Abstract
Background
A hospitalized patient’s length of stay (LOS) can have a significant impact on the performance and operating costs of a healthcare facility. Among pediatric patients, traumatic injuries are common causes of emergency room visits and hospitalizations. In Saudi Arabia, little is known about the burden of pediatric traumas on population health and the healthcare facilities. Therefore, the aim of this study was to investigate the associations between traumatic pediatric injury mechanisms and extended LOS in a trauma center.
Methods
Data was obtained from the trauma registry. From 2001 to 2018, trauma patients between the ages of 0 and 18 years old with LOSs of > 0 days were analyzed. The independent variable was the injury mechanism, which was classified as follows: falls, burns, drowning, motor vehicle collisions, motorcycle collisions, pedestrian, and intentional injuries. The dependent variable was an extended LOS defined as ≥21 days. A multivariate logistic regression analysis was used to evaluate the associations between the injury mechanisms and an extended LOS.
Results
A total of 5563 pediatric patients were included in this study. Of those, 774 (14%) had extended LOSs. Those patients with extended LOSs suffered more severe injuries than those with short hospital stays as measured by the Injury Severity Score (mean scores: 15.4 vs. 6.8, p < 0.01), the Glasgow Coma Scale score (mean scores: 10.4 vs, 14.0, p < 0.01), and the Revised Trauma Score (mean scores: 9.9 vs. 11.0, p < 0.01). Approximately one half of the patients with extended LOSs were admitted due to motor vehicle injuries. In addition, those patients were almost five times more likely to have extended LOSs than the patients who suffered fall injuries (odds ratio: 4.8, 95% confidence interval: 3.2–7.1).
Conclusions
Based on the study results, motor vehicle injuries were significantly associated with extended hospitalizations. Prevention is instrumental for reducing healthcare utilization; therefore, these findings call for public health professionals and policymakers to plan, design, and implement preventive measures to reduce the traffic injury burden. In addition, increased traffic law enforcement, such as the use of car restraints, is warranted to reduce the preventable injuries and improve the overall population health.
Similar content being viewed by others
Introduction
Hospital quality improvement and cost reduction continue to be some of the most critical issues for healthcare payers, providers, and policymakers worldwide. A patient’s hospital length of stay (LOS) is one of many criteria that are widely used to evaluate a hospital’s performance and operating costs [1]. Inevitably, extended hospitalizations are associated with increased costs, which place a greater burden on the healthcare system [2]. Each extended hospitalization day for a single patient can cost as much as $836 US dollars, according to a study of community-acquired pneumonia patients [3]. Naturally, reducing hospital LOSs is instrumental for achieving service efficiency and minimizing the healthcare-associated infection risk.
Certain injuries are associated with the hospital LOS. Globally, previous literature has investigated the causes of extended LOSs; for example, one study in Iran found that age, gender, and injury characteristics were associated with the hospital LOS [4]. Another study compared the hospital LOSs of teaching and nonteaching hospitals, and the results showed no differences among the pediatric trauma cases [5]. Other studies have examined the factors associated with an extended LOS among pediatric patients admitted to the emergency department (ED) [6]. In one study conducted in China, several factors were associated with hospital LOSs > 24 h in pediatric emergency units, including the age, the need for emergency transfusions, and the sociodemographic conditions [ In summary, we found that MVC and burn injuries were associated with a significant burden of the extended LOSs. Prevention is instrumental for reducing healthcare utilization and improving population health. Therefore, these findings call for public health professionals and policymakers to plan and implement preventive measures to reduce the MVC burden. Moreover, public health programs aimed to improve traffic safety for children, including the enforcement of car restraints, are desperately needed to reduce the burden of preventable injuries.Conclusion
Availability of data and materials
The study data is available upon request.
Abbreviations
- CI:
-
Confidence interval
- ED:
-
Emergency department
- GCS:
-
Glasgow Coma Scale
- ICU:
-
Intensive care unit
- ISS:
-
Injury Severity Score
- KAMC:
-
King Abdulaziz Medical City
- LOS:
-
Length of stay
- MVC:
-
Motor vehicle crash
- OR:
-
Odds ratio
- RTS:
-
Revised Trauma Score
- SA:
-
Saudi Arabia
- US:
-
United States
References
Bhattarai N, McMeekin P, Price C, Vale L. Economic evaluations on centralisation of specialised healthcare services: a systematic review of methods. BMJ Open. 2016;6:e011214.
Bosio RM, Delaney CP, Senagore AJ. Economic impact of POI and prolonged length of stay. Semin Colon Rectal Surg. 2005;16:235–8.
Fine MJ, Pratt HM, Obrosky DS, Lave JR, McIntosh LJ, Singer DE, et al. Relation between length of hospital stay and costs of care for patients with community-acquired pneumonia. Am J Med. 2000;109:378–85.
Haghparast-Bidgoli H, Saadat S, Bogg L, Yarmohammadian MH, Hasselberg M. Factors affecting hospital length of stay and hospital charges associated with road traffic-related injuries in Iran. BMC Health Serv Res. 2013;13:281. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3726419/pdf/1472-6963-13-281.pdf.
Myers J, Lehna C. Where are length of stays longer and Total charges higher for pediatric burn patients? J Burn Care Res. 2014;35:1. https://doi.org/10.1097/BCR.0000000000000012.
Bekmezian A, Chung PJ, Cabana MD, Maselli JH, Hilton JF, Hersh AL. Factors associated with prolonged emergency department length of stay for admitted children. Pediatr Emerg Care. 2011;27:110–5.
**e J, Lin Y, Kissoon N. Factors associated with prolonged stay in a pediatric emergency observation unit of an urban tertiary Children’s Hospital in China. Pediatr Emerg Care. 2013;29:183–90.
Ministry of Health Statistical Yearbook [Internet]. Riyadh, Saudi Arabia; 2017. Available from: https://www.moh.gov.sa/en/Ministry/Statistics/book/Documents/ANNUAL-STATISTICAL-BOOK-1438H.pdf.
Commodari E. Children staying in hospital: a research on psychological stress of caregivers. Ital J Pediatr. 2010;36:40.
Zhang Y-X, Wang S-R. Monitoring of blood pressure in overweight and obese children in Shandong, China. Ann Hum Biol. 2011;38:603–7.
Tintinalli JE, Stapczynski JS, Ma OJ, Yealy DM, Meckler GD, Cline D. Tintinalli’s emergency medicine: a comprehensive study guide. 2016.
Alhabdan S, Zamakhshary M, Alnaimi M, Mandora H, Alhamdan M, Al-Bedah K, et al. Epidemiology of traumatic head injury in children and adolescents in a major trauma center in Saudi Arabia: implications for injury prevention. Ann Saudi Med. 2013;33:52–6.
Teasdale G, Jennett B. Assessment of coma and impaired consciousness. Lancet [Internet]. 1974;304(7872):81–4. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0140673674916390. [cited 2019 Jun 1].
Kuhls DA, Malone DL, McCarter RJ, Napolitano LM. Predictors of mortality in adult trauma patients: the physiologic trauma score is equivalent to the trauma and injury severity score. J Am Coll Surg. 2002;194:695–704.
Saudi Red Crescent Authority. The establishment of the Saudi red crescent authority. 2016.
Doctoroff L, Hsu DJ, Mukamal KJ. Trends in prolonged hospitalizations in the United States from 2001 to 2012: a longitudinal cohort study. Am J Med. 2017;130(4):483.e1–7.
Hall MJ, Kozak LJ. Long-stay patients in short-stay hospitals. Adv Data. 1993;(229):1–16.
Mansuri FA, Al-Zalabani AH, Zalat MM, Qabshawi RI. Road safety and road traffic accidents in Saudi Arabia. A systematic review of existing evidence. Saudi Med J. 2015;36:418–24.
Burd RS, Jang TS, Nair SS. Evaluation of the relationship between mechanism of injury and outcome in pediatric trauma. J Trauma. 2007;62:1004–14.
Evbuomwan I. Paediatric trauma admissions in the Sakaka central hospital, Al-Jouf Province, Saudi Arabia. Saudi Med J. 1994;15:435–7.
Chowdhury SM, Rahman A, Mashreky SR, Giashuddin SM, Svanstrom L, Horte LG, et al. The horizon of unintentional injuries among children in low-income setting: an overview from Bangladesh health and injury survey. J Environ Public Health. 2009;2009:435403.
Adesunkanmi ARK, Oginni LM, Oyelami AO, Badru OSM. Epidemiology of childhood Injury. J Trauma Acute Care Surg. 1998;44:506–11.
Khatlani K, Alonge O, Rahman A, Hoque MD, Bhuiyan A-A, Agrawal P, et al. Caregiver supervision practices and risk of childhood unintentional injury mortality in Bangladesh. Int J Environ Res Public Health. 2017;14:515–27.
Ansari S, Akhdar F, Mandoorah M, Moutaery K. Causes and effects of road traffic accidents in Saudi Arabia. Public Health. 2000;114:37–9.
Abbas AK, Hefny AF, Abu-Zidan FM. Seatbelts and road traffic collision injuries. World J Emerg Surg. 2011;6:18.
Crankson SJ. Motor vehicle injuries in childhood: a hospital-based study in Saudi Arabia. Pediatr Surg Int. 2006;22:641–5.
Alghnam S, Alrowaily M, Alkelya M, Alsaif A, Almoaiqel F, Aldegheishem A. The prevalence of seatbelt and mobile phone use among drivers in Riyadh, Saudi Arabia: an observational study. J Saf Res. 2018;66:33–7.
Greenwell NK. Results of the National Child Restraint use Special Study; 2015.
Highway Traffic Safety Administration N, Department of Transportation U. Research note: effectiveness of child passenger safety information for the safe transportation of children. 2013.
Ahmad M. Pakistani experience of childhood burns in a private setup. Ann Burns Fire Disasters. 2010;23:25–7.
Sengoelge M, El-Khatib Z, Laflamme L. The global burden of child burn injuries in light of country level economic development and income inequality. Prev Med Reports. 2017;6:115–20.
Lari AR, Alaghehbandan R, Nikui R. Epidemiological study of 3341 burns patients during three years in Tehran. Iran Burns. 2000;26:49–53.
Keswani MH. The prevention of burning injury. Burns. 1986;12:533–9.
Aljerian N, Alhaidar S, Alothman A, AlJohi W, Albaqami FA, Alghnam SA. Association between the mode of transport and in-hospital medical complications in trauma patients: findings from a level-I trauma center in Saudi Arabia. Ann Saudi Med. 2018;38:8–14.
Group ETEMSAT, Hamam AF, Bagis MH, AlJohani K, Tashkandi AH. Public awareness of the EMS system in Western Saudi Arabia: identifying the weakest link. Int J Emerg Med. 2015;8:35.
Hemmila MR, Jakubus JL, Maggio PM, Wahl WL, Dimick JB, Campbell DA, et al. Real money: complications and hospital costs in trauma patients. Surgery. 2008;144:307–16. https://doi.org/10.1016/j.surg.2008.05.003.
Velopulos CG, Enwerem NY, Obirieze A, Hui X, Hashmi ZG, Scott VK, et al. National cost of trauma care by payer status. J Surg Res. 2013;184:444–9. https://doi.org/10.1016/j.jss.2013.05.068.
Alghnam S, Alkelya M, Alfraidy M, Al-bedah K, Albabtain ITIT, Alshenqeety O. Outcomes of road traffic injuries before and after the implementation of a camera ticketing system: a retrospective study from a large trauma center in Saudi Arabia. Ann Saudi Med. 2017;37:1–9. https://doi.org/10.5144/0256-4947.2017.1.
Alghnam S, Towhari J, Alkelya M, Binahmad A, Bell TM. The effectiveness of introducing detection cameras on compliance with mobile phone and seatbelt laws: a before-after study among drivers in Riyadh, Saudi Arabia. Inj Epidemiol. 2018;5:31. https://doi.org/10.1186/s40621-018-0161-z.
Government of Saudi Arabia. Saudi Arabia Vision. 2016;2030:85.
MacKenzie EJ, Rivara FP, Jurkovich GJ, Nathens AB, Frey KP, Egleston BL, et al. A national evaluation of the effect of trauma-center care on mortality. N Engl J Med. 2006;354:366–78.
Acknowledgements
Not applicable.
Funding
No funding was received for this study.
Author information
Authors and Affiliations
Contributions
SA and IA conceived the study question and design. MA wrote part of the Introduction section, JT wrote part of the Methods section, MD wrote part of the Results section, and MN wrote part of the Discussion section. SA wrote parts of all of the sections, and HA interpreted the results and critically reviewed all of the drafts. All of the authors reviewed various drafts of the manuscript. All authors read and approved the final manuscript.
Corresponding author
Ethics declarations
Ethics approval and consent to participate
This study was reviewed and approved by the Institutional Review Board at King Abdullah International Medical Research Center (KAIMRC).
Consent for publication
Not Applicable.
Competing interests
The authors declare that they have no competing interests.
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
About this article
Cite this article
Alghnam, S., Towhari, J.A., Al Babtain, I. et al. The associations between injury mechanism and extended hospital stay among pediatric patients: findings from a trauma Center in Saudi Arabia. BMC Pediatr 19, 177 (2019). https://doi.org/10.1186/s12887-019-1559-7
Received:
Accepted:
Published:
DOI: https://doi.org/10.1186/s12887-019-1559-7