Difficulty in Identifying Factors Responsible for Pressure Ulcer Healing in Veterans With Spinal Cord Injury

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• 作者：Marylou Guihan ; PhD^a ; ^b ; ^{Marylou.guihan@va.gov} ; Min-Woong Sohn ; PhD^c ; William A. Bauman ; MD^d ; ^e ; Ann M. Spungen ; EdD^d ; ^e ; Gail M. Powell-Cope ; PhD ; ARNP ; FAAN^f ; ^g ; Susan S. Thomason ; DNP ; RN DNP ; RN ; ACNS-BC ; CWCN ; CRRN^f ; Joseph F. Collins ; PhD^h ; Barbara M. Bates-Jensen ; PhD ; RN^a ; ⁱ ; ^j
• 关键词：Pressure ulcer ; Rehabilitation ; Spinal cord injuries ; Veterans
• 刊名：Archives of Physical Medicine and Rehabilitation
• 出版年：2016
• 出版时间：December 2016
• 年：2016
• 卷：97
• 期：12
• 页码：2085-2094.e1
• 全文大小：305 K
• 卷排序：97

文摘

To identify characteristics associated with pressure ulcer (PrU) healing for individuals with spinal cord injury (SCI).DesignSecondary analysis of a large clinical trial's data for healing PrUs in individuals with SCI; prospective Delphi process was conducted with SCI and/or PrU experts.SettingSpinal cord injury centers.ParticipantsThere were 629 screening and 162 treatment participants (N=791); 185 SCI clinicians/national PrU/wound care experts participated in the Delphi process.InterventionsNone.Main Outcome MeasurePrU healing of 50% and 100% at weeks 4 and 12.ResultsPoisson regression models using the top Delphi-recommended factors found that only ulcer stage consistently predicted 50% and 100% healing at weeks 4 and 12. Additionally, ischial/perineal location was associated with 33% higher likelihood of 50% healing at week 4. Patient noncompliance with treatment recommendations, the top-ranked Delphi factor, did not predict healing at week 4 or 12. Expanded models found that at week 4, baseline PrU size, PrU stage IV, PrU pain, and American Spinal Injury Association grade A significantly predicted 100% healing, while at week 12, only PrU stage (IV) significantly predicted 100% healing. Significant predictors of 50% healing at week 4 included baseline PrU size, stage, ischial/perianal location body mass index >30kg/m2, foul odor, and signs of infection. At week 12, PrU duration, paraplegia predicted 50% healing. SCI center identifiers consistently showed 2- to 5-fold variation in predicting 50% PrU healing at weeks 4 and 12.ConclusionsDelphi panel-recommended factors (eg, patient compliance) did not predict PrU healing. Reducing center-level variability in wound healing by learning from best practices should be a health system goal. PrU healing in SCI is still poorly understood, and future studies should focus on as yet unidentified or underappreciated factors.