Incidence of pressure injuries in patients with spinal cord injury: A systematic review and meta-analysis.

OBJECTIVE

To systematically evaluate the incidence of pressure injuries (PIs) in patients with spinal cord injury (SCI) and to provide a basis for preventing and treating PIs.

METHODS

A systematic review and meta-analysis were performed according to the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) guidelines. Electronic databases such as PubMed, Embase, Cochrane Library, Web of Science, China Knowledge Resource Integrated Database (CNKI), Wan-fang Database, Weipu Database (VIP), and the China Biomedical Database (CBM) were searched to collect cross-sectional and cohort studies related to PIs in SCI patients. All electronic literature sources were searched for relevant articles from inception to July 2024. Studies were independently assessed by two researchers and reviewed by a third. Data were extracted and presented in tabular form. The risk of bias was assessed using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist and the Agency for Healthcare Quality and Research (AHRQ) Cross-Sectional Study Evaluation Criteria. All data were analysed using Stata 16.0. The I2 statistics and random effects models were used to determine heterogeneity, and results were expressed as incidence with 95 % confidence intervals (CI).

RESULTS

11,754 articles were screened, and 35 studies involving 150,391 patients were finally included. The combined incidence of PIs in SCI patients was 28.8 % (95%CI: 24.2 to 33.4). For different genders, the incidence of PIs in male SCI patients was 29.2 % (95 % CI: 20.4 to 38.1), while for female SCI patients, it was 25.2 % (95 % CI: 16.1 to 34.3). The PI incidence rate in patients with SCI was 33.9 % (95 % CI: 27.1 to 40.7) before 2005, 29.4 % (95 % CI: 19.1 to 39.7) from 2006 to 2015, and 27.1 % (95 % CI: 20.8 to 33.3) from 2016 to 2024. According to regional distribution data by country, the combined incidence of PIs in SCI patients was 34.3 % (95 % CI: 21.0 to 47.6) in European countries, 20.9 % (95 % CI: 12.8 to 28.9) in Asian countries, 43.3 % (95 % CI: 16.5 to 70.1) in African countries, 25.0 % (95 % CI: 15.9 to 34.0) in North American countries, and 65.3 % (95 % CI: 55.9-74.7) in South American countries. In 12 studies that reported the anatomical location of PIs in patients with SCI, 1113 patients developed 1836 PIs. The sacrococcygeal region had the highest number of these injuries, totalling 521 (28.8 %), followed by the sciatic tuberosity, with 233 (12.9 %), then, the heel, with 221 (12.3 %).

CONCLUSION

The study's results showed an overall incidence of PIs in patients with SCI of 28.8 %, significantly exceeding the average incidence rate in adults. We found that the incidence of PIs was higher in men than in women in patients with SCI. Therefore, clinical care staff needs to adopt effective preventive and therapeutic measures and strategies to reduce the occurrence of PIs. Additionally, the risk factors for PIs in patients with SCI can be further investigated to prevent and treat PIs effectively.