1
|
Plonczak AM, Dole HP, Pimblett V, Conway L, Hague A, Falder S. What the COVID pandemic taught us about the management of pediatric minor trauma. J Plast Reconstr Aesthet Surg 2023; 84:334-340. [PMID: 37390542 PMCID: PMC10228152 DOI: 10.1016/j.bjps.2023.05.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 04/12/2023] [Accepted: 05/25/2023] [Indexed: 07/02/2023]
Abstract
The COVID-19 pandemic necessitated a change in our practice in the management of pediatric soft-tissue injuries. Patients were managed conservatively whenever possible. Our aim in this study was to see whether this more conservative approach adversely affected clinical, and patient-reported outcomes, including scarring. A prospective record of children presenting to the plastic surgery "Early Bird" clinic for pediatric trauma between 01.04.2020 and 30.06.2020 was kept. Electronic patient records were reviewed. An outpatient telephone clinic was scheduled for all patients. Parents were asked about complications and what they thought about the scar and to rate it as either: "poor," "satisfactory," "good," or "excellent." There were 240 patients, including 136 (57%) males and 104 (43%) females. The most frequent type of injury was a facial laceration in 123 patients (51.3%), followed by hand lacerations in 43 (17.9%), fingertip injuries in 31 (12.9%), and others. Ninety out of 240 (37.5%) were offered surgery. Follow-up times ranged from 17 to 20 months. Most parents (86.2%) were happy with the scarring and reported it as "good" or "excellent." The proportion rating the scar "excellent" or "good" was similar in the non-operated cohort (i.e., 85.5%) versus the operated cohort (88.5%) (p-value 0.16). The overall complication rate of patients seen during this time was 5.9%; 7.4% in the conservatively managed and 4.9% of those who went to the theater. Despite managing more wounds, including some dog bites, conservatively, patients and parents reported low complication rates and high levels of satisfaction with the final scarring.
Collapse
Affiliation(s)
- A M Plonczak
- Alder Hey Children's Hospital, E Prescot Road, Liverpool L14 5AB, United Kingdom.
| | - H P Dole
- Alder Hey Children's Hospital, E Prescot Road, Liverpool L14 5AB, United Kingdom
| | - V Pimblett
- Alder Hey Children's Hospital, E Prescot Road, Liverpool L14 5AB, United Kingdom
| | - L Conway
- Alder Hey Children's Hospital, E Prescot Road, Liverpool L14 5AB, United Kingdom
| | - A Hague
- Alder Hey Children's Hospital, E Prescot Road, Liverpool L14 5AB, United Kingdom
| | - S Falder
- Alder Hey Children's Hospital, E Prescot Road, Liverpool L14 5AB, United Kingdom
| |
Collapse
|
2
|
Young A, Davies A, Tsang C, Kirkham J, Potokar T, Gibran N, Tyack Z, Meirte J, Harada T, Dheansa B, Dumville J, Metcalfe C, Ahuja R, Wood F, Gaskell S, Brookes S, Smailes S, Jeschke M, Cinar MA, Zia N, Moghazy A, Mathers J, Falder S, Edgar D, Blazeby JM. Establishment of a core outcome set for burn care research: development and international consensus. BMJ Med 2022; 1:e000183. [PMID: 36936572 PMCID: PMC9978679 DOI: 10.1136/bmjmed-2022-000183] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 05/24/2022] [Indexed: 11/03/2022]
Abstract
Objective To develop a core outcome set for international burn research. Design Development and international consensus, from April 2017 to November 2019. Methods Candidate outcomes were identified from systematic reviews and stakeholder interviews. Through a Delphi survey, international clinicians, researchers, and UK patients prioritised outcomes. Anonymised feedback aimed to achieve consensus. Pre-defined criteria for retaining outcomes were agreed. A consensus meeting with voting was held to finalise the core outcome set. Results Data source examination identified 1021 unique outcomes grouped into 88 candidate outcomes. Stakeholders in round 1 of the survey, included 668 health professionals from 77 countries (18% from low or low middle income countries) and 126 UK patients or carers. After round 1, one outcome was discarded, and 13 new outcomes added. After round 2, 69 items were discarded, leaving 31 outcomes for the consensus meeting. Outcome merging and voting, in two rounds, with prespecified thresholds agreed seven core outcomes: death, specified complications, ability to do daily tasks, wound healing, neuropathic pain and itch, psychological wellbeing, and return to school or work. Conclusions This core outcome set caters for global burn research, and future trials are recommended to include measures of these outcomes.
Collapse
Affiliation(s)
- Amber Young
- Centre for Surgical Research, Population Health Sciences, Bristol Biomedical Research Centre, Bristol Medical School, University of Bristol, Bristol, UK
| | - Anna Davies
- Centre for Surgical Research, Population Health Sciences, Bristol Biomedical Research Centre, Bristol Medical School, University of Bristol, Bristol, UK
| | - Carmen Tsang
- Centre for Surgical Research, Population Health Sciences, Bristol Biomedical Research Centre, Bristol Medical School, University of Bristol, Bristol, UK
| | - Jamie Kirkham
- Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, UK
| | - Tom Potokar
- Centre for Global Burn Injury Policy and Research, Swansea University, Swansea, UK
| | - Nicole Gibran
- UW Medicine Regional Burn Center, Harborview Medical Center, UW Department of Surgery, University of Washington (UW), Seattle, WA, USA
| | - Zephanie Tyack
- Child Health Research Centre, Faculty of Medicine, Centre for Children’s Burns and Trauma Research, Queensland University of Technology, Brisbane, QLD, Australia
| | - Jill Meirte
- Department of Medicine and Health Sciences, University of Antwerp, Antwerpen, Belgium
| | - Teruichi Harada
- Seitokai Medical and Social Welfare Corporation, Teramoto Memorial Hospital, Kawachinagano, Osaka, Japan
| | - Baljit Dheansa
- Department of plastic surgery and burns, Queen Victoria Hospital, East Grinstead, UK
| | - Jo Dumville
- Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, UK
- Division of Nursing, Midwifery, and Social Work, University of Manchester, Manchester, UK
| | - Chris Metcalfe
- Bristol Medical School, University of Bristol, Bristol, UK
| | - Rajeev Ahuja
- Department of Burns & Plastic Surgery, Lok Nayak Hospital and Maulana Azad Medical College, New Delhi, India
| | - Fiona Wood
- Burn service, University of Western Australia, Perth, WA, Australia
| | - Sarah Gaskell
- Paediatric Psychosocial Service, Royal Manchester Children's Hospital, Manchester, UK
| | - Sara Brookes
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Sarah Smailes
- Department of physiontherapy, Broomfield Hospital, Mid Essex Hospitals, Chelmsford, UK
| | - Marc Jeschke
- Department of Surgery and Plastic Surgery, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada
| | - Murat Ali Cinar
- Department of Physical Therapy and Rehabilitation, Hasan Kalyoncu University, Gaziantep, Turkey
| | - Nukhba Zia
- Johns Hopkins International Injury Research Unit, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Amr Moghazy
- Department of plastic surgery, Suez Canal University, Ismailia, Egypt
| | - Jonathan Mathers
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Sian Falder
- Department of plastic surgery, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Dale Edgar
- Adult Burns Unit, Fiona Stanley Hospital, Murdoch, WA, Australia
| | - Jane Mary Blazeby
- Centre for Surgical Research, Population Health Sciences, Bristol Biomedical Research Centre, Bristol Medical School, University of Bristol, Bristol, UK
| |
Collapse
|
3
|
Potokar T, Bendell R, Phuyal K, Dhital A, Karim E, Falder S, Kynge L, Price PE. The development of the Delivery Assessment Tool (DAT) to facilitate quality improvement in burns services in low-middle income countries. Burns 2021; 48:1488-1496. [PMID: 34903404 DOI: 10.1016/j.burns.2021.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 10/02/2021] [Accepted: 10/20/2021] [Indexed: 11/16/2022]
Abstract
Implementation science is a useful tool to consider ways in which we can introduce improvements to burn services in low-and-middle income countries (LMICs), where the majority of the burden of burn injury is now experienced. This paper outlines the development of the Delivery Assessment Tool (DAT), a method for facilitating quality improvement in burn services in LMICs. We used a participatory approach that ensured that local clinicians and experts were fully involved in piloting the tool. The DAT is based on internationally agreed operational standards for burn care service delivery and has undergone an iterative process of improvement and refinement through an initial three-year project in Nepal and Bangladesh. The DAT, a 50-item tool organised into 10 subsections, is used to assess a service through a participatory focus group discussion with a mixed, multidisciplinary team of staff working at the burn service, typically 6-10 participants. This usually lasts 2-3 h. The staff in the unit then select priority areas for quality improvement programmes that are within their control to achieve, which starts a cycle of audit and review. The final version of the tool was used in a further three-year project to evaluate 11 hospitals in Nepal and Bangladesh. Education and training are key components of this work; both were provided by Interburns as part of on-going support for the clinical teams. At the end of the project a>19% improvement in scores was demonstrated using the final version of the DAT in both Nepal and Bangladesh; this achievement is remarkable given the continued difficulties in service provision where patient numbers far outstrip the resources available to care for them. As a result of this work, we have made a digital version of the tool available free of charge.
Collapse
Affiliation(s)
- T Potokar
- Interburns, Cardiff, Wales, UK; Centre for Global Burn injury Policy and Research, Swansea University, UK.
| | | | - K Phuyal
- Interburns, Cardiff, Wales, UK; SAGUN: A Search for Harmony, Kupandol, Lalitpur, Nepal
| | - A Dhital
- Interburns, Cardiff, Wales, UK; SAGUN: A Search for Harmony, Kupandol, Lalitpur, Nepal
| | - E Karim
- Acid Survivors Trust, Bangladesh
| | - S Falder
- Interburns, Cardiff, Wales, UK; Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - L Kynge
- Interburns, Cardiff, Wales, UK
| | - P E Price
- Interburns, Cardiff, Wales, UK; Centre for Global Burn injury Policy and Research, Swansea University, UK
| |
Collapse
|
4
|
Hampton V, Hampton T, Dheansa B, Falder S, Emery P. Evaluation of high protein intake to improve clinical outcome and nutritional status for patients with burns: a systematic review. Burns 2021; 47:1714-1729. [PMID: 33722450 DOI: 10.1016/j.burns.2021.02.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 01/07/2021] [Accepted: 02/24/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIM Patients with severe burns undergo a local and systemic response to the injury. As part of this response the patient becomes hypermetabolic. Current guidelines advise high protein intakes to counteract the catabolic response to burns, but this appears to be based on minimal experimental evidence. Hence the aim of this review was to examine the evidence for improvements in nutritional status and clinical outcome with the administration of high protein intakes for patients with burns. METHODS Eight databases were searched for clinical trials with burn patients receiving two or more levels of protein intake at or above the level recommended for healthy individuals (0.75g/kg/d) and presenting results for at least one of the following pre-defined outcomes: nitrogen balance, length of stay, weight change, survival, physical therapy index, protein fractional synthetic rate, immunological measurements, bacteraemic days, systemic antibiotic days and net protein synthesis. RESULTS Six studies were included, 4 of which were randomized trials. All had major methodological limitations, in particular none was blinded. There was too much heterogeneity in study design, patient characteristics and the timing and magnitude of the interventions to justify formal meta-analysis. There was no reliable evidence of improvement in nitrogen balance, but there was some evidence of increased weight gain on higher protein diets. One small study reported an increase in survival and significant improvements in infection rates and some indicators of immune function in children. Length of stay was not significantly improved. There was weak evidence of an improvement in muscle strength and endurance but no significant increase in protein synthesis in muscle or skin, or net protein synthesis in the whole body. CONCLUSION There is currently only very weak evidence to justify administering high protein diets to patients following burns.
Collapse
Affiliation(s)
- Veronique Hampton
- Kings College London Department of Nutritional Sciences, Franklin-Wilkins Building, Stamford Street, London SE1 9NH, UK
| | - Thomas Hampton
- Alder Hey Children's NHS Foundation Trust, Eaton Road, Liverpool, L12 2AP, UK.
| | - Baljit Dheansa
- Queen Victoria Hospital, Holtye Road, East Grinstead RH19 3DZ, UK
| | - Sian Falder
- Alder Hey Children's NHS Foundation Trust, Eaton Road, Liverpool, L12 2AP, UK
| | - Peter Emery
- Kings College London Department of Nutritional Sciences, Franklin-Wilkins Building, Stamford Street, London SE1 9NH, UK
| |
Collapse
|
5
|
Davies A, Teare L, Falder S, Dumville J, Shah M, Jenkins A, Collins D, Dheansa B, Coy K, Booth S, Moore L, Marlow K, Agha R, Young A. Consensus demonstrates four indicators needed to standardize burn wound infection reporting across trials in a single-country study (ICon-B study). J Hosp Infect 2020; 106:217-225. [DOI: 10.1016/j.jhin.2020.07.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 07/22/2020] [Indexed: 01/10/2023]
|
6
|
Potokar T, Bendell R, Chamania S, Falder S, Nnabuko R, Price PE. A comprehensive, integrated approach to quality improvement and capacity building in burn care and prevention in low and middle-income countries: An overview. Burns 2020; 46:1756-1767. [PMID: 32616426 PMCID: PMC7772751 DOI: 10.1016/j.burns.2020.05.029] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 05/22/2020] [Accepted: 05/22/2020] [Indexed: 11/26/2022]
Abstract
Quality improvement requires a comprehensive integrated approach. Clinical standards are a vital first step in improving outcomes for LMICs. Capacity building needs a range of educational courses from basic to advanced. Evaluation tools are needed to measure progress.
Consistent evidence has emerged over many years that the mortality and morbidity outcomes for burn patients in low and middle-income countries (LMICs) lag behind those in more resource rich countries. Interburns is a charity that was set up with the aim of working to reduce the disparity in the number of cases of burns as well as the outcomes for patients in LMICs. This paper provides an overview of a cyclical framework for quality improvement in burn care for use in LMICs that has been developed using an iterative process over the last 10 years. Each phase of the process is outlined together with a description of the tools used to conduct a gap analysis within the service, which is then used to frame a programme of capacity enhancement. Recent externally reviewed projects have demonstrated sustained improvement with the use of this comprehensive and integrated approach over a three-year cycle. This overview paper will be supported by further publications that present these results in detail.
Collapse
Affiliation(s)
- T Potokar
- Interburns, Welsh Centre for Burns and Plastic Surgery, Swansea, Wales, UK; Centre for Global Burn Injury Policy and Research, Swansea University, Wales, UK.
| | - R Bendell
- Interburns, Welsh Centre for Burns and Plastic Surgery, Swansea, Wales, UK
| | - S Chamania
- Interburns, Welsh Centre for Burns and Plastic Surgery, Swansea, Wales, UK; Choithram Hospital and Research Centre, Indore, Madhya Pradesh, India
| | - S Falder
- Interburns, Welsh Centre for Burns and Plastic Surgery, Swansea, Wales, UK; Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - R Nnabuko
- Interburns, Welsh Centre for Burns and Plastic Surgery, Swansea, Wales, UK; Mercy Clinics Enugu Nigeria, Federal University Teaching Hospital Abakaliki, Nigeria
| | - P E Price
- Interburns, Welsh Centre for Burns and Plastic Surgery, Swansea, Wales, UK; Centre for Global Burn Injury Policy and Research, Swansea University, Wales, UK
| |
Collapse
|
7
|
Davies A, Teare L, Falder S, Coy K, Dumville JC, Collins D, Moore L, Dheansa B, Jenkins ATA, Booth S, Agha R, Shah M, Marlow K, Young A. Protocol for the development of a core indicator set for reporting burn wound infection in trials: ICon-B study. BMJ Open 2019; 9:e026056. [PMID: 31092650 PMCID: PMC6530370 DOI: 10.1136/bmjopen-2018-026056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION Systematic reviews of high-quality randomised controlled trials are necessary to identify effective interventions to impact burn wound infection (BWI) outcomes. Evidence synthesis requires that BWI is reported in a consistent manner. Cochrane reviews investigating interventions for burns report that the indicators used to diagnose BWI are variable or not described, indicating a need to standardise reporting. BWI is complex and diagnosed by clinician judgement, informed by patient-reported symptoms, clinical signs, serum markers of inflammation and bacteria in the wound. Indicators for reporting BWI should be important for diagnosis, frequently observed in patients with BWI and assessed as part of routine healthcare. A minimum (core) set of indicators of BWI, reported consistently, will facilitate evidence synthesis and support clinical decision-making. AIMS The Infection Consensus in Burns study aims to identify a core indicator set for reporting the diagnosis of BWI in research studies. METHODS (1) Evidence review: a systematic review of indicators used in trials and observational studies reporting BWI outcomes to identify a long list of candidate indicators; (2) refinement of the long list into a smaller set of survey questions with an expert steering group; (3) a two-round Delphi survey with 100 multidisciplinary expert stakeholders, to achieve consensus on a short list of indicators; (4) a consensus meeting with expert stakeholders to agree on the BWI core indicator set. ETHICS AND DISSEMINATION Participants will be recruited through professional bodies, such that ethical approval from the National Health Service (NHS) Health Research Authority (HRA) is not needed. The core indicator set will be disseminated through peer-reviewed publication, co-production with journal editors, research funders and professional bodies, and presentation at national conferences. PROSPERO REGISTRATION NUMBER CRD42018096647.
Collapse
Affiliation(s)
- Anna Davies
- Centre for Academic Child Health, University of Bristol, Bristol, UK
| | - Louise Teare
- Department of Microbiology, Chelmsford Hospital, Chelmsford, UK
| | - Sian Falder
- Burns and Plastic Surgery, Alder Hey Children’s NHS Foundation Trust, Liverpool, UK
| | - Karen Coy
- Centre for Children’s Burns Research, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Jo C Dumville
- Division of Nursing, Midwifery and Social work, The University of Manchester, Manchester, UK
| | - Declan Collins
- Department of Plastic Surgery, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Luke Moore
- Department of Microbiology, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
- National Institute for Health Research Health Protection Research Unit, Imperial College London, London, UK
| | - Baljit Dheansa
- Department of Plastic Surgery and Burns, Queen Victoria Hospital NHS Foundation Trust, East Grinstead, UK
| | | | - Simon Booth
- School of Pharmacy and Biomolecular Sciences, University of Brighton, Brighton, UK
| | - Riaz Agha
- Department of Plastic Surgery, Royal Free Hospital NHS Foundation Trust, London, UK
| | - Mamta Shah
- Department of Plastic Surgery, Royal Manchester Children’s Hospital, Manchester, UK
| | - Karen Marlow
- Burns and Plastic Surgery, Alder Hey Children’s NHS Foundation Trust, Liverpool, UK
| | - Amber Young
- Centre for Children’s Burns Research, Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
- Bristol Centre for Surgical Research, University of Bristol, Bristol, UK
| |
Collapse
|
8
|
Wallace HJ, Cadby G, Melton PE, Wood FM, Falder S, Crowe MM, Martin LJ, Marlow K, Ward SV, Fear MW. Genetic influence on scar height and pliability after burn injury in individuals of European ancestry: A prospective cohort study. Burns 2018; 45:567-578. [PMID: 30595539 DOI: 10.1016/j.burns.2018.10.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 08/15/2018] [Accepted: 10/04/2018] [Indexed: 12/26/2022]
Abstract
After similar extent of injury there is considerable variability in scarring between individuals, in part due to genetic factors. This study aimed to identify genetic variants associated with scar height and pliability after burn injury. An exome-wide array association study and gene pathway analysis were performed on a prospective cohort of 665 patients treated for burn injury. Outcomes were scar height (SH) and scar pliability (SP) sub-scores of the modified Vancouver Scar Scale (mVSS). DNA was genotyped using the Infinium® HumanCoreExome-24 BeadChip. Associations between genetic variants (single nucleotide polymorphisms) and SH and SP were estimated using an additive genetic model adjusting for age, sex, number of surgical procedures and % total body surface area of burn in subjects of European ancestry. No individual genetic variants achieved the cut-off threshold of significance. Gene regions were analysed for spatially correlated single nucleotide polymorphisms and significant regions identified using comb-p software. This gene list was subject to gene pathway analysis to find which biological process terms were over-represented. Using this approach biological processes related to the nervous system and cell adhesion were the predominant gene pathways associated with both SH and SP. This study suggests genes associated with innervation may be important in scar fibrosis. Further studies using similar and larger datasets will be essential to validate these findings.
Collapse
Affiliation(s)
- Hilary J Wallace
- Burn Injury Research Unit, School of Biomedical Sciences, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Australia; School of Medicine, The University of Notre Dame Australia, Fremantle, Australia.
| | - Gemma Cadby
- Centre for Genetic Origins of Health and Disease, Faculty of Health and Medical Sciences, The University of Western Australia and Faculty of Health Science, Curtin University, Perth, Australia
| | - Phillip E Melton
- Centre for Genetic Origins of Health and Disease, Faculty of Health and Medical Sciences, The University of Western Australia and Faculty of Health Science, Curtin University, Perth, Australia; School of Pharmacy and Biomedical Sciences, Faculty of Health Science, Curtin University, Perth, Australia
| | - Fiona M Wood
- Burn Injury Research Unit, School of Biomedical Sciences, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Australia; Burns Service of Western Australia, Princess Margaret Hospital for Children and Fiona Stanley Hospital, Perth, Australia
| | - Sian Falder
- Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Margaret M Crowe
- Burns Service of Western Australia, Princess Margaret Hospital for Children and Fiona Stanley Hospital, Perth, Australia
| | - Lisa J Martin
- Burns Service of Western Australia, Princess Margaret Hospital for Children and Fiona Stanley Hospital, Perth, Australia
| | - Karen Marlow
- Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Sarah V Ward
- Centre for Genetic Origins of Health and Disease, Faculty of Health and Medical Sciences, The University of Western Australia and Faculty of Health Science, Curtin University, Perth, Australia
| | - Mark W Fear
- Burn Injury Research Unit, School of Biomedical Sciences, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Australia
| |
Collapse
|
9
|
|
10
|
Hollén L, Hughes R, Dodds N, Coy K, Marlow K, Pullan N, Davies J, Dailami N, Keating K, Falder S, Shah M, Young A. Use of procalcitonin as a biomarker for sepsis in moderate to major paediatric burns. Trauma 2018. [DOI: 10.1177/1460408618760940] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Linda Hollén
- Centre for Child and Adolescent Health, Bristol Medical School, University of Bristol, Bristol, UK
- The Scar Free Foundation Centre for Children's Burn Research, Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Ryan Hughes
- Faculty of Medicine and Dentistry, University of Bristol, Bristol, UK
| | - Nick Dodds
- University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Karen Coy
- The Scar Free Foundation Centre for Children's Burn Research, Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Karen Marlow
- Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Nicola Pullan
- Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | | | - Narges Dailami
- Faculty of Environment and Technology, University of the West of England, Bristol, UK
| | - Katrina Keating
- Faculty of Life Sciences, Royal Manchester Children's Hospital, Manchester, UK
| | - Sian Falder
- Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Mamta Shah
- Faculty of Life Sciences, Royal Manchester Children's Hospital, Manchester, UK
| | - Amber Young
- The Scar Free Foundation Centre for Children's Burn Research, Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| |
Collapse
|
11
|
Jakeman M, Jeevan R, Burn SC, Falder S. Neurosurgical transection of the breast: an unexpected extracranial complication of ventriculoperitoneal shunt insertion. J Neurosurg Pediatr 2017; 20:517-520. [PMID: 28984537 DOI: 10.3171/2017.7.peds16708] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Ventriculoperitoneal (VP) shunt placement is among the most common surgical procedures undertaken by neurosurgeons. Complications arising from the thoracic portion of the shunt are relatively rare in comparison with those of the intraventricular and peritoneal portions. Disruption of primary breast development following VP shunt placement has not previously been reported. The authors describe the case of a 15-year-old girl referred to the plastic surgery department with a significant right breast deformity and associated asymmetry following VP shunt placement performed during the neonatal period. The calcified shunt was excised and the breast deformity was corrected surgically through multiple scar tissue releases and restoration of the normal breast parenchymal anatomy via a minimally invasive approach, resulting in an excellent aesthetic outcome. This case highlights the potential for injury to occult breast tissue in pediatric patients undergoing VP shunt placement, which can impair subsequent cosmesis and quality of life.
Collapse
Affiliation(s)
- Molly Jakeman
- 1Regional Burns and Paediatric Plastic Surgery Service, and
| | - Ranjeet Jeevan
- 1Regional Burns and Paediatric Plastic Surgery Service, and
| | - Sasha C Burn
- 2Department of Neurosurgery, Alder Hey Children's NHS Foundation Trust, Liverpool, United Kingdom
| | - Sian Falder
- 1Regional Burns and Paediatric Plastic Surgery Service, and
| |
Collapse
|
12
|
Abstract
INTRODUCTION Burn injury is common and depth is one measure of severity. Although the depth of burn injury is determined by many factors, the relationship between the temperature of the injurious agent and exposure duration, known as the time-temperature relationship, is widely accepted as one of the cornerstones of burn research. Moritz and Henriques first proposed this relationship in 1947 and their seminal work has been cited extensively. However, over the years, readers have misinterpreted their findings and incorporated misleading information about the time-temperature relationship into a wide range of industrial standards, burn prevention literature and medicolegal opinion. AIM The purpose of this paper is to present a critical review of the evidence that relates temperature and time to cell death and the depth of burn injury. These concepts are used by researchers, burn prevention strategists, burn care teams and child protection professionals involved in ascertaining how the mechanism of burning relates to the injury pattern and whether the injury is consistent with the history. REVIEW METHODS This review explores the robustness of the currently available evidence. The paper summarises the research from burn damage experimental work as well as bioheat transfer models and discusses the merits and limitations of these approaches. REVIEW FINDINGS There is broad agreement between in vitro and in vivo studies for superficial burns. There is clear evidence that the perception of pain in adult human skin occurs just above 43°C. When the basal layer of the epidermis reaches 44°C, burn injury occurs. For superficial dermal burns, the rate of tissue damage increases logarithmically with a linear increase in temperature. Beyond 70°C, rate of damage is so rapid that interpretation can be difficult. Depth of injury is also influenced by skin thickness, blood flow and cooling after injury. There is less clinical evidence for a time-temperature relationship for deep or subdermal burns. Bioheat transfer models are useful in research and becoming increasingly sophisticated but currently have limited practical use. Time-temperature relationships have not been established for burns in children's skin, although standards for domestic hot water suggest that the maximum temperature should be revised downward by 3-4°C to provide adequate burn protection for children. CONCLUSION Time-temperature relationships established for pain and superficial dermal burns in adult human skin have an extensive experimental modeling basis and reasonable clinical validation. However, time-temperature relationships for subdermal burns, full thickness burns and burn injury in children have limited clinical validation, being extrapolated from other data, and should be used with caution, particularly if presented during expert evidence.
Collapse
Affiliation(s)
- N A Martin
- St. Andrews Centre for Burns and Plastic Surgery, Broomfield Hospital, Chelmsford, Essex CM1 7ET, UK.
| | - S Falder
- Department of Burns and Plastic Surgery, Alder Hey Children's NHS Foundation Trust, Liverpool L12 2AP, UK.
| |
Collapse
|
13
|
Beattie S, Fielding J, Chawla R, McPartland J, Falder S. Spitz naevi in children: 5 year audit in a paediatric hospital and proposed management guidelines. Int J Surg 2014. [DOI: 10.1016/j.ijsu.2014.08.082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
14
|
Tan KT, Prowse PM, Falder S. Ethnic differences in burn mechanism and severity in a UK paediatric population. Burns 2012; 38:551-5. [DOI: 10.1016/j.burns.2011.10.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2011] [Revised: 10/09/2011] [Accepted: 10/13/2011] [Indexed: 11/28/2022]
|
15
|
Rose A, Hassan Z, Davenport K, Evans N, Falder S. Adherence to National Burn Care Review referral criteria in a paediatric Emergency Department. Burns 2010; 36:1165-71. [DOI: 10.1016/j.burns.2010.03.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2009] [Revised: 02/28/2010] [Accepted: 03/05/2010] [Indexed: 11/25/2022]
|
16
|
Watts G, Falder S, Rea S, Silbert P, Wood F. Parsonage–Turner Syndrome in a major burns patient. Burns 2009; 35:1038-41. [DOI: 10.1016/j.burns.2008.07.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2008] [Accepted: 07/01/2008] [Indexed: 11/25/2022]
|
17
|
Rose A, Hassan Z, Davenport K, Falder S. Adherence to national burn care review referral criteria in a paediatric emergency department. Burns 2009. [DOI: 10.1016/j.burns.2009.06.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
18
|
Falder S, Browne A, Edgar D, Staples E, Fong J, Rea S, Wood F. Core outcomes for adult burn survivors: A clinical overview. Burns 2009; 35:618-41. [PMID: 19111399 DOI: 10.1016/j.burns.2008.09.002] [Citation(s) in RCA: 156] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2004] [Accepted: 09/02/2008] [Indexed: 11/25/2022]
|
19
|
Thomas PB, Falder S, Jolly M, Saunders NJSG, Smith JR. The role of blunt-tipped needles and a new needle-holder in reducing needlestick injury. J OBSTET GYNAECOL 2009. [DOI: 10.3109/01443619509030936] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
20
|
Morellini NM, Giles NL, Rea S, Adcroft KF, Falder S, King CE, Dunlop SA, Beazley LD, West AK, Wood FM, Fear MW. Exogenous metallothionein-IIA promotes accelerated healing after a burn wound. Wound Repair Regen 2008; 16:682-90. [DOI: 10.1111/j.1524-475x.2008.00418.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
21
|
Abstract
INTRODUCTION The Internet has also become an increasingly important source of health-related information. However, with this exponential increase comes the problem that although the volume of information is huge, the quality, accuracy and completeness of the information are questionable, not only in the field of medicine. Previous studies of single medical conditions have suggested that web-based health information has limitations. The aim of this study was to evaluate Internet usage among burned patients and the people accompanying them to the outpatient clinic. METHODS A customised questionnaire was created and distributed to all patients and accompanying persons in the adult and paediatric burns clinics. This investigated computer usage, Internet access, usefulness of Internet search and topics searched. RESULTS Two hundred and ten people completed the questionnaire, a response rate of 83%. Sixty three percent of responders were patients, parents 21.9%, spouses 3.3%, siblings, children and friends the remaining 10.8%. Seventy seven percent of attendees had been injured within the last year, 11% between 1 and 5 years previously, and 12% more than 5 years previously. Seventy four percent had computer and Internet access. Twelve percent had performed a search. Topics searched included skin grafts, scarring and scar management treatments such as pressure garments, silicone gel and massage. DISCUSSION This study has shown that computer and Internet access is high, however a very small number actually used the Internet to access further medical information. Patients with longer standing injuries were more likely to access the Internet. Parents of burned children were more frequent Internet users. As more burn units develop their own web sites with information for patients and healthcare providers, it is important to inform patients, family members and friends that such a resource exists. By offering such a service patients are provided with accurate, reliable and easily accessible information which is appropriate to their needs.
Collapse
Affiliation(s)
- S Rea
- Burn Service of Western Australia, Royal Perth Hospital, Perth, Western Australia, Australia.
| | | | | | | |
Collapse
|
22
|
Falder S, Rea S, Wood F. The Western Australian experience of Integra® use in paediatric patients 1996–2006. Burns 2007. [DOI: 10.1016/j.burns.2006.10.364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
23
|
Reynolds N, Exley J, Hills S, Falder S, Duff C, Kenealy J. The role of the Lumina intense pulsed light system in the treatment of port wine stains—a case controlled study. ACTA ACUST UNITED AC 2005; 58:968-80. [PMID: 16043156 DOI: 10.1016/j.bjps.2005.04.006] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2004] [Revised: 02/25/2005] [Accepted: 04/12/2005] [Indexed: 11/28/2022]
Abstract
The pulsed dye laser has been the treatment of choice for port wine stains over the past 20 years. In the past 5 years there has been increasing discussion of the role of other light treatments, such as the intense pulsed light system in the treatment of port wine stains. These systems use high-energy lamps, which emit noncoherent broad-spectrum light. Cut off filters are applied depending on the treatment modality to limit the wavelengths emitted. We present the results of a 3-year prospective within patient controlled clinical trial using an intense pulsed light system called the Lumina, developed by Lynton Lasers of Cheshire, England. Our aims and objectives were to assess the effectiveness of the system in the treatment of port wine stains in a human model and to record the optimum treatment parameters and the incidence of side effects. Following ethical approval 12 subjects were enrolled into the trial. In order to meet the requirements of the local ethics committee these were all adults with port wine stains located in less visible areas of the body. The results showed that eight of the 12 subjects had some degree of fading of their port wine stain as measured on a percentage scoring system. Of the four who failed to show any response, all had pink port wine stains. It did seem the case that the darker the port wine stain, the better the fading seen. Furthermore, the more distal lesions tended to be less responsive than those situated closer to the head area. However, it is difficult to draw any definitive statistical conclusions due to the small number of patients in the trial.
Collapse
Affiliation(s)
- N Reynolds
- Department of Plastic Surgery, Laser Centre of the South West, Frenchay Hospital, Frenchay, Bristol BS16 1LE, UK.
| | | | | | | | | | | |
Collapse
|
24
|
Azad S, Falder S, Harrison J, Graham K. An adherent dressing for aplasia cutis congenita. ACTA ACUST UNITED AC 2005; 58:1159-61. [PMID: 16039625 DOI: 10.1016/j.bjps.2005.04.046] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2004] [Revised: 02/14/2005] [Accepted: 04/29/2005] [Indexed: 11/17/2022]
|
25
|
Azad S, Falder S, Wilkinson D, James I, Graham K. A GP guide to treating burns. Practitioner 2004; 248:638, 642, 645-6 passim. [PMID: 15376549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Affiliation(s)
- Sanjay Azad
- Department of Burns and Plastic Surgery, Whiston Hospital, Prescot, Merseyside
| | | | | | | | | |
Collapse
|
26
|
Falder S, Sinclair JS, Rogers CA, Townsend PLG. Long-term behaviour of the free vascularised fibula following reconstruction of large bony defects. Br J Plast Surg 2003; 56:571-84. [PMID: 12946376 DOI: 10.1016/s0007-1226(03)00186-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Thirty-two free vascularised fibula grafts performed at our unit have been assessed retrospectively with respect to success, bony union and percentage graft hypertrophy. Between 1981 and 1998, there were 21 males and 11 females (aged 8-61 years) with follow-up of 5 months to 14.6 years. The mean bony defect bridged was 12.0 cm (standard deviation 4.8; range 5.0-21.0 cm). Bony union and hypertrophy were assessed radiographically. Time to bony union was compared using the log-rank, Wilcoxon or likelihood ratio tests. Kaplan-Meier survival curves were constructed. Hypertrophy was compared with Wilcoxon's rank sum test.Three flaps failed. Seventy-four percent of patients healed primarily at a median time of 4.75 months; five patients required further surgery to heal by 18 months (interquartile range 14-20 months). Complication rate and donor site morbidity were low. The stress fracture rate was 21%. Ninety percent of patients regained a functional limb by 12 months.Hypertrophy was measured in 22 patients and ranged from 0 to 316% (median 71%; interquartile range 10-145%). Median hypertrophy in the lower limb was 76.5% (interquartile range 26.5-165%) compared to 33.5% in the upper limb (0-88%); p=0.16. Median hypertrophy in trauma cases was 80% (interquartile range 10-167%) compared to 70% in tumour cases (33-105%); p=0.62.Our findings confirm that the fibula responds physiologically to biomechanical loading. Our results compare well with other series and alternative reconstructive modalities. We conclude that the free fibula flap can provide excellent results in the salvage of limbs with large bony defects.
Collapse
Affiliation(s)
- S Falder
- Department of Plastic and Reconstructive Surgery, North Bristol NHS Trust, Frenchay Hospital, Frenchay Park Road, Bristol BS16 1LE, UK.
| | | | | | | |
Collapse
|
27
|
|
28
|
Pigott RW, Albery EH, Hathorn IS, Atack NE, Williams A, Harland K, Orlando A, Falder S, Coghlan B. A comparison of three methods of repairing the hard palate. Cleft Palate Craniofac J 2002; 39:383-91. [PMID: 12071786 DOI: 10.1597/1545-1569_2002_039_0383_acotmo_2.0.co_2] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To compare growth, speech, and nasal symmetry outcomes of three methods of hard palate repair. PATIENTS Consecutive available records of children born with unilateral bony complete cleft lip and palate over the period 1972 to 1992. INTERVENTIONS Identical management of lip, nose, alveolus, and soft palate. Hard palate repair by Cuthbert Veau (CV) from 1972 to 1981, von Langenbeck (vL) from 1982 to 1989, or medial Langenbeck (ML) from 1989 to 1991. OUTCOME MEASURES For growth: GOSLON yardstick or 5-year model index. For speech: articulation test. Nasal anemometry. For nasal symmetry: Coghlan computer-based assessment. All these measures were developed during the period of data collection but not for this project. RESULTS There was a strong trend toward more favorable anteroposterior maxillary growth with the change from CV to vL to ML techniques. This fell short of statistical significance because of the small sample size. There was a significant reduction in cleft-related articulation faults (p =.01) considered to be related to improved arch form. In the absence of improved rates of velopharyngeal insufficiency or nasal symmetry, increased surgical experience was discounted as a significant contribution to improved growth and articulation outcomes. CONCLUSIONS Reduced periosteal undermining and residual exposed palatal shelf from CV to vL to ML improved incisor relationships and articulation.
Collapse
Affiliation(s)
- R W Pigott
- Department of Speech and Language Therapy, Frenchay Healthcare NHS Trust, Frenchay Hospital, Bristol, United Kingdom
| | | | | | | | | | | | | | | | | |
Collapse
|
29
|
Pigott RW, Albery EH, Hathorn IS, Atack NE, Williams A, Harland K, Orlando A, Falder S, Coghlan B. A Comparison of Three Methods of Repairing the Hard Palate. Cleft Palate Craniofac J 2002. [DOI: 10.1597/1545-1569(2002)039<0383:acotmo>2.0.co;2] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
|
30
|
|
31
|
|
32
|
Falder S. Basic surgical training. West J Med 1999. [DOI: 10.1136/bmj.319.7217.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
33
|
Falder S. Balancing medicine with a life. West J Med 1998. [DOI: 10.1136/bmj.317.7172.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
34
|
Falder S, Nichols PH, Hosking SW. Surgical technique. Testing for Helicobacter pylori during emergency duodenal ulcer surgery. Ann R Coll Surg Engl 1997; 79:464-5. [PMID: 9422879 PMCID: PMC2502969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Affiliation(s)
- S Falder
- Department of Surgery, Poole Hospital NHS Trust, Dorset
| | | | | |
Collapse
|
35
|
Falder S, Thomas P, Jolly M, Iatrakis G, Smith JR. Reducing the risk of needlestick injury in surgical practice. J OBSTET GYNAECOL 1994. [DOI: 10.3109/01443619409025975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|