Evolving treatment in a decade of pediatric burn care.
BACKGROUND
Over the last decade, an ambulatory burn care (ABC) and procedural sedation (PS) program was instituted at St Louis Children's Hospital (SLCH). This study assessed the effect of these interventions on resource utilization.


METHODS
The authors reviewed the hospital experience comparing 1993 with 2002 data regarding gender, age, burn depth, patient admissions, inpatient days, and ABC visits. Outcome measures included length of stay (LOS), incidence of infection, and hospital charges.


RESULTS
Gender, age, and burn depth were similar; 192 patients were admitted in 1993. In 2002, there were 167 admissions and 118 patients treated solely on an ABC basis resulting in a total of 285 burn patients treated (+48%). Hospital days decreased from 2,041 (1993) to 963 (2002 [-53%]). LOS declined from 10.4 +/- 8.3 days (1993) to 5.8 +/- 14.2 days (2002 [-44%; P <.05]). PS was used sporadically in 1993, and increased to 71% in patients in 2002. There were no ABC visits in 1993 and 501 visits in 2002. The incidence of infection was 5.2% in 1993 versus 3.0% in 2002 (P <.05) Average charge per patient fell 45% from 13,286 dollars (1993) to 7,372 dollars (2002), adjusted to 1993 dollars using medical care price index.


CONCLUSIONS
Over a 10-year period, the program achieved a significant reduction in resource utilization while increasing the number of patients treated and maintaining a low incidence of infection. This was due in large part to a shift to ABC and the use of PS.
Foglia
Robert P
RP
Division of Pediatric Surgery, Washington University School of Medicine and St Louis Children's Hospital, St Louis, MO 63110, USA.
Moushey
Robin
R
Meadows
Lisa
L
Seigel
Jennifer
J
Smith
Maureen
M
D000293:Adolescent; D000554:Ambulatory Care Facilities / Q000191:economics / Q000706:statistics & numerical data / Q000639:trends; D000700:Analgesics / Q000627:therapeutic use; D001458:Bandages; D002053:Burn Units / Q000191:economics / Q000706:statistics & numerical data* / Q000639:trends; D002056:Burns / Q000191:economics / Q000453:epidemiology / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D016292:Procedural Sedation; D003646:Debridement / Q000191:economics / Q000379:methods; D016527:Drug Costs; D005260:Female; D017721:Hospital Costs; D006801:Humans; D015994:Incidence; D007223:Infant; D007239:Infections / Q000191:economics / Q000453:epidemiology / Q000209:etiology; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008499:Medical Records; D008923:Missouri / Q000453:epidemiology; D008991:Monitoring, Physiologic / Q000191:economics; D010343:Patient Admission / Q000706:statistics & numerical data; D026741:Physical Therapy Modalities / Q000191:economics; D012042:Registries
D000700:Analgesics