Bedside prediction of the progress of pressure ulcer healing in patients with spinal cord injury using the 'Decu-stick'

Study design: This is a prospective cohort study. Objectives: The objective of this study was to predict the progress of healing of pressure ulcers (PUs) in spinal cord injury (SCI) patients after the first 4 weeks. Setting: The study was conducted in a specialized SCI rehabilitation unit in The Netherlands. Methods: Weekly measurements of length, width and depth/undermining of grades II-IV PUs under sacrum or ischial tuberosity in SCI patients with the 'Decu-stick' were taken. The speed of reduction of the greatest dimension in the first 4 weeks of the granulation-epithelization (G-E) phase was compared with the speed of reduction of this dimension after week 4 until the end of observation. Results: Fifty-one PUs in 45 patients were measured. During the first 4 weeks of the G-E phase, the greatest dimension of 23/51 PUs reduced with a speed of >= 0.5 cm per week. In 22 of these 23 PUs, this speed remained >= 0.5 from week 4 until the end of observation (weeks 5-22). Closure: 21 patients (pts); operation: 2 pts. Of 28/51 PUs, this dimension reduced with Conclusion: Measurement of PUs in SCI patients with the 'Decu-stick' provides a reliable, quick, cheap and easy-to-learn bedside method to predict the progress of healing in PUs in SCI patients after 4 weeks of conservative treatment with a positive predictive value of 0.95 and an negative predictive value of 0.96. This provides a scientific basis for the decision on operative or alternative conservative treatment

Monitoring healing of pressure ulcers: a review of assessment instruments for use in the spinal cord unit

Study design: Review. Objectives: To identify the pressure ulcer healing assessment instrument that is the best choice for use in spinal cord injury rehabilitation. Methods: Articles were retrieved from PubMed. Inclusion criteria were written in English, published up to December 2008 and describing instruments evaluated in more than one study. Search terms were pressure ulcer, wound healing, severity of illness index, reproducibility of results, sensitivity and specificity. Articles describing pressure ulcer staging scales and articles not describing clinimetric properties of an instrument were excluded. Validity, reliability, responsiveness and feasibility for routine clinical use were described of all instruments evaluated in two or more studies. Results: Eleven instruments were described. Clinimetric information was incomplete for all instruments. Clinimetric information was most complete and promising for two instruments: 'ruler length and width' and the 'Sessing' scale. The ruler method showed good intra-rater and inter-rater reliability and good concurrent validity. The 'Sessing' scale has a moderate concurrent validity but was not tested for its responsiveness. Conclusion: Further study of the clinimetric properties of pressure ulcer assessment instruments is necessary before the best instrument can be selected. Spinal Cord (2010) 48, 92-99; doi: 10.1038/sc.2009.146; published online 1 December 200