21 A Case-Controlled Retrospective Review of Burn Patients Meeting American Burn Association’s Verified Burn Center Referral Criteria

• Published in: Journal of burn care & research 2019-03, Vol.40 (Supplement_1), p.S17-S18
• Main Authors: Murray, D O, Richey, K J, Baker, M E, Kothari, K, Foster, K N
• Format: Article
• Language: English
• ISSN: 1559-047X; 1559-0488
• DOI: 10.1093/jbcr/irz013.025

Abstract Introduction Regulatory and advisory bodies have published guidelines that trigger patient referral to a verified burn center. Despite these easily referenced resources, non-verified burn units admit and manage patients who meet burn center referral criteria. This may deny patients access to appropriate multidisciplinary care, increase their risk of complications, and increase the cost of care. The purpose of this study was to describe several characteristics and sequelae of patients with delayed referral (DR) to a verified burn center compared to patients who were immediately referred. Methods This was a matched case-controlled retrospective study of inpatients who met 1 or more referral criteria to a verified burn center but were delayed in their referral from 2012–2017. Patients who had DR were compared to those who were referred within 3 days (IR). Cases were matched on age, total body surface area (TBSA) and ABA referral criteria. Basic descriptive statistics were calculated. Results Of the 3,759 patients who were admitted during the study period, 60 had delayed referrals and all were successfully matched. There was no significant difference in past medical history. DR were seen on average at 7.6 days post-injury as compared to 0.45 days IR (p < .0001). There was no significant difference for the specific referral criteria, burn location, discharge disposition or between those with a payor source and those who were uninsured. However, for patients with a payor source those with private insurance were more likely to have a DR (p = .045). Flame/flash injuries were more likely to be immediately referred (p < .001) and contact burns were more often delayed (p < 0.001). Females were more often DR than males (p = 0.009) as were non-minorities (p = 0.042). DR had longer hospitalizations 17.67 days vs 10.83 (p = .023) and required surgery more often 47 vs. 28 (p = .0003). DR suffered more acute complications 27 vs 7 (p < .001) and more long-term complications 20 vs 10 (p = .034). Conclusions Based on our data, DR results in increased surgeries, increased lengths of stay, and more complications. All these factors are associated with increased cost of care and increased nosocomial risk for patients. Applicability of Research to Practice Eliminating DR may have a significant positive impact on the cost and morbidity of burn care.