Objectives

Identifying factors associated with the occurrence of pressure injuries (PI) during acute care and with longer length of stay (LOS), focusing on modifiable factors that can be addressed and optimized by the acute rehabilitation team.

Design

Prospective cohort study.

Setting

A single Level-1 trauma center specialized in SCI care.

Participants

A cohort of 301 patients with acute TSCI was studied.

Outcome measures

The primary outcome was the occurrence of PI during acute care stay. The secondary outcome was acute care LOS. Bivariate and multivariate logistic or linear regression analyses were performed to determine the association between non-modifiable factors and outcomes (PI of any stage and acute LOS), whereas bivariate and hierarchical multivariate logistic or linear regression analyses were used for modifiable factors.

Results

When controlling for the level and severity of the TSCI, the occurrence of pneumonia (OR = 2.1, CI = 1.1–4.1) was significantly associated with the occurrence of PI. When controlling for the level and severity of the TSCI, the occurrence of medical complications (PI, urinary tract infection and pneumonia) and lesser daily therapy resulted in significantly longer acute care LOS (P < .001).

Conclusions

Prevention of PI occurrence and the optimization of the acute care LOS represent crucial challenges of the acute rehabilitation team, as they are significantly associated with higher functional outcomes. Patients who develop pneumonia may benefit from more aggressive prevention strategies to reduce PI occurrence. Systematic protocols for the prevention of complications as well as greater volume of therapy interventions should be considered to optimize the acute care LOS.

中文翻译：

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减少急性创伤性脊髓损伤患者的压力性损伤和急性护理住院时间

 目标

确定与急性护理期间发生压力性损伤 (PI) 和较长住院时间 (LOS) 相关的因素，重点关注急性康复团队可以解决和优化的可修改因素。

 设计

前瞻性队列研究。

 环境

专门从事 SCI 护理的一级创伤中心。

 参加者

对 301 名急性 TSCI 患者进行了研究。

 结果衡量

主要结局是急性护理期间发生 PI。次要结局是急性护理 LOS。进行双变量和多变量逻辑或线性回归分析以确定不可修改因素和结果（任何阶段的 PI 和急性 LOS）之间的关联，而双变量和分层多变量逻辑或线性回归分析用于可修改因素。

 结果

当控制 TSCI 的水平和严重程度时，肺炎的发生（OR = 2.1，CI = 1.1-4.1）与 PI 的发生显着相关。当控制 TSCI 的水平和严重程度时，医疗并发症（PI、尿路感染和肺炎）的发生和每日治疗的减少导致急性护理 LOS 显着延长 (P < .001)。

 结论

预防 PI 发生和优化急性护理 LOS 是急性康复团队面临的关键挑战，因为它们与更高的功能结果显着相关。肺炎患者可能会受益于更积极的预防策略，以减少 PI 的发生。应考虑预防并发症的系统方案以及更多的治疗干预措施，以优化急性护理服务水平。