SCI: Pressure Ulcers (2003)
- 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
Dependent Variables
- Risk factors for pressure ulcers listed as “major” and “potential” as they apply to SCI
Independent Variables
- Spinal cord injury
Control Variables
Initial N: 190 citations
Attrition (final N): 190
Age: not mentioned
Ethnicity: not mentioned
Other relevant demographics:
Anthropometrics:
Location: Worldwide studies
15 Major Risk Factors
Severity of SCI
- Decreased activity
- Immobility
- Completeness of the SCI
- Urine incontinence/moisture
- Autonomic dysreflexia/severe spasticity.
Preexisting Conditions
- 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
- Hypocholesterolemia
- Low BMI/thinness
- Inadequate fluid intake/dehydration
- Poor nutritional intake
- Achexia/pronounced emaciation
- Obesity
- 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 | ||
Not-for-profit |
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Quality Criteria Checklist: Review Articles
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Relevance Questions | |||
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 | |
Validity Questions | |||
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 | |