Pressure Ulcer in Trauma Patients: A Higher Spinal Cord Injury Level Leads to Higher Risk

Abstract Background Cricothyroidotomy and surgical tracheostomy are methods to secure airway patency. In emergency surgery, these methods are nowadays mostly reserved for patients unsuited for percutaneous procedures. Detailed description of complications and functional outcomes following both procedures is underreported in current literature. The aim of this study was to evaluate outcomes following cricothyroidotomy and tracheostomy in this presumed complex population. Methods In this retrospective cohort study, adult emergency surgical patients treated with cricothyroidotomy and/or surgical tracheostomy were included. Postoperative complications and functional outcomes in trauma and non-trauma patients were evaluated. Results Forty-one trauma patients and 11 non-trauma emergency surgical patients (mainly after elective onco-abdominal or vascular surgery) were included. Of 52 patients, seven underwent cricothyroidotomy pre-tracheostomy. Mortality was higher in non-trauma patients (p = 0.04) following both procedures. Over half of patients (56%, n = 29) regained unsupported airway patency with a tendency toward increased tracheostomy removal in trauma patients. Among complications, only pneumonia occurred frequently (60%, n = 31), with no relation to patient type. Other complications included local infection (5.8%, n = 4) and wound dehiscence (1.9%, n = 1). Adverse functional outcomes were frequently observed and were mild and self-limiting. Cervical spinal cord injury reduced overall unsupported airway patency (p = 0.01); with high cervical spinal cord injury related to adverse functional outcomes and increased home ventilation need. Conclusions No major procedure-related complications or functional adverse events were encountered following cricothyroidotomy and surgical tracheostomy, even though only complex patients were included. Only mild, self-limiting functional problems occurred, especially in trauma patients with cervical injury who underwent early tracheostomy by longitudinal incision. This information can aid clinicians in making tailor-made decisions for individual patients.

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Prevention and treatment of pressure sore following spinal cord injury

Journal of Korean Medical Association ◽

10.5124/jkma.2020.63.10.623 ◽

2020 ◽

Vol 63 (10) ◽

pp. 623-632

Author(s):

Myeong Ok Kim

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Pressure Ulcer ◽

Wound Care ◽

Pressure Sore ◽

Therapeutic Interventions ◽

Advisory Panel ◽

Pressure Sores ◽

Cord Injury ◽

Pressure Injury

Pressure sores or pressure injury is a serious complication of a spinal cord injury (SCI), representing a challenging problem for patients, their caregivers, and their physicians. Persons with SCI are vulnerable to pressure sores throughout their life. Pressure sores can potentially interfere with the physical, psychosocial, and overall quality of life. Outcomes directly depend on education and prevention along with conservative and surgical management. Therefore, it is very important to understand everything about pressure sores following SCI. This review covers epidemiology, cost, pathophysiology, risk factors, staging, evaluation tools, prevention, education, conservative wound care methods, surgical treatment, and future trends in wound healing related to post-SCI pressure sores. A change in nomenclature was adopted by the National Pressure Ulcer Advisory Panel in 2016, replacing “pressure ulcer”with “pressure injury.” New concepts of pressure injury staging, such as suspected deep tissue injuries and unstageable pressure injuries, were also introduced. A systematic evidence-based review of the prevention of and therapeutic interventions for pressure sores was also discussed.

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Recurrence rate after pressure ulcer reconstruction in patients with spinal cord injury in patients under control by a plastic surgery and physical medicine and rehabilitation team

Turkish Journal of Physical Medicine and Rehabilitation ◽

10.5606/tftrd.2018.2175 ◽

2018 ◽

Vol 64 (4) ◽

pp. 322-327

Author(s):

Nurdan Paker

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Plastic Surgery ◽

Recurrence Rate ◽

Pressure Ulcer ◽

Physical Medicine ◽

Rehabilitation Team ◽

Physical Medicine And Rehabilitation ◽

Cord Injury

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Inflammatory Mediators Associated With Pressure Ulcer Development in Individuals With Pneumonia After Traumatic Spinal Cord Injury: A Pilot Study

Archives of Physical Medicine and Rehabilitation ◽

10.1016/j.apmr.2016.12.018 ◽

2017 ◽

Vol 98 (9) ◽

pp. 1792-1799 ◽

Cited By ~ 6

Author(s):

Shilpa Krishnan ◽

Yoram Vodovotz ◽

Patricia E. Karg ◽

Gregory Constantine ◽

Gwendolyn A. Sowa ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Pilot Study ◽

Pressure Ulcer ◽

Inflammatory Mediators ◽

Traumatic Spinal Cord Injury ◽

Cord Injury ◽

Pressure Ulcer Development

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Knowledge, Attitude and Practice Among Caregivers Towards Pressure Ulcer in Spinal Cord Injury at Rehabilitation Center in Bangladesh

10.21203/rs.3.rs-225668/v1 ◽

2021 ◽

Author(s):

Niraj Tharu ◽

Monzurul Alam ◽

Shristi Bajracharya ◽

Mohammad Kabir

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Pressure Ulcer ◽

Positive Attitude ◽

Moderate Level ◽

Attitude And Practice ◽

Cord Injury ◽

Level Of Knowledge ◽

Knowledge And Practice ◽

Knowledge Attitude And Practice

Abstract Study design: A quantitative cross-sectional survey study. Objective To determine the knowledge, attitude and practice (KAP) among caregivers regarding prevention and care of pressure ulcer in patients with spinal cord injury and relationship between KAP. Setting: Centre for Rehabilitation of Paralysed, Dhaka, Bangladesh. Methods A descriptive correlational design with modified semi-structured questionnaire implemented through convenient sampling procedure. McDonald’s standard of learning outcome measured criteria was used to categorize caregivers’ level of knowledge and practice while, the total scores of attitude were categorized into three levels based on mean percentage and standard deviation: negative attitude below (mean ± 1 SD), neutral level (mean ± 1 SD), and positive attitude above (mean ± 1 SD). The pearson product-moment correlation coefficient (r) was used to examine the relationships between caregivers’ KAP and p- value of 0.05 or less was considered as statistically significant. Results Our results suggest that caregivers had a moderate level of knowledge (M = 73.68%, SD = 6.43), neutral level of attitude (M = 70.32%, SD = 6.89), and moderate level of practice (M = 74.77%, SD = 9.08). There was a positive correlation between caregivers’ knowledge and attitude (r = 0.30, p < 0.01), and between knowledge and practice (r = 0.37, p < 0.01). However, no correlation existed between attitude and practice (r = 0.12, p > 0.05). Conclusion The study findings suggests that caregivers need to develop a positive attitude and increase their knowledge in order to improve their practice.

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Trauma

Congress of Neurological Surgeons Essent ◽

10.1093/med/9780197534342.003.0005 ◽

2020 ◽

pp. 131-170

Keyword(s):

Traumatic Brain Injury ◽

Spinal Cord ◽

Spinal Cord Injury ◽

Brain Injury ◽

Severe Traumatic Brain Injury ◽

Brain Injuries ◽

Cervical Spinal Cord ◽

Trauma Patients ◽

Cervical Spine Injuries ◽

Cord Injury

This chapter discusses traumatic spinal cord and brain injuries. The first three studies review the background and key findings of the third National Acute Spinal Cord Injury Study (NASCIS) trial, examine the efficacy of the Canadian C-Spine Rule in the evaluation of cervical spine injuries in alert and stable trauma patients; and describe the development of the Thoracolumbar Injury Classification and Severity Score (TLICS) classification system. The next two studies assess the effect of early surgical decompression in patients with traumatic cervical spinal cord injury and delineate the role of secondary brain injury in determining patient outcome in severe traumatic brain injury. The following set of four studies evaluates the efficacy of phenytoin in preventing posttraumatic seizures, as well as the efficacy of intracranial pressure monitoring, induction of hypothermia, and decompressive craniectomy for severe traumatic brain injury. The last study, which is of historical value, identifies predictors of outcome in comatose patients with traumatic acute subdural hematoma.

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Intraabdominal Injury is Common in Blunt Trauma Patients who Sustain Spinal Cord Injury

The American Surgeon ◽

10.1177/000313480707301025 ◽

2007 ◽

Vol 73 (10) ◽

pp. 1035-1038

Author(s):

Ali Salim ◽

Marcus Ottochian ◽

Ryan J. Gertz ◽

Carlos Brown ◽

Kenji Inaba ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Length Of Stay ◽

Blunt Trauma ◽

Injury Severity ◽

Unit Length ◽

Hospital Length Of Stay ◽

Trauma Patients ◽

Cord Injury ◽

Intraabdominal Injury

The evaluation of the abdomen in patients with spinal cord injury (SCI) is challenging for obvious reasons. There are very little data on the incidence and complications of patients who sustain SCI with concomitant intraabdominal injury (IAI). To determine the incidence and outcomes of IAI in blunt trauma patients with SCI, a trauma registry and record review was performed between January 1998 and December 2005. Baseline demographic data, Injury Severity Score, and associated IAI were collected. Two groups were established and outcomes were analyzed based on the presence or absence of IAI. Intraabdominal and hollow viscus injures were found in 15 per cent and 6 per cent, respectively, of 292 patients with blunt SCI. The presence of intraabdominal injury varied according to the level of the SCI: 10 per cent of cervical, 23 per cent of thoracic, and 18 per cent of lumbar SCI. The overall mortality was 16 per cent. The presence of intraabdominal injury was associated with longer intensive care unit length of stay (13 versus 6 days, P < 0.01), hospital length of stay (23 versus 18 days, P < 0.05), higher complication rate (46% versus 33%, P = 0.09), and higher mortality (44% versus 11%, P < 0.01) when compared with patients with SCI without IAI. Intraabdominal injuries are common in blunt SCI. Liberal evaluation with computed tomography is necessary to identify injuries early.

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