Burn related injuries: a nationwide analysis of adult inter-facility transfers over a six-year period in the United States

Christopher S. Evans, Kimberly Hart, Wesley H. Self, Sayeh Nikpay, Callie M. Thompson, Michael J. Ward

Research output: Contribution to journalArticlepeer-review

3 Scopus citations


Background: US emergency department (ED) visits for burns and factors associated with inter-facility transfer are unknown and described in this manuscript. Methods: We conducted a retrospective analysis of burn-related injuries from 2009–2014 using the Nationwide Emergency Department Sample (NEDS), the largest sample of all-payer datasets. We included all ED visits by adults with a burn related ICD-9 code and used a weighted multivariable logistic regression model to predict transfer adjusting for covariates. Results: Between 2009–2014, 3,047,701 (0.4%) ED visits were for burn related injuries. A total of 108,583 (3.6%) burn visits resulted in inter-facility transfers occurred during the study period, representing approximately 18,097 inter-facility transfers per year. Burns with greater than 10% total body surface area (TBSA) resulted in a 10-fold increase in the probability of transfer, compared to burn visits with less than 10% TBSA burns. In the multivariable model, male sex (adjusted odds ratio [aOR] 2.4, 95% CI 2.3–2.6) was associated with increased odds of transfer. Older adults were more likely to be transferred compared to all other age groups. Odds of transfer were increased for Medicare and self-pay patients (vs. private pay) but there was a significant interaction of sex and payer and the effect of insurance varied by sex. Conclusions: In a national sample of ED visits, burn visits were more than twice as likely to have an inter-facility transfer compared to the general ED patient population. Substantial sex differences exist in U.S. EDs that impact the location of care for patients with burn injuries and warrants further investigation.

Original languageEnglish (US)
Article number147
JournalBMC Emergency Medicine
Issue number1
StatePublished - Dec 2022

Bibliographical note

Funding Information:
Dr. Ward received support from the National, Heart, Lung, and Blood Institute (K23HL127130) and by the Department of Veterans Affairs, Veterans Health Administration, VA Office of Rural Health (ORH-10808). Ms. Hart was also supported by the Vanderbilt Trans-Institutional Programs and a VICTR grant from CTSA (NCATS UL1 TR002243). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health nor the U.S. Department of Veteran Affairs.

Publisher Copyright:
© 2022, The Author(s).


  • Burns
  • Disparities
  • Emergency medicine
  • Inter-facility transfer


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