Epidemiology and registration
- Implementation, consolidation and further development shared registration system R3
- Insight in epidemiology of burn injuries in general and of specific high risk groups, based on the combined historical database of Dutch burn centres
- Development of methodology of economic evaluations in burn care
- Insight in cost-effectiveness of (specific interventions) in burn care
- Development of evidence-based clinical guidelines in burn care
In the past years the main goal was to develop a uniform burn-specify registration reference database, to be able to conduct epidemiological studies into process and outcome of burn care. In the three Dutch burn centre’s a new shared registration system is developed, named R3 (registration with 3 centres). The version R3.1 was implemented in the three centres in January 2009.
The current version of R3 includes the essential information on burn patient, treatment and outcome. A first extension will include patient data on the reconstruction phase. Adaptation and extension of the database will be considered in close cooperation with the actual users, to keep up to date with developments in burn care and to enhance comparability with international registries.
In 2008 we successfully started the generation of one historical database, based on the three historical databases from Beverwijk, Groningen en Rotterdam. This database enables us to give nationwide incidence data on burn injuries admitted to burn centers
With this historical database, we aim to give an overview of the epidemiology of burn injuries over the past 20 years in the Netherlands. Next, we want to focus on the epidemiology of specific high risk groups within the population of patients with burn injuries, for instance patient with inhalation trauma.
Economic evaluation studies
We aim to develop a research line into the ‘Economic evaluation of burn care’. Recently, we started the data collection for a cost-effectiveness analysis alongside the 4-arm multicentre trial, comparing the addition of a dermal matrix, Matriderm, either or not in combination with topical negative pressure to the standard treatment of split skin grafts in patients with deep dermal and full thickness burns. A second step will be to conduct an economic evaluation study regarding the diagnosis of burn depth with an existing laser Doppler imaging technique
We will conduct these studies in close cooperation with experts in the field of economic evaluations from the Department of Public health, Erasmus Medical Centre.
In the future we aim to develop a Quality Programme, in close cooperation with the clinical research programme The economic evaluation of burn care will be one of the research lines within this programme.
Another line is the development of guidelines and protocols. As a first step, we are conducting a Cochrane review into the effectiveness of topical interventions in facial burns. We aim to support the development of specific clinical guidelines, in close collaboration with clinicians from the Dutch burn centres.
The programme Epidemiology and Registration lacked substantial staff until the end of 2007. Then, Margriet.E. van Baar PhD was appointed as programme leader. In addition, from 2008 on, two senior burn physicians started their fellowships.
Mortality and causes of death in a burn centre.
Bloemsma GC, Dokter J, Boxma H, Oen IMMH, from Rotterdam Burn Centre
Burns. 2008 Dec;34(8):1103-7
Mortality rates are important outcome parameters after burn, and can serve as objective end points for quality control. Causes of death after severe burn have changed over time; in the international literature, multisystem organ failure is seen as the most important cause, but the exact distribution of causes of death remains unknown. Insight into underlying agents of mortality can be directive in research and prevention programmes.
This comparison between results from the Rotterdam Burn Centre (RBC) and the American National Burn Repository (NBR) examines the most important predictive parameters for fatal outcome, i.e. age,total body surface area involved and presence of inhalation injury. Causes of death were attributed for all fatal outcomes treated in the RBC from 1996 to 2006. The mortality rate at the RBC was 6.9% and at the NBR was 5.6%, with almost no differences in age or total body surface area involved. The discrepancy in mortality rate might have been due to the high incidence of inhalation injury among the RBC population. However, the mortality rate at the RBC after admission with intention to treat decreased to 4.9%. The most frequent cause of death appeared to be multisystem organ failure, in 64.9% of cases; 93% of these had systemic inflammatory response syndrome at time of death and, in 45.9%, infection was deemed responsible for the fatal clinical deterioration (in 21.3% sepsis was proved and in 24.6% was highly suspected).
To compare mortality rates between different burn centres and periods of time, uniform classifications are needed, particularly for presence of inhalation injury and for causes of death. Prevention of multisystem organ failure, by better management of infection and systemic inflammatory response syndrome, might do most to decrease mortality after burn.
Impact burn care
Insight in the incidence, diagnosis, treatment and outcome of burn injuries, activities aimed at the prevention of burn injuries can be improved. Knowledge of high risk population enables a tailored primary prevention in society. In addition, insight in the determinants of suboptimal outcome after burns can be used to optimize treatment and aftercare in these patients.