Department of General Surgery, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA.
J Am Coll Surg. 2011 Apr;212(4):487-93, 493.e1-6; discussion 493-5. doi: 10.1016/j.jamcollsurg.2010.12.044.
The effectiveness and benefits of regionalized trauma care are well substantiated; however, the effectiveness of regionalized burn care and potential benefits of burn center verification have not been fully validated.
This was a retrospective study of all acute burn admissions using a statewide discharge database from October 1, 2000, to September 30, 2007. Demographics, referral patterns, care practices, and outcomes were compared between 2 American Burn Association (ABA)-verified burn centers (VBCs) and the remaining 107 nonburn centers (NBCs) in North Carolina.
Overall, 6,873 adult burn patients required admission, with 79% of them meeting ABA burn center referral criteria. Of the 5,402 patients meeting ABA referral criteria, 43% were admitted to an NBC, and 25% of all NBC patients had burn operations. Burns admitted to NBCs tended to involve the hand/wrist and lower extremities. Older patients with comorbidities/concomitant trauma were more likely to be admitted to NBCs (p < 0.0001); however, larger burns were more likely to be admitted to a VBC (p < 0.0001). More NBC patients were discharged to nursing homes (p < 0.0001). Patients with Medicare were more likely to be admitted to NBCs (p < 0.0001), and uninsured patients or those with Workman's Compensation insurance were more likely to be admitted to VBCs (p < 0.0001), and payer status remained a significant predictor of treatment at a VBC on regression analysis.
This is the most comprehensive study of its kind and demonstrates that ABA burn center referral criteria are not always used for effective regionalized burn care or to ensure the best possible outcomes. Even with establishment of the burn center verification process, the mere presence of a VBC is insufficient for effective regionalized care. A greater emphasis is needed on the development of burn care systems.
区域化创伤护理的有效性和益处已得到充分证实；然而，区域化烧伤护理的有效性和烧伤中心验证的潜在益处尚未得到充分验证。
这是一项回顾性研究，使用 2000 年 10 月 1 日至 2007 年 9 月 30 日的全州出院数据库，对所有急性烧伤入院患者进行研究。在北卡罗来纳州的 2 家美国烧伤协会 (ABA) 认证烧伤中心 (VBC) 和其余 107 家非烧伤中心 (NBC) 之间，比较了人口统计学、转诊模式、护理实践和结果。
总体而言，6873 名成年烧伤患者需要入院治疗，其中 79%符合 ABA 烧伤中心转诊标准。在符合 ABA 转诊标准的 5402 名患者中，43%被收入 NBC，所有 NBC 患者中有 25%接受了烧伤手术。收入 NBC 的烧伤往往涉及手/腕和下肢。有合并症/合并伤的老年患者更有可能被收入 NBC（p < 0.0001）；然而，较大的烧伤更有可能被收入 VBC（p < 0.0001）。更多的 NBC 患者出院到疗养院（p < 0.0001）。有医疗保险的患者更有可能被收入 NBC（p < 0.0001），而没有保险或有工人补偿保险的患者更有可能被收入 VBC（p < 0.0001），并且在回归分析中，支付人状态仍然是治疗 VBC 的重要预测因素。
这是此类研究中最全面的一项，表明 ABA 烧伤中心转诊标准并不总是用于有效的区域化烧伤护理或确保最佳结果。即使建立了烧伤中心验证流程，仅仅存在 VBC 不足以实现有效的区域化护理。需要更加重视烧伤护理系统的发展。
