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Published on: February 23, 2024
Consistency of total body surface area assessment in severe burns: Implications for practice
1NSW Newborn and Paediatric Emergency Transport Service, Sydney, New South Wales, Australia.
Background:
Paediatric burn injury is common and often serious. Injuries occur across New South Wales (NSW), with specialised treatment provided in a centralised burns unit. Early management prior to transfer is essential but variation is seen.
Objectives:
To determine if differences exist between referring hospital estimates of the total body surface area (TBSA) of burns, and estimates for the same burns by the Burns Unit. To consider if differences in estimations influence initial and ongoing management, and decisions regarding transfer/retrieval.
Methods:
A retrospective record review of all patients referred to NSW Newborn and Paediatric Emergency Transport Service (NETS) with burn injury between January 2009 and January 2011. Both NETS and NSW Burns Unit records were analysed.
Results:
A total of 123 patients were referred to NETS with burn injury. Approximately half (55/123 = 45%) were referred with a TBSA >10% and transferred to the NSW Burns Unit, where just over half (33/55 = 60%) were assessed as >10%. This means 40% of cases received an initial overestimation of TBSA by referring hospitals. NETS medical teams transferred 34 patients to the Burns Unit, eight (24%) of which on retrospective review did not meet the NSW Burn Transfer Guidelines criteria for a medical team transfer.
Conclusions:
Our review demonstrated significant differences between the TBSA assessment of referring hospitals and the NSW Burns Unit. These inconsistencies may have resulted in children receiving treatment and transport not indicated based on accurate TBSA assessment. Potentially unnecessary transfers have implications for the displacement of children and families but also impact overall health costs and resource availability.
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