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 <0.5 cm per week. In 27/28 PUs, this speed remained <0.5 from week 4 until the end of observation (weeks 9-37). Closure: 6 pts; operation: 16 pts; discharge with open ulcer: 6 pts. 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.