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Zia N, Mashreky SR, He H, Patel N, Ahmed FA, Hashmi M, Al-Ibran E, Rahman AF, Khondoker S, Hyder AA, Latif A. Factors associated with emergency department disposition among burn injury patients: Analysis of prehospital and emergency care characteristics using South Asia Burn Registry (SABR) data. Burns 2024; 50:874-884. [PMID: 38245393 PMCID: PMC11055681 DOI: 10.1016/j.burns.2024.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 12/17/2023] [Accepted: 01/10/2024] [Indexed: 01/22/2024]
Abstract
INTRODUCTION Improvement in burn injury data collections and the quality of databanks has allowed meaningful study of the epidemiologic trends in burn care. The study assessed factors associated with disposition of burn injury patients from emergency department accounting for pre-hospital care and emergency care. METHODS This prospective observational pilot study of the South Asia Burn Registry project was conducted at selected public sector burn centers in Bangladesh and Pakistan (September 2014 - January 2015). All age groups with an initial presentation to the burn centers were enrolled. Descriptive and regression analysis is presented. RESULTS A total of 2749 patients were enrolled. The mean age was 21.7 ± 18.0 years, 55.3% were males, and about a quarter were children < 5 years. About 46.9% of the females were housewives. Scald burns were common among children (67.6%) while flame burns were common among adults (44.3%). About 75% of patients were brought in via non-ambulance mode of transport. More than 55% of patients were referrals from other facilities or clinics. The most common first aid given pre-hospital was the use of water or oil. About 25% were admitted for further care. The adjusted odds of being admitted compared to being sent home were highest for children < 5 yrs, those with higher total body surface area burnt, having arrived via ambulance, scald and electrical burn, having an associated injury and inhalational injury. CONCLUSION The study provides insight into emergency burn care and associated factors that influenced outcomes for patients with burn injuries.
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Affiliation(s)
- Nukhba Zia
- Johns Hopkins International Injury Research Unit, Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | | | - Huan He
- Johns Hopkins International Injury Research Unit, Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Nishit Patel
- Johns Hopkins International Injury Research Unit, Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Fasih Ali Ahmed
- Division of Surgical Oncology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Madiha Hashmi
- Department of Critical Care Medicine, Ziauddin University Hospital, Karachi, Pakistan
| | | | | | - Sazzad Khondoker
- National Institute of Burn and Plastic Surgery, Dhaka, Bangladesh
| | - Adnan A Hyder
- Center on Commercial Determinants of Health and Department of Global Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Asad Latif
- Johns Hopkins International Injury Research Unit, Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Anesthesiology, Aga Khan University, Karachi, Pakistan
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Zvizdic Z, Hukic L, Ljubovic AD, Milisic E, Jonuzi A, Vranic S. Epidemiology and early bacterial colonization of minor and moderate pediatric burns: A retrospective study from a developing country. Burns 2024; 50:623-629. [PMID: 37981486 DOI: 10.1016/j.burns.2023.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 09/03/2023] [Accepted: 10/26/2023] [Indexed: 11/21/2023]
Abstract
OBJECTIVES Infection is still the leading cause of morbidity and mortality among burn patients worldwide. Isolation and identification of pediatric burn wound bacterial colonizers can prevent infection and improve burn trauma treatment. In this study, we explored early microbial colonizers within the burn wounds and the susceptibility of those isolates to antibiotics among hospitalized pediatric patients with minor and moderate burns, clinically significant infections and outcomes. METHODS A retrospective analysis of pediatric patients admitted to the inpatient pediatric surgical ward and treated for minor and moderate burns from 2009 to 2018 was performed. RESULTS One hundred six patients met the inclusion criteria. The mean age was 3.6 ± three years (0.2-14.1 years). The most common type of burn was scald burns (82.1%). The mean TBSA of the hospitalized pediatric burn cases was 8.5% (IQR, 6-12%). Seventy-nine (74.5%) patients had positive wound cultures at admission, regardless of the hospital admission day. Fifty-eight (73.4%) had one bacterial growth (mono isolate), while 21 (26.6%) had mixed growth or poly isolates. Among patients with mixed growth or poly isolate, 16 had two bacteria, three had three bacteria, and one had four bacteria isolated, totaling 105 isolated microorganisms (14 different species, 70.5% Gram-positive bacteria and 29.5% Gram-negative bacteria). Twelve patients (11%) developed clinically significant infections (eleven got burn wound infection, and one had septicemia). All patients received prophylactic systemic antibiotics. Only 35.2% of the isolated bacteria from the wounds were sensitive to the prophylactic antibiotics, and only ∼17% in case of clinically significant infections. We found a statistically significant difference in the length of hospital stay between patients with initially colonized samples of burn wounds compared with patients with initial negative samples (p = 0.008). All patients in the cohort survived hospital discharge. CONCLUSION Despite common bacterial colonization of acute burn wounds, only ∼10% of the patients developed clinically significant infections, a minority of which were sensitive to prophylactic antibiotics. Our findings indicate the need to refine the antibiotic approach in pediatric patients with minor/moderate burns in our local setting.
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Affiliation(s)
- Zlatan Zvizdic
- Clinic of Pediatric Surgery, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Lamija Hukic
- Public Institution Health Center of the Canton Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Amela Dedeic Ljubovic
- Department of Clinical Microbiology, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Emir Milisic
- Clinic of Pediatric Surgery, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Asmir Jonuzi
- Clinic of Pediatric Surgery, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Semir Vranic
- College of Medicine, QU Health, Qatar University, Doha, Qatar.
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Suijker J, Pijpe A, Hoogerbrug D, Heymans MW, van Zuijlen PPM, Halm JA, Meij-de Vries A. IDENTIFICATION OF POTENTIALLY MODIFIABLE FACTORS TO IMPROVE RECOGNITION AND OUTCOME OF NECROTIZING SOFT-TISSUE INFECTIONS. Shock 2024; 61:585-591. [PMID: 38315508 DOI: 10.1097/shk.0000000000002325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
ABSTRACT Background : Necrotizing soft-tissue infections (NSTIs) present a surgical emergency of increasing incidence, which is often misdiagnosed and associated with substantial mortality and morbidity. A retrospective multicenter (11 hospitals) cohort study was initiated to identify the early predictors of misdiagnosis, mortality, and morbidity (skin defect size and amputation). Methods : Patients of all ages who presented with symptoms and were admitted for acute treatment of NSTIs between January 2013 and December 2017 were included. Generalized estimating equation analysis was used to identify early predictors (available before or during the first debridement surgery), with a significance level of P < 0.05. Results : The median age of the cohort (N = 216) was 59.5 (interquartile range = 23.6) years, of which 138 patients (63.9%) were male. Necrotizing soft-tissue infections most frequently originated in the legs (31.0%) and anogenital area (30.5%). More than half of the patients (n = 114, 54.3%) were initially misdiagnosed. Thirty-day mortality was 22.9%. Amputation of an extremity was performed in 26 patients (12.5%). Misdiagnosis was more likely in patients with a higher Charlson Comorbidity Index (β = 0.20, P = 0.001), and less likely when symptoms started in the anogenital area (β = -1.20, P = 0.003). Besides the established risk factors for mortality (septic shock and age), misdiagnosis was identified as an independent predictor of 30-day mortality (β = 1.03, P = 0.01). The strongest predictors of the final skin defect size were septic shock (β = 2.88, P < 0.001) and a skin-sparing approach to debridement (β = -1.79, P = 0.002). Conclusion : Recognition of the disease is essential for the survival of patients affected by NSTI, as is adequate treatment of septic shock. The application of a skin-sparing approach to surgical debridement may decrease morbidity.
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Affiliation(s)
| | | | | | - Martijn W Heymans
- Amsterdam, Department of Epidemiology and Data Science, Amsterdam, The Netherlands
| | | | - Jens A Halm
- Trauma Unit, Amsterdam UMC location AMC, Amsterdam, The Netherlands
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Cleland H, Stewardson A, Padiglione A, Tracy L. Bloodstream infections and multidrug resistant bacteria acquisition among burns patients in Australia and New Zealand: A registry-based study. Burns 2024:S0305-4179(24)00088-3. [PMID: 38714428 DOI: 10.1016/j.burns.2024.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 01/29/2024] [Accepted: 03/11/2024] [Indexed: 05/09/2024]
Abstract
INTRODUCTION This study interrogates infection related data in the Burns Registry of Australia and New Zealand (BRANZ), to examine associations of multi-drug resistant organisms (MDROs) and blood stream infection (BSI). METHODS Data between July 2016 and June 2021 were analysed to determine prevalence, risk factors and outcomes associated with BSIs and MDROs: Methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus (VRE), carbapenem-resistant Pseudomonas spp. (CRP), and carbapenem-resistant Enterobacter (CRE). Data completeness and value for quality improvement activity were assessed. RESULTS We found a low incidence (3.4%) of the resistant organisms of interest, and no change over the study period. Fequency varied between services and increased with age and size of burn. MRSA was the commonest organism in all age groups. A positive BSI result occurred in 1.6% of patients (12.1% of cultures taken) at a median time of 10.2 days post injury. Free text identification of organisms was inconsistently documented. CONCLUSIONS The low rate and patterns of acquisition of MDROs of interest and BSIs is comparable with reports from countries with low incidence of massive burns. Wider adoption of a standardized laboratory reporting framework would help realise the potential of clinical quality registries to provide data which supports evidence based infection prevention initiatives.
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Affiliation(s)
- Heather Cleland
- Victorian Adult Burns Service, Alfred Hospital, Melbourne, Australia; Department of Surgery, Central Clinical School, Monash University, Melbourne, Australia.
| | - Andrew Stewardson
- Department of Infectious Diseases, Alfred Hospital, Melbourne, Australia; Department of Infectious diseases,Central Clinical School, Monash University, Melbourne, Australia
| | - Alex Padiglione
- Department of Infectious Diseases, Alfred Hospital, Melbourne, Australia
| | - Lincoln Tracy
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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Suijker J, Wurfbain L, Emmen AMLH, Pijpe A, Kwa KAA, van der Vlies CH, Nieuwenhuis MK, van Zuijlen PPM, Meij-de Vries A. The Role of Burn Centers in the Treatment of Necrotizing Soft-Tissue Infections: A Nationwide Dutch Study. J Burn Care Res 2023; 44:1405-1412. [PMID: 37227902 PMCID: PMC10628513 DOI: 10.1093/jbcr/irad073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Indexed: 05/27/2023]
Abstract
Patients with extensive and complex wounds due to Necrotizing Soft-Tissue Infections (NSTI) may be referred to a burn center. This study describes the characteristics, outcomes, as well as diagnostic challenges of these patients. Patients admitted to three hospitals with a burn center for the treatment of NSTI in a 5-year period were included. Eighty patients (median age 54 years, 60% male) were identified, of whom 30 (38%) were referred by other centers, usually after survival of the initial septic phase. Those referred from other centers, compared to those primarily admitted to the study hospitals, were more likely to have group A streptococcal involvement (62% vs 35%, p = .02), larger wounds (median 7% vs 2% total body surface area, p < .001), and a longer length of stay (median 49 vs 22 days, p < .001). Despite a high incidence of septic shock (50%), the mortality rate was low (12%) for those primarily admitted. Approximately half (53%) of the patients were initially misdiagnosed upon presentation, which was associated with delay to first surgery (16 hours vs 4 hours, p < .001). Those initially misdiagnosed had more (severe) comorbidities, and less frequently reported pain or blue livid discoloration of the skin. This study underlines the burn centers' function as referral centers for extensively affected patients with NSTI. Besides the unique wound and reconstructive expertise, the low mortality rate indicates these centers provide adequate acute care as well. A major remaining challenge remains recognition of the disease upon presentation. Future studies in which factors associated with misdiagnosis are explored are needed.
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Affiliation(s)
- Jaco Suijker
- Burn Centre, Red Cross Hospital, Beverwijk, The Netherlands
- Association of Dutch Burn Centres, Beverwijk, The Netherlands
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Plastic, Reconstructive and Hand Surgery, De Boelelaan 1117, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Tissue Function and Regeneration, Amsterdam, The Netherlands
| | - Lisca Wurfbain
- Burn Centre, Red Cross Hospital, Beverwijk, The Netherlands
| | - Anouk M L H Emmen
- Department of Surgery, Rode Kruis Ziekenhuis, Beverwijk, The Netherlands
| | - Anouk Pijpe
- Burn Centre, Red Cross Hospital, Beverwijk, The Netherlands
- Association of Dutch Burn Centres, Beverwijk, The Netherlands
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Plastic, Reconstructive and Hand Surgery, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Kelly A A Kwa
- Burn Centre, Red Cross Hospital, Beverwijk, The Netherlands
| | - Cornelis H van der Vlies
- Burn Centre, Maasstad Ziekenhuis, Rotterdam, The Netherlands
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Marianne K Nieuwenhuis
- Association of Dutch Burn Centers, Burn Centre, Martini Hospital, Groningen, The Netherlands
- Centre for Human Movement Sciences, University Medical Centre Groningen, Groningen, The Netherlands
- Research group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences Groningen, Groningen, Nederland
| | - Paul P M van Zuijlen
- Burn Centre, Red Cross Hospital, Beverwijk, The Netherlands
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Plastic, Reconstructive and Hand Surgery, De Boelelaan 1117, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Tissue Function and Regeneration, Amsterdam, The Netherlands
- Amsterdam UMC location University of Amsterdam, Pediatric Surgical Centre, Emma Children's Hospital, Meibergdreef 9, Amsterdam, Netherlands
| | - Annebeth Meij-de Vries
- Burn Centre, Red Cross Hospital, Beverwijk, The Netherlands
- Department of Surgery, Rode Kruis Ziekenhuis, Beverwijk, The Netherlands
- Amsterdam UMC location University of Amsterdam, Pediatric Surgical Centre, Emma Children's Hospital, Meibergdreef 9, Amsterdam, Netherlands
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Obed D, Gruber L, Salim M, Knoedler S, Panayi AC, Krezdorn N, Dastagir K, Bingoel AS, Vogt PM. In-hospital Mortality Following Suicidal Burns: A Propensity Score-Matched Analysis. J Burn Care Res 2023; 44:1413-1418. [PMID: 36892312 DOI: 10.1093/jbcr/irad034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Indexed: 03/10/2023]
Abstract
We carried out a retrospective single-center study and analyzed all patients who have been admitted to our intensive care burn unit following suicide attempt and accidental burns within 14 years. Clinical and demographic parameters were collected and evaluated. Propensity score matching was performed in order to minimize the confounding effect of the parameters age, sex, total body surface area (TBSA), and the presence of full-thickness burns and inhalation injury. 45 burn patients following attempted suicide by burning and 1266 patients following accidental burn injury were admitted. Patients with suicidal burn injuries were significantly younger and showed significantly higher burn severity, reflected by larger TBSA affected, higher incidence of full-thickness burns and inhalation injury. They also experienced increased hospital length of stay (LOS) and longer ventilation durations. Their in-hospital mortality was significantly higher. Following propensity score matching in 42 case pairs, no differences were detected with regard to in-hospital mortality, hospital LOS, duration of mechanical ventilation, and frequency of surgical interventions. Attempted suicide by burning is associated with overall worse outcomes and higher mortality rates. Following propensity score matching, significant differences in outcomes were no longer detectable. Given the comparable survival probability compared to accidentally burned patients, life-sustaining treatment should not be withheld in burn patients following suicide attempt.
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Affiliation(s)
- Doha Obed
- Department of Plastic, Aesthetic, Hand and Reconstructive Surgery, Hannover Medical School, Hannover, Germany
| | - Lisa Gruber
- Department of Plastic, Aesthetic, Hand and Reconstructive Surgery, Hannover Medical School, Hannover, Germany
| | - Mustafa Salim
- Department of Human Genetics, Hannover Medical School, Hannover, Germany
| | - Samuel Knoedler
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Adriana C Panayi
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany
| | - Nicco Krezdorn
- Department of Plastic, Aesthetic, Hand and Reconstructive Surgery, Hannover Medical School, Hannover, Germany
| | - Khaled Dastagir
- Department of Plastic, Aesthetic, Hand and Reconstructive Surgery, Hannover Medical School, Hannover, Germany
| | - Alperen S Bingoel
- Department of Plastic, Aesthetic, Hand and Reconstructive Surgery, Hannover Medical School, Hannover, Germany
| | - Peter M Vogt
- Department of Plastic, Aesthetic, Hand and Reconstructive Surgery, Hannover Medical School, Hannover, Germany
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Abarca L, Guilabert P, Martin N, Usúa G, Barret JP, Colomina MJ. Epidemiology and mortality in patients hospitalized for burns in Catalonia, Spain. Sci Rep 2023; 13:14364. [PMID: 37658072 PMCID: PMC10474035 DOI: 10.1038/s41598-023-40198-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 08/07/2023] [Indexed: 09/03/2023] Open
Abstract
Burn injuries are one of the leading causes of morbidity worldwide. Although the overall incidence of burns and burn-related mortality is declining, these factors have not been analysed in our population for 25 years. The aim of this study has been to determine whether the epidemiological profile of patients hospitalized for burns has changed over the past 25 years. We performed a retrospective cohort study of patients hospitalised between 1 January 2011 and 31 December 2018 with a primary diagnosis of burns. The incidence of burns in our setting was 3.68/105 population. Most patients admitted for burns were men (61%), aged between 35 and 45 years (16.8%), followed by children aged between 0 and 4 years (12.4%). Scalding was the most prevalent mechanism of injury, and the region most frequently affected was the hands. The mean burned total body surface (TBSA) area was 8.3%, and the proportion of severely burned patients was 9.7%. Obesity was the most prevalent comorbidity (39.5%). The median length of stay was 1.8 days. The most frequent in-hospital complications were sepsis (16.6%), acute kidney injury (7.9%), and cardiovascular complications (5.9%). Risk factors for mortality were advanced age, high abbreviated burn severity index score, smoke inhalation, existing cardiovascular disease full-thickness burn, and high percentage of burned TBSA. Overall mortality was 4.3%. Multi-organ failure was the most frequent cause of death, with an incidence of 49.5%. The population has aged over the 25 years since the previous study, and the number of comorbidities has increased. The incidence and severity of burns, and the percentage of burned TBSA have all decreased, with scalding being the most prevalent mechanism of injury. The clinical presentation and evolution of burns differs between children and adults. Risk factors for mortality were advanced age, smoke inhalation, existing cardiovascular disease, full-thickness burn, and high percentage of burned TBSA.
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Affiliation(s)
- L Abarca
- Anesthesia and Critical Care Department, Hospital Universitari Vall d'Hebron, 08035, Barcelona, Spain.
| | - P Guilabert
- Anesthesia and Critical Care Department, Hospital Universitari Alicante, Alicante, Spain
| | - N Martin
- Anesthesia and Critical Care Department, Hospital Clinic, Barcelona, Spain
| | - G Usúa
- Anesthesia and Critical Care Department, Hospital Universitari Vall d'Hebron, 08035, Barcelona, Spain
| | - Juan P Barret
- Plastic Surgery Department and Burn Centre, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Maria J Colomina
- Department of Anesthesia, Critical Care and Pain Clinic, Hospital Universitari de Bellvitge, Barcelona, Spain
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Heard J, Cronin L, Romanowski K, Greenhalgh D, Palmieri T, Sen S. Massive Burn Injuries: Characteristics and Outcomes From a Single Institution. J Burn Care Res 2023; 44:925-930. [PMID: 36378582 DOI: 10.1093/jbcr/irac173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
Massive burn injuries are a unique patient population with unique treatment paradigms. Data from 155 adult patients, admitted from 2009 to 2019, with >50% total body surface area burns (TBSA) were collected and analyzed. Average burn size was 70% TBSA and 63% had a concomitant inhalation injury. Approximately 30% of patients (46/155) transitioned to comfort care-only measures within 24 hours of admission. Standard treatment patients were younger (37 ± 13 vs 60 ± 19 years; p < .00001), male (94% vs 28%; p = .001) and had smaller TBSA (66 ± 13 vs 80 ± 16; p < .00001). Of the standard treatment group, 72 (66%) survived to discharge. Survivors had smaller TBSA (64 ± 13 vs 71 ± 13; p = .003), less third-degree TBSA (48 ± 25 vs 71 ± 13; p = .003) and lower incidence of renal failure requiring dialysis (22% vs 73%, p < .00001). Multivariate regression analysis showed that age (OR 1.05; p = .025), total TBSA (OR 1.07; p = .005), and renal failure (OR 10.2; p = .00005) were independently associated with mortality. Inhalation injury was not significantly associated with mortality. About 23% (35/155) of patients had a psychiatric condition on admission and 19% (30/155) of patients were burned attempting suicide. Patients with psychiatric conditions spent more time in the hospital (62 vs 30 days; p = .004), more time on ventilator (31 vs 12 days; p = .046), underwent more surgery (4 vs 2 operations, p = .03), and were less likely to die (34% vs 59%; p = .02). In summary, age, burn size, and renal failure were independently associated with mortality, with renal failure being the strongest factor. Psychiatric conditions are prevalent pre-injury and tend to require more inpatient care.
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Affiliation(s)
- J Heard
- Burn Division, Department of Surgery University of California Davis, Sacramento, California, USA
| | - Laura Cronin
- Burn Division, Department of Surgery University of California Davis, Sacramento, California, USA
| | - K Romanowski
- Burn Division, Department of Surgery University of California Davis, Sacramento, California, USA
| | - D Greenhalgh
- Burn Division, Department of Surgery University of California Davis, Sacramento, California, USA
| | - T Palmieri
- Burn Division, Department of Surgery University of California Davis, Sacramento, California, USA
| | - S Sen
- Burn Division, Department of Surgery University of California Davis, Sacramento, California, USA
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Mirahmadizadeh A, Moftakhar L, Dehghani SS, Hassanzadeh J, Dehghani SP, Azarbakhsh H. Mortality Rate and Years of Life Lost Due to Burns in Southern Iran During 2004-2019: A Population-Based Study. ARCHIVES OF IRANIAN MEDICINE 2023; 26:205-211. [PMID: 38301080 PMCID: PMC10685748 DOI: 10.34172/aim.2023.31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 12/12/2022] [Indexed: 02/03/2024]
Abstract
BACKGROUND Burns constitute one of the most important etiologies of infection and mortality worldwide, with the most significant number of cases in low- and middle-income countries. This is a cross-sectional study on deaths due to burns in southern Iran. METHODS In this study, data on all deaths due to burns in southern Iran between 2004 and 2019 was extracted from the population-based Electronic Death Registry System (EDRS). The Joinpoint Regression method was used to examine the trend of crude mortality rate, standardized mortality rate, and years of life lost (YLL) rate. In order to measure YLL, the number of deaths and life expectancy for different age and gender groups were used, for which the standard life table was considered. RESULTS During this study, 2175 deaths due to burns occurred, 50.6% (1106 cases) of which were in men and 38.7% (841 cases) were in the 15-29 age group. The crude and the standardized mortality rate had a decreasing trend during the study years. The total number of YLL was 25260 (0.8 per 1000) in men, 25,785 (0.8 per 1000) in women, and 51,045 (0.8 per 1000) in both genders during the 16 years of the study. CONCLUSION Considering the high mortality rate in the 15-29 age group, which consists of the active and productive labor force, necessary actions are needed in order to improve safety equipment and to make the workplace safe.
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Affiliation(s)
- Alireza Mirahmadizadeh
- Non-Communicable Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Leila Moftakhar
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Jafar Hassanzadeh
- Research Center for Health Sciences, Institute of Health, Department of Epidemiology, Shiraz University of Medical Sciences, Shiraz, Iran
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Van Yperen DT, Van Lieshout EMM, Van Baar ME, Polinder S, Verhofstad MHJ, Van der Vlies CH. Burn injury characteristics, referral pattern, treatment (costs), and outcome in burn patients admitted to a hospital with or without a specialized Burn Centre (BURN-Pro). Eur J Trauma Emerg Surg 2023; 49:1505-1515. [PMID: 36735021 DOI: 10.1007/s00068-023-02233-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 01/18/2023] [Indexed: 02/04/2023]
Abstract
PURPOSE Data on the epidemiology, treatment, and outcome of burn patients treated at non-burn centre hospitals are not available. The primary aim was to compare the burn characteristics of patients admitted to a hospital with or without a specialized burn centre. METHODS This multicentre, prospective, cohort study enrolled patients with burns admitted to a hospital without a burn centre and patients with < 10% total body surface area (TBSA) burned admitted to the burn centre. Primary outcome measure was the burn-related injury characteristics. Secondary outcome measures were adherence to the Emergency Management of Severe Burns (EMSB) referral criteria, treatment (costs), quality of life, and scar quality. RESULTS During the 2-year study period, 48 patients were admitted to a non-burn centre and 148 patients to the burn centre. In the non-burn centre group, age [44 (P25-P75 26-61) versus 30 (P25-P75 8-52) years; P = 0.007] and Injury Severity Score [2 (P25-P75 1-4) versus 1 (P25-P75 1-1); P < 0.001] were higher. In the burn centre group, the TBSA burned was significantly higher [4% (P25-P75 2-6) versus 2% (P25-P75 1-4); P = 0.001], and more surgical procedures were performed (in 54 versus 7 patients; P = 0.004). At 12 months, > 85% of the non-burn centre group and > 75% of the burn centre group reported no problems in quality of life. Scar quality score was < 1.5 in both groups, with significantly poorer scores in the burn centre group (P ≤ 0.007). CONCLUSION Both groups differed in patient, burn, and treatment characteristics. At 12 months, quality of life and scar quality were good in both groups. Significantly poorer scar quality scores were found in the burn centre group. This might be related to their larger burns and more frequent surgery. The organization of burn care in the Netherlands seems to work adequately. Patients are treated locally when possible and are transferred when necessary.
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Affiliation(s)
- Daan T Van Yperen
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Centre Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.,Burn Centre, Maasstad Hospital, Rotterdam, The Netherlands
| | - Esther M M Van Lieshout
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Centre Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.
| | - Margriet E Van Baar
- Association of Dutch Burn Centres, Burn Centre, Maasstad Hospital, Rotterdam, The Netherlands.,Department of Public Health, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Suzanne Polinder
- Department of Public Health, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Michael H J Verhofstad
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Centre Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Cornelis H Van der Vlies
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Centre Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.,Burn Centre, Maasstad Hospital, Rotterdam, The Netherlands
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11
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Spronk I, van Baar ME, Verheij RA, Panneman MJ, Dokter J, Polinder S, Haagsma JA. The burden of disease of fatal and non-fatal burn injuries for the full spectrum of care in the Netherlands. Arch Public Health 2023; 81:3. [PMID: 36617544 PMCID: PMC9827636 DOI: 10.1186/s13690-022-01020-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 12/28/2022] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND A comprehensive overview of the burden of disease of burns for the full spectrum of care is not available. Therefore, we estimated the burden of disease of burns for the full spectrum in the Netherlands in 2018, and explored whether the burden of disease changed over the past 5 years (2014-2018). METHODS Data were collected at four levels: general practice, emergency department, hospital, and mortality data. For each level, years lived with disability (YLD), years of life lost (YLL), and disability-adjusted life-years (DALY) were estimated using a tailored methodology. RESULTS Burns resulted in a total of 9278 DALYs in the Netherlands in 2018, comprising of 7385 YLDs (80%) and 1892 YLLs (20%). Burn patients who visited the general practice contributed most DALYs (64%), followed by deceased burn patients (20%), burn patients admitted to hospital (14%) and those treated at the emergency department (2%). The burden of disease was comparable in both sexes (4734 DALYs (51%) for females; 4544 DALYs (49%) for males), though the distribution of DALYs by level of care varied; females contributed more DALYs at the general practice level, and males at all other levels of care. Among children boys 0-4 years had the highest burden of disease (784 DALYs (9%)), and among adults, females 18-34 years old (1319 DALYs (14.2%)) had the highest burden of disease. Between 2014 and 2018 there was a marginal increase of 0.8% in the number of DALYs. CONCLUSIONS Burns cause a substantial burden of disease, with burns requiring care at the general practice level contributing most DALYs. Information on burden of burns by the full level of care as well as by subgroup is important for the development of tailored burn prevention strategies, and the updated figures are recommended to be used for priority setting and resource allocation.
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Affiliation(s)
- Inge Spronk
- grid.5645.2000000040459992XDepartment of Public Health, Erasmus MC, University Medical Centre Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands ,grid.416213.30000 0004 0460 0556Association of Dutch Burn Centres, Maasstad Hospital, Rotterdam, the Netherlands
| | - Margriet E. van Baar
- grid.5645.2000000040459992XDepartment of Public Health, Erasmus MC, University Medical Centre Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands ,grid.416213.30000 0004 0460 0556Association of Dutch Burn Centres, Maasstad Hospital, Rotterdam, the Netherlands
| | - Robert A. Verheij
- grid.416005.60000 0001 0681 4687Nivel, Netherlands Institute for Health Services Research, Utrecht, The Netherlands ,Tranzo, Tilburg School of Social and Behavioural Sciences, Tilburg, The Netherlands
| | - Martien J. Panneman
- grid.491163.80000 0004 0448 3601Consumer Safety Institute, Amsterdam, The Netherlands
| | - Jan Dokter
- grid.416213.30000 0004 0460 0556Burn Centre, Maasstad Hospital, Rotterdam, the Netherlands
| | - Suzanne Polinder
- grid.5645.2000000040459992XDepartment of Public Health, Erasmus MC, University Medical Centre Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands
| | - Juanita A. Haagsma
- grid.5645.2000000040459992XDepartment of Public Health, Erasmus MC, University Medical Centre Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands
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12
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Carvalho EN, Paggiaro AO, Nicolosi JT, Gemperli R, de Carvalho VF. Retrospective Evaluation of Characteristics of Patients with Burn Injuries Treated at the Largest Reference Hospital in Brazil. PLASTIC AND AESTHETIC NURSING 2023; 43:22-28. [PMID: 36583585 DOI: 10.1097/psn.0000000000000471] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Burn injuries are a significant cause of morbidity and mortality in the Brazilian population. We conducted this study in a tertiary hospital in Brazil to discover the epidemiological characteristics of patients with burn injuries. We conducted a cohort review of patients admitted to the burn unit of our institute during a 5-year period. For each patient, we collected data that included age, gender, total percentage of burned body surface area, burn location, burn mode, and burn cause. We analyzed the data using the R programming language. We included a total of 496 patients in our study. The mean age of the patients was 28 ± 14.7 years. The median length of hospital stay was 2 weeks. We found a significant correlation between the total percentage of burned body surface area and the length of hospitalization (p < .001) and the length of hospitalization in the intensive care unit (p < .001). A total of 427 patients (86%) were discharged from the hospital after successful treatment. In contrast, 43 patients (8.67%) died. The mortality rate was highest in patients who had more than 70% of their total body surface area burned. The average length of hospitalization aligned with global and national statistics presented in the literature. The main causes of the burn injuries were thermal (e.g., fire, hot liquids). We found inhalation injuries present in more than one third of the patients who were hospitalized in the intensive care unit with thermal burns.
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Affiliation(s)
- Elisangela Nunes Carvalho
- Elisangela Nunes Carvalho, MS, is a biologist at Guarulhos University, São Paulo, Brazil
- André Oliveira Paggiaro, PhD, MD, a professor in the nursing postgraduate program at Guarulhos University, São Paulo, Brazil, and a plastic surgeon in the Plastic Surgery Division, Faculty of Medicine, University of São Paulo, Brazil
- Júlia Teixeira Nicolosi, PhD, RN, is a professor in the nursing postgraduate program at Guarulhos University, São Paulo, Brazil, and at Rua Maria Leonete da Silva Nóbrega, São Paulo, Brazil
- Rolf Gemperli, PhD, MD, is a professor in the Plastic Surgery Division, Faculty of Medicine at University of São Paulo, Brazil
- Viviane Fernandes de Carvalho, PhD, RN, is a professor in the nursing postgraduate program at Guarulhos University, São Paulo, Brazil
| | - André Oliveira Paggiaro
- Elisangela Nunes Carvalho, MS, is a biologist at Guarulhos University, São Paulo, Brazil
- André Oliveira Paggiaro, PhD, MD, a professor in the nursing postgraduate program at Guarulhos University, São Paulo, Brazil, and a plastic surgeon in the Plastic Surgery Division, Faculty of Medicine, University of São Paulo, Brazil
- Júlia Teixeira Nicolosi, PhD, RN, is a professor in the nursing postgraduate program at Guarulhos University, São Paulo, Brazil, and at Rua Maria Leonete da Silva Nóbrega, São Paulo, Brazil
- Rolf Gemperli, PhD, MD, is a professor in the Plastic Surgery Division, Faculty of Medicine at University of São Paulo, Brazil
- Viviane Fernandes de Carvalho, PhD, RN, is a professor in the nursing postgraduate program at Guarulhos University, São Paulo, Brazil
| | - Júlia Teixeira Nicolosi
- Elisangela Nunes Carvalho, MS, is a biologist at Guarulhos University, São Paulo, Brazil
- André Oliveira Paggiaro, PhD, MD, a professor in the nursing postgraduate program at Guarulhos University, São Paulo, Brazil, and a plastic surgeon in the Plastic Surgery Division, Faculty of Medicine, University of São Paulo, Brazil
- Júlia Teixeira Nicolosi, PhD, RN, is a professor in the nursing postgraduate program at Guarulhos University, São Paulo, Brazil, and at Rua Maria Leonete da Silva Nóbrega, São Paulo, Brazil
- Rolf Gemperli, PhD, MD, is a professor in the Plastic Surgery Division, Faculty of Medicine at University of São Paulo, Brazil
- Viviane Fernandes de Carvalho, PhD, RN, is a professor in the nursing postgraduate program at Guarulhos University, São Paulo, Brazil
| | - Rolf Gemperli
- Elisangela Nunes Carvalho, MS, is a biologist at Guarulhos University, São Paulo, Brazil
- André Oliveira Paggiaro, PhD, MD, a professor in the nursing postgraduate program at Guarulhos University, São Paulo, Brazil, and a plastic surgeon in the Plastic Surgery Division, Faculty of Medicine, University of São Paulo, Brazil
- Júlia Teixeira Nicolosi, PhD, RN, is a professor in the nursing postgraduate program at Guarulhos University, São Paulo, Brazil, and at Rua Maria Leonete da Silva Nóbrega, São Paulo, Brazil
- Rolf Gemperli, PhD, MD, is a professor in the Plastic Surgery Division, Faculty of Medicine at University of São Paulo, Brazil
- Viviane Fernandes de Carvalho, PhD, RN, is a professor in the nursing postgraduate program at Guarulhos University, São Paulo, Brazil
| | - Viviane Fernandes de Carvalho
- Elisangela Nunes Carvalho, MS, is a biologist at Guarulhos University, São Paulo, Brazil
- André Oliveira Paggiaro, PhD, MD, a professor in the nursing postgraduate program at Guarulhos University, São Paulo, Brazil, and a plastic surgeon in the Plastic Surgery Division, Faculty of Medicine, University of São Paulo, Brazil
- Júlia Teixeira Nicolosi, PhD, RN, is a professor in the nursing postgraduate program at Guarulhos University, São Paulo, Brazil, and at Rua Maria Leonete da Silva Nóbrega, São Paulo, Brazil
- Rolf Gemperli, PhD, MD, is a professor in the Plastic Surgery Division, Faculty of Medicine at University of São Paulo, Brazil
- Viviane Fernandes de Carvalho, PhD, RN, is a professor in the nursing postgraduate program at Guarulhos University, São Paulo, Brazil
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13
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Changes in epidemiology and care strategies at the Norwegian National Burn Centre over 35 years (1986–2020). BURNS OPEN 2023. [DOI: 10.1016/j.burnso.2022.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
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14
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Obed D, Schroeter A, Gruber L, Bucher F, Salim M, Bingoel AS, Krezdorn N, Dastagir K, Vogt PM. Epidemiology and outcome analysis of 1359 intensive care burn patients: A 13-year retrospective study in a major burn center in Germany. Burns 2022:S0305-4179(22)00236-4. [DOI: 10.1016/j.burns.2022.08.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 08/29/2022] [Accepted: 08/30/2022] [Indexed: 12/01/2022]
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15
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Spronk I, Trommel N, Baartmans M, Polinder S, van Baar M. Parent-Reported Health-Related Quality of Life of Pediatric Burn Patients 5 to 7 Years after Burn Injuries: A Multicenter Study. Eur J Pediatr Surg 2022; 33:219-227. [PMID: 35882357 DOI: 10.1055/s-0042-1751047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Pediatric burns significantly impact the short-term health-related quality of life (HRQL) of children. Knowledge regarding the long-term impact is scarce. We therefore evaluated the parent-reported HRQL in pediatric burn patients 5 to 7 years after burns. METHODS We invited parents of eligible children admitted to a Dutch Burn Center between August 2011 and September 2012. This sample was enriched with children with severe burns (> 10% of total body surface area [TBSA] burned) admitted between January 2010 and March 2013. The EQ-5D was completed by parents 5 to 7 years postburn. Outcomes and predictive factors were studied and compared between children with minor/moderate and severe burns. RESULTS We included 130 children (mean TBSA burned 7%): 102 children with mild/intermediate burns and 28 with severe burns. Mean EQ-5D summary was 0.96 and EQ visual analogue scale (VAS) 93.1. These outcomes were significantly better in children with minor/moderate burns (0.97; 94.4) compared with children with severe burns (0.93; 88.3) (p < 0.05). Nineteen percent of the children with minor/moderate burns and 43% of those with severe burns reported any problems. The most frequently reported problem was anxiety/depression for both groups. Pain/discomfort (p = 0.012) and cognition (p = 0.035) were statistically significantly worse in children with severe burns compared with those with minor/moderate burns. Full thickness burns and number of surgeries were found to predict long-term HRQL impairment. CONCLUSION Five to seven years postburn, the majority of children in our study (76%) did not experience long-term problems with HRQL. In a minority of the children, burns showed to have a prolonged negative impact, especially in those being severely burned and who had to undergo surgery for their burns. Most experienced problems were related to anxiety/depression. These important insights could be used to inform children and their parents about the expected long-term HRQL after pediatric burns.
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Affiliation(s)
- Inge Spronk
- Association of Dutch Burn Centres, Maasstad Hospital, Rotterdam, Zuid-Holland, the Netherlands.,Public Health, Erasmus MC, Rotterdam, the Netherlands.,Dutch Burns Foundation, Beverwijk, the Netherlands
| | - Nicole Trommel
- Burn Center, Maasstad Hospital, Rotterdam, Zuid-Holland, the Netherlands
| | - Martin Baartmans
- Burn Center, Maasstad Hospital, Rotterdam, Zuid-Holland, the Netherlands.,Department of Pediatrics, Maasstad Hospital, Rotterdam, Zuid-Holland, the Netherlands
| | | | - Margriet van Baar
- Association of Dutch Burn Centres, Maasstad Hospital, Rotterdam, Zuid-Holland, the Netherlands.,Public Health, Erasmus MC, Rotterdam, the Netherlands
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16
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Gus E, Brooks S, Multani I, Zhu J, Zuccaro J, Singer Y. Burn Registries State of Affairs: A Scoping review. J Burn Care Res 2022; 43:1002-1014. [PMID: 35766390 DOI: 10.1093/jbcr/irac077] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Registry science allows for the interpretation of disease-specific patient data from secondary databases. It can be utilized to understand disease and injury, answer research questions, and engender benchmarking of quality-of-care indicators. Numerous burn registries exist globally, however, their contributions to burn care have not been summarized. The objective of this study is to characterize the available literature on burn registries. The authors conducted a scoping review, having registered the protocol a priori. A thorough search of the English literature, including grey literature, was carried out. Publications of all study designs were eligible for inclusion provided they utilized, analyzed, and/or critiqued data from a burn registry. Three hundred twenty studies were included, encompassing 16 existing burn registries. The most frequently used registries for peer-reviewed publications were the American Burn Association Burn Registry, Burn Model System National Database, and the Burns Registry of Australia and New Zealand. The main limitations of existing registries are the inclusion of patients admitted to burn centers only, deficient capture of outpatient and long-term outcome data, lack of data standardization across registries, and the paucity of studies on burn prevention and quality improvement methodology. Registries are an invaluable source of information for research, delivery of care planning, and benchmarking of processes and outcomes. Efforts should be made to stimulate other jurisdictions to build burn registries and for existing registries to be improved through data linkage with administrative databases, and by standardizing one international minimum dataset, in order to maximize the potential of registry science in burn care.
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Affiliation(s)
- Eduardo Gus
- Division of Plastic, Reconstructive & Aesthetic Surgery, The Hospital for Sick Children, Toronto, Canada.,Department of Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Stephanie Brooks
- Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | | | - Jane Zhu
- Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Jennifer Zuccaro
- Division of Plastic, Reconstructive & Aesthetic Surgery, The Hospital for Sick Children, Toronto, Canada
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17
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Aetiology of severe burn incidents in children under 5 years of age in the Netherlands: A prospective cohort study. Burns 2022; 48:713-722. [PMID: 34602299 DOI: 10.1016/j.burns.2021.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 06/01/2021] [Accepted: 08/24/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Risk factors and mechanisms of injury may change over time. Since knowledge on aetiology of severe burn incidents in children under 5 years of age in the Netherlands is outdated, this study aimed to identify current risk factors and mechanisms of severe burn injury in children under 5 years of age in the Netherlands to direct future prevention campaigns. METHODS Information on personal-, environmental- and behavioural circumstances as well as the mechanism of burn injury was prospectively collected in all burn centres during one year from patient records and structured interviews with parents. RESULTS Boys around 18 months of age, who, while in upright position, pulled down a cup of hot tea over themselves, were overrepresented. Children in families with more children, having a migration background, living in urbanised neighborhoods or with a low socioeconomic status (SES) are at increased risk for severe burn injury. Most incidents happened in their own home with the parents in close proximity to the child. CONCLUSION Outcomes of this prospective cohort study provide up-to-date and extensive knowledge on the aetiology of severe burn incidents in children under 5 years of age in the Netherlands, and provide directions for prevention policy and campaigns.
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18
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Pieptu V, Moscalu R, Mihai A, Moscalu M, Pieptu D, Azoicăi D. Epidemiology of hospitalized burns in Romania: A 10-year study on 92,333 patients. Burns 2022; 48:420-431. [PMID: 34670711 DOI: 10.1016/j.burns.2021.05.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 05/19/2021] [Accepted: 05/26/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND No epidemiological information is available of the number of burns treated in the past 30 years in Romania. The aim of the present study is to investigate the extent of burn injuries in Romania, as well as to detect and analyze the essential epidemiological characteristics. METHODS A comprehensive retrospective study was conducted over a period of 10 years (1.01.2006 to 31.12.2015). Patient-related data were obtained from the Diagnosis-related group (DRG) Center of National School of Public Health, Management and Professional Development, which is the only official national structure that collects and manages data concerning all the hospitalized patients in Romania. RESULTS Included in this study were all 92,333 patients with burn injury as the main International Classification of Diseases (ICD-10) code of discharge from Romanian hospitals. The data was analyzed using SPSS V.24, IBM Statistics Package. The annual number of burns decreased gradually from 10,547 in 2006 to 7313 in 2015, reaching statistical significance (p = 0.001). The incidence decreased from 47 cases per 100,000 in 2006 to 36.93 per 100,000 in 2015. The seasonal evolution showed that the number of burns increases in July-August (8.8% and 9.1% of annual burns). The mean length of stay (LoS) was 10.59 days, with the highest value in 2012 (11.00) and the lowest in 2014 (10.30). The median LoS and the mean LoS values during the 10 years period have a plateau-type evolution, with no tendency for improvement. We found a significant correlation (r = 0.708, p = 0.0118) between increased mortality and the year of study. CONCLUSIONS This is the first nationwide epidemiological study concerning hospitalized burns in Romania. It provides insight in demographical characteristics but also uncovers a worrying trend of increasing mortality rates, which requires further investigation. This study cannot make any reference to the severity of burns (surface and depth) or towards major burns events which unfolded during the studied period, due to lack of data. Consequently, it should raise awareness towards policymakers and caregivers that for a durable burns management strategy in Romania, it would be extremely useful to implement a national burn registry.
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Affiliation(s)
- V Pieptu
- Department of Plastic and Reconstructive Surgery, Grigore T Popa University of Medicine and Pharmacy Iasi, Romania.
| | - R Moscalu
- The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.
| | - A Mihai
- Department of Plastic and Reconstructive Surgery, Grigore T Popa University of Medicine and Pharmacy Iasi, Romania.
| | - M Moscalu
- Department of Informatics and Biostatistics, Grigore T Popa University of Medicine and Pharmacy Iasi, Romania.
| | - D Pieptu
- Department of Plastic and Reconstructive Surgery, Grigore T Popa University of Medicine and Pharmacy Iasi, Romania.
| | - D Azoicăi
- Department of Epidemiology, Grigore T Popa University of Medicine and Pharmacy Iasi, Romania.
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19
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van Zoonen EE, van Baar ME, van Schie CHM, Koppes LLJ, Verheij RA. Burn injuries in primary care in the Netherlands: Risk factors and trends. Burns 2022; 48:440-447. [PMID: 34167851 DOI: 10.1016/j.burns.2021.04.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 04/25/2021] [Accepted: 04/29/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Research to date has mainly focused on burn injuries treated in secondary care. This study aims to provide knowledge on the epidemiology of burn injuries in primary care, to give directions for burn prevention. METHODS Data were derived from routine electronic health records of general practices and their out-of-hours service organisations in the Netherlands that participated in the Nivel Primary Care Database 2010-2015. We studied risk factors and trends. RESULTS The average burn injury prevalence rate was 4.40 (95% CI 4.27-4.53) per 1000 person-years in daytime general practice care and 1.47 (95% CI 1.46-1.49) per 1000 inhabitants in out-of-hours care. Children of 0-4 years old, especially boys, and young adult women had a higher risk. Burn injury risk was higher during the summer months and around New Year's Eve. Living in low socioeconomic and strongly urbanised neighbourhoods was associated with a higher risk of burn injury than living in other neighbourhoods. CONCLUSION Dutch general practitioners have a large share in burn care and therefore can play a significant role in burn prevention. Prevention may be most effective in the summer and around New Year's Eve, and specific attention seems to be warranted for low socioeconomic groups and strongly urbanised neighbourhoods.
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Affiliation(s)
| | - Margriet E van Baar
- Association of Dutch Burn Centres, Burn Centre, Maasstad Hospital, Rotterdam, The Netherlands; Department of Public Health, Erasmus MC, Rotterdam, The Netherlands
| | | | - Lando L J Koppes
- Nivel, Netherlands Institute for Health Services Research, Utrecht, The Netherlands; Faculty of Health, Nutrition & Sports, The Hague University of Applied Sciences, The Hague, The Netherlands
| | - Robert A Verheij
- Nivel, Netherlands Institute for Health Services Research, Utrecht, The Netherlands; Tranzo, Tilburg School of Social and Behavioural Sciences, Tilburg University, Tilburg, The Netherlands
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20
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Tracy LM, Gold M, Reeder S, Cleland HJ. Treatment Decisions in Patients with Potentially Non-Survivable Burn Injury in Australia and New Zealand: A Registry-based Study. J Burn Care Res 2022; 44:675-684. [PMID: 35170735 PMCID: PMC10152993 DOI: 10.1093/jbcr/irac017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Indexed: 11/13/2022]
Abstract
Whilst burn-related mortality is rare in high-income countries, there are unique features related to prognostication that make examination of decision-making practices important to explore. Compared to other kinds of trauma, burn patients (even those with non-survivable injuries) may be relatively stable after injury initially. Complications or patient comorbidity may make it clear later in the clinical trajectory that ongoing treatment is futile. Burn care clinicians are therefore required to make decisions regarding the withholding or withdrawal of treatment in patients with potentially non-survivable burn injury. There is yet to be a comprehensive investigation of treatment decision practices following burn injury in Australia and New Zealand. Data for patients admitted to specialist burn services between July 2009 and June 2020 were obtained from the Burns Registry of Australia and New Zealand. Patients were grouped according to treatment decision: palliative management, active treatment withdrawn, and active treatment until death. Predictors of treatment initiation and withholding or withdrawing treatment within 24 hours were assessed using multilevel mixed-effects logistic regression. Descriptive comparisons between treatment groups were made. Of the 32,186 patients meeting study inclusion criteria, 327 (1.0%) died prior to discharge. Fifty-six patients were treated initially with palliative intent and 227 patients had active treatment initiated and later withdrawn. Increasing age and burn size reduced the odds of having active treatment initiated. We demonstrate differences in demographic and injury severity characteristics as well as end of life decision-making timing between different treatment pathways pursued for patients who die in-hospital. Our next step into the decision-making process is to gain a greater understanding of the clinician's perspective (e.g., through surveys and/or interviews).
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Affiliation(s)
- Lincoln M Tracy
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Michelle Gold
- Palliative Care Service, Alfred Health, Melbourne, Australia
| | - Sandra Reeder
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.,Monash Partners Academic Health Science Centre, Kanooka Grove Clayton, VIC, Australia
| | - Heather J Cleland
- Victorian Adult Burns Service, Alfred Hospital, Melbourne VIC, Australia
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21
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Monte-Soldado A, López-Masramon B, Rivas-Nicolls D, Andrés-Collado A, Aguilera-Sáez J, Serracanta J, Barret JP. Changes in the epidemiologic profile of burn patients during the lockdown in Catalonia (Spain): A warning call to strengthen prevention strategies in our community. Burns 2022; 48:228-233. [PMID: 33858713 PMCID: PMC8022510 DOI: 10.1016/j.burns.2021.03.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 03/09/2021] [Accepted: 03/12/2021] [Indexed: 01/06/2023]
Abstract
BACKGROUND The worldwide coronavirus disease 2019 (COVID-19) epidemic, caused by the SARS-CoV-2 coronavirus, is the defining global health crisis of our time. Spain has had one of the highest burdens of COVID-19 worldwide. During this period, Vall d'Hebron University Hospital Burn Center (Barcelona) has faced a unique challenge: supporting the hospital response against COVID whilst continued offering an optimal care to the burn patient. OBJECTIVE The aim of this study is to characterize the clinical and epidemiological characteristics of acute burn patients who received urgent health care or admission to the our Burn Center during the mandatory confinement period in Spain forced by the COVID-19 epidemic. METHODS We analyzed the medical records of burn patients who received urgent care and/or admission to our Burn Center during the mandatory confinement period in Spain (Period 1: from March 14th to May 9th, 2020) and during the same period of the last year (Period 2: from March 14th to May 9th, 2019). Both groups were compared in order to find differences in the epidemiologic profile of burned patients. RESULTS A total of 350 burns cases were analyzed. A 36% reduction in the number of emergency department visits was identified during Period 1. However, we found an increase in the rate of hospital admissions in Period 1 (20% of the burn cases) compared with Period 2 (13% of the burn cases). Seventy-six burn-related primary admissions were analyzed: 37 patients were admitted during Period 1 and 39 patients during Period 2. No differences were found between the two periods in the proportion of patients that underwent surgical treatment: 59.5% of patients admitted during Period 1 and 61.5% of patients admitted during Period 2. A statistically significant increase was noted in the rate of paediatric (aged 0-16 years old) admissions during Period 1 (40.54%, n = 15) compared to Period 2 (20.5%, n = 8). Among paediatric patients, an increase in the rate of surgical procedures was noted in Period 1 (47% of children), compared with Period 2 (37% of children). Proportion of patients that were admitted to the Intensive Care Unit was higher among burn children admitted during period 1 (46.7%, n = 7) than those admitted during Period 2 (25%, n = 2). Among the 37 patients admitted during the lockdown period, two positive COVID-19 patients were confirmed. CONCLUSIONS This study gives an overview of the clinical and epidemiologic profile of burned patients during the stringent lockdown in Spain forced by the COVID-19 epidemic. Our data shows a stable trend in the number of burn-related admissions and burn related-surgeries during the confinement period. A significant increase in the rate of burn children admitted and an increase in the severity of injuries in this population is noted. These data must be taken in account in the development of strategies to ensure the maintenance of Burn Centers function in extremely situations such as the current epidemic. A lack of effective burn prevention campaigns in our environment has been noted and the development of focused prevention strategies is a priority.
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Affiliation(s)
- Alejandra Monte-Soldado
- Plastic Surgery Department and Burn Center, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.
| | - Bernat López-Masramon
- Plastic Surgery Department and Burn Center, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.
| | - Danilo Rivas-Nicolls
- Plastic Surgery Department and Burn Center, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.
| | - Aranzazu Andrés-Collado
- Plastic Surgery Department and Burn Center, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.
| | - Jorge Aguilera-Sáez
- Plastic Surgery Department and Burn Center, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.
| | - Jordi Serracanta
- Plastic Surgery Department and Burn Center, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.
| | - Juan P Barret
- Plastic Surgery Department and Burn Center, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.
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22
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Van Yperen DT, Van Lieshout EMM, Verhofstad MHJ, Van der Vlies CH. Epidemiology of burn patients admitted in the Netherlands: a nationwide registry study investigating incidence rates and hospital admission from 2014 to 2018. Eur J Trauma Emerg Surg 2021; 48:2029-2038. [PMID: 34463772 PMCID: PMC9192419 DOI: 10.1007/s00068-021-01777-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 08/15/2021] [Indexed: 01/02/2023]
Abstract
Purpose The aim of this study was to gain insight into the epidemiology of burn patients admitted to a hospital without a burn center or referred to a burn center. Methods This retrospective, nationwide, cohort study included patients with burns or inhalation trauma, admitted between 2014 and 2018, from a national trauma registry. The primary outcome measure was admission to a hospital with or without a burn center. Secondary outcome measures were patient and injury characteristics, Intensive Care Unit (ICU) admission and length of stay, and hospital length of stay (HLOS). Results Of the 5524 included patients, 2787 (50.4%) were treated at a non-burn center, 1745 (31.6%) were subsequently transferred to a burn center, and 992 (18.0%) were primarily presented and treated at a burn center. The annual number of patients decreased from 1199 to 1055 (− 12.4%). At all admission locations, a clear incidence peak was observed in children ≤ 4 years and in patients of ≥ 80 years. The number of ICU admissions for the entire population increased from 201 to 233 (33.0%). The mean HLOS for the entire population was 8 (SD 14) days per patient. This number remained stable over the years in all groups. Conclusion Half of all burn patients were admitted in a non-burn center and the other half in a burn center. The number and incidence rate of patients admitted with burns or inhalation trauma decreased over time. An increased incidence rate was found in children and elderly. The number of patients admitted to the ICU increased, whereas mean hospital length of stay remained stable. Supplementary Information The online version contains supplementary material available at 10.1007/s00068-021-01777-y.
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Affiliation(s)
- Daan T Van Yperen
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
- Burn Center Maasstad Hospital, Rotterdam, The Netherlands
| | - Esther M M Van Lieshout
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.
| | - Michael H J Verhofstad
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Cornelis H Van der Vlies
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
- Burn Center Maasstad Hospital, Rotterdam, The Netherlands
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23
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Spronk I, Stortelers A, van der Vlies CH, van Zuijlen PPM, Pijpe A. Scar quality in children with burns 5-7 years after injury: A cross-sectional multicentre study. Wound Repair Regen 2021; 29:951-960. [PMID: 34133037 PMCID: PMC8596883 DOI: 10.1111/wrr.12953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 02/15/2021] [Accepted: 03/02/2021] [Indexed: 11/29/2022]
Abstract
Long-term scar formation is an important adverse consequence in children with burns, however, information regarding scar quality in the long-term is lacking. Therefore, we evaluated scar quality and its predictors in children with burns 5-7 years after injury. Parents of children with mild/intermediate burns (≤10% total body surface area burned), and of children with severe burns (>10% burned) completed the patient scale of the Patient and Observer Scar Assessment Scale (POSAS 2.0) for their children's-in their opinion-worst scar 5-7 years post-burn. Outcomes and predictive factors of scar quality were studied, and, for children with severe burns, POSAS parent scores were compared with observer scores. We included 103 children with mild/intermediate burns and 28 with severe burns (response rate: 51%). Most children (87%) had scars that differed from normal skin, with most differences reported for colour, and least for pain. Except for colour, children with severe burns had significantly higher scores (difference 0-2 points) on all scar characteristics (representing poorer scar quality) compared with children with mild/intermediate burns. Parent POSAS scores were on average 2.0-2.6 points higher compared to observer scores. Number of surgeries predicted both the mean POSAS and the mean overall opinion of a scar. In conclusion, 5-7 years post-burn, the scar of the majority of children differed from normal skin, especially on the characteristic colour. The uncovered insights are useful in counselling of children and their parents on expectations of the final outcome of their (children's) scar(s), and help in further targeting scar prevention strategies for the individual child.
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Affiliation(s)
- Inge Spronk
- Association of Dutch Burn Centres, Maasstad Hospital, Rotterdam, Netherlands.,Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | | | - Cornelis H van der Vlies
- Burn Centre, Maasstad Hospital, Rotterdam, Netherlands.,Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Paul P M van Zuijlen
- Burn Centre, Red Cross Hospital, Beverwijk, Netherlands.,Dept. of Plastic, Reconstructive & Hand Surgery, Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Department of Plastic, Reconstructive and Hand Surgery, Red Cross Hospital, Beverwijk, Netherlands.,Paediatric Surgical Centre, Emma Children's Hospital, Amsterdam UMC, Amsterdam, Netherlands
| | - Anouk Pijpe
- Burn Centre, Red Cross Hospital, Beverwijk, Netherlands.,Dept. of Plastic, Reconstructive & Hand Surgery, Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
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24
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Filaj VH, Belba MK. Epidemiological trends of severe burns, 2009-2019: A study in the service of burns in Albania. Burns 2021; 47:930-943. [PMID: 33148488 DOI: 10.1016/j.burns.2020.09.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 08/15/2020] [Accepted: 09/23/2020] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Statistical and epidemiological data taken throughout decades show trends of the pathology of burns and its treatment. The aim of this study is to analyze the summarized epidemiological and clinical data of severe burn patients during the period 2009-2019 in order to acquire an accurate and recent picture of this pathology. This can create a basis for improving community health outcomes. MATERIAL AND METHOD The study retrospectively analyzes the data of severe burn patients admitted in the Intensive Care Unit (ICU) of the Service of Burns and Plastic Surgery of the University Hospital Center in Tirana, Albania, from 2009 to 2019. SPSS 23 software is used for the conduction of the Descriptive and Inferential Statistics. Statistical significance is defined as p<0.05. RESULTS Incidence rate of burn admissions which need ICU treatment in our data was 5.2 patients/100,000population/year. The mean age of our population was 24.9±25.5 years. The most frequent causes of burns in all patients were scalds (49.6%) followed by flame (39.5%), electrical (5.1%), chemical (5%) and with unknown cause (0.7%). Death rate from fire and burns for the period 2009-2019 was 0.3 patients per 100,000population/year. Overall mortality was 6.8%. The ABSI, Baux and R Baux scoring system remain accurate and valuable tools in the prediction of burn patient mortality. A probability of death chart for our service has been developed based on age and BSA (%) burned which needs to validate in the future. CONCLUSIONS Etiology of burns have changed toward an increase in proportion of flame burns especially in adults and elderly population. Survival following severe burns has improved over the past 11 years even in patients with three risk factors (age ≥60, BSA (%) burned ≥40% and presence of inhalation burn). LA 50 for all patients was 80%. LOS/BSA (%) ratio is a more valuable indicator than LOS alone. Improvement in the treatment of severe burns is a combination of preventive health care, appropriate treatment protocols and improvements in equipment and infrastructure.
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Affiliation(s)
- Vladimir Haxhi Filaj
- Department of Surgery, Service of Burns and Plastic Surgery, University Hospital Center "Mother Teresa", Tirana, Albania
| | - Monika Kristaq Belba
- Department of Surgery, Service of Burns and Plastic Surgery, University Hospital Center "Mother Teresa", Tirana, Albania; Department of Surgery, Service of Burns and Plastic Surgery, Service of Anesthesiology, University Hospital Center "Mother Teresa", Tirana, Albania; Department of Biomedical and Experimental Courses, Field of science: Pharmacology, Faculty of Medicine, University of Medicine, Tirana, Albania.
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25
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Kim KJ, Boo S, Oh H. Burn Survivors' Experiences of the Ongoing Challenges after Discharge in South Korea: A Qualitative Study. Adv Skin Wound Care 2021; 34:1-6. [PMID: 33797424 DOI: 10.1097/01.asw.0000734380.80661.cc] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To help burn survivors during the recovery time after discharge, healthcare professionals need to understand their experiences and care requirements. However, little is known about the experience of burn survivors after discharge in South Korea. This study aims to explore their experiences in a community setting. METHODS Using a qualitative descriptive format, data were collected by semistructured interview from 10 patients who had sustained major burns. Each interview was based on a protocol of 60 to 90 minutes' duration and used a qualitative content analysis. RESULTS Three themes were identified in the analysis: (1) ongoing distressing symptoms and the unpredictability of hypertrophic scars, (2) difficulties in reintegration into society, and (3) burden of health expenditure. CONCLUSIONS Several participants expressed consistent difficulties with distressing symptoms such as wound pain, pruritus, sleep disturbances, and unpredictable scar and symptom changes. Survivors further described the financial burden associated with high expenditures from nonreimbursable rehabilitation expenses, and the high cost incurred with consistent skin care. By providing support based on their needs, appropriate interventions would be more readily available for burn survivors.
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Affiliation(s)
- Kyung Ja Kim
- Kyung Ja Kim, PhD, RN, is Unit Manager, Hangang Sacred Heart Hospital, Hallym University, Seoul, Korea. Sunjoo Boo, PhD, RN, is Associate Professor, Ajou University, Suwon, Korea. Hyunjin Oh, PhD, RN, is Associate Professor, Gachon University, Incheon, Korea. Acknowledgments: The authors thank the patients who participated in the study. This work was supported by the National Research Foundation of Korea grant funded by the Korean government (Ministry of Science and ICT, 2017R1C1B1005527). The authors have disclosed no other financial relationships related to this article. Submitted March 20, 2020; accepted in revised form May 13, 2020; published online ahead of print, March 31, 2021
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26
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Spronk I, Van Loey NEE, van der Vlies CH, Haagsma JA, Polinder S, van Baar ME. Activity impairment, work status, and work productivity loss in adults 5-7 years after burn injuries. J Burn Care Res 2021; 43:256-262. [PMID: 33693704 PMCID: PMC8737115 DOI: 10.1093/jbcr/irab047] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
An important aspect of the rehabilitation of burn patients is social participation, including daily activities and work. Detailed information on long-term activity impairment and employment is scarce. Therefore, we investigated activity impairment, work status, and work productivity loss in adults 5–7 years following burn injuries, and investigated associations with burn-specific health-related quality of life (HRQL) domains. Adult participants completed the Work Productivity and Activity Impairment General Health questionnaire and the Burn Specific Health Scale-brief (BSHS-B) 5–7 years post-burn. Outcomes were compared between participants with mild/intermediate and severe burns (>20% total body surface area burned). Seventy-six (36%) of the 213 participants experienced some degree of activity impairment due to burn-related problems 5–7 years post-burn. Seventy percent of the population was employed; 12% of them experienced work productivity loss due to burn-related problems. Nineteen percent reported changes in their work situation (partly) because of the burn injury. A higher proportion of participants with severe burns had activity impairments (56% vs 29%; P = .001) and work productivity loss (26% vs 8%; P < .001) compared to participants with mild/intermediate burns. Activity impairment and work productivity loss were both associated with burn-related work problems and lower mood, measured with the BSHS-B. In conclusion, a substantial part of the study population experienced activity impairment and work productivity loss, was unemployed, and/or reported changes in their work situation due to their injury. Particularly patients with severe burns reported productivity loss and had lower employment rates. This subscribes the importance of addressing work-related functioning in the rehabilitation of burn patients.
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Affiliation(s)
- Inge Spronk
- Association of Dutch Burn Centres, Maasstad Hospital, Rotterdam, the Netherlands.,Erasmus MC, University Medical Center Rotterdam, Department of Public Health, Rotterdam, the Netherlands
| | - Nancy E E Van Loey
- Association of Dutch Burn Centres, Department Behavioural Research, Beverwijk, the Netherlands.,Utrecht University, Department Clinical Psychology, Utrecht, the Netherlands
| | - Cornelis H van der Vlies
- Burn Centre, Maasstad Hospital, Rotterdam, the Netherlands.,Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Juanita A Haagsma
- Erasmus MC, University Medical Center Rotterdam, Department of Public Health, Rotterdam, the Netherlands
| | - Suzanne Polinder
- Erasmus MC, University Medical Center Rotterdam, Department of Public Health, Rotterdam, the Netherlands
| | - Margriet E van Baar
- Association of Dutch Burn Centres, Maasstad Hospital, Rotterdam, the Netherlands.,Erasmus MC, University Medical Center Rotterdam, Department of Public Health, Rotterdam, the Netherlands
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27
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Adherence to the emergency management of severe burns referral criteria in burn patients admitted to a hospital with or without a specialized burn center. Burns 2021; 47:1810-1817. [PMID: 33707084 DOI: 10.1016/j.burns.2021.02.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 01/31/2021] [Accepted: 02/16/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND The primary aim was to determine to what extent referral and admission of burn patients to a hospital with or without a burn center was in line with the EMSB referral criteria. METHODS This was a retrospective, multicenter cohort study. Burn patients admitted from 2014 to 2018 to a hospital in the Southwest Netherland trauma region and Network Emergency Care Brabant were included in this study. Outcome measures were the adherence to the EMSB referral criteria. RESULTS A total of 1790 patients were included, of whom 951 patients were primarily presented to a non-burn center. Of these patients, 666 (70.0%) were managed according to the referral criteria; 263 (27.7%) were appropriately not referred, 403 (42.4%) were appropriately referred. Twenty (2.1%) were overtransferred, and 265 (27.9%) undertransferred. In 1213 patients treated at a burn center 1119 (92.3%) met the referral criteria. Adherence was lowest for electrical (N = 4; 14.3%) and chemical burns (N = 16; 42.1%), and was highest in 'children ≥5% total body surface area (TBSA) burned' (N = 109; 83.2%). CONCLUSION The overall adherence to the referral criteria of patients presented to a non-burn center was fairly high. However, approximately 25% was not transferred to a burn center while meeting the criteria. Most improvement for individual criteria can be achieved in patients with electrical and chemical burns.
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28
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Lowery AS, Dion G, Thompson C, Weavind L, Shinn J, McGrane S, Summitt B, Gelbard A. Incidence of Laryngotracheal Stenosis after Thermal Inhalation Airway Injury. J Burn Care Res 2020; 40:961-965. [PMID: 31332446 DOI: 10.1093/jbcr/irz133] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Inhalation injury is independently associated with burn mortality, yet little information is available on the incidence, risk factors, or functional outcomes of thermal injury to the airway. In patients with thermal inhalation injury, we sought to define the incidence of laryngotracheal stenosis (LTS), delineate risk factors associated with LTS development, and assess long-term tracheostomy dependence as a proxy for laryngeal function. Retrospective cohort study of adult patients treated for thermal inhalation injury at a single institution burn critical care unit from 2012 to 2017. Eligible patients' records were assessed for LTS (laryngeal, subglottic, or tracheal stenosis). Patient characteristics, burn injury characteristics, and treatment-specific covariates were assessed. Descriptive statistics, Mann-Whitney U-tests, odds ratio, and chi-square tests compared LTS versus non-LTS groups. Of 129 patients with thermal inhalation injury during the study period, 8 (6.2%) developed LTS. When compared with the non-LTS group, patients with LTS had greater mean TBSA (mean 30.3, Interquartile Range 7-57.5 vs 10.5, Interquartile Range 0-15.12, P = .01), higher grade of inhalation injury (mean 2.63 vs 1.80, P = .05), longer duration of intubation (12.63 vs 5.44; P < .001), and greater inflammatory response (mean white blood cell count on presentation 25.8 vs 14.9, P = .02, mean hyperglycemia on presentation 176.4 vs 136.9, P = .01). LTS patients had a significantly higher rate of tracheostomy dependence at last follow-up (50 vs 1.7%, P < .001). Six percent of patients with thermal inhalation injury develop LTS. LTS was associated with more severe thermal airway injury, longer duration of intubation, and more severe initial host inflammation. Patients with inhalation injury and LTS are at high risk for tracheostomy dependence. In burn patients with thermal inhalation injury, laryngeal evaluation and directed therapy should be incorporated early into multispecialty pathways of care.
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Affiliation(s)
- Anne Sun Lowery
- Department of Otolaryngology, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Greg Dion
- Department of Otolaryngology and Head and Neck Surgery, Brooke Army Medical Center, Fort Sam Houston, Houston, Texas
| | - Callie Thompson
- Division of Trauma and Surgical Critical Care, Vanderbilt University Medical Center
| | - Liza Weavind
- Division of Anesthesiology Critical Care Medicine, Vanderbilt University Medical Center
| | - Justin Shinn
- Department of Otolaryngology and Head and Neck Surgery, Vanderbilt University Medical Center
| | - Stuart McGrane
- Division of Anesthesiology Critical Care Medicine, Vanderbilt University Medical Center
| | - Blair Summitt
- Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Alexander Gelbard
- Division of Trauma and Surgical Critical Care, Vanderbilt University Medical Center
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29
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Holzer JC, Tiffner K, Kainz S, Reisenegger P, Bernardelli de Mattos I, Funk M, Lemarchand T, Laaff H, Bal A, Birngruber T, Kotzbeck P, Kamolz LP. A novel human ex-vivo burn model and the local cooling effect of a bacterial nanocellulose-based wound dressing. Burns 2020; 46:1924-1932. [DOI: 10.1016/j.burns.2020.06.024] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 05/08/2020] [Accepted: 06/23/2020] [Indexed: 10/23/2022]
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30
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Kwa KA, Pijpe A, Korte DD, Snoeks A, Breederveld RS, Meij-de Vries A. Using fibrin sealant for skin graft fixation to avoid sedation in children with burns: a prospective study. J Wound Care 2020; 29:642-648. [PMID: 33175622 DOI: 10.12968/jowc.2020.29.11.642] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To investigate whether a fibrin sealant, Fitrix (Sanquin Blood Supply Foundation, The Netherlands), for fixation of skin grafts in children with burn wounds is less invasive and equally effective in comparison with skin staples. METHOD A single-centre prospective observational cohort study was conducted. Children requiring skin grafting after burns were included and received the fibrin sealant. This group was compared with a retrospective control group of children whose skin grafts were fixed with skin staples. Study outcomes were graft take, graft dislocation, other wound complications, healing and need for sedation. RESULTS In the fibrin sealant and the control groups, 17 and 27 patients were included, respectively. The percentage of total body surface area (%TBSA) grafted was smaller (p=0.028) in the fibrin sealant group (median 1.0, interquartile range (IQR) 1.5 versus 2.0, IQR 2.5). There was no significant difference in graft take or wound healing. There were two graft dislocations in the fibrin sealant group and none in the control group. Other complications included a patient with graft failure in the fibrin sealant group, and another patient with a vanishing graft and wound infection in the control group. There were fewer sedations in the fibrin sealant group compared with the control group (one versus 20, p<0.0001). CONCLUSION The fibrin sealant used in this study was non-inferior for the fixation of skin grafts in comparison with skin staples, and avoided sedation procedures.
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Affiliation(s)
- Kelly Aa Kwa
- Burn Centre, Red Cross Hospital, PO Box 1074, 1940 EB Beverwijk, the Netherlands.,Department of Traumasurgery, Leiden University Medical Centre, K6-R, PO Box 9600, 2300 RC Leiden, the Netherlands
| | - Anouk Pijpe
- Burn Centre, Red Cross Hospital, PO Box 1074, 1940 EB Beverwijk, the Netherlands
| | - Dirk de Korte
- Department Product and Process Development, Sanquin Blood Bank, Postbus 9892, 1006 AN Amsterdam, The Netherlands.,Department of Blood Cell Research, Sanquin Research, Postbus 9892, 1006 AN Amsterdam, The Netherlands
| | - Annabel Snoeks
- Burn Centre, Red Cross Hospital, PO Box 1074, 1940 EB Beverwijk, the Netherlands
| | - Roelf S Breederveld
- Burn Centre, Red Cross Hospital, PO Box 1074, 1940 EB Beverwijk, the Netherlands.,Department of Traumasurgery, Leiden University Medical Centre, K6-R, PO Box 9600, 2300 RC Leiden, the Netherlands
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31
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Aydogdu HI, Kirci GS, Askay M, Bagci G, Peksen TF, Ozer E. Medicolegal evaluation of cases with burn trauma: Accident or physical abuse. Burns 2020; 47:888-893. [PMID: 33131946 DOI: 10.1016/j.burns.2020.10.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 08/01/2020] [Accepted: 10/07/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION AND OBJECTIVE Burns are thermal injuries that may have a wide variety of clinical consequences from simple injuries to mortality. There are many aspects that must be medicolegally addressed in both non-survivors and survivors from burn injuries. The objective of this study was to determine sociodemographic characteristics, injury patterns, treatment requirements and prognoses of patients with burn injuries to evaluate the findings of neglect-abuse and forensic reporting processes. This study also aimed to contribute to the medicolegal classification criteria in respect of the factors that have an effect on the prognosis in the analyses. MATERIAL AND METHOD The study was conducted by retrospective review of digital files and paper records of patients who received therapy in the Burns Unit of KTU Farabi Hospital between 1st January, 2013, and 31st December, 2017. RESULTS Evaluation was made of a total of 1225 patients, comprising 769 (62.8%) males and 456 (37.2%) females, with a mean age of 21.8 ± 23.8 years (range, 1-89 years). The mean burnt body surface area was 14.29 ± 13.74. A trauma-related psychiatric disorder was diagnosed in 60 (4.9%) patients during treatment. When the medical history and physical examination findings were evaluated together, burn injuries suggested physical abuse in 54 patients (4.4%). The doctors who evaluated the patients with burn injuries in the emergency room and those who applied treatment in the Burns Unit made a forensic notification for 379 (30.9%) patients. The mean age of non-survivors was significantly higher than that of patients who survived to discharge (56.54 ± 28.60 years for non-survivors and 19.39 ± 23.12 years for survivors; p < 0.001). CONCLUSION Burn injuries are frequently encountered, and they require precautionary measures. Burn injuries due to abuse are more frequently observed in the elderly and especially in children. Thus, the findings must be correctly interpreted, and more effort should be made to improve the knowledge of healthcare professionals about forensic reporting. Moreover, regulations should be implemented in respect of the medicolegal classification of trauma.
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Affiliation(s)
| | - Guven Seckin Kirci
- Karadeniz Technical University, Faculty of Medicine, Department of Forensic Medicine, Trabzon, Turkey
| | - Mehmet Askay
- Karadeniz Technical University, Faculty of Medicine, Department of Forensic Medicine, Trabzon, Turkey
| | - Gozde Bagci
- Karadeniz Technical University, Faculty of Medicine, Department of Forensic Medicine, Trabzon, Turkey
| | - Tevfik Furkan Peksen
- Karadeniz Technical University, Faculty of Medicine, Department of Forensic Medicine, Trabzon, Turkey
| | - Erdal Ozer
- Karadeniz Technical University, Faculty of Medicine, Department of Forensic Medicine, Trabzon, Turkey
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32
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Spronk I, Bonsel GJ, Polinder S, van Baar ME, Janssen MF, Haagsma JA. The added value of extending the EQ-5D-5L with an itching item for the assessment of health-related quality of life of burn patients: an explorative study. Burns 2020; 47:873-879. [PMID: 33012569 DOI: 10.1016/j.burns.2020.08.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 08/04/2020] [Accepted: 08/31/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Health-related quality of life (HRQL) is an important outcome in burn care and research. An advantage of a generic HRQL instrument, like the EQ-5D, is that it enables comparison of outcomes with other conditions and the general population. However, the downside is that it does not include burn specific domains, like scar issues or itching. Adding extra items to a generic instrument might overcome this issue. This study explored the potential and added value of extending the EQ-5D-5L with a burn-specific item, using a itching item as an example. METHODS The EQ-5D-5L and the Patient and Observer Scar Assessment Scale (POSAS) was completed by adult patients 5-7 years after injury. A separate POSAS itching item was used to study the added value of an itching item for the EQ-5D-5L. The EQ-5D-5L + Itching was created by adding the POSAS itching item to the EQ-5D-5L. Five psychometric properties were compared between EQ-5D-5L and EQ-5D-5L + Itching: distribution (e.g. ceiling), informativity cf. Shannon's indices, convergent validity, dimension dependency, and explanatory power respectively. RESULTS A total of 243 patients were included, of whom 49% reported any itching on the POSAS. Adding an itching item to the EQ-5D-5L decreased the ceiling effect, and resulted in increased absolute informativity (H' = 4.76 vs. H' = 3.64) and relative informativity (J' = 0.34 vs. J' = 0.31). The extra itching item decreased the convergent validity (Spearman's rank correlation coefficient = -0.51 vs. -0.59). Mutual dependency of dimensions existed, showing that all other items were dominant over the itching item. Adding the itching item to the standard EQ-5D-5L barely improved explanatory power (49.3% vs. 49.0%). CONCLUSIONS PThe present study showed adding a burn-specific item to the EQ-5D-5L is possible and has potential. However, 5 to 7 years after injury, adding an itching item to the EQ-5D-5L provides little additional information; the gain in terms of added value is relatively small. Apart from instances where itching information is specifically needed, a strong case is not present for adding an itching item to the EQ-5D-5L for long-term (>5 yr after burns) HRQL assessment in burn patients. In early time periods after burn, the added value might be greater and we recommend exploring this potential in future studies, ideally on multiple timepoints after burn.
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Affiliation(s)
- I Spronk
- Erasmus MC, University Medical Center Rotterdam, Department of Public Health, Rotterdam, the Netherlands; Association of Dutch Burn Centres, Maasstad Hospital, Rotterdam, the Netherlands.
| | - G J Bonsel
- Erasmus MC, University Medical Center Rotterdam, Department of Public Health, Rotterdam, the Netherlands; EuroQol Group Executive Office, Rotterdam, The Netherlands
| | - S Polinder
- Erasmus MC, University Medical Center Rotterdam, Department of Public Health, Rotterdam, the Netherlands
| | - M E van Baar
- Erasmus MC, University Medical Center Rotterdam, Department of Public Health, Rotterdam, the Netherlands; Association of Dutch Burn Centres, Maasstad Hospital, Rotterdam, the Netherlands
| | - M F Janssen
- Section Medical Psychology and Psychotherapy, Department of Psychiatry, Erasmus, MC, Rotterdam, The Netherlands
| | - J A Haagsma
- Erasmus MC, University Medical Center Rotterdam, Department of Public Health, Rotterdam, the Netherlands
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Dijksteel GS, Ulrich MMW, Vlig M, Sobota A, Middelkoop E, Boekema BKHL. Safety and bactericidal efficacy of cold atmospheric plasma generated by a flexible surface Dielectric Barrier Discharge device against Pseudomonas aeruginosa in vitro and in vivo. Ann Clin Microbiol Antimicrob 2020; 19:37. [PMID: 32814573 PMCID: PMC7439657 DOI: 10.1186/s12941-020-00381-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 08/13/2020] [Indexed: 02/07/2023] Open
Abstract
Background Cold atmospheric plasma (CAP), which is ionized gas produced at atmospheric pressure, could be a novel and potent antimicrobial therapy for the treatment of infected wounds. Previously we have shown that CAP generated with a flexible surface Dielectric Barrier Discharge (sDBD) is highly effective against bacteria in vitro and in ex vivo burn wound models. In the current paper, we determined the in vitro and in vivo safety and efficacy of CAP generated by this sDBD device. Methods The effect of CAP on DNA mutations of V79 fibroblasts was measured using a hypoxanthine–guanine-phosphoribosyltransferase (HPRT) assay. Furthermore, effects on cell proliferation, apoptosis and DNA damage in ex vivo burn wound models (BWMs) were assessed using immunohistochemistry. Next, 105 colony forming units (CFU) P. aeruginosa strain PAO1 were exposed to CAP in a 3D collagen-elastin matrix environment to determine the number of surviving bacteria in vitro. Finally, rat excision wounds were inoculated with 107 CFU PAO1 for 24 h. The wounds received a single CAP treatment, repeated treatments on 4 consecutive days with CAP, 100 µL of 1% (wt/wt) silver sulfadiazine or no treatment. Wound swabs and punch biopsies were taken to determine the number of surviving bacteria. Results Exposure of V79 fibroblasts to CAP did not increase the numbers of mutated colonies. Additionally, the number of proliferative, apoptotic and DNA damaged cells in the BWMs was comparable to that of the unexposed control. Exposure of PAO1 to CAP for 2 min resulted in the complete elimination of bacteria in vitro. Contrarily, CAP treatment for 6 min of rat wounds colonized with PAO1 did not effectively reduce the in vivo bacterial count. Conclusions CAP treatment was safe but showed limited efficacy against PAO1 in our rat wound infection model.
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Affiliation(s)
- Gabrielle S Dijksteel
- Association of Dutch Burn Centres, Zeestraat 29, 1941 AJ, Beverwijk, The Netherlands. .,Dept. of Plastic, Reconstructive & Hand Surgery, Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
| | - Magda M W Ulrich
- Association of Dutch Burn Centres, Zeestraat 29, 1941 AJ, Beverwijk, The Netherlands.,Dept. of Plastic, Reconstructive & Hand Surgery, Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.,Dept. of Pathology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Marcel Vlig
- Association of Dutch Burn Centres, Zeestraat 29, 1941 AJ, Beverwijk, The Netherlands
| | - Ana Sobota
- Dept. of Applied Physics, Eindhoven University of Technology, PO Box 513, 5600 MB, Eindhoven, The Netherlands
| | - Esther Middelkoop
- Association of Dutch Burn Centres, Zeestraat 29, 1941 AJ, Beverwijk, The Netherlands.,Dept. of Plastic, Reconstructive & Hand Surgery, Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Bouke K H L Boekema
- Association of Dutch Burn Centres, Zeestraat 29, 1941 AJ, Beverwijk, The Netherlands
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García-Díaz A, Durán-Romero AJ, PurificaciónGacto-Sánchez, Carbajal-Guerrero J, Gómez-Cía T, Pereyra-Rodríguez JJ. Trends in burn injury mortality in Spain (1979-2018): Sex-specific age-cohort-period effects. Burns 2020; 47:714-720. [PMID: 32878699 DOI: 10.1016/j.burns.2020.08.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 07/08/2020] [Accepted: 08/05/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Previous studies about burns mortality are often exclusively based on hospital and burn centre data. National population-based reports on this topic are rather limited. The aim of this study was to analyse sex- and age-specific mortality rates of burns in Spain during the period 1979-2018. METHODS Age-standardised burns mortality rates were calculated from death records and mid-year population data were provided by the Spanish National Statistics Institute. Joinpoint regression analyses were used to identify significant points of change in trends over time and to compute average annual per cent change (AAPC). Age, period and cohort effects were also analysed. RESULTS Mortality due to burn injury decreased in both sexes between 1979 and 2018: from the first quinquennium of this period up to the last one age-adjusted mortality rates decreased from 1.37 to 0.49 per 100,000 in men and from 0.96 to 0.26 per 100,000 in women. CONCLUSIONS Burns mortality rates in Spain have been decreasing during the last decades. Promotion of primary prevention measures should continue.
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Affiliation(s)
- Antonio García-Díaz
- Plastic Surgery Department, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | | | | | | | - Tomás Gómez-Cía
- Plastic Surgery Department, Hospital Universitario Virgen del Rocío, Sevilla, Spain
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Legemate CM, Ooms PJ, Trommel N, Goei H, Lucas Y, Middelkoop E, Baar ME, Vlies CH. Course of scar quality of donor sites following split skin graft harvesting: Comparison between patients and observers. Wound Repair Regen 2020; 28:696-703. [DOI: 10.1111/wrr.12840] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 05/28/2020] [Accepted: 06/01/2020] [Indexed: 12/21/2022]
Affiliation(s)
- Catherine M. Legemate
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam Movement Sciences Amsterdam UMC, Vrije Univeristeit Amsterdam Amsterdam the Netherlands
- Maasstad Hospital, Burn Center Rotterdam the Netherlands
| | | | - Nicole Trommel
- Maasstad Hospital, Burn Center Rotterdam the Netherlands
| | - Harold Goei
- Department of Surgery, Amsterdam Movement Sciences Amsterdam UMC, Vrije Univeristeit Amsterdam Amsterdam the Netherlands
| | - Ymke Lucas
- Maasstad Hospital, Burn Center Rotterdam the Netherlands
| | - Esther Middelkoop
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam Movement Sciences Amsterdam UMC, Vrije Univeristeit Amsterdam Amsterdam the Netherlands
- Association of Dutch Burn Centres, Red Cross Hospital, Beverwijk the Netherlands
| | - Margriet E. Baar
- Maasstad Hospital, Burn Center Rotterdam the Netherlands
- Department of Public Health, Erasmus MC University Medical Center Rotterdam Rotterdam the Netherlands
| | - Cornelis H. Vlies
- Maasstad Hospital, Burn Center Rotterdam the Netherlands
- Department of Public Health, Erasmus MC University Medical Center Rotterdam Rotterdam the Netherlands
- Trauma Research Unit, Department of Surgery, Erasmus MC University Medical Center Rotterdam Rotterdam the Netherlands
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Demographics and clinical outcomes of adult burn patients admitted to a single provincial burn centre: A 40-year review. Burns 2020; 46:1958-1967. [PMID: 32660831 DOI: 10.1016/j.burns.2020.06.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 06/23/2020] [Indexed: 11/18/2022]
Abstract
INTRODUCTION This study evaluated trends in demographics and outcomes of cutaneous burns over a forty-year period at a Canadian burn centre. METHODS Retrospective review was performed of all consecutive adult burn admissions to the Vancouver General Hospital (VGH) between 1976 and 2015. Comparison was made to the 2016 American Burn Association - National Burn Repository. RESULTS There were 4105 admissions during study period. Both overall admissions and admissions per 100,000 BC residents declined (p < 0.0001). Males represented three quarters of admissions. There was a decrease in large burns (p < 0.05). Flame burns were most commonly associated with larger TBSA, ICU stays, and mortality. Mortality decreased from 11.3% to 2.8% (p < 0.05). Factors found to affect mortality included: increased length of stay, age and burn size, male gender, and number of complications. Baux50 and rBaux50 increased, from 102.8 to 116.7 and 112.2 to 125.3 respectively (p < 0.05, respectively). CONCLUSIONS This study represents the largest report on burn epidemiology in Canada. The incidence of burns has decreased significantly over the last forty years. Mortality has improved over this time frame, as evident by increases in Baux50 and rBaux50 scores. Further data is largely in concurrence with that of the National Burn Repository's amalgamation of US centres.
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Spronk I, Bonsel GJ, Polinder S, van Baar ME, Janssen MF, Haagsma JA. Exploring the relation between the EQ-5D-5L pain/discomfort and pain and itching in a sample of burn patients. Health Qual Life Outcomes 2020; 18:144. [PMID: 32429975 PMCID: PMC7236121 DOI: 10.1186/s12955-020-01394-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 05/07/2020] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND The EQ-5D domain pain/discomfort (PD) uses one item to capture pain and other aspects of discomfort, like itching. This study explored how pain, itching and the EQ-5D-5L PD domain relate to each other in a sample of burn patients. METHODS Adult burn patients completed the EQ-5D-5L and the Patient and Observer Scar Assessment Scale (POSAS) 5-7 years after sustaining their injury. The POSAS includes a separate pain and an itching item. Spearman's correlation coefficient established the association between the EQ-5D-5L PD and the POSAS pain and itching item. With multivariable regression analysis the linear association between the POSAS pain and itching item and EQ-5D-5L PD domain was tested. RESULTS Data from 245 patients were included. Mean EQ-5D-5L index value was 0.87 and 39.2% reported at least slight problems on the EQ-5D-5L PD domain. Most patients gave corresponding answers on the EQ-5D-5L PD domain and on the POSAS pain (73%) and itching (70%) item. Spearman correlation coefficients of the EQ-5D-5L PD domain with the POSAS pain and itching were 0.468 (p < 0.001) and 0.473 (p < 0.001), respectively. Among respondents with pain and without itching and respondents with itching and without pain, Spearman correlation coefficients were 0.585 (p = 0.076) and 0.408 (p = 0.001), respectively. POSAS pain (unstandardized Beta = 0.14) and POSAS itching (unstandardized Beta = 0.08) were significantly associated with EQ-5D-5L PD domain (p < 0.001). CONCLUSIONS Our findings indicate that, in a sample of burn patients, pain and itching are captured by the broader EQ-5D-5L PD domain. The EQ-5D-5L PD domain can thus be used to assess pain and itching in relation to HRQL, but the POSAS pain and itching items are more sensitive. The EQ-5D-5L is, however, no replacement of the POSAS when the POSAS is used for its primary aim; assessment of scar quality. TRIAL REGISTRATION Netherlands Trial Register (NTR6407).
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Affiliation(s)
- I Spronk
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000, CA, Rotterdam, The Netherlands. .,Association of Dutch Burn Centres, Maasstad Hospital, Rotterdam, the Netherlands.
| | - G J Bonsel
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000, CA, Rotterdam, The Netherlands.,EuroQol Group Executive Office, Rotterdam, The Netherlands
| | - S Polinder
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000, CA, Rotterdam, The Netherlands
| | - M E van Baar
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000, CA, Rotterdam, The Netherlands.,Association of Dutch Burn Centres, Maasstad Hospital, Rotterdam, the Netherlands
| | - M F Janssen
- Section Medical Psychology and Psychotherapy, Department of Psychiatry, Erasmus MC, Rotterdam, The Netherlands
| | - J A Haagsma
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000, CA, Rotterdam, The Netherlands
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Tian H, Wang L, Xie W, Shen C, Guo G, Liu J, Han C, Ren L, Liang Y, Liu J, Lv Y, Wang Y, Zhang J, Huang Y. Epidemiology and outcome analysis of facial burns: A retrospective multicentre study 2011–2015. Burns 2020; 46:718-726. [DOI: 10.1016/j.burns.2019.08.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Revised: 08/18/2019] [Accepted: 08/29/2019] [Indexed: 10/25/2022]
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Odondi RN, Shitsinzi R, Emarah A. Clinical patterns and early outcomes of burn injuries in patients admitted at the Moi Teaching and Referral Hospital in Eldoret, Western Kenya. Heliyon 2020; 6:e03629. [PMID: 32258478 PMCID: PMC7096742 DOI: 10.1016/j.heliyon.2020.e03629] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 03/03/2020] [Accepted: 03/16/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Burns are the fourth most common type of trauma worldwide and a major cause of mortality and disability in developing countries. Although burns are common in Kenya, the mortality and morbidity patterns are yet to be well studied and documented comprehensively. OBJECTIVE To evaluate burn clinical patterns, early outcomes and their associations among patients admitted with burn injuries at Moi Teaching and Referral Hospital (MTRH). METHODS A cross-sectional descriptive study was conducted at MTRH between January 2016 and June 2017. A total of 189 patients admitted to the hospital with burns were recruited into the study. An interviewer-administered structured questionnaire and chart reviews were used to collect data on sociodemographic variables, burn clinical characteristics and early burn outcomes. Associations between patient characteristics and early burn outcomes were assessed by multivariable logistic regression. RESULTS Of the 182 burn patients whose data was analyzed, the median age was 2.4 years (IQR = 5.8) years and 149 (82%) were children below 18 years. Majority (76%) of burns were due to scalds. The commonest burn locations were the trunk and upper limbs (56%). Only 40% of patients received prehospital intervention. The median Total Burn Surface Area (TBSA) was 14.5% and 74% of the patients had 2nd degree burns. The median length of hospital stay was 16 days (IQR = 28) and commonest complication was wound infection. Proportion of deaths due to burns accounted for 9.3% of the patients. A TBSA of 20%-30% (p = 0.01) was associated with presence of burn complications while a TBSA of >10% (p = 0.03) and time from burn to admission (p = 0.03) were associated with the length of hospital stay. CONCLUSIONS In our study, death was likely to occur in one in ten patients admitted with burns and TBSA was a predictor of presence of burn complications and length of hospital stay. There is a need for continued health education of the public on fire safety within the home environment for children and other vulnerable persons. Timely hospital intervention would also reduce burn complications as well as length of hospital stay.
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Affiliation(s)
| | - Rose Shitsinzi
- Moi University, School of Medicine, Eldoret, Kenya
- The Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Ashraf Emarah
- Moi University, School of Medicine, Eldoret, Kenya
- The Moi Teaching and Referral Hospital, Eldoret, Kenya
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van Yperen DT, Raats JW, Dokter J, Ziere G, Roukema GR, van Baar ME, van der Vlies CH. Prevalence and Risk Factors for Delirium in Elderly Patients With Severe Burns: A Retrospective Cohort Study. J Burn Care Res 2020; 41:371-376. [PMID: 31504611 DOI: 10.1093/jbcr/irz161] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Little is known about delirium in elderly burn center patients. The aim of this study is to provide information on the prevalence of delirium and risk factors contributing to the onset of delirium. All patients aged 70 years or older admitted with burn injuries to the Burn Center, Maasstad Hospital, in 2011 to 2017 were eligible for inclusion. We retrospectively collected data regarding the presence of delirium, potential risk factors contributing to the onset of delirium and outcome after delirium. We included elderly 90 patients in this study. The prevalence of delirium in our population was 13% (N = 12). Risk factors for delirium were advanced age, increased American Society for Anesthesiologists score, physical impairment and the use of anticholinergic drugs during admission. Patients with delirium had a poorer outcome, with prolonged hospital stay and increased mortality 6 and 12 months after discharge. Delirium is diagnosed in 13% of the elderly patients admitted to our burn center. Risk factors for delirium found in this study are advanced age, poor physical health status, physical impairment, and the use of anticholinergic drugs. Delirium is related to poor outcomes, including prolonged hospital stay and mortality after discharge.
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Affiliation(s)
- Daan T van Yperen
- Burn Center, Maasstad Hospital, Maasstadweg 31, 3079 DZ Rotterdam, The Netherlands.,Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, 3000 CA, The Netherlands
| | - Jelle W Raats
- Department of Surgery, Maasstad Hospital, Maasstadweg 31, 3079 DZ Rotterdam, The Netherlands
| | - Jan Dokter
- Burn Center, Maasstad Hospital, Maasstadweg 31, 3079 DZ Rotterdam, The Netherlands
| | - Gijsbertus Ziere
- Geriatric Medicine, Maasstad Hospital, Maasstadweg 31, 3079 DZ Rotterdam, The Netherlands
| | - Gert R Roukema
- Burn Center, Maasstad Hospital, Maasstadweg 31, 3079 DZ Rotterdam, The Netherlands.,Department of Surgery, Maasstad Hospital, Maasstadweg 31, 3079 DZ Rotterdam, The Netherlands
| | - Margriet E van Baar
- Association of Dutch Burn Centers, Burn Center, Maasstad Hospital, Maasstadweg 31, 3079 DZ Rotterdam, The Netherlands
| | - Cornelis H van der Vlies
- Burn Center, Maasstad Hospital, Maasstadweg 31, 3079 DZ Rotterdam, The Netherlands.,Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, 3000 CA, The Netherlands.,Department of Surgery, Maasstad Hospital, Maasstadweg 31, 3079 DZ Rotterdam, The Netherlands
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Spronk I, Edgar DW, van Baar ME, Wood FM, Van Loey NEE, Middelkoop E, Renneberg B, Öster C, Orwelius L, Moi AL, Nieuwenhuis M, van der Vlies CH, Polinder S, Haagsma JA. Improved and standardized method for assessing years lived with disability after burns and its application to estimate the non-fatal burden of disease of burn injuries in Australia, New Zealand and the Netherlands. BMC Public Health 2020; 20:121. [PMID: 31996206 PMCID: PMC6988230 DOI: 10.1186/s12889-020-8233-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 01/16/2020] [Indexed: 12/16/2022] Open
Abstract
Background Burden of disease estimates are an important resource in public health. Currently, robust estimates are not available for the burn population. Our objectives are to adapt a refined methodology (INTEGRIS method) to burns and to apply this new INTEGRIS-burns method to estimate, and compare, the burden of disease of burn injuries in Australia, New Zealand and the Netherlands. Methods Existing European and Western-Australian health-related quality of life (HRQL) datasets were combined to derive disability weights for three homogenous burn injury groups based on percentage total body surface area (%TBSA) burned. Subsequently, incidence data from Australia, New Zealand, and the Netherlands from 2010 to 2017 were used to compute annual non-fatal burden of disease estimates for each of these three countries. Non-fatal burden of disease was measured by years lived with disability (YLD). Results The combined dataset included 7159 HRQL (EQ-5D-3 L) outcomes from 3401 patients. Disability weights ranged from 0.046 (subgroup < 5% TBSA burned > 24 months post-burn) to 0.497 (subgroup > 20% TBSA burned 0–1 months post-burn). In 2017 the non-fatal burden of disease of burns for the three countries (YLDs/100,000 inhabitants) was 281 for Australia, 279 for New Zealand and 133 for the Netherlands. Conclusions This project established a method for more precise estimates of the YLDs of burns, as it is the only method adapted to the nature of burn injuries and their recovery. Compared to previous used methods, the INTEGRIS-burns method includes improved disability weights based on severity categorization of burn patients; a better substantiated proportion of patients with lifelong disability based; and, the application of burn specific recovery timeframes. Information derived from the adapted method can be used as input for health decision making at both the national and international level. Future studies should investigate whether the application is valid in low- and middle- income countries.
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Affiliation(s)
- Inge Spronk
- Erasmus MC, Department of Public Health, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands. .,Association of Dutch Burn Centres, Maasstad Hospital, Rotterdam, the Netherlands. .,Amsterdam UMC, Department of Plastic, Reconstructive and Hand Surgery, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.
| | - Dale W Edgar
- State Adult Burn Unit, Fiona Stanley Hospital, Murdoch, Western Australia, Australia.,Burn Injury Research Node, The University of Notre Dame, Fremantle, Western Australia, Australia.,Fiona Wood Foundation, Murdoch, Western Australia, Australia
| | - Margriet E van Baar
- Erasmus MC, Department of Public Health, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.,Association of Dutch Burn Centres, Maasstad Hospital, Rotterdam, the Netherlands
| | - Fiona M Wood
- State Adult Burn Unit, Fiona Stanley Hospital, Murdoch, Western Australia, Australia.,Fiona Wood Foundation, Murdoch, Western Australia, Australia
| | - Nancy E E Van Loey
- Association of Dutch Burn Centres, Department Behavioural Research, Beverwijk, the Netherlands.,Department Clinical Psychology, Utrecht University, Utrecht, the Netherlands
| | - Esther Middelkoop
- Amsterdam UMC, Department of Plastic, Reconstructive and Hand Surgery, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Association of Dutch Burn Centres, Red Cross Hospital, Beverwijk, the Netherlands
| | - Babette Renneberg
- Department of Clinical Psychology and Psychotherapy, Freie Universität Berlin, Berlin, Germany
| | - Caisa Öster
- Department of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden
| | - Lotti Orwelius
- Department of Anaesthesiology and Intensive Care, and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Asgjerd L Moi
- Department of Health and Caring Sciences, Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway.,Department of Plastic, Hand and Reconstructive Surgery, National Burn Centre, Haukeland University Hospital, Bergen, Norway
| | - Marianne Nieuwenhuis
- Association of Dutch Burn Centres, Martini Hospital, Groningen, the Netherlands.,Center for Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Cornelis H van der Vlies
- Burn Centre, Maasstad Hospital, Rotterdam, the Netherlands.,Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Suzanne Polinder
- Erasmus MC, Department of Public Health, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Juanita A Haagsma
- Erasmus MC, Department of Public Health, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
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Ribeiro AF, Martins Pereira S, Gomes B, Nunes R. Do patients, families, and healthcare teams benefit from the integration of palliative care in burn intensive care units? Results from a systematic review with narrative synthesis. Palliat Med 2019; 33:1241-1254. [PMID: 31296110 DOI: 10.1177/0269216319862160] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Burn units are intensive care facilities specialized in the treatment of patients with severe burns. As burn injuries have a major impact in physical, psychosocial, and spiritual health, palliative care can be a strengthening component of integrated care. AIM To review and appraise the existing evidence about the integration of palliative care in burn intensive care units with respect to (1) the concept, model and design and (2) the benefits and outcomes of this integration. DESIGN A systematic review was conducted following PRISMA guidelines. Protocol registered with PROSPERO (CRD42018111676). DATA SOURCES Five electronic databases were searched (PubMed/NLM, Web of Science, MEDLINE/TR, Ovid, and CINAHL/EBSCO) until May 2019. A narrative synthesis of the findings was constructed. Hawker et al.'s tool was used for quality appraisal. RESULTS A total of 299 articles were identified, of which five were included for analysis involving a total of 7353 individuals. Findings suggest that there may be benefits from integrating palliative care in burn units, specifically in terms of patients' comfort, decision-making processes, and family care. Multidisciplinary teams may experience lower levels of burden as result of integrating palliative care in burn units. CONCLUSION This review reflects the challenging setting of burn intensive care units. Evidence from these articles suggests that the integration of palliative care in burn intensive care units improves patients' comfort, decision-making process, and family care. Further research is needed to better understand how the integration of palliative care in burn intensive care units may be fostered and to identify the outcomes of this integration.
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Affiliation(s)
| | - Sandra Martins Pereira
- Instituto de Bioética, Universidade Católica Portuguesa, Porto, Portugal.,UNESCO Chair in Bioethics, Instituto de Bioética, Universidade Católica Portuguesa, Porto, Portugal.,Centro de Estudos em Gestão e Economia (CEGE), Porto Católica Business School, Universidade Católica Portuguesa, Porto, Portugal
| | - Barbara Gomes
- Faculdade de Medicina, Universidade de Coimbra, Coimbra, Portugal.,Cicely Saunders Institute, King's College London, London, UK
| | - Rui Nunes
- Faculdade de Medicina, Universidade do Porto, Porto, Portugal.,International Network UNESCO Chair in Bioethics
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Mauck MC, Shupp JW, Williams F, Villard MA, Jones SW, Hwang J, Smith J, Karlnoski R, Smith DJ, Cairns BA, McLean SA. Hypertrophic Scar Severity at Autograft Sites Is Associated With Increased Pain and Itch After Major Thermal Burn Injury. J Burn Care Res 2019; 39:536-544. [PMID: 29596686 DOI: 10.1093/jbcr/irx012] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Approximately three quarters of major thermal burn injury (MThBI) survivors suffer from hypertrophic scarring (HTS) and over half experience chronic pain or itch. In survivors of MThBI, HTS and chronic pain or itch are considered one of the greatest unmet challenges of postburn injury care and psychosocial reintegration. Although scarring, itch, and pain have been clinically associated, there are no prospective, multisite studies examining tissue autograft site pain or itch and scar outcomes. The authors collected a representative cohort (n = 56) of MThBI survivors who received autografting within 14 days of injury and evaluated graft-site pain or itch severity (0-10 Numeric Rating Scale) and HTS using a validated scar photograph assessment scale 6 months following MThBI. Given that stress is known to influence wound healing, the authors also assessed the relationship between previous trauma exposure, peritraumatic stress, preburn overall health (SF-12), scarring, and chronic pain or itch severity using Spearman's correlation. Association between HTS and chronic pain or itch was significant in a linear regression model adjusted for age, sex, and ethnicity (β = 0.2, P = .033 for pain, β = 0.2, P = .019 for itch). Results indicate that prior trauma exposure is inversely correlated (r = -.363, P = .030) with scar severity, but not pain or itch severity 6 months after MThBI. Study results suggest that preburn chronic pain or itch is associated with pathological scarring 6 months following MThBI. Results also indicate that stress may improve scarring after MThBI. Further work to understand the mechanisms that underlie both HTS and chronic pain or itch and their relationship to chronic stress is critical to the development of novel therapies to assist burn survivors recover.
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Affiliation(s)
- Matthew C Mauck
- Institute for Trauma Recovery, Chapel Hill, North Carolina.,Department of Anesthesiology, University of North Carolina, Chapel Hill, North Carolina
| | - Jeffrey W Shupp
- The Burn Center, MedStar Washington Hospital Center, Washington, DC
| | - Felicia Williams
- Jaycee Burn Center, University of North Carolina Chapel Hill, North Carolina
| | - Marie Ashley Villard
- Institute for Trauma Recovery, Chapel Hill, North Carolina.,Department of Anesthesiology, University of North Carolina, Chapel Hill, North Carolina
| | - Samuel W Jones
- Jaycee Burn Center, University of North Carolina Chapel Hill, North Carolina
| | - James Hwang
- Jaycee Burn Center, University of North Carolina Chapel Hill, North Carolina
| | - Jennifer Smith
- Institute for Trauma Recovery, Chapel Hill, North Carolina.,Department of Anesthesiology, University of North Carolina, Chapel Hill, North Carolina
| | - Rachel Karlnoski
- Department of Surgery, University of South Florida, Tampa, Florida
| | - David J Smith
- Department of Surgery, University of South Florida, Tampa, Florida
| | - Bruce A Cairns
- Jaycee Burn Center, University of North Carolina Chapel Hill, North Carolina
| | - Samuel A McLean
- Institute for Trauma Recovery, Chapel Hill, North Carolina.,Department of Anesthesiology, University of North Carolina, Chapel Hill, North Carolina.,Emergency Medicine, University of North Carolina, Chapel Hill, North Carolina
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44
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Epidemiology and outcomes of in-hospital acute burn-patients in Togo: A retrospective analysis. BURNS OPEN 2019. [DOI: 10.1016/j.burnso.2019.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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45
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Spronk I, Polinder S, van Loey NE, van der Vlies CH, Pijpe A, Haagsma JA, van Baar ME. Health related quality of life 5–7 years after minor and severe burn injuries: a multicentre cross-sectional study. Burns 2019; 45:1291-1299. [DOI: 10.1016/j.burns.2019.03.017] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 03/26/2019] [Indexed: 10/26/2022]
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46
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Kwa KAA, Goei H, Breederveld RS, Middelkoop E, van der Vlies CH, van Baar ME. A systematic review on surgical and nonsurgical debridement techniques of burn wounds. J Plast Reconstr Aesthet Surg 2019; 72:1752-1762. [PMID: 31515194 DOI: 10.1016/j.bjps.2019.07.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 05/27/2019] [Accepted: 07/27/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To provide a complete overview of all burn debridement techniques studied in recent literature and to find the best evidence with regard to efficiency and safety. METHOD A systematic review was performed. Searches were conducted in electronic databases such as PubMed, Embase, Cochrane, CINAHL, Web of Science, and Academic Search Premier. All studies published from 1990 onwards, on the efficiency and/or safety of burn debridement techniques in patients with thermal burn injuries of any age, were included. Primary outcomes were time to complete wound healing and time to complete debridement. Randomized trials were critically appraised. RESULTS Twenty-seven studies, including four randomized clinical trials, were included. Time to wound healing in the conventional tangential excision (seven studies), hydrosurgery (eight studies), enzymatic debridement (eleven studies), and shock waves group (one study) ranged from 13-30, 11-13, 19-33, and 16 days, respectively. Time to complete debridement ranged from 5-10, 4-23, and 1-9 days, respectively. Furthermore, secondary outcomes (including grafting, mortality, and scar quality) were compared between the debridement categories. CONCLUSION Convincing evidence in favor of any of these techniques is currently lacking. Future studies regarding (new) debridement techniques need to use standardized and validated outcome measurement tools to allow improved standardization and comparisons across studies.
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Affiliation(s)
- K A A Kwa
- Burn Center Beverwijk, Red Cross Hospital, Vondellaan 13, 1942 LE Beverwijk, the Netherlands; Department of Traumasurgery, Leiden University Medical Center, K6-50, P.O. Box 9600, 2300 RC Leiden, the Netherlands.
| | - H Goei
- Burn Center, Maasstad Hospital, P.O. Box 9100, 3007 AC Rotterdam, the Netherlands; Department of Plastic, Reconstructive and Hand Surgery, Amsterdam Movement Sciences, VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands
| | - R S Breederveld
- Burn Center Beverwijk, Red Cross Hospital, Vondellaan 13, 1942 LE Beverwijk, the Netherlands; Department of Traumasurgery, Leiden University Medical Center, K6-50, P.O. Box 9600, 2300 RC Leiden, the Netherlands
| | - E Middelkoop
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam Movement Sciences, VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands; Association of Dutch Burn Centers, P.O. Box 1015, 1940 EA Beverwijk, the Netherlands
| | - C H van der Vlies
- Burn Center, Maasstad Hospital, P.O. Box 9100, 3007 AC Rotterdam, the Netherlands
| | - M E van Baar
- Burn Center, Maasstad Hospital, P.O. Box 9100, 3007 AC Rotterdam, the Netherlands; Association of Dutch Burn Centers, P.O. Box 1015, 1940 EA Beverwijk, the Netherlands; Department of Public Health, Erasmus Medical Center, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands.
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47
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Rashaan ZM, Kwa KAA, van der Wal MBA, Tuinebreijer WE, van Zuijlen PPM, Breederveld RS. Patterns and predictors of burn scar outcome in the first 12 months after burn: The patient's perspective. Burns 2019; 45:1283-1290. [PMID: 31176509 DOI: 10.1016/j.burns.2019.03.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 02/22/2019] [Accepted: 03/26/2019] [Indexed: 12/22/2022]
Abstract
OBJECTIVE This study aimed to provide insight into the patterns and factors that predict burn scar outcomes at 3, 6 and 12 months after burn. METHODS The Patient and Observer Scar Assessment Scale (POSAS) was used to assess the scar formation of each patient. Structural equation modelling was used. The predictor variables used in this study were sex, three age categories, TBSA, depth of the wound and cause of the burn. RESULTS The POSAS patient total and individual item scores demonstrated a statistically significant decrease in the first 12 months after burn, except for the relief item. Male patients had a lower total and items scores (better scar quality) for pain and pruritus compared with female patients. Full thickness burns had a higher scores for pruritus, pliability, thickness and relief compared to the partial-thickness burns. Ages younger than 5 years, higher TBSA values and flame burns were predictors of various POSAS items at 3 and 6 months after burn. CONCLUSION The POSAS patient total and individual item scores demonstrated a statistically significant improvement in the scar quality in the first 12 months after burn, except for the relief. Sex, age, depth of the wound, the percentage of TBSA and flame burns were predictors of various POSAS patient items at 3, 6 and 12 months after burn.
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Affiliation(s)
- Z M Rashaan
- Department of Surgery, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA Leiden, Leiden, The Netherlands; Burn Centre and Department of Surgery, Red Cross Hospital, Vondellaan 13, 1942 LE, Beverwijk, The Netherlands.
| | - K A A Kwa
- Department of Surgery, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA Leiden, Leiden, The Netherlands; Burn Centre and Department of Surgery, Red Cross Hospital, Vondellaan 13, 1942 LE, Beverwijk, The Netherlands.
| | - M B A van der Wal
- Association of Dutch Burn Centres, Zeestraat 27-29, 1941 AJ, Beverwijk, The Netherlands.
| | - W E Tuinebreijer
- Burn Centre and Department of Surgery, Red Cross Hospital, Vondellaan 13, 1942 LE, Beverwijk, The Netherlands.
| | - P P M van Zuijlen
- Burn Centre and Department of Plastic and Reconstructive Surgery, Red Cross Hospital, Vondellaan 13, 1942 LE, Beverwijk, The Netherlands; Department of Plastic and Reconstructive Surgery and MOVE Research Institute, VU University of Amsterdam, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands.
| | - R S Breederveld
- Department of Surgery, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA Leiden, Leiden, The Netherlands; Burn Centre and Department of Surgery, Red Cross Hospital, Vondellaan 13, 1942 LE, Beverwijk, The Netherlands.
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48
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Morgan M, Deuis JR, Frøsig-Jørgensen M, Lewis RJ, Cabot PJ, Gray PD, Vetter I. Burn Pain: A Systematic and Critical Review of Epidemiology, Pathophysiology, and Treatment. PAIN MEDICINE 2019; 19:708-734. [PMID: 29036469 DOI: 10.1093/pm/pnx228] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Objective This review aims to examine the available literature on the epidemiology, pathophysiology, and treatment of burn-induced pain. Methods A search was conducted on the epidemiology of burn injury and treatment of burn pain utilizing the database Medline, and all relevant articles were systemically reviewed. In addition, a critical review was performed on the pathophysiology of burn pain and animal models of burn pain. Results The search on the epidemiology of burn injury yielded a total of 163 publications of interest, 72 of which fit the inclusion/exclusion criteria, with no publications providing epidemiological data on burn injury pain management outcomes. The search on the treatment of burn pain yielded a total of 213 publications, 14 of which fit the inclusion/exclusion criteria, highlighting the limited amount of evidence available on the treatment of burn-induced pain. Conclusions The pathophysiology of burn pain is poorly understood, with limited clinical trials available to assess the effectiveness of analgesics in burn patients. Further studies are needed to identify new pharmacological targets and treatments for the effective management of burn injury pain.
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Affiliation(s)
- Michael Morgan
- Centre for Pain Research, Institute for Molecular Bioscience, The University of Queensland, St Lucia, Queensland, Australia
| | - Jennifer R Deuis
- Centre for Pain Research, Institute for Molecular Bioscience, The University of Queensland, St Lucia, Queensland, Australia
| | - Majbrit Frøsig-Jørgensen
- Centre for Pain Research, Institute for Molecular Bioscience, The University of Queensland, St Lucia, Queensland, Australia
| | - Richard J Lewis
- Centre for Pain Research, Institute for Molecular Bioscience, The University of Queensland, St Lucia, Queensland, Australia
| | - Peter J Cabot
- School of Pharmacy, The University of Queensland, Wooloongabba, Queensland, Australia
| | - Paul D Gray
- Tess Cramond Multidisciplinary Pain Centre, Royal Brisbane & Women's Hospital, Metro North Health, Herston, Queensland, Australia.,School of Medicine, The University of Queensland, Herston, Queensland, Australia
| | - Irina Vetter
- Centre for Pain Research, Institute for Molecular Bioscience, The University of Queensland, St Lucia, Queensland, Australia.,School of Pharmacy, The University of Queensland, Wooloongabba, Queensland, Australia
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49
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Spronk I, Polinder S, Haagsma JA, Nieuwenhuis M, Pijpe A, van der Vlies CH, Middelkoop E, van Baar ME. Patient-reported scar quality of adults after burn injuries: A five-year multicenter follow-up study. Wound Repair Regen 2019; 27:406-414. [PMID: 30793408 PMCID: PMC6850449 DOI: 10.1111/wrr.12709] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 02/12/2019] [Indexed: 12/28/2022]
Abstract
Scar formation is an important adverse consequence of burns. How patients appraise their scar quality is often studied shortly after sustaining the injury, but information in the long‐term is scarce. Our aim was, therefore, to evaluate long‐term patient‐reported quality of burn scars. Adults with a burn center admission of ≥1 day between August 2011 and September 2012 were invited to complete a questionnaire on long‐term consequences of burns. We enriched this sample with patients with severe burns (>20% total body surface area [TBSA] burned or TBSA full thickness >5%) treated between January 2010 and March 2013. Self‐reported scar quality was assessed with the Patient Scale of the Patient and Observer Scar Assessment Scale (POSAS). Patients completed this scale for their—in their opinion—most severe scar ≥5 years after burns. This study included 251 patients with a mean %TBSA burned of 10%. The vast majority (91.4%) reported at least minor differences with normal skin (POSAS item score ≥2) on one or more scar characteristics and 78.9% of the patients’ overall opinion was that their scar deviated from normal skin. Patients with severe burns had higher POSAS scores, representing worse scar quality, than patients with mild/intermediate burns, except for color, which was high in both groups. A longer hospital stay predicted reduced scar quality (both mean POSAS and mean overall opinion of the scar) in multivariate analyses. In addition, female gender was also associated with a poorer overall opinion of the scar. In conclusion, this study provides new insights in long‐term scar quality. Scars differed from normal skin in a large part of the burn population more than 5 years after burns, especially in those with severe burns. Female gender is associated with a poorer patients’ overall opinion of their scar, which may be an indication of gender differences in perception of scar quality after burns.
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Affiliation(s)
- Inge Spronk
- Association of Dutch Burn Centres, Maasstad Hospital, Rotterdam, The Netherlands.,Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Plastic, Reconstructive and Hand Surgery, Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Suzanne Polinder
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Juanita A Haagsma
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Marianne Nieuwenhuis
- Association of Dutch Burn Centres, Martini Hospital, Groningen, The Netherlands.,Center for Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Anouk Pijpe
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Burn Centre, Red Cross Hospital, Beverwijk, The Netherlands
| | - Cornelis H van der Vlies
- Burn Centre, Maasstad Hospital, Rotterdam, The Netherlands.,Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Esther Middelkoop
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Association of Dutch Burn Centres, Red Cross Hospital, Beverwijk, The Netherlands
| | - Margriet E van Baar
- Association of Dutch Burn Centres, Maasstad Hospital, Rotterdam, The Netherlands.,Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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50
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Cheng W, Shen C, Zhao D, Zhang H, Tu J, Yuan Z, Song G, Liu M, Li D, Shang Y, Qin B. The epidemiology and prognosis of patients with massive burns: A multicenter study of 2483 cases. Burns 2019; 45:705-716. [PMID: 30837206 DOI: 10.1016/j.burns.2018.08.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 06/21/2018] [Accepted: 08/07/2018] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Epidemiological features of massively burned patients in China remains unclear. This study was designed to investigate the epidemiological characteristics and evaluate the burn index (BI) and other risk factors associated with the prognosis of massively burned patients. METHODS Data of patients with ≥30% total body surface area burned admitted in 2014 were retrieved from 106 burn centers in the mainland of China. Information of epidemiological features and the outcome were collected for retrospective analysis. RESULTS A total of 2483 massively burned patients were included in this study, with a male-to-female ratio of 2.29:1, the mean age of 49.23±16.67 years, mean TBSA of 55.53±21.39% and the mean BI of 39.75±21.59. Scald accounted for 81.07% of the injuries in children, while flame accounted for 66.89% and 74.31% of the injuries in adults and seniors. Approximately 17.76% of the patients were admitted to the local burn center after 6h of injury, and the wound areas of 1154 (46.48%) patients were covered with folk remedies. The mortality was 9.79%, and the area under the receiver operating characteristic (ROC) curve for BI was 0.941 (95% CI, 0.929-0.954). When the value of BI was above a threshold of 29 in the 0-14 years age group, 43.5 in the 15-59 years age group and 35.5 in the 60 years or older age group, the mortality increased significantly. Multivariate logistic regression analyses showed that the odds ratio (OR) of death increased 6% with an increase in the BI of 1.0. Patients older than 60 years, the admission time longer than 6h after-injury (adjusted OR, 1.797; 95% CI, 1.179-2.740; adjusted p<0.001), and patients with a combined inhalation injury (adjusted OR, 6.649; 95% CI, 4.517-9.789; adjusted p<0.000), were at higher risk of death. CONCLUSIONS There are etiological characteristics of the different age groups that should be considered for prevention. BI can be a reliable index of prognosis in severely burned patients. The results of the study showed that a large BI, elderly age, delayed admission after injury and combined inhalation injury are the main risk factors for extensively burned patients.
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Affiliation(s)
- Wenfeng Cheng
- Department of Critical Care Medicine, Henan Provincial People's Hospital, Zhengzhou, China
| | - Chuanan Shen
- Department of Burns & Plastic Surgery, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, China.
| | - Dongxu Zhao
- Department of Burns & Plastic Surgery, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Hongyan Zhang
- Department of Burns, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Jiajin Tu
- Department of Burns, Ganzhou Municipal Hospital of Jiangxi Province, Ganzhou, China
| | - Zhiqiang Yuan
- Institute of Burn Research, Southwest Hospital, State Key Laboratory of Trauma, Burns and Combined Injury, The Third Military Medical University, Chongqing, China
| | - Guodong Song
- Department of Burns, Affiliated Jinan Central Hospital, Shandong University, Jinan, China
| | - Miao Liu
- Department of Epidemiology, Institute of Geriatrics, PLA General Hospital, Beijing, China
| | - Dawei Li
- Department of Burns & Plastic Surgery, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Yuru Shang
- Department of Burns & Plastic Surgery, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Binyu Qin
- Department of Critical Care Medicine, Henan Provincial People's Hospital, Zhengzhou, China
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