Burns can be among the most devastating of injuries. Following the formulation of practice guidelines (PGs) that addressed the care and management of burn injuries in developed countries, the International Society for Burn Injuries (ISBI) has updated these recommendations to guide the improvement of care of burn patients in resource-limited settings (RLS). Published in Burns, the official journal of ISBI, these guidelines are an important step in ISBI's global effort to achieve "one world, one standard of care."
Burn care, especially for severe burns, can involve multiple steps and multiple medical specialties over an extended time. Given the modesty of service, as well as lack of access to scientific publications and critical appraisal expertise among burn care givers in developing countries, ISBI proposed evidence-based practice guidelines in an endeavor to enhance and standardize burn care worldwide.
The extensive "ISBI Practice Guidelines for Burn Care" presents best-practice recommendations for improved patient care and outcomes, discussions, and cost considerations, with specific emphasis on resource-limited environments. It covers a comprehensive range of topics including initial assessment and stabilization, resuscitation, wound care, potential surgical interventions, infection prevention, nutrition management, scar prevention, and rehabilitation.
"The mission of the 2015-16 committee established by ISBI was to create PGs for burn care to improve the care of burn patients in both RLS and resource-replete settings," explained Michael D. Peck, MD, ScD, Director, International Outreach and Ambulatory Services, Arizona Burn Center, and co-chair of the ISBI Practice Guidelines Committee. "An important component of this effort is to communicate a consensus opinion on recommendations for burn care for different aspects of burn management. The guidelines for burn care also make possible the comparison among the burn units all over the world, promoting the quality of burn care. An additional goal is to reduce costs by outlining effective and efficient recommendations for management of medical problems specific to burn care. These recommendations are supported by the best research evidence, as well as by expert opinion. Although our vision was the creation of clinical guidelines that could be applicable in RLS, the ISBI PGs for burn care have been written to address the needs of burn specialists everywhere in the world."
In an accompanying editorial, Rajeev B. Ahuja, MS, MCh, DNB, President, International Society for Burn Injuries, from the Department of Burns and Plastic Surgery, Lok Nayak Hospital and Associated Maulana Azad Medical College, New Delhi, India, and co-chair of the ISBI Practice Guidelines Committee, emphasized some of the challenges associated with providing burn care in the developing world. He noted that burn mortality rates are nearly six times higher in low- and middle-income countries than in high-income countries and that fire-related burns account for 10 million disability-adjusted life years lost every year.
"Having worked for over three decades in a very poor country with an extraordinarily high burn incidence, I considered it a 'no brainer' that the majority of burn patients were being managed by specialists who were not trained in burn management; such training didn't exist in curricula for graduate or postgraduate courses in surgery," said Dr. Ahuja.
ISBI has created these practice guidelines as a guide to burn care for RLS, one that would finally be written in a manner that addressed the needs of all burn specialists everywhere in the world. Dr. Ahuja commented that "many more randomized controlled trials, meta-analyses, and systematic reviews will be required before cost-effective models of care can be proposed for universal adoption. Once this is accomplished, however, our aspiration is to transform an approach to burn care from an ability to spend to a standard of care based on the necessity of expense."