National Burn Repository 2005: A Ten-Year Review

IntroductionPreviously, cases of abuse may only have been coded as such when the investigation was complete, thus skewing the data available in the National Burn Repository (NBR) toward more severe or obvious cases of abuse. The introduction of the ICD10 coding system in 2015 brought with it the concept of “confirmed” and “suspected” cases of abuse. We hypothesized that the creation of these two categories might shift our understanding of non-accidental pediatric burn injuries.MethodsWe queried the NBR, a retrospective database maintained by the American Burn Association (ABA) which contains data submitted by all ABA-verified burn centers as well as some non-verified centers, for all children under the age of 18. Data were cleaned using e-codes where appropriate. To create equal samples, we created two cohorts: the ICD-9 sample comprises all children treated from 2012-2014, and the ICD-10 sample includes all children treated from 2016 to 2018. Data from 2015 were omitted as the ICD-10 coding system was introduced part way through the year.ResultsA total of 34,456 patients are included in the sample, including 18,783 (54.5%) in the ICD-9 group and 15,673 in the ICD-10 group. The most common causes of injury in both eras was scald (48.7% in ICD-9 and 55.2% in ICD-10), followed by fire/ flame (20.3% in ICD-9 and 20.9% in ICD-10). The overall rate of abuse (including both suspected and confirmed abuse in the ICD-10 group) was higher in the ICD-9 era than the ICD-10 era (4.2 vs 3.2%, p< 0.001). As seen in previous studies, children with injuries due to abuse were younger (median age 2.0 vs 3.0 years, p< 0.001), had a larger median burn size (3.0 vs 5.0%, p< 0.001), a longer hospital length of stay (2.0 vs 4.0 days, p< 0.001), and a higher rate of mortality (0.8 vs 0.5%, p< 0.001). In the ICD-10 cohort, only 17 cases were coded as “confirmed” abuse (0.1%) and 478 were coded as “suspected” (3.0%). In contrast, in the ICD-9 group, 789 patients (4.2%) were coded as being victims of abuse.ConclusionsWe expected that adoption of ICD-10, with its ability to yield increased data granularity, would yield a higher overall incidence of injury. Specifically, we expected more patients with smaller injuries to be included in the new “suspected” category, given the lower threshold to apply that diagnosis. However, this was not demonstrated in the NBR dataset, and in fact the overall incidence of abuse decreased. Given the added layers of complexity within the ICD-10 system, it is possible that the differences reflect challenges in coding cases of abuse rather than actual epidemiological changes.

Introduction The American Burn Association (ABA) verifies pediatric burns centers to maintain the highest quality in the care of burned children. However, children may be triaged to other facilities. To date, there are no population health level studies exploring factors that determine which burned children are treated at pediatric verified burn centers. Further, there is a need to define characteristics of those most at risk for under-referral. We hypothesize that factors including race, distance to the burn center, social deprivation index (SDI), and insurance status will impact treatment at verified pediatric burn centers. Methods A state’s health care information database was queried from 2010-2019 extracting all pediatric emergency department (ED) and inpatient admissions. Individual patients were linked between ED and inpatient encounters. The distance between the burn center and patient’s home was calculated by using the geographic coordinates of the patient’s and facility’s zip codes. Facilities were categorized as pediatric verified burn centers, non-verified burn centers, or non-burn centers using information from the ABA. The primary outcome was admission to a verified pediatric burn center which was modeled with multivariable logistic regression. Study variables included race, social deprivation index (SDI), insurance status, and travel distance. The model was adjusted for age, TBSA, non-accidental trauma, and inhalation injury. Results There were 108,541 ED visits of which 10,099 (9.3%) were admitted or transferred. Of patients admitted from an ED, 45.48 % were admitted to pediatric verified centers, 32.39% were admitted to non-verified burn centers, and 22.12% were admitted to non-burn centers. 5.95% were transferred from initial ED to a different facility. Of all admitted transfers, 42.62% occurred to verified centers compared to 31.05% to non-verified centers and 26.33% to non burn centers. SDI (aOR 0.99, 95% CI 0.99-0.99, p = 0.002) and public health insurance status (aOR 0.50, CI 0.41- 0.59, p&amp;lt; 0.001) were significantly associated with admission to verified centers. Conclusions Children living in areas with higher SDI or with public health insurance were less likely to be admitted to a verified pediatric burn center from the ED. The data suggests a significant economic disparity in access to specialized burn care. Future interventions can be targeted to address the link between childhood poverty and poorer access to quality burn care. Applicability of Research to Practice Understanding referral patterns in pediatric burn patients is crucial for shaping local and statewide efforts to improve access to specialized, high-quality care for all children with burns. Identifying barriers to referral can guide revisions to referral guidelines and enhance the effectiveness of American Burn Association educational initiatives, ultimately ensuring more equitable access to pediatric-specific burn care. Funding for the Study Institutional Pediatrics Residency Research Grant - January 2024

Detailed information on the cause of burns is necessary to construct effective prevention programs. The International Classification of External Causes of Injury (ICECI) is a data collection tool that allows comprehensive categorization of multiple facets of injury events. The objective of this study was to conduct a process evaluation of software designed to improve the ease of use of the ICECI so as to identify key additional variables useful for understanding the occurrence of burn injuries, and compare this software with existing data-collection practices conducted for burn injuries. The authors completed a process evaluation of the implementation and ease of use of the software in six U.S. burn centers. They also collected preliminary burn injury data and compared them with existing variables reported to the American Burn Association's National Burn Repository (NBR). The authors accomplished their goals of 1) creating a data-collection tool for the ICECI, which can be linked to existing operational programs of the NBR, 2) training registrars in the use of this tool, 3) establishing quality-control mechanisms for ensuring accuracy and reliability, 4) incorporating ICECI data entry into the weekly routine of the burn registrar, and 5) demonstrating the quality differences between data collected using this tool and the NBR. Using this or similar tools with the ICECI structure or key selected variables can improve the quantity and quality of data on burn injuries in the United States and elsewhere and thus can be more useful in informing prevention strategies.

IntroductionThe American Burn Association (ABA) Burn Therapist Certification (BT-C) program, developed in 2018, derived from an organizational desire to promote vetted quality burn care across the interprofessional team. Leadership positions within organizations, are responsible for formulating policy, developing education, and providing oversite to ensure the success of the association. A previous study examining interdisciplinary representation within burn society leadership for the ABA and International Society of Burn Injuries, found that rehabilitation representation within governance positions was 7% and 9% within committee memberships. In a 2022 Letter to the Editor, therapists described limited center support as a barrier for obtaining BT-C. This study aims to examine BT-C member involvement within ABA society leadership.MethodsOfficial ABA society and membership websites were accessed to identify BT-C recipients who currently hold positions within society governance and committee memberships. ABA Special Interest Group (SIG) membership was also examined. The Journal of Burn Care and Research (JBCR) website was accessed to identify BT-C recipients on the editorial board. BT-C members were compared to other therapist involvement.ResultsOf 32 qualified BT-C therapists, 26 continue their ABA memberships. BT-C therapists hold 3 Governance positions (Board membership and current ABA President) and maintain 36 of the available 77 committee positions (47%). Excluding the BT-C Committee from data collection, BT-C therapists make up 44% (n=23) of therapist committee positions within the ABA. BT-C therapists hold a combined 46 SIG memberships. The JBCR currently lists 2 therapists on the editorial board, both of whom are BT-C.ConclusionsDespite representing a fraction of the burn therapy community, BT-C therapists continue to be leaders within the burn field by participation in ABA membership, governance, and committee memberships. Current BT-C therapists serve to establish standards in research published within the JBCR. Professional and academic societies depend on qualified leaders to set standards of burn care. Promoting BT-C within individual burn centers may stimulate leadership within the center and burn professional organizations.Applicability of Research to PracticeDefinitive evidence supporting the benefits of BT-C to individuals and organizations is needed to overcome current barriers to certification.

Introduction Point of care for burn survivors has traditionally been the inpatient burn unit. Advances in burn care have resulted in significantly reduced length of stay or allowed survivors to avoid admission. However, an outpatient shift within burn care only emphasizes a growing need for rehabilitation resources. This study surveyed burn centers within the United States (US) to determine current outpatient burn clinic structure and evaluate utilization of burn therapy. Methods A 20-question survey was electronically distributed to burn clinicians at burn centers within the US. Questions included the location of their burn clinic, operational hours, dedicated staff, and utilization of burn therapy services. Chi-square test was used to analyze frequency differences between American Burn Association (ABA) verified and non-verified centers with significance set at &amp;lt; 0.05. Results The survey was completed by representatives of 54 burn centers treating Adults (n=17), Pediatric (n=7), or both (n=30). Burn centers were ABA verified (61%, n=33) and non-verified (39%, n=21) centers. Outpatient clinics included permanently dedicated burn therapists at 65% (n=35) of responding burn centers (OT= 32, PT =28) (Table 1). Respondents reported that therapy services in the outpatient clinics saw “Almost all patients,” 15% (n=8) of the time, while the majority stated therapist saw “Most” (30%, n=16) or “Some” patients (24%, n=13). Only 7 centers report standing therapy orders, while the majority report pre-screening by APPs/physicians (n=43). Only 39% (n=21) reported that reconstructive patients were “Often” referred for therapy. The greatest barriers to outpatient follow up were “distance from burn center”(n=43) and “transportation”(n=30), with 50% of respondents offering transportation support for patients. Verified burn centers were statistically more likely to have either PT or OT dedicated to the burn clinic (79%, p=0.007) than non-verified centers. However, there was no difference in verification status for therapy treating “Most” or “All” patients (50%, p=0.112), and having a dedicated burn therapy treatment space (59%, p=0.067) Conclusions Outpatient Burn Rehabilitation is currently being underutilized, with many centers setting standards below those established for inpatient burn care. Transitioning care to the outpatient setting does not eliminate, or reduce patients’ need for specialized burn therapy. Hospital, physician, and outpatient leaders must consider the rehabilitative needs of burn patients as care is shifted to outpatient and ensure adequate therapy involvement in care. Applicability of Research to Practice Burn centers must prepare to treat an increasing number of burn survivors throughout the entire burn continuum of care. Therapy resources must be optimized within the outpatient setting to match the shift in care toward the ambulatory environment to adequately support burn survivors. Funding for the Study N/A

Introduction In 2018 the World Health Organization (WHO) launched the Global Burn Registry (GBR). Its purpose is to help improve the understanding of burn injury worldwide. The purpose of this study was to identify early findings from this database. Methods The GBR was accessed in September 2019. Cases from centers in low income (LIC) and low-middle income countries (LMIC) were combined into a Low Resource (LR) group, and cases in High Income (HIC) and Upper Middle Income (UMIC) countries were combined into a High Resource group (HR). Statistical analysis was performed with SAS 9.4. Data are expressed as mean ± SEM. Logistic Regression was used to identify risk factors for death. Revised Baux Score (RBS) was calculated as described by Osler (2010). Odds ratios are expressed as mean (95% confidence interval). The LA50 was calculated from the regression of death and total burn size (TBSA) for different age groups. Results At the time of analysis, there were 2,315 cases in the GBR treated at 23 facilities in 15 countries (4 HIC, 5 UMIC, 4 LIMC, and 2 LIC). There were 1,346 cases (58%) from HR countries and 969 (42%) from LR countries. The patients in LR were older than those in HR (26.2 ± 0.6 years vs 20.7 ± 0.6, p&amp;lt; 0.01) and had larger TBSA burns (31.0 ± 0.8 % TBSA vs 16.6 ± 0.4, p&amp;lt; 0.01). There were fewer scald burns and more flame injuries in the LR countries (26 ± 1.4 % vs 54 ± 1.4, and 56 ± 1.6 % vs 32 ± 1.3, p&amp;lt; 0.01). Case fatality and RBS were greater in LR (31.5 ± 1.5 % vs 4.8 ± 0.6 and 61.4 ± 1.3 % vs 38.9 ± 0.9, p&amp;lt; 0.01). In regression analysis, LR was an independent risk factor for death with an odds ratio of 6.3 (4.3 – 9.4). The LA50 for HR countries was similar to those in the National Burn Repository. For LR countries the LA50 was lower for all ages except those 65 and older, ranging from 30–45% TBSA. Conclusions Only a few facilities have contributed data to the GBR so far, with lower resourced countries less represented than higher resourced ones. The proportion of cases in the pediatric age group is much less represented in LR countries than in HR, possibly because many burned children in LR countries do not get burn care at specialized centers. Survival in HR countries is similar to that in North America. The GBR provides early insights into global burn care. Opportunities for improvement are greatest in LR countries. New Innovations may be necessary to increase participation from burn centers in LR countries. Applicability of Research to Practice This report provides an early look at burn care across the globe based on cases in the GBR. It may inform further efforts to characterize and improve burn care in low resourced countries.

IntroductionRegistry science applies observational study designs to interpret large secondary databases. It can be utilized to understand disease and injury, answer research questions, inform regulatory decision making, and engender benchmarking of quality-of-care indicators. Numerous burn registries exist globally, however their contributions to the science of burn epidemiology, care and treatment have not been summarized. The objective of this study is to characterize the available literature on burn registries.MethodsWe conducted a scoping review, having registered the protocol a priori. A comprehensive literature search across several databases, including the grey literature, was carried out. Studies of all methodological designs were included provided they utilized, analyzed, and/or critiqued burn registry data. Pilot projects from registries in development were included as well. Studies involving non-burn specific registries or registries from a single burn centre were excluded.ResultsTwo hundred and sixty-eight studies were included, encompassing 16 existing burn registries. Although registry science has been used to investigate burn care since 1970, the majority of studies were published after 2007. Most studies utilized the American Burn Association Burn Registry or one of its previous versions (75.7%) and the Burns Registry of Australia and New Zealand (10.4%). Main limitations of existing registries are the inclusion of patients admitted to burn centres only, deficient capture of outpatient and long-term outcome data, and lack of data standardization across registries.ConclusionsRegistries are an invaluable source of data for research, delivery of care planning, and benchmarking of processes and outcomes. Efforts should be made to stimulate other jurisdictions to build and maintain burn registries, to incorporate data linkage from administrative and other secondary databases, and to standardize data collection, in order to maximize the potential of registry science in burn care.

Because burn care in the United States is regionalized, burn patients are often transported across state lines to receive their burn treatment. The authors hypothesized that there are differences between in-state and out-of-state reimbursement for burn care. This project was conducted by the American Burn Association (ABA) Government Affairs Committee through the ABA Multicenter Trials Group. Participation was open to any member of the ABA. This retrospective observational study was approved by the institutional review boards of each participating institution. Subjects were identified using registry of each site, selecting patients hospitalized for burn injuries during FY2004-FY2006 of the hospitals. Once identified by the registry, the ID numbers were used to collect billing and reimbursement data from the financial offices. Data were sorted by age (adult and pediatric), location (in state and out of state), and payor source (Medicare, Medicaid, commercial, workers compensation, and self-pay). The rate of reimbursement was calculated based on charges and recoveries. Comparisons on data of each center were performed using Student's t-test with type I error <1%. Six facilities contributed data. A total of 4850 burn patients were reviewed, of whom 3941 were in-state burn patients and 909 were out-of-state burn patients. When the results from all six states were analyzed together, reimbursement for adults from Medicaid and Medicare was higher for in-state patients than for out-of-state patients. However, when analyzed by state, Medicare reimbursement between in-state and out-of-state patients did not differ significantly. In one state (Kansas), in-state Medicaid reimbursement was higher, but in two others (Arizona and Pennsylvania), in-state Medicaid reimbursement was lower than that for out-of-state reimbursement. Reimbursement for the care of children did not differ significantly based on state of residence. From these data, we conclude that there are indeed variations between in-state and out-of-state reimbursement, but those variations differ regionally. Indeed, in some cases, out-of-state reimbursement exceeds in-state reimbursement. Careful examination of these data is necessary before recommending policy change, although consideration should be given to a national policy that guarantees uniformity of reimbursement across all payors for burn patients regardless of their state of residence.

To develop a comprehensive definition to identify work-related burns in the National Burn Repository (NBR) based on multiple fields and describes injuries by occupation. The NBR, which is an inpatient dataset, was used to compare type and severity of burn injuries by occupation. Using the definition developed for this analysis, 22,969 burn injuries were identified as work-related. In contrast, the single work-related field intended to capture occupational injuries only captured 4696 cases. The highest numbers of burns were observed in construction/extraction, food preparation, and durable goods production occupations. Occupations with a mean total body surface area (TBSA) burned greater than 10% include transportation and material-moving, architecture and engineering, and arts/design/entertainment/sports/media occupations. The NBR dataset should be further utilized for occupational burn injury investigations and multiple fields should be considered for case ascertainment.

Baux Cutoff Points Predict Geriatric Burn Outcomes

This research agenda was developed at a national, invitational conference of child health care experts, burn care clinicians, and payers held on November 7 to 8, 2001, and organized by the American Burn Association (ABA) as a part of a public-private partnership. The ABA is a nonprofit 501(c)3 organization, whose primary mission includes fostering research in acute care, rehabilitation, and prevention of burns and promoting educational opportunities for burn care professionals. The ABA gratefully acknowledges the tireless efforts of conference chair Ronald G. Tompkins, MD, ScD, group facilitator Matthew Liang, MD, MPH, and James Perrin, MD in providing leadership for this national invitational conference, Outcomes Measurement in Pediatric Burn Care: An Agenda for Research. We extend our gratitude to Lewis Kazis, ScD for sharing his expertise in translating research into policy. Thanks are also due to Susan M. Browning, MPH and Michelle I. Hinson, RN, for their stellar efforts in conference development and manuscript preparation. In addition, the ABA wishes to thank the Agency for Healthcare Research and Quality and the Shriners Hospitals for Children for their generous support of this project. This project was supported by grant number R13 HS10950 from the Agency for Healthcare Research and Quality.

BackgroundBurn related injuries from natural disasters are not well described and natural disasters are not identified as an etiology of burn injury in the National Burn Repository (NBR) of the American Burn Association. The natural disaster Super Storm Hurricane Sandy had devastating effects. Our goal was to detail the burn related injuries following this natural disaster and to compare the data to the NBR.MethodsThis was a retrospective chart review of thirty four patients who sustained burn related injuries following Super Storm Hurricane Sandy (SSHS) and were managed at Staten Island University Hospital Burn Center. Institutional Review Board approval was obtained. Data variables included age, gender, race, past medical history (PMHx), burn type, percentage total body surface area (%TBSA), hospital length of stay (HLOS), and mortality. We compared data from SSHS to the 2003-2013 NBR. Categorical data were summarized using frequency counts, percentages and Clopper-Pearson 95 % confidence interval for proportion. Continuous outcome data were summarized by descriptive statistics. Data analyses performed with SAS® System Version 9.3 (SAS Institute Inc., Cary, NC) and p < 0.05 was significant.ResultsIn the SSHS group, average age was 36 + 24 years, range 1-80 years, and 44.1 % were males (15/34, 95 % CI: 27.2 - 62.1). Caucasians comprised 58.8 %, (20/34, 95 % CI: 40.7, 75.4) and 73.5 % had no PMHx (25/34, 95 % CI: 55.6, 87.1). The most common burn type was scald, 55.9 %, (19/34, 95 % CI: 37.9, 72.8) and %TBSA ranged 1 %–47 %, average of 7 % + 12 %. The average HLOS was 13 + 26 days, range of 1–113 days. Mortality was 2.9 % (1/34, 95 % CI: 0.07–15). In comparison, the NBR reported an average age of 32 years and 69 % were males. Caucasians comprised 59.1 %. The most common burn type was flame, 43.2 % and the %TBSA ranged 1 %–9.9 %. HLOS ranged 8.4–10.2 days and mortality was 3.4 %.ConclusionWe conclude that burn related injuries following a natural disaster differ as compared to those most commonly reported in the NBR.

IntroductionPrior to the introduction of the Burn Nurse Educator (BNE), at a growing and newly established burn center, the education of the Burn Trauma ICU staff was completed by the Burn Director and Burn Supervisor. In this burn center, large amounts of education became difficult to create and distribute by the current Burn Director and Burn Supervisor due to the demand of their respective job roles. The role of the BNE was to create initial and ongoing education for the Burn Trauma ICU Staff, Ortho-Trauma staff, ED staff, local EMS agencies, and the community.MethodsThe Burn Nurse Educator reviewed previous education that was provided to the staff, compared it to the Burn Nurse Competencies established by the American Burn Association, and was able to formulate a new education plan. The Burn Nurse Educator created several burn-based courses. These classes included: Floating into Burn Care, Burn Boot Camp, and Burns in the Pediatric Population. There was also the introduction of mock codes focused on the pediatric burn population. In addition to the formulation of these educational opportunities, the Burn Nurse Educator worked directly with the Quality Improvement Committee to find gaps in care. These gaps were then turned into project improvement plans and additional education was provided to the bedside staff. The Burn Nurse Educator formed relationships with local EMS agencies and was able to provide burn lectures and continuing education.ResultsEach class offered had a pre and post test administered, all with improved scores. A sample size of 30 nurses who enrolled in Burns in the Pediatric Population had a score increase from 46% to 94%. A sample size of 14 nurses had a score increase of 55% to 80% after enrolling in Floating into Burn Care. A sample size of 30 nurses who enrolled in Burn Boot Camp had a score increase of 71% to 95%. More importantly, the staff expressed a higher level of confidence when caring for a burn patient after these classes. The outreach with local EMS agencies also increased our EMS admits to the hospital, improved knowledge for caring for burn victims, and created a relationship with our local cities EMS.ConclusionsIt is anticipated that as the program continues to expand, the role of the Burn Nurse Educator will continue to grow and encompass new responsibilities. To ensure each nurse remains competent in their skill set, additional knowledge testing will be completed one year after a nurse has completed a class.

IntroductionBurn injuries are life-threatening conditions consisting of elevated oxidative stress, severe inflammation, and an increased hypermetabolic and catabolic state. It is recommended to start enteral nutrition (EN) early in the burn injured patients. These patients undergo many operations, and with stopping of EN the intermittent caloric deficit multiplies. This leads to increased risk of negative outcomes. We sought to analyze the efficacy of continuing EN feedings during burn surgeries to maximize caloric intake while also evaluating for adverse outcomes such as pneumonia.MethodsA retrospective chart review of intraoperative feeding and pneumonia rates in pediatric and adult burn patients admitted during 2011-2017 to a regional burn center was conducted. Inclusion criteria included patients with secured airway via endotracheal tube or tracheostomy, mechanical ventilation for at least four days, and those who received EN during operations. The 2017 National Burn Repository (NBR) was used as the control population with mechanical ventilation ≥4 days and a yes/no pneumonia diagnosis. Our assumption was that these patients likely did not receive intraoperative EN as this is not standard protocol at this time.Results67 patients from our center and 779 NBR patients met inclusion criterion. EN were provided in 49-79% of total operations in the study group. The study group had a longer length of stay (LOS: 62 ± 34.4 vs 41 Days ± 31.7; p< 0.0001), Ventilator days (39 ± 28.9 vs 23 ± 43.9; p< 0.0001) and total body surface area burn percentage (TBSA: 36 ± 21 vs 31 ± 23 p-0.029).The relationship between pneumonia, inhalation injury, COPD, diabetes, and current smoking status was examined in the case population. The odds of a patient with inhalation injury developing pneumonia was 2.83 times greater than a patient without an inhalation injury. There was a higher pneumonia rate in the study group compared to control population (56.7% vs 18.9%; p< 0.0001). However based on a multinomial logistics regression analysis, there was no statistically significant association between intraoperative feeding and pneumonia in the study group (p-0.597).ConclusionsWe found a significant difference in the occurrence of pneumonia in our patient group compared to the NBR population, but our patients had higher LOS, ventilator days and TBSA burns. This suggest that our study group may have had higher acuity increasing risk of pneumonia. Our pneumonia rates do correspond with the rates reported from other comparable populations of burn patients. Despite this we did not find and association suggesting intraoperative feedings as the cause.

Electrical injuries usually represent a small proportion of a burn center's admissions. Although burn size may be small, internal tissue damage is sometimes extensive. This study reviews a single institution's experience with electrical injuries and compares it to the multi-institutional data of the National Burn Repository (NBR). The 2009 NBR and the records of a large urban burn center (single institution) were queried for adult electrical injuries over an 8-year period. Data examined included demographics, %TBSA burn, length of stay (LOS), injury circumstance, and disposition. Multiple linear regression models were created to determine factors related to LOS. One hundred ninety-one single-institution patients and 2837 multi-institution patients met the criteria. Both cohorts were mostly white males approximately 30 years of age and injuries where often work-related. Single-institution patients had a mean injury size of 4% TBSA, while multi-institution patients had 7%. The most common exposure source was domestic wiring for single-institution patients and electrical power plants/lines for multi-institution patients. Single-institution data showed that females had a shorter LOS than males (P < .0001). Single-institution data showed that independent risk factors for an increased LOS were infection, amputation, fasciotomy, and being Hispanic. Independent risk factors for multi-institution patients were being Hispanic and large %TBSA burn. There was no difference in mortality, gender, age, LOS, or intensive care unit LOS between the cohorts. In this analysis, there was no statistical difference between outcomes in the single- or multi-institutional groups. However, injuries reported in the NBR were slightly larger. In both cohorts, an increase in LOS was associated with %TBSA, as expected. Interestingly, Hispanic ethnicity correlated with an increased LOS. Future work will be aimed at understanding this correlation to determine whether it is specific to electrical injury or burns in general.