Cohort Definition Name: “Skin Burns”
Contributor name: Jill Hardin
Contributor OrcId: 0000-0003-2682-2187
Logic Description: 1 code of Skin Burns and a drug or procedure treatment within 1 to 180 days post index
Recommended study application: outcome
Assertion statement: This cohort definition was executed on at least one real person-level observational health data source and resulted in a cohort with at least 1 person.
Submitted cohort definition:
SkinBurns.txt (13.6 KB)
Target Clinical Description
Overview:
Skin burns are injuries caused by exposure to thermal, chemical, electrical, or radiation sources that lead to tissue damage. Burn injuries vary in severity, ranging from superficial to full-thickness burns, and can result in pain, tissue destruction, and potential complications. Proper assessment, classification, and management are essential to optimize outcomes and minimize complications. Between 0.5% and 24.6% of burns in children are non-accidental. Early and appropriate treatment of burns significantly influences short-term outcomes by preventing infection, promoting wound healing, and reducing pain. Long-term outcomes depend on the extent and severity of the burn. Scarring, contractures, and functional impairments are possible, requiring ongoing management and rehabilitation.
Synonyms:
- Thermal injuries, Burn injuries
Presentation:
Clinical presentation of skin burns may be categorized by their depth as superficial (1st degree), partial-thickness (2nd degree), and full-thickness (3rd degree). Superficial burns affect the epidermis only and present with redness, pain, and mild swelling without blisters. Superficial burns are often caused by sunburn or brief exposure to hot liquids. Superficial partial thickness burns affect the superficial dermis, whereas deep partial thickness burns affect the lower layers of the dermis. Partial thickness burns present with blisters, intense pain, and redness. They are often caused by scalds from hot liquids or steam, minor flame contact, brief contact with a hot object, chemicals, or electricity. Full thickness burns affect the full skin thickness and underlying structures. Full thickness burns present with a white, charred appearance, and an insensate, and leathery texture. They are often caused by severe scalds, flame, or severe chemical exposure.
Burns may also be classified as electrical burns, chemical burns and radiation burns. Electrical burns are characterized by entry and exit wounds, tissue destruction, and potential internal injuries. Chemical burns are characterized by discoloration, tissue damage, and pain at the site of contact. Radiation burns are characterized by skin erythema, desquamation, and potential systemic effects.
Assessment:
Assessment of skin burns involves first assessing the burn depth classification, using visual assessment and classification of burn depth based on appearance and symptoms. The “Rule of Nines” is applied to estimating the percentage of total body surface area (TBSA) affected, in order to guide treatment decisions. X-rays or other imaging may be done to assess for fractures or foreign bodies in electrical or high-velocity burns. Blood tests to assess electrolyte imbalances, fluid shifts, and potential systemic effects. For children, non-accidental trauma should be considered. Electrical burns require assessment for internal injuries and cardiac monitoring.
Plan:
Superficial burns usually heal without scarring within 5 to 10 days. The treatment of superficial burns includes analgesics and cool compresses for pain relief, topical ointments to soothe and protect the affected area. Healing of superficial partial thickness burns typically occurs within 3 weeks with minimal scarring, while deep partial thickness burns by take 3-8 weeks to heal, with scarring. The treatment for partial thickness burns includes cleaning and debridement of blisters under aseptic conditions, dressings to prevent infection and promote healing, analgesics, and potential tetanus prophylaxis. Full thickness burns present with minimal to no pain due to decreased sensation. Full thickness burns heal by contracture and healing takes greater than 8 weeks. The treatment for full thickness burns includes early excision and grafting for wound closure, infection prevention with sterile dressings and antibiotics, pain management and supportive care.
Management of electrical burns requires tetanus prophylaxis, in addition to surgical debridement, wound care, and pain management. Chemical burns are managed with immediate irrigation to flush the chemical off the skin, neutralization if applicable, dressings, and pain management. Radiation burns are treated with topical treatments for symptom relief, and supportive care for systemic effects.
References:
- Aronson JF, et al. Electrical and lightning injuries. Med Clin North Am. 2005;89(6):1257-1275.
- Loos, M-L H.J, et al. Incidence and characteristics of non-accidental burns in children: A systematic review. Burns 2020; 46(6): 1243-1253.
- Monafo WW. Initial management of burns. N Engl J Med. 1996;335(21):1581-1586
- Moy RL, et al. Acute radiation dermatitis in breast cancer patients: challenges and solutions. Breast Cancer (Dove Med Press). 2017;9:313-327.
- Peck MD. Epidemiology of burns throughout the world. Part I: Distribution and risk factors. Burns. 2011;37(7):1087-1100.
- Peck MD. Epidemiology of burns throughout the world. Part II: Intentional burns in adults. Burns. 2012;38(5):630-637.
- Saffle JR. Practice guidelines for burn care. J Burn Care Res. 2006;27(4):437-438.
- Saffle JR. The phenomenon of “fluid creep” in acute burn resuscitation. J Burn Care Res. 2007;28(3):382-395.
- Singer AJ, et al. Thermal burns: stop the burn progression. J Emerg Med. 2007;33(3):235-239.
- Singer AJ, et al. American Burn Association consensus conference to define sepsis and infection in burns. J Burn Care Res. 2007;28(6):776-790.
- Warby R, Maani CV. Burn Classification. [Updated 2022 Aug 29]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: Burn Classification - StatPearls - NCBI Bookshelf
- Wasiak J, et al. Burns involving 40% total body surface area and greater in the Northern Territory of Australia and the Australian Capital Territory, 2003-2012. Burns. 2014;40(8):1712-1718.
Phevaluator results show the highest PPV results in the algorithm requiring 1 code for skin burns and a drug or procedural treatment within 180 days of index. This definition decreases the sensitivity compared to the definition which requires only 1 burn code and has the highest sensitivity. The numbers of subjects identified in the definition requiring 1 code for skin burns and a drug or procedural treatment are reduced by ~60% compared the definition requiring 1 code for skin burns. There is a high degree of overlap between the two definitions (35-45%), the difference owed to the treatment requirement.
We recommend use of cohort that requires a single burn code and treatment within 180 days of index.