Prevalence of secondary medical complications and risk factors for pressure ulcers after traumatic spinal cord injury during acute care in South Africa

Abstract

Study design: Prospective, population-based cohort study. Objectives: To determine the prevalence of selected complications following traumatic spinal cord injury during acute care and to identify the risk factors for pressure ulcers. Setting: The only tertiary academic (Groote Schuur) hospital in the catchment region providing specialised acute care. Methods: A descriptive, observational study of an inception cohort. Secondary complications were predefined and consisted of pressure ulcers, pulmonary complications (pneumonia and atelectasis), urinary tract infections, autonomic dysreflexia, deep vein thrombosis, pulmonary embolism, postural hypotension, neuropathic pain and spasticity. Possible risk factors for pressure ulcers included variables concerning demographic and injury characteristics and complications. Both univariate and multivariate logistic regression analyses were used. Results: Data of 141 patients (97%) were analysed. In total, 71 (50.3%) patients had one or more complication. The most common was pressure ulcers (n=42; 29.8%), followed by pulmonary complications (n=33; 23.4%) and urinary tract infections (n=24; 17%). Significant risk factors were gun-shot injury, motor completeness (American Spinal Injury Association Impairment Scale (AIS) AB), vertebral injury, no spinal surgery, pulmonary complications, urinary tract infection and level of consciousness. In the final multivariate model that correctly predicted 81.6% of subjects, motor completeness and vertebral injury remained significant independent factors, whereas having a urinary tract infection was associated with an increased risk (odds ratio: 2.86), but not significant at the 5% level. Conclusion: Pressure ulcers and pulmonary complications were prevalent during specialised acute phase. The occurrence of pressure ulcers, despite protocols in place, is worrisome. To prevent pressure ulcers, special attention seems necessary for persons with motor complete lesions and those with vertebral injuries.