title: Inter-facility transfer of pediatric burn patients from U.S. Emergency Departments.
abstract: OBJECTIVE
  To describe the epidemiology of pediatric burn patients seen in U.S. emergency departments (EDs) and to determine factors associated with inter-facility transfer.
  
  
  METHODS
  We analyzed data from the 2012 Nationwide Emergency Department Sample. Current American Burn Association (ABA) Guidelines were used to identify children <18 who met criteria for referral to burn centers. Burn patient admission volume was used as a proxy for burn expertise. Logistic models were fitted to examine the odds of transfer from low volume hospitals.
  
  
  RESULTS
  In 2012, there were an estimated 126,742 (95% CI: 116,104-137,380) pediatric burn ED visits in the U.S. Of the 69,003 (54.4%) meeting referral criteria, 83.2% were in low volume hospitals. Only 8.2% of patients meeting criteria were transferred from low volume hospitals. Of the 52,604 (95% CI: 48,433-56,775) not transferred, 98.3% were treated and released and 1.7% were admitted without transfer; 54.7% of burns involved hands.
  
  
  CONCLUSIONS
  Over 90% of pediatric burn ED patients meet ABA burn referral criteria but are not transferred from low volume hospitals. Perhaps a portion of the 92% of patients currently receiving definitive care in low volume hospitals are under-referred and would have improved clinical outcomes if transferred at the time of presentation.
authors.affiliation: Center for Pediatric Trauma Research, The Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, United States; Center for Injury Research and Policy, The Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, United States. Electronic address: Sarah.Johnson@nationwidechildrens.org.
authors.forename: Sarah A
authors.initials: SA
authors.lastname: Johnson
authors.affiliation: Center for Pediatric Trauma Research, The Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, United States; Center for Injury Research and Policy, The Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, United States. Electronic address: Junxin.Shi@nationwidechildrens.org.
authors.forename: Junxin
authors.initials: J
authors.lastname: Shi
authors.affiliation: Center for Pediatric Trauma Research, The Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, United States; The Ohio State University College of Medicine, 370 W 9th Ave, Columbus, OH 43210, United States; Department of Pediatric Surgery, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, United States. Electronic address: Jonathan.Groner@nationwidechildrens.org.
authors.forename: Jonathan I
authors.initials: JI
authors.lastname: Groner
authors.affiliation: Center for Pediatric Trauma Research, The Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, United States; The Ohio State University College of Medicine, 370 W 9th Ave, Columbus, OH 43210, United States; Department of Pediatric Surgery, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, United States. Electronic address: Rajan.Thakkar@nationwidechildrens.org.
authors.forename: Rajan K
authors.initials: RK
authors.lastname: Thakkar
authors.affiliation: Center for Pediatric Trauma Research, The Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, United States; The Ohio State University College of Medicine, 370 W 9th Ave, Columbus, OH 43210, United States; Department of Pediatric Surgery, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, United States. Electronic address: Renata.Fabia@nationwidechildrens.org.
authors.forename: Renata
authors.initials: R
authors.lastname: Fabia
authors.affiliation: The Ohio State University College of Medicine, 370 W 9th Ave, Columbus, OH 43210, United States; Department of Pediatric Surgery, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, United States; Center for Perinatal Research, The Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, United States. Electronic address: Gail.Besner@nationwidechildrens.org.
authors.forename: Gail E
authors.initials: GE
authors.lastname: Besner
authors.affiliation: Center for Pediatric Trauma Research, The Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, United States; Center for Injury Research and Policy, The Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, United States; The Ohio State University College of Medicine, 370 W 9th Ave, Columbus, OH 43210, United States. Electronic address: Huiyun.Xiang@nationwidechildrens.org.
authors.forename: Huiyun
authors.initials: H
authors.lastname: Xiang
authors.affiliation: Center for Pediatric Trauma Research, The Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, United States; Center for Injury Research and Policy, The Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, United States. Electronic address: Krista.Wheeler@nationwidechildrens.org.
authors.forename: Krista K
authors.initials: KK
authors.lastname: Wheeler
mesh_terms: D000293:Adolescent; D002053:Burn Units; D002056:Burns / Q000453:epidemiology / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D019468:Disease Management; D004636:Emergency Service, Hospital; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006230:Hand Injuries / Q000453:epidemiology / Q000628:therapy*; D006760:Hospitalization; D061847:Hospitals, High-Volume; D061846:Hospitals, Low-Volume; D006801:Humans; D007223:Infant; D008297:Male; D010360:Patient Transfer / Q000592:standards*; D017410:Practice Guidelines as Topic; D012017:Referral and Consultation / Q000592:standards*; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology
keywords: Burn; Pediatric; Referral; Transfer