Incidence, severity and time course of pressure injuries over the first two years following discharge from hospital in people with spinal cord injuries in Bangladesh

• Published in: Spinal cord 2022-04, Vol.60 (4), p.348-353
• Main Authors: D Costa, Punam, Harvey, Lisa A., Hossain, Mohammad Sohrab, Islam, Md. Shofiqul, Rahman, Md. Akhlasur, Glinsky, Joanne V., Liu, Hueiming, Jan, Stephen, Cameron, Ian D., Herbert, Robert D.
• Format: Article
• Language: English
• Subjects: 692/700/228/491; 692/700/478/174; Anatomy; Bangladesh - epidemiology; Biomedical and Life Sciences; Biomedicine; Cohort Studies; Contact pressure; Hospitals; Human Physiology; Humans; Incidence; Injuries; Injury prevention; Neurochemistry; Neuropsychology; Neurosciences; Patient Discharge; Prediction models; Predictions; Pressure; Pressure Ulcer - epidemiology; Pressure Ulcer - etiology; Pressure ulcers; Sacrum; Spinal cord injuries; Spinal Cord Injuries - epidemiology; Spinal Cord Injuries - therapy; Statistical analysis
• ISSN: 1362-4393; 1476-5624
• DOI: 10.1038/s41393-021-00732-3

Design Cohort study embedded in a clinical trial. Setting Community, Bangladesh. Objectives To determine the incidence, severity and time course of pressure injuries over the first two years following discharge from hospital in people with spinal cord injuries (SCI) in Bangladesh. Methods Participants ( n  = 186) were contacted by telephone 39 times and assessed face-to-face 4 to 6 times over the two years following discharge. At each point of contact the presence and severity of pressure injuries were determined using the Pressure Ulcer Scale for Healing (PUSH). Survival analyses were conducted to determine the time course of development of pressure injuries and recovery from pressure injuries. Lasso regression was used to construct multivariable prediction models. Results Seventy-seven participants (41%; 95% CI 34% to 49%) developed at least one pressure injury in the first two years after discharge (incidence rate 0.27 per person-year, 95% CI 0.22 to 0.34). Most pressure injuries were on the sacrum (23%). Pressure injuries took a median (IQR) of 40 (29 to 57) days to heal. The median (IQR) peak PUSH score was 11.0/17 (8.0 to 13.5). The multivariable prediction models had poor predictive properties (maximum c-statistic 0.75). Conclusion Pressure injuries impose a large health burden on people with SCI in Bangladesh. However, they are difficult to predict, treat and prevent. Further research is needed to identify who is at most risk and to find solutions for the treatment and prevention of pressure injuries in Bangladesh and other low-middle income countries.