Burn Centers Survey: 4 Ways Care Has Changed in 20 Years

Over 450,000 people in the U.S. suffer from serious burn wounds that require medical treatment each year, according to the American Burn Association. Management of severe burns can be a challenge, however, due to the potential for severe complications, evolving treatment in burn centers and shifts in costs.

Real-world data from burn centers can help form more complete patient insights, determine resource allocation and fine-tune treatment decisions. To that end, Carter et al. conducted a survey from burn centers throughout the U.S. to determine how burn injury treatment has changed since the last National Burn Repository (NBR) report in 2019, which included data from 2002 to 2018.

They hoped to identify shifts in burn management that could shed new light on the current standard of care as well as the varying burn center criteria that is used both regionally and nationally. Their survey included surgeons from 14 burn centers distributed across the U.S., representing 10% of all U.S. burn centers.

Here are four key takeaways from their survey on burn injury treatment, published in the Journal of Burn Care and Research:

• • • More severe burn wounds are being treated in the inpatient setting, with more low-TBSA burns and/or superficial burns being treated outpatient.
      Carter et al. found that there was an increase in full thickness (FT) burn wounds treated inpatient, and a decrease in superficial partial thickness (SPT) and deep partial thickness (DPT) burns treated inpatient compared to data from Kowal et al.

Regionally, burn centers in the Northeast and Western regions saw more of the smaller burns. The Eastern Great Lakes and Midwest regions were more likely to have patients treated inpatient, and those patients were more likely to have FT burns.

• • • There are less autografting procedures being performed per percent TBSA burned.
      For large burn wounds, the average number of autograft procedures per 10% TBSA burned was 0.75 in DPT burns and 0.95 in FT burns. However, for small burns, the average number of autograft procedures was similar in both DPT and FT burns.

With regards to burn depth, in DPT and FT burns, the average number of autograft procedures per 10% TBSA burned decreased as the size of the burn increased. Meanwhile burn centers in the Northeast region tended to have higher averages of autograft procedures per 10% TBSA burned in DPT and FT.

• • • The average surgical time by TBSA burned for the donor site and graft site decreases as the burn size increases.
      Carter et al. surmise that this burn management trend could be indicative of the fixed amount of time needed for all O.R. procedures, including preparation time and turnover time. Given that all procedures have to account for these components, this could reveal why the surgical time for larger burn wounds seems to be especially efficient.

For FT and mixed depth burns, the national average surgical time for the graft site was 6.10 minutes when the TBSA burned was 10%. That number decreased to 4.20 minutes when the TBSA burned jumped to 40%. For DPT burns, the average surgical time was 5.78 minutes for TBSA burned 10%, and that dropped to 3.87 minutes for TBSA burned of 40%.

This trend continued for the surgical time for the donor site. For FT and mixed depth burns, the average national surgical time was 3.04 minutes for TBSA burned 10%, and this number dropped to 2.22 minutes when the TBSA burned increased to 40%. Likewise, for DPT burns, the average national surgical time was 2.93 minutes for TBSA burned 10%, and 2.16 minutes for TBSA burned 40%.

• • • Burn care costs have significantly increased.
      The biggest increases in costs in burn care management, according to the study, were found to be in anesthesiology costs per patient, with the national average being $5,817, and O.R. costs per hour, with a national average of $4,844. On a regional level, burn centers in the Eastern Great Lakes and Midwest regions had the highest costs for both anesthesiology and O.R. time.

While knowing how care at burn centers is evolving may lead to optimization, Carter et al. note that there are some limitations to their study. Some reported data on burn management may be subjective based on one’s own unique experiences rather than empirical data, and there were only a small number of participants included.

A Novel Burn Injury Treatment: Telemedicine

As Carter et al. sought to better understand the standard of care at burn centers throughout the U.S., Yenikomshian et al. set out to improve burn management at their own center by implementing a new technology that could make rounds more efficient.

In their study published in Telemedicine and e-Health, they created what they call “Zoom Rounds,” a technique using the videoconferencing platform Zoom to decrease the amount of team members needed for inpatient burn rounds.

Most of the burn team members surveyed felt that Zoom Rounds were a “positive change” for the burn care unit and felt that it “enhanced learning.” The majority of patients and family members surveyed felt that they knew what to expect with wound rounds and that their privacy was respected.

Overall, the study authors found that using telemedicine as part of burn care management was beneficial for both patients and team members in their burn center and believe that Zoom Rounds could become an important tool for burn patient care in the future.

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