Telemedicine to triage minor hand burn referrals to a tertiary centre: A retrospective observational cohort study.

Abstract

Hand burns are a common presentation to Emergency Departments and can range from minor burns which heal without consequence to debilitating injuries that cause permanent loss of function. It is of interest to investigate current methods of triage and identify which injuries can safely be managed locally without assessment by burns services. Referrals of isolated hand burn injuries over six months were reviewed. Photographs of burns were reviewed at the time of referral using a telemedicine system and were triaged either for face-to-face review (F2F), or for local follow-up (LFU). A total of 194 referrals of isolated hand burns were received. Forty-six patients (24 %) were triaged for LFU; the remaining 148 were seen F2F (76 %). Of the F2F referrals, 67/148 (45 %) healed within 2 weeks with simple dressings only and did not require admission, scar clinic referral, surgery, or treatment for infection. Of the remainder, 16 developed infection (11 %), 9 required admission (6 %), 21 required specialist dressings management (14 %), and 9 required surgery (6 %). Median time to heal was 8 days (range 0-56). This increased significantly to 20 days for full-thickness injuries (range 2-56, p = 0.018 [Mann-Whitney U]). Of the 46 LFU patients, none required re-referral to the burns service, suffered complications, or required surgery. Annually, around 100 referrals to our centre with minor hand burns are safely triaged without face-to-face review. Of those seen F2F, 45 % heal without complications within 2 weeks using simple dressings, accounting for 130 patients per year. Assuming that adequate protocols and criteria are established, we anticipate that many hand burns can be managed locally, thereby ensuring that burns service resources are reserved for more severe and complex injuries.