Harshman Jamie, Roy Mélissa, Cartotto Robert
Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre, University of Toronto, Canada.
J Burn Care Res. 2019 Feb 20;40(2):166-188. doi: 10.1093/jbcr/iry060.
Good burn care starts with correct management of the burn patient before transfer to a burn center. The purpose of this study was to perform a systematic review of the medical literature describing preburn center care. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed for this review. Studies were included if they were published from a burn center and they measured or evaluated any aspect of preburn center care of adult or pediatric acute burn patients referred to that burn center. A comprehensive search of MEDLINE, EMBASE, and Cochrane databases was performed from their inception to May 28, 2018. Outcomes of interest included errors in burn size estimation, airway management, fluid resuscitation, dressings and wound care, use of systemic antibiotics, core temperature monitoring and preservation, and analgesia provision. Meta-analysis of the discrepancy between preburn center and burn center burn size estimation was conducted. From 3768 initially identified titles, 37 studies were included in this systematic review. Burn size estimation was frequently inaccurate. The ratio of overestimation to underestimation in burn size ranged between 2.2:1 and 19:1. The pooled mean absolute error in % total body surface area burn was 6.28 (95% CI: 4.72, 7.85). The average relative percent error in burn size estimation by referring providers ranged between 75% and 3500%. Unnecessary endotracheal intubation was performed in 28% to 53% of transfers. Over-estimation and over-delivery of fluid resuscitation volumes was prevalent, but other problems pertaining to resuscitation included administration of the wrong fluid and failure to titrate fluids. Wounds were not consistently covered with simple dry dressings or sheets. Core temperature was not consistently monitored or preserved. Analgesics were often not given or were of insufficient dose. Many elements of preburn center care need improvement. These findings should be used to form the foundation of future initiatives between burn professionals and emergency providers to improve care of the burn patient before transfer to a burn center.
良好的烧伤护理始于在将烧伤患者转送至烧伤中心之前对其进行正确的管理。本研究的目的是对描述烧伤中心前护理的医学文献进行系统综述。本综述遵循系统评价和荟萃分析的首选报告项目（PRISMA）指南。如果研究是由烧伤中心发表的，并且测量或评估了转至该烧伤中心的成人或儿童急性烧伤患者烧伤中心前护理的任何方面，则纳入该研究。对MEDLINE、EMBASE和Cochrane数据库从其创建至2018年5月28日进行了全面检索。感兴趣的结果包括烧伤面积估计错误、气道管理、液体复苏、敷料和伤口护理、全身性抗生素的使用、核心体温监测与维持以及镇痛措施。对烧伤中心前和烧伤中心烧伤面积估计之间的差异进行了荟萃分析。从最初识别的3768篇标题中，37项研究纳入了本系统综述。烧伤面积估计经常不准确。烧伤面积高估与低估的比例在2.2:1至19:1之间。总体表面积烧伤的合并平均绝对误差为6.28（95%CI：4.72，7.85）。转诊提供者估计烧伤面积的平均相对百分比误差在75%至3500%之间。在28%至53%的转运中进行了不必要的气管插管。液体复苏量的高估和过量输注很普遍，但与复苏相关的其他问题包括给予错误的液体和未能调整液体剂量。伤口并未始终用简单的干敷料或床单覆盖。核心体温并未始终得到监测或维持。镇痛药物常常未给予或剂量不足。烧伤中心前护理的许多方面需要改进。这些发现应用于构成烧伤专业人员和急救人员未来举措的基础，以改善在将烧伤患者转送至烧伤中心之前的护理。
