A study led by scientists at The Ohio State University Wexner Medical Center and College of Medicine in Berlin, Germany, provides the first evidence that hospital-acquired pressure ulcers are a significant risk factor for poor neurologic recovery in patients with acute spinal cord injury (SCI).

The study, published online in the journal JAMA Network Open, involved 1,282 patients with spinal cord injury, of whom 45.7% (594) developed pressure ulcers during their initial hospitalization. The study found that patients with pressure ulcers had significantly less motor function recovered within one year after injury and had significantly limited independence in activities of daily living.

"Pressure ulcers send inflammatory signals throughout the body, which may also directly interfere with the healing process at the site of spinal cord injury, thereby hindering neurological recovery," said Jan M. Schwab, PhD, a neurologist and professor of neurology at Ohio State and co-corresponding author of the study.

Dr. Schwab, an expert who specializes in treating patients with spinal cord injuries and studying immune dysfunction that interferes with neurological recovery, noted that patients with spinal cord injuries often develop pressure ulcers early in their hospital stay, affecting about half of patients. These wounds are underappreciated sites of immune-active infection, but they harbor bacteria that can spread throughout the body through the bloodstream.

Patients in this multicenter study were enrolled from 1996 to 2006 and followed until 2016. Patients were recruited from 20 centers in the SCI Model System Database in Birmingham, Alabama. The main inclusion criterion was acute traumatic cervical spine SCI with associated motor impairment as measured by the American Spinal Injury Association (ASIA) Impairment Scale.

The primary endpoint of the study was the change in ASIA motor score one year after SCI. Secondary endpoints included recovery of functional independence measure (FIM) motor items one year after SCI and mortality up to 10 years.

"Patients with pressure ulcers face increased long-term disability and a higher risk of death," said co-corresponding author Marcel Kopp, PhD, a clinician scientist at the Department of Experimental Neurology at Charité - Universitätsmedizin Berlin. "We believe that preventing the development of pressure ulcers could help protect these patients and improve medical care."

This study highlights the importance of referring patients with acute SCI to specialized neurorehabilitation centers with dedicated protocols and standards to effectively prevent pressure ulcers.

About The Ohio State University Wexner Medical Center

The Ohio State University Wexner Medical Center is a comprehensive academic medical center known for its innovative medical care, advanced research, and outstanding education. As part of Ohio State University, the Medical Center is committed to providing state-of-the-art patient care and pushing the boundaries of medical knowledge.

Source:

University of Copenhagen - The Faculty of Health and Medical