Early burn center transfer shortens the length of hospitalization and reduces complications in children with serious burn injuries

Prompt transfer of the child with acute burns can be difficult from distant or inaccessible locations, and it is believed that the outcomes of childre n with serious burns whose transfer to a specialized burn care facility is delayed may be compromised. A 4-year experience with 16 consecutive childre n with serious burns (greater than or equal to 20% of the body surface area ) whose transfer to a burn care facility was delayed for 5 or more days was reviewed to document the difficulties that can follow such delays. These 1 6 children had an average age of 8.6 +/- 1.6 years and an average wound siz e of 57.6% +/- 5.8% of the body surface area, and they arrived a mean of 16 .3 +/- 3.4 days after the injury (range, 5 to 44 days). These children had undergone an average of 1 operation, excluding escharotomies, at referring facilities. Only 4 (25%) of the children had no infectious focus at transfe r, and at admission resistant bacteria were recovered from 9 (56%) of the c hildren and fungal organisms were found in 10 (63%). Compared with a concur rently managed matched control group of patients admitted to the burn cente r within 24 hours of injury, the delayed-transfer group had statistically s ignificantly more bacteremia, renal dysfunction, wound sepsis, and central venous catheter days. It was also more expensive to manage these children; the delayed-transfer group required statistically significantly longer to a chieve 95% wound closure, and they had greater total lengths of hospital st ay and more rehabilitation days. The early transfer of children with seriou s burns to a specialized burn center may truncate hospitalization and there by reduce costs.