An international RAND/UCLA expert panel to determine the optimal diagnosis and management of burn inhalation injury.

Background: Burn inhalation injury (BII) is a major cause of burn-related mortality and morbidity. Despite published practice guidelines, no consensus exists for the best strategies regarding diagnosis and management of BII. A modified DELPHI study using the RAND/UCLA (University of California, Los Angeles) Appropriateness Method (RAM) systematically analysed the opinions of an expert panel.

Exploring the similarities and differences of variables collected by burn registers globally: protocol for a data dictionary review study.

Introduction: Burn registers can provide high-quality clinical data that can be used for surveillance, research, planning service provision and clinical quality assessment. Many countrywide and intercountry burn registers now exist. The variables collected by burn registers are not standardised internationally.

Using data to drive service improvement: false dawns and a promised land?

Increasing emphasis and expectation is being placed on the role of healthcare data in addressing the problems faced by the NHS. The ideal is to replace the current fragmented system of individual systems and registries with a universal, integrated data system that provides frontline staff with what they need while also allowing monitoring of services, intelligent population-based commissioning and the facilitation of quality improvement (QI) and research. With the recently published tender for the creation of a federated data platform (FDP) there is optimism that these aspirations are being addressed; however, concerns remain that the future use of healthcare data in the UK will not fulfil its potential if the current well-recognised shortcomings of existing systems and processes are not dealt with.

Surviving Burn Injury: Drivers of Length of Hospital Stay.

With a reduction in the mortality rate of burn patients, length of stay (LOS) has been increasingly adopted as an outcome measure. Some studies have attempted to identify factors that explain a burn patient's LOS. However, few have investigated the association between LOS and a patient's mental and socioeconomic status.

Comparison of the international Burn Injury Database nurse dependency tool with the Safer Nursing Care Tool: Observational study.

Background: Safe and effective nurse staffing is widely recognised as an important issue to ensure quality patient care and reduce mortality. There are many nurse dependency tools described in the literature but no gold standard tool that can be used in all specialities. In burn care there are even fewer burn specific tools and none reported for use in the UK to date.

Burn service costing using a mixed model methodology.

Introduction: The escalating cost of modern healthcare is threatening the fundamental "free at the point of delivery" principle of the UK National Health Services. A new remuneration system using a fixed tariff for pre-assigned diagnostic groups caters poorly for the heterogeneity of burn injuries. This study was to develop a system for Patient Level Costing (PLC), the first steps of which were to determine the true cost of burn care at service level.

The SILKIE (Skin graftIng Low friKtIon Environment) study: a non-randomised proof-of-concept and feasibility study on the impact of low-friction nursing environment on skin grafting success rates in adult and paediatric burns.

Objectives: To evaluate the impact of low-friction (LF) bedding on graft loss in an acute burn care setting, and to examine the feasibility and costs of using LF bedding compared with standard care.

Design: Proof of concept before and after study with feasibility of delivering the intervention.

Setting: Three burns services within two UK hospital trusts.

Extracorporeal membrane oxygenation in severe respiratory failure resulting from burns and smoke inhalation injury.

Extracorporeal membrane oxygenation (ECMO) is one of the most frequent forms of extracorporeal life support (ECLS) and can be used as rescue therapy in patients with severe respiratory failure resulting from burns and/or smoke inhalation injury. Experience and literature on this treatment option is still very limited, consequently results are varied. We report a retrospective analysis of our experience with veno-venous (VV) ECMO in burn patients.

Circadian actin dynamics drive rhythmic fibroblast mobilization during wound healing.

Fibroblasts are primary cellular protagonists of wound healing. They also exhibit circadian timekeeping, which imparts an approximately 24-hour rhythm to their biological function. We interrogated the functional consequences of the cell-autonomous clockwork in fibroblasts using a proteome-wide screen for rhythmically expressed proteins.

Human survival in volcanic eruptions: Thermal injuries in pyroclastic surges, their causes, prognosis and emergency management.

This study of burns patients from two eruptions of Merapi volcano, Java, in 1994 and 2010, is the first detailed analysis to be reported of thermal injuries in a large series of hospitalised victims of pyroclastic surges, one of the most devastating phenomena in explosive eruptions. Emergency planners in volcanic crises in populated areas have to integrate the health sector into disaster management and be aware of the nature of the surge impacts and the types of burns victims to be expected in a worst scenario, potentially in numbers and in severity that would overwhelm normal treatment facilities. In our series, 106 patients from the two eruptions were treated in the same major hospital in Yogyakarta and a third of these survived.

Mortality risk prediction in burn injury: Comparison of logistic regression with machine learning approaches.

Introduction: Predicting mortality from burn injury has traditionally employed logistic regression models. Alternative machine learning methods have been introduced in some areas of clinical prediction as the necessary software and computational facilities have become accessible. Here we compare logistic regression and machine learning predictions of mortality from burn.

Patient outcomes vs. service workload: an analysis of outcomes in the burn service of England and Wales.

Background: Patient outcomes in specialist burns units have been used as a metric of care needs and quality. Besides patient factors there are service factors that might influence Length of Stay (LOS) and mortality, e.g.

A review of the international Burn Injury Database (iBID) for England and Wales: descriptive analysis of burn injuries 2003-2011.

Objective: To describe, for the first time, distribution (by geography, age, sex) and time trends in burn injury in England and Wales over the period that the international Burn Injury Database (iBID) has been in place.

Setting: Data from the iBID for the years 2003-2011 were used for a retrospective descriptive observational study of specialised services workload and admissions in England and Wales.

Participants: All patients who have been visited or admitted to the burn injury specialised health service of England and Wales during the time period 2003-2011.

Geographical analysis of socioeconomic factors in risk of domestic burn injury in London 2007-2013.

Purpose: This study aims to explore the geographical distribution of burn injuries in Greater London and the association of socioeconomic factors in areas at risk.

Methods: Data on burn injury cases classified as occurring in patients' own homes in Greater London and admitted to a specialised burns service for ≥1 day during a 7-year period were obtained from the International Burn Injury Database (iBID). Age- and gender-adjusted standardised incidence ratios (SIRs) were calculated for each Lower Layer Super Output Area (LSOA) in Greater London.

Burn related mortality in Greater Manchester: 11-year review of Regional Coronial Department Data.

Introduction: The Coroners Department (CD) records hold important demographic, injury and death details for victims of burn injuries derived from various sources yet this rich source of data has been infrequently utilised previously in describing the epidemiology of burn related mortality. The aim of this study was to use CD data to comprehensively investigate burn related mortality in the Greater Manchester region of United Kingdom.

Materials And Methods: A retrospective study design was used to collect data for deceased demographics, injury details, site of death and cause of death from four CD offices in GM over an 11-year period (2000-2010 inclusive).

Cost-effectiveness of interventions for increasing the possession of functioning smoke alarms in households with pre-school children: a modelling study.

Background: The UK has one of the highest rates for deaths from fire and flames in children aged 0-14 years compared to other high income countries. Evidence shows that smoke alarms can reduce the risk of fire-related injury but little exists on their cost-effectiveness. We aimed to compare the cost effectiveness of different interventions for the uptake of 'functioning' smoke alarms and consequently for the prevention of fire-related injuries in children in the UK.

A model of British in-hospital mortality among burns patients.

Introduction: Mortality among patients treated in hospital for burn is routinely examined, but none of the many models in use in the UK was developed using nationwide data. The aim of this research was to develop a prediction model using national data, representative of the British population.

Methods: Data were gathered from the international Burns Injury Database (iBID) and included 66,611 patients from England and Wales from 2003 to 2011.

Accuracy of commercial reporting systems to monitor quality of care in burns.

Introduction: Capse Healthcare Knowledge Systems (CHKS) is a global commercial organisation that operates health benchmarking programmes in the UK and internationally. In absence of a specialty-specific quality monitoring programme for burn services, CHKS has been producing comparative quality data for burn services for a number of years. The major quality indicator reported by CHKS is mortality as a Risk Adjusted Mortality Index (RAMI).

Predicting length of stay in thermal burns: a systematic review of prognostic factors.

Background: Continued improvement in all aspects of the management of thermal injury has resulted in marked improvements in the traditionally reported outcome of mortality. This has resulted in the search for alternative parameters that can be monitored to indicate the performance of burn services. Length of stay (LOS) in hospitalised burn patients has long been considered reflective of injury-associated morbidity, cost and the quality of care, which can be monitored consistently across services.

Predicting survival in thermal injury: a systematic review of methodology of composite prediction models.

Background: The widespread use of mathematical models to predict mortality as an outcome in burn injury is limited by concerns regarding the accuracy of the predictions. This discrepancy in reported and actual model accuracy can be the result of lack of adherence to appropriate methodological standards for the construction of prediction models.

Aim: We undertook a systematic review of the methodology of published mortality prediction models against methodological standards.

Burns represent a significant proportion of the total serious trauma workload in England and Wales.

Traumatic injury is the leading cause of death in the first four decades of life. However, current estimates for traumatic injury rates fail to take into account burns. The aim of this work was to estimate the contribution of burns to serious traumatic injury in England and Wales.

Do illness perceptions and mood predict healing time for burn wounds? a prospective, preliminary study.

Unlabelled: Some burn wounds take longer to heal than others, but this cannot be fully explained by physical factors such as burn size and depth. Research interest has therefore focussed on the potential contribution of psychological factors, such as perception of the burn and distress, to the wound healing process.

Objectives: Using the framework of Leventhal's Common-Sense Model, we investigated whether patients' perceptions of their burn wounds and distress contributed to healing time, and whether this was via the mediating role of adherence to treatment recommendations.