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Examining Triage Patterns of Inhalation Injury and Toxic Epidermal Necrolysis–Stevens Johnson Syndrome

Davis, James S. MD; Pandya, Reeni K. BS; Pizano, Louis R. MD, MBA; Namias, Nicholas MD, MBA; Dearwater, Stephen MS; Schulman, Carl I. MD, PhD, MSPH

doi: 10.1097/BCR.0b013e3182a2ad17
Original Articles

The American Burn Association recommends that patients with toxic epidermal necrolysis–Stevens Johnson syndrome (TEN-SJS) or burn inhalation injuries would benefit from admission or transfer to a burn center (BC). This study examines to what extent those criteria are observed within a regional burn network. Hospital discharge data from 2000 to 2010 was obtained for all hospitals within the South Florida regional burn network. Patients with International Classification of Disease-9th revision discharge diagnoses for TEN-SJS or burn inhalation injury and their triage destination were compared using burn triage referral criteria to determine whether the patients were triaged differently from American Burn Association recommendations. Two hundred ninety-nine TEN-SJS and 131 inhalation injuries were admitted to all South Florida hospitals. Only 25 (8.4%) of TEN-SJS and 27 (21%) of inhalation injuries were admitted to the BC. BC patients had greater length of stay (TEN-SJS 22 vs 10 days; inhalation 13 vs 7) and were more likely to be funded by charity or be self-paid (TEN-SJS 24 vs 9.5%, P = .025; inhalation 44 vs 14%, P < .001), but less likely to hold some form of private or government insurance (TEN-SJS 72 vs 88%, P = .02; inhalation 48 vs 81%, P = .006). TEN-SJS BC patients were more frequently discharged home for self-care (76 vs 50%, P = .006). Non-BC patients were more often discharged to other healthcare facilities (28 vs 0% TEN-SJS, 20 vs 7.4% inhalation). Inappropriate triage may occur in more than 3 out of 4 of the TEN-SJS and inhalation injury patients within our burn network. Unfamiliarity with triage criteria, patient insurance status, and overcoding may play a role. Further studies should fully characterize the problem and implement education or incentives to encourage more appropriate triage.

From the Division of Burn Care, DeWitt Daughtry Family Department of Surgery, Jackson Memorial Hospital/University of Miami Burn Center, Miller School of Medicine, University of Miami, Florida.

The authors declare no conflict of interest.

Address correspondence to Carl I. Schulman, MD, PhD, MSPH, Ryder Trauma Center, PO Box 016960 (D-40), Miami, Florida 33101.

© 2013 The American Burn Association