Trends in length-of-stay per total body surface area burn in pediatric patients: A report from the pediatric injury and quality improvement collaborative

BACKGROUND: Previous studies have shown that a length of stay (LOS) of one day per percent total body surface area (TBSA) burn is expected in children with burn injuries, with variability by mechanism. Recent practice has shifted towards earlier discharge and outpatient management. We predicted that an updated multi-institutional analysis of LOS/TBSA burn would demonstrate a downward trend. METHODS: A retrospective study from five pediatric burn centers conducted between March 2022 and February 2025 of burn patient demographics and clinical course metrics. LOS/TBSA burn ratios were calculated and compared across multiple variables using χ 2 and Kruskal-Wallis tests. p <0.05 was considered statistically significant. RESULTS: Among 1,543 unique patients, 57.4% were male and the median age was 2.52 years interquartile range (IQR), 1.32–7.1. Burn etiology was most commonly scald burn (55.3%), as well as flame/fire-related burns (10.7%), and other mechanisms (34.0%). Most burns were small, with 56.0% of patients presenting with TBSA burn <5% and 27.4% of patients with TBSA burn 5% to 10%. Inhalation injury was rare (2.7%). Median LOS/TBSA for all burn patients was 0.6 days (IQR, 0.33–1.2). Patients with accidental injuries had significantly shorter median LOS/TBSA than those with nonaccidental injuries 0.61 d (IQR, 0.33–1.14) vs. 1.31 d (IQR, 0.50–2.31); p <0.001. Median LOS/TBSA also varied significantly by mechanism of burn injury cald 0.48 d (IQR, 0.29–0.88) vs. fire-related 0.90 d (IQR, 0.50–1.60) vs. other 1.00 d (IQR, 0.50–2.00); p <0.001. CONCLUSIONS: Data from this multi-institutional cohort of pediatric burn patients reports updated burn injury demographics and establishes that the median LOS/TBSA burn is less than the previously established one-day/TBSA burn. Focus on earlier discharge and frequent outpatient visits likely decreased median LOS/TBSA. Factors such as nonaccidental etiology and fire-related burn led to higher predicted LOS/TBSA, and these families should be counseled accordingly. Total burn care delivered, rather than inpatient census, should be used to set standards for pediatric burn centers. ( J Trauma Acute Care Surg . 2026;00: 00–00. Copyright © 2026 Wolters Kluwer Health, Inc. All rights reserved.) LEVEL OF EVIDENCE: Level II.