Factors associated with pressure ulcer risk in spinal cord injury rehabilitation

Am J Phys Med Rehabil. 2014 Nov;93(11):971-86. doi: 10.1097/PHM.0000000000000117.


Objective: The aim of this study was to identify patient and clinical factors most strongly associated with a spinal cord injury patient's risk for developing a pressure ulcer (PU) during rehabilitation.

Design: This is a prospective observational cohort study conducted at an urban rehabilitation hospital-based specialized spinal cord injury center. The main outcome measure was the onset of a stage 2 or higher PU.

Results: Study patients (N = 159) with new (n = 66) and patients with earlier (n = 99) spinal injuries had identical rates at which they acquired a new PU (stage ≥2) in rehabilitation--13.1%. The patients who came to rehabilitation with a PU or myocutaneous flap exhibited a higher rate of developing yet another PU while in rehabilitation (30.2%) than those who came to rehabilitation without an existing PU or flap (6.9%). Logistic regression analysis identified two variables that best predicted a patient's risk at admission for developing a PU during rehabilitation (c = 0.77)--entering rehabilitation with a PU and admission Functional Independence Measure transfers score of less than 3.5.

Conclusions: The greatest risk of developing a new PU in rehabilitation is being admitted with an existing PU followed by admission Functional Independence Measure transfers score of less than 3.5. Using these two variables, one can develop a patient PU risk algorithm at admission that can alert clinicians for the need to enhance vigilance, skin monitoring, and early patient education.

Publication types

  • Observational Study
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adult
  • Age Factors
  • Cohort Studies
  • Female
  • Follow-Up Studies
  • Hospitals, Urban
  • Humans
  • Incidence
  • Injury Severity Score
  • Length of Stay*
  • Male
  • Middle Aged
  • Physical Therapy Modalities
  • Predictive Value of Tests
  • Preexisting Condition Coverage*
  • Pressure Ulcer / epidemiology*
  • Pressure Ulcer / physiopathology
  • Prospective Studies
  • Rehabilitation Centers*
  • Risk Factors
  • Severity of Illness Index
  • Spinal Cord Injuries / diagnosis
  • Spinal Cord Injuries / rehabilitation*
  • Spinal Cord Injuries / surgery
  • Treatment Outcome
  • Young Adult