Pressure Ulcer Prevention and Treatment Following Spinal Cord Injury - 11

CLINICAL PRACTICE GUIDELINE

Recommendations
Risk and Risk
Assessment

A

ll individuals with SCI are at risk for the
development of pressure ulcers. Among the
numerous risk factors that have been identified
are demographic characteristics, SCI-related
factors, medical comorbidities, and psychosocial
factors. Identifying an individual's risk factors is
the first step toward preventing pressure ulcers.
The literature is replete with studies that describe
the differences of opinion among researchers and
clinicians regarding the significance of various
risk factors. These differences derive from the
various ways studies were conducted, many of
which did not control for the numerous variables
that contribute to risk.

1. Conduct an assessment of pressure ulcer
risk factors in individuals with SCI at every
appropriate opportunity.


Assess the following risk factors for the
development of pressure ulcers.
* Demographic
* SCI-related, such as incontinence
* Comorbid medical
* Nutritional
* Psychological, cognitive, contextual,
and social
* Support surface for bed, wheelchair,
and all durable medical equipment
(DME) surface such as shower/
commode chair or bathroom
equipment related



Use both a validated risk-assessment
tool and clinical judgment to assess risk.

(Scientific evidence-I/II/III/V; Grade of recommendation-
A/B/C; Strength of panel opinion-Strong)

Demographic Risk Factors
AGE

As individuals with SCI age, particularly after
age 40, the number and severity of pressure
ulcers that develop increase (Vidal and Sarrias
(1991)). Muscle mass, collagen, and normal
elastin decreases with age , increasing the risk
for developing pressure ulcers (Bergstrom et al.,
1996). Rochon et al. (1993) found that SCI

individuals 60 years or older were at higher risk
than younger individuals with SCI but observed
that comorbidities may be more important than
age in predicting this pressure ulcer development.
Salzberg et al. (1998) and Mawson et al. (1988)
did not find associations between age and
pressure ulcer development in persons with SCI
in either the community or immediately post
injury in their studies. Chen (2005) found
pressure ulcers were more common in persons
with SCI who were older than 50 as compared
to those who were younger.
GENDER

Almost 81% of SCIs occur among males
(NSCI SC 2/2013, published in 2014).
Although Vidal and Sarrias (1991) found
there was a 3:1 ratio of males to females in
developing pressure ulcers, Salzberg et al.
(1996) and Salzberg et al. (1998) found no
gender differences in the SCI population with
regard to pressure ulcer development.
ETHNI CI TY

Bergstrom et al. (1996) and Jiricka et al.
(1995) reported that caucasians may be at
greater risk for developing pressure ulcers than
nonwhites; however, Allman et al. (1995), Ek et
al. (1991), and Mawson et al. (1988) reported
that race was not a significant factor in pressure
ulcer development. Chen (2005) in a large Model
Systems cohort reported a greater risk for African
Americans. In a multisite randomized controlled
trial of veterans with SCI, the strongest predictor
of pressure ulcer recurrence was African
American race (multivariate logistic regression,
odds ratio=9.3) Guihan, Garber et al. 2008.
MARI TAL STATUS

Several investigators have studied the effect
of marital status on the occurrence of pressure
ulcers. Young and Burns (1981a and 1981b)
found that, at follow-up, married people were less
likely to have a pressure ulcer. Conversely, Vidal
and Sarrias (1991) reported that married people
were more likely than single people to have a
pressure ulcer. Carlson et al. (1992) and Fuhrer
et al. (1993) found no relation between marital
status and having an ulcer, while Chen et al.
(2005) found a higher prevalence in singles.
EDUCATI ON

Davidoff et al. (1990) found that less formal
education predicted more hospital readmissions
among a group of 88 people with a recent SCI

11
Pressure Ulcer Prevention and Treatment Following Spinal Cord Injury

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