• Developed as a measure of the risk for pressure ulcer development for individuals with SCI who are in a rehabilitation centre.
  • Items for the scale were identified based on statistical analysis of data from 176 individuals 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.

Clinical Considerations

  • Although the SCIPUS is reported to be the best measure for individuals with SCI, the reliability of the scale has not been demonstrated with this population. 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.

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 better prognosis.

Languages

English

Training Required

No advanced training required.

Availability

Can be found here.

# of studies reporting psychometric properties: 4

Interpretability

  • Scores range from 0 (best prognosis) to 25 (worst prognosis).
  • 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

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

(Delparte et al. 2015; Higgins et al. 2019)

Validity

  • 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 = 0.343) and with the number of ulcers developed (Spearman’s r = 0.339).

(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)

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. Vanessa Noonan, Jeremy Mak, John Zhu

Date Last Updated

3 August 2020

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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