Severe burn injuries significantly challenge acute medical care, particularly in resource-limited environments. Current predictive scoring systems, often impractical and adult-focused, neglect crucial aspects like mechanical ventilation and length of hospital stay (LOS).
Methods
This study analyzed 2,618 severe burn patients, developing new predictive models for survival, mechanical ventilation, and LOS, based on promptly accessible factors applicable in any setting.
Results
We observed significant seasonality and clear age- and gender-specific patterns, highlighting the necessity for targeted interventions. We developed and publicly released new predictive models for mortality, mechanical ventilation, and LOS for both adult and pediatric populations.
Discussion
Targeting deficiencies in existing scoring systems, this study potentially advances acute burn management, with a particular focus on resource-limited settings. It provides crucial insights into the epidemiology, etiology, and prognostic factors of severe burn injuries, encapsulated in 10 actionable points. We also present an innovative freely accessible online assessment tool: https://burn-scores.com.
Conclusion
By bridging gaps in current scoring methodologies and improving acute phase management, our research offers insights to improve clinical outcomes for severe burn patients globally. The integration of tailored predictive models and technology-driven solutions, especially relevant in resource-constrained settings, represents a major stride in enhancing the quality of burn care.
{"title":"Acute phase optimization in burn care: Online tools and comprehensive predictive models for adult and pediatric patients","authors":"Enrico Cocchi , Fortunato Cassalia , Stefano Palo , Carmine D’Acunto , Anna Belloni Fortina , Marcello Stella , Davide Melandri","doi":"10.1016/j.burnso.2024.100370","DOIUrl":"10.1016/j.burnso.2024.100370","url":null,"abstract":"<div><h3>Background</h3><p>Severe burn injuries significantly challenge acute medical care, particularly in resource-limited environments. Current predictive scoring systems, often impractical and adult-focused, neglect crucial aspects like mechanical ventilation and length of hospital stay (LOS).</p></div><div><h3>Methods</h3><p>This study analyzed 2,618 severe burn patients, developing new predictive models for survival, mechanical ventilation, and LOS, based on promptly accessible factors applicable in any setting.</p></div><div><h3>Results</h3><p>We observed significant seasonality and clear age- and gender-specific patterns, highlighting the necessity for targeted interventions. We developed and publicly released new predictive models for mortality, mechanical ventilation, and LOS for both adult and pediatric populations.</p></div><div><h3>Discussion</h3><p>Targeting deficiencies in existing scoring systems, this study potentially advances acute burn management, with a particular focus on resource-limited settings. It provides crucial insights into the epidemiology, etiology, and prognostic factors of severe burn injuries, encapsulated in 10 actionable points. We also present an innovative freely accessible online assessment tool: <span><span>https://burn-scores.com</span><svg><path></path></svg></span>.</p></div><div><h3>Conclusion</h3><p>By bridging gaps in current scoring methodologies and improving acute phase management, our research offers insights to improve clinical outcomes for severe burn patients globally. The integration of tailored predictive models and technology-driven solutions, especially relevant in resource-constrained settings, represents a major stride in enhancing the quality of burn care.</p></div>","PeriodicalId":72486,"journal":{"name":"Burns open : an international open access journal for burn injuries","volume":"8 4","pages":"Article 100370"},"PeriodicalIF":0.0,"publicationDate":"2024-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2468912224000580/pdfft?md5=8b83bbbd38e3e53955f98e0644dbc33c&pid=1-s2.0-S2468912224000580-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141993277","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-03DOI: 10.1016/j.burnso.2024.100363
Christian Weinand
Introduction
Burn intensive care unit (BICU) patients suffer from reduced immunological competence. Often bacterial and fungal infections occur as single or associated infection of the burn site. However, common factors in associated infections are discussed controversially. In this study we evaluated factors common in associated occurrence of bacterial and fungal infection in the burn population.
Patients and methods
In total 213 patients, admitted to the ICU of Cologne Merheim Clinical Center between 1988 and 2011, with associated infections were included in this study. Exclusion criteria were no bacterial, or no fungal infection, or incomplete data. Data evaluated were sex, age, type of burn injury, total body surface area (TBSA), abbreviated burn severity index (ABSI) score, 3rd degree burn, inhalation injury, length of BICU stay, antibiotic therapy, bacterial strand, fungal strand, incidence of bacteria and fungus infection, single or associated occurrence and bacteria species associated with fungus species. Statistical analysis comprised of univariate, Chi-square and Fischer Exact test, multivariate analysis, positive and negative predictive value, logistic regression analysis with the Nagelkerke, Cox/ Snell R-square.
Results
196 patients were included into the study, 147 male and 49 female. Total mean age was 47 years, in the fire burn group 47 years, in scalding 53 years, in electrical burn 29 years and in chemical burn 62 years. 123 male and 45 female were combusted, 15 male and 3 female scalded, 9 male had an electrical burn and 1 female a chemical burn. The mean TBSA in fire burns was 41 %, in scalding 42 %, in electrical burns 46 %, and in chemical burn 16 %. The mean ABSI in fire burn and scalding was 9, in electrical burn 8 and in chemical burn 7. The 3rd degree burns were 16 % in fire burn and 13 % in scalding and electrical burn and 0 % in chemical burn. The length of BICU stay was 49 days for fire burn, 47 days for scalding, 58 days in electrical burn and 21 days in chemical burn patients.
The gram-positive bacterial strands most often found were Staphylococcus strands, gram negative Pseudomonas and Acinetobacter strands. Candida albicans was the most often present fungal strand. There was no difference in incidence between gram positive and gram-negative bacteria. In patients suffering from fire burns the most common bacteria were Staphylococcus and Pseudomonas, in scalding Acinetobacter, and in chemical burns Staphylococcus. In electrical burns no predominant bacterial strand was found. The associated occurrence of Staphylococcus and Candida albicans and Pseudomonas and Candida albicans was predominant. In patients with fire burn, 48% showed an associated infection, in scalding 21%, in electrical burn 33% and in chemical burn 100%.
Combusted patients had the highest incidence of associated infection in age group 80–89 years, in scalding 40–49, 50–59 a
{"title":"Associated bacterial and fungal infections in burn wounds: Common factors, distribution in etiology, age groups, bacterial and fungal strands – Evaluation of a single burn center experience of 20 years","authors":"Christian Weinand","doi":"10.1016/j.burnso.2024.100363","DOIUrl":"10.1016/j.burnso.2024.100363","url":null,"abstract":"<div><h3>Introduction</h3><p>Burn intensive care unit (BICU) patients suffer from reduced immunological competence. Often bacterial and fungal infections occur as single or associated infection of the burn site. However, common factors in associated infections are discussed controversially. In this study we evaluated factors common in associated occurrence of bacterial and fungal infection in the burn population.</p></div><div><h3>Patients and methods</h3><p>In total 213 patients, admitted to the ICU of Cologne Merheim Clinical Center between 1988 and 2011, with associated infections were included in this study. Exclusion criteria were no bacterial, or no fungal infection, or incomplete data. Data evaluated were sex, age, type of burn injury, total body surface area (TBSA), abbreviated burn severity index (ABSI) score, 3rd degree burn, inhalation injury, length of BICU stay, antibiotic therapy, bacterial strand, fungal strand, incidence of bacteria and fungus infection, single or associated occurrence and bacteria species associated with fungus species. Statistical analysis comprised of univariate, Chi-square and Fischer Exact test, multivariate analysis, positive and negative predictive value, logistic regression analysis with the Nagelkerke, Cox/ Snell R-square.</p></div><div><h3>Results</h3><p>196 patients were included into the study, 147 male and 49 female. Total mean age was 47 years, in the fire burn group 47 years, in scalding 53 years, in electrical burn 29 years and in chemical burn 62 years. 123 male and 45 female were combusted, 15 male and 3 female scalded, 9 male had an electrical burn and 1 female a chemical burn. The mean TBSA in fire burns was 41 %, in scalding 42 %, in electrical burns 46 %, and in chemical burn 16 %. The mean ABSI in fire burn and scalding was 9, in electrical burn 8 and in chemical burn 7. The 3rd degree burns were 16 % in fire burn and 13 % in scalding and electrical burn and 0 % in chemical burn. The length of BICU stay was 49 days for fire burn, 47 days for scalding, 58 days in electrical burn and 21 days in chemical burn patients.</p><p>The gram-positive bacterial strands most often found were Staphylococcus strands, gram negative Pseudomonas and Acinetobacter strands. Candida albicans was the most often present fungal strand. There was no difference in incidence between gram positive and gram-negative bacteria. In patients suffering from fire burns the most common bacteria were Staphylococcus and Pseudomonas, in scalding Acinetobacter, and in chemical burns Staphylococcus. In electrical burns no predominant bacterial strand was found. The associated occurrence of Staphylococcus and Candida albicans and Pseudomonas and Candida albicans was predominant. In patients with fire burn, 48% showed an associated infection, in scalding 21%, in electrical burn 33% and in chemical burn 100%.</p><p>Combusted patients had the highest incidence of associated infection in age group 80–89 years, in scalding 40–49, 50–59 a","PeriodicalId":72486,"journal":{"name":"Burns open : an international open access journal for burn injuries","volume":"8 4","pages":"Article 100363"},"PeriodicalIF":0.0,"publicationDate":"2024-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2468912224000518/pdfft?md5=96e6815fb038ba2f47e1b776c261c1e0&pid=1-s2.0-S2468912224000518-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142021436","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-02DOI: 10.1016/j.burnso.2024.100369
Mohammedbabalrahma Bashier Ahmed Koko , Mohamed Daffalla Awadalla Gismalla , Mohammed Yousof Bakhiet , Alshareef Mohamed Alshareef , Mohammed Aseri , Aimen Elsheikh Khalil Abuelnour
{"title":"Corrigendum to “Evaluation of clinical presentation and management outcome of burns, experience at secondary referral hospital in a low-income, sub-Saharan country: A cohort study” [Burns Open 8(2) (2024) 82–86]","authors":"Mohammedbabalrahma Bashier Ahmed Koko , Mohamed Daffalla Awadalla Gismalla , Mohammed Yousof Bakhiet , Alshareef Mohamed Alshareef , Mohammed Aseri , Aimen Elsheikh Khalil Abuelnour","doi":"10.1016/j.burnso.2024.100369","DOIUrl":"10.1016/j.burnso.2024.100369","url":null,"abstract":"","PeriodicalId":72486,"journal":{"name":"Burns open : an international open access journal for burn injuries","volume":"8 4","pages":"Article 100369"},"PeriodicalIF":0.0,"publicationDate":"2024-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2468912224000579/pdfft?md5=a8d67f4a712fbe220b12b2ae75fa8629&pid=1-s2.0-S2468912224000579-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141978925","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-26DOI: 10.1016/j.burnso.2024.100365
Kai Hsun Hsiao , Joseph Kalanzi , Stuart B Watson , Srinivas Murthy , Ani Movsisyan , Kavita Kothari , Flavio Salio , Pryanka Relan
Background
Resource limitations in settings such as burn mass casualty incidents (MCIs) present challenges to the judicious fluid resuscitation required for major burns. Previous recommendations for burns care in MCIs have suggested certain adaptations from routine care, such as delaying intravenous (IV) fluid resuscitation until arrival at facility; using a fluid calculation formula that is independent of percentage of total body surface area (%TBSA) burned; or using fluid calculation formula based on time of arrival to first receiving facility rather than from time of injury, thus omitting ‘catch-up’ fluid.
Objectives
To synthesize and assess certainty of evidence from resource-limited settings on the three adaptations to fluid resuscitation for patients with major burns in MCIs.
Methods
PubMed, EMBASE, CINAHL, and Cochrane Library were searched on 8 September 2023 with an update search on 8 July 2024. Primary quantitative studies in resource-limited settings meeting eligibility criteria as assessed by two reviewers were included. Where available, outcome effects for these adaptations compared to routine burns care were calculated. Evidence certainty was determined by GRADE.
Results
Two eligible studies were identified from 544 search results. One study with 48 participants provided very uncertain evidence that delayed IV fluid resuscitation may increase acute kidney injury compared to prehospital resuscitation (OR 2.48, 95% CI 0.58–10.62). The other study with a cohort of 10 children provided very uncertain evidence that calculating fluid requirements based on time of arrival to first receiving facility, i.e. omitting ‘catch-up’ fluids, may maintain adequate urine output and be associated with no complications of fluid over- or under-resuscitation. There were no studies on use of a simplified %TBSA-independent fluid calculation formula.
Conclusions
There is very limited and uncertain evidence to inform on delayed IV fluid resuscitation, simplified %TBSA-independent formula, and omission of ‘catch up’ fluids for burns care in MCIs. Contextual factors, local values, preferences and feasibility also need to be considered.
{"title":"Adapted approaches to initial fluid management of patients with major burns in resource-limited settings: A systematic review","authors":"Kai Hsun Hsiao , Joseph Kalanzi , Stuart B Watson , Srinivas Murthy , Ani Movsisyan , Kavita Kothari , Flavio Salio , Pryanka Relan","doi":"10.1016/j.burnso.2024.100365","DOIUrl":"10.1016/j.burnso.2024.100365","url":null,"abstract":"<div><h3>Background</h3><p>Resource limitations in settings such as burn mass casualty incidents (MCIs) present challenges to the judicious fluid resuscitation required for major burns. Previous recommendations for burns care in MCIs have suggested certain adaptations from routine care, such as delaying intravenous (IV) fluid resuscitation until arrival at facility; using a fluid calculation formula that is independent of percentage of total body surface area (%TBSA) burned; or using fluid calculation formula based on time of arrival to first receiving facility rather than from time of injury, thus omitting ‘catch-up’ fluid.</p></div><div><h3>Objectives</h3><p>To synthesize and assess certainty of evidence from resource-limited settings on the three adaptations to fluid resuscitation for patients with major burns in MCIs.</p></div><div><h3>Methods</h3><p>PubMed, EMBASE, CINAHL, and Cochrane Library were searched on 8 September 2023 with an update search on 8 July 2024. Primary quantitative studies in resource-limited settings meeting eligibility criteria as assessed by two reviewers were included. Where available, outcome effects for these adaptations compared to routine burns care were calculated. Evidence certainty was determined by GRADE.</p></div><div><h3>Results</h3><p>Two eligible studies were identified from 544 search results. One study with 48 participants provided very uncertain evidence that delayed IV fluid resuscitation may increase acute kidney injury compared to prehospital resuscitation (OR 2.48, 95% CI 0.58–10.62). The other study with a cohort of 10 children provided very uncertain evidence that calculating fluid requirements based on time of arrival to first receiving facility, i.e. omitting ‘catch-up’ fluids, may maintain adequate urine output and be associated with no complications of fluid over- or under-resuscitation. There were no studies on use of a simplified %TBSA-independent fluid calculation formula.</p></div><div><h3>Conclusions</h3><p>There is very limited and uncertain evidence to inform on delayed IV fluid resuscitation, simplified %TBSA-independent formula, and omission of ‘catch up’ fluids for burns care in MCIs. Contextual factors, local values, preferences and feasibility also need to be considered.</p></div>","PeriodicalId":72486,"journal":{"name":"Burns open : an international open access journal for burn injuries","volume":"8 4","pages":"Article 100365"},"PeriodicalIF":0.0,"publicationDate":"2024-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2468912224000531/pdfft?md5=503b28a1d46468b83036d3c4961eb5b4&pid=1-s2.0-S2468912224000531-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141843090","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-25DOI: 10.1016/j.burnso.2024.100364
Kai Hsun Hsiao , Joseph Kalanzi , Stuart B. Watson , Srinivas Murthy , Ani Movsisyan , Kavita Kothari , Flavio Salio , Pryanka Relan
Background
Timely and safe intravenous (IV) fluid resuscitation for major burns may be difficult or impossible during mass casualty burn incidents. Oral/enteral fluid resuscitation may be an alternative.
Objectives
To synthesize and assess certainty of evidence on oral/enteral fluid resuscitation as compared to IV or no fluid resuscitation for major burns.
Methods
PubMed, EMBASE, CINAHL, and Cochrane Library were searched on 8 September 2023. Primary quantitative studies meeting criteria as assessed by two reviewers were included. Meta-analyses for outcome effects of oral/enteral versus IV and of oral/enteral versus no fluid resuscitation were conducted. Evidence certainty was assessed using GRADE.
Results
Seven human and eight animal studies were included. Three human RCTs totalling 100 participants contributed to estimates. Compared to IV fluid resuscitation, oral/enteral fluid resuscitation is associated with a statistically insignificant increased risk of mortality (OR 1.33, 95% CI 0.33–5.36) but the evidence is very uncertain, and no difference in urine output (SMD −0.17, 95% CI −0.65–0.31) with moderate certainty of evidence. Eight controlled animal studies totalling 212 participants contributed to estimates. From these animal studies, enteral fluid resuscitation may increase mortality (OR 36.00, 95% CI 2.72–476.28), worsen creatinine levels (MD 22 mmol/L, 95% CI 15.8–28.2), and increase urine output (MD 1 ml/kg/h, 95% CI 0.55–1.45) compared to IV, but all with very low certainty of evidence. Again, from animal studies, all the evidence is very uncertain, but compared to no fluid resuscitation, enteral resuscitation is associated with a statistically insignificant reduction in mortality (OR 0.29, 95% CI 0.08–1.09), improved creatinine levels (SMD −3.48, 95% CI −4.69 to −2.28), and increased urine output (MD 0.55 ml/kg/h, 95% CI 0.38–0.72).
Conclusions
Current evidence comparing oral/enteral and IV fluid resuscitation for major burns is limited and uncertain. However, where IV fluid resuscitation is unavailable or delayed, oral fluid resuscitation could be considered.
背景在大规模伤亡烧伤事件中，对重度烧伤进行及时、安全的静脉注射（IV）液体复苏可能很困难或不可能。目的 综合并评估口服/肠道液体复苏与静脉注射或不进行液体复苏治疗重度烧伤的证据确定性。方法 于 2023 年 9 月 8 日检索了 PubMed、EMBASE、CINAHL 和 Cochrane 图书馆。纳入了经两名审稿人评估符合标准的主要定量研究。对口服/肠道与静脉注射以及口服/肠道与无液体复苏的结果效应进行了 Meta 分析。采用 GRADE 对证据的确定性进行了评估。三项人类 RCT 共 100 名参与者参与了估算。与静脉输液复苏相比，口服/肠道输液复苏与死亡率风险增加（OR 1.33，95% CI 0.33-5.36）相关，但在统计学上并不显著，但证据非常不确定，而尿量无差异（SMD -0.17，95% CI -0.65-0.31），证据的确定性为中等。八项动物对照研究共 212 名参与者参与了估算。从这些动物研究来看，与静脉注射相比，肠内液体复苏可能会增加死亡率（OR 36.00，95% CI 2.72-476.28）、恶化肌酐水平（MD 22 mmol/L，95% CI 15.8-28.2）和增加尿量（MD 1 ml/kg/h，95% CI 0.55-1.45），但证据的确定性都很低。同样，在动物实验中，所有的证据都很不确定，但与不进行液体复苏相比，肠内复苏与死亡率的降低（OR 0.29，95% CI 0.08-1.结论目前比较口服/肠道和静脉输液复苏治疗重度烧伤的证据有限且不确定。然而，在无法使用静脉输液或静脉输液延迟的情况下，可以考虑口服液复苏。
{"title":"Oral/enteral fluid resuscitation in the initial management of major burns: A systematic review and meta-analysis of human and animal studies","authors":"Kai Hsun Hsiao , Joseph Kalanzi , Stuart B. Watson , Srinivas Murthy , Ani Movsisyan , Kavita Kothari , Flavio Salio , Pryanka Relan","doi":"10.1016/j.burnso.2024.100364","DOIUrl":"10.1016/j.burnso.2024.100364","url":null,"abstract":"<div><h3>Background</h3><p>Timely and safe intravenous (IV) fluid resuscitation for major burns may be difficult or impossible during mass casualty burn incidents. Oral/enteral fluid resuscitation may be an alternative.</p></div><div><h3>Objectives</h3><p>To synthesize and assess certainty of evidence on oral/enteral fluid resuscitation as compared to IV or no fluid resuscitation for major burns.</p></div><div><h3>Methods</h3><p>PubMed, EMBASE, CINAHL, and Cochrane Library were searched on 8 September 2023. Primary quantitative studies meeting criteria as assessed by two reviewers were included. Meta-analyses for outcome effects of oral/enteral versus IV and of oral/enteral versus no fluid resuscitation were conducted. Evidence certainty was assessed using GRADE.</p></div><div><h3>Results</h3><p>Seven human and eight animal studies were included. Three human RCTs totalling 100 participants contributed to estimates. Compared to IV fluid resuscitation, oral/enteral fluid resuscitation is associated with a statistically insignificant increased risk of mortality (OR 1.33, 95% CI 0.33–5.36) but the evidence is very uncertain, and no difference in urine output (SMD −0.17, 95% CI −0.65–0.31) with moderate certainty of evidence. Eight controlled animal studies totalling 212 participants contributed to estimates. From these animal studies, enteral fluid resuscitation may increase mortality (OR 36.00, 95% CI 2.72–476.28), worsen creatinine levels (MD 22 mmol/L, 95% CI 15.8–28.2), and increase urine output (MD 1 ml/kg/h, 95% CI 0.55–1.45) compared to IV, but all with very low certainty of evidence. Again, from animal studies, all the evidence is very uncertain, but compared to no fluid resuscitation, enteral resuscitation is associated with a statistically insignificant reduction in mortality (OR 0.29, 95% CI 0.08–1.09), improved creatinine levels (SMD −3.48, 95% CI −4.69 to −2.28), and increased urine output (MD 0.55 ml/kg/h, 95% CI 0.38–0.72).</p></div><div><h3>Conclusions</h3><p>Current evidence comparing oral/enteral and IV fluid resuscitation for major burns is limited and uncertain. However, where IV fluid resuscitation is unavailable or delayed, oral fluid resuscitation could be considered.</p></div>","PeriodicalId":72486,"journal":{"name":"Burns open : an international open access journal for burn injuries","volume":"8 4","pages":"Article 100364"},"PeriodicalIF":0.0,"publicationDate":"2024-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S246891222400052X/pdfft?md5=cb9faeea0777563e90825b3d5295256d&pid=1-s2.0-S246891222400052X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141849379","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-20DOI: 10.1016/j.burnso.2024.100361
Alejandro Angel Corona-Figueroa , Mario Vélez-Palafox , Erik Agustin Marquez-Gutierrez , Erika Barlandas-Quintana , Samuel Eloy Gutierrez-Barreto
Background
The percentage of the total body surface area (TBSA) is a simplified way to address the magnitude and severity of a thermal injury. The burn care providers recognize the relationship between burn size, prognosis, and number of required interventions. This study aims to identify the prevalence and magnitude of TBSA estimation inconsistencies between referring hospitals and the National Burn Center in Mexico and introduce new telemedicine and mobile applications for effectively estimating burn areas for non-burn-trained personnel.
Methods
We included patients with any thermal injury at the National Rehabilitation Institute in Mexico City referred from any other hospital in the country. Data was collected from the referral email and our medical records, and the burn estimation error was calculated using the following formula: (TBSA referral Hospital – TBSA Burn Center) / TBSA Burn Center multiplied by 100.
Results
Seventy-eight patients were transferred to the institute; the mean age was 27 years, 55 were male. The mean %TBSA from the referring hospital was 36 %, and in our Burn Center was 28 %, with a mean difference of 8.8 %. There were 59 cases with overestimated %TBSA, and ten were underestimated; the rest were similar in percentage.
Conclusions
Our study highlights substantial discrepancies between the estimated %TBSA by referring hospitals and the actual %TBSA, consistently tending towards overestimation.
{"title":"Burn vs. Referral Physicians' TBSA Estimation Errors: A Cross-Sectional Study at the National Burn Center","authors":"Alejandro Angel Corona-Figueroa , Mario Vélez-Palafox , Erik Agustin Marquez-Gutierrez , Erika Barlandas-Quintana , Samuel Eloy Gutierrez-Barreto","doi":"10.1016/j.burnso.2024.100361","DOIUrl":"10.1016/j.burnso.2024.100361","url":null,"abstract":"<div><h3>Background</h3><p>The percentage of the total body surface area (TBSA) is a simplified way to address the magnitude and severity of a thermal injury. The burn care providers recognize the relationship between burn size, prognosis, and number of required interventions. This study aims to identify the prevalence and magnitude of TBSA estimation inconsistencies between referring hospitals and the National Burn Center in Mexico and introduce new telemedicine and mobile applications for effectively estimating burn areas for non-burn-trained personnel.</p></div><div><h3>Methods</h3><p>We included patients with any thermal injury at the National Rehabilitation Institute in Mexico City referred from any other hospital in the country. Data was collected from the referral email and our medical records, and the burn estimation error was calculated using the following formula: (TBSA referral Hospital – TBSA Burn Center) / TBSA Burn Center multiplied by 100.</p></div><div><h3>Results</h3><p>Seventy-eight patients were transferred to the institute; the mean age was 27 years, 55 were male. The mean %TBSA from the referring hospital was 36 %, and in our Burn Center was 28 %, with a mean difference of 8.8 %. There were 59 cases with overestimated %TBSA, and ten were underestimated; the rest were similar in percentage.</p></div><div><h3>Conclusions</h3><p>Our study highlights substantial discrepancies between the estimated %TBSA by referring hospitals and the actual %TBSA, consistently tending towards overestimation.</p></div>","PeriodicalId":72486,"journal":{"name":"Burns open : an international open access journal for burn injuries","volume":"8 4","pages":"Article 100361"},"PeriodicalIF":0.0,"publicationDate":"2024-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S246891222400049X/pdfft?md5=cdecf09df87b374863c335044dc20fc9&pid=1-s2.0-S246891222400049X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141843576","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Burns remains a major preventable cause of injury in children worldwide with morbidity and mortality disproportionately affecting low- and middle-income countries. Complications following burn injuries in children are not well studied in Mozambique.
Methods
Children between 1 month and 14 years old hospitalized for burns between 2015 and 2017 at Hospital Central de Maputo were identified retrospectively. Child and burns characteristics were compiled with complications including wound infection, sepsis, anemia, hypoalbuminemia, hyperglycemia, and dehydration. The association of complications with demographic variables and burn characteristics were assessed through bivariate analysis.
Results
Of the 206 children, the most common cause of burns was hot liquids (66%), followed by fire (28%) and electrical current (6%). Children aged one to four years old were most frequently affected (54%). Of the 91 children with complications, 68% had severe burns with a significant relationship between lesion depth and complications. Among the complications, hypoalbuminemia (56%), hyperglycemia (51%), and wound infections (17%) were the most common. Children who had flame/fire burns and 2nd and 3rd degree burns were associate with a greater risk of having complications.
Conclusions
Pediatric burns in the early years are more frequent in Mozambique and hold a high burden of complications. Moreover, flame/fire burns and 2nd and 3rd degree burns were associated with increased odds of complications. Primary prevention measures within the family will be critical to minimize pediatric burns and additional research is warranted to better understand clinical interventions to prevent mortality and complications in low- and middle-income countries.
{"title":"Characteristics of pediatric burns complications in the main referral hospital of Mozambique","authors":"Luísa Huo , Shannon Richardson , Celma Issufo , Valeria Chicamba , Baltazar Chilundo , Natércia Fernandes , Vanda Amado","doi":"10.1016/j.burnso.2024.100362","DOIUrl":"10.1016/j.burnso.2024.100362","url":null,"abstract":"<div><h3>Background</h3><p>Burns remains a major preventable cause of injury in children worldwide with morbidity and mortality disproportionately affecting low- and middle-income countries. Complications following burn injuries in children are not well studied in Mozambique.</p></div><div><h3>Methods</h3><p>Children between 1 month and 14 years old hospitalized for burns between 2015 and 2017 at Hospital Central de Maputo were identified retrospectively. Child and burns characteristics were compiled with complications including wound infection, sepsis, anemia, hypoalbuminemia, hyperglycemia, and dehydration. The association of complications with demographic variables and burn characteristics were assessed through bivariate analysis.</p></div><div><h3>Results</h3><p>Of the 206 children, the most common cause of burns was hot liquids (66%), followed by fire (28%) and electrical current (6%). Children aged one to four years old were most frequently affected (54%). Of the 91 children with complications, 68% had severe burns with a significant relationship between lesion depth and complications. Among the complications, hypoalbuminemia (56%), hyperglycemia (51%), and wound infections (17%) were the most common. Children who had flame/fire burns and 2nd and 3rd degree burns were associate with a greater risk of having complications.</p></div><div><h3>Conclusions</h3><p>Pediatric burns in the early years are more frequent in Mozambique and hold a high burden of complications. Moreover, flame/fire burns and 2nd and 3rd degree burns were associated with increased odds of complications. Primary prevention measures within the family will be critical to minimize pediatric burns and additional research is warranted to better understand clinical interventions to prevent mortality and complications in low- and middle-income countries.</p></div>","PeriodicalId":72486,"journal":{"name":"Burns open : an international open access journal for burn injuries","volume":"8 4","pages":"Article 100362"},"PeriodicalIF":0.0,"publicationDate":"2024-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2468912224000506/pdfft?md5=9995c153ba6c8c5a9718d96e98363ae8&pid=1-s2.0-S2468912224000506-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141838953","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Burn injuries are becoming a growing burden, negatively impacting both individuals and society. They affect a person’s health and lead to psychosocial and economic problems. This study evaluates the prevalence, characteristics, and short-term outcomes of patients with burn injuries admitted to a tertiary care hospital in Northern Sri Lanka.
Methods
This prospective cross-sectional study was conducted on patients with burn injuries admitted to Tertiary care centre Jaffna over six months in 2023. Ethical clearance was obtained from the Ethics Review Committee of the Faculty of Medicine, University of Jaffna. Baseline characteristics and clinical features during hospitalisation were recorded. Categorical variables were compared using the Chi-square test, with post hoc Tukey tests conducted where applicable.
Results
This study included 57 patients aged 1 to 88 years, with a mean age of 35.19 ± 21.16 years. Most participants were female (53.4 %), and most had completed secondary education (62.1 %). Approximately 65.5 % were employed in unskilled jobs, with the remainder in skilled professions. Accidental burns were the most common cause (72.4 %), with 84.5 % of injuries occurring at home, though suicide-related burns accounted for 24.1 %. Flame-related burns constituted 50 % of injuries, with first-degree burns being the most common (44.8 %). The availability of first aid significantly influenced outcomes, with 74.1 % receiving assistance, primarily through removing clothing (43.8 %) and using running water (15.8 %). A combined approach of care was received by most patients (52.7 %), while 8.8 % were hospitalised in the plastic and reconstructive surgery department. Many patients had burns covering less than 10 % of their body surface area (46.6 %).
Conclusion
The findings of this study on patients with burn injuries underscore the importance of understanding the causes of burns, administering appropriate first aid, recognising different injury types and severities, assessing the total burn surface area, and tailoring patient treatment. These insights are crucial for informing prevention strategies and healthcare planning, aiming to mitigate the impact of burn injuries and improve patient outcomes.
{"title":"Characteristics of patients with burn injuries managed at a tertiary care centre","authors":"Suntharamoorthy Iyer Thuraisamy Sarma, Sreekanthan Gobishangar, Suwaminathan Thiruvarangan, Nadarajah Hamsavakini, Paramanathan Shathana","doi":"10.1016/j.burnso.2024.100360","DOIUrl":"https://doi.org/10.1016/j.burnso.2024.100360","url":null,"abstract":"<div><h3>Introduction</h3><p>Burn injuries are becoming a growing burden, negatively impacting both individuals and society. They affect a person’s health and lead to psychosocial and economic problems. This study evaluates the prevalence, characteristics, and short-term outcomes of patients with burn injuries admitted to a tertiary care hospital in Northern Sri Lanka.</p></div><div><h3>Methods</h3><p>This prospective cross-sectional study was conducted on patients with burn injuries admitted to Tertiary care centre Jaffna over six months in 2023. Ethical clearance was obtained from the Ethics Review Committee of the Faculty of Medicine, University of Jaffna. Baseline characteristics and clinical features during hospitalisation were recorded. Categorical variables were compared using the Chi-square test, with post hoc Tukey tests conducted where applicable.</p></div><div><h3>Results</h3><p>This study included 57 patients aged 1 to 88 years, with a mean age of 35.19 ± 21.16 years. Most participants were female (53.4 %), and most had completed secondary education (62.1 %). Approximately 65.5 % were employed in unskilled jobs, with the remainder in skilled professions. Accidental burns were the most common cause (72.4 %), with 84.5 % of injuries occurring at home, though suicide-related burns accounted for 24.1 %. Flame-related burns constituted 50 % of injuries, with first-degree burns being the most common (44.8 %). The availability of first aid significantly influenced outcomes, with 74.1 % receiving assistance, primarily through removing clothing (43.8 %) and using running water (15.8 %). A combined approach of care was received by most patients (52.7 %), while 8.8 % were hospitalised in the plastic and reconstructive surgery department. Many patients had burns covering less than 10 % of their body surface area (46.6 %).</p></div><div><h3>Conclusion</h3><p>The findings of this study on patients with burn injuries underscore the importance of understanding the causes of burns, administering appropriate first aid, recognising different injury types and severities, assessing the total burn surface area, and tailoring patient treatment. These insights are crucial for informing prevention strategies and healthcare planning, aiming to mitigate the impact of burn injuries and improve patient outcomes.</p></div>","PeriodicalId":72486,"journal":{"name":"Burns open : an international open access journal for burn injuries","volume":"8 4","pages":"Article 100360"},"PeriodicalIF":0.0,"publicationDate":"2024-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2468912224000488/pdfft?md5=a124304ab43abb497a38d80710e70b16&pid=1-s2.0-S2468912224000488-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141605597","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-05DOI: 10.1016/j.burnso.2024.100359
Tamara Mertz, Amr Elassy, Christopher Wearn
Purpose of the study
To investigate the local and national incidence of contact burns secondary to microwave-heated drinkware and specifically those with a metallic coating.
Methods
This retrospective analysis from November 2018 to December 2022 includes UK-wide data on burn mechanism, demographics, TBSA (total body surface area), depth and additionally, local data on injury details, management, complications, healing duration, return-to-work time, and follow-up duration within our service.
Results
National: In the UK, 87 patients sustained burns related to microwave heating of drinkware. Median (IQR) burn size was 0.21% (+/−0.15) TBSA. Most burn injuries were superficial dermal (SD) (88.7%). All cases were treated conservatively.
Regional: Contact burns from microwave-heated metallic coated drinkware were identified in 28 patients. The median (IQR) TBSA was 0.12% (+/−0). Most injuries were assessed as SD (90%, 45/50), however, 4/5 (80%) of the deeper burns were caused by metallic-coated drinkware. The median (IQR) follow-up was 6.04 days (+/−4.5). Median (IQR) healing time was 14.17 (+/−0) days and mean time to return to work was 7.57 (+/−3.5) days.
Conclusions
Microwave-heated drinkware burns, while constituting a small portion of referrals to UK burns services, may have a larger true population incidence. Due to their size, these injuries are probably treated locally without referral to a burns service. Regional data analysis highlighted that metallic coated drinkware related injuries were associated with longer healing times.
{"title":"Too hot to handle − Microwaved drinkware: An emerging cause of contact burn injuries?","authors":"Tamara Mertz, Amr Elassy, Christopher Wearn","doi":"10.1016/j.burnso.2024.100359","DOIUrl":"https://doi.org/10.1016/j.burnso.2024.100359","url":null,"abstract":"<div><h3>Purpose of the study</h3><p>To investigate the local and national incidence of contact burns secondary to microwave-heated drinkware and specifically those with a metallic coating.</p></div><div><h3>Methods</h3><p>This retrospective analysis from November 2018 to December 2022 includes UK-wide data on burn mechanism, demographics, TBSA (total body surface area), depth and additionally, local data on injury details, management, complications, healing duration, return-to-work time, and follow-up duration within our service.</p></div><div><h3>Results</h3><p><em>National:</em> In the UK, 87 patients sustained burns related to microwave heating of drinkware. Median (IQR) burn size was 0.21% (+/−0.15) TBSA. Most burn injuries were superficial dermal (SD) (88.7%). All cases were treated conservatively.</p><p><em>Regional:</em> Contact burns from microwave-heated metallic coated drinkware were identified in 28 patients. The median (IQR) TBSA was 0.12% (+/−0). Most injuries were assessed as SD (90%, 45/50), however, 4/5 (80%) of the deeper burns were caused by metallic-coated drinkware. The median (IQR) follow-up was 6.04 days (+/−4.5). Median (IQR) healing time was 14.17 (+/−0) days and mean time to return to work was 7.57 (+/−3.5) days.</p></div><div><h3>Conclusions</h3><p>Microwave-heated drinkware burns, while constituting a small portion of referrals to UK burns services, may have a larger true population incidence. Due to their size, these injuries are probably treated locally without referral to a burns service. Regional data analysis highlighted that metallic coated drinkware related injuries were associated with longer healing times.</p></div>","PeriodicalId":72486,"journal":{"name":"Burns open : an international open access journal for burn injuries","volume":"8 4","pages":"Article 100359"},"PeriodicalIF":0.0,"publicationDate":"2024-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2468912224000476/pdfft?md5=d77c48aea66bb87a41a84dc43abdc9d3&pid=1-s2.0-S2468912224000476-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141594571","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-02DOI: 10.1016/j.burnso.2024.100358
Alberta Amissah Rockson , Natalie Benjamin-Damons , Sonti Imogene Pilusa
Introduction
Burn injuries among children have emerged as a significant global public health concern, accounting for substantial morbidity and mortality worldwide. Low and Middle-Income Countries bear a significant burden of paediatric burn injuries. In Ghana, limited data exists on the prevalence, characteristics and outcomes of paediatric burns. This study provides vital data on the local burden and epidemiology of paediatric burns at Ghana’s main burns treatment center. The findings have significant value in informing prevention strategies, allocating resources, and improving quality of paediatric burn care.
Study objective
To establish the prevalence and characteristics of paediatric burns injuries in Ghana’s leading burn center.
Methodology
A retrospective cohort study analyzed data from 662 adult and paediatric patients who presented with burns from all over Ghana between 2020 and 2022. The study encompassed medical records of paediatric burn cases (aged 0–14 years) admitted to the center from January 2020 to December 2022. A purposive sampling technique was used to select cases based on the inclusion criteria and elimination of cases with 20 % missing data. A total of 335 paediatric records were reviewed.
Data analytical methods
Descriptive statistics, such as frequencies, mean, percentages were used to establish period prevalence and demographic characteristics of paediatric burns. Chi-square analysis and univariate logistic regression was utilized to explore associations between categorical variables, and predictors of burn outcome.
Results
The period prevalence of paediatric burns was found to be 50.6 %. Paediatric burn cases predominantly affected males (57.6 %). Majority of cases fell within the age range of 1 to 5 years (70.1 %). Hot water emerged as the leading cause (58.4 %), whiles superficial partial thickness burns (51.9 %) was the predominant type of burn. Most cases involved burns affecting less than 20 % Total Body Surface Area (59.0 %). Multi-part body injuries were common (87.2 %), with the lower limb being the most affected (25.36 %). The mortality rate was calculated to be 21.0 %. Higher TBSA was a significant predictor of mortality (p < 0.001).
Conclusion
This study found a high prevalence of paediatric burns with hot water and foods being the predominant causes. Higher TBSA predicted lower chances of survival. The findings have scientific value in informing prevention strategies, allocating resources, and improving the quality of care.
{"title":"Prevalence and characteristics of paediatric burns at the National Reconstructive Plastic Surgery and Burns Centre, Korle Bu Teaching Hospital, Ghana","authors":"Alberta Amissah Rockson , Natalie Benjamin-Damons , Sonti Imogene Pilusa","doi":"10.1016/j.burnso.2024.100358","DOIUrl":"https://doi.org/10.1016/j.burnso.2024.100358","url":null,"abstract":"<div><h3>Introduction</h3><p>Burn injuries among children have emerged as a significant global public health concern, accounting for substantial morbidity and mortality worldwide. Low and Middle-Income Countries bear a significant burden of paediatric burn injuries. In Ghana, limited data exists on the prevalence, characteristics and outcomes of paediatric burns. This study provides vital data on the local burden and epidemiology of paediatric burns at Ghana’s main burns treatment center. The findings have significant value in informing prevention strategies, allocating resources, and improving quality of paediatric burn care.</p></div><div><h3>Study objective</h3><p>To establish the prevalence and characteristics of paediatric burns injuries in Ghana’s leading burn center.</p></div><div><h3>Methodology</h3><p>A retrospective cohort study analyzed data from 662 adult and paediatric patients who presented with burns from all over Ghana between 2020 and 2022. The study encompassed medical records of paediatric burn cases (aged 0–14 years) admitted to the center from January 2020 to December 2022. A purposive sampling technique was used to select cases based on the inclusion criteria and elimination of cases with 20 % missing data. A total of 335 paediatric records were reviewed.</p></div><div><h3>Data analytical methods</h3><p>Descriptive statistics, such as frequencies, mean, percentages were used to establish period prevalence and demographic characteristics of paediatric burns. Chi-square analysis and univariate logistic regression was utilized to explore associations between categorical variables, and predictors of burn outcome.</p></div><div><h3>Results</h3><p>The period prevalence of paediatric burns was found to be 50.6 %. Paediatric burn cases predominantly affected males (57.6 %). Majority of cases fell within the age range of 1 to 5 years (70.1 %). Hot water emerged as the leading cause (58.4 %), whiles superficial partial thickness burns (51.9 %) was the predominant type of burn. Most cases involved burns affecting less than 20 % Total Body Surface Area (59.0 %). Multi-part body injuries were common (87.2 %), with the lower limb being the most affected (25.36 %). The mortality rate was calculated to be 21.0 %. Higher TBSA was a significant predictor of mortality (p < 0.001).</p></div><div><h3>Conclusion</h3><p>This study found a high prevalence of paediatric burns with hot water and foods being the predominant causes. Higher TBSA predicted lower chances of survival. The findings have scientific value in informing prevention strategies, allocating resources, and improving the quality of care.</p></div>","PeriodicalId":72486,"journal":{"name":"Burns open : an international open access journal for burn injuries","volume":"8 4","pages":"Article 100358"},"PeriodicalIF":0.0,"publicationDate":"2024-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2468912224000464/pdfft?md5=738e7741addc028c0101f1d772465df3&pid=1-s2.0-S2468912224000464-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141541241","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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