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

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

scholarly journals Prevention of deep tissue injury through muscle contractions induced by intermittent electrical stimulation after spinal cord injury in pigs

2013 ◽  
Vol 114 (2) ◽  
pp. 286-296 ◽  
Author(s):  
Leandro R. Solis ◽  
Elizabeth Twist ◽  
Peter Seres ◽  
Richard B. Thompson ◽  
Vivian K Mushahwar
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Electrical Stimulation ◽  
Tissue Damage ◽  
Tissue Injury ◽  
External Loading ◽  
Support Surface ◽  
Deep Tissue ◽  
Deep Tissue Injury ◽  
Cord Injury

Deep tissue injury (DTI) is a severe medical complication that commonly affects those with spinal cord injury. It is caused by prolonged external loading of the muscles, entrapping them between a bony prominence and the support surface. The entrapment causes excessive mechanical deformation and increases in interstitial pressure, leading to muscle breakdown deep around the bony prominences. We proposed the use of intermittent electrical stimulation (IES) as a novel prophylactic method for the prevention of DTI. In this study, we assessed the long-term effectiveness of this technique in pigs that had received a partial spinal cord injury that paralyzed one hindlimb. The pigs recovered for 2 wk postsurgery, and subsequently, their paralyzed limbs were loaded to 25% of their body weights 4 h/day for 4 consecutive days each week for 1 mo. One group of pigs ( n = 3) received IES during the loading, whereas another group ( n = 3) did not. DTI was quantified using magnetic resonance imaging (MRI) and postmortem histology. In the group that did not receive IES, MRI assessments revealed signs of tissue damage in 48% of the volume of the loaded muscle. In the group that did receive IES, only 8% of the loaded muscle volume showed signs of tissue damage. Similar findings were found through postmortem histology. This study demonstrates, for the first time, that IES may be an effective technique for preventing the formation of DTI in loaded muscles after spinal cord injury.

scholarly journals Deep tissue injury rat model for pressure ulcer research on spinal cord injury

2010 ◽  
Vol 19 (2) ◽  
pp. 67-76 ◽  
Author(s):  
Fang Lin ◽  
Atek Pandya ◽  
Andrew Cichowski ◽  
Mauli Modi ◽  
Briana Reprogle ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Pressure Ulcer ◽  
Rat Model ◽  
Tissue Injury ◽  
Deep Tissue ◽  
Deep Tissue Injury ◽  
Cord Injury

Effects of Intramuscular Fat Infiltration, Scarring, and Spasticity on the Risk for Sitting-Acquired Deep Tissue Injury in Spinal Cord Injury Patients

2011 ◽  
Vol 133 (2) ◽  
Author(s):  
Ran Sopher ◽  
Jane Nixon ◽  
Claudia Gorecki ◽  
Amit Gefen
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Outcome Measures ◽  
Tissue Injury ◽  
Intramuscular Fat ◽  
Von Mises Stress ◽  
Deep Tissue ◽  
Fat Infiltration ◽  
Deep Tissue Injury ◽  
Cord Injury

Sitting-acquired deep tissue injury (DTI) is a severe form of pressure ulcer (PU) often affecting patients with spinal cord injury (SCI) who also tend to suffer from intramuscular fat infiltration, soft tissue scarring (due to previous PU), and/or muscle spasticity in their buttocks. We previously used finite element (FE) modeling to evaluate whether abnormal bodyweight is a risk factor for sitting-acquired DTI. Here we hypothesize that fat infiltration, scarring, or spasms increase internal loads in the gluteus muscles in the vicinity of the ischial tuberosities during sitting, which consequently put SCI patients with these conditions at a higher risk for DTI. Our objective was to determine changes in gluteal strains and stresses and tissue volumes exposed to elevated strains/stresses associated with these factors. Thirty-five FE models of coronal slices through the seated buttocks, simulating these conditions at different severities, were developed. We calculated peak strains and stresses in glutei and percentage volumes of muscle tissue exposed to above-critical strains/stresses (compression strain≥50%, compression/von Mises stress≥2 kPa, and strain energy density≥0.5 kPa). Progressive intramuscular fat infiltration increased all the aforementioned outcome measures. Increase in size of scar patterns that were contained in both muscle and fat tissues similarly elevated the outcome measures. Spasms increased muscle stresses and volumetric exposures to stress, but tissue volumes at risk were ∼1–2% and increases due to spasticity were slight. We conclude that the above potential risk factors can be listed according to the following order of importance: (i) fat infiltration, (ii) scars contained in both muscle and fat tissues, and (iii) spasms. This information should be considered when prioritizing prevention means and resources for patients with SCI.

scholarly journals An animal model for simulating deep tissue injury for pressure ulcer research on spinal cord injury

2010 ◽  
Vol 24 (S1) ◽  
Author(s):  
Mohsen Makhsous ◽  
Fang Lin ◽  
Andrew Cichowski ◽  
Atek Pandya ◽  
Mauli Modi
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Animal Model ◽  
Pressure Ulcer ◽  
Tissue Injury ◽  
Deep Tissue ◽  
Deep Tissue Injury ◽  
Cord Injury
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