Date of Award

January 2017

Document Type

Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

John Geibel

Abstract

Aim: Over a quarter of all burn admissions in the United States are children <18y. The American Burn Association (ABA) has outlined characteristics of a burn that warrant referral to a burn care facility. Estimation of total body surface area (TBSA) and burn severity are essential to accurate burn assessment, however discrepancies exist between the evaluation of medical professionals who do not routinely engage in burn care and those who do. We hypothesized that utilizing telemedicine for real-time consult with a regional burn center (BC) would result in improved burn triage and management.

Method: We reviewed the records of all burn patients presenting to Level 1 Pediatric Trauma Center (PTC) and transferred to the BC over a 2-year period before and after institution of a policy requiring Telehealth based review of burn injury (February 2015).

Results: 59 patients were included, 31 prior to telemedicine implementation and 28 after. The majority of burns were scald (73%) or contact (20%). Median TBSA burn was 5% in the first reporting period and 4% in the second. PTS estimation of burn size was significantly greater than BC estimation both before and after institution of telemedicine review (p=0.0001) but demonstrated improved correlation after policy implementation (R=0.57 vs R=0.95). Length of stay (LOS) was decreased from 3.1 days to 1.5 days, associated with an increase in referrals to the outpatient burn clinic.

Conclusion: The institution of telemedicine based burn evaluation improved the triage accuracy of pediatric burns and resulted in a decrease in hospital LOS and increase in outpatient referrals and treatment plans.

Comments

This thesis is restricted to Yale network users only. It will be made publicly available on 06/25/2100

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