Invited Critique: National Study of Emergency Department Visits for Burn Injuries, 1993 to 2004

Drs. Fagenholz, Sheridan, Harris, Camargo, and Ms. Pelletier have contributed to our understanding of characteristics of primary emergency medical treatment of burn injuries in the United States.1 The importance of this study derives from three major lines of observation: The authors' citation of data indicating that the incidence and population rates for burns treated in emergency departments (EDs) declined during the time period studied is in harmony with similar trends for fire and burn death and burn injury hospitalization. Deaths caused by fire and flames in the United States decreased from 5991 in 1979 to 3377 in 2000,2 and burn injury hospitalization decreased from an estimated 52,000 in 1991 to 39,000 in 2003.3,4 The authors state that the most cogent reasons for decline in injury are “prevention, control or efficient treatment.” However, this reasoning, endemic in the burn literature, fails to consider the potential influence that major social changes may have on injury incidence, independent of societal attempts to prevent injury. In recent decades, American occupational and dining patterns have changed radically. Millions of manufacturing jobs have been automated or transferred offshore, whereas food and beverage preparation and consumption has shifted significantly to take advantage of more convenient drive-through, home-delivered, and sit-down restaurant dining options. As a result, the population as a whole is much less exposed to burn hazards in the workplace and the kitchen than was the case when health care data collection developed in the 1970s. Similarly, marked variations in death rates caused by injury have occurred in the nations of the former Union of Soviet Socialist Republics, vacillations that have much more to do with changes in the economy and sociopolitical environment than with efforts at injury control.5