Pediatric Burn Care for Burn Injury: Outcomes by Timing of Referral Using a U.S. Single-Center Retrospective Cohort, 2005-2019

Hannah L Gale; Steven J Staffa; Matthew A DePamphilis; Sarah Tsay; Jeffrey Burns; Robert Sheridan

doi:10.1097/PCC.0000000000003623

Pediatric Burn Care for Burn Injury: Outcomes by Timing of Referral Using a U.S. Single-Center Retrospective Cohort, 2005-2019

Pediatr Crit Care Med. 2024 Oct 25. doi: 10.1097/PCC.0000000000003623. Online ahead of print.

Authors

Hannah L Gale^{1

2}, Steven J Staffa³, Matthew A DePamphilis⁴, Sarah Tsay⁵, Jeffrey Burns^{3

6}, Robert Sheridan⁶

Affiliations

¹ Department of Pediatrics, Brooke Army Medical Center, Ft Sam Houston, TX.
² Department of Pediatrics, Uniformed Services University, Bethesda, MD.
³ Division of Critical Care Medicine, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA.
⁴ Boston University Medical School, Boston, MA.
⁵ Department of Emergency Management, Business Continuity, and Medical Center Operators, University of California San Diego Health, San Diego, CA.
⁶ Division of Burns, Shriners Children's Boston, Harvard Medical School, Boston, MA.

PMID: 39451099
DOI: 10.1097/PCC.0000000000003623

Abstract

Objectives: Burn centers offer specialized care to pediatric patients with burn injuries. However, data about outcome in relation to timing of transfer are limited. We examined these timings and outcomes among burn-injured pediatric patients.

Design: Single-center, retrospective cohort study of U.S. national and international practice.

Setting: Shriners ESO Trauma Burn Registry, 2005-2019.

Patients: Patients 0-17 years old admitted to a pediatric burn center with 10-80% total body surface area (TBSA) burn between 2005 and 2019.

Interventions: None.

Measurements and main results: The cohort of 761 patients was subcategorized according to timing of referral: early presentation (EP) (0-7 d), delayed presentation (DP) (8-60 d), and very delayed presentation (VDP) (> 60 d). Primary outcomes included hospital length of stay (LOS), ICU LOS, percent TBSA (%TBSA)/LOS ratio, mortality, and disposition. Dichotomous outcomes were analyzed using logistic regression and continuous outcomes were compared using median regression, both utilizing multivariable analysis adjusting for a priori confounders and presented as adjusted coefficients (ACs) with 95% CI. Delayed referral (DP and VDP) was associated with higher %TBSA burn and with fewer referrals from high-income countries. Compared with EP, VDP was associated with higher LOS/%TBSA (AC, 0.2 [0.01-0.4]). On univariate analysis, in comparison with EP, DP and VDP were associated with higher ICU (DP 16 [6-29]; VDP 8 [0-18]) and hospital LOS (DP 34 [21-55]; VDP 32 [18-58]). Overall, ten of 761 patients died (1.3%), and we found no association between timing of referral and mortality. Also, in 751 survivors, 635 patients (84.6%) were discharged home without home health, and we found no association with timing of referral on multivariable analysis.

Conclusions: In this report, we have reviewed our single-center, international burn-injured pediatric cohort, operating in the United States (2005-2019). We find that referral with VDP as opposed to EP was associated with increased LOS/%TBSA.