A Retrospective Cohort Study of Incidence, Progression and Management of Pressure Ulcers in Spinal Cord Injury Patients in a Tertiary Care Spinal Cord Injury Center

Abstract

Gurmeet Singh Sarla and Samrat Sunkar

Study Design: Retrospective Cohort study.

Objectives: To analyze the incidence, prevalence, characteristics and treatment outcomes of pressure ulcers (PUs) in Spinal cord injury (SCI) patients.

Setting: A Tertiary care center in Western India dedicated to provide acute care and rehabilitation to Spinal cord injury patients.

Patients & Methods: Incidence and characteristics of PUs in 79 in-hospital adult patients aged between 16 – 55 years with SCI were studied through retrospective clinical records of admitted patients from 30 May 2018 to 26 Oct 2022 and prospectively thereafter till 27 Jun 2024. Ulcer characteristics were recorded on a daily basis throughout the hospitalization period. NPIAP guidelines for prevention and management of PUs were meticulously enforced. Appropriate wound care, antibiotic therapy, physiotherapy, NPWT and surgical interventions were carried out in an evidence-based manner. Only those in-hospital-spinal-cord- injured (SCI) patients were included in the study whose historical clinical records had been maintained by referring hospitals as per NPIAP guidelines. Patients admitted with spinal injuries without cord involvement & those whose clinical history had been recorded in an arbitrary fashion were excluded from the study. The collected data was Statistically analyzed.

Results: Patients with Neurological impairment of ASIA Grade A or B, or Quadriplegia tended to have already developed PUs by the time of admission and a greater number of PUs overall, they also showed a tendency to develop grade 3 or 4 PUs and to require Plastic surgical flap cover procedures. Patients who had already developed a grade 3 or 4 PU by the time of admission tended to develop another grade 3 or 4 PU after admission. Increasing lengths of in-hospital stay tended to increase the number of PUs. It was observed that significantly greater number of Grade 2 PUs occurred in the pre admission period as compared with Grade 1, Grade 3 or 4 PUs. After admission at this center significantly greater number of Grade 1 PUs were observed as compared with higher grades.

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