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Interrater Agreement and Reliability of Burn Size Estimations between Emergency Physicians and Burn Unit.

OBJECTIVE
The initial approach to burn injuries has remained essentially unchanged over the past several decades and revolves around trauma assessment and fluid resuscitation, frequently occurring in the emergency department (ED). While previous research suggests that emergency physicians (EP) are poor estimators at total body surface area (TBSA) affected, we believe that estimation differences are improving drastically. This study investigated the interrater agreement and reliability of burn size estimations at an academic ED and its cohabiting burn unit.


METHODS
This single center, retrospective study was conducted at a trauma center with a cohabited burn unit. The study included adult patients admitted to the burn unit after receiving paired burn size estimations from EPs and the burn unit. The primary endpoint was the interrater agreement, measured by kappa (k), of 10% TBSA estimation intervals. The secondary endpoint was the intraclass correlation coefficient (ICC), evaluating the reliability of absolute TBSA estimations.


RESULTS
A chart review was performed for patients evaluated from November 1, 2016 to July 31, 2019. 1,184 patients were admitted to the burn unit, 1,176 of which met inclusion criteria for the primary endpoint. The interrater agreement of TBSA between EPs and the burn unit was 0.586, while the weighted k was 0.775. These values correlate to moderate and substantial agreements, respectively. Additionally, 971 patients had specific TBSA estimations from paired EPs and the burn unit which were used for the secondary endpoint. The ICC between EPs and the burn unit was 0.966, demonstrating an excellent agreement. Further sub-analysis was performed, revealing absolute mean overestimation and underestimation differences of 3.93% and 2.93%, respectively.


CONCLUSION
EPs at academic institutions with cohabited burn units are accurate estimators of TBSA in the assessment of burn injuries.