[[alternative]]The distribution and temporal trend of children burns in Taiwan

[[abstract]]中文摘要背景：燒燙傷是兒童常見的傷害之一，對於兒童和父母都有很大的影響，因為燒燙傷所導致的死亡、外觀及功能的殘疾可能會顯著影響兒童及父母，在生理、心理及經濟層面的問題，然而我國有關兒童燒燙傷的研究非常有限。目的：1.探討台灣地區2000年、2005年、2010年兒童燒燙傷的社會人口特性(性別、年齡、家庭收入、投保地區、投保地區都市化程度、發生季節)；2.分析台灣地區2000年、2005年、2010年兒童門急診、急診、重大傷病、住院及院內死亡之燒燙傷發生率趨勢；3.探討兒童燒燙傷住院的相關因素。方法：本研究使用國家衛生研究院發行之全民健康保險研究資料庫2000年、2005年及2010年百萬人歸人檔資料，利用SAS 9.3統計套裝軟體進行資料分析，首先使用描述性統計描述台灣地區2000至2010年兒童燒燙傷的概況及特性，其次，以Cytel Studio 8套裝軟體進行兒童燒燙傷就診率的線性趨勢檢定(Test for linear trend)，最後，以羅輯斯迴歸(logistic regression)探討兒童燒燙傷住院的相關因素。結果：0-18歲兒童總人數從2000年的244,539人下降至2010年的195,535人，平均年齡由2000年的8.25歲增加至2010年的9.06歲，兒童燒燙傷人數亦從2000年的1,711人下降至2010年的1,369人，平均年齡由2000年的6.90歲增加至2010年的7.50歲；就發生比率而言，以男性兒童、1-3歲兒童、低收入戶兒童、鄉村兒童及東部兒童較高。在趨勢分析方面，就門急診而言，4-6歲兒童有上升的趨勢，達統計上的顯著水準，就急診而言，13-18歲兒童有上升的趨勢，達統計上的顯著水準，就住院而言，兒童整體(0-18歲)及女性兒童整體有下降的趨勢，達統計上的顯著水準，1-3歲兒童下降幅度最為明顯；在兒童燒燙傷住院相關因素分析方面，就病患特質而言，相較於年齡0歲以下兒童，13-18歲兒童燒燙傷住院的勝算比較低(OR=0.416)，就投保地區而言，相較於北區，南區兒童燒燙傷住院的勝算比(OR=1.649)較高，就就醫方式而言，相較於非急診就醫兒童，急診就醫兒童燒燙傷住院的勝算比較高(OR=5.132)。結論：本研究結果顯示，4-6歲兒童燒燙傷門急診發生率有上升的趨勢，因此，建議衛生主管機關針對幼稚園兒童設計一套簡單生動的燒燙傷教材，教導兒童如何遠離燒燙傷以及發生燒燙傷事件時該如何簡易處理。關鍵詞：兒童、燒燙傷、全民健康保險[[abstract]]AbstractBackground: A burn injury is one of the commonly seen injuries in children and has a tremendous impact on the child and their parents. As a burn injury has the potential to cause death, significant physical appearance or functional damage, the patient and their families need to deal with issues at the physiological, psychological and economical level. In Taiwan, studies related to burn injuries are very limited.Objectives: First, to investigate the pediatric burn patient population characteristics during the years 2000, 2005 and 2010 in regions of Taiwan (gender, age, family income, insured area, insured area urbanized level, season which such incidence occurred). Second, to analyze the incidence rate trend for pediatric burn patient in pediatric emergency admission, emergency admission, catastrophic illness and death during hospital admission during the years 2000, 2005 and 2010 in regions of Taiwan.Third, to discuss the relative factors that affects the pediatric burn patient in hospital admission.Methods: This study used the longitudinal Health Insurance Database from year 2000, 2005 and 2010 of the National Health Insurance Research Database (NHIRD) derived from the Bureau of National Health Insurance, Taiwan (BNHI) and maintained by the National Health Research Institutes. SAS 9.3 program was used for data analysis. Initially, descriptive statistical analysis was performed for the regions in Taiwan between the years 2000 to 2010 to verify the overall characteristic of pediatric burn patients. Then, Cytel Studio 8 software was applied to give the test a linear trend. Lastly, logistic regression was adopted to discuss the relative factors which affect the hospitalization of pediatric burn patients.Results: Between 2000 to 2010, there was a decline in the total number of burn pediatric patients aged between 0-18 years old from 244,539 to 195,535. The average age of pediatric burn patients increased from 8.25 to 9.06 years old. Cases of pediatric burns within 2000-2010 periods had decreased from 1,711 to 1,369. There was an increase in the average age of the pediatric patient from 6.90 to 7.50. Male, children aged 1-3 yeared old, low income, children in the rural area and pediatric population situated in the Eastern region of Taiwan tend of to have higher occurrence rate. The linear trend analysis showed statistically significance in the incline of pediatric patient (aged 4-6 and 13-18) in emergency admission; decreased in the overall hospital admission for female pediatric patient and overall hospital admission (aged 0-18). Such a decline was the most significant in patients’ aged 1-3 years old. In the analysis for the relative factors that affects the pediatric burn patients in hospital admission, when comparing patients’ characteristics, patient’s aged 13-18 years old had a lower odds ratio (OR=0.416) than patients below the age of 0. In terms of insured area, Southern Taiwan children had a higher hospital admission odds ratio (OR=1.649) than those who live in the Northern Taiwan. Regarding the means of seeking for treatment, emergency admission had a higher odds ratio (OR=5.132) compared to the normal outpatient clinic. Conclusions: This study indicated a descent in trend for the emergency admission for pediatric aged 4-6. It was therefore recommended that, health management authority should design an uncomplicated and active teaching material that teaches children to stay away from potential burn incidence, as well as simple burn management.Keywords: children, burn, National Health Insuranc