Let the right one in: High admission rate for low-acuity pediatric burns

Abstract

BackgroundThe purpose of this study was to characterize emergency pediatric burn care triage at a tertiary children's hospital to identify targets for quality improvement. MethodsA retrospective review of patients <18 years with primary burn injuries who presented to a children's emergency department in 2016 was conducted. Demographic and injury characteristics were recorded. Low acuity was defined by size (<5% total body surface area burn), depth (not third degree), and no need for conscious sedation for debridement. Multiple logistic regression was used for analysis. ResultsA total of 309 pediatric burn patients were triaged in the emergency department. Patients were typically young (median 3.3 years), male (59%), Hispanic (47%), publically insured (77%), and transferred in (65%). Scalding was the most common mechanism (59%). Though most burns were small (median 2% total body surface area), not deep (<third degree: 91%), and debrided without sedation (70%), most patients were admitted (80%). On regression, larger total body surface area, child protective services involvement, and in-transfer, but not mechanism, location of injury, or time of day, were associated with observation admission (<24 hours) versus emergency department discharge. ConclusionThough burns were low acuity, most children were admitted. Social factors may play an important role in triage decisions but there may be an opportunity for improved resource utilization.