Risk factors and acute in-hospital costs for infected pressure ulcers among gunshot-spinal cord injury victims in southeastern Michigan

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• 作者：Teena Chopra ; MD ; MPH^a ; Dror Marchaim ; MD^b ; ^c ; Reda A. Awali ; MD ; MPH^a ; ^{rawali@med.wayne.edu" class="auth_mail" title="E-mail the corresponding author} ; Miriam Levine ; MD^a ; Smitha Sathyaprakash ; MD^a ; Indu K. Chalana ; MD^a ; Farah Ahmed ; MD^a ; Emily T. Martin ; PhD^d ; Mary Sieggreen ; MSN ; RN^a ; Jack D. Sobel ; MD^a ; Keith S. Kaye ; MD ; MPH^a
• 关键词：Gunshot-spinal cord injury ; Infected pressure ulcer ; Cost
• 刊名：American Journal of Infection Control
• 出版年：2016
• 出版时间：1 March 2016
• 年：2016
• 卷：44
• 期：3
• 页码：315-319
• 全文大小：175 K

文摘

Management of pressure ulcers (PrUs) in patients with gunshot-spinal cord injuries (SCIs) presents unique medical and economic challenges for practitioners.

Methods

A retrospective chart review was conducted at 3 acute care hospitals in metropolitan Detroit for patients admitted with PrUs due to gunshot-SCIs between January 2004 and December 2008. Multivariate analysis using logistic regression was conducted to choose for the independent predictors of infected PrUs. Mean adjusted in-hospital costs per patient and per hospitalization were calculated and compared between infected and noninfected PrUs.

Results

The study cohort included 201 gunshot-SCI patients with PrUs contributing to 395 admissions, including readmissions, between 2004 and 2008. Seventy-six patients (38%) had infected PrUs at time of the index admission. Independent predictors of infected PrUs on index admission included Charlson Comorbidity Index ≥2 (odds ratio, 2.18, P = .026) and stage III/IV PrU (odds ratio, 4.82; P <.0001). During the study period, the cumulative median duration of hospitalization per patient was 12 days (interquartile range, 6-24 days), resulting in a mean adjusted cost of $19,969 ± $6639 per patient. The mean adjusted cost per hospitalization for patients with infected PrUs was significantly higher than that for patients with noninfected PrUs ($16,735 ± $8310 vs $12,356 ± $7007; P <.001).

Conclusions

A multidisciplinary approach including home-based rehabilitation programs and SCI wound clinics might help prevent PrUs and their complications and reduce associated costs.