Pressure Ulcer Risk Factors Associated with Level of Paralysis in Persons with Spinal Cord Injury: Analysis of the National Spinal Cord Injury Database

Abstract

The National Spinal Cord Injury Model Systems (SCIMS) were established in 1970 to provide and study comprehensive care for anyone with a traumatic spinal cord injury. A spinal cord injury (SCI) is defined as transient or permanent motor and/or sensory deficits as a result of an acute traumatic injury to the spinal cord. Twenty-nine federally funded Model System Centers have collected data from approximately 6% of new SCI cases in the United States since the founding of the National Spinal Cord Injury Database. The National Spinal Cord Injury Database (NSCID) was created in 1973 to store the collected data, and NSCID is the most extensive spinal cord injury database in the world. The purpose of this study was to determine the association between known pressure ulcer (PU) risk factors and presence of pressure ulcer, stratified by level of paralysis, in persons with traumatic injury SCI whose data are included in the NSCID. This study also determined the association between known PU risk factors and level of paralysis in the same population. Persons with paraplegia reported PU at a higher percentage than persons with tetraplegia, 30.9% vs. 27.7%, p<.001. There were 17 PU risk factors measured in this study, and 77 subfactors. Paraplegics reported a greater percentage of PU than tetraplegics in 65 of these subfactors. paraplegics were 8% more likely to report PU than tetraplegics, OR=1.08, 95% CI (1.04, 1.13). There were 77 subfactors in this study, and 36 of those had significant OR, with paraplegics more likely to report PU than tetraplegics for 35 of the 36 significant findings. Paraplegics need to be informed of their higher risk for pressure ulcers. Identification of a biomarker would be the gold standard for early identification and prevention of pressure ulcers.