Division of Pediatric Surgery, Department of Surgery, Medical University of South Carolina, Charleston, SC.
Division of Pediatric Surgery, Department of Surgery, Medical University of South Carolina, Charleston, SC.
J Pediatr Surg. 2020 Oct;55(10):2134-2139. doi: 10.1016/j.jpedsurg.2020.03.018. Epub 2020 Apr 17.
Approaches to burn care in the pediatric population are highly variable and can be targeted as a potential measure in cost-reduction. We hypothesized that institutions vary significantly in treatment allocation of nonsevere burns to either inpatient or outpatient care.
We queried the PHIS database for fiscal year 2017 to quantify small pediatric burn admissions and Emergency Department visits (ED). The ICD-10 code T31.0 was used to identify burns involving <10% of total body surface area (TBSA). Centers were categorized by burn center status and length of stay, readmissions, and charges were compared.
Inpatient versus outpatient management distribution was significantly different across the included pediatric children's hospitals (n = 34, p < 0.00001). When data were analyzed with respect to outpatient care, a bimodal distribution distinguished two groups: high hospital utilizers with an average of 30% outpatient burn care and low-utilizers averaging 87%. Median inpatient charge per patient was greater than 31-fold compared to ED burn management (p < 0.0001).
Variability of inpatient versus outpatient pediatric burn management in small burns was significant. Compared to outpatient burn care, inpatient care is significantly more costly. Implementing protocols and personnel to provide adequate attention to small burns in the ED could be an important cost-saving measure.
Retrospective analysis.
Level III.
儿科人群的烧伤治疗方法差异很大，可以将其作为降低成本的潜在措施。我们假设，各机构在非严重烧伤患者的治疗分配上存在显著差异，要么住院治疗，要么门诊治疗。
我们在 PHIS 数据库中查询了 2017 财年的数据，以量化小儿小面积烧伤的住院和急诊就诊（ED）人数。ICD-10 编码 T31.0 用于识别涉及<10%的全身体表面积（TBSA）的烧伤。根据烧伤中心的地位和住院时间长短对中心进行分类，并比较再入院率和费用。
纳入的儿童医院中，住院与门诊治疗的分配存在显著差异（n=34，p<0.00001）。当根据门诊治疗数据进行分析时，存在一个双峰分布，将两组区分开来：高医院利用率者平均有 30%的门诊烧伤治疗，低利用率者平均为 87%。与 ED 烧伤管理相比，每位患者的住院费用中位数是其 31 倍以上（p<0.0001）。
小儿小面积烧伤的住院与门诊治疗方法的差异很大。与门诊烧伤治疗相比，住院治疗的费用明显更高。在 ED 中实施适当处理小面积烧伤的方案和人员配备可能是一项重要的节省成本措施。
回顾性分析。
III 级。
