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Epidemiology

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While the number of burn injuries is decreasing in the United States, nearly 1.25 million people are burned every year.1 Of these, 60,000–80,000 patients per year require hospitalization due to burn injuries, and about 5,500 of these patients die.1,2 Burns requiring hospitalization typically include burns greater than 10% of the total body surface area (TBSA) or significant burns of the face, hands, feet, or perineum.

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The highest incidence of burn injury occurs during the first few years of life and between 20 and 29 years of age. The major causes of severe burn injury are flame burns, which cause most of the burn deaths, and liquid scalds.

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From 1971 to 1991, burn deaths decreased by 40%, with a concomitant 12% decrease in deaths associated with inhalation injury.2 Since 1991, burn deaths per capita have decreased another 25% according to statistics from the Centers for Disease Control and Prevention (www.cdc.gov/ncipc/wisqars). These improvements are due to prevention strategies resulting in fewer burns of lesser severity, as well as significant improvements in the care of severely burned patients, especially children. In 1949, Bull and Fisher first reported the expected 50% mortality rate for burn sizes in several age groups based on data from their unit.3 They reported that approximately one half of children aged 0–14 years with burns of 49% TBSA would die.3 This dismal statistic has dramatically improved, with the latest reports indicating 50% mortality for 98% TBSA burns in children 14 years and under.4,5 A healthy young patient with any size burn might be expected to survive.6 The same cannot be said, however, for those aged 45 years or older. Improvements in this group have been much more modest, especially in patients over 65 years of age where a 35% burn still kills half of the patients.7 The improved survival figures after massive burns are due to advances in understanding of resuscitation, improvements in wound coverage by early excision and grafting, better support of the hypermetabolic response to injury, early nutritional support, more appropriate control of infection, and improved treatment of inhalation injuries. Aggressive treatment of patients with severe burns has improved outcomes to the point that survival in massive injuries is common. Future breakthroughs in the field are likely to be in the area of faster and better return of function and improved cosmetic outcomes.

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Criteria for Referral to Burn Centers

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Some burn patients benefit from treatment in specialized burn centers. These centers have dedicated resources and the expertise of all the required disciplines to maximize outcomes from such devastating injuries.8 The American Burn Association and the American College of Surgeons Committee on Trauma have established guidelines about which patients should be transferred to a specialized burn center. Patients meeting the following criteria should be treated at a designated burn center:

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