Predictors of hospital‑acquired pressure injuries in patients with complete spinal cord injury: a retrospective case–control study

BMC Musculoskeletal Disorders, 2023 · DOI: https://doi.org/10.1186/s12891-023-06369-y · Published: March 24, 2023

Spinal Cord Injury Critical Care Dermatology

Simple Explanation

This study investigates risk factors for pressure injuries (PIs) in patients with complete spinal cord injuries (SCIs). PIs are a common and costly complication for these patients. The researchers analyzed data from 82 patients with complete SCIs, looking at factors like age, gender, injury severity, length of hospital stay, and treatments such as vasopressors. The study found that male gender and increased length of hospital stay were associated with a higher risk of developing PIs, while having orders for higher mean arterial pressure (MAP) was associated with a reduced risk.

Study Duration

4 years

Participants

82 adults with acute complete SCIs ASIA-A

Evidence Level

Level 3: Retrospective case–control study

Key Findings

1
Male gender was associated with a significantly increased risk of developing pressure injuries (OR:34.1; CI95:2.3–506.5, p = 0.010).
2
Increased length of hospital stay (LOS) was associated with an increased risk of pressure injuries (OR:20.5, CI95:2.8–149.9, p = 0.003).
3
Having an order for a MAP > 80mmg was associated with a reduced risk of PI (OR:0.05; CI95:0.01–0.30, p = 0.001).

Research Summary

This retrospective case–control study examined the association between norepinephrine treatment and pressure injury (PI) formation in patients with acute complete spinal cord injury (SCI). The study found that norepinephrine treatment parameters were not associated with the development of PI, but longer hospital stays and male gender were associated with increased PI risk, while maintaining MAP targets greater than 80 mmHg was protective. The findings suggest a need for vigilant monitoring and reinforcement of preventive guidelines, especially in male patients with complete SCI, and highlight the importance of MAP targets in SCI management.

Practical Implications

Clinical Guidelines Reinforcement

Adherence to preventive guidelines and vigilant monitoring of PIs in males with complete SCI should be reinforced within institutions.

MAP Target Focus

MAP targets should be a continued focus for future investigations in acute SCI management.

LOS Vigilance

Increased LOS should prompt high-risk PI prevention and vigilance.

Study Limitations

1
Indications for the use of norepinephrine could have stemmed from reasons other than SC perfusion.
2
The present study was not able to address whether epinephrine application is related to PI occurrence due to the small sample size of patients who received epinephrine.
3
Several relevant factors were not accounted for; these include duration of time on a hard spine board, use of preventative dressings, and number of patient-turns.

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