The Journal of burn care & rehabilitation
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J Burn Care Rehabil · Nov 1991
Randomized Controlled Trial Comparative Study Clinical TrialBurn size estimate reliability: a study.
A study was undertaken to assess any differences between physicians' and nurses' estimates of burn size from drawings of 10 hypothetical patients with burns. Patient drawings were sent to the 199 burn facilities that are listed in the American Burn Association's Burn Care Resources in North America 1989-1990. The mailings were randomized between physicians and nurses. ⋯ Estimates of burn sizes with the use of standardized burn forms were consistently the same whether estimates were made by physicians or nurses. Sixty-eight percent of the respondents used the Rule of Nines or the Lund & Browder chart to estimate burn size, but 21% of the respondents failed to answer the question about which method is used in their units. In conclusion, there appears to be little variance in estimation of burn size as made by experienced burn nurses and physicians, and use of these estimates in a centralized data bank should be reliable.
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J Burn Care Rehabil · Nov 1991
Comparative StudyA prospective safety study of femoral vein versus nonfemoral vein catheterization in patients with burns.
A prospective study was undertaken to determine the safety of femoral vein catheterization in patients with burns. Forty-two patients had a total of 275 catheterizations and were divided into two groups: group 1, femoral vein catheterization = 80 catheters and group 2, nonfemoral vein catheterization = 195 catheters (180 subclavian, 8 internal jugular, and 7 supraclavicular). All catheters were changed to new sites every 48 hours, and dressings were changed every 24 hours. ⋯ There were no noninfectious complications from femoral vein catheterization. Two subclavian catheters had to be repositioned. This study suggests that central venous access in patients with burns can be safely employed with the use of the femoral vein.
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J Burn Care Rehabil · Nov 1991
Comparative StudyCultured epithelial autografts: three years of clinical experience with eighteen patients.
Eighteen patients with major burns (mean total body surface area burned was 49% and mean total body surface area with full-thickness burns was 38%) had cultured epithelial autografts applied to 2% to 35% of the body surface area. In six patients successful "take" of greater than 65% occurred, and in 12 patients less than 40% "take" occurred. Most wounds underwent early excision to subcutaneous fat or fascia, and the wounds of 16 patients had been treated previously with homograft. ⋯ The anterior trunk and thighs are the best recipient sites. The number of autograft harvests that were required to close wounds and the length of hospital stay were not significantly decreased by the use of cultured epithelial allografts as compared with comparable full-thickness burns that were treated previously without cultured epithelial allografts. Presently, grafting with cultured epithelial allografts is an adjunct but not an alternative to conventional burn-wound coverage with split-thickness autograft, because engraftment is inconsistent.
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J Burn Care Rehabil · Nov 1991
Do trauma scores accurately predict outcomes for patients with burns?
A highly refined quality assurance program relies on accurate outcome evaluations and the identification of patients who are truly worthy of peer review. In our hospital, the Glasgow Coma Score, the Trauma Score, and the Injury Severity Score are used to monitor patients with burns. ⋯ Linear regression techniques demonstrated that only the Baux Score, the Edlich Burn Score, and the Zawacki Score were correlated with length of stay (p less than 0.01). On the basis of this retrospective review, the Baux Score, the Edlich Burn Score, and the Zawacki Score more accurately predicted outcomes for patients with burns than did the Trauma Score, the Injury Severity Score, and the Glasgow Coma Score; these scores can thus provide the most valuable information for quality assurance activities.
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J Burn Care Rehabil · Nov 1991
Quantitative threshold changes in cutaneous sensation of patients with burns.
Decreased cutaneous sensation is common after burn injury. This study was designed to quantitate threshold sensory loss with the use of a microcomputer-based sensory testing device that generated precisely controlled stimuli. Threshold evaluations of two-point discrimination, pinprick, warming, touch, and vibration were performed on patients with burns (n = 16) and on control subjects (n = 42). ⋯ When controls for age were applied, touch and vibration thresholds remained significantly elevated above control levels, and decreases in significance for two-point discrimination and warming were noted. It was concluded that sensory function is reduced in patients with burns. Alternative mechanisms that may have caused the sensory changes were discussed.