Epidemiological Characteristics And Economic Burden Of Pediatric Burns In North China

Burns are injuries that severely threaten the health of children. Many studies have shown that children account for a high proportion of hospitalized burn patients. In general, hospitalized burns are severe burns relative to burns not admitted to hospitals. And children with severe burns require relatively long recovery times and multipleskin grafts and treatments, causing long-term physiological, psychological, and economic burdens for families and society.Because burns are preventable accidental injuries in children,accurate epidemiological data and trend analyses of burns inchildren can provide basic information for the decision-making processes of relevant state departments to facilitate the timely development of effective preventive measures. Previous domestic epidemiologic studies of burns in children are mostly confined to a single hospital or institute with sample sizes of fewer than 3000 cases and a lack of annual trend analysis. Thus, these studies do not fully and faithfully reflect the epidemiologic characteristics andtrends of childhood burns. With the development andadvancement of society, the epidemiological characteristics of children hospitalized for burns may have changed in recent years, requiring studies with larger sample sizes to evaluatethe current epidemiologic characteristics and trends in ChinaThe epidemic characteristics and the temporal and spatial distribution characteristics of hospitalized pediatric patients with burns in North China were analyzed, and a prediction model is established for pediatric burn inpatients,the aim is to provide comprehensive guidance for prevention of pediatric burn.The economic burden of pediatric burn and its main influencing factors were explored,the goal is to provided scientific basis for taking targeted measures to reduce the economic burden of pediatric burn. The study is divided into two parts.The first part The epidemic characteristics of children with burns Objective:To investigate the epidemic characteristics and trend of hospitalized pediatric burns in North China. Methods:(1) The epidemiological characteristics of hospitalized pediatric burns were analyzed.(2) The demographic information and treatment information of "Guo lian Kang" burn patients were studied, and the epidemic characteristics of "Guo Lian Kang" with other causes of scalds were compared.(3) Based on the ARIMA model, the month average temperature variable was introduced into the model, ARIMAX model was used to predict the number of hospitalized children with burns.(4) Taking monthly children burn admissions as health effect index, the generalized additive model(GAM) of time series model was set up, under control of the medium and long term trends related to the children burn admissions and other confounding factors, the relationship between temperature change and hospitalized children with burns was studied.(5) Based on the space-time scan method, children with burns data sets was created, the distribution map was made according to the geographical characteristics of children with burns, and the characteristics of temporal and space of children with burns were explored by spatial autocorrelation and temporal and spatial scanning analysis. Result:(1) In this study, children accounted for 43.57% of all hospitalized burns, with a gradually increasing trend(P = 0.003). Among children hospitalized burns, the percentage of children younger than three years was 69.9%, with an upward trend(P < 0.001). The ratio of male to female was 1.53:1. Scald burns accounted for 89.79% and 71.54% had burns of <10% total body surface area, with increasing trends(P<0.001). The medians of length of hospital stay and hospitalization cost were eight days and 2469 RMB yuan respectively.(2) Among the 1,993 clearly documented children with hot liquid vessel-induced scalds, 795(39.89%) had burns due to “guo lian kang”, The proportion of the pediatric burns caused by “guo lian kang” was 55.56% in 2002 and 37.30% in 2011, with a decreasing trend. One-year-old children accounted for the highest proportion of children with burns due to “guo lian kang”(male:female = 1.54:1). Scalding mostly occurred from October to May; the most common times were around 8:00 AM, 11:00 AM, and 7:00 PM. Most scalds occurred on the upper limbs, 90.22% of which were second-degree burns. The median burn area was 11% of the total body surface area. The burn agent was mainly hot water in the pot. Scalding mostly occurred when the children accidentally sat on, or fell or stepped into the pot while playing. Among the children with “guo lian kang”-induced scalds, up to 42.26% of the children did not receive any treatment before hospital admission, and 18.86% of the children were admitted to the hospital 6 hours or more after the occurrence of burns. In addition, 74.97% of the children’s families can afford the medical expenses, while 5.28% abandoned treatment because of financial difficulties. There were no significant differences between children with scalds caused by “guo lian kang” and scalds caused due to other reasons considering the age and sex. Compared to scalds due to other reasons, children with “guo lian kang”-induced scalds had greater burn area and depth, shock incidence, surgery rate, blood transfusion rate, length of hospital stay, and hospitalization costs.(3) The effects of monthly average temperature on the total number of children with burns is not monotone linear relationship, but a quadratic curve approximation is open to the bottom, for under 3 years old boy, girl, the influence is similar to the influence of the total number of hospitalized children with burns,and influence on boys aged three and above presents a more complicated piecewise curve relationship, no nonlinear effect was found for girls aged three years and above.(4) The ARIMA(0,1,1)(0,1,1)12(5) The spatial distribution of children with burns in Hohhot city is significant positive correlation in the global, the global autocorrelation index is 0.128; the following street or town exists gathering phenomenon of children burn patients in local area:Gen Gi Khan street, You You Ban town, Hailar Road East Street and Zhaojun road street are "high-high" regional, model was used to forecast the number of hospitalized children with burns in Hohhot city between 2011 January to December, the number of childrenwith burns were within 95% confidence interval of hospital admissions. The fitting effects of ARIMAX regression model included monthly average temperature of pediatric hospitalized burns is better than the ARIMA model, the Statationary R squared = 0.728 is higher than 0.691 of ARIMA model, compared to the ARIMA model,the mean absolute error and maximum absolute error reduced. the Daqing Shan of Wuchuan county is the "low-high" region. High gathering phenomenon exists between 2001 April and 2008 January.Monthly scan showed that the incidence of 1-4 month, 10-12 month for Hohhot children with burns was high. Gen Gi Khan street is one of the most likely gathering area. The main clustering area one is composed of black town, Erdos Road, Xi Cai Yuan and Zhaojun Road, the actual number is more than theoretical number of cases. The secondary clustering area two is composed of thirteen street or township, the secondary clustering district three consists of two street or township. The results of purely spatial clustering and purely temporal are similar to the result of retrospective space and time analysis. The prospective space-time scan found that children burn first gathered in Gen Gi Khan street, Xiao Hei He town, Erdos road, Zhaojun Road, Xi Hua Yuan, and then gradually spread to the Jin He town, Chile Chuan and Zhao Wuda road.Conclusion:(1) Children under three years of age, boys and children with a small area of mild scald burns should be made the focus of childhood burn prevention. Improving the medical insurancesystem for children is urgently needed.(2) Preventive measures against burns should be taken from October to May and mainly at cooking time in order to prevent burns in children with age less than three years old, especially in one-year-old boys. The most simple and effective preventive measure is to install a barrier between the pot and bed. The incidence of shock in children may be reduced if parents and primary medical staff undergo training to perform first aid for burns and if there are improvements in the referral system after burns.(3) When the parameter fitting condition of data is not satisfied, generalized additive model can effectively identify the relationship between the number of children with burns and temperature, the results can provide useful information for the formulation of pediatric burn prevention measures.(4) Comparing with the ARIMA model, the prediction effect of ARIMAX model included the monthly average temperature is improved.In future, the direct influence factors on the children with burns can be gradually try to included to make the forecast more accurately.(5) The main clustering areas of children with burns are Gen Gi Khan street, Xiao Hei He town, Erdos Road, Zhaojun Road, Xi Hua Yuan.The cause of high incidence of pediatric burn should be investigated to provide prevention measures.The second part The economic burden of pediatric burn patients Objective:To understand and forcast the basic rules and the major effect of economic burden among pediatric burn patients, and to provide reference for the cost benefit analysis of medical resources allocation. Methods:(1) The literature review and survey methods were used to analyze the direct and indirect cost of pediatric burn patients quantificationally.(2) The pediatric burn patients were clustered four groups based on K-means method according to the cost of medical record classification, considering the pseudo F statistic, CCC statistic(cubic clustering criterion) and R2to determine the best classification number in clustering, the burn characteristics of pediatric burn patients were analyzed based on the clustering results.The discriminant function was established.(3) The system dynamics method was used to explore the economic burden and the influence factors of children with burns.The economic burden model of pediatric burn was established by Vensim software, and the economic burden of the system behavior and internal operation mechanism were analyzed quantificationally. Result:(1) The number of study on the economic burden of pediatric burn at domestic and abroad are scarce, the current studies focused on the hospitalization expenses of a medical institutions or the evaluation of interventions only reflect economic burden the of pediatric hospitalized burn patients, and the majority of research only discuss the direct costs.(2) The hospitalization expenses of pediatric burn patients is mainly composed of medicine and treatment costs, accounting for 67.59% of all the total cost. Considering the pseudo F statistics, R 2 and CCC Statistics(cubic clustering criterion),the 16882 cases of pediatric burn patients were clustered as four groups according to their hospitalization cost, and the hospitalization expenses and length of stay of the standard value and range were calculated, and the depth of burn, the shock, burn area, operation and blood transfusion of four groups are analyzed.(3) The average economic burden of pediatric outpatient burn patient is 8874 yuan, is 1.24 times the average annual income of local rural households. The economic burden of inpatients is 37459.2 yuan, is 5.24 times the average annual income of local rural families. Indirect costs are mainly composed of informal care costs and the lost income.(4) The the economic burden system dynamics model of pediatric burn was constructed, the prediction accuracy of the model meets the requirements. To 2020, the economic burden of pediatric burn will reach 104.06 million yuan, of which 10.47 million yuan is direct cost, indirect cost is 93.59 million yuan, the ratio of direct and indirect cost was 1:8.94. Conclusion:The analysis of the economic burden of pediatric burn patients contributes to the understanding of its characteristics and influence factors, and it has a certain practical significance for reducing the economic burden caused by burns in children.(1) The optimal classification number of pediatric burn patients based on the pseudo F statistics, R2 and CCC values is effective. According to the construction characteristics of the clustering results,the discriminant function of burn patients was set up, it can be used to established the payment standard of pediatric burn patients.(2) The economic burden characteristics of Datong childrenwith burns were described by the system dynamics model. Maintaining the stability of intervention measures in Datong, the results of model simulation show that the number of pediatric burn was decreased, but the number of inpatient increased. The main part of children’s economic burden is indirect costs, especially for the early death in patients with indirect losses, thus lowered the incidence of burns in children and the death rate is the key factor for reducing the economic burden.