Victorian Adult Burns Service, The Alfred, 55 Commercial Rd, Melbourne, Victoria 3004, Australia; Department of Surgery, Central Clinical School, Monash University, 99 Commercial Rd, Melbourne, Victoria 3004, Australia.
School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, Victoria 3004, Australia.
Burns. 2023 Sep;49(6):1289-1297. doi: 10.1016/j.burns.2023.03.010. Epub 2023 Mar 23.
In Australia and New Zealand, children with burn injuries are cared for in either general hospitals which cater to both adult and paediatric burn injuries or in children's hospitals. Few publications have attempted to analyse modern burn care and outcomes as a function of treating facilities.
The aim of this study was to compare in-hospital outcomes of paediatric burn injuries managed in children's hospitals to those treated in general hospitals that regularly treated both adult and paediatric burn patients.
A retrospective cohort study of cases was undertaken using data from the Burns Registry of Australia and New Zealand (BRANZ). All paediatric patients with data for an acute or transfer admission to a BRANZ hospital and registered with BRANZ with a date of admission between 1 July 2016 and 30 June 2020 were included in the study. The primary outcome of interest was the acute admission length of stay. Secondary outcome measures of interest included admission to the intensive care unit and readmission to a specialist burn service within 28 days. The Alfred Hospital Ethics Committee granted ethical approval for this study (project 629/21).
A total of 4630 paediatric burn patients were included in the analysis. Approximately three quarters of this cohort (n = 3510, 75.8%) were admitted to a paediatric only hospital, while the remaining quarter (n = 1120, 24.2%) were admitted to a general hospital. A greater proportion of patients admitted to general hospitals underwent burn wound management procedures in the operating theatre (general hospitals 83.9%, children's hospitals 71.4%, p < 0.001). Patients admitted to children's hospitals had a longer median time to their first episode of grafting (children's hospitals 12.4 days, general hospitals 8.3 days, p < 0.001). The adjusted regression model for hospital LOS indicate that patients admitted to general hospitals had a 23% shorter hospital LOS, compared to patients admitted to children's hospitals. Neither the unadjusted or adjusted model for intensive care unit admission was significant. After accounting for relevant confounding factors, there was no association between service type and hospital readmission rates.
Comparing children's hospitals and general hospitals, different models of care seem to exist. Burn services in children's hospitals adopted a more conservative approach and were more inclined to facilitate healing by secondary intention rather than surgical debridement and grafting. General hospitals are more "aggressive" in managing burn wounds in theatre early, and debriding and grafting the burn wounds whenever considered necessary.
在澳大利亚和新西兰，儿童烧伤患者在综合医院或儿童医院接受治疗，综合医院同时治疗成人和儿童烧伤患者。很少有文献试图分析现代烧伤治疗和结果与治疗设施的关系。
本研究旨在比较在儿童医院接受治疗的儿童烧伤患者与在综合医院接受治疗的烧伤患者的院内治疗结果，综合医院定期治疗成人和儿童烧伤患者。
本研究使用澳大利亚和新西兰烧伤登记处（BRANZ）的数据进行回顾性队列研究。所有在 BRANZ 医院急性或转院入院，且 BRANZ 有入院日期在 2016 年 7 月 1 日至 2020 年 6 月 30 日之间的儿童患者均纳入本研究。主要观察指标为急性入院治疗时间。次要观察指标包括入住重症监护病房和 28 天内再次入住烧伤专科服务。阿尔弗雷德医院伦理委员会批准了本研究（项目编号 629/21）。
共纳入 4630 名儿科烧伤患者进行分析。该队列中约四分之三（n=3510，75.8%）患者被收入专门的儿科医院，其余四分之一（n=1120，24.2%）患者被收入综合医院。综合医院烧伤患者进行手术清创和植皮的比例更高（综合医院 83.9%，儿童医院 71.4%，p<0.001）。儿童医院入院患者接受首次植皮的中位时间更长（儿童医院 12.4 天，综合医院 8.3 天，p<0.001）。调整后的住院时间回归模型表明，与儿童医院入院患者相比，综合医院入院患者的住院时间缩短了 23%。未调整和调整后的重症监护病房入院模型均无统计学意义。在考虑了相关混杂因素后，服务类型与医院再入院率之间没有关联。
比较儿童医院和综合医院，似乎存在不同的治疗模式。儿童医院的烧伤服务采用了更为保守的方法，更倾向于通过二期愈合而不是手术清创和植皮来促进愈合。综合医院在手术室早期更积极地处理烧伤伤口，只要认为有必要，就会进行清创和植皮。
