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AT-A-GLANCE

AT-A-GLANCE

  • Burns are common in adults and kids; most are small and managed in the outpatient setting with dressing changes.

  • Serious burns require inpatient care, ideally in a verified burn center.

  • Large burns are managed in 4 general phases:

    • Initial evaluation and resuscitation.

    • Wound debridement and biologic closure.

    • Rehabilitation and reconstruction.

    • Long-term outcome quality tends to be very good in patients surviving large burns.

EPIDEMIOLOGY

In the year 2016, 486,000 patients in the United States received medical care for burns. In other words, 3 of every 3000 persons in the United States sustained a burn injury requiring medical attention.1 Although the incidence of burn injury appears large, it has actually decreased by 60% since the early 1990s as the result of safety implementations, reduction in tobacco use and alcohol abuse, prevention education programs, change in home cooking practices, and decreased industrial employment.2 Although some professions carry an increased risk of burn injury, the majority of burns occur at home. Males sustain the majority of burn injuries, and are twice as likely as females to require admission to a specialized burn center. Sadly, almost every 2.5 hours someone dies as a result of a fire, making the likelihood of fire-related death in the United States 1.5:1000.1

Of all United States patients receiving medical care for burns, only 5% to 10% are hospitalized for burn care, illustrating the tremendous role of outpatient care in the management of disease burden.1,3 While not all of the other 90% to 95% patients receiving medical care for burns will require outpatient followup, of those who do, 30% will ultimately be admitted to the hospital for pain management or surgery (thus the importance of educating outpatient providers). Outpatient providers are most familiar with scald burns, as this is the most common mechanism of injury in the outpatient setting, whereas flame burns are the majority of inpatient burns.4 Only 60% of hospitalized burn patients receive care at one of the 128 burn centers in the United States, which average about 200 patients per burn center each year. The organization of specialized, accredited burn centers has been arguably the most effective intervention in improving mortality of burn patients in the last half-century, with burn center survival rates now higher than 96%.1,5

Worldwide, burn injury poses a far more dramatic societal burden with much less optimistic outcomes. Yearly, 11 million people require treatment for burn injuries—more than the combined incidence of tuberculosis and HIV, and slightly less than the incidence of all combined malignant neoplasms—with 300,000 deaths annually. Socioeconomic disparities in treatment are vast, with 90% of all burn deaths sustained in low- to middle-income countries. Worldwide, injury is the cause of death in 1 in 10 persons, with burns as the fourth leading cause of injury-related death. For children who survive burn injury, 15% sustain long-term temporary disability, ...

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