PIT8 Severe Burn Injuries in Germany - Are Different Patients Treated Differently in Burn-Centers and NON-Burn-Centers?

Abstract

In Germany 36 burn care center are covering all regions. They are reporting to a registry of the German associations for burn care (DGV) for quality assurance. A relevant share of patients with severe burn is nevertheless treated in other hospitals for a variety of reasons. The German hospital coding system allows to discriminate procedures whether they had been undertaken for burns or for other injuries. On the example of burn-wound coverages, it should be examined what are structural differences in care between centers and non-centers. Quality reports 2018 for all German hospitals were analyzed for coded burn coverages, the body location, type of department and type of materials. The data for burn centers and non-burn centers were compared. 12,946 hospitalized severe burn injuries with complex burn-wound coverage were reported in 2018. 27.5% in 182 non-burn-centers (children 38.9%), 72.5% in 36 burn-centers (children 61.1%). The treating departments in centers (c) and non-centers (nc) were surgery 48.3%c, 29.5%nc; pediatric surgery 28.5%c, 43.2%nc; specialized ICU 19.9%c, 5.3%nc; internal or pediatric 3.1%c, 17.5%nc; other 0.3%c, 4.4%nc. The distribution of body regions was comparable. Biggest differences: lower arm and hand 24.4%c, 27.5%nc; breast 10.5%c, 13.7%nc; head 9.7%c; 5.9%nc. The coverages used differ: hydrolytic resorbable membranes 64.3%c, 49.5%nc; alloplastic material 19.2%c; 41.5%nc; xenograft 8.4%c; 3.5%nc; allogenic material 7.2%c, 3.7nc; other 0.9c; 1.9nc. Germany has a burn care structure with regional burn centers. More than a quarter of patients with a higher degree burn and demand for complex wound coverage are treated in non-burn-centers. In burn-centers almost all patients are treated in surgical/ICU departments. Despite the distribution of treated body parts is comparable, the selected coverage types differ with the non-centers. It might be considered to extend the quality assurance to the non-burn centers to ensure comparable standards.