The Value Of A Picture: Improving The Accuracy Of Burn Assessment And Quality Of Care Through Telemedicine In A Level 1 Pediatric Trauma Center
*Patricia A Morrell1, Chris Marfo2, Alisa Savetamal3, *Marc Auerbach1, *Emily Christison-Lagay1
1Yale-New Haven Children's Hospital, New Haven, CT;2Yale University School of Medicine, New Haven, CT;3Connecticut Burn Center, Bridgeport, CT
Background: Over a quarter of all burn admissions in the United States are children <18y. The American Burn Association has outlined characteristics of a burn that warrant referral to a burn care facility. Estimation of total body surface area (TBSA) and burn severity are essential to accurate burn assessment, however discrepancies exist between the evaluation of medical professionals who do not routinely engage in burn care and those who do. We hypothesized that utilizing telemedicine for real-time consult with a regional burn center (BC) would result in improved burn triage and management. Methods: We reviewed the records of all burn patients presenting to a Level 1 Pediatric Trauma Center (PTC) and transferred to the BC over a 2 year period before and after institution of a policy requiring Telehealth based review of burn injury (February, 2015). Findings: 59 patients were included, 31 prior to telemedicine implementation and 28 after. The majority of burns were scald (73%) or contact (20%). Median TBSA burn was 5% in the first reporting period and 4% in the second. PTC estimation of burn size was significantly greater than BC estimation both before and after institution of telemedicine review (p=0.0001) but demonstrated improved correlation after policy implementation (R=0.57 vs R=0.95). Length of stay (LOS) was decreased from 3.1 days to 1.5 days, associated with an increase in referrals to the outpatient burn clinic.
Conclusions: The institution of telemedicine based burn evaluation improved the triage accuracy of pediatric burns and resulted in a decrease in hospital LOS and increase in outpatient referrals and treatment plans.
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