Accurate analysis of injuries is paramount when allocating resources for prevention, research, education, and legislation. As burn mortality has improved over recent decades, the societal burden of burn injuries has grown ambiguous to the public while a scarcity of investigational funding for survivors has led to a gap in understanding lifelong sequela. We aim to compare national references reporting the incidence of burn injuries in the United States. The American Burn Association Burn Injury Summary Report (ABA-BISR), American Burn Association Fact Sheet, Centers for Disease Control and Prevention (CDC) Web-based Injury Statistics Query and Reporting (WISQARS) database, the CDC National Center for Health Statistics’ National Hospital Ambulatory Medical Care Survey (NHAMCS), National Inpatient Sample (NIS), National Emergency Department Sample (NEDS), and commercially available claims databases were queried for 2020 or the most recent data available. The BISR estimated 30,135 burn admissions in 2022. The 2016 ABA Fact Sheet reported 486,000 burns presented to US emergency departments (ED). In 2020, CDC’s WISQARS database reported 3,529 fatal, and 287,926 non-fatal, burn injuries. The 2020 NEDS reported 438,185 ED visits while the 2020 NIS estimated 103,235 inpatients. The NHAMCS reported 359,000 ED visits for burn injuries in the same period, and an analysis of ICD-10 burn codes demonstrated over 698,555 claims. Our study demonstrates a large variability in the reported incidence of burn injury by the ABA, CDC, national samples, and claims databases. Per our analyses, we estimate that 600,000 individuals annually suffer a burn injury which merits emergent care in the United States.

Burn Center (BC) verification is a rigorous process designed to ensure optimal care for burn injury patients. The American Burn Association (ABA) lists 135 verification criteria, yet only 50%-60% of BCs are verified. This study assesses the operational, financial, and clinical disparities between verified burn centers (VBCs) and nonverified burn centers (nVBCs) in the United States. The study was conducted using The Databases for Optimal Resources for Injury Care (DORIC), a centralized database developed from the American Hospital Association (AHA), American College of Surgeons Committee on Trauma, ABA, all fifty United States’ Departments of Health, the National Injury Resource Database (NIRD), and claims databases, through collaboration with BData, Louisiana State University Health Sciences Center (LSUHSC), and University of New Orleans (UNO). Data were analyzed for quality and statistical rigor by a data analyst and a biostatistician. The study demonstrated no significant differences in hospital size, location (urban/rural), hospital bed number, or burn intensive care unit bed number between VBCs and nVBCs. However, significant differences were identified in total hospital discharges and revenue. VBCs had more patient discharges (median 22 212 vs 15 639; P = .019) and generated significantly more total revenue (median $994 945 750 vs $652 390 948; P = .014), Medicare revenue (median $171 016 940 vs $83 739 527; P = .0023), and inpatient revenue (median $2 070 789 977 vs $1 347 440 093; P = .0125) compared to nVBCs. These disparities in discharges and revenue underline the financial and operational benefits of BC verification. Our findings provide valuable insights to guide policy and decision-making in burn care, aiming to improve care quality, accessibility, and equity.

We performed a needs assessment to determine the essential elements for a curriculum teaching burn care during Large Scale Combat Operations against peer/near-peer adversaries within multi-domain contested combat environments. Virtual and face-to-face site visit meetings were conducted with 20 stakeholders at 3 levels: (1) Subject Matter Experts in military burn casualty care at the US Army Institute of Surgical Research (USAISR), the Joint Trauma System, and the US Army Medical Center of Excellence (US Army MedCOE) in Joint Base San Antonio (JBSA) – Fort Sam Houston, TX; (2) Course Directors, Instructors, Curriculum Innovators, and Writers for the Combat Paramedic Branch and the Critical Care Flight Paramedic Program at JBSA; and (3) regulatory administrators providing education, research, and Institutional Review Board (IRB) administration for USAISR and US Army MedCOE. The identified terminal learning objectives (TLOs) consisted of training in burn casualty monitoring and principles of burn wound care according to available resources; best practices during prolonged casualty care for pain, nutrition, and infection control; specific management of inhalation, chemical, radiation, electrical, pediatric, and mass casualty burn injuries; and procedural skill training for patient decontamination, debridement, dressings, and escharotomy. Additionally, needs were identified for novel technology that provides asynchronous individual learning opportunities using interactive role-play simulations, immersive simulation, or virtual reality simulation as well as hands-on procedure simulators. Stakeholder engagement resulted in the identification of 16 TLOs that were subsequently used as the basis for a military curriculum we are calling the “Burns for Providers Program” (BP2).

Patients recovering from burn injuries experience long-term psychological, physiological, and biomechanical challenges due to scarring. While interventions to address these challenges exist, insurance coverage is often limited. This study examines the insurance policies of major health insurers regarding cosmetic reconstruction (CR) following burn injuries. A comprehensive review of coverage policies was conducted for 5 major health insurance providers: UnitedHealth Group, Elevance Health (formerly Anthem), Humana, CVS (Aetna), and Centene Corporation. The review focused on invasive and noninvasive CR interventions for burn injuries. Data were collected from state-specific insurance documents using Microsoft Excel. As of 2024, UnitedHealth Group holds a 28% share of the Medicare Advantage market and 14% of the commercial market, serving all 50 states. Humana controls 18% of the Medicare Advantage market, while CVS (Aetna) holds 11% in both markets, with nationwide coverage. However, none provides coverage for CR unless there is documented significant functional impairment (FI). Elevance Health has limited coverage in 19 states, contingent on FI documentation, while Centene Corporation covers CR on a case-by-case basis, leading to fragmented access across the United States. Standardized, equitable coverage for burn-related CR is needed to remove bureaucratic barriers hindering survivors’ recovery. Inconsistent insurance policies prevent access to essential aftercare, exacerbating physical and emotional burdens. Policy reform is crucial to ensure all burn survivors receive the care needed for recovery and a restored quality of life.