Epidemiological and clinical profile of patients with pressure injury after spinal cord trauma

Introduction: The prevalence of pressure injury (PI) varies with the clinical environment and the characteristics of the patient, thus, patients with spinal cord trauma (SCT) are configured among those with greater predisposition to the length of hospitalization, presenting impaired movements and sensitivity. Objective: To know and analyze the prevalence of pressure injury in patients suffering from spinal cord trauma hospitalized in a reference hospital. Method: Cross-sectional, retrospective study. The sample consists of medical records of patients with spinal cord trauma who presented pressure injury during hospitalization in a reference https://doi.org/10.30886/estima.v17.773_PT


INTRODUCTION
The increase in life expectancy is also due to advances in healthcare, enabling the survival of patients with severe, chronic and debilitating diseases, which results in longer length of stay and the appearance of complications, such as pressure injury (PI) 1  In Brazil, it is estimated that there are about 40 new cases of SCI per million inhabitants, with a total of six to eight thousand cases per year, among which 80% of the victims are men, representing a high cost to the health system. It is noteworthy that the data are not accurate due to the non-obligation of notification 4 .
In hospitalized patients, the development of PI is a major health problem, as it can cause physical discomfort, increased risk of additional complications, prolonged hospitalization and increased costs related to treatment 5  It is a multifactorial lesion whose assistance is a challenge for the nursing team, considering the complexity of care. However, this category has implemented systematic preventive measures in protocols based on international guidelines 5 . According to this, health service managers have been concerned with the theme related to the occurrence RESUMEN Introducción: La prevalencia de la lesión a presión varía según el entorno clínico y las características del paciente, por lo tanto, los pacientes con Trauma de la Médula Espinal (TME) se configuran entre aquellos con mayor predisposición a la duración de la hospitalización, presentando movimientos y sensibilidad deteriorados. Objetivo: Conocer y analizar la prevalencia de lesión por presión en pacientes que sufren de traumatismo de la médula espinal hospitalizados en un hospital de referencia. Método: Estudio transversal retrospectivo. La muestra consiste en registros médicos de pacientes con traumatismo de la médula espinal que presentaron lesión por presión durante la hospitalización en un hospital de referencia en el estado de Pará, Brasil, durante el período de 2013 a 2016. Resultados: Analizamos 565 registros médicos de pacientes con médula espinal, con la prevalencia de Lesión por Presión en pacientes con traumatismo de la médula espinal del 8%. La edad media fue de 37 años, con un 80% compuesto por hombres, con una duración media de hospitalización de 66,68 días. La mayoría se presentó como etiología de accidentes de lesión de la médula espinal por arma de fuego y caída, con 32 y 30% respectivamente. La lesión de la médula espinal fue predominante en la región torácica (50%), donde el 64% tenía paraplejia como secuencias y el 86% presentó lesión por presión en la región sacral. Conclusión: Fue posible identificar la prevalencia de lesión por presión en pacientes con traumatismo de la médula espinal y conocer su comportamiento. Por lo tanto, la disponibilidad de datos ayudó a demostrar la aparición de LP como una complicación en pacientes con TME durante la hospitalización, y puede servir de base para la asignación de recursos y medidas preventivas, así como más estudios sobre el tema.

RESULTS
The  (Table 1).       15 patients (30%) of the total of medical records analyzed presented infected PI, all in the sacral region.

DISCUSSION
This study evidenced the PI as one of the complications developed by patients with SCI, considering that the spinal cord injury is one of the most serious complications that causes disability to humans, compromising vital functions, including locomotion and loss of sensitivity.
Similar studies address the prevalence of PI in these patients and that the appearance of PI in patients with spinal cord injury strongly impacts the quality of life of these people 7,8 .
The affliction of SCI in men is still bigger than in women, as in research similar to this study. This profile may be related to lifestyle, as men exhibit challenging behavior by exposing themselves more to risky occasions 9 .
Regarding other sociodemographic variables of patients with SCI, were found patients aged around 37 years, from the metropolitan area or interior of the state, with mean hospitalization time over 60 days due to complications, among them the PI 10 . Also, regarding the origin of the patients, it is worth mentioning that Pereira, Gomes and Rodrigues reported in a similar study that many of the patients are transferred to large cities, due to the lack of structure and beds for treatment of polytraumatized patients 10 .
It is important to point out that the death rate in this study was not high, thus, patients who received improved discharge and returned to their homes with some type of special permanent need, therefore, will sometimes need specialized care, not feasible in view of the social condition or the absence of reference and rehabilitation services 10,11 .
The most affected medullar segments are the cervical and thoracic regions, caused by firearm accidents, followed by accidents caused by falls and diving in shallow water 10,12,13 , corroborating the findings of this research. The total medullary trauma of the cervical segment and the initial part of the thoracic spine may result in quadriplegia and, in other situations, the partial dissection of other parts of the spine will result in paraplegia as a sequel, according to this investigation and the analyzed study 14 . In Brazil, a study conducted to verify the occurrence of PI in patients with spinal cord injury emphasized the interventions for prevention. This same concern is also punctuated by nurses when considering the nursing process focused on the clinical view of the patient as essential, with regard to prevention and care specifically aimed at patients with PI 20,21 .
As limitations of the study, the authors had the minimum time provided by the health institution for data collection and the lack of coherent information regarding the diagnosis of SCI and the time of appearance of PI in patients.

CONCLUSION
The The study also showed that the spinal cord level most affected by trauma were the thoracic and cervical regions.
The mean time for the appearance of the first PI was 19 days, the majority of patients presented only one PI and the region sacral was the most frequently affected.
In addition, the preventive care listed by the nursing staff to patients with SCI was known as a way to reduce the risks of PI. In this context, it is important to emphasize the need for the engagement of the transdisciplinary team, the involvement of the leaders of health institutions, the training for the nursing professional and the team for skin care and treatment of PI when installed, as well as continuing education and feedback of the results achieved.
Therefore, the availability of data helped to demonstrate the occurrence of PI as a complication in patients with SCI during hospitalization, and may serve as a basis for the allocation of resources and preventive measures, as well as subsequent studies on the subject.