与儿科烧伤患者住院时间延长相关的因素。
Factors associated with an extended length of stay in the pediatric burn patient.
机构信息
Department of Surgery, Division of Pediatric Surgery, Children's Hospital of Michigan/Wayne State University, Detroit, MI.
Department of Surgery, Division of Pediatric Surgery, Children's Hospital of Michigan/Wayne State University, Detroit, MI.
出版信息
Surgery. 2023 Mar;173(3):774-780. doi: 10.1016/j.surg.2022.07.044. Epub 2022 Oct 27.
BACKGROUND
The Center for Medicaid and Medicare Services predicts the length of stay for pediatric burn patients based on several variables. However, many patients exceed their anticipated length. This study looks to identify aspects of patient presentation, wound characteristics, treatment, and discharge that are associated with a longer-than-predicted length of stay to identify strategies to safely reduce it.
METHODS
We conducted a retrospective chart review of 535 pediatric burn patients admitted to our academic hospital from January 2018 to December 2020. 405 patients met inclusion criteria. Data were collected and analyzed.
RESULTS
Average patient age was 3.36 years. 72.3% were treated for scald burns. Average length of stay was 13.5 days. 20.5% (n = 83) of patients exceeded their predicted length of stay. In comparing patients who exceeded their predicted length of stay to those who did not, the former had significant differences in burn causes, percent total body surface area burned (12.80% vs 4.24% [P = .000]), and body areas involved. Patients who exceeded length of stay had a higher incidence of endotracheal intubation (15.7% vs 1.3%), surgical intervention (85.5% vs 29.2%), need for tube-feeding (48.2% vs 4.3%), and intensive care unit admissions (22.9% vs 2.2% [P = .00 all]). They also averaged more operations, autografting (31.3% vs 1.6% [P = .00]), total operating room time (250 vs 31 minutes [P = .00]), and time to the first operation (2.32 vs 1.64 days [P = .00]). Tube-feeding averaged 9.52 vs 0.72 days (P = .00) extending patient stay after wound stability (43.9% vs 4.3% [P = .00]). These patients also required more discharge planning, with higher rates of Child Protective Services involvement (39.8% vs 10.9% [P = .00]), services consulted (1.06 vs 0.24 [P = .00]), and discharges to inpatient rehabilitation (8.6% vs 0.6% [P = .00]). 89.6% of all patients followed up in clinic.
CONCLUSIONS
Twenty percent of pediatric burn patients had a longer length of stay than predicted by the Center for Medicaid and Medicare Services. Many factors were strongly associated with a longer-than-predicted length of stay. Identifying these early on might help reduce length of stay and meet the targets of the Center for Medicaid and Medicare Services.
背景
医疗补助和医疗保险服务中心根据几个变量预测儿科烧伤患者的住院时间。然而，许多患者的住院时间超过了预期。本研究旨在确定与预测住院时间延长相关的患者表现、伤口特征、治疗和出院方面的因素，以确定安全缩短住院时间的策略。
方法
我们对 2018 年 1 月至 2020 年 12 月期间在我们学术医院住院的 535 名儿科烧伤患者进行了回顾性病历审查。405 名患者符合纳入标准。收集并分析了数据。
结果
平均患者年龄为 3.36 岁。72.3%的患者接受了烫伤烧伤治疗。平均住院时间为 13.5 天。20.5%（n=83）的患者住院时间超过了预期。与未超过预期住院时间的患者相比，前者在烧伤原因、烧伤总面积百分比（12.80% vs 4.24%[P=0.000]）和身体受累部位方面存在显著差异。超过预期住院时间的患者中，气管插管的发生率更高（15.7% vs 1.3%）、手术干预（85.5% vs 29.2%）、需要管饲喂养（48.2% vs 4.3%）和重症监护病房入院（22.9% vs 2.2%[P=0.00 所有]）。他们的平均手术次数也更多，自体移植（31.3% vs 1.6%[P=0.00]）、总手术室时间（250 分钟 vs 31 分钟[P=0.00]）和第一次手术时间（2.32 天 vs 1.64 天[P=0.00]）也更长。管饲喂养时间平均为 9.52 天 vs 0.72 天（P=0.00），延长了伤口稳定后的住院时间（43.9% vs 4.3%[P=0.00]）。这些患者还需要更多的出院计划，儿童保护服务的参与率更高（39.8% vs 10.9%[P=0.00]）、咨询的服务更多（1.06 次 vs 0.24 次[P=0.00]）和住院康复（8.6% vs 0.6%[P=0.00]）。所有患者中有 89.6%在门诊进行了随访。
结论
20%的儿科烧伤患者的住院时间超过了医疗补助和医疗保险服务中心的预测。许多因素与预测住院时间延长密切相关。尽早发现这些因素可能有助于缩短住院时间，并达到医疗补助和医疗保险服务中心的目标。
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