI) and to provide a basis for preventing and treating PIs.

METHODS

A systematic review and meta-analysis were performed according to the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) guidelines. Electronic databases such as PubMed, Embase, Cochrane Library, Web of Science, China Knowledge Resource Integrated Database (CNKI), Wan-fang Database, Weipu Database (VIP), and the China Biomedical Database (CBM) were searched to collect cross-sectional and cohort studies related to PIs in SCI patients. All electronic literature sources were searched for relevant articles from inception to July 2024. Studies were independently assessed by two researchers and reviewed by a third. Data were extracted and presented in tabular form. The risk of bias was assessed using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist and the Agency for Healthcare Quality and Research (AHRQ) Cross-Sectional Study Evaluation Criteria. All data were analysed using Stata 16.0. The I2 statistics and random effects models were used to determine heterogeneity, and results were expressed as incidence with 95 % confidence intervals (CI).

RESULTS

11,754 articles were screened, and 35 studies involving 150,391 patients were finally included. The combined incidence of PIs in SCI patients was 28.8 % (95%CI: 24.2 to 33.4). For different genders, the incidence of PIs in male SCI patients was 29.2 % (95 % CI: 20.4 to 38.1), while for female SCI patients, it was 25.2 % (95 % CI: 16.1 to 34.3). The PI incidence rate in patients with SCI was 33.9 % (95 % CI: 27.1 to 40.7) before 2005, 29.4 % (95 % CI: 19.1 to 39.7) from 2006 to 2015, and 27.1 % (95 % CI: 20.8 to 33.3) from 2016 to 2024. According to regional distribution data by country, the combined incidence of PIs in SCI patients was 34.3 % (95 % CI: 21.0 to 47.6) in European countries, 20.9 % (95 % CI: 12.8 to 28.9) in Asian countries, 43.3 % (95 % CI: 16.5 to 70.1) in African countries, 25.0 % (95 % CI: 15.9 to 34.0) in North American countries, and 65.3 % (95 % CI: 55.9-74.7) in South American countries. In 12 studies that reported the anatomical location of PIs in patients with SCI, 1113 patients developed 1836 PIs. The sacrococcygeal region had the highest number of these injuries, totalling 521 (28.8 %), followed by the sciatic tuberosity, with 233 (12.9 %), then, the heel, with 221 (12.3 %).

CONCLUSION

The study's results showed an overall incidence of PIs in patients with SCI of 28.8 %, significantly exceeding the average incidence rate in adults. We found that the incidence of PIs was higher in men than in women in patients with SCI. Therefore, clinical care staff needs to adopt effective preventive and therapeutic measures and strategies to reduce the occurrence of PIs. Additionally, the risk factors for PIs in patients with SCI can be further investigated to prevent and treat PIs effectively.

Non-adherence to follow-up care in persons with spinal cord injury within 10 years after initial rehabilitation

OBJECTIVE

This study aimed to describe the temporal dynamics of and risk factors for non-adherence to outpatient follow-up care in the first 10 years after spinal cord injury.

DESIGN

Retrospective single-centre cohort study using data from medical records and municipal resident registers.

SUBJECTS/PATIENTS

Patients admitted to a specialized spinal cord injury centre in Switzerland discharged between 1 January 2010 and 31 December 2012 (n = 225). Time-to-event analysis was used to investigate the timing of the first non-adherence event, its association with spinal cord injury, and sociodemographic characteristics.

RESULTS

36% of patients were adherent to annual follow-up appointments; 2% formally transferred to another SCI centre; 44% were non-adherent for general reasons (patient's will to discontinue care [12%] or unknown reasons [32%]); and 18% were non-adherent due to death. Risk factors for non-adherence included older age, lack of long-term partner, and more than 2 h of travel time to the clinic. In the youngest age group (18-30 years), 55% were non-adherent after 10 years.

CONCLUSION

A relevant proportion of individuals with spinal cord injury were lost to annual follow-up care. A holistic approach to patient engagement integrating solutions such as telemedicine and involvement of support networks could reduce the risk of non-adherence.

The prevalence and risk factors of pressure ulcers among residents of long-term care institutions: a case study of Kazakhstan

Limited information is available regarding the prevalence of pressure ulcers (PUs) in residential homes in Central Asia. Therefore, the aim of this study was to identify the prevalence rates and risk factors associated with PUs among residents of long-term care medical institutions in the Republic of Kazakhstan. This cross-sectional study was conducted in four long-term care institutions in Kazakhstan. The study sample consisted of 640 patients who were assessed for the presence of PUs and associated risk factors. The evaluation was performed using the International Prevalence Measurement of Care Quality (Landelijke Prevalentiemeting Zorgkwaliteit, LPZ), the Braden scale, and the Care Dependency Score (CDS). The overall prevalence of PUs, classified as categories I-IV, was found to be 37%. When excluding category I PUs, the prevalence decreased to 35.6%. The odds ratios (ORs) for presenting with PUs were as follows: history of stroke (OR 5.22), diseases of the digestive system (OR 10.01), presence of spinal cord lesions/paraplegia (OR 20.50), recent reported confusion within the last 7 days (OR 184.00), and limited extent dependency according to the CDS (OR 4.44; 95%CI 1.31-16.1). It is imperative to establish specialized training programs aimed at equipping medical personnel, relatives, and patients themselves with the necessary skills to provide optimal care for individuals affected by PUs.

Pressure ulcers and acute risk factors in individuals with traumatic spinal fractures with or without spinal cord injuries: A prospective analysis of the National Spinal Column/Cord Injury Registry of Iran (NSCIR-IR) data

PURPOSE

To identify risk factors for developing pressure ulcers (PUs) in the acute care period of traumatic spinal fracture patients with or without spinal cord injuries (SCIs) METHODS: Data were collected prospectively in participating the National Spinal column/Cord Injury Registry of Iran (NSCIR-IR) centers from individuals with traumatic spinal fractures with or without SCIs, inclusive of the hospital stay from admission to discharge. Trained nursing staff examined the patients for the presence of PUs every 8 h during their hospital stay. The presence and grade of PUs were assessed according to the European Pressure Ulcer Advisory Panel classification. In addition to PU, following data were also extracted from the NSCIR-IR datasets during the period of 2015-2021: age, sex, Glasgow coma scale score at admission, having SCIs, marital status, surgery for a spinal fracture, American Spinal Injury Association impairment scale (AIS), urinary incontinence, level of education, admitted center, length of stay in the intensive care unit (ICU), hypertension, respiratory diseases, consumption of cigarettes, diabetes mellitus and length of stay in the hospital. Logistic regression models were used to estimate the unadjusted and adjusted odds ratio (OR) with 95% confidence intervals (CI).

RESULTS

Altogether 2785 participants with traumatic spinal fractures were included. Among them, 87 (3.1%) developed PU during their hospital stay and 392 (14.1%) had SCIs. In the SCI population, 63 (16.1%) developed PU during hospital stay. Univariate logistic regression for the whole sample showed that marital status, having SCIs, urinary incontinence, level of education, treating center, number of days in the ICU, age, and Glasgow coma scale score were significant predictors for PUs. However, further analysis by multiple logistic regression only revealed the significant risk factors to be the treating center, marital status, having SCIs, and the number of days in the ICU. For the subgroup of individuals with SCIs, marital status, AIS, urinary incontinence, level of education, the treating center, the number of days in the ICU and the number of days in the hospital were significant predictors for PUs by univariate analysis. After adjustment in the multivariate model, the treating center, marital status (singles vs. marrieds, OR 3.06, 95% CI 1.55-6.03, p = 0.001), and number of days in the ICU (OR 1.06, 95% CI 1.04-1.09, p < 0.001) maintained significance.

CONCLUSIONS

These data confirm that individuals with traumatic spinal fractures and SCIs, especially single young patients who suffer from urinary incontinence, grades A-D by AIS, prolonged ICU stay, and more extended hospitalization are at increased risk for PUs; as a result strategies to minimize PU development need further refinement.

Incidence, severity and time course of pressure injuries over the first two years following discharge from hospital in people with spinal cord injuries in Bangladesh

DESIGN

Cohort study embedded in a clinical trial.

SETTING

Community, Bangladesh.

OBJECTIVES

To determine the incidence, severity and time course of pressure injuries over the first two years following discharge from hospital in people with spinal cord injuries (SCI) in Bangladesh.

METHODS

Participants (n = 186) were contacted by telephone 39 times and assessed face-to-face 4 to 6 times over the two years following discharge. At each point of contact the presence and severity of pressure injuries were determined using the Pressure Ulcer Scale for Healing (PUSH). Survival analyses were conducted to determine the time course of development of pressure injuries and recovery from pressure injuries. Lasso regression was used to construct multivariable prediction models.

RESULTS

Seventy-seven participants (41%; 95% CI 34% to 49%) developed at least one pressure injury in the first two years after discharge (incidence rate 0.27 per person-year, 95% CI 0.22 to 0.34). Most pressure injuries were on the sacrum (23%). Pressure injuries took a median (IQR) of 40 (29 to 57) days to heal. The median (IQR) peak PUSH score was 11.0/17 (8.0 to 13.5). The multivariable prediction models had poor predictive properties (maximum c-statistic 0.75).

CONCLUSION

Pressure injuries impose a large health burden on people with SCI in Bangladesh. However, they are difficult to predict, treat and prevent. Further research is needed to identify who is at most risk and to find solutions for the treatment and prevention of pressure injuries in Bangladesh and other low-middle income countries.