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Regional and institutional variation in burn care
S M Fakhry1, J Alexander, D Smith
1North Carolina Jaycee Burn Center, University of North Carolina Hospitals, Chapel Hill 27599, USA.
The Journal of Burn Care & Rehabilitation
|January 1, 1995
Summary
Burn care practices vary significantly across North America, with expert experience heavily influencing treatment over established literature. Resuscitation and wound care protocols show considerable institutional differences.
Area of Science:
- Burn Care and Treatment
- Clinical Practice Variation
- Trauma Medicine
Background:
- Significant differences exist in burn therapy literature and clinical practice.
- Variations in burn care protocols among institutions and experts necessitate investigation.
Purpose of the Study:
- To assess current burn care administration in United States and Canadian burn centers.
- To identify variations in resuscitation, wound care, medications, and pain control.
Main Methods:
- Survey of 140 American Burn Association-listed burn centers.
- Data collected from 83 responding hospitals (60% response rate).
- Inquiry into resuscitation, wound care, medications, antimicrobials, and pain management.
Main Results:
- Burn center director experience (85%) was the primary influence on care, more so than literature (12%).
- Parkland formula used by 78%; Brooke formula rarely used (81%).
- Variations noted in fluid choices post-resuscitation, colloid use, topical antimicrobial application, and early enteral nutrition initiation.
Conclusions:
- Burn care practices are highly variable, driven by individual expertise rather than consistent adherence to literature.
- Standardization of evidence-based burn care protocols is needed across institutions.