Catalyst Consultants, Rickmansworth, UK
King's College London, London, UK.
BMJ Open. 2020 Apr 8;10(4):e035345. doi: 10.1136/bmjopen-2019-035345.
To evaluate health outcomes, resource use and corresponding costs attributable to managing burns in clinical practice, from initial presentation, among a cohort of adults in the UK.
Retrospective cohort analysis of the records of a randomly selected cohort of 260 patients from The Health Improvement Network (THIN) database who had 294 evaluable burns.
Primary and secondary care sectors in the UK.
Patients' characteristics, wound-related health outcomes, healthcare resource use and total National Health Service (NHS) cost of patient management.
Diagnosis was incomplete in 63% of patients' records as the location, depth and size of the burns were missing. Overall, 70% of all the burns healed within 24 months and the time to healing was a mean of 7.8 months per burn. Sixty-six per cent of burns were initially managed in the community and the other 34% were managed at accident and emergency departments. Patients' wounds were subsequently managed predominantly by practice nurses and hospital outpatient clinics. Forty-five per cent of burns had no documented dressings in the patients' records. The mean NHS cost of wound care in clinical practice over 24 months from initial presentation was an estimated £16 924 per burn, ranging from £12 002 to £40 577 for a healed and unhealed wound, respectively.
Due to incomplete documentation in the patients' records, it is difficult to say whether the time to healing was excessive or what other confounding factors may have contributed to the delayed healing. This study indicates the need for education of general practice clinicians on the management and care of burn wounds. Furthermore, it is beholden on the burns community to determine how the poor healing rates can be improved. Strategies are required to improve documentation in patients' records, integration of care between different providers, wound healing rates and reducing infection.
评估英国临床实践中管理烧伤的健康结果、资源利用和相应成本，从初始就诊开始，针对一个成年人队列。
从健康改善网络（THIN）数据库中随机选择的 260 名患者的记录中进行回顾性队列分析，这些患者中有 294 例可评估的烧伤。
英国的初级和二级保健部门。
患者特征、伤口相关健康结果、医疗资源利用和患者管理的总国民保健服务（NHS）成本。
63%的患者记录中诊断不完整，因为烧伤的位置、深度和大小缺失。总体而言，所有烧伤中有 70%在 24 个月内愈合，愈合时间平均为每个烧伤 7.8 个月。66%的烧伤最初在社区管理，34%的烧伤在急症室管理。患者的伤口随后主要由执业护士和医院门诊诊所管理。45%的烧伤在患者记录中没有记录敷料。从初始就诊开始的 24 个月内，临床实践中伤口护理的 NHS 平均成本估计为每个烧伤 16924 英镑，愈合和未愈合的伤口分别为 12002 英镑至 40577 英镑。
由于患者记录中的文件不完整，很难说愈合时间是否过长，或者还有哪些其他混杂因素可能导致愈合延迟。这项研究表明，需要对全科医生进行烧伤伤口管理和护理方面的教育。此外，烧伤界有责任确定如何提高愈合率。需要采取策略来改善患者记录中的文件记录、不同提供者之间的护理整合、伤口愈合率和降低感染率。
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