Factors Associated With An Extended Length Of Stay In The Pediatric Burn Patient
*Michelle C Coughlin, *Elika Ridelman, *Marissa A Ray, *Justin D Klein, *Christina M Shanti
Wayne State University, Detroit, MI
The Center for Medicaid and Medicare Services (CMS) predicts the length of stay (LOS) of pediatric burn patients based on several variables. However, many patients exceed their anticipated LOS. This study looks to identify aspects of patient presentation, wound characteristics, treatment, and discharge that are associated with a longer-than-predicted LOS to identify strategies to safely reduce LOS.
We conducted a retrospective chart review of 535 pediatric thermal burn patients admitted to our academic hospital from January 2018 to December 2020. 405 patients met inclusion and exclusion criteria. Clinical data was collected and analyzed. Significance was given for a p-value <0.05
The average patient age was 3.36years, 58.8% were male and 46.9% black. 72.3% were treated for scald burns. Average LOS was 13.5 days. 20.5% (n=83) of patients exceeded their predicted LOS.In comparing patients who exceeded their predicted LOS to those who did not, the former had significant differences in burns caused by flame (30.1%-vs-17.7%), a greater %TBSA (12.80%-vs-4.24%), and more body areas involved with a greater mixed involvement of central and peripheral areas(68.7%-vs-21.1%).Patients who exceeded LOS 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 ICU admissions (22.9%-vs-2.2%) (p=0.00all). They also averaged more operations (2.83-vs-0.46 ), index auto-grafting (31.3%-vs-1.6%), total time spent in the OR (250-vs-31minutes ) and had a longer time from admission to the first OR (2.32-vs-1.64 days) (p=0.00all). Tube feeding averaged 9.52-vs-0.72days extending patient stay after wound stability (43.9%-vs-4.3%).Patients who exceeded predicted LOS also required more discharge planning, with higher rates of CPS involvement (39.8%-vs-10.9%), services consulted (1.06-vs-0.24consults), and discharges to inpatient rehabilitation (8.6%-vs-0.6%)). Finally, these patients also had a higher 30 day readmission rates (16.9%-vs-5.9% (p=0.002)). 89.6% of all patients followed-up in clinic.CONCLUSIONS:
In this study we identified several factors associated with extended stay. The next step is for us to individually evaluate these factors to modify our practice on the treatment of pediatric burn patients For example evaluating patient nutrition and initiating outpatient tube-feeding and follow-up after wound stability to reduce LOS.
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