Palmieri TL, Taylor S, Lawless M, Curri T, Sen S, Greenhalgh DG. Pediatr. Crit. Care Med. 2015; 16(4): 319-324.
Affiliation
Burn Division, Department of Surgery, Shriners Hospital for Children Northern California, Sacramento, CA.; Department of Surgery, University of California Davis, Sacramento, CA.; Department of Public Health Sciences, University of California Davis Medical Center, Sacramento, CA.
OBJECTIVES:: Determine the relationship between the volume of burn admissions and outcomes for children with burns.
DESIGN:: Retrospective review of the National Burn Repository from 2000-2009 using mixed effect logistic regression modeling. SETTING:: Tertiary burn centers in the United States. PATIENTS:: All children <18 years of age admitted with burn injury to a burn center submitting data to the National Burn Repository. INTERVENTIONS:: None. MEASUREMENTS AND MAIN RESULTS:: Of the 210,683 records in the NBR from 2000-2009, 33,115 records for children ≤18 years of age met criteria for analysis; 26,280 had burn sizes smaller than 10%; only 32 of these children died. Volume of children treated varied greatly among facilities. Age, total body surface area burn, inhalation injury, and burn center volume influenced mortality (p < 0.05) An increase in the median yearly admissions of 100 decreased the odds of mortality by approximately 40%. High volume centers (admitting >200 pediatric patients/year) had the lowest mortality when adjusting for age and injury characteristics (p < 0.05).
CONCLUSIONS:: Higher volume pediatric burn centers had lower mortality, particularly at larger burn sizes. The lower mortality of children a high volume centers could reflect greater experience, resource, and specialized expertise in treating pediatric patients.