Identifying Pressure Ulcer Risk Factors in Persons With Spinal Cord Injury Over Time to Inform Clinical Evaluations

Introduction: Persons with spinal cord injury (SCI) or disease are at high risk of developing pressure ulcers (PrUs) throughout their lives.Seating evaluations typically involve interviews that seek to understand wheelchair use, activities, and factors that might indicate higher levels of PrU risk.The objective was to identify risk factors as a function of time since injury to help clinicians focus questions during their evaluations.The results of this study can be used to inform clinicians to ask about specific risk factors at various timeframes since injury.Methods: The study used the SCI Model Systems database, which collects a robust dataset on persons with SCI starting one year after injury and then at five-year timeframes thereafter (Follow-up Year).The dataset included 13,990 individuals who answered the item about PrUs.Fourteen possible risk factors were identified based on a review of literature and clinician interviews.Variables were dichotomized for inclusion in the modeling to foster a more clinically usable model.Cut points for continuous variables were determined through an optimized machine learning approach.Separate logistic binary regressions were run for the full dataset and each Follow-up Year group.Results: PrU occurrence incrementally increased in each Follow-up Year group, rising from 26% in Year 1 to 34% in the Year30+ group.All variables were significant in the regression using the full dataset, but some fell out of the timeframe-based models.Having a previous PrU was a top risk factor from YR5 onward.Three risk factors appeared in all five timeframes: 1) having a urinary tract infection (UTI) in the past year, 2) having a bowel incontinence episode at least once a month, and 3) being a power wheelchair user.Conclusion: The results found that asking about UTIs, bowel incontinence, and prior occurrences of PrUs should be a part of interviews regardless of time since injury.The use of powered wheelchairs was also a top risk factor over all timeframes.