Leveraging the unique expertise of our clinical colleagues: a real-world example for collaborative harnessing of the National Burn Repository.

This month’s Glimmer from the National Burn Repository (NBR) takes a decidedly practical turn and illustrates how the burn unit in Washington DC is moving ahead with burn database research in tandem with the section of infectious diseases. A leap in academic productivity is for the asking if we are all brave enough to extend a welcoming hand beyond the confines of our burn centers to our internal medicine colleagues. Major burn victims are amongst the sickest in our hospitals. Most of all burn physicians and nurses become reasonably adept in the core competencies of medical intensive care. However, consultants in cardiology, nephrology, infectious diseases, gastroenterology, endocrinology, neurology, and other specialties possess clinical finesse that our serviceable, albeit “pedestrian,” skill-sets are sometimes lacking. Real synergy in patient care happens when we find medical specialists who are willing to view burn physiology as unique, and requiring non-traditional approaches. This month’s co-author, Shmuel Shoham, is our infectious disease consultant and embraces this collaborative approach. Dr. Shoham has been able to integrate his clinical recommendations with our established burn unit practices of antibiotic parsimony, very large dose/ short duration antimicrobials, and continuous adjustment of aminoglycoside dosing given the large, dynamic volumes of distribution we encounter. In addition to designing prospective clinical studies together, we have begun in earnest to examine the NBR for an understanding of what the aggregate baseline experience is vis-à-vis infectious disease for the burn population. This is critical to appropriately frame our nascent prospective work. Dr. Shoham’s particular research interest focuses on fungal infections, an area with much work left unfinished in the burn population. After acquiring permission to query the latest version of the NBR from the American Burn Association, Dr. Shoham abstracted the general distribution of 23,517 infectious complications graphically (Figure 1). Several illustrative points have “shook out” of our ongoing daily discussions from this launching point. To wit: 1) approximately 3% of the infectious complications involve Dr. Shoham’s particular area of expertise, fungal infections—a very large raw number of cases, 2) in the pie chart, infections have been grouped in a fashion that makes sense to an infectious disease expert but was not intuitively arrived at by the burn surgeon, 3) several follow-on questions about non-fungal infections have been spurred by mutually contemplating this global “birds-eye” view, and 4) we will need the help of medical student volunteers to manually abstract the non-uniform data (pre-TRACS v.5), a time-consuming task, before moving forward. One example of questions synthesized from an infectious disease consultant’s point of view is whether the distribution of infection types would be different for the four geographic areas intrinsic to the NBR data (ie, NW, SW, NE, SE United States). If so, a statement could be made that infectious disease in burn injuries is not a homogenous problem but is subject to strong local influences. The downstream therapeutic implications of such a conclusion are tantalizing. Another collaboratively generated question is whether the bacterial species information could be teased out of the NBR data. Although species name are not spelled out for each entry in the NBR, there may be statistical legitimacy in using a representative approach/logic for the extant species data; please refer to the past NBR Glimmer that describes logical From the *Burn Center and †Division of Infectious Diseases, Department of Medicine, Washington Hospital Center, Washington DC. Address correspondence to James C. Jeng, MD, Washington Hospital Center, 110 Irving St. NW, Rm 3B-55, Washington DC 20010. Copyright © 2008 by the American Burn Association. 1559-047X/2008