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与超出预测的住院时间相关的因素 在儿科创伤患者中
Michelle C Coughlin1, Elika Ridelman1, Lydia J Donoghue1
1Department of Surgery, Division of Pediatric Surgery, Children's Hospital of Michigan, Wayne State University, Detroit, MI, USA.
Clinical pediatrics
|September 29, 2025
概括
儿童创伤患者的伤害严重性得分较高,非意外创伤和复杂伤害往往超过预测的住院时间. 识别这些因素可以改善停留时间 (LOS) 的预测,并减少实际的LOS,以获得更好的报销.
科学领域:
- 创伤外科 手术 创伤外科
- 儿科重症监护中心儿童重症监护中心
- 医疗保健服务研究 医疗服务研究
背景情况:
- 医疗保险和医疗补助服务中心 (CMS) 使用预测停留时间 (LOS) 进行报销.
- 伤害严重性评分 (ISS) 和非意外创伤 (NAT) 与儿科创伤患者住院时间更长有关.
- 在儿科创伤中影响CMS预测的LOS的因素尚未完全理解.
研究的目的:
- 确定影响儿童创伤患者CMS预测LOS的因素.
- 确定实践变化是否可以减少实际的LOS.
- 制定改善LOS预测和减少实际LOS的策略.
主要方法:
- 1005名儿科创伤患者的回顾性图表审查 (2018年1月 - 2020年12月).
- 分析患者数据,包括人口统计,损伤特征和医院过程.
- 在P < .05.05时设置显著性的统计分析.
主要成果:
- 17.6%的患者超过了CMS预测的LOS.
- 过度的LOS与较高的ISS,确认的NAT,儿童保护服务的参与,ICU入院,输管,呼吸机日,输血和住院康复病人的出院有关.
- 像机动车事故和疑似虐待等病因,以及大脑和内脏器官受伤,与更长的逗留相关.
- 在患有过度LOS的患者中,增加了成像研究,手术程序和更长的手术时间.
结论:
- 儿童创伤患者的很大一部分超过了CMS预测的LOS,影响了医院的报销.
- 与患者人口统计学,创伤病因学和住院护理相关的因素会影响过度的LOS.
- 解决已识别的因素可以改善LOS预测,并可能减少实际的LOS.
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