title: Quantitative Analysis of Estimated Burn Size Accuracy for Transfer Patients.
abstract: The objective of this study was to quantify differences between estimated TBSA from referring hospitals vs calculated TBSA in the burn unit in regards to several variables. We conducted a retrospective review of 735 burn patients admitted over a 17-month period. Three hundred twenty-six patients fit the criteria of transfers with recorded %TBSA estimations from referring hospitals. Referring %TBSA was compared with actual %TBSA, and the difference was expressed as a percentage of actual %TBSA. This was then used to group referring estimations as underestimated (less than -25%), satisfactory (-25 to 25%), or overestimated (greater than 25%). A paired t-test was used to assess the paired differences for significance. Secondary variables were then assessed between groups. When assessing associations of these clinical measures, a one-way analysis of variance was used for continuous variables and Pearson's χ test or Fisher's exact test was used. Of the 326 patients analyzed, 13 were underestimated, 63 were satisfactory, and 250 were overestimated. The ratio of overestimation to underestimation exceeded 19:1 and the ratio of overestimation to satisfactory estimation was nearly 4:1, with a statistically significant difference in referred %TBSA and actual %TBSA (P < .0001). Within the over and underestimated groups, there were significant differences between referred %TBSA and actual %TBSA (P < .0001). Larger burns were more accurately estimated (P < .0001). There are significant inaccuracies between referring hospital estimated %TBSA and actual %TBSA, which consistently and grossly skew toward overestimation. Inaccuracy in burn size estimation is systemic and can affect patient care and burn unit efficiency.
authors.affiliation: From the *Loyola University Stritch School of Medicine, Maywood, Illinois; †Clinical Research Office, Health Sciences Division, Loyola University Chicago, Illinois; and ‡Department of Surgery, Loyola University Medical Center, Maywood, Illinois.
authors.forename: Joseph Robert
authors.initials: JR
authors.lastname: Armstrong
authors.forename: Luke
authors.initials: L
authors.lastname: Willand
authors.forename: Beverly
authors.initials: B
authors.lastname: Gonzalez
authors.forename: Jasmin
authors.initials: J
authors.lastname: Sandhu
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Mosier
mesh_terms: D000328:Adult; D001830:Body Surface Area; D002056:Burns / Q000175:diagnosis* / Q000628:therapy*; D015331:Cohort Studies; D016208:Databases, Factual; D005069:Evaluation Studies as Topic; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D010360:Patient Transfer; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D013997:Time Factors; D055815:Young Adult