Factors associated with duration of hospitalization and outcome in burns patients: a cross sectional study from Government Tertiary Care Hospital in Karachi, Pakistan

Associated predictors of prolonged length of stay in patients surviving extensive burns: A large multicenter retrospective study

BACKGROUND

Patients with extensive burns are critically ill and have long treatment periods. Length of stay (LOS) is a good measure for assessing treatment. This study sought to identify predictors of prolonged LOS in patients with extensive burns (≥50% TBSA).

METHODS

This retrospective multicenter cohort study included adults aged ≥ 18 years who survived extensive burns in three burn centers in Eastern China between January 2016 and June 2022. Epidemiological, demographic and clinical outcomes data were extracted from electronic medical records and compared between patients with/without prolonged LOS, which was defined as LOS greater than the median. Logistic regression analysis was used to identify predictors of prolonged LOS.

RESULTS

The study sample included 321 patients, of whom 156 (48.6%) had an LOS of 58 days (IQR 41.0-77.0). Univariate regression analysis showed that increased total burn area and increased full-thickness burn area; electrical, chemical and other burns; increased erythrocytes, leukocytes, platelets or serum creatinine within 24 h of admission; concomitant inhalation injury, pulmonary edema, sepsis, bloodstream infection, wound infection, pulmonary infection, urinary tract infection, or HB < 70 g/L during hospitalization were associated with prolonged LOS in patients with extensive burns. Increased number of surgical operations, mechanical ventilation and renal replacement therapy were also associated with prolonged LOS (P < 0.05 or P < 0.001). Multivariate regression analysis revealed that increased total burn area (ratio 1.032, 95%CI 1.01-1.055; P = 0.004), electrical and chemical or other burns (3.282, 1.335-8.073; P = 0.01), development of wound infection (2.653 1.285-5.481; P = 0.008) and increased number of operative procedures (1.714, 1.388-2.116, P < 0.001) were significant predictors.

CONCLUSIONS

Increased area of full-thickness burn,occurrence of electrical and chemical or other burns,occurrence of wound infection and increased number of surgeries are the best predictors of prolonged LOS in patients with extensive burns. Clarifying relevant predictors of burn patients' LOS provides a reliable reference for clinical treatment.

Queima às bruxas: feminismo e feminicídios íntimos por queimadura em uma metrópole brasileira

Resumo O feminicídio se configura como assassinato de mulheres em decorrência das relações desiguais de poder. É uma realidade crescente, que gera agravos e expõe relações de gênero, raça e classe desiguais, que culminam em violência extrema e morte. Objetiva-se analisar três casos de feminicídio por queimaduras ocorridos na cidade de Campinas (SP) durante os anos de 2018-2019. Trata-se de um estudo qualitativo que usou o método de autópsia verbal para o levantamento de informações e utilizou narrativas para descrever os casos. Foram discutidas as circunstâncias da morte das mulheres, integrando na discussão os conceitos de feminismos, a representação simbólica do fogo, a interseccionalidae, o patriarcado e suas implicações a partir do olhar da saúde coletiva.

Predictors of short-term outcomes of burn in a newly established burn centre in Iran

Aim

This study aimed to determine the predictors of hospital stay and mortality in patients with burns.

Design

This is a cross‐sectional, retrospective study.

Methods

This study was performed on 626 medical records in Velayat Subspecialty Burn and Plastic Surgery Center in Rasht, Iran, during 2008–2013.

Results

Men comprised 78.4% of the study population. Overall, 50.2% of the participants lived in rural areas, and 72.5% were married. The majority of burns occurred at home (49.5%), and thermal factor (87.4%) was the major cause of burn injuries. Also, 6.9% of the patients died after burns. The mean length of hospital stay was 12.62 ± 13 days. Age (OR = 1.07), total body surface area (TBSA%) (OR = 1.12) and length of ICU stay (OR = 1.06) were the strongest predictors of mortality. Gender (IRR = 0.85), TBSA% (IRR = 1.01), location of burn (IRR = 1.1), skin graft (IRR = 2.12), length of ICU stay (IRR = 1.04), re‐hospitalization (IRR = 1.77) and burn degree (IRR = 1.09) were the predictors of the length of hospital stay.

Conclusion

BSA is still an important predictor of mortality and length of hospital stay, as the most important short‐term outcomes of burns.

Factors associated with outcomes after burn care: A retrospective study in Eastern Democratic Republic of Congo

OBJECTIVE

In low income countries, incidence of burns is high and severe burns are frequently managed at peripheral facilities. Outcome after burn care is poorly studied although it might help identify risk-group and improve treatment strategies. This study aimed to study factors associated with in-hospital outcomes in a burn cohort in the Democratic Republic of Congo.

METHODS

In this retrospective study we included burn patients admitted to the surgical department at the Hôpital Provincial Général de Référence de Bukavu between January 2013 and December 2018. Differences between groups were tested using χ2 test or Fisher's exact tests or Wilcoxon rank sum test, as appropriate. Multivariate logistic regression was used to analyze the effect of patients and of burn characteristics on in-hospital mortality, prolongated length of stay (=LOS≥25days) and occurrence of complications.

RESULTS

The study population consisted of 100 patients, mainly young male with rural origin, moderate sized but deep burns. Of them, 46 developed complications, 12 died. Median LOS was 25 days (IQR: 15-42). In-hospital death was independently associated with Total Burn Surface Area percentage "TBSA%" (OR=3.96; 95% CI=1.67-9.40) and Full thickness Burns "FTB" (10.68; 1.34-84.74); prolongated LOS with FTB (3.35; 1.07-10.49), and complication with rural origin (5.84; 1.51-22.53), TBSA% (3.96; 1.67-9.40), FTB (4.08; 1.19-14.00) and burns on multiple sites (4.38; 1.38-13.86).

CONCLUSION

In-hospital death was associated with TBSA% and FTB, prolongated LOS with FTB, and complication with burns characteristics and rural origin of the patients. Further studies are necessary to investigate the effect of provided burn care on outcomes.

Dental health status and oral health behaviours of patients with facial burn in Pakistan

Background

There is a limited understanding about the oral health of patients with facial burn, hence the aim was to describe the oral health status and the related risks factors.

Methods

This cross-sectional study had randomly and systematically recruited facial burn patients from the Burn Care Center, Pakistan Institute of Medical Sciences, Islamabad, from June of 2016 to July of 2017. Intraoral examination recorded the DMFT, CPI and OHI-S. Information on the socio-demographic status, self-perceived oral health, oral health behaviours were collected using a self-administered questionnaire and; the burn characteristics were obtained from the patients’ medical record. The t-test, ANOVA, SLR, and chi-square test were used to examine the relationship between oral health and each factor. A parameter was derived from the clinical indices using the principal component analysis and used in the multiple linear regression analysis to determine the important factors associated with oral health status.

Results

A total of 271 burn patients (69% female and 31% male) had participated in the study. All of the participants had caries with mean DMFT = 10.96 (95%CI: 10.67, 11.25). There were 59.0% (95%CI: 53.15, 64.93%) and 66.1% (95%CI: 60.38, 71.73%) of the participants who had periodontitis and poor oral hygiene respectively. About 79 and 80% of the participants rated their dental and periodontal status as poor. About 78% reported brushing once daily and 89% did not practice regular dental visit. The DMFT, CPI and OHI-S were associated with the burn characteristics and oral health behaviours (p < 0.05). Dental anxiety, cost and social issues were the most cited reasons for not utilising oral health services. Greater burn severity, the longer time elapsed since the burn incident, and dental anxiety were associated with poorer oral health status and; brushing twice or more and regular dental visit, with better status (p < 0.01).

Conclusion

Patients with oro-facial burn injury had a generally poor oral health and, the risks are greater in those with a more severe and wider area of injury, the longer time elapsed since the burn incident and dental anxiety; but a good oral hygiene practice and regular dental visits were protective against the risk.

Is location of burns related to outcome? A comparison between burns on extremities and burns on head and/or trunk in patients with low to intermediate TBSA in a burn center in The Netherlands

In the literature no study was found about the effect of location of burns on outcome. The objective of this retrospective study was to investigate the effect of location on outcome parameters of 371 patients, admitted to our burn center from January 2009 to December 2011. The patients were included in the study if more than 80% of the burn(s) was localized either on the extremities or on the head and/or trunk. Two groups of TBSA were elaborated, low: 0 to 5% and intermediate: 5 to 15%. Two-hundred ninety-two patients (78.7%) had a low TBSA (<5%) and 79 (21.3%) an intermediate TBSA (5-15%). None of the included patients died. The patients with an intermediate TBSA were on average 8.0 days longer admitted compared with the patients with a low TBSA adjusted for age and depth (95% confidence interval: 6.5-9.4). The patients with burns on the head and/or trunk were more often admitted to the intensive care unit, mostly as a result of suspected inhalation injury (6.2 vs 0.9%; P = .008). More complications were seen in the intermediate TBSA group. In this study no difference in outcome was found between burns on the head and/or trunk or on extremities. The patients with burns on the head and/or trunk group are more frequently admitted to intensive care.

Burn injury characteristics: findings from Pakistan National Emergency Department Surveillance Study

Background

Burn injury is an important yet under-researched area in Pakistan. The objective of this study was to determine the characteristics and associated outcomes of burn injury patients presenting to major emergency departments in Pakistan.

Methods

Pakistan National Emergency Department Surveillance (Pak-NEDS) was a pilot active surveillance conducted between November 2010 and March 2011. Information related to patient demographics, mode of arrival, cause of burn injury, and outcomes was analyzed for this paper. Data were entered using Epi Info and analyzed using SPSS v.20. Ethical approval was obtained from all participating sites.

Results

There were 403 burn injury patients in Pak-NEDS, with a male to female ratio 2:1. About 48.9% of the burn injury patients (n = 199) were between 10 - 29 years of age. There was no statistically significant difference between unintentional and intentional burn injury patients except for body part injured (p-value 0.004) and ED disposition (p-value 0.025). Among 21 patients who died, most were between 40 - 49 years of age (61.9%) and suffered from fire burns (81%).

Conclusion

Burn injuries are a burden on emergency rooms in Pakistan. We were able to demonstrate the significant burden of burn injuries that is not addressed by specialized burn centers.

Factors associated with length of hospital stay in minor and moderate burns at Popayan, Colombia. Analysis of a cohort study

OBJECTIVE

To determine the independent contribution of prognostic factors to length of hospital stay of minor and moderate burn victims at the Hospital Universitario San José (HUSJ), Popayán, Colombia, 2000-2010.

METHODS

This was a retrospective cohort study of minor and moderate burn victims admitted between 2000 and 2010, at the burn unit (HUSJ). This is a further analysis of a same cohort previously published in Burns. The following variables were recorded and analyzed: age, gender, origin, depth and extent of burn, causal agent, length of hospital stay and mortality. The main outcome under study was length of stay. Survival analysis was done to explore the association of covariates and length of hospital stay and Cox regression model to adjust the effect of covariates in the outcome.

RESULTS

During the study period 2000-2010, 842 of 921 (91.5%) patients treated at the Burn Unit of HUSJ that had complete data were included. There were 520 (61.8%) males and 322 (38.2%) females with a male to female ratio of 1.6:1. Their median age was 9 years (IQR 3-28). The median of percent total body surface area burned (TBSA) was 12% (IQR 7-21) and the most common degree of burn was 2nd degree with 58% (488 patients). There were 12 deaths (censored data) and 830 patients were discharged alive. After multivariate adjustment, significant associations with length of hospital stay remained for age group, burn degree and extension of the burn. The strongest relationship found was for burn degree (2nd degree superficial vs. 3rd degree hazard ratio=2.66 CI 95% [2.13-3.33]).

CONCLUSIONS

In patients admitted with mild and moderate burns at HUSJ, the main predictors of length of stay were age, burn degree and extension of the burn.

Guidelines for burn rehabilitation in China

Quality of life and functional recovery after burn injury is the final goal of burn care, especially as most of burn patients survive the injury due to advanced medical science. However, dysfunction, disfigurement, contractures, psychological problems and other discomforts due to burns and the consequent scars are common, and physical therapy and occupational therapy provide alternative treatments for these problems of burn patients. This guideline, organized by the Chinese Burn Association and Chinese Association of Burn Surgeons aims to emphasize the importance of team work in burn care and provide a brief introduction of the outlines of physical and occupational therapies during burn treatment, which is suitable for the current medical circumstances of China. It can be used as the start of the tools for burn rehabilitation.