Spinal Cord Injury Pressure Ulcer Scale – Acute (SCIPUS-A)

The SCIPUS-A scale was developed as a measure of the risk for pressure ulcer development for individuals with SCI during the acute phase of injury (within 30 days of admission) (Salzber et al. 1999). It evaluates eight domains: 1) extent of paralysis, 2) moisture, 3) serum creatinine, 4) incontinence, 5) albumin, 6) mobility, 7) pulmonary disease, and 8) level of activity. 

Number of items: 8

Procedure/Administration: 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, tetraparesis:4, paraplegia:8 and tetraplegia:10.

How scored: Scales are scored based on descriptive criteria provided on the scoring sheet. 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. 

Interpretability: Lower scores equal better prognosis. Sensitivity and specificity percentages are provided at a variety of cut-off scores.

Acceptability: Items for the scale were identified based on statistical analysis of data from 226 individuals with SCI, which compared development of pressure ulcers with demographic variables and 50 potential pressure ulcer risk factors. The content validity for the tool is high as it was designed for individuals with SCI.

Languages: English

Usability: There is minimal burden related to administering or scoring the scale if tests for albumin and serum creatinine are already part of the patient’s medical record.  Otherwise the blood tests required would be invasive and create respondent burden.

Time to administer: 5-10 minutes (as long as laboratory data is already available).

Time to score: N/a

Training required: N/a

Availability: The scale and its operational scoring definitions is available in the article that describes its development and testing (Salzberg et al. 1999).

Equipment required: N/a

Summary: The SCIPUS-A scale is a quick and easy to use measure that provides predictive information about risk of pressure sore development. Despite the good content validity, other validity evidence is only adequate, and there has been no reliability or responsiveness testing with these individuals with SCI

Psychometric Summary:

Note: TR= Test re-test; IC= Internal Consistency;Inter-O=Inter-observer; Intra-O=Intra-observer; SS=Sensitivity/Specificity.

Red light= A single study involving SCI subjects which has less than adequate findings of reliability, validity, and/or responsiveness.

Yellow light= A single study involving subjects with SCI which has adequate to excellent findings of reliability, validity, and/or responsiveness.

Green light= At least 2 studies involving subjects with SCI which have adequate to excellent findings of reliability, validity, and/or responsiveness.

N/a= No information.

References

• Ash D. An exploration of the occurrence of pressure ulcers in a British spinal injuries unit. J Clin Nurs 2002;11:470-478.
• 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.