Development of the spinal cord injury pressure sore onset risk screening (SCI-PreSORS) instrument: a pressure injury risk decision tree for spinal cord injury rehabilitation


Study design

Psychometric study based on retrospectively collected data.


Development of a pressure injury (PI) risk screening instrument for use during spinal cord injury (SCI) rehabilitation.


Tertiary rehabilitation center.


Medical charts of 807 inpatients participating in SCI rehabilitation were reviewed. Two models (recursive partitioning and logistic regression) were developed with demographic and Functional Independence Measure (FIM) variables and compared with the SCI Pressure Ulcer Scale (SCIPUS, n = 603) and Braden scale (n = 100) using modeling (n = 615) and validation (n = 192) datasets. Sensitivity and specificity analyses were completed for each model. Models yielding high sensitivity and area under the curve (AUC), while minimizing false negatives (FN < 0.5%) were preferred.


In the modeling dataset, a single dichotomized FIM variable, Bed/Chair Transfers <4, was predictive of PI incidence (sensitivity = 97%, AUC = 74%, FN = 0.49%) and had similar metrics as the logistic regression model (sensitivity = 97%, AUC = 76%, FN = 0.49%). The recursive partitioning model had fewer FN (sensitivity = 98%, AUC = 75%, FN = 0.33%). When applied to the validation dataset, both models performed similarly. The SCIPUS performed poorly (AUC < 70%). When analyses were limited to cases with available Braden data and no admission PI, recursive partitioning outperformed the other methods for PI risk screening.


A recursive partitioning model, named the SCI-PreSORS (SCI Pressure Sore Onset Risk Screening), demonstrated promise for PI risk screening during inpatient SCI rehabilitation. Prospective validation of the new model is warranted.

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Fig. 1: Recursive Partitioning Model.

Data availability

The datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request.


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The study was funded through a partnership of the Rick Hansen Institute and the Ontario Neurotrauma Foundation. Grants # 2010-RHI-ONF-BPI-832, 2015-RHI-BPI-996.

Author information




JJD was responsible for designing the study protocol, overseeing data collection and entry, analyzing data, interpreting results, and drafting the methods and results sections of the manuscript. CYS was responsible for designing the study protocol, and reviewing the manuscript. HMF was responsible for designing the study protocol, and reviewing the manuscript. As the senior author, ASB was responsible for oversight of all study activities including designing the study protocol, data analysis, interpreting the data, and manuscript preparation.

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Correspondence to Anthony S. Burns.

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We certify that all applicable institutional and governmental regulations concerning the ethical use of human volunteers/animals were followed during the course of this research. All study procedures were reviewed by the TRI-UHN REB (#12-0543-DE).

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Delparte, J.J., Flett, H.M., Scovil, C.Y. et al. Development of the spinal cord injury pressure sore onset risk screening (SCI-PreSORS) instrument: a pressure injury risk decision tree for spinal cord injury rehabilitation. Spinal Cord (2020).

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