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Published on: February 23, 2024
Pediatric Burn Care for Burn Injury: Outcomes by Timing of Referral Using a U.S. Single-Center Retrospective Cohort,
Hannah L Gale1,2, Steven J Staffa3, Matthew A DePamphilis4
1Department of Pediatrics, Brooke Army Medical Center, Ft Sam Houston, TX.
Insights
Very delayed presentation (VDP) of pediatric burn injuries, occurring after 60 days, is linked to longer hospital stays relative to burn size. Early presentation (EP) is associated with better outcomes in pediatric burn care.
Area of Science:
- Pediatric Burn Care
- Trauma Surgery
- Public Health
Background:
- Burn centers provide specialized pediatric burn injury care.
- Limited data exists on the impact of transfer timing on patient outcomes.
- Understanding referral patterns is crucial for optimizing care.
Purpose of the Study:
- To examine the relationship between the timing of transfer to a burn center and patient outcomes.
- To analyze the impact of early, delayed, and very delayed presentation on pediatric burn injury management.
Main Methods:
- Retrospective cohort study using the Shriners ESO Trauma Burn Registry (2005-2019).
- Included pediatric patients (0-17 years) with 10-80% total body surface area (TBSA) burns.
- Analyzed outcomes including length of stay (LOS), intensive care unit (ICU) LOS, mortality, and disposition based on referral timing: early (EP, 0-7 days), delayed (DP, 8-60 days), and very delayed (VDP, >60 days).
Main Results:
- Delayed referral (DP and VDP) was associated with higher %TBSA burns.
- Very delayed presentation (VDP) showed a higher length of stay to %TBSA burn ratio compared to early presentation (EP).
- No significant association was found between referral timing and mortality or discharge disposition.
Conclusions:
- Referral timing significantly impacts resource utilization, specifically length of stay relative to burn severity.
- Very delayed presentation (VDP) in pediatric burn patients is associated with increased length of stay per %TBSA burn.
- Optimizing early referral to specialized burn centers is essential for efficient pediatric burn care.
Objectives:
Burn centers offer specialized care to pediatric patients with burn injuries. However, data about outcome in relation to timing of transfer are limited. We examined these timings and outcomes among burn-injured pediatric patients.
Design:
Single-center, retrospective cohort study of U.S. national and international practice.
Setting:
Shriners ESO Trauma Burn Registry, 2005-2019.
Patients:
Patients 0-17 years old admitted to a pediatric burn center with 10-80% total body surface area (TBSA) burn between 2005 and 2019.
Interventions:
None.
Measurements And Main Results:
The cohort of 761 patients was subcategorized according to timing of referral: early presentation (EP) (0-7 d), delayed presentation (DP) (8-60 d), and very delayed presentation (VDP) (> 60 d). Primary outcomes included hospital length of stay (LOS), ICU LOS, percent TBSA (%TBSA)/LOS ratio, mortality, and disposition. Dichotomous outcomes were analyzed using logistic regression and continuous outcomes were compared using median regression, both utilizing multivariable analysis adjusting for a priori confounders and presented as adjusted coefficients (ACs) with 95% CI. Delayed referral (DP and VDP) was associated with higher %TBSA burn and with fewer referrals from high-income countries. Compared with EP, VDP was associated with higher LOS/%TBSA (AC, 0.2 [0.01-0.4]). On univariate analysis, in comparison with EP, DP and VDP were associated with higher ICU (DP 16 [6-29]; VDP 8 [0-18]) and hospital LOS (DP 34 [21-55]; VDP 32 [18-58]). Overall, ten of 761 patients died (1.3%), and we found no association between timing of referral and mortality. Also, in 751 survivors, 635 patients (84.6%) were discharged home without home health, and we found no association with timing of referral on multivariable analysis.
Conclusions:
In this report, we have reviewed our single-center, international burn-injured pediatric cohort, operating in the United States (2005-2019). We find that referral with VDP as opposed to EP was associated with increased LOS/%TBSA.
