Veeravagu Anand, Yoon Byung C, Jiang Bowen, Carvalho Carla M, Rincon Fred, Maltenfort Mitchell, Jallo Jack, Ratliff John K
From the Departments of *Neurosurgery and †Surgery, Stanford University School of Medicine, Palo Alto, California; ‡Department of Neurology and Neurosurgery, Thomas Jefferson University, Philadelphia, Pennsylvania; and §Department of Biostatistics, The Rothman Institute, Philadelphia, Pennsylvania.
J Burn Care Res. 2015 Mar-Apr;36(2):258-65. doi: 10.1097/BCR.0000000000000064.
The aim of this study was describe national trends in prevalence, demographics, hospital length of stay (LOS), hospital charges, and mortality for burn patients with and without inhalational injury and to compare to the National Burn Repository. Burns and inhalation injury cause considerable mortality and morbidity in the United States. There remains insufficient reporting of the demographics and outcomes surrounding such injuries. The National Inpatient Sample database, the nation's largest all-payer inpatient care data repository, was utilized to select 506,628 admissions for burns from 1988 to 2008 based on ICD-9-CM recording. The data were stratified based on the extent of injury (%TBSA) and presence or absence of inhalational injury. Inhalation injury was observed in only 2.2% of burns with <20% TBSA but 14% of burns with 80 to 99% TBSA. Burn patients with inhalation injury were more likely to expire in-hospital compared to those without (odds ratio, 3.6; 95% confidence interval, 2.7-5.0; P < .001). Other factors associated with higher mortality were African-American race, female sex, and urban practice setting. Patients treated at rural facilities and patients with hyperglycemia had lower mortality rates. Each increase in percent of TBSA of burns increased LOS by 2.5%. Patients with burns covering 50 to 59% of TBSA had the longest hospital stay at a median of 24 days (range, 17-55). The median in-hospital charge for a burn patient with inhalation injury was US$32,070, compared to US$17,600 for those without. Overall, patients who expired from burn injury accrued higher in-hospital charges (median, US$50,690 vs US$17,510). Geographically, California and New Jersey were the states with the highest charges, whereas Vermont and Maryland were states with the lowest charges. The study analysis provides a broad sampling of nationwide demographics, LOS, and in-hospital charges for patients with burns and inhalation injury.
本研究的目的是描述伴有和不伴有吸入性损伤的烧伤患者在患病率、人口统计学特征、住院时间（LOS）、住院费用及死亡率方面的全国趋势，并与国家烧伤资料库进行比较。烧伤和吸入性损伤在美国导致相当高的死亡率和发病率。关于此类损伤的人口统计学特征和结局的报告仍然不足。利用国家住院患者样本数据库（全国最大的全付费者住院护理数据资料库），根据ICD-9-CM记录，选取了1988年至2008年期间506,628例烧伤住院病例。数据根据损伤程度（%TBSA）以及是否存在吸入性损伤进行分层。在TBSA＜20%的烧伤病例中，仅2.2%观察到吸入性损伤，但在TBSA为80%至99%的烧伤病例中，这一比例为14%。与无吸入性损伤的烧伤患者相比，有吸入性损伤的烧伤患者更有可能在住院期间死亡（优势比，3.6；95%置信区间，2.7 - 5.0；P＜0.001）。与较高死亡率相关的其他因素包括非裔美国人种族、女性性别以及城市医疗机构环境。在农村医疗机构接受治疗的患者和患有高血糖的患者死亡率较低。烧伤TBSA百分比每增加1%，住院时间增加2.5%。TBSA覆盖50%至59%的烧伤患者住院时间最长，中位数为24天（范围，17 - 55天）。伴有吸入性损伤的烧伤患者住院费用中位数为32,070美元，而无吸入性损伤的患者为17,600美元。总体而言，因烧伤死亡的患者住院费用更高（中位数，50,690美元对17,510美元）。在地理上，加利福尼亚州和新泽西州是费用最高的州，而佛蒙特州和马里兰州是费用最低的州。该研究分析为烧伤和吸入性损伤患者的全国人口统计学特征、住院时间及住院费用提供了广泛的抽样数据。
