title: Transfer time to a specialist burn service and influence on burn mortality in Australia and New Zealand: A multi-centre, hospital based retrospective cohort study.
abstract: BACKGROUND
  In Australia and New Zealand (ANZ), health care is provided for ∼26 million people dispersed across the eight million square kilometres of the two countries. Providing optimal care prior to and during transfer across such vast distances is challenging. Lengthening the time taken to definitive burn care has a negative impact on burn outcome. The aims of this study were to determine if transfer time and admission pathway influenced burn mortality and to identify the factors predicting burn mortality in ANZ.
  
  
  METHODS
  The study included all adult burn patient admission data from 15 of 17 burn services submitted to the Australian and New Zealand Burn Association bi-national registry (2010-2012). Multivariate logistic regression analyses were conducted to address the study aims.
  
  
  RESULTS
  Of the 2892 patients, 69 (2.4%) died following burn. Time to admission and direct admission to a burn centre did not independently influence burn mortality except when patients with inhalation injury took >16 h to transfer to definitive care. The risk of death was increased 5.7 times in the presence of inhalation injury. Burn size and age amplified the risk of death while gender did not.
  
  
  CONCLUSIONS
  In ANZ, pre-hospital transport systems and peripheral hospital stabilisation were not associated with an increased risk of death due to burn except when inhalation injury was present. The results of this study indicate that burn patients with inhalation injury should be stabilised and transferred to a burn service within 16 h of burn.
authors: Fiona Wood Foundation, Perth, Western Australia; University College Dublin, Ireland.
authors: T John
authors: TJ
authors: Cassidy
authors: Fiona Wood Foundation, Perth, Western Australia; Royal Perth Hospital, Burn Unit, Western Australia, Australia; Burn Injury Research Node, University of Notre Dame, Fremantle, Australia; Burn Injury Research Unit, University of Western Australia, Australia; Australian and New Zealand Burn Association, Australia.
authors: Dale W
authors: DW
authors: Edgar
authors: Fiona Wood Foundation, Perth, Western Australia; Harry Perkins Institute for Medical Research, Australia.
authors: Michael
authors: M
authors: Phillips
authors: Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
authors: Peter
authors: P
authors: Cameron
authors: Australian and New Zealand Burn Association, Australia; Harry Perkins Institute for Medical Research, Australia; Victorian Adult Burns Service, The Alfred Hospital, Melbourne, Victoria, Australia; Department of Surgery, Central & Eastern Clinical School, Monash University, Melbourne, Victoria, Australia.
authors: Heather
authors: H
authors: Cleland
authors: Fiona Wood Foundation, Perth, Western Australia; Burn Injury Research Unit, University of Western Australia, Australia; Burn Service of Western Australia, Australia. Electronic address: Fiona.wood@health.wa.gov.au.
authors: Fiona M
authors: FM
authors: Wood
mesh_terms: D000328:Adult; D000367:Age Factors; D001315:Australia; D001830:Body Surface Area; D002053:Burn Units; D002056:Burns / Q000401:mortality* / Q000473:pathology; D015331:Cohort Studies; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009520:New Zealand; D010360:Patient Transfer / Q000706:statistics & numerical data*; D012017:Referral and Consultation; D012042:Registries; D012189:Retrospective Studies; D012737:Sex Factors; D015208:Smoke Inhalation Injury / Q000401:mortality*; D013997:Time Factors; D015599:Trauma Severity Indices; D055815:Young Adult
keywords: Acute burn; Burn; Inhalation injury; Mortality; Pre-hospital; Transfer