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| COMMENTARY |
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| Year : 2012 | Volume
: 20
| Issue : 1 | Page : 55-56 |
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Commentary on "Socio-economic Burden of burns: How do families of patients cope?"
Michael Peck
The Arizona Burn Center, Maricopa Medical Center, Phoenix, Arizona, Department of Surgery, University of Arizona College of Medicine, Phoenix, Division of Community, Environment and Policy, Mel and Enid Zuckerman College of Public Health, University of Arizona Health Sciences Center, Tucson
| Date of Web Publication | 13-May-2013 |
Correspondence Address:
Michael Peck
Arizona Burn Center, Maricopa Medical Center, 2601 East Roosevelt Street, Phoenix, Arizona USA 85008
 Source of Support: None, Conflict of Interest: None  | Check |
How to cite this article:
Peck M. Commentary on "Socio-economic Burden of burns: How do families of patients cope?". Indian J Burns 2012;20:55-6 |
In 2004, incidence of burns severe enough to require medical attention was nearly 11 million people, [1] fourth in all injuries behind road traffic accidents, falls, and interpersonal violence - this is higher than the combined incidence of tuberculosis and HIV infections, and just slightly less than the incidence of all malignant neoplasms. Most burn injuries lead to prolonged and expensive hospital stays. In addition to pain management and wound care, burn patients require attention to nutritional deficiencies, to the consequences of suppression of the immune system and to rehabilitation therapy. In the USA, the average hospital charges for care of a patient with extensive third-degree burns requiring skin grafting is more than 52 lakh rupees. [2] Yet in spite of this lavish medical care, many burned patients leave hospitals in the USA with permanent physical and psychological scars.
In high-income countries, this means that burn survivors from struggling family backgrounds are likely to have problems reassimilating into school and community. In low-and middle-income countries, the consequences are direr, with isolation from or even abandonment by the family, social segregation, unemployment, and extreme poverty. Survivors develop burn wound contractures and other physical impairments that limit function, lead to handicaps and reduce their chance of leading economically productive lives. Additionally, these disfigurements often result in social stigma and restriction in their participation in society. Although, burn victims from affluent families in low income countries (LIC) have a chance of recuperation, the vast majority of burn survivors will start from living situations that deny them the opportunity to recover from even a small burn.
The authors of the manuscript entitled, "Socio-Economic Burden of Burns: How Do the Families of Patients Cope?" have made a significant contribution to our understanding of the devastating economic impact associated with recovery from burn injuries. There can be no question about the pain and suffering - both bodily and emotional - endured by patients and their families as they recuperate from burn injuries. Now the authors have provided us with evidence of the economic suffering experienced as well.
More importantly, the authors have also documented that the mode of treatment employed can significantly affect the economic burden of burn care. For early excision and grafting, the average total expenditure (including direct medical costs and indirect costs to the families) was Indian national rupees (INR) 60,000, which was a 73% reduction in the costs associated with delayed surgery. The bulk of this reduction (80%) was due to the decrease in direct medical costs, presumably related to lessening of the length of stay, which was nearly cut in half by early surgery.
These results are of course consistent with previously published reports and cumulative experience over the years with early excision and grafting of burns. For example, Engrav et al., from the University of Washington noted as early as 1983 that compared to non-operative treatment with silver sulfadiazine cream, early excision, and grafting resulted in shorter hospitalization, lower cost, and less time away from work. [3] Both length of stay as well as hospital and physician costs were reduced by 30%, and patients were able to return to work 2.5 months earlier on average.
Of course, the primary advantages of early excision and grafting of burns lie in the clinical benefits, such as reduction in morbidity and mortality, as well as improved functional and cosmetic outcomes. Nevertheless, as health care institutions make the transition from the traditional approaches of conservative (non-operative) or delayed surgical treatments, there needs to be clear evidence of the gains offered by early excision so that convincing arguments can sway reluctant patients, families, fellow health care workers, and hospital administrators. This elegant piece of work offers significant support for persuasion of the doubtful, because it clearly demonstrates the amelioration of potentially crippling economic burdens on burn survivors. The authors are to be applauded for their efforts and for their contribution.
| References | |  |
| 1. | The Global Burden of Disease: 2004 Update. Geneva [CH]: World Health Organization; 2008. Available from: http://www.who.int/healthinfo/global_burden_disease/GBD_report_2004update_full.pdf. [Last accessed 2013 Feb 21]. 
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| 2. | National burn repository (2012 report). Chicago IL: American Burn Association; 2012. Available from: http://www.ameriburn.org/2012NBRAnnualReport.pdf. [ Last accessed 2013 Feb 20].
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| 3. | Engrav LH, Heimbach DM, Reus JL, Harnar TJ, Marvin JA. Early excision and grafting vs. nonoperative treatment of burns of indeterminant depth: A randomized prospective study. J Trauma 1983;23:1001-4.
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