Development of the national injury resource database (NIRD).

INTRODUCTION: Lack of an accurate, publicly available database of burn/trauma resources creates challenges in providing burn care. In response to this gap, our group developed the National Injury Resource Database (NIRD), a comprehensive database of all US burn centers (BC) and trauma centers (TC) and their capabilities. METHODS: Lists of all national BC and TC were obtained from the American Burn Association (ABA), the American College of Surgeons, and every state department of health. Data was cross-checked and included BC/TC were linked with a 7-digit identification number using the American Hospital Association Quick Search guide. Each center's resources and verification status were validated with electronic or telephonic communications. RESULTS: The final database includes 135 BC and 617 TC, of which 18 are BC-only, 500 are TC-only, and 117 are combined BC/TC. ABA-verified BC (n = 76) are only found in Washington DC and 31 states, and 8 states have no BC. In the last 10 years, a net increase of 7 burn centers was found nationally. The ABA's online BC directory is outdated. CONCLUSIONS: NIRD represents the only up-to-date, comprehensive listing of BC and TC in existence. It categorizes all currently operating BC and TC across myriad classifications of designation and capabilities.

The utility of bronchoscopy after inhalation injury complicated by pneumonia in burn patients: results from the National Burn Repository.

There are no guidelines to determine when bronchoscopy is appropriate in patients with inhalation injury complicated by pneumonia. We reviewed the National Burn Repository from 1998 to 2007 to determine if there is any difference in outcome in burn patients with inhalation injury and pneumonia who did and did not undergo bronchoscopy. Three hundred fifty-five patients with pneumonia did not undergo bronchoscopy, 173 patients underwent one bronchoscopy, and 96 patients underwent more than one bronchoscopy. Patients with a 30 to 59% surface area burn and pneumonia who underwent bronchoscopy had a decreased duration of mechanical ventilation compared with those who did not (21 days, 95% CI: 19-23 days vs 28 days, 95% CI: 25-31 days, P=.0001). When compared with patients who did not undergo bronchoscopy, patients having a single bronchoscopy had a significantly shorter length of intensive care unit stay and hospital stay (35+/-3 vs 39+/-2, P=.04, and 45+/-3 vs 49+/-2, P=.009). The hospital charges were on average much higher in those patients who did not undergo bronchoscopy, compared with those who did ($473,654+/-44,944 vs $370,572+/-36,602, P=.12). When compared with patients who did not undergo bronchoscopy, patients who did have one or more bronchoscopies showed a reduced risk of death by 18% (OR=0.82, 95% CI: 0.53-1.27, P=.37). Patients with inhalation injury complicated by pneumonia seem to benefit from bronchoscopy. This benefit can be seen in a decreased duration of mechanical ventilation, decreased length of intensive care unit stay, and decreased overall hospital cost. In addition, there was a trend toward an improvement in mortality. The aggressive use of bronchoscopy after inhalation injury may be justified.