Division of Pediatric Emergency Medicine, Monroe Carell Children's Hospital at Vanderbilt, Nashville, TN 37232, USA.
Division of Pediatrics, Monroe Carell Children's Hospital at Vanderbilt, Nashville, TN 37232,USA.
J Burn Care Res. 2024 Aug 6;45(4):985-989. doi: 10.1093/jbcr/irae011.
Pediatric burn care is an essential component of emergency care and there are disparities in access to regional burn centers. Teleburn is a tool that enables providers without a certified burn center to provide photos of a burn to experts and receive recommendations. The purpose of this study is to evaluate the effectiveness of a Teleburn system to the in-person consultation regarding burn infection rate, clinic follow-up rate, postburn admission rate, and 72-h bounce back rate. Data were collected from December 2019 to March 2022 through the electronic medical record. A total of 416 patient encounters that met the criteria were analyzed. A non-inferiority study was designed comparing proportional outcomes of Teleburn initial visits to emergency department visits regarding burn infection rate, clinic follow-up rate, postburn admission rate, and 72-h bounce back rate. The data were compared with a difference of greater than 10% being considered inferior. No differences were identified in rates of readmission-1.67% difference (95% CI -27%< x < 23.8%) and return within 72 h-0.7% difference (-18.4%< x < 19.7%). Teleburn patients were 12.6% less likely to follow-up (2.7%< x < 22.40%). Only one infection was identified, which was insufficient to conclude non-inferiority. While convenient, Teleburn consult could not be demonstrated to be non-inferior to in-person consultation. No differences in infection rates were identified, and differences in readmission and return were clinically insignificant. This study demonstrates that Teleburn may be effective and feasible for regional burn centers if follow-up can be improved.
儿科烧伤护理是急救护理的重要组成部分，但在获得区域烧伤中心方面存在差异。Teleburn 是一种工具，使没有认证烧伤中心的提供者能够将烧伤照片提供给专家，并获得建议。这项研究的目的是评估 Teleburn 系统在烧伤感染率、诊所随访率、烧伤后入院率和 72 小时反弹率方面对面对面咨询的有效性。数据是通过电子病历从 2019 年 12 月至 2022 年 3 月收集的。共分析了符合标准的 416 例患者就诊情况。设计了一项非劣效性研究，比较 Teleburn 初次就诊和急诊科就诊在烧伤感染率、诊所随访率、烧伤后入院率和 72 小时反弹率方面的比例结果。将数据与差异大于 10%的结果进行比较，认为差异较大。在再入院率方面没有差异-1.67%的差异（95%CI-27%<x<23.8%）和 72 小时内返回率-0.7%的差异（-18.4%<x<19.7%）。Teleburn 患者的随访率低 12.6%（2.7%<x<22.40%）。仅发现一例感染，不足以得出非劣效性结论。虽然方便，但 Teleburn 咨询不能证明优于面对面咨询。未发现感染率存在差异，再入院率和返回率的差异在临床上无意义。这项研究表明，如果能够提高随访率，Teleburn 可能对区域烧伤中心有效且可行。
