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Do not excise and autograft partial thickness burns, including scald burns in children, without a period of wound care and observation, unless obvious deep partial thickness.
Choosing Wisely Canada
Burns Canada
A significant proportion of partial thickness burn injuries will heal within two to three weeks without surgery. A period of observation of a week or more, especially in smaller burns, will allow the wound to manifest features of healing or the capacity to heal. This is especially true in the context of paediatric scald burns, the most common category of burn injuries globally. A conservative approach to the management of these wounds has the potential to reduce healthcare costs, the need for ...
ver más ... 2020It is not recommended to perform routine investigations such as daily blood tests or chest radiographs unless they will guide decision making with respect to management of the patient with burns.
Choosing Wisely Canada
Burns Canada
The medical team should regularly reassess the indications for routine daily bloodwork and chest radiographs as the clinical course proceeds, especially when there has been no significant intervening condition change. Several studies have demonstrated the cost benefits of such a strategy, without compromising the delivery of optimal patient care.
ver más ... 2020Do not routinely initiate fluid resuscitation in patients when the burn is less than 15% total body surface area (TBSA).
Choosing Wisely Canada
Burns Canada
Partial and full thickness burns affecting less than 15% of the TBSA do not require specific directed fluid resuscitation. Patients with burn injuries under 15% can typically meet their requirements with maintenance intravenous fluid infusions or oral fluid intake alone. There may be other associated indications for fluid replacement, however, such as concomitant trauma, dehydration, alcohol intoxication, or other fluid losses.
ver más ... 2020Don’t routinely perform sperm DNA fragmentation testing.
Choosing Wisely Canada
Canadian Fertility and Andrology Society
High-grade evidence to support the routine use of sperm DNA fragmentation testing as part of initial screening investigations for infertility is lacking. Sperm DNA fragmentation tests are poor at predicting outcomes in patients undergoing assisted reproductive technologies, particularly for patients undergoing IVF or intracytoplasmic sperm injection (ICSI), and should not be used to guide treatment decision-making.
ver más ... 2020Do not undertake medical or surgical procedures if these are inconsistent with the burn patient’s expressed goals of care.
Choosing Wisely Canada
Burns Canada
All patients should have a goals of care discussion (between the health care team and the patient and/or substitute decision maker) during the first 48 hours of their hospital stay. This is especially relevant for patients with extensive burn injuries, the elderly, and those at high risk of death. Interventions should only be undertaken when they are in keeping with the patient’s previously expressed goals of care or best interests, as determined by the patient’s substitute decision-maker ...
ver más ... 2020