SCI: Pressure Ulcers (2003)
Byrne DW, Salzberg CA. Major risk factors for pressure ulcers in the spinal cord disabled: a literature review. Spinal Cord 1996:43:255-263.PubMed ID: 8963971
- To provide an overview of published reports on the principal risk factors for pressure ulcers in persons with spinal cord injury
- Most pressure ulcer research has been on the elderly. The drastically altered physiology of persons with SCI makes the risk factors and thresholds for each of these risk factors unique.
- Medical, nursing, and nutritional research literature that pertained to risk factors for pressure ulcer development.
- Not described.
Recruitment: Methods for article inclusion not described.
Design: Narrative Review
Blinding Used (if applicable): not applicable
Intervention (if applicable): "Critically evaluated” the research literature.
Statistical Analysis: Statistical analysis not completed.
Timing of measurements: not applicable
- Risk factors for pressure ulcers listed as “major” and “potential” as they apply to SCI
- Spinal cord injury
Initial N: 190 citations
Attrition (final N): 190
Age: not mentioned
Ethnicity: not mentioned
Other relevant demographics:
Location: Worldwide studies
15 Major Risk Factors
Severity of SCI
- Decreased activity
- Completeness of the SCI
- Urine incontinence/moisture
- Autonomic dysreflexia/severe spasticity.
- Advanced age (age 35 and 65)
- Tobacco use/smoking
- Cardiac disease/abnormal electrocardiogram
- Diabetes/poor glycemic control
- Renal disease
- Impaired cognitive function
- Residing in a nursing home/hospital.
Malnutrition and Anemia
- Hypoalbuminemia/hypo-proteinemia (albumin<3.5)
- Anemia (hemoglobin<12, hematocrit<36).
Potential Nutritional Risk Factors
- Negative nitrogen balance
- Low BMI/thinness
- Inadequate fluid intake/dehydration
- Poor nutritional intake
- Achexia/pronounced emaciation
- Inadequate serum ascorbic acid or zinc
- Ideal body weight below normal
- Triceps skinfold below normal
- Inadequate protein intake (as percent RDA)
- Vitamin deficiencies in general
- Low serum calcium, magnesium, vitamin D and Vitamin E deficiencies.
There is no question that preventing pressure ulcers is far less expensive than treating them. Patients with multiple risk factors are in a high-risk group and should be enrolled in a comprehensive program for preventing pressure ulcer. Pressure ulcer prevention in a high-risk group of SCI deserves a high priority in future health care and insurance reforms. The 15 major risk factors help make such a prevention program more manageable.
|Government:||New York State Dept. of Health, CDC|
Quality Criteria Checklist: Review Articles
|1.||Will the answer if true, have a direct bearing on the health of patients?||Yes|
|2.||Is the outcome or topic something that patients/clients/population groups would care about?||Yes|
|3.||Is the problem addressed in the review one that is relevant to dietetics practice?||Yes|
|4.||Will the information, if true, require a change in practice?||Yes|
|1.||Was the question for the review clearly focused and appropriate?||Yes|
|2.||Was the search strategy used to locate relevant studies comprehensive? Were the databases searched and the search termsused described?||No|
|3.||Were explicit methods used to select studies to include in the review? Were inclusion/exclusion criteria specified andappropriate? Wereselectionmethods unbiased?||No|
|4.||Was there an appraisal of the quality and validity of studies included in the review? Were appraisal methodsspecified,appropriate, andreproducible?||???|
|5.||Were specific treatments/interventions/exposures described? Were treatments similar enough to be combined?||???|
|6.||Was the outcome of interest clearly indicated? Were other potential harms and benefits considered?||Yes|
|7.||Were processes for data abstraction, synthesis, and analysis described? Were they applied consistently acrossstudies and groups? Was thereappropriate use of qualitative and/or quantitative synthesis? Was variation in findings among studies analyzed? Were heterogeneity issued considered? If data from studies were aggregated for meta-analysis, was the procedure described?||No|
|8.||Are the results clearly presented in narrative and/or quantitative terms? If summary statistics are used, are levels ofsignificance and/or confidence intervals included?||Yes|
|9.||Are conclusions supported by results with biases and limitations taken into consideration? Are limitations ofthe review identified anddiscussed?||Yes|
|10.||Was bias due to the review's funding or sponsorship unlikely?||Yes|