Special Aspects in Pediatric Surgical Inpatient Care of Refugee Children: A Comparative Cohort Study

Abstract

Background: Recently, the number of refugees in Germany has skyrocketed, leading to a marked increase in refugee children admitted to hospitals. This study describes the special characteristics encountered in pediatric surgical inpatient refugees compared to locally residing patients.

Methods: Hospital records of minor refugees admitted to our department from 2005 up to and including 2015 were retrospectively reviewed. Demographic data, diagnoses, comorbidities, body mass indexes, hemoglobin values, and lengths of stay were extracted and statistically compared to local patients.

Results: A total of 63 refugee children were analyzed and compared to 24,983 locally residing children. There was no difference in median body mass index (16.2 vs. 16.3, respectively, p = 0.26). However, refugee children had significantly lower hemoglobin values (11.95 vs. 12.79 g/dL, p < 0.0001) and were more likely to be colonized with methicillin-resistant Staphylococcus. aureus (8% vs. 0.04%, p < 0.01). Refugees were much more likely to present with burn injuries (16% versus 3% of admissions, p < 0.001), esophageal foreign bodies (4% vs. 0.5%, p < 0.001), as well as trauma, except for closed head injury.

Conclusion: The cohort of refugee children in this study was found to be at a particular risk for suffering from burn injuries, trauma, foreign body aspirations, and anemia. Appropriate preventive measures and screening programs should be implemented accordingly.

Keywords: Methicillin-resistant Staphylococcus aureus; Multidrugresistant gram negative bacteria; anemia; burns; children; foreign bodies; refugee; trauma.

Figure 1

Number of refugee children treated at our department from January 2005 until December 2015. The blue line represents inpatients, the red line represents ambulatory patients. A sharp rise is evident in the years 2014 and 2015.

Figure 2

Comparison of body mass index (BMI) between refugees (left) and locally residing in-house patients. While the mean values were similar at 16.2 versus 16.3 (p = 0.25, nonsignificant (NS)), the range was greater in the minor refugee group.

Figure 3

Hemoglobin values of refugee children (left) versus locally residing pediatric surgical inpatients (right). Refugees had significantly lower values and were more likely at risk for anemia.

Figure 4

Relative proportion of admission diagnoses of refugee children (in green) and locally residing patients (in red) admitted to pediatric surgery from January 2005 until December 2015. While minor closed head injuries were more common in locals, refugees were more likely to be diagnosed with burns, esophageal foreign bodies, wrist injuries, and other types of trauma combined.