Xia Z G, Zhou X L, Kong W C, Li X Z, Song J H, Fang L S, Hu D L, Cai C, Tang Y Z, Yu Y X, Wang C H, Xu Q L
Department of Burns and Plastic Surgery, the Fourth Affiliated Hospital of Anhui Medical University, Hefei 230022, China.
Zhonghua Shao Shang Za Zhi. 2018 Mar 20;34(3):143-148. doi: 10.3760/cma.j.issn.1009-2587.2018.03.005.
To explore the influence of three-level collaboration network of pediatric burns in Anhui province on treatment effects of burn children. The data of medical records of pediatric burn children transferred from Lu'an People's Hospital and Fuyang People's Hospital to the First Affiliated Hospital of Anhui Medical University from January 2014 to December 2015 and January 2016 to September 2017 (before and after establishing three-level collaboration network of pediatric burns treatment) were analyzed: percentage of transferred burn children to hospitalized burn children in corresponding period, gender, age, burn degree, treatment method, treatment result, occurrence and treatment result of shock, and operative and non-operative treatment time and cost. Rehabilitation result of burn children transferred back to local hospitals in 2016 and 2017. Data were processed with test, chi-square test, Mann-Whitney test, and Fisher's exact test. (1) Percentage of burn children transferred from January 2014 to December 2015 was 34.3% (291/848) of the total number of hospitalized burn children in the same period of time, which was close to 30.4% (210/691) of burn children transferred from January 2016 to September 2017 ((2)=2.672, >0.05). (2) Gender, age, burn degree, and treatment method of burn children transferred from the two periods of time were close ((2)=3.382, =-1.917, -1.911, (2)=3.133, >0.05). (3) Cure rates of children with mild, moderate, and severe burns transferred from January 2016 to September 2017 were significantly higher than those of burn children transferred from January 2014 to December 2015 ((2)=11.777, 6.948, 4.310, <0.05). Cure rates of children with extremely severe burns transferred from the two periods of time were close ((2)=1.181, >0.05). (4) Children with mild and moderate burns transferred from the two periods of time were with no shock. The incidence of shock of children with severe burns transferred from January 2014 to December 2015 was 6.0% (4/67), and 3 children among them were cured. The incidence of shock of children with severe burns transferred from January 2016 to September 2017 was 3.9% (2/51), and both children were cured. The incidences and cures of shock of children with severe burns transferred from the two periods of time were close ((2)=0.006, >0.05). Incidence of shock of children with extremely severe burns transferred from January 2014 to December 2015 was 57.1% (32/56), significantly higher than that of burn children transferred from January 2016 to September 2017 [34.5% (10/29), (2)=3.925, <0.05]. Shock of 25 children with extremely severe burns transferred from January 2014 to December 2015 were cured, and shock of 9 children with extremely severe burns transferred from January 2016 to September 2017 were cured. The cures of shock of children with extremely severe burns transferred from the two periods of time were close ( (2)=0.139, >0.05). (5) Time of operative treatment of children with moderate, severe, and extremely severe burns transferred from January 2014 to December 2015 was obviously longer than that of burn children transferred from January 2016 to September 2017 (=2.335, 2.065, 2.310, <0.05). Time of operative treatment of children with mild burns transferred from the two periods of time was close (=-0.417, >0.05). Costs of operative treatment of children with moderate and severe burns transferred from January 2014 to December 2015 were significantly more than those of burn children transferred from January 2016 to September 2017 (=-3.324, =2.167, <0.05). Costs of operative treatment of children with mild and extremely severe burns transferred from the two periods of time were close (=0.627, 0.808, >0.05). (6)Time of non-operative treatment of children with mild, moderate, and severe burns transferred from January 2014 to December 2015 was obviously longer than that of burn children transferred from January 2016 to September 2017 (=2.335, =-2.095, =2.152, <0.05). Time of non-operative treatment of children with extremely severe burns transferred from the two periods of time was close (=0.450, >0.05). Costs of non-operative treatment of children with moderate and severe burns transferred from January 2014 to December 2015 were obviously higher than those of burn children transferred from January 2016 to September 2017 (=-2.164, =2.040, <0.05). Costs of non-operative treatment of children with mild and extremely severe burns transferred from the two periods of time were close (=0.146, 1.235, >0.05). (7) Sixty-seven burn children transferred from January 2016 to September 2017 were transferred back to local hospitals for rehabilitation under the guidance of experts of the First Affiliated Hospital of Anhui Medical University, with 25 patients in 2016 and 42 patients in 2017. Effective rehabilitation rates of burn children transferred back to local hospitals for rehabilitation in 2016 and 2017 were both 100%. The three-level collaboration network of pediatric burns treatment in Anhui province can effectively increase cure rate of children with mild, moderate, and severe burns, reduce incidence of shock of children with extremely severe burns, shorten time of operative treatment of burn children with moderate, severe, and extremely severe burns, and time of non-operative treatment of children with mild, moderate, and severe burns, reduce treatment costs of children with moderate and severe burns, and improve rehabilitation effectiveness of children transferred from Lu'an People's Hospital and Fuyang People's Hospital to the the First Affiliated Hospital of Anhui Medical University.
探讨安徽省小儿烧伤三级协作网络对烧伤患儿治疗效果的影响。分析2014年1月至2015年12月以及2016年1月至2017年9月（小儿烧伤治疗三级协作网络建立前后）从六安市人民医院和阜阳市人民医院转至安徽医科大学第一附属医院的小儿烧伤病历资料：各时间段转院烧伤患儿占同期住院烧伤患儿的百分比、性别、年龄、烧伤程度、治疗方法、治疗结果、休克发生情况及治疗结果，以及手术和非手术治疗时间与费用。2016年和2017年转回当地医院的烧伤患儿康复结果。数据采用t检验、卡方检验、Mann-Whitney U检验和Fisher确切概率法进行处理。（1）2014年1月至2015年12月转院烧伤患儿占同期住院烧伤患儿总数的34.3%（291/848），接近2016年1月至2017年9月转院烧伤患儿的30.4%（210/691）（χ²=2.672，P>0.05）。（2）两个时间段转院烧伤患儿的性别、年龄、烧伤程度及治疗方法相近（χ²=3.382，t=-1.917，t=-1.911，χ²=3.133，P>0.05）。（3）2016年1月至2017年9月转院的轻度、中度和重度烧伤患儿治愈率显著高于2014年1月至2015年12月转院的烧伤患儿（χ²=11.777，χ²=6.948，χ²=4.310，P<0.05）。两个时间段转院的特重度烧伤患儿治愈率相近（χ²=1.181，P>0.05）。（4）两个时间段转院的轻度和中度烧伤患儿均未发生休克。2014年1月至2015年12月转院的重度烧伤患儿休克发生率为6.0%（4/67），其中3例治愈。2016年1月至2017年9月转院的重度烧伤患儿休克发生率为3.9%（2/51），2例均治愈。两个时间段转院的重度烧伤患儿休克发生率及治愈率相近（χ²=0.006，P>0.05）。2014年1月至2015年12月转院的特重度烧伤患儿休克发生率为57.1%（32/56），显著高于2016年1月至2017年9月转院的烧伤患儿[34.5%（10/29），χ²=3.925，P<0.05]。2014年1月至2015年12月转院的25例特重度烧伤患儿休克治愈，2016年1月至2017年9月转院的9例特重度烧伤患儿休克治愈。两个时间段转院的特重度烧伤患儿休克治愈率相近（χ²=0.139，P>0.05）。（5）2014年1月至2015年12月转院的中度、重度和特重度烧伤患儿手术治疗时间明显长于2016年1月至2017年9月转院的烧伤患儿（t=2.335，t=2.065，t=2.310，P<0.05）。两个时间段转院的轻度烧伤患儿手术治疗时间相近（t=-0.417，P>0.05）。2014年1月至2015年12月转院的中度和重度烧伤患儿手术治疗费用显著高于2016年1月至2017年9月转院的烧伤患儿（t=-3.324，t=2.167，P<0.05）。两个时间段转院的轻度和特重度烧伤患儿手术治疗费用相近（t=0.627，t=0.808，P>0.05）。（6）2014年1月至2015年12月转院的轻度、中度和重度烧伤患儿非手术治疗时间明显长于2016年1月至2017年9月转院的烧伤患儿（t=2.335，t=-2.095，t=2.152，P<0.05）。两个时间段转院的特重度烧伤患儿非手术治疗时间相近（t=0.450，P>0.05）。2014年1月至2015年12月转院的中度和重度烧伤患儿非手术治疗费用明显高于2016年1月至2017年9月转院的烧伤患儿（t=-2.164，t=2.040，P<0.05）。两个时间段转院的轻度和特重度烧伤患儿非手术治疗费用相近（t=0.146，t=1.235，P>0.05）。（7）2016年1月至2017年9月转院的67例烧伤患儿在安徽医科大学第一附属医院专家指导下转回当地医院康复，2016年25例，2017年42例。2016年和2017年转回当地医院康复的烧伤患儿有效康复率均为100%。安徽省小儿烧伤治疗三级协作网络可有效提高轻度、中度和重度烧伤患儿治愈率，降低特重度烧伤患儿休克发生率，缩短中度、重度和特重度烧伤患儿手术治疗时间以及轻度、中度和重度烧伤患儿非手术治疗时间，降低中度和重度烧伤患儿治疗费用，提高从六安市人民医院和阜阳市人民医院转至安徽医科大学第一附属医院患儿的康复效果。
