You can download the Top Ten or our Infographics_English
Priority 1
What are the best acute treatments in early burns management for improving patient outcomes, and reducing and treating complications?
Acute or early intervention in burns care is pivotal for good clinical and patient outcomes. However, there is a lack of consensus around the best approaches to acute burns care. These uncertainties include resuscitation protocols and fluid resuscitation formulae, calculations for determining burns surface area and severity, timing of and techniques in surgery, medication and intensive care management. Further research is needed to address these inequities, and to improve the evidence base to enable clinicians to make the best treatment choices for patients, and to improve survivor’s outcomes and experiences.
Priority 2
What are the best ways to identify, measure and treat the psychological impact of burn injuries and treatments for survivors and carers?
Burn injuries and treatments for burns have long-lasting psychological impacts on survivors and their carers. There are veryfew standardised ways to identify and measure these psychological impacts, and there is a poor quality evidence for effective psychosocial interventions that can be successfully delivered in different settings. As well as the psychological trauma associated with a burn injury, burns treatments can be traumatising for patients and carers. Further research is needed to develop standardised measures to assess psychological impact, and to identify interventions and support that will reduce the negative psychological impacts of burn and post-burn treatments worldwide, including interventions that will be effective in low-resource settings.
Priority 3
What are the best ways to prevent, assess and treat burns scars and their complications (e.g. contractures)?
Burns scars can result in debilitating complications such as contractures, which impact on mobility, function and quality of life. Preventing these issues relies on adequate assessment and treatment of problematic scarring, which can be dependent on resources, settings and access to healthcare. Even in well-resourced settings, there is a lack of evidence regarding the best ways to prevent and reduce problematic scarring (e.g. pressure garments, silicone sheets, laser treatments). Further research is needed to explore these issues.
Priority 4
What are the best ways to understand and reduce pain and anxiety from burn injuries and treatments, including during burn dressing changes, to improve care and support for survivors and carers?
Burn injuries are incredibly painful and treatments such as dressing changes can be equally painful. These can trigger traumatic thoughts and memories to the extent that in some settings they are conducted under anaesthesia. Pain and anxiety are interlinked and are aggravating factors to each other, with many burns patients experiencing heightened anxiety and pain in anticipation of painful treatments and procedures. There is a lack of consensus on the best pharmacological and non-pharmacological approaches to pain management. Further research is needed to explore accessible and cost-effective methods of pain management for burns survivors during treatment and recovery.
Priority 5
How can the stigma of burns scarring be better understood and reduced in different cultural, ethnic and social settings?
Burns scarring is often visible and carries a stigma that can greatly affect survivors and their carers both psychologically and socially. Bullying, unwanted staring, exclusion, judgement and harassment are often reported by burns survivors. Any interventions to address these issues need to be developed within and informed by different cultural and social contexts, as stigma is expressed and experienced uniquely in different settings. Further research is needed to better understand the drivers of social stigma related to burns and scars, and in turn reduce the impact on survivors and carers.
Priority 6
What are the best ways to improve the education and training of health care professionals, and all those involved in burns care, to improve treatments and outcomes?
Burn survivors and their carers interact with numerous multi-disciplinary teams during treatment and recovery. Some of these clinicians are specialists in burn care, whereas others may treat relatively few burn patients within their wider practice. Lack of knowledge and experience in caring for burns amongst such health care teams can lead to negative patient experiences and poorer outcomes. Improvements to training for all those involved in burns care can help to address this issue. Similarly, it is important that those specialising in burns care are trained in the most up-to-date evidence-based treatments. Further research is needed to enable this and identify the optimal approaches to improving education and training.
Priority 7
What are the best and most cost-effective burn wound dressings and treatments to improve patient experiences, wound healing, and outcomes, and reduce complications?
There are diverse types of burn wound dressings available, ranging from petroleum jelly and gauze to biological, antimicrobial or hydrogel dressings, some of which can be expensive and beyond the means of clinics in low-resource settings. There is a lack of clear evidence as to which dressings are most effective for different types and severities of burns, which is again effected by the cost-effectiveness of, and local accessibility to dressings. Reducing variation in burn wound dressing choices can improve availability in low resources settings, wound healing and reduce scar complications, leading to better patient symptoms, outcomes and experiences. Further research in this area of clinically and cost-effective burn wound dressings is needed to improve care and patient experiences.
Priority 8
What are the best ways to provide effective burns treatment and support survivors and carers in resource limited settings?
Many treatments for burn injuries can be expensive and are often beyond the means of patients in low-resource setting and in countries without affordable access to healthcare. In some countries, patient mortality is higher for burns that are routinely survivable with good functional outcomes for patients in other countries. This inequity can contribute to higher than expected rates of complications such as contractures and can disproportionately and greatly affect quality of life, well-being and function. Lower-cost and more cost-effective treatments that can lead to better patient outcomes are needed to support patients and carers in setting where financial pressures are a barrier to care, and further research is required to identify these.
Priority 9
What are the most cost-effective burns treatments that improve patient outcomes, for example in low-resource settings where financial cost is a barrier to treatment?
Seventy percent of global burn injuries occur in low-resource settings where there are financial and other barriers to appropriate care. Much research in burns treatment focusses on technological advancements and innovations, while in many parts of the world tens of thousands of burns patients do not have access to basic, adequate care. This contributes to negative outcomes such as complications and contractures, and is a burden not experienced in highly developed nations. Burn injury in low resource settings disproportionately impacts survivor and carers’ quality of life and function. Research could improve this situation by focussing on which cost-effective treatments (e.g. burns dressings or debridement techniques) improve patient outcomes and experiences. Further, research exploring how to improve the equity of access to, and dissemination of unavailable treatments into low resource settings is warranted.
Priority 10
After initial treatment and rehabilitation, what are the best long-term treatments or types of support for improved outcomes and quality of life in survivors and carers?
Burn survivors and carers often report that most treatment and support focusses on initial treatment associated with short-term recovery and rehabilitation. However, burn scars are a life-long issue often associated with systemic multi-morbidities, included psychosocial impact, which evolve and can negatively affect quality of life years after leaving acute care. In low-resource settings, treatment is often focussed on survival from the injury rather than long-term functioning and adjustment. Further research regarding the best and most cost-effective long-term treatments and support for burn survivors and carers will help to specifically address these issues.