Predicting Pressure Ulcers during Initial Hospitalization for Acute Spinal Cord Injury

Pressure ulcers develop in more than a third of spinal cord injured patients during their initial hospitalization. Because more than 200 risk factors have been reported for pressure ulcers, practical application of this information is difficult. Although the Braden Scale is often used to assess the risk of pressure ulcers, it was not developed for patients with spinal cord injuries and has not been proven an accurate predictor in this population. Although there is a Spinal Cord Injury Pressure Ulcer Scale (SCIPUS), it was designed to be used after the initial hospitalization. To assess the prediction of early pressure ulcers, we analyzed data on 226 patients hospitalized for spinal cord injuries and evaluated five of the existing pressure ulcer scales. The data showed that of the general-purpose scales, the Braden Scale was most accurate. However, SCIPUS was more accurate than the Braden Scale. Using modified cutoff points and the additional risk factors of extent of paralysis, serum albumin, and serum creatinine, a new acute version of SCIPUS was designed specifically for the initial hospitalization following a spinal cord injury, which we refer to as SCIPUS-A. Our results suggest that this new scale is an accurate predictor of pressure ulcers during the first hospitalization after a spinal cord injury. This information should be useful in prioritizing today's limited health care resources in the most cost-effective manner to reduce the incidence of pressure ulcers after a spinal cord injury.