Burn Unit Admission Criteria
Patients meeting specific burn severity thresholds should be admitted to specialized burn centers, with distinct criteria for adults and children based on total body surface area (TBSA), burn depth, anatomical location, and patient-specific factors. 1
Adult Admission Criteria
Absolute Indications (Any Single Criterion)
- TBSA burned > 20%
- Deep burns > 5%
- Smoke inhalation injury (known or suspected)
- Deep burns in function-sensitive areas: face, hands, feet, perineum
- High-voltage electrical burns
Relative Indications (TBSA < 20% PLUS one or more of the following)
- Age > 75 years
- Severe comorbidities
- Known or suspected smoke inhalation
- Deep circular burns
- Superficial burns in function-sensitive areas (face, hands, feet, perineum, skin folds)
- TBSA > 10%
- Deep burns 3-5%
- Low-voltage electrical burns
- Chemical burns (e.g., hydrofluoric acid)
Pediatric Admission Criteria
Any Single Criterion Warrants Admission
- TBSA > 10%
- Deep burns > 5%
- Infants < 1 year of age (regardless of burn size)
- Severe comorbidities
- Smoke inhalation injuries
- Deep burns in function-sensitive areas (face, hands, feet, perineum, flexure lines)
- Circular burns
- Electrical or chemical burns
Critical Implementation Points
Specialist Consultation is Mandatory
All patients meeting any referral criterion should have urgent specialist consultation to determine burn severity, measure TBSA accurately, and guide appropriate referral. 1 This is particularly crucial for burns involving anatomical areas requiring specialized care (face, hands, feet, flexure lines, genitals, perineum) or when special medico-social care or long-term rehabilitation needs are anticipated. 1
Direct Admission Preferred
When burn center admission is indicated, direct transfer is strongly preferred over secondary transfer. 1 Evidence demonstrates that direct admission reduces time to surgical excision, decreases mechanical ventilation duration, and improves both morbidity and mortality outcomes. 1 The only exception is when patients exhibit haemodynamic or respiratory instability requiring stabilization at a nearby facility before transfer. 1
Telemedicine for Triage
When burn specialists are not immediately available, telemedicine should be utilized to improve TBSA measurement accuracy and severity characterization. 1 This prevents both overtriage (unnecessary resource consumption) and undertriage (which increases morbidity and mortality risk). 1
Common Pitfalls to Avoid
Undertriage remains a significant problem: Research shows that 48% of patients meeting referral criteria at non-burn centers are never transferred, with the most commonly undertriaged burns involving hands, wrists, face, neck, and lower extremities. 2 All deaths occurring at non-burn centers in one study met referral criteria but were not transferred. 2
Age-based criteria are absolute in children: Any infant under 1 year with a burn injury warrants burn center evaluation, regardless of burn size. 1
Circular burns require urgent assessment: Deep circumferential burns can cause compartment syndrome leading to limb ischemia or thoracic/abdominal compartment syndrome. Escharotomy should ideally be performed at a burn center by experienced providers within 48 hours if compartment syndrome develops. 1
TBSA measurement accuracy matters: Use the Lund-Browder chart (most accurate method) rather than the Wallace rule of nines, which significantly overestimates TBSA and is unsuitable for children. 1 The open hand method (palm and fingers = 1% TBSA) is acceptable for rapid assessment. 1
Evidence Quality Note
These criteria are based on expert consensus from the 2020 French Society of Anesthesiology and Intensive Care Medicine (SFAR) guidelines, which achieved strong agreement among European burn specialists. 1 While powered studies on mortality outcomes are limited, the multidisciplinary approach at burn centers has demonstrated improved survival, reduced complications, shorter hospital stays, and better long-term functional outcomes. 1