Timing of sacral pressure injury development during acute care after traumatic spinal cord injury: a prospective study of 142 patients.

STUDY

DESIGN

Prospective cohort study.

OBJECTIVES

To characterize the temporal pattern of sacral PI development and examine how clinical factors relate to PI risk over time following traumatic SCI.

SETTING

Level I trauma center at Hôpital du Sacré-Cœur de Montréal, Québec, Canada.

METHODS

142 individuals with traumatic SCI (L2 or above;AIS A-C) were included. The primary outcome was time from trauma to first sacral PI. Kaplan-Meier analysis estimated PI-free survival, and Cox regression identified predictors of PI timing, reported as adjusted hazard ratios (HR) with 95% confidence intervals (CI).

RESULTS

Forty-five individuals (31.7%) developed a sacral PI, with 50% occurring within the first two weeks. Motor-complete SCI (AIS A or B) was independently associated with increased sacral PI hazard (adjusted HR = 2.27, 95% CI 1.07 to 4.83, p = 0.032). While PI incidence was similar between groups during the first 14 days, Kaplan-Meier analysis showed divergence thereafter, with motor-complete injuries exhibiting a more rapid decline in PI-free survival (log-rank p = 0.04). Lower Braden scores at admission showed a borderline association with sacral PI development over time (adjusted HR = 0.90, 95% CI 0.81 to 1.00, p = 0.0504).

CONCLUSIONS

Early risk stratification after traumatic SCI is essential to identify individuals at greatest risk for sacral PI during acute care. Preventive strategies should be intensified during the first two weeks of hospitalization, when vulnerability to PI development appears highest, while patients with motor-complete injuries may remain at increased risk later during hospitalization.

SPONSORSHIP: Medline Industries, Inc.