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Published on: February 23, 2024
Factors Associated With Pediatric Burn Clinic Follow-up After Emergency Department Discharge
Paige L Seegan1, Kavya Tangella2, Nicholas P Seivert3
1Division of Child and Adolescent Psychiatry, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Insights
One-third of pediatric burn patients missed outpatient follow-up appointments. Older age, superficial burns, smaller burn size, and Medicaid insurance were linked to lower follow-up rates in this study.
Area of Science:
- Pediatric Medicine
- Burn Care
- Health Services Research
Background:
- Follow-up care after emergency department discharge is crucial for pediatric patients.
- Attrition in outpatient follow-up is a significant issue, yet understudied in pediatric burn populations.
- Understanding factors influencing adherence is vital for improving outcomes in pediatric burn survivors.
Purpose of the Study:
- To investigate sociodemographic factors and burn characteristics associated with outpatient follow-up adherence in pediatric burn patients.
- To identify predictors of missed appointments after emergency department discharge.
- To inform the development of interventions to improve follow-up care in this population.
Main Methods:
- Retrospective review of medical records from a burn registry at an urban academic children's hospital.
- Analysis of data from 196 pediatric burn patients discharged from the emergency department between January 2018 and December 2019.
- Statistical analysis to determine associations between patient/burn characteristics and follow-up adherence.
Main Results:
- 33% of pediatric burn patients failed to attend their scheduled outpatient follow-up within one week.
- Factors associated with lower follow-up adherence included older patient age, superficial burns, smaller total body surface area (% TBSA) burns, and Medicaid or lack of insurance.
- Patient gender, race, ethnicity, and distance to the clinic were not significantly associated with follow-up adherence.
Conclusions:
- Significant attrition exists in outpatient follow-up for pediatric burn patients.
- Identifying specific patient and burn-related factors associated with non-adherence is critical.
- Further research and targeted interventions are needed to enhance follow-up care and improve health outcomes for pediatric burn patients.
Abstract:
Attrition between emergency department discharge and outpatient follow-up is well documented across a variety of pediatric ailments. Given the importance of outpatient medical care and the lack of related research in pediatric burn populations, we examined sociodemographic factors and burn characteristics associated with outpatient follow-up adherence among pediatric burn patients. A retrospective review of medical records was conducted on patient data extracted from a burn registry database at an urban academic children's hospital over a 2-year period (January 2018-December 2019). All patients were treated in the emergency department and discharged with instructions to follow-up in an outpatient burn clinic within 1 week. A total of 196 patients (Mage = 5.5 years; 54% male) were included in analyses. Average % TBSA was 1.9 (SD = 1.5%). One third of pediatric burn patients (33%) did not attend outpatient follow-up as instructed. Older patients (odds ratio [OR] = 1.00; 95% confidence interval [CI]: [0.99-1.00], P = .045), patients with superficial burns (OR = 9.37; 95% CI: [2.50-35.16], P = .001), patients with smaller % TBSA (OR = 1.37; 95% CI: [1.07-1.76], P = .014), and patients with Medicaid insurance (OR = 0.22; 95% CI: [0.09-0.57], P = .002) or uninsured/unknown insurance (OR = 0.07; 95% CI: [0.02-0.26], P = .000) were less likely to follow up, respectively. Patient gender, race, ethnicity, and distance to clinic were not associated with follow-up. Follow-up attrition in our sample suggests a need for additional research identifying factors associated with adherence to follow-up care. Identifying factors associated with follow-up adherence is an essential step in developing targeted interventions to improve health outcomes in this at-risk population.
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