1
|
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.
Collapse
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
| |
Collapse
|
2
|
Holm S, Tell K, Karlsson M, Huss F, Pompermaier L, Elmasry M, Löfgren J. Sociodemographic Patterns of Pediatric Patients in Specialized Burn Care in Sweden. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2022; 10:e4246. [PMID: 35506021 PMCID: PMC9049026 DOI: 10.1097/gox.0000000000004246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 02/09/2022] [Indexed: 06/14/2023]
Abstract
UNLABELLED Trauma is a leading cause of mortality in children. Burns affect children disproportionally. Although burn incidence and mortality are decreasing, differences in the risk depend on socioeconomic status. The present study aimed to investigate the sociodemographic patterns of pediatric patients (0-17 years) managed at the two burn centers in Sweden, Uppsala, and Linköping, between 2010 and 2020. METHOD This retrospective register-based study used hospital records from the two burn centers combined with information from Statistics Sweden plus data regarding number of asylum seekers from the Swedish Migrations Agency. Choropleth maps representing the patients' geographical distribution were created. Information about income levels per geographic area was added. A Wilcoxon signed-rank test was performed to investigate differences in median income levels between the areas where the patients lived, related to Sweden's median income. RESULTS The study included 2455 patients. Most of the children aged below 5 years (76%) and were boys (60%). The mean percentage of total skin area was 4.2%. There was no significant increment or decrease in the incidence of pediatric burns during the study. Most patients with recorded zip codes lived in areas with an income level below the national median (n = 1974, 83%). Children with asylum status were over-represented compared with residents and/or Swedish citizens. CONCLUSIONS In Sweden, most pediatric burns occur in families that live in areas with low-income levels. Pediatric burns affect children with asylum status disproportionally compared with those who are residents in and/or citizens of Sweden. Prevention strategies should be designed and implemented to alleviate this health inequity.
Collapse
Affiliation(s)
- Sebastian Holm
- From the Department of Plastic and Maxillofacial Surgery, Uppsala University Hospital, Uppsala, Sweden
| | - Katinka Tell
- Department of Emergency Care and Internal Medicine, Uppsala University Hospital, Uppsala, Sweden
| | - Matilda Karlsson
- Department of Hand Surgery, Plastic Surgery and Burns, Linköping University, Linköping, Sweden
| | - Fredrik Huss
- From the Department of Plastic and Maxillofacial Surgery, Uppsala University Hospital, Uppsala, Sweden
- Department of Surgical Sciences, Plastic Surgery, Uppsala University, Uppsala, Sweden
| | - Laura Pompermaier
- Department of Hand Surgery, Plastic Surgery and Burns, Linköping University, Linköping, Sweden
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Moustafa Elmasry
- Department of Hand Surgery, Plastic Surgery and Burns, Linköping University, Linköping, Sweden
| | - Jenny Löfgren
- Department of Molecular Medicine and Surgery, Karolinska Institute, Solna, Sweden
- Department of Reconstructive Surgery, Karolinska University Hospital, Sweden
| |
Collapse
|
3
|
Kontaktverbrennungen durch einen Nachtspeicherofen – Unfall oder Misshandlung? Rechtsmedizin (Berl) 2021. [DOI: 10.1007/s00194-021-00467-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ZusammenfassungEin 7 Monate alter weiblicher Säugling wurde mit Kontaktverbrennungen 2. Grades an beiden Beinen von seinen Eltern in der Notaufnahme eines Krankenhauses vorgestellt. Die Eltern berichteten, das Kind sei unbeaufsichtigt und nur mit einem Body bekleidet gegen den Nachtspeicherofen im Kinderzimmer gekrabbelt. Bei der 10 Tage später durchgeführten klinisch-rechtsmedizinischen Untersuchung zeigten sich streifige, teils parallel zueinander gestellte und gelenkübergreifende Verbrennungen an der rechten Oberschenkelaußen- und Unterschenkelrückaußenseite, an beiden Fußrücken und den Zehen sowie ein flächenhaftes Verbrennungsareal an der linken Unterschenkelaußenseite mit abgrenzbaren streifigen Anteilen.Im Rahmen einer Ortsbegehung der elterlichen Wohnung mit Vermessung und Begutachtung der in der Wohnung befindlichen 3 Nachtspeicheröfen konnte zunächst festgestellt werden, dass sich die Verbrennungsmuster an den Beinen des Kindes mit dem Luftauslassgitter der beiden Nachtspeicheröfen im Wohn- und im Elternschlafzimmer (jeweils identisches Modell), hingegen nicht mit dem des Nachtspeicherofens im Kinderzimmer in Deckung bringen ließen. Für die Begutachtung konnte durch ergänzende Informationen eines technischen Sachverständigen zu den entsprechenden Nachtspeicheröfen und durch eine Literaturrecherche ein möglicher Geschehensablauf rekonstruiert werden.Dieser Fall verdeutlicht zum einen, welche Gefahr für Säuglinge und Kleinkinder von Nachtspeicheröfen ausgehen kann, wenn diese nicht regelrecht gesichert und die Kinder unbeaufsichtigt sind. Zum anderen wird die Bedeutung einer detaillierten und – wenn nötig – interdisziplinären Rekonstruktion, inklusive einer Ortsbegehung, zur Abgrenzung eines möglichen Unfallhergangs von einer Kindesmisshandlung unterstrichen.
Collapse
|
4
|
Singer AJ, Zhou JW, Osman OB, Harris ZB, Khani ME, Baer E, Zhang N, McClain SA, Arbab MH. Comparison of comparable scald and contact burns in a porcine model: A preliminary report. Wound Repair Regen 2020; 28:789-796. [PMID: 32729128 DOI: 10.1111/wrr.12848] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 06/03/2020] [Accepted: 06/04/2020] [Indexed: 11/29/2022]
Abstract
Whether the depth and healing of scalds and contact burns are similar is controversial. Due to water's greater heat capacity, we hypothesized that when exposed to similar temperatures and durations of exposure, burns caused by hot water would be deeper than those caused by contact with hot metal. Forty standardized burns were created in two anesthetized female domestic pigs using a brass bar or circulating heated water. In one pig, the temperature was kept constant (95°C) while the duration of exposure varied (5, 10, 15 seconds) In the second pig, the exposure time was kept constant (10 seconds) while the temperature of exposure varied (70°C, 80°C, 98°C). Periodic punch biopsies were taken to determine burn depth immediately after injury, percentage burns reepithelialized within 21 days, and depth of scar at 28 days. The analysis was performed using analysis of variance. When the temperature was held constant, duration of exposure (5, 10, and 15 seconds) was associated with scar depth (2.1 vs 3.8 vs 5.0 mm, respectively, P = 0.001) but not with burn depth (2.0 vs 2.2 vs 2.3 mm, respectively, P = 0.10). When exposure duration was held constant, temperature (70°C, 80°C, 98°C) was associated with scar depth (0.6 vs 1.7 vs 3.6, P < 0.001) but not with burn depth (1.2 vs 1.5 vs 1.7 mm, respectively, P = 0.21). Burn depths were greater for scald than contact burns although not significantly greater. After controlling for temperature, the difference in scar depth between scalds and contact burns was statistically significant (marginal means 3.0 for contact burns, 4.3 for scalds, P = 0.008). We conclude that burns created in swine with circulating hot water result in deeper scars than those created by contact with a brass bar when controlling for temperature and duration of exposure.
Collapse
Affiliation(s)
- Adam J Singer
- Departments of Emergency Medicine, Stony Brook University, Stony Brook, New York, USA
| | - Juin W Zhou
- Department Biomedical Engineering, Stony Brook University, Stony Brook, New York, USA
| | - Omar B Osman
- Department Biomedical Engineering, Stony Brook University, Stony Brook, New York, USA
| | - Zachery B Harris
- Department Biomedical Engineering, Stony Brook University, Stony Brook, New York, USA
| | - Mahmoud E Khani
- Department Biomedical Engineering, Stony Brook University, Stony Brook, New York, USA
| | - Evyatar Baer
- Departments of Emergency Medicine, Stony Brook University, Stony Brook, New York, USA
| | - Nigel Zhang
- Departments of Emergency Medicine, Stony Brook University, Stony Brook, New York, USA
| | - Steve A McClain
- Departments of Emergency Medicine, Stony Brook University, Stony Brook, New York, USA
| | - M Hassan Arbab
- Department Biomedical Engineering, Stony Brook University, Stony Brook, New York, USA
| |
Collapse
|
5
|
Javaid AA, Bennett V, Hollén L, Kemp AM. Contact burns: the influence of agents and mechanisms of injury on anatomical burn locations in children <5 years old and associations with child protection referrals. Arch Dis Child 2020; 105:580-586. [PMID: 31871044 DOI: 10.1136/archdischild-2019-318140] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 12/09/2019] [Accepted: 12/10/2019] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To identify how causative agents and mechanisms of injury influence the location of an accidental contact burn in children and whether these factors differ in cases referred for child protection (CP) assessment. DESIGN Prospective multicentre cross-sectional study. SETTING 20 hospital sites across England and Wales, including: emergency departments, minor injury units and regional burn units. PATIENTS Children less than 5 years old who attended hospital for a contact burn (August 2015 to September 2018). MAIN OUTCOME MEASURES Location of burns with respect to agent and mechanism for accidental contact burns. Secondary outcome: mechanism, agent and location of burns referred for CP assessment. RESULTS 816 accidental burns and 92 referrals for CP assessment. The most common for accidental burns: mechanism was reaching while stationary (68%, 553/816), agent was oven (24.5%, 200/816) and site was the hand (69.2%, 565/816). Burns to head and trunk were rare at 3.7% (30/816). The data enabled a tabulation of the locations of burns as predicted by agent and mechanism of injury. The location of the burn was most strongly influenced by mechanism.Burns from irons (p<0.01), caused by mechanisms independent of the child (p=0.01), unwitnessed burns (p<0.001) and burns to the head and trunk (p<0.001) were significantly more common among the children referred for CP assessment. CONCLUSIONS By overlaying agent, mechanism and site it was possible to tabulate and quantify simple narratives of accidental contact burns in population of young children. These findings have the potential to aid clinicians in recognising accidental contact burns.
Collapse
Affiliation(s)
- Assim Ali Javaid
- Department of Population Health, Cardiff University, Cardiff, UK
| | - Verity Bennett
- Department of Population Health, Cardiff University, Cardiff, UK
| | - Linda Hollén
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Alison Mary Kemp
- Department of Population Health, Cardiff University, Cardiff, UK
| |
Collapse
|
6
|
Hepburn K, Bennett V, Kemp AM, Hollen LI, Nuttall D, Roberts Z, Farrell D, Mullen S. Burns and Scalds Assessment Template: standardising clinical assessment of childhood burns in the emergency department. Emerg Med J 2020; 37:351-354. [DOI: 10.1136/emermed-2019-208595] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 02/16/2020] [Accepted: 03/14/2020] [Indexed: 11/04/2022]
Abstract
ObjectivesThe Burns and Scalds Assessment Template (BaSAT) is an evidence-based proforma coproduced by researchers and ED staff with the aim of (1) standardising the assessment of children attending ED with a burn, (2) improving documentation and (3) screening for child maltreatment. This study aimed to test whether the BaSAT improved documentation of clinical, contributory and causal factors of children’s burns.MethodsA retrospective before-and-after study compared the extent to which information was recorded for 37 data fields after the BaSAT was introduced in one paediatric ED. Pre-BaSAT, a convenience sample of 50 patient records of children who had a burn was obtained from the hospital electronic database of 2007. The post-BaSAT sample included 50 randomly selected case notes from 2016/2017 that were part of another research project. Fisher's exact test and Mann-Whitney U tests were conducted to test for statistical significance.ResultsPre-BaSAT, documentation of key data fields was poor. Post-BaSAT, this varied less between patients, and median completeness significantly (p<0.001) increased from 44% (IQR 4%–94%) to 96% (IQR 94%–100%). Information on ‘screening for maltreatment, referrals to social care and outcome’ was poorly recorded pre-BaSAT (median of 4% completed fields) and showed the greatest overall improvement (to 95%, p<0.001). Documentation of domestic violence at home and child’s ethnicity improved significantly (p<0.001) post-BaSAT; however, these were still not recorded in 36% and 56% of cases, respectively.ConclusionIntroduction of the BaSAT significantly improved and standardised the key clinical data routinely recorded for children attending ED with a burn.
Collapse
|
7
|
Hardon SF, Haasnoot PJ, Meij-de Vries A. Burn wounds after electrical injury in a bathtub: a case report. J Med Case Rep 2019; 13:304. [PMID: 31554506 PMCID: PMC6761724 DOI: 10.1186/s13256-019-2231-4] [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: 06/20/2019] [Accepted: 08/13/2019] [Indexed: 11/27/2022] Open
Abstract
Background Increased smartphone use among minors makes our population more prone to electrical injury. Despite regulations on electrical home safety standards, smartphones and chargers still pose a risk for severe injury among users. Case presentation We present a case of a patient with low-voltage electrical burns due to smartphone use in a bathtub. The 13-year-old Caucasian patient was using a smartphone plugged into the electrical grid while taking a bath. We report the burns and their treatment. We discuss the likely burn mechanism. Conclusions Burn wounds after electrical injury due to smartphone use are rare. The presented case shows the danger of smartphone use in bathtubs.
Collapse
Affiliation(s)
- Sem F Hardon
- Department of Surgery, Amsterdam UMC - VU University Medical Center, Room ZH 7F 020, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands.
| | - Pieter J Haasnoot
- Department of Surgery, Red Cross Hospital, Beverwijk, The Netherlands
| | - Annebeth Meij-de Vries
- Department of Surgery, Red Cross Hospital, Beverwijk, The Netherlands.,Burn Center, Red Cross Hospital, Beverwijk, The Netherlands
| |
Collapse
|
8
|
Choi YM, Chopra T, Smith D, Moulton S. Sun heated surfaces are an environmental hazard for young children. Perspect Public Health 2019; 139:264-270. [PMID: 30920359 DOI: 10.1177/1757913919826600] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIMS Children commonly sustain heat contact type burn injuries from sun heated surfaces during the summer months in hot, sunny climates. The aim of this study was to review the causes and outcomes in a series of heat contact type burns sustained by children who touched hot sun heated surfaces. METHODS A retrospective chart review was performed to identify all children who sustained burn injuries due to naturally heated surfaces and were treated between January 2012 and December 2017 at Children's Hospital Colorado. Demographics of the subjects and clinical data regarding their burn injuries were collected. RESULTS A total of 58 children were identified over the study period, involving 118 burn wounds. The median age was 17 months (interquartile range = 14-23), and 33 were male (57%). Mean total body surface area (TBSA) was 1.4% (standard deviation = 1). A foot was the most commonly involved area, affecting 36 subjects (62%). The most common causes of these burn injuries were metal thresholds (n = 7, 12%) and metal covers or lids (n = 5, 9%) outside the home. The depth of the burn injury was partial thickness in 57 children (98%). The mean time to heal was 12 ± 6 days, and the majority of injuries occurred in June (n = 28, 48%). CONCLUSION Heat contact type burn injuries from sun heated surfaces commonly affect children ⩽2 years of age during the summer months, and the majority of these injuries occur around the home environment. They are preventable injuries, and this information should be used for prevention and education materials for parents and healthcare providers, who reside in hot, sunny climates.
Collapse
Affiliation(s)
- Y M Choi
- Rutgers New Jersey Medical School, Newark, NJ, USA
- Division of Pediatric Surgery, Children's Hospital Colorado, 13123 E. 16th Avenue B245, Aurora, CO 80045, USA
| | - T Chopra
- Division of Pediatric Surgery, Children's Hospital Colorado, Aurora, CO, USA
| | - D Smith
- Division of Pediatric Surgery, Children's Hospital Colorado, Aurora, CO, USA
| | - S Moulton
- Division of Pediatric Surgery, Children's Hospital Colorado, Aurora, CO, USA
- School of Medicine, University of Colorado, Aurora, CO, USA
| |
Collapse
|
9
|
Ye H, Rahul, Dargar S, Kruger U, De S. Ultrasound elastography reliably identifies altered mechanical properties of burned soft tissues. Burns 2018; 44:1521-1530. [PMID: 29859811 DOI: 10.1016/j.burns.2018.04.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 01/24/2018] [Accepted: 04/25/2018] [Indexed: 10/16/2022]
Abstract
Although burn injury to the skin and subcutaneous tissues is common in both civilian and military scenarios, a significant knowledge gap exists in quantifying changes in tissue properties as a result of burns. In this study, we present a noninvasive technique based on ultrasound elastography which can reliably assess altered nonlinear mechanical properties of a burned tissue. In particular, ex vivo porcine skin tissues have been exposed to four different burn conditions: (i) 200°F for 10s, (ii) 200°F for 30s, (iii) 450°F for 10s, and (iv) 450°F for 30s. A custom-developed instrument including a robotically controlled ultrasound probe and force sensors has been used to compress the tissue samples to compute two parameters (C10 and C20) of a reduced second-order polynomial hyperelastic material model. The results indicate that while the linear model parameter (C10) does not show a statistically significant difference between the test conditions, the nonlinear model parameter (C20) reliably identifies three (ii-iv) of the four cases (p<0.05) when comparing burned with unburned tissues with a classification accuracy of 60-87%. Additionally, softening of the tissue is observed because of the change in structure of the collagen fibers. The ultrasound elastography-based technique has potential for application under in vivo conditions, which is left for future work.
Collapse
Affiliation(s)
- Hanglin Ye
- Center for Modeling, Simulation and Imaging in Medicine (CeMSIM), Rensselaer Polytechnic Institute, Troy, NY, USA
| | - Rahul
- Center for Modeling, Simulation and Imaging in Medicine (CeMSIM), Rensselaer Polytechnic Institute, Troy, NY, USA
| | - Saurabh Dargar
- Center for Modeling, Simulation and Imaging in Medicine (CeMSIM), Rensselaer Polytechnic Institute, Troy, NY, USA
| | - Uwe Kruger
- Center for Modeling, Simulation and Imaging in Medicine (CeMSIM), Rensselaer Polytechnic Institute, Troy, NY, USA; The Department of Biomedical Engineering, Rensselaer Polytechnic Institute, Troy, NY, USA
| | - Suvranu De
- Center for Modeling, Simulation and Imaging in Medicine (CeMSIM), Rensselaer Polytechnic Institute, Troy, NY, USA.
| |
Collapse
|