An exploratory study of pressure ulcers after spinal cord injury: relationship to protective behaviors and risk factors.

OBJECTIVES: To identify protective behaviors and risk factors associated with the development of pressure ulcers (PUs) after spinal cord injury (SCI). DESIGN: A cross-sectional study to evaluate the relationship between protective behaviors and risk factors and 3 PU outcomes: a current PU, PUs within the past year, and ever hospitalized for a PU. Logistic regression was then used to identify the variables most strongly associated with PU outcomes. SETTING: Data were collected by case managers employed by the Arkansas Spinal Cord Commission, an agency that provides services to persons with SCI. PARTICIPANTS: A total of 650 of 991 eligible individuals with SCI from a statewide population-based SCI registry participated. All ambulatory participants were eliminated, leaving 560 patients. Average age of the respondents was 27.2 years at injury (median age, 25yr) and 43.6 years at the time of the survey (median age, 42yr). MAIN OUTCOME MEASURES: A 200-item interview was developed to measure a broad range of outcomes associated with SCI (including secondary conditions such as PUs), as well as risk and protective behaviors related to these outcomes. RESULTS: Several characteristics and behaviors were related to PU outcomes. Being underweight (odds ratio [OR] = 2.18), having used medications to treat pain (OR = 1.33) or spasticity (OR = 1.31), having smoked at least 100 cigarettes over a lifetime (OR = 1.31), and being a current smoker (OR = 1.21) were associated with having a PU in the past year. Having completed a college degree (OR = 0.23), being married (OR = 0.49), and being currently employed (OR = 0.54) were associated with a lower risk of having a PU in the past year. Being underweight (OR = 1.94), having a history of incarceration (OR = 1.78), having attempted suicide (OR = 1.71), and reporting alcohol or drug treatment (OR = 1.65) were associated with having been hospitalized for a PU since injury. This study was unable to evaluate the efficacy of traditional health maintenance or protective behaviors for PUs, such as weight shifts or skin checks. CONCLUSIONS: PUs are least likely to occur among individuals who maintain normal weight, return to a work and family role, and who do not have a history of tobacco use, suicidal behaviors, or self-reported incarcerations, or alcohol or drug abuse. Additional research is needed to identify better the risk factors for the occurrence of PUs.

A comparison of women and men with spinal cord injury.

While research on spinal cord injury (SCI) is abundant, few studies focus on women. This population-based study investigates differences in the prevalence of secondary conditions between 128 women and 522 men. Case managers retrospectively interviewed 650 persons regarding medical and psychological conditions secondary to SCI, as well as other life issues. Overall, males and females show more similarities than differences in the ways in which they manage life with SCI. Differences were found, though, regarding etiology of initial injury, insurance coverage, caregiver use, transportation use, medication use, and in other medical and behavioral areas. Females are significantly involved in more automobile crashes than males, while males are involved in more galls than females. Females are more reliant on Medicaid, while males report more Medicare and Worker's Compensation coverage. Females are more likely to have a paid attendant as a caregiver while males are more likely to have their spouse or parents assist. Males report more independence in their use of transportation than females. Males and females also report significant differences in the use of medication. Females are more likely to use medication any time it is a treatment option. Males are more active, use tobacco more and have more arm fractures postinjury than females.