Verified Centers, Nonverified Centers, or Other Facilities: A National Analysis of Burn Patient Treatment Location

David Zonies, Christopher Mack, Bradley Kramer, Frederick Rivara, Matthew Klein

Research output: Contribution to journalArticle

26 Citations (Scopus)

Abstract

Background: Although comprehensive burn care requires significant resources, patients may be treated at verified burn centers, nonverified burn centers, or other facilities due to a variety of factors. The purpose of this study was to evaluate the association between patient and injury characteristics and treatment location using a national database. Study Design: We performed an analysis of all burn patients admitted to United States hospitals participating in the Healthcare Cost and Utilization Project over 2 years. Univariate and multivariate analyses were performed to identify patient and injury factors associated with the likelihood of treatment at designated burn care facilities. Definitive care facilities were categorized as American Burn Association-verified centers, nonverified burn centers, or other facilities. Results: During the 2 years of the study, 29,971 burn patients were treated in 1,376 hospitals located in 19 participating states. A total of 6,712 (22%) patients were treated at verified centers, with 26% and 52% treated at nonverified or other facilities, respectively. Patients treated at verified centers were younger than those treated at nonverified or other facilities (33.1 years versus 33.7 years versus 41.9 years; p <0.001) and had a higher rate of inhalation injury (3.4% versus 3.2% versus 2.2%; p <0.001). Independent factors associated with treatment at verified centers include burns to the head or neck (relative risk [RR], 2.4; CI, 2.1 to 2.7), hand (RR, 1.8; CI, 1.6 to 1.9), electrical injury (RR, 1.4; CI, 1.2 to 1.7), and fewer comorbidities (RR, 0.55; CI, 0.5 to 0.6). Conclusions: More than two-thirds of significantly burned patients are treated at nonverified burn centers in the United States. Many patients meeting American Burn Association criteria for transfer to a burn center are being treated at nonburn center facilities.

Original languageEnglish (US)
Pages (from-to)299-305
Number of pages7
JournalJournal of the American College of Surgeons
Volume210
Issue number3
DOIs
StatePublished - Mar 2010
Externally publishedYes

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Burn Units
Therapeutics
Wounds and Injuries
State Hospitals
Health Care Costs
Inhalation
Comorbidity
Neck
Multivariate Analysis
Hand
Head
Databases

ASJC Scopus subject areas

  • Surgery

Cite this

Verified Centers, Nonverified Centers, or Other Facilities : A National Analysis of Burn Patient Treatment Location. / Zonies, David; Mack, Christopher; Kramer, Bradley; Rivara, Frederick; Klein, Matthew.

In: Journal of the American College of Surgeons, Vol. 210, No. 3, 03.2010, p. 299-305.

Research output: Contribution to journalArticle

Zonies, David ; Mack, Christopher ; Kramer, Bradley ; Rivara, Frederick ; Klein, Matthew. / Verified Centers, Nonverified Centers, or Other Facilities : A National Analysis of Burn Patient Treatment Location. In: Journal of the American College of Surgeons. 2010 ; Vol. 210, No. 3. pp. 299-305.
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abstract = "Background: Although comprehensive burn care requires significant resources, patients may be treated at verified burn centers, nonverified burn centers, or other facilities due to a variety of factors. The purpose of this study was to evaluate the association between patient and injury characteristics and treatment location using a national database. Study Design: We performed an analysis of all burn patients admitted to United States hospitals participating in the Healthcare Cost and Utilization Project over 2 years. Univariate and multivariate analyses were performed to identify patient and injury factors associated with the likelihood of treatment at designated burn care facilities. Definitive care facilities were categorized as American Burn Association-verified centers, nonverified burn centers, or other facilities. Results: During the 2 years of the study, 29,971 burn patients were treated in 1,376 hospitals located in 19 participating states. A total of 6,712 (22{\%}) patients were treated at verified centers, with 26{\%} and 52{\%} treated at nonverified or other facilities, respectively. Patients treated at verified centers were younger than those treated at nonverified or other facilities (33.1 years versus 33.7 years versus 41.9 years; p <0.001) and had a higher rate of inhalation injury (3.4{\%} versus 3.2{\%} versus 2.2{\%}; p <0.001). Independent factors associated with treatment at verified centers include burns to the head or neck (relative risk [RR], 2.4; CI, 2.1 to 2.7), hand (RR, 1.8; CI, 1.6 to 1.9), electrical injury (RR, 1.4; CI, 1.2 to 1.7), and fewer comorbidities (RR, 0.55; CI, 0.5 to 0.6). Conclusions: More than two-thirds of significantly burned patients are treated at nonverified burn centers in the United States. Many patients meeting American Burn Association criteria for transfer to a burn center are being treated at nonburn center facilities.",
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