title: Burden of burns in Portugal, 2000-2013: A clinical and economic analysis of 26,447 hospitalisations.
abstract: BACKGROUND
  There is a lack of recent and nation-wide epidemiological studies of burns in Europe, mainly in southern Europe. There are no recent studies describing the clinical and economic burden of burns in this European area. Hence, this research aimed to describe the clinical and economic burden of burn hospitalisations in Portugal.
  
  
  METHODS
  A retrospective observational study was performed and the Portuguese hospitalisation database of public hospitals was used; all inpatients, discharged between 2000 and 2013, with a main or secondary diagnosis of burns (ICD-9-CM: 940.xx-949.xx) were taken into account. Furthermore, admissions to hospitals with and without burn centres were compared.
  
  
  RESULTS
  A total of 26,447 burn hospitalisations were registered (mean of 1889burn admissions/year). The total hospitalisation rate was of 18.9hospitalisations/100,000inhabitants/year, and there was a higher incidence of male patients. Burn hospitalisations and hospitalisation rates are significantly decreasing - mostly in 0-14-year-old patients - and children below the age of 5 years represented a fifth of all admissions. Besides the important morbidity, the in-hospital mortality rate was of 4.4%. With a total annual charge of almost 13million Euros, the average cost per burn admission is increasing, and reached 8032Euros in 2013. Additionally, more than half of the patients admitted to hospitals without burn centres were not transferred to hospitals with burn centres, not following the European Burns Association transferral criteria.
  
  
  CONCLUSIONS
  As the largest southern European nation-wide epidemiological study of burn patients, this research highlights that burn admissions, as well as hospitalisation rates, are decreasing significantly. This was particularly obvious among the youngest patients despite the fact that the numbers still remain very high. Moreover, the in-hospital mortality rate is still excessively high and the burn transferral criteria are not being followed. Thus, it is important to improve preventive measures, reach out to and educate providers about the burn transferral criteria, and develop specific health care strategies for children with these injuries.
authors.affiliation: CIDES - Department of Health Information and Decision Sciences, Faculty of Medicine, University of Porto, Portugal; CINTESIS - Center for Health Technology and Services Research, Portugal. Electronic address: jvasco.santos@gmail.com.
authors.forename: João V
authors.initials: JV
authors.lastname: Santos
authors.affiliation: CIDES - Department of Health Information and Decision Sciences, Faculty of Medicine, University of Porto, Portugal.
authors.forename: Andreia
authors.initials: A
authors.lastname: Oliveira
authors.affiliation: CIDES - Department of Health Information and Decision Sciences, Faculty of Medicine, University of Porto, Portugal; CINTESIS - Center for Health Technology and Services Research, Portugal.
authors.forename: Altamiro
authors.initials: A
authors.lastname: Costa-Pereira
authors.affiliation: Department of Plastic, Reconstructive, and Aesthetic Surgery, Hospital São João, Faculty of Medicine, University of Porto, Portugal.
authors.forename: José
authors.initials: J
authors.lastname: Amarante
authors.affiliation: CIDES - Department of Health Information and Decision Sciences, Faculty of Medicine, University of Porto, Portugal; CINTESIS - Center for Health Technology and Services Research, Portugal.
authors.forename: Alberto
authors.initials: A
authors.lastname: Freitas
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D002053:Burn Units / Q000706:statistics & numerical data; D002056:Burns / Q000191:economics / Q000453:epidemiology* / Q000209:etiology; D002648:Child; D002675:Child, Preschool; D005260:Female; D017721:Hospital Costs / Q000706:statistics & numerical data; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D007223:Infant; D038801:International Classification of Diseases; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011174:Portugal / Q000453:epidemiology; D012189:Retrospective Studies; D055815:Young Adult
keywords: Burden of disease; Burns; Costs; Epidemiology; Hospital; Portugal; Southern Europe