The Costs of Burn Victim Hospital Care around the World: A Systematic Review

Background: Burn injuries are very common and fire-related burns account for over 300,000 deaths per year globally. The costs of the treatment of these patients change around the world. The aim of the present study was to conduct a systematic literature review to identify the costs related to hospital stays of burn victims in countries with different Human Development Index (HDIs). Methods: PubMed, CINAHL and BVIS databases were searched using the following terms: “burn,” treatment” and “costs”. The review included articles that presented cost studies or economic assessments of burn victims in which the costs were reported, and published between 2012 and 2019. The quality of the evidence was assessed using the Consensus on Health Economic Criteria. This review presents register in Prospero (CRD42019137580). Results: The review included 19 economic studies conducted in 13 countries, most with a very high HDIs. Most studies estimated direct acute burn care costs through bottom-up costing and institutional data. Total hospital care costs ranged from US$ 10.58 to US$ 125,597.86 per patient, the cost of 1% of total body surface area burned ranged from US$ 2.65 to US$ 11,245.04, and the cost of hospital care per day, from US$ 24.23 to US$ 4,125.50. Conclusion: The costs are high and show wide discrepancies among countries. Medical costs and other losses caused by fatal and non-fatal burn injuries differ considerably among demographic groups, care protocols, and country HDIs.

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Supporting the Regional Network for Children with Burn Injuries in a Pediatric Referral Hospital for COVID-19

Healthcare ◽

10.3390/healthcare9050551 ◽

2021 ◽

Vol 9 (5) ◽

pp. 551

Author(s):

Gloria Pelizzo ◽

Elettra Vestri ◽

Giulia del Re ◽

Claudia Filisetti ◽

Monica Osti ◽

...

Keyword(s):

Average Length ◽

Total Body Surface Area ◽

Burn Injuries ◽

Treatment Team ◽

Pediatric Hospital ◽

Regional Network ◽

Burn Treatment ◽

Burn Care ◽

Management Protocol ◽

Set Up

Considerable reorganization of the regional network for pediatric burn treatment during the pandemic was required to cope with severe burn injuries in small children. In support of the emergency network for burns during the COVID-19 pandemic, we referred to regional indications for centralization in our hospital for all children aged less than 5 years who presented with severe burns, >15% of total body surface area (TBSA), or who necessitated admittance to the pediatric intensive care unit (PICU). A new service with a dedicated management protocol was set up to treat pediatric burns in our SARS-CoV-2 pediatric hospital during the lockdown period. A multidisciplinary burn treatment team was set up to offer compassionate and comprehensive burn care. Patient’s clinical data, burn features, treatment and follow up were recorded. A higher number of admissions was recorded from February to December 2020 compared with the same period in 2019 (52 vs. 32 admissions). Eighteen patients were admitted to the COVID-19 Service (10 M/8 F; 3.10 ± 2.6 yrs); ten children (55.5%) were hospitalized in the ward and eight in the ICU (44.5%). Fifty percent of the cases presented with lesions extending over >15% TBSA; in one case, TBSA was 35%. All patients suffered 2nd-degree burns; while five patients also had 3rd degree lesions covering more than 15% TBSA. All of the injuries occurred at home. No major secondary infections were recorded. Successful treatment was achieved in 94.4% of cases. The average length of stay was 15.2 ± 12.6 days. A proactive, carefully planned service, involving a multidisciplinary team, was created to ensure appropriate care in a pediatric hospital during the COVID-19 period, despite the effective pandemic associated challenges. Better health promotion in pediatric burn cases should also include dedicated TBSA assessment and a database of children’s burn characteristics.

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Perception of Community and Hospital Personnel on Burn Treatment and Outcome in Nepal

Journal of Nepal Medical Association ◽

10.31729/jnma.3889 ◽

2018 ◽

Vol 56 (214) ◽

pp. 924-930

Author(s):

Jaswan Sakya ◽

Sujit Kumar Sah ◽

Khakindra Bahadur Bhandari ◽

Laxmi Raj Pathak ◽

Santosh Bikram Bhandari ◽

...

Keyword(s):

Joint Stiffness ◽

Burn Injuries ◽

Medical Attention ◽

Management Approach ◽

Burn Treatment ◽

Burn Victims ◽

Burn Care ◽

Care Services ◽

Referral Hospitals ◽

Community People

Introduction: Globally, eleven million people sustain burn injuries every year enough to require medical attention. WHO has estimated Disability associated limited years of 84,000 per year just due to deformities and 2100 people die every year due to burn injuries in Nepal. The overall objective of the study is to explore the effectiveness of burn injuries treatment and management approach of hospitals.Methods: This qualitative study approached to 40 Health Personnel for Key Informants Interviews and 18 Focus Group Discussions with community people at the ten referral hospitals of eight district from May-June 2016. Qualitative data were analyzed using At.Lasti Software. Results: Female burn victims are brought late to the hospital compared to male patients and false reporting about incident is usually done by her attendants. More than three-fourth (80%) of the hospitals and about one-third male and female from FGD reported that the community people seek home remedy first rather than medical treatment. Majority of the medical doctors and nursing chiefs reported that first degree cases accounts for 50% of the total burn cases with a success rate of 80%. Medical and Nursing staff reported that deformities like hypertrophic scar, keloids, joint stiffness and compartment syndrome are mostly observed during the treatment. Hypothermia and sepsis were the major causes of death in most of the burn patients.Conclusions: Usually, people who engaged in house and agriculture works, have visited public health posts/hospitals more frequently due to financial constraints and transportation issues where quality of burn care services are unavailable.

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102 Wildfire Burns: Implications for Burn Care

Journal of Burn Care & Research ◽

10.1093/jbcr/iraa024.105 ◽

2020 ◽

Vol 41 (Supplement_1) ◽

pp. S67-S67

Author(s):

Tina L Palmieri ◽

Kathleen S Romanowski ◽

Soman Sen ◽

David G Greenhalgh

Keyword(s):

Length Of Stay ◽

Burn Injury ◽

Total Body Surface Area ◽

Ventilatory Support ◽

Mass Casualty ◽

Inhalation Injury ◽

Burn Injuries ◽

Injury Incidence ◽

Burn Centers ◽

Burn Care

Abstract Introduction Climate change, the encroachment of populations into wilderness, and carelessness have combined to increase the incidence of wildfire injuries. With the increased incidence has come an increase in the number of burn injuries. Prolonged extrication, delays in resuscitation, and the extreme fire and toxic air environment in a wildfire has the potential to cause more severe burn injury. The purpose of this study is to examine the demographics and outcomes of wildfire injuries and compare those outcomes to non-wildfire injuries. Methods Charts of patients admitted to a regional burn center during a massive wildfire in 2018 were reviewed for demographic, treatment, and outcome. We then obtained age, gender, and burn size matched controls from within 2 years of the incident, analyzed the same measures, and compared treatment and outcomes between the two groups. Results A total of 20 patients, 10 wildfire (WF) burns and 10 non-wildfire (NWF) burns, were included in the study. Age (59.6±7.8 WF vs. 59.4±7.4 years), total body surface area burn (TBSA) (14.9±4.7 WF vs. 17.2±0.9 NWF) and inhalation injury incidence (2 WF and 2 NWF) were similar between groups. Days on mechanical ventilation (24.3±19.4 WF vs. 9.4±9.8 NWF), length of stay (49.9±21.8 WF vs. 28.2±11.7 days) and ICU length of stay (43.0±25.6 WF vs 24.4±11.2 NWF) were higher in the WF group. WF patients required twice the number of operations. Mortality was similar in both groups (1 death/group). Conclusions Wildfire burn injuries, when compared to age, inhalation injury, and burn size matched controls, require more ventilatory support and have more operations. As a result, they have longer lengths of stay and have a prolonged ICU course. Burn centers should be prepared for the increased resource utilization that accompanies wildfire injuries. Applicability of Research to Practice All burn centers must be prepared for the possibility of wildfires and the increased resource utilzation that accompanies mass casualty events.

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Demographic Profile of Electrical Burns in a Tertiary Burn Care Centre

IRA-International Journal of Applied Sciences (ISSN 2455-4499) ◽

10.21013/jas.v4.n2.p9 ◽

2016 ◽

Vol 4 (2) ◽

pp. 284

Author(s):

S K S Sutha S Sellamoni ◽

U. Rasheedha Begum ◽

Vinoth Kumar ◽

G Karthikeyan Karthikeyan

Keyword(s):

Renal Damage ◽

Early Mobilization ◽

Burn Injuries ◽

Burn Victims ◽

Burn Care ◽

The Family ◽

Fluid Requirement ◽

Authentic Care ◽

Electrical Burns

<div><p><em> Electrical burn injuries are challenging burns that require multi disciplinary approach. It is a major cause of morbidity among burn victims and requires more number of interventions and hospital stay. Certain unique features that are to be kept in mind while treating electrical burn patients are the differences in fluid requirement, assessment of cardiac involvement, other associated injuries like head spine or bony injuries and renal damage. Aim of treatment of these victims is to prevent infection, to achieve skin cover to allow early mobilization, to optimize function and to minimize long term scarring. Special effective authentic care and proper rehabilitation can make the electrical burn victim a useful productive member of the family/society.</em></p></div>

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Pre-hospital care in burn injury

Indian Journal of Plastic Surgery ◽

10.1055/s-0039-1699457 ◽

2010 ◽

Vol 43 (S 01) ◽

pp. S15-S22

Author(s):

Prabhat Shrivastava ◽

Arun Goel

Keyword(s):

Hospital Care ◽

Burn Injury ◽

Care Facility ◽

First Aid ◽

Vital Role ◽

Burn Injuries ◽

Care Providers ◽

Care Centre ◽

Burn Care ◽

Management Plans

ABSTRACTThe care provided to the victims of burn injury immediately after sustaining burns can largely affect the extent and depth of the wound. Although standard guidelines have been formulated by various burn associations, they are still not well known to public at large in our country. In burn injuries, most often, the bystanders are the first care providers. The swift implementation of the measures described in this article for first aid in thermal, chemical, electrical and inhalational injuries in the practical setting, within minutes of sustaining the burn, plays a vital role and can effectively reduce the morbidity and mortality to a great extent. In case of burn disasters, triage needs to be carried out promptly as per the defined protocols. Proper communication and transport from the scene of the accident to the primary care centre and onto the burn care facility greatly influences the execution of the management plans

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97 Major Psychiatric Illness and Substance Use Disorder Influence Mortality in Major Burn Injury: A Secondary Analysis of the Transfusion Requirement in Burn Care Evaluation (TRIBE) Study

Journal of Burn Care & Research ◽

10.1093/jbcr/irab032.101 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

pp. S66-S67

Author(s):

John A Andre ◽

Soman Sen ◽

David G Greenhalgh ◽

Tina L Palmieri ◽

Kathleen S Romanowski

Keyword(s):

Psychiatric Illness ◽

Transfusion Requirement ◽

Total Body Surface Area ◽

Secondary Analysis ◽

Inhalation Injury ◽

Burn Injuries ◽

Burn Care ◽

Major Burn ◽

Total Body ◽

Care Evaluation

Abstract Introduction Prior studies of burn patients with < 20% total body surface area (TBSA) burns have found that 15.4% of patients have major psychiatric illness (MPI) and 27.6% have Substance Use Disorder (SUD). In patients with small burns, SUD is associated with larger burn size and secondarily with longer length of stay while MPI is associated with longer lengths of stay while not increasing burn size. The purpose of this study was to determine whether MPI or SUD dependence affects outcomes such as mortality in patients with major burn injuries (≥20% TBSA). Methods A secondary analysis from the prospective, randomized, multicenter Transfusion Requirement in Burn Care Evaluation (TRIBE) study was conducted. Patients with MPI and SUD were compared with patients without these disorders. Statistical analysis with chi-square for categorical variables and student’s t-test for continuous variables was conducted. Mortality between those with and without MPI and SUD were analyzed with a multivariable regression analysis. Results A total of 347 patients with a mean age of 43±17 years, 274 men and 73 women, were analyzed. The mean total body surface area burn (TBSA) was 38±18%, and 23% had inhalation injury. In this study population, 29.1% had SUD, 7.5% had MPI, and 2.3% had both. There was no difference with respect to age, gender, TBSA, frailty, or assignment to the liberal or restrictive transfusion strategy based on the presence of MPI, SUD, or both. Inhalation injury was more common in patients with MPI (27%) or SUD (35%) when compared with patients without these comorbidities (18%) or those who have both (11%) (p=0.006). Patients with MPI were more likely to die of their burn injuries (27%) when compared with those with SUD (17%), both (11%), or neither (8%) (p=0.014). On multivariate analysis for mortality controlling for TBSA and inhalation injury, MPI was found to be an independent predictor of death with an odds ratio of 5 (95% confidence interval 1.7–15, p=0.003). Conclusions In burns >20% TBSA, both MPI and SUD influence patient’s likelihood of sustaining inhalation injury. MPI is also independently associated with mortality in the study. Further work must be done to mitigate the effects of mental illness on burn outcomes.

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The Effect of Transfer on Outcomes in Burns

Journal of Burn Care & Research ◽

10.1093/jbcr/irab092 ◽

2021 ◽

Author(s):

Nathan E Bodily ◽

Elizabeth H Bruenderman ◽

Neal Bhutiani ◽

Selena The ◽

Jessica E Schucht ◽

...

Keyword(s):

Total Body Surface Area ◽

Infectious Complications ◽

Burn Injuries ◽

Burn Patients ◽

Burn Care ◽

Burn Center ◽

Field Versus ◽

High Acuity ◽

Total Body ◽

Inhalation Burn

Abstract Patients with burn injuries are often initially transported to centers without burn capabilities, requiring subsequent transfer to a higher level of care. This study aimed to evaluate the effect of this treatment delay on outcomes. Adult burn patients meeting American Burn Association (ABA) criteria for transfer at a single burn center were retrospectively identified. A total of 122 patients were evenly divided into two cohorts – those directly admitted to a burn center from the field, versus those transferred to a burn center from an outlying facility. There was no difference between the transfer and direct admit cohorts with respect to age, percent total body surface area burned, concomitant injury, or intubation prior to admission. Transfer patients experienced a longer median time from injury to burn center admission (1 vs. 8 hours, p &lt, 0.01). Directly admitted patients were more likely to have inhalation burn (18 vs. 4, p &lt, 0.01), require intubation after admission (10 vs. 2, p = 0.03), require an emergent procedure (18 vs. 5, p &lt, 0.01), and develop infectious complications (14 vs. 5, p = 0.04). There was no difference in ventilator days, number of operations, length of stay, or mortality. The results suggest that significantly injured, high acuity burn patients were more likely to be immediately identified and taken directly to a burn center. Patients who otherwise met ABA criteria for transfer were not affected by short delays in transfer to definitive burn care.

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618 Clinical and Humanistic Burdens of Pediatric Burns: A Systematic Literature Review

Journal of Burn Care & Research ◽

10.1093/jbcr/irab032.268 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

pp. S163-S164

Author(s):

Helen Hahn ◽

Tzy-Chyi Yu ◽

Randi L Rutan ◽

David L Salyer

Keyword(s):

Peer Relationships ◽

Burn Injury ◽

Donor Site ◽

Total Body Surface Area ◽

Burn Injuries ◽

Burn Care ◽

Increased Risk ◽

Patient Reported ◽

Pediatric Burns ◽

Over Time

Abstract Introduction Children face long-term clinical and psychological sequelae from burn injuries. This review summarizes the scientific literature on the clinical and humanistic burdens of pediatric burns. Methods A systematic review of literature published between Jan 2015 and Jun 2020 was conducted based on PRISMA guidelines in Embase, Biosis, and MEDLINE to identify publications examining the clinical, humanistic, economic, and/or epidemiologic burdens of illness associated with pediatric burns in the US. Results Of 2,286 unique articles identified, 28 met eligibility criteria. This analysis focused on studies relating to the clinical (n=8) and humanistic (n=9) burdens of pediatric burns. Across all studies, flame and scald were the most common burn etiologies. Among the 8 clinical studies, several evaluated outcomes (n=2) or treatments (n=3) in predominantly graft recipients. One study found that 64% of pediatric split-thickness autograft recipients exhibited hypertrophic scarring (HTS) at the donor site. Other variables (time to re-epithelialization, donor-site harvest depth, harvest in an acute burn care setting, thigh donor-site location) were associated with increased risk of HTS. An increase in percentage total body surface area (%TBSA) burned corresponded to increased number of autograft procedures, risk for HTS, and viral infection risk. Other reported outcomes included infections (eg, healthcare-associated, wound, viral), pain, inhalation injury, and sepsis. One study found that while the frequency and intensity of pruritis decreased over time, 63% of children continued to report symptoms at 2 years after injury. Among the 9 humanistic studies, 4 reported larger %TBSA corresponded to worse health-related quality of life assessed by various instruments. In a study of patients under age 5 with burns, Burns Outcomes Questionnaire (0–4) scores improved over time in multiple domains. In youth with a history of burn injuries, patient-reported pain interference with daily living was significantly associated with decreased physical functioning, depression, and impaired peer relationships. Two studies assessed caregiver burden, with one study finding that 19% of caregivers self-reported clinical or at-risk levels of distress following the child’s burn injury. Conclusions Pediatric burns place a substantial clinical and humanistic burden on patients and their caregivers. While outcomes appeared to improve over time, clinical and humanistic consequences of pediatric burns endured. More research on novel treatment products and procedures is needed to reduce the burden of burns for this population.

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Epidemiological studies of burn patients in a burn center in Ghana: any clues for prevention?

Burns & Trauma ◽

10.1186/s41038-016-0041-0 ◽

2016 ◽

Vol 4 ◽

pp. 1-4 ◽

Cited By ~ 4

Author(s):

P. Agbenorku ◽

K. Aboah ◽

J. Akpaloo ◽

R. Amankwa ◽

B. Farhat ◽

...

Keyword(s):

Total Body Surface Area ◽

Epidemiological Studies ◽

Burn Injuries ◽

Burn Patients ◽

Middle Income ◽

Burn Victims ◽

Middle Income Countries ◽

Burn Prevention ◽

Working Environments ◽

Total Body

Abstract Background Burn injuries are a serious problem worldwide, with most occurrences in low- and middle-income countries. Depending on the extent of injury, burn victims are faced with the challenges of fitting into society due to complications such as extensive scarring and contractures. The current study seeks to determine whether epidemiological studies of burn patients can provide guidelines to enhance burn prevention among the Ghanaian population. Methods Data from the Burns Registry of the Burns Intensive Care Unit (BICU) of Komfo Anokye Teaching Hospital (KATH) was obtained. Data on sex, age, aetiology, % total body surface area (TBSA), and admission outcomes from May 1, 2009, to April 30, 2013, were retrieved for a total of 487 patients during this period. Results Data on burn admissions comprising 263 (54.0 %) males and 224 (46.0 %) females were obtained from the Burns Registry. Children 0–10 years were the most affected age group. The yearly mean % TBSA ranged from 24.74 % to 35.07 %. The majority of burns was caused by scalding. Mortality rates ranged from 8.4 % to 32.0 % during the period under review. Conclusions The study shows that children of 10 years old and below are the most affected group; this may be due to inattention to these children by parents/caretakers. Safety and safe working environments should be provided at home and workplaces, and promotion of education on burn prevention should be intensified.

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Early Excision and Grafting in Burns: An Experience in a Tertiary Care Industrial Hospital of Eastern India

Indian Journal of Plastic Surgery ◽

10.1055/s-0039-3402707 ◽

2019 ◽

Vol 52 (03) ◽

pp. 337-342

Author(s):

Prasenjit Goswami ◽

Seelora Sahu ◽

Pankaj Singodia ◽

Manjeet Kumar ◽

Tukulu Tudu ◽

...

Keyword(s):

Length Of Stay ◽

Burn Injury ◽

Tertiary Care ◽

Total Body Surface Area ◽

Burn Patients ◽

Cost Of Treatment ◽

Outcome Parameters ◽

Burn Care ◽

Significant Difference ◽

The Cost

Abstract Introduction To compare the burn patients undergoing early excision and grafting (within 7 days of burn injury) with the patients undergoing late surgeries (more than 7 days after burn injury) to see if there was any difference in surgical and outcome parameters including length of stay, expenditure, and overall outcome of the patients. Material and Methods A retrospective analysis of the data collected from the burn care unit records over a period of one year was done. Fifty-eight patients who matched with our inclusion criteria were divided into two groups. An early excision group who underwent surgery within 7 days of sustaining burn injury (n = 24) and a late excision group who underwent excision and grafting/debridement after 7 days of sustaining burn (n = 34). Data recorded included demographic variables like age, sex, percentage total body surface area (TBSA) burn; nature of burn; date of sustaining burn; date of admission to the burn care unit; and treatment and outcome parameters like date of surgery, days from burn injury to first surgery, number of surgeries, type of surgery, percentage of TBSA resurfaced with skin graft, blood products used, length of stay, outcome, and total expenditure incurred by patients. Results There was no statistically significant difference in the number of surgeries done, the units of packed cell used, and the number of fresh frozen plasma (FFP) used between the early excision group and the late excision group. The length of stay was significantly low in the early excision group as compared with the late excision group. The expenditure incurred in the treatment of the early excision group was significantly lower than the cost of treatment of the late excision group. Conclusion Early excision and grafting in burn cases reduces the length of the stay of burn patients and, in turn, reduces the cost of treatment. However, having a dedicated burn care unit is important for the hospitals and both public and private hospitals should make a move in that direction.

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