The Burden of Paediatric Chronic Wounds: A Nationwide Analysis

Chronic wounds affect 10.5 million Americans annually and are projected to cost over $30 billion by 2030. Adult chronic wounds are well characterised, yet the paediatric burden remains understudied, hindering cost-effective management. Objectives were to (1) characterise epidemiology (prevalence, demographics, aetiology and comorbidities) and (2) quantify the economic impact of their hospitalisations. A retrospective cohort analysis of the 2017-2020 National Inpatient Sample (NIS), a 20% stratified sample of U.S. community hospital discharges identified patients ≤ 18 years with primary or secondary ICD-10-CM codes for chronic pressure ulcers, non-pressure ulcers, or osteomyelitis (haematogenous cases excluded). Variables included wound type, demographics, hospital characteristics (admission type, discharge disposition and region) and comorbidities. Outcomes comprised wound prevalence, length of stay and total inpatient costs (adjusted to 2020 USD). Multivariable models evaluated factors associated with costs. Of 45,645 paediatric chronic wound admissions, osteomyelitis was most common (47%-88%) and pressure ulcers appeared in 45% of secondary diagnoses. Males represented 61%; 55% were Medicaid beneficiaries. Median LOS was 8 days (IQR 3-16) for pressure ulcers and 4 days (IQR 3-7) for osteomyelitis. Four-year costs totalled $3.51 billion (≈$900 million annually), highest for head wounds ($5397/day) and pressure ulcers ($4668/day). Cerebral palsy (20%) and malnutrition (3%) were frequent comorbidities. Fourteen percent required home healthcare; inpatient mortality was 2%. Paediatric chronic wounds, predominantly osteomyelitis with complex comorbidities, incur high costs and prolonged hospitalisations. Tailored prevention and management strategies are essential to improve outcomes and reduce this healthcare burden.