A national, retrospective, cross-sectional study.
To analyze the prevalence of pressure injury (PI), and characteristics associated with PI development in the hospitalized population of persons with a newly acquired spinal cord injury (SCI) between 2004 and 2014.
All three specialized Spinal Cord Units in Norway.
Demographic data related to prevalence and potential risk factors were retrieved from the electronic medical record (EMR). Statistical analyses were performed, using IBM SPSS Statistics, version 23.
We identified 1012 individuals with a new SCI. Mean age at injury was 48 years (SD 19). The period prevalence of PI was 16% (95% CI = 0.14–0.19), and identified PI associations were complete SCI (OR = 0.1), being injured abroad (OR = 2.4), bowel (OR = 13), and bladder (OR = 9.2) dysfunction; comorbidities like diabetes mellitus 1 (OR = 7.9), diagnosed depression (OR = 3.8), ventilator support (OR = 3.0), drug abuse (OR = 3.0), and concurrent traumatic brain injury (OR = 1.7). Individuals in the age group of 15–29 years had higher odds of PI compared with middle-aged individuals (45–59 years).
PI is a serious complication after SCI. The association between depression or comorbidity and PI occurrence should be investigated more thoroughly. We recommend implementation of a simple follow-up program regarding observation and prevention of PI. Increased awareness of factors that could contribute to PI will help to focus on better prevention and early recognition of PI. This will contribute to more optimal rehabilitation.
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The data set is stored in a locked and fireproof research cabinet at the research department, Sunnaas Rehabilitation Hospital, Norway, and can be made available on request, according to the Norwegian Data and Telecommunications Authority’s requirements for safe information flow .
The National Pressure Ulcer Advisory Panel (NPUAP). http://www.epuap.org/. Downloaded July 22, 2019.
Coleman S, Gorecki C, Nelson AE, Closs JS, Defloor T, Halfens R, et al. Patient risk factors for pressure ulcer development: systematic review. Int J Nurs Stud. 2013;50:974–1003.
Eslami V, Saadat S, Habibi Arejan R, Vaccaro AR, Ghodsi SM, Rahimi-Movaghar V. Factors associated with the development of pressure ulcers after spinal cord injury. Spinal Cord. 2012;50:899–903.
Hagen EM, Eide GE, Rekand T, Gilhus NE, Gronning M. A 50-year follow-up of the incidence of traumatic cord injuries in Western Norway. Spinal Cord. 2010;48:313–8.
Smith Bridget M, Marylou Guihan, LaVela Sherri L, Garber Susan L. Factors predicting pressure ulcers in veterans with spinal cord injuries. Am J Phys Med Rehabilit. 2008;87:750–7.
van der Wielen H, Post MWM, Lay V, Gläsche K, Scheel-Sailer A. Hospital acquired pressure ulcer in spinal cord injured patients: time to occur, time until closure and risk factors. Spinal Cord. 2016;54:726–31.
Verschueren JHM, Post MWM, de Groot S, van der Woude LHV, van Asbeck FWA, Rol M. Occurrence and predictors of pressure ulcer during primary in—patient spinal cord injury rehabilitation. Spinal Cord. 2011;49:106–12.
Saunders LL, Krause JS, Acuna J. Association of race, socioeconomic status, and health care access with pressure ulcers after spinal cord injury. Arch Phys Med Rehabilit. 2012;93:972–7.
Baumgarten M, Margolis DJ, Localio AR, Kagan SH, Lowe RA, Kinosian B. Pressure ulcers among elderly patients in the hospital stay. J Gerontol A Biol Sci Med Sci. 2006;61:749–54.
Grigorian A, Sugimoto M, Joe V, Schubl S, Lekawa M, Dolich M, et al. Pressure ulcer in trauma patients: a higher spinal cord injury level leads to higher risk. J Am Coll Clin Wound Spec. 2018;9:24–31.e1. 19
Irgens I, Hoff JM, Sørli H, Haugland H, Stanghelle JK, Rekand T. Hospital based care at home; study protocol for a mixed epidemiological and randomized controlled trial. Trials. 2019;20:77 https://doi.org/10.1186/s13063-019-3185-y
Strom V, Manum G, Leiulfsrud A, Wedege P, Rekand T, Halvorsen A, et al. People with spinal cord injury in Norway. Am J Phys Med Rehabilit. 2017;96:S99–101.
NY. https://helsenorge.no/pasientjournal/andres-innsyn-i-din-pasientjournal. Downloaded December 9, 2019.
eHelse. https://www.ehelse.no/personvern-og-informasjonssikkerhet/relevante-lover-og-forskrifter. Downloaded July 21, 2019.
The National Regional Ethical Committee (REC) 2014/684/REK-Nord. https://helseforskning.etikkom.no/. Downloaded July 21, 2019.
Ethical Committee Guidelines. www.etikkom.no/RETNINGSLINJER/ Downloaded May 1, 2019.
Biering-Sorensen F, DeVivo MJ, Charlifue S, Chen Y, New PW, Noonan V, et al. International Spinal Cord Injury Core Data Set (version 2.0)—including standardization of reporting. Spinal Cord. 2017;55:759–64.
Halvorsen A, Pettersen AL. The Norwegian SCI registry. Trondheim: St Olavs Hospital; 2018. https://stolav.no/fag-og-forskning/medisinske-kvalitetsregistre/norskryggmargsskaderegisternorscir#rapporter.
Kirshblum SC, Burns SP, Biering-Sorensen F, Donovan W, Graves DE, Jha A, et al. International standards for neurological classification of spinal cord injury (revised 2011). J Spinal Cord Med. 2011;34:535–46.
Halvorsen A, Pettersen AL, Nilsen SM, Halle KK, Schaanning EE, Rekand T. Epidemiology of traumatic spinal cord injury in Norway in 2012–6: a registry-based cross-sectional. Spinal Cord. 2019;57:331–8.
Halvorsen A, Pettersen AL, Nilsen SM, Halle KK, Schaanning EE, Rekand T. Non-traumatic spinal cord injury in Norway 2012–6: analysis from a national registry and comparison with traumatic spinal cord injury. Spinal Cord. 2019;57:324–30.
Bhattacharya S, Mishra RK. Pressure ulcers: current understanding and newer modalities of treatment. Indian J Plast Surg. 2015;48:4–16.
Salzberg CA, Byrne DW, Kabier R, von Niewerburg P, Cayton CG. Predicting pressure ulcers during initial hospitalization for acute spinal cord injury. Wounds. 1999;11:45–57.
Ash D. An exploration of the occurrence of pressure ulcers in a British Spinal Injuries Unit. J Clin Nurs. 2002;11:470–78. https://doi.org/10.1046/j.1365-2702.2002.00603.x.
Curry K, Casady L. The relationship between extended periods of immobility and decubitus ulcer formation in the acutely spinal cord-injured individual. J Neurosci Nurs. 1992;24:185–9.
Mawson AR, Biundo JJ Jr, Neville P, Linares HA, Winchester Y, Lopes A. Risk factors for early occuring pressure ulcer following spinal cord injury. Am J Phys Med Rehabilit. 1988;67:123–7.
Brienza D, Krishnan S, Karg P, Sowa G, Allegretti AL. Predictors of pressure ulcer incidence following traumatic spinal cord injury: a secondary analysis of a prospective longitudinal study. Spinal Cord. 2018;56:28–34.
Regan MA, Teasell RW, Keast D, Aubut J-AL, Foulon B, Mehta S. Pressure ulcers following spinal cord injury. Spinal Cord Injury Rehabilitation Evidence (SCIRE). 2014. Version 3.0. www.scireproject.com. Downloaded May 1, 2019.
Chen D, Apple DF, Hudson MF, Bode R. Medical complications during acute rehabilitation following spinal cord injury. Arch Phys Med Rehabilitation. 1999;80:1397–401.
Bredesen IM, Bjøro K, Gunningberg L, Hofoss D. The prevalence, prevention and multilevel variance of pressure ulcers in Norwegian hospitals: a cross-sectional study. Int J Nurs Stud. 2015;52:149–56.
Multiresistant bacterias and hospitalization in Norway. https://forskning.no/land-og-regioner-sykdommer-bakterier/i-disse-ferielandene-er-det-mest-resistente-bakterier/335688. Downloaded July 21, 2019.
Scovil CY, Delparte JJ, Walia S, Flett HM, Guy SD, Wallace M, et al. Implementation of pressure injury prevention best practices across 6 Canadian rehabilitation sites: results from the spinal cord injury knowledge mobilization network. Arch Phys Med Rehabilit. 2019;100:327–35.
Sheerin F, Gillick A, Doyle B. Pressure ulcers and spinal cord injury: incidence among admissions to the Irish national specialist unit. J Wound Care. 2005;14:112–5.
Kottner J, Gefen A, Lahmann N. Weight and pressure ulcer occurrence: a secondary data analysis. Int J Nurs Stud. 2011;48:1339–48.
Your right to medical care. https://helsenorge.no/other-languages/english/rights/health-care-rights?redirect=false. Downloaded July 21, 2019.
Beeckman D. A decade of research on incontinence-associated dermatitis (IAD): evidence, knowledge gaps and next steps. J Tissue Viabil. 2017;26:47–56.
Apostolopoulou E, Tselebis A, Terzis K, Kamarinou E, Lambropoulos I, Kalliakmanis A. Pressure ulcer incidence and risk factors in ventilated intensive care patients. Health Sci J. 2014;8:333–42.
Greenhalgh DG. Wound healing and diabetes mellitus. Clin Plast Surg. 2003;30:37–45.
Frankel H, Sperry J, Kaplan L. Risk factors for pressure ulcer development in a best practice Surgical Intensive Care Unit. Am Surg. 2007;73:1215–7.
2015 National Kidney Foundation. Diabetes—a major risk factor for kidney disease. https://www.kidney.org/atoz/content/diabetes. Downloaded August 16, 2019.
Tate DG, Forchheimer MB, Krause JS, Meade MA, Bombardier CH. Patterns of alcohol and substance use and abuse in persons with spinal cord injury: risk factors and correlates. Arch Phys Med Rehabilit. 2004;85:1837–47.
Kang H. The prevention and handling of the missing data. Korean J Anesthesiol. 2013;64:402–6.
Taylor C. The difference between type I and type II errors in hypothesis testing; 2019. https://www.thoughtco.com/difference-between-type-i-and-type-ii-errors-3126414. Downloaded August 19, 2019.
The Declaration of Helsinki (DoH), 1964, amended last time at the General Assembly, October 2013. www.wma.net/what-we-do/medical-ethics/declaration-of-Helsinki/. Downloaded July 22, 2019.
Thanks to Toril Stensrud at Sunnaas Rehabilitation Hospital, Tori Lunde, and Hege Storlid at the Spinal Cord Unit at Haukeland University Hospital, and to Tom Tørhaug and Ellen Marie Hatlen at the Spinal Cord Unit at St. Olavs Hospital for all the help with the data collection. Thanks to Annette Halvorsen for guiding in Spinal Cord Injury Core Data Set questions.
The first author is funded by the DAM Foundation. Name and contact information for the trial founder: Linda Åsheim, e-mail; email@example.com. The DAM foundation has no influence on the trial protocol or the results.
Conflict of interest
The authors declare that they have no conflict of interest.
The research project was carried out in accordance with current ethical guidelines and privacy rights for health services in Norway , based on the Code of Ethics of the World Medical Association (Declaration of Helsinki)  for experiments involving humans. The research project was approved by the Norwegian Regional Ethical Committee (REC) on January 9th 2015 (2014/684 REK-Nord) , and registered in Clinical Trials.gov in May 2016 (NCT02800915).
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Irgens, I., Hoff, J.M., Jelnes, R. et al. Spinal cord injury and development of pressure injury during acute rehabilitation in Norway: a national retrospective cross-sectional study. Spinal Cord (2020). https://doi.org/10.1038/s41393-020-0465-z