Actionable Nuggets for SCI (2nd ed., 2013)
Individuals with spinal cord injury (SCI) are at life-long risk for developing pressure ulcers due primarily to poor sensation and circulation. Skin breakdowns result as a complex inter-relationship of multiple risk factors, including being underweight, smoking, malnutrition, incontinence, decreased mobility, diabetes and spasticity.
Assess for risk of pressure ulcer using the Braden Scale, and refer to specialist if high risk.
Additional information: Bradenscale for predicting pressure sore risk
Evidence-based Best Practice:
Pressure ulcers are considered at least 50% preventable, and the cost of prevention is one-tenth the cost of treatment; yet patient knowledge about pressure ulcers is low and declines over time post-rehabilitation. Effective prevention must be highly customized to individual lifestyles, and oriented toward the formation of good skin care habits. A specialized interdisciplinary approach is recommended, including nutrition and lifestyle counseling, seating optimization and rehabilitation.
Incidence of pressure ulcers (or decubiti) in the spinal cord injury population is estimated at 20-31% annually, and point prevalence at 10-30%, increasing with age. Pressure sores have very significant onsequences for functioning, health and quality of life. Care for episodic pressure ulcers consumes approximately ¼ of all the resources spent on the SCI population.
The Braden scale is an evidence-based measure for predicting pressure sore risk. It has been shown to be a sensitive tool for individuals with SCI and to have excellent reliability for those living in the community. Scoring is as follows:
|Very High Risk||< 9|
|High Risk||10 – 12|
|Moderate Risk||13 – 14|
|Mild Risk||15 – 18|
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