Comparing the Incidence Rate of Pressure Injury Development in the Acute Adult SCI Patient

Purpose: To evaluate the validity of utilizing a replacement four inch high-density foam cushion (FIHDFC) in the seat hatch of the spinal stabilization table (SST) as compared with using the SST original manufacturer's cushion to reduce the incidence of pressure injury (PI) development in the study population of acute adult Spinal Cord Injury (SCI) patients admitted through the Trauma Center. According to the AHQR (Agency for Healthcare Quality and Research), a government agency, "Pressure ulcers cost $9.1-$11.6 billion per year in the US. Cost of individual patient care ranges from $20,900 to $151,700 per pressure ulcer. Medicare estimated in 2007 that each pressure ulcer added $43,180 in costs to a hospital stay. Lawsuits: More than 17,000 lawsuits are related to pressure ulcers annually." (https://www.ahrq.gov/professionals/systems/hospital/pressureulcertoolkit/putool1.html). With this figure in mind, prevention is the key to promoting patient and family satisfaction in the hospital setting as well as promoting a greater reduction in occurrence of PI development with resulting decrease in financial and litigious losses for the facility. In the long run the act of early PI reduction protocols in the SCI patient are a "win-win" for the patient, their family and the medical facility.

NOTE: The National Pressure Ulcer Advisory Panel (NPUAP in 2016) changed the terms, "pressure ulcer (PU) to pressure injury (PI)." The terms may be used interchangeably throughout the submission depending upon the sources noted in the submission.

Methods: Retrospective study. Data was collected through University of Florida/ Department of Research Affairs for 59 months (February 2012-January 2017). The data included forty-nine adult, acute patients admitted through the Trauma Center who sustained an unstable spine and requiring surgical fusion/intervention. Data was compiled and results were analyzed comparing the regulation SST cushion as compared with the FIHDFC concerning the incidence of pressure injuries developed utilizing these two cushions. Two hospital Intensive Care Units were the study units. The experimental group replaced the original SST seat hatch cushion with the FIHDFC and the control group used the original SST seat hatch cushion from the SST manufacturer.

Results: Forty patients of the original forty-nine patients sustained a complete SCI. Of this population, nine patients utilized the FIHDFC. In the experimental group none of the nine patients developed pressure injuries. The length of time on the SST for the experimental group ranged from two to twenty-seven days; length of time on the SST for the control group was one to thirty-three days. Of the forty patients in the control group, one was dropped from the study due to the presence of a deep tissue injury on admission. There was a total of 39 patients in the control group with 14 of that group developing a PI while on the SST. In the control group 14 of 39 patients developed at least one pressure injury (35.89%). Of the 14 patients developing at least one PI, some occurred as early as within two days of placement on the SST cushion. One of the experimental group patients, a male in his 60's, utilized the replacement FIHDFC surface for 27 days was discharged having developed no PI. However another male also in his 60's (control group) utilized the original SST cushion for 14 days and sustained a deep tissue injury which evolved into a Stage 4 pressure injury. After surgical debridement, his injury progressed to bone exposure resulting in the need for prolonged use of a wound vac application to promote wound closure. The course of litigation was resolved with by an undisclosed amount of funds from the facility.

Conclusion: Utilization of a replacement FIHDFC in the seat hatch of the SST greatly reduces the incidence of PI development in the acute, adult spinal cord injury patient admitted through the Trauma Center with an unstable spine requiring surgery with or without a SCI.