Does trauma center designation impact management, complications, and outcomes in burn patients? A National Trauma Data Bank analysis.

Abstract

Burn injuries, particularly those involving large total body surface area (TBSA), present significant challenges due to fluid shifts, increased metabolic demands, and heightened susceptibility to complications. Trauma center designation, ranging from Level 1 (highest acuity) to Level 3, reflects differences in resources, expertise, and care protocols, which may influence patient outcomes. This study evaluates the impact of trauma center designation on transfusion practices, complications, and mortality among burn patients. The Trauma Quality Improvement Program (TQIP) database (2017-2022) was queried to identify burn patients by ICD-9/10 codes. Patients were categorized based on trauma center designation: Level 1 versus non-Level 1 (Levels 2 and 3). Outcomes analyzed included transfusion practices (e.g., packed red blood cells, plasma, platelets), inpatient complications, and mortality. Multivariable logistic regression was performed, adjusted for age, gender, %TBSA, inhalation injury, and Injury Severity Score (ISS). Subgroup analysis was performed for patients with burns > 20 % TBSA. Among 72,474 burn patients, 47 % were treated at Level 1 centers. Patients at Level 1 centers presented with higher injury severity and had significantly higher rates of complications, including respiratory failure, sepsis, and surgical site infections. Despite the higher complication rates, Level 1 centers demonstrated significantly lower mortality compared to non-Level 1 centers (adjusted OR=0.46, 95 % CI 0.25-0.83, p = 0.011). Transfusion practices did not differ significantly between center levels after adjustment. In patients with burns > 20 % TBSA, Level 1 centers maintained lower mortality rates (adjusted OR=0.83, 95 % CI 0.79-0.88, p < 0.001). Trauma center designation is associated with significant differences in burn outcomes. Level 1 centers, despite managing more severe cases, demonstrate lower mortality, emphasizing the importance of specialized care for burn patients. Standardizing burn care protocols and optimizing transfer practices may further improve outcomes for this high-acuity population.