Predictors of pressure ulcer recurrence in veterans with spinal cord injury.
OBJECTIVE
To predict recurrence of pressure ulcers (PrUs) in a high-risk population of veterans with spinal cord injury (SCI).


METHODS
Cross-sectional observational design.


METHODS
A convenience sample of 64 subjects from 6 Department of Veterans Affairs (VA) SCI Centers who had been admitted to the hospital for the treatment of stage III-IV pelvic PrUs and were healed at the time of discharge back to the community.


METHODS
Primary outcome measures were pelvic PrU recurrence, defined as self-reported new skin breakdown (stage II or greater) in the pelvic area (not necessarily in the same location as previous ulcer) and time to recurrence.


RESULTS
There were no differences between those with/without recurrences with regard to age, age at/level of injury, number of previous ulcers or surgery, rate of or time, to recurrence. Mean age was 56 years; most were white and men, lived at home, and had some college education. Mean time since SCI was 22 years; 28% had tetraplegia; mean number of prior pressure ulcers was 3; and almost one half had a previous ulcer in the same location. The strongest predictor of recurrence in a multivariate logistic regression was African American race (odds ratio = 9.3). Additional predictors included higher scores on the Charlson Co-Morbidity Index (indicating a higher burden of illness), the Salzburg PrU Risk Assessment Scales, and longer sitting time at discharge.


CONCLUSIONS
Identifying individuals at highest risk for recurrence and developing effective prevention programs are essential rehabilitation goals. We recommend that the unique findings of this exploratory study be considered preliminary until replication of these results is published.
Guihan
Marylou
M
Center for Management of Complex Chronic Care, Edwards Hines Jr. VA Hospital, Hines, IL 60141, USA. marylou.guihan@va.gov
Garber
Susan L
SL
Bombardier
Charles H
CH
Goldstein
Barry
B
Holmes
Sally A
SA
Cao
Lishan
L
D000328:Adult; D001741:Black or African American; D000368:Aged; D003430:Cross-Sectional Studies; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011237:Predictive Value of Tests; D003668:Pressure Ulcer / Q000453:epidemiology / Q000209:etiology* / Q000473:pathology; D012008:Recurrence; D018570:Risk Assessment; D012307:Risk Factors; D013119:Spinal Cord Injuries / Q000150:complications* / Q000473:pathology; D013997:Time Factors; D014728:Veterans