Utilization of the Burn Unit for Nonburn Patients: The “Wound Intensive Care Unit”

Barillo, David J.; Hallock, Geoffrey G.; Mastropieri, Cynthia J.; Troiani, Yvonne M.; Knowlton, Carol

doi:10.1097/00000637-198911000-00008

Cited by 9 publications

(6 citation statements)

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“…As previously mentioned, smaller scale studies have shown patients with necrotizing soft-tissue infections have improved outcomes when treated on a burn unit, as they are more likely to receive proper nutritional support via enteral nutrition, improved wound care with documentation, topical antimicrobials (silver nitrate solution, bacitracin, and xeroform), temporary wound coverage with biological dressings (xenografts and allografts), improved monitoring, and infection surveillance. [5][6][7][8][9]25,26 These patients were also less likely to receive unnecessary treatments such as prophylactic antibiotics and corticosteroids, which do not improve survival and increase the risk of superinfection. 25,29 Other studies have shown similar results, with transfer of these patients to a burn center improving outcomes and decreasing morbidity and mortality.…”

Section: Resultsmentioning

confidence: 99%

“…Most of these have been smaller retrospective studies regarding specific diagnoses such as necrotizing fasciitis, Fournier's gangrene, or exfoliative skin conditions like Stevens-Johnson syndrome or toxic epidermal necrolysis (TENS). [3][4][5][6]8,9,29 To our knowledge, there is no large-scale study that has examined differences in demographics and outcomes for this heterogeneous group of nonburn conditions when compared with burn patients.…”

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confidence: 99%

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Patients With Burns Versus Patients With Complex Skin and Soft-Tissue Disease

Maximus

Phelan

Joe

2016

Journal of Burn Care & Research

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With the incidence of burns decreasing nationally, burn units are caring for more patients with nonburn conditions. The American Burn Association National Burn Repository does not currently report data regarding patients cared for in burn units without a diagnosis of burn. Using the National Inpatient Sample, we examined if there was a difference in characteristics and outcomes of patients admitted for burns compared with those with a primary admitting diagnosis of necrotizing skin infections and soft-tissue infections and exfoliative skin conditions. This is a retrospective study querying the National Inpatient Sample database to identify 56,102 patients from 2007 to 2012 who were admitted with a diagnosis of a burn (burn group). This group was then compared with 375,857 patients who had a primary admitting diagnosis of a necrotizing skin and/or soft-tissue infection or exfoliative skin conditions (nonburn group). Clinical and demographic variables were analyzed to determine characteristics of each patient group including length of stay, disposition, complications, comorbidities, and mortality. The average age of the nonburn group was 63.7 years, whereas the average age of the burn group was 40.1 years. Overall length of stay was higher in the nonburn patients than in burn patients (10.5 vs 8.4 days, P < .001). Nonburn patients had a higher rate of medical comorbidities. Nonburn patients had higher rates of mortality (6.9% vs 2.7%) and complications. After adjusting for confounders, such as age, gender, ethnicity, and comorbidities, the nonburn group was found to have higher rates of all recorded complications. Burn patients were more likely to undergo a major operating room procedure (39.3% vs 28.1%) and routine discharge (68.4% vs 26.3%) compared with the nonburn group. Patients with necrotizing skin and soft-tissue infections and exfoliative skin conditions are older, have more comorbidities, higher complication rates, and higher mortality rates than burn patients. Given these findings, burn units may need to adjust their resource utilization, competencies, and research priorities to improve the quality of care being delivered to these two different populations.

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Section: Resultsmentioning

confidence: 99%

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confidence: 99%

Patients With Burns Versus Patients With Complex Skin and Soft-Tissue Disease

Maximus

Phelan

Joe

2016

Journal of Burn Care & Research

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“…Even two decades ago, 96% of burn units were admitting and managing nonburn patients. 3 The burn center has been described as the "wound intensive care unit." 3 The principles of a wound intensive care unit are to prevent further skin injury and provide general supportive care needed to minimize the physiological consequences of a large open wound.…”

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confidence: 99%

“…3 The burn center has been described as the "wound intensive care unit." 3 The principles of a wound intensive care unit are to prevent further skin injury and provide general supportive care needed to minimize the physiological consequences of a large open wound. 3 They have been applied to nonburn pathologies such as toxic epidermal necrolysis syndrome (TENS), Stevens-Johnson syndrome (SJS), and necrotizing fasciitis.…”

mentioning

confidence: 99%

“…3 The principles of a wound intensive care unit are to prevent further skin injury and provide general supportive care needed to minimize the physiological consequences of a large open wound. 3 They have been applied to nonburn pathologies such as toxic epidermal necrolysis syndrome (TENS), Stevens-Johnson syndrome (SJS), and necrotizing fasciitis. 4 Over an 8-year period, five large American Burn Association-verified regional academic burn centers saw a 244% increase in admissions for nonburn diagnoses.…”

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confidence: 99%

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Management of Severe Rheumatological Disease in the Burn Center

Reddy

Ahrenholz

Mohr

et al. 2012

Journal of Burn Care & Research

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In recent years, Burn Center has evolved to become a "wound intensive care unit" treating disease processes other than those due to thermal injury. Recent data have shown that more than 16% of admissions to Burn Centers are for nonburn injuries, particularly severe dermatologic diseases. The role of the Burn Center has been expanded to include treatment of patients with severe cutaneous manifestations of rheumatologic diseases. This approach has not been described before. All collagen vascular disease admissions to the Burn Center from 2005 to 2010 have been reviewed. There were 16 admissions where intensive wound management was a major component of the disease management. Disease processes included systemic lupus erythematosus, progressive systemic sclerosis, Raynaud's phenomenon, antiphospholipid syndrome, and dermatomyositis, among others. The authors describe five of these cases in detail. Comanagement of these patients by the Rheumatology and Burn services led to outstanding, successful outcomes. Collagen vascular diseases represent another area where the Burn Center may be the appropriate site for therapy.

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Concept review of regionalized systems of acute care: Is regionalization the next frontier in sepsis care?

Walton

Mohr

2022

JACEP Open

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Regionalization has become a buzzword in US health care policy. Regionalization, however, has varied meanings, and definitions have lacked contextual information important to understanding its role in improving care. This concept review is a comprehensive primer and summation of 8 common core components of the national models of regionalization informed by text‐based analysis of the writing of involved organizations (professional, regulatory, and research) guided by semistructured interviews with organizational leaders. Further, this generalized model of regionalized care is applied to sepsis care, a novel discussion, drawing on existing small‐scale applications. This discussion highlights the fit of regionalization principles to the sepsis care model and the actualized and perceived potential benefits. The principal aim of this concept review is to outline regionalization in the United States and provide a roadmap and novel discussion of regionalized care integration for sepsis care.

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Utilization of the Burn Unit for Nonburn Patients: The “Wound Intensive Care Unit”

Cited by 9 publications

References 0 publications

Patients With Burns Versus Patients With Complex Skin and Soft-Tissue Disease

Patients With Burns Versus Patients With Complex Skin and Soft-Tissue Disease

Management of Severe Rheumatological Disease in the Burn Center

Concept review of regionalized systems of acute care: Is regionalization the next frontier in sepsis care?

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