The Management of Burn Injuries by Dermatologist: A Single Center Pilot Study
July 2015 | Volume 14 | Issue 7 | Original Article | 721 | Copyright © 2015
Tagai Musaev BA,a Angelo Landriscina BA,a Jamie Rosen BA,a and Adam J. Friedman MDa,b,c
aDepartment of Medicine (Division of Dermatology), Albert Einstein College of Medicine, Bronx, NY
bDepartment of Physiology and Biophysics, Albert Einstein College of Medicine, Bronx, NY
cDepartment of Dermatology, George Washington School of Medicine and Health Sciences, Washington, DC
BACKGROUND: Burns are a major cause of morbidity and mortality worldwide. Most burn patients are treated in an outpatient setting. However, the type of burn injuries, frequency of burn injuries treated by dermatologists, and therapeutic approach is unknown.
OBJECTIVE: To assess burn injury incidence in a single center academic dermatology practice, and describe demographic characteristics of burn patients seen by dermatologists.
METHODS: A retrospective chart review analysis of 51 patients seen by 7 dermatologists from April 2010 to July 2014.
RESULTS: Of the 51 patients seen, burns from hot metal were the main mechanism of injury followed by contact with hot liquids. Silver sulfadiazine was the most commonly prescribed treatment. At the time of the visit 84.3% (n=43) had other dermatological conditions.
CONCLUSION: Our study demonstrates that burns are not frequently seen by dermatologists. We hypothesize that longer wait times in specialty practices, the lack of burn-specific training and the complexities of burn care prevent dermatologists from being first line providers in this arena. A larger epidemiological study is needed to further elucidate these issues.
J Drugs Dermatol. 2015;14(7):721-724.
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Burns are a type of trauma where a transfer of external energy leads to damage of skin and soft tissue that can potentially lead to physical and psychological disability. In the United States, it is estimated that there are over 1 million burn injuries per year.1 Of the 450,000 patients that received medical care for burns in 2013, the majority were treated in an outpatient setting.2 Burn care is known to be costly, and with rising healthcare expenditure cost-effective outpatient burn care is critical.3,4
Burns are complex injuries often requiring a multifaceted approach to treatment and evaluation in order to address pain, infection, pruritus and scarring.5 A 2001 study found that the formation of an interdisciplinary burn team including a dermatologist resulted in improved treatment compliance and a lower re-admission rate.6 Given the extensive training dermatologists receive on the physiology and pathophysiology of the integumentary system, one would assume that dermatologists would be first line providers in this arena. However, a thorough literature review revealed a lack of studies conducted in dermatology clinics in the United States that would confirm or refute this assumption. A study conducted in Taiwan, however, showed that as few as 15.9% of outpatient burns are seen by dermatologists, indicating the importance of epidemiological data about burns and burn treatment in these settings.7
While the National Burn Registry collects data on inpatient treatment and outcome, no such data is available for outpatient burn visits. In this single center study, we aimed to assess demographic characteristic as well as provide a perspective on epidemiological significance of burn injuries in a dermatology clinic.
PATIENTS AND METHODS
This study was approved by the Institutional Review Board of Albert Einstein College of Medicine of Yeshiva University. A retrospective chart review was conducted at the Einstein-Montefiore Division of Dermatology. Electronic medical records were queried to identify dermatology visits with a burn diagnosis using ICD-9 codes for burns (940.0-949.5). Patients presenting with sunburns were excluded from the study. The following parameters were collected: gender, age, burn etiology, degree of burn injury, body part affected, duration of injury and type of treatment received. Burns were classified using the following classification system: 1st degree (erythema, epidermal loss), 2nd degree (blisters with epidermal loss, bullae and erosions) and 3rd degree (full-thickness burns).