1065 — Pressure Ulcers and Occipital Alopecia in Polytrauma: Research Translation Opportunities

Harrow JJ (Tampa VAMC), Rashka SL (Tampa VAMC), Fitzgerald SG (Tampa VAMC), Nelson AL (Tampa VAMC)

Objectives:
Casualties from Operation Iraqi Freedom arriving at a VA Polytrauma Rehabilitation Center (PRC) were noted to have pressure ulcers and/or hair loss on the back of their heads (occiput). To address this quality improvement opportunity, the prevalence and severity of pressure-related injuries were monitored on all Polytrauma Rehabilitation Center admissions.

Methods:
Retrospective analysis of all admissions from active duty from 2003-2006. A pressure ulcer, pressure-related alopecia, or pressure-related scar was considered present if it was documented as a secondary diagnosis, or found in the admitting physical exam, admission nursing assessment, or Wound/Ostomy/Continence Nurse notes. The pressure-related injury was characterized by its location and stage according to National Pressure Ulcer Advisory Panel guidelines. The mechanism of polytrauma, year of admission, and interval between wounding and admission were obtained from VA and military records.

Results:
On the day of their VA admission, 27% of PRC admissions from active duty had pressure-related injuries; 30% of these were Stage I, and 70% non-Stage I. There were 32 non-stage I lesions, of which 26 were from injuries in Iraq. Of these 26, occipital lesions constituted 50%. Occipital lesions were more severe than those of the sacrum or extremities, with all the Stage 3 and 4 ulcers being occipital. Literature review indicated risk of occipital pressure injury in relation to extended surgical time and cervical collar use > 5 days.

Implications:
Military transport may contribute to increased risk of occipital lesions and alopecia. Strategies to minimize this risk have been identified. Further epidemiological research should be done to identify factors which contribute to pressure injury in the military continuum-of-care, by linking specific military medical evacuation and treatment processes and patient characteristics with patient outcomes. A trial of pressure-reducing surfaces under the head during evacuation/transport is warranted, although this study does not isolate the injury process to evacuation/transport.

Impacts:
1. Preventable occipital pressure ulcers and alopecia are developing in current military evacuation and treatment. 2. The back of the head is a particularly sensitive target, being subject to permanent alopecia and the most severe pressure ulcers. 3. This is an opportunity to partner with the Department of Defense to implement evidence-based strategies.