Development of the spinal cord injury pressure sore onset risk screening (SCI-PreSORS) instrument: a pressure injury risk decision tree for spinal cord injury rehabilitation

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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Individualized Clinical Practice Guidelines for Pressure Injury Management: Development of an Integrated Multi-Modal Biomedical Information Resource (Preprint)

10.2196/preprints.10871 ◽

2018 ◽

Author(s):

Kath M Bogie ◽

Guo-Qiang Zhang ◽

Steven K Roggenkamp ◽

Ningzhou Zeng ◽

Jacinta Seton ◽

...

Keyword(s):

Risk Factors ◽

Spinal Cord ◽

Spinal Cord Injury ◽

Clinical Practice ◽

Injury Risk ◽

Tissue Injury ◽

Care Planning ◽

Deep Tissue ◽

Cord Injury ◽

Pressure Injury

BACKGROUND Pressure ulcers (PU) and deep tissue injuries (DTI), collectively known as pressure injuries are serious complications causing staggering costs and human suffering with over 200 reported risk factors from many domains. Primary pressure injury prevention seeks to prevent the first incidence, while secondary PU/DTI prevention aims to decrease chronic recurrence. Clinical practice guidelines (CPG) combine evidence-based practice and expert opinion to aid clinicians in the goal of achieving best practices for primary and secondary prevention. The correction of all risk factors can be both overwhelming and impractical to implement in clinical practice. There is a need to develop practical clinical tools to prioritize the multiple recommendations of CPG, but there is limited guidance on how to prioritize based on individual cases. Bioinformatics platforms enable data management to support clinical decision support and user-interface development for complex clinical challenges such as pressure injury prevention care planning. OBJECTIVE The central hypothesis of the study is that the individual’s risk factor profile can provide the basis for adaptive, personalized care planning for PU prevention based on CPG prioritization. The study objective is to develop the Spinal Cord Injury Pressure Ulcer and Deep Tissue Injury (SCIPUD+) Resource to support personalized care planning for primary and secondary PU/DTI prevention. METHODS The study is employing a retrospective electronic health record (EHR) chart review of over 75 factors known to be relevant for pressure injury risk in individuals with a spinal cord injury (SCI) and routinely recorded in the EHR. We also perform tissue health assessments of a selected sub-group. A systems approach is being used to develop and validate the SCIPUD+ Resource incorporating the many risk factor domains associated with PU/DTI primary and secondary prevention, ranging from the individual’s environment to local tissue health. Our multiscale approach will leverage the strength of bioinformatics applied to an established national EHR system. A comprehensive model is being used to relate the primary outcome of interest (PU/DTI development) with over 75 PU/DTI risk factors using a retrospective chart review of 5000 individuals selected from the study cohort of more than 36,000 persons with SCI. A Spinal Cord Injury Pressure Ulcer and Deep Tissue Injury Ontology (SCIPUDO) is being developed to enable robust text-mining for data extraction from free-form notes. RESULTS The results from this study are pending. CONCLUSIONS PU/DTI remains a highly significant source of morbidity for individuals with SCI. Personalized interactive care plans may decrease both initial PU formation and readmission rates for high-risk individuals. The project is using established EHR data to build a comprehensive, structured model of environmental, social and clinical pressure injury risk factors. The comprehensive SCIPUD+ health care tool will be used to relate the primary outcome of interest (pressure injury development) with covariates including environmental, social, clinical, personal and tissue health profiles as well as possible interactions among some of these covariates. The study will result in a validated tool for personalized implementation of CPG recommendations and has great potential to change the standard of care for PrI clinical practice by enabling clinicians to provide personalized application of CPG priorities tailored to the needs of each at-risk individual with SCI. REGISTERED REPORT IDENTIFIER RR1-10.2196/10871

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Biomarkers for recurrent pressure injury risk in persons with spinal cord injury

Journal of Spinal Cord Medicine ◽

10.1080/10790268.2019.1645406 ◽

2019 ◽

Vol 43 (5) ◽

pp. 696-703 ◽

Cited By ~ 1

Author(s):

Katie Schwartz ◽

M. Kristi Henzel ◽

Mary Ann Richmond ◽

Jennifer K. Zindle ◽

Jacinta M. Seton ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Injury Risk ◽

Cord Injury ◽

Pressure Injury

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Exploring adipogenic and myogenic circulatory biomarkers of recurrent pressure injury risk for persons with spinal cord injury

Journal of Circulating Biomarkers ◽

10.33393/jcb.2020.2121 ◽

2020 ◽

Vol 6 (1) ◽

pp. 1-7

Author(s):

Kath M Bogie ◽

Katelyn Schwartz ◽

Youjin Li ◽

Shengxuan Wang ◽

Wei Dai ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Repeated Measures ◽

Injury Risk ◽

Univariate Analysis ◽

Model Development ◽

Pyruvate Dehydrogenase Kinase ◽

Cord Injury ◽

Pressure Injury ◽

Nonlinear Correlations

Purpose: To investigate linkages between circulatory adipogenic and myogenic biomarkers, gluteal intramuscular adipose tissue (IMAT), and pressure injury (PrI) history following spinal cord injury (SCI). Methods: This is an observational repeated-measures study of 30 individuals with SCI. Whole blood was collected regularly over 2-3 years. Circulatory adipogenic and myogenic gene expression was determined. IMAT was defined as above/below 15% (IMATd) or percentage (IMAT%). PrI history was defined as recurrent PrI (RPrI) or PrI number (nPrI). Model development used R packages (version 3.5.1). Univariate analysis screened for discriminating genes for downstream multivariate and combined models of averaged and longitudinal data for binary (RPrI/IMATd) and finer scales (nPrI/IMAT%). Results: For adipogenesis, Krüppel-like factor 4 was the top RPrI predictor together with resistin and cyclin D1, and sirtuin 2 was the top IMAT predictor. For myogenesis, the top RPrI predictor was dysferlin 2B, and pyruvate dehydrogenase kinase-4 was the top IMAT predictor together with dystrophin. Conclusion: Circulatory adipogenic and myogenic biomarkers have statistically significant relationships with PrI history and IMAT for persons with SCI. Biomarkers of interest may act synergistically or additively. Variable importance rankings can reveal nonlinear correlations among the predictors. Biomarkers of interest may act synergistically or additively, thus multiple genes may need to be included for prediction with finer distinction.

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