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OPERATIVE REQUIREMENTS OF SEVERE BURN PATIENTS: IMPLICATIONS FOR A DISASTER MANAGEMENT PLAN
Author(s) -
Phua Y. S.,
She R. W.,
Moazzam A.
Publication year - 2009
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1111/j.1445-2197.2009.04914_4.x
Subject(s) - medicine , triage , total body surface area , burn injury , emergency medicine , concomitant , airway , retrospective cohort study , severe burn , mass casualty incident , airway management , medical emergency , injury prevention , poison control , surgery
Purpose: To determine the operative requirements of patients with severe burns and to develop a disaster management plan for our centre. Methodology: A retrospective review was undertaken of 46 patients with burns of more than 20% admitted to the Middlemore Hospital National Burn Centre from June 2006 to October 2008. The main outcome measures were length of inpatient stay, number of operative procedures, and total operating time. The impact of burn severity and other clinical factors on these outcome measures was analysed. Results: The mean length of hospital stay for the 38 survivors was 51.4 days. Overall 197.6 visits to theatre per year were required (79.3 operative procedures and 118.3 changes of dressing per year). This equated to 0.14 operative procedures and 36.7 operating minutes per percentage burn. Operative procedure time was greatest in the first week. Patients with burns more than 50% required a longer length of stay and greater number of operative procedures though had a higher overall mortality. Resource utilization was also higher in older patients and those with airway burns without a improvement in survival. Conclusion: With the high operative requirements of a major burn, a policy on triage in a mass burn casualty is required. While theatre time for changes of dressing can be eliminated in a disaster setting, theatre time requirements in the first week are largely unaffected. Limited intervention is recommended for burns over 50% in a disaster setting, taking into account age and concomitant injuries.