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一个儿科烧伤门诊短期住院项目在烧伤治疗效果相当的情况下缩短了患者的住院时间。

A Pediatric Burn Outpatient Short Stay Program Decreases Patient Length of Stay With Equivalent Burn Outcomes.

作者信息

Zens Tiffany, Yan Amy, Lee Christina W, Schmitz Cindy, Faucher Lee, Gibson Angela

机构信息

Division of Trauma, Acute Care Surgery, Burn and Surgical Critical Care, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison.

University of Wisconsin School of Medicine and Public Health, Madison.

出版信息

J Burn Care Res. 2018 Apr 20;39(3):353-362. doi: 10.1097/BCR.0000000000000599.

Abstract

Traditionally, small pediatric burns are managed with inpatient admission and daily dressing changes. In 2011, our burn center implemented an outpatient short stay (OSS) program in which small pediatric burns were managed as an outpatient utilizing Mepilex AgTM dressings changed under moderate sedation every 5 to 7 days. Pediatric burn cases were queried for 2 time periods: before the OSS program (2009-2010) and after the OSS program (2013-2014). Burns > 15% total body surface area (TBSA), children with polytrauma, and children > 10 years old were excluded. Independent t tests and chi-square tests were conducted to analyze differences in patient demographics, burn management, and burn outcomes between these groups. Two hundred nineteen cases were included in the analysis (77 pre-OSS and 142 post-OSS). There was no difference in patient age (P = 0.872) or TBSA (P = 0.786) between the groups. The post-OSS group had shorter inpatient length of stay (2.93 days vs 5.21 days; P < 0.001) and fewer dressing changes (2.32 vs 4.71; P < 0.001). There were no changes in readmission rates (P = 0.375) or burns requiring grafting (P = 0.155). Although not reaching statistical significance, less children in the post-OSS group had infectious complications (P = 0.054) or required reoperation in a 2-year follow-up period (P = 0.081). Patient and family satisfaction with the program was high. Children treated after the implementation of an OSS burn program at the University of Wisconsin had decreased inpatient length of stay and fewer painful burn dressing changes. These patients exhibited equivalent, if not superior burn outcomes.

摘要

传统上,小儿小面积烧伤采用住院治疗并每日更换敷料。2011年,我们的烧伤中心实施了一项门诊短期住院(OSS)计划,其中小儿小面积烧伤患者作为门诊患者进行治疗,使用美皮康银离子抗菌敷料(Mepilex AgTM),在适度镇静下每5至7天更换一次。对小儿烧伤病例进行了两个时间段的查询:OSS计划实施前(2009 - 2010年)和OSS计划实施后(2013 - 2014年)。排除烧伤总面积(TBSA)> 15%的患者、多发伤儿童以及10岁以上儿童。进行独立t检验和卡方检验以分析这些组之间患者人口统计学、烧伤治疗和烧伤结局的差异。分析纳入了219例病例(OSS计划实施前77例,OSS计划实施后142例)。两组之间患者年龄(P = 0.872)或TBSA(P = 0.786)无差异。OSS计划实施后组的住院时间较短(2.93天对5.21天;P < 0.001),换药次数较少(2.32次对4.71次;P < 0.001)。再入院率(P = 0.375)或需要植皮的烧伤情况(P = 0.155)无变化。虽然未达到统计学意义,但OSS计划实施后组在2年随访期内发生感染并发症的儿童较少(P = 0.054)或需要再次手术的儿童较少(P = 0.081)。患者和家属对该计划的满意度较高。威斯康星大学实施OSS烧伤计划后接受治疗的儿童住院时间缩短,痛苦的烧伤换药次数减少。这些患者的烧伤结局即使不更优也相当。

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