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. 2020 Oct;55(10):2134-2139.
doi: 10.1016/j.jpedsurg.2020.03.018. Epub 2020 Apr 17.

Interhospital variation of inpatient versus outpatient pediatric burn treatment after emergency department evaluation

Denise I Garcia  1 , Aaron P Lesher  2 , Corinne Corrigan  3 , H Ryan Howard  2 , Robert A Cina  2
Affiliations

Interhospital variation of inpatient versus outpatient pediatric burn treatment after emergency department evaluation

Denise I Garcia et al. J Pediatr Surg. 2020 Oct.

Abstract

Background: Approaches to burn care in the pediatric population are highly variable and can be targeted as a potential measure in cost-reduction. We hypothesized that institutions vary significantly in treatment allocation of nonsevere burns to either inpatient or outpatient care.

Methods: We queried the PHIS database for fiscal year 2017 to quantify small pediatric burn admissions and Emergency Department visits (ED). The ICD-10 code T31.0 was used to identify burns involving <10% of total body surface area (TBSA). Centers were categorized by burn center status and length of stay, readmissions, and charges were compared.

Results: Inpatient versus outpatient management distribution was significantly different across the included pediatric children's hospitals (n = 34, p < 0.00001). When data were analyzed with respect to outpatient care, a bimodal distribution distinguished two groups: high hospital utilizers with an average of 30% outpatient burn care and low-utilizers averaging 87%. Median inpatient charge per patient was greater than 31-fold compared to ED burn management (p < 0.0001).

Conclusions: Variability of inpatient versus outpatient pediatric burn management in small burns was significant. Compared to outpatient burn care, inpatient care is significantly more costly. Implementing protocols and personnel to provide adequate attention to small burns in the ED could be an important cost-saving measure.

Type of study: Retrospective analysis.

Level of evidence: Level III.

Keywords: Emergency department; Inpatient; Mean charge; Nonsevere burns; Total burn surface area.

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Conflict of interest statement

Conflicts of Interest: None

Figures

Figure 1:
Figure 1:
Histogram demonstrating bimodal distribution of institutions as high hospital utilizers with <30% ED only management and admission of 70–100% of small burns versus >70% of ED management and only 0–30% of patients admitted.
Figure 2:
Figure 2:
Bar graph showing distribution of burn management allocation: inpatient (gray lines), observation (white), or outpatient (black), within each hospital (n=34) ranging from 0 to 100% outpatient. High hospital utilizers (>70% admission rate) and low hospital utilizers (<30% ◆ admission rate). = Verified Burn Center
See this image and copyright information in PMC

References

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