Journal of burn care & research : official publication of the American Burn Association
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Advanced Burn Life Support emphasizes endotracheal intubation for patients with facial burns before transfer to a burn center to prevent airway obstruction. Many patients are intubated before transport and are often extubated shortly after burn center arrival. We hypothesize that many intubations performed before burn center transport are unnecessary. ⋯ As a burn community, we have emphasized early intubation before transfer for those who have sustained significant burns, inhalational injury, or facial burns. Unfortunately, this has led to many potentially unnecessary intubations that expose patients to unnecessary complications. Although early intubation is a lifesaving intervention for many burn patients, criteria should be developed to determine when intubation is not needed.
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Comparative Study
Comparative Analysis of Early Excision and Grafting vs Delayed Grafting in Burn Patients in a Developing Country.
The present study attempts to compare how the patients who undergo early excision and grafting behave as compared with patients who are treated along usual conservative lines of management in centers where the resources are less than optimal. The data of 20 female patients were analyzed. Age of the patients ranged between 20 and 30 years, percentage area burn ranged between 20 and 40%, and percentage area resurfaced by skin grafting 5 to 10%. ⋯ The mean hospital stay in the patients who underwent early excision and grafting was 15.1 ± 4.1 days, whereas that in the patients who underwent delayed grafting was 36.2 ± 6.3 days (P = .001). Early excision and grafting decreases the hospital stay of burn patients. The present study suggests that it has a definite applicability even in places where the resources might be less than optimal.
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Comparative Study
Acute Respiratory Distress Syndrome in Burn Patients: A Comparison of the Berlin and American-European Definitions.
The purpose of this study was to compare the Berlin definition to the American-European Consensus Conference (AECC) definition in determining the prevalence of acute respiratory distress syndrome (ARDS) and associated mortality in the critically ill burn population. Consecutive patients admitted to our institution with burn injury that required mechanical ventilation for more than 24 hours were included for analysis. Included patients (N = 891) were classified by both definitions. ⋯ By contrast, under the AECC definition increased mortality was seen only for ARDS category (14.7% no ARDS; 15.1% acute lung injury; and 46.0% ARDS, P < 0.001). The mortality of the 22 subjects meeting the AECC, but not the Berlin definition was not different from patients without ARDS (P = .91). The Berlin definition better stratifies ARDS in terms of severity and correctly excludes those with minimal disease previously captured by the AECC.
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We conducted a systematic review of the literature to identify evidence to support the use of measures of depression for adults with burn injuries. Our goal was to be able to identify the most reliable, valid, and efficient means of identifying adults with symptoms of depression including major depressive disorder. We modified established guidelines for conducting systematic reviews by excluding measures that focused on distress or anxiety or only used depression as a predictor of interest. ⋯ Greater understanding of depression after burn injury can be gained by evaluating the existing general measures of depression and how they are used in the field of burn injury rehabilitation. The ultimate goal is to develop a set of recommendations for the standardization of how depressive symptomatology is assessed in this population. In this review, we highlight the deficiencies of validated measures of depression in the field of burn recovery and provide specific recommendations for both clinicians and researchers to advance our knowledge of depression following a burn injury, which will allow us to advance treatment.
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Since 1981, the number of US burn centers has decreased by 29%, resulting in more long distance referrals to remaining facilities. Air transport is often the only feasible method for remote patients to reach few remaining burn centers. A significant proportion of flown-in patients have minor burns and are discharged within 24 hours, representing potential over-utilization of resources with increased cost to the healthcare system for no perceptible benefit. ⋯ The average estimate of charges for transfer was between $25,000 and 30,000/patient. The incidence of overtriage among flown-in burn patients, approximately 20%, represents substantial unnecessary healthcare expenditure. Improved burn care education, incentives to increase use of telemedicine, and modification of American Burn Association guidelines to include consultation with a burn center rather than automatic transfer are needed to reduce this cost to the healthcare system.