When is it appropriate to refer a patient with a burn to a specialist burn unit?

It is appropriate to refer a patient with a burn injury to a specialist burn unit in the following situations:

• All complex burn injuries and all full-thickness burns require specialist referral ²,¹.
• Deep dermal burns affecting more than 5% of total body surface area (TBSA) in adults, and all deep dermal burns in children, should be referred ²,¹.
• All circumferential deep dermal burns, any high-pressure steam injury, and burns associated with suspected non-accidental injury should be referred ²,¹.
• Burns affecting critical areas such as the face, hands, feet, genitalia, perineum, or any flexural surface (neck, axilla, elbow, knee) require specialist referral ²,¹.
• Burns associated with suspected inhalation injury (signs include singed eyebrows or nasal hairs, sore throat, black carbon in sputum, hoarse voice, stridor, wheeze, or carbon in the oropharynx) should be referred urgently ²,¹.
• People with significant comorbidities that may affect wound healing or increase risk of complications, or those clinically judged to be at risk of complications, should be referred ²,¹.
• Patients with other significant injuries or trauma (e.g., crush injuries, fractures, head injuries, penetrating injuries) should be referred ²,¹.
• Very young children with burns covering greater than 10% BSA, and adults with greater than 15–25% BSA blistering, should be considered for hospital admission and specialist care ²,¹.
• Burn wounds that have not healed within 2–3 weeks or are not healing as expected should be referred for specialist assessment and management ²,¹.
• Burns with inadequate pain control or difficult-to-manage dressings in primary care warrant referral ²,¹.
• High-voltage electrical burns require immediate specialist management ¹.
• Referral should also be considered if there is uncertainty about the need for referral, or if the patient requires special social, emotional, or rehabilitative intervention ²,¹.