The effect of surface electric stimulation of the gluteal muscles on the interface pressure in seated people with spinal cord injury

van Londen A, Herwegh M, van der Zee CH, Daffertshofer A, Smit CA, Niezen A, Janssen TW. The effect of surface electric stimulation of the gluteal muscles on the interface pressure in seated people with spinal cord injury.

Objective

To study effects of surface electric stimulation of the gluteal muscles on the interface pressure in seated persons with spinal cord injury (SCI).

Design

One session in which alternating and simultaneous surface electric stimulation protocols were applied in random order.

Setting

Research laboratory of a rehabilitation center.

Participants

Thirteen subjects with SCI.

Intervention

Surface electric stimulation of the gluteal muscles.

Main Outcome Measures

Interface pressure, maximum pressure, pressure spread, and pressure gradient for the stimulation measurement. Variables were compared using 2-tailed paired t tests.

Results

Alternating and simultaneous stimulation protocol caused a significant (P<.01) decrease in interface pressure (-17±12mmHg, -19±14mmHg) and pressure gradient (-12±11mmHg, -14±12mmHg) during stimulation periods compared with rest periods. There was no significant difference in effects between the 2 protocols.

Conclusions

Surface electric stimulation of the gluteal muscles in persons with SCI causes a decrease in interface pressure. This might restore blood flow in compressed tissue and help prevent pressure ulcers.     

Effect of wheelchair tilt-in-space and recline angles on skin perfusion over the ischial tuberosity in people with spinal cord injury

Jan Y-K, Jones MA, Rabadi MH, Foreman RD, Thiessen A. Effect of wheelchair tilt-in-space and recline angles on skin perfusion over the ischial tuberosity in people with spinal cord injury.

Objective

To investigate the efficacy of wheelchair tilt-in-space and recline on enhancing skin perfusion over the ischial tuberosity in wheelchair users with spinal cord injury (SCI).

Design

Repeated-measures, intervention, and outcomes-measure design.

Setting

A university research laboratory.

Participants

Wheelchair users with SCI (N=11; 9 men, 2 women; mean ± SD age, 37.7±14.2y; body mass index, 24.7±2.6kg/m²; duration of injury, 8.1±7.5y).

Interventions

Protocols (N=6) of various wheelchair tilt-in-space and recline angles were randomly assigned to participants. Each protocol consisted of a 5-minute sitting-induced ischemic period and a 5-minute wheelchair tilt-in-space and recline pressure-relieving period. Participants sat in a position without tilt or recline for 5 minutes and then sat in 1 of 6 wheelchair tilted and reclined positions, including (1) 15° tilt-in-space and 100° recline, (2) 25° tilt-in-space and 100° recline, (3) 35° tilt-in-space and 100° recline, (4) 15° tilt-in-space and 120° recline, (5) 25° tilt-in-space and 120° recline, and (6) 35° tilt-in-space and 120° recline. A 5-minute washout period (at 35° tilt-in-space and 120° recline) was allowed between protocols.

Main Outcome Measures

Laser Doppler flowmetry was used to measure skin perfusion over the ischial tuberosity in response to changes in body positions caused by performing wheelchair tilt-in-space and recline. Skin perfusion response to wheelchair tilt-in-space and recline was normalized to skin perfusion of the upright seated position (no tilt/recline).

Results

Combined with 100° recline, wheelchair tilt-in-space at 35° resulted in a significant increase in skin perfusion compared with the upright seated position (no tilt/recline; P<.05), whereas there was no significant increase in skin perfusion at 15° and 25° tilt-in-space (not significant). Combined with 120° recline, wheelchair tilt-in-space at 15°, 25°, and 35° showed a significant increase in skin perfusion compared with the upright seated position (P<.05).

Conclusions

Our results indicate that wheelchair tilt-in-space should be at least 35° for enhancing skin perfusion over the ischial tuberosity when combined with recline at 100° and should be at least 25° when combined with recline at 120°. Although smaller angles of wheelchair tilt-in-space and recline are preferred by wheelchair users for functional purposes, wheelchair tilt-in-space less than 25° and recline less than 100° may not be sufficient for effective pressure reduction for enhancing skin perfusion over the ischial tuberosity in people with SCI.     

Nontraumatic spinal cord injury rehabilitation: pressure ulcer patterns, prediction, and impact

OBJECTIVE: To investigate the characteristics, predictors, and consequences of pressure ulcers in patients with nontraumatic spinal cord injury (SCI). DESIGN: Retrospective, 3-year, case series. SETTING: Tertiary medical unit specializing in SCI rehabilitation. PARTICIPANTS: Consecutive sample of 134 adult inpatient referrals with nontraumatic SCI. Patients requiring initial rehabilitation or readmission were included. INTERVENTION: Chart review. MAIN OUTCOME MEASURES: Primary outcome measures were presence of pressure ulcers on admission to rehabilitation, incidence of new pressure ulcers developing during hospitalization, and any complications attributable to pressure ulcers during inpatient rehabilitation. Secondary objectives were to examine the predictability of risk factors for pressure ulcers, to assess the usefulness of a model previously developed for predicting pressure ulcers in patients with chronic SCI, and to estimate the effect of pressure ulcers on rehabilitation of nontraumatic SCI. RESULTS: Prevalence of pressure ulcers among admissions was 31.3% (n=42). Only 2.2% (n=3) of patients developed a new pressure ulcer after admission. The length of stay (LOS) of patients admitted with a pressure ulcer was significantly longer than that of those without a pressure ulcer (geometric mean, 62.3 d for pressure ulcer vs 28.2 d for no pressure ulcer, P=.0001). Many previously identified risk factors for pressure ulcers in SCI patients did not apply to our nontraumatic SCI patients. It is estimated that the inpatient LOS for those patients with a significant pressure ulcer was increased by 42 days. CONCLUSIONS: Pressure ulcers are a common complication for people with nontraumatic SCI who are admitted for rehabilitation, and they have a significant impact on LOS.     

Wavelet analysis of skin blood oscillations in persons with spinal cord injury and able-bodied subjects

OBJECTIVE: To assess the blood oscillations in the skin over the ischial tuberosity (high-risk area for pressure ulcer) using spectral analysis of laser Doppler flowmetry signals based on wavelet transform. DESIGN: Wavelet analysis of skin blood oscillations in persons with spinal cord injury (SCI) and able-bodied subjects. SETTING: Seating and body support interface laboratory. PARTICIPANTS: Ten men were recruited for this study, of whom 5 were able-bodied subjects (age, 31.2+/-3.3 y) and 5 were persons with SCI (age, 37.2+/-7.3 y). INTERVENTIONS: External pressure of 16.0 kPa (120 mmHg) was applied to the ischial tuberosity via 1 specifically designed pneumatic indentor. The loading duration was 30 minutes. MAIN OUTCOME MEASURES: Skin blood flow was monitored for 10 minutes prior to loading and 20 minutes after the prescribed loading period. With spectral analysis based on wavelet transform, 5 frequency intervals were identified (.01-.02, .02-.06, .06-.15, .15-.40, .40-2.0 Hz) corresponding to endothelial related metabolic, neurogenic, myogenic, respiratory, and cardiac activities, respectively. RESULTS: The relative amplitude of the metabolic component for persons with SCI was significantly lower (F=5.26, P=.032) during the resting conditions as compared with able-bodied subjects. During the postloading period, the response of oscillatory activities was evidently lower in the skin over the ischial tuberosity for persons with SCI when compared with able-bodied subjects. In addition, the relative amplitude of the neurogenic component (.02-.06 Hz) during postloading was significantly lower for persons with SCI (F=5.44, P=.029). CONCLUSIONS: These findings suggest that the contributions of endothelial related metabolic and neurogenic activities to the blood perfusion regulation become relatively less for persons with SCI during the resting and postloading periods, respectively.     

Preventing recurrent pressure ulcers in veterans with spinal cord injury: impact of a structured education and follow-up intervention

Rintala DH, Garber SL, Friedman JD, Holmes SA. Preventing recurrent pressure ulcers in veterans with spinal cord injury: impact of a structured education and follow-up intervention.

Objective

To test the hypothesis that enhanced education and structured follow-up after pressure ulcer surgery will result in fewer recurrences.

Design

Randomized controlled trial.

Setting

Veterans Affairs medical center.

Participants

Forty-nine veteran men with spinal cord injury or dysfunction were approached on admission for pressure ulcer surgery. Five never had surgery, 2 refused to participate, and one withdrew. Forty-one were randomized into 3 groups. Three participants' ulcers did not heal, so follow-up could not begin.

Interventions

Group 1 received individualized pressure ulcer education and monthly structured telephone follow-up (n=20); group 2 received monthly mail or telephone follow-up without educational content (n=11); and group 3 received quarterly mail or telephone follow-up without educational content (n=10). Follow-up continued until recurrence, death, or 24 months.

Main Outcome Measure

Time to pressure ulcer recurrence.

Results

Group 1 had a longer average time to ulcer recurrence or end of study than groups 2 and 3 (19.6mo, 10.1mo, 10.3mo; P=.002) and had a smaller rate of recurrence (33%, 60%, 90%; P=.007). Survival analysis confirmed these findings (P=.009).

Conclusions

Individualized education and structured monthly contacts may be effective in reducing the frequency of or delaying pressure ulcer recurrence after surgical repair of an ulcer.     

Earnings among people with spinal cord injury

Krause JS, Terza JV, Dismuke C. Earnings among people with spinal cord injury.

Objective

To identify differences in conditional and unconditional earnings among participants with spinal cord injury (SCI) attributable to biographic, injury, educational, and employment factors by using a 2-part model (employment, earnings).

Design

A secondary analysis of cross-sectional survey data.

Setting

A Midwestern university hospital and a private hospital in the Southeastern United States.

Participants

All participants (N=1296) were adults between the ages of 18 and 64 who had a traumatic SCI at least 1 year before study initiation.

Interventions

Not applicable.

Main Outcome Measures

Earnings were defined by earnings within the previous 12 months and were measured by a single categoric item. Conditional earnings reflect the earnings of employed participants, whereas unconditional earnings reflect all participants with $0 in earnings recorded for those unemployed.

Results

Sex and race were significantly related to conditional earnings, even after controlling for educational and vocational variables. Additionally, conditional earnings (employed participants only) were related to 16 or more years of education, number of years employed, the percentage of time after SCI spent employed, and working in either government or private industry (not self-employed or family business). There was a greater number of significant variables for unconditional earnings, largely reflective of the influence of the portion employed (those not working having $0 in earnings).

Conclusions

Efforts to improve employment outcomes should focus on facilitating return to work immediately after injury, returning to preinjury job, maintaining regular employment, and working for placement in government or private industry. Special efforts may be needed to promote vocational outcomes among women and nonwhites.     

Poster 27: Pressure ulcer history and spinal cord injury

Objective: To identify risk and protective factors associated with a history of recurrent pressure ulcers after spinal cord injury (SCI). Design: Cross-sectional. Setting: Large southeastern US specialty hospital. Participants: 826 nonambulatory adults with traumatic SCI of at least 5 years in duration. Interventions: Not applicable. Main Outcome Measures: Outcomes included current pressure ulcers, pressure ulcers within the past years, days adversely impacted by pressure ulcers, pressure ulcer surgeries, and pressure ulcer history (recurrent vs nonrecurrent). Results: 69% failed to report recurrent pressure ulcers, whereas 13% reported a clear pattern of recurring pressure ulcers of 1 or more per year (18% could not be classified). Logistic regression identified several general protective behaviors for recurrent pressure ulcers (eg, lifestyle, exercise, diet), none of which included those generally recommended during inpatient rehabilitation to prevent pressure ulcers (eg, skin checks, weight shifts). Fewer risk behaviors were associated with pressure ulcer history, although several proxy variables were related to pressure ulcer history. Conclusions: Pressure ulcer history is a more viable measure of pressure ulcer outcomes than measures taken at a single point in time (current), over a brief period of time (eg, 1y), or those relying on critical events occurring at any time since SCI onset (ie, surgeries to repair pressure ulcers). A general healthy lifestyle appears to be strongly associated with an absence of recurrent pressure ulcers, whereas the efficacy of specific prevention behaviors was not demonstrated.     

Patterns of recurrent pressure ulcers after spinal cord injury: identification of risk and protective factors 5 or more years after onset

OBJECTIVES: To identify risk and protective factors associated with a history of recurrent pressure ulcers among participants with spinal cord injury (SCI). DESIGN: A mail survey was used to identify factors associated with the presence or absence of recurrent pressure ulcers. SETTING: A large specialty hospital in the southeastern United States. PARTICIPANTS: All participants had traumatic SCI, were nonambulatory, 18 years or older, and had been injured at least 5 years. A total of 826 subjects participated, 633 of whom reported a pressure ulcer history that could be classified as to whether they did or did not have a history of recurrent pressure ulcers. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: History of pressure ulcers was measured by a single item that required participants to classify their history into 1 of 5 options, ranging from never having any pressure ulcers to having almost continuous pressure ulcers, often requiring hospitalization. Those who either never had a pressure ulcer or had them mostly for a short period after SCI onset were classified as nonrecurrent, whereas those who reported at least 1 per year were classified as recurrent. RESULTS: Seventy percent of the participants failed to report recurrent pressure ulcers (never had any or had them only immediately after SCI onset), whereas 13% reported a clear pattern of recurring pressure ulcers of 1 or more per year. Logistic regression analyses suggested several general behaviors were protective for recurrent pressure ulcers, including lifestyle, exercise, and diet. Yet none of the behaviors generally recommended during inpatient rehabilitation specifically to prevent pressure ulcers (eg, skin checks weight shifts) were associated with pressure ulcer history. Only 2 risk behaviors were identified (number of cigarettes smoked, use of medication for sleep), although several proxy variables were related to pressure ulcer history. CONCLUSIONS: Pressure ulcer history is a more viable measure of pressure ulcer outcomes than measures taken at a single point in time (current), over a brief period (eg, 1y), or those relying on critical events occurring at any time since SCI onset (ie, surgeries to repair pressure ulcers). A healthy lifestyle appears to be strongly associated with avoiding pressure ulcers, whereas the efficacy of specific prevention behaviors was not demonstrated. Problem solving and coping strategies should be targets for further research.     

Evaluation of the cost-effectiveness of electrical stimulation therapy for pressure ulcers in spinal cord injury

Mittmann N, Chan BC, Craven BC, Isogai PK, Houghton P. Evaluation of the cost-effectiveness of electrical stimulation therapy for pressure ulcers in spinal cord injury.

Objective

To evaluate the incremental cost-effectiveness of electrical stimulation (ES) plus standard wound care (SWC) as compared with SWC only in a spinal cord injury (SCI) population with grade III/IV pressure ulcers (PUs) from the public payer perspective.

Design

A decision analytic model was constructed for a 1-year time horizon to determine the incremental cost-effectiveness of ES plus SWC to SWC in a cohort of participants with SCI and grade III/IV PUs. Model inputs for clinical probabilities were based on published literature. Model inputs, namely clinical probabilities and direct health system and medical resources were based on a randomized controlled trial of ES plus SWC versus SWC. Costs (Can $) included outpatient (clinic, home care, health professional) and inpatient management (surgery, complications). One way and probabilistic sensitivity (1000 Monte Carlo iterations) analyses were conducted.

Setting

The perspective of this analysis is from a Canadian public health system payer.

Participants

Model target population was an SCI cohort with grade III/IV PUs.

Interventions

Not applicable.

Main Outcome Measure

Incremental cost per PU healed.

Results

ES plus SWC were associated with better outcomes and lower costs. There was a 16.4% increase in the PUs healed and a cost savings of $224 at 1 year. ES plus SWC were thus considered a dominant economic comparator. Probabilistic sensitivity analysis resulted in economic dominance for ES plus SWC in 62%, with another 35% having incremental cost-effectiveness ratios of $50,000 or less per PU healed. The largest driver of the economic model was the percentage of PU healed with ES plus SWC.

Conclusions

The addition of ES to SWC improved healing in grade III/IV PU and reduced costs in an SCI population.     

Trajectories in the course of life satisfaction after spinal cord injury: identification and predictors

van Leeuwen CM, Post MW, Hoekstra T, van der Woude LH, de Groot S, Snoek GJ, Mulder DG, Lindeman E. Trajectories in the course of life satisfaction after spinal cord injury: identification and predictors.

Objective

To identify different life satisfaction trajectories in the period between the start of active spinal cord injury (SCI) rehabilitation and 5 years after discharge, and to find predictors for distinguishing between trajectories. The hypotheses were that different life satisfaction trajectories would be identified and that demographic, lesion, physical, and social characteristics would be predictors of life satisfaction trajectory membership.

Design

Multicenter prospective cohort study with measurements at the start of active rehabilitation, after 3 months, at discharge, and 1, 2, and 5 years after discharge.

Setting

Eight Dutch rehabilitation centers with specialized SCI units.

Participants

Persons (N=225) with recently acquired SCI between the ages of 18 and 65 years were included, and data from 206 persons were analyzed.

Interventions

Not applicable.

Main Outcome Measures

Life satisfaction was measured as the sum score of “current life satisfaction” and “current life satisfaction compared with life satisfaction before SCI” (range, 2–13).

Results

Five life satisfaction trajectories were identified by using latent class growth mixture modeling: (1) low median scores (3–5) at all time points (27%), (2) intermediate scores (6–7) at all time points (31%), (3) high scores (8–10.5) at all time points (17%), (4) improvements from 3 to 9 (23%), and (5) deterioration from 9 to 4 (2%). Logistic regression showed that predictors of the low versus high life satisfaction trajectory were functional independence and pain. Predictors of the low life satisfaction versus the recovery trajectory were sex and functional independence. These predictors explained only a small part of the total variance.

Conclusions

Life satisfaction in people with SCI follows distinct trajectories. Monitoring life satisfaction at the start of active rehabilitation and 3 months later might allow identification of persons at risk for poor long-term adjustment.     

Measuring fatigue in persons with spinal cord injury

Anton HA, Miller WC, Townson AF. Measuring fatigue in persons with spinal cord injury.

Objective

To evaluate the psychometric properties of the Fatigue Severity Scale (FSS) in persons with spinal cord injury (SCI).

Design

A 2-week methodologic study was conducted to assess the internal consistency, reliability, and construct validity of the FSS.

Setting

A tertiary spinal cord rehabilitation facility.

Participants

Forty-eight community-living subjects at least 1 year post-SCI with American Spinal Injury Association (ASIA) grade A or B SCI and no medical conditions causing fatigue. The sample was predominantly male (n=31 [65%]) with tetraplegia (n=26 [54%]) and ASIA grade A injuries (n=30 [63%]). The average duration since injury was 14.9 years.

Interventions

Not applicable.

Main Outcome Measures

The ASIA Impairment Scale, the FSS, a visual analog scale for fatigue (VAS-F), the vitality scale of the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36), and the Center for Epidemiologic Studies Depression Scale (CES-D).

Results

Mean FSS score ± standard deviation at baseline was 4.4±1.4, with 54% (n=26) scoring greater than 4. The internal consistency of the FSS was excellent (Cronbach α=.89). Two-week test-retest reliability was adequate (intraclass correlation coefficient, .84; 95% confidence interval, .74-.90). The magnitude of the relationship was as hypothesized for the VAS-F (r=.67) and CES-D (r=.58) and lower than hypothesized for the vitality subscore (r=−.48) of the SF-36.

Conclusions

The FSS has acceptable reliability with regard to internal consistency, test-retest reliability, and validity in persons with motor complete SCI.     

Quantitative evaluation of long sitting in paraplegic patients with spinal cord injury

OBJECTIVES: To evaluate the characteristics of long sitting (ie, sitting with legs extended) in patients with spinal cord injury (SCI) and to compare these results with able-bodied control subjects. DESIGN: A kinematic study using a video camera and forceplate with a strain-gauge type load cell. SETTING: A referral center for patients with SCI in Japan. PARTICIPANTS: Twenty-four subjects, including 11 able-bodied, matched control subjects and 13 SCI patients with complete paraplegia. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Sitting posture in the sagittal plane as well as the movement pattern and distance of the center of pressure (COP). RESULTS: Patients with SCI kept their pelvis tilted posteriorly and the lumbar spine was less lordotic during long sitting. The changing COP pattern during long sitting differed in able-bodied subjects as compared patients with SCI. During long sitting with arms outstretched over the thighs, COP movement in the subjects with SCI was significantly greater than that in the able-bodied subjects. When the arms were outstretched over the thighs, the COP shifted anteriorly in the able-bodied subjects and posteriorly in the patients with SCI. CONCLUSIONS: Long sitting in the paraplegic patients with SCI was unstable compared with the able-bodied subjects. The COP distribution pattern differed significantly between the 2 groups. The support and function of the upper extremities may influence balance during long sitting in the patients with SCI. The method of seating evaluation using a video camera and gravicorder was easy to use and appeared to provide an objective measurement of dynamic seating function in the patients with SCI.     

Inactivated influenza vaccination for people with spinal cord injury

OBJECTIVE: To examine the antibody responses of people with spinal cord injury (SCI) to the commercially available trivalent influenza vaccine. DESIGN: Prospective trial of patients and controls. SETTING: Veterans Affairs medical center. PARTICIPANTS: Forty people with SCI and 40 able-bodied subjects. INTERVENTION: Intramuscular administration of inactivated influenza vaccine. MAIN OUTCOME MEASURES: Antibody responses were determined by using the standard hemagglutination-inhibition test before and 4 weeks after vaccination. Serum antibody responses were assessed as follows: (1) percentage of each cohort achieving a 4-fold or greater rise in antibody titer, (2) percentage of each cohort achieving a postvaccination antibody titer of 32 or more, and (3) postvaccination geometric mean antibody titers. RESULTS: The serum antibody responses to each vaccine antigen were similar for the SCI and the control cohorts for the 3 outcomes. Neither the time since injury (1 y) nor the level of injury (paraplegia vs quadriplegia) affected the vaccine antibody responses in the SCI cohort. Subjects older than 65 years had lower postvaccination serum antibody levels than those younger than 65 years ( P <.05). CONCLUSIONS: People with SCI responded to influenza vaccination in a manner similar to able-bodied subjects and would be expected to benefit from vaccination.     

Lessons learned while conducting research on prevention of pressure ulcers in veterans with spinal cord injury

OBJECTIVE: To describe the challenges of conducting a large randomized controlled trial (RCT) to assess the effectiveness of an intervention to prevent recurrent pressure ulcers among a high-risk population of subjects with spinal cord injury (SCI). DESIGN: Prospective multisite, randomized design comparing outcomes of patients who received individualized education and structured telephone counseling follow-up with those of patients receiving customary care. This study was stopped early because of unanticipated recruitment problems. SETTING: Six Veterans Affairs SCI specialty centers. PARTICIPANTS: Veterans (N=150) treated for stage III or IV pelvic pressure ulcers. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Recurrence (defined as new skin breakdown in the pelvic area) and time to recurrence. The study was stopped early because of slow recruitment, so the focus of this study is lessons learned, not the main planned outcome measures. RESULTS: Subject recruitment did not meet original expectations because almost 50% of those enrolled left the hospital with the study ulcer unhealed (having a healed ulcer was a requirement for participation). No significant differences were observed between groups on rate of or time to recurrence at the time the study was stopped. Among the 6 sites, variability in ulcer management (eg, length of stay, receipt of medical vs surgical treatment, sitting tolerance before discharge) and time to recurrence (median, 4mo) were observed. CONCLUSIONS: RCTs in real-world settings are the most robust method of assessing the effectiveness of prevention strategies. However, in complex, rapidly changing health care organizations, blinding is infeasible, it may be impractical to control for every variable that influences a study's outcome, and any assumptions that usual care is static are probably mistaken. Investigators must be prepared to use innovative approaches to maintain the integrity of the study design, including flexibility in inclusion and exclusion criteria to support accrual, obtaining a better understanding of the important aspects of usual care that may need to be standardized, continuous improvement within the intervention arm, and anticipation and minimization of risks from organizational changes. With attention to these delivery system issues and the usual design features of randomized trials, we believe real-world care settings can serve as important laboratories to test pressure ulcer prevention strategies in this population.     

Gram-negative intravascular catheter-related bacteremia in patients with spinal cord injury

Hussain R, Cevallos ME, Darouiche RO, Trautner BW. Gram-negative intravascular catheter-related bacteremia in patients with spinal cord injury.

Objective

To determine whether the prevalence of gram-negative catheter-related bloodstream infection (CRBSI) is higher in patients with spinal cord injury (SCI) than in patients without SCI.

Design

Retrospective chart review from August 1998 to August 2006.

Setting

A Veterans Affairs medical center, which serves as a tertiary care medical center to over 500 veterans with SCI and is the primary source of health care for veterans in southeast Texas.

Participants

All hospitalized patients who had an International Classification of Diseases, Ninth Revision, code for bacteremia associated with their hospital stay.

Interventions

Not applicable.

Main Outcome Measure

The proportion of CRBSI caused by gram-negative organisms in the SCI patients to the proportion of CRBSI caused by gram-negative organisms in the non-SCI patients.

Results

Eight (42%) of 19 episodes of CRBSI in the SCI were caused by a gram-negative organism as compared with 4 (11%) of 36 infections in the non-SCI group (P<.01). Factors associated with having a gram-negative organism rather than a gram-positive organism as the causative agent of CRBSI were SCI, femoral catheter site, prolonged hospitalization, decubitus ulcer, and urinary catheter.

Conclusions

In our medical center, patients with SCI who develop CRBSI are more likely to have an infection with a gram-negative organism than are patients without SCI. This knowledge may guide initial empirical therapy of suspected bloodstream infection.     

Risk factors of pelvic pressure ulcer recurrence after primary skin flap surgery in people with spinal cord injury

Background

Flap surgery for deep pelvic pressure ulcers (PPUs) has been found effective, but the recurrence rate remains high and few risk factors have been identified.