title: Risk factors and acute in-hospital costs for infected pressure ulcers among gunshot-spinal cord injury victims in southeastern Michigan.
abstract: BACKGROUND
  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.
authors.affiliation: Division of Infectious Diseases, Detroit Medical Center and Wayne State University, Detroit, MI.
authors.forename: Teena
authors.initials: T
authors.lastname: Chopra
authors.affiliation: Division of Infectious Diseases, Assaf Harofeh Medical Center, Zerifin, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
authors.forename: Dror
authors.initials: D
authors.lastname: Marchaim
authors.affiliation: Division of Infectious Diseases, Detroit Medical Center and Wayne State University, Detroit, MI. Electronic address: rawali@med.wayne.edu.
authors.forename: Reda A
authors.initials: RA
authors.lastname: Awali
authors.affiliation: Division of Infectious Diseases, Detroit Medical Center and Wayne State University, Detroit, MI.
authors.forename: Miriam
authors.initials: M
authors.lastname: Levine
authors.affiliation: Division of Infectious Diseases, Detroit Medical Center and Wayne State University, Detroit, MI.
authors.forename: Smitha
authors.initials: S
authors.lastname: Sathyaprakash
authors.affiliation: Division of Infectious Diseases, Detroit Medical Center and Wayne State University, Detroit, MI.
authors.forename: Indu K
authors.initials: IK
authors.lastname: Chalana
authors.affiliation: Division of Infectious Diseases, Detroit Medical Center and Wayne State University, Detroit, MI.
authors.forename: Farah
authors.initials: F
authors.lastname: Ahmed
authors.affiliation: Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI.
authors.forename: Emily T
authors.initials: ET
authors.lastname: Martin
authors.affiliation: Division of Infectious Diseases, Detroit Medical Center and Wayne State University, Detroit, MI.
authors.forename: Mary
authors.initials: M
authors.lastname: Sieggreen
authors.affiliation: Division of Infectious Diseases, Detroit Medical Center and Wayne State University, Detroit, MI.
authors.forename: Jack D
authors.initials: JD
authors.lastname: Sobel
authors.affiliation: Division of Infectious Diseases, Detroit Medical Center and Wayne State University, Detroit, MI.
authors.forename: Keith S
authors.initials: KS
authors.lastname: Kaye
mesh_terms: D000328:Adult; D005260:Female; D017721:Hospital Costs; D006801:Humans; D008297:Male; D008824:Michigan / Q000453:epidemiology; D008875:Middle Aged; D003668:Pressure Ulcer / Q000191:economics / Q000453:epidemiology* / Q000628:therapy*; D012189:Retrospective Studies; D012307:Risk Factors; D013119:Spinal Cord Injuries / Q000150:complications*
keywords: Cost; Gunshot-spinal cord injury; Infected pressure ulcer