Overutilization of regional burn centers for pediatric patients--a healthcare system problem that should be corrected

Minor burns represent .96% to 1.5% of emergency department visits, yet burn center referral is common. Analysis of the Grady Memorial Hospital Burn Center examined the feasibility and savings if pediatric burns were managed locally with as-needed consultation.

Prospective data on 219 consecutive admissions to Grady Memorial Hospital Burn Center between December 2008 and September 2010 were reviewed. National and international cohorts were compared.

Sixty-six percent of patients were male, the mean age was 6.1 years, and 92% were insured. The most common mechanism of burning was liquid scalding (40%). Seventy percent had burns over <10% of the total body surface area, and 73% of all pediatric admissions healed without surgery. Thirty-six percent were discharged within 24 hours of admission. Forty-five percent of patients transferred from other facilities were discharged within 24 hours. Fifteen percent were transported by helicopter; of those, 37% were discharged within 24 hours. Helicopter transport cost $12,500 and averaged 45 miles.

Pediatric burns require assessment, debridement, and dressing changes. Grafting is rarely necessary. Patients are transferred because of a lack of training, and patients suffer economic burden and treatment delay. Savings could be realized were patients treated locally with select burn center referral.