Incidence, severity and time course of pressure injuries over the first two years following discharge from hospital in people with spinal cord injuries in Bangladesh

Abstract

Pressure injuries are a common complication of spinal cord injury (SCI) particularly following discharge from hospital. They are believed to be more prevalent in low-and-middle-income countries (LMICs) than high-income countries (HICs). Pressure injuries are a leading cause of premature death particularly in LMICs. Despite the problems pressure injuries pose for people with SCI in LMICs, there are few accurate data about the incidence and severity of pressure injuries from these countries: the focus of my thesis. My thesis includes a cohort study that was embedded in a clinical trial. One hundred and eighty-six participants were contacted by telephone 39 times and assessed in person 4 to 6 times over the two years following discharge as part of the cohort study. At each point of contact the presence and severity of pressure injuries were determined using the Pressure Ulcer Scale for Healing (PUSH). Survival analyses were done to determine the time course of development of pressure injuries and recovery from pressure injuries. Lasso regression was used to construct multivariate prediction models. Seventy-seven participants (41%; 95% CI 34% to 49%) developed at least one pressure injury, 21 participants (11%) developed two pressure injuries, and 18 participants (10%) developed three or more pressure injuries in the first two years after discharge. The incidence rate was 0.27 per person-year (95% CI 0.22 to 0.34). Most pressure injuries were on the sacrum (23%). Pressure injuries took a median (interquartile range, IQR) of 40 days (29 to 57) days to heal. The median peak PUSH score was 11/17 (8 to 13.5). The multivariate prediction models had poor predictive properties (maximum c-statistic 0.75). My study proves that pressure injuries are still a very common and severe complication of SCI in LMICs like Bangladesh. Interestingly, it is very difficult to predict who are likely to develop pressure injuries at the time of discharge from hospital.