Pressure Ulcer in Trauma Patients: A Higher Spinal Cord Injury Level Leads to Higher Risk

Areg Grigorian; Megumi Sugimoto; Victor Joe; Sebastian Schubl; Michael Lekawa; Matthew Dolich; Eric Kuncir; Cristobal Barrios Jr; Jeffry Nahmias

doi:10.1016/j.jccw.2018.06.001

Pressure Ulcer in Trauma Patients: A Higher Spinal Cord Injury Level Leads to Higher Risk

J Am Coll Clin Wound Spec. 2018 Jun 19;9(1-3):24-31.e1. doi: 10.1016/j.jccw.2018.06.001. eCollection 2017.

Authors

Areg Grigorian¹, Megumi Sugimoto¹, Victor Joe¹, Sebastian Schubl¹, Michael Lekawa¹, Matthew Dolich¹, Eric Kuncir¹, Cristobal Barrios Jr¹, Jeffry Nahmias¹

Affiliation

¹ University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, Orange, CA, USA.

Abstract

Background: In a systematic review, the level of spinal cord injury (SCI) was not associated with risk for pressure ulcer (PU). We hypothesized that in the acute trauma population, upper-SCI (cervical/thoracic) has greater risk for PU when compared to lower-SCI (lumbar/sacral). We additionally sought to identify risk factors for development of PUs in trauma.

Methods: A retrospective analysis of the NTDB (2007-2015) was performed. Covariates were included in a multivariable logistic regression analysis to determine risk for PU.

Results: Of 62,929 patients (0.9%) with SCI, most had an upper-SCI (83%). The overall rate of PUs in patients with SCI was 5.1%. More patients with upper-SCI developed PUs compared to lower-SCI (5.8% vs. 2.2%, p < 0.001). SCI was the strongest predictor for PU (OR = 13.77, CI = 13.25-14.31, p < 0.001). Upper-SCI demonstrated greater risk compared to lower-SCI (OR = 2.81, CI = 2.45-3.22, p < 0.001).

Conclusions: Contrary to previous reports, a higher SCI level is associated with a three-fold greater risk for PU compared to lower SCI.

Keywords: Pressure ulcer; Spinal cord injury; Trauma.