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Background: Each year 30,000 children suffer from burn injuries in Germany and 2000 of these children must be treated in special pediatric burn centers. Approximately two thirds of these children are less than 4 years old, 70% of thermal injuries are due to scalding with hot liquids., Objectives: The aim of this article is to give an overview of the characteristics of pediatric burn trauma with recommendations for initial treatment, surgical therapy as well as follow-up treatment., Conclusion: Physicians are especially challenged by pediatric burn injuries which can cause lifelong stigma by scarring and other physical defects. The treatment of pediatric thermal injuries should be performed in clinics with expertise in treating pediatric burns to achieve optimal results.

The calculation of REC forms the basis of expert opinions for the purposes of making accident insurance assessments after an occupational accident or an accident suffered en route while travelling to or from the workplace. The estimation of REC is based on a procedure quoted in the 1995 "Jahrbuch der Versicherungsmedizin" (Yearbook of Insurance Medicine) using a form developed by Henkel von Donnersmarck and Hoerbrand. The overall estimation of damages resulting from the accident comprises 3 main components, namely the functional impairment, the assessment of local findings and the resulting somatic and vegetative complaints. The criteria for all 3 components are nevertheless imprecise and open to a great deal of interpretation on the part of the evaluator, leading to a highly variable and subjective overall assessment of REC. The new REC form includes a modified factor-based categorisation of the scar quality and the localisation, so that assessment can now be carried out in a differentiated manner. Visible, stigmatising areas such as the neck are provided with their own Q values. The pigmental and textural alterations describing the scar quality are now more precisely defined. Considering the complexity of the somatic and vegetative alterations, more precise (objective) assessments can now be derived. The new REC form increases the validity and transparency of post-thermal trauma REC assessments for the purposes of making statutory accident insurance assessments., (© Georg Thieme Verlag KG Stuttgart · New York.)

The total REC (reduction in earning capacity) after a thermal trauma is usually assessed using an appraisal form for burns victims, initially developed by Hoerbrandt and von Donnersmarck (1995). The criteria for functional impairment, local findings and vegetative-somatic complaints are somewhat imprecise given the broad scope of interpretation which the evaluator can employ in making an appraisal. This means that the overall appraisal of REC is subjective on the part of the evaluator. In addition, one can only calculate an overall REC of at most 40% from local findings and vegetative-somatic symptoms, even in patients with extensive large area burns. Considering these points we investigated the dependency of the results on the evaluator as well as the limited validity of the appraisal form originally developed by Hörbrand and Donnersmark., (© Georg Thieme Verlag KG Stuttgart · New York.)

Burns are classified according to the depth of the burn wound and extent of affected burned body surface area. In deep second degree and higher grade burns the epidermis and skin appendages are destroyed so that healing can only take place with severe scarring. In these cases necrectomy and skin grafting are recommended. Extensive and deep burns should be treated at specialized centers and more precise criteria for this are laid down in the guidelines. Emergency room treatment protocols have improved the quality of admission and treatment. Concomitant injuries need to be diagnosed and treated early. In addition to the damage to the skin the subsequent burn disease with massive accumulation of interstitial fluid determines the prognosis. The circulation is stabilized and the risk of infection is controlled by intensive fluid management, early necrectomy and split thickness skin grafting. Modern sedation and ventilation management allows a more rapid convalescence.

Purpose: To analyze the German, Austrian, Italian and Spanish Diagnosis-Related Group (DRG)-systems regarding burns., Methods: We analyzed 78 cases of inpatients with burns which were processed by national DRG-groupers. DRGs were linked to thresholds concerning length of stay as well as reimbursement tables of the respective countries., Main Findings: Fifty-one % of cases showed higher reimbursement in Germany compared to Austria, 55% compared to Italy and 67% as against Spain. Total proceeds are highest in Austria with 1,577,000 €, followed by Italy with 1,569,000 €, Germany with 1,502,000 € and Spain with 902,596 €. No correlation was found between macroeconomic key figures and our data., Conclusions: International comparison of reimbursement of burns by DRG could be a useful instrument for benchmarking while not depending solely on political decisions or country-specific cost data. For better comparability, hospital indices based on healthcare baskets should be discussed., (Copyright © 2011 Elsevier Ltd and ISBI. All rights reserved.)

The burned bodies (n = 68) autopsied at the Freiburg Institute of Forensic Medicine in the years 1996-2001 (until the end of February) were examined with regard to the extent of consumption by the fire using the classifications suggested by Eckert et al., Maxeiner, Glassman and Crow, and Gerling et al. Further classification parameters were exposure of the body cavities and amputation of extremities as a result of the fire. Most cases were accidental deaths (approximately 75%). The fires occurred mainly in buildings (57%) or vehicles (34%); in 6 cases the burning took place in the open air. In most cases the degree of consumption by the fire was slight to moderate. Only 15% of the burned bodies showed extensive destruction with severe loss of soft tissue and shrinking or amputation of the extremities. In one case the soft tissue was completely destroyed with fragmentation of the calcined skeletal remains. In bodies recovered from house fired the extent of consumption by the fire was usually less pronounced than in bodies retrieved from burned-out vehicles.