title: The effectiveness of regionalized burn care: an analysis of 6,873 burn admissions in North Carolina from 2000 to 2007.
abstract: BACKGROUND
  The effectiveness and benefits of regionalized trauma care are well substantiated; however, the effectiveness of regionalized burn care and potential benefits of burn center verification have not been fully validated.
  
  
  METHODS
  This was a retrospective study of all acute burn admissions using a statewide discharge database from October 1, 2000, to September 30, 2007. Demographics, referral patterns, care practices, and outcomes were compared between 2 American Burn Association (ABA)-verified burn centers (VBCs) and the remaining 107 nonburn centers (NBCs) in North Carolina.
  
  
  RESULTS
  Overall, 6,873 adult burn patients required admission, with 79% of them meeting ABA burn center referral criteria. Of the 5,402 patients meeting ABA referral criteria, 43% were admitted to an NBC, and 25% of all NBC patients had burn operations. Burns admitted to NBCs tended to involve the hand/wrist and lower extremities. Older patients with comorbidities/concomitant trauma were more likely to be admitted to NBCs (p < 0.0001); however, larger burns were more likely to be admitted to a VBC (p < 0.0001). More NBC patients were discharged to nursing homes (p < 0.0001). Patients with Medicare were more likely to be admitted to NBCs (p < 0.0001), and uninsured patients or those with Workman's Compensation insurance were more likely to be admitted to VBCs (p < 0.0001), and payer status remained a significant predictor of treatment at a VBC on regression analysis.
  
  
  CONCLUSIONS
  This is the most comprehensive study of its kind and demonstrates that ABA burn center referral criteria are not always used for effective regionalized burn care or to ensure the best possible outcomes. Even with establishment of the burn center verification process, the mere presence of a VBC is insufficient for effective regionalized care. A greater emphasis is needed on the development of burn care systems.
authors.affiliation: Department of General Surgery, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA. jholmes@wfubmc.edu
authors.forename: James H
authors.initials: JH
authors.lastname: Holmes
authors.forename: Jeffrey E
authors.initials: JE
authors.lastname: Carter
authors.forename: Lucas P
authors.initials: LP
authors.lastname: Neff
authors.forename: Bruce A
authors.initials: BA
authors.lastname: Cairns
authors.forename: Ralph B
authors.initials: RB
authors.lastname: d'Agostino
authors.forename: Leah P
authors.initials: LP
authors.lastname: Griffin
authors.forename: J Wayne
authors.initials: JW
authors.lastname: Meredith
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002053:Burn Units / Q000458:organization & administration*; D002056:Burns / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D015331:Cohort Studies; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D009657:North Carolina; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012041:Regional Medical Programs / Q000458:organization & administration*; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult