The Difficulty in Identifying Factors Responsible for Pressure Ulcer Healing in Veterans with Spinal Cord Injury

Publication date: Available online 1 July 2016
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Marylou Guihan, Min-Woong Sohn, William A. Bauman, Ann M. Spungen, Gail M. Powell-Cope, Susan S. Thomason, Joseph F. Collins, Barbara M. Bates-Jensen
ObjectiveTo identify characteristics associated with pressure ulcer (PrU) healing for individuals with spinal cord injury (SCI)DesignSecondary analysis of a large clinical trial data for healing PrUs in individuals with SCI; Prospective Delphi process was conducted with SCI and/or PrU experts.SettingUS Department of Veterans Affairs Spinal Cord Injury CentersParticipants629 screening and 162 treatment participants; 185 SCI clinicians/national PrU/wound care experts participated in the Delphi process.InterventionsNoneMain Outcome Measure(s)50% and 100% PrU healing at Weeks 4 and 12ResultsScreening participants were 57±11 years, non-Hispanic white (61%), with complete motor paraplegia and more than a college education (55%). Baseline PrU size was 15.3 ± 19.0 cm² and located on the ischium or perineum (48%).Poisson regression models using the top Delphi-recommended factors found that baseline ulcer size and ulcer severity (Stage IV) did not significantly predict 50% or 100% healing at Weeks 4 or 12. Ischial/perineal location was associated with 33% higher likelihood of 50% healing at Week 4. Patient non-compliance with treatment recommendations, the top-ranked Delphi factor, did not predict 50% or 100% healing at Week 12. At Week 4, baseline PrU size, PrU stage IV, multiple PrUs, PrU pain, and ASIA A significantly predicted 100% healing. At Week 12, only PrU stage (IV) significantly predicted 100% healing. Significant predictors of 50% healing at Week 12 included PrU duration and paraplegia. SCI center identifiers consistently showed two to five-fold variation in 50% PrU healing.ConclusionsDelphi panel-recommended factors such as 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 under-appreciated factors.



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