Burn epidemiology and cost of medication in paediatric burn patients

Topical diosmetin attenuates nociception and inflammation in a ultraviolet B radiation-induced sunburn model in mice

Burns are a global health problem and can be caused by several factors, including ultraviolet (UV) radiation. Exposure to UVB radiation can cause sunburn and a consequent inflammatory response characterised by pain, oedema, inflammatory cell infiltration, and erythema. Pharmacological treatments available to treat burns and the pain caused by them include nonsteroidal anti-inflammatory drugs (NSAIDs), opioids, antimicrobials and glucocorticoids, which are associated with adverse effects. Therefore, the search for new therapeutic alternatives is needed. Diosmetin, an aglycone of the flavonoid diosmin, has antinociceptive, antioxidant and anti-inflammatory properties. Thus, we evaluated the antinociceptive and anti-inflammatory effects of topical diosmetin (0.01, 0.1 and 1%) in a UVB radiation-induced sunburn model in mice. The right hind paw of the anaesthetised mice was exposed only once to UVB radiation (0.75 J/cm2) and immediately treated with diosmetin once a day for 5 days. The diosmetin antinociceptive effect was evaluated by mechanical allodynia and pain affective-motivational behaviour, while its anti-inflammatory activity was assessed by measuring paw oedema and polymorphonuclear cell infiltration. Mice exposed to UVB radiation presented mechanical allodynia, increased pain affective-motivational behaviour, paw oedema and polymorphonuclear cell infiltration into the paw tissue. Topical Pemulen® TR2 1% diosmetin reduced the mechanical allodynia, the pain affective-motivational behaviour, the paw oedema and the number of polymorphonuclear cells in the mice's paw tissue similar to that presented by Pemulen® TR2 0.1% dexamethasone. These findings indicate that diosmetin has therapeutic potential and may be a promising strategy for treating patients experiencing inflammatory pain, especially those associated with sunburn.

Investigation of morbidity, length of stay, and healthcare costs of inpatient paediatric burns

Burn injuries are the third most common cause of death in children due to trauma. Hospitalizations related to burn injuries are common. Prolonged hospitalization associated with burn treatment can result in increased resource utilization, leading to higher costs. Thus, it is essential to investigate these areas to reduce costs. The study investigated the morbidity and length of hospital stay of paediatric burn patients, as well as calculated the social security costs of hospitalization and treatment. The retrospective observational descriptive study examined the medical records of 774 paediatric patients treated in a burn intensive care unit at a tertiary medical faculty hospital between 01 March 2019 and 31 March 2022. The invoice records of payments made by the Social Security Institution to the hospital in return for health services provided to patients were examined. The healthcare costs were calculated. A total of 57.6% of the participants were boys and 79.2% were between the ages of 1-4. About 90% of the cases involved burns with a total body surface area (TBSA) of less than 20% and a 2nd-degree burn depth. Scalding was the most common cause of burns (88.2%). Among all patients, the mortality rate was 2.1% (n = 16). The mean length of hospital stay was 10.29 ± 9.59 days. The mean cost per day was 212.02 ± 190.94 US dollars ($US), and the cost per 1% TBSA was 241.70 ± 301.32 $US. According to the causes of burn injury, the mean cost of electricity was 5000.77 ± 8101.85 $US, fire 4818.02 ± 5852.22 $US, and chemical 3285.49 ± 4503.2 $US were observed in the first 3 ranks respectively. According to this study, paediatric burn cases occur due to preventable causes, and even though the mortality rate was low, the severity of burns, TBSA%, and presence of complications caused prolonged lengths of hospital stays, which caused social security costs to rise.

Quality of life in paediatric burn patients with non-severe burns

BACKGROUND

Burns are common worldwide, and the vast majority are non-severe burns of less than 20% of the total body surface area (TBSA). In Australia, paediatric burns account for a third of all burn admissions, thus understanding the quality-of-life outcomes after a non-severe burn in children is important.

METHODS

This retrospective cohort study describes a paediatric cohort from Western Australia with non-severe burns occurring between 2018 and 2020 and characterises the child's quality-of-life outcomes which is measured using the Paediatric quality of life survey (PedsQL). The PedsQL included a parent-report and child-report assessment, each with a physical function domain and a psychosocial function domain which comprised of an emotional, a social and a school category.

RESULTS

Data collected from 249 patients; 50.6% were male, 45.6% were toddlers. The most common cause was scald (48.19%), the majority had burns smaller than 5% TBSA (91.97%), and most included visible areas such as head, neck or hands (77.51%). The parent-report PedsQL scores were significantly different for both physical and psychosocial domains between the different age groups (p = 0.002, p = 0.001, respectively) and for burn cause (p = 0.004, p = 0.005, respectively). For child-reported scores we found evidence of an effect of burn cause across both domains that did not reach a statistical significance (p = 0.076, p = 0.078, respectively). The psychosocial functions in both the parent-report and the self-report were significantly different for the socioeconomic status groups (p = 0.015, p = 0.032, respectively). Quality of life scores were critically low in 16.46% of paediatric burn patients at three months after burn.

CONCLUSION

Parent-reported and child-reported psychosocial function was significantly poorer in higher socioeconomic groups, for older children and for those with flame burns. About 16% of patients had scores below the critical cut off. These data provide insight into the quality-of-life outcomes of paediatric patients with non-severe burns, allowing future studies to investigate burn prevention strategies and services to help paediatric burn patients in their recovery.

Epidemiological and Clinical Profile of Pediatric Burns in the COVID-19 Era: The Experience of a Reference Center

Pediatric burns represent a significant public health problem. We analyzed the characteristics of pediatric burns in a reference center, in order to identify better strategies for prevention and care. Burn patients admitted to the pediatric departments of our hospital from January 2020 to June 2022 were retrospectively evaluated. Age, gender, the etiology of injuries, the total burn surface area (TBSA), the degree of burns, the length of hospital stay (LOS), concomitant SARS-CoV-2 infection, and burn surface microbial colonization were analyzed. Forty-seven patients were included in the analysis (M:F = 1:0.67). Most of the cases involved patients between 0 and 4 years of age (83%). Hot liquid burns accounted for 79% of cases, flame burns for 9%, thermal burns for 6%, scald burns for 4% and chemical burns for 2%. Mean TBSA was 14 ± 11%. A second-degree lesion was detected in 79% of patients and third-degree in 21%. Mean LOS was 17 days. No additional infection risks or major sequelae were reported in patients with SARS-CoV-2 infection. Fifteen different species of bacteria plus C. parapsilosis were isolated, while no anaerobic microorganisms were detected. In the light of our experience, we recommend a carefully planned and proactive management strategy, always multidisciplinary, to ensure the best care for the burned child.

The effect of training program based on health belief model on burn prevention knowledge in mothers of children aged to 1-3 years: A randomized controlled

PURPOSE

One of the effective models in health education is the health belief model that considers a person's behavior as a under the influence of knowledge and attitude. In the present study, we investigated the efficacy of a training program based on the health belief model in burn prevention knowledge in mothers of children aged between 1 and 3 years old.

DESIGN AND METHODS

This single blind randomized Control Trial study was conducted on 64 mothers with a child aged between 12 and 36 months who were referred to the Health Centers of Shiraz, Iran, in 2018. Accordingly, using cluster sampling, 4 health centers were selected and then 2 centers were assigned to the intervention group and 2 other centers to the control group by randomization. The intervention group received six sessions of training. However, in order to observe the ethical principles, the educational content was provided to the control group at the end of the present study. Both groups completed health belief model questionnaire before, after the intervention, and by passing 2 months from the intervention. The collected data were compared between the two groups using SPSS software, version 25.

RESULTS

We found no differences in the demographics of the two study groups (P > 0.05). Intragroup comparison in the intervention and control groups indicated a significant difference among the three intervals (both P = 0.001). As well, a difference was found between the intervention and the control groups immediately after the intervention and 2 months after the intervention (both P < 0.001). Additionally, in both groups, the relationship between mothers' knowledge score and each dimension of the health belief model was examined, which was a significant. (P = 0.001).

CONCLUSION

Health belief model can be considered as an effective method for educating mothers in terms of the prevention of children's burn and the increased the mothers' knowledge.

PRACTICE IMPLICATIONS

The health belief model was shown to have a good effect on educating mothers regarding child burn's prevention. So, due to this reason, it is recommended to use this model for burn's prevention training programs.

Tolerance to Glucose and Lipid High Metabolic Reactions After Burns in an Obese Rat Model

The goal of this study was to determine what effect obese body weight and a burn injury can have on the metabolism of glucose and lipids in rats. We used a 3 * 3 factorial model design to provide basic glucose and lipid metabolic data characterizing the interaction between different weight and burn injury groups. Two hundred Sprague Dawley rats were categorized into three weight groups (normal, overweight, obese) and then further divided into control, second-degree, and third-degree burn groups. Our model compared interactions between weight and burn injury factors according to the above groups. Blood glucose and lipid metabolism indicators were monitored on the 1st, 3rd, 7th, and 14th days after burn injury occurred, and burned skin and blood samples were collected for testing. Compared with the normal weight group, the overweight group's fast blood glucose, fast insulin, and homeostasis model assessment of insulin resistance were higher (P < .05), and FBG in the obese group was higher than the normal weight group (P < .05). Burn injuries combined with obese body weight had an interactive effect on fast blood glucose, fast insulin, and homeostasis model assessment of insulin resistance after burn injury (P < .05). Burn injury combined with obese body weight had an interaction on low-density lipoprotein cholesterol on the 3rd day after burn injury (P < .05). Burn injury combined with obese weight had no interaction on triglyceride, total cholesterol, and high-density lipoprotein cholesterol (P > .05). Rats in the overweight and obese weight groups were observed to develop an adaptation and tolerance to a higher metabolic rate after burn injuries occurred.

Using Social Media for the Prevention of Pediatric Burn Injuries: Pilot Design and Usability Study

BACKGROUND

Most pediatric burn injuries are preventable. Social media is an effective method for delivering large-scale messaging and may be useful for injury prevention in this domain.

OBJECTIVE

This study evaluates the feasibility of creating a social media campaign for pediatric burn injury prevention.

METHODS

Ad spots containing a headline, short introduction, and video were created and posted on Facebook and Instagram over 4 months. Ad spots were targeted to parents and caregivers of children in our region with the highest number of burn injuries. We assessed the impact of each ad set using ThruPlays, reach, and video plays.

RESULTS

We created 55 ad spots, with an average length of 24.1 (range 10-44) seconds. We reached 26,496 people during the campaign. The total ThruPlays of the 55 ad spots were 14,460 at US $0.19 per ThruPlay. Ad spots related to home safety had a significantly higher daily ThruPlay rate than those related to fire safety (6.5 vs 0.5 per day; P<.001).

CONCLUSIONS

Social media is a feasible modality for delivering public health messages focused on preventing pediatric burn injuries. Engagement with these ads is influenced by ad presentation and the focus of the underlying injury prevention message.

Cost-drivers of medical expenses in burn care management

BACKGROUND

Profound differences exist in the cost of burn care globally, thus we aim to investigate the affected factors and to delineate a strategy to improve the cost-effectiveness of burn management.

METHODS

A retrospective analysis of 66 patients suffering from acute burns was conducted from 2013 to 2015. The average age was 26.7 years old and TBSA was 42.1% (±25.9%). We compared the relationship between cost and clinical characteristics.

RESULTS

The estimated cost of acute burn care with the following formula (10,000 TWD) = -19.80 + (2.67 × percentage of TBSA) + (124.29 × status of inhalation injury) + (147.63 × status of bacteremia) + (130.32 × status of respiratory tract infection).

CONCLUSION

The majority of the cost were associated with the use of antibiotics and burns care. Consequently, it is crucial to prevent nosocomial infection in order to promote healthcare quality and reduce in-hospital costs.

Copaiba oleoresin has topical antinociceptive activity in a UVB radiation-induced skin-burn model in mice

ETHNOPHARMACOLOGICAL RELEVANCE

Copaiba oleoresin, extracted from Copaifera L., is used as a wound healing, analgesic, antimicrobial and, mainly, anti-inflammatory agent. Thus, in this study we investigated the antinociceptive and anti-inflammatory effects of a topical formulation containing Copaiba oleoresin (3%) in a UVB radiation-induced skin burn model (0.75 J/cm²) in mice and performed a cream-formulation stability study.

MATERIALS AND METHODS

The chemical composition of Copaiba oleoresin was analyzed using gas chromatography (GC-MS). The topical antinociceptive (evaluated through mechanical allodynia and thermal hyperalgesia) and the anti-inflammatory (dermal thickness and inflammatory cell infiltration) effects of treatments were assessed. The cream-formulation stability study was performed after two months, and organoleptic characteristics, pH, spreadability and rheological characteristics were analyzed.

RESULTS

Copaiba oleoresin cream was able to prevent UVB radiation-induced mechanical allodynia on the 2nd, 3rd and 4th day after UVB radiation exposure with a maximum inhibition (I_max) of 64.6 ± 7% observed on the 2nd day; it also reduced the thermal hyperalgesia on the 1st and 2nd days post UVB radiation, with a I_max of 100% observed on the 2nd day. Moreover, topical treatment with Copaiba oleoresin cream inhibited the inflammatory cell infiltration, but did not reduce the dermal thickness. Such effects can be attributed, at least in part, to the presence of biological components, such as β-caryophyllene and other sesquiterpenes identified by GC-MS.

CONCLUSION

Our results demonstrate that the topical formulation containing Copaiba oleoresin presented antinociceptive and anti-inflammatory effects in mice subjected to a UVB radiation and that the cream-formulation was stable for two months. Thus, use of Copaiba oleoresin is a promising strategy for the treatment of inflammatory pain associated with sunburn.

Anti-inflammatory and Wound Healing Activities of Aloe vera, Honey and Milk Ointment on Second-Degree Burns in Rats

The aim of the present study was morphological and morphometric investigation of burn healing impacts of an honey, milk, and Aloe vera (HMA) ointment on experimentally induced second-degree burns, to approve the medicinal basis of its use in Iranian traditional medicine. A total of 21 male Albino rats weighing 200 to 300 g were divided into 3 groups of 7, including (1) control group, (2) positive control group, and (3) the treatment group that were treated with eucerin, silver sulfadiazine 3% and HMA ointment 5% respectively.After anesthetizing, the second-degree burns (1 cm2 areas) were made on the back of the animals using a digital controlled hot plaque, and each group was treated topically, based on the time scheduled. Then, skin punch biopsies were obtained on the 1st, 14th, and 28th days of post–burn induction; processed; and stained using hematoxylin and eosin and Masson’s trichrome methods. The results showed that HMA ointment induces cell proliferation, increasing the wound closure rate, blood vessel counts, and collagen fiber density in treated animals. It also reduced the wound secretions, inflammation, and scar formation. According to the obtained morphological, morphometric results, we concluded that the traditional HMA ointment, which is rich in therapeutic biomaterials and minerals, has multiple healing effects on burn wounds in rats.

Evaluation of the "Early" Use of Albumin in Children with Extensive Burns: A Randomized Controlled Trial

OBJECTIVE

To compare early versus delayed albumin resuscitation in children with burns in terms of clinical outcome and response.

DESIGN

Randomized controlled trial.

SETTING

Burn center at a tertiary care teaching hospital.

PATIENTS

Forty-six children aged 1-12 years with burns greater than 15-45% total body surface area admitted within 12 hours of burn injury.

INTERVENTIONS

Fluid resuscitation was based on the Parkland formula (3 mL/kg/% total body surface area), adjusted according to urine output. Patients received 5% albumin solution between 8 and 12 hours post burn in the intervention group (n = 23) and 24 hours post burn in the control group (n = 23). Both groups were assessed for reduction in crystalloid fluid infusion during resuscitation, development of fluid creep, and length of hospital stay.

MEASUREMENTS AND MAIN RESULTS

There was no difference between groups regarding age, weight, sex, % total body surface area, cause of burn, or severity scores. The median crystalloid fluid volume required during the first 3 days post burn was lower in the intervention than in the control group (2.04 vs 3.05 mL/kg/% total body surface area; p = 0.025 on day 1; 1.2 vs 1.71 mL/kg/% total body surface area; p = 0.002 on day 2; and 0.82 vs 1.3 mL/kg/% total body surface area; p = 0.002 on day 3). The median urine output showed no difference between intervention and control groups (2.1 vs 2.0 mL/kg/hr; p = 0.152 on day 1; 2.58 vs 2.54 mL/kg/hr; p = 0.482 on day 2; and 2.9 vs 3.0 mL/kg/hr; p = 0.093 on day 3). Fluid creep was observed in 13 controls (56.5%) and in one patient (4.3%) in the intervention group. The median length of hospital stay was 18 days (range, 15-21 d) for controls and 14 days (range, 10-17 d) in the intervention group (p = 0.004).

CONCLUSIONS

Early albumin infusion in children with burns greater than 15-45% total body surface area reduced the need for crystalloid fluid infusion during resuscitation. Significantly fewer cases of fluid creep and shorter hospital stay were also observed in this group of patients.

Incidence and risk factors of burn injuries among infants, Finland 1990-2010

BACKGROUND

Our aim was to study the incidence, mechanisms, treatment, and risk factors of burn injuries in infants younger than 1 year.

METHODS

Data on burn-injured infants during 1990-2011 in Finland came from the National Hospital Discharge Register (NHDR). Information on birth and maternal-related factors came from the Finnish Medical Birth Register, and data on fatal injuries from the Cause of Death Register of Finland.

RESULTS

This study included 1842 children, female to male 1:1.5. The annual overall incidence of inhospital and outpatient admissions increased during the study period (p<0.05). Major risk factors were male gender, parity, and the mother's socioeconomic status and young age. The most common causes were scalds and contact burns. Severity of the injury increased along with increasing age, and children aged 9-12 months had the highest prevalence of surgical treatment.

CONCLUSIONS

Burn injury incidence in children under 1 year has increased during recent decades in Finland. First-born 9- to 12-month-old boys of young mothers of low socioeconomic status are at higher risk of burn injuries. Preventative work needs strengthening to reduce infant burn injuries.

Development a minimum data set of the information management system for burns

BACKGROUND

Burns are the most common and destructive injuries in across of the world and especially in developing countries. Nevertheless, a standard tool for collecting the data of burn injury has not been developed yet. The purpose of this study was to develop a minimum data set (MDS) of the information management system for burns in Iran.

MATERIALS AND METHODS

This descriptive and cross-sectional study was performed in 2014. Data were collected from hospitals affiliated with Hormozgan and Iran University of Medical Sciences and medical documents centers, emergency centers and legal medicine centers located in Bandar Abbas city, in addition to internet access and library. Investigated documents were burn injury records in 2013, and documents that retrieved from the internet, and printed materials. Records were selected randomly based on T20-T29 categories from ICD-10. Data were collected using a checklist. In order to make a consensus about the data elements the decision Delphi technique was applied using a questionnaire. The content validity and reliability of questionnaire were assessed by expert's opinions and test-retest method, respectively.

RESULTS

An MDS of burns was developed. This MDS divided into two categories: administrative and clinical with six and 17 section and 161 and 311 data elements respectively.

CONCLUSIONS

This study showed that comprehensive and uniform data elements about burns do not exist in Iran. Therefore a MDS was developed for burns in Iran. Development of an MDS will result in standardization and effective management of the data through providing uniform and comprehensive data elements for burns. Thus, comparability of the extracted information from different analyses and researches will be possible in various levels. In addition, establishment of policies and prevention and control of burns will be possible, which results in the improvement of the quality of care and containment of costs.

[Epidemiologic profile of children with burns from the Civil Hospital of Guadalajara "Dr. Juan I. Menchaca", 2009-2011]

BACKGROUND

Burns are a public health problem, ranking among the 20 principal causes of morbidity in Mexico. Children are a more vulnerable group to suffer from these injuries. For that reason, we analyzed cases in order to gain a better comprehension and to propose preventive measures for this problem. The aim of the study was to determine the epidemiological profile of those injuries to allow us to plan and implement actions for burn prevention.

METHODS

We conducted a cross-sectional study that included demographic characteristics of the child, the parents and the burn injuries from children treated at this Burn Unit. Statistical analysis was done to calculate amounts, proportions and 95% confidence intervals.

RESULTS

The epidemiological profile of the injuries included males (63.4%) <5 years of age (65.2%) with educational level according to their age (56.2%). Parents of the included children were <35 years old with basic educational level. Burns were caused by hot water (56.2%) and occurred between noon and midnight (73.0%). The majority of the burns were shallow and deep second-degree or minor (69.2%) and affected <20% of body surface area (74.5%).

CONCLUSIONS

This epidemiological profile paved the way for preventive actions beginning with scientific research to guide the actions in a progressive direction along with the cooperative actions of public and private institutions in the development of programs and strategies. The end result would be the establishment of a public policy for accidental injuries.

Improving burn care and preventing burns by establishing a burn database in Ukraine

BACKGROUND

Burns are a challenge for trauma care and a contribution to the surgical burden. The former Soviet republic of Ukraine has a foundation for burn care; however data concerning burns in Ukraine has historically been scant. The objective of this paper was to compare a new burn database to identify problems and implement improvements in burn care and prevention in this country.

METHODS

Retrospective analyses of demographic and clinical data of burn patients including Tukey's post hoc test, analysis of variance, and chi square analyses, and Fisher's exact test were used. Data were compared to the American Burn Association (ABA) burn repository.

RESULTS

This study included 1752 thermally injured patients treated in 20 hospitals including Specialized Burn Unit in Municipal Hospital #8 Lviv, Lviv province in Ukraine. Scald burns were the primary etiology of burns injuries (70%) and burns were more common among children less than five years of age (34%). Length of stay, mechanical ventilation use, infection rates, and morbidity increased with greater burn size. Mortality was significantly related to burn size, inhalation injury, age, and length of stay. Wound infections were associated with burn size and older age. Compared to ABA data, Ukrainian patients had double the length of stay and a higher rate of wound infections (16% vs. 2.4%).

CONCLUSION

We created one of the first burn databases from a region of the former Soviet Union in an effort to bring attention to burn injury and improve burn care.