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Developing a Statewide System for Prehospital Routing of Burn Injuries

Published online by Cambridge University Press:  13 July 2023

Randy Kearns ,
Tracee Short ,
David Barrios ,
Kevin Sittig ,
Paige Hargrove ,
Chris Hector  and
Jeffrey Carter
Randy Kearns
Affiliation:
University of New Orleans, New Orleans, USA
Tracee Short
Affiliation:
Baton Rouge General Hospital, Baton Rouge, USA
David Barrios
Affiliation:
Our Lady of Lourdes, Layfette, USA
Kevin Sittig
Affiliation:
Louisiana State University, Shreveport, USA
Paige Hargrove
Affiliation:
Louisiana Emergency Response Network, Baton Rouge, USA
Chris Hector
Affiliation:
Louisiana Emergency Response Network, Baton Rouge, USA
Jeffrey Carter
Affiliation:
Louisiana State University, New Orleans, USA
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Abstract

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Introduction:

In the USA, traumatic injuries are the leading cause of death before age 45 and have significantly lower mortality if treated in a verified trauma center. Burn injuries are included in trauma statistics and represent 1.1 million injured people annually seeking medical assistance. Routing of burn injuries to ABA-recognized burn centers has yet to be assessed as it has in trauma injury. Our goal was to examine the impact of prehospital routing of burn injuries on hospital length of stay, mortality, and potential costs-of-care through a statewide care coordination center.

Method:

Our study is a retrospective statewide analysis of burn injuries from 01/01/2017 thru 12/31/2019 using the Louisiana Hospital Inpatient Discharge Database. Routing of burn patients was implemented in 2018 using the ABA burn referral criteria. Data included: total admissions with primary burn diagnosis, region, discharge status, length of stay, and raw mortality by region and state. Descriptive and comparative statistics were performed to assess the impact of routing burn-injured patients. Cost analysis was performed using Louisiana Medicaid per diem rates from 2021 at $1,907.92/day.

Results:

1,288 patients were treated in Louisiana during the study period, with 855 post-routing and 433 pre-routing. The mean length of stay was reduced from 11.84 days in 2017 to 8.82 days in 2018 (p value=0.0988), with a potential savings of 761 inpatient care days or $2.17 million. Overall mortality across the state was unchanged except in the highest volume region, where it dropped from 7.9% in 2017 to 3.6% in 2019 (54%).

Conclusion:

Burn injuries are a time-sensitive trauma. This study marks the first analysis pre and post-implementation of routing for burn injuries by a statewide care coordination center. Our study demonstrates improvement in length of stay and mortality but a continued need to examine other contributing factors, such as injury severity and concomitant trauma.

Type
Lightning and Oral Presentations
Information
Prehospital and Disaster Medicine , Volume 38 , Supplement S1: 22nd Congress on Disaster and Emergency Medicine , May 2023 , pp. s84
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Copyright
© The Author(s), 2023. Published by Cambridge University Press on behalf of World Association for Disaster and Emergency Medicine