Primary Burns Dressings and cost implications: A UK National Survey results
Introduction
Despite abundant literature demonstrating a wide range of dressings’ efficacies and costs, there are no national consensus or guidelines available for primary burns dressings applied following the initial burn debridement. The choice of primary dressings must factor in different aspects including appropriate patient care, need for wound inspection and cost to achieve efficient utilisation of resources.  

Methods
We conducted a telephone survey with 28 major burns centres across the UK enquiring about the primary dressing applied to superficial partial thickness; mixed depth, deep partial or deep dermal, and full thickness burns injuries. The product literature was used to classify the type of dressings accordingly and analyse the cost of the most frequently used ones.

Results 
19 UK burns units participated in the survey demonstrating a significant variation in the types of dressings used. The use of anti-bacterial dressings to prevent wound infections correlated with increased burn depth. Superficial partial thickness and mixed depth burns were frequently dressed with hydrocolloid dressings. Deep partial-to-full thickness burns were frequently dressed with topical ointments. Cost analysis demonstrated hydrocolloid dressings as the most expensive dressing with topical ointments the cheapest. 

Discussion 
In the absence of robust evidence in the literature, the choice of primary dressings applied to burn injuries is rarely evidence based. In addition, there is lack of national consensus or guidelines directing the choice of primary dressings recommended for burn wounds of varying depths. Our findings demonstrated a significant variation in the application of primary dressings to partial thickness, deep dermal, mixed depth and full thickness burns with significant cost implications. Level I evidence is required to provide evidence based recommendations for the efficacy of different primary dressings in variable burns wound depth.