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COLUMBUS, OH – Despite recommendations that children with significant burns be transferred to a specialized center for evaluation and care, that usually doesn’t happen at most low-volume emergency departments.
That’s according to a new study published in the journal Burns. In low-volume hospitals, 90.3% of patients were treated and released from the ED, 4% were admitted to that same hospital without transfer, and 5.6% were transferred to another hospital, according to the report.
Background information in the study led by researchers from the Center for Pediatric Trauma Research and the Center for Injury Research and Policy at Nationwide Children's Hospital points out that nearly 127,000 children in the United States had burn injuries in 2012. More than half of those, 69,000, suffered burns considered significant injuries by the American Burn Association (ABA).
The ABA recommends that a child with a significant burn be referred for evaluation and care at a burn center, which must meet rigorous standards for personnel expertise, facility resources, and medical services. In addition, the specialized centers also must treat sufficient numbers of patients to demonstrate that expertise.
Yet, the researchers found that wasn’t occurring very often. Results indicate that 83.2% of the pediatric burn visits to EDs were at low-volume hospitals, and that only 8.2% of patients meeting criteria were transferred.
"While the majority of children treated without being transferred are likely receiving adequate burn care in the emergency department or possibly with outpatient follow-up care, ABA guidelines do not specify when outpatient follow-up is appropriate," said senior author Krista Wheeler. "The ABA could lessen this room for error by clarifying their guidance."
In fact, the ABA referral criteria might be too broad and would possibly benefit from urgency specifications regarding care, added co-author Jonathan Groner, MD, pediatric burn surgeon, and medical director of the Center for Pediatric Trauma Research. While some of the pediatric burn patients receiving care in low-volume hospitals could have improved clinical outcomes if they were transferred upon presentation, Groner suggested, others might need only outpatient follow-up at a burn center.
For the study, researchers used data from the 2012 Nationwide Emergency Department Sample (NEDS), the largest all-payer emergency department database in the United States.