Department of Pediatrics, Maasstad Hospital, PO Box 9100, 3007 AC, Rotterdam, The Netherlands.
Injury. 2012 Sep;43(9):1451-6. doi: 10.1016/j.injury.2011.06.027. Epub 2011 Jul 7.
Total body surface area (TBSA) burned, expressed as percentage is one of the most important aspects of the initial care of a burn victim. It determines whether transfer to a burn centre is necessary as well as the need for, and amount of, intravenous fluid resuscitation. Numerous studies, however, have highlighted inaccuracies in TBSA assessment. Therefore, the differences in burn size estimates between referrers and burn centre's in children and its consequences in terms of transfer and intravenous fluid resuscitation were investigated.
This study involved two time periods from January 2002 until March 2004 and January 2007 until August 2008. All referred children admitted to a Dutch Burn centre within 24h post burn were eligible. Data were obtained from patient records retrospectively and in part prospectively.
A total of 323 and 299 children were included in periods 1 and 2, respectively. Referring physicians overestimated burn size with a factor two (mean difference: 6% TBSA ± 5.5). About one in five children was referred to a burn centre without fulfilling the criteria for referral with regard to burn size (assessed by burn specialists) special localisation or inhalation trauma. Proportions of children receiving intravenous fluid resuscitation regardless of indication increased from 33% to 49% (p<0.01). The received volumes tended to be higher than necessary.
Referring physicians overestimate burn size in children admitted to Dutch burn centres. This has little negative consequences, however, in terms of unindicated transfers to a burn centre or unnecessary fluid resuscitation.
烧伤总面积（TBSA）以百分比表示，是烧伤患者初始治疗中最重要的方面之一。它决定了是否需要转至烧伤中心，以及是否需要、需要多少静脉补液复苏。然而，许多研究强调了 TBSA 评估的不准确性。因此，研究了转诊医生和烧伤中心在儿童烧伤面积估计方面的差异，以及它们在转院和静脉补液复苏方面的后果。
本研究包括两个时间段，分别为 2002 年 1 月至 2004 年 3 月和 2007 年 1 月至 2008 年 8 月。所有在烧伤后 24 小时内被转诊至荷兰烧伤中心的儿童均符合条件。数据从患者记录中回顾性和部分前瞻性获得。
第 1 阶段和第 2 阶段分别纳入了 323 名和 299 名儿童。转诊医生高估了烧伤面积，倍数为二（平均差异：6% TBSA ± 5.5）。大约五分之一的儿童被转诊至烧伤中心，而烧伤大小（由烧伤专家评估）、特殊部位或吸入性创伤等转诊标准并未得到满足。无论是否有补液指征，接受静脉补液复苏的儿童比例从 33%增加到 49%（p<0.01）。接受的液体量往往高于所需量。
转诊至荷兰烧伤中心的儿童，转诊医生高估了烧伤面积。然而，这在未经指示转院或不必要的液体复苏方面，几乎没有产生负面影响。
