Risk Analyses of Pressure Ulcer in Tetraplegic Spinal Cord-Injured : A French Long-Term Survey
Résumé
Research Objectives: To identify the long-term clinical, individual, and social risk factors for the development of pressure ulcers (PUs) in traumatic spinal cord-injured persons with tetraplegia (TSCIt). Design: Cohort survey with self-applied questionnaires in 1995 and 2006. Setting: Thirty-five French-speaking European physical medicine and rehabilitation centers participating in the Tetrafigap surveys. Participants: A total of 1641 tetraplegic adults were surveyed after an initial post-traumatic period of at least 2 years. Eleven years later, a followup was done for 1327 TSCIt, among whom 221 were deceased and 547 could be surveyed again. Interventions: Not applicable. Main Outcome Measure(s): The proportion of PUs documented at the various defined time points, relative to the medical and social situations of the TSCIt, by using univariate analyses followed by logistic regression. Results: Of the participants, 73.4% presented with a PU during at least one period after their injury. Four factors had a proper effect on the occurrence of PU at the long term. On the one hand, a protective feature for this population, persons with incomplete motor impairment (OR Z 0.5) and moreover those who were able to walk (OR Z 0.2); on the other hand, a strong pre-dictive factor was the development of a PU during the initial post-trauma phase (OR Z 2.7). Finally, a significant situational factor was the lack of social network (OR Z 3.1). Conclusion/Discussion: We believe that the highlighting of a motor incomplete feature of SCI (protective for the development of PU) and of a medical risk factor, an early PU (which served as a definitive marker of the trajectory of TSCIt), together with a social situational factor, indicates the crucial role of initial management and of long-term follow-up.
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