What are the criteria for transferring a patient to a burn center?

Criteria for Transfer to a Burn Center

Patients with burns should be transferred to a burn center if they have >10% total body surface area (TBSA) epidermal loss, burns involving critical areas (face, hands, feet, genitalia, perineum, or major joints), or circumferential burns requiring specialized care and management. 1

Primary Transfer Criteria

TBSA Criteria

• Adults: Burns >10-15% TBSA
• Children: Burns >10% TBSA
• Elderly: Burns >10% TBSA

Anatomical Location

Burns involving:

• Face
• Hands
• Feet
• Genitalia or perineum
• Major joints
• Flexure lines

Burn Depth and Type

• Full-thickness (third-degree) burns
• Deep partial-thickness burns requiring specialized care
• Circumferential burns (risk of compartment syndrome)
• Chemical burns
• Electrical burns
• Burns with inhalation injury

Secondary Transfer Criteria

Patient Factors

• Age extremes (very young or elderly)
• Significant comorbidities
• Pregnancy
• Concomitant trauma or injuries requiring specialized care

Wound Management Needs

• Need for surgical intervention (excision and grafting)
• Complex wound care requirements
• Need for specialized nursing care

Assessment Tools

• The Lund and Browder chart is the most accurate method for measuring TBSA in both adults and children 2
• Alternative methods include:
  • Serial halving method
  • Open hand method (palm and fingers represent approximately 1% TBSA)

Transfer Process

1. Immediate Specialist Consultation

   • Contact burn specialists urgently for severe burns to determine severity, measure TBSA, initiate appropriate fluid resuscitation, and ensure appropriate management 1
   • Use telemedicine when burn specialists aren't readily available to improve TBSA measurement and characterize severity 1

2. Direct Admission Preferred

   • Direct admission to a burn center is associated with better outcomes including decreased morbidity and mortality 1
   • Early surgical excision and skin grafting, routinely performed at burn centers, significantly reduce morbidity, mortality, and length of hospital stay 1

3. Initial Management Before Transfer

   • Stabilize airway, breathing, and circulation
   • Initiate fluid resuscitation for large burns
   • Cover burns with sterile, non-adherent dressings
   • Maintain normothermia
   • Provide adequate pain management

Special Considerations

Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis (SJS/TEN)

• Patients with SJS/TEN with >10% BSA epidermal loss should be admitted without delay to a burn center or ICU with experience treating SJS/TEN 1
• These patients require specialized care including barrier nursing, temperature control (25-28°C), and pressure-relieving mattresses 1

Circumferential Burns

• Require urgent specialist assessment due to risk of compartment syndrome
• May require escharotomy to prevent ischemia and further tissue damage 1

Inhalation Injury

• Suspected inhalation injury requires close monitoring
• Consider intubation for patients with burns involving the entire face if they have deep circular neck burns, symptoms of airway obstruction, or very extensive burns (TBSA >40%) 1

Cautions and Pitfalls

• Avoid unnecessary transfers of patients with minor burns that can be managed at local facilities 3
• Consider palliative approaches for patients with extremely severe burns unlikely to survive, as transfer may negatively impact families when loved ones die far from home 4
• Avoid undertriage, which increases risk of morbidity and mortality 1
• Don't delay transfer to perform procedures that can be done at the burn center (e.g., bronchial fibroscopy for suspected smoke inhalation) 1

Transfer to a burn center is associated with improved survival, facilitated rehabilitation, and reduced complications, length of hospital stay, and costs when appropriate criteria are met 1.