Elsevier

Burns

Volume 33, Issue 2, March 2007, Pages 155-160
Burns

Guidelines for the management of partial-thickness burns in a general hospital or community setting—Recommendations of a European working party

https://doi.org/10.1016/j.burns.2006.07.025Get rights and content

Abstract

Most partial-thickness burns in Europe and the United States are managed by non-burns specialists who do not treat burns on a regular basis. To achieve better patient outcomes, partial-thickness burns should be properly managed in non-specialist centres and referred to burn units when appropriate. Although some guidelines have been published to assist non-specialists, few have attempted to provide a comprehensive step-by-step guidance emphasising wound-healing principles. A working party of European burn specialists devised a new treatment algorithm to provide clear and current guidance on the management of partial-thickness burns in the general hospital and community setting. Four areas were identified for improvement: diagnosis and referral, wound preparation, wound covering and post-wound care. The guidelines take into account the role of wound dressings, infection and general patient well-being, bearing in mind the different working environments that occur across Europe. They are aimed at improving the overall outcome for community-treated patients within the expanding European Union and reducing the number of preventable late referrals to specialists.

Introduction

The vast majority of partial-thickness burns in Europe are treated by non-specialists in a general hospital or community setting. Of the 2000 people per million who suffer from burns per year, most are managed by healthcare professionals for whom burns treatment constitutes only a small proportion of the healthcare services that they provide and who may lack experience in this evolving field.

For best patient outcomes, partial-thickness burns should be properly managed in non-specialist centres, with referrals to burns units being reserved for appropriate cases. However, the identification of appropriate referrals can sometimes be problematic, and the clinical management of partial-thickness burns by non-specialists can have variable results. For example, sequelae such as hypertrophic scarring and contractures after deep partial-thickness burns are now considered unacceptable in the Western world; however, a recent review of the literature has shown that up to 20% of all burns patients have restrictions in their range of motion even 5 years after injury, whereas one in seven patients who are treated for ‘minor burns’ report long-lasting problems with their appearance [1].

A recent survey of the minor burn facility at a major teaching hospital in Australia, Royal Perth Hospital, showed that only 39% had received appropriate first aid from their primary healthcare provider [2]. Equally, a review of the management of minor burns within the emergency departments of hospitals in Ontario, Canada, showed that 70% of responding physicians would not measure the extent of the burn area when making an assessment, whereas 45% failed to discuss analgesic requirements [3]. Clearly, there is room for improvement.

These guidelines and accompanying treatment algorithm were produced out of a desire by burns specialists from European countries to provide clear and up-to-date advice on the management of partial-thickness burns in the general hospital and community setting. It is hoped that this guidance will also support the dialogue between local burns centres and colleagues in their referral area so that regionalised care plans can be produced. Their aim is to raise the standards of community-treated patients across the whole of Europe and to reduce the number of preventable late referrals to specialist units, those about whom it is said, “If only…”

Section snippets

Developing a consensus

The management of partial-thickness burns is a neglected area in the literature, with the evidence base being highest in the area of more severe burns injury or in sub-groups such as children [1]. Although a number of publications provided valuable advice in this area [4], [5], [6], [7], none have attempted to provide comprehensive step-by-step guidance to the non-specialist, which includes applying the principles of modern burn wound healing and dressing choice.

This treatment algorithm has

The guidelines

A treatment algorithm describing the assessment and management of burns in a non-specialist setting is shown in Fig. 1. Four key areas for improvement were identified: diagnosis and referral, wound preparation, wound covering and post-wound care. These are reviewed in turn.

Conclusions

These guidelines on the management of partial-thickness burns are intended to provide non-burns specialists with comprehensive guidance on improving patient outcomes. We recognise the pivotal role of non-specialists who continue to treat the vast majority of burn injuries and believe it is the responsibility of burns specialists to ensure that they receive adequate guidance in this evolving field.

For any such guidance to be effective, there must be adequate communication between specialists and

Acknowledgements

Many thanks to the members of the European Burns Association (EBA) for their useful insights.

References (21)

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