Joseph C, Nilsson Wikmar L
Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Stockholm, Sweden.
Spinal Cord. 2016 Jul;54(7):535-9. doi: 10.1038/sc.2015.189. Epub 2015 Oct 20.
Prospective, population-based cohort study.
To determine the prevalence of selected complications following traumatic spinal cord injury during acute care and to identify the risk factors for pressure ulcers.
The only tertiary academic (Groote Schuur) hospital in the catchment region providing specialised acute care.
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.
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) A│B), 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.
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.
前瞻性、基于人群的队列研究。
确定急性护理期间创伤性脊髓损伤后特定并发症的患病率,并确定压疮的危险因素。
集水区内唯一提供专业急性护理的三级学术(格罗特·舒尔)医院。
对起始队列进行描述性观察研究。继发性并发症预先定义,包括压疮、肺部并发症(肺炎和肺不张)、尿路感染、自主神经反射异常、深静脉血栓形成、肺栓塞、体位性低血压、神经性疼痛和痉挛。压疮的可能危险因素包括与人口统计学和损伤特征及并发症相关的变量。采用单变量和多变量逻辑回归分析。
分析了141例患者(97%)的数据。共有71例(50.3%)患者发生一种或多种并发症。最常见的是压疮(n = 42;29.8%),其次是肺部并发症(n = 33;23.4%)和尿路感染(n = 24;17%)。显著的危险因素包括枪伤、运动完全性(美国脊髓损伤协会损伤量表(AIS)A│B)、椎体损伤、未进行脊柱手术、肺部并发症、尿路感染和意识水平。在正确预测81.6%受试者的最终多变量模型中,运动完全性和椎体损伤仍然是显著的独立因素,而发生尿路感染与风险增加相关(比值比:2.86),但在5%水平上不显著。
在专业急性期,压疮和肺部并发症很常见。尽管有相关方案,但压疮的发生令人担忧。为预防压疮,对于运动完全性损伤患者和椎体损伤患者似乎需要特别关注。