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Regional Disparities in Access to Verified Burn Center Care in the United States.

BACKGROUND
Burn injuries result in 50,000 annual admissions. Despite joint referral criteria from the American College of Surgeons (ACS) and American Burn Association (ABA), many severely injured patients are not treated at verified centers with specialized care. Only one prior study explores regional variation in access to burn centers, focusing on flight or driving distance without considering the size of the population accessing that center. We hypothesize that disparities exist in access to verified centers, measured at a population level. We aim to identify a subset of non-verified centers that, if verified, would most impact access to the highest level of burn care.


METHODS
We collected ABA data for all verified and non-verified adult burn centers and geocoded their locations. We used county-level population data and a two-step floating catchment method to determine weighted access in terms of total beds available locally per population. We compared regions, as defined by the ABA, in terms of overall access. Low access was calculated to be less than 0.3 beds per 100,000 people using a conservative estimate.


RESULTS
We identified 113 centers, 59 verified and 54 non-verified. Only 2.9% of the population lives in areas with no verified center in 300 miles; however, 24.7% live in areas with low access. Significant regional disparities exist, with 37.3% of the population in the Southern Region having low access as compared to just 10.5% in the Northeastern Region. We identified 8 non-verified centers that would most impact access in areas with no or low access.


CONCLUSIONS
We found significant disparities in access to verified center burn care and determined non-verified centers with the greatest potential to increase access, if verified. Our future directions include identifying barriers to verification, such as lack of fellowship-trained burn surgeons or lack of hospital commitment.


LEVEL OF EVIDENCE
Care management study, level IV.