title: Verified centers, nonverified centers, or other facilities: a national analysis of burn patient treatment location.
abstract: BACKGROUND
  Although comprehensive burn care requires significant resources, patients may be treated at verified burn centers, nonverified burn centers, or other facilities due to a variety of factors. The purpose of this study was to evaluate the association between patient and injury characteristics and treatment location using a national database.
  
  
  METHODS
  We performed an analysis of all burn patients admitted to United States hospitals participating in the Healthcare Cost and Utilization Project over 2 years. Univariate and multivariate analyses were performed to identify patient and injury factors associated with the likelihood of treatment at designated burn care facilities. Definitive care facilities were categorized as American Burn Association-verified centers, nonverified burn centers, or other facilities.
  
  
  RESULTS
  During the 2 years of the study, 29,971 burn patients were treated in 1,376 hospitals located in 19 participating states. A total of 6,712 (22%) patients were treated at verified centers, with 26% and 52% treated at nonverified or other facilities, respectively. Patients treated at verified centers were younger than those treated at nonverified or other facilities (33.1 years versus 33.7 years versus 41.9 years; p < 0.001) and had a higher rate of inhalation injury (3.4% versus 3.2% versus 2.2%; p < 0.001). Independent factors associated with treatment at verified centers include burns to the head or neck (relative risk [RR], 2.4; CI, 2.1 to 2.7), hand (RR, 1.8; CI, 1.6 to 1.9), electrical injury (RR, 1.4; CI, 1.2 to 1.7), and fewer comorbidities (RR, 0.55; CI, 0.5 to 0.6).
  
  
  CONCLUSIONS
  More than two-thirds of significantly burned patients are treated at nonverified burn centers in the United States. Many patients meeting American Burn Association criteria for transfer to a burn center are being treated at nonburn center facilities.
authors.affiliation: University of Washington Burn Center, Harborview Medical Center, Seattle, WA 98104, USA.
authors.forename: David
authors.initials: D
authors.lastname: Zonies
authors.forename: Christopher
authors.initials: C
authors.lastname: Mack
authors.forename: Bradley
authors.initials: B
authors.lastname: Kramer
authors.forename: Frederick
authors.initials: F
authors.lastname: Rivara
authors.forename: Matthew
authors.initials: M
authors.lastname: Klein
mesh_terms: D017677:Age Distribution; D002053:Burn Units / Q000592:standards*; D002056:Burns / Q000145:classification / Q000453:epidemiology / Q000628:therapy*; D016009:Chi-Square Distribution; D019992:Databases as Topic; D003710:Demography; D005260:Female; D006760:Hospitalization; D006801:Humans; D007902:Length of Stay; D008297:Male; D018709:Statistics, Nonparametric; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology