The impact of different co-morbidities on clinical outcomes and resource utilization in critically ill burn and surgical patients: A population-based analysis of social determinants of health.

BACKGROUND: This study aims to establish the significance of social determinants of health and prevalent co-morbidities on multiple indicators for quality of care in patients admitted to the Burn and Surgical Intensive Care Unit (ICU). METHODS: We performed a retrospective analysis of population group data for patients admitted at the Burn and Surgical ICU from January 1, 2016, to November 18, 2019. The primary outcomes were length of hospital stay (LOS), mortality, 30-day readmission, and hospital charges. Pearson's chi-square test for categorical variables and t-test for continuous variables were used to compare population health groups. RESULTS: We analyzed a total of 487 burn and 510 surgical patients. When comparing ICU patients, we observed significantly higher mean hospital charges and length of stay (LOS) in BICU v. SICU patients with a history of mental health ($93,259.40 v. $50,503.36, p = 0.013 and 16.28 v. 9.16 days, p = 0.0085), end-stage-renal-disease (ESRD) ($653,871.05 v. $75,746.35, p = 0.0047 and 96.15 v. 17.53 days, p = 0.0104), sepsis ($267,979.60 v. $99,154.41, p = <0.001 and 39.1 v. 18.42 days, p = 0.0043), and venous thromboembolism (VTE) ($757,740.50 v. $117,816.40, p = <0.001 and 93.11 v. 20.21 days, p = 0.002). Also, higher mortality was observed in burn patients with ESRD, ST-Elevation Myocardial Infarction (STEMI), sepsis, VTE, and diabetes mellitus. 30-day-readmissions were greater among burn patients with a history of mental health, drug dependence, heart failure, and diabetes mellitus. CONCLUSIONS: Our study provides new insights into the variability of outcomes between burn patients treated in different critical care settings, underlining the influence of comorbidities on these outcomes. By comparing burn patients in the BICU with those in the SICU, we aim to highlight how differences in patient backgrounds, including the quality of care received, contribute to these outcomes. This comparison underscores the need for tailored healthcare strategies that consider the unique challenges faced by each patient group, aiming to mitigate disparities in health outcomes and healthcare spending. Further research to develop relevant and timely interventions that can improve these outcomes.

Burn Care in Low-Resource and Austere Settings.

More than 95% of the 11 million burns that occur annually happen in low-resource settings, and 70% of those occur among children. Although some low- and middle-income countries have well-organized emergency care systems, many have not prioritized care for the injured and experience unsatisfactory outcomes after burn injury. This chapter outlines key considerations for burn care in low-resource settings.

The cost of inpatient burn management in Nepal.

INTRODUCTION: The management of burns is costly and complex with inpatient burns accounting for a high proportion of the costs associated with burn care. We conducted a study to estimate the cost of inpatient burn management in Nepal. Our objectives were to identify the resource and cost components of the inpatient burn care pathways and to estimate direct and overhead costs in two specialist burn units in tertiary hospitals in Nepal. METHODS: We conducted fieldwork at two tertiary hospitals to identify the cost of burns management in a specialist setting. Data were collected through semi-structured in-depth interviews (IDIs) and focus group discussions (FGDs) with burn experts; unit cost data was collected from hospital finance departments, laboratories and pharmacies. The study focused on acute inpatient burn cases admitted to specialist burn centres within a hospital-setting. RESULTS: Experts divided inpatient burn care pathways into three categories: superficial partial-thickness burns (SPT), mixed depth partial-thickness burns (MDPT) and full thickness burns (FT). These pathways were confirmed in the FGDs. A 'typical' burns patient was identified for each pathway. Total resource use and total direct costs along with overhead costs were estimated for acute inpatient burn patients. The average per patient pathway costs were estimated at NRs 102,194 (US$ 896.4), NRs 196,666 (US$ 1725), NRs 481,951 (US$ 4,227.6) for SPT, MDPT and FT patients respectively. The largest cost contributors were surgery, dressings and bed charges respectively. CONCLUSION: This study is a first step towards a comprehensive estimate of the costs of severe burns in Nepal.

Using Pressure Mapping to Optimize Hospital-Acquired Pressure Injury Prevention Strategies in the Burn Intensive Care Unit.

Although prior studies have demonstrated the utility of real-time pressure mapping devices in preventing pressure ulcers, there has been little investigation of their efficacy in burn intensive care unit (BICU) patients, who are at especially high risk for these hospital-acquired injuries. This study retrospectively reviewed clinical records of BICU patients to investigate the utility of pressure mapping data in determining the incidence, predictors, and associated costs of hospital-acquired pressure injuries (HAPIs). Of 122 patients, 57 (47%) were studied prior to implementation of pressure mapping and 65 (53%) were studied after implementation. The HAPI rate was 18% prior to implementation of pressure monitoring, which declined to 8% postimplementation (chi square: P = .10). HAPIs were less likely to be stage 3 or worse in the postimplementation cohort (P < .0001). On multivariable-adjusted regression accounting for known predictors of HAPIs in burn patients, having had at least 12 hours of sustained pressure loading in one area significantly increased odds of developing a pressure injury in that area (odds ratio 1.3, 95% CI 1.0-1.5, P = .04). Patients who developed HAPIs were significantly more likely to have had unsuccessful repositioning efforts in comparison to those who did not (P = .02). Finally, implementation of pressure mapping resulted in significant cost savings-$6750 (standard deviation: $1008) for HAPI-related care prior to implementation, vs $3800 (standard deviation: $923) after implementation, P = .008. In conclusion, the use of real-time pressure mapping decreased the morbidity and costs associated with HAPIs in BICU patients.

Yarning up about out-of-pocket healthcare expenditure in burns with Aboriginal families.

OBJECTIVE: This study sought to understand the impact of out-of-pocket healthcare expenditure (OOPHE) on Aboriginal families of children with acute burns injury. METHODS: Families participating in a larger Australia-wide study on burns injuries in Aboriginal and Torres Strait Islander children were approached to participate. Decolonising methodology and yarning were employed with participants to scope OOPHE for burns care. Thematic analyses were used with transcripts and data organised using qualitative analysis software (NVivo, Version 12). RESULTS: Six families agreed to participate. Four yarning sessions were undertaken across South Australia, New South Wales and Queensland. The range of OOPHE identified included: costs (transport, pain medication, bandages), loss (employment capacity, social and community) and support (family, service support). The need to cover OOPHE significantly impacted on participants, from restricting social interactions to paying household bills. Close family connections and networks were protective in alleviating financial burden. CONCLUSION: OOPHE for burns care financially impacted Aboriginal families. Economic hardship was reported in families residing rurally or with reduced employment capacity. Family and network connections were mitigating factors for financial burden. Implications for public health: Targeted support strategies are required to address OOPHE in burns-related injuries for Aboriginal communities.

The Impact of the Affordable Care Act on Burn Outcomes.

Uninsured and low socioeconomic status patients who suffer burn injuries have disproportionately worse morbidity and mortality. The Affordable Care Act was signed into law with the goal of increasing access to insurance, with Medicaid expansion in January 2014 having the largest impact. To analyze the population-level impact of the Affordable Care Act on burn outcomes, and investigate its impact on identified at-risk subgroups, a retrospective time series of patients was created using data from the Healthcare Cost and Utilization Project National Inpatient Sample database between 2011 and 2016. An interrupted time series analysis was conducted to examine mortality, length of stay, and the probabilities of discharge home, home with home health, and to another facility before and after January 2014. There were no changes in burn mortality detected. There was a statistically significant reduction in the probability of being discharged home (-0.000967, P < .01; 95% confidence interval [CI] -0.0015379 to -0.0003962) or discharged home with home health (-0.000709, P < .01; 95% CI -0.00110 to 0.000317) after 2014. There was an increase in the probability of being discharged to another facility (0.00108, P = .01; 95% CI 0.000282-0.00188). While the enactment of the major provisions of the Affordable Care Act in 2014 was not associated with a change in mortality for burn patients, it was associated with more patients being discharged to a facility: This may represent a significant improvement in access to care and rehabilitation. Future studies will assess the societal and economic impact of improved access to post-discharge facilities and rehabilitation.

Impact of the affordable care act's medicaid expansion on burn outcomes and disposition.

BACKGROUND: We aimed to analyze the impact of the Affordable Care Act's Medicaid Expansion on clinical outcomes and patient disposition after burn injury. We hypothesized that increased insurance coverage results in improved outcomes and higher rates of discharge to inpatient rehabilitation. METHODS: We reviewed the University of Washington Regional Burn Center registry data for patients admitted from 2011 to 2018. Patients were grouped into two categories: before (2011-2013) and after (2015-2018) Medicaid expansion; we excluded 2014 data to serve as a washout period. Outcomes assessed included length of hospital stay, patient disposition, and mortality. Multivariable logistic and linear regression models with covariates for sex, age, burn size, ethnicity ethnicity, distance from burn center, etiology of burn, and presence of inhalation injury were used to determine the impact of Medicaid expansion on outcomes. RESULTS: Rates of uninsured patients decreased while Medicaid coverage increased. Despite increased median burn size after Medicaid expansion, inpatient mortality rates did not change, but average acute care length of stay increased. More patients were discharged to rehabilitation centers. CONCLUSIONS: Our study corroborates prior findings of increased insurance coverage since Medicaid expansion. Increased insurance coverage is associated with higher rates of discharge to inpatient rehabilitation programs after burn injury.

The Economics of Burn Injuries Among Children Aged 0 to 4 Years in British Columbia.

Children under the age of 5 years have the highest rate of hospitalization and mortality from burns. Studies of costs associated with pediatric burns have included a limited number of patients and focused on inpatient and complication costs, limiting our understanding of the full economic burden of pediatric burns. This study aimed to develop a costing model for burn injuries among children to estimate the economic burden of child burns in British Columbia, Canada. Costs of services and resources used by children aged 0 to 4 years old who were treated at BC Children's Hospital (BCCH) between January 1, 2014 and March 15, 2018 for a burn injury were estimated and summed, using a micro-costing approach. The average cost of burn injuries per percentage of total body surface area (%TBSA) was then applied to the number of 0 to 4 years old children treated for a burn injury across British Columbia between January 1 and December 31, 2016. Based on 342 included children, a 1-5%, 6-10%, 11-20%, and >20% burn, respectively cost an average of $3338.80, $13,460.00, $20,228.80, and $109,881.00 to society. The societal cost of child burns in BC in 2016 totaled $2,711,255.01. In conclusion, pediatric burn injuries place an important, yet preventable economic burden on society. Preventing even a small number of severe pediatric burns or multiple small burns may have considerable economic impacts on society and allow for the reallocation of healthcare funds toward other clinical priorities.

Inhalation injury is associated with long-term employment outcomes in the burn population: Findings from a cross-sectional examination of the Burn Model System National Database.

INTRODUCTION: Inhalation injuries carry significant acute care burden including prolonged ventilator days and length of stay. However, few studies have examined post-acute outcomes of inhalation injury survivors. This study compares the long-term outcomes of burn survivors with and without inhalation injury. METHODS: Data collected by the Burn Model System National Database from 1993 to 2019 were analyzed. Demographic and clinical characteristics for adult burn survivors with and without inhalation injury were examined. Outcomes included employment status, Short Form-12/Veterans Rand-12 Physical Composite Score (SF-12/VR-12 PCS), Short Form-12/Veterans Rand-12 Mental Composite Score (SF-12/VR-12 MCS), and Satisfaction With Life Scale (SWLS) at 24 months post-injury. Regression models were used to assess the impacts of sociodemographic and clinical covariates on long-term outcome measures. All models controlled for demographic and clinical characteristics. RESULTS: Data from 1,871 individuals were analyzed (208 with inhalation injury; 1,663 without inhalation injury). The inhalation injury population had a median age of 40.1 years, 68.8% were male, and 69% were White, non-Hispanic. Individuals that sustained an inhalation injury had larger burn size, more operations, and longer lengths of hospital stay (p<0.001). Individuals with inhalation injury were less likely to be employed at 24 months post-injury compared to survivors without inhalation injury (OR = 0.63, p = 0.028). There were no significant differences in PCS, MCS, or SWLS scores between groups in adjusted regression analyses. CONCLUSIONS: Burn survivors with inhalation injury were significantly less likely to be employed at 24 months post-injury compared to survivors without inhalation injury. However, other health-related quality of life outcomes were similar between groups. This study suggests distinct long-term outcomes in adult burn survivors with inhalation injury which may inform future resource allocation and treatment paradigms.

A comprehensive, integrated approach to quality improvement and capacity building in burn care and prevention in low and middle-income countries: An overview.

Consistent evidence has emerged over many years that the mortality and morbidity outcomes for burn patients in low and middle-income countries (LMICs) lag behind those in more resource rich countries. Interburns is a charity that was set up with the aim of working to reduce the disparity in the number of cases of burns as well as the outcomes for patients in LMICs. This paper provides an overview of a cyclical framework for quality improvement in burn care for use in LMICs that has been developed using an iterative process over the last 10 years. Each phase of the process is outlined together with a description of the tools used to conduct a gap analysis within the service, which is then used to frame a programme of capacity enhancement. Recent externally reviewed projects have demonstrated sustained improvement with the use of this comprehensive and integrated approach over a three-year cycle. This overview paper will be supported by further publications that present these results in detail.

Interhospital variation of inpatient versus outpatient pediatric burn treatment after emergency department evaluation.

BACKGROUND: Approaches to burn care in the pediatric population are highly variable and can be targeted as a potential measure in cost-reduction. We hypothesized that institutions vary significantly in treatment allocation of nonsevere burns to either inpatient or outpatient care. METHODS: We queried the PHIS database for fiscal year 2017 to quantify small pediatric burn admissions and Emergency Department visits (ED). The ICD-10 code T31.0 was used to identify burns involving <10% of total body surface area (TBSA). Centers were categorized by burn center status and length of stay, readmissions, and charges were compared. RESULTS: Inpatient versus outpatient management distribution was significantly different across the included pediatric children's hospitals (n = 34, p < 0.00001). When data were analyzed with respect to outpatient care, a bimodal distribution distinguished two groups: high hospital utilizers with an average of 30% outpatient burn care and low-utilizers averaging 87%. Median inpatient charge per patient was greater than 31-fold compared to ED burn management (p < 0.0001). CONCLUSIONS: Variability of inpatient versus outpatient pediatric burn management in small burns was significant. Compared to outpatient burn care, inpatient care is significantly more costly. Implementing protocols and personnel to provide adequate attention to small burns in the ED could be an important cost-saving measure. TYPE OF STUDY: Retrospective analysis. LEVEL OF EVIDENCE: Level III.

Assessment and determinants of global outcomes among 445 mass-casualty burn survivors: A 2-year retrospective cohort study in Taiwan.

PURPOSE: To study outcomes among survivors of the mass-casualty powder explosion on 27 June 2015, at Formosa Fun Coast Waterpark, New Taipei City, Taiwan. METHODS: Using retrospective data on Taiwanese survivors, we analyzed prehospital management, burns assessment and prognosis, functional recovery, and medical costs, followed-up through 30 June 2017. We related outcomes to burn extent, categorized according to the percentages of total body surface area with second/third-degree burns (%TBSA) or autologous split-thickness skin grafts (%STSG), and an investigational scale: f{SASG} = (%TBSA + %STSG)/2, stratified by %STSG. Analyses included casualty dispersal, comparisons between %TBSA, %STSG and f{SASG}, and their relationships with length of hospitalization, times to rehabilitation and social/school re-entry, physical/mental disability, and medical costs. We also investigated how burn scars restricting joint mobility affected rehabilitation duration. RESULTS: 445 hospitalized casualties (excluding 16 foreigners, 23 with 0% TBSA and 15 fatalities) aged 12-38 years, had mean TBSA of 41.1%. Hospitalization and functional recovery durations correlated with %TBSA, %STSG and f{SASG} - mean length of stay per %TBSA was 1.5 days; more numerous burn scar contractures prolonged rehabilitation. Females had worse burns than males, longer hospitalization and rehabilitation, and later school/social re-entry; at follow-up, 62.3% versus 37.7% had disabilities and 57.7% versus 42.3% suffered mental trauma (all p ≤ 0.001). Disabilities affecting 225/227 people were skin-related; 34 were severely disabled but 193 had mild/moderate impairments. The prevalence of stress-related and mood disorders increased with burn extent. Treatment costs (mean USD-equivalents ∼$48,977/patient, ∼$1192/%TBSA) increased with burn severity; however, the highest %TBSA, %STSG and f{SASG} categories accounted for <10% of total costs, whereas TBSA 41-80% accounted for 73.2%. CONCLUSIONS: Besides %TBSA, skin-graft requirements and burn scar contractures are complementary determinants of medium/long-term outcomes. We recommend further elucidation of factors that influence burn survivors' recovery, long-term physical and mental well-being, and quality of life.

The Effect of Surgical Intervention on Pediatric Burn Injury Survival in a Resource-Poor Setting.

INTRODUCTION: Burns are one of the most common injuries sustained globally. Low- and middle-income countries (LMICs) are disproportionately affected by burn injury morbidity and mortality; African children have the highest burn mortality globally. In high-income countries, early surgical intervention has shown to improve survival. However, when applied to burn victims in LMICs, improved survival in the early excision cohort (≤5 d) was not seen. Therefore, we aimed to determine the magnitude of the effect of surgical intervention on burn injury survival. METHODS: A retrospective analysis of a prospectively collected data, utilizing the Kamuzu Central Hospital Burn Database from May 2011 to July 2019, was performed. Pediatric patients (≤12 y) were included. Patients were excluded if they underwent surgical intervention for nonacute burn care management. Bivariate analyses stratifying by type of surgical intervention was performed, comparing demographics, burn characteristics, surgical intervention, and patient mortality. Standardized estimates were adjusted using the inverse-probability of treatment weights to account for confounding. Weighted logistic regression modeling was performed to determine the odds of mortality based on if a patient underwent surgical intervention. RESULTS: During the study, 2364 patients were seen at the Kamuzu Central Hospital, 1785 (75.5%) were children ≤12 y who met inclusion criteria. In the overall cohort, 342 (19.2%) underwent operations, including split-thickness skin graft (n = 196, 57.3%), debridement (n = 116, 33.9%), escharotomy (n = 19, 5.6%), and amputation (n = 1, 0.3%). The surgery cohort was older (4.2 ± 3.1 versus 3.1 ± 2.6 y, P < 0.001) with larger percent total body surface area burns (16%, interquartile range: 10-24 versus 13%, interquartile range: 8-20, P < 0.001) than those who did not have surgery. In the propensity score-weighted logistic regression predicting survival, patients undergoing surgery after burn injury had an increased odds of survival (odds ratio: 5.24, 95% confidence interval: 2.40-11.44, P = 0.003) when compared with patients not undergoing surgery. CONCLUSIONS: In this propensity-weighted analysis, surgical intervention following burn injury increases the odds of survival by a factor of 5.24 when compared with patients not undergoing surgical intervention. Efforts to enhance burn infrastructure to deliver surgical care is imperative to attenuate burn mortality in resource-poor settings.

Cohort study evaluating management of burns in the community in clinical practice in the UK: costs and outcomes.

OBJECTIVE: To evaluate health outcomes, resource use and corresponding costs attributable to managing burns in clinical practice, from initial presentation, among a cohort of adults in the UK. DESIGN: Retrospective cohort analysis of the records of a randomly selected cohort of 260 patients from The Health Improvement Network (THIN) database who had 294 evaluable burns. SETTING: Primary and secondary care sectors in the UK. PRIMARY AND SECONDARY OUTCOME MEASURES: Patients' characteristics, wound-related health outcomes, healthcare resource use and total National Health Service (NHS) cost of patient management. RESULTS: Diagnosis was incomplete in 63% of patients' records as the location, depth and size of the burns were missing. Overall, 70% of all the burns healed within 24 months and the time to healing was a mean of 7.8 months per burn. Sixty-six per cent of burns were initially managed in the community and the other 34% were managed at accident and emergency departments. Patients' wounds were subsequently managed predominantly by practice nurses and hospital outpatient clinics. Forty-five per cent of burns had no documented dressings in the patients' records. The mean NHS cost of wound care in clinical practice over 24 months from initial presentation was an estimated £16 924 per burn, ranging from £12 002 to £40 577 for a healed and unhealed wound, respectively. CONCLUSIONS: Due to incomplete documentation in the patients' records, it is difficult to say whether the time to healing was excessive or what other confounding factors may have contributed to the delayed healing. This study indicates the need for education of general practice clinicians on the management and care of burn wounds. Furthermore, it is beholden on the burns community to determine how the poor healing rates can be improved. Strategies are required to improve documentation in patients' records, integration of care between different providers, wound healing rates and reducing infection.

Cost-drivers of medical expenses in burn care management.

BACKGROUND: Profound differences exist in the cost of burn care globally, thus we aim to investigate the affected factors and to delineate a strategy to improve the cost-effectiveness of burn management. METHODS: A retrospective analysis of 66 patients suffering from acute burns was conducted from 2013 to 2015. The average age was 26.7 years old and TBSA was 42.1% (±25.9%). We compared the relationship between cost and clinical characteristics. RESULTS: The estimated cost of acute burn care with the following formula (10,000 TWD) = -19.80 + (2.67 × percentage of TBSA) + (124.29 × status of inhalation injury) + (147.63 × status of bacteremia) + (130.32 × status of respiratory tract infection). CONCLUSION: The majority of the cost were associated with the use of antibiotics and burns care. Consequently, it is crucial to prevent nosocomial infection in order to promote healthcare quality and reduce in-hospital costs.

Burn service costing using a mixed model methodology.

INTRODUCTION: The escalating cost of modern healthcare is threatening the fundamental "free at the point of delivery" principle of the UK National Health Services. A new remuneration system using a fixed tariff for pre-assigned diagnostic groups caters poorly for the heterogeneity of burn injuries. This study was to develop a system for Patient Level Costing (PLC), the first steps of which were to determine the true cost of burn care at service level. METHODS: Detailed interrogation was conducted of the cost of care in our Burns & Plastic Surgery Department. Costs were determined through the amalgamation of two fundamental methodologies: (1) Top-Down Costing (from detailed budgetary analysis for the hospital) and (2) Bottom-Up Costing (detailed itemised costing of staff, equipment, drugs, consumables & maintenance). These costs were categorised & using various apportionment tools, traced to specific care areas. RESULTS: We demonstrated that the accuracy of costs derived by host organisations cannot be relied upon (our Burn Service was 62% more expensive than estimated by our host organisation), which therefore questions the accuracy of most published work on burn care costing based upon these assumptions. Using our costing model, an analysis was made of the cost of running the Department with zero activity but "open & ready for business". Costs such as drugs and consumables were thus removed. This demonstrated that despite no clinical activity, costs still remained at 90% of full occupancy cost and are thus fixed costs. CONCLUSIONS: We hope application of this new system of Patient Level Costing to burn care will avoid the threatened viability of burn services imposed by changes in remuneration, although it will inevitably be an iterative process. A fuller understanding of the true cost of healthcare, facilitates service development and planning, both at a local and national level.

Long-term quality of life and cost-effectiveness of treatment of partial thickness burns: A randomized controlled trial comparing enzyme alginogel vs silver sulfadiazine (FLAM study).

The clinical effectiveness and scar quality of the randomized controlled trial comparing enzyme alginogel with silver sulfadiazine (SSD) for treatment of partial thickness burns were previously reported. Enzyme alginogel did not lead to faster wound healing (primary outcome) or less scar formation. In the current study, the health-related quality of life (HRQoL), costs, and cost-effectiveness of enzyme alginogel compared with SSD in the treatment of partial thickness burns were studied. HRQoL was evaluated using the Burn Specific Health Scale-Brief (BSHS-B) and the EQ-5D-5L questionnaire 1 week before discharge and at 3, 6, and 12 months postburn. Costs were studied from a societal perspective (health care and nonhealth-care costs) for a follow-up period of 1 year. A cost-effectiveness analysis was performed using cost-effectiveness acceptability curves and comparing differences in societal costs and Quality Adjusted Life Years (QALYs) at 1 year postburn. Forty-one patients were analyzed in the enzyme alginogel group and 48 patients in the SSD group. None of the domains of BSHS-B showed a statistically significant difference between the treatment groups. Also, no statistically significant difference in QALYs was found between enzyme alginogel and SSD (difference -0.03; 95% confidence interval [CI], -0.09 to 0.03; P = .30). From both the health care and the societal perspective, the difference in costs between enzyme alginogel and SSD was not statistically significant: the difference in health-care costs was €3210 (95% CI, €-1247 to €7667; P = .47) and in societal costs was €3377 (95% CI €-6229 to €12 982; P = .49). The nonsignificant differences in costs and quality-adjusted life-years in favor of SSD resulted in a low probability (<25%) that enzyme alginogel is cost-effective compared to SSD. In conclusion, there were no significant differences in quality of life between both treatment groups. Enzyme alginogel is unlikely to be cost-effective compared with SSD in the treatment of partial thickness burns.

Paraffin dangers, health and socioeconomic consequences: Urgent need for policy action.

Illuminating paraffin (kerosene) is the primary cooking fuel for approximately two million South Africans. The highly flammable and toxic fuel is burnt in poorly made stoves that are prone to malfunction and are associated with accidental fires, burns and household air pollution. However, the fuel continues to be used as it is easily decanted, widely available in neighbourhood outlets, perceived as affordable, and often the only available option for low-income urban settlements. It is anticipated that increased and enforced home congestion during COVID-19 lockdowns will exacerbate exposure of homebound families to unsafe energy, especially during the cold winter months. Based on an accumulation of evidence on the health and socioeconomic impacts of paraffin, this article advocates for its expedited phase-out and substitution with safer energy.

Healthcare resource utilization, treatment patterns, and cost of care among patients with thermal burns and inpatient autografting in two large privately insured populations in the United States.

The current standard of care for severe burns includes autografting; however, there is scarce knowledge regarding the long-term economic burden associated with thermal burns and inpatient autografting. The objective of this study was to characterize healthcare resource utilization, treatment patterns, and cost of care for thermal burn patients in two large privately insured populations in the United States who underwent inpatient autografting between 01/01/2011 and 06/30/2016. Patient demographics, clinical characteristics, healthcare resource utilization, and total cost were examined during baseline (one year before the initial hospitalization with autografting) and two-year evaluation period. There was a substantial economic burden on thermal burn patients who received inpatient autografts (HIRD® database [HIRD]: N=371, mean age=39.6 years, male=67.1%; MarketScan® database [MarketScan]: N=698, mean age=38.2 years, male=63.3%) in the year 1 evaluation period (HIRD: mean=$184,805; MarketScan: mean=$155,272), which was mainly driven by the initial hospitalization with autografting (HIRD: mean=$157,384 and MarketScan: mean=$131,470). The percentage of patients with burn-related healthcare resource utilization and average burn-related costs were considerably reduced in the year 2 evaluation period (HIRD: mean=$3020; MarketScan: mean=$1990). Consistent with previous studies, mean length of hospital stay (days) and mean total medical costs generally increased as the percentage of total body surface area burned increased.

Management of paediatric burns in low- and middle-income countries: assessing capacity using the World Health Organization Surgical Assessment Tool.

BACKGROUND: Burns are a leading cause of global disease burden, with children in low- and middle-income countries (LMICs) disproportionately affected. Effective management improves outcomes; however, the availability of necessary resources in LMICs remains unclear. We evaluated surgical centres in LMICs using the WHO Surgical Assessment Tool (SAT) to identify opportunities to optimize paediatric burn care. METHODS: We reviewed WHO SAT database entries for 2010-2015. A total of 1121 facilities from 57 countries met the inclusion criteria: facilities with surgical capacity in LMICs operating on children. Human resources, equipment and infrastructure relevant to paediatric burn care were analysed by WHO Regional and World Bank Income Classifications and facility type. RESULTS: Facilities had an average of 147 beds and performed 485 paediatric operations annually. Discrepancies existed between procedures performed and resource availability; 86% of facilities performed acute burn care, but only 37% could consistently provide intravenous fluids. Many, particularly tertiary, centres performed contracture release and skin grafting (41%) and amputation (50%). CONCLUSIONS: LMICs have limited resources to provide paediatric burn care but widely perform many interventions necessary to address the burden of burns. The SAT may not capture innovative and traditional approaches to burn care. There remains an opportunity to improve paediatric burn care globally.