Abstract
Design
Cohort study embedded in a clinical trial.
Setting
Community, Bangladesh.
Objectives
To determine the incidence, severity and time course of pressure injuries over the first two years following discharge from hospital in people with spinal cord injuries (SCI) in Bangladesh.
Methods
Participants (n = 186) were contacted by telephone 39 times and assessed face-to-face 4 to 6 times over the two years following discharge. At each point of contact the presence and severity of pressure injuries were determined using the Pressure Ulcer Scale for Healing (PUSH). Survival analyses were conducted to determine the time course of development of pressure injuries and recovery from pressure injuries. Lasso regression was used to construct multivariable prediction models.
Results
Seventy-seven participants (41%; 95% CI 34% to 49%) developed at least one pressure injury in the first two years after discharge (incidence rate 0.27 per person-year, 95% CI 0.22 to 0.34). Most pressure injuries were on the sacrum (23%). Pressure injuries took a median (IQR) of 40 (29 to 57) days to heal. The median (IQR) peak PUSH score was 11.0/17 (8.0 to 13.5). The multivariable prediction models had poor predictive properties (maximum c-statistic 0.75).
Conclusion
Pressure injuries impose a large health burden on people with SCI in Bangladesh. However, they are difficult to predict, treat and prevent. Further research is needed to identify who is at most risk and to find solutions for the treatment and prevention of pressure injuries in Bangladesh and other low-middle income countries.
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Data Archiving
De-identified individual participant data will be made available in response to reasonable requests.
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Acknowledgements
The trial was funded by the Australian National Health and Medical Research Council (project grant APP1080259). PDC is a recipient of Australia Awards Scholarship offered by the Department of Foreign Affairs and Trade (DFAT), Australia. We acknowledge the assistance of the following people: Murali Dhakshinamurthy, Mohammad Muddasser, Md. Naushad Alam, Sarath Gudivada, Jitendra Rathore, Ambika Yoganathan, Faruq Ahmed, Md. Shahoriar Ahmed, SM Iftekhar Alam, Md. Jubair Hassan, Masud Ur Rahman, Pangkaz Kanti Dash, Habibur Rahman and Md. Gourab Hasan. The funder was not involved in any aspect of the study. PDC, RDH, and LAH have full access to all the data.
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PDC, LAH, RDH, and MSH conceived the study. LAH, MSH, RDH, SJ, and IDC secured funding. PDC, MSI, and MAR collected data. MSI, MAR, and PDC managed or contributed to the management of the site. LAH, RDH, and PDC conducted the statistical analyses. LAH, RDH, and PDC interpreted the results. PDC, LAH, and RDH wrote the first draft of the manuscript. MSH, MSI, MAR, JVG, HL, SJ, and IDC reviewed the manuscript.
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Ethical approval was obtained from the ethics committees of CRP, Bangladesh and the University of Sydney, Australia. Written consent was obtained from all participants involved in the study. Institutional and governmental regulations concerning the ethical use of human volunteers were followed.
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D Costa, P., Harvey, L.A., Hossain, M.S. et al. Incidence, severity and time course of pressure injuries over the first two years following discharge from hospital in people with spinal cord injuries in Bangladesh. Spinal Cord 60, 348–353 (2022). https://doi.org/10.1038/s41393-021-00732-3
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DOI: https://doi.org/10.1038/s41393-021-00732-3
