# Predictors of Prolonged Hospitalization in Pediatric Burn Patients: Insights From a Rural Burn Intensive Care Unit (BICU) in Appalachia

## TL;DR

This study identifies age, burn severity, and burn source as key factors in longer hospital stays for children with burns in a rural Appalachian hospital.

## Contribution

The study provides region-specific insights into predictors of prolonged hospitalization for pediatric burn patients in a rural setting.

## Key findings

- Flame burns significantly increased hospital length of stay compared to other burn sources.
- Each additional year of age was associated with a 0.15-day increase in hospital stay.
- Larger total body surface area burns strongly predicted longer hospital stays.

## Abstract

Introduction: Burn injuries are the fifth most common cause of non-fatal injuries among children worldwide. Pediatric burn patients require complex management due to their distinct physiology compared to adults. The purpose of this study is to investigate demographic and clinical factors contributing to a prolonged total hospital duration among pediatric burn patients in a rural, Level 2 Trauma Center and Burn Intensive Care Unit (BICU) located in the Appalachian region.

Methods: Data were collected from 2017 to 2023 and included all patients 18 years and younger who were admitted to the Cabell Huntington Hospital BICU. Patient demographics were analyzed using descriptive statistics. One-way ANOVA assessed the differences between gender and length of stay (LOS) and source of burn and LOS. A chi-square test analyzed the effect of an inhalation injury on LOS. Pearson correlation was used to assess the relationship between BMI and LOS and between total ventilation days (TVD) and LOS.

Results: A total of 232 patients were included in this study, consisting of 102 (44%) females and 130 (56%) males. The average patient age was 6.9 years (SD ± 6.2). The mean LOS was 3.1 (SD ± 4.4) among this cohort. The most common sources of burn injuries within this cohort were flame (43%), scald (35%), and other (chemical/electric/radiation) comprising 22%. Flame burns were found to have a significant impact on LOS (p = 0.039), requiring longer hospital stays compared to other burn sources. Age was a significant predictor, with each additional year of age associated with an increase of 0.15 days in LOS (95% CI: 0.05 to 0.25, p < 0.001). Similarly, the total body surface area (TBSA) showed a significant positive association, with larger burn areas strongly predicting longer hospital stays (p < 0.001). The median TBSA was 5.5% (SD ± 6.7). For every 1% increase in TBSA burns, the hospital stay increased by approximately 0.13 days (95% CI: 0.05 to 0.22, p < 0.05). However, variables such as inhalation injury (p = 0.748) and BMI (p = 0.058) did not significantly predict hospital duration.

Conclusion: The results of this study demonstrated that age, burn severity, and the source of the burn are significant predictors of prolonged hospital stay in pediatric burn patients. Recognizing these key predictors of LOS will allow providers to identify high-risk patients early and initiate prompt stabilization, management, and timely referral to tertiary centers when necessary. Further, the results of this study may serve as the framework for the development of preventative efforts and regional care guidelines for rural, underserved healthcare providers.