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Does Increased Patient Load Improve Mortality in Burns?

Identifying Benchmark Parameters Defining Quality of Burn Care

Busche, Marc Nicolai, MD*; Jacobs, Denise, MD*; Rennekampff, Hans-Oliver, MD

doi: 10.1097/SAP.0000000000001844
Burn Surgery and Research

Introduction In burn care, as in other medical fields, there is a tendency to increase the required number of patients for center certifications. Does the increase in patient load automatically improve the quality of burn care? What are the benchmark parameters that have been shown to improve burn care?

Methods To answer these questions, Medline, Cochrane Library, and Livivo were searched from inception through January 2018 for all studies evaluating the influence of treatment parameters on outcomes in different burn care settings.

Results Fifteen studies were included in this systematic review. In adults, not a single study showed a decreased mortality due to a higher patient load. However, in children, 2 studies demonstrated a further decrease of the already low mortality due to an increase in patient load. In contrast to patient load, benchmark parameters that had a significant influence on the outcome of burn care for adults and children were: single bed isolation, residency programs, American Burn Association certifications of burn centers, speed of wound closure, and standard operating procedures for burn care.

Conclusions This systematic review demonstrates that a clear correlation between patient load and mortality reduction in adult burn treatment is not supported by the existing literature, requiring future studies. In contrast, all efforts aiming to improve the quality of burn care, such as isolation of burn patients, speed of wound closure, American Burn Association verification and especially standard operating procedures for burn care improve survival and quality of burn care.

From the *Department of Plastic and Aesthetic Surgery, Burn Surgery, Klinikum Leverkusen, Leverkusen; and

Department of Plastic, Aesthetic and Burn Surgery, Rhein-Maas Klinikum, Würselen, Germany.

Received October 28, 2018, and accepted for publication, after revision December 26, 2018.

Conflicts of interest and sources of funding: none declared.

Reprints: Marc Nicolai Busche, MD, Department of Plastic and Aesthetic Surgery, Burn Surgery, Klinikum Leverkusen, Am Gesundheitspark 11, 51375 Leverkusen, Germany. E-mail:

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