The Journal of burn care & rehabilitation
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The subjective assessment of scar appearance is a widely used method in the evaluation of burn outcomes and the efficacy of treatment methods. The purpose of this study is to design a numeric scar-rating scale with better interrater reliability than has previously been reported. The rating scale assesses scar surface, thickness, border height, and color differences between a scar and the adjacent normal skin. ⋯ The raters then rated 10 photographs of different scars, referring to the teaching set of pictures for comparison. The intraclass correlation (interrater reliability) was 0.94, 0.95, 0.90, and 0.85 for scar surface, border height, thickness, and color, respectively. This rating system has proved to be a useful tool for the evaluation of scar surface, thickness, border height, and color.
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J Burn Care Rehabil · Jul 1997
Randomized Controlled Trial Clinical TrialStudy of antibiotic prophylaxis during burn wound debridement in children.
Twenty-three children completed a randomized, prospective, partially blinded study performed to assess the need and effectiveness of antibiotic prophylaxis at the time of burn wound debridement and grafting. Patients with a total body surface area (TBSA) burn less than 35% were randomized to receive cefazolin or placebo. Patients with burns of 35% or more TBSA were randomized to receive cefazolin or targeted antibiotics based on surveillance cultures. ⋯ All receiving cefazolin developed burn wound infection. Quantitative tissue culture was more than 10(5) colony-forming units per gram in all, whereas histologic examination was positive in one. In our patients with less than 35% burn, cefazolin was not necessary, and in those with 35% or more burn, it was not effective.
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J Burn Care Rehabil · Jul 1997
Comparative StudyMuch ado about nothing: methicillin-resistant Staphylococcus aureus.
The pathogenic methicillin-resistant Staphylococcus aureus (MRSA) has received a voluminous amount of notoriety. The four major reasons are its morbidity, mortality rate, cost of treatment, and constant appearance in intensive care units. Both Staphylococcus aureus and S. epidermidis (MRSE) account for 82% of our gram-positive wound isolates, whereas the gram-negative account for 34% of all isolates. ⋯ During this period there were 47 gram-negative infections requiring 10 to 15 additional days of hospital stay, with a daily antibiotic cost of $293.40. Costs for MRSA or MRSE are 28% less. Therefore our preoccupation with MRSA or MRSE infections is unwarranted and unsubstantiated.
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A concerted effort to decrease resource usage and length of stay without sacrificing quality of care was undertaken over a 2-year period in a high-census Burn Center. Through a series of changes in practice, substantial decreases in the costs of several high-usage items were tracked. During this period the average length of stay also was decreased. ⋯ During this period there was no significant change in the patient population as measured by total body surface area percentage burn and acuity level. With the exception of significant improvement in the infection rate, there was no substantial change in indicators of quality care as measured by readmission, morbidity, and posthospital would healing progression. This cost-reduction program showed that costs can be reduced without diminishing quality of care; in some respects quality of care improved due to the practice changes that were implemented.