The Effect of Transfer on Outcomes in Burns

Patients with burn injuries are often initially transported to centers without burn capabilities, requiring subsequent transfer to a higher level of care. This study aimed to evaluate the effect of this treatment delay on outcomes. Adult burn patients meeting American Burn Association criteria for transfer at a single burn center were retrospectively identified. A total of 122 patients were evenly divided into two cohorts-those directly admitted to a burn center from the field vs those transferred to a burn center from an outlying facility. There was no difference between the transfer and direct admit cohorts with respect to age, percentage of total body surface area burned, concomitant injury, or intubation prior to admission. Transfer patients experienced a longer median time from injury to burn center admission (1 vs 8 hours, P < .01). Directly admitted patients were more likely to have inhalation burn (18 vs 4, P < .01), require intubation after admission (10 vs 2, P = .03), require an emergent procedure (18 vs 5, P < .01), and develop infectious complications (14 vs 5, P = .04). There was no difference in ventilator days, number of operations, length of stay, or mortality. The results suggest that significantly injured, high acuity burn patients were more likely to be immediately identified and taken directly to a burn center. Patients who otherwise met American Burn Association criteria for transfer were not affected by short delays in transfer to definitive burn care.