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Wickens N, McGivern L, de Gouveia Belinelo P, Milroy H, Martin L, Wood F, Bullman I, Janse van Rensburg E, Woolard A. A wellbeing program to promote mental health in paediatric burn patients: Study protocol. PLoS One 2024; 19:e0294237. [PMID: 38359022 PMCID: PMC10868872 DOI: 10.1371/journal.pone.0294237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 10/27/2023] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND One of the most traumatic injuries a child can experience is a severe burn. Despite improvements in medical treatments which have led to better physical outcomes and reduced mortality rates for paediatric burns patients, the psychological impact associated with experiencing such a traumatic injury has mostly been overlooked. This is concerning given the high incidence of psychopathology amongst paediatric burn survivors. OBJECTIVES This project will aim to pilot test and evaluate a co-designed trauma-focused intervention to support resilience and promote positive mental health in children and adolescents who have sustained an acute burn injury. Our first objective is to collect pilot data to evaluate the efficacy of the intervention and to inform the design of future trauma-focussed interventions. Our second objective is to collect pilot data to determine the appropriateness of the developed intervention by investigating the changes in mental health indicators pre- and post-intervention. This will inform the design of future interventions. METHODS This pilot intervention study will recruit 40 children aged between 6-17 years who have sustained an acute burn injury and their respective caregivers. These participants will have attended the Stan Perron Centre of Excellence for Childhood Burns at Perth Children's Hospital. Participants will attend a 45-minute weekly or fortnightly session for six weeks that involves building skills around information gathering, managing reactions (behaviours and thoughts), identifying, and bolstering coping skills, problem solving and preventing setbacks. The potential effects and feasibility of our intervention will be assessed through a range of age-appropriate screening measures which will assess social behaviours, personal qualities, mental health and/or resilience. Assessments will be administered at baseline, immediately post-intervention, at 6- and 12-months post-intervention. CONCLUSION The results of this study will lay the foundation for an evidence-based, trauma-informed approach to clinical care for paediatric burn survivors and their families in Western Australia. This will have important implications for the design of future support offered to children with and beyond burn injuries, and other medical trauma populations.
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Affiliation(s)
- Nicole Wickens
- Telethon Kids Institute, Perth Children’s Hospital, Nedlands, Western Australia, Australia
| | - Lisa McGivern
- Telethon Kids Institute, Perth Children’s Hospital, Nedlands, Western Australia, Australia
- The University of Western Australia, Crawley, Western Australia, Australia
| | | | - Helen Milroy
- Telethon Kids Institute, Perth Children’s Hospital, Nedlands, Western Australia, Australia
- The University of Western Australia, Crawley, Western Australia, Australia
| | - Lisa Martin
- Burn Injury Research Unit, The University of Western Australia, Crawley, Western Australia, Australia
- Burn Service of Western Australia, Perth Children’s Hospital, Nedlands, Western Australia, Australia
| | - Fiona Wood
- Burn Injury Research Unit, The University of Western Australia, Crawley, Western Australia, Australia
- Burn Service of Western Australia, Perth Children’s Hospital, Nedlands, Western Australia, Australia
| | - Indijah Bullman
- Telethon Kids Institute, Perth Children’s Hospital, Nedlands, Western Australia, Australia
| | - Elmie Janse van Rensburg
- Telethon Kids Institute, Perth Children’s Hospital, Nedlands, Western Australia, Australia
- The University of Western Australia, Crawley, Western Australia, Australia
| | - Alix Woolard
- Telethon Kids Institute, Perth Children’s Hospital, Nedlands, Western Australia, Australia
- The University of Western Australia, Crawley, Western Australia, Australia
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Sagah GA, Sharif AF, Moustafa IMES, Hasan SF, Elhawary AE. Medico-legal evaluation of burn trauma injuries. Epidemiological features and predictors of mortality and other adverse outcomes. Injury 2024; 55:111276. [PMID: 38141390 DOI: 10.1016/j.injury.2023.111276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 12/04/2023] [Accepted: 12/10/2023] [Indexed: 12/25/2023]
Abstract
INTRODUCTION Burn trauma is a devastating, life-threatening public health issue responsible for significant morbidity and mortality. Developing countries suffer more from the medical, psychological, and economic consequences of burns. The current study aimed to investigate the medicolegal aspects of burn trauma by identifying the epidemiological factors and injury characteristics associated with increased risk of mortality, intentional infliction, and different types of complications. METHODS A prospective cross-sectional study was conducted enrolling the burn trauma patients admitted to Burn Unit, Tanta University Hospital, Egypt over one year. RESULTS The current study was conducted among 138 burn trauma patients with a case fatality rate of 13.8 %. Of them, 5.8 % were victims of intentional burns, 44.9 % were complicated, and the length of hospital stay ranged between one day and 52 days. Patients aged less than 10 years constituted about 33.3 %. The burn trauma was the highest in June, May and March. Intentionally exposed patients, patients with third-degree burns affecting the head, neck and trunk and those with burns involving a total body surface area (TBSA) of more than 33 % were at high mortality risk. Intentional burns were induced mainly by flame (100 %) and characterized by high severity (TBSA = 85 % and 87.5 % third-degree burns). Intentional burns involved mainly the trunk (p = 0.002) and external genitalia (p = 0.022). The involved TBSA and the highest burn degree were significant predictors of mortality with an excellent area under curves of 0.956 and 0.870, respectively and (p < 0.001). The TBSA of more than 17 % and the burn degrees above the second were significant predictors of in hospital complications (p < 0.001). Daytime intentional burns, burns involving the upper extremities and face, deep and widely distributed burns, and infected wounds were associated with a significant need for surgical treatments. The median length of hospital stay was ten days, primarily attributed to the in hospital complications (p = 0.02). CONCLUSION A high degree of vigilance and accurate assessment of burn size, depth and distribution with meticulous interpretation of the mechanism of infliction are central not only for treatment interventions but from the medicolegal point of view.
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Affiliation(s)
- Ghada Attia Sagah
- Department of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Asmaa F Sharif
- Department of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Tanta University, Tanta, Egypt; Clinical Medical Sciences Department, College of Medicine, Dar Al-Uloom University, Riyadh, Saudi Arabia.
| | | | - Sohier F Hasan
- Department of Emergency Medicine and Traumatology, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Amira Elsayed Elhawary
- Department of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Tanta University, Tanta, Egypt
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Rosa J, Marques MPM, Gonçalves D, Ferreira MT. Half a century of systematic research on heat-induced colour changes in bone - A review. Sci Justice 2023; 63:573-580. [PMID: 37718004 DOI: 10.1016/j.scijus.2023.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 07/06/2023] [Accepted: 07/16/2023] [Indexed: 09/19/2023]
Abstract
Skeletal human remains presenting heat-induced changes have been a focus of study for a long time. However, there is still a long way to go for the anthropologists to be able to fully interpret and understand these changes. Heat-induced colour modifications are one of the least understood phenomena in bone, displaying a variety of exceptions (e.g., tints of yellow, orange, blue, green, pink, and red) to the expected colour variations that bone can produce when exposed to high temperatures (i.e., ivory, brown, black, various shades of grey, and white). In addition to these, there is a lack of uniformization in the literature regarding the methods to determine the exact colourations observed and the nomenclature used, giving way to subjective descriptions. However, commitment to more objective and reliable methods is visible in more recent research. In this review, we compiled data published in the literature throughout the years to portray the state of the art regarding the potential of heat-induced colour changes for inferring the circumstances of death and the applicability of these methods in the legal framework.
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Affiliation(s)
- Joana Rosa
- University of Coimbra, Centre for Functional Ecology, Laboratory of Forensic Anthropology, Department of Life Sciences, Calçada Martim de Freitas, 3000-456 Coimbra, Portugal; University of Coimbra, Research Centre for Anthropology and Health, Department of Life Sciences, Calçada Martim de Freitas, 3000-456 Coimbra, Portugal; "Química-Física Molecular", Department of Chemistry, University of Coimbra, 3004-535 Coimbra, Portugal; Department of Life Sciences, University of Coimbra, 3000-456 Coimbra, Portugal.
| | - M Paula M Marques
- "Química-Física Molecular", Department of Chemistry, University of Coimbra, 3004-535 Coimbra, Portugal; Department of Life Sciences, University of Coimbra, 3000-456 Coimbra, Portugal
| | - David Gonçalves
- University of Coimbra, Centre for Functional Ecology, Laboratory of Forensic Anthropology, Department of Life Sciences, Calçada Martim de Freitas, 3000-456 Coimbra, Portugal; University of Coimbra, Research Centre for Anthropology and Health, Department of Life Sciences, Calçada Martim de Freitas, 3000-456 Coimbra, Portugal; Direção-Geral do Património Cultural, Laboratory of Archaeosciences (LARC), Lisbon, Portugal
| | - Maria Teresa Ferreira
- University of Coimbra, Centre for Functional Ecology, Laboratory of Forensic Anthropology, Department of Life Sciences, Calçada Martim de Freitas, 3000-456 Coimbra, Portugal; Department of Life Sciences, University of Coimbra, 3000-456 Coimbra, Portugal
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Jamaer M, Van den Eynde J, Aertgeerts B, Toelen J. Knowledge of Child Abuse and Neglect among General Practitioners and Pediatricians in Training: A Survey. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1429. [PMID: 37761390 PMCID: PMC10528059 DOI: 10.3390/children10091429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 08/16/2023] [Accepted: 08/21/2023] [Indexed: 09/29/2023]
Abstract
Child abuse and neglect is a common, underreported, and worldwide problem. Health care providers play an important role in detecting and reporting this problem. This study examined the knowledge on the clinical signs and mimickers of child abuse among Belgian trainees in family medicine and pediatrics. Participants filled out an anonymous online survey of 15 fictional but realistic cases with either suspicious or non-suspicious signs of abuse or neglect in the context of primary or emergency care. The overall score on all cases, the number of correct answers per case, and the median score were calculated, and the association of the participant's demographic characteristics with their score was examined using regression analysis. A total of 70 participants completed the survey. The overall median score was 73.3% (IQR 20.0%). The suspicious cases were solved more correctly than the non-suspicious cases (median: 85.7% versus 62.5%, p < 0.001). Regression analysis could not reveal a significant association of type and level of education with the performance on the survey. Knowledge of the clinical signs of child maltreatment among pediatricians and general practitioners in training is good, but there is still room for improvement.
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Affiliation(s)
- Marjolijn Jamaer
- Faculty of Medicine, KU Leuven, 3000 Leuven, Belgium; (M.J.); (J.V.d.E.)
| | - Jef Van den Eynde
- Faculty of Medicine, KU Leuven, 3000 Leuven, Belgium; (M.J.); (J.V.d.E.)
- Department of Cardiovascular Sciences, KU Leuven, 3000 Leuven, Belgium
- Helen B. Taussig Heart Center, The Johns Hopkins Hospital and School of Medicine, Baltimore, MD 21205, USA
| | - Bert Aertgeerts
- Department of Public Health and Primary Care, University Hospitals Leuven, 3000 Leuven, Belgium;
| | - Jaan Toelen
- Leuven Child and Health Institute, KU Leuven, 3000 Leuven, Belgium
- Department of Development and Regeneration, KU Leuven, 3000 Leuven, Belgium
- Department of Pediatrics, University Hospitals Leuven, 3000 Leuven, Belgium
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Ward JA, Cormack J, Dziewulski P, Martin NAJ. Indicators of intentional scald injury-A survey of UK burn consultants. Burns 2021; 47:1464-1465. [PMID: 33934908 DOI: 10.1016/j.burns.2021.03.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 03/11/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Joseph A Ward
- St Andrew's Centre for Plastic Surgery & Burns, Broomfield Hospital, Court Road, Broomfield, Chelmsford, UK.
| | - Jonathan Cormack
- St Andrew's Centre for Plastic Surgery & Burns, Broomfield Hospital, Court Road, Broomfield, Chelmsford, UK
| | - Peter Dziewulski
- St Andrew's Centre for Plastic Surgery & Burns, Broomfield Hospital, Court Road, Broomfield, Chelmsford, UK
| | - Niall A J Martin
- St Andrew's Centre for Plastic Surgery & Burns, Broomfield Hospital, Court Road, Broomfield, Chelmsford, UK
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Belghith M, Ben Khelil M, Harzallah H, Kebsi D, Zhioua M, Hamdoun M. Pattern of homicidal burns in Northern Tunisia: An autopsy-based study over 15 years (2005-2019). J Forensic Sci 2021; 66:940-946. [PMID: 33522609 DOI: 10.1111/1556-4029.14676] [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: 10/12/2020] [Revised: 01/04/2021] [Accepted: 01/08/2021] [Indexed: 11/29/2022]
Abstract
Data about homicidal burns remain scarce. Intentional burns are a challenging situation in the case of an individual found dead in a fire zone with no witness of the fatal act. This study aimed to analyze the victim profiles of homicidal burns in Northern Tunisia. It was a descriptive cross-sectional study with a retrospective data collection over 15 years (January 2005-December 2019). In total, 60 cases of homicidal burns were collected. The mean age was 40.22 ± 18.1 years (range 4-82 years). We noted a male predominance (sex ratio M/F = 1.3). Most of the victims were married (48.3%), unemployed (40%), and living in an urban area (63.3%). Homicidal burns occurred most frequently in private homes for female victims (80.8%) and in public places for male victims (31.4%) (p < 0.001). The reported motive varied according to the victim's sex; males were mostly assaulted by an acquaintance in an interpersonal conflict (47.1%), and females were mostly assaulted by an intimate partner while in a dispute (42.3%; p = 0.001). The median total body surface area (TBSA) that was burned was 60.4%, and burn injuries were observed mainly in the anterior part of the body. In 19 cases, the burns were associated with another type of trauma, from which the most common association was burning and stab wounds (12 cases). The identified pattern of homicidal burn casualties was similar to the reported data in Western countries and to homicides in general in Tunisia, suggesting that prevention measures should address those of intentional interpersonal violence.
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Affiliation(s)
- Meyssa Belghith
- Department of Legal Medicine, Charles Nicolle Hospital, Tunis, Tunisia.,Faculty of Medicine, University Tunis-El Manar, Tunis, Tunisia
| | - Mehdi Ben Khelil
- Department of Legal Medicine, Charles Nicolle Hospital, Tunis, Tunisia.,Faculty of Medicine, University Tunis-El Manar, Tunis, Tunisia
| | - Hana Harzallah
- Faculty of Medicine, University Tunis-El Manar, Tunis, Tunisia
| | - Dhouha Kebsi
- Department of Legal Medicine, Charles Nicolle Hospital, Tunis, Tunisia.,Faculty of Medicine, University Tunis-El Manar, Tunis, Tunisia
| | - Mongi Zhioua
- Department of Legal Medicine, Charles Nicolle Hospital, Tunis, Tunisia.,Faculty of Medicine, University Tunis-El Manar, Tunis, Tunisia
| | - Moncef Hamdoun
- Department of Legal Medicine, Charles Nicolle Hospital, Tunis, Tunisia.,Faculty of Medicine, University Tunis-El Manar, Tunis, Tunisia
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Giachetti RS, Hardyniec A. Characterization of the release of heated and pressurized water from a pressure cooker. Burns 2020; 47:1118-1128. [PMID: 33766431 DOI: 10.1016/j.burns.2020.10.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 09/18/2020] [Accepted: 10/21/2020] [Indexed: 11/27/2022]
Abstract
Recently, self-heating consumer pressure cookers have found reinvigorated use with consumers wanting faster, more convenient, and healthier cooking. With the increased popularity, injury reports have also increased. Hazards associated with dispersion from pressurized vessels, although qualitatively understood through elementary scientific principles, have not been experimentally characterized in the literature, nor has the human ability to respond to a sudden dispersion of contents been directly reviewed. This study examined the consequence of volume and pressure on the dispersion of hot water from a typical 6 quart pressure cooker contacting a clothed user. This study found that both pressure and volume level influence the dispersion of contents after lid opening as well as the lid departure speed. Results also indicate that the speed of both the departing lid and the dispersing liquid occurred quicker than a bystander, within arm's reach, can consciously react to avoid or to shield themselves from the hot contents. The results confirmed analytical analyses found in the literature that a single layer cotton shirt (e.g., a t-shirt) saturated with water is more likely to trap hot liquid, increasing the likelihood of a more severe burn in that area due to prolonged skin contact.
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Affiliation(s)
- R S Giachetti
- Exponent, Inc., 525 W. Monroe #1050, Chicago, IL, United States.
| | - A Hardyniec
- Exponent, Inc., 525 W. Monroe #1050, Chicago, IL, United States
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Aydogdu HI, Kirci GS, Askay M, Bagci G, Peksen TF, Ozer E. Medicolegal evaluation of cases with burn trauma: Accident or physical abuse. Burns 2020; 47:888-893. [PMID: 33131946 DOI: 10.1016/j.burns.2020.10.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 08/01/2020] [Accepted: 10/07/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION AND OBJECTIVE Burns are thermal injuries that may have a wide variety of clinical consequences from simple injuries to mortality. There are many aspects that must be medicolegally addressed in both non-survivors and survivors from burn injuries. The objective of this study was to determine sociodemographic characteristics, injury patterns, treatment requirements and prognoses of patients with burn injuries to evaluate the findings of neglect-abuse and forensic reporting processes. This study also aimed to contribute to the medicolegal classification criteria in respect of the factors that have an effect on the prognosis in the analyses. MATERIAL AND METHOD The study was conducted by retrospective review of digital files and paper records of patients who received therapy in the Burns Unit of KTU Farabi Hospital between 1st January, 2013, and 31st December, 2017. RESULTS Evaluation was made of a total of 1225 patients, comprising 769 (62.8%) males and 456 (37.2%) females, with a mean age of 21.8 ± 23.8 years (range, 1-89 years). The mean burnt body surface area was 14.29 ± 13.74. A trauma-related psychiatric disorder was diagnosed in 60 (4.9%) patients during treatment. When the medical history and physical examination findings were evaluated together, burn injuries suggested physical abuse in 54 patients (4.4%). The doctors who evaluated the patients with burn injuries in the emergency room and those who applied treatment in the Burns Unit made a forensic notification for 379 (30.9%) patients. The mean age of non-survivors was significantly higher than that of patients who survived to discharge (56.54 ± 28.60 years for non-survivors and 19.39 ± 23.12 years for survivors; p < 0.001). CONCLUSION Burn injuries are frequently encountered, and they require precautionary measures. Burn injuries due to abuse are more frequently observed in the elderly and especially in children. Thus, the findings must be correctly interpreted, and more effort should be made to improve the knowledge of healthcare professionals about forensic reporting. Moreover, regulations should be implemented in respect of the medicolegal classification of trauma.
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Affiliation(s)
| | - Guven Seckin Kirci
- Karadeniz Technical University, Faculty of Medicine, Department of Forensic Medicine, Trabzon, Turkey
| | - Mehmet Askay
- Karadeniz Technical University, Faculty of Medicine, Department of Forensic Medicine, Trabzon, Turkey
| | - Gozde Bagci
- Karadeniz Technical University, Faculty of Medicine, Department of Forensic Medicine, Trabzon, Turkey
| | - Tevfik Furkan Peksen
- Karadeniz Technical University, Faculty of Medicine, Department of Forensic Medicine, Trabzon, Turkey
| | - Erdal Ozer
- Karadeniz Technical University, Faculty of Medicine, Department of Forensic Medicine, Trabzon, Turkey
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Yamamoto R, Shibusawa T, Kurihara T, Sasaki J. Self-inflicted Burn Injury Is Independently Associated With Increased Mortality in a More Economically Developed Country: A Propensity Score Matching Analysis. J Burn Care Res 2020; 40:228-234. [PMID: 30649382 DOI: 10.1093/jbcr/irz009] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Self-inflicted burn accounts for considerable morbidity and mortality in more economically developed countries, and there is a substantial debate regarding the pathophysiological relevance between self-inflicted burns and unfavorable outcomes. To validate whether self-inflicted injury is an independent predictor of high mortality regardless of the severity of burn, they conducted a retrospective observational study using the Japan Trauma Data Bank, a nationwide database including over 200 major tertiary care centers. Among 2006 patients with burn who had arrived at collaborating centers between 2004 and 2016, they included patients aged ≥15 years, those who did not present with cardiopulmonary arrest upon arrival, and those who had ≥10 percent total body surface area burns. Patients with missing survival data or unknown mechanism of injury were excluded. In total, 1094 patients were eligible, of whom 222 (20.3 percent) had self-inflicted burns. The patients were divided into the self-inflicted and non-self-inflicted groups, and propensity score was calculated using the demographic information of the patients, injury variables, time from injury to hospital arrival, and other survival predictors. Via a propensity score matching, 98 pairs were selected, and the self-inflicted group had a higher mortality than the non-self-inflicted group (43.9 vs 28.6 percent, hazard ratio = 1.77; 95% confidence interval = 1.10-2.86; P = .02). Inverse probability weighting and multivariate logistic regression were performed as sensitivity analyses, and results validated that self-inflicted burn was independently associated with increased in-hospital mortality. Therefore, patients with self-inflicted burns should receive judicious management, regardless of burn injury severity.
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Affiliation(s)
- Ryo Yamamoto
- Department of Emergency and Critical Care Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Takayuki Shibusawa
- Department of Emergency and Critical Care Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Tomohiro Kurihara
- Department of Emergency and Critical Care Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Junichi Sasaki
- Department of Emergency and Critical Care Medicine, Keio University School of Medicine, Tokyo, Japan
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Yamamoto R, Toyosaki M, Kurihara T, Sasaki J. Length of hospital stay and mortality associated with burns from assault: a retrospective study with inverse probability weighting analysis. BURNS & TRAUMA 2020; 8:tkaa001. [PMID: 32341915 PMCID: PMC7175759 DOI: 10.1093/burnst/tkaa001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 10/07/2019] [Accepted: 01/06/2020] [Indexed: 11/13/2022]
Abstract
Background Burns resulting from assaults account for considerable morbidity and mortality among patients with burn injuries around the world. However, it is still unclear whether unfavorable clinical outcomes are associated primarily with the severity of the injuries. To elucidate the direct relationship between burns resulting from assaults and mortality and/or length of hospital stays, we performed this study with the hypothesis that burns from assault would be independently associated with fewer hospital-free days than would burns from other causes, regardless of the severity of burn injuries. Methods We conducted a retrospective cohort study, using a city-wide burn registry (1996-2017) accounting for 14 burn centers in Tokyo, Japan. Patients who arrived within 24 hours after injury were included, and those with self-inflicted burn injuries were excluded. Patients were divided into two groups according to mechanism of burns (assault vs. accident), and the number of hospital-free days until day 30 after injury (a composite of in-hospital death and hospital length of stay) was compared between the groups. To estimate the probability that an injury would be classified as an assault, we calculated propensity scores, using multivariate logistic regression analyses adjusted for known outcome predictors. We also performed an inverse probability weighting (IPW) analysis to compare adjusted numbers of hospital-free days. Results Of 7419 patients in the registry with burn injuries during the study period, 5119 patients were included in this study. Of these, 113 (2.2%) were injured as a result of assault; they had significantly fewer hospital-free days than did those with burns caused by accident (18 [27] vs. 24 [20] days; coefficient = [Formula: see text]3.4 [[Formula: see text]5.5 to [Formula: see text]1.3] days; p = 0.001). IPW analyses similarly revealed the independent association between assault burn injury and fewer hospital-free days (adjusted coefficient = [Formula: see text]0.6 [[Formula: see text]1.0 to [Formula: see text]0.1] days; p = 0.009). Conclusions Burn from assault was independently associated with fewer hospital-free days, regardless of the severity of burn injuries. The pathophysiological mechanism underlying the relationship should be further studied in a prospective observational study.
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Affiliation(s)
- Ryo Yamamoto
- Department of Emergency and Critical Care Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan
| | - Mitsunobu Toyosaki
- Department of Emergency and Critical Care Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan
| | - Tomohiro Kurihara
- Department of Emergency and Critical Care Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan
| | - Junichi Sasaki
- Department of Emergency and Critical Care Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan
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Simonit F, Da Broi U, Desinan L. The role of self-immolation in complex suicides: A neglected topic in current literature. Forensic Sci Int 2020; 306:110073. [DOI: 10.1016/j.forsciint.2019.110073] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Revised: 11/18/2019] [Accepted: 11/19/2019] [Indexed: 10/25/2022]
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13
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Yoosefi Lebni J, Mansourian M, Hossain Taghdisi M, Khosravi B, Ziapour A, Demir Özdenk G. A study of Kurdish women's tragic self-immolation in Iran: A qualitative study. Burns 2019; 45:1715-1722. [PMID: 31202529 DOI: 10.1016/j.burns.2019.05.012] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Revised: 05/02/2019] [Accepted: 05/21/2019] [Indexed: 01/22/2023]
Abstract
Self-immolation is one of the most painful methods of suicide which is widespread among women in Kurdish regions of Iran. The present study aimed to explore the causes and sociocultural groundwork of choosing self-immolation methods by women in Kurdish regions of Iran. This present study was conducted using a qualitative approach and conventional content analysis. The research population included women who self-immolated and were rescued in Kurdish regions of Iran. The data collection method was a deep interview as well as observation. The sampling method was based on objective and snowball sampling. The data collection continued to theoretical saturation, the number of participants reached 25 in the end, and Lincoln and Guba criteria were used to strengthen the research. From the analysis of the data obtained in this study, the 8 sub-themes related to cause of suicide attempt from the participants' viewpoints including unbridled coherence, lack of supportive social and environmental structures, economic pressure, aggravation of violence, humiliated ego, dominance of modern values over the local and indigenous ones, incoherent family, and giving up on changing conditions as well as 6 sub themes based on the cause of choosing the method of self-immolation including protesting, frightening the family, catching more attention, championing and showing courage, inducing more guilty feelings in the family and society, fashion or imitation, and easy access were revealed. Self-immolation is one of the most important problems in the Kurdish regions of Iran, which is rooted in various economic, social, psychological and cultural causes. To reduce this social harm, there is a need for comprehensive programs that cover all dimensions.
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Affiliation(s)
- Javad Yoosefi Lebni
- Health Promotion Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Morteza Mansourian
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
| | | | - Bahar Khosravi
- Students Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Arash Ziapour
- Ph.D Student of Health Education and Health Promotion, Kermanshah University of Medical Sciences, Kermanshah, Iran.
| | - Gülcan Demir Özdenk
- Vocational School of Health Services in Ahi Evran University, Kırsehir, Turkey
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Mullen S, Begley R, Roberts Z, Kemp AM. Fifteen-minute consultation: Childhood burns: inflicted, neglect or accidental. Arch Dis Child Educ Pract Ed 2019; 104:74-78. [PMID: 29934360 DOI: 10.1136/archdischild-2018-315167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 05/15/2018] [Accepted: 05/16/2018] [Indexed: 11/03/2022]
Abstract
Burns are a relatively common injury in children accounting for over 50 000 emergency department attendances each year. An estimated 1 in 10 of these are due to maltreatment. These may present in the form of physical abuse or neglect with a reported ratio of 1:9. A burn associated with maltreatment may be a marker for future abuse or neglect and it is paramount that concerns are identified and addressed at the initial visit. Paediatricians need to be confident to identify safeguarding concerns specific to childhood burns and investigate accordingly. In this review, key variables that may aid in differentiating maltreatment from accidental burns are discussed in a case-based format, utilising up-to-date evidence to support the recommendations. Despite a proportion of burns resulting from physical abuse, the rate of child protection investigations in these patients are significantly lower than for children who present with other forms of physical injuries despite a similar proportion of positive findings. Our objective is to review the available evidence to support the safe assessment and management of children presenting with scalds or contact burns.
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Affiliation(s)
- Stephen Mullen
- Paediatric Emergency Department, Royal Belfast Hospital for Sick Children, Belfast, Northern Ireland
| | - Roisin Begley
- Paediatric Emergency Department, University Hospital of Wales, Cardiff, UK
| | - Zoe Roberts
- Paediatric Emergency Department, University Hospital of Wales, Cardiff, UK
| | - Alison Mary Kemp
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
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15
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Vetrichevvel TP, Randall SM, Wood FM, Rea S, Boyd JH, Duke JM. A population-based comparison study of the mental health of patients with intentional and unintentional burns. BURNS & TRAUMA 2018; 6:31. [PMID: 30410943 PMCID: PMC6219153 DOI: 10.1186/s41038-018-0133-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 09/28/2018] [Indexed: 12/02/2022]
Abstract
Background A number of studies report high prevalence of mental health conditions among burn patients. However there is a need to understand differences in the temporal relationship between mental health conditions and intentional and unintentional burns to hasten psychological prevention and intervention. This study aims to compare the socio-demographic profile, burn characteristics and pre- and post-burn psychiatric morbidity of burn patients by intent-of-injury. Methods De-identified linked hospital, death and mental health (MH) case registry data of burn patients hospitalised in Western Australia between 1 January 1980 and 30 June 2012 were analysed. Crude (observed) post-burn rates of mental health admissions were generated by burn intent-of-injury. Descriptive statistics were performed to compare the characteristics of the burn patients. Results A total of 30,997 individuals were hospitalised for a first burn; 360 (1.2%) had self-harm burns and 206 (0.7%) assault burns. Over the study period, admission rates for assault burns increased by 4.8% per year (95% confidence interval (CI) 3.1–6.5%) and self-harm burns increased 6.9% per year (95% CI 4.8–9.1%). Self-harm and assault burns occurred mainly among those aged 15 to 44 years (median age, interquartile range (IQR): self-harm 30 years, 22–40; assault 31 years, 23–38). Those with self-harm burns had a longer index hospital stay (median (IQR): self-harm 15 days (5–35) vs 4 days (1–11) assault vs 4 days (1–10) unintentional) and higher in-hospital mortality (7.2% self-harm vs 1.9% assault burns vs 0.8% unintentional). More than half (55.0%) of self-harm burns had a prior hospitalisation (5-year lookback) for a MH condition vs 10.7% of assault burns and 2.8% of unintentional burns. Crude post-burn rates of MH admissions per 100 person-years (PY) by intent-of-burn subgroups: self-harm 209 per 100 PY, assault burns 11 per 100 PY and unintentional burns 3 per 100 PY. Conclusions Intentional burn patients experienced significantly higher pre- and post-burn mental health morbidity along with significant adverse outcome in comparison with unintentional burns. Early psychological assessment and intervention could help in improving the MH of these patients.
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Affiliation(s)
- Thirthar P Vetrichevvel
- 1Burn Injury Research Unit, Faculty of Health and Medical Sciences, The University of Western Australia, M318 35 Stirling Highway, Crawley, Perth, Western Australia 6009 Australia.,2Curtin Medical School, Curtin University, Perth, Australia
| | - Sean M Randall
- 3Centre for Data Linkage, Curtin University, Perth, Western Australia Australia
| | - Fiona M Wood
- 1Burn Injury Research Unit, Faculty of Health and Medical Sciences, The University of Western Australia, M318 35 Stirling Highway, Crawley, Perth, Western Australia 6009 Australia.,4Burns Service of Western Australia, Fiona Stanley Hospital and Princess Margaret Hospital, Perth, Western Australia Australia
| | - Suzanne Rea
- 1Burn Injury Research Unit, Faculty of Health and Medical Sciences, The University of Western Australia, M318 35 Stirling Highway, Crawley, Perth, Western Australia 6009 Australia.,4Burns Service of Western Australia, Fiona Stanley Hospital and Princess Margaret Hospital, Perth, Western Australia Australia
| | - James H Boyd
- 3Centre for Data Linkage, Curtin University, Perth, Western Australia Australia
| | - Janine M Duke
- 1Burn Injury Research Unit, Faculty of Health and Medical Sciences, The University of Western Australia, M318 35 Stirling Highway, Crawley, Perth, Western Australia 6009 Australia
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Abstract
Although the overall incidence of and mortality rate associated with burn injury have decreased in recent decades, burns remain a significant source of morbidity and mortality in children. Children with major burns require emergent resuscitation. Resuscitation is similar to that for adults, including pain control, airway management, and administration of intravenous fluid. However, in pediatrics, fluid resuscitation is needed for burns greater than or equal to 15% of total body surface area (TBSA) compared with burns greater than or equal to 20% TBSA for adults. Unique to pediatrics is the additional assessment for non-accidental injury and accurate calculation of the percentage of total burned surface area (TBSA) in children with changing body proportions are crucial to determine resuscitation parameters, prognosis, and disposition.
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Affiliation(s)
- Ashley M Strobel
- Department of Emergency Medicine, University of Minnesota School of Medicine, Hennepin County Medical Center, University of Minnesota Masonic Children's Hospital, 701 South Park Avenue R2.123, Minneapolis, MN 55414, USA.
| | - Ryan Fey
- Department of Surgery, University of Minnesota School of Medicine, Hennepin County Medical Center, 701 South Park Avenue, Minneapolis, MN 55414, USA
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17
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A 6-Year Case-Control Study of the Presentation and Clinical Sequelae for Noninflicted, Negligent, and Inflicted Pediatric Burns. J Burn Care Res 2018; 38:e101-e124. [PMID: 28009699 DOI: 10.1097/bcr.0000000000000408] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Inflicted burns are one of the leading causes of abuse-related fatalities in children. Between 30 and 60% of children accidentally returned to abusive homes suffer reabuse. Given the high chance for abuse recurrence and the associated morbidity/mortality, it is critical that inflicted burns are promptly identified to guide appropriate medical and child welfare management. Although previous studies proposed historical and mechanistic features using noncomparative or poorly powered data, this study utilized comparative data from a 6-year period (2009-2014) at a certified burn center along with expert analysis from Child Advocacy and Protective Services (CAPS) to provide higher level evidence supporting classical findings while elucidating new features with respect to burn severity and required interventions. A retrospective chart review of 408 pediatric burns was cross-referenced with the respective CAPS consultations to construct a multidisciplinary, deidentified database. The average age was 2.9 years (0.04-17 years) with 232 (57%) males and 330 (81%) African-Americans. CAPS investigations confirmed burn etiologies: noninflicted (346 [85%]), negligent (30 [7%]), and inflicted (32 [8%]). In comparing the three etiologies, statistical significance (P < .05) was observed for numerous variables including historical inconsistency, burn age, child welfare history, burn size and depth, distribution, concomitant injury rates, number of surgical interventions, infectious complications, and hospital length of stay. In addition to reaffirming classical features of abusive burns to fortify etiologic diagnoses, this study elucidated appreciable differences in burn severity, interventional sequelae, and burn-related complications, which will help guide medical and surgical interventions for future pediatric burn patients.
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18
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Bahar MA, Pakyari M, Bahar R. Burns in Tehran: demographic, etiological, and clinical trends. ASIAN BIOMED 2017. [DOI: 10.5372/1905-7415.0802.285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Abstract
Background: Burns are a major public health problem. They often require intensive care and long periods of hospitalization. In Tehran, about 5% of all hospitalized injuries are burns. There are no published long-term epidemiological studies regarding burn injuries of adults in Iran.
Objective: To identify risk factors for burn injuries and provide a starting point for the establishment of an effective prevention plan.
Methods: We analyzed the demographic, etiological, and clinical data of 1860 burn patients admitted to a major acute care hospital in Tehran between March 2010 and April 2011. Data were obtained from the registry recorded in Shahid Motahari Trauma Hospital and evaluated using a chi-square test.
Results: Males were more than twice as likely to be burn patients than females (72.0% vs. 28.0%). Second and third-degree burns with a body surface area of 21%-30% constituted the highest injury reported (75.3%). The most common causes of the recorded burns were natural gas, gasoline (42%) and open fire (10.2%). Unintentional burns were reported in 85% of the cases, and 15% of the burn victims were suicide-related incidents; mainly among women. In 75% of suicide attempts, women set themselves on fire to commit suicide. The mean duration of hospitalization was 25 days and the mortality rate was 10.7%. Mean age of reported deaths was 38.6 years; with a mean of 30 years among women and 51.5 years among men.
Conclusion: The group at highest risk was young men 21-30 years old. However, an astonishing finding was that 75% of suicidal-related incidents involved women setting themselves on fire. Those with the highest mortality rate were victims of burns with gas, gasoline, and kerosene; with a mean age of 30 years of death among women.
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Affiliation(s)
- Mohammad Ali Bahar
- Burn Research Center, Iran University of Medical Sciences and Health Services, Tehran 14155-6559, Iran (Islamic Republic of)
| | - Mohammadreza Pakyari
- Shiraz University of Medical Sciences, Shiraz 71345-1583, Iran (Islamic Republic of)
| | - Rayeheh Bahar
- Shiraz University of Medical Sciences, Shiraz 71345-1583, Iran (Islamic Republic of)
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Rosen T, Reisig C, LoFaso VM, Bloemen EM, Clark S, McCarthy TJ, Mtui EP, Flomenbaum NE, Lachs MS. Describing visible acute injuries: development of a comprehensive taxonomy for research and practice. Inj Prev 2016; 23:340-345. [PMID: 27913598 DOI: 10.1136/injuryprev-2016-042131] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 10/14/2016] [Accepted: 10/19/2016] [Indexed: 11/03/2022]
Abstract
BACKGROUND Little literature exists classifying and comprehensively describing intentional and unintentional acute injuries, which would be valuable for research and practice. In preparation for a study of injury patterns in elder abuse, our goal was to develop a comprehensive taxonomy of relevant types and characteristics of visible acute injuries and evaluate it in geriatric patients. METHODS We conducted an exhaustive review of the medical and forensic literature focusing on injury types, descriptions, patterns and analyses. We then prepared iteratively, through consensus with a multidisciplinary, national panel of elder abuse experts, a comprehensive classification system to describe these injuries. RESULTS We designed a three-step process to fully describe and classify visible acute injuries: (1) determining the type of injury, (2) assigning values to each of the characteristics common to all geriatric injuries and (3) assigning values to additional characteristics relevant for specific injuries. We identified nine unique types of visible injury and seven characteristics critical to describe all these injuries, including body region(s) and precise anatomic location(s). For each injury type, we identified two to seven additional critical characteristics, such as size, shape and cleanliness. We pilot tested it on 323 injuries on 83 physical elder abuse victims and 45 unintentional fall victims from our ongoing research to ensure that it would allow for the complete and accurate description of the full spectrum of visible injuries encountered and made modifications and refinements based on this experience. We then used the classification system to evaluate 947 injuries on 80 physical elder abuse victims and 195 unintentional fall victims to assess its practical utility. CONCLUSIONS Our comprehensive injury taxonomy systematically integrates and expands on existing forensic and clinical research. This new classification system may help standardise description of acute injuries and patterns among clinicians and researchers.
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Affiliation(s)
- Tony Rosen
- Division of Emergency Medicine, Weill Cornell Medical College, New York, New York, USA
| | - Christopher Reisig
- Division of Emergency Medicine, Weill Cornell Medical College, New York, New York, USA.,Division of Geriatric and Palliative Medicine, Weill Cornell Medical College, New York, New York, USA
| | - Veronica M LoFaso
- Division of Geriatric and Palliative Medicine, Weill Cornell Medical College, New York, New York, USA
| | | | - Sunday Clark
- Division of Emergency Medicine, Weill Cornell Medical College, New York, New York, USA
| | - Thomas J McCarthy
- Division of Emergency Medicine, Weill Cornell Medical College, New York, New York, USA
| | - Estomih P Mtui
- Department of Radiology, Weill Cornell Medical College, New York, New York, USA
| | - Neal E Flomenbaum
- Division of Emergency Medicine, Weill Cornell Medical College, New York, New York, USA
| | - Mark S Lachs
- Division of Geriatric and Palliative Medicine, Weill Cornell Medical College, New York, New York, USA
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21
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Epidemiology and outcomes of pediatric burns over 35 years at Parkland Hospital. Burns 2016; 42:202-208. [DOI: 10.1016/j.burns.2015.10.011] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Revised: 08/27/2015] [Accepted: 10/07/2015] [Indexed: 11/21/2022]
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22
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Lama BB, Duke JM, Sharma NP, Thapa B, Dahal P, Bariya ND, Marston W, Wallace HJ. Intentional burns in Nepal: a comparative study. Burns 2015; 41:1306-14. [PMID: 25716765 DOI: 10.1016/j.burns.2015.01.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Revised: 01/08/2015] [Accepted: 01/12/2015] [Indexed: 11/19/2022]
Abstract
AIMS Intentional burns injuries are associated with high mortality rates, and for survivors, high levels of physical and psychological morbidity. This study provides a comprehensive assessment of intentional burn admissions to the adult Burns Unit at Bir Hospital, Kathmandu, Nepal, during the period 2002-2013. METHODS A secondary data analysis of de-identified data of patients hospitalized at Bir Hospital, Kathmandu, with a burn during the period of 1 January 2002 to 31 August 2013. Socio-demographic, injury and psychosocial factors of patients with intentional and unintentional burns are described and compared. Chi-square tests, Fisher's exact test and Wilcoxon rank sum tests were used to determine statistical significance. RESULTS There were a total of 1148 burn admissions of which 329 (29%) were for intentional burn, 293 (26%) were self-inflicted and 36 (3%) were due to assault. Mortality rates for intentional burns were approximately three times those for unintentional burns (60 vs. 22%). When compared to unintentional burns, patients with intentional burns were more likely to be female (79 vs. 48%), married (84 vs. 67%), younger (25 vs. 30 years), have more extensive burns (total body surface area, %: 55 vs. 25) and higher mortality (60 vs. 22%). Intentional burns were more likely to occur at home (95 vs. 67%), be caused by fire (96 vs. 77%), and kerosene was the most common accelerant (91 vs. 31%). A primary psychosocial risk factor was identified in the majority of intentional burn cases, with 60% experiencing adjustment problems/interpersonal conflict and 32% with evidence of a pre-existing psychological condition. A record of alcohol/substance abuse related to the patient or other was associated with a greater proportion of intentional burns when compared with unintentional burns (17 vs. 4%). CONCLUSIONS The majority of intentional burn patients were female. Almost all intentional burns occurred in the home and were caused by fire, with kerosene the most common accelerant used. Underlying psychosocial risk factors were identified in most cases. Intentional burns resulted in severe burns with high mortality. Intentional burns are not only a serious medical issue; they represent significant public health and gender issues in Nepal.
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Affiliation(s)
| | - Janine M Duke
- Burn Injury Research Unit, School of Surgery, The University of Western Australia, Crawley, WA 6009, Australia.
| | | | | | | | | | | | - Hilary J Wallace
- Burn Injury Research Unit, School of Surgery, The University of Western Australia, Crawley, WA 6009, Australia
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23
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Clinical and Psychiatric Characteristics of Self-Inflicted Burn Patients in the United States. J Burn Care Res 2015; 36:381-6. [DOI: 10.1097/bcr.0000000000000100] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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24
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Tan A, Bharj AK, Nizamoglu M, Barnes D, Dziewulski P. Assaults from corrosive substances and medico legal considerations in a large regional burn centre in the United Kingdom: calls for increased vigilance and enforced legislation. Scars Burn Heal 2015; 1:2059513115612945. [PMID: 29799575 PMCID: PMC5965332 DOI: 10.1177/2059513115612945] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Burn injuries from corrosive substances have been recognised as a common method of assault in low and middle income countries (LMICs) motivated by various factors. Such injuries often leave survivors with severely debilitating physical and psychological injuries and scars. The number of reported cases of acid assaults within the United Kingdom (UK) appears to be on the rise. As one of the largest regional burn centres in the UK, we have reviewed our experience of chemical burns from assault. This study aims to: (1) review the demographics, incidence and patient outcomes; (2) evaluate the long-term psychosocial support provided; and (3) review current criminal litigation proceedings and preventative legislations in the UK specific to assault by corrosive substances. A 15-year retrospective review of 21 burn injuries from assault with corrosive substances presenting to a regional burn unit was conducted. Victims were mostly young men; male perpetrators were more common. The most common motive cited was assault. The most common anatomical region affected was the face and neck. The number of victims who pursue litigation is disproportionately lower than the number of total cases at presentation. In an effort to better understand the legal considerations surrounding such assaults, we also collaborated with lawyers experienced in this particular field. We hope that our work will help educate healthcare professionals regarding the legal assistance and existing laws available to protect these patients.
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Affiliation(s)
- Alethea Tan
- St. Andrew’s Centre for Plastic Surgery
and Burns, Broomfield Hospital, Chelmsford, UK
- St. Andrews Anglia Ruskin Plastic
Surgery and Burns Research Unit, Postgraduate Medical Institute, Chelmsford,
UK
| | | | - Metin Nizamoglu
- St. Andrew’s Centre for Plastic Surgery
and Burns, Broomfield Hospital, Chelmsford, UK
| | - David Barnes
- St. Andrew’s Centre for Plastic Surgery
and Burns, Broomfield Hospital, Chelmsford, UK
| | - Peter Dziewulski
- St. Andrew’s Centre for Plastic Surgery
and Burns, Broomfield Hospital, Chelmsford, UK
- St. Andrews Anglia Ruskin Plastic
Surgery and Burns Research Unit, Postgraduate Medical Institute, Chelmsford,
UK
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Evaluation of child maltreatment in the emergency department setting: an overview for behavioral health providers. Child Adolesc Psychiatr Clin N Am 2015; 24:41-64. [PMID: 25455575 DOI: 10.1016/j.chc.2014.09.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Emergency providers are confronted with medical, social, and legal dilemmas with each case of possible child maltreatment. Keeping a high clinical suspicion is key to diagnosing latent abuse. Child abuse, especially sexual abuse, is best handled by a multidisciplinary team including emergency providers, nurses, social workers, and law enforcement trained in caring for victims and handling forensic evidence. The role of the emergency provider in such cases is to identify abuse, facilitate a thorough investigation, treat medical needs, protect the patient, provide an unbiased medical consultation to law enforcement, and provide an ethical testimony if called to court.
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Gibbs LM. Understanding the medical markers of elder abuse and neglect: physical examination findings. Clin Geriatr Med 2014; 30:687-712. [PMID: 25439636 DOI: 10.1016/j.cger.2014.08.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A specific foundation of knowledge is important for evaluating potential abuse from physical findings in the older adult. The standard physical examination is a foundation for detecting many types of abuse. An understanding of traumatic injuries, including patterns of injury, is important for health care providers, and inclusion of elder abuse in the differential diagnosis of patient care is essential. One must possess the skills needed to piece the history, including functional capabilities, and physical findings together. Armed with this skill set, health care providers will develop the confidence needed to identify and intervene in cases of elder abuse.
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Affiliation(s)
- Lisa M Gibbs
- Division of Geriatric Medicine and Gerontology, Department of Family Medicine, University of California, Irvine, 101 The City Drive, Orange, CA 92868, USA.
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Riedlinger DI, Jennings PA, Edgar DW, Harvey JG, Cleland MHJ, Wood FM, Cameron PA. Scald burns in children aged 14 and younger in Australia and New Zealand—an analysis based on the Burn Registry of Australia and New Zealand (BRANZ). Burns 2014; 41:462-8. [PMID: 25440854 DOI: 10.1016/j.burns.2014.07.027] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Revised: 07/23/2014] [Accepted: 07/30/2014] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Scalds are a common injury in children and a frequent reason for hospitalisation despite being a preventable injury. METHODS This retrospective two year study reports data from 730 children aged 14 years or younger who sustained a scald between 2009 and 2010 and were admitted to a burns centre in Australia or New Zealand. Data were extracted from the Burn Registry of Australia and New Zealand (BRANZ), which included data from 13 burns centres in Australia and New Zealand. RESULTS Scald injury contributed 56% (95% CI 53-59%) of all pediatric burns. There were two high risk groups; male toddlers age one to two, contributing 34% (95% CI 31-38%) of all scalds, and indigenous children who were over 3 times more likely to experience a scald requiring admission to a burns unit than their non-indigenous peers. First aid cooling by non-professionals was initiated in 89% (95% CI 86-91%) of cases but only 20% (95% CI 16-23%) performed it as recommended. CONCLUSION This study highlights that effective burn first aid reduces hospital stay and reinforces the need to encourage, carers and bystanders to deliver effective first aid and the importance of targeted prevention campaigns that reduce the burden of pediatric scald burns in Australia and New Zealand.
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Affiliation(s)
- Dorothee I Riedlinger
- Monash University, Department of Epidemiology and Preventive Medicine, Melbourne, VIC, Australia; Charite University Medicine, Berlin, Germany
| | - Paul A Jennings
- Monash University, Department of Community Emergency Health and Paramedic Practice, Melbourne, VIC, Australia.
| | | | - John G Harvey
- The Children's hospital at Westmead, Sydney, NSW, Australia; The Children's Hospital Burns Research Institute, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | | | - Fiona M Wood
- Royal Perth Hospital, Burns Unit, Perth, WA, Australia; University of Western Australia, Faculty of Medicine, Dentistry & Health Sciences, Burns Injury Research, Perth, WA, Australia
| | - Peter A Cameron
- Monash University, Department of Epidemiology and Preventive Medicine, Melbourne, VIC, Australia
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Alunni V, Grevin G, Buchet L, Quatrehomme G. Forensic aspect of cremations on wooden pyre. Forensic Sci Int 2014; 241:167-72. [PMID: 24949561 DOI: 10.1016/j.forsciint.2014.05.023] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Revised: 03/05/2014] [Accepted: 05/27/2014] [Indexed: 11/17/2022]
Abstract
Three cases of cremation on open-air pyres are described. One was classified as a suicide and two as homicides. Fire duration was estimated at approximately 1 h, close to 2 h and more than 3 h, respectively. The position of the remains, the colour alteration of bone and the burned bone fractures biomechanics are discussed. Knowledge of normal burn patterns in fire and detection of perimortem lesions are essential. These three cases highlight the specific thermal alterations and burning processes in accordance with fire duration. In each case, careful investigation yielded clues as to the manner of death. Close cooperation between law enforcement and forensic pathology investigators is required in order to correctly identify the circumstances of death.
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Affiliation(s)
- Veronique Alunni
- Laboratoire de Médecine Légale et d'Anthropologie médico-légale, Université de Nice Sophia Antipolis, Faculté de Médecine, 28 Avenue de Valombrose, 06107 Nice Cedex 2, France.
| | - Gilles Grevin
- CEPAM (Cultures et Environnements, Préhistoire, Antiquité, Moyen Âge), UMR7264-CNRS, Université Nice Sophia Antipolis, Campus Saint-Jean d'Angély 3, 24 Avenue des Diables Bleus, 06357 Nice Cedex 4, France.
| | - Luc Buchet
- CEPAM (Cultures et Environnements, Préhistoire, Antiquité, Moyen Âge), UMR7264-CNRS, Université Nice Sophia Antipolis, Campus Saint-Jean d'Angély 3, 24 Avenue des Diables Bleus, 06357 Nice Cedex 4, France.
| | - Gérald Quatrehomme
- Laboratoire de Médecine Légale et d'Anthropologie médico-légale, Université de Nice Sophia Antipolis, Faculté de Médecine, 28 Avenue de Valombrose, 06107 Nice Cedex 2, France.
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Grivna M, Eid HO, Abu-Zidan FM. Epidemiology of burns in the United Arab Emirates: lessons for prevention. Burns 2013; 40:500-5. [PMID: 24011735 DOI: 10.1016/j.burns.2013.08.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Revised: 08/07/2013] [Accepted: 08/09/2013] [Indexed: 11/20/2022]
Abstract
PURPOSE To study mechanism, risk factors and outcome of hospitalized burns so as to give recommendations for prevention. METHODS Burn patients admitted to Al Ain hospital for more than 24h or who died after arrival were studied over 4 years. Demographics, burn type, location and time of injury, total body burned surface area (TBSA), body region, hospital and ICU stay and outcome were analyzed. RESULTS 203 patients were studied, 69% were males and 25% were children under 5 years old. The most common location for burn was home. Women were burned more at home (p<0.0001). 28% of patients were injured at work with more men (p<0.0001) and non-UAE nationals (p<0.01). Scalds from water, tea were the major hazard at home, while majority of burns at work were from gas and flame. Burns caused by gas and flame had larger TBSA and longer ICU stay. Six (3%) patients died and nine (4%) were transferred to the specialized burn center. CONCLUSIONS Safety education for caregivers and close supervision of young children is important to reduce pediatric burns. Occupational safety education of young men could prevent burns caused by gas and flame.
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Affiliation(s)
- Michal Grivna
- Institute of Public Health, College of Medicine and Health Sciences, UAE University, United Arab Emirates
| | - Hani O Eid
- Trauma Group, Department of Surgery, College of Medicine and Health Sciences, UAE University, United Arab Emirates
| | - Fikri M Abu-Zidan
- Trauma Group, Department of Surgery, College of Medicine and Health Sciences, UAE University, United Arab Emirates.
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In the media: Burns as a method of assault. Burns 2013; 39:1311-5. [DOI: 10.1016/j.burns.2013.03.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Revised: 03/03/2013] [Accepted: 03/04/2013] [Indexed: 11/22/2022]
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Leetch AN, Woolridge D. Emergency Department Evaluation of Child Abuse. Emerg Med Clin North Am 2013; 31:853-73. [DOI: 10.1016/j.emc.2013.04.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Schricke DI, Jennings PA, Edgar DW, Harvey JG, Cleland HJ, Wood FM, Cameron PA. WITHDRAWN: Scald burns in children aged 14 and younger in Australia and New Zealand-An analysis based on the Bi-National Burns Registry (BiNBR). Burns 2013:S0305-4179(13)00157-5. [PMID: 23790638 DOI: 10.1016/j.burns.2013.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Revised: 05/20/2013] [Accepted: 05/21/2013] [Indexed: 10/26/2022]
Abstract
This article has been withdrawn at the request of the author(s) and/or editor. The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at http://www.elsevier.com/locate/withdrawalpolicy.
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Affiliation(s)
- Dorothee I Schricke
- Monash University, Department of Epidemiology and Preventive Medicine, Melbourne, Victoria, Australia; Charite University Medicine Berlin, Germany
| | - Paul A Jennings
- Monash University, Department of Epidemiology and Preventive Medicine, Melbourne, Victoria, Australia.
| | - Dale W Edgar
- Royal Perth Hospital, Burns Unit, Perth, Western Australia, Australia
| | - John G Harvey
- The Children's Hospital at Westmead, Sydney, New South Wales, Australia; The Children's Hospital Burns Research Institute, Australia; Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Heather J Cleland
- The Victorian Adult Burns Unit, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Fiona M Wood
- Royal Perth Hospital, Burns Unit, Perth, Western Australia, Australia; University of Western Australia, Faculty of Medicine, Dentistry & Health Sciences, Burns Injury Research, Perth, Western Australia, Australia
| | - Peter A Cameron
- Monash University, Department of Epidemiology and Preventive Medicine, Melbourne, Victoria, Australia
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Scheven D, Barker P, Govindasamy J. Burns in rural Kwa-Zulu Natal: Epidemiology and the need for community health education. Burns 2012; 38:1224-30. [PMID: 22698838 DOI: 10.1016/j.burns.2012.04.001] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2011] [Revised: 03/27/2012] [Accepted: 04/01/2012] [Indexed: 11/30/2022]
Affiliation(s)
- D Scheven
- Ngwelezana Hospital, Empangeni, Kwa-Zulu Natal, South Africa.
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36
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Norouzi K, Taghinejad H, Mohammadi F, Mohammadi E, Suhrabi Z. What is missed in self-immolated patients' care?: a grounded theory study. J Clin Nurs 2012; 21:3418-28. [DOI: 10.1111/jocn.12006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Kian Norouzi
- Department of Nursing; University of Social Welfare and Rehabilitation Sciences; Tehran
| | - Hamid Taghinejad
- Department of Nursing; University of Social Welfare and Rehabilitation Sciences; Tehran
| | - Farahnaz Mohammadi
- Iranian Center on Aging, University of Social Welfare and Rehabilitation Sciences; Tehran
| | - Eesa Mohammadi
- Department of Nursing-Tarbiat; Modares University; Tehran
| | - Zainab Suhrabi
- Department of Midwifery; Ilam University of Medical Sciences; Ilam Iran
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37
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Palmer M, Brodell RT, Mostow EN. Elder abuse: dermatologic clues and critical solutions. J Am Acad Dermatol 2012; 68:e37-42. [PMID: 23058735 DOI: 10.1016/j.jaad.2011.03.016] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2010] [Revised: 02/13/2011] [Accepted: 03/01/2011] [Indexed: 11/18/2022]
Abstract
Elder abuse affects approximately 2% to 10% of older Americans. Unfortunately, it is often unrecognized and certainly underreported. Dermatologists have a unique role in the detection and reporting of elder abuse. An analysis of risk factors, clinical signs, reporting requirements, and prevention of elder abuse brings this issue into focus.
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Affiliation(s)
- Matthew Palmer
- Northeast Ohio Medical University, Rootstown, Ohio 44307, USA
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38
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Ahmad Z, Kisku W, Jaffe W. The deleterious impact of primary care-based commissioning on plastic surgery services and patients. J Plast Reconstr Aesthet Surg 2012; 65:966-8. [DOI: 10.1016/j.bjps.2011.11.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2011] [Revised: 10/18/2011] [Accepted: 11/08/2011] [Indexed: 11/30/2022]
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Abstract
Five types of elder abuse (physical, psychological, sexual, neglect and financial) are recognized. They are not new, occur worldwide and are associated with persistent morbidity and mortality. The forensic clinician has responsibilities to: (i) the patient, with competent history taking and examination, (ii) interpret findings and recognize patterns of harm and (iii) promulgate this issue in wider professional and public forums. Research into elder abuse is relatively recent; standardized terminology remains unsettled, and small-scale, local studies are hard to generalize. Cross-sectional, population-based studies of elder abuse should be possible, and standardized endpoints will require forensic science contributions.
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Affiliation(s)
- Anthony W Fox
- Cameron Forensic Medical Sciences, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Charterhouse Square, London EC1M 6BQ, UK
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40
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Peck MD. Epidemiology of burns throughout the World. Part II: intentional burns in adults. Burns 2012; 38:630-7. [PMID: 22325849 DOI: 10.1016/j.burns.2011.12.028] [Citation(s) in RCA: 103] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2011] [Revised: 11/28/2011] [Accepted: 12/27/2011] [Indexed: 10/14/2022]
Abstract
A significant number of burns and deaths from fire are intentionally wrought. Rates of intentional burns are unevenly distributed throughout the world; India has a particularly high rate in young women whereas in Europe rates are higher in men in mid-life. Data from hospitalized burn patients worldwide reveal incidence rates for assault by fire and scalds ranging from 3% to 10%. The average proportion of the body surface area burned in an assault by fire or scalds is approximately 20%. In different parts of the world, attempted burning of others or oneself can be attributed to different motives. Circumstances under which assaults occur fall largely into the categories of interpersonal conflict, including spousal abuse, elder abuse, or interactions over contentious business transactions. Contributing social factors to assaults by burning include drug and alcohol abuse, non-constructive use of leisure time, non-participation in religious and community activities, unstable relationships, and extramarital affairs. Although the incidence of self-mutilation and suicide attempts by burning are relatively low, deliberate self-harm carries a significant risk of death, with an overall mortality rate of 65% worldwide. In those who resort to self-immolation, circumstantial themes reflect domestic discord, family dysfunction, and the social ramifications of unemployment. Preventing injurious burn-related violence requires a multifaceted approach, including legislation and enforcement, education, and advocacy. Better standardized assessment tools are needed to screen for risks of abuse and for psychiatric disorders in perpetrators.
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Perera V, Karunadasa K, Perera C. Self-inflicted formic acid burn: rare form of acid burn (two case reports). EUROPEAN JOURNAL OF PLASTIC SURGERY 2012. [DOI: 10.1007/s00238-010-0541-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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42
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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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Toon MH, Maybauer DM, Arceneaux LL, Fraser JF, Meyer W, Runge A, Maybauer MO. Children with burn injuries--assessment of trauma, neglect, violence and abuse. J Inj Violence Res 2011; 3:98-110. [PMID: 21498973 PMCID: PMC3134932 DOI: 10.5249/jivr.v3i2.91] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2010] [Accepted: 10/13/2010] [Indexed: 11/16/2022] Open
Abstract
Burns are an important cause of injury to young children, being the third most frequent cause of injury resulting in death behind motor vehicle accidents and drowning. Burn injuries account for the greatest length of stay of all hospital admissions for injuries and costs associated with care are substantial. The majority of burn injuries in children are scald injuries resulting from hot liquids, occurring most commonly in children aged 0-4 years. Other types of burns include electrical, chemical and intentional injury. Mechanisms of injury are often unique to children and involve exploratory behavior without the requisite comprehension of the dangers in their environment. Assessment of the burnt child includes airway, breathing and circulation stabilization, followed by assessment of the extent of the burn and head to toe examination. The standard rule of 9s for estimating total body surface area (TBSA) of the burn is inaccurate for the pediatric population and modifications include utilizing the Lund and Browder chart, or the child's palm to represent 1% TBSA. Further monitoring may include cardiac assessment, indwelling catheter insertion and evaluation of inhalation injury with or without intubation depending on the context of the injury. Risk factors and features of intentional injury should be known and sought and vital clues can be found in the history, physical examination and common patterns of presentation. Contemporary burn management is underscored by several decades of advancing medical and surgical care however, common to all injuries, it is in the area of prevention that the greatest potential to reduce the burden of these devastating occurrences exists.
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Affiliation(s)
- Michael H. Toon
- Critical Care Research Group and The University of Queensland, The Prince Charles Hospital at Brisbane, Australia
| | - Dirk M. Maybauer
- Department of Anesthesia and Intensive Care, Philipps University of Marburg, Marburg, Germany
- Department of Anesthesiology, The University of Texas Medical Branch and Shriners Burns Hospital at Galveston, USA
| | - Lisa L. Arceneaux
- Department of Surgery, The University of Texas Medical Branch and Shriners Burns Hospital at Galveston, USA
| | - John F. Fraser
- Critical Care Research Group and The University of Queensland, The Prince Charles Hospital at Brisbane, Australia
| | - Walter Meyer
- Department of Psychiatry, The University of Texas Medical Branch and Shriners Burns Hospital at Galveston, USA
| | - Antoinette Runge
- Critical Care Research Group and The University of Queensland, The Prince Charles Hospital at Brisbane, Australia
| | - Marc O. Maybauer
- Critical Care Research Group and The University of Queensland, The Prince Charles Hospital at Brisbane, Australia
- Department of Anesthesia and Intensive Care, Philipps University of Marburg, Marburg, Germany
- Department of Anesthesiology, The University of Texas Medical Branch and Shriners Burns Hospital at Galveston, USA
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Staphylococcal infection mimicking child abuse: what is the differential diagnosis and appropriate evaluation? Pediatr Emerg Care 2011; 27:547-9. [PMID: 21642794 DOI: 10.1097/pec.0b013e31821dc717] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Twins with similar skin lesions are described. Although initially concerning for nonaccidental burn injury, further evaluation led to the diagnosis of bullous impetigo caused by Staphylococcus aureus. Thoughtful assessment is important in such cases to protect the child and prevent misdiagnosis.
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45
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Forensics in dermatology: Part II. J Am Acad Dermatol 2011; 64:811-24; quiz 825-6. [DOI: 10.1016/j.jaad.2010.06.066] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2009] [Revised: 04/08/2010] [Accepted: 06/04/2010] [Indexed: 11/23/2022]
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46
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Moniz P, Casal D, Mavioso C, Videira-Castro J, Angélica-Almeida M. The self-inflicted burns-Typology and its prognostic relevance in a 14-year review of self-inflicted burns in a tertiary referral centre. Burns 2011; 37:322-7. [DOI: 10.1016/j.burns.2010.07.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2010] [Revised: 07/21/2010] [Accepted: 07/22/2010] [Indexed: 11/29/2022]
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Franchitto N, Faurie C, Franchitto L, Minville V, Telmon N, Rougé D. Self-inflicted burns: the value of collaboration between medicine and law. J Forensic Sci 2011; 56:638-42. [PMID: 21361934 DOI: 10.1111/j.1556-4029.2011.01706.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Self-inflicted burns are rare in France, but they lead to major, often life-threatening complications. The authors reviewed medical data for patients hospitalized in a burn center from January 2004 to December 2008. Thirty-eight cases of self-inflicted burns were compared with 220 accidental burns. Women were predominantly affected (57.9%, n = 22). A psychiatric history (71%, n = 27) was more frequent in this population. The mean age of the victims was 38 years. The leading method of suicide was flame (94%, n = 36) associated with gasoline used as an accelerant (77.7%, n = 28). Mean total burn surface area (41.5%) and mortality (36.9%) were higher in the self-inflicted burn population. By recognizing epidemiological characteristics and patients at risk, we can better classify lesions related to self-immolation. It is important for the forensic physician to consult survival details to correlate these data with the results of autopsy.
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Affiliation(s)
- Nicolas Franchitto
- Department of Legal Medicine, Toulouse-Rangueil University Hospital, 1 Avenue Jean Poulhès, 31059 Toulouse, France.
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Makhlouf F, Alvarez JC, de la Grandmaison GL. Suicidal and criminal immolations: An 18-year study and review of the literature. Leg Med (Tokyo) 2011; 13:98-102. [DOI: 10.1016/j.legalmed.2010.11.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2010] [Revised: 11/15/2010] [Accepted: 11/29/2010] [Indexed: 11/15/2022]
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49
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A follow-up study of adults with suicidal burns: psychosocial adjustment and quality of life. J Burn Care Res 2010; 30:844-51. [PMID: 19692913 DOI: 10.1097/bcr.0b013e3181b48118] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The severity of the burn injuries, accompanying injuries, and the often concomitant psychiatric disease complicate the treatment of patients with suicidal burns. Data from 45 patients who were treated for suicidal burn injuries from 1994 to 2005 were acquired from the patients' charts and interviews with standardized questionnaires (n = 11) concerning their psychological status pretrauma and posttrauma, as well as their quality of life with special reference to psychosocial adjustments. None of the patients survived more than 69% TBSA burns; no one with 41% or less died. Most of the patients had prediagnosed psychiatric disorders. The educational and social background of the patients and religious beliefs played a minor role for choosing this method of suicide. Aggression levels were above the average population, whereas self-direction was underdeveloped. Forty percent, albeit unsuccessfully, committed subsequent suicide attempts. Most patients felt only moderate social impairment by the burn wound residuals, the majority had intensified and improved their social contacts, and most felt no relevant decrease of quality of life compared with their personal situation before the suicide attempt. Patients who survive the suicide attempt can become integrated in social life again. More data are needed to reliably identify patients at risk in advance.
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Abstract
Deliberate self-harm (DSH) is a widespread yet often hidden problem in adolescents and young adults. Though most DSH can be classified as "non-suicidal self-cutting", some do go on to commit suicide. In this paper, deliberate self-harm is examined, including its prevalence, etiology, management, and future research directions using self-cutting and self-burning as examples. This article reviews recent literature to help understand what is known about self-cutting behavior and its potential relationship to suicide as well as provide direction for research. Research shows that different ecological factors at the individual, family, peer, and societal levels are related to deliberate self-harm. Although there is an association between some self-injurers and drug abuse (including alcohol abuse) as well as eating disorders, there are various subgroups of self-cutters and most are not at high risk for suicide. However, all acts of self-injury should be taken seriously by health care professionals and comprehensive therapy offered to any adolescent with a history of DSH. Future research directions on deliberate self-harm are also discussed.
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