A Comprehensive Review of the Assessment of and Early Intervention for Burn Injuries in New South Wales, Australia with Recommendations for Clinical Practice

Abstract

Burn injuries are heterogeneous and dynamic problems. Accurate assessment and early intervention through calculation of the extent of the burn injury, implementation of cooling (first aid), and providing appropriate treatment of the wound, can limit progression of the burn injury and achieve wound healing. The aim of this clinically-based research was to validate the efficacy of the components of assessment and early intervention for burn injuries within New South Wales, Australia, and make recommendations for future burn care. The first study examined the accuracy of burn size estimation in a large series of adult burn injured patients that required retrieval and transfer to a specialised Burns Unit. Accuracy was found to be poor, and overestimation occurred at an alarming rate, indicating that current methods of burn size assessment are ineffective and should be challenged. The effect of cooling (first aid) as an early intervention was examined in a large series of both minor outpatient-based burns and severe burn injuries. Significant benefits were seen in a reduction in wound depth, body surface area burned, healing times, and decreased skin grafting requirements. These human cohort studies are the first to clinically corroborate landmark experimental animal studies. Practices of treating the acute burn wound were assessed by way of two clinical studies. Results indicated that multiple treatments are efficacious for the acute burn wound, and that perhaps the optimal treatment is prompt referral to the specialised Burns Unit where expertise in wound care and the use of bioengineered skin substitutes exists. This thesis has reviewed multiple phases of the assessment of and early intervention for burn injuries in New South Wales, Australia, and has provided a clinically-oriented evidence base for early burn care which was previously limited. Implications for clinical practice include novel methods to achieve definitive burn size calculation as well as further education of health care providers in hospital settings, global dissemination of first aid recommendations, and development of burn care models or pathways that involve early (within 12 hours) retrieval or transfer of partial thickness burn injuries to specialised Burn Units to facilitate burn wound treatment.