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

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.
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