Gale Hannah L, Staffa Steven J, DePamphilis Matthew A, Tsay Sarah, Burns Jeffrey, Sheridan Robert
Department of Pediatrics, Brooke Army Medical Center, Ft Sam Houston, TX.
Department of Pediatrics, Uniformed Services University, Bethesda, MD.
Pediatr Crit Care Med. 2024 Dec 1;25(12):1150-1158. doi: 10.1097/PCC.0000000000003623. Epub 2024 Oct 25.
Burn centers offer specialized care to pediatric patients with burn injuries. However, data about outcome in relation to timing of transfer are limited. We examined these timings and outcomes among burn-injured pediatric patients.
Single-center, retrospective cohort study of U.S. national and international practice.
Shriners ESO Trauma Burn Registry, 2005-2019.
Patients 0-17 years old admitted to a pediatric burn center with 10-80% total body surface area (TBSA) burn between 2005 and 2019.
None.
The cohort of 761 patients was subcategorized according to timing of referral: early presentation (EP) (0-7 d), delayed presentation (DP) (8-60 d), and very delayed presentation (VDP) (> 60 d). Primary outcomes included hospital length of stay (LOS), ICU LOS, percent TBSA (%TBSA)/LOS ratio, mortality, and disposition. Dichotomous outcomes were analyzed using logistic regression and continuous outcomes were compared using median regression, both utilizing multivariable analysis adjusting for a priori confounders and presented as adjusted coefficients (ACs) with 95% CI. Delayed referral (DP and VDP) was associated with higher %TBSA burn and with fewer referrals from high-income countries. Compared with EP, VDP was associated with higher LOS/%TBSA (AC, 0.2 [0.01-0.4]). On univariate analysis, in comparison with EP, DP and VDP were associated with higher ICU (DP 16 [6-29]; VDP 8 [0-18]) and hospital LOS (DP 34 [21-55]; VDP 32 [18-58]). Overall, ten of 761 patients died (1.3%), and we found no association between timing of referral and mortality. Also, in 751 survivors, 635 patients (84.6%) were discharged home without home health, and we found no association with timing of referral on multivariable analysis.
In this report, we have reviewed our single-center, international burn-injured pediatric cohort, operating in the United States (2005-2019). We find that referral with VDP as opposed to EP was associated with increased LOS/%TBSA.
烧伤中心为烧伤的儿科患者提供专科护理。然而，关于转运时机与预后关系的数据有限。我们研究了烧伤儿科患者的这些转运时机及预后情况。
对美国国内及国际实践进行的单中心回顾性队列研究。
2005 - 2019年史瑞纳儿童医院烧伤创伤登记处。
2005年至2019年间，年龄在0 - 17岁、全身烧伤面积（TBSA）为10% - 80%并入住儿科烧伤中心的患者。
无。
761例患者队列根据转诊时机进行亚分类：早期就诊（EP）（0 - 7天）、延迟就诊（DP）（8 - 60天）和极延迟就诊（VDP）（> 60天）。主要结局包括住院时间（LOS）、重症监护病房住院时间（ICU LOS）、TBSA百分比（%TBSA）/LOS比值、死亡率及出院情况。二分结局采用逻辑回归分析，连续结局采用中位数回归分析，均采用多变量分析调整先验混杂因素，并以调整系数（ACs）及95%置信区间呈现。延迟转诊（DP和VDP）与较高的%TBSA烧伤相关，且来自高收入国家的转诊较少。与EP相比，VDP与较高的LOS/%TBSA相关（AC，0.2 [0.01 - 0.4]）。单因素分析显示，与EP相比，DP和VDP与较高的ICU住院时间（DP为16天[6 - 29天]；VDP为8天[0 - 18天]）和住院时间（DP为34天[21 - 55天]；VDP为32天[18 - 58天]）相关。总体而言，761例患者中有10例死亡（1.3%），我们发现转诊时机与死亡率之间无关联。此外，在751名幸存者中，635例患者（84.6%）出院回家且无需家庭健康护理，多变量分析显示我们未发现与转诊时机存在关联。
在本报告中，我们回顾了在美国（2005 - 2019年）运营的单中心国际烧伤儿科队列。我们发现与EP相比，VDP转诊与LOS/%TBSA增加相关。
