Let the right one in: High admission rate for low-acuity pediatric burns

Background: The purpose of this study was to characterize emergency pediatric burn care triage at a tertiary children's hospital to identify targets for quality improvement. Methods: A retrospective review of patients <18 years with primary burn injuries who presented to a children's emergency department in 2016 was conducted. Demographic and injury characteristics were recorded. Low acuity was defined by size (<5% total body surface area burn), depth (not third degree), and no need for conscious sedation for debridement. Multiple logistic regression was used for analysis. Results: A total of 309 pediatric burn patients were triaged in the emergency department. Patients were typically young (median 3.3 years), male (59%), Hispanic (47%), publically insured (77%), and transferred in (65%). Scalding was the most common mechanism (59%). Though most burns were small (median 2% total body surface area), not deep (<third degree: 91%), and debrided without sedation (70%), most patients were admitted (80%). On regression, larger total body surface area, child protective services involvement, and in-transfer, but not mechanism, location of injury, or time of day, were associated with observation admission (<24 hours) versus emergency department discharge. Conclusion: Though burns were low acuity, most children were admitted. Social factors may play an important role in triage decisions but there may be an opportunity for improved resource utilization.