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Introduction/Background Pressure ulcer risk assessment provides an indicator of quality of care in French health establishments. The predictive value of clinical assessment tools is lower for people with spinal cord injury (SCI). We hypothesized that skin complications would be less frequent in traumatic SCI patients with tetraplegia (TSCIt) who were initially managed in French regions with a high level of specialized SCI rehabilitation experience. Material and method First, we used the most recent French epidemiological survey of patients with SCI to determine a “Level of Regional Experience in Specialized Physical Medicine and Rehabilitation” (LRE). We then studied the medical and social variables reported in the Tetrafigap survey (which compiled a cohort of TSCIt, to assess their trajectory and life conditions following the return to community life) using univariate analysis according to these LREs (Chi 2 test using a significance threshold of P < 0.05). We finally performed a series of logistic regressions to determine the link between LREs and pressure ulcers. Results Management in high-LRE regions was associated with a lower occurrence of pressure ulcers during early treatment and in the long-term (on average, 8 years post-trauma). Conclusion Using pressure ulcers as a marker, our study demonstrated the protective link of regional experience of the early management of TSCIt. In our opinion, efforts should first prevent a dilution effect through holistic health care for SCI, within the scope of a regional organization that would link referral centers and local health care networks. [ABSTRACT FROM AUTHOR]