Social Work Evaluations Among Pediatric Patients Transferred for Burn Care

• Published in: The American surgeon 2022-08, Vol.88 (8), p.1809-1813
• Main Authors: Barré, Alyssa M., Tyler, Lauren A., Rhodes, Marvin A., McEvoy, Christian S., Ricca, Robert L.
• Format: Article
• Language: English
• Subjects: Burn treatment; Burns; Child abuse & neglect; Children; Children & youth; Codes; Ethnicity; Health care access; Insurance; Minority & ethnic groups; Patients; Pediatrics; Race; Rural areas; Secondary analysis; Social work; Socioeconomic factors; Trauma; Urban areas
• ISSN: 0003-1348; 1555-9823
• DOI: 10.1177/00031348221084089

Introduction Regionalization efforts aim to improve healthcare by designating specialty centers for a geographic area. Regionalization may play a role in determining patient treatment plans and outcomes. We hypothesize that these factors may be influenced by race, socioeconomics, insurance, and longitudinal follow-up. Methods Retrospective review of 81 patients ages 0-18 years evaluated at our Level 2 Trauma Center between February 2016-December 2020 who met criteria for transfer to a Regional Burn Center. Results 67% of patients were transferred to the Regional Burn Center. There was no difference in the percentage of transferred patients with respect to age, race, ethnicity, insurance type, or rurality of home address. Secondary analysis showed that 57.4% of children were transferred without evaluation by social work. Five patients’ injuries were due to non-accidental trauma (NAT); two of these patients were transferred without social work evaluations. 28% of those transferred had documented involvement of Child Protective Services (CPS). Of the 31 transferred patients without social work evaluation, 67% had incomplete or missing notes from the burn center, including 100% of those subsequently confirmed to be due to NAT. Only 32% of patients received follow-up at our institution. Conclusion We identified no differences in transfer percentages with respect to race, ethnicity, or insurance type. Secondary analysis demonstrated a significant gap in care regarding access to records and social work involvement. As NAT and social concerns are common amongst children with burns, we propose policies to ensure that these concerns are not overlooked during regionalization efforts.