Differences in Assessments of Total Burn Surface Area Involving Children Transferred To A Burn Center for Treatment – Experience In Southern Brazil

Purpose: To analyze discrepancies between the evaluation of total body surface area (TBSA) of burn injuries involving children performed by clinicians at hospitals and clinics in southern Brazil before patients are transferred to a Burn Care Unit (BU) and the same evaluation by trained burn specialists, in order to determine the accuracy of burn size estimation and to evaluate clinical data to inform whether efforts to increase knowledge are warranted to optimize early management and treatment of burned pediatric patients. Methods: This is an observational study in which data was analyzed involving burn patients transferred from regional hospitals and clinics for admission to Joana de Gusmão Children’s Hospital, located in the city of Florianópolis in southern Brazil, that maintains a BU for referral of pediatric patients. The analysis consists of comparisons between the estimated values of TBSA of the burn obtained from the “Transferred burnt patient form” completed by the referring clinician and values registered in patient records upon arrival at the BU. In addition, other quantitative and qualitative data, such as burn mechanism patient age, and whether resuscitation with intravenous (IV) fluids occurred, were collected to further inform management and treatment of the injuries. Results: At the early assessment, there was overestimation of TBSA burned in 76.4% of patients (n = 39), 32 of those had a TBSA of less than 15%, and the mean TBSA estimate was 291% higher (p-value 0.0001). The 1-4 age group represented the largest group of patients, 56.4% (n =29), and the most common mechanism of burn was due to heated water in 60.8% (n=31) of the cases. There was correlation (p-value 0.014) between increased length of hospitalization and burn mechanism when the burn was caused by direct contact with fire or electric shock which resulted in patients staying for 26 ± 9.35 days. In addition, 66.7% of patients included in this study had been administered IV fluids at the city of origin prior to arriving at the children’s BU. Conclusion: When the estimate of the TBSA of the burn obtained by non-specialists, was compared to the estimate after admission to a specialized burn unit, there was an overestimation in most cases and this has the potential to lead to mismanagement of pediatric burn patients.