763 - Association of Timing of Admission to Specialized Pediatric Burn Care and Outcomes of Burn Injured Pediatric Patients
Sunday, April 30, 2023
3:30 PM – 6:00 PM ET
Poster Number: 763 Publication Number: 763.306
Hannah Gale, Boston Children's Hospital, Boston, MA, United States; Sarah Tsay, Harvard T.H. Chan School of Public Health, Boston, MA, United States; Steven Staffa, Boston Children's Hospital, Boston, MA, United States; Robert Sheridan, Harvard Medical School, Boston, MA, United States; Jeffrey P. Burns, Harvard Medical School, Boston, MA, United States; Matthew A. DePamphilis, Shriners Hospitals for Children - Boston, Boston, MA, United States
Clinical Fellow Boston Children's Hospital Boston, Massachusetts, United States
Background: Burn centers offer specialized care to pediatric patients with burn injuries. While it is believed that early and targeted referral to a specialized burn center improves outcomes, data to support differences in outcome of prompt vs. late transfer of burn injured pediatric patients is limited. Objective: To examine whether the timing of referral to a specialized pediatric burn center is associated with outcomes among burn injured pediatric patients. Design/Methods: We conducted a retrospective cohort study of patients 0-17 years who were admitted to a specialized burn center with 10-80% TBSA burn from 2005-2019. Patients were divided into Early Presentation (0-7 days), Delayed Presentation (8-60 days), and Very Delayed Presentation ( >60 days). Primary outcomes included mortality, length of hospital stay, length of ICU stay, mechanical ventilation days, central venous access days, and disposition. Secondary outcomes included tracheostomy placement, amputation, sepsis/bacteremia, CLABSI, osteomyelitis, and contracture/scar complication. Dichotomous outcomes were analyzed using logistic regression and continuous outcomes were compared using median regression. Results: Of 761 patients included in analysis, there were 507 with Early Presentation, 179 with Delayed Presentation, and 75 with Very Delayed Presentation. International transfers accounted for 33.1% of admissions. Patients had higher TBSA in the Delayed (OR 1.04 [CI 1.03-1.05]) and Very Delayed Presentation (OR 1.03 [CI 1.01-1.04) groups. Patients in the Delayed group had longer ICU and Hospital lengths of stay than those in the Early Presentation group. Mortality across all groups was low. Patients with both delayed and very delayed presentation had higher rates of tracheostomy (AOR 30.4 [CI 3.3, 280.8] and AOR 119 [CI 12.3, 1150], respectively). Those with very delayed presentation had higher rates of amputation (AOR 6.32 [CI 2.45, 16.3]) and scar/contracture complications (AOR 43.5 [CI 12.4, 153]). Sepsis, CLABSI, and osteomyelitis rates were not significantly different between the groups.
Conclusion(s): Referral of burn injured pediatric patients to a specialized pediatric burn center was associated with a low mortality rate and high rates of discharge to home. However, timing of transfer was associated with differences in hospital and ICU length of stay, CVC days, and rates of amputation and tracheostomy. Interpretation of study findings is limited by the observational design.
