Burns and metabolism.

The purpose of this review is to highlight advances in burn treatment made during 1999. This short review cannot summarize all the excellent work done last year. There has been an abundance of basic science and clinical research efforts made. The articles chosen reflect the changing emphasis in this specialty. In the dawn of the new millennium it is appropriate to identify work that reflects the direction being taken in the art and science of burn treatment. Research and development of new treatment modalities for care of the burn victims have been influenced by the same forces that currently affect all medical specialties. There has been an explosion of new technologies. These new materials have resulted in rising costs. At the same time, financial resources dedicated to health care have decreased. Sustained pressure to justify cost has influenced this field and has led to more studies that are targeting overall outcomes, including cost, in the variables analyzed. Basic science research has similarly adapted, with a greater attempt to keep it clinically oriented. History alone will judge the true outcomes of these interactions. A cooperative effort of the American College of Surgeons and the American Burn Association created the National Tracs Burn, which led to the formal introduction of the National Tracs/American Burn Association Burn Registry in 1996. This past year, the American Burn Association continued to offer training programs for the use of the national registry, and additional training courses were given, including ICD Coding for the Burn Registry, Fundamentals of Data Collection and Abstraction, and Descriptive Statistics for the Burn Registry. The number of burn treatment facilities contributing data to the national registry has increased. The American Burn Association’s Verification Program has grown, with increasingly more burn facilities undergoing this process. Data collection and analysis of process and outcomes have become integral parts of operations for specialized burn treatment facilities. Survival from burn injuries remains an important outcomes variable, particularly in an aging population. In 1999, articles involving results from burn care broadened the goals of outcomes to include functional and psychological variables encompassing the more global concept of quality of life of the survivors. It is no longer acceptable to provide costly clinical treatments without consideration of the outcomes relative to quality of survival and the use of available resources. Patient involvement in all aspects of the decision process relative to medical care reflects a health care system that is in the process of transition. The field of health care ethics involves the entire medical community, including the burn treatment teams. Many issues remain unresolved but they are now being addressed through education and development of an infrastructure to properly attack these difficult questions. Specialized burn treatment facilities now exist to service virtually all areas of the United States. Timely transfer of patients to these facilities is critical. Data to confirm the benefit of this timely transfer to a burn treatment facility have been difficult to obtain. Sheridan and colleagues reported a 4-year experience with children with serious burns whose transfer to a burn facility was delayed for 5 days or more. Compared with concurrently managed matched controls who had been admitted within 24 hours of injury, the delayed-transfer group had statistically significantly more bacteremia, renal dysfunction, wound sepsis, and central venous catheter days. The cost of treatment of the delayed transfer group was higher, patients took longer to achieve wound closure, and the total hospital and rehabilitation days were significantly longer. Data confirmed that children with serious Received October 27, 1999; Accepted October 27, 1999. From the Department of Surgery, University of South Alabama College of Medicine, Mobile, AL. Correspondence address: Arnold Luterman, MD, FRCS, FACS, Department of Surgery, Mastin Building, Suite 706, 2451 Fillingim St, University of South Alabama College of Medicine, Mobile, AL 36617.