Forty-four per cent of Ontario children with burns have characteristics that warrant referral to a specialized burn centre, yet only 22 per cent of those children are actually treated at these centres.
A new study has found that 44 per cent of Ontario children with burns have characteristics that warrant referral to a specialized burn centre, yet only 22 per cent of those children are actually treated at these centres.
“Our study highlights missed opportunities for specialized care in cases of children and adolescents with burn injuries,” says lead author Eduardo Gus, a staff surgeon and project investigator at The Hospital for Sick Children (SickKids) in Toronto.
The study, from researchers at ICES, SickKids, and the University of Toronto, was published recently in JAMA Network Open.
In Ontario, burn injuries are a leading cause of emergency department visits and hospitalizations among children and teens. Between 2003 and 2023, there were almost 80,000 children (17 years old and younger) who were treated at a hospital for a burn injury. Just over half of burn patients were male, 20 per cent lived in rural areas and 24% lived in low-income neighbourhoods.
A child is referred to a specialized burn centre when they meet one or more clinical criteria from Ontario guidelines, which are consistent with guidelines from other countries such as the U.S., Europe, and Australia.
“When a child comes in to the emergency department, we examine several clinical aspects of the patients and their injuries, including the depth of the burn, how much of the body it covers, critical body parts affected, and whether there are other associated injuries,” says Gus. “Our goal in this study was to understand how well these established burn referral criteria are adhered to. In other words, we need to know if those who require burn centre care are being treated at these specialized facilities.”
The findings showed a mismatch between the severity of the burn and location of where the child was treated.
“The mismatch went both ways,” says senior author Natasha Saunders, an ICES scientist, staff physician and senior associate scientist at SickKids. “Just over half of youth treated at a burn centre did not have any identifiable clinical criteria that warranted treatment at a specialized centre, and 41 per cent of those treated at non-burn centres met at least one of the criteria.”
“This means many children are receiving more specialized resources than necessary, while others are not getting the treatment they need to optimize outcomes,” says Saunders, who is also an associate professor of paediatrics in UofT’s Temerty Faculty of Medicine.
We found that children in urban areas or in regions that already have a burn centre were also more likely to receive specialized treatment, leaving families in northern and rural communities facing long travel times and fewer referral options.
Saunders notes that as the number of referral criteria that a child met increased, the greater the likelihood they were referred to a burn centre. However, one-third of children meeting three or more criteria were not treated at a burn centre, which highlights opportunities for system-level improvements.
While smoke inhalation and chemical burns were the criteria with highest association with burn centre care, electrical injuries showed no association with specialized care. This highlights how the burn centre referral criteria are inconsistently adhered to.
Children’s access to specialized burn care varied widely depending on their age and where they live. Younger children were far more likely to be treated at dedicated burn centres, while teenagers were often cared for in non-specialized hospitals.
“We found that children in urban areas or in regions that already have a burn centre were also more likely to receive specialized treatment, leaving families in northern and rural communities facing long travel times and fewer referral options,” says Gus.
Despite these gaps, the study found that children from the most economically disadvantaged neighbourhoods were just as likely as others to receive specialized care, suggesting Ontario’s single‑payer healthcare system may help reduce some inequities seen elsewhere.
The researchers say that future studies should explore what influences clinicians’ decisions to refer patients to burn centres, and to examine whether specialized burn care improves recovery, especially for children who qualify for this care.
