Accuracy of Prehospital Care Providers in Determining Total Body Surface Area Burned in Severe Pediatric Thermal Injury

McCulloh, Christopher J.; Nordin, Andrew B.; Talbot, Lindsay J.; Shi, Junxin; Fabia, Renata; Thakkar, Rajan K.

doi:10.1093/jbcr/irx004

Cited by 17 publications

(9 citation statements)

References 25 publications

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“…Most patients benefited from systemic analgesia (with either fentanyl or ketamine) with a significant reduction in pain upon arrival at the hospital. We devoted specific attention to the comparison of the prehospital and in-hospital TBSA estimations as accurate assessment of the burn size remains a challenge in the prehospital care of burned patients [14][15][16][17]. We mostly used the rule of nines in prehospital care, whereas a Lund and Browder chart was used by the burn specialists.…”

Section: Discussionmentioning

confidence: 99%

“…Oxygenation and sometimes intubation in patients with suspected smoke inhalation or impaired consciousness [9,10], co-intoxication treatment, analgesia, and protection against hypothermia are indicated on site [11,12]. On the other hand, prehospital recommendations are inconsistent regarding the method and accuracy of the estimation of the total burned surface area [13][14][15][16][17], the amount of fluid volume to be infused precociously [18] and the type of analgesia to be administered [19].…”

Section: Introductionmentioning

confidence: 99%

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Prehospital management of burns requiring specialized burn centre evaluation: a single physician-based emergency medical service experience

Maudet

Pasquier

Pantet

et al. 2020

Scand J Trauma Resusc Emerg Med

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Background: Emergency medical services regularly encounter severe burns. As standards of care are relatively wellestablished regarding their hospital management, prehospital care is comparatively poorly defined. The aim of this study was to describe burned patients taken care of by our physician-staffed emergency medical service (PEMS). Methods: All patients directly transported by our PEMS to our burn centre between January 2008 and December 2017 were retrospectively enrolled. We specifically addressed three "burn-related" variables: prehospital and hospital burn size estimations, type and volume of infusion and pain assessment and management. We divided patients into two groups for comparison: TBSA < 20% and ≥ 20%. We a priori defined clinically acceptable limits of agreement in the small and large burn group to be ±5% and ± 10%, respectively. Results: We included 86 patients whose median age was 26 years (IQR 12-51). The median prehospital TBSA was 10% (IQR 6-25). The difference between the prehospital and hospital TBSA estimations was outside the limits of agreement at 6.2%. The limits of agreement found in the small and large burn groups were − 5.3, 4.4 and − 10.1, 11, respectively. Crystalloid infusion was reported at a median volume of 0.8 ml/kg/TBSA (IQR 0.3-1.4) during the prehospital phase, which extrapolated over the first 8 h would equal to a median volume of 10.5 ml/kg/TBSA. The median verbal numeric rating scale on scene was 6 (IQR 3-8) and 3 (IQR 2-5) at the hospital (p < 0.001). Systemic analgesia was provided to 61 (71%) patients, predominantly with fentanyl (n = 59; 69%), followed by ketamine (n = 7; 8.1%). The median doses of fentanyl and ketamine were 1.7 mcg/kg (IQR 1-2.6) and 2.1 mg/kg (IQR 0.3-3.2), respectively. Conclusions: We found good agreement in burn size estimations. The quantity of crystalloid infused was higher than the recommended amount, suggesting a potential risk for fluid overload. Most patients benefited from a correct systemic analgesia. These results emphasized the need for dedicated guidelines and decision support aids for the prehospital management of burned patients.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Prehospital management of burns requiring specialized burn centre evaluation: a single physician-based emergency medical service experience

Maudet

Pasquier

Pantet

et al. 2020

Scand J Trauma Resusc Emerg Med

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“… 2 The care of patients with burns is decided on the initial assessment and estimation of burn size and depth. This represents a widely known challenge of burn management, 3 , 4 as a large proportion of these injuries are initially managed in peripheral hospitals with no dedicated burn specialist and this can be a challenge for primary care providers. 3 This potentially results in either over-triaging or under-treating patients, each with its own drawbacks.…”

mentioning

confidence: 99%

“… 3 This potentially results in either over-triaging or under-treating patients, each with its own drawbacks. 4–6 …”

mentioning

confidence: 99%

Adherence of Burn Outpatient Clinic Referrals to ABA Criteria in a Tertiary Center: Creating Unnecessary Referrals?

Chambers

Garland

Dai

et al. 2021

Journal of Burn Care &Amp; Research

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Initial assessment and triage of burns is guided by the American Burn Association criteria for referral to a burn centre. These criteria are sensitive but not specific, and can potentially lead to over-triage and “unnecessary” clinic visits. We are a Level 1 trauma centre with burn subspecialty care, and due to the COVID-19 pandemic, referrals to our multidisciplinary outpatient burn clinic required triaging for virtual care appointments. In order to improve the triage process, we retrospectively reviewed our outpatient burn clinic referrals over a 2-year period 2018-2019, for adherence to American Burn Association criteria. We collected data pertaining to patient and burn characteristics, as well as treatment outcome, to characterize referrals not requiring an in-person appointment. Of the 244 patients referred, 73% met the referral criteria, with 45% of these patients being healed at first visit and 14.6% requiring surgical management. Mean time from injury to first visit was 9.7 days (mode 6), and average number of visits was 2. Overall, mean burn size was 2%, with the majority of injuries being partial thickness (71%), located in the hand or extremity (77%). There was fairly equal distribution of contact (36%), flame (21%), and scald (26%) burns. This study highlights the non-specific nature of the American Burn Association referral criteria. We found that paediatric and hand burns in particular were over-triaged and lead to “unnecessary” appointments. This information is useful to help adjust referral criteria and to guide triaging of appointments with the evolution of telehealth and virtual care.

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“…Previous studies have evaluated the assessment of TBSA assessments. Specifically, pediatric patients from referral centers have been compared to those later determined at the receiving burn centers; they found a significant difference in TBSA estimates [3]. Some studies found that the referring institutions overestimated the size of the burn by up to 44% TBSA and that burns between 10% and 19.9% TBSA were overestimated most significantly and most frequently [4,5].…”

mentioning

confidence: 99%

Estimates of Total Burned Surface Area by Emergency Department Clinicians and Burn Specialists

Hahn

Roh

Price

et al. 2020

Cureus

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Introduction Correctly assessing burn size is extremely important since it is directly associated with a patient's subsequent management. Further, an accurate assessment of the total body surface area (TBSA) involved is crucial to decide if specialty care in a burn unit is necessary, whereby overestimation has the potential to lead to unnecessary patient transfers and undesirable burdens on the healthcare system and inconvenience to patients. The goal of this study was to identify whether burn injury estimates of TBSA percentage correlate between emergency department (ED) clinician and burn specialists. Methods This was a retrospective study conducted between February 1, 2018 and July 31, 2019 of patients with a burn injury who were evaluated by both an ED clinician and a burn specialist during the same ED visit. Charts were reviewed to identify the documentation of TBSA by prehospital personnel, ED nursing staff, ED mid-level providers (MLP), ED attending physicians, burn consultant MLPs, and burn consultant attending physicians. Results During the study period, 189 subjects with both an ED and burn consultant. The median age was 11 years [interquartile range (IQR) 1-49], and 103 (54%) were males. More than half of the subjects (n=106, 56%) were under the age of 18. There was a statistically significant correlation between estimates of TBSA between ED and burn consultants overall (p<0.0001). Furthermore, there was a statistically significant correlation between ED and burn MLPs (p<0.0001) as well as ED and burn attending physicians (p<0.0001). When adjusted for MLP and attending sex, there was still a correlation among all groups (p<0.0001). Conclusions In this study, there was a statistically significant correlation between estimates of TBSA between ED and burn consultants

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Accuracy of Prehospital Care Providers in Determining Total Body Surface Area Burned in Severe Pediatric Thermal Injury

Cited by 17 publications

References 25 publications

Prehospital management of burns requiring specialized burn centre evaluation: a single physician-based emergency medical service experience

Prehospital management of burns requiring specialized burn centre evaluation: a single physician-based emergency medical service experience

Adherence of Burn Outpatient Clinic Referrals to ABA Criteria in a Tertiary Center: Creating Unnecessary Referrals?

Estimates of Total Burned Surface Area by Emergency Department Clinicians and Burn Specialists

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