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News Monday, June 01, 2015

Dr. Palmieri leads study that points to better outcomes for pediatric burn patients

Study reveals high-volume centers have better outcomes

Tina Palmieri, M.D., assistant chief of burns at Shriners Hospitals for Children — Northern California, published results of a nine-year study on mortality rates for burn-injured children in the May 2015 issue of Pediatric Critical Care Medicine, a publication of the Society of Critical Care Medicine. The study reveals that mortality rates are lower in high-volume pediatric burn centers, including the Northern California Shriners Hospital and its sister burn centers in Galveston, Cincinnati, and Boston.

“In an effort to promote positive outcomes in children with burn injuries, we felt it was important to examine survival rates of children treated at burn centers throughout the United States. Because children have unique medical needs, we suspected a link between the number of patients treated and patient outcomes,” says Dr. Palmieri.

According to the National Center for Injury Prevention and Control (NCICP), accidents are the leading cause of death in children in the United States, and burns are the third leading cause of unintentional injury deaths in children 0-9 years old. Between 2001 and 2011, more than 1.5 million children sustained burn injuries, and 5,842 of those children died, according to the NCICP.

To determine the relationship between the volume of burn admissions and the outcomes for children with burns, the research included a retrospective review of 210,683 records entered in the National Burn Repository (NBR) from 2000-2009. Of those records, 33,115 were for children under 18 years of age treated for burn injuries at 65 facilities in the United States. The number of patients varied greatly among facilities.

“The study showed that factors influencing survival rates include age, size of burn and inhalation injury,” says Dr. Palmieri. “But the most significant finding was the relationship between patient volume and mortality rates. Data revealed that hospitals that admitted more than 200 pediatric burn patients a year had the lowest mortality rates for children, and the death rate for children with burn injury is decreased by 40 percent for every 100 patients treated at a center.

There are seven tertiary burn centers in the United States with more than 200 pediatric burn admissions a year, and four of those are Shriners Hospitals for Children. The Northern California Shriners Hospital in Sacramento is the region’s busiest pediatric burn center, admitting more than 350 new patients annually and seeing upwards of 4,300 children in its burn clinic each year.

Dr. Palmieri, a past president of the American Burn Association, extends her expertise in critical care to adults and children though her work at Shriners Hospital and as professor and director of the Firefighters Burn Center at the University of California, Davis. She is a member of the American College of Surgeons, the Association for Academic Surgery, the American Association for Surgery and Trauma, the Society of Critical Care Medicine, the Pacific Coast Surgical Society, and the International Society for Burn Injury.

The study was co-authored by Sandra Taylor, Ph.D., MaryBeth Lawless, R.N., Terese Curri, M.S., Soman Sen, M.D., and David Greenhalgh, M.D. Complete results of the study appear in May 2015 issue of Pediatric Critical Care Medicine in the article “Burn Center Volume Makes a Difference for Burned Children.”