Burning questions: ED management of pediatric burns at a non-burn health care system

American Burn Association (ABA) referral criteria help identify patients to be transferred. Limited data exist on characteristics of patients being transferred and utilization of these criteria at non-burn centers (NBC).

To describe pediatric emergency department (ED) disposition practices at a non-burn center and compare these practices to ABA referral criteria.

Retrospective review of electronic records of patients < 18 years old, with discharge diagnosis of burn at a non-burn healthcare system, from December 2016 to June 2022, was performed. Descriptive statistics and multivariable logistic regression was used to analyze transfer rates and determine odds ratios of different factors, comparing transferred and discharged patients.

1231 cases were identified with 35% transferred. Of the 65% of patients discharged, 52% met ABA referral criteria. For all visits, 64% met at least one ABA criterion, of which 47% were transferred. Infants had greatest odds of transfer (OR 9.62, 95% CI 4.6 - 20.1). Burns to high-risk anatomical zones (OR 5.89, 95% CI 4.1 - 8.4), those with > 20% total body surface area (OR 16.86, 95% CI 4.3 - 66.7) and full/partial thickness burns (OR 11.47, 95% CI 5.5 - 23.9) were also all associated with highest odds of transfer.

The majority of visits met ABA criteria for transfer to a burn center; however, only about half those qualified were transferred. Some may have been appropriately discharged. Infants, large burns, burns to high-risk anatomic zones, or full/partial thickness burns were more often transferred indicating appropriate adherence to the established guideline. These data suggest that ABA criteria are very broad for pediatrics and do not have face validity for community physicians. Further work is needed to refine pediatric ABA referral criteria.