title: Telemedicine evaluation of acute burns is accurate and cost-effective.
abstract: BACKGROUND
  As the number of US burn centers has declined, access to burn care is increasingly limited. Inexperience in burn wound assessment by referring physicians often results in overtriage or undertriage. In an effort to improve access to burn care in our region, we instituted a program of telemedicine evaluation of acute burns.
  
  
  METHODS
  We created a telemedicine network linking our burn center to three hospitals located 298 to 350 air miles away. Participants agreed to perform telemedicine consultation for acutely burned patients admitted to their emergency departments. We compared consults and referrals from these facilities during the period July 2005 to August 2007 (TELE) to those during a 2-year period before instituting telemedicine (PRE-TELE).
  
  
  RESULTS
  During the TELE period, 80 patients were referred, of whom 70 were seen acutely by telemedicine, compared with 28 PRE-TELE referrals. The groups did not differ in age or burn size. Only 31 patients seen by telemedicine received emergency air transport (44.3%), compared with 100% of PRE-TELE patients (p < 0.05). Nine other TELE patients were transported by family; 30 other patients were treated locally. Ten remaining patients were transported without telemedicine evaluation. TELE patients transported by air had somewhat larger burn sizes (9.0% vs. 6.5% total body surface area; p = NS) and longer length of stay (13.0 days vs. 8.0 days; p = NS) than PRE-TELE patients. Burn size estimates by burn center physicians made either by telemedicine or direct inspection correlated closely but both differed significantly from those of referring physicians. Providers and patients expressed a high level of satisfaction with the telemedicine experience.
  
  
  CONCLUSIONS
  Acute evaluation of burn patients can be performed accurately by telemedicine. This can reduce undertriage or overtriage for air transport, improve resource utilization, and both enhance and extend burn center expertise to many rural communities at low cost.
authors: Department of Surgery, University of Utah Health Center, Salt Lake City, Utah 84132, USA. jeffrey.saffle@hsc.utah.edu
authors: Jeffrey R
authors: JR
authors: Saffle
authors: Linda
authors: L
authors: Edelman
authors: Louanna
authors: L
authors: Theurer
authors: Stephen E
authors: SE
authors: Morris
authors: Amalia
authors: A
authors: Cochran
mesh_terms: D000293:Adolescent; D000328:Adult; D002056:Burns / Q000175:diagnosis* / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D012017:Referral and Consultation; D017216:Telemedicine; D014218:Triage; D055815:Young Adult