Open access Protocol BMJ Open: first published as 10.1136/bmjopen-2018-023709 on 15 November 2018. Downloaded from Epidemiology of injuries, treatment (costs) and outcome in burn patients admitted to a hospital with or without dedicated burn centre (Burn-Pro): protocol for a multicentre prospective observational study Esther MM Van Lieshout,1 Daan T Van Yperen,1,2 Margriet E Van Baar,3,4 Suzanne Polinder,4 Doeke Boersma,5 Anne YMVP Cardon,6 Piet AR De Rijcke,7 Marc Guijt,8 Taco MAL Klem,9 Koen WW Lansink,10 Akkie N Ringburg,11 Maarten Staarink,12 Leon Van de Schoot,13 Alexander H Van der Veen,14 Floortje C Van Eijck,15 Percy V Van Eerten,16 Paul A Vegt,17 Dagmar I Vos,18 Marco Waleboer,19 Michael HJ Verhofstad,1 Cornelis H Van der Vlies1,2 To cite: Van Lieshout EMM, ABSTRACT Strengths and limitations of this study Van Yperen DT, Van Baar ME, Introduction The Emergency Management of Severe et al. Epidemiology of Burns (EMSB) referral criteria have been implemented injuries, treatment (costs) ► This study will provide insight into care of burn pa- for optimal triaging of burn patients. Admission to a burn and outcome in burn patients tients both in hospitals with and without a dedicated admitted to a hospital with centre is indicated for patients with severe burns or with burn centre. specific characteristics like older age or comorbidities. or without dedicated burn ► It is a prospective, multicentre, observational study centre (Burn-Pro): protocol Patients not meeting these criteria can also be treated with a best possible methodological design. for a multicentre prospective in a hospital without burn centre. Limited information is ► Participation of over 20 hospitals will increase the observational study. BMJ Open available about the organisation of care and referral of reliability and generalisability of the data. 2018;8:e023709. doi:10.1136/ these patients. The aims of this study are to determine Although the study will be mostly relevant for the http://bmjopen.bmj.com/ bmjopen-2018-023709 ► the burn injury characteristics, treatment (costs), quality Netherlands, it is also informative for other regions. ► Prepublication history for of life and scar quality of burn patients admitted to a this paper is available online. hospital without dedicated burn centre. These data will To view these files, please visit subsequently be compared with data from patients the journal online (http:// dx. doi. with<10% total bodysurface area (TBSA) burned who Ethics and dissemination This study has been exempted org/ 10. 1136/ bmjopen- 2018- are admitted (or secondarily referred) to a burn centre. If by the medical research ethics committee Erasmus MC 023709). admissions were in agreement with the EMSB, referral (Rotterdam, The Netherlands). Each participant will provide written consent to participate and remain encoded during EMMVL and DTVY contributed criteria will also be determined. equally. Methods and analysis In this multicentre, prospective, the study. The results of the study are planned to be on October 2, 2021 by guest. Protected copyright. observational study (cohort study), the following two published in an international, peer-reviewed journal. Received 19 April 2018 groups of patients will be followed: 1) all patients (no age Trial registration number NTR6565. Revised 21 August 2018 limit) admitted with burn-related injuries to a hospital Accepted 12 October 2018 without a dedicated burn centre in the Southwest Netherlands or Brabant Trauma Region and 2) all INTRODUCTIon patients (no age limit) with<10% TBSA burned who are © Author(s) (or their Burns cause significant morbidity and primarily admitted (or secondarily referred) to the burn employer(s)) 2018. Re-use mortality worldwide. Globally, some studies centre of Maasstad Hospital. Data on the burn injury permitted under CC BY-NC. No are available on the epidemiology of emer- commercial re-use. See rights characteristics (primary outcome), EMSB compliance, and permissions. Published by gency department (ED) treatments of burn treatment, treatment costs and outcome will be collected 1–8 BMJ. from the patients’ medical files. At 3weeks and at 3, 6 injuries, including three from the Neth- 7–9 For numbered affiliations see and 12 months after trauma, patients will be asked to erlands. These data were limited to home end of article. complete the quality of life questionnaire (EuroQoL-5D), and leisure accidents; work-related burn inju- and the patient-reported part of the Patient and Observer ries were not included. Correspondence to Professor Esther MM Van Scar Assessment Scale (POSAS). At those time visits, Depending on the severity, burn injuries Lieshout; the coordinating investigator or research assistant will may require specialised burn care. In order e. vanlieshout@ erasmusmc. nl complete the observer-reported part of the POSAS. to enable proper triaging and referral, Van Lieshout EMM, et al. BMJ Open 2018;8:e023709. doi:10.1136/bmjopen-2018-023709 1 Open access BMJ Open: first published as 10.1136/bmjopen-2018-023709 on 15 November 2018. Downloaded from to compare the injury pattern and outcome of these Box 1 Emergency Management of Severe Burns referral patients with burn patients with <10% total body surface criteria10 area (TBSA) burned who are admitted (or secondarily 1. The percentage total body surface area burned (TBSA referred) to a burn centre. We expect that burn patient burned; >10% TBSA in adults or >5% in children). admission outside the burn centre is restricted to a 2. Burns of special areas (face, hands, feet, perineum, genitalia and maximum of 10% TBSA, and that outcome is similar to major joints). that achieved for a subgroup with similar burn injury 3. Full thickness burns >5% TBSA burned. severity admitted to a burn centre. 4. Electrical burns. 5. Chemical burns. 6. Burns with associated inhalation injury. METHODS AND ANALYSES 7. Circumferential burns of limbs or chest. 8. Extremes of age (children and elderly). Study design and setting 9. Pre-existing medical disorders, which could complicate manage- This study will follow a multicentre, prospective, obser- ment and prolong recovery or effect mortality. vational study design (cohort study). Patients will be 10. Associated trauma. recruited from every hospital in two large trauma regions in The Netherlands, the Southwest Netherlands trauma region and Network Emergency Care Brabant. the Emergency Management of Severe Burns (EMSB) The Burn Centre of Maasstad Hospital is included in 10 referral criteria have been implemented (box 1). the Southwest Netherlands trauma area. The following In 2014, 322 patients with burns or inhalation injury 18 hospitals in The Netherlands will participate: Admi- were admitted to a hospital in the trauma region of South- raal De Ruyter Ziekenhuis (Goes), Albert Schweitzer west Netherlands. Of these patients, 109 (34%) were Ziekenhuis (Dordrecht), Amphia Ziekenhuis (Breda), admitted to hospitals without specialised burn centre. Beatrix Ziekenhuis (Gorinchem), Bravis Ziekenhuis There is a lack of insight into the epidemiology, treat- (Roosendaal), Catharina Ziekenhuis (Eindhoven), Elis- ment (including treatment costs) and outcome (both abeth-TweeSteden Ziekenhuis (Tilburg), Elkerliek Ziek- clinical results and quality of life) of the patients treated enhuis (Helmond), Erasmus MC, University Medical in hospitals without burn centre. Centre (Rotterdam), Franciscus Gasthuis and Vlietland In order to get insight into the epidemiology of burn (Rotterdam), IJsselland Ziekenhuis (Capelle aan de patients, detailed data collection on patient characteris- IJssel), Ikazia Ziekenhuis (Rotterdam), Jeroen Bosch tics, aetiology, burn injury characteristics, treatment and Ziekenhuis (‘s-Hertogenbosch), Burn Centre Maasstad outcome is critical. Such data are currently not avail- Hospital (Rotterdam), Máxima Medisch Centrum (Veld- able from current registries. The Dutch Burn Repos- hoven), Van Weel-Bethesda Ziekenhuis (Dirksland) and itory R3 only registers data for patients admitted to a ZorgSaam Zeeuws-Vlaanderen (Terneuzen). The study 11 burn centre. The National Injury Surveillance System started in September 2017 and the recruiting periods will http://bmjopen.bmj.com/ (in Dutch: Letsel Informatie Systeem; www. veiligheid. be 18 months. With a follow-up of 1 year, the presentation 12 nl) and the National Medical Registration (in Dutch: of data will be expected by the end of 2020. Landelijke Medische Registratie; www. dutchhospitaldata. nl)13 register non-admitted and admitted patients, respec- Study registration tively. Both are insufficient, as they register patients based The study is registered at the Netherlands Trial Register on the main diagnosis, which may not always be the burn (NTR6565; 12 July 2017). injury. The Dutch National Trauma Registry (in Dutch: Landelijke Trauma Registratie; www. lnaz. nl) registers all Recruitment and informed consent on October 2, 2021 by guest. Protected copyright. admitted trauma patients. It encodes burn wounds, but Eligible persons admitted with burn-related injuries (or with limited detail, and does not contain relevant treat- the parents of paediatric patients) will be informed about ment and outcome data. the study as soon as possible after hospital presentation. Based on the above, there are currently no data available They may receive the information at the ED or while that provide sufficient details about patients admitted to admitted at the surgical ward. The local staff will ask a hospital without burn centre. It is also not clear