Variations in access to specialty care for children with severe burns*

Background: Pediatric burns account for 120,000 emergency department visits and 10,000 hospitalizations annu- ally. 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. Methods: Using weighted discharge data from the Nationwide Inpatient Sample 2001 -2011, we identi fied pedi- atric patients with International Classi fication 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. Results: Of 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 mul- tiple 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 signi ficantly 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 signi ficant differences in mortality (0.7% versus 0.8%, p = 0.692). Conclusion: The majority of children who met criteria were treated at burn centers. There was no signi ficant dif- ference between geographical regions. Of those who were treated at burn centers, more severe injury patterns were noted, but there was no signi ficant mortality difference. Further study of optimal referral of pediatric burn patients is needed.