Pressure Ulcer Prevention and Treatment Following Spinal Cord Injury - 10

PRESSURE ULCER PREVENTION AND TREATMENT FOLLOWING SPINAL CORD INJURY

An increased prevalence of pressure ulcers
is seen in persons with longer SCI durations,
especially among those 10 years or more postinjury (Chen, et. al., 2005). Among veterans with
SCI, over 1/3 report having pressure ulcers
during the previous year (Smith, et al., 2008).
Pressure ulcers remain the second leading cause
of rehospitalization after urinary causes for
persons with SCI enrolled in the US SCI Model
Systems Database accounting for 17% of the
rehospitalizations in the first year after injury,
23% at 5 years, 29% at 10 years, and 38% at
20 years post injury (NSCISC, 2012).

Costs of Pressure Ulcers
The costs related to the treatment of
pressure ulcers include direct costs (e.g., costs
of dressings, medications, nursing care, physical
therapy, hospitalization, surgery), as well as the
much more difficult to ascertain indirect costs,
which include caregiver burden, loss of
vocational productivity, and psychological stress.
Few published reports address cost of
treating pressure ulcers among populations of
persons with SCI. Brem et al., (2010) reported
the cost of the hospitalization of patients with
category/stage IV pressure ulcers at a tertiary,
university hospital in the United States to be,
on average, more than $124,000, regardless
of whether they were hospital-acquired or
community acquired. This included the costs for

the treatment of the category/stage IV pressure
ulcers and their associated complications. Dealey
et al. (2012) estimated that the cost of healing a
non-complicated category/stage IV pressure
ulcer to be the equivalent of $23,000 while the
cost of treatment of a patient with a category/
stage IV ulcer with underlying osteomyelitis to be
the equivalent of $65,000. The high costs were
attributed to both the higher daily costs of
treatment, as well as the longer length of stay
in the hospital. Therefore, it is universally
recognized that the direct costs associated with
the treatment of pressure ulcers to be very high.
This is not even taking into account the indirect
costs to the patients, their families and society.
Two recent reports have examined the direct
costs of the treatment of pressure ulcers in
persons with SCI. Chan et al. (2013) studied the
costs of treating chronic pressure ulcers among
community-dwelling SCI individuals in Ontario,
Canada. The average monthly cost was found to
be $4,745 per community dwelling SCI individual.
Costs for hospital admission were found to make
up for the largest percentage of the total costs.
Stroupe et al. (2011) studied the costs of treating
pressure ulcers among veterans with SCI. The
total inpatient cost per year for SCI veterans with
pressure ulcers was $91,341 while that for a
veteran without pressure ulcer was $13,754. The
total outpatient cost per year for SCI veterans
with pressure ulcers was $19,844, compared to
$11,829 for those without a pressure ulcer.

Pressure Ulcer Prevention and Treatment Following Spinal Cord Injury

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