Trauma system management of adults with severe burns in Victoria, Australia

Objectives

The aim of the present study was to examine the profile, management and outcomes of adult patients with severe burns within the Victorian State Trauma System (VSTS).

Methods

Data from the Victorian State Trauma Registry (VSTR) was analysed to characterise patient and injury characteristics and review pre-hospital management and clinical outcomes of adult patients with severe burns.

Results

There were 421 cases over 13 years of the study. Approximately 80% of cases were flame burns, and 5% were associated with other significant trauma. Approximately 75% were male; with 83% of patients under 65 years old, 40% of lower socioeconomic status, 25% having pre-existing drug and alcohol involvement, and 36% living with associated comorbidities. All but 11 patients (of 421) were managed definitively at the burns service. Around one-third of patients had interhospital transfer, with median (interquartile range (IQR)) time spent in the primary hospital 3.0 (1.9–4.3) h. Only five patients had multiple interhospital transfers. Nearly 75% of patients were admitted to an ICU. The median (IQR) length of definitive hospital stay was 27.2 (11.2–44.9) days. The mortality rate was 23.8%.

Conclusions

Severe burns are uncommon injuries with high mortality. There is a high rate of adherence to VSTS guidelines for managing patients with severe burns, and a decrease in patients requiring transfer associated with an increase in acceptable time to a trauma-receiving hospital. The VSTS operates to deliver almost all patients with severe burns to the definitive burns service efficiently.