Pressure ulcer risk

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As clinicians so much of our time nowadays is focused on MS DMTs that we lack the time or forget to ask questions about general health and well being during our consults; for example, cognition, employment, co-morbidities and in some instances the risk of pressure ulcers.

According to this publication (see below for abstract) 4% of PwMS have pressure ulcers; sacral ulcers being the commonest. There is an almost parallel risk of developing pressure ulcers with increasing levels of disability.

Image result for pressure ulcers
Stages of pressure ulcer

Prevention is better than trying to manage ulcers once formed and therefore risk factors matter. This is an American study (and not generalisable to everywhere), but after review they are quoted as: black race, male sex, Braden score less than 13 (pressure ulcer risk scale where a low score increases the risk), low albumin, presence of kidney disease, and high C-reactive protein (CRP). Specifically low albumin is an indicator of ill health and poor diet, whilst a high CRP is reflective of underlying infections that also compromise health. Regular examination of pressure points (see diagram above) for breakdown is therefore important.

Abstract

Adv Skin Wound Care. 2020 Mar;33(3):146-154. doi: 10.1097/01.ASW.0000653152.36482.7d.

Pressure Ulcer Risk Factors in Persons with Mobility-Related Disabilities.

Sprigle S, McNair D, Sonenblum S.

OBJECTIVE:

To assess pressure ulcer (PU) risk in persons with mobility impairments using a large data set to identify demographic, laboratory, hemodynamic, and pharmacologic risk factors.

METHODS:

The cohort of interest was persons with disabilities who have mobility impairments and are diagnostically at risk of PUs. To define this cohort, diagnoses that qualify patients for skin protection wheelchair cushions were used. Data were obtained from the Cerner Health Facts data warehouse. Two cohorts were defined: persons with and without a history of PUs. Analysis included descriptive statistics and multivariate logistic regression modeling. Variables retained in the model were identified using LASSO, gradient boosting, and Bayesian model averaging.

MAIN RESULTS:

The resulting cohorts included more than 87,000 persons with a history of PUs and more than 1.1 million persons who did not have a PU. The data revealed seven disability groups with the greatest prevalence of PUs: those with Alzheimer disease, cerebral palsy, hemiplegia, multiple sclerosis, paraplegia/quadriplegia, Parkinson disease, and spina bifida. Ulcers in the pelvic region accounted for 82% of PUs. Persons with disabilities who were male or black had a greater prevalence of PUs. Physiologic risk factors included the presence of kidney or renal disease, decreased serum albumin, and increased serum C-reactive protein.

CONCLUSIONS:

The results indicate that, although persons with disabilities can exhibit a wide functional range, they remain at risk of PUs and should be evaluated for proper preventive measures, including support surfaces and wheelchair cushions.

About the author

Neuro Doc Gnanapavan

1 comment

  • Thank you for highlighting this very important subject. Many of the people I see who are at risk, are terrified that they will develop an open sore almost ‘in the blink of an eye’. The majority don’t understand that a pressure sore starts with a red mark which doesn’t blanch after brief finger pressure. We ought to reassure them that pressure sores are largely preventable and, if caught early, will not result in the horror story that is a grade 4 ulcer. They ought to be encouraged to be vigilant about checking for red marks and given advice on how to alleviate pressure on an affected area. As well as the importance of good nutrition and hygiene.

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