Actionable Nuggets for SCI (3rd ed., 2016)
Treat stage I or II wounds with standard wound care. Treat stage III or IV wounds with specialist / surgical intervention.
Approximately 75% of pressure injuries in the SCI population are Stage I or II, and can be managed conservatively. The remaining 25% are Stage III or IV, and require more specialized management. Severe pressure injuries can lead to decreased mobility, loss of independence, amputation, and even fatal infections. Pressure injuries are most effectively treated when diagnosed and treated early.
Evidence-based Best Practice:
Standard wound care for Stage I and II injuries includes cleansing, debridement and infection management. A wide array of dressings is available, such as hydrocolloid, transparent film, hydrogel, alginate, foam, silver, silicone, collagen matrix, honey and iodine. Referral to rehabilitation is recommended for seating and activity protocols. Referral to a dietician may be beneficial, since nutritional status can significantly affect healing, especially energy and protein needs.
For Stage III and IV injuries, prompt referral to a surgeon is indicated, and discovery and treatment of osteomyelitis is a priority. A variety of biophysical modalities may also be considered, including electrical stimulation, electromagnetic agents, pulsed radio frequency, phototherapy (laser, infrared, ultraviolet), ultrasound, negative pressure therapy, and hydrotherapy. Evidence is building for electrical stimulation, but standardization of administration protocols is needed.
Telephone and video conferencing have been highly effective in making specialized wound care more accessible to community clinicians, with good rates of agreement with in-person specialist care.
European Pressure Ulcer Advisory Panel and National Pressure Ulcer Advisory Panel. (2014). Prevention and Treatment of Pressure Ulcers : Quick Reference Guide. Clinical Practice Guideline. http://www.npuap.org/wp-content/uploads/2014/08/Updated-10-16-14-Quick-Reference-Guide-DIGITAL-NPUAP-EPUAP-PPPIA-16Oct2014.pdf
Additional References (chronological order):
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