A Half-Century of Burn Epidemiology and Burn Care in a Rural State

Blaisdell, Laura; Chace, Reeve; Hallagan, Lee D.; Clark, David E.

doi:10.1097/bcr.0b013e3182343dab

Cited by 15 publications

(9 citation statements)

References 12 publications

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“…Nor did we find improvement in the ABA-NBR data since 1995. This suggests that burn care has achieved the floor of survival, as also noted by Blaisdell [75] . The regression revealed improved survival for the elderly as also reported by Macrino [76] Gomez [77] and Lionelli [78] although none of the authors clearly segregated standard and short-stay admissions.…”

Section: Resultsmentioning

confidence: 63%

“…Third, we could develop satellite burn centers in Montana, Idaho, Eastern Washington, and Alaska to care for the smaller, simpler injuries. Blaisdell [75] has already suggested that burn centers be identified with a “level” designation; these new satellites could be “level 2”. A fourth option is to offload various Burn Center activities to “burn team extenders”, ICU care to intensivists trained in the needs of burn injury, outpatient non-operative care to other physicians trained in non-operative burn management, outpatient occupational and physical therapy to non-Burn Center therapists trained in the needs of burn injury.…”

Section: Discussionmentioning

confidence: 99%

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Harborview Burns – 1974 to 2009

et al. 2012

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BackgroundBurn demographics, prevention and care have changed considerably since the 1970s. The objectives were to 1) identify new and confirm previously described changes, 2) make comparisons to the American Burn Association National Burn Repository, 3) determine when the administration of fluids in excess of the Baxter formula began and to identify potential causes, and 4) model mortality over time, during a 36-year period (1974–2009) at the Harborview Burn Center in Seattle, WA, USA.Methods and Findings14,266 consecutive admissions were analyzed in five-year periods and many parameters compared to the National Burn Repository. Fluid resuscitation was compared in five-year periods from 1974 to 2009. Mortality was modeled with the rBaux model. Many changes are highlighted at the end of the manuscript including 1) the large increase in numbers of total and short-stay admissions, 2) the decline in numbers of large burn injuries, 3) that unadjusted case fatality declined to the mid-1980s but has changed little during the past two decades, 4) that race/ethnicity and payer status disparity exists, and 5) that the trajectory to death changed with fewer deaths occurring after seven days post-injury. Administration of fluids in excess of the Baxter formula during resuscitation of uncomplicated injuries was evident at least by the early 1990s and has continued to the present; the cause is likely multifactorial but pre-hospital fluids, prophylactic tracheal intubation and opioids may be involved.Conclusions1) The dramatic changes include the rise in short-stay admissions; as a result, the model of burn care practiced since the 1970s is still required but is no longer sufficient. 2) Fluid administration in excess of the Baxter formula with uncomplicated injuries began at least two decades ago. 3) Unadjusted case fatality declined to ∼6% in the mid-1980s and changed little since then. The rBaux mortality model is quite accurate.

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Section: Resultsmentioning

confidence: 63%

Section: Discussionmentioning

confidence: 99%

Harborview Burns – 1974 to 2009

et al. 2012

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“…In Ecuador, males are twice as likely to get burned compared to females; this relationship 2.3:1 seems to be within the range described worldwide [4,14,15,25]. The conditions of the burn unit and the outcome of the patients show that mortality rates are a lot higher than in developed countries [3,22].…”

Section: Discussionmentioning

confidence: 61%

A population-based study of the epidemiology of acute adult burns in Ecuador from 2005 to 2014

Ortíz-Prado

Armijos

Iturralde

2015

Burns

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“…National statistics use International Classifications of Diseases (ICD) external causes codes that attempt to capture multiple causation dimensions in a single code. These codes lack the detailed causation information that is required to inform injury prevention initiatives and studies using coded mortality data suffer similar limitations [45][46][47][48].…”

Section: Discussionmentioning

confidence: 98%