Outpatient Burn Care: Prevention and Treatment

 

Am Fam Physician. 2020 Apr 15;101(8):463-470.

  Patient information: See related handout on burn injuries, written by the authors of this article.

Author disclosure: No relevant financial affiliations.

Most patients with burn injuries are treated as outpatients. Two key determinants of the need for referral to a burn center are burn depth and percentage of total body surface area involved. All burn injuries are considered trauma, prompting immediate evaluation for concomitant injuries. Initial treatment is directed at stopping the burn process. Superficial (first-degree) burns involve only the epidermal layer and require simple first-aid techniques with over-the-counter pain relievers. Partial-thickness (second-degree) burns are subdivided into two categories: superficial and deep. Superficial partial-thickness burns extend into the dermis, may take up to three weeks to heal, and require advanced dressings to protect the wound and promote a moist environment. Deep partial-thickness burns require immediate referral to a burn surgeon for possible early tangential excision. Full-thickness (third-degree) burns involve the entire dermal layer, and patients with these burns should automatically be referred to a burn center. Prophylactic antibiotics are not indicated for outpatient management and may increase bacterial resistance. People with diabetes mellitus are at increased risk of complications and infection, and early referral to a burn center should be considered. Pruritus, hypertrophic scarring, and permanent hyperpigmentation are long-term complications of partial-thickness burns. Burn injuries are more likely to occur in children and older people. Patient education during primary care visits may be an effective prevention strategy.

Approximately 500,000 patients seek medical care for burns every year in the United States, and roughly 92% are treated as outpatients.1,2 Even small-appearing burns can cause significant morbidity because of pain, secondary infection, and scarring if not treated properly.1 The mechanism of burn injury can be categorized as thermal (caused by contact with flames, steam, or hot surfaces), electrical, chemical, and radiation.1,3 Thermal burns are the most common type among all ages.2,3

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SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendationEvidence ratingComments

Burn patients who meet American Burn Association referral criteria should be promptly transferred to a burn center.10,11

C

Expert opinion

The burn surface should be cooled with running tap water for at least 20 minutes within three hours of the burn injury.19,20

B

Cohort studies and animal models

Patients with partial- or full-thickness burns who have unknown or inadequate tetanus immunization status should be vaccinated and given tetanus immune globulin.13,14,37

C

Consensus guidelines

Burn patients with diabetes mellitus who develop complications, such as cellulitis, should be referred to a burn center for further treatment.38

C

Expert opinion

Patients with burns expected to take longer than 14 days to heal should be referred to a burn center because of the risk of hypertrophic scarring.15

C

Expert opinion

In children, burns to the feet, buttocks, or posterior legs and hands; a history incongruent with injury; and the presence of burns with other unrelated injuries may be indicators of abuse.1,24

C

Case series, expert opinion

Targeted education initiatives may be effective in increasing patient and caregiver fire safety knowledge.52,53

B

Longitudinal interventional trials


A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to https://www.aafp.org/afpsort.

The Authors

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JASON S. LANHAM, MD, MA, FAAFP, is program director of the Family Medicine Residency Program at Eisenhower Army Medical Center, Fort Gordon, Ga., and is assistant professor in the Department of Family Medicine at the Uniformed Services University of the Health Sciences, Bethesda, Md....

NICOLE K. NELSON, DO, is a faculty member in the Family Medicine Residency Program at Eisenhower Army Medical Center and is assistant professor in the Department of Family Medicine at the Uniformed Services University of the Health Sciences.

BRYAN HENDREN, MD, FACS, is the trauma medical director at Eisenhower Army Medical Center and an assistant professor in the Department of Surgery at the Uniformed Services University of the Health Sciences.

TENEISHA S. JORDAN, MD, is a resident in the Family Medicine Residency Program at Eisenhower Army Medical Center.

Address correspondence to Jason S. Lanham, MD, MA, FAAFP, 300 Hospital Rd., Fort Gordon, GA 30905 (email: jason.s.lanham.mil@mail.mil). Reprints are not available from the authors.

Author disclosure: No relevant financial affiliations.

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