Each year, one-fourth of the 200,000 individuals with spinal cord injury in the United States develop pressure ulcers. No method currently exists, however, to accurately identify which of these individuals are at increased risk for development of pressure ulcers. We studied 219 spinal cord-injured patients, seen at a Veterans Affairs Medical Center, during a 6-yr period. Our goal was to develop a pressure ulcer risk assessment scale, specifically for persons with SCI. Each risk factor had to meet four criteria: (1) statistical association with pressure ulcer development; (2) biologically plausible mechanism; (3) literature support; (4) improved prediction. Among the 219 spinal cord-injured patients evaluated, 176 (80.4 percent) had a history of one or more pressure ulcers. Fifteen risk factors met the four criteria for inclusion into the risk assessment scale. They were as follows: restricted activity level, degree of immobility, complete spinal cord injury, urinary incontinence, autonomic dysreflexia, advanced age, the comorbidities of cardiac, pulmonary, and renal disease, impaired cognitive function, diabetes, cigarette smoking, residence in a nursing home or hospital, hypoalbuminemia, and anemia. Compared with the more general scales available, for quantifying the risk of pressure ulcer development, preliminary results suggest that this new scale is a significant improvement for the spinal cord-disabled.
1From the Division of Plastic and Reconstructive Surgery (C.A.S.), the Institute for Trauma & Emergency Care (D.W.B., C.G.C., P.V.N., J.G.M.), New York Medical College, Westchester County Medical Center, Valhalla, New York, the Department of Surgery, Our Lady of Mercy Hospital, Bronx, New York (C.G.C.), and the Spinal Cord Injury Unit, Castle Point Veterans Affairs Medical Center, Castle Point, New York (C.A.S., M.V.).
Supported in part by grants from the New York State Department of Health, the Centers for Disease Control and Prevention, and the Eastern Paralyzed Veterans Association.
2 All correspondence and requests for reprints should be addressed to: Westchester Burn Center, Westchester County Medical Center, Valhalla, New York 10595.
1996 Series Number 4