Effect of dexmedetomidine on fluid resuscitation in burn-injured patients.

Fluid creep occurs when resuscitation after extensive burn injury reaches volumes higher than predicted. Since this has been described in patients with high opioid requirements, continuous analgesics and sedatives, including dexmedetomidine, have been avoided during resuscitation. This study sought to describe the impact of dexmedetomidine on fluid resuscitation requirements. This retrospective cohort study included adult patients with burns greater than 20% total body surface area (TBSA) resuscitated between January 2017 and June 2022 at a regional burn center. Patients deceased within 48 hours of burn were excluded. Primary outcome was volume of fluid required in the first 24 and 48 hours post-burn. Secondary outcomes were the incidence of fluid-related adverse events within 7 days post-burn. A total of 170 patients were included: 55 in the dexmedetomidine cohort and 115 in the control cohort. After propensity matching for variables associated with fluid creep, the dexmedetomidine cohort required 4.2 ± 1.7 mL/kg/%TBSA in the first 24 hours compared to 3.6 ± 1.1 mL/kg/%TBSA in the control cohort (p=0.03). The difference was no longer significant at 48 hours (p=0.11). There were no differences in the incidence of acute respiratory distress syndrome, delayed escharotomy/fasciotomy, intraabdominal hypertension, or renal replacement therapy. Dexmedetomidine exposure during acute resuscitation resulted in increased fluid requirements in the first 24 hours, suggesting it is independently associated with fluid creep; however, this increase was not sustained at 48 hours. Clinical significance of this finding is unclear as there was no increase in adverse events related to excessive fluid resuscitation between cohorts.

Use of Cultured Epithelial Autograft in Conjunction with Biodegradable Temporizing Matrix in Massive Burns: A Case Series.

Intensive care for massively burn patients has increased survival and highlights the need for a solution to the problem of insufficient donor sites for autologous skin coverage. In this case series, we present 10 patients with average burn size of 81% TBSA and mean age of 24 years old, who underwent burn excision followed by either immediate or delayed biodegradable temporizing matrix (BTM) placement. After an integration period, the BTM was delaminated either the day before or immediately prior to placement of cultured epithelial autografts over a widely meshed (4:1 or 6:1) split thickness skin graft. One patient had cultured epithelial autografts alone, without split thickness skin graft, placed on integrated BTM and had successful take. Seven patients survived to discharge and had average 95% wound closure at 135 ± 35 days. The patients had on average 10.4 total operations and 8.7 excision and grafting operations. Five patients had complications related to the BTM requiring removal or replacement including three fungal infections, one bacterial infection and one with bleeding and a large clot burden. In conclusion, this surgical strategy is a viable option for patients with massive burns and insufficient donor for autologous skin grafting.

Poverty and Frailty Are Not Related to Each Other With Regard to Outcomes in Middle-Aged and Older Patients with Burn Injuries.

The purpose of this study was to determine the relationship between frailty and poverty in burn patients ≥50 years old, and their association with patient outcomes. This was a single-center retrospective chart review from 2009 to 2018 of patients ≥50 years old admitted with acute burn injuries. Frailty was assigned using the Canadian Study of Health and Aging Clinical Frailty Scale. Poverty was defined as a patient from a zip code that had >20% of people living in poverty. The relationship between frailty and poverty, as well as each variable independently on mortality, length of stay (LOS), and disposition location, was examined. Of 953 patients, the median age was 61 years, 70.8% were male, and the median total body surface area burn was 6.6%. Upon admission, 26.4% and 35.2% of patients were frail and from impoverished neighborhoods, respectively. The mortality rate was 8.8%. Univariate analysis demonstrated that nonsurvivors had significantly higher chances of living in poverty (P = .02) and were more likely to be frail compared to survivors. There was no significant correlation between poverty and frailty (P = .08). Multivariate logistic regression confirmed the relationship between lack of poverty and mortality (OR .47, 95% CI 0.25-0.89) and frailty and mortality (OR 1.62, 95% CI 1.24-2.12). Neither poverty (P = .26) nor frailty (P = .52) was associated with LOS. Both poverty and frailty were associated with a patient's discharge location (P = .03; P < .0001). Poverty and frailty each independently predict mortality and discharge destination in burn patients ≥50, but they are not associated with LOS nor each other.

Analysis of MLL2 gene in the first Brazilian family with Kabuki syndrome.

Most patients with Kabuki syndrome (KS) are the only person in their family with the condition. However, familial cases of KS have been described showing evidence that this syndrome can be inherited as a dominant trait with variable expressivity. We report on two related individuals with facial findings characteristic of KS. The proposita had arched eyebrows, long and upward slanting palpebral fissures, cleft lip and palate, retromicrognathia, brachydactyly of hands and feet, stubby fingers, nail hypoplasia, and prominent finger pads. Her mother had eyebrows with dispersed lateral half, long and upward slanting palpebral fissures, retrognathia, abnormal and posteriorly rotated ears, prominent finger pads, brachydactyly of feet, learning difficulties, and psychomotor development delay. DNA sequencing revealed a novel missense mutation in the MLL2 gene in both the proposita and her mother. The mutation (p.R5432Q) was found in the exon 51, within the SET domain of the gene, which confers methyltransferase activity on the protein. Therefore, the epigenetic and transcriptional regulatory properties of this protein may be altered and this suggests that the mutation is the cause of phenotype observed in both the patient and her mother. The clinical signs and the molecular evidence in this family further support the notion that KS is an autosomal dominant condition with variable expressivity. To our knowledge this is the first report of a Brazilian family with recurrence of this syndrome.

Thrombolytic Use in Management of Frostbite Injuries: Eight Year Retrospective Review at a Single Institution.

Frostbite injuries are uncommon, understudied, and lack standardized treatment protocols. Although thrombolytics are commonly used, their efficacy remains controversial. Herein, we report the results of a retrospective review of frostbite treatment practices at a single institution. The impact of thrombolytics on outcomes was evaluated. Medical records of frostbite patients admitted between January 2010 and April 2018 were reviewed. Demographics, injury details, treatment, and outcomes were collected. Descriptive statistics were obtained. A case-control analysis comparing patients who received tissue plasminogen activator (tPA) with those who did not was performed. A total of 102 patients were included. The mean age was 43 ± 17.7; 82.4% were male. About 13% of patients were presented with first-degree, 54% with second-degree, 29% with third-degree, and 5% with fourth-degree frostbite. Toes (69%), fingers (53%), and feet (43%) were most commonly affected. Thirteen patients had angiograms. Twelve patients received tPA: three systemic tPA and nine catheter-directed tPA. Overall, 32 patients (31%) required surgery and 27 (26.5%) patients required amputation with an average of 6.5 digits amputated. Digit salvage rate based on angiography was 84.7%. Length of stay (P = .046), number of operations (P = .037), and need for surgery (P = .030) were significantly lower for patients who received thrombolytics. Two patients had bleeding complications but did not require intervention or interruption of therapy. Despite its small sample size, our study suggests benefits from thrombolytic therapy. Prospective, well designed, and multi-institutional studies are warranted to establish evidence-based treatment guidelines for the management of frostbite injuries.

Burn Survivor Quality of Life and Barriers to Support Program Participation.

After a serious burn, re-entry into family life, society, and work can be incredibly difficult. Support services such as professional counseling and peer support play a key role for recovering survivors. Herein, we sought to identify support service participation rates, barriers to participation, and quality of life (QOL) among burn survivors treated at a regional burn center. A survey of burn survivors over 18 years old treated for a burn for 5 days or greater between 2006 and 2016 were invited to participate in a survey. The three-part survey contained sections covering demographics, questions regarding support program (SP) awareness, needs and participation, and QOL surveys. Univariate and multivariate regression analyses were performed to identify factors related to SP participation and QOL scores. Nine hundred sixty-eight patients were eligible; 150 responses were received. Over one third (40, 31%) of the responding survivors wanted support, but only half of those (23, 17%) participated in SPs. Distance and awareness of the available programs were two barriers to participation. Those attending SPs were more likely to have had larger burns (OR = 3.7, P = 0.05) and visible burns (OR = 7.5, P = 0.031). Lower scores on selected QOL scales were associated with burns more than 30%, visible burns, female gender, time from burn, and age group. A sizable number of burn survivors want SPs. However, access to these services and advertising their existence are hurdles to overcome. Future burn survivor SPs should focus on psychosocial stresses identified in the QOL assessments.

A National Study of the Effect of Race, Socioeconomic Status, and Gender on Burn Outcomes.

Age, burn size, and inhalation injury are the major contributing variables related to burn mortality. While the female gender has been linked to higher mortality, the impact of socioeconomic status has not been well studied. The interplay between these three factors is also unknown. This study sought to clarify the effects of these variables on outcomes in a national sample of patients with burns. A retrospective review of 172,640 patient records of the National Burn Repository (version 8, 2002-2011) data was conducted. Of those records, 36,960 (21.4%) patient entries were excluded for duplicate entries, follow-up visits, readmissions, nonburn injuries, skin diseases, and incompleteness (missing date of admission, date of discharge, race, or TBSA of burn or TBSA). Univariate and multivariate analyses were performed to compare outcomes by race (Caucasian, African-American, and other minority groups). P < .05 was considered significant. The study group included 135,680 patients and was predominately Caucasian (59.0% Caucasian, 19.0% African-American, and 22.0% other minority groups). The African-American race had more females, operations, longer length of stay, ventilator days, septicemia (all P < .001), and urinary tract infections (UTIs, P < .01). Caucasians had the largest burns (9.27 ± 13.22, P <.001) and were more likely to be older, to be intubated, and to have longer intensive care unit stays and higher mortality (all P < .001). Other non-African-American minorities (other minority group) had the second largest burn sizes, most uninsured members, and lowest mortality (P < .001). On multivariate analysis, mortality was related to African-American race, female gender, TBSA, full-thickness burn injury, inhalation injury, uninsured status, and burn mechanism. African-Americans were 50% more likely to have complications (P < .001), 30% more likely to have UTIs (P = .002), and 41% more likely to get septicemia (P < .001). Other racial minority groups had more acute respiratory distress syndrome, pneumonias, septicemia, UTIs, length of stay, and hospital charges when compared with Caucasian patients. Socioeconomic status was related to mortality but inconsistently related to other outcomes. Race appears to play a significant role in burn injury outcomes. Minority groups, especially African-Americans, have a higher risk of morbidity and mortality compared with Caucasian patients with burns. Socioeconomic status and gender also play a significant role in burn outcomes. Future studies should focus on delineating the reasons for this disparity.

The National Incidence and Resource Utilization of Burn Injuries Sustained While Smoking on Home Oxygen Therapy.

Considerable risk of burn injury exists for those patients on home oxygen therapy (HOT) who continue to smoke. In this study, the authors sought to establish the national incidence of burns incurred while smoking on HOT and to determine the resource utilization and sequelae of these injuries. A retrospective review of the American Burn Association's National Burn Repository was conducted to identify patients burned while on HOT during the years 2002 to 2011. Duplicate entries, as well as records of follow-up visits and readmissions, were removed. Univariate analysis was used to compare the differences between patients sustaining burn injuries related to HOT and patients with other mechanisms of injury. Multivariate analysis provided odds ratios for mortality controlling for all significant variables. The frequency of burns sustained on HOT significantly increased during the 10-year period reviewed and were associated with increased comorbidities and certain complications. Compared with non-HOT injuries, HOT injuries had higher incidence of inhalation injury and mortality. Inhalation injury was the strongest predictor of mortality in HOT burn injuries. The likelihood of poor prognosis was even more pronounced in patients who required intubation. Smoking was responsible for 83% of the HOT burn injuries described here. Therefore, smoking cessation counseling and treatment should be mandatory in all patients prescribed HOT.

Video-Enhanced Telemedicine Improves the Care of Acutely Injured Burn Patients in a Rural State.

The acute care of burn patients is critical and can be a daunting experience for emergency personnel because of the scarcity of burn injuries. Telemedicine that incorporates a visual component can provide immediate expertise in the treatment and management of these injuries. The authors sought to evaluate the addition of video telemedicine to our current telephone burn transfer program. During a 2-year period, 282 patients, 59.4% of all burn patients transferred from outside hospitals, were enrolled in the study. In addition to the scripted call with the charge nurse (ChargeRN) and the accepting physician, nine hospitals also transmitted video images of the wounds before transfer as part of a store and forward telemedicine transfer program (77, 27.6%). The accuracy of burn size estimations (BSA burned) and management changes (fluid requirements, transfer mode, and final disposition) were analyzed between the telephones-only sites (T only) and the video-enhanced sites. Referringstaff participating in video-enhanced telemedicine were sent a Google survey assessing their experience the following day. The referring staff (Referringstaff) was correct in their burn assessment 20% of the time. Video assessment improved the ChargeRN BSA burned and resulted in more accurate fluid resuscitation (P = .030), changes in both transportation mode (P = .042), and disposition decisions (P = .20). The majority of the Referringstaff found that video-enhanced telemedicine helped them communicate with the burn staff more effectively (3.4 ± 0.37, scale 1-4). This study reports the successful implementation of video-enhanced telemedicine pilot project in a rural state. Video-enhanced telemedicine using a store and forward process improved burn size estimation and facilitated management changes. Although not quantitatively assessed, the low cost of the system coupled with the changes in transportation and disposition strongly suggests a decrease in healthcare costs associated with the addition of video to a telephone-only transfer program.

An Evaluation of Factors Related to Postoperative Pain Control in Burn Patients.

Satisfactory treatment of burn pain continues to be elusive. The perioperative period is particularly challenging. The contributions of acute tolerance and opioid-induced hyperalgesia have not been previously explored in burn patients. As these phenomena have been identified perioperatively in other patient populations, we sought to characterize the burn perioperative period and to determine variables associated with poor postoperative (post-OR) pain control. A retrospective review of 130 adult burn patients who underwent surgical treatment for their burn injuries was performed. Variables collected included: demographics, burn injury data, perioperative self-reported pain scores, and perioperative opioid amounts. Correlations and multiple logistic regressions were used to assess the relationship between these variables and post-OR pain control. Pain increased throughout the perioperative period from 2.64 24 hours prior to the operation (pre-OR) to 3.81 24 hours following the OR (post-OR, P < .0001). Post-OR pain was correlated with pre-OR pain, pre-OR opioid amounts, OR opioid amounts, and post-OR opioid amounts. When the subgroup of patients with controlled pre-OR pain (<3 pain rating) was analyzed, only pre-OR opioids and post-OR opioids remained correlated with worse post-OR pain. While this study is retrospective, there is a suggestion that opioid amounts given pre-OR and intraoperatively are correlated with worse post-OR pain. While an increase in pain ratings postoperatively are anticipated, the additional contributions of acute tolerance and opioid-induced hyperalgesia need to be determined. Pharmacologic intervention directed at these mechanisms can then be administered to achieve better postoperative pain control.

Regional and national review of factors associated with burn wound cellulitis.

Burn wound cellulitis (BWC) is the second leading complication reported in burns. In this study we sought to identify demographic variables, burn factors, and other factors that may predispose patients to BWC. Regional data was obtained through retrospective medical record review of burn patients treated between May 2009 to April 2013 for BWC within 8 days of the injury. The patients were matched 1:2 with contemporaneously treated patients. Similarly, the National Burn Repository was queried to identify burn patients with BWC between the years 2002 to 2011, which were then compared to the remaining entries who did not have BWC reported. The data sets were analyzed separately. Univariate and multiple variable analyses were performed to evaluate risk factors for BWC. The risk factors that were consistent regionally and nationally were older age, male sex, African-American race (protective), lower extremity burns, scald burns, and full thickness burns. The treatment delay was only collected regionally, and was associated with an eight times increased risk. The factors that were inconsistent or significant in one sample only were smoking status, psychiatric conditions, upper extremity burns, and the place of injury. Cellulitis remains a significant problem for the burn community. Future prospective analyses need to clarify the impact of these factors as well as other factors on the development of BWC. Preventing BWC from occurring through earlier intervention or targeted prophylactic antibiotics may help reduce morbidity and decrease associated healthcare costs.

Gabapentin is ineffective as an analgesic adjunct in the immediate postburn period.

Successful treatment of burn pain requires a multimodality approach. Although opioid agents are the mainstay, other nonopioid agents, such as anticonvulsants, are frequently employed for pain control, with unknown benefits. The authors sought to determine the efficacy of gabapentin in acute burn pain management. Patients admitted to the burn center with burns more than 5% total body surface area and expected length of stay more than 48 hours were randomized and prospectively enrolled in this double-blind, placebo-controlled study from February 2010 to September 2011. Drug escalation and titration were done by protocol. Pain was assessed by unit protocol with the Numeric Rating Scale. Neuropathic pain and anxiety were recorded at least biweekly. Psychosocial adjustment was assessed at follow-up. Opioid medications were converted to morphine equivalents. Differences between pain levels and opioid consumption were analyzed between groups with the Student's t-test and χ test, respectively. The study was designed to detect a difference of 22% in opioid use between the two study groups with an enrollment of 50 patients with α of 0.05 and ß of 80%. P < .5 was considered significant. Fifty-three patients consented for the study and received the loading dose. Four patients withdrew. Both an intention-to-treat and actual treatment analysis were performed on all 53 patients. The placebo and drug populations were well matched for demographic variables, body surface area burned, and need for surgical intervention. The average length of stay was 11 ± 6.8 days and did not vary between groups. The study drug group received 10.8 ± 0.67 days of study drug, with eight patients receiving a dosage of 300 mg thrice daily (TID), 24 receiving 600 mg TID, 14 receiving 800 mg TID, and seven receiving 1200 mg TID. The incidence of neuropathic pain was 39% in the study drug arm and 38% in the placebo group. Neither pain scores (rest and procedural) nor opioid consumption differed between the groups. Forty-three patients (81.1%) were assessed at their first clinic visit. There was no difference in psychosocial functioning in either treatment group. In this randomized, double-blind, placebo-controlled study, the use of gabapentin in acute burn pain management did not decrease pain scores or lessen opioid requirements. Further research into nonopioid alternatives for burn pain analgesia is needed.

Factors related to child maltreatment in children presenting with burn injuries.

The underpinnings of maltreatment in children presenting with burn injuries are necessary to discern as detection and prevention rest on a clear delineation of factors associated with maltreatment. Inaccurate identification of child victims can result in perpetuation of the maltreatment and its attendant neuropsychological sequela. The authors sought to determine factors associated with maltreatment in children presenting with burn injuries, which would guide the burn team in assessing the likelihood of maltreatment. All consenting children admitted with burn injuries were surveyed regarding their injury mechanism and current sociodemographic status. Suspicious injuries were referred by the burn team to the multidisciplinary review team (MRT). The MRT reported injuries with signs of physical abuse, supervision neglect, neglect of other basic needs, or sexual abuse. These children constituted the cases in our study. Variables related to maltreatment were entered into stepwise logistic regression to identify independent predicting variables. P< .05 was considered significant. MRT identified 16 children (24%) admitted with burn injuries with suspicions of maltreatment. Risk factors related to suspicions of maltreatment included: young age, large burns, tap water injury, immersion lines, delay in care, absence of a two-parent family (unconventional family structure), young parents, inconsistent history, and injury pattern. In this single-center prospective study, the authors identified several factors that, when present in injuries with initial suspicion of maltreatment, should trigger a child maltreatment workup. Burn clinicians have an important role as advocates for children and their families. It is important to continue to further the knowledge of maltreatment detection and prevention among children presenting with burn injuries.

Burn prevention in Zambia: a targeted epidemiological approach.

The aim of this study is to assess primary burn prevention knowledge in a rural Zambian population that is disproportionately burdened by burn injuries. A 10-question survey was completed by youths, and a 15-question survey was completed by adults. The survey was available in both English and Nyanja. The surveys were designed to test their knowledge in common causes, first aid, and emergency measures regarding burn injuries. Logistic regression analysis was used to explore relationships between burn knowledge, age, school, and socioeconomic variables. A burn prevention coloring book, based on previous local epidemiological data, was also distributed to 800 school age youths. Five hundred fifty youths and 39 adults completed the survey. The most significant results show knowledge deficits in common causes of burns, first aid treatment of a burn injury, and what to do in the event of clothing catching fire. Younger children were more likely to do worse than older children. The adults performed better than the youths, but still lack fundamental burn prevention and treatment knowledge. Primary burn prevention data from the youths and adults surveyed demonstrate a clear need for burn prevention and treatment education in this population. In a country where effective and sustainable burn care is lacking, burn prevention may be a better investment to reduce burn injury than large investments in healthcare resources.

Burn prevention in Zambia: a work in progress.

The aim of this study was to assess both burn prevention knowledge and the effectiveness of educational intervention in alleviating the current knowledge deficit in Zambian youth. In one rural Zambian district, a burn prevention program was implemented in June 2011. Children at two elementary schools completed a 10-question survey that aimed to assess knowledge regarding burn injuries. After completing the survey, children received a burn and fire safety presentation and a burn prevention coloring book. Children were reassessed in May 2012 using the same survey to determine program efficacy and knowledge retention. Burn knowledge assessments were also completed for children at other schools who did not receive the burn prevention program in 2011. Logistic regression analysis was used for statistical adjustment for confounding variables. Between June 2011 and May 2012, 2747 children from six schools were assessed for their burn knowledge, with 312 of them resurveyed after educational intervention since initial survey. Reassessed children performed significantly better on three questions after controlling for confounders. They did better on five questions but their performance on these failed to achieve statistical significance. Children performed significantly worse on one concept about first aid treatment of a burn. A majority of the children demonstrated knowledge deficit in three concepts, even after educational intervention. There is a large variation in first burn knowledge survey performance of children from different schools, with inconsistency between concepts. With half the questions, knowledge deficit did not improve with advancement in school grade. Low- and moderate-income countries (LMICs) face the largest burns burden. With the lack of adequate burn care facing LMICs, burn injury prevention is of particular importance in those countries. This study shows that burn educational intervention could be effective in reducing burn knowledge deficit; however, the residual deficit posteducation could still be large and potentially contributing to heightened burn injury incidence. Customized and integrated educational programs may be proposed regarding the epidemiological profile of burn knowledge deficit from various schools. This study represents one of the few reports on the effectiveness of a burn prevention program in an LMIC. Future epidemiological data will be needed from nearby healthcare facilities to determine whether this program decreased burn morbidity and mortality at the hospital level.

A pilot study of the use of biocide-impregnated gauze as an adjunct to wound care in a burn population.

The aim of this study was to evaluate the use of a polyhexamethylene biguanide biocide-impregnated gauze (Kerlix™ AMD gauze dressing, Covidien d/b/a Tyco Healthcare Group LP) as an adjuvant to routine burn care and its impact on the incidence of hospital-associated infections in burn population. One hundred eight burn patients admitted to the Burn Treatment Center were prospectively enrolled from August 2008 to June 2009 and matched 1:2 with historic controls who were admitted from March 2006 to July 2008. Clinical care remained otherwise unchanged; however, several hospital initiatives (the national surgical improvement project, the surgical care improvement project, and a central venous line bundle) were initiated before and during the study. There were significantly less infections in the study population (18.52% of case patients vs 28.70% of control patients had infections, P = .047). Although there was a decrease in each infection subtype analyzed, a statistically significant reduction was only reached for pneumonias (1.85% in cases vs 5.86 in controls, P = .042). Implementation of polyhexamethylene biguanide biocide-impregnated gauze was temporally correlated with a significant decrease in healthcare-associated infections in burn population. As there was no corresponding decrease in wound infections, the impact of the gauze on healthcare-associated infections, if any, cannot be conclusively determined by this study. A larger prospective study powered to detect a decrease in wound-related infections is warranted.

Burn injuries in eastern Zambia: impact of multidisciplinary teaching teams.

The American Burn Association/Children's Burn Foundation (ABA/CBF) sponsors teams who offer burn education to healthcare providers in Zambia, a sub-Saharan country. The goals of this study are 1) to acquire burn-patient demographics for the Eastern Province, Zambia and 2) to assess the early impact of the ABA/CBF-sponsored burn teams. This is a retrospective chart review of burn patients admitted in one mission hospital in Katete, Zambia, July 2002 to June 2009. July 2002 to December 2006 = data before ABA/CBF burn teams and January 2007 to June 2009 = burn care data during/after burn outreach. There were 510 burn patients hospitalized, male:female ratio 1.2:1. Average age = 15.6 years, with 44% younger than 5 years. Average TBSA burned = 11% and mean fatal TBSA = 25%. Average hospital length of stay = 16.9 days survivors and 11.6 days nonsurvivors. Most common mechanisms of burn injuries: flame (52%) and scald (41%). Ninety-two patients (18%) died and 23 (4.5%) left against medical advice. There were 191 (37.4%) patients who underwent 410 surgical procedures (range 1-13/patient). There were 138 (33.7%) sloughectomies, 118 (28.7%) skin grafts, 39 (9.5%) amputations, and 115 (28.1%) other procedures. Changes noted in the 2007 to 2009 time period: more patients had burn diagrams (48.6 vs 27.6%, P < .001), received analgesics (91 vs 84%, P = .05), resuscitation fluid (56 vs 49%, P = not significant [NS]), topical antimicrobials (40 vs 37%, P = NS), underwent skin grafting (35.5 vs 25.1%, P = NS), and underwent any operative intervention (40.6 vs 35.2%, P = NS), compared with patients treated between 2002 and 2006. This study represents the largest, most comprehensive burn data set for a sub-Saharan region in Africa. There has been a statistically significant improvement in documentation of burn size as well as administration of analgesics, validating the efficacy of the ABA/CBF-sponsored burn teams. Continued contact with burn teams may lead to increased use of resuscitation fluids, topical antimicrobials, and more patients undergoing operative intervention, translating into improved burn patient outcomes.