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

Abstract

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.

Pediatric Plastic Surgery in the COVID-19 Era

“…66 Looking forward, making outpatient referral criteria more specific may be beneficial to address this. 66 Although the previous study examined burn outcomes in the United States, multiple studies show how patients were impacted globally. In an article from an Italian hospital, designated as a "COVID-19 pediatric hub," the characteristics of the pediatric burn patients during the COVID-19 pandemic were described.…”

“…This further highlights the requirement for urgent public health communication and injury prevention strategies to decrease these preventable occurrences. On top of that, a Canadian level 1 trauma center found that pediatric burns were being overtriaged and led to an increase in unnecessary appointments despite attempts to limit the number of outpatient clinic visits 66 . Looking forward, making outpatient referral criteria more specific may be beneficial to address this 66 …”