title: Difficulty in Identifying Factors Responsible for Pressure Ulcer Healing in Veterans With Spinal Cord Injury.
abstract: To identify characteristics associated with pressure ulcer (PrU) healing for individuals with spinal cord injury (SCI).
  
  
  
  Secondary analysis of a large clinical trial's data for healing PrUs in individuals with SCI; prospective Delphi process was conducted with SCI and/or PrU experts.
  
  
  
  Spinal cord injury centers.
  
  
  
  There were 629 screening and 162 treatment participants (N=791); 185 SCI clinicians/national PrU/wound care experts participated in the Delphi process.
  
  
  
  None.
  
  
  
  PrU healing of 50% and 100% at weeks 4 and 12.
  
  
  
  Poisson regression models using the top Delphi-recommended factors found that only ulcer stage consistently predicted 50% and 100% healing at weeks 4 and 12. Additionally, ischial/perineal location was associated with 33% higher likelihood of 50% healing at week 4. Patient noncompliance with treatment recommendations, the top-ranked Delphi factor, did not predict healing at week 4 or 12. Expanded models found that at week 4, baseline PrU size, PrU stage IV, PrU pain, and American Spinal Injury Association grade A significantly predicted 100% healing, while at week 12, only PrU stage (IV) significantly predicted 100% healing. Significant predictors of 50% healing at week 4 included baseline PrU size, stage, ischial/perianal location body mass index >30kg/m2, foul odor, and signs of infection. At week 12, PrU duration, paraplegia predicted 50% healing. SCI center identifiers consistently showed 2- to 5-fold variation in predicting 50% PrU healing at weeks 4 and 12.
  
  
  
  Delphi panel-recommended factors (eg, patient compliance) did not predict PrU healing. Reducing center-level variability in wound healing by learning from best practices should be a health system goal. PrU healing in SCI is still poorly understood, and future studies should focus on as yet unidentified or underappreciated factors.
authors.affiliation: Spinal Cord Injury Quality Enhancement Research Initiative, Edward Hines Jr Veterans Administration Hospital, Hines, IL; Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL. Electronic address: Marylou.guihan@va.gov.
authors.forename: Marylou
authors.initials: M
authors.lastname: Guihan
authors.affiliation: Public Health Sciences, School of Medicine, University of Virginia, Charlottesville, VA.
authors.forename: Min-Woong
authors.initials: MW
authors.lastname: Sohn
authors.affiliation: Veterans Administration Rehabilitation Research and Development National Center for the Medical Consequences of Spinal Cord Injury, James J. Peters Veterans Administration Medical Center, Bronx, NY; Department of Medicine and Rehabilitation Medicine, The Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: William A
authors.initials: WA
authors.lastname: Bauman
authors.affiliation: Veterans Administration Rehabilitation Research and Development National Center for the Medical Consequences of Spinal Cord Injury, James J. Peters Veterans Administration Medical Center, Bronx, NY; Department of Medicine and Rehabilitation Medicine, The Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: Ann M
authors.initials: AM
authors.lastname: Spungen
authors.affiliation: Center of Innovation for Disability and Rehabilitation Research, Tampa, FL; School of Nursing, University of South Florida, Tampa, FL.
authors.forename: Gail M
authors.initials: GM
authors.lastname: Powell-Cope
authors.affiliation: Center of Innovation for Disability and Rehabilitation Research, Tampa, FL.
authors.forename: Susan S
authors.initials: SS
authors.lastname: Thomason
authors.affiliation: Cooperative Studies Program Coordinating Center, Perry Point Veterans Administration Medical Center, Perry Point, MD.
authors.forename: Joseph F
authors.initials: JF
authors.lastname: Collins
authors.affiliation: Spinal Cord Injury Quality Enhancement Research Initiative, Edward Hines Jr Veterans Administration Hospital, Hines, IL; School of Nursing, University of California at Los Angeles, Los Angeles, CA; David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA.
authors.forename: Barbara M
authors.initials: BM
authors.lastname: Bates-Jensen
mesh_terms: D000328:Adult; D000368:Aged; D001837:Body Weights and Measures; D003697:Delphi Technique; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D003668:Pressure Ulcer / Q000209:etiology / Q000503:physiopathology* / Q000628:therapy*; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D012044:Regression Analysis; D012307:Risk Factors; D012720:Severity of Illness Index; D012907:Smoking / Q000453:epidemiology; D012959:Socioeconomic Factors; D013119:Spinal Cord Injuries / Q000150:complications*; D014728:Veterans; D014945:Wound Healing / Q000502:physiology*
keywords: Pressure ulcer; Rehabilitation; Spinal cord injuries; Veterans