Byrne and Salzberg identified risk factors associated with development of pressure ulcers in patients with spinal cord injuries. These can help identify patients who may require closer monitoring and more aggressive management. The authors are from the New York Medical College and Castle Point VA Medical Center in New York.

Spinal cord injury:

(1) decreased level of activity

(2) prolonged immobilization

(3) completeness and level of the spinal cord injury

(4) urine incontinence

(5) fecal incontinence

(6) autonomic dysreflexia/severe spasticity


Comorbid (pre-existing) illness:

(1) advanced age

(2) pulmonary disease

(3) cardiac disease

(4) diabetes with poor glycemic control

(5) renal disease

(6) impaired cognitive function

(7) circulatory disorders (peripheral vascular disease)


Nutritional and circulatory:

(1) hypoalbuminemia

(2) malnutrition

(3) anemia

(4) extremes of body weight (cachexia, morbid obesity)

(5) edema



(1) noncompliance with pressure ulcer prevention

(2) uncooperative behavior

(3) low self-esteem



(1) sedatives and tranquilizers

(2) steroids and anti-inflammatory agents



(1) history of a previous pressure ulcer

(2) tobacco use, smoking

(3) friction or shearing of skin surfaces

(4) poverty

(5) poor level of hygiene

(6) residing in a nursing home or hospital

(7) alcohol or drug abuse


Decreased risk:

(1) admission to center specializing in spinal cord injury


The presence of multiple risk factors identifies a patient who is at high risk for development of pressure ulceration and who should receive aggressive preventive care.

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