Johannes Schalamon

Neonatal “surgical” malformations are associated with higher costs than major “non-surgical” birth defects. We aimed to analyze the financial burden on the Austrian health system of five congenital malformations requiring timely postnatal surgery. The database of the Austrian National Public Health Institute for the period from 2002 to 2014 was reviewed. Diagnosis-related group (DRG) points assigned to hospital admissions containing five congenital malformations coded as principal diagnosis (esophageal atresia, duodenal atresia, congenital diaphragmatic hernia, gastroschisis, and omphalocele) were collected and compared to all hospitalizations for other reasons. Out of 3,518,625 total hospitalizations, there were 1664 admissions of patients with the selected malformations. The annual mean number was 128 (SD 17, range 110–175). The mean cost of the congenital malformations per hospital admission expressed in DRG points was 26,588 (range 0–465,772, SD 40,702) and was significantly higher compared to the other hospitalizations (n = 3,516,961; mean DRG 2194, range 0–834,997; SD 6161; p < 0.05). Surgical conditions requiring timely postnatal surgery place a significant financial burden on the healthcare system. The creation of a dedicated national register could allow for better planning of resource allocation, for improving the outcome of affected children, and for optimizing costs.

This study focuses on the impact of a prevention program regarding dog bites in children. As a consequence of our previous investigation in 2005, we have initiated a child safety program for primary school children starting January 2008 until present to teach children how to avoid dog attacks and how to behave in case of an attack. In our retrospective study, we analyzed all patients younger than 15 years presenting with dog-related injuries between 2014 and 2018. As the main indicator for success of the prevention measures taken, we have defined the severity of injury in comparison to our previous study. Out of 296 children with dog-related injuries, 212 (71.6%) had sustained a dog bite. In the vast majority (n = 195; 92%), these patients presented with minor injuries; the extremities were most commonly affected (n = 100; 47%). Injuries to the head (n = 95; 45%) and trunk (n = 18; 8%) were less frequent. The proportion of severe injuries (8%) was significantly lower compared to our previous study, where 26% of children presented with severe injuries necessitating surgical intervention, while the number of patients requiring in-hospital treatment declined from 27.5% in the period 1994–2003 to 9.0% in the period between 2014 and 2018 (p < 0.05).Conclusion: Teaching of primary school children may effectively reduce the injury severity of dog bites. What is Known:• Dog bites are a substantial healthcare problem especially in children. What is New:• This study shows that a broad-based prevention program for primary school children can effectively decrease the severity but not the frequency of dog bite injuries in children.

Zusammenfassung: Die Behandlung von seltenen Erkrankungen im Bereich der Kinder- und Jugendchirurgie ist in Österreich auf 7 Zentren verteilt. Obwohl es durchaus sinnvoll erscheint, weitere Schwerpunkte zu definieren, stehen zum jetzigen Zeitpunkt keine Informationen über aktuelle Fallzahlen und keine Outcome-Analysen der jeweiligen Abteilungen zur Verfügung. Daher empfiehlt sich als erster Schritt eine transparente Aufarbeitung der aktuellen Datenlage unter Einbeziehung der Sozialversicherungsträger. Nur dann können eine messbare Situationsanalyse und eine nachvollziehbare Verbesserung in der Betreuung von Patientinnen und Patienten mit seltenen Erkrankungen in Österreich erreicht werden.

Injury represents a major concern for children and adolescents worldwide. It is estimated that 10% to 25% of all pediatric injuries will result in fractures. This study aimed to analyze the epidemiology, gender distribution, age, and circumstances of fractures in childhood in a Level I Trauma Center in Austria. Children managed with fractures between December 2004 and October 2006 were prospectively evaluated. Patients were divided into four age groups: infants (14 years). The study included 3,339 patients younger than 19 years, who presented with 3,421 fractures. There was a male predominance (61.3%, n = 2,096). Girls (38.7%, n = 1,325) had a lower mean age at presentation of 8.2 years (boys, 9.8 years). An increase in the incidences of fractures was observed until a peak of 11 years in girls and 12 years in boys. A majority of fractures occurred in sports facilities (34.7%), followed by those at home (17.6%) and outdoors (16.7%). The most frequent mechanisms were falls on level surface (41.9%), falls from a height <3 m (23.2%), and involuntary contact with persons or objects (18.2%). The most common fractures were those of the distal radius (15.3%), followed by those of the finger (14%) and distal forearm fractures (8%). As the Department of Pediatric Surgery in Graz serves as the referral center at least for nearly all major pediatric fractures in the Austrian state of Styria, mechanisms and patterns of major fractures in this study can serve as the basis for state-wide pediatric injury prevention efforts. These prevention strategies should not aim to reduce the level of exposure but should increase the risk awareness and encourage children and their parents to use necessary precautions.