Marylou Guihan1, Min-Woong Sohn2, William A Bauman3, Ann M Spungen3, Gail M Powell-Cope4, Susan S Thomason5, Joseph F Collins6, Barbara M Bates-Jensen7. 1. 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. 2. Public Health Sciences, School of Medicine, University of Virginia, Charlottesville, VA. 3. 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. 4. Center of Innovation for Disability and Rehabilitation Research, Tampa, FL; School of Nursing, University of South Florida, Tampa, FL. 5. Center of Innovation for Disability and Rehabilitation Research, Tampa, FL. 6. Cooperative Studies Program Coordinating Center, Perry Point Veterans Administration Medical Center, Perry Point, MD. 7. 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.
Abstract
OBJECTIVE: To identify characteristics associated with pressure ulcer (PrU) healing for individuals with spinal cord injury (SCI). DESIGN: 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. SETTING: Spinal cord injury centers. PARTICIPANTS: There were 629 screening and 162 treatment participants (N=791); 185 SCI clinicians/national PrU/wound care experts participated in the Delphi process. INTERVENTIONS: None. MAIN OUTCOME MEASURE: PrU healing of 50% and 100% at weeks 4 and 12. RESULTS: 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. CONCLUSIONS: 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. Published by Elsevier Inc.
OBJECTIVE: To identify characteristics associated with pressure ulcer (PrU) healing for individuals with spinal cord injury (SCI). DESIGN: 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. SETTING:Spinal cord injury centers. PARTICIPANTS: There were 629 screening and 162 treatment participants (N=791); 185 SCI clinicians/national PrU/wound care experts participated in the Delphi process. INTERVENTIONS: None. MAIN OUTCOME MEASURE: PrU healing of 50% and 100% at weeks 4 and 12. RESULTS: 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. CONCLUSIONS: 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. Published by Elsevier Inc.
Authors: Jennifer N Hill; Bridget M Smith; Frances M Weaver; Kim M Nazi; Florian P Thomas; Barry Goldstein; Timothy P Hogan Journal: J Spinal Cord Med Date: 2017-03-21 Impact factor: 1.985
Authors: Sang Kyu Cho; Soeren Mattke; Hanna Gordon; Mary Sheridan; William Ennis Journal: Adv Wound Care (New Rochelle) Date: 2020-01-24 Impact factor: 4.730