WRITING SAMPLE 1
This writing sample is extracted from a business case that I worked on and is based
on the introduction section divided into sub-sections- on the severity of acute burns
and its associated complications.
1 Burden of Disease
Introduction
Severe burns are one of the most common and traumatic injuries that trigger devastating
morbidity and significant mortality. Despite decreasing incidence worldwide, severe burn injuries
still have poor management and cause debilitating complications including infections.
A plethora of factors guide the evaluation, management and treatment of severe burns including
the amount of body surface area burned (expressed as a percentage of total body surface area
(TBSA)) (2) and the degree of burns.
The TBSA is determined by “rule of nines”, which helps guide treatment decisions such as fluid
resuscitation. It is integrated as part of the treatment guidelines to determine if there is a need to
transfer a patient to a burn’s unit. According to the rule of nines each body part is assigned a
certain percentage as shown in the Figure 1 and
Figure 2 below. Burns have four varying degrees depending upon the severity and the depth of
the burn wound.
Figure 1: Rule of nines percentages
Anterior thorax 18%
Posterior thorax 18%
Leg
18%
Arm
9%
Head / neck
9%
Perinuem
1%
Figure 2: Rule of “nines”
Panel A – Is often sued to estiamte the surface area of a burn in adults. However this approach is less accurate in children.
Panel B- Lund -Browder use values for the legs and head that vary according to a patient’s age.
*Subtract 1% from head for each year over one year of age
**Add 1/2 % to each leg for each year over one year of age
Epidemiology
Severe burns are devastating injuries that cause significant morbidity and mortality as well as a
financial burden to the health service with extensive hospitalization, rehabilitation and expensive
treatments (3). The consequences of burns for patients can also be devastating and include
hypertrophic scarring, disfigurement and functional impairment (3). Severe burns cause
debilitating effects on the life of the patients and their families.
The mortality rate of burn injuries in Europe is between 1.4-18% (4). In England and Wales only,
81,181 patients were referred for burn injuries in 9 years from 2003-2011, of which 57,801 were
admitted to the hospital (5).
Annual incidence of severe burns • 0.2 - 2.9 / 10,000 inhabitants
in Europe (1)
WHO estimates (2)
• 180,000 deaths every year are casued by burns
The major risk factors that may increase the mortality rate of patients due to acute burns include
(6);
Older age
Higher total burned surface area (TBSA) ~ 80%
Smoke Inhalation injuries
Clinical Burden
Severe burn injuries can lead to significant morbidity such as traumatic and physically debilitating
conditions (7). Urgent specialized care is imperative in order to minimize morbidity and mortality.
Surgical procedures are used to restore mobility and functional outcomes (8). Burn injuries often
lead to complications including;
Infections
Functional impairment
Scarring and disfigurement
1.3.1 Infections
The maximum destruction and loss due to severe burns are caused to the skin. Since skin acts as
the major protective barrier for the human body, its destruction and loss sets the patients up for
invasion by microorganisms causing infection and sepsis (9). Infections pose a serious problem in
burn management since they cause a delay in epidermal maturation and lead to additional scar
tissue formation (10, 11). Burn wounds are the one of the most common sites of an infection (12).
75% of all deaths in patients with severe burns who have a TBSA of more than 40% , are due to
infections, sepsis or inhalation injury (13). Invasive infections account for 51% of death in burn
patients, are the primary reasons for death after the first 24 hours of admission to the hospital
and often lead to death of the patients after the first 2 weeks of hospitalization. Infections due to
sever buns are also expensive to treat. The estimates from National Healthcare System (NHS)
United Kingdom (UK) suggest that the cost per patient for infections or complications of
procedures with multiple interventions are high (14). Hence it is imperative for a burn treatment
to target and prevent/cure infections in burn patients.
Infection may lead to invasion of microorganisms into the layer of tissue below the dermis which
might result in sepsis and/or impair organ function leading to multiple-organ dysfunction
syndrome (MODS) (12) and increase the mortality rate (15). Several factors increase the risk of
MODS including >20% TBSA, age, male gender sepsis, hypoperfusion and under-resuscitation.
1.3.2 Long term complications
The long-term challenges for severely burn patients include scarring, functional impairment,
change in appearance disfigurement among others. Burns near the face and hands are notably
challenging and disturbing as they are always visible to other people. They lead to changes in the
cosmetic appearance of the patient and can cause deleterious psychological effects.
Burns occurring near joints often make them less mobile. Further, burn sites are sensitive to heat
or cold from solar radiation or warmth which might cause pain and discomfort (8). Burns can also
cause long term functional disabilities. It has been reported that 15-20% of patients who have
more than 70% TBSA have serious physical disability even 15 years after the injury (16). If burn
patients are not treated properly or if their deep dermal burns are not identified then scar
contracture may form which can lead to disfigurement and/or functional impairment depending
on the location of the burn (8). Functional impairment is a serious complication of acute burns
since it intervenes and limits the daily activities of the burn patient. Most of the time functional
impairment requires reoperation in order to enhance mobility.
Despite several advances in the early treatment of burns, functional and aesthetic complications
including slow wound healing, infection, pain, and hypertrophic scarring continue to remain the
major challenges in burns management (17).