Burns Unit, Concord Repatriation General Hospital, Sydney, Australia; ANZAC Research Institute, Concord Repatriation General Hospital, Sydney, Australia.
Burns Unit, Concord Repatriation General Hospital, Sydney, Australia.
Burns. 2019 Mar;45(2):433-439. doi: 10.1016/j.burns.2018.09.024. Epub 2018 Oct 15.
Animal studies indicate treating burn injuries with running water (first aid) for 20min up to 3h post-burn reduces healing time and scarring. There is a lack of human data to support such a recommendation. The purpose of this cohort study was to assess the effect of first aid on clinical outcomes.
Data was prospectively collected for patients with <10% total body surface area (TBSA) burns from 2007-2012. Multivariate regression analysis was used to determine the association of adequate first aid with four outcomes - wound depth, requirement for skin grafting, healing time (in non-grafted patients), and TBSA not grafted (in grafted patients). Adequate first aid was defined as the application of 20min of cool, running tap water up to 3h following the burn injury.
4918 patients were identified. Adequate first aid was received in 58.1% (2859) of patients. It was associated with a statistically significant reduction in burn wound depth (OR 1.39; 95% CI 1.24-1.55; P<0.001) but was not associated with a reduction in TBSA (P=0.86) or requirement for grafting (P=0.47). In patients not requiring grafting, those who received adequate first aid were healed on average 10% (HR 1.10; 95% CI 1.03-1.18; P<0.01) or 1.9 days faster (95% CI -2.9 to -0.9; P<0.001). Adequate first aid in patients requiring grafting was associated with a 15% increase in TBSA that was not grafted (0.27%; 95% CI 0.01-0.52; P=0.04).
Adequate first aid with 20min of running water is associated with improved outcomes. Benefits are seen in a reduction in wound depth, faster healing, and decreased grafting requirements. This has significant patient and health system benefits, and calls for promotion of 20min of running water globally in burns care.
动物研究表明，在烧伤后 20 分钟至 3 小时内用流水（急救）处理烧伤可以减少愈合时间和疤痕形成。目前缺乏支持这种建议的人体数据。本队列研究的目的是评估急救对临床结果的影响。
2007 年至 2012 年期间，前瞻性收集了小于 10%总体表面积（TBSA）烧伤患者的数据。多变量回归分析用于确定适当急救与以下四个结果之间的关联：伤口深度、植皮需求、愈合时间（非植皮患者）和未植皮的 TBSA（植皮患者）。适当的急救定义为在烧伤后 3 小时内应用 20 分钟冷却的自来水。
共确定了 4918 名患者。在 58.1%（2859 名）的患者中接受了适当的急救。它与烧伤伤口深度的显著降低相关（OR 1.39；95%CI 1.24-1.55；P<0.001），但与 TBSA 或植皮需求无关（P=0.86）。在不需要植皮的患者中，接受适当急救的患者平均愈合速度快 10%（HR 1.10；95%CI 1.03-1.18；P<0.01）或提前 1.9 天（95%CI -2.9 至 -0.9；P<0.001）。在需要植皮的患者中接受适当急救与未植皮的 TBSA 增加了 15%（0.27%；95%CI 0.01-0.52；P=0.04）。
用 20 分钟的自来水进行适当的急救与改善的结果相关。好处在于减少伤口深度、更快的愈合和减少植皮需求。这对患者和卫生系统都有重大的益处，并呼吁在全球烧伤护理中推广 20 分钟的自来水。
