Annals of burns and fire disasters最新文献

Scalds constitute the most common type of childhood burns. Given their potential for spontaneous healing, a variety of dressings are used to promote healing and prevent infection. This comparative study was carried out to document the clinical presentation of pediatric scald burns and evaluate their management outcome with hydrocolloid dressings versus silver sulphadiazine (SSD) in terms of complete healing, healing time, mean number of dressings required to achieve healing, and any need for split thickness skin grafting at three weeks. The study included all pediatric scald patients (aged ≤15 years) who presented with superficial partial-thickness and deep partial-thickness wounds during the study period. Exclusion criteria included children over the age of 15 years, facial scalds and full thickness scalds. Half of the patients were randomly assigned to the hydrocolloid group and half to the SSD group. Out of a total of 100 patients, 66% (n=66) were males whereas 34% (n=34) were females. Age ranged from 3 months to 15 years, with a mean of 2.88±2.86 years. Total body surface area (TBSA) affected ranged from 3% to 17% with a mean of 7.00±4.76%. The majority of the children (75%) were managed on an outpatient basis whereas 25% were hospitalized. Hydrocolloid dressings yielded superior results in terms of complete healing of the scalds, healing time, the mean number of dressings required to achieve healing, and less frequent need for split thickness skin grafting at three weeks. Given the observed benefits, hydrocolloid dressings should constitute the preferred choice of dressing for managing superficial and deep partial thickness scalds in the pediatric population.

Burn area may progress into a more profound wound, known as burn wound conversion. Early prediction of burn wound conversion guides clinicians in their treatment decision. This study aimed to assess the reliability of FLIR One^® in predicting burn wound conversion. We conducted a prospective cohort study, including patients who were admitted to our tertiary hospital from December 2018 to December 2019. All adult patients with mid-dermal burn injury of less than 40% TBSA that occurred within 72 hours were included in our study. Thermal imaging FLIR One^® was used to evaluate the difference between burn wound and healthy skin in the same area (DT1), and ImageJ software objectively measured the burn's extension. The examinations were done by a plastic surgeon on the 1^st and the 3^rd day of admission. Data were later compared and statistically analyzed. A total of 157 wound samples were collected from 40 patients - a slightly higher number were found in males (57.5%). The major cause of burn was gas explosion (50%), mostly with less than 20% TBSA (55%). The area under the curve (AUC) for DT1 was 0.884 (95% CI: 0.822 - 0.945) p<0.05 with a cut-off point at DT1 more than 1.25°C lower than unburned skin. However, there was no correlation between DT1 and extension of the wound area. Thermal difference (DT1), measured using thermal imaging FLIR One^® could be considered as a predictor of burn wound conversion from mid-dermal to deep dermal, with the optimal cut-off point of 1.25°C lower than unburned skin.

The objective of this study is to analyze incidence and risk factors for intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) in major burn patients. Aprospective cohort study was conducted at a Burns Treatment Center, including all patients with a burned body surface area ≥20% admitted from August 2015 to January 2018. Intra-abdominal pressure was measured periodically during the first week of ICU stay. Sixty-four patients were analyzed, with median age of 39 years (interquartile range ITQ: 28-53) and 66% were male. Median burned body surface area was 30% (ITQ: 20-46). Twenty-eight (56%) patients presented criteria for IAH and seven (14%) developed clinical signs compatible with ACS. Burn severity was greater in the group that developed IAH, represented by the ABSI score. This group also presented higher values of creatinine and positive fluid balance. The group of patients with ACS showed a higher frequency of alterations in renal and respiratory functions. The organ systems most frequently affected in groups with diagnostic criteria for IAH and ACS were renal, cardiovascular and respiratory. Mortality rate at hospital outcome was 56%. In conclusion, the incidence of IAH during the study period was high in patients with extensive burns. The occurrence of ACS was associated with organic dysfunctions of the respiratory, cardiovascular and renal systems. The factors associated with intra-abdominal hypertension were age, extension of burned body surface, inhalation injury, and need for mechanical ventilation.

Accuracy of burn size estimation is critical in acute burn management because it directly affects the patient's outcome and prognosis. This study aims to quantify the discrepancies of total body surface area (TBSA) burned between the burn unit (TBSAb) and the referring facilities (TBSAr). Data of all referred adult and paediatric patients admitted to the Hospital Universiti Sains Malaysia Burn Unit within 24 hours post burn were retrospectively reviewed from 2015 to 2019. %TBSA discrepancies were calculated by the differences between TBSAb and TBSAr. A total of 208 patients (111 adults and 97 paediatric patients) were recruited in this study. Of these, the TBSA was overestimated in 60.58% cases, underestimated in 13.46% cases, accurate in 7.69% cases, and in 18.27% cases the referrals had no TBSAr stated. The %TBSA discrepancy was the highest in severe burns (mean 10.80% in adults and 7.59 in paediatric patients; P<0.001). The time interval between referral and reassessment and patients' body mass index (BMI) were not statistically significant for the magnitude of TBSA discrepancy. The number of burn areas involved correlated with the %TBSA discrepancies, with the highest recorded discrepancy being 21.50% in whole body involvement. There were significant discrepancies in TBSA estimations between the referring facilities and those of the Hospital Universiti Sains Malaysia (USM) burn unit, especially among the paediatric patients and those with severe burns. Implementation of educational programs by burn care experts and agreement on a universal method of TBSA assessment are necessary in reducing the discrepancies.

Enzymatic debridement (ED) is increasingly used for cutaneous burns. Compared with surgical debridement, ED has better preservation of viable dermis, less blood loss and autografting, however ED is painful. Current recommendations suggest local anaesthesia (LA) is useful for minor burns, but the evidence base is minimal. In our centre, we routinely use LA with good analgesic effect. This study was a single-centre, prospective analysis conducted at the Queen Victoria Hospital (UK). Patients had at least superficial partial thickness burns and received subcutaneous LA prior to ED during a 1-year period (October 2019-September 2020). Pain was assessed using a numeric scale of 1-10, recorded before, during and after the procedure. In total, 27 patients were included (n=17 males) with a median age of 47 (18-88 years). The mean total burn surface area was 1.5% (0.3-5.0). Treated sites included head and neck (1), trunk (5), upper limb (9) and lower limb (16). The most used LAwas bupivacaine 0.25% (n=25), followed by lidocaine 1% (n=2). Some required additional oral analgesia (n=8) or a regional blockade (n=2). Average pain score during debridement was 1.9 We have found LA effective, with favourable pain scores in comparison to previous studies with oral analgesia or regional blockade. LA is quick and easy to perform, as opposed to nerve blocks, which require trained personnel with ultrasound guidance. LA is a useful analgesic for patients with minor cutaneous burns undergoing ED. In some cases, it is sufficient without additional oral analgesia or regional blockade.

Burn wound conversion describes the process by which superficial-partial thickness burns convert into deeper burns within 3-7 days after burn. Autophagy, inflammation, ischemia, infection and reactive oxygen species are thought to have a role in pathogenesis of burn wound conversion. This study aims to assess risk factors for burn conversion and develop a scoring system to predict it. The study was conducted using nested case control method, in burn patients treated in Dr. Cipto Mangunkusumo Hospital and Jakarta Islamic Hospital Cempaka Putih. Subjects were recruited by consecutive sampling in February 2019-August 2020. The role of clinical characteristics, local and systemic examination as predictors of burn wound conversion were assessed. Risk factors were analysed using bivariate and multivariate analysis. There were 40 subjects in the case group and 20 subjects in the control group. Involvement of trunk, limbs, burn extent measured using ImageJ, ≥ 9.49%TBSA, wound surface temperature measured using Flir one^® thermography ≤ -1.55°C, procalcitonin level ≥ 0.075 ng/mL, and blood lactate level ≥ 1.75 mmol/L had a significant relationship with burn wound conversion. Three scoring models were developed: model 1 to be applied in tertiary health facilities, and model 2 and 3 to be applied in primary and secondary health facilities with sensitivity and specificity of 92.5% and 85%, 95% and 70% and 92.5% and 85%, respectively. The scoring models can be used in daily practice, especially as a reference for conservative and operative management.

Despite advances in medical technology, mortality due to burn injuries remains significant. Scoring systems are aimed at allowing physicians to effectively and accurately predict the mortality of a given patient. Patients at a higher risk of death from burns include older patients over the age of 65, high-severity burn, presence of co-morbidities, and presence of inhalation injury. Constructing a burn prediction model also needs its own methodological standards. Hence, choosing a prediction model for predicting burn mortality requires careful analysis of its methodology. Attention towards mortality risk factors should be taken when treating burn patients. Tools such as burn prediction models prove helpful in aiding physicians to accurately and effectively predict a patient's mortality, stratify patient severity, and allocate resources appropriately, especially in settings where resources are scarce, such as natural disasters. Additionally, prediction models are used to monitor patient care and for research purposes.

Early in the morning of Wednesday 5^th February 1766, Stanislaw Leszcziynski (Leczinski), Duke of Lorraine and Bar, fell to the ground, very close to the fireplace in his room. He remained in this position for a long time, exposed to the flames, and suffered serious burns. During the first nine days, physicians used topical agents and dressings, associated with internal drugs, particularly quinine. But septicemia occurred after about two weeks. By February 20^th, Stanislaw was in a very poor condition. Some stimulating drugs were administered, but he died three days later. He was 88 years old.

A platelet count of less than 150,000 per microliter of blood is called thrombocytopenia. Platelet count monitoring is essential in the care of burn patients. The aim of this study was to evaluate platelet count in groups of patients with different percentage of burns on the body surface and its relationship with the severity of burns and mortality. This retrospective descriptive cross-sectional study was performed on patients admitted to Shahid Motahari Hospital over a period of six months. The study was conducted on burn patients who were admitted to the hospital on the first day after injury. Patients were divided into two groups of with or without thrombocytopenia in the first week. Demographic information and treatment information about the patients were recorded. SPSS V.26 software was used for the statistical analysis of data. In this study, the prevalence of thrombocytopenia in the first week after burns was 36%. The variables of age, sex, duration of hospitalization, burn agent, percentage of burns and use of silver sulfadiazine ointment were significantly different in the two groups of patients. The group without thrombocytopenia had a mortality rate of 5.1%, while the group with thrombocytopenia had a rate of 32.2%. Based on the results of this study, thrombocytopenia is significantly associated with mortality in burn patients. Furthermore, the results of this study indicate that age, sex, burn agent, percentage of burns, and the use of silver sulfadiazine ointment have a clear impact on the thrombocytopenic status of patients.

The formation of pathological scars is a common medical and aesthetic problem worldwide. Surgical interventions, burns and injuries are the most common cause. Treating these scars is a challenge for any surgeon. The Clinic of Plastic-Reconstructive and Aesthetic Surgery with Thermal Trauma and Imaging Diagnostics applied an innovative method of thermotherapy with high-intensity, focused ultrasound in 20 patients with hypertrophic scars and keloids of different age, etiology and parameters. After a series of procedures, we got excellent results, reducing scar size, pigmentation, pain and itching. This type of thermotherapy is successfully applied to pathological scars. In this way, a change in scar density is achieved by converting hard collagen into a gelatin-like mass.As a subsequent procedure, moderately compressive massages are applied for faster resorption of the pathological collection. Our results show that high-intensity focused ultrasound thermotherapy of pathological scars is a non-invasive method of treatment with reasonably good results as regards both aesthetic and functional aspects.