From the Guidelines
Burns that require transfer to a burn unit include those involving the face, hands, feet, and genitals, as well as burns with a large surface area, such as those covering more than 10% of the total body surface area (TBSA) in adults and 5% in children. These criteria are based on the severity and complexity of the injuries, which often require specialized care including fluid resuscitation, wound management, surgical intervention, and rehabilitation that may not be available in general hospitals 1.
Key Indications for Burn Unit Transfer
- Partial thickness burns covering more than 10% of TBSA in adults and 5% in children
- Full thickness burns of any size
- Burns involving critical areas like the face, hands, feet, genitalia, perineum, or major joints
- Electrical burns (including lightning injury)
- Chemical burns
- Inhalation injuries
- Burns in patients with significant pre-existing medical conditions
- Burns with associated trauma
- Burns in special populations such as children and the elderly Early transfer to a burn unit is crucial for optimal outcomes, ideally within the first 24 hours after injury 1. Before transfer, initial management should include stopping the burning process, providing adequate pain control, covering wounds with clean dry dressings, starting fluid resuscitation if needed, and avoiding hypothermia. The American Burn Association recommends that patients with second- or third-degree burns involving the face, hands, feet, and genitals and those involving >10% body surface area (5% in children) be treated in a specialized burn center because of the likely need for intravenous fluid resuscitation, surgery, and other specialized treatments 1.
From the Research
Burn Types Requiring Transfer to a Burn Unit
The following types of burns require transfer to a burn unit:
- Full-thickness (third-degree) burns, as they involve the entire dermal layer 2
- Deep partial-thickness burns, as they require immediate referral to a burn surgeon for possible early tangential excision 2
- Burns with a large percentage of total body surface area involved, as this is a key determinant of the need for referral to a burn center 2
- Burns in patients with diabetes mellitus, as they are at increased risk of complications and infection 2
- Burns with inhalation injury, as this can lead to serious complications and requires specialized care 3
Patient Characteristics Requiring Burn Unit Transfer
Patients with the following characteristics may require transfer to a burn unit:
- Older adults, as burn injuries are more likely to occur in this population 2
- Children, as burn injuries are more likely to occur in this population 2
- Patients with severe burns, as defined by a large burn area or third-degree burns 3
- Patients with risk factors for mortality, such as age and third-degree burn area 3
Importance of Burn Unit Transfer
Transfer to a burn unit is crucial for patients with severe burns, as it provides access to specialized care and improves outcomes 3, 4