Referral to specialist burn services

In certain circumstances, patients should be referred to specialist burn services.

The minimum threshold for referral suggested by the British Burn Association can be summarised as:

• All burns 2% TBSA in children or 3% TBSA in adults
• All full thickness burns
• All circumferential burns
• Any burn not healed in 2 weeks
• Any burn with suspicion of non-accidental injury should be referred to a burn unit/centre for expert assessment within 24 hours

In addition, the following factors should prompt a discussion with a consultant in a specialised burn care service and consideration given to referral:

• All burns to hands, feet, face, perineum, or genitalia
• Any chemical, electrical or friction burn
• Any cold injury
• Any unwell/febrile child with a burn
• Any concerns regarding burn injuries and co-morbidities that may affect treatment or healing of the burn

If the above criteria not met, continue with local care and dressings as required

If the burn wound changes in appearance or there are signs of infection or concerns regarding healing, then discuss with a specialised burn service

If there is any suspicion of toxic shock syndrome (TSS) then refer early. Consider this in any patient with any size burn, presenting with:

• Pyrexia
• Rash
• Diarrhoea/vomiting
• General malaise
• Anorexia
• Tachycardia/tachypnoea/hypotension
• Reduced urine output

Local referral policy may differ and should be followed. Local centres may also have an online referral method with the capability to send photographs of burns in a secure way, which can be extremely useful.