Telemedicine in burn care

Overview

Telemedicine in burn care encompasses the use of telecommunications technology to deliver burn expertise across distances, from initial triage consultation to ongoing wound management. Applications include telephone consultation, store-and-forward image review, real-time video conferencing, smartphone applications, and emerging augmented reality platforms ^[1]. Telemedicine addresses a fundamental access problem: the United States has only 59 ABA-verified burn centers, and patients living farthest from these centers are also least likely to have the infrastructure needed for telehealth access ^[2].

Modes of Teleburn Consultation

Store-and-Forward

Store-and-forward telemedicine involves the referring provider capturing wound photographs and transmitting them (with clinical data) to a burn specialist for asynchronous review and recommendations. This is the most widely implemented model due to its simplicity and low technology requirements ^[1][3]. Limitations include image quality variability, lack of real-time interaction, and inability to perform tactile wound assessment.

Real-Time Video Conferencing

Synchronous video consultation allows direct interaction between the referring provider and burn specialist, enabling real-time wound visualization, guided assessment, and immediate disposition recommendations ^[1][3]. This mode requires stable broadband connectivity, which may not be available in the rural settings where teleburn consultation is most needed ^[2].

Smartphone Applications

Garcia et al. developed and pilot-tested the TeleBurn App, a smartphone application that provides expert burn care in the home through text and image messaging, video conferencing, and instructional videos. Patients using the app had shorter mean healing time (11.6 vs 14.3 days, p = 0.03) and fewer clinical encounters (0.93 vs 3.3, p = 0.001) compared to standard therapy, with no wound infections or unexpected returns ^[4]. Adherence with completion of therapy was higher in the app group (80% vs 64%).

Augmented Reality

Park et al. reviewed emerging augmented reality technologies for immersive, real-time burn triage. While not extensively studied or implemented, augmented reality shows promise for enabling burn specialists to virtually "see" a wound through the referring provider's perspective ^[1].

Clinical Applications

Triage and Transfer Decisions

Telemedicine improves triage accuracy by providing burn center expertise at the point of initial care. Ajami and Arzani-Birgani reported that acute evaluation of burn patients by telemedicine improves access to expertise, raises physician confidence, and reduces under-triage or over-triage for transport, saving time and cost ^[5]. Store-and-forward consultation allows burn centers to determine whether a patient requires transfer or can be managed locally, reducing unnecessary transfers that burden both patients and burn centers ^[1][5].

Outpatient Follow-Up

Telemedicine enables burn centers to extend follow-up care to patients who would otherwise face significant travel burden. This is particularly relevant for minor burns managed in the outpatient setting, where wound monitoring and dressing guidance can be delivered remotely ^[6][7].

Pediatric Burn Care

Ayers et al. compared teleburn to in-person consultation for pediatric patients in a children's emergency department. No differences were identified in rates of readmission (1.67% difference) or 72-hour return visits (0.7% difference). However, teleburn patients were 12.6% less likely to follow up, suggesting that remote consultation may need enhanced follow-up mechanisms ^[8].

System Design

Hosseini et al. designed and implemented a web-based teleburn system with separate interfaces for general practitioners/nurses and burn specialists. Twenty-eight burn consultations were completed successfully, and usability testing showed good ratings across all user groups (mean scores: specialists 8.4, GPs 7.7, nurses 7.5 on a 10-point scale) ^[3].

Infrastructure Barriers

Geographic and Socioeconomic Disparities

Edwards et al. analyzed the relationship between proximity to burn centers and access to critical telehealth infrastructure. Distance from an ABA-verified burn center was negatively correlated with access to smartphones, broadband internet, and cellular data plans (all p < 0.0001). People living farthest from burn centers, who theoretically have the most to gain from telehealth, are least likely to have the infrastructure needed to access it ^[2]. Income affects both overall access and the degree to which access changes with proximity.

Language Barriers

Limited English proficiency may compound telehealth barriers, though Edwards et al. found that the proportion of limited English-speaking households actually decreased with distance from burn centers, suggesting that language barriers are more concentrated in urban periburn-center populations ^[2].

Controversies and Evidence Gaps

Evidence for teleburn efficacy is largely observational, with no large randomized controlled trials comparing telemedicine-guided burn management to in-person care. Image quality standards for store-and-forward burn consultation are not standardized. The effect of telemedicine on diagnostic accuracy for burn depth (as opposed to size) is not well characterized. The follow-up compliance gap identified in the Ayers pediatric study raises questions about whether remote care may reduce engagement for certain populations ^[8]. Medicolegal liability frameworks for telemedicine-guided burn triage recommendations vary by jurisdiction and remain unsettled. Cost-effectiveness data are sparse.

References

[1] Park C et al. (2022). Telehealth and Burn Care: From Faxes to Augmented Reality. Bioengineering (Basel). 9(5):211. PMID: 35621489 [2] Edwards SR et al. (2024). Barriers to Remote Burn Care Delivery: An Analysis of Burn Center Proximity and Access to Critical Telehealth Infrastructure. Ann Plast Surg. 92(6S Suppl 4):S391-S396. PMID: 38857001 [3] Hosseini F et al. (2018). Teleburn: Designing A Telemedicine Application to Improve Burn Treatment. Open Med Inform J. 12:33-41. PMID: 30288202 [4] Garcia DI et al. (2018). Expert Outpatient Burn Care in the Home Through Mobile Health Technology. J Burn Care Res. 39(5):680-684. PMID: 29562343 [5] Ajami S, Arzani-Birgani A (2014). Fast resuscitation and care of the burn patients by telemedicine: A review. J Res Med Sci. 19(6):562-6. PMID: 25197300 [6] Warner PM, Coffee TL, Yowler CJ (2014). Outpatient burn management. Surg Clin North Am. 94(4):879-92. PMID: 25085094 [7] Chipp E (2023). Outpatient and Minor Burn Treatment. Surg Clin North Am. 103(3):377-387. PMID: 37149375 [8] Ayers C et al. (2024). A Comparison of Teleburn to In-Person Consultation of Pediatric Patients in a Children's Emergency Department. J Burn Care Res. 45(4):985-989. PMID: 38280192