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Factors Associated with Inter-Facility Transfer of Pediatric Burn Patients in U.S. Emergency Departments
Sarah Johnson, BA, Junxin Shi, MD, PhD, Huiyun Xiang, MD, MPH, PhD, Jonathan Groner, MD, Rajan K. Thakkar, MD, Renata Fabia, MD, PhD, Gail Besner, MD and Krista K. Wheeler, MS, Nationwide Children's Hospital, Columbus OH

Abstract: Purpose: To determine factors associated with inter-facility transfer of pediatric burn patients in U.S. emergency departments (EDs). Methods: We analyzed data from the 2012 Nationwide Emergency Department Sample. The current American Burn Association (ABA) Guidelines were used to identify children <18 who met criteria for referral to burn centers. Burn patient admission volume was used as a proxy for burn expertise. Patients meeting at least one ABA burn referral criterion who were treated in low volume hospitals (<100 burn patient admissions/year) were considered under-referred. Logistic models were fitted to examine the odds of transfer from low volume hospitals. Results: In 2012, there were 126,742 (95% CI: 116,104-137,380) pediatric burn ED visits in the U.S. Of the 66,640 (52%) meeting referral criteria, 85.3% were in low volume hospitals including 76% in hospitals with <20 burn admissions/year. Only 8.2% of patients meeting criteria were transferred from low volume hospitals, leaving 51,964 (95% CI: 47,869 – 56,138) under-referred. Of those under-referred, 98.1% were treated and released and 1.9% were admitted without transfer; 56.6% of burns involved hands. In the logistic model, patients with age≤4, >10% TBSA, full thickness burns, and burns of the face/head/neck or genitalia were more likely to be transferred. Patients in medium metropolitan hospitals and those with chemical burns were less likely to be transferred. Income by zip code and payer were not associated with transfer. Conclusion: Many pediatric burn ED patients meet ABA burn referral criteria but are not transferred to hospitals with burn expertise, potentially leading to worse outcomes.

Objective: Identify factors associated with inter-facility transfer of pediatric burn patients in U.S. Emergency Departments (EDs).

Objective Content: 1. Describe pediatric burn patients seen in U.S. Emergency Departments 2. Discuss pediatric burn patients meeting American Burn Association referral criteria 3. Explain factors associated with transfer for those patients who met referral criteria.


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