Factors associated with pressure ulcers in individuals with spina bifida

doi:10.1016/j.apmr.2015.02.029

Multicenter Study

. 2015 Aug;96(8):1435-1441.e1.

doi: 10.1016/j.apmr.2015.02.029. Epub 2015 Mar 18.

Factors associated with pressure ulcers in individuals with spina bifida

Sunkyung Kim¹, Elisabeth Ward², Brad E Dicianno³, Gerald H Clayton⁴, Kathleen J Sawin⁵, Patricia Beierwaltes⁶, Judy Thibadeau⁷; National Spina Bifida Patient Registry

Collaborators, Affiliations

Collaborators

National Spina Bifida Patient Registry:
William Walker, Kathryn Smith, Kurt Freeman, Pamela Wilson, Kathleen Sawin, Jeffrey Thomson, Heidi Castillo, Timothy Brei, David Joseph, Elaine Pico, Mitul Kapadia, Robin Bowman, John Wiener, Paula Peterson, Mark Dias, Karen Ratliff-Schaub, Brad Dicianno, James Chinarian

Affiliations

¹ Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA. Electronic address: wox0@cdc.gov.
² Carter Consulting, Inc., Atlanta, GA.
³ Department of Physical Medicine and Rehabilitation, University of Pittsburgh Medical Center, Pittsburgh, PA.
⁴ Department of Physical Medicine and Rehabilitation, University of Colorado Denver and Children's Hospital Colorado, Aurora, CO.
⁵ College of Nursing, University of Wisconsin-Milwaukee, Milwaukee, WI; Children's Hospital of Wisconsin, Milwaukee, WI.
⁶ Children's Hospital of Michigan, Detroit, MI; Wayne State University, Detroit, MI.
⁷ Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA.

PMID: 25796136
PMCID: PMC4519375
DOI: 10.1016/j.apmr.2015.02.029

Multicenter Study

Factors associated with pressure ulcers in individuals with spina bifida

Sunkyung Kim et al. Arch Phys Med Rehabil. 2015 Aug.

. 2015 Aug;96(8):1435-1441.e1.

doi: 10.1016/j.apmr.2015.02.029. Epub 2015 Mar 18.

Authors

Sunkyung Kim¹, Elisabeth Ward², Brad E Dicianno³, Gerald H Clayton⁴, Kathleen J Sawin⁵, Patricia Beierwaltes⁶, Judy Thibadeau⁷; National Spina Bifida Patient Registry

Collaborators

National Spina Bifida Patient Registry:
William Walker, Kathryn Smith, Kurt Freeman, Pamela Wilson, Kathleen Sawin, Jeffrey Thomson, Heidi Castillo, Timothy Brei, David Joseph, Elaine Pico, Mitul Kapadia, Robin Bowman, John Wiener, Paula Peterson, Mark Dias, Karen Ratliff-Schaub, Brad Dicianno, James Chinarian

Affiliations

¹ Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA. Electronic address: wox0@cdc.gov.
² Carter Consulting, Inc., Atlanta, GA.
³ Department of Physical Medicine and Rehabilitation, University of Pittsburgh Medical Center, Pittsburgh, PA.
⁴ Department of Physical Medicine and Rehabilitation, University of Colorado Denver and Children's Hospital Colorado, Aurora, CO.
⁵ College of Nursing, University of Wisconsin-Milwaukee, Milwaukee, WI; Children's Hospital of Wisconsin, Milwaukee, WI.
⁶ Children's Hospital of Michigan, Detroit, MI; Wayne State University, Detroit, MI.
⁷ Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA.

PMID: 25796136
PMCID: PMC4519375
DOI: 10.1016/j.apmr.2015.02.029

Abstract

Objective: To describe factors associated with pressure ulcers in individuals with spina bifida (SB) enrolled in the National Spina Bifida Patient Registry (NSBPR).

Design: Unbalanced longitudinal multicenter cohort study.

Setting: Nineteen SB clinics.

Participants: Individuals with SB (N=3153) enrolled in 19 clinic sites that participate in the NSBPR.

Interventions: Not applicable.

Main outcome measures: Pressure ulcer status (yes/no) at the annual visit between 2009 and 2012.

Results: Of 3153 total participants, 19% (n=603) reported ulcers at their most recent annual clinic visit. Seven factors-level of lesion, wheelchair use, urinary incontinence, shunt presence, above the knee orthopedic surgery, recent surgery, and male sex-were significantly associated with the presence of pressure ulcers. Of these factors, level of lesion, urinary incontinence, recent surgery, and male sex were included in the final logistic regression model. The 3 adjusting variables-SB type, SB clinic, and age group-were significant in all analyses (all P<.001).

Conclusions: By adjusting for SB type, SB clinic, and age group, we found that 7 factors-level of lesion, wheelchair use, urinary incontinence, shunt presence, above the knee orthopedic surgery, recent surgery, and male sex-were associated with pressure ulcers. Identifying key factors associated with the onset of pressure ulcers can be incorporated into clinical practice in ways that prevent and enhance treatment of pressure ulcers in the population with SB.

Keywords: Pressure ulcer; Rehabilitation; Risk factors; Spinal cord injuries.

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Figures

**Fig 1**
Count (#) of pressure ulcers by location for myelomeningocele (top) and others (bottom) at the most recent annual clinic visit.

**Fig 2**
Adjusted prevalence (%) of pressure ulcers by associated factors over various age groups for myelomeningocele (top) and others (bottom), adjusting SB clinic. Adjusted prevalence was calculated using GEE analysis. Each model included the factor of interest, age group, SB type, and SB clinic.

**Fig 3**
OR (95% CI) for SB clinics in the final model.

See this image and copyright information in PMC

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References

1. Shin M, Besser LM, Siffel C, et al. Congenital Anomaly Multistate Prevalence and Survival Collaborative. Prevalence of spina bifida among children and adolescents in 10 regions in the United States. Pediatrics. 2010;126:274–9. - PubMed
1. Dicianno BE, Kurowski BG, Yang JM, et al. Rehabilitation and medical management of the adult with spina bifida. Am J Phys Med Rehabil. 2008;87:1027–50. - PubMed
1. Berlowitz D, VanDeusen Lukas C, Parker V, et al. Preventing pressure ulcers in hospitals: a toolkit for improving quality of care. Agency for Healthcare Research and Quality; Rockville: Apr, 2011. Available at: http://www.ahrq.gov/professionals/systems/long-term-care/resources/press.... Accessed July 12, 2014.
1. Vangilder C, Macfarlane GD, Meyer S. Results of nine international pressure ulcer prevalence surveys: 1989 to 2005. Ostomy Wound Manage. 2008;54:40–54. - PubMed
1. McLane KM, Bookout K, McCord S, McCain J, Jefferson LS. The 2003 national pediatric pressure ulcer and skin breakdown prevalence survey: a multisite study. J Wound Ostomy Continence Nurs. 2004;31:168–78. - PubMed

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[1] Shin M, Besser LM, Siffel C, et al. Congenital Anomaly Multistate Prevalence and Survival Collaborative. Prevalence of spina bifida among children and adolescents in 10 regions in the United States. Pediatrics. 2010;126:274–9. - PubMed

[2] Shin M, Besser LM, Siffel C, et al. Congenital Anomaly Multistate Prevalence and Survival Collaborative. Prevalence of spina bifida among children and adolescents in 10 regions in the United States. Pediatrics. 2010;126:274–9. - PubMed

[3] Dicianno BE, Kurowski BG, Yang JM, et al. Rehabilitation and medical management of the adult with spina bifida. Am J Phys Med Rehabil. 2008;87:1027–50. - PubMed

[4] Dicianno BE, Kurowski BG, Yang JM, et al. Rehabilitation and medical management of the adult with spina bifida. Am J Phys Med Rehabil. 2008;87:1027–50. - PubMed

[5] Berlowitz D, VanDeusen Lukas C, Parker V, et al. Preventing pressure ulcers in hospitals: a toolkit for improving quality of care. Agency for Healthcare Research and Quality; Rockville: Apr, 2011. Available at: http://www.ahrq.gov/professionals/systems/long-term-care/resources/press.... Accessed July 12, 2014.

[6] Berlowitz D, VanDeusen Lukas C, Parker V, et al. Preventing pressure ulcers in hospitals: a toolkit for improving quality of care. Agency for Healthcare Research and Quality; Rockville: Apr, 2011. Available at: http://www.ahrq.gov/professionals/systems/long-term-care/resources/press.... Accessed July 12, 2014.

[7] Vangilder C, Macfarlane GD, Meyer S. Results of nine international pressure ulcer prevalence surveys: 1989 to 2005. Ostomy Wound Manage. 2008;54:40–54. - PubMed

[8] Vangilder C, Macfarlane GD, Meyer S. Results of nine international pressure ulcer prevalence surveys: 1989 to 2005. Ostomy Wound Manage. 2008;54:40–54. - PubMed

[9] McLane KM, Bookout K, McCord S, McCain J, Jefferson LS. The 2003 national pediatric pressure ulcer and skin breakdown prevalence survey: a multisite study. J Wound Ostomy Continence Nurs. 2004;31:168–78. - PubMed

[10] McLane KM, Bookout K, McCord S, McCain J, Jefferson LS. The 2003 national pediatric pressure ulcer and skin breakdown prevalence survey: a multisite study. J Wound Ostomy Continence Nurs. 2004;31:168–78. - PubMed

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Factors associated with pressure ulcers in individuals with spina bifida

Collaborators

Affiliations

Factors associated with pressure ulcers in individuals with spina bifida

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