The incidence, trends, and costs of treatment of femoral shaft fractures among Finnish children aged 2-12 years between 1998 and 2016.

Purpose: The purpose of this study was to determine the incidence and trends of both hip spica casting and elastic stable intramedullary nailing in children aged 2-12 years who sustained femoral diaphyseal fracture between 1998 and 2016 in Finland. We also evaluated the actual hospital costs of both treatment methods as well as calculating the length of hospital stay. Methods: This study included all 2- to 12-year-old children with femoral diaphyseal fracture who were treated in Finland between 1998 and 2016. Data were collected from the National Hospital Discharge Register of Finland. Children were classified by age into five groups. The annual incidences per 100,000 persons were calculated using annual mid-year population census data obtained from Statistics Finland. Data on the annual actual daily hospital costs were collected from the Finnish Institute for Health and Welfare. Results: In total, 1064 patients aged 2-12 years who had sustained femoral diaphyseal fracture were treated with elastic stable intramedullary nailing or hip spica casting between 1998 and 2016. In children aged 4-5 years, the incidence of elastic stable intramedullary nailing increased during the study period from 5.4 per 100,000 persons in 1998 to 8.1 per 100,000 persons in 2016. Conclusions: The length of hospitalization in patients treated with elastic stable intramedullary nailing was shorter and, therefore, the total costs of hospital treatment were lower than in those children treated with hip spica cast. Level of evidence: level III.

Incidence of femoral fractures in children and adolescents in Finland and Sweden between 1998 and 2016: A binational population-based study.

BACKGROUND AND OBJECTIVE: Femoral fractures in children have significant impact for patients, family, and trauma resources as they usually require hospitalization and surgical treatment. The aim of this study was to determine the incidence and trends of femoral fractures among children and adolescents hospitalized between 1998 and 2016 in Finland and Sweden. METHODS: All patients younger than 17 years of age in Finland and Sweden with a femoral fracture treated surgically between 1998 and 2016 were included in the study. Data were collected from National Hospital Discharge Registries. Patients were classified by gender and age into four groups. The annual incidences per 100,000 were calculated using annual mid-year population census data obtained from the Official Statistics of Finland and Sweden. RESULTS: In total, 6410 patients younger than 17 years of age diagnosed with femoral fracture were included in this study. The total incidence per 100,000 femoral fractures was 13.3 in Finland and 11.0 in Sweden. The incidence of femoral fractures decreased during the study period in all age groups, except for teenage Finnish girls. Most of the fractures were located in femoral shaft. Fractures of the upper and distal femur were rare. Male predominance was detected in all age groups older than 1 year. CONCLUSIONS: The incidence of femoral fractures decreased in all age groups except in teenage Finnish girls. Majority of femoral fractures were located in femoral shaft with male predominance. In children younger than 1 year of age, female predominance was found.

The long-term health-related quality of life in children treated for burns as infants 5-9 years earlier.

The long-term outcome after infant burn was queried 5-9 years after the initial accident. All participants had been treated for burn in Children's Hospital, Helsinki, Finland, before the age of 1 year. We hypothesized that the health-related quality of life (HRQoL) in young burn survivors may be impaired compared to healthy age matched peers. The health-related quality of life of 126 infant burned patients with a mean total body surface area (TBSA) of 3.5% was queried with the standardized and validated 17D questionnaire. The HRQoL of the respondents was compared to that of a representative sample of the general age-standardized population. A total of 44 (35%) children with a mean age of 7 years responded, and 64% of them were male. The median time from trauma was 6.3 years. Burn related features, age at burn time, burn size and site, and the treatment given were similar in the respondents group and all children approached. The mean HRQoL score of the respondents was better than that of the control population (p<0.05). Comparison of the 17D profiles of the patients having been treated as inpatients or outpatients showed that those treated on an outpatient basis had better scores on the dimensions of speech, breathing, and friends (p<0.05). The 17D profiles of patients with scalds or contact burns were similar. The perceived and expressed long-term HRQoL in the burned children was good, and on some dimensions (sleeping, learning, discomfort and symptoms, breathing, depression, and appearance) even better, than that of the control population.

Incidence and risk factors of burn injuries among infants, Finland 1990-2010.

BACKGROUND: Our aim was to study the incidence, mechanisms, treatment, and risk factors of burn injuries in infants younger than 1 year. METHODS: Data on burn-injured infants during 1990-2011 in Finland came from the National Hospital Discharge Register (NHDR). Information on birth and maternal-related factors came from the Finnish Medical Birth Register, and data on fatal injuries from the Cause of Death Register of Finland. RESULTS: This study included 1842 children, female to male 1:1.5. The annual overall incidence of inhospital and outpatient admissions increased during the study period (p<0.05). Major risk factors were male gender, parity, and the mother's socioeconomic status and young age. The most common causes were scalds and contact burns. Severity of the injury increased along with increasing age, and children aged 9-12 months had the highest prevalence of surgical treatment. CONCLUSIONS: Burn injury incidence in children under 1 year has increased during recent decades in Finland. First-born 9- to 12-month-old boys of young mothers of low socioeconomic status are at higher risk of burn injuries. Preventative work needs strengthening to reduce infant burn injuries.

Outpatient treated burns in infants younger than 1 year in Helsinki during 2005-2009.

In general, voluminous data exists concerning burns in children, but the data focusing specially on children less than 1 year of age is sporadic. We therefore focused on examining the special features of burns in children less than 1 year of age. A retrospective study of all outpatient treated burn patients <1 year old at the Hospital for Children and Adolescents, Helsinki, Finland, from January 2005 to December 2009 was performed. During the 5-year period we identified 106 outpatient treated infants with burns, representing 15% of all pediatric burns during the study period. The majority was male and aged 9-12 months. Most of the burns occurred at home, and in most cases a caregiver was present in the injury room. Scalds were the most common type of injury followed by contact burns. The most common source of scald was from cups containing hot drink, and the most common source of contact burn was hot stoves or oven doors. Special attention needs to be targeted toward the prevention of burns in children less than 1 year of age. The majority of the injuries could have been prevented with more vigilance.

Burn injuries requiring hospitalization for infants younger than 1 year.

To investigate burn injuries requiring hospitalization sustained during the first year of life, clinical data collected during hospital treatment of infants younger than 1 year were reviewed. The principal aim was to chart the etiology and mechanism of burn injuries in this group to focus on the necessary preventive measures. The authors also review literature focusing especially on children younger than 1 year. Patients identified in the electronic database were referred to the Hospital for Children and Adolescents, Helsinki University Hospital, Helsinki, Finland, from January 2005 to December 2009. Specific inclusion criteria yielded a cohort of 20 patient records, which accounted for 3% of the 692 admissions due to pediatric burn injury during the 5-year study period. The male to female ratio was 1:1.5 and the mean age was 6.3 months. Most burns were sustained at home during domestic tasks and were most often witnessed. The etiology in the majority of the cases was scalding (85%), while contact burns accounted for the remaining. The final TBSA ranged from 0.5 to 40% (mean 8.5%). In 13 cases (65%), the initial TBSA was overestimated. Overall, it was concluded that burn injuries in this age group are most often witnessed and take place while the infant is being held at the same time as the hot item. Parental education on typical situations in which burn injuries happen in preambulatory infants may help reduce the number of burn injuries.

Bowel function and gastrointestinal quality of life among adults operated for Hirschsprung disease during childhood: a population-based study.

OBJECTIVE: To assess bowel function and gastrointestinal quality of life among adults with operated Hirschsprung's disease (HD). SUMMARY BACKGROUND DATA: Outcomes of HD extending to adulthood are unclear; bowel function and quality of life may deteriorate by aging. METHODS: Bowel function and gastrointestinal quality of life were cross-sectionally assessed in a population-based manner among adults operated for HD during childhood between 1950 and 1986. Patients were interviewed during their outpatient visit. Controls matched for age and sex were randomly chosen from the Population Register Centre of Finland. RESULTS: Ninety-two (64%) patients representative for the entire study population responded. The mean age of patients (79% male) was 43 (interquartile range [IQR], 35-48) years. Most (78%) had undergone Duhamel operation, and 94% had aganglionosis confined to the rectosigmoid. The mean overall bowel function score was decreased among patients (17.1 ± 2.8 vs 19.1 ± 1.2; P < 0.0001). They reported increased incidence of inability to hold back defecation (40% vs 17%), fecal soiling (48% vs 22%), constipation (30% vs 9%) and social problems related to bowel function (29% vs 11%; P < 0.05 for all). Gastrointestinal quality of life was only marginally lower among patients (121 ± 15.3 vs 125 ± 13.1; P = 0.0578) mainly because of significantly lower scores in questions assessing disease-specific factors such as bowel function and continence. Age was the only predictor of poor bowel function (OR 1.07, 95% CI 1.00-1.14, P = 0.049), which weakly predicted gastrointestinal quality of life (OR 0.81, 95% CI 0.66-1.01, P = 0.055). CONCLUSIONS: Although bowel function deteriorates with increasing age after operated HD, it is associated with only slightly decreased gastrointestinal quality of life.