title: Factors associated with pressure ulcer risk in spinal cord injury rehabilitation.
abstract: OBJECTIVE
  The aim of this study was to identify patient and clinical factors most strongly associated with a spinal cord injury patient's risk for developing a pressure ulcer (PU) during rehabilitation.
  
  
  METHODS
  This is a prospective observational cohort study conducted at an urban rehabilitation hospital-based specialized spinal cord injury center. The main outcome measure was the onset of a stage 2 or higher PU.
  
  
  RESULTS
  Study patients (N = 159) with new (n = 66) and patients with earlier (n = 99) spinal injuries had identical rates at which they acquired a new PU (stage ≥2) in rehabilitation--13.1%. The patients who came to rehabilitation with a PU or myocutaneous flap exhibited a higher rate of developing yet another PU while in rehabilitation (30.2%) than those who came to rehabilitation without an existing PU or flap (6.9%). Logistic regression analysis identified two variables that best predicted a patient's risk at admission for developing a PU during rehabilitation (c = 0.77)--entering rehabilitation with a PU and admission Functional Independence Measure transfers score of less than 3.5.
  
  
  CONCLUSIONS
  The greatest risk of developing a new PU in rehabilitation is being admitted with an existing PU followed by admission Functional Independence Measure transfers score of less than 3.5. Using these two variables, one can develop a patient PU risk algorithm at admission that can alert clinicians for the need to enhance vigilance, skin monitoring, and early patient education.
authors.affiliation: From the MedStar National Rehabilitation Network, Washington, DC (GDJ, CJH, PB, TB); Department of Rehabilitation Medicine, Georgetown University School of Medicine, Washington, DC (GDJ); and Institute for Clinical Outcomes Research, Salt Lake City, Utah (PB, RJS, SDH).
authors.forename: Gerben
authors.initials: G
authors.lastname: DeJong
authors.forename: Ching-Hui J
authors.initials: CH
authors.lastname: Hsieh
authors.forename: Patrick
authors.initials: P
authors.lastname: Brown
authors.forename: Randall J
authors.initials: RJ
authors.lastname: Smout
authors.forename: Susan D
authors.initials: SD
authors.lastname: Horn
authors.forename: Pamela
authors.initials: P
authors.lastname: Ballard
authors.forename: Tara
authors.initials: T
authors.lastname: Bouchard
mesh_terms: D000328:Adult; D000367:Age Factors; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006786:Hospitals, Urban; D006801:Humans; D015994:Incidence; D015601:Injury Severity Score; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D026741:Physical Therapy Modalities; D011237:Predictive Value of Tests; D064266:Preexisting Condition Coverage; D003668:Pressure Ulcer / Q000453:epidemiology* / Q000503:physiopathology; D011446:Prospective Studies; D012047:Rehabilitation Centers; D012307:Risk Factors; D012720:Severity of Illness Index; D013119:Spinal Cord Injuries / Q000175:diagnosis / Q000534:rehabilitation* / Q000601:surgery; D016896:Treatment Outcome; D055815:Young Adult