McKnight's Long-Term Care News, April 2019, page 8, Wound Care, Joyce Stechmiller

Skilled nursing residents with paraplegia are more likely to develop pressure ulcers than their quadriplegic counterparts, according to a new study whose authors say providers should pay better attention to residents with limited mobility.

In a review of MDS data, researchers from the University of Florida College of Nursing found 27.5% of those with quadriplegia developed a wound, while 41.2 % of those with paraplegia did. Residents with hemiplegia developed wounds about 10% of the time, close to the overall average in long-term care.

“These findings may indicate that LTC facilities have been less successful at PU prevention interventions for patients with paraplegia than they have for individuals with quadriplegia [who rely on LTC staff for total care],” the authors wrote. “These findings provide strong evidence for the need to improve PU preventive interventions in LTC residents who are wheelchair- or chair-bound, especially individuals with paraplegic paralysis.”

Pressure may be higher when sitting than lying supine; paraplegics may experience more frequent transfers that lead to skin shearing; and paraplegia patients may smoke more than quadriplegics.

Patients with paraplegia also are typically given more responsibility for their own care and repositioning versus patients with quadriplegia. Assistive technology, staff education and resident reminders can help reduce incidence.