Burn Center Referral Practice Evaluation and Treatment Outcomes Comparison Among Verified, Nonverified Burn Centers, and Nonburn Centers: A Statewide Perspective

2020 ◽  
Author(s):  
Zhenna Huang ◽  
Linda Forst ◽  
Lee S Friedman
Keyword(s):  
Treatment Outcomes ◽  
Injured Patient ◽  
Linear Regression Models ◽  
Hospital Data ◽  
Skilled Nursing ◽  
Burn Centers ◽  
Burn Center ◽  
Referral Criteria ◽  
Burn Units ◽  
Level I

Abstract The American Burn Association (ABA) has developed comprehensive referral criteria to determine which burn-injured patient should be transferred to burn centers. This was a retrospective analysis of burn injuries using Illinois inpatient and outpatient hospital data from 2010 to 2015. Multivariable logistic and linear regression models were developed to evaluate ABA burn center referral criteria adherence and to compare treatment outcomes among those treated in verified burn center (VB), nonverified burn center (NVB), and other facilities (OF). In this study, 66% of those treated in facilities without specialized burn teams met the ABA referral criteria. Patients who were older than the age of 40 years, lived farther from burn units, and were originally treated in level I trauma center without burn units were less likely to be transferred to burn centers. Those transported and treated in burn centers had overall better treatment outcomes including fewer infection complications (VB vs OF: adjusted odds ratio [aOR]: 0.5, 95% confidence interval [CI]: 0.4–0.6; NVB vs OF: aOR: 0.5, 95% CI: 0.4–0.6), fewer patients requiring additional care in skilled nursing/rehabilitation facilities (VB vs OF: aOR: 0.5, 95% CI: 0.4–0.6; NVB vs OF: aOR: 0.7, 95% CI: 0.6–0.9), shorter length of hospitalization (VB vs OF: β: −0.4, P < .001; NVB vs OF: β: −0.8, P < .001), and comparable in-hospital mortality (VB vs OF: aOR: 1.3, 95% CI: 0.97–1.7; NVB vs OF: aOR: 1.01, 95% CI: 0.7–1.5). While verified and unverified burn centers demonstrated better treatment outcomes, the data demonstrated a need to understand the barriers of adhering to ABA criteria and an improved regional burn center referral guidelines education.

Geospatial Mapping as a Guide for Resource Allocation Among Burn Centers in India

2019 ◽  
Vol 41 (4) ◽  
pp. 853-858
Author(s):  
Kavitha Ranganathan ◽  
Charles A Mouch ◽  
Michael Chung ◽  
Ian B Mathews ◽  
Paul S Cederna ◽  
...  
Keyword(s):  
Burn Injury ◽  
Cross Sectional ◽  
Burn Centers ◽  
Optimal Outcomes ◽  
Burn Care ◽  
Burn Center ◽  
Level Data ◽  
Burn Units ◽  
Time Required ◽  
Reallocation Of Resources

Abstract Timely treatment is essential for optimal outcomes after burn injury, but the method of resource distribution to ensure access to proper care in developing countries remains unclear. We therefore sought to examine access to burn care and the presence/absence of resources for burn care in India. We surveyed all eligible burn centers (n = 67) in India to evaluate burn care resources at each facility. We then performed a cross-sectional geospatial analysis using geocoding software (ArcGIS 10.3) and publicly available hospital-level data (WorldStreetMap, WorldPop database) to predict the time required to access care at the nearest burn center. Our primary outcome was the time required to reach a burn facility within India. Descriptive statistics were used to present our results. Of the 67 burn centers that completed the survey, 45% were government funded. More than 1 billion (75.1%) Indian citizens live within 2 hours of a burn center, but only 221.9 million (15.9%) live within 2 hours of a burn center with both an intensive care unit (ICU) and a skin bank. Burn units are staffed primarily by plastic surgeons (n = 62, 93%) with an average of 5.8 physicians per unit. Most burn units (n = 53, 79%) have access to hemodialysis. While many Indian citizens live within 2 hours of a burn center, most centers do not offer ICU and skin bank services that are essential for modern burn care. Reallocation of resources to improve transportation and availability of ICU and skin bank services is necessary to improve burn care in India.

scholarly journals Treatment outcomes in a rural HIV clinic in South Africa: Implications for health care

2016 ◽  
Vol 17 (1) ◽  
Author(s):  
Olufemi B. Omole ◽  
Mary-Anne M.L. Semenya
Keyword(s):  
Treatment Outcomes ◽  
Antiretroviral Treatment ◽  
Hospital Admissions ◽  
Opportunistic Infections ◽  
Limpopo Province ◽  
Cd4 Count ◽  
Viral Rebound ◽  
Hospital Data ◽  
Adherence Support ◽  
Patient Retention

Objective: To assess the treatment outcomes of an HIV clinic in rural Limpopo province, South Africa.Methods: A retrospective cohort study involving medical records review of HIV-positive patients initiated on antiretroviral treatment (ART) was conducted from December 2007 to November 2008 at Letaba Hospital. Data on socio-demographic characteristics, CD4 counts, viral loads (VLs), opportunistic infections, adverse effects of treatment, hospital admissions, and patient retention at 6, 12, 24, and 36 months on ART were collected. Analysis included descriptive statistics, chi-square and t-tests.Results: Of 124 patient records sampled, the majority of patients were female (69%), single (49%), unemployed (56%), living at least 10 km from the hospital (52.4%), and were on treatment at 36 months (69%). Approximately 84% of patients achieved viral suppression (VLs < 400 copies/mL) by 6 months of ART and the mean CD4 count increased from 128 at baseline to 470 cells/mm3 at 24 months. There was a mean weight gain of 5.9 kg over the 36 months and the proportion of patients with opportunistic infections decreased from 54.8% (n = 68) at baseline to 15.3% (n = 19) at 36 months. Although the largest improvements in CD4, VLs, and weights were recorded in the first 6 months of ART, viral rebound became evident thereafter. Of all variables, only age < 50 years and being pregnant were significantly associated with higher VLs (p = 0.03).Conclusion: Good treatment outcomes are achievable in a rural South African ART clinic. However, early viral rebound and higher VLs in pregnancy highlight the need for enhanced treatment adherence support, especially for pregnant women to reduce the risk of mother to child transmission.Keywords: CD4 count; viral load; rura;, treatment outcomes; antiretroviral treatment; patient retention

Differences in Treatment of Stevens–Johnson Syndrome and Toxic Epidermal Necrolysis at Burn Centers and Nonburn Centers

2020 ◽  
Vol 41 (5) ◽  
pp. 945-950
Author(s):  
Rachel M Nygaard ◽  
Frederick W Endorf
Keyword(s):  
Toxic Epidermal Necrolysis ◽  
Severe Disease ◽  
Definitive Treatment ◽  
Stevens Johnson Syndrome ◽  
Skin Disorders ◽  
National Inpatient Sample ◽  
Term Care ◽  
Burn Centers ◽  
Burn Center ◽  
Johnson Syndrome

Abstract Stevens–Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), and Stevens–Johnson/TEN overlap syndrome (SJS/TEN) are severe exfoliative skin disorders resulting primarily from allergic drug reactions and sometimes from viral causes. Because of the significant epidermal loss in many of these patients, many of them end up receiving treatment at a burn center for expertise in the care of large wounds. Previous work on the treatment of this disease focused only on the differences in care of the same patients treated at nonburn centers and then transferred to burn centers. We wanted to explore whether patients had any differences in care or outcomes when they received definitive treatment at burn centers and nonburn centers. We queried the National Inpatient Sample database from 2016 for patients with SJS, SJS/TEN, and TEN diagnoses. We considered burn centers as those with greater than 10 burn transfers to their center and fewer than 5 burn transfers out of their center in a year. Multivariable logistic regression assessed factors associated with treatment at a burn center and mortality. Using the National Inpatient Sample, a total of 1164 patients were identified. These were divided into two groups, nonburn centers vs burn centers, and those groups were compared for demographic characteristics as well as variables in their hospital course and outcome. Patients treated at nonburn centers were more likely to have SJS and patients treated at burn centers were more likely to have both SJS/TEN and TEN. Demographics were similar between treatment locations, though African-Americans were more likely to be treated at a burn center. Burn centers had higher rates of patients with extreme severity and mortality risks and a longer length of stay. However, burn centers had similar actual mortality compared to nonburn centers. Patients treated at burn centers had higher charges and were more likely to be transferred to long-term care after their hospital stay. The majority of patients with exfoliative skin disorders are still treated at nonburn centers. Patients with SJS/TEN and TEN were more likely to be treated at a burn center. Patients treated at burn centers appear to have more severe disease but similar mortality to those treated at nonburn centers. Further study is needed to determine whether patients with these disorders do indeed benefit from transfer to a burn center.

Triage and Transfer to a Regional Burn Center—Impact of a Mobile Phone App

2020 ◽  
Vol 41 (5) ◽  
pp. 971-975
Author(s):  
Heather Carmichael ◽  
Kiran Dyamenahalli ◽  
Patrick S Duffy ◽  
Anne Lambert Wagner ◽  
Arek J Wiktor
Keyword(s):  
Mobile Phone ◽  
Mobile App ◽  
Transfer Mode ◽  
Burn Center ◽  
Telemedicine Technology ◽  
Ambulance Transport ◽  
Intermediate Size ◽  
Thermal Injuries ◽  
Level I

Abstract Telemedicine technology can be used to facilitate consultations from nonburn-trained referring providers. However, there is a paucity of evidence indicating these technologies influence transfer decisions and follow-up care. In 2016, our regional burn center implemented a mobile phone app, which allows a referring provider to send photos of the wound along with basic demographic and clinical data to the burn specialist. A retrospective review was performed on consults to our regional burn center from a Level I trauma center approximately 70 miles away with a shared electronic medical record. Patients were considered to be “down-triaged” if they could be managed locally or if the transfer could occur via personal vehicle instead of ground or air ambulance transport. During the 2-year study period, 126 consultations were made for thermal injuries. Eighty-seven patients (69%) were referred using the Burn App. Overall, 49 patients (39%) were transferred. When the subset of intermediate size (1–10% TBSA) burns were considered (n = 48), the Burn App allowed for successful “down-triage” of 12 patients (33%) referred through the app. No patient referred without the app could be “down-triaged” (P = .02). Although 57 patients (44%) were recommended for outpatient follow-up, only 42% followed up. A mobile app can be used to successfully triage patients with intermediate size burn injuries to a lower acuity of follow-up and transfer mode. However, only a minority of patients triaged to outpatient management actually follow up with a regional burn center. Telemedicine efforts should focus on improving not only initial triage, but also aftercare.

Adherence to Burn Center Referral Criteria—The Major Tip of the “Minor” Iceberg?

2010 ◽  
Vol 31 (5) ◽  
pp. 832 ◽  
Author(s):  
Aidan Michael Rose ◽  
Zahid Hassan ◽  
Sian Falder
Keyword(s):  
Burn Center ◽  
Referral Criteria

590 Is There a Burn Center Community Standard on How to Best Manage Pediatric Burn Patients?

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S137-S137
Author(s):  
Emily Helmold ◽  
Niknam Eshraghi
Keyword(s):  
Pediatric Patients ◽  
Multidisciplinary Care ◽  
Standard Of Care ◽  
Teaching Hospitals ◽  
Burn Patients ◽  
Burn Centers ◽  
Children's Hospital ◽  
Burn Center ◽  
Children’S Hospital ◽  
Community Standard

Abstract Introduction A burn center is defined by the American College of Surgeons as a program that facilitates the provision of specialized multidisciplinary care in a designated setting. The Children’s Hospital Association states that pediatric patients need age specific health care delivered by specialty trained clinicians in an environment designed just for kids. When these two different specialty areas within one organization cross paths, how does the organization determine all the factors that go into determining the standard of care? One burn center found itself at the heart of this question when asked to determine the best location and how to care for pediatric burn patients. Methods An email survey was sent to burn centers verified with the American Burn Association (ABA) to care for both adult and pediatric patients and located within their region or with a similar volume. The questions included: Results Thirteen burn centers responded. Nine of the thirteen were located within the western region, two in the mid-west, one each in the south and northeast regions. Eight burn centers were categorized as academic and the other five as teaching hospitals. Bed size ranged from 8–44 with an average of 18 beds. Eighty-five percent of the respondents stated they admitted most if not all pediatric burn patients to the burn unit with two of those centers being the only location within their hospital for pediatric patients. Over seventy-five percent provided 24/7 provider coverage. There was more variability in answers regarding rate of pediatrician consultation, code blue team response, and geographic proximity to a children’s hospital however pediatric consultation was obtained in the majority of cases. Conclusions The survey responses were helpful to communicate some degree of burn center community standard although more centers and increased specificity would have strengthened the argument for a burn center remaining the preferred location for all pediatric burn admissions. Applicability of Research to Practice Sharing of our experience and recommendation that the ABA establish a burn community standard, especially one that takes how to manage competing specialties into consideration, will be helpful to all burn centers who could face this same challenge.

Repeat Computed Tomography for Trauma Patients Undergoing Transfer to a Level I Trauma Center

2012 ◽  
Vol 78 (6) ◽  
pp. 675-678 ◽  
Author(s):  
Andrew Joseph Young ◽  
Kenneth Sadlermeyers ◽  
Luke Wolfe ◽  
Therese Marieduane
Keyword(s):  
Computed Tomography ◽  
Ct Scan ◽  
Injury Severity ◽  
Trauma Registry ◽  
Injured Patient ◽  
Ct Scans ◽  
Trauma Patients ◽  
Lengths Of Stay ◽  
Level I ◽  
Repeat Imaging

Our goal was to determine the characteristics of trauma transfer patients with repeat imaging. A retrospective trauma registry review was performed to evaluate trauma patients who were transferred from referring institutions between January 2005 and December 2009. Patients were divided into those who had a duplicate computed tomography (CT) scan versus those who did not. There were 2678 patients included of whom 559 (21%) had at least one repeat CT scan, whereas 2119 (79%) did not have any repeat CT scans. Those with repeat CT scans were older (42.3 ± 27.3 years vs 37.3 ± 25.6 years), had a higher Injury Severity Score (ISS) (13.7 ± 8.7 vs 11.9 ± 8.8), and more likely to have blunt trauma (odds ratio, 4.7; confidence interval, 2.3 to 9.6) (P for all < 0.0007). Those with CT scans done only at the referring facility were younger, had a lower ISS, and shorter lengths of stay (P for all < 0.0003). ISS and age were independent predictors for repeat CT scans. Transfer patients had imaging repeated one-fifth of the time. The younger, less injured patient went without repeat imaging suggesting that they may have been adequately cared for at the outside institution.

scholarly journals 562 Burn Bed Availability in the Northeast Region During the COVID-19 Pandemic

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S131-S131
Author(s):  
Christina Lee ◽  
Kathe M Conlon ◽  
Michael A Marano ◽  
Margaret A Dimler ◽  
Robin Lee ◽  
...  
Keyword(s):  
Mass Casualty Incident ◽  
Mass Casualty ◽  
Published Data ◽  
Burn Patients ◽  
Northeast Region ◽  
Burn Centers ◽  
State Hospitals ◽  
Burn Center ◽  
Mass Casualty Event ◽  
Local Trauma

Abstract Introduction The coronavirus disease pandemic has placed enormous strain on all medical services with ICU capabilities throughout the Northeast region. The surge in ICU beds might severely limit burn centers to accept burn patients in a regional mass casualty incident. Methods Burn bed data was collected by a regional burn disaster consortium. Open burn bed census was collected via telephone from each burn center in the consortium on April 15th, May 7th, May 21st, June 4th and June 18th of 2020. This data was compared to published data from 2009 to 2016. Results The results are listed in Table 1. Lowest available burn bed was 35 beds on April 15th, 2020. Conclusions Although a disaster may impact surrounding local and state hospitals, it does not always impact a burn center’s ability to transfer patients from a local trauma center or nearby burn center. A pandemic however affects a larger region and impacts all hospitals within that region. Peak ICU utilization in the Northeast was between the second and third week of April. During the peak utilization time, burn bed census was about 50% of the historical average. Burn bed census did not return to historical average until May 7, 2020. If a mass casualty event occurred in the pandemic region, the Northeast region would have to reach out to other ABA designated regions for assistance. Historically, burn mass casualty plans are based on the capacity to move burn patients to other burn centers in order to relieve surge capacity at the affected center. This data illustrates that, in a pandemic, burn beds are being utilized for non-burn patients. The ability to follow these plans will be greatly impacted.

scholarly journals Adherence to the Emergency Management of Severe Burns referral criteria in burn patients admitted to a hospital with or without a specialized burn center

Burns ◽  
2021 ◽  
Author(s):  
Daan T. Van Yperen ◽  
Esther M.M. Van Lieshout ◽  
Leendert H.T. Nugteren ◽  
A. Cornelis Plaisier ◽  
Michael H.J. Verhofstad ◽  
...  
Keyword(s):  
Emergency Management ◽  
Burn Patients ◽  
Burn Center ◽  
Severe Burns ◽  
Referral Criteria
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