Risk Analyses of Pressure Ulcer in Tetraplegic Spinal Cord-Injured Persons: A French Long-Term Survey

Arch Phys Med Rehabil. 2017 Sep;98(9):1782-1791. doi: 10.1016/j.apmr.2016.12.017. Epub 2017 Jan 25.


Objective: To identify the long-term clinical, individual, and social risk factors for the development of pressure ulcers (PUs) in traumatic spinal cord-injured persons with tetraplegia (TSCIt).

Design: Cohort survey with self-applied questionnaires in 1995 and 2006.

Setting: Thirty-five French-speaking European physical medicine and rehabilitation centers participating in the Tetrafigap surveys.

Participants: Tetraplegic adults (N=1641) were surveyed after an initial posttraumatic period of at least 2 years. Eleven years later, a follow-up was done for 1327 TSCIt, among whom 221 had died and 547 could be surveyed again.

Interventions: Not applicable.

Main outcome measures: The proportion of PUs documented at the various defined time points, relative to the medical and social situations of the TSCIt, by using univariate analyses followed by logistic regression.

Results: Of the participants, 73.4% presented with a PU during at least 1 period after their injury. Four factors had an effect on the occurrence of PUs in the long-term. Protective features for this population were incomplete motor impairment (odds ratio, 0.5) and the ability to walk (odds ratio, 0.2), whereas a strong predictive factor was the development of a PU during the initial posttrauma phase (odds ratio, 2.7). Finally, a significant situational factor was the lack of a social network (odds ratio, 3.1).

Conclusions: We believe that the highlighting of a motor incomplete feature of SCI (protective against the development of a PU) and of a medical risk factor, an early PU (which served as a definitive marker of the trajectory of TSCIt), together with a social situational factor, indicates the crucial role of initial management and long-term follow-up.

Keywords: Cohort studies; Follow-up studies; Recurrence; Rehabilitation; Risk factors; Surveys and questionnaires.

MeSH terms

  • Adult
  • Female
  • Follow-Up Studies
  • France
  • Humans
  • Logistic Models
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Odds Ratio
  • Pressure Ulcer / etiology*
  • Quadriplegia / complications*
  • Quadriplegia / physiopathology
  • Risk Factors
  • Social Support
  • Spinal Cord Injuries / complications*
  • Spinal Cord Injuries / physiopathology
  • Surveys and Questionnaires
  • Walking