Epidemiologic investigation of burns in the elderly in Sichuan Province

Time trends in thermal burns incidence among Brazil, Russia, India, China, and South Africa (BRICS), an age-period-cohort analysis from the GBD 2019

Burns are a serious public health problem. Despite the decline in the global burden of burns, the burden of burns remains high in low- and middle-income regions, including BRICS countries. To analyse the trend of burn injury incidence in BRICS countries (Brazil, Russia, India, China, South Africa) from 1990 to 2019 and to provide a reference basis for burn injury prevention and management. Data were obtained from the Global Burden of Disease 2019 data, and an age‒period‒cohort model was used to analyse the burn injury incidence data of BRICS countries from 1990 to 2019 via the apc package of R 4.3.0 software. The incidence of burn injuries in BRICS countries decreased from 1990 to 2019, from 114.50 to 85.90 per 100,000, a decrease of 24.98%. Brazil had the largest decrease, 57.05%, and China had the smallest decrease, 7.66%. There was an overall decreasing trend in the incidence of burn injuries in Brazil and South Africa. The results of the age‒period‒cohort (APC) model revealed that the net drift values of burn injury incidence in India, China, South Africa, Russia, and Brazil were ( -0.05% [ 95% CI, -0.30 to 0.21 ] ), ( 0.19% [ 95% CI, 0.03 to 0.35 ] ), ( -1.35% [ 95% CI, -1.65 to -1.04 ] ), ( -0.91% [ 95% CI, -1.02 to -0.80 ] ), ( -3.33% [ 95% CI, -3.49 to -3.16 ] ), respectively. There was an overall decreasing trend in the localized drift curves in Brazil and China. The incidence of burns is greater in children and young adults. Between 1990 and 2019, the time trend had the most significant impact on Brazil's burn incidence, and the period effect also contributed positively, making Brazil the most notable among the BRICS countries in terms of improvement trends. From 1990 to 2004, the period effect positively impacted China's burn incidence, whereas from 2010 to 2019, it had a negative effect. In Brazil, South Africa, and Russia, the burden on cohorts born between 1990 and 2019 has been steadily decreasing, and the cohort effect has had a positive effect on the incidence of burns among later birth cohorts. However, in China, the burden borne by cohorts born from 1990 to 2019 has been consistently increasing. There was an overall decreasing trend in the incidence of burns in BRICS countries from 1990 to 2019. Children and adolescents have a high incidence of burns. It is recommended that burn prevention and control strategies be developed according to the age structure and economic level of different countries.

Immunomodulatory hydrogels for skin wound healing: cellular targets and design strategy

Skin wounds significantly impact the global health care system and represent a significant burden on the economy and society due to their complicated dynamic healing processes, wherein a series of immune events are required to coordinate normal and sequential healing phases, involving multiple immunoregulatory cells such as neutrophils, macrophages, keratinocytes, and fibroblasts, since dysfunction of these cells may impede skin wound healing presenting persisting inflammation, impaired vascularization, and excessive collagen deposition. Therefore, cellular target-based immunomodulation is promising to promote wound healing as cells are the smallest unit of life in immune response. Recently, immunomodulatory hydrogels have become an attractive avenue to promote skin wound healing. However, a detailed and comprehensive review of cellular targets and related hydrogel design strategies remains lacking. In this review, the roles of the main immunoregulatory cells participating in skin wound healing are first discussed, and then we highlight the cellular targets and state-of-the-art design strategies for immunomodulatory hydrogels based on immunoregulatory cells that cover defect, infected, diabetic, burn and tumor wounds and related scar healing. Finally, we discuss the barriers that need to be addressed and future prospects to boost the development and prosperity of immunomodulatory hydrogels.

Factor XIII: More than just a fibrin stabilizer for the burn patient? A matched-pair analysis

Background

Acquired factor XIII deficiency is an underestimated risk in patients with large surface burns, which potentially exposes these patients to prolonged bleeding and delayed wound healing if undetected.

Methods

A retrospective matched-pair analysis of the burn registry of the Department of Plastic, Aesthetic, Hand, and Reconstructive Surgery of Hannover Medical School was performed from 2018 to 2023.

Results

A total of 18 patients were included. Acquired factor XIII deficiency was not statistically significant correlated with age, sex, or body mass index. Patients who developed acquired factor XIII deficiency had a significantly longer hospital stay (72.8 days) compared with those in the matched group (46.4 days), although burn depths, total body surface area, and Abbreviated Burn Severity Index were not statistically correlated with factor XIII deficiency.

Conclusions

Little is known about acquired factor XIII deficiency in patients with burns. Factor XIII supplementation may improve hemostasis, wound healing, and general outcome while reducing the patient's exposure to blood products.

Epidemiological and clinical characteristics of older adults with burns: a 15-year retrospective analysis of 2554 cases in Wuhan Institute of Burns

BACKGROUND

With the increase of geriatric burns, it's urgent to summarize its characteristics. The aim of this study was to analyze the epidemiological and clinical characteristics of older adults with burns in a large center, and to provide suggestions for the prevention and treatment of geriatric burns.

METHODS

This retrospective study was conducted at Wuhan Institute of Burns which is the largest burn center in central China between 2004 to 2018. Demographic and clinical data of the 60 years or above older burn inpatients were collected from medical records, analyzed and compared among groups.

RESULTS

This study analyzed 2554 elderly burns, which included 50.9% in young geriatric group (60-69 years old), 32.9% in middle geriatric group (70-79 years old) and 16.2% in the oldest geriatric group (80 years old or above). The most common causes of elderly burns were flames (1081, 42.3%) and scalding (1041, 40.8%). Elderly burns with total body surface area (TBSA) of 0-9% accounted for 60.6% and the larger TBSA, the fewer number of patients. The majority of patients (70.5%) injured at home.The median of time interval from injury to admission was 7 h and the oldest geriatric group (24 h) was highest. One hundred and twenty-one cases (8.5%) were treated by cooling treatment, and 72.7% of these patients were treated less than 10 min. The median number of pre-injury diseases was one. Ninety patients (6.3%) had inhalation injury.The median length of stay (LOS) was 14 days.The median hospital cost was 10,410 CNY or 2137 CNY per % TBSA, which was correlated with TBSA, LOS, surgery, inhalation injury, number of pre-injury diseases and etiology. The mortality rate was 3.0% and correlated with TBSA, inhalation injury, pulmonary disease and Alzheimer's disease. The lethal area 50% (LA₅₀) for total admitted elderly burns was 78.3% TBSA (95% confidence interval [CI] = 69.8 ~ 89.9% TBSA).

CONCLUSION

Geriatric burns was still common and even increasing in central China, with flame burns and scalds the most common causes, majority of whom injured at home and often had problems such as few cooling treatment, improper emergency management and delayed admission. TBSA, etiology, pre-injury diseases and inhalation injury were the risk factors of length of stay, hospital cost and treatment outcomes.

Epidemiology of Burn-Related Morbidity and Mortality in Patients Over Eighty Years of Age

Burns cause greater morbidity and mortality in older patients owing to the physiological changes and functional status declines with age. We sought to characterize the epidemiology of burn injuries in the patient population aged over eighty years. A retrospective analysis of all patients aged >80 years admitted to a tertiary burn center in Brazil over a 10-year period was conducted. Multiple parameters including comorbidities, body surface area(BSA) burned, intensive care unit(ICU) admissions, inhalation injury and revised Baux score were analyzed to assess association with mortality. 26 patients were identified. The overall mortality rate was 42.3%. The mortality rate increased with the TBSA, with 100% mortality at >20% total BSA involvement(p<0.001). Inhalation injury occurred in 3(11.5%) patients, all of whom suffered mortality(p<0.001). ICU admission was necessary for 14(53.8%) patients, out of which 11(78.6%) did not survive(p<0.001). The revised Baux score had a significant impact on the mortality, with higher values among patients who did not survive(89.2 ± 6.2 versus 110.7 ± 17.9,p < 0.001). Burns cause high mortality in the octogenarian and nonagenarian populations. It is important to stratify patients at high risk, institute prompt treatment and discuss goals of care early on for optimal patient outcomes.

Effect of the Mini Nutritional Assessment-Short Form (MNA-SF) in Elderly Burn Patients

OBJECTIVE

Nutritional assessment can early identify patients who are malnourished and at risk of malnutrition. To examine the effect of nutritional status on wound healing in elderly burn patients, we used the MNA-SF to measure the nutritional status of elderly patients. This study aimed to examine the role of MNA-SF in elderly burn patients through the correlation analysis of wound-healing indicators and MNA-SF score.

DESIGN

Prospective observational and cross-sectional study.

METHODS

This study used the MNA-SF to investigate the elderly burn patients at the department of burn. According to the score, the patients fell into three groups: good nutritional status (more than 12 points), malnutrition risk (8~11 points), and malnutrition (0~7 points). At the same time, we measured and compared the wound-healing indicators among the three groups of patients, and detected the correlation.

RESULTS

The statistical analysis found gender had a slight influence on the score of nutritional status. While age was negatively correlated with the MNA-SF score and nutrition-related indicators. There was a low positive linear correlation between the wound healing percent area change or wound healing rate of patients and the score of the MNA-SF.

CONCLUSION

This study finds malnutrition is common among hospitalized elderly burn patients. The application of the MNA-SF in elderly burn patients is efficient and accurate to identify malnutrition early and prevent further obstruction of the normal wound healing, which can provide reference points for early nutrition intervention programs.

Evaluation of the epidemiological characteristics of the patients admitted to our clinic as a result of electric shock

INTRODUCTION

Electric shocks (ES) are common traumas in burn units that require treatment by specialists due to high mortality and morbidity.

OBJECTIVE

This study aimed to investigate the demographic and clinical characteristics of patients of ES, complications, and injury-related mortality and morbidity rates.

MATERIALS AND METHODS

We retrospectively analyzed data of 432 ES patients treated at the Gazi Yaşargil Training and Research Hospital Burn Center, Turkey, between January 2010 and December 2020.

RESULTS

Of the 432 patients, 92 (21.3%) and 340 (78.7%) sustained high- and low-voltage injuries, respectively. While high-voltage burns were common in January and December, low-voltage burns peaked in September and July. Burn patients were mostly males and were between the ages of 19 and 59 years. The majority of the ES events occurred at home. All four patients who died had suffered high-voltage burns, with two of high-voltage burns (2.17%) requiring amputation. None of the patients with low-voltage burns underwent amputation. High-voltage injuries manifested with larger burn surfaces, longer hospitalization, and more complications.

CONCLUSION

Electrical injuries are largely preventable with simple safety precautions in daily life as well as serious consideration of workplace safety.

Epidemiological and clinical characteristics of burns in the older person: a seven-year retrospective analysis of 693 cases at a burn center in south-west China

Background

Burns are one of the major traumas that may affect older individuals. The purpose of this study was to investigate the epidemiological and clinical characteristics of geriatric burns at a major center in south-west China.

Methods

This retrospective study was conducted at the Institute of Burn Research, Southwest Hospital of Army Medical University between 2010 and 2016, and the data collected from medical records included admission date, age, gender, premorbid disease, burn etiology, injured anatomical location, burn area and depth, inhalation injury, number of surgeries, length of stay (LOS), clinical outcome, and medical cost.

Results

Of the 693 older burn patients included, 60.75% were male and 56.85% were aged 60–69 years. Burns peaked in December–March and June. Flame was the most common cause of burns, making up 51.95% of all cases, and also dominated in the burn patients aged 60–69 years. Limbs were the most common anatomical sites of burns (69.41%), and the median total body surface area (TBSA) was 5% (interquartile range [IQR]: 2%–15%). The percentage of the patients who underwent surgeries and number of surgeries significantly increased in the cases of contact burns, younger age and full-thickness burns. Six deaths resulted in a mortality of 0.9%. The median LOS was 16 days (IQR: 8–29 days), and the main risk factors were more surgeries, better outcomes, and full-thickness burns. The median cost was 20,228 CNY (IQR: 10,457– 46,581.5 CNY), and major risk factors included longer LOS, larger TBSA, and more surgeries. Furthermore, compared to the earlier data from our center, the proportion of older adults among all burns (7.50% vs. 4.15%), proportion of flame burns (51.95% vs. 33.90%), and mean age (69.05 years vs. 65.10 years) were significantly higher, while the proportion of premorbidities (16.9% vs. 83.9%), mortality (0.9% vs. 7.5%) and median TBSA (5% vs. 21%) were significantly lower.

Conclusions

This study suggested that closer attention should be paid to prevent burn injuries in older people aged 60–69 years, especially males, regarding incidents in the summer and winter, and flame burns. Moreover, tailored intervention strategies based on related risk factors should be under special consideration.

Epidemiological Investigation of Elderly Patients with Severe Burns at a Major Burn Center in Southwest China

Background

The treatment of elderly patients with severe burns is difficult and the mortality rate is high. The aim of this study was to investigate the epidemiological features of elderly patients with severe burns.

Material/Methods

Data from 109 elderly patients with severe burns between January 2009 and December 2018 were retrospectively analyzed. Demographic data, clinical characteristics, treatments, and outcomes were statistically analyzed.

Results

Among the 109 elderly patients with severe burns, the male-to-female ratio was 1.73: 1.0. The median age of the elderly patients was 67 years, and the median total body surface area (TBSA) burned was 42%. Notably, 67.9% of burns occurred at home and most frequently occurred in summer (38.5%) and winter (28.4%); flame and flash burns predominated (83.4%). The incidence of inhalation injury was 35.8%, and pre-existing comorbidities were observed in approximately 51.4% of the patients. The median length of stay in the hospital per TBSA burned was 0.4 days. The mortality rate in the elderly patients was 24.8%, and the mortality rates in the ≥70% TBSA group, inhalation injury group, and patients with 3 or more pre-existing comorbidities were significantly higher than in the other groups. The risk of death increased with an increase in the number of pre-existing comorbidities (odds ratio: 2.222; 95% confidence interval: 1.174–4.205).

Conclusions

At a major burn center in Southwest China, the incidence and mortality of elderly patients with severe burns displayed no downward trend. There are etiological characteristics of these age groups that should be considered for prevention. Meanwhile, multidisciplinary treatment in a hospital and an increase in the social support for the elderly population might improve outcomes.

Epidemiology of electrical burns: a 10-year retrospective analysis of 376 cases at a burn centre in South China

OBJECTIVE

To investigate the epidemiological profile and associated outcomes of electrical injuries at a major burn centre in southern China.

METHODS

This retrospective study enrolled consecutive electrical burn patients admitted to the burn centre of the First Affiliated Hospital of Guangxi Medical University between 2008 and 2017. Demographic and clinical data and outcomes were recorded. Mann-Whitney U tests/Pearson's chi-squared tests were used to examine the differences between low-voltage and high-voltage injuries.

RESULTS

There were 217 high-voltage injuries and 159 low-voltage injuries. High-voltage burns were frequently observed between March and August, and low-voltage burns peaked between June and September. Burn patients were mainly men. Most burns occurred in participants aged 21 to 50 years and in industrial workers and electricians at work or householders at home. Only one person with high-voltage burns died (a mortality rate of 0.46%). Amputation rates were 37.33% for high-voltage burns and 22.01% for low-voltage burns. High-voltage injuries were associated with more extensive burns, longer hospital stays, and more complications and amputations.

CONCLUSIONS

More attention should be paid to prevention of electrical burns in male adults. Particular focus is needed on industrial workers, incidents in the spring and summer, and high-voltage injuries.

The epidemiology and prognosis of patients with massive burns: A multicenter study of 2483 cases

OBJECTIVE

Epidemiological features of massively burned patients in China remains unclear. This study was designed to investigate the epidemiological characteristics and evaluate the burn index (BI) and other risk factors associated with the prognosis of massively burned patients.

METHODS

Data of patients with ≥30% total body surface area burned admitted in 2014 were retrieved from 106 burn centers in the mainland of China. Information of epidemiological features and the outcome were collected for retrospective analysis.

RESULTS

A total of 2483 massively burned patients were included in this study, with a male-to-female ratio of 2.29:1, the mean age of 49.23±16.67 years, mean TBSA of 55.53±21.39% and the mean BI of 39.75±21.59. Scald accounted for 81.07% of the injuries in children, while flame accounted for 66.89% and 74.31% of the injuries in adults and seniors. Approximately 17.76% of the patients were admitted to the local burn center after 6h of injury, and the wound areas of 1154 (46.48%) patients were covered with folk remedies. The mortality was 9.79%, and the area under the receiver operating characteristic (ROC) curve for BI was 0.941 (95% CI, 0.929-0.954). When the value of BI was above a threshold of 29 in the 0-14 years age group, 43.5 in the 15-59 years age group and 35.5 in the 60 years or older age group, the mortality increased significantly. Multivariate logistic regression analyses showed that the odds ratio (OR) of death increased 6% with an increase in the BI of 1.0. Patients older than 60 years, the admission time longer than 6h after-injury (adjusted OR, 1.797; 95% CI, 1.179-2.740; adjusted p<0.001), and patients with a combined inhalation injury (adjusted OR, 6.649; 95% CI, 4.517-9.789; adjusted p<0.000), were at higher risk of death.

CONCLUSIONS

There are etiological characteristics of the different age groups that should be considered for prevention. BI can be a reliable index of prognosis in severely burned patients. The results of the study showed that a large BI, elderly age, delayed admission after injury and combined inhalation injury are the main risk factors for extensively burned patients.

Epidemiologic Investigation of Burn Patients in Sichuan Province, China

BACKGROUND We investigated the epidemiology of patients admitted to the Burn Center of West China Hospital during 2011-2016, to provide measures for burn prevention. MATERIAL AND METHODS We conducted a retrospective review of patients admitted to the Burn Center of West China Hospital during 2011-2016. We collected information on patient demographics, burn etiology, burn extent, place of injury, education level, and burn knowledge of patients. RESULTS A total of 1323 patients (1033 males and 290 females), mean age 35.4 years (range 10 days to 91 years), were admitted to our burn center. Among all patients, 214 were children aged 0-14 years, 998 were adults aged 15-59 years, and 111 were elderly adults over age 60 years. Scalds were the predominant cause of pediatric burns; however, flame burns were most common among adults and elderly patients. The injury location varied by age, with most burns occurring at work among adults; however, most children and elderly patients were burned at home. Educational levels were lower among adults from rural areas than those from urban areas, but both groups had little first aid knowledge. Furthermore, rural patients had received less vocational education and training than urban patients. CONCLUSIONS There has been a decrease in burn incidence in Sichuan Province. Flame injury should be a focus of attention in all age groups. Prevention programs for adults in the workplace are imperative. Burn prevention programs should continue to improve living conditions, especially for elderly people.

Epidemiologic and clinical characteristics of severe burn patients: results of a retrospective multicenter study in China, 2011-2015

Background

Severe burns injury is a serious pathology, leading to teratogenicity and significant mortality, and it also has a long-term social impact. The aim of this article is to describe the hospitalized population with severe burns injuries in eight burn centers in China between 2011 and 2015 and to suggest future preventive strategies.

Methods

This 5-year retrospective review included all patients with severe burns in a database at eight institutions. The data collected included gender, age, month distribution, etiology, location, presence of inhalation injury, total burn surface area, depth of the burn, the length of hospitalization, and mortality. SPSS 19.0 software was used to analyze the data.

Results

A total of 1126 patients were included: 803 (71.3%) male patients and 323 (28.7%) female patients. Scalds were the most common cause of burns (476, 42.27%), followed by fire (457, 40.59%). The extremities were the most frequently affected areas, followed by the trunk. The median length of hospitalization was 30 (15, 52) days. The overall mortality rate was 14.21%.

Conclusions

Although medical centers have devoted intensive resources to improving the survival rates of burn patients, expenditures for prevention and education programs are minimal. Our findings suggest that more attention should be paid to the importance of prevention and the reduction of injury severity. This study may contribute to the establishment of a nationwide burn database and the elaboration of strategies to prevent severe burns injury.

Epidemiology and outcome analysis of 6325 burn patients: a five-year retrospective study in a major burn center in Southwest China

Burns are a major cause of injury worldwide. We investigated the epidemiology and outcomes of burn patients in a major burn center in southwest China between 2011 and 2015 to provide guidance for burn prevention. Of the 6,325 included burn patients, 66.8% were male and 34.7% were 0 ~ 6 years old. The incidence of burns peaked in autumn. Scald was the most common cause of burns, which was predominant in patients aged 0 ~ 6 years. The mean total body surface area (TBSA) of burns was 13.4%, and patients with burns ≤10% TBSA comprised 64.1% of all cases. Patients with full-thickness burns accounted for 40.1% of all patients and 81.0% of operated patients; these burns were primarily caused by flame (34.8%), scald (21.0%), and electricity (20.4%). Fifty-six deaths occurred (mortality 0.9%), and risk factors included full-thickness burns, larger TBSA and older age. The median length of stay was 17 days, and major risk factors included more operations, better outcomes and larger TBSA. Our data showed that closer attention should be paid to children under 6 years old, males, incidents in autumn and scald burns to prevent burn injuries. Furthermore, individualized burn prevention and treatment measures based on related risk factors should be adopted.

Outcomes of burns in the elderly: revised estimates from the Birmingham Burn Centre

Outcomes after burn have continued to improve over the last 70 years in all age groups including the elderly. However, concerns have been raised that survival gains have not been to the same magnitude in elderly patients compared to younger age groups. The aims of this study were to analyze the recent outcomes of elderly burn injured patients admitted to the Birmingham Burn Centre, compare data with a historical cohort and published data from other burn centres worldwide. A retrospective review was conducted of all patients ≥65 years of age, admitted to our centre with cutaneous burns, between 2004 and 2012. Data was compared to a previously published historical cohort (1999-2003). 228 patients were included. The observed mortality for the study group was 14.9%. The median age of the study group was 79 years, the male to female ratio was 1:1 and median Total Body Surface Area (TBSA) burned was 5%. The incidence of inhalation injury was 13%. Median length of stay per TBSA burned for survivors was 2.4 days/% TBSA. Mortality has improved in all burn size groups, but differences were highly statistically significant in the medium burn size group (10-20% TBSA, p≤0.001). Burn outcomes in the elderly have improved over the last decade. This reduction has been impacted by a reduction in overall injury severity but is also likely due to general improvements in burn care, improved infrastructure, implementation of clinical guidelines and increased multi-disciplinary support, including Geriatric physicians.