• Clifton Ewbank, Clifford C Sheckter, Nicholus M Warstadt, Elizabeth A Pirrotta, Catherine Curtin, Christopher Newton, and N Ewen Wang.
• University of California San Francisco East Bay Department of Surgery, Oakland, CA, United States of America; University of California San Francisco Benioff Children's Hospital Oakland, Oakland, CA, United States of America. Electronic address: clifton.ewbank@ucsf.edu.
• Am J Emerg Med. 2020 Jun 1; 38 (6): 1146-1152.

BackgroundPediatric burns account for 120,000 emergency department visits and 10,000 hospitalizations annually. The American Burn Association has guidelines regarding referrals to burn centers; however there is variation in burn center distribution. We hypothesized that disparity in access would be related to burn center access.MethodsUsing weighted discharge data from the Nationwide Inpatient Sample 2001-2011, we identified pediatric patients with International Classification of Diseases-9th Revision codes for burns that also met American Burn Association criteria. Key characteristics were compared between pediatric patients treated at burn centers and those that were not.ResultsOf 54,529 patients meeting criteria, 82.0% (n = 44,632) were treated at burn centers. Patients treated at burn centers were younger (5.6 versus 6.7 years old; p < 0.0001) and more likely to have burn injuries on multiple body regions (88% versus 12%; p < 0.0001). In urban areas, 84% of care was provided at burn centers versus 0% in rural areas (p < 0.0001), a difference attributable to the lack of burn centers in rural areas. Both length of stay and number of procedures were significantly higher for patients treated at burn centers (7.3 versus 4.4 days, p < 0.0001 and 2.3 versus 1.1 procedures, p < 0.0001; respectively). There were no significant differences in mortality (0.7% versus 0.8%, p = 0.692).ConclusionThe majority of children who met criteria were treated at burn centers. There was no significant difference between geographical regions. Of those who were treated at burn centers, more severe injury patterns were noted, but there was no significant mortality difference. Further study of optimal referral of pediatric burn patients is needed.Copyright © 2019 Elsevier Inc. All rights reserved.

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