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.
10.1016/j.cjtee.2023.03.007
- Author:
Farzin FARAHBAKHSH
1
,
2
,
3
,
4
;
Hossein REZAEI ALIABADI
5
;
Vali BAIGI
6
;
Zahra GHODSI
1
,
7
;
Mohammad DASHTKOOHI
1
,
8
;
Ahmad POUR-RASHIDI
1
,
9
;
James S HARROP
10
;
Vafa RAHIMI-MOVAGHAR
1
,
2
,
3
,
11
,
12
,
13
Author Information
1. Sina and Trauma Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
2. Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
3. Department of Neurosurgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
4. Sports Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran.
5. School of Medicine, Bam University of Medical Sciences, Bam, Iran.
6. Sina and Trauma Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran.
7. Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran.
8. Students' Scientific Research Center (SSRC), Tehran University of Medical Sciences, Tehran, Iran.
9. Department of Neurosurgery, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran.
10. Department of Neurosurgery, Thomas Jefferson University, Philadelphia, USA.
11. Universal Scientific Education and Research Network (USERN), Tehran, Iran
12. Institute of Biochemistry and Biophysics, University of Tehran, Tehran, Iran
13. Spine Program, University of Toronto, Toronto, Canada. Electronic address: v_rahimi@sina.tums.ac.ir.
- Publication Type:Journal Article
- Keywords:
NSCIR-IR;
Pressure ulcer;
Spinal cord injuries;
Spinal fractures
- MeSH:
Humans;
Spinal Fractures/etiology*;
Pressure Ulcer/complications*;
Iran/epidemiology*;
Spinal Cord Injuries/epidemiology*;
Risk Factors;
Spine;
Registries;
Urinary Incontinence/complications*;
Suppuration/complications*
- From:
Chinese Journal of Traumatology
2023;26(4):193-198
- CountryChina
- Language:English
-
Abstract:
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) 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.
