Effects of Differences in Percent Total Body Surface Area Estimation on Fluid Resuscitation of Transferred Burn Patients

We sought to analyze the effect that differences in estimation of burn size and burn resuscitation had on complications and death among our transferred burn patients, in comparison with outcomes for burn patients directly admitted to our rural Level 1 trauma center. A retrospective chart review was performed for all patients suffering thermal injuries who were treated at a rural Level I trauma center and regional burn center. Percent TBSA burn estimates at referring hospitals were compared to burn center estimates. The Parkland formula was used to calculate the difference between the theoretical and actual resuscitation volumes given prior to admission. Of 127 burn patients, 82 (65%) were transferred from outside hospitals. For small burns (<20% TBSA), the mean estimate difference between outside hospitals and the burn center was 4.3 +/- 6.9%. For large burns (> or =20% TBSA), the mean estimate difference was -4.9 +/- 9.1% (P < .0002). The mean difference in intravenous fluid administered prior to admission to the burn center and the Parkland formula guideline was an excess of 554 +/- 1099 ml for small burns and a deficit of -414 +/- 2081 ml for larger burns (P = .03, Wilcoxon's rank-sum test). Differences in burn estimation and deviation from the Parkland formula were not statistically significant for complication and death. In the rural, transferred burn patient, smaller burns tended to be overestimated and overresuscitated and larger burns tended to be underestimated and underresuscitated.