RESULTS
There were a total of 67 burn related visits distributed amongst 7 dermatologists from April 2010 to July 2014. Of these visits, 51 were initial consultations and 16 were follow-ups. Patient and injury characteristics are summarized in Table 1. The majority of the patients were female (84.4%). The mean age of the patients was 40.6±19.36 years, ranging from 1 to 91 years.
The most commonly reported etiologies were contact with metal (21.6%) followed by scald injury (17.6%). The average duration from the time of injury to visit was 8.6 days. Silver sulfadiazine was the most prescribed medication (52.9%) followed by mupirocin (15.6%) (Figure.1). In addition, the following dressings were used Telfa (n=2) and Xeroform (n=1). Out of 51 patients 33.3% (n=17) were categorized as 1st degree burns, with 2nd and 3rd degree burns in 31.4% (n=16) and 21.6% (n=11) patients, respectively. The upper extremity was the most commonly affected area (Figure 2). The majority of the patients (84.3%) sought medical attention for other dermatological conditions at the time of the visit.
DISCUSSION
In this single center study, we found that patients infrequently visited dermatologists with a burn as the chief complaint. Furthermore, the majority of these patients presented with additional reported dermatological comorbidities. This finding suggests that many patients presented for a separate dermatological complaint, and were treated for their burns incidentally, or that they had accessed dermatologic care in the past for a separate condition. We can speculate that perhaps patients do not consider their dermatologist for initial evaluation of their burns. Most of the burns were caused by direct contact with a hot object followed by scald burns whereas nationally, the most common cause of burns is fire/flame followed by scald burns.8 Most of the burns appeared to be unrelated to occupational exposure. Etiology of burn injury and body part affected are similar to patients presenting to an emergency department.9 While we noted many similarities between our patients and those treated in the emergency department, the frequency of dermatologic visits was significantly lower.9-11
It is unclear what accounts for the lower frequency of burn injuries seen in our study. Several factors, such as appointment availability for acute burn injuries, burn injury training during residency and continued exposure to the field of burn care, need to be further explored to account for these differences. For example, severe pain associated with thermal injury may force patients to seek immediate care.12 Furthermore, the low frequency of burns observed in our study may, in part, be explained by a shortage of dermatologists and the ensuing longer wait times for an appointment.13 A study done in 2008, showed that the average wait time for a new appointment to see a dermatologist was 33 days.13 Availability of follow-up appointments is critical, as burn wounds may require close monitoring for signs of infection and proper scar formation. To address this issue some practices have hired physician extenders; in fact, utilization of nurse practitioners and physician assistants has increased over the years, with shorter wait times in settings with these providers.13,14 Therefore, employing physician extenders may encourage patients to seek specialty care from their dermatologist by mitigating barriers to entry. Additionally, to accommodate patients presenting with acute pain individual practices can allocate urgent care appointments to see patients on an emergent basis.
In a joint effort, the American Counsel of Graduate Medical Education and the American Board of Dermatology have identified proper wound care and management as one of the
