The frequency of osteomyelitis after pressure injury in spinal cord injury: a systematic review and meta-analysis

A systematic review and meta-analysis

To determine the global frequency of osteomyelitis in individuals with spinal cord injury who have pressure injuries (SCI-PI).

A comprehensive search on PubMed, EMBASE, Scopus, and the Web of Science has been conducted until November 2023. The Cochrane Handbook for Systematic Reviews was followed. Cohort and cross-sectional studies included SCI-PI participants who reported the frequency of osteomyelitis without language restriction. Data extraction was performed by four reviewers in two groups. We used the Newcastle-Ottawa Quality Assessment Scale for quality assessment. The Chi-squared and I² tests were applied to detect heterogeneity between studies. Also, a random-effects model was performed for the report data.

Ten out of 986 studies met our eligibility criteria, with 492 SCI-PI individuals. It was discovered that most SCIs were thoracolumbar injuries and male. There was a history of PI in more than half the patients. SCI was primarily caused by trauma. A meta-analysis revealed a significantly heterogeneous 43.0% osteomyelitis frequency. There was no evidence of publication bias. Subgroup analysis based on study quality revealed that the frequency of osteomyelitis in low-quality studies was 34.5%, whereas the frequency in high-quality research was 47.4%. Furthermore, the overall frequency of osteomyelitis was 29.0% in the subgroup analysis of research carried out in the USA.

Our study highlights the significant burden of osteomyelitis among SCI-PI individuals. These findings underscore the pressing need for standardized diagnostic and management protocols to mitigate the morbidity associated with osteomyelitis in this vulnerable population.