Epidemiological characteristics and factors affecting length of hospital stay for children and adults with burns in Zunyi, China: a retrospective study

Abstract

ObjectiveBurn wounds are a global public health problem, and a large number of casualties are caused by burns each year. In this study, we explored the epidemiological characteristics associated with burns and the factors affecting the length of hospital stay (LOS) in children and adults with burn wounds.MethodsRecords of patients with burns in the Affiliated Hospital of Zunyi Medical University from January 1, 2014 to August 31, 2016 were retrieved. Information on demographic characteristics, mechanism of burns, first treatment received, clinical details of burns, and LOS were extracted from hospital medical records.ResultsA total of 465 children and 327 adults with burns were identified over about 2.5 years. The ratio of male to female children with burn wounds was 1.6 and 2.3 in adults. The epidemiological characteristics of burns, including gender, season, location, etiology, degree and site, differed between children and adults. There were differences in external remedies used (e.g., traditional Chinese medicine powder) and wound protection (towels covering wounds) between children and adults, but few patients had both protected wounds and did not use external remedies. LOS was reduced with age (hazard ratio [HR] = 0.993) and skin grafting (HR = 0.339). LOS increased with the male gender (HR = 1.234), deep partial thickness burns (HR = 3.128), and full-thickness burns (HR = 1.791). LOS was increased when total body surface area (TBSA) of burns reached from 10% to 29% (HR = 3.978), when TBSA was greater than 30% (HR = 1.787), and heat vs. non-heat etiologies (HR = 1.497).ConclusionOur findings for the epidemiological characteristics of burns in children and adults in Zunyi will help with a targeted awareness campaign and improve knowledge of first-aid and wound treatment.

Factors contributing to longer length of stay in Aboriginal and Torres Strait Islander children hospitalised for burn injury

“…skin grafting, in Australian children from rural locations as compared to metropolitan areas (Hyland et al 2015). We found that split skin grafts increased LOS for Aboriginal and Torres Strait Islander children in this study, which is different to past research in other populations, which reported grafting as decreasing LOS in children (Wang et al 2018). Recent research has suggested that Aboriginal and Torres Strait Islander children are remaining longer in hospital for their burns treatment, due to perceived social issues from clinical teams and for easier access to multidisciplinary support and care i.e.…”

“…The most significant prognostic factor providing the highest discharge ratios in all children was %TBSA, similar to previous research (Dolp et al 2018;Möller et al 2017;Hussain and Dunn 2013;AbdelWahab et al 2018;Taylor et al 2017;Gravante et al 2007;Matin et al 2015;Elrod et al 2019;Wang et al 2018;Hyland et al 2015;Meshulam-Derazon et al 2006). In Aboriginal and Torres Strait Islander children, greater %TBSA levels have been reported to increase LOS, however our ratios were greater than previous reports (Möller et al 2017).…”

“…Full thickness burns was another prognostic factor for Aboriginal and Torres Strait Islander children, again in line with past reporting (Möller et al 2017). In adult populations, full thickness burns and bacterial infections have been associated with increased LOS (Dolp et al 2018;Hussain and Dunn 2013;AbdelWahab et al 2018;Taylor et al 2017;Gravante et al 2007;Wang et al 2018). Although Aboriginal and Torres Strait Islander children had a higher proportion of bacterial infection, it was not associated with increased LOS, unlike for other Australian children.…”

“…Internationally there is a sound body of knowledge surrounding prognostic factors for hospital LOS in burn injuries (Dolp et al 2018;Moore et al 2015;Hussain and Dunn 2013;AbdelWahab et al 2018;Taylor et al 2017;Gravante et al 2007;Sierra Zúñiga et al 2016;Matin et al 2015;Elrod et al 2019;Wang et al 2018). In adults, percentage total body surface area (%TBSA), full thickness burns, socioeconomic status (SES), age, inhalation injury, comorbidities, surgical interventions, and injury complications have been shown to be associated with a longer LOS (Dolp et al 2018;Moore et al 2015;Hussain and Dunn 2013;AbdelWahab et al 2018;Taylor et al 2017;Gravante et al 2007;Sierra Zúñiga et al 2016).…”

“…In adults, percentage total body surface area (%TBSA), full thickness burns, socioeconomic status (SES), age, inhalation injury, comorbidities, surgical interventions, and injury complications have been shown to be associated with a longer LOS (Dolp et al 2018;Moore et al 2015;Hussain and Dunn 2013;AbdelWahab et al 2018;Taylor et al 2017;Gravante et al 2007;Sierra Zúñiga et al 2016). In children with a burn injury, large %TBSA (> 16%), burn cause (scald or flame compared to other types), full and partial thickness burns increase LOS, whereas younger age and early skin grafting decrease LOS (Matin et al 2015;Elrod et al 2019;Wang et al 2018). There has been comparatively limited research focussed on understanding prognostic factors contributing to longer LOS for burn injury in First Nation children.…”