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Letters
Major burns: incidence, treatment and outcomes in Aboriginal
and non-Aboriginal people in Western Australia
MJA 2005; 182 (3):138
Fiona M Wood,* Bess V Fowler,† Daniel McAullay,‡ Jocelyn R Jones§
* Plastic Surgeon and Director, † Epidemiologist, Burns Service
of Western Australia, Royal Perth Hospital, GPO Box X2213, Perth,
WA 6847; ‡ Senior Policy Officer, § Manager, Office of Aboriginal
Health, Health Department of Western Australia, Perth, WA. FionawATmccomb.org.au
To the Editor: People with major burn injuries (50% total body
surface area or more) now have an improved likelihood of survival
with the implementation of aggressive treatment regimens, including
supportive therapy, nutrition, and advances in the control of
sepsis. Technological developments and treatments, particularly
expedient wound closure, early surgical debridement, covering
of large burn wounds, early skin repair,1 use of cultured epithelial
autograft2 and ventilation,3 have also contributed to improved
outcomes for people with these injuries.
In Australia, there are inequities in access to health services
which may particularly affect Aboriginal people.4 We therefore
undertook a retrospective, observational study to compare the
incidence of major burn injuries, clinical and demographic characteristics
of patients with burns, as well as treatment and outcomes between
Aboriginal and non-Aboriginal children and adults in Western Australia
between 1992 and 2002. Potential cases were identified using data
linkage from the Western Australian Department of Health. Raw
data came from clinical records.
Of the 84 people identified with major burn injuries, nine were
Aboriginal (11%) and 75 were non-Aboriginal (89%). The incidence
of major burn injury among Aboriginal people is greater than expected,
as data from 2001 show that 3.5% of the WA population are Aboriginal.
Aboriginal people with major burn injuries were younger than
non-Aboriginal people with those injuries (mean, 21 v 35 years).
Eight of the nine Aboriginal people (89%) had flame-only burns,
compared with 33 of 75 non-Aboriginal people (44%). No statistically
significant difference was seen between the groups in the percentage
of total body surface area affected, provision of treatment (including
number of operative procedures, applications of cultured epithelial
autografts, units of blood products used, nasogastric feeds, and
antibiotic doses) or length of hospital stay.
We found that, although a greater percentage of Aboriginal people
sustained major burn injuries, after this group entered the hospital
system they experienced comparable levels of service and outcomes
to non-Aboriginal people. Further research into burn care is warranted,
from culturally and environmentally appropriate prevention through
to critical appraisal of outcomes.
References
Wood FM. Quality assurance in burns patient care:
the James Laing Memorial Prize Essay 1994. Burns 1995; 21: 563-568.
<PubMed>
Carsin H, Ainaud P, Le Bever H, et al. Cultured epithelial autografts
in extensive burn coverage of severely traumatized patients: a
five-year single-center experience with 30 patients. Burns 2000;
26: 379-387. <PubMed>
Papini RP, Wood FM. Current concepts in the management of burns
with inhalation injury. Care Crit Ill 1999; 15: 61-66.
Henry BR, Houton S, Mooney G. Institutional racism in Australian
health care: a plea for decency. Med J Aust 2004; 180: 517-519.
<PubMed><eMJA full text>
(Received 25 Jun 2002, accepted 24 Jul 2002)
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