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Evaluating The Cost-effectiveness, Efficacy, Safety, And Tolerance Of Silver Sulfadiazine (ssd) Dressings Once Daily Versus Twice Daily In The Treatment Of Burn Wounds
Tomer Lagziel, MD Candidate, Louis Born, MD Candidate, Luis Quiroga, MD, Vidhi Javia, BS, Benjamin Slavin, MD Candidate, Pragna Shetty, MD Candidate, Carrie Cox, MSN, Eliana Duraes, MD, Charles Scott Hultman, MD, Mohammed Asif, MD.
Johns Hopkins University School of Medicine, Baltimore, MD, USA.

PURPOSE:
Topical Silver Sulfadiazine cream (SSD 1%) has been the gold standard for burn care since 1960s. Due to the immediate burst release of the drug into the exposed areas, application is relatively frequent, usually twice daily. However, it remains unknown whether twice-daily SSD dressings are superior to once-daily. Our study aim is to evaluate whether a once-daily or twice-daily application of SSD impacts burn wound healing outcomes.
METHODS:
Our institution maintained a twice-daily dressing change standard of care until 01/01/2019. Patients admitted after that date had their dressing changed once daily. Our goal is to review outcomes for 75 patients before the change-of-practice and 75 patients after the change. Our main outcomes recorded are wound infection, average pain scores, average daily narcotic requirements and length-of-stay.
RESULTS:
Preliminary results of 20 pre-change-of-practice and 20 post-change-of-practice patients showed no difference in the outcomes between the two groups. The infection rates were the same for both groups (10%), pain scores (Graph 1) for the post-change group were slightly higher (pre=5.9, post=6.8), length-of-stay (Graph 2) was longer in the pre-change group (pre=9.2, post=5.7), and no other surgical complications were reported for patients in either group.
CONCLUSION:
Preliminary results show that a once-daily dressing change of SSD, has no negative impact on burn wound outcomes. In addition, it is associated with a decreased length-of-stay. A decreased length-of-stay means reduced medical expenses for the patient and the hospital. Changing the standard-of-care to once-daily could prove beneficial. Further patient review will shed more light on the significance of these results, however so far there is no inferiority in wound healing.


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