Related Experiment Video
Updated: Jul 20, 2025
Author Spotlight: A Multi-Depth Porcine Model for Comprehensive Study of Burn Injuries and Healing Processes
Published on: February 23, 2024
Factors associated with an extended length of stay in the pediatric burn patient
Michelle C Coughlin1, Elika Ridelman1, Marissa A Ray1
1Department of Surgery, Division of Pediatric Surgery, Children's Hospital of Michigan/Wayne State University, Detroit, MI.
Insights
Pediatric burn patients often exceed their predicted length of stay. Factors like burn severity, need for surgery, and intensive care unit admission significantly increase hospital stays, highlighting areas for intervention.
Area of Science:
- Pediatric Burn Care
- Healthcare Outcomes Research
Background:
- The Center for Medicaid and Medicare Services (CMS) provides length of stay predictions for pediatric burn patients.
- A significant number of pediatric burn patients experience a longer length of stay than predicted by CMS.
- This discrepancy necessitates identifying factors contributing to extended hospitalizations.
Purpose of the Study:
- To identify patient presentation, wound characteristics, treatment, and discharge factors associated with exceeding predicted length of stay in pediatric burn patients.
- To inform strategies for safely reducing length of stay and aligning with CMS targets.
Main Methods:
- Retrospective chart review of 405 pediatric burn patients admitted between January 2018 and December 2020.
- Analysis of demographic, burn-specific, treatment, and discharge data.
- Comparison of patients who exceeded predicted length of stay versus those who did not.
Main Results:
- 20.5% of patients exceeded their predicted length of stay.
- Factors associated with longer stays included higher total body surface area burned, scald burns, endotracheal intubation, surgical interventions, and intensive care unit admissions.
- Increased operations, autografting, operating room time, and prolonged tube-feeding also correlated with extended stays.
- Higher rates of Child Protective Services involvement and discharges to inpatient rehabilitation were observed in patients with longer stays.
Conclusions:
- Approximately one-fifth of pediatric burn patients experience longer hospital stays than predicted by CMS.
- Several clinical and dispositional factors are strongly associated with these extended stays.
- Early identification of these factors can guide interventions to reduce length of stay and improve resource utilization.
Background:
The Center for Medicaid and Medicare Services predicts the length of stay for pediatric burn patients based on several variables. However, many patients exceed their anticipated length. This study looks to identify aspects of patient presentation, wound characteristics, treatment, and discharge that are associated with a longer-than-predicted length of stay to identify strategies to safely reduce it.
Methods:
We conducted a retrospective chart review of 535 pediatric burn patients admitted to our academic hospital from January 2018 to December 2020. 405 patients met inclusion criteria. Data were collected and analyzed.
Results:
Average patient age was 3.36 years. 72.3% were treated for scald burns. Average length of stay was 13.5 days. 20.5% (n = 83) of patients exceeded their predicted length of stay. In comparing patients who exceeded their predicted length of stay to those who did not, the former had significant differences in burn causes, percent total body surface area burned (12.80% vs 4.24% [P = .000]), and body areas involved. Patients who exceeded length of stay had a higher incidence of endotracheal intubation (15.7% vs 1.3%), surgical intervention (85.5% vs 29.2%), need for tube-feeding (48.2% vs 4.3%), and intensive care unit admissions (22.9% vs 2.2% [P = .00 all]). They also averaged more operations, autografting (31.3% vs 1.6% [P = .00]), total operating room time (250 vs 31 minutes [P = .00]), and time to the first operation (2.32 vs 1.64 days [P = .00]). Tube-feeding averaged 9.52 vs 0.72 days (P = .00) extending patient stay after wound stability (43.9% vs 4.3% [P = .00]). These patients also required more discharge planning, with higher rates of Child Protective Services involvement (39.8% vs 10.9% [P = .00]), services consulted (1.06 vs 0.24 [P = .00]), and discharges to inpatient rehabilitation (8.6% vs 0.6% [P = .00]). 89.6% of all patients followed up in clinic.
Conclusions:
Twenty percent of pediatric burn patients had a longer length of stay than predicted by the Center for Medicaid and Medicare Services. Many factors were strongly associated with a longer-than-predicted length of stay. Identifying these early on might help reduce length of stay and meet the targets of the Center for Medicaid and Medicare Services.
Related Concept Videos
01:22Burn Injuries
The damage results in the death of skin cells, which can lead to a massive loss of fluid. Dehydration, electrolyte imbalance, and renal and circulatory failure follow, which can be fatal. Burn patients are treated with intravenous fluids to offset...
01:19Restorative Care
01:19Factors Affecting Pulmonary Ventilation
Alveolar Surface Tension
The alveolar fluid lines the luminal surface of the alveoli and exerts a force called surface tension. This force is caused by the polar water molecules in the liquid being more strongly attracted to each...
01:30Pneumonia V: Nursing management and Prevention
The nurse must practice strict medical asepsis and adhere to infection control guidelines to minimize healthcare-associated infections.
Enhance airway patency
Position the patient correctly to facilitate drainage of the affected lung segments. Manual or mechanical percussion and vibration can also be employed....
01:30Pneumonia I: Introduction
Risk Factors
Various factors influence the likelihood of developing pneumonia. Age plays a crucial role, with infants, children under two, and individuals over 65 at increased risk due to their...
01:23Peripheral Artery Disease V: Postoperative Nursing Management