Predictors of pressure ulcers in patients with spinal cord injuries

Abstract

Introduction: Pressure ulcers (PUs) are often secondary complications in spinal cord injury (SCI) patients. Purpose: To investigate the presence and possible factors associated with pressure ulcers in SCI patients undergoing acute and functional rehabilitation. Methods: This was a retrospective study of 453 patients with SCI treated at the Clinic for Rehabilitation 'Dr M. Zotovic', Belgrade, Serbia, between January 2000 and December 2009. Factors that were tested for their influence on pressure ulcers in spinal cord injury patients included age, sex, mechanism of injury, neurological level of injury, completeness of injury, spasticity and length of stay. The presence and location of pressure ulcers were recorded on admission, during acute and functional rehabilitation and at discharge. The level of statistical significance in our study was set to 0.05. Results: The study included 453 patients: 383 (84.5%) did not have a pressure ulcer during rehabilitation, and 70 (15.5%) patients had a pressure ulcer during rehabilitation. Of the total number of patients, 333 (73.5%) were male, and 120 (26.5%) were female. The average age of patients enrolled in the study was 51.8 ± 17.2 years. In a multiple logistic regression model, one statistically significant predictor of pressure ulcers during rehabilitation was pressure ulcer before rehabilitation (B = 1420, p <0.001), with an odds ratio (OR) = 4.1. This result shows that patients who had pressure ulcers on admission are 4 times more likely to regain pressure ulcers during rehabilitation after controlling for all of the factors in the model. Another statistically significant predictor of pressure ulcers during rehabilitation was FIM score on admission (B = -0036, p = 0.015). Conclusion: The prevention of pressure ulcers in acute and functional rehabilitation increases functional outcomes in patients with SCI.