Article

OBJECTIVE: To identify characteristics associated with pressure ulcer (PrU)
healing for individuals with spinal cord injury (SCI).
DESIGN: Secondary analysis
of a large clinical trial's data for healing PrUs in individuals with SCI; prospective Delphi process was conducted with SCI and/or PrU experts. SETTING:
Spinal cord injury centers. PARTICIPANTS: There were 629 screening and 162
treatment participants (N=791); 185 SCI clinicians/national PrU/wound care
experts participated in the Delphi process. INTERVENTIONS: None. MAIN OUTCOME MEASURE: PrU healing of 50% and 100% at weeks 4 and 12. RESULTS: Poisson
regression models using the top Delphi-recommended factors found that only ulcer
stage consistently predicted 50% and 100% healing at weeks 4 and 12.
Additionally, ischial/perineal location was associated with 33% higher likelihood
of 50% healing at week 4. Patient noncompliance with treatment recommendations,
the top-ranked Delphi factor, did not predict healing at week 4 or 12. Expanded
models found that at week 4, baseline PrU size, PrU stage IV, PrU pain, and
American Spinal Injury Association grade A significantly predicted 100% healing,
while at week 12, only PrU stage (IV) significantly predicted 100% healing.
Significant predictors of 50% healing at week 4 included baseline PrU size,
stage, ischial/perianal location body mass index >30kg/m2, foul odor, and signs
of infection. At week 12, PrU duration, paraplegia predicted 50% healing. SCI
center identifiers consistently showed 2- to 5-fold variation in predicting 50%
PrU healing at weeks 4 and 12. CONCLUSIONS: Delphi panel-recommended factors (eg,
patient compliance) did not predict PrU healing. Reducing center-level
variability in wound healing by learning from best practices should be a health
system goal. PrU healing in SCI is still poorly understood, and future studies
should focus on as yet unidentified or underappreciated factors.
CI - Published by Elsevier Inc.

Langue : ANGLAIS