title: Pressure ulcer development in trauma patients with suspected spinal injury; the influence of risk factors present in the Emergency Department.
abstract: OBJECTIVE
  To explore the influence of risk factors present at Emergency Department admission on pressure ulcer development in trauma patients with suspected spinal injury, admitted to the hospital for evaluation and treatment of acute traumatic injuries.
  
  
  METHODS
  Prospective cohort study setting level one trauma center in the Netherlands participants adult trauma patients transported to the Emergency Department on a backboard, with extrication collar and headblocks and admitted to the hospital for treatment or evaluation of their injuries.
  
  
  METHODS
  Between January and December 2013, 254 trauma patients were included. The following dependent variables were collected: Age, Skin color and Body Mass Index, and Time in Emergency Department, Injury Severity Score, Mean Arterial Pressure, hemoglobin level, Glasgow Coma Score, and admission ward after Emergency Department.
  
  
  RESULTS
  Pressure ulcer development during admission was associated with a higher age (p 0.00, OR 1.05) and a lower Glasgow Coma Scale score (p 0.00, OR 1.21) and higher Injury Severity Scores (p 0.03, OR 1.05). Extra nutrition decreases the probability of PU development during admission (p 0.04, OR 0.20). Pressure ulcer development within the first 48h of admission was positively associated with a higher age (p 0.01, OR 1.03) and a lower Glasgow Coma Scale score (p 0.01, OR 1.16). The proportion of patients admitted to the Intensive Care Unit and Medium Care Unit was higher in patients with pressure ulcers.
  
  
  CONCLUSIONS
  The pressure ulcer risk during admission is high in patients with an increased age, lower Glasgow Coma Scale and higher Injury Severity Score in the Emergency Department. Pressure ulcer risk should be assessed in the Emergency Department to apply preventive interventions in time.
authors.affiliation: University Medical Center Utrecht, The Netherlands. Electronic address: H.W.Ham@umcutrecht.nl.
authors.forename: H W Wietske
authors.initials: HW
authors.lastname: Ham
authors.affiliation: University of Southampton, Faculty of Health Sciences, Southampton, United Kingdom.
authors.forename: L Lisette
authors.initials: LL
authors.lastname: Schoonhoven
authors.affiliation: University Medical Center Utrecht, The Netherlands.
authors.forename: M Marieke J
authors.initials: MM
authors.lastname: Schuurmans
authors.affiliation: University Medical Center Utrecht, The Netherlands.
authors.forename: L Luke P H
authors.initials: LL
authors.lastname: Leenen
mesh_terms: D000328:Adult; D000368:Aged; D015992:Body Mass Index; D015331:Cohort Studies; D004636:Emergency Service, Hospital / Q000458:organization & administration; D005260:Female; D006801:Humans; D007103:Immobilization / Q000009:adverse effects* / Q000379:methods; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009426:Netherlands; D003668:Pressure Ulcer / Q000209:etiology*; D016684:Prone Position / Q000502:physiology; D011446:Prospective Studies; D012307:Risk Factors; D013124:Spinal Injuries / Q000150:complications* / Q000209:etiology; D011795:Surveys and Questionnaires; D013997:Time Factors; D014947:Wounds and Injuries / Q000150:complications*
keywords: Emergency Department; Pressure ulcers; Preventive spinal immobilization; Risk factors; Trauma patients