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Dion GR, Teng S, Bing R, Hiwatashi N, Amin MR, Branski RC. Development of an in vivo model of laryngeal burn injury. Laryngoscope 2016; 127:186-190. [DOI: 10.1002/lary.26123] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Accepted: 05/09/2016] [Indexed: 11/09/2022]
Affiliation(s)
- Gregory R. Dion
- NYU Voice Center, Department of Otolaryngology-Head and Neck Surgery; New York University School of Medicine; New York New York U.S.A
| | - Stephanie Teng
- NYU Voice Center, Department of Otolaryngology-Head and Neck Surgery; New York University School of Medicine; New York New York U.S.A
| | - Renjie Bing
- NYU Voice Center, Department of Otolaryngology-Head and Neck Surgery; New York University School of Medicine; New York New York U.S.A
| | - Nao Hiwatashi
- NYU Voice Center, Department of Otolaryngology-Head and Neck Surgery; New York University School of Medicine; New York New York U.S.A
| | - Milan R. Amin
- NYU Voice Center, Department of Otolaryngology-Head and Neck Surgery; New York University School of Medicine; New York New York U.S.A
| | - Ryan C. Branski
- NYU Voice Center, Department of Otolaryngology-Head and Neck Surgery; New York University School of Medicine; New York New York U.S.A
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Emami SA, Motevalian SA, Momeni M, Karimi H. The epidemiology of geriatric burns in Iran: A national burn registry-based study. Burns 2016; 42:1128-1132. [PMID: 27126815 DOI: 10.1016/j.burns.2016.03.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Revised: 01/28/2016] [Accepted: 03/17/2016] [Indexed: 12/01/2022]
Abstract
Defining the epidemiology and outcome of geriatric burn patients is critical for specialized burn centers, health-care workers, and governments. Better resource use and effective guidelines are some of the advantages of studies focusing on this aspect. The outcome of these patients serves as an objective criterion for quality control, research, and preventive programs. We used data from the burn registry program in our country. For 2 years, >28,700 burn patients were recorded, 1721 of whom were admitted. Among them, 187 patients were ≥55 years old. Sixty-nine percent of patients were male and 31% female, with a male to female ratio of 2.22:1. The mean±standard deviation (SD) of age was 63.4±8.1. The cause of burns was flame (58.2%) and scalds (20.3%). Most of the burns were sustained at home. The mean duration of hospital stay was 19.5 days (range 3-59 days). The mean (SD) of the total body surface area (TBSA) was 20.3% (8.4%). The median hospital stay (length of stay (LOS)) was 11 days (SD=14). The increase in TBSA was related to a longer LOS (p<0.02). Burn wound infection developed in 44.3% of patients. The presence of inhalation injury was significantly related to mortality (p<0.001). Among the patients, 9% recovered completely, 74.9% recovered partially (requiring further treatment), 1% underwent amputation, and 12.8% died. The lack of insurance coverage did not affect the survival of our geriatric burn patients. However, being alone or single, ignition of clothing, cause of burn, comorbid illnesses, complications following the burn, TBSA, age, and sepsis were positively correlated with mortality. The mean cost of treatment for each patient was about $7450.
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Affiliation(s)
| | | | - Mahnoush Momeni
- Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Hamid Karimi
- Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran.
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Yoshino Y, Ohtsuka M, Kawaguchi M, Sakai K, Hashimoto A, Hayashi M, Madokoro N, Asano Y, Abe M, Ishii T, Isei T, Ito T, Inoue Y, Imafuku S, Irisawa R, Ohtsuka M, Ogawa F, Kadono T, Kawakami T, Kukino R, Kono T, Kodera M, Takahara M, Tanioka M, Nakanishi T, Nakamura Y, Hasegawa M, Fujimoto M, Fujiwara H, Maekawa T, Matsuo K, Yamasaki O, Le Pavoux A, Tachibana T, Ihn H. The wound/burn guidelines - 6: Guidelines for the management of burns. J Dermatol 2016; 43:989-1010. [PMID: 26971391 DOI: 10.1111/1346-8138.13288] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Accepted: 12/04/2015] [Indexed: 12/16/2022]
Abstract
Burns are a common type of skin injury encountered at all levels of medical facilities from private clinics to core hospitals. Minor burns heal by topical treatment alone, but moderate to severe burns require systemic management, and skin grafting is often necessary also for topical treatment. Inappropriate initial treatment or delay of initial treatment may exert adverse effects on the subsequent treatment and course. Therefore, accurate evaluation of the severity and initiation of appropriate treatment are necessary. The Guidelines for the Management of Burn Injuries were issued in March 2009 from the Japanese Society for Burn Injuries as guidelines concerning burns, but they were focused on the treatment for extensive and severe burns in the acute period. Therefore, we prepared guidelines intended to support the appropriate diagnosis and initial treatment for patients with burns that are commonly encountered including minor as well as moderate and severe cases. Because of this intention of the present guidelines, there is no recommendation of individual surgical procedures.
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Affiliation(s)
- Yuichiro Yoshino
- Department of Dermatology, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan
| | - Mikio Ohtsuka
- Department of Dermatology, Fukushima Medical University, Fukushima, Japan
| | - Masakazu Kawaguchi
- Department of Dermatology, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Keisuke Sakai
- Intensive Care Unit, Kumamoto University Hospital, Kumamoto, Japan
| | - Akira Hashimoto
- Department of Dermatology, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Masahiro Hayashi
- Department of Dermatology, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Naoki Madokoro
- Department of Dermatology, Mazda Hospital, Hiroshima, Japan
| | - Yoshihide Asano
- Department of Dermatology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Masatoshi Abe
- Department of Dermatology, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Takayuki Ishii
- Department of Dermatology, Faculty of Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Ishikawa, Japan
| | - Taiki Isei
- Department of Dermatology, Kansai Medical University, Osaka, Japan
| | - Takaaki Ito
- Department of Dermatology, Hyogo College of Medicine, Hyogo, Japan
| | - Yuji Inoue
- Department of Dermatology and Plastic Surgery, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Shinichi Imafuku
- Department of Dermatology, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Ryokichi Irisawa
- Department of Dermatology, Tokyo Medical University, Tokyo, Japan
| | - Masaki Ohtsuka
- Department of Dermatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Fumihide Ogawa
- Department of Dermatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Takafumi Kadono
- Department of Dermatology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Tamihiro Kawakami
- Department of Dermatology, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Ryuichi Kukino
- Department of Dermatology, NTT Medical Center, Tokyo, Japan
| | - Takeshi Kono
- Department of Dermatology, Nippon Medical School, Tokyo, Japan
| | - Masanari Kodera
- Department of Dermatology, Japan Community Health Care Organization Chukyo Hospital, Aichi, Japan
| | - Masakazu Takahara
- Department of Dermatology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Miki Tanioka
- Department of Dermatology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Takeshi Nakanishi
- Department of Dermatology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | | | - Minoru Hasegawa
- Department of Dermatology, Faculty of Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Ishikawa, Japan
| | - Manabu Fujimoto
- Department of Dermatology, Faculty of Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Ishikawa, Japan
| | - Hiroshi Fujiwara
- Department of Dermatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Takeo Maekawa
- Department of Dermatology, Jichi Medical University, Tochigi, Japan
| | - Koma Matsuo
- Department of Dermatology, The Jikei University School of Medicine, Tokyo, Japan
| | - Osamu Yamasaki
- Department of Dermatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | | | - Takao Tachibana
- Department of Dermatology, Osaka Red Cross Hospital, Osaka, Japan
| | - Hironobu Ihn
- Department of Dermatology and Plastic Surgery, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
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Harvey L, Mitchell R, Brodaty H, Draper B, Close J. Dementia: A risk factor for burns in the elderly. Burns 2016; 42:282-90. [DOI: 10.1016/j.burns.2015.10.023] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Revised: 10/21/2015] [Accepted: 10/22/2015] [Indexed: 10/22/2022]
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Huang Y, Zhang L, Lian G, Zhan R, Xu R, Huang Y, Mitra B, Wu J, Luo G. A novel mathematical model to predict prognosis of burnt patients based on logistic regression and support vector machine. Burns 2016; 42:291-9. [PMID: 26774603 DOI: 10.1016/j.burns.2015.08.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Revised: 07/09/2015] [Accepted: 08/07/2015] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To develop a mathematical model of predicting mortality based on the admission characteristics of 6220 burn cases. METHODS Data on all the burn patients presenting to Institute of Burn Research, Southwest Hospital, Third Military Medical University from January of 1999 to December of 2008 were extracted from the departmental registry. The distributions of burn cases were scattered by principal component analysis. Univariate associations with mortality were identified and independent associations were derived from multivariate logistic regression analysis. Using variables independently and significantly associated with mortality, a mathematical model to predict mortality was developed using the support vector machine (SVM) model. The predicting ability of this model was evaluated and verified. RESULTS The overall mortality in this study was 1.8%. Univariate associations with mortality were identified and independent associations were derived from multivariate logistic regression analysis. Variables at admission independently associated with mortality were gender, age, total burn area, full thickness burn area, inhalation injury, shock, period before admission and others. The sensitivity and specificity of logistic model were 99.75% and 85.84% respectively, with an area under the receiver operating curve of 0.989 (95% CI: 0.979-1.000; p<0.01). The model correctly classified 99.50% of cases. The subsequently developed support vector machine (SVM) model correctly classified nearly 100% of test cases, which could not only predict adult group but also pediatric group, with pretty high robustness (92%-100%). CONCLUSION A mathematical model based on logistic regression and SVM could be used to predict the survival prognosis according to the admission characteristics.
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Affiliation(s)
- Yinghui Huang
- Institute of Burn Research, Southwest Hospital, Third Military Medical University, Chongqing, China; Institute of Combined Injury, State Key Laboratory of Trauma, Burns and Combined Injury, Chongqing Engineering Research Center for Nanomedicine, College of Preventive Medicine, Third Military Medical University, Chongqing, China; Department of Biochemistry and Molecular Biology, Third Military Medical University, Chongqing, China.
| | - Lei Zhang
- College of Communication Engineering, Chongqing University, Chongqing 400044, China.
| | - Guan Lian
- Institute of Burn Research, Southwest Hospital, Third Military Medical University, Chongqing, China.
| | - Rixing Zhan
- Institute of Burn Research, Southwest Hospital, Third Military Medical University, Chongqing, China.
| | - Rufu Xu
- The Department of Epidemiology, Third Military Medical University, Chongqing, China.
| | - Yan Huang
- Department of Biochemistry and Molecular Biology, Third Military Medical University, Chongqing, China.
| | - Biswadev Mitra
- Trauma Service Center, Alfred Hospital, 55 Commercial Road, Melbourne, VIC 3004, Australia.
| | - Jun Wu
- Institute of Burn Research, Southwest Hospital, Third Military Medical University, Chongqing, China.
| | - Gaoxing Luo
- Institute of Burn Research, Southwest Hospital, Third Military Medical University, Chongqing, China.
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56
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Steinvall I, Elmasry M, Fredrikson M, Sjoberg F. Standardised mortality ratio based on the sum of age and percentage total body surface area burned is an adequate quality indicator in burn care: An exploratory review. Burns 2015; 42:28-40. [PMID: 26700877 DOI: 10.1016/j.burns.2015.10.032] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Revised: 10/28/2015] [Accepted: 10/29/2015] [Indexed: 11/27/2022]
Abstract
Standardised Mortality Ratio (SMR) based on generic mortality predicting models is an established quality indicator in critical care. Burn-specific mortality models are preferred for the comparison among patients with burns as their predictive value is better. The aim was to assess whether the sum of age (years) and percentage total body surface area burned (which constitutes the Baux score) is acceptable in comparison to other more complex models, and to find out if data collected from a separate burn centre are sufficient for SMR based quality assessment. The predictive value of nine burn-specific models was tested by comparing values from the area under the receiver-operating characteristic curve (AUC) and a non-inferiority analysis using 1% as the limit (delta). SMR was analysed by comparing data from seven reference sources, including the North American National Burn Repository (NBR), with the observed mortality (years 1993-2012, n=1613, 80 deaths). The AUC values ranged between 0.934 and 0.976. The AUC 0.970 (95% CI 0.96-0.98) for the Baux score was non-inferior to the other models. SMR was 0.52 (95% CI 0.28-0.88) for the most recent five-year period compared with NBR based data. The analysis suggests that SMR based on the Baux score is eligible as an indicator of quality for setting standards of mortality in burn care. More advanced modelling only marginally improves the predictive value. The SMR can detect mortality differences in data from a single centre.
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Affiliation(s)
- Ingrid Steinvall
- The Burn Centre, Department of Plastic Surgery, Hand Surgery, and Burns, Linköping University, Linköping, Sweden; Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
| | - Moustafa Elmasry
- The Burn Centre, Department of Plastic Surgery, Hand Surgery, and Burns, Linköping University, Linköping, Sweden; Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden; The Plastic Surgery Unit, Surgery Department, Suez Canal University, Ismailia, Egypt
| | - Mats Fredrikson
- Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Folke Sjoberg
- The Burn Centre, Department of Plastic Surgery, Hand Surgery, and Burns, Linköping University, Linköping, Sweden; Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden; Department of Anaesthesiology and Intensive Care, Linköping University, Linköping, Sweden
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57
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Middelkoop E, Vloemans AFPM. Response to Burns in the Elderly: What is Pathophysiology and What is Physiology? EBioMedicine 2015; 2:1314-5. [PMID: 26629525 PMCID: PMC4634750 DOI: 10.1016/j.ebiom.2015.09.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Revised: 09/04/2015] [Accepted: 09/04/2015] [Indexed: 11/16/2022] Open
Affiliation(s)
- E Middelkoop
- Burn Centre, Association of Dutch Burn Centres, Red Cross Hospital, Beverwijk, The Netherlands ; Department of Plastic, Reconstructive and Hand Surgery, Research Institute MOVE, VU University Medical Center, Amsterdam, The Netherlands
| | - A F P M Vloemans
- Burn Centre, Association of Dutch Burn Centres, Red Cross Hospital, Beverwijk, The Netherlands
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Ceniceros A, Pértega S, Galeiras R, Mourelo M, López E, Broullón J, Sousa D, Freire D. Predicting mortality in burn patients with bacteraemia. Infection 2015; 44:215-22. [DOI: 10.1007/s15010-015-0847-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 09/21/2015] [Indexed: 11/28/2022]
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Wearn C, Hardwicke J, Kitsios A, Siddons V, Nightingale P, Moiemen N. Outcomes of burns in the elderly: revised estimates from the Birmingham Burn Centre. Burns 2015; 41:1161-8. [PMID: 25983286 DOI: 10.1016/j.burns.2015.04.008] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Revised: 02/22/2015] [Accepted: 04/17/2015] [Indexed: 11/18/2022]
Abstract
Outcomes after burn have continued to improve over the last 70 years in all age groups including the elderly. However, concerns have been raised that survival gains have not been to the same magnitude in elderly patients compared to younger age groups. The aims of this study were to analyze the recent outcomes of elderly burn injured patients admitted to the Birmingham Burn Centre, compare data with a historical cohort and published data from other burn centres worldwide. A retrospective review was conducted of all patients ≥65 years of age, admitted to our centre with cutaneous burns, between 2004 and 2012. Data was compared to a previously published historical cohort (1999-2003). 228 patients were included. The observed mortality for the study group was 14.9%. The median age of the study group was 79 years, the male to female ratio was 1:1 and median Total Body Surface Area (TBSA) burned was 5%. The incidence of inhalation injury was 13%. Median length of stay per TBSA burned for survivors was 2.4 days/% TBSA. Mortality has improved in all burn size groups, but differences were highly statistically significant in the medium burn size group (10-20% TBSA, p≤0.001). Burn outcomes in the elderly have improved over the last decade. This reduction has been impacted by a reduction in overall injury severity but is also likely due to general improvements in burn care, improved infrastructure, implementation of clinical guidelines and increased multi-disciplinary support, including Geriatric physicians.
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Affiliation(s)
- Christopher Wearn
- Healing Foundation Centre for Burns Research, University Hospital Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham B15 2WB, UK; University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - Joseph Hardwicke
- Healing Foundation Centre for Burns Research, University Hospital Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham B15 2WB, UK; University of Birmingham, Edgbaston, Birmingham B15 2TT, UK.
| | | | | | - Peter Nightingale
- Wellcome Trust Clinical Research Facility Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham B15 2WB, UK
| | - Naiem Moiemen
- Healing Foundation Centre for Burns Research, University Hospital Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham B15 2WB, UK; University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
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Tsurumi A, Que YA, Yan S, Tompkins RG, Rahme LG, Ryan CM. Do standard burn mortality formulae work on a population of severely burned children and adults? Burns 2015; 41:935-45. [PMID: 25922299 DOI: 10.1016/j.burns.2015.03.017] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Revised: 02/24/2015] [Accepted: 03/28/2015] [Indexed: 10/23/2022]
Abstract
Accurate prediction of mortality following burns is useful as an audit tool, and for providing treatment plan and resource allocation criteria. Common burn formulae (Ryan Score, Abbreviated Burn Severity Index (ABSI), classic and revised Baux) have not been compared with the standard Acute Physiology and Chronic Health Evaluation II (APACHEII) or re-validated in a severely (≥20% total burn surface area) burned population. Furthermore, the revised Baux (R-Baux) has been externally validated thoroughly only once and the pediatric Baux (P-Baux) has yet to be. Using 522 severely burned patients, we show that burn formulae (ABSI, Baux, revised Baux) outperform APACHEII among adults (AUROC increase p<0.001 adults; p>0.5 children). The Ryan Score performs well especially among the most at-risk populations (estimated mortality [90% CI] original versus current study: 33% [26-41%] versus 30.18% [24.25-36.86%] for Ryan Score 2; 87% [78-93%] versus 66.48% [51.31-78.87%] for Ryan Score 3). The R-Baux shows accurate discrimination (AUROC 0.908 [0.869-0.947]) and is well-calibrated. However, the ABSI and P-Baux, although showing high measures of discrimination (AUROC 0.826 [0.737-0.916] and 0.848 [0.758-0.938]) in children), exceedingly overestimates mortality, indicating poor calibration. We highlight challenges in designing and employing scores that are applicable to a wide range of populations.
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Affiliation(s)
- Amy Tsurumi
- Department of Surgery, Massachusetts General Hospital, Bigelow 1302, 55 Fruit Street, Boston, MA 02114, USA; Department of Microbiology and Immunobiology, Harvard Medical School, 77 Ave. Louis Pasteur, Boston, MA, USA; Shriners Hospitals for Children-Boston®, 51 Blossom St., Boston, MA, USA.
| | - Yok-Ai Que
- Department of Intensive Care Medicine, Lausanne University Hospital, BH 08-624, CH-1011 Lausanne, Switzerland.
| | - Shuangchun Yan
- Department of Surgery, Massachusetts General Hospital, Bigelow 1302, 55 Fruit Street, Boston, MA 02114, USA; Department of Microbiology and Immunobiology, Harvard Medical School, 77 Ave. Louis Pasteur, Boston, MA, USA; Shriners Hospitals for Children-Boston®, 51 Blossom St., Boston, MA, USA.
| | - Ronald G Tompkins
- Department of Surgery, Massachusetts General Hospital, Bigelow 1302, 55 Fruit Street, Boston, MA 02114, USA.
| | - Laurence G Rahme
- Department of Surgery, Massachusetts General Hospital, Bigelow 1302, 55 Fruit Street, Boston, MA 02114, USA; Department of Microbiology and Immunobiology, Harvard Medical School, 77 Ave. Louis Pasteur, Boston, MA, USA; Shriners Hospitals for Children-Boston®, 51 Blossom St., Boston, MA, USA.
| | - Colleen M Ryan
- Department of Surgery, Massachusetts General Hospital, Bigelow 1302, 55 Fruit Street, Boston, MA 02114, USA; Shriners Hospitals for Children-Boston®, 51 Blossom St., Boston, MA, USA.
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Duke JM, Boyd JH, Rea S, Randall SM, Wood FM. Long-term mortality among older adults with burn injury: a population-based study in Australia. Bull World Health Organ 2015; 93:400-6. [PMID: 26240461 PMCID: PMC4450710 DOI: 10.2471/blt.14.149146] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Revised: 02/10/2015] [Accepted: 02/16/2015] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE To assess if burn injury in older adults is associated with changes in long-term all-cause mortality and to estimate the increased risk of death attributable to burn injury. METHODS We conducted a population-based matched longitudinal study - based on administrative data from Western Australia's hospital morbidity data system and death register. A cohort of 6014 individuals who were aged at least 45 years when hospitalized for a first burn injury in 1980-2012 was identified. A non-injury comparison cohort, randomly selected from Western Australia's electoral roll (n = 25 759), was matched to the patients. We used Kaplan-Meier plots and Cox proportional hazards regression to analyse the data and generated mortality rate ratios and attributable risk percentages. FINDINGS For those hospitalized with burns, 180 (3%) died in hospital and 2498 (42%) died after discharge. Individuals with burn injury had a 1.4-fold greater mortality rate than those with no injury (95% confidence interval, CI: 1.3-1.5). In this cohort, the long-term mortality attributable to burn injury was 29%. Mortality risk was increased by both severe and minor burns, with adjusted mortality rate ratios of 1.3 (95% CI: 1.1-1.9) and 2.1 (95% CI: 1.9-2.3), respectively. CONCLUSION Burn injury is associated with increased long-term mortality. In our study population, sole reliance on data on in-hospital deaths would lead to an underestimate of the true mortality burden associated with burn injury.
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Affiliation(s)
- Janine M Duke
- Burn Injury Research Unit, School of Surgery, Faculty of Medicine, Dentistry and Health Sciences, University of Western Australia, M318 35 Stirling Highway, Crawley, 6009, Perth, Western Australia, Australia
| | - James H Boyd
- Centre for Data Linkage, Curtin University, Perth, Australia
| | - Suzanne Rea
- Burns Service of Western Australia, Royal Perth Hospital and Princess Margaret Hospital, Perth, Australia
| | - Sean M Randall
- Centre for Data Linkage, Curtin University, Perth, Australia
| | - Fiona M Wood
- Burns Service of Western Australia, Royal Perth Hospital and Princess Margaret Hospital, Perth, Australia
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Shariff Z, Rodrigues JN, Anwar U, Austin O, Phipps A. Burns in patients over 90: A fifteen-year series from a regional burns centre. Burns 2015; 41:297-300. [DOI: 10.1016/j.burns.2014.06.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2014] [Revised: 06/19/2014] [Accepted: 06/22/2014] [Indexed: 10/24/2022]
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Dokter J, Felix M, Krijnen P, Vloemans JF, Baar MEV, Tuinebreijer WE, Breederveld RS. Mortality and causes of death of Dutch burn patients during the period 2006–2011. Burns 2015; 41:235-40. [DOI: 10.1016/j.burns.2014.10.009] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Revised: 10/11/2014] [Accepted: 10/14/2014] [Indexed: 11/27/2022]
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Jackson PC, Hardwicke J, Bamford A, Nightingale P, Wilson Y, Papini R, Moiemen N. Revised estimates of mortality from the Birmingham Burn Centre, 2001-2010: a continuing analysis over 65 years. Ann Surg 2014; 259:979-84. [PMID: 23598383 DOI: 10.1097/sla.0b013e31829160ca] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The Birmingham Burn Centre has continued to publish mortality data over the last 65 years. It is one of the longest running cross-sectional cohort studies in the world. We present the latest data from the study, with a comparison to previous results. BACKGROUND Results from the previous decade failed to show any improvement in mortality despite perceived advances in burn care. The aim of this update was to establish current mortality statistics and ascertain whether improvement had now been made. METHODS Data were collected for a 10-year period on all burn-injured patients admitted to the Birmingham Burn Centre (Birmingham Children's Hospital, Selly Oak Hospital, and Queen Elizabeth Hospital Birmingham). Patients' age, percentage of burn, date of injury, and outcome were recorded and analyzed with both probit and logistic regression analyses. RESULTS A total of 4577 patients were included in the analysis, with a mean total body surface area (TBSA) burn of 7.2% and a mean age of 22 years. Comparison of probit model results with previous results demonstrates improvement in predicted mortality and lethal area (LA50) of burns. Logistic regression produces similar results to the probit analysis. Trend analysis proved a statistically significant improvement in mortality. CONCLUSIONS The last decade of burn care at Birmingham Burn Centre demonstrates an improvement in predicted mortality and LA50. This reflects our structured, multidisciplinary approach to burn-injured patients, early surgical excision and wound closure, and general advances in the intensive care of patients.
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Affiliation(s)
- Philippa C Jackson
- *West Midlands Regional Burns Centre, University Hospitals of Birmingham NHS Foundation Trust, New Queen Elizabeth Hospital, Mindelsohn Way, Edgbaston, Birmingham, United Kingdom †Birmingham Children's Hospital NHS Foundation Trust, Steelhouse Lane, Birmingham, United Kingdom ‡Wellcome Trust Clinical Research Facility, Queen Elizabeth Hospital, Edgbaston, Birmingham, United Kingdom
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65
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Abstract
Advances in burn care have decreased mortality in the past 20 years, but affecting elderly mortality rates (>65 years) remain challenging. This study evaluates the impact of home caregiver support on elderly burn patients' mortality. The authors retrospectively reviewed patients aged 65 and older admitted to their burn center from July 1995 to October 2004. Patient demographics, Injury Severity Score, TBSA, and patients' primary caregiver were collected. The outcomes were mortality, disposition, and length of stay and these were evaluated using univariate and subsequently multivariate regression. Significance was calculated at P ≤ .05. A total of 112 patients were included in the analysis. The mean age was 76±8. Male patients constituted 47%, whereas 53% were female patients, and mean TBSA was 21±16%. Thirty patients' primary caregiver was a spouse, for 38 it was a child, and 44 had no caregiver. Fifty-eight patients survived (51.7%), and 54 patients died (48.3%). Only 21% of the survivors had a child as their primary caregiver; however, 48% of the nonsurvivors had a child as the primary caregiver (P ≤ 0.05). On multivariate analysis, age, TBSA, and child as primary caregiver were all independent predictors of mortality. Having a child as a caregiver provided the largest impact, with an odds ratio of 4.4 (95% confidence interval, 1.2-15.62; P = .02).
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66
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The influence of advancing age on quality of life and rate of recovery after treatment for burn. Burns 2013; 39:1067-72. [DOI: 10.1016/j.burns.2013.05.017] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2013] [Revised: 05/22/2013] [Accepted: 05/25/2013] [Indexed: 11/24/2022]
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Hussain A, Choukairi F, Dunn K. Predicting survival in thermal injury: A systematic review of methodology of composite prediction models. Burns 2013; 39:835-50. [DOI: 10.1016/j.burns.2012.12.010] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2012] [Revised: 11/13/2012] [Accepted: 12/06/2012] [Indexed: 12/26/2022]
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68
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Aguayo-Becerra OA, Torres-Garibay C, Macías-Amezcua MD, Fuentes-Orozco C, Chávez-Tostado MDG, Andalón-Dueñas E, Espinosa Partida A, Alvarez-Villaseñor ADS, Cortés-Flores AO, González-Ojeda A. Serum albumin level as a risk factor for mortality in burn patients. Clinics (Sao Paulo) 2013; 68:940-5. [PMID: 23917657 PMCID: PMC3714858 DOI: 10.6061/clinics/2013(07)09] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Accepted: 03/11/2013] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Hypoalbuminemia is a common clinical deficiency in burn patients and is associated with complications related to increased extravascular fluid, including edema, abnormal healing, and susceptibility to sepsis. Some prognostic scales do not include biochemical parameters, whereas others consider them together with comorbidities. The purpose of this study was to determine whether serum albumin can predict mortality in burn patients. METHODS We studied burn patients ≥16 years of age who had complete clinical documentation, including the Abbreviated Burn Severity Index, serum albumin, globulin, and lipids. Sensitivity and specificity analyses were performed to determine the cut-off level of albumin that predicts mortality. RESULTS In our analysis of 486 patients, we found that mortality was higher for burns caused by flame (p=0.000), full-thickness burns (p=0.004), inhalation injuries (p=0.000), burns affecting >30% of the body surface area (p=0.001), and burns associated with infection (p=0.008). Protein and lipid levels were lower in the patients who died (p<0.05). Albumin levels showed the highest sensitivity and specificity (84% and 83%, respectively), and the area under the receiver-operating characteristic curve (0.869) had a cut-off of 1.95 g/dL for mortality. CONCLUSION Patients with albumin levels <2 g/dL had a mortality risk of >80%, with 84% sensitivity and 83% specificity. At admission, the albumin level could be used as a sensitive and specific marker of burn severity and an indicator of mortality.
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Affiliation(s)
- Olivia Alejandra Aguayo-Becerra
- Internal Medicine and Geriatrics Department, Medical Unit of High Specialty, Mexican Institute of Social Security, Specialties Hospital of the Western Medical Center, Guadalajara, Jalisco/Mexico.
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69
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Tyson AF, Boschini LP, Kiser MM, Samuel JC, Mjuweni SN, Cairns BA, Charles AG. Survival after burn in a sub-Saharan burn unit: challenges and opportunities. Burns 2013; 39:1619-25. [PMID: 23768710 DOI: 10.1016/j.burns.2013.04.013] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2013] [Revised: 04/14/2013] [Accepted: 04/15/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Burns are among the most devastating of all injuries and a major global public health crisis, particularly in sub-Saharan Africa. In developed countries, aggressive management of burns continues to lower overall mortality and increase lethal total body surface area (TBSA) at which 50% of patients die (LA50). However, lack of resources and inadequate infrastructure significantly impede such improvements in developing countries. METHODS This study is a retrospective analysis of patients admitted to the burn center at Kamuzu Central Hospital in Lilongwe, Malawi between June 2011 and December 2012. We collected information including patient age, gender, date of admission, mechanism of injury, time to presentation to hospital, total body surface area (TBSA) burn, comorbidities, date and type of operative procedures, date of discharge, length of hospital stay, and survival. We then performed bivariate analysis and logistic regression to identify characteristics associated with increased mortality. RESULTS A total of 454 patients were admitted during the study period with a median age of 4 years (range 0.5 months to 79 years). Of these patients, 53% were male. The overall mean TBSA was 18.5%, and average TBSA increased with age--17% for 0-18 year olds, 24% for 19-60 year olds, and 41% for patients over 60 years old. Scald and flame burns were the commonest mechanisms, 52% and 41% respectively, and flame burns were associated with higher mortality. Overall survival in this population was 82%; however survival reduced with increasing age categories (84% in patients 0-18 years old, 79% in patients 19-60 years old, and 36% in patients older than 60 years). TBSA remained the strongest predictor of mortality after adjusting for age and mechanism of burn. The LA50 for this population was 39% TBSA. DISCUSSION Our data reiterate that burn in Malawi is largely a pediatric disease and that the high burn mortality and relatively low LA50 have modestly improved over the past two decades. The lack of financial resources, health care personnel, and necessary infrastructure will continue to pose a significant challenge in this developing nation. Efforts to increase burn education and prevention in addition to improvement of burn care delivery are imperative.
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Affiliation(s)
- Anna F Tyson
- Department of Surgery, University of North Carolina, United States
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70
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Abstract
BACKGROUND Chromogranin A (CgA) in plasma (P-CgA), a neuroendocrine marker of sympathetic stress, has been shown to predict mortality in medical intensive care. We hypothesized that the magnitude of CgA release would reflect stress load, and thereby injury severity in burn intensive care patients. METHODS Fifty-one consecutive patients with a burn area exceeding 10% were included. P-CgA was measured twice daily for seven days after injury. The point value at 24h, the mean and maximum values and the AUC at days 1-7, were tested as possible predictors. Injury severity in the form of organ dysfunction was measured as SOFA score at day 7. RESULTS P-CgA could be classified into two types with respect to variability over time. Patients with high variability had more deep injuries and were older than those with low variability. All measures of CgA correlated with SOFA score at day 7, but not with total burn size. Univariate regressions showed that age, burn size and three of four measures of P-CgA predicted organ dysfunction. Multiple regressions showed that age, burn size, and either P-CgA at 24h, the mean value up to day 7, or the maximum value up to day 7, were independent predictors for organ dysfunction. Significant organ dysfunction was best predicted by age, burn area and the CgA point value at 24h with an AUC value of 0.91 in a ROC-analysis. CONCLUSIONS The extent of neuroendocrine activation assessed as P-CgA after a major burn injury is independently related to organ dysfunction.
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Affiliation(s)
- Andreas E Lindahl
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
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71
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Abstract
BACKGROUND With unprecedented survival rates in modern burn care, there is increasing focus on optimizing long-term functional outcomes. However, 3% to 8% of patients admitted to burn centers still die of injury. Patterns in which these patients progress to death remain poorly characterized. We hypothesized that burn nonsurvivors will follow distinct temporal distributions and patterns of decline, parallel to the trimodality of deaths previously described for trauma. METHODS We retrospectively identified all adult deaths from 1995 to 2007 in the National Burn Repository database (n = 5,975) and at our regional burn center (n = 237). We stratified patients by age and analyzed injury and death characteristics. We used objective criteria to allocate nonsurvivors to one of four trajectories: early rapid decline, early organ failure, late sudden death, or late-onset decline. RESULTS The greatest concentration of deaths in both samples and age groups occurred within 72 hours of injury and decreased subsequently with no later mortality peak. Death was most often caused by burn shock within the first week of injury, cardiogenic shock or lung injury in Weeks 1 to 2, and sepsis/multiorgan failure after Week 2. In decreasing frequency, trajectories to death fit the pattern of early rapid decline (58%), early organ failure (20%), late-onset decline (16%), and late sudden death (6%). CONCLUSION Most burn deaths follow a pattern of early rapid decline or early organ failure manifested by death or critical illness within several days of the burn. These findings indicate that more than three quarters of burn deaths are attributable to failure or significant decompensation beginning in the resuscitation phase. Sporadic deaths later in hospitalization are uncommon. Despite significant advances in burn resuscitation, our data indicate that ongoing efforts to mitigate deaths in modern burn care should still focus on care improvements in the resuscitation phase. LEVEL OF EVIDENCE Epidemiologic study, level III.
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Shields WC, Perry EC, Szanton SL, Andrews MR, Stepnitz RL, McDonald EM, Gielen AC. Knowledge and injury prevention practices in homes of older adults. Geriatr Nurs 2013; 34:19-24. [DOI: 10.1016/j.gerinurse.2012.06.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2011] [Revised: 05/23/2012] [Accepted: 06/04/2012] [Indexed: 10/28/2022]
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Abstract
Although the elderly represent a substantial proportion of the population, limited information exists on postdischarge long-term outcomes of elderly burn survivors. The purpose of this study was to assess elderly burn patient outcomes 2 to 10 years after discharge. This study was a prospective cross-sectional survey assessment of quality of life and retrospective trauma registry for the American College of Surgeons review of patients ≥ 60 years of age discharged alive after acute burn from 1997 to 2007. In-hospital treatment and burn demographic information were obtained from database and chart review. Surviving patients or their families were contacted, and the Short-Form-12 and Functional Independence Measure (FIM) administered. Of the 344 patients discharged, 232 participated. Mean age was 72.3 (60-85.8) years, TBSA burn was 7.8% (1-79), and length of stay was 11.2 ± 0.9 days (1-51). Most patients were discharged home (71%) or to a skilled nursing facility (SNF; 20%). Mean interval between discharge and survey administration was 46.1 months. In all, 24% of patients sent home died after discharge and prior to interview compared with 58% of patients sent to an SNF. On multivariate analysis, mortality increased with age (confidence interval [CI] 1.04-1.09), and government insurance (CI 0.34-0.94), but decreased with discharge to home (CI 1.68-4.47). There were no differences in FIM or Short-Form-12 scores between groups. Long-term mortality after discharge in elderly burn survivors is substantial. Patients sent to an SNF or with government insurance had increased mortality postdischarge. These data suggest that issues that may influence disposition status of elderly burn patients should be optimized prior to discharge to mitigate adverse outcomes associated with SNF placement.
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Brusselaers N, Agbenorku P, Hoyte-Williams PE. Assessment of mortality prediction models in a Ghanaian burn population. Burns 2012; 39:997-1003. [PMID: 23146574 DOI: 10.1016/j.burns.2012.10.023] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2012] [Revised: 09/30/2012] [Accepted: 10/24/2012] [Indexed: 11/19/2022]
Abstract
PURPOSE Over 40 new or modified outcome prediction models have been developed for severe burns; with age, total burned surface area (TBSA) and inhalation area as major determinants of mortality. The objective of this study was to assess their applicability in a developing country. PROCEDURES Data were collected retrospectively of a consecutive series of 261 patients (2009-2011) admitted to a Burns Intensive Care. Five outcome prediction models based on admission criteria were evaluated: Bull grid, Abbreviated Burn Severity Index--ABSI, Ryan-model, Belgian Outcome in Burn Injury--BOBI and revised Baux. Discriminative power and goodness-of-fit were assessed by receiver operating characteristic analyses (area under the curve--AUC) and Hosmer-Lemeshow tests. FINDINGS Median age was 10.5 years (IQR: 2.5-27 years), median TBSA 21% (IQR: 11-34%); 55.2% were male, 28 patients died (10.7%). Only 2 patients were intubated (0.8%). The AUC were between 77 and 86%. The ABSI model showed the best calibration (28.7 expected deaths). Ryan, BOBI and rBaux significantly underestimated mortality, whereas Bull showed an overestimation. CONCLUSION This study on a young group of burn patients showed moderate to good discriminative power using all five prediction models. The expected number of deaths tended to be underestimated in the three most recent prediction models.
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Affiliation(s)
- N Brusselaers
- General Internal Medicine, Infectious Diseases and Psychosomatic Medicine, Ghent University Hospital, Ghent, Belgium; Unit of Upper Gastrointestinal Research, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
| | - P Agbenorku
- Reconstructive Plastic Surgery & Burns Unit, Komfo Anokye Teaching Hospital, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - P E Hoyte-Williams
- Reconstructive Plastic Surgery & Burns Unit, Komfo Anokye Teaching Hospital, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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A new algorithm to allow early prediction of mortality in elderly burn patients. Burns 2012; 38:1114-8. [PMID: 22999211 DOI: 10.1016/j.burns.2012.08.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2012] [Revised: 08/15/2012] [Accepted: 08/21/2012] [Indexed: 11/20/2022]
Abstract
INTRODUCTION The elderly are the fastest growing population segment, and particularly susceptible to burns. Predicting outcomes for these patients remains difficult. Our objective was to identify early predictors of mortality in elderly burn patients. METHODS Our Burn Center's prospective database was reviewed for burn patients 60+ treated in the past 10 years. Predictor variables were identified by correlative analysis and subsequently entered into a multivariate logistic regression analysis examining survival to discharge. RESULTS 203 patients of 1343 (15%) were eligible for analysis. The average age was 72 ± 10 (range 60-102) and the average total body surface area (TBSA) burned was 23 ± 18% (range 1-95). Age, TBSA, base deficit, pO(2), respiratory rate, Glasgow Coma Score (GCS), and Revised Trauma Score (RTS, based on systolic blood pressure, respiratory rate, and GCS) all correlated with mortality (p ≤0 .05). Using multiple logistic regression analysis, a model with age, TBSA and RTS was calculated, demonstrating: In this model, β(0) is a constant that equals -8.32. CONCLUSIONS Predicting outcomes in elderly burn patients is difficult. A model using age, TBSA, and RTS can, immediately upon patient arrival, help identify patients with decreased chances of survival, further guiding end-of-life decisions.
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Engrav LH, Heimbach DM, Rivara FP, Kerr KF, Osler T, Pham TN, Sharar SR, Esselman PC, Bulger EM, Carrougher GJ, Honari S, Gibran NS. Harborview burns--1974 to 2009. PLoS One 2012; 7:e40086. [PMID: 22792216 PMCID: PMC3390332 DOI: 10.1371/journal.pone.0040086] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2012] [Accepted: 05/31/2012] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Burn demographics, prevention and care have changed considerably since the 1970s. The objectives were to 1) identify new and confirm previously described changes, 2) make comparisons to the American Burn Association National Burn Repository, 3) determine when the administration of fluids in excess of the Baxter formula began and to identify potential causes, and 4) model mortality over time, during a 36-year period (1974-2009) at the Harborview Burn Center in Seattle, WA, USA. METHODS AND FINDINGS 14,266 consecutive admissions were analyzed in five-year periods and many parameters compared to the National Burn Repository. Fluid resuscitation was compared in five-year periods from 1974 to 2009. Mortality was modeled with the rBaux model. Many changes are highlighted at the end of the manuscript including 1) the large increase in numbers of total and short-stay admissions, 2) the decline in numbers of large burn injuries, 3) that unadjusted case fatality declined to the mid-1980s but has changed little during the past two decades, 4) that race/ethnicity and payer status disparity exists, and 5) that the trajectory to death changed with fewer deaths occurring after seven days post-injury. Administration of fluids in excess of the Baxter formula during resuscitation of uncomplicated injuries was evident at least by the early 1990s and has continued to the present; the cause is likely multifactorial but pre-hospital fluids, prophylactic tracheal intubation and opioids may be involved. CONCLUSIONS 1) The dramatic changes include the rise in short-stay admissions; as a result, the model of burn care practiced since the 1970s is still required but is no longer sufficient. 2) Fluid administration in excess of the Baxter formula with uncomplicated injuries began at least two decades ago. 3) Unadjusted case fatality declined to ∼6% in the mid-1980s and changed little since then. The rBaux mortality model is quite accurate.
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Affiliation(s)
- Loren H Engrav
- Division of Plastic Surgery, Department of Surgery, University of Washington, Seattle, Washington, United States of America.
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Liu Y, Chen JJ, Crook N, Yu R, Xu XW, Cen Y. Epidemiologic investigation of burns in the elderly in Sichuan Province. Burns 2012; 39:389-94. [PMID: 22673117 DOI: 10.1016/j.burns.2012.04.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2011] [Revised: 03/14/2012] [Accepted: 04/24/2012] [Indexed: 02/05/2023]
Abstract
OBJECTIVE This study analysed the epidemiology of burns in the elderly in Sichuan Province, China, with the objective of formulating a prevention programme. METHODS A retrospective review of elderly patients admitted to the Burn Centre of West China Hospital during 2003-2009 was performed, including patient demographics, education and burn aetiology. RESULTS A total of 103 patients, mean age 69.5 years (range 60-95 years; 58 male, 45 female) were admitted. The most common causes of burn were flames (51.5%), scalding (37.9%), electrical (4.9%) and chemical (2.9%), respectively. The majority occurred at home (68.9%), principally in the kitchen (35.9%), while 19.4% occurred in the workplace. Burns with total body surface area (TBSA) of 0-10% accounted for 52.5% of those admitted for treatment; 10-30% TBSA burns accounted for 20.3%; 30-50% TBSA burns accounted for 15.5%; and burns with a TBSA >50% accounted for 11.7%. Only 6% of patients received appropriate first aid, and 32% did not receive treatment until more than 24h after injury. The education level was lower in the rural group. Both urban and rural groups had little knowledge of first aid for burns. CONCLUSIONS Burn-prevention programmes should promote improved living conditions and medical insurance, with prevention education for the elderly, especially in rural areas.
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Affiliation(s)
- Yong Liu
- Department of Burn and Plastic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
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Recovery from an eighty-percent total body surface area burn injury sustained at work. Arh Hig Rada Toksikol 2012; 63:223-6. [PMID: 22728806 DOI: 10.2478/10004-1254-63-2012-2169] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
This article presents a case of severe burn injury at work involving 80 % of body surface area and patient treatment and rehabilitation, which resulted in preserved working ability. The worker was injured by hot water and steam. After initial treatment in the intensive care unit, he underwent comprehensive clinical and outpatient rehabilitation that took 92 weeks, after which he returned to work. His working disability was 100 % after the initial treatment in the intensive care unit, but rehabilitation improved it to 50 %. It should always be kept in mind that even patients with serious or life-threatening injuries can be reintegrated into the workforce if patients, physicians, occupational physicians, and employers all work together.
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Gaucher S, Grabar S, Fragny D, Lecam B, Stéphanazzi J, Wassermann D. Burns in older people. Epidemiology, surgical management and outcome in a university hospital referral burn unit, 1994–2004. Eur Geriatr Med 2012. [DOI: 10.1016/j.eurger.2011.11.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Duke J, Wood F, Semmens J, Edgar D, Spilsbury K, Rea S. An assessment of burn injury hospitalisations of adolescents and young adults in Western Australia, 1983–2008. Burns 2012; 38:128-35. [DOI: 10.1016/j.burns.2011.02.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2010] [Revised: 02/07/2011] [Accepted: 02/24/2011] [Indexed: 10/15/2022]
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Burns in Sulaymaniyah province, Iraq: epidemiology and risk factors for death in patients admitted to hospital. J Burn Care Res 2011; 32:e126-34. [PMID: 21593682 DOI: 10.1097/bcr.0b013e3182223ef5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
This retrospective study was undertaken to describe the epidemiology of burns in the province of Sulaymaniyah in Iraqi Kurdistan and investigate factors associated with mortality. Hospital records of all patients admitted to the Burns and Plastic Surgery Centre of Sulaymaniyah for a burn incident during the calendar year of 2006 were reviewed retrospectively. A total of 947 acute burn patients were admitted over the year (females 53.5%, males 46.5%) of whom 41% were aged 0 to 14 years. Flame injuries were responsible for 59% and scalds for 37% of injuries. The median TBSA burnt was 19%, the median length of hospital stay was 5 days, and in-hospital mortality rate was 28%. Multivariable logistic regression showed that burn size, inhalation injury, older age, and female sex were significant risk factors for death. The adjusted odds ratios were 4.8 (95% confidence interval [CI] 1.3-20.0) for those aged 60 years or older compared with children aged 0 to 5 years; 2.2 (95% CI 1.2-4.1) for females compared with males; 9.8 (95% CI 4.8-20.0) for presence of inhalation injury; and 112.8 (95% CI 57.4-221.4) for ≥ 40% TBSA burnt compared with < 40% TBSA burnt. Burn injuries are an important public health problem in Iraq, and further studies are required to investigate circumstances surrounding burns and risk factors to inform planning of prevention programs.
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Survival function and protein malnutrition in burns patients at a rural hospital in Africa. World J Surg 2011; 35:1546-52. [PMID: 21573721 DOI: 10.1007/s00268-011-1122-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND The aim of this study was to estimate the incidence of acute malnutrition and to identify predictors of case fatality among burn patients in the poorest South African province, Eastern Cape. METHODS This longitudinal follow-up study was conducted among consecutive burn patients admitted to Nelson Mandela Academic Hospital, Mthatha, South Africa, between 2006 and 2008. Patients were monitored and treated daily from admission to discharge. Outcomes were acute protein malnutrition and mortality. Patients' demography, total body surface area (TBSA) of the burn, cause of the burn, weight, height, location of the burn, hemoglobin, serum albumin, wound infection, and antibiotics after culture and sensitivity results were the potential predictors of in-hospital mortality. A Cox's proportional hazards model for the time to death was then used to identify independent predictors of mortality after adjusting for confounding factors. Kaplan-Meier survival curves were generated for each arm of exposure status. RESULTS In all, 67 patients (35 males, 59 children) were studied. The mean (range) age was 8±12 years (1 month to 59 years). The cumulative incidence of acute malnutrition was 62.0% (n=42): 46.3% (n=31) at admission and 15.7% (n=11) after 7 days of hospitalization. Incidence of mortality was 16.4% (n=11 with in-hospital acute malnutrition). The only significant and independent predictors of mortality were total body surface area (TBSA) burn>40% [hazard ratio (HR) 10.5, 95% confidence interval (CI) 1.7-63; P<0.01] and affected anterior trunk (HR 4.4, 95% CI 1.3-14.7; P=0.018). CONCLUSIONS Urgent prevention strategies of burns and evidence-based practice with early nutritional supplementation are needed to reduce high rates of malnutrition and mortality.
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Albornoz CR, Villegas J, Sylvester M, Peña V, Bravo I. Burns are more aggressive in the elderly: Proportion of deep burn area/total burn area might have a role in mortality. Burns 2011; 37:1058-61. [DOI: 10.1016/j.burns.2011.03.006] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2010] [Revised: 01/31/2011] [Accepted: 03/12/2011] [Indexed: 11/29/2022]
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Forster NA, Zingg M, Haile SR, Künzi W, Giovanoli P, Guggenheim M. 30 years later—Does the ABSI need revision? Burns 2011; 37:958-63. [DOI: 10.1016/j.burns.2011.03.009] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2010] [Revised: 03/10/2011] [Accepted: 03/18/2011] [Indexed: 10/18/2022]
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88
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Duke J, Wood F, Semmens J, Edgar DW, Spilsbury K, Willis A, Hendrie D, Rea S. Rates of hospitalisations and mortality of older adults admitted with burn injuries in Western Australian from 1983 to 2008. Australas J Ageing 2011; 31:83-9. [DOI: 10.1111/j.1741-6612.2011.00542.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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89
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Influence of race and neighborhood on the risk for and outcomes of burns in the elderly in North Carolina. Burns 2011; 37:762-9. [PMID: 21353744 DOI: 10.1016/j.burns.2011.01.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2010] [Accepted: 01/18/2011] [Indexed: 11/20/2022]
Abstract
Risk factors for mortality and length of hospital stay in elderly burn patients are well established, but the influence of race and socioeconomic status has not been evaluated. This study evaluates the effect of neighborhood level socioeconomic indicators on burns risk, and determines whether race and neighborhood influence burn injury outcomes in the elderly. Data from the North Carolina Jaycee Burn Center was linked to United States Census Bureau block group socioeconomic data. The odds of death and increased length of hospital stay for European-Americans and Minorities were determined using logistic regression. Rates of burn were determined using Poisson regression, and multilevel modeling was used to evaluate the influence of neighborhood on outcomes. No significant differences in mortality were observed between European-American and Minority patients in individual (Minority OR 0.71; p=0.3200) and multilevel (0.72; p=0.4020) models. Minorities had significantly higher odds of increased length of hospital stay in individual (2.05; p=0.0020) and multilevel (2.55; 0.037) models. High proportions of rural households (RR=1.39; p=0.0010) and poverty (1.26; p<0.0001) were significantly associated with increased risk of burn. Additional investigation using larger databases will allow further elucidation of the contextual effects of socioeconomic status on burn in the elderly.
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90
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Rafla K, Tredget EE. Infection control in the burn unit. Burns 2010; 37:5-15. [PMID: 20561750 DOI: 10.1016/j.burns.2009.06.198] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2009] [Revised: 05/20/2009] [Accepted: 06/03/2009] [Indexed: 10/19/2022]
Abstract
The survival rates for burn patients have improved substantially in the past few decades due to advances in modern medical care in specialized burn centers. Burn wound infections are one of the most important and potentially serious complications that occur in the acute period following injury. In addition to the nature and extent of the thermal injury influencing infections, the type and quantity of microorganisms that colonize the burn wound appear to influence the future risk of invasive wound infection. The focus of medical care needs to be to prevent infection. The value of infection prevention has been acknowledged in organized burn care since its establishment and is of crucial importance. This review focuses on modern aspects of the epidemiology, diagnosis, management, and prevention of burn wound infections and sepsis.
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Affiliation(s)
- Karim Rafla
- Division of Plastic and Reconstructive Surgery and Critical Care, Department of Surgery, University of Alberta, University of Alberta, Edmonton, Alberta, Canada
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91
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Moore EC, Pilcher DV, Bailey MJ, Cleland H, McNamee J. A simple tool for mortality prediction in burns patients: APACHE III score and FTSA. Burns 2010; 36:1086-91. [PMID: 20494521 DOI: 10.1016/j.burns.2010.03.013] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2009] [Revised: 03/20/2010] [Accepted: 03/26/2010] [Indexed: 11/30/2022]
Abstract
Prediction of outcome for patients with major thermal injury is important to inform clinical decision making, alleviate individual suffering and improve hospital resource allocation. Age and burn size are widely accepted as the two largest contributors of mortality amongst burns patients. The APACHE (Acute Physiology and Chronic Health Evaluation) III-j score, which incorporates patient age, is also useful for mortality prediction, of intensive care populations. Validation for the burns specific cohort is unclear. A retrospective cohort study was performed on patients admitted to the Intensive Care Unit (ICU) via the Victorian Adult Burns Service (VABS), to compare observed mortality with burns specific markers of illness severity and APACHE III-j score. Our primary aim was to develop a mortality prediction tool for the burns population. Between January 1, 2002 and December 31, 2008, 228 patients were admitted to the ICU at The Alfred with acute burns. The mean age was 45.6 years and 81% (n=184) were male. Patients had severe injuries: the average percent TBSA (total body surface area) was 28% (IQR 10-40) and percent FTSA (full thickness surface area) was 18% (IQR 10-25). 86% (n=197) had airway involvement. Overall mortality in the 7-year period was 12% (n=27). Non-survivors were older, had larger and deeper burns, a higher incidence of deliberate self-harm, higher APACHE III-j scores and spent less time in hospital (but similar time in ICU), compared with survivors. Independent risk factors for death were percent FTSA (OR 1.03, 95% CI 1.01-1.05, p=0.01) and APACHE III-j score (OR 1.04, 95% CI 1.02-1.07, p<0.001). Mortality prediction based on both of these variables in combination was more specific than either individual variable alone (AUROC 0.85, 95% CI 0.79-0.92). Likelihood of death for patients with severe thermal injury can be predicted with accuracy from APACHE III-j score and percent FTSA. Prospective validation of our model on different burn populations is necessary.
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Affiliation(s)
- E C Moore
- Victorian Adult Burns Service, The Alfred Hospital, Commercial Rd, Prahran, 3181, Melbourne, Australia.
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92
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Outcome predictors and quality of life of severe burn patients admitted to intensive care unit. Scand J Trauma Resusc Emerg Med 2010; 18:24. [PMID: 20420719 PMCID: PMC2873368 DOI: 10.1186/1757-7241-18-24] [Citation(s) in RCA: 96] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2009] [Accepted: 04/27/2010] [Indexed: 11/10/2022] Open
Abstract
Background Despite significant medical advances and improvement in overall mortality rate following burn injury, the treatment of patients with extensive burns remains a major challenge for intensivists. We present a study aimed to evaluate the short- and the long-term outcomes of severe burn patients (total body surface area, TBSA > 40%) treated in a polyvalent intensive care unit (ICU) and to assess the quality of life of survivors, one year after the injury using the EuroQol-5D (EQ-5D) questionnaire. Methods A prospective-observational study was performed in an ICU of a University-affiliated hospital. Logistic regression analysis was used to identify the factors predicting in-hospital mortality. The EQ-5D questionnaire was used to asses participant's long term self-reported general health. Results During a period of five years, 50 patients participated in the study. Their mean age was 53.8 ± 19.8; they had a mean of %TBSA burned of 54.5 ± 18.1. 44% and 10% of patients died in the ICU and in the ward after ICU discharge, respectively. Baux index, SAPS II and SOFA on admission to the ICU, infectious and respiratory complications, and time of first burn wound excision were found to have a significant predictive value for hospital mortality. The level of health of all survivors was worse than before the injury. Problems in the five dimensions studied were present as follows: mobility (moderate 68.5%; extreme 0%), self-care (moderate 21%; extreme 36.9%), usual activities (moderate 68.5%; extreme 21%), pain/discomfort (moderate 68.5%; extreme 10.5%), anxiety/depression (moderate 36.9%; extreme 42.1%). Conclusions In severe burn patients, Baux index, severity of illness on admission to the ICU, complications, and time of first burn wound excision were the major contributors to hospital mortality. Quality of life was influenced by consequences of injury both in psychological and physical health.
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93
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Patient Safety Measures in Burn Care: Do National Reporting Systems Accurately Reflect Quality of Burn Care? J Burn Care Res 2010; 31:125-9. [DOI: 10.1097/bcr.0b013e3181cb8d00] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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94
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Yin Z, Qin Z, Xin W, Gomez M, Zhenjiang L. The characteristics of elderly burns in Shanghai. Burns 2009; 36:430-5. [PMID: 19828257 DOI: 10.1016/j.burns.2009.06.204] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2008] [Revised: 05/23/2009] [Accepted: 06/16/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVE This study aims to analyse the epidemiologic characteristics of severe burn in the elderly in Shanghai and to discusses a possible prevention programme for this population. METHODS A retrospective review of all medical records of elderly patients (aged 60 and older) admitted with acute burns to the Burn Center of the RuiJin Hospital between January 1996 and December 2004 was carried out. Patient demographics, etiology of burn, mechanism of injury, burn extent, anatomical areas burned, number of operations, and outcomes were reviewed. RESULTS A total of 201 (5.8% of hospitalised patients) elderly patients (mean age (+/-SD) of 69.3+/-7.1 years (range 60-90 years)) were admitted. Majority of the patients were men (62.2%) and the most common etiologies were flames (52.7%) and scalds (39.8%). The majority of burns occurred at home (73.6%), followed by burns at workplace (15.9%) and public areas (10.5%). The median total body area burned was 11.7% (range 0-84%), and the majority of burns were classified as mild (60.2%) and moderate (32.8%). Predominant anatomical areas involved were the legs (76.1%), arms (67.2%), head and neck (49.8%) and hands (49.3%). The most common pre-injury conditions were cardiovascular diseases (25.9%), diabetes (8.5%) and neurological diseases (6%). Eighty-seven patients (43.3%) required surgical treatment. The most common complications were multiple organ failure (2%), pneumonia (1%) and wound infection (1%). Sixteen patients (8%) died: half of them in hospital, and the rest at home. There was a significant correlation between post-injury complications and death (r=0.69, p<0.001). The mean total hospitalisation cost was yen 22993.09 (US$ 3381.34). CONCLUSIONS Domestic and workplace burns with devastating consequences are very common in the elderly population in Shanghai. Burn prevention education and implementation of safety measures at home and at workplace would help reduce such incidences.
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Affiliation(s)
- Zhang Yin
- Burn Center of Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, 200025 Shanghai, PR China
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95
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Li X, Peng Y, Shang X, Liu S. Epidemiologic investigation of geriatric burns in Southwest China. Burns 2009; 35:714-8. [DOI: 10.1016/j.burns.2008.10.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2008] [Accepted: 10/30/2008] [Indexed: 10/21/2022]
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96
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Keck M, Lumenta DB, Andel H, Kamolz LP, Frey M. Burn treatment in the elderly. Burns 2009; 35:1071-9. [PMID: 19520515 DOI: 10.1016/j.burns.2009.03.004] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2008] [Revised: 02/19/2009] [Accepted: 03/16/2009] [Indexed: 12/25/2022]
Abstract
The population of elderly patients is expected to rise continuously over the next decades due to global demographic changes. The elderly seem to be most vulnerable to burns and their management remains undoubtedly a challenge. A clear age margin for elderly patients is not yet defined, but most studies adhere to the inclusion of patients 65 years and above, but the general condition and social situation must be taken into account. The understanding of the physiological basis of aging and its related pathophysiological changes has only marginally influenced treatment and decision making in elderly burn patients. When looking at treatment regimens currently applied in elderly burn patients, the discussion of standards in intensive care as well as surgical strategies is ongoing. However, trends towards a moderate, non-aggressive resuscitation approach and careful inclusion of key parameters like physiological age, pre-burn functional status and premorbid conditions, seem to be useful guidelines for interdisciplinary treatment decisions. Once ordered for surgical treatment, the amount of body surface area operated in one session should be adapted to the general status of the patient. Even if older burn victims have a reported higher mortality rate than younger patients, improved therapeutic options have contributed to a reduced mortality rate even in the elderly over the last decades. As a result of improved outcome, more attention has to be given to a comprehensive rehabilitation program. This review will give an overview of the current literature and will draw attention to specific topics related to this important subpopulation of burn patients.
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Affiliation(s)
- M Keck
- Vienna Burn Centre, Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University Vienna, 1090 Vienna, Austria
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97
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Lundgren RS, Kramer CB, Rivara FP, Wang J, Heimbach DM, Gibran NS, Klein MB. Influence of comorbidities and age on outcome following burn injury in older adults. J Burn Care Res 2009; 30:307-14. [PMID: 19165104 DOI: 10.1097/bcr.0b013e318198a416] [Citation(s) in RCA: 95] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Despite advances in medical and surgical techniques, older adults tend to be at high risk for adverse outcomes following burn injury. The purpose of this study was to examine the relative impacts of age and medical comorbidities on outcome following injury in a cohort of older adults. This was a retrospective study of all patients age 55 and over admitted to the University of Washington Burn Center from 1999 to 2003. To examine the effect of baseline medical comorbidities on outcome, a Charlson Comorbidity Index score was calculated for each patient. Multivariate regression analyses were used to examine the impact of age and comorbidities on mortality and other complications. Patient records were also matched with the National Death Index to determine the effects of age and comorbidities on mortality within 1 year following hospital discharge. A total of 325 patients who were of 55 years and older were admitted to the burn center during the 5-year study period. The overall mortality rate was 18.5%. Mortality was independently associated with age, inhalation injury, and burn size. One-year mortality was significantly associated with those older than age 75 and the Charlson score. Longer length of stay was significantly associated with burn size, inhalation injury, and total number of in-hospital complications. This study demonstrates that patient age-independent of baseline medical comorbidities-and TBSA burn are the most significant factors impacting in-hospital mortality risk following burn injury. Higher number of medical comorbidities was associated with increased mortality risk within 1 year following discharge.
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Affiliation(s)
- Rachel S Lundgren
- University of Washington Burn Center, Department of Surgery, University of Washington, Seattle, Washington, USA
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98
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Miller JT, Btaiche IF. Oxandrolone treatment in adults with severe thermal injury. Pharmacotherapy 2009; 29:213-26. [PMID: 19170590 DOI: 10.1592/phco.29.2.213] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Severe thermal injury is associated with hypermetabolism and hypercatabolism, leading to skeletal muscle breakdown, lean body mass loss, weight loss, and negative nitrogen balance. Muscle protein catabolism in patients with severe thermal injury is the result of stress-induced increased release of cytokines and counterregulatory hormones. Coupled with decreased serum anabolic hormone concentrations such as testosterone and growth hormone along with the presence of insulin resistance, anabolism in patients with severe thermal injury is inefficient or impossible during the acute postburn period. This causes difficulty in restoring lean body mass and regaining lost body weight, as well as poor healing of the burn wound and delayed patient recovery. Oxandrolone, a synthetic derivative of testosterone, has been used in adult patients with severe thermal injury to enhance lean body mass accretion, restore body weight, and accelerate wound healing. In clinical studies, oxandrolone 10 mg orally twice/day improved wound healing, restored lean body mass, and accelerated body weight gain. During the rehabilitation period, oxandrolone therapy with adequate nutrition and exercise improved lean body mass, increased muscle strength, and restored body weight. However, most data on oxandrolone use in adult patients with severe thermal injury are derived from single-center studies, many of which enrolled a relatively small number of subjects and some of which had a poor design. Multicenter, prospective, randomized studies are needed to better define the optimal oxandrolone dosage and to confirm the efficacy and safety of this drug in adult patients with severe thermal injury.
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Affiliation(s)
- James T Miller
- Department of Pharmacy Services, Sinai-Grace Hospital, Detroit, Michigan, USA
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99
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Abstract
In the acute-care setting, it is widely accepted that elderly patients have increased morbidity and mortality compared with young healthy patients. The reasons for this, however, are largely unknown. Although animal modeling has helped improve treatment strategies for young patients, there are a scarce number of studies attempting to understand the mechanisms of systemic insults such as trauma, burn, and sepsis in aged individuals. This review aims to highlight the relevance of using animals to study the pathogenesis of these insults in the aged and, despite the deficiency of information, to summarize what is currently known in this field.
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100
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Lumenta D, Hautier A, Desouches C, Gouvernet J, Giorgi R, Manelli JC, Magalon G. Mortality and morbidity among elderly people with burns—Evaluation of data on admission. Burns 2008; 34:965-74. [DOI: 10.1016/j.burns.2007.12.004] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2007] [Accepted: 12/05/2007] [Indexed: 11/30/2022]
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