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Pressure Ulcer Prevalence by Level of Paralysis in Patients With Spinal Cord Injury in Long-term Care

Cowan, Linda J., PhD, ARNP, CWOC; Ahn, Hyochol, PhD, MSN, APRN, ANP-BC; Flores, Micah, PhD, MS; Yarrow, Joshua, PhD; Barks, Lelia S., PhD, ARNP; Garvan, Cyndi, PhD; Weaver, Michael T., PhD, RN, FAAN; Stechmiller, Joyce, PhD, ACNP-BC, FAAN

Advances in Skin & Wound Care: March 2019 - Volume 32 - Issue 3 - p 122–130
doi: 10.1097/

OBJECTIVE: Scientific literature suggests pressure ulcer (PU) risk increases as immobility increases, indicating that more extensive paralysis confers a greater risk of PU. Yet the specific level of paralysis (ie, hemiplegia vs paraplegia vs quadriplegia), apart from neurodegenerative diagnoses, has never been examined in the long-term care (LTC) population. This study examined the prevalence of PU among LTC residents with different paralysis levels.

METHODS: The authors conducted a secondary data analysis of the 2012 US Minimum Data Set of LTC facilities (n = 51,664 residents). Measures included PU stage, level of paralysis, functional impairments, comorbidities, and sociodemographic factors. After removing residents with neurodegenerative disease, comatose patients, and those with hip fractures from the analysis, logistic regressions were used to examine the association of risk factors and sociodemographic characteristics with the presence of PU.

MAIN RESULTS: The sample included 7,540 patients with quadriplegia, 11,614 patients with paraplegia, and 32,510 patients with hemiplegia in LTC facilities. The PU prevalence in the sample (stages 2, 3, and 4; suspected deep-tissue injury; and unstageable PUs) was 33.9% for patients with quadriplegia, 47.4% for patients with paraplegia, and 9.6% for patients with hemiplegia.

CONCLUSIONS: Within paralysis groups (quadriplegic, paraplegic, hemiplegic), risk factors for PU differed in type and magnitude. The PU rates associated with quadriplegia and paraplegia are much higher than LTC residents without paralysis, and PU prevalence for hemiplegia is similar to the rate in LTC residents without paralysis. When the risk factor of paraplegia versus quadriplegia was isolated, PU prevalence for patients with paraplegia was significantly higher.

Linda J. Cowan, PhD, ARNP, CWOC, is Associate Chief of Nursing Service/Research, Center of Innovation for Disability and Rehabilitation Outcomes Research Section, James A. Haley Veterans Hospital, Tampa, Florida. Hyochol Ahn, PhD, MSN, APRN, ANP-BC, is Director, Brain Stimulation and Imaging Laboratory, Jane and Robert Cizik School of Nursing, University of Texas Health Science Center, Houston, Texas. Micah Flores, PhD, is Operations Support Manager, BioMonde, Gainsville, Florida. Joshua Yarrow, PhD, MS, is Research Health Scientist, North Florida/South Georgia Veterans Health System, Malcom Randall VA Medical Center, Gainesville, Florida. Lee Barks, PhD, ARNP, is a Nurse Researcher, Veterans Administration Research and Education Foundation, Tampa, Florida. At the University of Florida College of Nursing in Gainesville, Florida, Cyndi Garvan, PhD, is Research Associate Professor; Michael T. Weaver, PhD, RN, FAAN, is Professor and Associate Dean for Research; and Joyce Stechmiller, PhD, ACNP-BC, FAAN, is Associate Professor. Acknowledgments: This work was supported by resources provided by the Department of Veterans Affairs, Veterans Health Administration, North Florida/South Georgia Veterans Health System, Gainesville, Florida, as well as the University of Florida College of Nursing. The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs or the University of Florida College of Nursing. The authors have disclosed no other financial relationships related to this article. Submitted July 12, 2018; accepted in revised form September 6, 2018.

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