• The Spinal Cord Injury Pressure Ulcer Scale (SCIPUS) was developed as a measure of the risk for pressure ulcer development for individuals with SCI who are in a rehabilitation centre (i.e., after acute, and being community/outpatient/at home).
  • The SCIPUS-acute (SCIPUS-A) is a version designed from the SCIPUS to be used in the acute care setting (within 30 days of injury).

SCIPUS

  • Items for the scale were identified based on statistical analysis of data from 176 people with SCI, which compared development of pressure ulcers with demographic variables and potential pressure ulcer risk factors.
  • Every patient is evaluated in fifteen domains:
    1. Level of activity
    2. Mobility
    3. Complete SCI
    4. Urine incontinence or constant moistness
    5. Autonomic dysreflexia or severe spasticity
    6. Age
    7. Tobacco use/smoking
    8. Pulmonary disease
    9. Cardiac disease
    10. Blood glucose levels: > 110 mg/dl
    11. Renal disease
    12. Impaired cognitive function
    13. In a nursing home or hospital
    14. Albumin < 3.4 or T, protein < 6.4
    15. Hematocrit <36.0%
  • Most items are scored dichotomously as either present or absent, but 4 items have three response options.

SCIPUS-A

  • Items for the scale were identified based on statistical analysis of data from 226 people with SCI, which compared development of pressure ulcers with demographic variables and 50 potential pressure ulcer risk factors. It evaluates eight domains:
    1. Extent of paralysis
    2. Moisture
    3. Serum creatinine
    4. Incontinence
    5. Albumin
    6. Mobility
    7. Pulmonary disease
    8. Level of activity

Clinical Considerations

  • The SCIPUS is reported to be the best measure for assessing pressure ulcer risk in people with SCI. The scale was developed specifically for use in rehabilitation centers and has not been tested in community dwelling populations.
  • There is minimal burden related to administering or scoring the scale if tests for diabetes, albumin and hemocrit are already part of the patient’s medical record. Otherwise the blood tests required would be invasive and create respondent burden.
  • The SCIPUS-A scale is a quick and easy to use measure that provides predictive information about risk of pressure sore development.

ICF Domain

Body Function ▶ Functions of the Skin

Administration

  • Clinician-administered; raters indicate client status based on personal knowledge of the client or chart review
  • Dichotomous items are given a weighted score of 0 when absent and 1 or 2 when present
  • Non-dichotomous items are given a weighted score based on the descriptive criteria provided on the scoring sheet. For example, the presence of pulmonary disease (ICD codes 450, 460-519 & 796.0) = a score of 2.

Number of Items

15

Equipment

None

Scoring

  • By adding domain scores together, a summary score (0-25) is calculated
  • Lower scores indicate low risk for pressure ulcer development

Languages

English

Training Required

No advanced training required.

Availability

The Spinal Cord Injury Pressure Ulcer Scale worksheet can be found here.

# of studies reporting psychometric properties: 4

Interpretability

  • Scores range from 0 (low risk for pressure ulcer development) to 25 (high risk for pressure ulcer development)
  • A cut off score of 6 has been suggested to indicate clients at risk for pressure ulcer development

MCID: not established in SCI
SEM: not established in SCI
MDC: not established in SCI

Reliability – Low to High

This measure has high inter-rater reliability (ICC = 0.91) and low internal consistency (person separation index PSI = 0.44).

(Delparte et al. 2015: 509 males, 250 females; 16% complete injury, 84% incomplete injury; 53% paraplegia, 47% quadriplegia; mean (SD) time since injury = 84.9 (379.7) days)
(Higgins et al. 2019: n=886; 59% males; ASIA A-D; etiology: 56% non-traumatic, 44% traumatic)

Validity – Low to Moderate

  • The optimal balance of sensitivity (75.6%) to specificity (74.4%) was found at a cut-off point of ≥6 for SCIPUS score. The positive predictive value was 92.4% and the negative predictive value was 42.7%.
  • Correlation of the SCIPUS is moderate with the stage of the first pressure ulcer (Spearman’s r = 0.34) and with the number of ulcers developed (Spearman’s r = 0.34).

(Salzberg et al. 1996; Salzberg et al. 1999)

  • Low  accuracy of “high risk” categorization (cut-off scores of ≥ 6, ≥ 7, ≥ 8):
    AUC < 0.70

(Delparte et al. 2015: 509 males, 250 females; 16% complete injury, 84% incomplete injury; 53% paraplegia, 47% quadriplegia; mean (SD) time since injury = 84.9 (379.7) days)

Responsiveness

No values have been reported for the responsiveness of the SCIPUS for the SCI population at this time.

Floor/Ceiling Effect

No values were reported for the presence of floor/ceiling effects in the SCIPUS for the SCI population.

Reviewers

Dr. Carlos L. Cano-Herrera, Elsa Sun

Date Last Updated

31 December 2024

Administration

  • Clinician-administered; raters indicate client function status based on personal experience or chart review
  • Response categories are either dichotomous (present/ absent (score = 1 to 2 or 0, respectively) or have 3 to 5 options. For example, for ‘extent of paralysis’ –  absent (i.e. no paralysis) is awarded a score of 0, paraparesis: 1, quadriparesis: 4, paraplegia: 8 and quadriplegia: 10.

Number of Items

8

Equipment

None

Scoring

  • Scales are scored based on descriptive criteria provided on the scoring sheet
  • As noted above, responses to each item are awarded a value between 0 to 1-10 and these are added together to create a summary score ranging from 0-25
  • Lower scores indicate lower risk of developing pressure ulcers

Languages

English

Training Required

No advanced training required.

Availability

The Spinal Cord Injury Pressure Ulcer Scale – Acute worksheet can be found in the appendix of the following article: https://pubmed.ncbi.nlm.nih.gov/10326341/

# of studies reporting psychometric properties: 2

Interpretability

  • Lower scores indicate low risk for pressure ulcer development.
  • Sensitivity and specificity percentages are provided at a variety of cut-off scores.
  • Mean (Range) scores:
    • All patients (n=144) = 12.8 (12-13.6)
    • Patients with ulcers at any stage (n=80) = 14.9 (14-15.9)
    • Patients without ulcers at any stage (n=64) = 10.1 (9.6-10.6)

(Ash 2002: n=144; mean time from injury to discharge = 152 (range 9-506) days)

  • Scores of 0-12 demote low risk of developing a pressure ulcer, 13-18 moderate risk, 19-20 high risk, and 21-25 very high risk.

(Salzberg et al. 1999; n=226, 188 males; mean (SD) age = 33.2 (15.2) years; acute SCI)

MCID: not established in SCI
SEM: not established in SCI
MDC: not established in SCI

Reliability

No values have been reported for the reliability of the SCIPUS-A for the SCI population at this time.

Validity – Moderate

  • For the SCIPUS-A, the best balance point was found at a cut-off point of ≥18, which gave a sensitivity of 88.5% and a specificity of 59%.
  • When comparing results versus other pressure ulcer risk scales, the SCIPUS-A (71%) was the most accurate in predicting pressure ulcer development, followed by the SCIPUS (65.9%), Braden Scale (62.3%), Gosnell (62.2%), Abruzzese (60.1%) and Norton (60.8%) scales.
  • Correlation of the SCIPUS is moderate with the stage of the first pressure ulcer (Spearman’s r=0.488) and with the number of ulcers developed (Spearman’s r=0.519).

(Salzberg et al. 1999: n=226, 188 males; acute SCI)
(Ash 2002: n=144, mean time from injury to discharge = 152 days)

Responsiveness

No values have been reported for the responsiveness of the SCIPUS-A for the SCI population at this time.

Floor/Ceiling Effect

No values were reported for the presence of floor/ceiling effects in the SCIPUS-A for the SCI population.

Reviewers

Dr. Carlos L. Cano-Herrera, Elsa Sun

Date Last Updated

31 December 2024

Ash D. An exploration of the occurrence of pressure ulcers in a British spinal injuries unit. J Clin Nurs 2002;11:470-478.
http://www.ncbi.nlm.nih.gov/pubmed/12100643

Delparte JJ, Scovil CY, Flett HM, Higgins J, Laramée MT, Burns AS. Psychometric Properties of the Spinal Cord Injury Pressure Ulcer Scale (SCIPUS) for Pressure Ulcer Risk Assessment During Inpatient Rehabilitation. Arch Phys Med Rehabil. 2015;96(11):1980-5.
http://www.ncbi.nlm.nih.gov/pubmed/26205694

Higgins J, Laramée MT, Harrison KR, Delparte JJ, Scovil CY, Flett HM, Burns AS. The Spinal Cord Injury Pressure Ulcer Scale (SCIPUS): an assessment of validity using Rasch analysis. Spinal Cord. 2019;57(10):874-880.
https://pubmed.ncbi.nlm.nih.gov/31053776/

Salzberg CA, Byrne DW, Cayten CG, van Niewerburgh P, Murphy JG, Viehbeck M. A new pressure ulcer risk assessment scale for individuals with spinal cord injury. Am J Phys Med Rehabil 1996;75:96-104.
http://www.ncbi.nlm.nih.gov/pubmed/8630201

Salzberg CA, Byrne DW, Kabir R, van Niewerburg P, Cayten CG. Predicting pressure ulcers during initial hospitalization for acute spinal cord injury. Wounds 1999;11:45-57.
http://scholar.google.ca/scholar?hl=en&q=Predicting+pressure+ulcers+during+initial+hospitalization+for+acute+spinal+cord+injury&btnG=&as_sdt=1%2C5&as_sdtp

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