A Review of Emergency Department Fluid Resuscitation of Burn Patients Transferred to a Regional, Verified Burn Center

Abstract

The purpose of this study was to examine the adequacy of burn patient fluid resuscitation in relationship to the American Burn Association formula before arrival at a regional burn center. Further substratification of the data was undertaken to compare total burn surface area and fluid volume resuscitation as evaluated from the primary hospital's emergency department staff vs. the burn intensive care unit staff. The charts of all patients admitted to the burn center during 1 year were reviewed retrospectively. Data were compiled to calculate the time of injury, time of arrival in the referring emergency room, time in transit to the burn unit, and time of arrival in the burn unit. The total number of patients evaluated in the study was 41. Patients who were not referred from outside hospitals or who had incomplete charts were excluded. The average time from initial burn to transfer to the burn intensive care unit was 6.26 hours (range, 0.5-96 hours). The average total body surface area (TBSA) evaluated by the referring emergency department staff was 23.9% (range, 5-70%) compared with the burn intensive care unit staff evaluation average of 17.8% (range, 2-55%). Using the referring emergency department staff TBSA percentage, evaluation of the data revealed that only 23% of patients fell within the accepted range using the American Burn Association formula. Furthermore, 30% of patients were overresuscitated whereas 47% were underresuscitated. Of the overresuscitated patients, 1 patient was critically overresuscitated. In the group of underresuscitated patients, five were critically underresuscitated. Thirty-three percent of the patients' TBSA had a more than 50% discrepancy between the burn unit and the emergency department calculations. The authors conclude that better educating providers referring patients to regional burn centers can make a marked improvement in the overall care of burn patients. More important, early communication with the referring burn staff has been encouraged. Early communication permits review of estimated TBSA burn evaluations and permits cooperative calculations and optimal delivery of early fluid resuscitation. Burn center practitioners can improve care of patients before arrival by appropriately guiding the referring physician.