Citation

Bettencourt AP, Romanowski KS, Joe V, Jeng JC, Carter JE, Cartotto R, Craig CK, Fabia R, Vercruysse GA, Liu Y, Hickerson WL, Ryan C, Schulz Iii JT. J. Burn Care Res. 2020; ePub(ePub): ePub.

Affiliation

Medical Director, Sumner Redstone Burn Center Massachusetts General Hospital, Boston, MA Assistant Professor Harvard Medical School Boston, MA.

Copyright

(Copyright © 2020, American Burn Association, Publisher Lippincott Williams and Wilkins)

DOI

10.1093/jbcr/iraa038

PMID

32123911

Abstract

Existing burn center referral criteria were developed several years ago, and subsequent innovations in burn care have occurred. Coupled with frequent errors in estimation of extent of burn injury and depth by referring providers, patients are both over and under-triaged when the existing criteria are used to support patient care decisions. In the absence of compelling clinical trial data on appropriate burn patient triage, we convened a multi-disciplinary panel of experts to execute an iterative eDelphi consensus process to facilitate a revision. The eDelphi process panel consisted of n=61 burn stakeholders and experts and progressed through four rounds before reaching consensus on key clinical domains. The major findings are that 1) burn center consultation is strongly recommended for all patients with deep partial thickness or deeper burns ≥ 10% TBSA burned, for full thickness burns ≥ 5% TBSA burned, for children and older adults with specific dressing and medical needs, and for special burn circumstances including electrical, chemical, and radiation injuries; 2) smaller burns are ideally followed in burn center outpatient settings as soon as possible after injury, preferably without delays of a week or more; 3) frostbite, Stevens-Johnson Syndrome/TENS, and necrotizing soft tissue infection patients benefit from burn center treatment; and 4) telemedicine and technological solutions are of likely benefit in achieving this standard. Unlike the original criteria, the revised consensus-based guidelines create a framework promoting communication so that triage and treatment are specifically tailored to individual patient characteristics, injury severity, geography, and the capabilities of referring institutions.

© The Author(s) 2020. Published by Oxford University Press on behalf of the American Burn Association. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Language: en