Abstract
Retrospective, case-control study. In a traumatic spinal injury (TSI) cohort from Tanzania, we sought to: (1) describe potential risk factors for pressure ulcer development, (2) present an illustrative case, and (3) propose a low-cost outpatient protocol for prevention and treatment. Tertiary referral hospital. All patients admitted for TSI over a 33-month period were reviewed. Variables included demographics, time to hospital, injury characteristics, operative management, length of hospitalization, and mortality. Pressure ulcer development was the primary outcome. Regressions were used to report potential predictors, and international guidelines were referenced to construct a low-cost outpatient protocol. Of 267 patients that met the inclusion criteria, 51 developed a pressure ulcer. Length of stay was greater for patients with pressure ulcers compared with those without (45 vs. 30 days, p < 0.001). Potential predictors for developing pressure ulcers were: increased days from injury to hospital admission (p = 0.036), American Spinal Injury Association Impairment Scale grade A upon admission (p < 0.001), and thoracic spine injury (p = 0.037). The illustrative case described a young male presenting ~2 months after complete thoracic spinal cord injury with a grade IV sacral pressure ulcer that lead to septic shock and death. Considering the dramatic consequences of pressure ulcers in lower- and middle-income countries (LMICs), we proposed a low-cost protocol for prevention and treatment targeting support surfaces, repositioning, skin care, nutrition, follow-up, and dressing. Pressure ulcers after TSI in LMICs can lead to increased hospital stays and major adverse events. High-risk patients were those with delayed presentation, complete neurologic injuries, and thoracic injuries. We recommended aggressive prevention and treatment strategies suitable for resource-constrained settings.
Highlights
Traumatic spinal injury (TSI) with associated spinal cord injury (SCI) is a major public health problem in lower- and middle-income countries (LMICs) [1]
In Africa, one report suggested that pressure ulcer treatment accounts for 25% of all costs related to SCI care [7]
The current study represents an extension of a prior series that focused exclusively on operative treatment of TSI and did not address pressure ulcer development [10]
Summary
Traumatic spinal injury (TSI) with associated spinal cord injury (SCI) is a major public health problem in lower- and middle-income countries (LMICs) [1]. In Africa, one report suggested that pressure ulcer treatment accounts for 25% of all costs related to SCI care [7]. The prevalence of pressure ulcers in TSI patients across LMICs ranges from 27 to 46% [8], it is believed this may be an underestimation [9]. Prevention and treatment strategies targeting less-resourced populations have largely been descriptive, suggesting improvements in acute care, nurse-to-patient ratios, and support surfaces, and are limited to inpatient settings [8]. Rehabilitation centers in LMICs are limited, and patients are usually discharged home
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