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A Comparison Between the Estimated Total Body Surface Area Reported by Referring Facilities and the Subsequent Assessment at a Pediatric Burn Center
Leticia M Ryan, MD MPH, Bruce L Klein, MD, Lisa Puett, RN BSN, Valerie Strockbine RN BSN, Susan Ziegfeld, PNP-BC, Marlene R Miller, MD MSc and Dylan Stewart, MD. Johns Hopkins University School of Medicine, Baltimore, MD, USA.

Background: The estimated total body surface area (%TBSA) is a measurement of burn severity that influences fluid and transport decisions. We compared %TBSA reported by referring facilities (RFs) to %TBSA determined at a pediatric burn center (PBC) to assess consistency.

Methods: This single-site retrospective cohort study included children transferred to a PBC between July 2014-June 2015 for acute burn care. The RF %TBSA was obtained from transport registry data. The PBC %TBSA was obtained from institutional burn registry data. Descriptive statistics were used.

Results: There were 164 children from 30 RFs transferred for burn care. Of these, 60/164 (36.5%) had RF %TBSA reported. In comparison to PBC %TBSA, RF %TBSA was high in 52/60 cases, low in 4/60 cases and exact in 4/60 cases. The range of difference for high estimates was 0.5-27% [mean difference: 5%4.9SD]. The range of difference for low estimates was 0.5-2% [mean difference: 1%0.7]. Importantly, 18/52 (34.6%) of high estimates had potentially clinically significant (≥5%) differences. In comparison to estimates with <5% differences, estimates with ≥5% differences did not differ in patient age, gender, or PBC %TBSA but were associated with a higher RF %TBSA (15.0 7.1 vs 6.3 4.4; p< 0.01) and showed a trend suggesting an association with scald burns [17/18(94.4%) vs 30/42(71.4%); p=0.11].

Conclusions: Our data suggest that RFs often overestimate the %TBSA, which may trigger inappropriately aggressive interventions with potential for patient harm. These results provide additional rationale to develop practices that enhance consistency of assessments between PBCs and RFs.


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