Barriers to Remote Burn Care Delivery: An Analysis of Burn Center Proximity and Access to Critical Telehealth Infrastructure.

ABSTRACT: Mounting evidence supports the use of telehealth to improve burn care access and efficiency. However, barriers to telehealth use remain throughout the United States and may disproportionately affect specific populations, such as rural and non-English-speaking patients. This study analyzes the association between physical proximity to burn care and determinants of telehealth access.The relationship between telehealth-associated measures and proximity to burn care was analyzed with linear regression analysis. County-level data was sourced from the Agency for Healthcare Research and Quality's Social Determinants of Health Database (2020) and the American Community Survey (2021). County-level distances to the nearest American Burn Association (ABA)-verified burn center were calculated based on verified centers listed in the ABA burn center directory (n = 59). A subsequent analysis was performed on income-stratified datasets available for subset counties.Distance was negatively correlated with access to a smartphone (P < 0.0001), broadband internet (P < 0.0001), and cellular data plan (P < 0.0001) and positively correlated with the percent of households with no computing device (P < 0.0001) and no internet access (P < 0.0001). Analysis of income-stratified data revealed similar results. The percent population not speaking English well (P < 0.0001) at all (P = 0.0009) and the proportion of limited English-speaking households (P = 0.0001) decreased as a function of distance.People living furthest from an ABA-verified burn center in the United States are less likely to have adequate access to critical telehealth infrastructure compared to their counterparts living closer to a burn center. However, income impacts overall access and the degree to which access changes with proximity. Conversely, language-associated barriers decrease as distance increases.

The cost of keeping warm: a relationship between a rise in the cost of domestic energy and burn injuries caused by personal heating equipment.

INTRODUCTION: During 2022-2023, the UK found itself in the midst of a domestic energy crisis, with the average domestic gas and electricity bill rising by 75% between 2019 and 2022. As a result, the use of hot water bottles, radiant heaters, and electric blankets increased. An unintended consequence of this may be an increase in burn injuries caused by misfortune, misuse, or the use of items in a state of disrepair. PURPOSE: The aim of this study was to explore any increase in referrals to a single burns centre in England for injuries caused by hot water bottles, radiant heaters, or electric blankets. METHODS: This was a retrospective study of a prospectively maintained database of referrals. All referrals between January 2022 and January 2023 were selected and compared with the same period from 2020-2021 (before the rise in energy prices). Referrals were screened for the terms "hot water bottle," "electric heater," "electric blanket," and "heater." Total referrals in each period, demographic data (age, gender), anatomical location and the mechanism of injury were compared between cohorts. RESULTS: We found a statistically significant increase in the number of burns relating to heating implements between 2020/21 and 2022/23, rising from 54 to 81 (p = 0.03) - a 50% increase in injuries. Injuries in working age adults increased significantly (52% to 69%, p < 0.05). The most frequently injured area was the leg (30%) followed by the hand (18%). The commonest type of injury described was scald (72%). We found a moderately-strong correlation between the number of referrals and the average cost of energy in 2022-23. CONCLUSION: The number of injuries sustained by people using personal heating equipment is significantly increasing, which correlated with the rise in domestic energy prices. The most affected demographic appears to be working age adults, with wider implications around lost work-time yet to be explored. Further prospective, population-based work is indicated to assess the strength of the correlation seen in this study.

The economic burden of burned patients for hospitalization in Canada.

BACKGROUND: Burn injuries pose a significant burden on both patients and healthcare systems. Yet, costs arising from the consumption of resources by these patients are rarely examined in Canada. OBJECTIVE: The objective of this study was to assess real-world costs resulting from the initial hospitalization of patients admitted to a major burn unit in Quebec, Canada. METHODS: A cost study based on a retrospective cohort was undertaken using in-hospital economic data matched to hospital chart data. Our cohort included all burn-injured patients admitted between April 1, 2017, and March 31, 2021, to the hospital's major burn unit during their initial hospitalization. Descriptive statistics were tabulated for sociodemographic and economic data. Costing data were analyzed unstratified and stratified according to burn severity (i.e., ≥ 20% of total body surface area [TBSA] vs. < 20%). Costs were presented in CAD 2021. RESULTS: Our cohort included 362 patients, including 65 (18%) with TBSA ≥ 20%. The average initial hospitalization cost was $32,360 ($22,783 for < 20% TBSA and $76,121 for ≥ 20% TBSA). CONCLUSION: Findings reveal that the total cost of the initial hospitalization, from a public hospital perspective, was $11,714,348. Our study underlines the substantial burden associated with burns and highlights the need for long-term cost evaluations.

Associations between burn care services and impairment at discharge after burn injury: Analysis of the Global Burn Registry.

BACKGROUND: Throughout the world, burn injury is a major cause of death and disability. In resource-limited countries, burn injury is one of the leading causes of permanent disability among children who survive traumatic injuries, and burn injury is the fourth leading cause of disability worldwide. This study applied Andersen's model of health care access to evaluate if patient characteristics (predisposing factors), burn care service availability (enabling factors) and injury characteristics (need) are associated with physical impairment at hospital discharge for patients surviving burn injuries globally. Specifically, access to rehabilitation, nutrition, operating theatre, specialized burn unit services, and critical care were investigated as enabling factors. The secondary aim was to determine whether associations between burn care service availability and impairment differed by country income level. METHODS: This is a cross-sectional secondary analysis of prospectively collected data from the World Health Organization, Global Burn Registry. The outcome of interest was physical impairment at discharge. Simple and multivariable logistic regressions were used to test the unadjusted and adjusted associations between the availability of burn care services and impairment at hospital discharge, controlling for patient and injury characteristics. Effect modification was analyzed with service by country income level interaction terms added to the models and, if significant, the models were stratified by income. RESULTS: The sample included 6622 patients from 20 countries, with 11.2% classified with physical impairment at discharge. In the fully adjusted model, patients had 89% lower odds impairment at discharge if the treatment facility provided reliable rehabilitation services compared to providing limited or no rehabilitation services (OR.11, 95%CI.08,.16, p < .01). However, this effect was modified by county income with the strong and significant association only present in high/upper middle-income countries. Sophisticated nutritional services were also significantly associated with less impairment in high/upper middle-income countries (OR=.04, 95% CI 0.203, 0.05, p < .01), but significantly more impairment in lower middle/low-income countries (OR=2.01, 95% CI 1.50, 2.69, p < .01). Patients had 444% greater odds of impairment if treated at a center with specialty burn unit services (OR 5.44, 95%CI 3.71, 7.99, p < .01), possibly due to a selection effect. DISCUSSION: Access to reliable rehabilitation services and sophisticated nutritional services were strongly associated with less physical impairment at discharge, but only in resource-rich countries. Although these findings support the importance of rehabilitation and nutrition after burn injury, they also highlight potential disparities in the quantity or quality of services available to burn survivors in poorer countries.

Social Distancing or Socially Dividing? A Greater Proportion of Vulnerable Patients Admitted to a Metropolitan Burn Center During the COVID-19 Pandemic.

Due to stay-at-home mandates and social distancing, we hypothesized the coronavirus disease 2019 global pandemic altered the epidemiology of burn injuries that presented to a single-institution, metropolitan burn center. A retrospective review of adult and pediatric patients admitted to the center during a 3-year period: 3/20/19-3/19/20 (pre-pandemic year), 3/20/20-3/19/21 (pandemic year 1), and 3/20/21-3/19/22 (pandemic year 2). Variables included patient demographics, burn injury, and hospitalization characteristics. A greater proportion of males compared to females were admitted during the pre-pandemic year with a significant increase in this difference during pandemic year 1 (P < .05). There was a significant increase in the proportion of undomiciled patients admitted between the pre-pandemic year and pandemic year 2 (P < .01). There were significant increases in the proportion of admitted patients who were uninsured, had a history of mental illness and/or substance abuse between pandemic years 1 and 2 (P < .001, P < .05, P < .01) and between the pre-pandemic year and pandemic year 2 (P < .001, P < .01, P < .001). There were significant differences in deepest burn depth and burn etiology between individual years. The proportion of patients with burns treated purely non-operatively significantly increased during pandemic year 1 (P < .05). Greater changes in the demographics of patients with burns admitted after the onset of the pandemic were reported compared to the characteristics and management of their burn injuries. Overall, this study demonstrated that a greater proportion of vulnerable patients were admitted during the pandemic, providing a better understanding of existing health disparities and the differential impact of the pandemic on lower socioeconomic populations.

Access to Certified Burn Centers in the United States: The Geospatial and Transport Cost of Transfer.

Specialized burn centers are critical to minimizing burn-associated morbidity and mortality. However, American Burn Association-verified burn centers are unequally distributed across the United States, and fewer centers are available for pediatric patients relative to adults. The economic burden of transporting patients to these centers contributes significantly to the high cost of burn care. This study quantifies inequitable burn care access in the contiguous United States due to age group and location as a function of physical proximity to a verified burn center and transportation cost. County-level distances to the nearest verified adult or pediatric burn center were determined and mapped. Distance calculations for each population were combined with transport cost data (2022 CMS Ambulance Fee Schedules) to estimate transportation costs for each population (adult vs pediatric, urban vs rural). Pediatric patients reside 30.5 miles further than adults from the nearest center, significantly increasing transportation costs. Ground and air transport costs also increased for rural versus urban patients. Notably, rural patients face almost double the cost of air transport. While physical proximity to burn care appears to differ only modestly across age and region, this marginal increase in distance is associated with significant economic impact. This study highlights physical and economic barriers to burn care access faced by rural and pediatric patients and underscores the critical need to improve equity in burn care access. Future studies should expand on this report's findings to more fully characterize the additional costs associated with inequitable burn care access.

Quantifying the clinical and economic burden of desquamating dermatological conditions: Implications for a supraregional burns centre.

INTRODUCTION: This study aimed to identify the spectrum of desquamating skin diseases referred for tertiary burns care and quantify the care requirements and expenses associated with caring for these patients within the burns service. METHODS: Patient records were identified with nonburn-induced skin loss between 2016 and 2022. Data was extracted from inpatient records, operative notes, and dressing clinic records. A cost analysis was conducted using figures from the National Schedule of National Health Service Costs and our own unit-specific costs. RESULTS: Twenty patients were identified, with a median age of 46.5 and a median total body surface area of 30%. The mean length of stay was 21.2 days, with 8/20 patients requiring intensive care. Overall mortality was 30%, rising to 50% if patients required intensive treatment unit (ITU) admission. Patients had a mean of 1.5 procedures under general anaesthesia and a mean operative time of 169 min per patient. Postoperatively, a mean of 8.3 dressing changes was required per patient (range 1-21). Of 75% of patients referred as suspected toxic epidermal necrolysis syndrome (TENS), only 32% of patients histologically had TENS (32%), with linear IgA disease, pemphigus vulgaris and bullous lupus comprising the other diagnoses. Cost analysis predicted a total cost to the unit of £1,422,106. CONCLUSION: Desquamating dermatological diseases are life-threatening conditions with exhaustive care requirements. Our experiences highlight the importance of awareness of the range of desquamating skin conditions beyond TENS to enable optimum management and the need to ensure adequate financial provisions to accommodate the care requirements mandated by these patients.

Health Equity Ratings of U.S. Burn Centers-Does For-Profit Status Matter?

Achieving health equity is forefront in national discussions on healthcare structuring. Burn injuries transcend racial and socioeconomic boundaries. Burn center funding ranges from safety-net to for-profit without an understanding of how funding mechanisms translate into equity outcomes. We hypothesized that health equity would be highest at safety-net facilities and lowest at for-profit centers. All verified and non-verified American Burn Association burn centers were collated in 2022. Safety-net status, for-profit status, and health equity rating were extracted from national datasets. Equity ratings were compared across national burn centers and significance was determined with comparative statistics and ordinal logistic regression. On an equity grade of A-D (A is the best), 27.6% of centers were rated A, 27.6% rated B, 41.5% rated C, and 3.3% rated D. About 17.1% of all burn centers were designated as for-profit compared to 21.1% of centers that were safety-net. About 73.1% of safety-net centers scored an A rating, and 14.3% of for-profit centers scored an A rating. Safety-net centers were 21.8 times more likely (P < .001) to have the highest equity score compared to nonsafety-net centers. There was an 80% decrease in the odds of having a rating of A for for-profit centers compared to nonprofit centers (P = .04). Safety-net centers had the highest equity ratings while for-profit burn centers scored the lowest. For-profit funding mechanisms may lead to the delivery of less equitable burn care. Burn centers should focus on health equity in the triage and management of their patients.

Examining Disparities in Alcohol Use Testing on Burn Patient Admissions: A Call for Association Guidance.

Burn injuries are associated with as well as complicated by alcohol misuse. To date, there are no stated guidelines for alcohol testing upon burn patient admissions. This study investigated if there were associations between race and testing for alcohol upon burn admissions, controlling for demographics, burn severity (degree), and other circumstances associated with burn injuries. This study was a secondary analysis of 32 258 cases from the National Burn Data Repository. The dependent variable was whether a burn case was screened for alcohol use, and independent variables were age, gender, whether physical abuse was reported, mental health comorbidities, marital status, the severity of burns, whether the injury was work-related, injury circumstances, and etiology of injury. Controlling for independent variables, race was associated with an increased probability of having been screened for alcohol use on admission to a burn center. Data reflecting alcohol screening/testing results reported in the NBR were not included in the analysis. Study results were consistent with the possibility of bias and may have influenced decisions to screen/test for alcohol misuse/abuse in reported burn cases. It is argued these findings support the recommendation that guidelines for alcohol testing of burn patients are warranted and would benefit from specific guidance from the American Burn Association.

[Pay attention to burn rehabilitation assessment].

With the vigorous development of burn rehabilitation, many burn units in China are paying more and more attention to the application of burn rehabilitation treatment methods in burn patients. However, the development of burn rehabilitation assessment cannot be ignored in the process of burn rehabilitation treatment. Burn rehabilitation assessment is characterized with a long assessment time span and a large and complex assessment contents, resulting in the inability to develop a standardized assessment form that is suitable for all burn patients. In addition, factors including the shortage of professionals in burn rehabilitation assessment in some domestic burn units, relatively small number of objective assessment instruments and various institutional limitations, have also led to insufficient motivation and low quality of burn rehabilitation assessment. Based on those, this article analyzes the characteristics and main contents of burn rehabilitation assessment in China, and puts forward some suggestions in view of the shortcomings of burn rehabilitation assessment, in order to provide a reference for burn rehabilitation practitioners.

[A cross-sectional survey on the allocation of nursing human resources in burn centers in China].

Objective: To investigate the allocation of nursing human resources in burn centers in China. Methods: A cross-sectional survey was conducted. Using a self-designed questionnaire, a survey was carried out from January to March 2022 to investigate the January to December 2021 status of 39 burn centers in China that met the inclusion criteria based on six strategic regions and other regions, including the hospital grade and the region, the number of nurses and opening beds in the burn centers and burn intensive care units (BICUs), the age, working seniority in burn specialty, educational background, professional title, personnel employment, and turnover of nurses and training of newly recruited nurses in the burn centers. Results: This survey covered 30 provinces, municipalities, and autonomous regions in China (excluding Hong Kong Special Administrative Region, Macao Special Administrative Region, and Taiwan region of China). A total of 39 questionnaires were collected, all of which were valid. The 39 burn centers were located in 38 tertiary A hospitals and 1 tertiary B hospital, with 26 burn centers in strategic areas. The nurse/bed ratio of burn centers in the Greater Bay Area of Guangdong, Hong Kong, and Macao was the highest, while the nurse/bed ratio of burn centers in border ethnic minority area was the lowest. Except for the Chengdu-Chongqing Economic Circle, BICUs had been set up in burn centers in other regions. Among the 39 burn centers, the percentage of nurses aged 25 to 34 years was 51.21% (738/1 441), the percentage of nurses worked in burn specialty for less than 5 years was 31.16% (449/1 441), the percentage of nurses with bachelor's degree was 69.74% (1 005/1 441), and the percentage of nurses with nursing professional title was 44.14% (636/1 441), which were the highest. There were significant differences in the employment of nurses, the percentage of permanent nurses in burn centers in the collaborative development zone of Beijing-Tianjin-Hebei was 82.48% (113/137), while the percentage of permanent nurses in burn centers in important military strategic area was only 9.42% (34/361); the turnover rate of nurses was 9.03% (143/1 584), among which the turnover rate of nurses was 18.14% (80/441) in burn centers in important military strategic area. The training for newly recruited nurses in 39 burn centers was mainly based on the guidance of senior nurses and the pre-job education+specialist training. Conclusions: The burn nursing human resources in strategic areas in China are seriously insufficient and unevenly distributed, with unstable nurse team and lack of standardized specialist training. In particular, the nursing human resources in BICUs need to be equipped and supplemented urgently.

Factors associated with an extended length of stay in the pediatric burn patient.

BACKGROUND: The Center for Medicaid and Medicare Services predicts the length of stay for pediatric burn patients based on several variables. However, many patients exceed their anticipated length. This study looks to identify aspects of patient presentation, wound characteristics, treatment, and discharge that are associated with a longer-than-predicted length of stay to identify strategies to safely reduce it. METHODS: We conducted a retrospective chart review of 535 pediatric burn patients admitted to our academic hospital from January 2018 to December 2020. 405 patients met inclusion criteria. Data were collected and analyzed. RESULTS: Average patient age was 3.36 years. 72.3% were treated for scald burns. Average length of stay was 13.5 days. 20.5% (n = 83) of patients exceeded their predicted length of stay. In comparing patients who exceeded their predicted length of stay to those who did not, the former had significant differences in burn causes, percent total body surface area burned (12.80% vs 4.24% [P = .000]), and body areas involved. Patients who exceeded length of stay had a higher incidence of endotracheal intubation (15.7% vs 1.3%), surgical intervention (85.5% vs 29.2%), need for tube-feeding (48.2% vs 4.3%), and intensive care unit admissions (22.9% vs 2.2% [P = .00 all]). They also averaged more operations, autografting (31.3% vs 1.6% [P = .00]), total operating room time (250 vs 31 minutes [P = .00]), and time to the first operation (2.32 vs 1.64 days [P = .00]). Tube-feeding averaged 9.52 vs 0.72 days (P = .00) extending patient stay after wound stability (43.9% vs 4.3% [P = .00]). These patients also required more discharge planning, with higher rates of Child Protective Services involvement (39.8% vs 10.9% [P = .00]), services consulted (1.06 vs 0.24 [P = .00]), and discharges to inpatient rehabilitation (8.6% vs 0.6% [P = .00]). 89.6% of all patients followed up in clinic. CONCLUSIONS: Twenty percent of pediatric burn patients had a longer length of stay than predicted by the Center for Medicaid and Medicare Services. Many factors were strongly associated with a longer-than-predicted length of stay. Identifying these early on might help reduce length of stay and meet the targets of the Center for Medicaid and Medicare Services.

Integration of Cutaneous Functional Units Principles in Burn Rehabilitation: A Diffusion of Innovations Assessment.

Early recognition of contractures can lead to a more targeted therapy regimen, potentially preventing range of motion losses and improving function and quality of life. Cutaneous functional units (CFUs) allow therapists to explain motion limitations and formulate patient-specific treatment plans. Evidence-based research demonstrates the potential of using these principles to improve the current standard of care. Still, the consistent use of these principles has been slow to diffuse through burn care. Occupational and physical therapists were surveyed to determine the degree to which CFU principles are being integrated into clinical practice. Respondents (297) were occupational therapists (52%) and physical therapists (49%) working in burn units (81%) in North America (70.7%). Most respondents (78.4%) report familiarity with CFU principles. Of those familiar, most respondents reported their knowledge (66.7%) and ability to apply (65.7%) at an intermediate level or greater. A slight majority (59.3%) responded that the concepts influenced their practice, while 40.7% said the concepts did not influence their practice. Forty percent to sixty-nine percent of respondents correctly answered knowledge questions, but only 15% of respondents correctly completed CFUs identification questions. Respondents (77%) report barriers, including difficulty incorporating into practice, time constraints, and the need for more education. Results suggest that diffusion can be improved by developing tools to assist therapists in understanding and incorporating CFUs' principles.

Agreement of clinical assessment of burn size and burn depth between referring hospitals and burn centres: A systematic review.

BACKGROUND: The quality of burn care is highly dependent on the initial assessment and care. The aim of this systematic review was to investigate the agreement of clinical assessment of burn depth and %TBSA between the referring units and the receiving burn centres. METHODS: Included articles had to meet criteria defined in a PICO (patients, interventions, comparisons, outcomes). Relevant databases were searched using a predetermined search string (November 6th 2021). Data were extracted in a standardised fashion. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach for test accuracy was used to assess the certainty of evidence. The QUADAS-2 tool was used to assess the risk of bias of individual studies as 'high', 'low' or 'unclear'. RESULTS: A total of 412 abstracts were retrieved and of these 28 studies with a total of 6461 patients were included, all reporting %TBSA and one burn depth. All studies were cross-sectional and most of them comprising retrospectively enrolled consecutive cohort. All studies showed a low agreement between %TBSA calculations made at referring units and at burn centres. Most studies directly comparing estimations of %TBSA at referring institutions and burn centers showed a proportion of overestimations of 50% or higher. The study of burn depth showed that 55% were equal to the estimates from the burn centre. Most studies had severe study limitations and the risk of imprecision was high. The overall certainty of evidence for accuracy of clinical estimations in referring centres is low (GRADE ⊕⊕ОО) for %TBSA and very low (GRADE ⊕ООО) for burn depth and resuscitation. CONCLUSION: Overestimation of %TBSA at referring hospitals occurs very frequently. The overall certainty of evidence for accuracy of clinical estimations in referring centres is low for burn size and very low for burn depth. The findings suggest that the burn community has a significant challenge in educating and communicating better with our colleagues at referring institutions and that high-quality studies are needed.

Resiliência: avaliação de pacientes queimados em um hospital de urgência e emergência / Resilience: evaluation of burned patients in an urgency and emergency hospital / Resiliencia: evaluación de pacientes quemados en un hospital de urgencias y emergencias

A recuperação de vítimas de queimaduras é longa e dolorosa e afeta diversas esferas da vida do paciente. A resiliência, que se refere à capacidade humana de enfrentar e se adaptar a eventos adversos, exerce grande importância no processo de recuperação da queimadura. Logo, este trabalho objetiva avaliar a capacidade de resiliência de pacientes queimados, no momento da admissão e da alta hospitalar, em um hospital de emergência e urgência de Goiânia. Trata-se de um estudo descritivo, quantitativo e transversal que utiliza a Escala de Resiliência de Connor-Davidson (CD-RISC) como instrumento de mensuração. Na admissão hospitalar, a média da resiliência foi de 71,35, tendo sido observada uma relação significativa entre o fator Amparo da escala CD-RISC e a presença do(a) companheiro(a). O escore de resiliência encontrado nesta pesquisa é consistente com outros achados da literatura científica internacional e nacional referente à expressão da resiliência em vítimas de queimaduras e outros adoecimentos. A relação entre o fator Amparo e a presença de um(a) companheiro(a) enfatiza a importância da rede de apoio familiar na reabilitação do paciente queimado.(AU)

The recovery of burned patients is long and painful and impacts on different areas of people's lives. Resilience, which refers to the human capacity to face and adapt to adverse events, plays a major role in the process of recovery from burns. Therefore, the present study aims to assess the resilience of burned patients, on admission and hospital discharge, in an emergency and urgency hospital in Goiânia. This is a descriptive, quantitative and cross-sectional study that uses the Connor-Davidson Resilience Scale (CD RISC) as a measuring instrument. At hospital admission, the mean resilience was 71.35, with a significant association between the Support factor on the CD RISC scale and the presence of a partner. The resilience score found in the present study is consistent with other findings in the international and national scientific literature regarding the expression of resilience in victims of burns and other illnesses. The relationship between the Support factor and the presence of a partner emphasizes the importance of the family support network in the rehabilitation of the burned patient.(AU)

La recuperación de los pacientes quemados es larga y dolorosa e impacta en diferentes esferas de la vida de las personas. La resiliencia, que se refiere a la capacidad humana para enfrentar y adaptarse a eventos adversos, juega un papel importante en el proceso de recuperación de las quemaduras. Por tanto, el presente estudio tiene como objetivo evaluar la resiliencia de los pacientes quemados, en el momento del ingreso y el alta, en un hospital de emergencia y urgencia en Goiânia. Se trata de un estudio descriptivo, cuantitativo y transversal que utiliza la Escala de Resiliencia Connor-Davidson (CD RISC) como instrumento de medida. Al ingreso hospitalario, la resiliencia media fue de 71,35, con associación significativa entre el factor Amparo de la escala CD RISC y la presencia de pareja. El puntaje de resiliencia encontrado en el presente estudio es consistente con otros hallazgos en la literatura científica nacional e internacional sobre la expresión de resiliencia en víctimas de quemaduras y otras enfermedades. La relación entre el factor Amparo y la presencia de pareja enfatiza la importancia de la red de apoyo familiar en la rehabilitación del paciente quemado.(AU)

Evaluating Real-World National and Regional Trends in Definitive Closure in U.S. Burn Care: A Survey of U.S. Burn Centers.

To better understand trends in burn treatment patterns related to definitive closure, this study sought to benchmark real-world survey data with national data contained within the National Burn Repository version 8.0 (NBR v8.0) across key burn center practice patterns, resource utilization, and clinical outcomes. A survey, administered to a representative sample of U.S. burn surgeons, collected information across several domains: burn center characteristics, patient characteristics including number of patients and burn size and depth, aggregate number of procedures, resource use such as autograft procedure time and dressing changes, and costs. Survey findings were aggregated by key outcomes (number of procedures, costs) nationally and regionally. Aggregated burn center data were also compared to the NBR to identify trends relative to current treatment patterns. Benchmarking survey results against the NBR v8.0 demonstrated shifts in burn center patient mix, with more severe cases being seen in the inpatient setting and less severe burns moving to the outpatient setting. An overall reduction in the number of autograft procedures was observed compared to NBR v8.0, and time efficiencies improved as the intervention time per TBSA decreases as TBSA increases. Both nationally and regionally, an increase in costs was observed. The results suggest resource use estimates from NBR v8.0 may be higher than current practices, thus highlighting the importance of improved and timely NBR reporting and further research on burn center standard of care practices. This study demonstrates significant variations in burn center characteristics, practice patterns, and resource utilization, thus increasing our understanding of burn center operations and behavior.

Gender-based disparities in burn injuries, care and outcomes: A World Health Organization (WHO) Global Burn Registry cohort study.

BACKGROUND: We aimed to describe the gender-based disparities in burn injury patterns, care received, and mortality across national income levels. METHODS: In the WHO Global Burn Registry (GBR), we compared patient demographics, injury characteristics, care and outcomes by sex using Chi-square statistics. Logistic regression was used to identify the associations of patient sex with surgical treatment and in-hospital mortality. RESULTS: Among 6431 burn patients (38 % female; 62 % male), females less frequently received surgical treatment during index hospitalization (49 % vs 56 %, p < 0.001), and more frequently died in-hospital (26 % vs 16 %, p < 0.001) than males. Odds of in in-hospital death was 2.16 (95 % CI: 1.73-2.71) times higher among females compared to males in middle-income countries. CONCLUSIONS: Across national income levels, there appears to be important gender-based disparities among burn injury epidemiology, treatment received and outcomes that require redress. Multinational registries can be utilized to track and to evaluate initiatives to reduce gender disparities at national, regional and global levels.

Registro Nacional de Quemados Chile: presentación de una plataforma online y mirada al pronóstico de pacientes no trasladados a Centro de Quemados / Presentation of an online National Registration Platform for severely burned patients in the Chilean Public Health System and a look into the prognosis of patients not transferred to the National Reference Burn Center

Resumen Introducción: En el año 2017 se incorporó un registro de notificación en línea (Registro Nacional de Quemados) al flujo de derivación de pacientes quemados en Chile. Objetivo: A partir de la información obtenida de esta plataforma, se describe la epidemiología de las quemaduras y las variables que podrían explicar los traslados fallidos a nuestra unidad de quemados. Materiales y Método: Se analizaron los casos subidos a esta plataforma entre julio de 2017 y julio de 2018. Se caracterizó la población global y comparó variables relevantes entre el grupo de pacientes no trasladados a nuestra unidad y los que fueron trasladados con éxito. Resultados: Se analizaron 319 pacientes, 66% hombres, edad promedio 51 años, IMC de 27% y 47% con enfermedades previas. El fuego fue la principal causa de quemaduras. Se observó un 31% de injuria inhaladora. 107 pacientes no se trasladaron a nuestro centro de quemados. Los pacientes trasladados puntuaron más alto en comorbilidad, índice de gravedad, superficie corporal total quemada y aseo quirúrgico en el hospital base. El grupo de pacientes no trasladados puntuó más alto en injuria inhalatoria. La mortalidad global fue 20,4%. La mortalidad fue mayor en pacientes no trasladados (33,6% versus 13,7%; p < 0,001). Conclusiones: Además de facilitar el flujo de pacientes y ahorrar recursos, un uso noble de esta plataforma es ser fuente de información epidemiológica y de implementación de políticas públicas, lo cual puede ser tomado como ejemplo por otros países en vías de desarrollo. Además, se demuestra que ser trasladado constituye un factor protector de muerte por quemaduras.

Introduction: In 2017, an online notification register, the National Burn Registry, was incorporated into the referral flow of burned patients in Chile. Aim: Through the information obtained from this platform, we describe the epidemiology of burns in Chile, and identify variables that could explain failed transfers to our burn unit. Materials and Method: Cases uploaded to this platform between July 2017 - July 2018 were analyzed. We characterize the global population and relevant variables were compared between the group of patients that failed to be transferred to the burn unit and the ones who were successfully transferred. Results: 319 patients were analyzed, 66% men, average age 51 years, BMI of 27 and 47% with previous illnesses. Fire was the main cause of burn injury. Smoke inhalation injury was observed for 31%. 107 patients failed to reach to our burn center. Transferred patients rated higher in comorbidity, severity index, total burned body surface and surgical debridement at base hospital. The group of not transferred patients rated higher in inhalation injury. Overall mortality was 20.4%. Mortality was higher in non-transferred patients (33.6% versus 13.7%; p < 0.001). Conclusions: Aside from facilitating the flow of burned patients and resources saving, a noble use of this platform has been to serve as a source of epidemiological information and implementation of public policies, which can be taken as an example by other developing countries. Also, being transferred is a protective factor for death from burn injuries.

Assessment of cleaning methods on bacterial burden of hospital privacy curtains: a pilot randomized controlled trial.

Healthcare-associated infections (HAIs) are an important global issue, leading to poor patient outcomes. A potential route of transmission of HAIs is through contact with hospital privacy curtains. The aim of this study is to evaluate cleaning on reduction of curtain bacterial burden. In this pilot cluster randomized controlled trial we compared the bacterial burden between three groups of 24 curtains on a regional burn/plastic surgery ward. A control group was not cleaned. Two groups were cleaned at 3-4 day intervals with either disinfectant spray or wipe. The primary outcome was the difference in mean CFU/cm2 between day 0 to day 21. The secondary outcome was the proportion of curtains contaminated with Methicillin-resistant Staphylococcus aureus (MRSA). By day 21, the control group was statistically higher (2.2 CFU/cm2) than spray (1.3 CFU/cm2) or wipe (1.5 CFU/cm2) (p < 0.05). After each cleaning at 3-4 day intervals, the bacterial burden on the curtains reduced to near day 0 levels; however, the level increased again over the intervening 3-4 days. By day 21, 64% of control curtains were contaminated with MRSA compared to 10% (spray) and 5% (wipe) (p < 0.05). This study show that curtains start clean and progressively become contaminated with bacteria. Regularly cleaning curtains with disinfectant spray or wipes reduces bacterial burden and MRSA contamination.