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Boissin C. Clinical decision-support for acute burn referral and triage at specialized centres - Contribution from routine and digital health tools. Glob Health Action 2022; 15:2067389. [PMID: 35762795 PMCID: PMC9246103 DOI: 10.1080/16549716.2022.2067389] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Specialized care is crucial for severe burn injuries whereas minor burns should be handled at point-of-care. Misdiagnosis is common which leads to overburdening the system and to a lack of treatment for others due to resources shortage. OBJECTIVES The overarching aim was to evaluate four decision-support tools for diagnosis, referral, and triage of acute burns injuries in South Africa and Sweden: referral criteria, mortality prediction scores, image-based remote consultation and automated diagnosis. METHODS Study I retrospectively assessed adherence to referral criteria of 1165 patients admitted to the paediatric burns centre of the Western Cape of South Africa. Study II assessed mortality prediction of 372 patients admitted to the adults burns centre by evaluating an existing score (ABSI), and by using logistic regression. In study III, an online survey was used to assess the diagnostic accuracy of burn experts' image-based estimations using their smartphone or tablet. In study IV, two deep-learning algorithms were developed using 1105 acute burn images in order to identify the burn, and to classify burn depth. RESULTS Adherence to referral criteria was of 93.4%, and the age and severity criteria were associated with patient care. In adults, the ABSI score was a good predictor of mortality which affected a fifth of the patients and which was associated with gender, burn size and referral status. Experts were able to diagnose burn size, and burn depth using handheld devices. Finally, both a wound identifier and a depth classifier algorithm could be developed with relatively high accuracy. CONCLUSIONS Altogether the findings inform on the use of four tools along the care trajectory of patients with acute burns by assisting with the diagnosis, referral and triage from point-of-care to burns centres. This will assist with reducing inequities by improving access to the most appropriate care for patients.
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Affiliation(s)
- Constance Boissin
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
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McCrory MC, Woodruff AG, Saha AK, Halvorson EE, Critcher BM, Holmes JH. Characteristics of Burn-Injured Children in 117 U.S. PICUs (2009-2017): A Retrospective Virtual Pediatric Systems Database Study. Pediatr Crit Care Med 2021; 22:616-628. [PMID: 33689253 DOI: 10.1097/pcc.0000000000002660] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To describe characteristics and outcomes of children with burn injury treated in U.S. PICUs. DESIGN Retrospective study of admissions in the Virtual Pediatric Systems, LLC, database from 2009 to 2017. SETTING One hundred and seventeen PICUs in the United States. PATIENTS Patients less than 18 years old admitted with an active diagnosis of burn at admission. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS A total of 2,056 patients were included. They were predominantly male (62.6%) and less than 6 years old (66.7%). Cutaneous burns were recorded in 92.1% of patients, mouth/pharynx burns in 5.8%, inhalation injury in 5.1%, and larynx/trachea/lung burns in 4.5%. Among those with an etiology recorded (n = 861), scald was most common (38.6%), particularly in children less than 2 years old (67.8%). Fire/flame burns were most common (46.6%) in children greater than or equal to 2 years. Multiple organ failure was present in 26.2% of patients. Most patients (89%) were at facilities without American Burn Association pediatric verification. PICU mortality occurred in 4.5% of patients. On multivariable analysis using Pediatric Index of Mortality 2, greater than or equal to 30% total body surface area burned was significantly associated with mortality (odds ratio, 5.40; 95% CI, 2.16-13.51; p = 0.0003). When Pediatric Risk of Mortality III was used, greater than or equal to 30% total body surface area burned (odds ratio, 5.45; 95% CI, 1.95-15.26; p = 0.001) and inhalation injury (odds ratio, 5.39; 95% CI, 1.58-18.42; p = 0.007) were significantly associated with mortality. Among 366 survivors (18.6%) with Pediatric Cerebral Performance Category or Pediatric Overall Performance Category data, 190 (51.9%) had a greater than or equal to 1 point increase in Pediatric Cerebral Performance Category or Pediatric Overall Performance Category disability category and 80 (21.9%) had a new designation of moderate or severe disability, or persistent vegetative state. CONCLUSIONS Burn-injured patients in U.S. PICUs have a substantial burden of organ failure, morbidity, and mortality. Coordination among specialized facilities may be particularly important in this population, especially for those with higher % total body surface area burned or inhalation injury.
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Affiliation(s)
- Michael C McCrory
- Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, NC
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, NC
| | - Alan G Woodruff
- Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, NC
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, NC
- Center for Redox in Biology and Medicine, Wake Forest School of Medicine, Winston-Salem, NC
- Department of Nursing, Wake Forest School of Medicine, Winston-Salem, NC
- Department of Surgery, Wake Forest School of Medicine, Winston-Salem, NC
| | - Amit K Saha
- Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, NC
| | | | | | - James H Holmes
- Department of Surgery, Wake Forest School of Medicine, Winston-Salem, NC
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Chambers SB, Garland K, Dai C, DeLyzer T. Adherence of Burn Outpatient Clinic Referrals to ABA Criteria in a Tertiary Centre: Creating Unnecessary Referrals? J Burn Care Res 2021; 42:1275-1279. [PMID: 34139766 PMCID: PMC8344558 DOI: 10.1093/jbcr/irab117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Initial assessment and triage of burns are guided by the American Burn Association criteria for referral to a burn center. These criteria are sensitive but not specific and can potentially lead to over-triage and “unnecessary” clinic visits. We are a Level 1 trauma center with burn subspecialty care, and due to the COVID-19 pandemic, referrals to our multidisciplinary outpatient burn clinic required triaging for virtual care appointments. In order to improve the triage process, we retrospectively reviewed our outpatient burn clinic referrals over a 2-year period, 2018 to 2019, for adherence to American Burn Association criteria. We collected data pertaining to patient and burn characteristics, as well as treatment outcome, to characterize referrals not requiring an in-person appointment. Of the 244 patients referred, 73% met the referral criteria, with 45% of these patients being healed at the first visit and 14.6% requiring surgical management. Mean time from injury to first visit was 9.7 days (mode 6), and the average number of visits was 2. Overall, mean burn size was 2%, with the majority of injuries being partial thickness (71%), located in the hand or extremity (77%). There was a fairly equal distribution of contact (36%), flame (21%), and scald (26%) burns. This study highlights the nonspecific nature of the American Burn Association referral criteria. We found that pediatric and hand burns in particular were over-triaged and lead to “unnecessary” appointments. This information is useful to help adjust referral criteria and to guide triaging of appointments with the evolution of telehealth and virtual care.
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Affiliation(s)
- Spencer B Chambers
- Division of Plastic and Reconstructive Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Katie Garland
- Division of Plastic and Reconstructive Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Cecilia Dai
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Tanya DeLyzer
- Division of Plastic and Reconstructive Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
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Adherence to the emergency management of severe burns referral criteria in burn patients admitted to a hospital with or without a specialized burn center. Burns 2021; 47:1810-1817. [PMID: 33707084 DOI: 10.1016/j.burns.2021.02.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 01/31/2021] [Accepted: 02/16/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND The primary aim was to determine to what extent referral and admission of burn patients to a hospital with or without a burn center was in line with the EMSB referral criteria. METHODS This was a retrospective, multicenter cohort study. Burn patients admitted from 2014 to 2018 to a hospital in the Southwest Netherland trauma region and Network Emergency Care Brabant were included in this study. Outcome measures were the adherence to the EMSB referral criteria. RESULTS A total of 1790 patients were included, of whom 951 patients were primarily presented to a non-burn center. Of these patients, 666 (70.0%) were managed according to the referral criteria; 263 (27.7%) were appropriately not referred, 403 (42.4%) were appropriately referred. Twenty (2.1%) were overtransferred, and 265 (27.9%) undertransferred. In 1213 patients treated at a burn center 1119 (92.3%) met the referral criteria. Adherence was lowest for electrical (N = 4; 14.3%) and chemical burns (N = 16; 42.1%), and was highest in 'children ≥5% total body surface area (TBSA) burned' (N = 109; 83.2%). CONCLUSION The overall adherence to the referral criteria of patients presented to a non-burn center was fairly high. However, approximately 25% was not transferred to a burn center while meeting the criteria. Most improvement for individual criteria can be achieved in patients with electrical and chemical burns.
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Assessment of a quality improvement intervention to improve the consistency of total body surface area burn estimates between referring facilities and a pediatric burn center. Burns 2019; 45:1827-1832. [DOI: 10.1016/j.burns.2019.07.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 06/14/2019] [Accepted: 07/18/2019] [Indexed: 11/22/2022]
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Ewbank C, Sheckter CC, Warstadt NM, Pirrotta EA, Curtin C, Newton C, Wang NE. Variations in access to specialty care for children with severe burns. Am J Emerg Med 2019; 38:1146-1152. [PMID: 31474377 DOI: 10.1016/j.ajem.2019.158401] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 08/09/2019] [Accepted: 08/18/2019] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Pediatric burns account for 120,000 emergency department visits and 10,000 hospitalizations annually. The American Burn Association has guidelines regarding referrals to burn centers; however there is variation in burn center distribution. We hypothesized that disparity in access would be related to burn center access. METHODS Using weighted discharge data from the Nationwide Inpatient Sample 2001-2011, we identified pediatric patients with International Classification of Diseases-9th Revision codes for burns that also met American Burn Association criteria. Key characteristics were compared between pediatric patients treated at burn centers and those that were not. RESULTS Of 54,529 patients meeting criteria, 82.0% (n = 44,632) were treated at burn centers. Patients treated at burn centers were younger (5.6 versus 6.7 years old; p < 0.0001) and more likely to have burn injuries on multiple body regions (88% versus 12%; p < 0.0001). In urban areas, 84% of care was provided at burn centers versus 0% in rural areas (p < 0.0001), a difference attributable to the lack of burn centers in rural areas. Both length of stay and number of procedures were significantly higher for patients treated at burn centers (7.3 versus 4.4 days, p < 0.0001 and 2.3 versus 1.1 procedures, p < 0.0001; respectively). There were no significant differences in mortality (0.7% versus 0.8%, p = 0.692). CONCLUSION The majority of children who met criteria were treated at burn centers. There was no significant difference between geographical regions. Of those who were treated at burn centers, more severe injury patterns were noted, but there was no significant mortality difference. Further study of optimal referral of pediatric burn patients is needed.
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Affiliation(s)
- Clifton Ewbank
- University of California San Francisco East Bay Department of Surgery, Oakland, CA, United States of America; University of California San Francisco Benioff Children's Hospital Oakland, Oakland, CA, United States of America.
| | - Clifford C Sheckter
- Stanford University Department of Surgery, Stanford, CA, United States of America
| | - Nicholus M Warstadt
- Stanford University School of Medicine, Stanford, CA, United States of America
| | | | - Catherine Curtin
- Stanford University Department of Surgery, Stanford, CA, United States of America
| | - Christopher Newton
- University of California San Francisco Benioff Children's Hospital Oakland, Oakland, CA, United States of America
| | - N Ewen Wang
- Stanford University Department of Emergency Medicine, Stanford, CA, United States of America
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Anderson KT, Bartz-Kurycki MA, Garwood GM, Martin R, Gutierrez R, Supak DN, Wythe SN, Kawaguchi AL, Austin MT, Huzar TF, Tsao K. Let the right one in: High admission rate for low-acuity pediatric burns. Surgery 2019; 165:360-364. [DOI: 10.1016/j.surg.2018.06.046] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 05/11/2018] [Accepted: 06/25/2018] [Indexed: 10/28/2022]
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Klingberg A, Wallis LA, Hasselberg M, Yen PY, Fritzell SC. Teleconsultation Using Mobile Phones for Diagnosis and Acute Care of Burn Injuries Among Emergency Physicians: Mixed-Methods Study. JMIR Mhealth Uhealth 2018; 6:e11076. [PMID: 30341047 PMCID: PMC6231743 DOI: 10.2196/11076] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 07/18/2018] [Accepted: 07/18/2018] [Indexed: 02/01/2023] Open
Abstract
Background The referral process in acute care remains challenging in many areas including burn care. Mobile phone apps designed explicitly for medical referrals and consultations could streamline the referral process by using structured templates and integrating features specific to different specialties. However, as these apps are competing with commercial chat services, usability becomes a crucial factor for successful uptake. Objective The aim of this study was to assess the usability of a mobile phone app for remote consultations and referrals of burn injuries. Methods A total of 24 emergency doctors and 4 burns consultants were recruited for the study. A mixed-methods approach was used including a usability questionnaire and a think-aloud interview. Think-aloud sessions were video-recorded, and content analysis was undertaken with predefined codes relating to the following 3 themes: ease of use, usefulness of content, and technology-induced errors. Results The users perceived the app to be easy to use and useful, but some problems were identified. Issues relating to usability were associated with navigation, such as scrolling and zooming. Users also had problems in understanding the meaning of some icons and terminologies. Sometimes, some users felt limited by predefined options, and they wanted to be able to freely express their clinical findings. Conclusions We found that users faced problems mainly with navigation when the app did not work in the same way as the other apps that were frequently used. Our study also resonates with previous findings that when using standardized templates, the systems should also allow the user to express their clinical findings in their own words.
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Affiliation(s)
- Anders Klingberg
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Lee Alan Wallis
- Division of Emergency Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Marie Hasselberg
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Po-Yin Yen
- Institute for Informatics, Division of General Medical Sciences, Department of Medicine, Washington University School of Medicine, St. Louis, MO, United States.,Goldfarb School of Nursing, Barnes-Jewish College, St. Louis, MO, United States
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Survey of the Statewide Impact of Payer Source on Referral of Small Burns to Burn Centers. J Burn Care Res 2018; 38:e699-e703. [PMID: 27606548 DOI: 10.1097/bcr.0000000000000437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
It is generally agreed that patients with large burns will be referred to organized burn centers, however, the referral of patients with smaller burns is less certain. A two-part survey was conducted to identify referral patterns for burn patients that meet American Burn Association referral criteria, and any effect insurance type might have on the referral patterns. The emergency departments of our state hospital association's member hospitals were contacted seeking a referral for a fictitious patient with a third-degree scald of the dominant hand. The referral sites were contacted twice, first stating that the patient had commercial insurance, next stating that the patient had Medicaid. Data collected included wait time for an appointment or reasons for denial of an appointment. Of 218 hospitals, 46 were excluded because they did not offer emergency care, and eight because they were listed as burn centers on the American Burn Association website. Of the remaining 164, 119 (73%) would refer to a burn center, 21 (13%) to a plastic surgeon, 10 (6%) to a hand surgeon, 7 (4%) to a wound center, 7 (4%) to another nonburn physician resource. There was no difference in wait time to the first available appointment with regards to insurance type (6.56 ± 4.68 vs 6.53 ± 5.05 days). Our state's referral pattern gives us insight into the regional referral pattern. This information will be used to guide a focused education and communication program to provide better service for the burn victims of our state.
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Adherence to Referral Criteria at Admission and Patient Management at a Specialized Burns Centre: The Case of the Red Cross War Memorial Children's Hospital in Cape Town, South Africa. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14070732. [PMID: 28684713 PMCID: PMC5551170 DOI: 10.3390/ijerph14070732] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 06/15/2017] [Accepted: 07/03/2017] [Indexed: 11/25/2022]
Abstract
Referral guidelines for burn care are meant to assist in decision-making as regards patient transfer and admissions to specialized units. Little is known, however, concerning how closely they are followed and whether they are linked to patient care. This is the object of the current study, focused on the paediatric burns centre of the Red Cross War Memorial Children’s Hospital in Cape Town, South Africa. All patients admitted to the centre during the winters of 2011–2015 (n = 1165) were included. The patient files were scrutinized to clarify whether the referral criteria in place were identified (seven in total) and to compile data on patient and injury characteristics. A case was defined as adherent to the criteria when at least one criterion was fulfilled and adherence was expressed as a percentage with 95% confidence intervals, for all years aggregated as well as by year and by patient or injury characteristics. The association between adherence to any individual criterion and hospital care (surgery or longer length of stay) was measured using logistic regressions. The overall adherence was 93.4% (100% among children under 2 years of age and 86% among the others) and it did not vary remarkably over time. The two criteria of “injury sustained at a specific anatomical site” (85.2%) and “young age” (51.9%) were those most often identified. Children aged 2 years or older were more likely to undergo surgery or to stay longer than those of young age (although a referral criterion) and so were those with higher injury severity (a referral criterion). In this specialized paediatric burns centre, children are admitted mainly according to the guidelines. However, given the high prevalence of paediatric burns in the region and the limited resources at the burns centre, adherence to the guidelines need to be further studied at all healthcare levels in the province.
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Hashemi SS, Sharhani A, Lotfi B, Ahmadi-Juibari T, Shaahmadi Z, Aghaei A. A Systematic Review on the Epidemiology of Pediatric Burn in Iran. J Burn Care Res 2017; 38:e944-e951. [DOI: 10.1097/bcr.0000000000000524] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Santos JV, Viana J, Amarante J, Freitas A. Paediatric burn unit in Portugal: Beds needed using a bed-day approach. Burns 2016; 43:403-410. [PMID: 27644139 DOI: 10.1016/j.burns.2016.08.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 08/01/2016] [Accepted: 08/17/2016] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Despite the high burden of children with burns, there is not a paediatric burn unit (PBU) in Portugal. We aimed to estimate the Portuguese health care providing needs on paediatric burns. METHODS We performed a nation-wide retrospective study, between 2009 and 2013, among less than 16 years-old inpatients with burns that met the transfer criteria to a burn unit in Portugal. A bed-day approach was used, targeting an occupancy rate of 70-75%, and possible locations were studied. The primary outcome was the number of beds needed, and secondary outcomes were the overload and revenue for each possible number of beds in a PBU. RESULTS A total of 1155 children met the transfer criteria to a burn unit, representing a total of 17,371 bed-days. Occupancy rates of 11-bed, 12-bed, 13-bed and 14-bed PBU were, respectively, 79.7%, 75.3%, 71.0% and 66.8%. The 13-bed PBU scenario would represent an overload of 523 bed-days, revenue of more than 5 million Euros and a ratio of 1 PBU bed per 123,409 children. CONCLUSIONS Using a groundbreaking approach, the optimal number of PBU beds needed in Portugal is 13. However, as half of the patients who met burn transfer criteria are not transferred, this bed number might be overestimated if this pattern maintains, despite the underestimation with our method approach. If a PBU is to be created the preferable location is Porto. Cost-effectiveness studies should be performed.
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Affiliation(s)
- João V Santos
- CIDES-Department of Health Information and Decision Sciences, Faculty of Medicine, University of Porto, Portugal; CINTESIS-Centre for Health Technology and Services Research, Portugal.
| | - João Viana
- CIDES-Department of Health Information and Decision Sciences, Faculty of Medicine, University of Porto, Portugal; CINTESIS-Centre for Health Technology and Services Research, Portugal
| | - José Amarante
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Hospital São João and Faculty of Medicine, University of Porto, Portugal
| | - Alberto Freitas
- CIDES-Department of Health Information and Decision Sciences, Faculty of Medicine, University of Porto, Portugal; CINTESIS-Centre for Health Technology and Services Research, Portugal
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Johnson SA, Shi J, Groner JI, Thakkar RK, Fabia R, Besner GE, Xiang H, Wheeler KK. Inter-facility transfer of pediatric burn patients from U.S. Emergency Departments. Burns 2016; 42:1413-1422. [PMID: 27554628 DOI: 10.1016/j.burns.2016.06.024] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 06/10/2016] [Accepted: 06/17/2016] [Indexed: 11/19/2022]
Abstract
PURPOSE To describe the epidemiology of pediatric burn patients seen in U.S. emergency departments (EDs) and to determine factors associated with inter-facility transfer. METHODS We analyzed data from the 2012 Nationwide Emergency Department Sample. Current American Burn Association (ABA) Guidelines were used to identify children <18 who met criteria for referral to burn centers. Burn patient admission volume was used as a proxy for burn expertise. Logistic models were fitted to examine the odds of transfer from low volume hospitals. RESULTS In 2012, there were an estimated 126,742 (95% CI: 116,104-137,380) pediatric burn ED visits in the U.S. Of the 69,003 (54.4%) meeting referral criteria, 83.2% were in low volume hospitals. Only 8.2% of patients meeting criteria were transferred from low volume hospitals. Of the 52,604 (95% CI: 48,433-56,775) not transferred, 98.3% were treated and released and 1.7% were admitted without transfer; 54.7% of burns involved hands. CONCLUSIONS Over 90% of pediatric burn ED patients meet ABA burn referral criteria but are not transferred from low volume hospitals. Perhaps a portion of the 92% of patients currently receiving definitive care in low volume hospitals are under-referred and would have improved clinical outcomes if transferred at the time of presentation.
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Affiliation(s)
- Sarah A Johnson
- Center for Pediatric Trauma Research, The Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, United States; Center for Injury Research and Policy, The Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, United States.
| | - Junxin Shi
- Center for Pediatric Trauma Research, The Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, United States; Center for Injury Research and Policy, The Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, United States.
| | - Jonathan I Groner
- Center for Pediatric Trauma Research, The Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, United States; The Ohio State University College of Medicine, 370 W 9th Ave, Columbus, OH 43210, United States; Department of Pediatric Surgery, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, United States.
| | - Rajan K Thakkar
- Center for Pediatric Trauma Research, The Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, United States; The Ohio State University College of Medicine, 370 W 9th Ave, Columbus, OH 43210, United States; Department of Pediatric Surgery, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, United States.
| | - Renata Fabia
- Center for Pediatric Trauma Research, The Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, United States; The Ohio State University College of Medicine, 370 W 9th Ave, Columbus, OH 43210, United States; Department of Pediatric Surgery, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, United States.
| | - Gail E Besner
- The Ohio State University College of Medicine, 370 W 9th Ave, Columbus, OH 43210, United States; Department of Pediatric Surgery, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, United States; Center for Perinatal Research, The Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, United States.
| | - Huiyun Xiang
- Center for Pediatric Trauma Research, The Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, United States; Center for Injury Research and Policy, The Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, United States; The Ohio State University College of Medicine, 370 W 9th Ave, Columbus, OH 43210, United States.
| | - Krista K Wheeler
- Center for Pediatric Trauma Research, The Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, United States; Center for Injury Research and Policy, The Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, United States.
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