Profile, transport and outcomes of severe burns patients within an inclusive, regionalized trauma system

Background: Severe burns represent a challenging and complex clinical presentation, requiring highly specialized burns centres that are staffed and equipped appropriately. The integration of burns care into trauma systems has been recommended. This study describes the profile, transfer and outcomes of severe burns within an inclusive, regionalized trauma system. Methods: A retrospective analysis of prospectively collected data from the Victorian State Trauma Registry for the period July 2001-June 2009 was performed. Major trauma cases with any burn injury were analysed. A severe burns case was defined as a total body surface area (TBSA) burned >= 20%. Descriptive statistics were used to define the profile of severe burns cases, their management and in-hospital outcomes. Results: For the 315 cases, the mean (standard deviation) age was 39 (22) years, and 73% were male. Fire/flames was the predominant cause (72%), and 39% sustained an inhalation injury. All paediatric (n = 37) and 98% of adult cases with a % TBSA >= 20 were managed at the state's burn services. Half of the cases experienced an inter-hospital transfer. Sixty-seven percent of cases were admitted to the intensive care unit, 22% died in-hospital and the median length of stay was 31 days. Conclusions: An inclusive trauma system with burns services co-located at the major trauma services resulted in almost complete referral of severe burns cases to burns services for management. Half of the cases arrived at the burns services directly from the scene of injury, highlighting the importance of ongoing clinical education about the initial management of severe burns at non-burns service hospitals.