title: Adherence to National Burn Care Review referral criteria in a paediatric Emergency Department.
abstract: BACKGROUND
  The National Burn Care Review (NBCR) gives guidance on the recognition of potentially complex burns requiring assessment and management in a burn unit. This guidance provides a referral framework for those initiating assessment and management of burns. The effect of close adherence to NBCR guidance on workload is at present unknown.
  
  
  OBJECTIVE
  To audit referral patterns of burns in our paediatric Emergency Department (ED) in comparison to NBCR referral criteria. To identify the type of injuries not referred despite meeting criteria, and their outcomes, to assess whether these patients come to any harm short-term. To estimate the effect that closer adherence would have on workload and how our unit proposes to work with the ED to improve its distribution and our patients care.
  
  
  METHODS
  A retrospective case-note audit of patients presenting to a paediatric ED with a triage diagnosis of "burn/scald" over a 6-month period between 1st April and 29th September 2008.
  
  
  RESULTS
  190 patients presented with burns during this period, of which 126 (66%) had potentially complex burns. Of these, 93 (74%) were not referred to the burns unit i.e. were "under-referred". In this group burns to specialized areas in patients under 5 years of age were particularly prevalent. 78 (84%) were reviewed in the ED and received no specialist input. Seven patients suffered minor complications. Only three of these patients (3.2%) required subsequent referral to the burns unit for opinion. None required any further specialist intervention.
  
  
  CONCLUSIONS
  Strict adherence to NBCR referral criteria could result in a significant increase in workload for regional burn units with as yet unquantifiable benefit in patient outcomes. Many minor injuries appear to be safely managed in the ED with little adverse outcome. Even small improvements in practice could result in a considerable workload increase for a burns unit. Further prospective research is required, particularly looking at longer-term outcomes. We are hoping to improve educational and clinical links between our EDs and burn unit to improve patient care and distribution of clinical workload. Further national guidance maybe necessary.
authors.affiliation: Alder Hey Children's NHS Foundation Trust, Alder Hey Children's Hospital, Eaton Road, West Derby, Liverpool, Merseyside, L12 2AP, United Kingdom. aidan_rose@hotmail.co.uk
authors.forename: A M
authors.initials: AM
authors.lastname: Rose
authors.forename: Z
authors.initials: Z
authors.lastname: Hassan
authors.forename: K
authors.initials: K
authors.lastname: Davenport
authors.forename: N
authors.initials: N
authors.lastname: Evans
authors.forename: S
authors.initials: S
authors.lastname: Falder
mesh_terms: D000293:Adolescent; D002053:Burn Units / Q000706:statistics & numerical data*; D002056:Burns / Q000473:pathology / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D054869:Clinical Audit; D004636:Emergency Service, Hospital / Q000592:standards*; D019983:Guideline Adherence / Q000592:standards* / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D017063:Outcome Assessment, Health Care; D012017:Referral and Consultation / Q000592:standards* / Q000706:statistics & numerical data; D012189:Retrospective Studies; D016526:Workload / Q000706:statistics & numerical data