Subject(s)
Melanoma , Skin Neoplasms , Humans , Skin Neoplasms/diagnosis , Skin Neoplasms/psychology , Melanoma/diagnosis , Skin , Adaptation, PsychologicalSubject(s)
COVID-19 , Infection Control , Occupational Exposure/prevention & control , Plastic Surgery Procedures , Skin Neoplasms , Time-to-Treatment/statistics & numerical data , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19/psychology , Health Services Misuse/prevention & control , Health Services Misuse/statistics & numerical data , Humans , Infection Control/methods , Infection Control/organization & administration , Needs Assessment , Plastic Surgery Procedures/methods , Plastic Surgery Procedures/standards , Plastic Surgery Procedures/trends , SARS-CoV-2 , Skin Neoplasms/diagnosis , Skin Neoplasms/epidemiology , Skin Neoplasms/surgery , Wales/epidemiologyABSTRACT
INTRODUCTION: Globally, many burns units moved away from colloid resuscitation in response to the Cochrane review (1998). Recent literature has introduced the concept of fluid creep: patients receiving volumes far in excess of the upper limit of the Parkland formula. The Cochrane review has been widely criticised, however, and we continued to use 4.5% human albumin solution after 8 h of crystalloid as a hybrid of Parkland and Muir & Barclay's regime. METHODS: Adult patients ⩾15% TBSA were identified from data prospectively entered into our database over a 5-year period (2003-2008). Medical notes and intensive care charts were reviewed comparing volumes of fluids received with requirement estimates. Adverse events were also documented. RESULTS: A total of 72 cases with 34 sets of intensive care charts were analysed. Mean TBSA was 35.2% (range, 15-95%). A total of 75% survived; 3% were haemofiltered. Forty-one percent of patients were resuscitated using the Parkland formula alone, while 59% switched at 8 h post burn to the Muir and Barclay formula (Hybrid group). There was a significantly greater TBSA in the Hybrid group, but they received significantly less fluid volumes than the Parkland group (P = 0.0363; the Hybrid group received 1.36 times calculated need vs. 1.62 in the Parkland group). CONCLUSION: Our patients still demonstrate fluid creep, but to a lesser extent than previously reported. Fluid creep has been mitigated but not eliminated through this strategy.
ABSTRACT
It has been accepted for many years that the cost of care for the burn-injured patient is high. There is, however, little published data to show how "expensive" it is. At the Welsh Centre for burns we have undertaken a costing exercise in an attempt to define the true cost to the treatment of burns. Using our current cost base and activity, we established a cost per health related group (HRG) for burns and also prospectively calculated costs for three inpatients to determine whether HRG-based burn tariffs accurately represent these costs. The NHS is under increasing pressure to provide evidence to support budgetary requirements; we feel this paper offers a framework for burn care costing upon which calculations could be based.
