Conclusions

This review indicates that the advances in burn care achieved since WWII were not accidental, but depended on integrated laboratory and clinical research; generous national funding; centers of excellence focused on comprehensive burn care; highly skilled multidisciplinary clinical teams; and committed leadership. Reflecting on recent progress in the 1976 American Burn Association presidential address, Colonel Basil Pruitt noted the importance of a tight working relationship between clinicians and basic scientists, working together to solve problems of clinical significance [124]. This paradigm should be strengthened and expanded, since we have entered an era in which the number of large burns has declined nationwide [125]. As a result, we are challenged with the need for multicenter trials if we are to continue to make progress. Fortunately, the creation of the American Burn Association (ABA) Multicenter Trials Group, and federal funding of several proposals under ABA leadership, has created the framework and the opportunity for such collaboration. In a manner reminiscent of events in the UK and US during WWII, the recent conflicts in Iraq and Afghanistan [126] and the attacks of 11 September 2001 [127] have highlighted the importance of thermal injury as a national problem. As a result, the following multicenter trials are currently being initiated:

Outcomes after burn injury, using the National Burn Repository database

Transfusion triggers

Impact of occupational and physical therapy on outcomes

High-volume hemofiltration in burn patients with septic shock and renal failure

Rapid polymerase chain reaction (PCR) test for

Staphylococcus aureus infection

Community-based exercise

Enteral glutamine effect on infections

Inhalation injury scoring

The spirit of collaboration and inquiry embodied by these projects is the surest guarantee that they will bear fruit in the years to come.

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Correspondence: Dr. L. Cancio, USAISR, Ft. Sam Houston, TX 78234–6315, USA, E-mail: Lee.cancio@us.army.mil