Spinal cord injury and development of pressure injury during acute rehabilitation in Norway: a national retrospective cross-sectional study


Study design

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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Fig. 1: Location and frequency of the PIs in the studied population.
Fig. 2: The trend between the AIS grade and the PI risk in the studied population.
Fig. 3: Suggested action plan for prevention of PI.

Data availability

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 [14].


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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; linda.aasheim@nhf.no. The DAM foundation has no influence on the trial protocol or the results.

Author information




II is a medical doctor (MD) at Sunnaas Rehabilitation Hospital, and a PhD fellow at the University of Oslo. She is the main investigator of the study, and the only investigator with access to the complete data set collected in the study. She is also the main contributor in the writing of the paper. TR is the main supervisor. TR and II were responsible for the design of the study. JKS is the research director at Sunnaas Rehabilitation Hospital, and the project manager. JMH and RJ are co-supervisors in the project. MA is a collaborator in the project. MT is a statistician, guiding in the statistical design of the study and analyses of the results. JKS, TR, JMH, RJ, MA, and MT all contributed to the draft of this paper. All authors read and approved the final paper before submission.

Corresponding author

Correspondence to Ingebjørg Irgens.

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The authors declare that they have no conflict of interest.

Ethical approval

The research project was carried out in accordance with current ethical guidelines and privacy rights for health services in Norway [14], based on the Code of Ethics of the World Medical Association (Declaration of Helsinki) [44] for experiments involving humans. The research project was approved by the Norwegian Regional Ethical Committee (REC) on January 9th 2015 (2014/684 REK-Nord) [15], 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

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