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Invited Critique: Results of an Internet Survey on the Treatment of Partial Thickness Burns, Full Thickness Burns, and Donor Sites

At first blush, one may be tempted to ask about the appropriate place for an Internet survey report amongst peer-reviewed surgical literature. Informal surveys of common clinical practice may be used as a preamble to the development of a clinical trial when there is a lack of prior published information on a given topic. There is certainly no lack of literature on treatment of the burn wound. The survey as a study design is very limited in its ability to test the comparative value of any clinical practice, which usually represents the highest aspiration of a clinical study. This manuscript, however, is remarkable in a number of ways that deserve a more careful consideration. The author has chosen a subject of inquiry that drives directly to the soul of every practitioner engaged in the field of burn care; how do you treat the burn wound? This is basic underlying metric by which we identify ourselves as members of the same community across the world. Other topics may cause us to distinguish our differences; academic versus community practice, basic science versus clinical focus; but this topic binds us all across nations, continents, and generations. The 30% response rate to the survey is remarkable, insofar as surveys are fortunate to achieve 20% response on average. Perhaps, burn center directors have a particular need to compare notes on this topic. This survey has many data points, and one can only attribute the response rate to the penetration of the Internet as a means of communication and the ease and spontaneity of response by this mechanism. In fact, difficulties in accurately ascertaining email addresses and successfully transmitting the survey instrument probably limited the potential response more than the interest or graciousness of the recipients. The geographic distribution of responses is also remarkable. The distribution of responses closely matches the distribution of burn care facilities worldwide. This affords an unprecedented glimpse into basic clinical practice across the entire spectrum of the burn care community. The survey demonstrates the penetration of similar practices into parts of the world we may be tempted to assume are not as advanced in the care of the burn wound. The author has assembled quite a thorough compendium of techniques and products commonly applied to the burn wound. The data are well summarized and easy to assimilate. The author leads us easily across the burn injury as we are used to confronting it: nonoperative, surgical technique and donor site management. The range of treatments represented are both comforting to practitioners who find our treatment of choice amongst the broadly accepted methods across the world, but then also challenging to our subconscious biases when confronted with evidence that a significant percentage of practitioners choose something other than our favorite treatment modality. The survey methodology provides essentially no answers to the “why” of our treatment choices, but allows us the luxury of contemplating other ways of doing our work without confronting the more difficult questions of statistical validity, study design, and other necessary tasks of critical analysis. Like the weather report, it provides a useful glimpse of the world as it is beyond our immediate view. From the Oregon Burn Center, Portland. Address correspondence to Nathan A. Kemalyan, MD, FACS, 3001 N. Gantenbein Ave., Portland, Oregon 97227. Copyright © 2007 by the American Burn Association. 1559-047X/2007