The global burden of pressure ulcers among patients with spinal cord injury: a systematic review and meta-analysis

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Abstract

Background

Pressure ulcers (PU), one of the common challenging public health problems affecting patient with spinal cord injury. PUs occurs over bony areas of the body where pressure and tissue distortion is greatest. It has a significant impact to the patient and health care system. Moreover, it has psychological, physical, social burden and decrease the quality of life (QoL) of patients. Despite its serious complications, limited evidence is available on the global magnitude of pressure ulcers among patient with spinal cord injury. Hence, this review and meta-analysis aimed to estimate the global magnitude of pressure ulcers among patient with spinal cord injury.

Methods

PubMed, Scopus, Google Scholar, African Journals Online, PsycINFO, and Web of Science were systematically searched to retrieve related articles. The Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guideline was followed. DerSimonian and Laird random-effects model was applied to obtain the pooled effect size. To investigate heterogeneity across the included studies, I ² test was employed. Publication bias was examined using funnel plot and Egger’s regression test statistic. Sensitivity analysis was deployed to see the effect of a single study on the overall estimation. Analysis was done using STATA™ Version 14 software.

Results

A total of 24 studies which comprises of 600,078 participants were included in this study. The global pooled magnitude of pressure ulcers among patients with spinal cord injury was 32.36% (95% CI (28.21, 36.51%)). Based on the subgroup analysis, the highest magnitude of pressure ulcer was observed in Africa 41.19% (95% CI: 31.70, 52.18).

Conclusion

This systematic review and meta-analysis revealed that about one in three patients with spinal cord injury had pressure ulcers. This implies that the overall global magnitude of pressure ulcer is relatively high. Therefore, policy maker and other concerned body should be design country context- specific preventive strategies to reduce the burden of pressure ulcers in patients with spinal cord injury.

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Most cited references 46

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Impact of pressure ulcers on quality of life in older patients: a systematic review.

Claudia Gorecki, Julia Brown, E Nelson … (2009)

To identify the impact of pressure ulcers (PUs) and PU interventions on health-related quality of life (HRQL). Systematic review and metasynthesis of primary research reporting the impact of PU and PU interventions on HRQL according to direct patient reports. Quality assessment criteria were developed and applied. Data extraction identified findings in the form of direct quotes from patients or questionnaire items and domain results. Combined synthesis of qualitative and quantitative research was performed using content analysis to generate categories and themes from findings. Thirteen electronic databases were searched, and hand searching, cross-referencing, contact with experts, and an online search was undertaken. No language restrictions were applied. Adults with PUs in acute, community, and long-term care settings across Europe, the United States, Asia, and Australia. Thirty-one studies including 2,463 participants with PUs were included in the review. Ages ranged from 17 to 96. The review included 10 qualitative and 21 quantitative studies; 293 findings, 46 categories, and 11 themes emerged. The 11 HRQL themes were physical impact, social impact, psychological effect, PU symptoms, general health, and other impacts of PUs: healthcare professional-client relationships, need for versus effect of interventions, impact on others, financial impact, perceived etiology, and need for knowledge. There is evidence that PUs and PU interventions have a significant impact on HRQL and cause substantial burden to patients.

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Acute spinal cord injury, part I: pathophysiologic mechanisms.

R Dumont, D O Okonkwo, S. Verma … (2015)

Spinal cord injury (SCI) is a devastating and common neurologic disorder that has profound influences on modern society from physical, psychosocial, and socioeconomic perspectives. Accordingly, the present decade has been labeled the Decade of the Spine to emphasize the importance of SCI and other spinal disorders. Spinal cord injury may be divided into both primary and secondary mechanisms of injury. The primary injury, in large part, determines a given patient's neurologic grade on admission and thereby is the strongest prognostic indicator. However, secondary mechanisms of injury can exacerbate damage and limit restorative processes, and hence, contribute to overall morbidity and mortality. A burgeoning body of evidence has facilitated our understanding of these secondary mechanisms of injury that are amenable to pharmacological interventions, unlike the primary injury itself. Secondary mechanisms of injury encompass an array of perturbances and include neurogenic shock, vascular insults such as hemorrhage and ischemia-reperfusion, excitotoxicity, calcium-mediated secondary injury and fluid-electrolyte disturbances, immunologic injury, apoptosis, disturbances in mitochondrion function, and other miscellaneous processes. Comprehension of secondary mechanisms of injury serves as a basis for the development and application of targeted pharmacological strategies to confer neuroprotection and restoration while mitigating ongoing neural injury. The first article in this series will comprehensively review the pathophysiology of SCI while emphasizing those mechanisms for which pharmacologic therapy has been developed, and the second article reviews the pharmacologic interventions for SCI.

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Incidence of traumatic spinal cord injury worldwide: a systematic review.

Seyed Jazayeri, Sara Beygi, Farhad Shokraneh … (2015)

Traumatic spinal cord injuries (TSCI) are among the most devastating conditions in developed and developing countries, which can be prevented. The situation of TSCI around the world is not well understood which complicates the preventive policy decision making in fight against TSCI. This study was aimed to gather the available information about incidence of TSCI around the world.

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Author and article information

Contributors

Wondimeneh Shibabaw Shiferaw: wshibabaw2015@gmail.com

Journal

Journal ID (nlm-ta): BMC Musculoskelet Disord

Journal ID (iso-abbrev): BMC Musculoskelet Disord

Title: BMC Musculoskeletal Disorders

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-2474

Publication date (Electronic): 29 May 2020

Publication date PMC-release: 29 May 2020

Publication date Collection: 2020

Volume: 21

Electronic Location Identifier: 334

Affiliations

[1 ]GRID grid.464565.0, ISNI 0000 0004 0455 7818, Department of Nursing, College of Health Science, Institute of Medicine and College of Health Science, , Debre Berhan University, ; P.O. Box 445, Debre Berhan, Ethiopia

[2 ]GRID grid.449044.9, ISNI 0000 0004 0480 6730, Department of Nursing, College of Health Science, , Debre Markos University, ; Debre Markos, Ethiopia

Article

Publisher ID: 3369

DOI: 10.1186/s12891-020-03369-0

PMC ID: 7260823

PubMed ID: 32471497

SO-VID: 21d5f94e-523e-4a7e-b0fe-fe075b23ae96

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 25 September 2019

Date accepted : 25 May 2020

Custom metadata

ScienceOpen disciplines: Orthopedics

Keywords: pressure ulcers,spinal cord injury,systematic review,meta-analysis,ethiopia

Data availability:

ScienceOpen disciplines: Orthopedics

Keywords: pressure ulcers, spinal cord injury, systematic review, meta-analysis, ethiopia

The global burden of pressure ulcers among patients with spinal cord injury: a systematic review and meta-analysis

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Most cited references 46

Impact of pressure ulcers on quality of life in older patients: a systematic review.

Acute spinal cord injury, part I: pathophysiologic mechanisms.

Incidence of traumatic spinal cord injury worldwide: a systematic review.

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