O3217: The Burden of Pediatric Chronic Wounds: A Nationwide Analysis From the United States

Background: Annually, 10.5 million Americans suffer from chronic wounds, which necessitate frequent wound care and remain susceptible to severe complications. Wound management costs are thus projected to reach over 30 billion USD by 2030, imposing a substantial humanistic and economic burden on the healthcare system. Despite a recent increase in chronic wound cases among younger individuals, there is a paucity of research on the overall burden of pediatric chronic wounds, limiting cost-effective management strategies. The objectives of this study were: 1) to evaluate the epidemiology, including prevalence, demographics, etiology, and comorbidities, and 2) to assess the economic impact of pediatric chronic wound hospitalizations.

Methods: Children aged 18 years or younger were included in the study if they had inherently chronic wounds. These were defined by a principal diagnosis of either pressure ulcers, non-pressure ulcers, or osteomyelitis according to the International Classification of Diseases, Tenth Revision, Clinical Modification codes, identified from the National Inpatient Sample (NIS) data between the years 2017 and 2020. Survey procedures were employed to obtain national estimates (NE) of the total counts and hospital charges per day, accounting for stratum, weight, and clustering in the NIS dataset. Statistical analysis utilized one-way ANOVA testing to compare means within each variable. All costs were adjusted 2020 equivalents using the Consumer Price Index value provided by the Bureau of Labor Statistics.

Results: A total of 3,468 (NE 17,340, CI [16,006-18,674]) hospitalizations for pediatric chronic wounds were identified. Among these cases, over 72% were aged 6 years or older, with males constituting more than 60% of the cohort. Medicaid was the primary payer for 49% of the admissions. Primary diagnosis of osteomyelitis comprised over 90% of hospitalizations, and the lower extremity was the predominant site for more than half of the wounds. Common comorbidities included cerebral palsy (8%), myelomeningocele (5%), and malnutrition (3%).

The nationally estimated summed hospital charges for the cohort from 2017 to 2020 were $1,145,891,145 (CI $1,020,567,398 -$1,271,214,892). Discharge to home healthcare incurred a daily cost of $11,818 (CI $11,038-$12,599), significantly higher than that of other discharge dispositions, such as routine discharge and transfer to other facilities or short-term hospitals (p < 0.001). There were significant differences in cost per day among hospitals of varying rurality status (p < 0.001), with the largest disparity existing between metropolitan ($11,664, CI [$11,249-$12,079]) and rural ($9,449, CI [$8,623-$10,276]) hospitals. Hospitals in the western United States incurred significantly greater total daily charges compared to those in other regions (p < 0.001).

Conclusion: These findings substantiate the magnitude of chronic wounds that result in hospitalization among children. Future research should explore factors influencing hospitalization, duration, and cost for streamlined management. Interventions must focus on reducing hospitalization rates and optimizing chronic wound care to alleviate both humanistic and economic burden.