| Injuries not only threatened to the physical and mental health of children and adolescent seriously,but also make serious burden of disease.It has been an important problem of the public health.Whether they gain the succors in time is one of the important factors for the outcome.Limited information was documented regarding the epidemiological characteristics,diagnosis and treatment,as well as the change tendencies of injury and its burden of disease among 0~14 year old hospitalized injuries children.In this study,we selected the child which is one of the disadvantaged groups in the health services study as the subjective.To analyze the epidemiological characteristics,the diagnosis and treatment characteristics of hospitalized injuries children from 2008 to 2013 in Shanxi.The aim is to provide comprehensive guidance for prevention of injuries and more effective treatment.The economic burden of injures and its main influence factors were explored in the present study.Objectives:1.To investigate the epidemiological characteristics and change tendencies of injury among hospitalized injuries children.2.To describe the characteristics of diagnosis and treatment among hospitalized injuries children,and analyses the risk factors of urgency degree,complication,operative treatment and outcome.3.To analyze the burden of disease and its change tendencies.Methods:This was a retrospective analysis in which data was collected in children(0~14 years old)involving injury from January 2008 to December 2013.The hospitalized patients were from 7 hospitals in Shanxi.International Classification of Diseases(10th Revision)was used to define injury.All hospitalized injury children were selected for analysis in this period time.Injury types were classified by using the ICD-10-CM code(V01-Y98).Injury location and injury quality were identified by using the ICD-10-CM code(S00-T98).Data collected included:(1)the demographic factors: gender,age,birth date,living region,etc.;(2)epidemiological characteristics of injury: injury types,injury site of body,location of injuries occurring,injury quality,cause of injuries;(3)hospitalizations characteristics: length in hospitalized,disease severity(minor,moderate,and severe),department of treatment,complication(yes/no),type of therapies(whether operation or not)and outcome(cure,improvement,disabilities,and death).The indexes of the burden of disease include: length of stay in hospital,PYLL,DALY,cost of hospitalization and the way of paying(medical insurance for urban residents,new rural cooperatives medical service,and commercial insurance and self-paying).All the information was input into an Excel sheet,statistical analyses were performed by using SPSS v13.0 statistical software.Descriptive analysis of the data was presented as percentage,mean and SD.Qualitative data were compared between differed group by using the chi-squared test or nonparametric rank sum test.Furthermore,associations between each index were assessed using Spearman’s correlation analysis.A multiple linear regression analysis was used to assess the risk factors of length of stay in hospital.A binary classification logistic regression analysis was used to assess the risk factors of therapy and complication.An ordinal logistic regression analysis was used to assess the risk factors of disease severity and outcome.A dynamic series was used to assess the change tendencies of hospitalizations person-time,length of stay,and cost of hospitalization.We also used an auto-regressive integrated moving average(ARIMA)modeling of the time series analysis to predict future cost of hospitalization.A path analysis was used to assess the risk factors of cost of hospitalization by SAS9.2.A p-value < 0.05 indicated statistical significance.Results: Part I: Injury epidemiological characteristics and change tendencies among hospitalized injuries children 1.A total of 11177 person-times were collected during the study period.Boys were 63% and girls were37%,males-females ratio was 1.70:1.The males-females ratio was increased with age.Urban children were 37.4%,rural were 62.6%,and urban-rural ratio was 1:1.67.The person-time of 1~4 years old was 46.7%,composing the largest proportion.The median age was 3 years old.2.There was an upward trend of person-time among hospitalized injury children from 2008 to 2013.The average speed of development was 114.7% per year;the average speed of growth was 14.7% per year.The average speed of growth of person-time with age in girls(-12.24%)was less than boys(-7.66%),in rural(-10.28%)was less than urban(-7.38%).3.The hospitalized unintentional injury children were 98.7%(11034 person-times).The main injury types were fall(25.6%),traffic accident(18.9%),and foreign bodies’ injury(18.7%).1.28%(143 person-times)was intentional injury.In intentional injury,self-injury was 16.9%,and 83.1% was injured by others.The cause of fall was tumble(55.7%)and fall from a height(44.3%).The children were walking(62.6%),by motor vehicle(31.0%),and by non-automatic vehicles(6.5%)when happen the traffic accident.The important types of foreign bodies’ injury were intratracheal foreign body(82.7%),esophageal foreign bodies(9.5%),and gastrointestinal(stomach and small intestine)foreign bodies(2.2%).4.The significant difference were all found in the distributions of injury type according to ages,urban and rural,males and females(P<0.001).5.250 people hospitalization medical unintentional injury were total 1820 person-times.42.4% hospitalized one times,57.6% hospitalized more than two times.The highest frequency were 93,average frequency was 7.92.The people hospitalized repeatedly two or more times were due to the same medical unintentional injury.6.The main injury sites were head(32.0%),chest(18.9%),and neck(17.3%).In untentional injury,50.5% of head injury was caused by fall,92.2% of thoracic injury was caused by foreign bodies,and 91.4% of neck injury was caused by medical unintentional injury.The significant difference were all found in the distributions of injury site according to injury type,injury intent,ages,urban and rural,males and females(P <0.001).Further analysis using Spearman’s analysis indicated the injury site of head,stomach-waist-pelvis,shoulder-upper arm,elbow-forearm,and knee-shank has a positive correlation with age respectively(sg = 0.125,0.127,0.138,0.134,and 0.146,P<0.01);the injury site of neck,and thoracic has a negative correlation with age respectively(sg =-0.328,-0.206,P<0.01).7.The main injury qualities were internal organ injury(24.2%),foreign bodies’ damage(18.2%),and nerve-spinal cord injury(16.1%).The leading cause of internal organ injuries was fall(55.7%),99.4% on the head.The leading cause of nerve-spinal cord injury was medical unintentional injury(98.2%),98.8% on the head and neck region.The significant difference were all found in the distributions of injury qualities according to ages,urban and rural,males and females(P <0.001).Further analysis using Spearman’s analysis indicated the spinal cord injury,and foreign object injury has a negative correlation with age respectively(sg =-0.358,-0.219,P<0.01);Fracture has a positive correlation with age(sg = 0.255,P<0.01).8.47.5% of all injury happened in home,26.9% in street or road,and 18.1% in public place.The significant differences were all found in the distributions of place according to ages,urban and rural,males and females(P < 0.001).Part II: Hospitalized characteristics among hospitalizations injuries children 1.The disease minor contribute 38.0% among 11177 person-times,48.8% was moderate,and 13.2% was severe.The significant difference were all found in the distributions of disease severity according to ages,urban and rural,males and females,type of injury,injury location,injury qualities(P < 0.001).The main risk affect factors on disease severity were age,rural children,and head organ damage caused by traffic accident.Under the other variables in controlling,the probability of occurrence of critical degree increases 1.057 times with annually age increased,in rural children was 1.300 times of urban children,the head and neck organ damage by traffic accident was 4.973 times of the multiple-site damage by other injury.2.56.0% person-times received surgical treatment.The significant difference were all found in the distributions of surgical treatment according to ages,urban and rural,males and females,injury type,injury location,injury qualities,with complication,and disease severity(P < 0.001).The main risk factors were with complication,in critical condition.Under the other variables in controlling,the probability of occurrence of operation in with complication was1.362 times of without complication,the disease critical was 2.850 times of in an ordinary condition.3.There were 8430 person-times recorded the information of complication.In these,55.4% were with complication,and 44.6% without complication.The main risk factors of complication were with urban children,disease critical,head and neck damage by medical unintentional injury,organ damage by traffic accident,and head organ damage.Under the other variables in controlling,the probability of occurrence of complication in urban children was1.126 times of rural children,in disease critical was 1.173 times of in disease ordinary,the head and neck damage by medical unintentional injury was 5.837 times of the multiple-site damage by other injury,the organ damage by traffic accident was 2.197 times of the other damage by other injury,the head organ damage was 2.269 times of the multiple-site other damage.4.In the outcome,60.9% was cure,32.4% improvement,4.8% disabilities,and 0.3% death.The main risk factors of outcome degree increase were without surgical treatment,disease critical,head and neck damage by medical unintentional injury,multiple-site damage by medical unintentional injury,and thoracoabdominal injury by impact injury.Under the other variables in controlling,the probability of occurrence of poor outcomes increase in without surgical treatment children was1.411 times of with surgical treatment children,the disease critical was 2.052 times of in ordinary condition,the head and neck damage by medical unintentional injury was 3.102 times of the multiple-site damage by other injury,the multiple-site damage by medical unintentional injury was 3.031 times of the multiple-site damage by other injury,and the thoracoabdominal injury by impact injury was 1.921 times of the multiple-site damage by other injury.Part III: Burden of disease and its change trends among hospitalizations injuries children 1.The median of length of stay in hospital was 7 days.The significant difference were all found in the distributions of length of stay according to urban and rural,surgical treatment,with complication,ages,injury type,injury sites,injury qualities,disease severity and outcome(p<0.001).The main risk factors of length of stay were rural children,disease critical,received surgical treatment,injury types: traffic accident,foreign bodies injury,medical unintentional injury,the injury location: head and neck region,thoracoabdominal,upper limb damage,lower limb damage,and injury quality: fracture or joint/muscle damage,organic damage(R2=0.358,adjust R2=0.357,F=234.893,P<0.001).2.The length of stay has increased tendency annually from 2008 to 2013.There was a slowly and unsteadiness decreasing tendency in average length of stay,chain base growth rate shows decreasing tendency.In urban,the chain base growth rate of average length of stay in hospital shows decreasing tendency,the average annual growth rate was-0.01%,in rural shows increasing tendency,the average annual growth rate was 0.22%.3.The total of PYLL was 2135.38 man-years among the hospitalizations injury children.The PYLLR account for 0.059‰ of 0~14 years old children,average PYLL was 73.63 man-years.The total of DALY was 312.35.4.The total cost of hospitalization was RMB 73.97 millions,with a mean cost of RMB 6491.31 Yuan per case.The total cost of hospitalization has increased annually from 2008 to 2013;the average annual growth rate was 0.23%.The chain base growth rate of mean cost shows decreasing tendency,but appears negative growth in 2013.From 2011,the chain base growth rate of total cost of hospitalization in urban children shows decreasing tendency,down from 16.3% to 6.6%.However,the chain base growth rate of total cost of hospitalization in rural children maintaining stable growth(13.0%).The average length of stay in hospital in rural children was more than urban children(P<0.001).5.In the influence factors,the largest contribution to the hospitalization cost was hospitalization days(r=0.45),followed by treatment(r=0.22),presence of complications(r=0.19),foreign bodies’ injury(r=-0.19),the thoracic injury(r=0.16),disease severity(r=0.13),organ damage(r=0.12).6.There was 83.0% person-times pay the hospitalization costs by medical insurance for urban residents or new rural cooperatives medical service.The significant difference were all found in the distributions of the medical payments according to ages,and urban and rural(p<0.001).Conclusions: 1.Foreign bodies’ injury is one of the main injury types of hospitalization injury children in Shanxi province.Medical unintentional injury is one of the few people but the more hospitalization person-times,mainly in children under the 5 years old;give priority to with neural spinal cord damage,is the main reason of children disability among hospitalization injury children.2.The disease severity,complication,surgical treatment and outcome of hospitalization injury children are influenced respectively by many risk factors.Prevention strategies for different external causes should be correspondingly specific.3.There was an upward trend of person-times and the total of length of stay in hospital among hospitalizations injuries children from 2008 to 2013.There was a slowly and unsteadiness decreasing tendency in average length of stay.There was an increasing tendency of total cost from 2008 to 2013.The chain base growth rate of mean cost shows decreasing tendency,appears negative growth in 2013.4.Hospitalization cost effects by the injury types,injury site,injury quality,and hospitalization characteristics;the largest contribution is from the length of stay.In conclusion,there were respective characteristics among children in different gender,age group,and region of living.In the base on the population intervention,we should take the individuation intervention among the high risk group.To pay attention to the risk factors in outcome of injury,so that we could carry out the prevention and precise treatment in pre-hospital care and hospitalized therapy.These would help for decreasing the negative outcome.Carry out the effective prevention measure from the first time of the injury happening,in order to decrease the medical cost and burden of disease. |
