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

Introduction: Annually, 10.5 million Americans suffer from chronic wounds, with associated costs projected to exceed 30 billion USD by 2030. Despite rising cases among younger individuals, there is a paucity of research on the overall burden of pediatric chronic wounds, limiting the development of cost-effective treatment strategies. This study aims to: 1) evaluate the epidemiology, including prevalence, demographics, etiology, and comorbidities and 2) assess the economic impact of pediatric chronic wound hospitalizations.Methods:Children 18 years with ICD-10-CM diagnoses of pressure ulcers, non-pressure ulcers, or osteomyelitis from 2017 to 2020 in the National Inpatient Sample were analyzed. Cohort 1 consisted exclusively of patients with primary admission diagnoses of these wounds. Cohort 2 included patients with these codes as either primary or secondary admission diagnoses. Survey procedures obtained national estimates of total counts and hospital charges, accounting for stratum, weight, and clustering. A one-way ANOVA test compared means within each variable. All charges were adjusted to 2020 equivalents using the Consumer Price Index value from the Bureau of Labor Statistics.Results:3,468 (NE 17,340, CI [16,006-18,674]) hospitalizations were identified in Cohort 1. Over 72% were 6 years or older, with males constituting more than 60% of the cohort. Medicaid was the primary payer for 49% of 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%). Cohort 2 had 10,649 (NE 53,245, CI [49,316-57,174]) hospitalizations, with osteomyelitis comprising 55% and pressure ulcers contributing to 38%. Annual estimated total hospital charges for Cohort 1 in 2020 were $3,013,932,287 (CI [210,741,554 – 392,045,020]). Discharge to home healthcare incurred a daily charge of $11,818 (CI [11,038 - 12,599]), significantly higher than other discharge dispositions, such as routine discharge and transfer to short-term hospitals (p 0.001). Hospitals in the western United States incurred significantly greater total daily charges compared to other regions (p 0.001). Estimated annual total hospital charges for Cohort 2 were $3,234,304,982 (CI [2,545,619,568 – 3,922,990,397]), representing the upper range of wound-related costs.Discussion: These findings are amongst the first to 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 are required to focus on reducing hospitalization rates and optimizing chronic wound care to alleviate both humanistic and economic burden.References:1. Sen CK. Human Wounds and Its Burden: An Updated Compendium of Estimates. Adv Wound Care (New Rochelle). 2019;8(2):39-48. 2. Graves N, Phillips CJ, Harding K. A narrative review of the epidemiology and economics of chronic wounds. Br J Dermatol. 2022;187(2):141-8. 3. Nussbaum SR, Carter MJ, Fife CE, DaVanzo J, Haught R, Nusgart M, et al. An Economic Evaluation of the Impact, Cost, and Medicare Policy Implications of Chronic Nonhealing Wounds. Value Health. 2018;21(1):27-32. 4. Baharestani MM. An overview of neonatal and pediatric wound care knowledge and considerations. Ostomy Wound Manage. 2007;53(6):34-6, 8, 40, passim.