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

Abstract

ObjectiveTo 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.DesignRetrospective 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.SettingPrimary and secondary care sectors in the UK.Primary and secondary outcome measuresPatients’ characteristics, wound-related health outcomes, healthcare resource use and total National Health Service (NHS) cost of patient management.ResultsDiagnosis 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.ConclusionsDue 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.

Economic Burden of Denatured Alcohol-Induced Burns: A 20-Year Retrospective Study

“…A systematic review showed that the mean cost per patient with burn in high-income countries was US$ 88,218 ( 17 ). In particular, the average cost of per patient burn care has been reported as US$ 6,755 in Japan ( 20 ), US$ 15,250 in Turkey ( 21 ), US$ 73,532 in Australia ( 22 ), US$22,759 (€26,540) in the Netherlands ( 23 ), US$ 114,576 (€105,116) in the United Kingdom (UK; for a patient with 27% TBSA) ( 7 ), US$ 22,617 in the United Kingdom per burn care in primary and secondary care settings ( 24 ), US$ 2,283 in Nepal as direct cost for inpatient burn treatment ( 25 ), US$ 1,060.5 in North India, US$ 704 in Bangladesh, and US$ 559.85 per patient in Malawi ( 25 ). Data were different in high vs. low- and middle-income countries (LMICs; mean costs per patient $88,218 vs. $5,196), as in the last countries there are different healthcare and finance structures, price levels, treatment protocols, and therapeutic possibilities, and limited resources ( 17 , 25 ).…”

To compare the effect of sea buckthorn and silver sulfadiazine dressing on period of wound healing in patients with second‐degree burns: A randomized triple‐blind clinical trial

“…Since the increased risk of infection and deceleration in wound healing are among the main concerns for caring for burns patients, a broad range of topical medicines that contain antiseptics and antibiotics nowadays are prescribed for treating burns 4,5 . Among these medications, 1% silver sulfadiazine (SSD) as a topical medicine is commonly prescribed to treat and prevent second‐degree burns from being infected 6 .…”

“…Since the increased risk of infection and deceleration in wound healing are among the main concerns for caring for burns patients, a broad range of topical medicines that contain antiseptics and antibiotics nowadays are prescribed for treating burns. 4,5 Among these medications, 1% silver sulfadiazine (SSD) as a topical medicine is commonly prescribed to treat and prevent second-degree burns from being infected. 6 When mixed with body fluids, however, SSD creates a thick pseudo-eschar that is difficult and painful to remove, 7 and due to its stickiness to the wound and its noxious effects on restoring keratinocytes, SSD can delay the wound healing process and leaves a puckered scar.…”

Preliminary Characterization of a Polycaprolactone-SurgihoneyRO Electrospun Mesh for Skin Tissue Engineering

“…Approximately 3.8 million people with a wound were treated by the National Health Service (NHS, United Kingdom) in 2017/2018 with an annual cost of £8.3 billion [ 13 ]. For example, the average cost of treating a burn over a 24-month period is approximately £17,000 in the NHS [ 14 ].…”