Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on sleep in brain health

LIVE: Thursday 2nd May 2024, 18:00-19:30 (CEST)

Quality sleep is essential for health. But what happens to our brains when sleep patterns are disturbed? Join our experts to explore the interplay between sleep disruption and neurological diseases, and the questions that you need to be asking your patients to help you prevent the harmful effects of sleep deprivation.
ADVANCED SEARCH
Log in
Top
BMC Musculoskeletal Disorders
Published in: BMC Musculoskeletal Disorders 1/2020

Open Access 01-12-2020 | Research article

The global burden of pressure ulcers among patients with spinal cord injury: a systematic review and meta-analysis

Authors: Wondimeneh Shibabaw Shiferaw, Tadesse Yirga Akalu, Henok Mulugeta, Yared Asmare Aynalem

Published in: BMC Musculoskeletal Disorders | Issue 1/2020

Login to get access

Abstract

Background

Pressure ulcers (PU), one of the common challenging public health problems affecting patient with spinal cord injury. PUs occurs over bony areas of the body where pressure and tissue distortion is greatest. It has a significant impact to the patient and health care system. Moreover, it has psychological, physical, social burden and decrease the quality of life (QoL) of patients. Despite its serious complications, limited evidence is available on the global magnitude of pressure ulcers among patient with spinal cord injury. Hence, this review and meta-analysis aimed to estimate the global magnitude of pressure ulcers among patient with spinal cord injury.

Methods

PubMed, Scopus, Google Scholar, African Journals Online, PsycINFO, and Web of Science were systematically searched to retrieve related articles. The Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guideline was followed. DerSimonian and Laird random-effects model was applied to obtain the pooled effect size. To investigate heterogeneity across the included studies, I2 test was employed. Publication bias was examined using funnel plot and Egger’s regression test statistic. Sensitivity analysis was deployed to see the effect of a single study on the overall estimation. Analysis was done using STATA™ Version 14 software.

Results

A total of 24 studies which comprises of 600,078 participants were included in this study. The global pooled magnitude of pressure ulcers among patients with spinal cord injury was 32.36% (95% CI (28.21, 36.51%)). Based on the subgroup analysis, the highest magnitude of pressure ulcer was observed in Africa 41.19% (95% CI: 31.70, 52.18).

Conclusion

This systematic review and meta-analysis revealed that about one in three patients with spinal cord injury had pressure ulcers. This implies that the overall global magnitude of pressure ulcer is relatively high. Therefore, policy maker and other concerned body should be design country context- specific preventive strategies to reduce the burden of pressure ulcers in patients with spinal cord injury.
Appendix
Available only for authorised users
Literature
1.
Jang Y, Wang Y-H, Wang J-D. Return to work after spinal cord injury in Taiwan: the contribution of functional independence. Arch Phys Med Rehabil. 2005;86(4):681–6.PubMedCrossRef
2.
Dumont RJ, Okonkwo DO, Verma S, Hurlbert RJ, Boulos PT, Ellegala DB, Dumont AS. Acute spinal cord injury, part I: pathophysiologic mechanisms. Clin Neuropharmacol. 2001;24(5):254–64.PubMedCrossRef
3.
White BA, Dea N, Street JT, Cheng CL, Rivers CS, Attabib N, Kwon BK, Fisher CG, Dvorak MF. The economic burden of urinary tract infection and pressure ulceration in acute traumatic spinal cord injury admissions: evidence for comparative economics and decision analytics from a matched case-control study. J Neurotrauma. 2017;34(20):2892–900.PubMedCrossRef
4.
Rahimi-Movaghar V, Moradi-Lakeh M, Rasouli MR, Vaccaro AR. Burden of spinal cord injury in Tehran, Iran. Spinal Cord. 2010;48(6):492.PubMedCrossRef
5.
Jazayeri SB, Beygi S, Shokraneh F, Hagen EM, Rahimi-Movaghar V. Incidence of traumatic spinal cord injury worldwide: a systematic review. Eur Spine J. 2015;24(5):905–18.PubMedCrossRef
6.
Li C, DiPiro N, Cao Y, Szlachcic Y, Krause J. The association between metabolic syndrome and pressure ulcers among individuals living with spinal cord injury. Spinal Cord. 2016;54(11):967.PubMedCrossRef
7.
Iyun AO, Malomo AO, Oluwatosin OM, Ademola SA, Shokunbi MT. Pattern of presentation of pressure ulcers in traumatic spinal cord injured patients in university college hospital, Ibadan. Int Wound J. 2012;9(2):206–13.PubMedCrossRef
8.
Mathew A, Samuelkamaleshkumar S, Radhika S, Elango A. Engagement in occupational activities and pressure ulcer development in rehabilitated south Indian persons with spinal cord injury. Spinal Cord. 2013;51(2):150.PubMedCrossRef
9.
Kruger EA, Pires M, Ngann Y, Sterling M, Rubayi S. Comprehensive management of pressure ulcers in spinal cord injury: current concepts and future trends. J Spinal Cord Med. 2013;36(6):572–85.PubMedPubMedCentralCrossRef
10.
Black J, Baharestani MM, Cuddigan J, Dorner B, Edsberg L, Langemo D, Posthauer ME, Ratliff C, Taler G. National Pressure Ulcer Advisory Panel's updated pressure ulcer staging system. Adv Skin Wound Care. 2007;20(5):269–74.PubMedCrossRef
11.
Ghaisas S, Pyatak EA, Blanche E, Blanchard J, Clark F. Lifestyle changes and pressure ulcer prevention in adults with spinal cord injury in the pressure ulcer prevention study lifestyle intervention. Am J Occup Ther. 2015;69(1):6901290020p6901290021–10.
12.
Gorecki C, Brown JM, Nelson EA, Briggs M, Schoonhoven L, Dealey C, Defloor T, Nixon J, group EQoLPUP. Impact of pressure ulcers on quality of life in older patients: a systematic review. J Am Geriatr Soc. 2009;57(7):1175–83.PubMedCrossRef
13.
Lala D, Dumont FS, Leblond J, Houghton PE, Noreau L. Impact of pressure ulcers on individuals living with a spinal cord injury. Arch Phys Med Rehabil. 2014;95(12):2312–9.PubMedCrossRef
14.
15.
Krause JS, Zhai Y, Saunders LL, Carter RE. Risk of mortality after spinal cord injury: an 8-year prospective study. Arch Phys Med Rehabil. 2009;90(10):1708–15.PubMedPubMedCentralCrossRef
16.
Le Fort M, Espagnacq M, Albert T, Lefèvre C, Perrouin-Verbe B, Ravaud J-F. Risk of pressure ulcers in tetraplegic people: a French survey crossing regional experience with a long-term follow-up. Eur J Pub Health. 2018;28(6):993–9.CrossRef
17.
Chan BC, Nanwa N, Mittmann N, Bryant D, Coyte PC, Houghton PE. The average cost of pressure ulcer management in a community dwelling spinal cord injury population. Int Wound J. 2013;10(4):431–40.PubMedCrossRef
18.
Van der Wielen H, Post M, Lay V, Gläsche K, Scheel-Sailer A. Hospital-acquired pressure ulcers in spinal cord injured patients: time to occur, time until closure and risk factors. Spinal Cord. 2016;54(9):726.PubMedCrossRef
19.
Zakrasek E, Creasey G, Crew J. Pressure ulcers in people with spinal cord injury in developing nations. Spinal Cord. 2015;53(1):7.PubMedCrossRef
20.
Eslami V, Saadat S, Arejan RH, Vaccaro A, Ghodsi S, Rahimi-Movaghar V. Factors associated with the development of pressure ulcers after spinal cord injury. Spinal Cord. 2012;50(12):899.PubMedCrossRef
21.
Chen Y, DeVivo MJ, Jackson AB. Pressure ulcer prevalence in people with spinal cord injury: age-period-duration effects. Arch Phys Med Rehabil. 2005;86(6):1208–13.PubMedCrossRef
22.
Idowu O, Yinusa W, Gbadegesin S, Adebule G. Risk factors for pressure ulceration in a resource constrained spinal injury service. Spinal Cord. 2011;49(5):643.PubMedCrossRef
23.
Verschueren J, Post M, De Groot S, Van der Woude L, Van Asbeck F, Rol M. Occurrence and predictors of pressure ulcers during primary in-patient spinal cord injury rehabilitation. Spinal Cord. 2011;49(1):106.PubMedCrossRef
24.
Joseph C, Wikmar LN. Prevalence of secondary medical complications and risk factors for pressure ulcers after traumatic spinal cord injury during acute care in South Africa. Spinal Cord. 2016;54(7):535.PubMedCrossRef
25.
Correa G, Fuentes M, Gonzalez X, Cumsille F, Pineros J, Finkelstein J. Predictive factors for pressure ulcers in the ambulatory stage of spinal cord injury patients. Spinal Cord. 2006;44(12):734.PubMedCrossRef
26.
Krause JS, Vines CL, Farley TL, Sniezek J, Coker J. An exploratory study of pressure ulcers after spinal cord injury: relationship to protective behaviors and risk factors. Arch Phys Med Rehabil. 2001;82(1):107–13.PubMedCrossRef
27.
Gould LJ, Olney CM, Nichols JS, Block AR, Simon RM, Guihan M. Spinal cord injury survey to determine pressure ulcer vulnerability in the outpatient population. Med Hypotheses. 2014;83(5):552–8.PubMedCrossRef
28.
Fazel FS, Derakhshanrad N, Yekaninejad MS, Vosoughi F, Derakhshanrad A, Saberi H. Predictive value of Braden risk factors in pressure ulcers of outpatients with spinal cord injury. Acta Medica Iranica. 2018;56:56–61.
29.
Pancorbo-Hidalgo PL, et al. Risk assessment scales for pressure ulcer prevention: a systematic review. J Adv Nurs. 2006;54(1):94–110.PubMedCrossRef
30.
McPheeters ML, Kripalani S, Peterson NB, Idowu RT, Jerome RN, Potter SA, Andrews JC. Quality improvement interventions to address health disparities: closing the quality gap-revisiting the state of the science. In: Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews. UK: Centre for Reviews and Dissemination; 2012.
31.
Modesti PA, Reboldi G, Cappuccio FP, Agyemang C, Remuzzi G, Rapi S, Perruolo E, Parati G, Settings EWGoCRiLR. Panethnic differences in blood pressure in Europe: a systematic review and meta-analysis. PLoS One. 2016;11(1):e0147601.PubMedPubMedCentralCrossRef
32.
Hoy D, Brooks P, Woolf A, Blyth F, March L, Bain C, Baker P, Smith E, Buchbinder R. Assessing risk of bias in prevalence studies: modification of an existing tool and evidence of interrater agreement. J Clin Epidemiol. 2012;65(9):934–9.PubMedCrossRef
33.
Borenstein M, Hedges L, Higgins J, Rothstein H. Introduction to meta-analysis. Chichester: Wiley; 2009.CrossRef
34.
Egger M, Davey-Smith G, Altman D. Systematic reviews in health care: meta-analysis in context: Wiley; 2008.
35.
Rücker G, Schwarzer G, Carpenter J. Arcsine test for publication bias in meta-analyses with binary outcomes. Stat Med. 2008;27(5):746–63.PubMedCrossRef
36.
StataCorp L. Stata statistical software (version release 14). College Station: Author; 2015.
37.
Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JP, Clarke M, Devereaux PJ, Kleijnen J, Moher D. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Med. 2009;6(7):e1000100.PubMedPubMedCentralCrossRef
38.
Brienza D, Krishnan S, Karg P, Sowa G, Allegretti A. Predictors of pressure ulcer incidence following traumatic spinal cord injury: a secondary analysis of a prospective longitudinal study. Spinal Cord. 2018;56(1):28.PubMedCrossRef
39.
DeJong G, Hsieh C-HJ, Brown P, Smout RJ, Horn SD, Ballard P, Bouchard T. Factors associated with pressure ulcer risk in spinal cord injury rehabilitation. Am J Phys Med Rehabil. 2014;93(11):971–86.PubMedCrossRef
40.
Garber SL, Rintala DH, Hart KA, Fuhrer MJ. Pressure ulcer risk in spinal cord injury: predictors of ulcer status over 3 years. Arch Phys Med Rehabil. 2000;81(4):465–71.PubMedCrossRef
41.
Krishnan S, Karg PE, Boninger ML, Brienza DM. Association between presence of pneumonia and pressure ulcer formation following traumatic spinal cord injury. J Spinal Cord Med. 2017;40(4):415–22.PubMedCrossRef
42.
Richard-Denis A, Thompson C, Bourassa-Moreau É, Parent S, Mac-Thiong J-M. Does the acute care spinal cord injury setting predict the occurrence of pressure ulcers at arrival to intensive rehabilitation centers? Am J Phys Med Rehabil. 2016;95(4):300–8.PubMedCrossRef
43.
Saunders LL, Krause JS, Acuna J. Association of race, socioeconomic status, and health care access with pressure ulcers after spinal cord injury. Arch Phys Med Rehabil. 2012;93(6):972–7.PubMedPubMedCentralCrossRef
44.
Ash D. An exploration of the occurrence of pressure ulcers in a British spinal injuries unit. J Clin Nurs. 2002;11(4):470–8.PubMedCrossRef
45.
Haisma JA, Van Der Woude LH, Stam HJ, Bergen MP, Sluis TA, Post MW, Bussmann JB. Complications following spinal cord injury: occurrence and risk factors in a longitudinal study during and after inpatient rehabilitation. J Rehabil Med. 2007;39(5):393–8.PubMedCrossRef
46.
Raghavan P, Raza W, Ahmed Y, Chamberlain M. Prevalence of pressure sores in a community sample of spinal injury patients. Clin Rehabil. 2003;17(8):879–84.PubMedCrossRef
47.
Scheel-Sailer A, Wyss A, Boldt C, Post M, Lay V. Prevalence, location, grade of pressure ulcers and association with specific patient characteristics in adult spinal cord injury patients during the hospital stay: a prospective cohort study. Spinal Cord. 2013;51(11):828.PubMedCrossRef
48.
Sheerin F, Gillick A, Doyle B. Pressure ulcers and spinal-cord injury: incidence among admissions to the Irish national specialist unit. J Wound Care. 2005;14(3):112–5.PubMedCrossRef
49.
Kovindha A, Kammuang-Lue P, Prakongsai P, Wongphan T. Prevalence of pressure ulcers in Thai wheelchair users with chronic spinal cord injuries. Spinal Cord. 2015;53(10):767.PubMedPubMedCentralCrossRef
50.
Tchvaloon E, Front L, Gelernter I, Ronen J, Bluvshtein V, Catz A. Survival, neurological recovery and morbidity after spinal cord injuries following road accidents in Israel. Spinal Cord. 2008;46(2):145.PubMedCrossRef
51.
Taghipoor KD, Arejan RH, Rasouli MR, Saadat S, Moghadam M, Vaccaro AR, Rahimi-Movaghar V. Factors associated with pressure ulcers in patients with complete or sensory-only preserved spinal cord injury: is there any difference between traumatic and nontraumatic causes? J Neurosurg Spine. 2009;11(4):438–44.PubMedCrossRef
52.
Löfvenmark I, Wikmar LN, Hasselberg M, Norrbrink C, Hultling C. Outcomes 2 years after traumatic spinal cord injury in Botswana: a follow-up study. Spinal Cord. 2017;55(3):285.PubMedCrossRef
53.
Chopra T, Marchaim D, Awali RA, Levine M, SM S, Chalana IK, Ahmed F. Risk factors and acute in-hospital costs for infected pressure ulcers among gunshot-spinal cord injury victims in southea stern Michigan. Am J Infect Control. 2016;44(3):315–9.PubMedCrossRef
54.
Al Mutairi KB, Hendrie D. Global incidence and prevalence of pressure injuries in public hospitals: a systematic review. Wound Med. 2018;22:23–31.CrossRef
55.
Xakellis GC Jr, Frantz RA, Lewis A, Harvey P. Translating pressure ulcer guidelines into practice: it's harder than it sounds. Adv Skin Wound Care. 2001;14(5):249–58.PubMedCrossRef
Metadata
Title
The global burden of pressure ulcers among patients with spinal cord injury: a systematic review and meta-analysis
Authors
Wondimeneh Shibabaw Shiferaw
Tadesse Yirga Akalu
Henok Mulugeta
Yared Asmare Aynalem
Publication date
01-12-2020
Publisher
BioMed Central
Published in
BMC Musculoskeletal Disorders / Issue 1/2020
Electronic ISSN: 1471-2474
DOI
https://doi.org/10.1186/s12891-020-03369-0

Other articles of this Issue 1/2020

BMC Musculoskeletal Disorders 1/2020 Go to the issue

Research article

Reconstruction of finger joints using autologous rib perichondrium – an observational study at a single Centre with a median follow-up of 37 years

Study protocol

The OPTIMIZE study: protocol of a pragmatic sequential multiple assessment randomized trial of nonpharmacologic treatment for chronic, nonspecific low back pain

Technical advance

Reliability of tibiofemoral contact area and centroid location in upright, open MRI

Research article

Treatment of distal clavicle fractures using a Scorpion plate and influence of timing on surgical outcomes: a retrospective cohort study of 105 cases

Technical advance

Minimally invasive versus conventional fixation of tracer in robot-assisted pedicle screw insertion surgery: a randomized control trial

Research article

Sacroiliac joint variation associated with diffuse idiopathic skeletal hyperostosis