Pressure ulcers in individuals with spinal cord injury: a comparative analysis of healing outcomes in inpatient and outpatient settings

Background Pressure ulcers (PUs) are a common and serious secondary complication in individuals with spinal cord injury (SCI). Effective treatment strategies are crucial for improving patient outcomes. However, it remains unclear whether inpatient or outpatient treatment leads to better healing outcomes. Study design Retrospective cohort study. Objective This study aimed to compare the healing progression of PUs grade 2 in SCI patients in the inpatient versus outpatient setting. Setting Spinal Cord Injury Centre, Balgrist University Hospital, Zurich, Switzerland. Methods Data from SCI patients treated for PUs between July 2017 and July 2019 were analysed retrospectively. Wound characteristics, localization, and healing progression were recorded for PUs grade 2. The primary outcome was the time to complete wound healing, analysed by localization and treatment setting. Kaplan-Meier survival analysis and the log-rank test were used to compare healing times between inpatient and outpatient treatment. Results Healing times varied by care setting. The mean time to complete healing was significantly reduced for inpatient care compared to the outpatient setting (median: 34 vs. 60 days; 95% CI 51.2 to 137.8 vs 30.2 to 63.1; p < 0.05). Kaplan-Meier analysis confirmed significantly shorter median healing times in the inpatient group (34 days; 95% CI: 27.2 to 57.4) compared to the outpatient group (69 days; 95% CI: 30.2 to 111.4; log-rank test, p = 0.014). Conclusion The study highlights the importance of care setting in PU management, with inpatient treatment of PUs grad 2 leading to significantly faster healing than outpatient care.