Epidemiology And Direct Costs Of Hospitalized Pediatric Burns

According to the 5 th national population census, population aged 0-14 in China in year1982, 1990 and 2000 were 338.65 million, 313.92 million and 289.75 million people, which is undoubtedly an enormous group. The harmfulness of pediatric burn is not only the physical pain and the money, the time and the human resources that wasted for it, but also the dysfunction on children's physical and psychological development caused by hypertrophic scars, limb contracture and dysfunction. The impact on psychological development will induce serious consequences during patients'lifetime. Many studies from all over the world have shown that pediatric burn is a kind of accidental injuries that can be prevented, the waste of social resources caused by pediatric burn can be avoided by burn prevention, and thus a more efficient allocation of health resources can be afforded. The prevention of pediatric burns is one of the most important contents of health care service, for reducing the suffering of pediatric burn and the waste of medical resources, also for improving the quality of life and utilization of limited health services.The primary problem to be solved for prevention of pediatric burn is to investigate the epidemiology of it. The prevention policy can't be established well until the epidemiology of pediatric burn had been studied clearly, or the health resources could be unnecessary wasted. However, the epidemiology of pediatric burn have not been unified planned, the medical and scientific research institutions do their job without enough cooperation, and data reported by different institutions are not unified or even contradictory to each other. The national epidemiological data on pediatric burn has never been published authoritatively.Scald is the main mechanism of burn injury both in developed and developing countries, consuming a large amount of medical resources. Although some studies have involved in the economic analysis of pediatric burns, there is no study published specially on direct hospitalization costs of pediatric burns according to the results of literature retrieval.Following the principles of evidence-based medicine, we performed a systematic review on 28 studies on epidemiology of pediatric burns published during January 2000 and December 2005 in the absence of national statistical tools that can be used. By this kind of work, we can reveal the epidemiological characteristics of hospitalized pediatric burn patients in China. If possible, we would try to estimate the national epidemiological characteristics of pediatric burns from these data available, and so that it would be a preparatory work for the future prevention of pediatric burns.I n this study, we also described the characteristics of length of hospital stay and direct hospitalization costs of pediatric scalds, and the factors that influenced them were also studied. The results revealed by this study displayed characteristics of health resources consumption and the feasibility, urgency of pediatric burn prevention.Objective.1. This is an effort to systematically examine the nationwide data available on hospitalized pediatric burns in order to reveal its epidemiology and guide the future education and prevention.2. To reveal the characteristic and distribution of LOS (Length of hospital stay) and direct hospitalization costs of pediatric scald.Methods.1. China biomedical disc database, Chongqing VIP database and China journal full-text database were searched for papers reporting data on children and their burns from January 2000 through December 2005. Studies were included that systematically investigated the epidemiology of hospitalized pediatric burns in China. Twenty-eight articles met the inclusion criteria and all were retrospective analyses. For each study included, two investigators independently abstracted the data related to the population description, including the percentage of pediatric burn patients, sex and distribution of age; type of residential area, place of injury, distributions of months and time, reasons of burn, anatomical sites of burn, severity of burn, mortality and reason of death using a standard form. These data were extracted and a retrospective statistical description was performed with SPSS11.0 for Windows.2. A prospective case series observation was performed during 1 January 2005 to 31 December 2006 at the department of burn, Changhai Hospital, Shanghai, China. Pediatric scald patients inclued were recorded with their demographics, clinical diagnosis and treatments since admission. Direct cost of a treatment event was input into the price system when it occurred. All cost data were abstract when the study was completed. Distribution of LOS and hospitalization costs were describe by sex, age, total burn area, depth of burn, blood transfusion or not and patterns of treatment. Mann-Whitney signed rank test was used to assess differences between continuous nonnormally distributed variables and multiple linear regression was used to model LOS and direct hospitalization costs. All analyses were undertaken with SPSS 15.0 statistical software.Results.1. As far as the studies were concerned, the proportion of children in all burn patients ranged from 22.50% to 54.66%, the male/female ratio ranged from 1.25:1 to 4.42:1. The ratio of children at age 3 or younger/children older than age 3 was 0.19:1 to 4.18:1. The rural/urban ratio was 1.60:1 to 12.94:1. The indoors/outdoors ratio was 1.62 to 17.00, and there were no effective hints on the distribution of seasons and anatomical sites of burn that could be found. The peak hours of pediatric burn were during 17:00 and 20:00. Most papers reported the sequence of reasons as hot liquid > flame > electricity> chemical, and scalding was by far the most predominant reason of burn. The majority of the studies reported the highest proportion involved in moderate burn, whilst the lowest proportion in critical burn. The mortality ranged from 0.49% to 9.08%, and infection, shock and MODS were the most common reasons of death.2. Patients aged 3 or below consumed more than half of total LOS and total hospitalization costs, patients with burn area less than 10% TBSA consumed more than 70 % total LOS and more than half of total hospitalization costs, and patients with second degree burn consumed more than 78% of total LOS and total hospitalization costs. Depth of burn, area of burn, patterns of treatment and blood transfusion were independent predictors of LOS; LOS, area of burn and blood transfusion were independent predictors of hospitalization costs.Conclusion.1. Children involved a very high proportion in hospitalized burn patients when the national proportion of children was considered, especially those male, at 3 or younger, and most time lived indoors, were susceptible groups. They should be paid great attention when hot water was used or during supper time. This compilation and analysis of hospitalization-based information has been proved useful in establishing the rational priorities for prevention, a family-school-factory-government mode of preventive strategy has come into being and was performed effectively.2. Pediatric scalds have particular characteristics in terms of distribution of LOS and direct hospitalization costs and the factors influenced them. The data presented in this study should help burn control practitioners and hospital epidemiologists estimate and compare the economic burden of pediatric burns at other institutions, it also may be useful in resource allocation and cost effectiveness analysis of treatment versus prevention strategies.