First aid is associated with improved outcomes in large body surface area burns |
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| Affiliation: | 1. Burns Unit, Concord Repatriation General Hospital, Sydney, Australia;2. ANZAC Research Institute, Concord Repatriation General Hospital, Sydney, Australia;3. Sydney Medical School, University of Sydney, Sydney, Australia;1. The Burn Centre, Department of Plastic Surgery, Hand Surgery, and Burns, Linköping University, Linköping, Sweden;2. Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden;3. The Plastic Surgery Unit, Surgery Department, Suez Canal University, Ismailia, Egypt;4. Department of Anaesthesiology and Intensive Care, Linköping University, Linköping, Sweden;1. KK Womens and Childrens Hospital, Accident and Emergency Department, 100 Bukit Timah Road, Singapore 229899, Singapore;2. Duke-NUS Graduate Medical School Singapore, Office of Clinical Science, #04-31, 8 College Road, Singapore 169857, Singapore;3. KK Womens and Childrens Hospital, Plastic Reconstructive and Aesthetic Surgery, 100 Bukit Timah Road, Singapore 229899, Singapore;1. Department of Plastic Surgery, Stoke Mandeville Hospital, and the Department of Oncology, University of Oxford, Green Templeton College, 43 Woodstock Road, Oxford OX2 6HG, United Kingdom;2. Medical Oncology, Department of Oncology, University of Oxford, Green Templeton College, 43 Woodstock Road, Oxford OX2 6HG, United Kingdom;3. Department of Plastic Surgery, Oxford University Hospitals, and the Botnar Research Centre, University of Oxford, Green Templeton College, 43 Woodstock Road, Oxford OX2 6HG, United Kingdom;1. National Critical Care and Trauma Response Centre, Royal Darwin Hospital, Northern Territory, Australia;2. Burns Service, Royal Darwin Hospital, Northern Territory, Australia;3. Menzies School of Health Research, Darwin, Northern Territory, Australia;1. Department of Emergency Medicine, College of Medicine, Soonchunhyang University, Republic of Korea;2. Department of Emergency Medicine, Bestian Hospital, Republic of Korea |
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| Abstract: | BackgroundAnimal studies indicate treating burn injuries with running water (first aid) for 20 min up to 3 h after burn reduces healing time and scarring. We have previously demonstrated the benefits of first aid in minor burn injuries with respect to a reduction in wound depth, faster healing, and decreased skin grafting utilisation. The purpose of this cohort study was to assess the effect of first aid on clinical outcomes in large body surface area burn injuries (≥20%).MethodsData was prospectively collected for patients with ≥20% TBSA burns from 2004– 2018. Multivariate regression analysis was used to determine the association of adequate first aid with 8 outcomes – mortality, total length of stay, total body surface area (TBSA), percentage/proportion of TBSA that was full thickness [PFTI], TBSA grafted, number of re-grafting sessions, intensive care admission, and intensive care length of stay. Adequate first aid was defined as the application of 20 min of cool, running tap water up to 3 h following the burn injury.Findings390 patients were identified. Adequate first aid was received in 35.6% (139) of patients. There was a trend towards a reduction in mortality (OR 0.37; 95% CI 0.12–1.13; P = 0.08). Patients who received adequate first aid had a statistically significant 9.8% reduction in TBSA (95% CI −13.6% to −6.1%; P < 0.0001) as well as a 12% lower PTFI compared to patients who received inadequate first aid (95% CI −19% to −4%; P < 0.01). Whilst there was no significant effect of adequate first aid on the TBSA grafted (P = 0.37), adequate first aid was associated with a significantly less number of re-grafting sessions (95% CI −-0.29 to −0.08; P < 0.001).InterpretationAdequate first aid with 20 min of running water is associated with improved outcomes in large burn injuries. Significant benefits are seen in a reduction in TBSA, proportion of the burn wound that is full thickness, as well as decreased re-grafting. This has significant patient and health system benefits and adds to the body of evidence supporting 20 min of cooling in burns care. |
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| Keywords: | First aid Cooling Jackson burn wound model Water Burn wound Mortality Total body surface area |
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