Chan Dan S, Podeszwa David A, Brown Debra, Starr Adam J
Children's Medical Center Dallas, TX, USA.
J Pediatr Orthop. 2009 Sep;29(6):612-7. doi: 10.1097/BPO.0b013e3181b29dc4.
Trauma continues to be the leading cause of morbidity and mortality among children. There is a perception among pediatric orthopaedists that the volume of pediatric orthopaedic trauma care is increasing. We hypothesized that the change in trauma volume was greater than the local and regional population change.
This retrospective analysis (1996 to 2006) of our institution's trauma registry analyzed changes in general trauma and orthopaedic trauma admissions, surgical volumes, patient and population demographics, and hospital reimbursement.
For the decade, the local pediatric population increased annually by only 2% to 3%. During that same period, there was an increase in the proportion of patients treated from outside the immediate county, from 13% in 1996 to 28% in 2006. Total general trauma patient admissions increased at an average of 10% per year from 1996 to 2006, whereas total orthopaedic trauma admissions and orthopaedic trauma admissions requiring operative treatment increased by an annual average of 18%. Orthopaedic trauma admissions as a percentage of total trauma admissions steadily increased from 26% in 1996 to 45% in 2006. During 2005 and 2006, an average total of 1216 orthopaedic trauma cases per year were performed generating an average 10,465 work relative value units per year. Between 1996 and 2005, the hospital's gross charges for pediatric orthopaedic trauma increased by an average of 26% annually; however, the percentage of total charges collected decreased from 67% in 1999 to 28% in 2005.
Pediatric orthopaedic trauma at this level 1 trauma center increased dramatically and more rapidly than the local population over the last decade, increasing the demand for physician and hospital resources. Physicians, hospitals, and the communities they serve face financial and logistical problems of providing care for an expanding volume of pediatric orthopaedic trauma patients with decreasing reimbursements, changing referral patterns and a decreasing population of pediatric orthopaedic specialists. Care of the pediatric orthopaedic trauma patient could become a national crisis.
Economic analysis-level III.
创伤仍然是儿童发病和死亡的主要原因。儿科骨科医生认为，儿科骨科创伤护理的数量正在增加。我们推测创伤数量的变化大于当地和区域人口的变化。
对我们机构创伤登记处进行的这项回顾性分析（1996年至2006年），分析了一般创伤和骨科创伤入院情况、手术量、患者和人口统计学特征以及医院报销情况的变化。
在这十年间，当地儿科人口每年仅增长2%至3%。在同一时期，来自本县以外地区接受治疗的患者比例有所增加，从1996年的13%增至2006年的28%。1996年至2006年，一般创伤患者总入院人数平均每年增长10%，而骨科创伤总入院人数以及需要手术治疗的骨科创伤入院人数平均每年增长18%。骨科创伤入院人数占总创伤入院人数的百分比从1996年的26%稳步增至2006年的45%。在2005年和2006年期间，每年平均共进行1216例骨科创伤病例，每年平均产生10465个工作相对价值单位。1996年至2005年期间，医院儿科骨科创伤的总费用平均每年增长26%；然而，收取的总费用百分比从1999年的67%降至了2005年的28%。
在过去十年中，这家一级创伤中心的儿科骨科创伤急剧增加，且增速超过当地人口，这增加了对医生和医院资源的需求。医生、医院及其服务的社区面临着为数量不断增加的儿科骨科创伤患者提供护理的财务和后勤问题，报销减少、转诊模式改变以及儿科骨科专家数量减少。儿科骨科创伤患者的护理可能会成为一场全国性危机。
经济分析——三级。
