Risk analyses of pressure ulcer in tetraplegic spinal cord-injured persons: A French long-term survey

Objective To identify the long-term clinical, individual, and social risk factors for the development of pressure ulcers (PUs) in traumatic spinal cord-injured persons with tetraplegia (TSCIt). Material/Patients and methods/Design Cohort survey with self-applied questionnaires in 1995 and 2006. Thirty-five French-speaking European physical medicine and rehabilitation centers participating in the Tetrafigap surveys. A total of 1641 tetraplegic adults were surveyed after an initial post-traumatic period of at least 2 years. Eleven years later, a follow-up was done for 1327 TSCIt, among whom 221 were deceased and 547 could be surveyed again. Main outcome measure was the proportion of PUs documented at the various defined time points, relative to the medical and social situations of the TSCIt, by using univariate analyses followed by logistic regression. Results Of the participants, 73.4% presented with a PU during at least one period after their injury. Four factors had an effect on the occurrence of PU at the long-term. On the one hand, a protective feature for this population, persons with incomplete motor impairment (OR = 0.5) and moreover those who were able to walk (OR = 0.2); on the other hand, a strong predictive factor was the development of a PU during the initial post-trauma phase (OR = 2.7). Finally, a significant situational factor was the lack of social network (OR = 3.1). Discussion/Conclusion We believe that the highlighting of a motor incomplete feature of SCI, protective for the development of PU, and of a medical risk factor, an early PU, which served as a definitive marker of the trajectory of TSCIt, together with a social situational factor, indicates the crucial role of initial management and of long-term follow-up.