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The Evolution of Resource Utilization in Regional Burn Centers

Kastenmeier, Andrew MD*; Faraklas, Iris BSN*; Cochran, Amalia MD*; Pham, Tam N. MD; Young, Samantha R. BS; Gibran, Nicole S. MD; Gamelli, Richard MD; Halerz, Marcia MBA; Light, Timothy D. MD§; Kealey, G Patrick MD§; Wibbenmeyer, Lucy MD§; Latenser, Barbara MD§; Jenabzadeh, K MD; Mohr, William J. MD; Ahrenholz, David H. MD; Saffle, Jeffrey R. MD*

doi: 10.1097/BCR.0b013e3181cb8ca2
Original Articles: 2009 ABA Papers

Regional burn centers provide unique multidisciplinary care that has been associated with dramatically improved outcomes for burn victims. Patients with complex skin and soft tissue injuries are increasingly admitted to these centers for definitive care. This study was designed to assess current trends in burn center resource utilization. Members of the Multicenter Trials Group of American Burn Association were invited to participate in this retrospective review of all patients admitted to their respective regional burn centers during a 10-year period. Collected data included admission diagnosis, demographics, length of stay (LOS), hospital charges, and mortality. Five regional academic burn centers participated. They collectively admitted 18,246 patients during the study period, of whom 15,219 (83.4%) had a primary burn diagnosis and 3027 (16.6%) were patients with nonburn diagnoses. During this period, annual admissions for the five centers increased by 34.7%, ranging from 19 to 83% for individual centers. Simultaneously, mean burn size decreased from 12.3 to 8.8% TBSA. From 1998 to 2006, admissions for nonburn diagnoses increased by 244.9%, whereas burn admissions increased by 31.1%. Although mean LOS was reduced by >25%, total charges for all patients increased by 37.7% after adjustment for inflation. Nonburn patients had significantly higher mean age, longer LOS, greater mortality, and higher daily charges. This review of admissions to five academic burn centers reveals that these centers are treating more patients with smaller burns and an increasing number of complex nonburn conditions. Nonburn patients represent an older and more debilitated population that consumes disproportionately more resources than burn patients. These data show a dramatic shift in burn center resource utilization and the concurrent evolution of regional burn centers into centers for the care of complex wounds.

From the *University of Utah Burn Center, Salt Lake City; †University of Washington Burn Center, Seattle; ‡Loyola University Burn Center, Maywood, Illinois; §University of Iowa Burn Center, Iowa City; and ¶Regions Hospital Burn Center, St. Paul, Minnesota.

Presented at the 41st Annual Meeting of the American Burn Association, San Antonio, TX, March 24–27, 2009.

Address correspondence to Jeffrey R. Saffle, MD, FACS, Department of Surgery, 3B-306, University of Utah Health Center, 50 North Medical Drive, Salt Lake City, UT 84132.

© 2010 The American Burn Association