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Edwards SR, Chamoun G, Hecox EE, Arnold PB, Humphries LS. Barriers to Remote Burn Care Delivery: An Analysis of Burn Center Proximity and Access to Critical Telehealth Infrastructure. Ann Plast Surg 2024; 92:S391-S396. [PMID: 38857001 DOI: 10.1097/sap.0000000000003960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2024]
Abstract
ABSTRACT Mounting evidence supports the use of telehealth to improve burn care access and efficiency. However, barriers to telehealth use remain throughout the United States and may disproportionately affect specific populations, such as rural and non-English-speaking patients. This study analyzes the association between physical proximity to burn care and determinants of telehealth access.The relationship between telehealth-associated measures and proximity to burn care was analyzed with linear regression analysis. County-level data was sourced from the Agency for Healthcare Research and Quality's Social Determinants of Health Database (2020) and the American Community Survey (2021). County-level distances to the nearest American Burn Association (ABA)-verified burn center were calculated based on verified centers listed in the ABA burn center directory (n = 59). A subsequent analysis was performed on income-stratified datasets available for subset counties.Distance was negatively correlated with access to a smartphone (P < 0.0001), broadband internet (P < 0.0001), and cellular data plan (P < 0.0001) and positively correlated with the percent of households with no computing device (P < 0.0001) and no internet access (P < 0.0001). Analysis of income-stratified data revealed similar results. The percent population not speaking English well (P < 0.0001) at all (P = 0.0009) and the proportion of limited English-speaking households (P = 0.0001) decreased as a function of distance.People living furthest from an ABA-verified burn center in the United States are less likely to have adequate access to critical telehealth infrastructure compared to their counterparts living closer to a burn center. However, income impacts overall access and the degree to which access changes with proximity. Conversely, language-associated barriers decrease as distance increases.
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Affiliation(s)
- Shelley R Edwards
- From the University of Mississippi Medical Center, 2500 North State Street, Jackson, MS
| | - Gabrielle Chamoun
- Hackensack Meridian Health Palisades Medical Center, Department of General Surgery, 7600 River Rd, North Bergen, NJ
| | - Emily E Hecox
- From the University of Mississippi Medical Center, 2500 North State Street, Jackson, MS
| | - Peter B Arnold
- From the University of Mississippi Medical Center, 2500 North State Street, Jackson, MS
| | - Laura S Humphries
- From the University of Mississippi Medical Center, 2500 North State Street, Jackson, MS
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Perkins M, Cleland H, Gabbe BJ, Tracy LM. Concordance between coding sources of burn size and depth across Australian and New Zealand specialist burn services. HEALTH INF MANAG J 2024; 53:129-136. [PMID: 36377225 DOI: 10.1177/18333583221135710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
BACKGROUND The percentage of total body surface area (%TBSA) burned and burn depth provide valuable information on burn injury severity. OBJECTIVE This study investigated the concordance between The International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification (ICD-10-AM) codes and expert burn clinicians in assessing burn injury severity. METHOD We conducted a retrospective population-based review of all patients who sustained a burn injury between July 1, 2009, and June 30, 2019, requiring admission into a specialist burn service across Australia and New Zealand. The %TBSA burned (including the percentage of full thickness burns) recorded by expert burn clinicians within the Burns Registry of Australia and New Zealand (BRANZ) were compared to ICD-10-AM coding. RESULTS 20,642 cases (71.5%) with ICD-10-AM code data were recorded. Overall, kappa scores (95% confidence interval [CI]) for burn size ranged from 0.64 (95% CI 0.63-0.66) to 0.86 (95% CI 0.78-0.94) indicating substantial to almost perfect agreement across all %TBSA groups. When stratified by depth, the lowest agreement was observed for < 10% TBSA and < 10% full thickness (kappa 0.03; 95% CI 0.02-0.04) and the highest agreement was observed for burns of ≥ 90% TBSA and ≥ 90% full thickness (kappa 0.72; 95% CI 0.58-0.85). CONCLUSION Overall, there was substantial agreement between the BRANZ and ICD-10-AM coded data for %TBSA classification. When %TBSA classification was stratified by burn depth, greater agreement was observed for larger and deeper burns compared with smaller and superficial burns. IMPLICATIONS Greater consistency in the classification of burns is needed.
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Affiliation(s)
- Monica Perkins
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Heather Cleland
- Victorian Adult Burns Service, Alfred Hospital, Melbourne, VIC, Australia
- Department of Surgery, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Belinda J Gabbe
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Health Data Research UK, Swansea University Medical School, Swansea University, Swansea, UK
| | - Lincoln M Tracy
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
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Lesher A, McDuffie L, Smith T, Foster A, Ruggiero K, Barroso J, Gavrilova Y. Optimizing an Outpatient mHealth Intervention for Children with Burns: A Convergent Mixed-Methods Study. J Burn Care Res 2023; 44:1092-1099. [PMID: 36779787 PMCID: PMC10483473 DOI: 10.1093/jbcr/irad020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Indexed: 02/14/2023]
Abstract
Burn injury is one of the most common traumatic injuries in childhood. Fortunately, 90% of pediatric burns may be treated in the outpatient setting after appropriate burn triage. Patients with burns face significant geographic disparities in accessing expert burn care due to regionalized care. To aid patients and their families during acute outpatient burn recovery, we developed a smartphone app, Telemedicine Optimized Burn Intervention (TOBI). With this app, we aimed to increase access to care by allowing secure, streamlined communication between patients and burn providers, including messaging and wound image transfer. The purpose of this study was to systematically evaluate user feedback to optimize the patient and provider experience. TOBI was evaluated using a convergent mixed-methods approach consisting of qualitative semi-structured interviews and quantitative measurements of app usability via the mHealth App Usability Questionnaire. Participants included 15 caregivers of pediatric patients with burns who used TOBI during treatment and ten burn providers. Users found TOBI to be a highly usable application in terms of usefulness, ease of use, satisfaction, and functionality. Qualitative data provided insight into user experience, satisfaction and preferences, difficulty navigating, usability and acceptability, and potential improvements. Although most users were highly satisfied, improvements were needed to optimize the burn app. We systematically made these improvements before we released TOBI for routine patient use. This study uncovered helpful recommendations for app improvements that can be generalized to other mobile health apps to increase their appeal and adoption.
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Affiliation(s)
- Aaron Lesher
- Department of Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Lucas McDuffie
- Department of Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Tiffany Smith
- Department of Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Abigail Foster
- Department of Public Health, College of Charleston, Charleston, SC, USA
| | - Kenneth Ruggiero
- College of Nursing, Medical University of South Carolina, Charleston, SC, USA
| | - Julie Barroso
- School of Nursing, Vanderbilt University, Nashville, TN, USA
| | - Yulia Gavrilova
- Department of Surgery, Medical University of South Carolina, Charleston, SC, USA
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
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Hayavi-Haghighi MH, Alipour J. Applications, opportunities, and challenges in using Telehealth for burn injury management: A systematic review. Burns 2023; 49:1237-1248. [PMID: 37537108 DOI: 10.1016/j.burns.2023.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 05/18/2023] [Accepted: 07/04/2023] [Indexed: 08/05/2023]
Abstract
INTRODUCTION Burns are global public health devastating and life-threatening injuries. Telehealth can be an appropriate answer for the effective utilization of health care resources, prevention referrals and reduce socio-economic burden of burns injuries. Thus, this study aimed to systematically evaluate the applications, opportunities, and challenges of using telehealth in burn injuries management. METHODS A structured search was conducted according to PRISMA statement guidelines in the Web of Science, PubMed, Scopus, and Science Direct as well as the Google Scholar for studies published until June 28, 2022. Of the total 2301 yielded studies, 36 articles were included in the final review. Quality appraisal was done according to the Mixed Methods Appraisal Tool (MMAT) version 2018. Thematic analysis was applied for data analysis. RESULTS Patient triage, transfer, and referral (38.9%) follow-up (22%), care (22%), consultation (9%), education (3%), and rehabilitation (3%) were the most prevalent application of telehealth, respectively. Our findings identified 72 unique concepts, eight initial themes, and two clinical and administrative final themes for opportunities of using telehealth in burn injury management. Furthermore, we identified 27 unique concepts, three initial themes, and two clinical and administrative final themes for remaining challenges. CONCLUSIONS Despite providing pivotal opportunities such as improving burn injury diagnosis and quality of care, increasing patient and provider satisfaction, and cost containment using telehealth in burn injuries management, the concept faces challenges such as the impossibility of the physical examination of patients and technological difficulties. Our findings provide valuable information for policymakers and decision-makers infield of burn injuries and effective planning for using telehealth technology.
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Affiliation(s)
- Mohammad Hosein Hayavi-Haghighi
- Department of Health Information Technology, Faculty of Paramedicine, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Jahanpour Alipour
- Health Human Resources Research Center, School of Health Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran.
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Brekke RL, Almeland SK, Hufthammer KO, Hansson E. Agreement of clinical assessment of burn size and burn depth between referring hospitals and burn centres: A systematic review. Burns 2023; 49:493-515. [PMID: 35843804 DOI: 10.1016/j.burns.2022.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 04/14/2022] [Accepted: 05/09/2022] [Indexed: 11/02/2022]
Abstract
BACKGROUND The quality of burn care is highly dependent on the initial assessment and care. The aim of this systematic review was to investigate the agreement of clinical assessment of burn depth and %TBSA between the referring units and the receiving burn centres. METHODS Included articles had to meet criteria defined in a PICO (patients, interventions, comparisons, outcomes). Relevant databases were searched using a predetermined search string (November 6th 2021). Data were extracted in a standardised fashion. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach for test accuracy was used to assess the certainty of evidence. The QUADAS-2 tool was used to assess the risk of bias of individual studies as 'high', 'low' or 'unclear'. RESULTS A total of 412 abstracts were retrieved and of these 28 studies with a total of 6461 patients were included, all reporting %TBSA and one burn depth. All studies were cross-sectional and most of them comprising retrospectively enrolled consecutive cohort. All studies showed a low agreement between %TBSA calculations made at referring units and at burn centres. Most studies directly comparing estimations of %TBSA at referring institutions and burn centers showed a proportion of overestimations of 50% or higher. The study of burn depth showed that 55% were equal to the estimates from the burn centre. Most studies had severe study limitations and the risk of imprecision was high. The overall certainty of evidence for accuracy of clinical estimations in referring centres is low (GRADE ⊕⊕ОО) for %TBSA and very low (GRADE ⊕ООО) for burn depth and resuscitation. CONCLUSION Overestimation of %TBSA at referring hospitals occurs very frequently. The overall certainty of evidence for accuracy of clinical estimations in referring centres is low for burn size and very low for burn depth. The findings suggest that the burn community has a significant challenge in educating and communicating better with our colleagues at referring institutions and that high-quality studies are needed.
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Affiliation(s)
- Ragnvald Ljones Brekke
- Department of Plastic, Hand and Reconstructive Surgery, Norwegian National Burn Center, Haukeland University Hospital, Haukelandsveien 22, NO-5021 Bergen, Norway; Department of Clinical Medicine, University of Bergen, Jonas Lies vei 87, NO-5021 Bergen, Norway.
| | - Stian Kreken Almeland
- Department of Plastic, Hand and Reconstructive Surgery, Norwegian National Burn Center, Haukeland University Hospital, Haukelandsveien 22, NO-5021 Bergen, Norway; Department of Clinical Medicine, University of Bergen, Jonas Lies vei 87, NO-5021 Bergen, Norway
| | - Karl Ove Hufthammer
- Centre for Clinical Research, Haukeland University Hospital, PO Box 1400, NO-5021 Bergen, Norway
| | - Emma Hansson
- Department of Plastic Surgery, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gröna Stråket 8, SE-413 45 Gothenburg, Sweden; Department of Plastic Surgery, Sahlgrenska University Hospital, Gröna Stråket 8, SE-413 45 Gothenburg, Sweden
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García-Díaz A, Vilardell-Roig L, Novillo-Ortiz D, Gacto-Sánchez P, Pereyra-Rodríguez JJ, Saigí-Rubió F. Utility of Telehealth Platforms Applied to Burns Management: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3161. [PMID: 36833860 PMCID: PMC9968161 DOI: 10.3390/ijerph20043161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 02/02/2023] [Accepted: 02/08/2023] [Indexed: 06/18/2023]
Abstract
The financial burden of burn injuries has a considerable impact on patients and healthcare systems. Information and Communication Technologies (ICTs) have demonstrated their utility in the improvement of clinical practice and healthcare systems. Because referral centres for burn injuries cover large geographic areas, many specialists must find new strategies, including telehealth tools for patient evaluation, teleconsultation, and remote monitoring. This systematic review was performed according to PRISMA guidelines. PubMed, Cochrane, Medline, IBECS, and LILACS were the search engines used. Systematic reviews, meta-analyses, clinical trials, and observational studies were included in the study search. The protocol was registered in PROSPERO with the number CRD42022361137. In total, 37 of 185 studies queried for this study were eligible for the systematic review. Thirty studies were comparative observational studies, six were systematic reviews, and one was a randomised clinical trial. Studies suggest that telehealth allows better perception of triage, more accurate estimation of the TBSA, and resuscitation measures in the management of acute burns. In addition, some studies assess that TH tools are equivalent to face-to-face outpatient visits and cost-efficient because of transport savings and unnecessary referrals. However, more studies are required to provide significant evidence. However, the implementation of telehealth should be specifically adapted to each territory.
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Affiliation(s)
- Antonio García-Díaz
- Plastic Surgery and Major Burns Service, Virgen del Rocío University Hospital, 41013 Seville, Spain
| | - Lluís Vilardell-Roig
- Faculty of Health Sciences, Universitat Oberta de Catalunya (UOC), 08018 Barcelona, Spain
| | - David Novillo-Ortiz
- Division of Country Health Policies and Systems, Regional Office for Europe, World Health Organization, 2100 Copenhagen, Denmark
| | | | - José Juan Pereyra-Rodríguez
- Faculty of Health Sciences, Universitat Oberta de Catalunya (UOC), 08018 Barcelona, Spain
- Dermatology Service, Virgen del Rocío University Hospital, 41013 Seville, Spain
| | - Francesc Saigí-Rubió
- Faculty of Health Sciences, Universitat Oberta de Catalunya (UOC), 08018 Barcelona, Spain
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Boissin C. Clinical decision-support for acute burn referral and triage at specialized centres - Contribution from routine and digital health tools. Glob Health Action 2022; 15:2067389. [PMID: 35762795 PMCID: PMC9246103 DOI: 10.1080/16549716.2022.2067389] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Specialized care is crucial for severe burn injuries whereas minor burns should be handled at point-of-care. Misdiagnosis is common which leads to overburdening the system and to a lack of treatment for others due to resources shortage. OBJECTIVES The overarching aim was to evaluate four decision-support tools for diagnosis, referral, and triage of acute burns injuries in South Africa and Sweden: referral criteria, mortality prediction scores, image-based remote consultation and automated diagnosis. METHODS Study I retrospectively assessed adherence to referral criteria of 1165 patients admitted to the paediatric burns centre of the Western Cape of South Africa. Study II assessed mortality prediction of 372 patients admitted to the adults burns centre by evaluating an existing score (ABSI), and by using logistic regression. In study III, an online survey was used to assess the diagnostic accuracy of burn experts' image-based estimations using their smartphone or tablet. In study IV, two deep-learning algorithms were developed using 1105 acute burn images in order to identify the burn, and to classify burn depth. RESULTS Adherence to referral criteria was of 93.4%, and the age and severity criteria were associated with patient care. In adults, the ABSI score was a good predictor of mortality which affected a fifth of the patients and which was associated with gender, burn size and referral status. Experts were able to diagnose burn size, and burn depth using handheld devices. Finally, both a wound identifier and a depth classifier algorithm could be developed with relatively high accuracy. CONCLUSIONS Altogether the findings inform on the use of four tools along the care trajectory of patients with acute burns by assisting with the diagnosis, referral and triage from point-of-care to burns centres. This will assist with reducing inequities by improving access to the most appropriate care for patients.
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Affiliation(s)
- Constance Boissin
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
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Head WT, Garcia D, Mukherjee R, Kahn S, Lesher A. Virtual Visits for Outpatient Burn Care during the COVID-19 Pandemic. J Burn Care Res 2021; 43:300-305. [PMID: 34687201 DOI: 10.1093/jbcr/irab202] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Burn-injured patients must frequently travel long distances to regional burn centers, creating a burden on families and impairing clinical outcomes. Recent federal policies in response to the coronavirus pandemic have relaxed major barriers to conducting synchronous videoconference visits in the home. However, the efficacy and benefits of virtual visits relative to in-person visits remained unclear for burn patients. Accordingly, a clinical quality assurance database maintained during the coronavirus pandemic (3/3/2020 to 9/8/2020) for virtual and/or in-person visits at a comprehensive adult and pediatric burn center was queried for demographics, burn severity, visit quality, and distance data. A total of 143 patients were included in this study with 317 total outpatient encounters (61 virtual and 256 in-person). The savings associated with the average virtual visit were 130 ± 125 miles (mean ± standard deviation), 164 ± 134 travel minutes, &104 ± 99 driving costs, and &81 ± 66 foregone wage earnings. Virtual visit technical issues were experienced by 23% of patients and were significantly lower in pediatric (5%) than in adult patients (44%; p=0.006). This study is the first to assess the efficacy of synchronous videoconference visits in the home setting for outpatient burn care. The findings demonstrate major financial and temporal benefits for burn patients and their families. Technical issues remain an important barrier, particularly for the adult population. A clear understanding of these and other barriers may inform future studies as healthcare systems and payors move toward improving access to burn care through remote healthcare delivery services.
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Affiliation(s)
- William T Head
- College of Medicine, Medical University of South Carolina, Charleston, SC
| | - Denise Garcia
- Department of Surgery, Medical University of South Carolina, Charleston, SC
| | - Rupak Mukherjee
- Department of Surgery, Medical University of South Carolina, Charleston, SC
| | - Steven Kahn
- Department of Surgery, Medical University of South Carolina, Charleston, SC
| | - Aaron Lesher
- Department of Surgery, Medical University of South Carolina, Charleston, SC
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Garber RN, Garcia E, Goodwin CW, Deeter LA. Pictures Do Influence the Decision to Transfer: Outcomes of a Telemedicine Program Serving an Eight-State Rural Population. J Burn Care Res 2021; 41:690-694. [PMID: 32044972 DOI: 10.1093/jbcr/iraa017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Triaging burn patients is a daunting task because burn injuries are rare; this inexperience leads to uncertainty in treatment and referral algorithms. Our regional burn center's catchment area includes eight states. Outlying facilities consult via telephone through the medical center's transfer center. Referring provider assessments of depth or size of injury infrequently correlates with burn provider's assessments. This causes over- and under-triage of patients managed outside of burn centers. A quality improvement telemedicine project was developed to allow burn providers to review photos with referring providers to determine best management, provide pertinent education, and initiate appropriate and timely resuscitation. Details tracked include date of service, consulting provider, follow-up education offered, and whether the image reviewed changed or confirmed the requested plan of care. Of the 155 cases between January 2017 and August 2018, 24.5% of patient images changed the initial transfer decision, and 75.5% confirmed the initial plan of care. Of the cases requiring change of plan, 60.5% were down-triaged to outpatient care and 39.5% were up-triaged to transfer. Implementation of this telemedicine program has increased efficiency of resource utilization, timely resuscitation, appropriate transfer of patients requiring admission, and real-time education. Findings suggest advanced practice providers' assessments are similar to those of referring physicians. These observations may have significant implications on Emergency Medical Treatment and Labor Act (EMTALA) guidelines defining physician to physician consultation and support efficient use of available resources. Telemedicine facilitates access to specialized care and improves fiscal responsibility.
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Affiliation(s)
- Rebecca N Garber
- Western States Burn Center, Banner Health North Colorado Medical Center, Greeley, Colorado
| | - Edwin Garcia
- Western States Burn Center, Banner Health North Colorado Medical Center, Greeley, Colorado
| | - Cleon W Goodwin
- Western States Burn Center, Banner Health North Colorado Medical Center, Greeley, Colorado
| | - Lyndsay A Deeter
- Western States Burn Center, Banner Health North Colorado Medical Center, Greeley, Colorado
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Stokes SC, Romanowski KS, Sen S, Greenhalgh DG, Palmieri TL. Wildfire Burn Patients: A Unique Population. J Burn Care Res 2021; 42:irab107. [PMID: 34105733 DOI: 10.1093/jbcr/irab107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Indexed: 11/13/2022]
Abstract
In the past ten years wildfires have burned an average of 6.8 million acres per year and this is expected to increase with climate change. Wildfire burn patient outcomes have not been previously well characterized. Wildfire burn patients from the Tubbs or Camp wildfires and non-wildfire burn matched controls were identified from the burn center database and outcomes were compared. The primary outcome was mortality. Secondary outcomes included length of stay (LOS), intensive care unit (ICU) LOS, readmission and development of wound infections. Time of presentation and operating room use after wildfires was evaluated. Sixteen wildfire burn patients were identified and matched with 32 controls. Wildfire burn patients trended towards higher mortality (19% wildfire vs. 9% non-wildfire, p=0.386), longer LOS (18 days wildfire vs. 15 days non-wildfire, p=0.406), longer ICU LOS (17 days wildfire vs. 11 days non-wildfire, p=0.991), increased readmission (19% wildfire vs. 3% non-wildfire, p=0.080) and higher rates of wound infection (31% wildfire vs. 19% non-wildfire, p=0.468). The majority of wildfire patients (88%) presented within 24 hours of the wildfire reaching a residential area. Operating room time within the first week was 13 hours 44 minutes for the Tubbs Fire and 19 hours 1 minute for the Camp Fire. Patients who sustain burns in wildfires are potentially at increased risk of mortality, prolonged LOS, wound infection and readmission.
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Affiliation(s)
- Sarah C Stokes
- Department of Surgery, Division of Burn Surgery, University of California, Davis, California
| | - Kathleen S Romanowski
- Department of Surgery, Division of Burn Surgery, University of California, Davis, California
- Shriners Hospital for Children Northern California, Sacramento, California
| | - Soman Sen
- Department of Surgery, Division of Burn Surgery, University of California, Davis, California
- Shriners Hospital for Children Northern California, Sacramento, California
| | - David G Greenhalgh
- Department of Surgery, Division of Burn Surgery, University of California, Davis, California
- Shriners Hospital for Children Northern California, Sacramento, California
| | - Tina L Palmieri
- Department of Surgery, Division of Burn Surgery, University of California, Davis, California
- Shriners Hospital for Children Northern California, Sacramento, California
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Gacto-Sánchez P, Molina-Morales J, Rodríguez-Vela F, Moreno-Conde J, Sendin-Martin M, Parra-Calderon C, Gomez-Cía T, Pereyra-Rodriguez JJ. Diagnostic accuracy of a telemedicine tool for acute burns diagnosis. Burns 2020; 46:1799-1804. [DOI: 10.1016/j.burns.2020.05.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 05/21/2020] [Accepted: 05/21/2020] [Indexed: 10/24/2022]
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Implementation and evaluation of telemedicine in burn care: Study of clinical safety and technical feasibility in a single burn center. Burns 2020; 46:1668-1673. [DOI: 10.1016/j.burns.2020.04.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 02/25/2020] [Accepted: 04/23/2020] [Indexed: 11/18/2022]
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Abstract
Abstract
Telemedicine technology can be used to facilitate consultations from nonburn-trained referring providers. However, there is a paucity of evidence indicating these technologies influence transfer decisions and follow-up care. In 2016, our regional burn center implemented a mobile phone app, which allows a referring provider to send photos of the wound along with basic demographic and clinical data to the burn specialist. A retrospective review was performed on consults to our regional burn center from a Level I trauma center approximately 70 miles away with a shared electronic medical record. Patients were considered to be “down-triaged” if they could be managed locally or if the transfer could occur via personal vehicle instead of ground or air ambulance transport. During the 2-year study period, 126 consultations were made for thermal injuries. Eighty-seven patients (69%) were referred using the Burn App. Overall, 49 patients (39%) were transferred. When the subset of intermediate size (1–10% TBSA) burns were considered (n = 48), the Burn App allowed for successful “down-triage” of 12 patients (33%) referred through the app. No patient referred without the app could be “down-triaged” (P = .02). Although 57 patients (44%) were recommended for outpatient follow-up, only 42% followed up. A mobile app can be used to successfully triage patients with intermediate size burn injuries to a lower acuity of follow-up and transfer mode. However, only a minority of patients triaged to outpatient management actually follow up with a regional burn center. Telemedicine efforts should focus on improving not only initial triage, but also aftercare.
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Harshman J, Roy M, Cartotto R. Emergency Care of the Burn Patient Before the Burn Center: A Systematic Review and Meta-analysis. J Burn Care Res 2020; 40:166-188. [PMID: 30452685 DOI: 10.1093/jbcr/iry060] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Good burn care starts with correct management of the burn patient before transfer to a burn center. The purpose of this study was to perform a systematic review of the medical literature describing preburn center care. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed for this review. Studies were included if they were published from a burn center and they measured or evaluated any aspect of preburn center care of adult or pediatric acute burn patients referred to that burn center. A comprehensive search of MEDLINE, EMBASE, and Cochrane databases was performed from their inception to May 28, 2018. Outcomes of interest included errors in burn size estimation, airway management, fluid resuscitation, dressings and wound care, use of systemic antibiotics, core temperature monitoring and preservation, and analgesia provision. Meta-analysis of the discrepancy between preburn center and burn center burn size estimation was conducted. From 3768 initially identified titles, 37 studies were included in this systematic review. Burn size estimation was frequently inaccurate. The ratio of overestimation to underestimation in burn size ranged between 2.2:1 and 19:1. The pooled mean absolute error in % total body surface area burn was 6.28 (95% CI: 4.72, 7.85). The average relative percent error in burn size estimation by referring providers ranged between 75% and 3500%. Unnecessary endotracheal intubation was performed in 28% to 53% of transfers. Over-estimation and over-delivery of fluid resuscitation volumes was prevalent, but other problems pertaining to resuscitation included administration of the wrong fluid and failure to titrate fluids. Wounds were not consistently covered with simple dry dressings or sheets. Core temperature was not consistently monitored or preserved. Analgesics were often not given or were of insufficient dose. Many elements of preburn center care need improvement. These findings should be used to form the foundation of future initiatives between burn professionals and emergency providers to improve care of the burn patient before transfer to a burn center.
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Affiliation(s)
- Jamie Harshman
- Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre, University of Toronto, Canada
| | - Mélissa Roy
- Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre, University of Toronto, Canada
| | - Robert Cartotto
- Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre, University of Toronto, Canada
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Pham C, Collier Z, Gillenwater J. Changing the Way We Think About Burn Size Estimation. J Burn Care Res 2020; 40:1-11. [PMID: 30247559 DOI: 10.1093/jbcr/iry050] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Burn size estimation is a crucial component of acute burn management that guides referral to burn centers, fluid resuscitation parameters, hospital resource distribution, and mortality-based interventions. Referring providers often misestimate the total BSA (TBSA) of burn injury, which contributes to unnecessary healthcare costs, misappropriation of limited resources, and delay in provision of appropriate patient care. A systematic literature review of articles available on PubMed, Scopus, Google Scholar, OvidSP Medline, and Web of Science was performed. All articles were evaluated in a standardized fashion by a panel of reviewers to assess applicability to the research question. Twenty-six relevant articles identified pervasive TBSA miscalculations ranging from 5% to 339% regardless of provider level with < 20% TBSA burns being disproportionately overestimated. This resulted in up to 77% of burns being inappropriately transferred to burn centers from referring hospitals. Improper use of TBSA estimation tools (palm, hand, Rule of 9s) without considering patient body mass index, race, age, and sex standards contributes to TBSA misestimation. Few studies with limited sample sizes argue that TBSA misestimations significantly affect fluid resuscitation volume, although the findings suggest that small burns (<20% TBSA) are over-estimated and over-resuscitated-the opposite of larger burns. TBSA misestimation is associated with an increased incidence of inappropriate transfers to burn centers and the associated costs. The data remains lacking, however, and larger studies are required to further elucidate the clinical impact of such errors. A systematic approach with telemedicine-facilitated computer-based burn assessments is required.
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Affiliation(s)
- Christopher Pham
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles
| | - Zachary Collier
- Division of Plastic Surgery, Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles
| | - Justin Gillenwater
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles.,Division of Plastic Surgery, Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles
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16
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Use of helicopters for retrieval of trauma patients: A geospatial analysis. J Trauma Acute Care Surg 2019; 87:168-172. [DOI: 10.1097/ta.0000000000002318] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Video-Enhanced Telemedicine Improves the Care of Acutely Injured Burn Patients in a Rural State. J Burn Care Res 2018; 37:e531-e538. [PMID: 26132049 DOI: 10.1097/bcr.0000000000000268] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The acute care of burn patients is critical and can be a daunting experience for emergency personnel because of the scarcity of burn injuries. Telemedicine that incorporates a visual component can provide immediate expertise in the treatment and management of these injuries. The authors sought to evaluate the addition of video telemedicine to our current telephone burn transfer program. During a 2-year period, 282 patients, 59.4% of all burn patients transferred from outside hospitals, were enrolled in the study. In addition to the scripted call with the charge nurse (ChargeRN) and the accepting physician, nine hospitals also transmitted video images of the wounds before transfer as part of a store and forward telemedicine transfer program (77, 27.6%). The accuracy of burn size estimations (BSA burned) and management changes (fluid requirements, transfer mode, and final disposition) were analyzed between the telephones-only sites (T only) and the video-enhanced sites. Referringstaff participating in video-enhanced telemedicine were sent a Google survey assessing their experience the following day. The referring staff (Referringstaff) was correct in their burn assessment 20% of the time. Video assessment improved the ChargeRN BSA burned and resulted in more accurate fluid resuscitation (P = .030), changes in both transportation mode (P = .042), and disposition decisions (P = .20). The majority of the Referringstaff found that video-enhanced telemedicine helped them communicate with the burn staff more effectively (3.4 ± 0.37, scale 1-4). This study reports the successful implementation of video-enhanced telemedicine pilot project in a rural state. Video-enhanced telemedicine using a store and forward process improved burn size estimation and facilitated management changes. Although not quantitatively assessed, the low cost of the system coupled with the changes in transportation and disposition strongly suggests a decrease in healthcare costs associated with the addition of video to a telephone-only transfer program.
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Blom L, Boissin C, Allorto N, Wallis L, Hasselberg M, Laflamme L. Accuracy of acute burns diagnosis made using smartphones and tablets: a questionnaire-based study among medical experts. BMC Emerg Med 2017; 17:39. [PMID: 29237400 PMCID: PMC5729255 DOI: 10.1186/s12873-017-0151-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Accepted: 12/01/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Remote assistance for burns by medical experts can support nurses and general physicians in emergency care with diagnostic and management advice. Previous studies indicate a high diagnostic accuracy based on images viewed on a computer screen, but whether image-based analysis by experts using handheld devices is accurate remains to be determined. METHOD A review of patient data from eight emergency centres in the Western Cape, South Africa, revealed 10 typical cases of burns commonly seen in children and adults. A web-based questionnaire was created with 51 images of burns representing those cases. Burns specialists from two countries (South Africa and Sweden (n = 8 and 7 respectively)) and emergency medicine specialists from South Africa (n = 11) were contacted by email and asked to assess each burn's total body surface area (TBSA) and depth using a smartphone or tablet. The accuracy and inter-rater reliability of the assessments were measured using intraclass correlation coefficients (ICC), both for all cases aggregated and for paediatric and adult burn cases separately. Eight participants repeated the questionnaire on a computer and intra-rater reliability was calculated. RESULTS The assessments of TBSA are of high accuracy all specialists aggregated (ICC = 0.82 overall and 0.81 for both child and adult cases separately) and remain high for all three participant groups separately. The burn depth assessments have low accuracy all specialists aggregated, with ICCs of 0.53 overall, 0.61 for child and 0.46 for adult cases. The most accurate assessments of depth are among South African burns specialists (reaching acceptable for child cases); the other two groups' ICCs are low in all instances. Computer-based assessments were similar to those made on handheld devices. CONCLUSION As was the case for computer-based studies, burns images viewed on handheld devices may be a suitable means of seeking expert advice even with limited additional information when it comes to burn size but less so in the case of burn depth. Familiarity with the type of cases presented could facilitate image-based diagnosis of depth.
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Affiliation(s)
- Lisa Blom
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
| | - Constance Boissin
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Nikki Allorto
- Edendale Burn Services, Department of General Surgery, University of KwaZulu-Natal, Durban, South Africa
| | - Lee Wallis
- Division of Emergency Medicine, Stellenbosch University, Bellville, South Africa
| | - Marie Hasselberg
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Lucie Laflamme
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.,University of South Africa, Institute for Social and Health Sciences, P.O. Box 1087, Lenasia, Johannesburg, 1820, South Africa
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Madiraju SK, Catino J, Kokaram C, Genuit T, Bukur M. In by helicopter out by cab: the financial cost of aeromedical overtriage of trauma patients. J Surg Res 2017; 218:261-270. [PMID: 28985859 DOI: 10.1016/j.jss.2017.05.102] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 05/12/2017] [Accepted: 05/25/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Helicopter transport of injured patients is controversial and costly. This study aims to show that a complex trauma algorithm leads to significant aeromedical overtriage at substantial cost. Our secondary outcomes were to compare adjusted mortality and outcomes between air and ground transport and determine predictors of overtriage. MATERIALS AND METHODS A 6-y retrospective analysis was conducted of all trauma activations at a Level I center. Patients were dichotomized by transportation method as well as trauma activation criteria. Overtriage was defined as those who were discharged from the emergency department, medically admitted without injuries, or admitted to observation status only. Overtriage and associated charges were calculated for each patient cohort, and multivariate regression models were created to derive adjusted mortality rates and predictors of overtriage. RESULTS A total of 4218 patients were treated with 28% arriving by helicopter. Overtriage increased significantly from 51% to 77% with lower tier activation criteria (P < 0.001). Median charges for air-evacuated patients was $10,478 (versus $1008 ground). Eliminating overtriage of air patients would result in a cost savings of $1,316,036 annually. Adjusted mortality between air and ground transport was not significantly different (8.5% versus 10.9%, P = 0.548). Predictors of overtriage included decreasing age, Injury Severity Score, Head Abbreviated Injury Score, nonoperative treatment, and lower tier activation criteria. CONCLUSIONS Significant overtriage (52%) and unnecessary air evacuation of minimally injured patients occurs at great financial cost. Revision of trauma activation protocols may result in more judicious air transport use and significant reductions in health care costs.
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Affiliation(s)
| | - Joseph Catino
- Trauma/Critical Care, Delray Medical Center, Delray Beach, Florida
| | - Candace Kokaram
- Trauma/Critical Care, Delray Medical Center, Delray Beach, Florida
| | - Thomas Genuit
- FAU Charles E. Schmidt College of Medicine, Boca Raton, Florida
| | - Marko Bukur
- Trauma/Critical Care, Bellevue Hospital Center, New York, New York
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Adherence to Referral Criteria at Admission and Patient Management at a Specialized Burns Centre: The Case of the Red Cross War Memorial Children's Hospital in Cape Town, South Africa. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14070732. [PMID: 28684713 PMCID: PMC5551170 DOI: 10.3390/ijerph14070732] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 06/15/2017] [Accepted: 07/03/2017] [Indexed: 11/25/2022]
Abstract
Referral guidelines for burn care are meant to assist in decision-making as regards patient transfer and admissions to specialized units. Little is known, however, concerning how closely they are followed and whether they are linked to patient care. This is the object of the current study, focused on the paediatric burns centre of the Red Cross War Memorial Children’s Hospital in Cape Town, South Africa. All patients admitted to the centre during the winters of 2011–2015 (n = 1165) were included. The patient files were scrutinized to clarify whether the referral criteria in place were identified (seven in total) and to compile data on patient and injury characteristics. A case was defined as adherent to the criteria when at least one criterion was fulfilled and adherence was expressed as a percentage with 95% confidence intervals, for all years aggregated as well as by year and by patient or injury characteristics. The association between adherence to any individual criterion and hospital care (surgery or longer length of stay) was measured using logistic regressions. The overall adherence was 93.4% (100% among children under 2 years of age and 86% among the others) and it did not vary remarkably over time. The two criteria of “injury sustained at a specific anatomical site” (85.2%) and “young age” (51.9%) were those most often identified. Children aged 2 years or older were more likely to undergo surgery or to stay longer than those of young age (although a referral criterion) and so were those with higher injury severity (a referral criterion). In this specialized paediatric burns centre, children are admitted mainly according to the guidelines. However, given the high prevalence of paediatric burns in the region and the limited resources at the burns centre, adherence to the guidelines need to be further studied at all healthcare levels in the province.
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Theurer L, Bashshur R, Bernard J, Brewer T, Busch J, Caruso D, Coccaro-Word B, Kemalyan N, Leenknecht C, McMillan LR, Pham T, Saffle JR, Krupinski EA. American Telemedicine Association Guidelines for Teleburn. Telemed J E Health 2017; 23:365-375. [DOI: 10.1089/tmj.2016.0279] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Affiliation(s)
- Lou Theurer
- Burn Telemedicine Program, Department of Telemedicine, University of Utah Health Sciences Center, Salt Lake City, Utah
| | - Rashid Bashshur
- School of Public Health, University of Michigan Health System, Ann Arbor, Michigan
| | | | | | | | - Daniel Caruso
- Burn Services, Arizona Burn Center, Phoenix, Arizona
| | | | | | | | | | - Tam Pham
- Harborview Burn Center, Seattle, Washington
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22
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Latifi NA, Karimi H. Why burn patients are referred? Burns 2017; 43:619-623. [DOI: 10.1016/j.burns.2016.09.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 08/25/2016] [Accepted: 09/12/2016] [Indexed: 10/20/2022]
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23
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The accuracy of burn diagnosis codes in health administrative data: A validation study. Burns 2017; 43:258-264. [PMID: 28069344 DOI: 10.1016/j.burns.2016.11.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 11/02/2016] [Accepted: 11/07/2016] [Indexed: 11/22/2022]
Abstract
BACKGROUND Health administrative databases may provide rich sources of data for the study of outcomes following burn. We aimed to determine the accuracy of International Classification of Diseases diagnoses codes for burn in a population-based administrative database. METHODS Data from a regional burn center's clinical registry of patients admitted between 2006-2013 were linked to administrative databases. Burn total body surface area (TBSA), depth, mechanism, and inhalation injury were compared between the registry and administrative records. The sensitivity, specificity, and positive and negative predictive values were determined, and coding agreement was assessed with the kappa statistic. RESULTS 1215 burn center patients were linked to administrative records. TBSA codes were highly sensitive and specific for ≥10 and ≥20% TBSA (89/93% sensitive and 95/97% specific), with excellent agreement (κ, 0.85/κ, 0.88). Codes were weakly sensitive (68%) in identifying ≥10% TBSA full-thickness burn, though highly specific (86%) with moderate agreement (κ, 0.46). Codes for inhalation injury had limited sensitivity (43%) but high specificity (99%) with moderate agreement (κ, 0.54). Burn mechanism had excellent coding agreement (κ, 0.84). CONCLUSIONS Administrative data diagnosis codes accurately identify burn by burn size and mechanism, while identification of inhalation injury or full-thickness burns is less sensitive but highly specific.
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Hoseini F, Ayatollahi H, Salehi SH. systematized review of telemedicine applications in treating burn patients. Med J Islam Repub Iran 2016; 30:459. [PMID: 28491834 PMCID: PMC5419220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 08/19/2016] [Indexed: 11/17/2022] Open
Abstract
Background: Telemedicine has been used in different fields of medicine in the past 20 years. The main advantages of this technology include saving costs, improving quality of care, and increasing access to specialists. This study aimed to review telemedicine applications in treating burn patients. Methods: In this systematized review study, related papers were searched using various databases, including PubMed, Scopus, and Science Direct. The time frame was between January 2000 and March 2016; finally, 32 papers were included in the study. Results: The findings revealed that telemedicine was used in burn care in three different ways: Remote patient follow-up, teleconsultation, and patient assessment. Conclusion: It seems that telemedicine can be easily applied in treating burn patients even when there is a limited financial resource. The use of this technology can help reduce possible errors in categorizing burn patients and decrease patients' transportation and treatment costs.
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Affiliation(s)
- Frahang Hoseini
- MSc in Medical Informatics, Department of Health Information Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran.
| | - Haleh Ayatollahi
- Assistant Professor of Medical Informatics, Department of Health Information Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran.
| | - Seyed Hamid Salehi
- Associate Professor of General Surgery, Iran University of Medical Sciences, Tehran, Iran.
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Plant MA, Novak CB, McCabe SJ, von Schroeder HP. Use of digital images to aid in the decision-making for acute upper extremity trauma referral. J Hand Surg Eur Vol 2016; 41:763-8. [PMID: 26634398 DOI: 10.1177/1753193415620177] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Accepted: 11/10/2015] [Indexed: 02/03/2023]
Abstract
UNLABELLED This study evaluated the use of digital smartphone images in the decision-making for acute upper extremity trauma referrals. Surgeons (n = 15) were presented with ten upper limb trauma scenarios for consideration of immediate transfer. Based on verbal history and with additional images, participants were asked questions regarding diagnosis, injured tissues, recommended management and diagnostic and treatment confidence. Statistical analyses evaluated confidence level changes and relationships between confidence levels and independent variables. Confidence levels for diagnosis and treatment were increased with the provision of smartphone images, and this was statistically significant. The decision to transfer was changed in 22%. The photographs were more useful for amputation versus non-amputation injuries (diagnosis and treatment) and hand versus forearm injuries (diagnosis), and these differences reached statistical significance. Smartphone digital images were shown to be useful for decision-making in acute upper extremity trauma referrals. This improved communication may have implications for health cost savings and patient burden by minimizing unnecessary acute transfers. LEVEL OF EVIDENCE Diagnostic Level III.
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Affiliation(s)
- M A Plant
- Toronto Western Hospital Hand Program, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - C B Novak
- Toronto Western Hospital Hand Program, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - S J McCabe
- Toronto Western Hospital Hand Program, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - H P von Schroeder
- Toronto Western Hospital Hand Program, Department of Surgery, University of Toronto, Toronto, ON, Canada
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27
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Boissin C, Laflamme L, Wallis L, Fleming J, Hasselberg M. Photograph-based diagnosis of burns in patients with dark-skin types: The importance of case and assessor characteristics. Burns 2015; 41:1253-60. [DOI: 10.1016/j.burns.2014.12.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Revised: 12/18/2014] [Accepted: 12/26/2014] [Indexed: 10/24/2022]
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Hop MJ, Polinder S, van der Vlies CH, Middelkoop E, van Baar ME. Costs of burn care: A systematic review. Wound Repair Regen 2014; 22:436-50. [DOI: 10.1111/wrr.12189] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Accepted: 04/01/2014] [Indexed: 11/30/2022]
Affiliation(s)
- M. Jenda Hop
- Association of Dutch Burn Centers; Burn Center; Maasstad Hospital; Rotterdam The Netherlands
- Department of Plastic, Reconstructive and Hand Surgery; MOVE Research Institute; VU University Medical Center; Amsterdam The Netherlands
| | - Suzanne Polinder
- Department of Public Health; Erasmus Medical Center; Rotterdam The Netherlands
| | | | - Esther Middelkoop
- Department of Plastic, Reconstructive and Hand Surgery; MOVE Research Institute; VU University Medical Center; Amsterdam The Netherlands
- Association of Dutch Burn Centers; Red Cross Hospital; Beverwijk The Netherlands
| | - Margriet E. van Baar
- Association of Dutch Burn Centers; Burn Center; Maasstad Hospital; Rotterdam The Netherlands
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Optimization of burn referrals. Burns 2014; 40:397-401. [DOI: 10.1016/j.burns.2013.08.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2013] [Revised: 06/26/2013] [Accepted: 08/02/2013] [Indexed: 11/18/2022]
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Bell N, Simons R, Hameed SM, Schuurman N, Wheeler S. Does direct transport to provincial burn centres improve outcomes? A spatial epidemiology of severe burn injury in British Columbia, 2001-2006. Can J Surg 2012; 55:110-6. [PMID: 22564514 DOI: 10.1503/cjs.014708] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND In Canada and the United States, research has shown that injured patients initially treated at smaller emergency departments before transfer to larger regional facilities are more likely to require longer stays in hospital or suffer greater mortality. It remains unknown whether transport status is an independent predictor of adverse health events among persons requiring care from provincial burn centres. METHODS We obtained case records from the British Columbia Trauma Registry for adult patients (age ≥ 18 yr) referred or transported directly to the Vancouver General Hospital and Royal Jubilee Hospital burn centres between Jan. 1, 2001, and Mar. 31, 2006. Prehospital and in-transit deaths and deaths in other facilities were identified using the provincial Coroner Service database. Place of injury was identified through data linkage with census records. We performed bivariate analysis for continuous and discrete variables. Relative risk (RR) of prehospital and in-hospital mortality and hospital stay by transport status were analyzed using a Poisson regression model. RESULTS After controlling for patient and injury characteristics, indirect referral did not influence RR of in-facility death (RR 1.32, 95% confidence interval [CI] 0.54- 3.22) or hospital stay (RR 0.96, 95% CI 0.65-1.42). Rural populations experienced an increased risk of total mortality (RR 1.22, 95% CI 1.00-1.48). CONCLUSION Transfer status is not a significant indicator of RR of death or hospital stay among patients who received care at primary care facilities before transport to regional burn centres. However, significant differences in prehospital mortality show that improvements in rural mortality can still be made.
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Affiliation(s)
- Nathaniel Bell
- Department of Surgery, University of British Columbia, Vancouver, BC.
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Wallace D, Hussain A, Khan N, Wilson Y. A systematic review of the evidence for telemedicine in burn care: With a UK perspective. Burns 2012; 38:465-80. [DOI: 10.1016/j.burns.2011.09.024] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2011] [Revised: 08/18/2011] [Accepted: 09/21/2011] [Indexed: 01/18/2023]
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Gardiner S, Hartzell TL. Telemedicine and plastic surgery: A review of its applications, limitations and legal pitfalls. J Plast Reconstr Aesthet Surg 2012; 65:e47-53. [DOI: 10.1016/j.bjps.2011.11.048] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2011] [Revised: 10/11/2011] [Accepted: 11/25/2011] [Indexed: 10/14/2022]
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Kyle E, Aitken P, Elcock M, Barneveld M. Use of telehealth for patients referred to a retrieval service: timing, destination, mode of transport, escort level and patient care. J Telemed Telecare 2012; 18:147-50. [DOI: 10.1258/jtt.2012.sft106] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We examined the utility of telehealth in assisting the decision-making processes of aeromedical coordinators, with particular focus on the timing, destination, mode of transport and escort level. Medical coordinators from the Northern Operations site of the Queensland emergency retrieval service were asked to complete a survey form about the changes that telehealth made to their retrieval decision-making process. Information was collected in six areas: diagnosis, severity, priority, crew, mode of transport and destination. During a 12-month period, there were 403 emergency referrals from the five participating sites. There were 136 eligible patient referrals for analysis, of which 90 did not have teleconsultations performed; the most common reasons were that the medical coordinator was too busy with other work or the new procedure was forgotten ( n = 39, 43%). The remaining 46 patients had a teleconsultation during the trial and 44 data sheets were available for analysis. In 21 cases some component of the decision-making process was altered by the use of telehealth, with decisions being significantly altered in nine cases. Most alterations were for severity of patient condition, then diagnosis and priority of transfer. The use of telehealth was thought to be beneficial in confirming the original decision in 30 cases. Telehealth was not of assistance in seven cases. Telehealth appears to assist in accurate decision-making during the medical coordination of aeromedical retrievals.
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Affiliation(s)
- Elizabeth Kyle
- Emergency Department, Townsville Hospital, Townsville, Australia
| | - Peter Aitken
- Emergency Department, Townsville Hospital, Townsville, Australia
- Anton Breinl Centre for Public Health, Tropical Medicine, James Cook University, Townsville, Australia
- Retrieval Services Queensland, Division of the Chief Health Officer, Queensland Health, Australia
| | - Mark Elcock
- Anton Breinl Centre for Public Health, Tropical Medicine, James Cook University, Townsville, Australia
- Retrieval Services Queensland, Division of the Chief Health Officer, Queensland Health, Australia
| | - Matthew Barneveld
- Retrieval Services Queensland, Division of the Chief Health Officer, Queensland Health, Australia
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Wigman LD, van Lieshout EMM, de Ronde G, Patka P, Schipper IB. Trauma-related dispatch criteria for Helicopter Emergency Medical Services in Europe. Injury 2011; 42:525-33. [PMID: 20381803 DOI: 10.1016/j.injury.2010.03.015] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2009] [Revised: 03/04/2010] [Accepted: 03/15/2010] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Helicopter Emergency Medical Services (HEMS) are used worldwide in order to provide potentially life-saving pre-hospital medical support to trauma patients at the accident scene. It is currently unclear how much overlap exists regarding the number and type of dispatch criteria used by individual HEMS organisations. The aim of the current study was to provide an overview of dispatch criteria for trauma cases used by HEMS organisations within Europe, and search for similarities and differences, between countries and HEMS stations. MATERIALS AND METHODS HEMS dispatch criteria related to trauma care were obtained from the literature and divided into four groups of criteria and processed in a questionnaire. HEMS providing organisations were identified and contacted by telephone and via email. RESULTS Fifty-five of the 65 organisations (85%) that were contacted completed the questionnaire. The criteria "Fall from height", "Lengthy extrication and significant injury" and "Multiple casualty incidents" were used most frequently. Criteria from the subgroup "Patient Characteristics-Co-morbidities and Age" were used the least. In 44 of the organisations the Central Dispatch Centre (CDC) was primarily responsible for HEMS dispatch. CONCLUSION This overview demonstrates the lack of uniformity in the use of dispatch criteria for trauma assistance on a national and international level. Furthermore, the activation of HEMS is not only depending on dispatch criterion protocols, but is also influenced by organisational factors like the education of the dispatcher, the training of the EMS personnel, the familiarity with the dispatch criteria, and the responses of bystanders. Future research should aim to identify a general set of criteria with the highest discriminating potential.
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Affiliation(s)
- Laura D Wigman
- Department of Surgery-Traumatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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Chipp E, Warner RM, McGill DJ, Moiemen NS. Air ambulance transfer of adult patients to a UK regional burns centre: Who needs to fly? Burns 2010; 36:1201-7. [DOI: 10.1016/j.burns.2010.05.023] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2009] [Revised: 04/04/2010] [Accepted: 05/28/2010] [Indexed: 11/27/2022]
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Burns caused by alcohol-based fires in the household coal stove in Anhui Province, China. Burns 2010; 36:861-70. [DOI: 10.1016/j.burns.2009.11.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2009] [Revised: 10/31/2009] [Accepted: 11/02/2009] [Indexed: 11/21/2022]
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Abstract
CONTEXT The delivery of burn care is a resource-intensive endeavor that requires specialized personnel and equipment. The optimal geographic distribution of burn centers has long been debated; however, the current distribution of centers relative to geographic area and population is unknown. OBJECTIVE To estimate the proportion of the US population living within 1 and 2 hours by rotary air transport (helicopter) or ground transport of a burn care facility. DESIGN AND SETTING A cross-sectional analysis of geographic access to US burn centers utilizing the 2000 US census, road and speed limit data, the Atlas and Database of Air Medical Services database, and the 2008 American Burn Association Directory. MAIN OUTCOME MEASURE The proportion of state, regional, and national population living within 1 and 2 hours by air transport or ground transport of a burn care facility. RESULTS In 2008, there were 128 self-reported burn centers in the United States including 51 American Burn Association-verified centers. An estimated 25.1% and 46.3% of the US population live within 1 and 2 hours by ground transport, respectively, of a verified burn center. By air, 53.9% and 79.0% of the population live within 1 and 2 hours, respectively, of a verified center. There was significant regional variation in access to verified burn centers by both ground and rotary air transport. The greatest proportion of the population with access was highest in the northeast region and lowest in the southern United States. CONCLUSION Nearly 80% of the US population lives within 2 hours by ground or rotary air transport of a verified burn center; however, there is both state and regional variation in geographic access to these centers.
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Affiliation(s)
- Matthew B Klein
- UW Burn Center, University of Washington, Seattle, WA 98104, USA.
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Ringburg AN, de Ronde G, Thomas SH, van Lieshout EMM, Patka P, Schipper IB. Validity of Helicopter Emergency Medical Services Dispatch Criteria for Traumatic Injuries: A Systematic Review. PREHOSP EMERG CARE 2009; 13:28-36. [DOI: 10.1080/10903120802472012] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Mathews KA, Elcock MS, Furyk JS. The use of telemedicine to aid in assessing patients prior to aeromedical retrieval to a tertiary referral centre. J Telemed Telecare 2008; 14:309-14. [DOI: 10.1258/jtt.2008.080417] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We evaluated the effect of telemedicine compared with traditional telephone conversations when evaluating patients for aeromedical retrieval. A convenience sample of consecutive patients referred for retrieval from Palm Island over a six-month period was compared retrospectively with patients referred during the previous six months. There was a significant difference ( P = 0.014) in the number of patients referred in the telemedicine period (113) compared to the previous six months (78), which may have been a seasonal fluctuation. There was a smaller proportion of aeromedical retrievals in the telemedicine period (78%) compared to the control period (92%), P = 0.009. Other significant differences between the telemedicine and control period included a larger proportion of patients not transferred at all (16% compared to 5%, P = 0.022) and a smaller percentage of rotary flights (52% compared with 73%, P = 0.004). Retrieval coordinators perceived that telemedicine use prevented 10 aeromedical flights and six night flights. The coordinators and referrers felt that telemedicine improved patient care in 75% and 65% of consultations, respectively. The coordinators felt that it improved communication with the referring doctor for 84% of the consultations.
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Abstract
Several reports have documented that modern burn patients receive far more resuscitation fluid than predicted by the Parkland formula-a phenomenon termed "fluid creep." This article reviews the incidence, consequences, and possible etiologies of fluid creep in modern practice and uses this information to propose some therapeutic strategies to reduce or eliminate excessive fluid resuscitation in burn care. A literature review was performed of historical references that form the foundation of modern fluid resuscitation, as well as reports of fluid creep and its consequences. The original Parkland formula required a 24-hour volume of 4 ml/kg/%TBSA lactated Ringer's solution followed by an infusion of 0.3-0.5 ml/kg/ %TBSA plasma. Modern iterations of this formula have omitted the colloid bolus. Numerous exceptions to the formula have been noted, most consistently patients with inhalation injuries. In contrast, recent reports document greatly increased fluid requirements in unselected patients, which seems to consist largely of progressive edema formation in unburned areas, increasing after the first 8 hours post-burn. This has been linked to occurrence of the abdominal compartment syndrome and other serious complications. Strategies to reduce fluid creep include the avoidance of early overresuscitation, use of colloid as a routine component of resuscitation or for "rescue," and adherence to protocols for fluid resuscitation. Fluid creep is a significant problem in modern burn care. Review of original investigations of burn shock, coupled with modern reports of fluid creep, suggests several mechanisms by which this problem can be controlled. Prospective trials of these therapies are needed to confirm their effectiveness.
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Affiliation(s)
- Jeffrey I L Saffle
- Department of Surgery, 3B-306, University of Utah Health Center, 50 N. Medical Drive, Salt Lake City, UT 84132, USA
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Tsai SH, Kraus J, Wu HR, Chen WL, Chiang MF, Lu LH, Chang CE, Chiu WT. The effectiveness of video-telemedicine for screening of patients requesting emergency air medical transport (EAMT). ACTA ACUST UNITED AC 2007; 62:504-11. [PMID: 17297342 DOI: 10.1097/01.ta.0000219285.08974.45] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Demand for emergency air medical transport (EAMT) services have increased in recent years. However, the high costs of these services have raised questions on the benefit to patient outcomes. In this study, we evaluate the effectiveness of video-telemedicine for the preflight screening of patients for air medical transports. METHOD A prospective cohort study. Medical records of patients transported from the Penghu Islands to Taiwan were retrospectively collected from November 1999 to October 2002 (stage 1). In addition, we collected medical records of patients who were preflight-screened by physicians using video Web cameras from November 1, 2002 through August 30, 2003 (stage 2). The intervention in stage 2 included a set of protocols and screening criteria for EAMT implemented by the National Aeromedical Consultation Center (NACC). In stage 1, there were no standardized protocols or screening guidelines for EAMT. The EAMT system before implementing preflight screening and telemedicine was mostly based on patient's requests and their health condition determined by the treating medical officers (TMO). RESULTS A total of 822 transfers were included in this study. Patient demographic backgrounds in the two groups were similar on gender, age, disease classification, and types of illnesses. Patients in stage 2 were significantly older than those in stage 1. In a comparison of flight frequencies between the two stages, the results revealed a 36.2% reduction of EAMT applications in stage 2. The flight approval rate was 91.2%. The intervention in stage 2 also presented a significant reduction in cross-zone transport (16.1% to 0.1% to the northern Taiwan region). Within-zone transfers increased from 74.9% to 88.3%. Cost analysis showed that physician triage in stage 2 resulted in a total annual savings on EAMTs of US 448,986 dollars. CONCLUSIONS This study demonstrates the physician-assisted preflight screening using video-telemedicine significantly reduced the frequency of unnecessary air medical transports and consequently led to reduced costs. Video-telemedicine can be an essential tool to support physicians in decision-making for patient screening.
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Affiliation(s)
- Shin-Han Tsai
- Institute of Injury Prevention and Control, Department of Neurological Surgery, Taipei Medical University-Wan Fang Hospital, Taipei, Taiwan.
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Abstract
Through progress in wound management, resuscitation, intensive care treatment, and a coordinated rehabilitation process, modern burn care has been able to deliver substantial increases in survival and improvement in functional outcomes for burn victims. The development of regionalized burn centers has contributed greatly to this progress. As the field of burns matures, burn centers are preparing to meet future challenges through collaborative efforts in disaster management and outcomes research.
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Affiliation(s)
- Tam N Pham
- University of Washington Burn Center, Department of Surgery, Harborview Medical Center, Box 359796, 325 Ninth Avenue, Seattle, WA 98104, USA
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Klein MB, Nathens AB, Heimbach DM, Gibran NS. An outcome analysis of patients transferred to a regional burn center: transfer status does not impact survival. Burns 2006; 32:940-5. [PMID: 17011131 DOI: 10.1016/j.burns.2006.04.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2006] [Accepted: 04/04/2006] [Indexed: 11/18/2022]
Abstract
BACKGROUND Optimal burn care is provided at specialized burn centers. Given the geographic location of these centers, many burn patients receive initial treatment at local emergency departments prior to transfer. The purpose of this study was to determine whether patients transferred from other facilities have worse outcomes than those admitted directly from the field. STUDY DESIGN A retrospective cohort study was performed comparing the outcomes of patients admitted to our burn center directly from the field with patients requiring transfer from a preliminary care facility. The outcomes of interest were mortality, length of stay, length of stay/TBSA burned, number of operations and hospital charges. Poisson regression or Cox proportional hazards model was used to evaluate differences in outcomes after adjusting for potential confounders. RESULTS From 2000 to 2003 a total of 1877 patients were admitted to our burn center and 953 (51%) were transferred from a preliminary care facility. No difference (p<0.05) was found in length of stay, number of operations, hospital charges and mortality between the two cohorts. CONCLUSIONS This study demonstrates that patients transferred to a regional burn center from local hospitals have equivalent mortality, length of stay and hospital charges as those admitted directly from the field.
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Affiliation(s)
- Matthew B Klein
- Burn Center, Department of Surgery, University of Washington, Harborview Medical Center, Seattle, WA 98121, USA.
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Cone JB. What’s new in general surgery: Burns and metabolism. J Am Coll Surg 2005; 200:607-15. [PMID: 15804476 DOI: 10.1016/j.jamcollsurg.2005.01.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2005] [Accepted: 01/14/2005] [Indexed: 10/25/2022]
Affiliation(s)
- John B Cone
- Trauma Service, Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
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