Establishing Evidence-based Parameters for Pressure Ulcer Healing
Marylou Guihan PhD MA BA
Edward Hines Jr. VA Hospital, Hines, IL
Hines, IL
Funding Period: July 2012 - June 2013

BACKGROUND/RATIONALE:
The care of individuals with spinal cord injury (SCI) has been designated as a special area of interest for the Department of Veterans Affairs (DVA). One of DVA's most important goals is to deliver the finest medical care for approximately 50,000 Veterans with SCI. Pressure ulcers (PrUs) are a frequent complication in Veterans with SCI. Because of denervation and immobilization, Veterans with SCI are at greatly increased risk of developing PrUs, with most of these Veterans developing at least one serious PrU during their lifetimes, at significant expense to all. The annual expense nationwide for the care of Veterans with SCI has been estimated to be in excess of $100,000 per ulcer.
Research has identified factors associated with healing (or non-healing) of other chronic wounds (e.g., diabetic foot ulcers [DFUs] and venous leg ulcers [VLUs]) in the non-SCI population. However, there is limited evidence for PrU healing, and more specifically, PrU healing in persons with SCI. Despite numerous PrU prevention strategies in the literature, there are no equivalent PrU healing strategies for persons with SCI. There are no published studies on the clinical correlates of PrU healing in the SCI population.

OBJECTIVE(S):
The overall objective of this study is to develop evidence-based parameters for PrU healing to be used as part of a larger strategy to develop standardized PrU healing algorithm and/or protocols in the SCI population. We propose using data from VA CSP #535 "Anabolic steroid therapy on PrU healing in persons with SCI", the largest known prospective, detailed database of patients of its kind to examine PrU healing among Veterans with SCI. Data collected for this study include PrU size and wound characteristics as well as ulcer healing status, nutritional status, metabolic values, clinical laboratory assessments, immune function, endogenous hormone levels and inflammatory markers, mood assessment, and quality of life scales. The immediate objective of the proposed study is to build evidence enabling clinical decision making and resource planning for individuals with SCI and PrUs.

METHODS:
A panel of experts in SCI and PrUs will assist us in developing the proposed model using consensus methods. The proposed analyses will use CSP#535 data to examine the impact of variables in 4 theoretical domains, including: 1) PrU factors, 2) Patient demographic factors, 3) Patient physiological factors, and 4) Patient psychological factors to predict the time to healing vs. non-healing PrUs.

FINDINGS/RESULTS:
n/a

IMPACT:
We propose to use what we learn from analyzing the CSP data to augment a newly developed evidence-based outcome tool, the SCI Pressure Ulcer Measurement Tool (SCI-PUMT). The SCI-PUMT is an assessment tool that will enable clinicians to objectively measure and monitor changes in wound characteristics in Veterans with SCI and PrUs over time. Additionally, in combination with the SCI-PUMT, our data will enable us to create a standardized monitoring system to make cross-site comparisons and serve as a foundation for future studies to evaluate the effectiveness of PrU treatments in Veterans with SCI.

PUBLICATIONS:
None at this time.

DRA: Brain and Spinal Cord Injuries and Disorders
DRE: Treatment - Efficacy/Effectiveness Clinical Trial
Keywords: QUERI Implementation
MeSH Terms: none