Factors in rehospitalisation for severe pressure ulcer care in spinal cord injury/disorders.
OBJECTIVE
Repeated hospital admissions (RHA) for ongoing pressure ulcer (PU) care remains a significant challenge in the clinical management of the spinal cord injury/disorders (SCI/D) population. The current study investigated the significance of risk factors for PU treatment and RHA.


METHODS
A retrospective chart review of veterans admitted to the Louis Stokes Cleveland Department of Veterans Affairs Medical Center (LSCDVAMC) Spinal Cord Injury (SCI) unit for Category III or IV PUs was carried out. A random sample of 105 individuals with SCI/D, evaluated by the Wound Care Team (WCT) from 2006 to 2009 was assessed. Multiple PU development risk factors were extracted from the electronic health record system using standardised data collection forms and entered into the Spinal Cord Injury Pressure Ulcer Database (SCIPUD). Potential associations with RHA were analysed.


RESULTS
Twenty variables were initially identified as potentially related to PU development. Descriptive statistics and statistically significant associations between risk factors and RHA were determined. Demographic factors showed no significant association with RHA. Duration of injury, power wheelchair use and sub-optimally managed spasticity (SMS) were significantly associated with higher RHA. Sub-optimally managed neurogenic bowel (SMNB) at admission was significantly associated with reduced RHA.


CONCLUSIONS
Factors previously found to be predictive of initial PU development may not, in fact, be predictive of RHA. Some protective trends were observed, such as polypharmacy and marital status, but these did not reach statistical significance in this preliminary study of admission characteristics, warranting further research.


BACKGROUND
There were no external sources of funding for this study. The authors have no conflicts of interests to declare.
MPH, Louis Stokes Cleveland Department of Veterans Affairs Medical Center (LSCDVAMC), Cleveland, Ohio, US. Department of Epidemiology & Biostatistics, Case Western Reserve University, Cleveland, Ohio, US.
B L
BL
Goodman
BA, The Ohio College of Podiatric Medicine, Cleveland, Ohio, US.
A
A
Schindler
RN, MS, Louis Stokes Cleveland Department of Veterans Affairs Medical Center (LSCDVAMC), Cleveland, Ohio, US.
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M
Washington
PhD, Louis Stokes Cleveland Department of Veterans Affairs Medical Center (LSCDVAMC), Cleveland, Ohio, US. Department of Orthopaedics, Case Western Reserve University, Cleveland, Ohio, US.
K M
KM
Bogie
MD, Louis Stokes Cleveland Department of Veterans Affairs Medical Center (LSCDVAMC), Cleveland, Ohio, US. Division of Physical Medicine & Rehabilitation, University of Calgary, Calgary, Canada.
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Ho
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006787:Hospitals, Veterans; D006801:Humans; D008297:Male; D008875:Middle Aged; D009128:Muscle Spasticity / Q000150:complications; D055496:Neurogenic Bowel / Q000150:complications; D009820:Ohio; D010359:Patient Readmission / Q000706:statistics & numerical data*; D003668:Pressure Ulcer / Q000628:therapy*; D012189:Retrospective Studies; D012307:Risk Factors; D013119:Spinal Cord Injuries / Q000150:complications*; D013997:Time Factors; D014910:Wheelchairs