Burn Wound Healing Outcomes

Development of metrics for burn care, including healing of skin wounds during the acute phase of treatment, is essential in an environment of decreasing resources and increasing interest in quality and accuracy of medical information. Advantages of consensus metrics include: tracking of trends in care; consistency of care; and correlation of treatment with medical outcomes. For cutaneous burn wounds, these advantages are confounded by factors that contribute to the heterogeneity of burn wounds, including but not limited to: TBSA of injury, depth of injury (partial or full thickness), cause, patient-dependent factors such as age, sex, and comorbidities, anatomic site, and time between injury and treatment. Similar factors contribute to complex injuries from trauma, and allow for risk adjustment of individuals in the population, who otherwise may be outliers to the statistical mean of the entire population.1–3Despite these confounding factors, certain common definitive events are necessary to accomplish healing of a burn wound, including: accurate diagnosis of burn depth, debridement or excision of devitalized tissue, dressing or grafting of the prepared wound bed, and assessment to determine wound closure. In the absence of confounding factors or comorbidities, wound closure is one of the key criteria for discharge from acute care whether in hospital, or ambulatory care. Not surprisingly, these metrics for wound healing have been used repeatedly in the assessment of developing therapies for wound care. In response, review by the FDA of novel therapies has led to Guidance for Industry: chronic cutaneous ulcer and burn wounds—developing products for treatment.1 With reference to cutaneous burns, this Guidance considers hemodynamic resuscitation, management of comorbidities, timely burn debridement and excision, wound closure, management of wound infection, pain control, nutritional support, measures to inhibit excessive scar formation, and rehabilitation, including passive range of motion when burns overlie joints. Other burn societies, most recently the Australia–New Zealand Burn Association, have also recognized the need for metrics of quality in burn care,4–7 the need to accumulate data from the practicing community, definition of clinical criteria for data collection, risk adjustment to compensate for variability in clinical populations, and data validation for use. In this context, the participants in the Wound Healing Breakout Session of the Burn Quality Consensus Conference discussed metrics for evaluation of quality in healing of burn wounds. Particular focus was given to diagnosis of burn depth, debridement or excision of devitalized tissue, wound infection, and wound closure. Each of these aspects of burn wound healing will be reviewed as a potential metric for prospective capture and trending in the American Burn Association TRACS/National Burn Registry to allow tracking of quality of burn care. Whereas burn wound healing involves a prolonged process that starts immediately after injury and may continue for many months or years, this consensus statement will focus on the early phase of burn wound healing Burn Wound Healing Outcomes