A retrospective, non-inferiority study of a Treat-at-Home strategy utilizing a surfactant-based dressing for partial-thickness burn wounds.

Abstract

Partial thickness (PT) burns are the most common depth of burn seen in emergency departments. This study aimed to evaluate the outcomes of patients managed with a treatment-at-home (TAH) strategy using water-soluble surfactant dressing (WSD) compared to any other dressing (non-WSD). This single-center, retrospective study included all patients with thermal burns treated in the burn center-specific emergency department between May 2019 and May 2023. Patients were excluded if admission was deemed necessary during the initial emergency department assessment. Additionally, patients were excluded for having first degree burns, full-thickness burns, electrical burns, being less than 18 years old, pregnant or incarcerated, or not expected to survive. The planned enrollment was designed to fulfill non-inferiority and potential superiority of surfactant-based dressing versus any another TAH strategy. Two-thousand seven-hundred forty-seven patients were screened over the four-year study. After applying exclusion criteria, 1,001 patients remained in the study group. There were no differences in demographics and injury mechanism, except the non-WSD group contained more patients that were cocaine positive (p = 0.009)and had burns to the head/neck (p < 0.0001). Few in the WSD or non-WSD group required subsequent admission for burn wound excision [5 (1.0%) vs. 2 (0.4%)] although the non-WSD had significantly fewer return for follow up [336 (68.71%) vs 273 (53.32%), p < 0.001]. This is the largest study to evaluate the use of WSD for immediate treatment of PT burns to avoid admission. WSD was found to be non-inferior to other non-WSD TAH strategies. But no matter the choice of home wound treatment, few required subsequent admission for surgery. Given the success of both groups, a TAH model, when feasible, could allow patients to recover at home and result in cost and resource savings associated with admission.