G. M. Garwood1, K. T. Anderson1,2, M. Bartz-Kurycki1,2, R. Martin1, D. Supak1, S. Wythe1, R. Gutierrez1, A. L. Kawaguchi1,2, M. T. Austin1,2, K. P. Lally1,2, K. Tsao1,2 1McGovern Medical School, The University Of Texas Health Sciences Center At Houston,Houston, TX, USA 2Children’s Memorial Hermann Hospital,Houston, TX, USA
Introduction: More than 125,000 children with burn injuries present to Emergency Departments (ED) annually in the US, with less than 10% admitted for treatment. Many pediatric burns are small and may be triaged in the ED with appropriate follow-up. The purpose of this study was to characterize pediatric burn care triage at a children’s hospital to identify targets for quality improvement.
Methods: A retrospective review of pediatric patients (<18 years) with primary burn injuries who presented to a tertiary, academic children’s ED in 2016 was conducted. Demographics, triage patterns, and injury characteristics (total body surface area (TBSA) percent burn, degree of burn and body location) were recorded. Patients transferred to a burn specialty center for large burns (>30% TBSA) were excluded. Complex areas were defined as burns to the face, hands, feet, genitalia, or major joints. Low acuity was defined by size (<5% TBSA), depth (not 3rd degree), and no need for conscious sedation for debridement. Child Protective Services (CPS) involvement did not require admission if fully evaluated in the ED. Descriptive statistics, chi2, and multivariate logistic regression was used for analysis. Variables were included in regression if p<0.25 on univariate analysis.
Results: In 2016, 300 pediatric burn patients were triaged in the ED, with only 4 requiring transfer to a burn specialty center. Patients were typically young (median age 3.2 years, IQR 1.3-7.3), male (59%), non-White Hispanic (46%), and publically insured (76%). The majority of patients were transferred from outside facilities (64%) and arrived by ambulance (74%). Scalding was the mechanism for most injuries (59%), followed by flame (17%) and contact thermal injuries (16%). Most burns were small (median 3% TBSA, IQR 1-5%), not deep (any 3rd degree: 9%), and able to be debrided without conscious sedation (70%). Half of patients (54%) had low acuity injuries of whom 68% were admitted. In the low acuity cohort, arrival by ambulance (p<0.01), CPS involvement (p=0.02), transfer (p<0.01), and burn mechanism (p=0.03) but not complex area involvement (p=0.36), after hour evaluation (p=0.20), or patient demographics- gender (p=0.30), race/ethnicity (0.90), insurance status (p=0.65)- were associated with admission. On multivariate regression, CPS involvement and arrival by ambulance remained associated with admission in low acuity burn patients (table).
Conclusion: Though most burns were low acuity, the majority of children were admitted. Social factors may play an important role in triage decisions but there may be an opportunity for improved resource utilization through standardized admission and discharge protocols.
