Harborview burns--1974 to 2009.
Burn demographics, prevention and care have changed considerably since the 1970s. The objectives were to 1) identify new and confirm previously described changes, 2) make comparisons to the American Burn Association National Burn Repository, 3) determine when the administration of fluids in excess o...
| Main Authors: | , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Public Library of Science (PLoS)
2012-01-01
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| Series: | PLoS ONE |
| Online Access: | http://europepmc.org/articles/PMC3390332?pdf=render |
| _version_ | 1818509619316654080 |
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| author | Loren H Engrav David M Heimbach Frederick P Rivara Kathleen F Kerr Turner Osler Tam N Pham Sam R Sharar Peter C Esselman Eileen M Bulger Gretchen J Carrougher Shari Honari Nicole S Gibran |
| author_facet | Loren H Engrav David M Heimbach Frederick P Rivara Kathleen F Kerr Turner Osler Tam N Pham Sam R Sharar Peter C Esselman Eileen M Bulger Gretchen J Carrougher Shari Honari Nicole S Gibran |
| author_sort | Loren H Engrav |
| collection | DOAJ |
| description | Burn demographics, prevention and care have changed considerably since the 1970s. The objectives were to 1) identify new and confirm previously described changes, 2) make comparisons to the American Burn Association National Burn Repository, 3) determine when the administration of fluids in excess of the Baxter formula began and to identify potential causes, and 4) model mortality over time, during a 36-year period (1974-2009) at the Harborview Burn Center in Seattle, WA, USA.14,266 consecutive admissions were analyzed in five-year periods and many parameters compared to the National Burn Repository. Fluid resuscitation was compared in five-year periods from 1974 to 2009. Mortality was modeled with the rBaux model. Many changes are highlighted at the end of the manuscript including 1) the large increase in numbers of total and short-stay admissions, 2) the decline in numbers of large burn injuries, 3) that unadjusted case fatality declined to the mid-1980s but has changed little during the past two decades, 4) that race/ethnicity and payer status disparity exists, and 5) that the trajectory to death changed with fewer deaths occurring after seven days post-injury. Administration of fluids in excess of the Baxter formula during resuscitation of uncomplicated injuries was evident at least by the early 1990s and has continued to the present; the cause is likely multifactorial but pre-hospital fluids, prophylactic tracheal intubation and opioids may be involved.1) The dramatic changes include the rise in short-stay admissions; as a result, the model of burn care practiced since the 1970s is still required but is no longer sufficient. 2) Fluid administration in excess of the Baxter formula with uncomplicated injuries began at least two decades ago. 3) Unadjusted case fatality declined to ∼6% in the mid-1980s and changed little since then. The rBaux mortality model is quite accurate. |
| first_indexed | 2024-12-10T22:47:54Z |
| format | Article |
| id | doaj.art-6414cabc1a754836a072c32708c3729e |
| institution | Directory Open Access Journal |
| issn | 1932-6203 |
| language | English |
| last_indexed | 2024-12-10T22:47:54Z |
| publishDate | 2012-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS ONE |
| spelling | doaj.art-6414cabc1a754836a072c32708c3729e2022-12-22T01:30:31ZengPublic Library of Science (PLoS)PLoS ONE1932-62032012-01-0177e4008610.1371/journal.pone.0040086Harborview burns--1974 to 2009.Loren H EngravDavid M HeimbachFrederick P RivaraKathleen F KerrTurner OslerTam N PhamSam R ShararPeter C EsselmanEileen M BulgerGretchen J CarrougherShari HonariNicole S GibranBurn demographics, prevention and care have changed considerably since the 1970s. The objectives were to 1) identify new and confirm previously described changes, 2) make comparisons to the American Burn Association National Burn Repository, 3) determine when the administration of fluids in excess of the Baxter formula began and to identify potential causes, and 4) model mortality over time, during a 36-year period (1974-2009) at the Harborview Burn Center in Seattle, WA, USA.14,266 consecutive admissions were analyzed in five-year periods and many parameters compared to the National Burn Repository. Fluid resuscitation was compared in five-year periods from 1974 to 2009. Mortality was modeled with the rBaux model. Many changes are highlighted at the end of the manuscript including 1) the large increase in numbers of total and short-stay admissions, 2) the decline in numbers of large burn injuries, 3) that unadjusted case fatality declined to the mid-1980s but has changed little during the past two decades, 4) that race/ethnicity and payer status disparity exists, and 5) that the trajectory to death changed with fewer deaths occurring after seven days post-injury. Administration of fluids in excess of the Baxter formula during resuscitation of uncomplicated injuries was evident at least by the early 1990s and has continued to the present; the cause is likely multifactorial but pre-hospital fluids, prophylactic tracheal intubation and opioids may be involved.1) The dramatic changes include the rise in short-stay admissions; as a result, the model of burn care practiced since the 1970s is still required but is no longer sufficient. 2) Fluid administration in excess of the Baxter formula with uncomplicated injuries began at least two decades ago. 3) Unadjusted case fatality declined to ∼6% in the mid-1980s and changed little since then. The rBaux mortality model is quite accurate.http://europepmc.org/articles/PMC3390332?pdf=render |
| spellingShingle | Loren H Engrav David M Heimbach Frederick P Rivara Kathleen F Kerr Turner Osler Tam N Pham Sam R Sharar Peter C Esselman Eileen M Bulger Gretchen J Carrougher Shari Honari Nicole S Gibran Harborview burns--1974 to 2009. PLoS ONE |
| title | Harborview burns--1974 to 2009. |
| title_full | Harborview burns--1974 to 2009. |
| title_fullStr | Harborview burns--1974 to 2009. |
| title_full_unstemmed | Harborview burns--1974 to 2009. |
| title_short | Harborview burns--1974 to 2009. |
| title_sort | harborview burns 1974 to 2009 |
| url | http://europepmc.org/articles/PMC3390332?pdf=render |
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