Poverty, population density, and the epidemiology of burns in young children from Mexico treated at a U.S. pediatric burn facility

Epidemiology and Etiology of Pediatric Burns in Iran

Pediatric burns have long-term physical, psychological, economic, and social consequences for the patient and family. This study was designed to investigate the epidemiology, causes, and mechanism of pediatric burns in Iran, considering the impact the cultural and environmental differences of countries have on burn incidence. This study is a survey study that was performed from 2016 to 2017 on patients referred to Shahid Motahari hospital. Patients in the study included hospitalized children aged 0-18 years who themselves or their parents were able to answer questions. Questions were answered in the categories of the demographic characteristics of the child and parents, epidemiological characteristics of the burn, information on socio-economic and education status, and the underlying causes of the accident. Most burns occurred in the age group less than two years of age and in boys. The most common cause of burns was hot liquids. Collision with containers containing hot liquids inside the kitchen, collision with containers containing hot liquids outside the kitchen space, and overturning containers containing hot liquids were the most common mechanisms of burns. Flame burns were the most common cause of burns in school-age children. Half of the parents had an elementary level or lower education. Economic, social, and cultural conditions of families, parents' education, and access to preventive education are related to the extent and mechanism of burns. Paying attention to epidemiology and recognizing the main causes of child burns plays an important role in designing and planning preventive measures.

Dark side of customs: scalding burns in childhood due to use of traditional teacup and teapot, in Turkey

The most common type of burn among children is scalding burn. This study aims to reveal child abuse and neglect as a specific etiological factor that specific to our country, traditional teapot- and teacup-related scalding burns. Burn cases that admitted to our Burn Center were investigated, and among these, 72 cases suffering from scalding burns were included in the study. The interview forms issued upon admission of these cases were evaluated in detail. Out of 148 scalding burn cases, 48.6% were related to the use of traditional teapots and teacups. After a detailed assessment, all cases were considered neglect-related burns. As a result of considering the role of traditional teapots and teacups in pediatric injuries in our country, parents and caregivers should be warned about these types of injuries. Also, physicians must determine the possibility of child abuse or neglect in all pediatric burn cases.

An 11-year retrospective study on the epidemiology of paediatric burns in the north of Iran

Burn injuries in children are distressing physical and emotional events with long-term disability. However, there is little research on the epidemiology of paediatric burns. This information is essential for the development of prevention intervention and acute management. This study aimed to describe epidemiologic characteristics and clinical outcomes of paediatric burns in a burn center in the north of Iran. A retrospective, single-center study was conducted of children (<18 years) admitted to the burns center between 2011 and 2021. The data were analysed by SPSS 24.0 software. The chi-squared test and Fisher's exact test were used to assess categorical variables, and Student's t-tests or One-Way ANOVA was used to evaluate continuous variables. 2951 paediatric burns with mean age 5.30 ± 5.27 years, were admitted during the 11 years, with 1777 boys (60.2%) and 1174 girls (39.8%). By age groups, the majority of children (59.7%) were between 0 and 4 years old, followed by 5 to 8 years (15.7%), 13 to 18 years (14.6%), and 9 to 12 years (10.0%), respectively. The most cause of injury was Hot liquids & vapours (1604, 54.4%). The mean age for burns with fire & flames, hot liquids & vapours, contact, chemical, and electrical was 4.46 ± 4.84, 5.70 ± 5.39, 5.44 ± 5.42, 3.93 ± 3.86, and 3.53 ± 4.06 years, respectively. The total body surface area (TBSA) burned was 14.96 ± 11.94. The longest length of stay (LOS) related to fire and flame was 5.63 ± 7.57 days. The mortality rate was 1.56%. There were significant differences among aetiology groups for the cost per % TBSA (F = 15.784, P < 0.001), which correlated with the burn depth, TBSA, aetiology, LOS, and age. The Ministry of Health should establish strategies for burn prevention and incorporate data surveillance for burn injuries. Community education on kitchen and cooking safety could positively impact the prevalence and outcomes of paediatric burns.

Epidemiology and Etiology of Burns in Iran Through the Examination of the Economic, Social and Educational Situation

Burn accidents continue to cause severe physical, psychological and economic damage to individuals and communities, especially in low- and middle-income countries. The present study was designed and conducted to investigate the epidemiology and identify the causes/mechanisms of burns in Iran, focusing on the economic, social and educational status of patients. This is a survey study that was performed from August 2016 to October 2017 on patients referred to Shahid Motahari University Hospital in Tehran. Samples included all patients whose parents or children were able to answer the questions. The data was extracted and analysed with SPSS Statistics v. 21. A total 1708 patients participated. Most of the patients were 19 to 39 years old. 70.6% had achieved a high school diploma or lower, and 11.5% patients were illiterate. Most of the patients lived in urban areas (91.7%) and in most cases, 4 people or less lived in a common space. Heat burns, chemical (acid) burns, and electrical burns account for the majority of cases. Most patients were unfamiliar with safety standards for burn prevention, safely stopping a fire, and fire safety equipment (alarms and extinguishers). The most common burn mechanisms were hot liquids inside the kitchen (12.6%) and gas explosion (11.9%). Based on these findings, the implementation of codified training programs, continuous control and monitoring of the safety standards in home and work environments, and the establishment of laws to standardize cooking and heating equipment will play an important role in reducing burn injuries in our country.

Microbial community succession in the intestine of mice with deep partial-thickness burns

Introduction

Burn injury has been shown to lead to changes in the composition of the gut microbiome and cause other damage in patients. However, little is known about how the gut microbial community evolves in individuals who have recovered from burn injury.

Methods

In this study, we established a model of deep partial-thickness burn in mice and collected fecal samples at eight time points (pre-burn, 1, 3, 5, 7, 14, 21, and 28 days post-burn) for 16S rRNA amplification and high-throughput sequencing.

Results

The results of the sequencing were analyzed using measures of alpha diversity, and beta diversity and taxonomy. We observed that the richness of the gut microbiome declined from day 7 post-burn and that the principal component and microbial community structure varied over time. On day 28 after the burn, the microbiome composition largely returned to the pre-burn level, although day 5 was a turning point for change. Some probiotics, such as the Lachnospiraceae_NK4A136_group, decreased in composition after the burn but were restored in the later recovery period. In contrast, Proteobacteria showed an opposite trend, which is known to include potential pathogenic bacteria.

Conclusion

These findings demonstrate gut microbial dysbiosis after burn injury and provide new insights into the burn-related dysbiosis of the gut microbiome and strategies for improving the treatment of burn injury from the perspective of the microbiota.

Determination of factors affecting prevention of burns among children under five years old using PRECEDE model: A cross-sectional study in urban and rural populations

BACKGROUND

Burns are one of the most important childhood injuries that can be controlled and prevented. Mothers play an important role in preventing child burns. Health education and promotional theories facilitate a precise recognition of the behavioral factors in mothers that help preventing burn injury in their children. Burns in children under five years old and the factors in prevention of burn by their mothers were examined using PRECEDE Model. The study environment was rural and urban areas of Kermanshah, Iran.

METHODS

This cross-sectional study was conducted on 330 mothers in urban and rural areas of Kermanshah County in the west of Iran. The participants were randomly selected among mothers who had at least one child younger than five years old. Data was collected through interviewing the mothers using a valid and reliable questionnaire. The questionnaire included questions on demographic characteristics, PRECEDE Model, and history of burn. The data were analyzed using SPSS-16.

RESULTS

The mean age of the mothers in urban areas (29.33 ± 5.987) was higher than that of those in rural areas (28.77 ± 6.236). More than 90% of the mothers were housewives, both in urban and rural areas. The rate of a history of burn in rural children under the age of five (8.3%) was greater than that in urban children (5.2%). Most of the burn cases in urban areas were mild whereas those in rural areas were moderate. The majority of burn cases had happened at home in children 1-3 years' age range; this rate was higher in boys. The majority of burns cases had happened when the child was playing (urban: 64.3%, rural: 100%). In addition, liquids and hot objects were the main causes of the burns (urban: 78.5%, rural: 100%). Among the constructs of PRECEDE models in the urban areas, knowledge (P < 0.001), attitudes (P = 0.027), and environmental factors (P = 0.03) had a significant relationship with burn-preventive behaviors in mothers. In addition, in the rural areas, attitudes (P = 0.038) had a significant relationship with burn-preventive behaviors in mothers.

CONCLUSION

Burn was an important injury in the study population, especially in the rural areas. The PRECEDE model can help us to identify the factors in burn injuries in children and the preventive behaviors in mothers. The findings can be used to develop preventive interventional programs to better protect this vulnerable group in society.

Epidemiology And Risk Factors For Death Of Pediatric Burns In A Developing Country. An Experience From The National Burn Hospital

This retrospective study investigated burn features and predicted factors for death of pediatric burn patients in Vietnam. The results showed that pediatric burn accounted for 48.1% of total admitted burn patients. Preschool children and boys were predominant, burns were mostly caused by scald (76.2%) and the majority of patients lived in a rural area (64.1%). In addition, 94.5% had burn size less than 30% total body surface area and deep burn injury was seen in 45.5% patients. Moreover, a significantly higher incidence of deep burn injury was recorded in preschool age, patients living in a rural area, and non-scald burn. Overall LA50 was 81.5% and a significantly higher mortality rate was seen in non-scald burns, older children, extensive burn and inhalation injury. Multivariate logistic analysis indicated that only burn extent and inhalation injury were independent risk factors for death. An increased 1% of burn extent resulted in a .7 probability unit of death (OR=1.08) and this was 2.16 in the case of inhalation injury (OR=8.67). This health issue should be highlighted in order to develop appropriate policies and intervention measures in developing countries.

Evaluating an urban pediatric hospital's scald burn prevention program

BACKGROUND

Over 450,000 individuals are hospitalized with burns annually and roughly 35% are scald burns. Children younger than 5 years of age are at the greatest risk of scald burn injury. Caregiver burn prevention programs have been found to reduce the prevalence of injuries in young children; however, low-income and underserved populations seldomly have access to these programs. The impact of scald burn prevention programs in underserved populations remains unexplored. The objective of the current study was to evaluate the efficacy of a scald burn prevention program at a Level One Pediatric Trauma Center in a low-income, underserved community.

METHODS

Our hospital developed a one-hour scald burn prevention program for caregivers with children 5 years of age or younger. The program educated caregivers on ways to prevent scald burns and create safeguards in their home. Caregivers completed a pre-post survey to measure their ability to identify hot or cold objects, as well as respond to items about their perceptions of the program's utility, their willingness to share it with others, and the likelihood that they would use the information in the future. Data was analyzed using a paired t-test.

RESULTS

Two-hundred and sixty-nine (N = 269) caregivers participated in the program. Before the program, caregivers could identify potentially hot objects 83.17% of the time, and after the program, they were able to identify these items 92.31% of the time: t (268) = 12.46, p < .001, d = 1.07. Additionally, 95% of caregivers indicated that the program was helpful, 99% stated that they were likely to share this information with others, and 100% indicated that they would use the information from the program.

CONCLUSIONS

Education is a critical component to prevent scald burns. Results indicate that a hospital-led scald burn prevention program can positively impact a caregiver's ability to identify possible scald-burn risks. Providing education to caregivers who typically do not receive this information could lower the prevalence of scald burns not only institutionally, but in communities that are disproportionately impacted by this mechanism of injury.

Role of Procalcitonin and C-reactive Protein as Marker of Sepsis in Major Burn Patients: A Systematic Review and Meta-analysis

AIM: Although absolute values for C-reactive protein (CRP) and procalcitonin (PCT) are well known to predict sepsis, it remains unclear how their diagnostic value in major burn patients as metabolic changes in burn patient mimic signs and symptoms for sepsis. This paper attempts to clarify these points for both of the markers. METHODS: A comprehensive literature search of PubMed, Scopus, DOAJ, Web of Science, and the Cochrane Library databases for studies published up to June 1, 2020, that evaluated PCT and/or CRP as a marker for diagnosing sepsis in burn patients was conducted. Review Manager 5.3 was used to analyze the data. RESULTS: A total of 11 literatures were obtained. The combined sensitivity and specificity for PCT as assessed by meta-analysis were 88% and 89%, respectively. The combined sensitivity and specificity of CRP were described as 85.5% and 57.5%, respectively. Meta-analysis cannot be performed for CRP parameters because there are only two literatures that include CRP diagnostic test values. DISCUSSION: PCT and CRP have additional diagnostic value for sepsis in patients with major burns. The pooled sensitivity and specificity of PCT are excellent. Although the difference in sensitivity between PCT and CRP is not very large, there are distinct differences in specificity. A low CRP specificity value will show many “false positives” when CRP is used as a biomarker. CONCLUSION: PCT provides a better diagnostic value than CRP in cases of sepsis in major burn patients. More study on combination of biomarker, clinical presentation, and microbial culture for diagnosing sepsis are needed. Further large-scale research with cohort or case control design should be done.

Comparison of Modified Meek Technique with Standard Mesh Method in Patients with Third Degree Burns

BACKGROUND

Covering burn wounds, especially high surface area burns has been always a challenge for surgeons. The Meek technique has been introduced to increase the covering area. There is paucity of clinical trials comparing the Meek technique and mesh in the same individuals to assess it efficacy.

METHODS

In a case-control study, 20 patients with grade III burns who underwent the Meek technique and mesh in different areas/limbs were enrolled. Expansion rate, re-epithelization, operation time, wound infection, graft failure, etc. were compared between the two groups.

RESULTS

Among patients, 18 were males and 2 were females. The mean of total body surface area (TBSA) was 36.9±16.6%. Mean time of re-epithelialization in the Meek group was 2.8±2.5 months and in the mesh group was 5.0±2.1 months (p=0.01). Operation time was shorter in modified Meek technique (p=0.04). Expansion ratio was higher in modified Meek technique (p=0.04). Local wound infection rates were slightly different without a statistically significant difference.

CONCLUSION

Meek technique provided higher surface area coverage in comparison to mesh; in addition to faster re-epithelization. Therefore, it is recommended to consider the Meek technique as a routine procedure, especially those with high surface area burns.

The Epidemiology of Burns in Children in Guatemala: A Single Center Report

Children in low- to middle-income countries are at high risk for sustaining severe burns. This study aimed to analyze the characteristics of pediatric burns in Guatemala that could help identify risk factors and guide prevention efforts. A retrospective review of the characteristics of patients < 18 years of age that were burned in Guatemala between 2015 and 2018 and treated at the Hospital Roosevelt Burn Unit in Guatemala City was performed. The medical records of 949 patients were reviewed (year 2015: 224, year 2016: 238, year 2017: 251, year 2018: 236). Mean age of the patients was 4.0 ± 3.6 years. Majority of the patients were male (54.2%) and suffered from scald burns (68.5%) due to spilling or falling into hot water. Children under the age of 9 years predominantly suffered from scald burns, whereas older children more frequently sustained flame burns. The mortality rate over the 4-year period was 5.2%. As in other low-income countries, pediatric burns in Guatemala are frequent and usually due to scald. Demographic characteristics have to be taken into account when developing strategies for improvements of prevention and treatment or transferring these from high-income countries. Especially education of parents and safety of daily tasks are crucial. Special attention and focusing of efforts in areas of higher incidence should be sought.

Profile and outcome of burn injuries amongst preschool children in a developing country

The aim of this study was to investigate characteristics, outcomes and risk factors for death from burn in preschool children. A retrospective study was conducted on 3688 preschool burn children admitted to the National Burn Hospital from 1/1/2016 to 31/12/2018. Collected data included patient demographics and burn characteristics. Bivariate and multivariate analysis was conducted to determine independent risk factors for death. Results showed that preschool children accounted for 78.8% of total admitted burn children. The main causal agent was scald. Boys were predominant, and 76.5% patients lived in rural areas. The highest number of burn accidents occurred in winter. In addition, average burn surface area was of 8.8% total body surface area (TBSA) and 43.5% of patients suffered deep burn injury. Overall mortality rate was 0.5% with LA50 of 81.7% and 49.1% for full thickness burn area. A significantly higher mortality rate was seen in patients with inhalation injury. Compared to survivors, patients who died had a significantly larger burn surface area and larger deep burn area. Multivariate logistic analysis for death indicated that presence of inhalation injury and increased burn extent were independent risk factors for death. Inhalation injury resulted in a 3.4 probability unit of death. In conclusion, preschool burn injuries were more common in boys living in the countryside and were mostly caused by scald, with a high proportion of deep injuries. Except for in cases of extensive burn, inhalation injury was not common but was still the main cause of death.

Incidence, severity and pattern of burns in children and adolescents: An epidemiological study among immigrant and Swiss patients in Switzerland

BACKGROUND

Despite advances in surgical management and critical care for burn surgery, morbidity and mortality of patients with severe burns remains high. Especially in the pediatric population, burns often lead to devastating consequences such as the necessity of corrective surgery until adulthood. Worldwide, 80%-90% of all severe burns occur in low to middle income countries. But also in high income countries, burns are distributed inequitably. Risk factors include age, sex, socioeconomic status, and ethnicity.

AIM

The objective of this study was to determine the typical demographics and injury-related data of pediatric burn patients in order to contribute to preventive measures. Special interest was paid to the question of whether the incidence of severe burns is higher among patients with an immigration background.

PATIENTS AND METHODS

Patient records of the 4373 patients admitted to the Pediatric Burn Unit of the University Children's Hospital of Zurich from 2006 to 2018 were analyzed. Demographic data and injury patterns are presented descriptively. Temporal trends concerning duration of hospitalization and setting (inpatient versus outpatient), differences in relative incidence and in burn mechanism in distinct cohorts (by nation and Human Development Index (HDI)) and seasonal trends were analyzed. Furthermore, risk factors for large burns and for (prolonged) inpatient treatment were examined using a multivariate approach.

RESULTS

Temporal resolution shows considerable variation between inpatient and outpatient treatment (p>0.001) and with shorter hospital stays (p=0.004). Swiss citizens and patients with an immigration background from very highly developed countries sustain a significantly lower incidence of heat-related injuries than all others (p<0.001). The most common burn causes among all children, independent of their country of citizenship, are related to kitchen items or hot tea and coffee (35.57%±4.01% resp. 32.39%±5.95%). Logistic regression revealed that migration background from a low HDI country is significantly associated with larger burns (>5% TBSA) and with a need for inpatient treatment.

CONCLUSION

The study emphasizes the need for highly specific measures of burn prevention and indicates the necessity of focusing on certain target groups who are especially vulnerable to burns, such as immigrants from less developed countries.