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Factors Predicting Recurrence of Severe Pressure Ulcers in Veterans with Spinal Cord Injury

Garber SL, Guihan ML, Goldstein B, Holmes SA, Durazo-Arvizu R, Bombardier CH. Factors Predicting Recurrence of Severe Pressure Ulcers in Veterans with Spinal Cord Injury. Poster session presented at: Advances in Skin and Wound Care Clinical Annual Symposium; 2005 Oct 1; Las Vegas, NV.




Abstract:

Statement of the problem: Pressure ulcers are frequent, costly complications of spinal cord injury (SCI). Treatment often requires hospitalization and/or surgery. Yet, little empirical information is available describing individuals with recurrent pressure ulcers. This presentation describes demographic, clinical and medical factors associated with recurrence among veterans with SCI.Rationale: Estimates of pressure ulcer prevalence range from 17-33% among persons with SCI. Recurrence rates range from 21-79%. The cost of treatment is enormous and yet, few widely accepted standards of care exist. Furthermore, follow-up after hospitalization is rare. This presentation describes characteristics of veterans with SCI who developed recurrent pressure ulcers. A better understanding of these characteristics may result in more effective prevention strategies.Methods: Data were derived from a randomized controlled trial with an intervention that included individualized education and monthly telephone follow-up.Results: 64 veterans with SCI, admitted to 6 VA SCI Centers, participated and were randomized to either control (n = 33) or intervention group (n = 31). Mean age-56 years; most were white and male, lived in their own home and had some college. Mean time since SCI-22 years; 28% had tetraplegia; mean number of prior pressure ulcers was 3; 47% had a previous ulcer in the same location. Patients who developed recurrences were more likely to be African-American, have higher Charlson scores and tetraplegia, not living with a spouse/significant other, and had larger ulcers on admission. Patients with recurrence knew less about related anatomy, symptoms and prevention strategies. Age, age at injury, number of previous ulcers or surgery, did not differ between groups Conclusion: Identifying individuals at highest risk for recurrence and developing effective prevention programs are essential rehabilitation goals. This presentation addresses both issues.





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