Annals of burns and fire disasters最新文献

Burn injuries are a critical public health issue globally, causing significant morbidity and mortality. This study investigates factors influencing mortality in burn patients. It also examines the effectiveness of total body surface area (TBSA) as a predictor of mortality, suggesting a new threshold to improve patient management and outcome predictions. A retrospective study was conducted at Lebanese Hospital Geitaoui - UMC from 2017 to 2023. The study included 474 patients with second-degree and third-degree burns. Statistical analyses were performed to identify factors significantly associated with mortality, and to assess the predictive power of TBSA. Of the 474 patients, 395 (83.3%) survived while 79 (16.7%) succumbed to their injuries. Patients with TBSA between 81% and 90% had a survival rate of 0%. The logistic regression analysis indicated that for each 1% increase in TBSA, the odds of mortality increased by 6% (p<0.001). Inhalation injuries were present in 70.9% of non-survivors (p<0.001). Patients requiring mechanical ventilation had markedly higher mortality (84.8% vs 15.2%) (p<0.001). Multi-site infections were notably more common among non-survivors (32.9%) substantially increasing mortality risk (p=0.001). The ROC curve analysis confirmed TBSA's strong predictive value. The optimal cutoff point identified was 42.5% TBSA, above which the mortality risk increases significantly. The study highlights the significant impact of demographic factors, burn severity and medical interventions on the survival of burn patients. TBSA emerged as a robust predictor of mortality, underscoring the need for targeted interventions and specialized care for patients with extensive burns.

Gastrointestinal (GI) dysfunction in severely burned patients is common and serious. It results in disruption of the mucosal barrier, which is directly implicated in SIRS and enhanced endotoxin absorption and bacterial translocation that leads to MODS and death. We conducted a retrospective descriptive study in an intensive burn care department in Tunisia, over a period of 6 years, in order to evaluate the incidence of GI complications in burn patients and their impact on burn prognosis. A total of 54 patients were included. The mean age of our patients was 40 ± 22.5 years, with a sex-ratio of 1.25/1. In our series, 2 patients had a history of peptic ulcer and only one was on long-term corticosteroids. TBSA was 36.8 ± 16.1% and ABSI was 6.4 ± 2.8. Antiulcer prophylaxis was prescribed in patients with a history of ulcer (n=2). Systemic analgesia during dressing changes was prescribed in 88.9% of cases. The incidence of GI complications was 2.4%. The median delay of occurrence of these complications was 11.5 days. Revealing symptoms were: melena (n=12), hematemesis (n=11), and abdominal distension (n=11). Digestive hemorrhage was the most frequent (59.3%), followed by abdominal compartment syndrome (16.7%) and isolated peptic ulcer (11.1%). Treatment was medical in 87% of cases and surgery was required in 13% of cases. Mortality in our series was 66.7%.

The occurrence of bacteremia during a hospital stay worsens the prognosis of patients. Especially in burn patients, it is one of the most severe infectious complications during their stay in intensive care units, with high mortality rates. Consequently, rapid detection of the pathogens responsible is crucial for the prompt initiation of effective antimicrobial therapy. In our study, we analysed 85 positive blood cultures collected from 66 patients hospitalised in the burns unit and presenting criteria for sepsis. The results of the molecular test FilmArray BCID2 were compared with those of conventional microbiology methods. Overall, the results of the BCID2 panel were concordant with those of conventional culture in 71.8% of cases. For monomicrobial cultures, the concordance of identification was 83.9%, while for polymicrobial cultures the concordance was 36.4%. The test showed a good performance in the detection of pathogens, with an overall sensitivity of 84.5% and specificity of 98.3%; for the panel targets these rates rose to 95.4% and 98.1% respectively. For resistance genes, the BCID2 detected the blaCTX-M gene in 9 enterobacteria and the carbapenemase genes: blaNDM, blaOXA-48- like, blaVIM in 20 BGN. The mecA/C gene was isolated from 5 Staphylococcus epidermidis and for vancomycin-resistant Enterococcus the vanA/B gene was detected in 3 Enterococcus faecuim. The sensitivity and specificity of the test for detecting resistance genes were 84.1% and 92%. The turnaround time (TAT) for molecular test results was 1 hour and 10min (Q1 1.09 h; Q3 1.12 h). The median TAT for BCID2 was significantly (Mann-Whitney, p<0.0001) shorter than for conventional culture 39.1 h (Q1 33 h; Q3 57.6 h). Antimicrobial therapy was modified on the basis of the molecular test results in 35.3% of patients. This was done within a median of 04 hours of receiving the test result [interquartile range 2.4h - 21h]. A favorable outcome was noted in 70% of these patients.

Breast burns scar reconstruction presents a unique challenge to the plastic surgeon. The consensus view and evidence base for the optimum reconstructive approach to take is not yet established in the literature. This study aims to review the literature to ascertain evidence-based principles for management of this patient cohort. A literature search of Medline was performed using the mesh terms: "breast burns", "chest burns", "reconstruction" and "surgery". Screening was performed by two independent assessors, with a senior assessor to resolve discrepancies. Expert articles, reviews, individual case reports and letters were excluded. Literature search generated 1,385 publications. Of these, 22 were deemed eligible for inclusion in this review. These encompassed 483 patients. We present the operative considerations, surgical technique used and outcomes. The recommendations from included literature were summarised to guide the surgeon when approaching breast burns. These include tangential excision, breast bud preservation, scar release at onset of thelarche, and reconstruction only once breast development has completed. Reconstructive approaches and their indications vary with burn severity, status of abdominal and back tissue, and unilateral or bilateral burn injury. The literature on breast burns reconstruction defines certain key steps for management. There is limited quantitative data on the various reconstructive options and lack of long term follow up data. Further work is needed to establish if a particular surgical approach leads to superior results when compared with others.

Burn injuries cause a considerable number of fatalities in Indonesia annually. Platelet-rich plasma (PRP) in combination with stromal vascular fraction (SVF) is a stem cell-related treatment modality for deep dermal burn wound healing that utilizes growth factors such as the epidermal growth factor (EGF) and basic fibroblast growth factor (FGF2). This study aimed to assess the relationship between serum EGF and FGF2 levels and their impact on re-epithelialization and fibroblast histopathology during deep dermal burn wound healing using PRP and SVF. Wistar rats (n=64) were categorized into the following groups: PRP+SVF injection (Group A), topical PRP+SVF application (Group B), topical Vaseline application (Group C), or control (Group D). Treatments were evaluated on days 1, 4, 7, 10 and 14 post-treatment for the treatment groups and day 0 for the control group. The software SPSS 22 was used for the statistical analysis, along with the Shapiro-Wilk, independent t-test, Mann-Whitney, Kruskal-Wallis, one-way ANOVA, and Kendall's Tau-B tests. The results showed that Group A exhibited the highest FGF2 and EGF levels (6.62 and 8.10 ng/ml, respectively), closely followed by Group B (6.40 and 7.09 ng/ml, respectively). Group C had lower FGF2 levels than Group D and similar EGF levels. The PRP+SVF injection group displayed faster re-epithelialization and fibroblast proliferation. The PRP+SVF injections outperformed the topical application and Vaseline, with greater re-epithelialization and higher EGF levels. Although the injections showed comparable healing to the topical application, Vaseline produced proliferation differences during deep dermal burn wound recovery.

Our objective is to compare the effect of early and late application of skin homograft regarding complications and mortality rate. Burn is a type of physical trauma to skin or tissue. Burn can lead to loss of skin, resulting in deep, widespread skin wounds or even death. This prospective comparative study was done at the Plastic and Reconstructive Surgery Department of Menoufia University Hospitals from December 2017 to July 2020. It was conducted on 31 patients with major burns, classified into two main groups: the early homograft group (8 patients) and the late homograft group (23 patients). All studied patients and donors were subjected to a full history, general and local examination, and investigations such as complete blood counts (CBC), blood glucose level, kidney and liver function tests, electrolytes, and coagulation profile. Additionally, pre-operative preparation along with intra-operative and post-operative care were done. There was a significant decrease in temperature, HR, RR, SIRS score, TLC and K measurements, along with a decrease in rejection % and LOS (length of hospital stay) in the early homograft group compared to the late homograft group (p < 0.05 respectively). Additionally, there was a significant increase in albumin and Na measurements (p < 0.05, respectively). The use of homograft in major burn patients improved their overall condition by improving laboratory and respiratory data post-operatively. However, early usage of the homograft, especially in the first three days, improved laboratory data, SIRS score, percentage of rejection, and length of hospital stay.

Burn injuries have a relatively high prevalence in Indonesia, and infection, as one of the serious complications, can significantly increase the risk of morbidity and mortality in patients. This study aimed to investigate the bacteriological profile, antimicrobial susceptibility pattern, and clinical outcomes of burn patients with bloodstream infection (BSI) in Indonesia. A retrospective cohort design was employed from January 2019 to December 2021 using secondary data from the patients' medical records. Factors associated with length of stay (LoS) and in-hospital mortality were evaluated through Mann-Whitney/Kruskal-Wallis test and chi square/Fisher's exact test, respectively. A total of 43 burn patients with culture-proven bloodstream infections were included in the analysis. Gram negative bacteria were the most commonly isolated pathogens (61.9%), with Acinetobacter baumannii being the primary species (34.9%). Coagulase-negative Staphylococci (CoNS) was the second most common species (26.9%), accounting for the majority of gram-positive bacteria. Carbapenem non-susceptibility was remarkably high in gram-negative bacteria, with piperacillin-tazobactam, amikacin, and tetracycline offering higher activity. The presence of other coinfections apart from BSI was significantly associated with prolonged LoS (p=0.039). Factors associated with in-hospital mortality include flame burns (p=0.041), TBSA ≥40% (p=0.003), and early BSI of <7 days (p=0.046). However, no difference in LoS or mortality was demonstrated in patients with A. baumanniii infection compared to CoNS. Prolonged length of stay and increased risk of mortality necessitates clinicians to further improve infection control within the burn unit and evaluate prudent use of antibiotics for patients.

The objective of this study was to investigate the characteristics and risk factors for early acute kidney injury (AKI) amongst adult patients with severe burns. KDIGO criteria was used to determine and classify the stage of AKI. Early AKI was defined if occurring within 3 days after burn. The results showed that of amongst 241 enrolled patients, early AKI developed in 25.3% of cases. Of them, AKI stage I was 60.7%, followed by stage II (26.2%) and stage III. Mortality rate of patients who developed early AKI was significantly higher than in the non-AKI group (54.1% vs. 15.6%; p = .001). Compared with the non early-AKI group, patients who developed early AKI were significantly older, suffered larger burn extent and deep burn area, and higher rate of inhalation injury (p <.005). In addition, prevalance of required mechanical ventilation, and concentrations of hematocrit and arterial blood lactate level on admission were significantly higher in the early AKI group (p <.001). Admission pH value, levels of protein and albumin were remarkably lower than in the group with early AKI (p <0.01). Multivariate analysis showed that deep burn area, arterial blood lactate level and mechanical ventilation on admission were independently associated with AKI. The incidence of early AKI increases along with number of independent risk factors. This was 19.7% with 1 risk factor, then it increased to 24.6% with 2 factors and up to 36.1% with 3 risk factors (p <.001).

In India around 7 million people suffer from burn injuries each year, with 140,000 deaths and 240,000 people having some form of residual disability. Human skin allograft is the gold standard for the treatment of burn wounds, hence having an in-house skin bank at a Burn Unit would be ideal. This article presents the efforts to introduce the concept of skin donation after death to the population of Udupi and Mangalore District, the response to this venture, and how our in-house skin bank helps in the management of patients in our burns centre. This study is a descriptive study done at our skin bank at Kasturba Medical College Hospital Manipal. All donor and recipient records of cadaveric allografts from MAHE Skin Bank from inception on 21-8-2021 to date were analysed. From inauguration to date, a total of 23 skin donation calls have been attended and a total of 56,560 sq. cm of skin harvested, with an average of 2570 sq. cm of skin harvested from the back and the bilateral lower limbs. A total of 20 inpatients in our burns unit received 28,475 sq. cm of cadaveric skin from our skin bank, with 3 patients dying due to sepsis (mortality rate - 15.00%). It is feasible to create a skin bank in a community with no concept of cadaveric skin donation, as demonstrated by the successful establishment of Coastal Karnataka's first skin bank at KMC Manipal Hospital.

The aim of the study was to identify the efficacy of platelet rich plasma plus nano fat therapy in comparison to nano fat therapy alone on burn scars. The study was conducted at the Department of Plastic & Reconstructive Surgery Dr. Ruth KM Pfau, Civil Hospital Karachi, Dow University of Health Sciences Pakistan from March 2021 to February 2022. Sixty-four patients with mature burn scar of both genders aged eighteen and above were included and randomly distributed in 2 groups: one group received treatment with nano fat therapy whereas the other group received treatment with nano fat therapy and platelet rich plasma. Vancouver scar scale (VSS) score was used to assess the scar at baseline, 1 month, 3 months and finally after 6 months. For both groups, the highest mean total VSS score values were observed at baseline and lowest at 6 months. All mean values at various points for the PRP + nano fat group were lower than mean values for the nano fat group. However, the mean difference between the two groups for scores after 6 months was insignificant. It was concluded that results of both treatments are equivocal.