Profile, transport and outcomes of severe burns patients within an inclusive, regionalized trauma system

Abstract

Background:Severe burns represent a challenging and complex clinical presentation, requiring highly specialized burns centres that are staffed and equipped appropriately. The integration of burns care into trauma systems has been recommended. This study describes the profile, transfer and outcomes of severe burns within an inclusive, regionalized trauma system. Methods: A retrospective analysis of prospectively collected data from the Victorian State Trauma Registry for the period July 2001-June 2009 was performed. Major trauma cases with any burn injury were analysed. A severe burns case was defined as a total body surface area (TBSA) burned Ն20%. Descriptive statistics were used to define the profile of severe burns cases, their management and in-hospital outcomes. Results: For the 315 cases, the mean (standard deviation) age was 39 (22) years, and 73% were male. Fire/flames was the predominant cause (72%), and 39% sustained an inhalation injury. All paediatric (n = 37) and 98% of adult cases with a %TBSA Ն20 were managed at the state's burn services. Half of the cases experienced an interhospital transfer. Sixty-seven percent of cases were admitted to the intensive care unit, 22% died in-hospital and the median length of stay was 31 days. Conclusions: An inclusive trauma system with burns services co-located at the major trauma services resulted in almost complete referral of severe burns cases to burns services for management. Half of the cases arrived at the burns services directly from the scene of injury, highlighting the importance of ongoing clinical education about the initial management of severe burns at non-burns service hospitals.

Patterns of multidrug resistant organism acquisition in an adult specialist burns service: a retrospective review

“…Victoria has a regionalised, hierarchical trauma system, which ensures transfer of patients with severe burns to the specialist service. Previous research has shown that 98% of adult patients with severe burn injury are managed at the VABS [ 13 ]. In addition, many patients with less severe burns are cared for in this service.…”

Burden and Costs of Severe Burn Injury in Victoria, Australia

“…Victoria operates an inclusive trauma system to ensure that injured patients receive their care at the most appropriate level in the system. Previous research has shown that 98% of adult patients with severe burn injury are managed at the Victorian Adult Burns Service (VABS) housed in the Alfred Hospital in Melbourne [4].…”

“…Severe burns are complex injuries with a high risk of mortality and long-term morbidity, and require management in a specialist service [1,2], where they contribute disproportionately and unpredictably to costs [3]. The Australian state of Victoria has one specialist adult burns service based at the Alfred Hospital in Melbourne which treats virtually all Victorian adult patients with severe burns [4]. Hospital funding in the state is largely determined using an activity-based case-mix approach which is designed to provide a 'rolled-up' average price for each admission, based on standardised coding [5].…”

Triaging the right patient to the right place in the shortest time

“…Patients with major burn injuries or those with concomitant burn injuries in addition to physical trauma should be triaged to major trauma centres with burns services. 40 The benefits of such triage are towards goal-directed resuscitation of burns shock through accurate fluid resuscitation and also the capacity for early debridement of burns injury. Blast injuries may further complicate resuscitation of such patients and clinical features of such injuries should be sought early through history and investigations.…”