Length of Stay Per Total Body Surface Area Burn: A Validation Study Using the National Burn Registry

Area of Science:

• Pediatric Burn Care
• Health Services Research
• Injury Epidemiology

Background:

• The established guideline of one day length of stay (LOS) per percent total body surface area (TBSA) burn lacks validation in current pediatric burn literature.
• Previous findings from the Pediatric Injury Quality Improvement Collaboration (PIQIC) require further confirmation using national data.

Purpose of the Study:

• To validate prior PIQIC research on pediatric burn LOS.
• To analyze how burn mechanism, sociodemographic factors, and clinical characteristics influence the LOS per TBSA burn ratio in children.
• To provide evidence-based insights for managing patient and family expectations and for clinical benchmarking in burn centers.

Main Methods:

• Utilized data from the National Burn Registry (NBR) for pediatric patients (0-18 years) from July 2008 to June 2018.
• Employed mixed-effects generalized additive regression models to identify factors associated with the LOS per TBSA burn ratio.
• Analyzed a cohort of 51,561 pediatric burn patients.

Main Results:

• The median LOS per TBSA burn ratio was 0.9 (IQR: 0.4, 1.75).
• Scald burns showed a predicted LOS per TBSA burn of 1.2, while chemical burns had the highest ratio at 4.8.
• Non-Hispanic White patients exhibited lower LOS per TBSA burn ratios compared to other racial and ethnic groups (p < .05).

Conclusions:

• The study confirms significant variability in the LOS per TBSA burn ratio among pediatric patients.
• Burn mechanism and race/ethnicity are key factors influencing this ratio.
• Understanding these variations is crucial for setting realistic expectations for families and for burn center performance evaluation.