Haik Josef, Weissman Oren, Givon Adi, Liran Alon, Tessone Ariel, Stavrou Demetris, Orenstein Arie, Peleg Kobi
Department of Plastic and Reconstructive Surgery, Sheba Medical Center, Tel Hashomer, Israel.
J Burn Care Res. 2012 Jul-Aug;33(4):510-7. doi: 10.1097/BCR.0b013e31824d1c09.
The treatment of burn victims constitutes a considerable challenge both to the clinician in regard to mundane treatment and to health systems in regard to structural organization. The state of Israel is in dire need of competent burn care capabilities for political, geographical, and demographic reasons. Israel currently has five designated burn units but no burn center. A review of the recent literature suggests that larger burn centers can convey lower mortality rates and better functional outcomes for severe burn patients in comparison to smaller burn units. The objective of this study is to assess Israel's burn care alignment needs and capabilities based on Israel's burn patient and burn unit data. In addition, the authors aim to compare the burn care alignment capabilities with those of the country's European and American counterparts. Data of all the burn patients hospitalized in Israel's level 1 trauma centers' burn units between the years 1998 and 2005 according to the Israeli Trauma Registry were analyzed. Simultaneously, data regarding the setup and arrangement of each burn unit were obtained from each burn unit director via phone. Between the years 1998 and 2005, 974 adult patients with burns of the second degree or higher spanning 20% TBSA and more were hospitalized in the five hospitals that operate a functional specialized burn unit. The average hospitalization period was 32.4 days while the mortality rate was 21.1%. Currently, Israel's five burn units report possessing 27 burn beds and 14 burn intensive care unit beds. Due to the continuous risk for terror attacks and military campaigns and due to Israel's inability to refer excess burn patients to neighboring countries, Israel desperately needs efficient burn care capabilities. Israel currently trails both the United States and Europe in regard to burn beds and burn centers per population. The annual quantity and severity of burn patients in Israel largely exceeds the amount needed to justify an establishment of a burn center by the current American Burn Association guidelines, while the literature provides vast amount of evidence proving burn centers' efficacy in improving outcome, shortening hospitalization periods, and reducing costs. Taking all these elements into consideration, it might be prudent to establish a national burn center in Israel to promote burn care standards and disaster planning up to international standards.
烧伤患者的治疗对临床医生的常规治疗以及卫生系统的结构组织而言都是一项重大挑战。出于政治、地理和人口统计学原因，以色列亟需具备专业的烧伤护理能力。目前以色列有五个指定的烧伤病房，但没有烧伤中心。近期文献综述表明，相较于规模较小的烧伤病房，规模较大的烧伤中心能降低重度烧伤患者的死亡率，并带来更好的功能恢复结果。本研究的目的是基于以色列烧伤患者和烧伤病房的数据，评估以色列烧伤护理的匹配需求和能力。此外，作者旨在将以色列的烧伤护理匹配能力与其欧美同行进行比较。根据以色列创伤登记处的数据，分析了1998年至2005年间在以色列一级创伤中心烧伤病房住院的所有烧伤患者的数据。同时，通过电话从每个烧伤病房主任处获取了有关每个烧伤病房设置和安排的数据。在1998年至2005年间，五家设有功能性专业烧伤病房的医院共收治了974例成人二度及以上烧伤、烧伤面积达20%体表面积及以上的患者。平均住院时间为32.4天，死亡率为21.1%。目前，以色列的五个烧伤病房报告共有27张烧伤病床和14张烧伤重症监护病床。由于恐怖袭击和军事行动的持续风险，以及以色列无法将过多的烧伤患者转诊至邻国，以色列迫切需要高效的烧伤护理能力。目前，以色列在人均烧伤病床和烧伤中心数量方面落后于美国和欧洲。以色列每年烧伤患者的数量和严重程度大大超过了按照美国烧伤协会现行指南设立烧伤中心所需的数量，而文献提供了大量证据证明烧伤中心在改善治疗效果、缩短住院时间和降低成本方面的有效性。综合考虑所有这些因素，在以色列建立一个国家烧伤中心以将烧伤护理标准和灾难规划提升至国际标准可能是明智之举。
