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Multidisciplinary approach may prevent pressure ulcer infection from gunshot-spinal cord injury
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Home-based rehabilitation and spinal cord injury-related wound clinics, as part of a multidisciplinary approach, may help prevent pressure ulcers and their complications in patients with gunshot-spinal cord injuries, according to a study published in the American Journal of Infection Control.
“In 2006, hospitalizations related to [pressure ulcers] in patients with and without [spinal cord injuries] accounted for a total of 503,300 hospital stays and significant health care expenditures, up to $11 billion,” Keith S. Kaye, MD, MPH, an Infectious Disease News Editorial Board member and a professor of medicine at Wayne State University, and colleagues wrote. “The Agency for Healthcare Research and Quality reported that hospitalizations as a result of [pressure ulcers] increased by approximately 80% from 1993 to 2006. In this report, younger patients (aged 18 to 44 years) had a longer average hospital stay related to [pressure ulcers] compared with patients aged 85 years and older (14 days vs. 10 days). The mean charge of hospitalization related to [pressure ulcers] was estimated as $37,800.”
Keith S. Kaye
According to the researchers, approximately 40% of spinal cord injuries in Detroit are the result of gunshot wounds. To investigate the risk factors of pressure ulcer infections, as well as identify in-hospital costs associated with such infections in patients with gunshot-related spinal cord injuries, they conducted a retrospective chart review at three acute care hospitals in the Detroit metropolitan area.
The review focused on patients admitted with pressure ulcers caused by gunshot-related spinal cord injuries between January 2004 and December 2008. The study cohort included 201 patients, representing 395 admissions — including readmissions. The researchers conducted multivariate analysis with logistic regression to identify the independent predictors of pressure ulcers. In addition, they calculated the mean adjusted in-hospital costs per patient and per hospitalization, and compared the results of patients with infected pressure ulcers with those with noninfected pressure ulcers.
According to Kaye and colleagues, 38% of the patients had infected pressure ulcers at the time of index admission. Independent predictors of pressure ulcer infection upon index admission included a Charlson Comorbidity Index score of 2 or more (adjusted OR = 2.18; 95% CI, 1.1-4.3) and stage III/IV pressure ulcers (aOR = 4.82; 95% CI, 2.3-10.14). The cumulative median hospitalization duration per patient was 12 days. The mean adjusted cost per patient was $19,969 ± $6,639. However, the mean adjusted cost per hospitalization for patients with infected pressure ulcers was significantly higher than the cost for those with noninfected pressure ulcers — $16,735 ± $8,310 vs. $12,356 ± $7,007.
“Although the incidence of gunshot-[spinal cord injuries] have increased significantly over the last 3 decades, there has been a dramatic improvement in the life expectancy of [these] patients, which puts these patients at life-long risk for the development of pressure ulcers,” Kaye and colleagues wrote. “Therefore, development and implementation of effective and innovative strategies targeted to home and health care settings are critically needed to prevent the development of infected and/or life-threating pressure ulcers in young gunshot-[spinal cord injury] victims. Such strategies will require spinal cord injury wound clinics and efforts provided by a multidisciplinary team including physicians, physical and occupational therapists, and social workers.” – by Jason Laday
Disclosure: The researchers report no relevant financial disclosures.
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