Decreasing pressure injuries and acute care length of stay in patients with acute traumatic spinal cord injury

The Journal of Spinal Cord Medicine, 2021 · DOI: 10.1080/10790268.2020.1718265 · Published: January 1, 2021

Spinal Cord Injury Rehabilitation Dermatology

Simple Explanation

Following a traumatic spinal cord injury (TSCI), patients go through a rehabilitation process with three phases: acute hospitalization, intensive functional rehabilitation (IFR), and community integration. Optimizing the early process after TSCI is crucial for efficient rehabilitation and better long-term functional outcomes. Pressure injuries (PI) are a common complication after TSCI, especially during acute hospitalization due to factors like immobility. Preventing PI during this phase is important because it can lead to more complications and hinder long-term functional outcome. This study aimed to identify how the acute rehabilitation team can reduce PI incidence and acute care length of stay (LOS) after TSCI. The focus was on finding factors that can be modified and optimized by the team.

Study Duration

April 2010 and October 2018

Participants

301 patients with acute TSCI

Evidence Level

Prospective cohort study

Key Findings

1
Pneumonia occurrence was significantly associated with pressure injury occurrence, even when considering the level and severity of the TSCI.
2
Medical complications (PI, urinary tract infection, and pneumonia) and lesser daily therapy resulted in significantly longer acute care length of stay.
3
More severe TSCI (AIS grade) and higher NLI were significantly associated with the occurrence of PI during the acute care hospitalization

Research Summary

This study investigated factors associated with pressure injuries (PI) and length of stay (LOS) in acute traumatic spinal cord injury (TSCI) patients. The goal was to identify modifiable factors that acute rehabilitation teams could address to improve outcomes. The study found that pneumonia was associated with a higher risk of PI, and medical complications along with lower daily therapy time were associated with longer LOS. These findings highlight the importance of preventing complications and optimizing therapy during acute care. The authors suggest focusing on preventing complications, early transfer to specialized trauma centers, and optimizing therapy interventions to decrease LOS and improve functional outcomes. They also emphasize prioritizing the reduction of missed therapy sessions.

Practical Implications

Aggressive Prevention Strategies for Pneumonia

Patients with higher NLI, more severe TSCI, and those at risk of pneumonia should receive more aggressive PI prevention strategies.

Early Transfer to SCI Centers

Early transfer to specialized trauma centers is recommended to ensure appropriate and aggressive medical complications prevention strategies.

Optimize Therapy Interventions

Additional therapy interventions may be considered to promote effective transfer to subsequent rehabilitation phases and ultimately higher functional outcomes.

Study Limitations

1
Single Level-1 trauma center, which may limit external validity.
2
Information regarding other potential factors was not collected, such as the occurrence of spasticity.
3
The study focused on physical and occupational therapy only, thereby neglecting the time spent with other caregivers.

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