Author: Ken Dunn

Burn Injury Telereferral system

An online burns referral system has been designed and produced by Medical Data Solutions and Services (MDSAS.com) on behalf of NHS England and the burn care Clinical Reference Group. It was piloted in Greater Manchester from May 2017 and proved highly successful. Currently, the system is being rolled out nationally. Referrals are submitted online by the referrer using an NHS Net web link the only requirement being the need to submit an NHS e-mail address. Clinical photographs and x-ray images can be attached to the electronic referral directly or by using a secure NHS-compliant app SiD (Secure Image Data). A short video of the application is available here: https://www.youtube.com/watch?v=vNbi52ZXVPA

Use of the system has reduced the number of cases transferred for assessment by over 60%.

The system has also been used to allow patients to upload their own wound or scar images post discharge to allow remote monitoring and management.

National Burn Awareness Day October 2020

The latest NBAD was a success despite the difficulty for burn services to collaborate with Fire Services and media in the promotion of the key messages which centred on the effect of the Covid-19 pandemic on the number and types of burn injury being seen in England and Wales and the clear association of burn injury with social and financial deprivation across all age groups. There where also messages about trying to avoid firework and bonfire related injuries during lock down.

Press Release for 14 Oct 2020

Worst off families in England and Wales most at risk of burn injuries to children

Today, on National Burn Awareness Day 2020, the Children’s Burns Trust and British Burn Association are campaigning to highlight a concerning correlation between social deprivation and the number of children sustaining life-altering burn injuries.

New data from the International Burn Injury Database (iBID), shows a clear link between children living in the most deprived areas of England and Wales and those who are admitted to a Specialist Burns Unit following a burn or scald injury. Children living in the top ten socially deprived areas are X times more likely to be burned or scalded than those living in the more affluent areas of England and Wales.

The Children’s Burns Trust and British Burn Association, have released this exclusive insight to raise awareness of the devastating number of children that are, on a daily basis, affected by life-altering burn injuries, and to promote the right burn-related first aid to parents, carers, grandparents and others involved in the care of children.

The data also highlights the top causes of burn injuries in children, with those under 5 being most at risk from hot drink spills, such as tea and coffee.

Older children, those in the 15 – 24-year age group, are most at risk from firework injuries and fires outside the home. The data shows….With Bonfire night fast approaching and organised firework displays being unable to take place due to Covid-19 restrictions, experts are concerned that injuries from these sources may increase this autumn/winter. Due to the many families who will take it upon themselves to organise their own firework displays at home.

The core aim of National Burn Awareness day is to urge families to be aware of the risks to children. A burn injury is for life, the scars are physical as well as psychological, and can present life-long challenges for the individual and their families.

case study quote:

Ken Dunn, Consultant Burn and Plastic Surgeon and Trustee of The Children’s Burns Trust, whose work is focused on children and their families said: “Looking at the correlation between deprivation and burn and scald injuries so far in 2020 brings into stark reality how important it is to raise awareness of the everyday dangers children are facing, especially around this time of year when firework injuries are most likely to occur. The vast majority of burn injuries are accidents, and most are entirely avoidable. On National Burn Awareness Day 2020, we need to see greater awareness about prevention and good first aid, both of which are key to reducing the number of injuries.”

Hundreds of NHS Services, Fire and Rescue Services, along with other organisations, come together each year on National Burn Awareness Day to raise awareness of the alarming number of people burned each and every day in the UK – the vast majority of which are preventable. The campaign also helps to promote the vital message of the importance of good first aid if a burn or scald does occur: COOL for 20 minutes under cool running water, CALL 999 OR 111 or your GP for advice, COVER the burn loosely with cling film.

All statistics have been provided by the International Burn Injury Database (iBID), incorporating data collected from all NHS Burn Services in England and Wales, they do not include the minor burns and scalds that are treated by Accident and Emergency Departments.

Lecture delivered by Mr Ken Dunn

Changing epidemiology of burn injuries in the UK: effective prevention programs?

In much the same way as any experiment a baseline of activity needs to be established followed by a well-designed intervention with the measurement of any subsequent change. The difficulty with injury prevention is that there are so many confounding factors that may influence over baseline and the results and that interventions are not single events but have been proven to require sustained effort and thus funding.

Recent technological developments and the availability of social media almost all have brought about different ways of accessing the population and influencing the behaviour. These appear to be having some effect in the absence of any identifiable other reason.

“How often have I said to you that when you have eliminated the impossible, whatever remains, however improbable, must be the truth?” ― Arthur Conan Doyle, The Sign of Four

Colebrook, L. (1951). The prevention of burning accidents in England and America. Bulletin of the New York Academy of Medicine, 27(December 1950), 425–438. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1930087/

Keswani, M. H. (1986). The prevention of burning injury. Burns, Including Thermal Injury, 12(8), 533–539. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/3454686

Keswani, M. H. (1996). The 1996 Everett Idris Evans Memorial Lecture. The cost of burns and the relevance of prevention. J Burn Care Rehabil, 17(6 Pt 1), 485–490. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/8951534

Peck, M. D. (2011). Epidemiology of burns throughout the world. Part I: Distribution and risk factors. Burns: Journal of the International Society for Burn Injuries, 37(7), 1087–1100. https://doi.org/10.1016/j.burns.2011.06.005

iBID Information Service

From a survey of all burn services and contributors to the iBID in 2015 it was clear that there was a desire to have access to the national dataset to allow flexible queries to be applied to national data.  It was felt the current series of reports provided were too restrictive.

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Site Specific Reports

The latest analysis of site specific reports have now been produced and sent out. Each quarter a series of reports are produced and sent directly to Burn Services.

All reports are derived using the most recently updated iBID software, which has successfully been deployed in all English and Welsh Burn Services. The reports are based on some of the the original templates in use over recent years but have been reduced in number in line with user feedback.

The a far more comprehensive set of web based reporting tools, configurable by the user, the iBID Information Service was released in early 2017.

Some general reports are accessible to non-registered / public users. The design of burn service reports for public use is under way as an extension to the iBID Information Service.

Any identified data problems may be local and may need resolution by the Burn Service with support from the Burn Care Network Manager, whilst others may represent technical problems requiring support from the iBID team centrally.

National Burn Awareness Day October 2019

Press Release:

Surgeons warn of lifelong consequences of severe burns – as new figures show there were over 35,000 child admissions in the past five years

• 49% (17,052) of child admissions to designated specialised burn services in the past five years involved scalds from hot food or drink.
• 51% (1,576) of child admissions for scalds to designated specialised burn services in 2018 involved children aged 0-2 years.
• 57% of the admissions to designated specialised burn services among 0-2 year-olds in 2018 related to hot tea or coffee spillages.
• The Royal College of Surgeons of England is backing this year’s “SafeTea Campaign” as part of National Burns Awareness Day.7

Plastic surgeons from the Royal College of Surgeons of England (RCS) and the British Burn Association are warning that children can face years of gruelling operations and treatment following preventable burns or scalds, such as from hot tea or coffee spillages. New figures from the International Burn Injury Database (iBID) show there were 35,007 child admissions to specialist burns hospitals in England and Wales in the past five years (2014-2018).

The figures show that almost half – 49% (17,052) – of child admissions to designated specialised burn services, in the past five years, involved children who had been scalded by hot food or liquid spillages. The Children’s Burns Trust estimates that the average cost to the NHS for treating a patient with a major burn is £168,155.1

As part of the ‘SafeTea Campaign’ to mark National Burns’ Awareness Day, surgeons are issuing preventative and first aid advice for burns. This year’s campaign aims to prevent serious scalds from mugs of hot tea or coffee and to reduce the number of children who are seriously burned each year, often due to preventable accidents.

A snapshot of the five year data, reveals that in 2018 there were 6,645 child admissions to designated specialised burn services in England and Wales; and 47% (3,119) of these burns to children involved spillages from hot food or drink. Over half – 51% (1,576) – of these burns admissions for scalds involved children aged 0-2 years old. More than half of these (57%) were for avoidable coffee and tea scalds.

Mr Andrew Williams, a consultant plastic surgeon at Chelsea and Westminster Hospital, who specialises in burns, says: “Burn injuries are common and potentially devastating. Tragically they occur too often. Prevention is clearly key to reducing the number of patients we treat, which is why we want to raise awareness of this issue. All it takes is for a small child to pull a kettle cord, or knock a cup of tea over, and they can be scarred for life. Every second counts when it comes to treating a new burn, so it is vital that parents know basic first aid – especially the importance of running scalded skin under cold water, for example.

He adds: “Recovering from a serious burn or scald can be physically gruelling if a patient has to undergo skin grafts and multiple operations, and it can impact the whole family. In young children, scar tissue might not grow with them, with the resulting need for potentially years of operations and therapy ahead of them. The road to recovery can also be psychologically very challenging, especially if a person has visible scars. This is why it is so important that we all – and particularly parents of young children – are aware of the simple steps they can take to reduce the likelihood of such accidents from happening the first place .”

The International Burn Injury Database is based on data from designated specialised burn services in England and Wales and therefore does not include minor injuries not referred to a burns service (i.e. where patients are treated by a GP surgery or in Accident and Emergency Departments).

The Children’s Burns Trust estimates that on average 110 children per day are seen in emergency departments with burn injuries – 46 as a result of a hot cup of tea or coffee spillage. It says that the most common place of injury for children is in the home – 49% of whom are burnt in the kitchen; and accidents are most likely to occur between 3pm and 6pm.

Mr Fadi Issa is Wellcome Trust CRCD Fellow, Consultant Plastic Surgeon at the regional Burns Unit at Stoke Mandeville Hospital, and Scientific Director of Restore, the Burn and Wound Research Trust. He is supervising a one-year RCS Research Fellowship in burns, wound healing or soft tissue reconstruction. Mr Issa says: “We see a large number of very young children with scald injuries where an accident has taken place at home.

“The way a burn is treated in those initial seconds and minutes after is crucial. A recent study, which was carried out at Stoke Mandeville Hospital and the University of Oxford2, and part-funded by the RCS, shows what a difference cooling a burn can make. Our advice is simple: 15-20-25. Run the scalded or burned skin under water at 15 °C for 20 minutes – and you could reduce the depth of a burn by up to 25%.3 This treatment can convert a deep burn needing surgery to one that just needs simple dressings to heal. The other key information is not to put any lotions or potions on a cooled burn. Cover it in cling film and seek urgent medical assistance.”

EBA conference – Helsinki, September 2019

Lecture by Mr Ken Dunn

Opportunities with Big Data analysis in burn care

The long-term collection of carefully structured data from all burn services within each health economy (usually national) allows several important functions to be fulfilled when sufficient data has been accumulated. These include:

  • An ability to understand the demand for burn services alongside an assessment of the current use of the existing capacity to identify either economies of scale or occasional rebalancing of services.
  • A clear understanding of how burn services should be optimally organised to meet the demands of their catchment population.
  • The ability to serially assess factors which impact on mortality and length of stay amongst the burn care population.
  • An opportunity to develop quality assurance measures and assessment of services against standards developed by consensus to indicate whether services are behaving optimally and in some instances identify outlier services that may require additional support or guidance.
  • In the longer term it also allows the monitoring of the epidemiology of burn injury and the effectiveness or otherwise of prevention strategies, recognising that observations from a single service or a small group of services remain unconvincing.

The value of centralised information gathering about burn service activity in sufficient detail to inform these issues, amongst others such as performing power calculations for clinical research projects are powerful arguments for the creation and long term maintenance of such systems in all health economies globally.

National Burn Awareness Day October 2018

Press Release 17 Oct 2018

Burn accidents costing the NHS £20 million per annum, show latest statistics released on National Burn Awareness Day.

Today, on National Burns Awareness Day 2018, exclusive data shows the NHS burn services treated more than 15,000 patients for burns and scalds in 2017 at a cost of more than £20 million.

The Children’s Burns Trust, together with the British Burn Association, have released this exclusive insight from the International Burn Injury Database to raise awareness of burn prevention and burn-related first aid on National Burn Awareness Day 2018.
The two leading organisations in burn prevention and support hope that by drawing attention to the cost of burn injuries to the NHS, that more people will understand the importance of burn prevention and good first aid, which are vital in reducing the number of injuries – as well as the pressure on NHS burns services.
The figures released include those patients treated in burns centres, burns units and burns facilities across the E&W. It only relates to the more serious injuries and does not include the cost of the thousands more patients seen for more minor burns in A&E departments.

As well as the physical and emotional impact a burn injury has on the individual and their family, the cost to the health service is staggering. In 2017 more than 40 admissions to NHS burns services were classified as extremely severe, with these burns costing more than £95,000 each to treat.

The Children’s Burns Trust, whose work is focused on children and their families, have highlighted that a significant proportion of burns and scalds are among children under the age of 5 where the most prevalent cause of injury is from hot liquids, such as tea and coffee spills. Accidents like these are entirely preventable.

Ken Dunn, Consultant Burns and Plastic Surgeon and member of the British Burn Association’s Prevention Committee, said: “Looking at the shocking number of burn and scald injuries that take place across the UK every year in the context of the cost to the NHS brings into stark reality how common such injuries are. The vast majority of burn injuries are accidents, and whether suffered by adults, children or the elderly, most are entirely avoidable. On National Burns Awareness Day 2018, we need to see greater awareness about prevention and good first aid, both of which are key in reducing the number of accidents.”

Hundreds of NHS Services, Fire and Rescue Services, along with other organisations, come together each year on National Burn Awareness Day to raise awareness of the alarming number of people burned each and every day in the UK – the vast majority of which are preventable. The campaign also helps to promote the vital message of the importance of good first aid if a burn or scald does occur. All statistics provided by the International Burn Injury Database (iBID: http://www.cbtrust.org.uk/burn-prevention/database/):

EBA Educational meeting – Rotterdam

Lecture by Mr Ken Dunn

Cost analysis in burn care

No clinician in healthcare would deny that finance is an important area, but it is rarely the subject of discussion at clinical meetings or areas of research undertaken by clinicians.  The value of such work is that it brings vitally important understanding to the problems and consequences associated with change. These changes can be in many areas: staffing, consumables, the introduction of new techniques, service resizing, service closure.

The work undertaken in Manchester, UK has focused on answering questions concerning the cost of burn care and on modelling change.  The process initiated in 2007 was to establish a financial baseline against which changes could be evaluated.  The many steps in this process will be coming to a conclusion in the near future and already allow a far more profound understanding of the consequences of changes in burn care.  These developments fall into 4 key areas, each 1 of which will be presented separately:

  • The financial consequences of change in terms of service funding.
  • An understanding of the epidemiology of burn care demand and the geographical areas of high demand.
  • The financial consequences of service reorganisation and the requirements for resilience in such planning.
  • The financial consequences of introducing changes in clinical practice and evaluating its impact on service activity and funding.

Burns Study Day – Nigeria, September 2018

Lecture by Mr Ken Dunn

Burn Injury Registries: What’s the Point?

A introduction to burn registries; their history, reach and function. Including an introduction to the WHO Global Burn Registry introduced in 2013.

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