1
|
Akbar Mohammadi A, Goodarzian MR, Parvar SY, Rafiei E, Keshavarz M, Zardosht M. Epidemiology of Burn Injuries Among Adult Females in Southern Iran; A Retrospective Study from 2007 to 2022. J Burn Care Res 2024; 45:638-643. [PMID: 37325927 DOI: 10.1093/jbcr/irad086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Indexed: 06/17/2023]
Abstract
Burn-by flame, flush, scald, electrical, and chemical types-accounts for 5%-12% of trauma injuries worldwide. In Iranian studies, females were the main victims of domestic burns with higher mortality and frequencies. This retrospective study evaluates the epidemiology and etiology of burn injuries in females aged 25-64 years between October 2007 and May 2022 in southern Iran. Demographics and burn etiology information were collected by questionnaires at admission. Univariate and multivariate regression analysis was used to determine the relationship between variables and burn mortality. Pearson's Chi-Square and One-way ANOVA tests were utilized to compare different burn etiologies. Of 3212 females with burn injuries, 1499 (46.6%) were included with a mean age of 38.5 ± 10.8 years. Flame (59.7%) and flush (28.9%) were significantly the most common injuries mechanism. Burn was most common in rural areas (53.9%) and indoor settings (62.1%) (P-value < .001). 77.9% of the population were under-diploma (P-value < .001), and 3.5% were divorced with higher burn-suicide attempts. The mean Total Body Surface Area (TBSA%) was 41.1 ± 28.3%, and the mean Length of Stay (LOS) was 14.5 ± 13.2 days with a 39.1% mortality rate. With univariate and multivariate analysis, TBSA%, indoor places, flame, flush, and urban living were risk factors for burn mortality. Briefly, flame in indoor settings is the most common type of burn injury affecting adult females with lower educational levels living in rural areas. Such epidemiological studies of burns in adult females may be helpful for health policymakers to develop burn prevention programs.
Collapse
Affiliation(s)
- Ali Akbar Mohammadi
- Department of Plastic Surgery, Amir-al-Moemenin Hospital, Burn and Wound Healing Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - MReza Goodarzian
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Elham Rafiei
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Keshavarz
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mitra Zardosht
- Department of Plastic Surgery, Amir-al-Moemenin Hospital, Burn and Wound Healing Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| |
Collapse
|
2
|
Mauck MC, Zhao Y, Goetzinger AM, Tungate AS, Spencer AB, Lal A, Barton CE, Beaudoin F, McLean SA. Incidence of persistent opioid use following traumatic injury. Reg Anesth Pain Med 2024; 49:79-86. [PMID: 37364919 DOI: 10.1136/rapm-2022-103662] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 05/11/2023] [Indexed: 06/28/2023]
Abstract
INTRODUCTION Major traumatic injuries are a known risk factor for persistent opioid use, but data describing the relationship between specific traumatic injuries and opioid use is lacking. METHODS We used insurance claims data from January 1, 2001 to December 31, 2020 to estimate the incidence of new persistent opioid use in three hospitalized trauma populations: individuals hospitalized after burn injury (3809, 1504 of whom required tissue grafting), individuals hospitalized after motor vehicle collision (MVC; 9041), and individuals hospitalized after orthopedic injury (47, 637). New persistent opioid use was defined as receipt of ≥1 opioid prescriptions 90-180 days following injury in an individual with no opioid prescriptions during the year prior to injury. RESULTS New persistent opioid use was observed in 12% (267/2305) of individuals hospitalized after burn injury with no grafting, and 12% (176/1504) of burn injury patients requiring tissue grafting. In addition, new persistent opioid use was observed in 16% (1454/9041) of individuals hospitalized after MVC, and 20% (9455/47, 637) of individuals hospitalized after orthopedic trauma. In comparison, rates of persistent opioid use in all trauma cohorts (19%, 11, 352/60, 487) were greater than the rates of persistent opioid use in both non-traumatic major surgery (13%) and non-traumatic minor surgery (9%). CONCLUSIONS These data demonstrate that new persistent opioid use frequently occurs in these common hospitalized trauma populations. Improved interventions to reduce persistent pain and opioid use in patients hospitalized after these and other traumas are needed.
Collapse
Affiliation(s)
- Matthew C Mauck
- Institute for Trauma Recovery, The University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
- Anesthesiology, The University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Ying Zhao
- Anesthesiology, The University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Amy M Goetzinger
- Anesthesiology, The University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Andrew S Tungate
- Institute for Trauma Recovery, The University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
- Anesthesiology, The University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Alex B Spencer
- Anesthesiology, The University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Asim Lal
- Institute for Trauma Recovery, The University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
- Anesthesiology, The University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Chloe E Barton
- Institute for Trauma Recovery, The University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
- Anesthesiology, The University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Francesca Beaudoin
- Department of Emergency Medicine, Brown University Warren Alpert Medical School, Providence, Rhode Island, USA
| | - Samuel A McLean
- Institute for Trauma Recovery, The University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
- Emergency Medicine, The University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| |
Collapse
|
3
|
Tejiram S, Solomon EA, Sen S, Greenhalgh DG, Palmieri TL, Romanowski KS. Does Socioeconomic Status or Methamphetamine use Impact Discharge Opioid Requirements in Burn Injured Patients? J Burn Care Res 2022. [DOI: 10.1093/jbcr/irac009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Methamphetamine (MA) use is associated with lower socioeconomic status (SES) and increased opioid use. Though MA use itself has been linked to larger burn injuries and increased length of stay, studies examining the effect of SES on opioid use in this patient population remain limited. The aim of this work was to examine how both SES and/or MA use in burn patients impacted discharge opioid requirements. Records of burn patients admitted to an ABA verified burn center were reviewed from January 2016 to December 2017. Patients were grouped into MA positive (MPOS) or negative groups (MNEG) based on admission urine toxicology screening. Pain scores, oral morphine opioid equivalents (OE), and adjunct pain medication use reported within 24 hours of discharge were examined. SES was determined by zip code. No difference was found between MPOS and MNEG groups regarding discharge OE (p=0.4), OE/TBSA (p=0.79), or pain score (p=0.09). Low SES was more prevalent in MPOS patients (p<0.0001) but low SES was not a predictor of discharge OE (p=0.7), OE/TBSA (p=0.7), or pain score (p = 0.15). Discharge OE and OE/TBSA requirements correlated with discharge pain score (p<0.0001) and LOS (p<0.01), but not SES. Multivariate linear regression found that MNEG status (p=0.005), pain score (p < 0.0001), concurrent use of benzodiazepines and gabapentin (p<0.001), but not low SES, were independently associated with increased OE. Although lower SES was seen in patients using MA, SES was not associated with discharge opioid use or pain scores. Additional work will be necessary to determine factors affecting opioid use in this population.
Collapse
Affiliation(s)
- Shawn Tejiram
- The Burn Center, MedStar Washington Hospital Center, Washington, DC, USA
| | - E A Solomon
- University of California, Davis Health, Sacramento, CA
| | - S Sen
- Department of Surgery, Burn Division, University of California, Davis, Sacramento, CA
| | - D G Greenhalgh
- Department of Surgery, Burn Division, University of California, Davis, Sacramento, CA
| | - T L Palmieri
- Department of Surgery, Burn Division, University of California, Davis, Sacramento, CA
| | - K S Romanowski
- Department of Surgery, Burn Division, University of California, Davis, Sacramento, CA
| |
Collapse
|
4
|
Abu Ibaid AH, Hebron CA, Qaysse HA, Coyne MJ, Potokar TS, Shalltoot FA, Shalabi MA. Epidemiology, aetiology and knowledge, attitudes, and practices relating to burn injuries in Palestine: A community-level research. Int Wound J 2021; 19:1210-1220. [PMID: 34761542 PMCID: PMC9284619 DOI: 10.1111/iwj.13716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 10/12/2021] [Accepted: 10/20/2021] [Indexed: 12/01/2022] Open
Abstract
The aim of this study was to identify the epidemiology, aetiology as well as the knowledge, attitudes, and practices relating to burn injuries in Palestine. A mixed‐method approach was used. A survey was distributed to a total of 1500 households selected by randomised approach. The survey was standardised based on World Health Organisation's guidelines for conducting community surveys on injury. Additionally, there were 12 focus group discussions and 10 key informant interviews to collect rich qualitative data. In the West Bank and Gaza, 1.5% of Palestinians had experienced serious burn injuries in the 12 months. The total sample of 1500 yields a margin of error (plus/minus) = 2.5% at a 95% level of confidence and a response distribution (P = 50%) with 3% non‐response rate. Of the 1500 households approached, 184 reported a total of 196 burn injuries, with 87.2% occurring inside the home: 69.4% were females and 39.3% were children. The main source of reported cause of burn was heat and flame (36%), electric current (31.6%), hot liquid (28.6%), and chemicals (2.7%). The most common first aid for burns was pouring water (74.7%). People in rural, refugee, and Bedouin settings had the highest incidence of burns. This study provides the burn prevalence rate, explanatory factors that contribute to the frequency of burns in Palestine. Making burn prevention a higher priority within the national policy is crucial.
Collapse
Affiliation(s)
| | - Caitlin A Hebron
- Centre for Global Burn, Policy & Research, Swansea University, Swansea, UK.,NIHR Global Health Research Group on Burn Trauma, Swansea, UK.,International Network for Training, Education & Research in Burns "Interburns", Cardiff, UK
| | | | | | - Tom S Potokar
- Centre for Global Burn, Policy & Research, Swansea University, Swansea, UK.,NIHR Global Health Research Group on Burn Trauma, Swansea, UK.,International Network for Training, Education & Research in Burns "Interburns", Cardiff, UK
| | | | | |
Collapse
|
5
|
Dalton MK, Riviello R, Kubasiak JC, Sokas CM, Osman SY, Jin G, Nitzschke SL, Ortega G. The impact of the Affordable Care Act's medicaid expansion on patients admitted for burns: An analysis of national data. Burns 2021; 48:1340-1346. [PMID: 34903411 DOI: 10.1016/j.burns.2021.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 10/24/2021] [Accepted: 10/29/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The first states began implementing the Medicaid expansion provisions of the Patient Protection and Affordable Care Act (ACA) in 2014. Studies have yet to address its impact on burn patients. METHODS Burn patients in geographic regions that expanded Medicaid coverage were compared to patients in regions that did not expand Medicaid before and after implementation of the ACA using bivariate statistics and a difference-in-differences model. A multivariable logistic regression was used to identify factors associated with having Medicaid insurance. The primary outcome of this study was the rate of Medicaid insurance. RESULTS Of 25,331 discharges, we found greater increases in Medicaid coverage after the ACA in the Medicaid expander regions (23.4-40.2%) compared to the non-expander regions (18.5-20.1%). The difference-in-differences estimate between the expander and non-expander regions was 0.15 (95% CI: 0.11-0.18, p < 0.001). Patients admitted in expander regions were more likely to be insured by Medicaid (OR 1.57 [95%CI 1.21-2.05]), as were patients of Black race (OR 1.25 [95%CI 1.19-1.32), Hispanic ethnicity (OR 1.29 [95%CI 1.14-1.46]), and female sex (OR 1.59 [95%CI 1.11-2.27]). We also found a significant interaction between time period (pre-ACA/post-ACA) and expander region location (OR 2.10 [95%CI 1.67-2.62]). CONCLUSIONS The Medicaid expansion provision of the ACA led to increased Medicaid coverage among burn patients which was significantly higher in areas with widespread implementation of the expansion.
Collapse
Affiliation(s)
- Michael K Dalton
- Center for Surgery and Public Health, Harvard Medical School, Harvard T. H. Chan School of Public Health, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA; Department of Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA.
| | - Robert Riviello
- Division of Trauma, Burns, and Surgical Critical Care, Brigham and Women's Hospital, Boston, MA, USA
| | - John C Kubasiak
- Division of Trauma, Burns, and Surgical Critical Care, Brigham and Women's Hospital, Boston, MA, USA
| | - Claire M Sokas
- Center for Surgery and Public Health, Harvard Medical School, Harvard T. H. Chan School of Public Health, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA; Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Samia Y Osman
- Center for Surgery and Public Health, Harvard Medical School, Harvard T. H. Chan School of Public Health, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Ginger Jin
- Center for Surgery and Public Health, Harvard Medical School, Harvard T. H. Chan School of Public Health, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | | | - Gezzer Ortega
- Center for Surgery and Public Health, Harvard Medical School, Harvard T. H. Chan School of Public Health, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA.
| |
Collapse
|
6
|
Abstract
INTRODUCTION Burn-related injuries are a leading cause of morbidity across the globe. Accurate assessment and treatment have been demonstrated to reduce the morbidity and mortality. This essay explores the forms of artificial intelligence to be implemented the field of burns management to optimise the care we deliver in the National Health Service (NHS) in the UK. METHODS Machine Learning methods which predict or classify are explored. This includes linear and logistic regression, artificial neural networks, deep learning, and decision tree analysis. DISCUSSION Utilizing Machine Learning in burns care holds potential from prevention, burns assessment, predicting mortality and critical care monitoring to healing time. Establishing a regional or national Machine Learning group would be the first step towards the development of these essential technologies. CONCLUSION The implementation of machine learning technologies will require buy-in from the NHS health boards, with significant implications with cost of investment, implementation, employment of machine learning teams and provision of training to medical professionals.
Collapse
Affiliation(s)
- Lydia Robb
- Core Surgical Trainee, East of Scotland Deanery, Plastic Surgery Department, NHS Lothian, St John's Hospital at Howden, Livingston
| |
Collapse
|
7
|
Peters J, Bello MS, Spera L, Gillenwater TJ, Yenikomshian HA. The Impact of Race/Ethnicity on the Outcomes of Burn Patients: A Systematic Review of the Literature. J Burn Care Res 2021; 43:323-335. [PMID: 34520543 DOI: 10.1093/jbcr/irab174] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Racial and ethnic disparities are endemic to the United States and are only beginning to attract the attention of researchers. With an increasingly diverse population, focused and tailored medicine to provide more equitable care is needed. For surgical trauma populations, this topic is a small but expanding field and still rarely mentioned in burn medicine. Disparities in prevention, treatment, and recovery outcomes between different racial and ethnic minorities who are burned are rarely discussed. The purpose of this study is to determine the current status of identified disparities of care in the burn population literature and areas of future research. A systematic review was conducted of literature utilizing PubMed for articles published between 2000-2020. Searches were used to identify articles that crossed the burn term (burn patient OR burn recovery OR burn survivor OR burn care) and a race/ethnicity and insurance status-related term (race/ethnicity OR African-American OR Black OR Asian OR Hispanic OR Latino OR Native American OR Indigenous OR Mixed race OR 2 or more races OR socioeconomic status OR insurance status). Inclusion criteria were English studies in the US that discussed disparities in burn injury outcomes or risk factors associated with race/ethnicity. 1,169 papers were populated, 55 were reviewed, and 36 articles met inclusion criteria. Most studies showed minorities had poorer inpatient and outpatient outcomes. While this is a concerning trend, there is a paucity of literature in this field and more research is needed to create culturally-tailored medical care and address the needs of disadvantaged burn survivors.
Collapse
Affiliation(s)
- Jasmine Peters
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Mariel S Bello
- LAC+USC Hospital, University of Southern California, Los Angeles, CA, USA.,Department of Psychology, University of Southern California, Los Angeles, CA, USA
| | - Leigh Spera
- LAC+USC Hospital, University of Southern California, Los Angeles, CA, USA
| | - T Justin Gillenwater
- Division of Plastic Surgery, University of Southern California, Los Angeles, CA, USA
| | - Haig A Yenikomshian
- Division of Plastic Surgery, University of Southern California, Los Angeles, CA, USA
| |
Collapse
|
8
|
Huang S, Dang J, Yenikomshian HA, Gillenwater J. Gender identification in burns: A call for inclusivity of transgender and gender diverse patients in burn care and research. J Burn Care Res 2021; 42:1292. [PMID: 34379768 DOI: 10.1093/jbcr/irab157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Samantha Huang
- Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Justin Dang
- Sidney Kimmel Medical College, Philadelphia, PA
| | - Haig A Yenikomshian
- Division of Plastic and Reconstructive Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA.,Los Angeles County Regional Burn Center, Los Angeles County + University of Southern California Medical Center, Los Angeles, CA
| | - Justin Gillenwater
- Division of Plastic and Reconstructive Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA.,Los Angeles County Regional Burn Center, Los Angeles County + University of Southern California Medical Center, Los Angeles, CA
| |
Collapse
|
9
|
Nanocarrier-Mediated Topical Insulin Delivery for Wound Healing. MATERIALS 2021; 14:ma14154257. [PMID: 34361451 PMCID: PMC8348788 DOI: 10.3390/ma14154257] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 07/23/2021] [Accepted: 07/25/2021] [Indexed: 12/12/2022]
Abstract
Wound care has been clinically demanding due to inefficacious treatment that represents an economic burden for healthcare systems. In Europe, approximately 7 million people are diagnosed with untreated wounds, leading to a cost between 6.000€ and 10.000€ per patient/year. In the United States of America, 1.5 million people over 65 years old suffer from chronic wounds. A promising therapeutic strategy is the use of exogenous growth factors because they are decreased at the wound site, limiting the recovery of the skin. Insulin is one of the cheapest growth factors in the market able to accelerate the re-epithelialization and stimulate angiogenesis and cell migration. However, the effectiveness of topical insulin in wound healing is hampered by the proteases in the wound bed. The encapsulation into nanoparticles improves its stability in the wound, providing adhesion to the mucosal surface and allowing its sustained release. The aim of this review is to perform a standing point about a promising strategy to treat different types of wounds by the topical delivery of insulin-loaded nanocarriers.
Collapse
|
10
|
Teklay S, Balai E, Patel L. The Complexity of Managing a Burned Irreducible Umbilical Hernia in an Adult. Cureus 2021; 13:e14030. [PMID: 33898118 PMCID: PMC8059485 DOI: 10.7759/cureus.14030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
We present a case of a 65-year-old male with a longstanding non-symptomatic irreducible umbilical hernia who presented with a three-day-old full-thickness thermal burn to the hernia. The burn was sustained while operating a metal drop forger, where the patient was repeatedly exposed to 30-second bursts of heat from the furnace, with temperature exceeding 1350°C. He estimated he had this exposure approximately 48 times during an 8-hour shift, giving him a total of 24 minutes cumulative exposure to the heat. The patient reported that he normally wore an abdominal binder under his heat-resistant apron to temporarily flatten and protect his hernia. On the day of the injury, he had not been wearing this binder. The patient was initially unaware that he had sustained a burn; upon delayed presentation to the hospital, he had cellulitis surrounding a 0.25% total body surface area (TBSA) full-thickness burn. Contrast-enhanced CT abdomen demonstrated an umbilical hernia with a neck diameter of 2.3cm, with breach of the hernia fascia but no communication between the bowel and burnt tissue. After discussion between Plastic Surgery and General Surgery teams the decision was made to manage the burn non-operatively with daily flamazine dressings and empirical antibiotics for the cellulitis. Once this area had healed, elective mesh repair of the umbilical hernia was carried out. This is the first adult case of a full-thickness burn overlying an umbilical hernia to be reported in the literature. The case highlights both an unusual aetiology and a rare injury, as well as the multi-disciplinary teamwork required to manage it successfully.
Collapse
Affiliation(s)
- Samuel Teklay
- Plastic Surgery, Queen Elizabeth Hospital, Birmingham, GBR
| | - Edward Balai
- Plastic Surgery, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, GBR
| | - Lopa Patel
- Plastic Surgery, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, GBR
| |
Collapse
|
11
|
Abrams TE, Lloyd AA, Held ML, Skeesick JD. Social workers as members of burn care teams: A qualitative thematic analysis. Burns 2021; 48:191-200. [PMID: 33773859 DOI: 10.1016/j.burns.2021.03.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 02/24/2021] [Accepted: 03/05/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Social workers on interprofessional teams contribute to treating the psychosocial sequelae of burn trauma patients in cooperation with many other burn-treatment team members. However, the roles and skills exercised by social workers can vary between burn units as well as the skills social work students are taught in their academic programs. METHODS A purposive sample of 13 burn unit social workers were interviewed online using semi-structured questions. This qualitative thematic analysis of data was conducted to identify how social workers perceive their roles, responsibilities, and knowledge as they relate to their work with patients and their families in a burn unit. RESULTS Skills, challenges and barriers to rehabilitation, and resources were identified during thematic analysis within and across participant data as factors social workers found to be important for their work in burn units. CONCLUSION By expanding the body of knowledge about factors that impact social work care for burn patients, Social work academic programs may better understand how to prepare medical social work students for best practices in the care of burn-injured patients, survivors, and families at inpatient and community levels.
Collapse
Affiliation(s)
- Thereasa E Abrams
- University of Tennessee Knoxville, College of Social Work, Nashville, TN, United States.
| | - Alison A Lloyd
- University of Tennessee Knoxville, College of Social Work, Nashville, TN, United States
| | - Mary L Held
- University of Tennessee Knoxville, College of Social Work, Nashville, TN, United States
| | - Jessica D Skeesick
- University of Tennessee Knoxville, College of Social Work, Nashville, TN, United States
| |
Collapse
|
12
|
Snelling S, Challoner T, Lewis D. Burns and socioeconomic deprivation: the experience of an adult burns centre. Burns 2021; 47:1890-1895. [PMID: 33722449 DOI: 10.1016/j.burns.2021.02.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 02/16/2021] [Accepted: 02/22/2021] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Burns incidence, mortality and complication rates have been shown to be directly correlated by race, gender and socioeconomic status. As such, socioeconomic status (SES) has been previously highlighted as a target for burn prevention in the UK and abroad. The Queen Elizabeth Hospital, Birmingham (QEHB) is the regional Burns Centre for the Midlands Burn Network, supporting a population of 13.7 million METHODS: 16-year retrospective review was performed of all acute adult burns assessed by the Burns and Plastics Department, QEHB. The data included patient demographics (age, gender, ethnic origin and postcode), mechanism of injury, total body surface area (TBSA) affected and whether first aid was given. IMD Rank, IMD Scores were obtained from individual postcodes, as well as incidence data per electoral ward. RESULTS In our analyses there were 3369 total acute admissions and acute assessments. 812 patients (24.1%) were in the most deprived decile. 1715 patients (50.9%) live within the 3 most deprived deciles. The deciles with the lowest completion of first aid were the first (524, 70.72%), third (257, 72.39%) and second (351, 72.82%). CONCLUSIONS This study shows patients from the most deprived areas are over-represented in burns incidence and are less likely to perform first aid. We feel this should be highlighted in burns prevention and education strategies.
Collapse
Affiliation(s)
- Samuel Snelling
- Department of Burns & Plastic Surgery, University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Edgbaston, Birmingham B15 2GW, United Kingdom.
| | - Thomas Challoner
- Department of Burns & Plastic Surgery, University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Edgbaston, Birmingham B15 2GW, United Kingdom
| | - Darren Lewis
- Department of Burns & Plastic Surgery, University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Edgbaston, Birmingham B15 2GW, United Kingdom
| |
Collapse
|
13
|
Abstract
BACKGROUND Among burn patients, research is conflicted, but may suggest that females are at increased risk of mortality, despite the opposite being true in non-burn trauma. Our objective was to determine whether sex-based differences in burn mortality exist, and assess whether patient demographics, comorbid conditions, and injury characteristics explain said differences. METHODS Adult patients admitted with burn injury-including inhalation injury only-between 2004 and 2013 were included. Inverse probability of treatment weights (IPTW) and inverse probability of censor weights (IPCW) were calculated using admit year, patient demographics, comorbid conditions, and injury characteristics to adjust for potential confounding and informative censoring. Standardized Kaplan-Meier survival curves, weighted by both IPTW and IPCW, were used to estimate the 30-day and 60-day risk of inpatient mortality across sex. RESULTS Females were older (median age 44 vs. 41 years old, p < 0.0001) and more likely to be Black (32% vs. 25%, p < 0.0001), have diabetes (14% vs. 10%, p < 0.0001), pulmonary disease (14% vs. 7%, p < 0.0001), heart failure (4% vs. 2%, p = 0.001), scald burns (45% vs. 26%, p < 0.0001), and inhalational injuries (10% vs. 8%, p = 0.04). Even after weighting, females were still over twice as likely to die after 60 days (RR 2.87, 95% CI 1.09, 7.51). CONCLUSION Female burn patients have a significantly higher risk of 60-day mortality, even after accounting for demographics, comorbid conditions, burn size, and inhalational injury. Future research efforts and treatments to attenuate mortality should account for these sex-based differences. The project was supported by the National Institutes of Health, Grant Number UL1TR001111.
Collapse
|
14
|
Vrouwe SQ, Johnson MB, Pham CH, Lane CJ, Garner WL, Gillenwater TJ, Yenikomshian HA. The Homelessness Crisis and Burn Injuries: A Cohort Study. J Burn Care Res 2020; 41:820-827. [PMID: 32619013 DOI: 10.1093/jbcr/iraa023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The United States is facing a growing homelessness crisis. We characterize the demographics and outcomes of homeless patients who sustain burn injury and compare them to a cohort of domiciled patients. A retrospective cohort study was performed at the Los Angeles County + University of Southern California Regional Burn Center for consecutive acute burn admissions in adults from June 1, 2015, to December 31, 2018. Patients were categorized as either domiciled or homeless at the time of their injury. Prevalence rates were estimated using data from the regional homeless count. From 881 admissions, 751 (85%) had stable housing and 130 (15%) were homeless. The rate of burn injury requiring hospitalization for homeless adults was estimated at 88 per 100,000 persons. Homeless patients had a significantly larger median burn size (7 vs 5%, P < .05) and a greater rate of flame burns (68 vs 42%, P < .001). For the homeless, rates of assault and self-inflicted injury were 4- (18 vs 4%, P < .001) and 2-fold higher (9 vs 4%, P < .001), respectively. Homeless patients had higher rates of mental illness (32 vs 12%, P < .001) and substance abuse (88 vs 22%, P < .001), and were less likely to follow-up as outpatients (54 vs 87%, P < .001). There was no difference in mortality. Homeless patients had a longer median length of stay (LOS; 11 vs 7 days, P < .001) without significant differences in LOS per percentage TBSA. Homeless individuals should be considered a high-risk population for burn injury. This distinction serves as a call to action for the development of burn prevention strategies.
Collapse
Affiliation(s)
- Sebastian Q Vrouwe
- Division of Plastic and Reconstructive Surgery, University of Southern California, Los Angeles, California
| | - Maxwell B Johnson
- Division of Plastic and Reconstructive Surgery, University of Southern California, Los Angeles, California
| | - Christopher H Pham
- Division of Plastic and Reconstructive Surgery, University of Southern California, Los Angeles, California
| | - Christianne J Lane
- Division of Biostatistics, University of Southern California, Los Angeles, California
| | - Warren L Garner
- Division of Plastic and Reconstructive Surgery, University of Southern California, Los Angeles, California
| | - T Justin Gillenwater
- Division of Plastic and Reconstructive Surgery, University of Southern California, Los Angeles, California
| | - Haig A Yenikomshian
- Division of Plastic and Reconstructive Surgery, University of Southern California, Los Angeles, California
| |
Collapse
|
15
|
Murphy S, Clark DE, Carter DW. Racial disparities exist among burn patients despite insurance coverage. Am J Surg 2018; 218:47-50. [PMID: 30195836 DOI: 10.1016/j.amjsurg.2018.08.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 08/13/2018] [Accepted: 08/23/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Age, total burn surface area (TBSA), and inhalation injury are proven predictors of mortality and morbidity following burn injury. Most previous studies have also found that African Americans and females with burns also fare worse. We sought to determine whether these disparities were reduced when burn victims were analyzed separately by categories of insurance coverage. METHODS We evaluated records in the National Burn Registry (NBR) from 2002 to 2011. Multivariate logistic regression was performed to determine factors associated with inpatient mortality, including age, TBSA, inhalation injury, race, and sex, and allowing for clustering by hospital. Separate models were constructed for each category of insurance. 95% confidence intervals (CI) not including 1 for any odds ratio were considered evidence of statistical significance (designated by * in the table below). RESULTS NBR included records from 172,640 patients (55.8% Caucasian, 18.1% African American, 14.2% Hispanic, 6.4% other minority groups, 5.4% unknown). Age, TBSA, and inhalation were strong predictors of mortality as expected. Non-African American males were the largest group for all insurance categories, and had the lowest mortality. Controlling for these factors, and compared with non-African American males, African American males had consistently increased odds of mortality regardless of insurance coverage. African American females had increased odds of mortality if they had Private, Medicare, or Medicaid insurance, and Non-African American females had increased odds of mortality if they had Private or Medicaid insurance. The association of Hispanic ethnicity with mortality was inconsistent or insignificant, and other minority groups had too few members to evaluate. Most patients were missing comorbidity data, and no other socioeconomic or hospital data were available in NBR. CONCLUSIONS African American males with burn injury are at increased risk of mortality regardless of insurance coverage, and most females are at increased risk regardless of race. Analyzing the reasons for these disparities will require databases containing more complete comorbidity, socioeconomic, and/or hospital data.
Collapse
Affiliation(s)
- Scha'chia Murphy
- Maine Medical Center, Department of Surgery, Portland, ME, United States.
| | - David E Clark
- Tufts University School of Medicine, Maine Medical Center Research Institute, 81 Research Drive, Scarborough, ME, 04074, United States.
| | - Damien W Carter
- Tufts University School of Medicine Director, MMC Burn & Soft Tissue Service, Maine Medical Center, Department of Surgery, 22 Bramhall Street, Portland, ME, 04102, United States.
| |
Collapse
|
16
|
Patel DD, Rosenberg M, Rosenberg L, Foncerrada G, Andersen CR, Capek KD, Leal J, Lee JO, Jimenez C, Branski L, Meyer WJ, Herndon DN. Poverty, population density, and the epidemiology of burns in young children from Mexico treated at a U.S. pediatric burn facility. Burns 2018; 44:1269-1278. [PMID: 29551448 DOI: 10.1016/j.burns.2018.02.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 01/24/2018] [Accepted: 02/01/2018] [Indexed: 10/17/2022]
Abstract
INTRODUCTION Children 5 and younger are at risk for sustaining serious burn injuries. The causes of burns vary depending on demographic, cultural and socioeconomic variables. At this pediatric burn center we provided medical care to children from Mexico with severe injuries. The purpose of this study was to understand the impact of demographic distribution and modifiable risk factors of burns in young children to help guide prevention. METHODS A retrospective chart review was performed with children 5 and younger from Mexico who were injured from 2000-2013. The medical records of 447 acute patients were reviewed. Frequency counts and percentages were used to identify geographic distribution and calculate incidence of burns. Microsoft Powermap software was used to create a geographical map of Mexico based on types of burns. A binomial logistic regression was used to model the incidence of flame burns as opposed to scald burns in each state with relation to population density and poverty percentage. In all statistical tests, alpha=0.05 for a 95% level of confidence. RESULTS Burns were primarily caused by flame and scald injuries. Admissions from flame injuries were mainly from explosions of propane tanks and gas lines and house fires. Flame injuries were predominantly from the states of Jalisco, Chihuahua, and Distrito Federal. Scalds were attributed to falling in large containers of hot water or food on the ground, and spills of hot liquids. Scald injuries were largely from the states of Oaxaca, Distrito Federal, and Hidalgo. The odds of a patient having flame burns were significantly associated with poverty percentage (p<0.0001) and population density (p=0.0085). Increasing levels of poverty led to decrease in odds of a flame burn, but an increase in the odds of scald burns. Similarly, we found that increasing population density led to a decrease in the odds of a flame burn, but an increase in the odds of a scald burn. CONCLUSIONS Burns in young children from Mexico who received medical care at this pediatric burn center were attributed to flame and scalds. Potential demographic associations have been identified. Different states in Mexico have diverse cultural and socioeconomic variables that may influence the etiology of burns in young children and this information may help efficiently tailor burn prevention campaigns for burn prevention efforts in each region. APPLICABILITY OF RESEARCH TO PRACTICE This information will be used to develop and help modify existing prevention campaigns.
Collapse
Affiliation(s)
- Dipen D Patel
- Department of Psychiatry and Behavioral Sciences at the University of Texas Medical Branch, Galveston, TX 77555, USA
| | - Marta Rosenberg
- Shriners Hospitals for Children in Galveston Texas, 77550, USA; Department of Psychiatry and Behavioral Sciences at the University of Texas Medical Branch, Galveston, TX 77555, USA.
| | - Laura Rosenberg
- Shriners Hospitals for Children in Galveston Texas, 77550, USA; Department of Psychiatry and Behavioral Sciences at the University of Texas Medical Branch, Galveston, TX 77555, USA
| | - Guillermo Foncerrada
- Shriners Hospitals for Children in Galveston Texas, 77550, USA; Department of Surgery at the University of Texas Medical Branch, Galveston, TX 77555, USA
| | - Clark R Andersen
- Department of Preventive Medicine and Community Health at the University of Texas Medical Branch, Galveston, TX 77555, USA
| | - Karel D Capek
- Shriners Hospitals for Children in Galveston Texas, 77550, USA; Department of Surgery at the University of Texas Medical Branch, Galveston, TX 77555, USA
| | - Jesus Leal
- Shriners Hospitals for Children in Galveston Texas, 77550, USA; Department of Surgery at the University of Texas Medical Branch, Galveston, TX 77555, USA
| | - Jong O Lee
- Shriners Hospitals for Children in Galveston Texas, 77550, USA; Department of Surgery at the University of Texas Medical Branch, Galveston, TX 77555, USA
| | - Carlos Jimenez
- Shriners Hospitals for Children in Galveston Texas, 77550, USA; Department of Surgery at the University of Texas Medical Branch, Galveston, TX 77555, USA
| | - Ludwik Branski
- Shriners Hospitals for Children in Galveston Texas, 77550, USA; Department of Surgery at the University of Texas Medical Branch, Galveston, TX 77555, USA
| | - Walter J Meyer
- Shriners Hospitals for Children in Galveston Texas, 77550, USA; Department of Psychiatry and Behavioral Sciences at the University of Texas Medical Branch, Galveston, TX 77555, USA
| | - David N Herndon
- Shriners Hospitals for Children in Galveston Texas, 77550, USA; Department of Surgery at the University of Texas Medical Branch, Galveston, TX 77555, USA
| |
Collapse
|
17
|
Park JU, Song EH, Jeong SH, Song J, Kim HE, Kim S. Chitosan-Based Dressing Materials for Problematic Wound Management. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1077:527-537. [DOI: 10.1007/978-981-13-0947-2_28] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
|