title: Overutilization of regional burn centers for pediatric patients--a healthcare system problem that should be corrected.
abstract: BACKGROUND
  Minor burns represent .96% to 1.5% of emergency department visits, yet burn center referral is common. Analysis of the Grady Memorial Hospital Burn Center examined the feasibility and savings if pediatric burns were managed locally with as-needed consultation.
  
  
  METHODS
  Prospective data on 219 consecutive admissions to Grady Memorial Hospital Burn Center between December 2008 and September 2010 were reviewed. National and international cohorts were compared.
  
  
  RESULTS
  Sixty-six percent of patients were male, the mean age was 6.1 years, and 92% were insured. The most common mechanism of burning was liquid scalding (40%). Seventy percent had burns over <10% of the total body surface area, and 73% of all pediatric admissions healed without surgery. Thirty-six percent were discharged within 24 hours of admission. Forty-five percent of patients transferred from other facilities were discharged within 24 hours. Fifteen percent were transported by helicopter; of those, 37% were discharged within 24 hours. Helicopter transport cost $12,500 and averaged 45 miles.
  
  
  CONCLUSIONS
  Pediatric burns require assessment, debridement, and dressing changes. Grafting is rarely necessary. Patients are transferred because of a lack of training, and patients suffer economic burden and treatment delay. Savings could be realized were patients treated locally with select burn center referral.
authors: Emory University School of Medicine, Grady Memorial Hospital, Atlanta, GA, USA. gary.vercruysse@emory.edu
authors: Gary A
authors: GA
authors: Vercruysse
authors: Walter L
authors: WL
authors: Ingram
authors: David V
authors: DV
authors: Feliciano
mesh_terms: D000293:Adolescent; D002053:Burn Units / Q000706:statistics & numerical data*; D002056:Burns / Q000601:surgery*; D002648:Child; D003646:Debridement / Q000592:standards*; D003695:Delivery of Health Care / Q000592:standards*; D005260:Female; D005500:Follow-Up Studies; D005845:Georgia; D006801:Humans; D008297:Male; D017063:Outcome Assessment, Health Care / Q000379:methods*; D012189:Retrospective Studies