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Olawoye OA, Isamah CP, Ademola SA, Iyun AO, Michael AI, Aderibigbe RO, Oluwatosin OM. Changing Epidemiology and Outcome of Pediatric Thermal Burn Injury in South Western Nigeria. J Burn Care Res 2024; 45:404-409. [PMID: 37863042 DOI: 10.1093/jbcr/irad161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Indexed: 10/22/2023]
Abstract
The pediatric age group has been noted to be particularly vulnerable to burn injuries. Burn is the fifth most common cause of childhood injuries. Nigeria has a very young population with a median age of 18.1 years. Scald is the most common form of burn injuries in this age group globally; however, previous reports from our institution found flame to be the most common form of burn in pediatric age. The most recent report from 13 years ago still maintained flame as the most common cause of pediatric burn injury. This study was carried out to determine the changes in epidemiology and outcome of pediatric thermal burn injury. This was a retrospective study carried out between January 2013 and December 2022. Data were analyzed using the statistical package for social sciences software version 23. The significance was set at a P-value of .05. Two hundred and sixty-five children presented with thermal burn with a male-to-female ratio of 1.3:1. 63.4% occurred in children 0-5 years. Scald (59.6%) was the most common cause of injury. Most flame injuries in females were due to liquified petroleum gas cookstove explosion, while petrol explosion was the most common cause in males (P ≤ .001). There is a yearly increase in burn depth (P = .009). Most inhalation injuries occurred in those aged 11-16 years (P = .006). Mortality rate was 10.2%, with total body surface area burned (P ≤ .001), burn depth (P ≤ .001), and inhalation injury (P ≤ .001) associated with increasing mortality. Scald is now the most common cause of thermal burn in our institution, with a remarkable reduction in mortality rate.
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Affiliation(s)
- Olayinka Adebanji Olawoye
- Department of Plastic, Reconstructive, and Aesthetic Surgery, University College Hospital Ibadan, Ibadan, 200212, Nigeria
- Department of Surgery, College of Medicine, University of Ibadan, Ibadan, 200005, Nigeria
| | - Chinsunum Peace Isamah
- Department of Plastic, Reconstructive, and Aesthetic Surgery, University College Hospital Ibadan, Ibadan, 200212, Nigeria
| | - Samuel Adesina Ademola
- Department of Plastic, Reconstructive, and Aesthetic Surgery, University College Hospital Ibadan, Ibadan, 200212, Nigeria
- Department of Surgery, College of Medicine, University of Ibadan, Ibadan, 200005, Nigeria
| | - Ayodele Olukayode Iyun
- Department of Plastic, Reconstructive, and Aesthetic Surgery, University College Hospital Ibadan, Ibadan, 200212, Nigeria
- Department of Surgery, College of Medicine, University of Ibadan, Ibadan, 200005, Nigeria
| | - Afieharo Igbibia Michael
- Department of Plastic, Reconstructive, and Aesthetic Surgery, University College Hospital Ibadan, Ibadan, 200212, Nigeria
- Department of Surgery, College of Medicine, University of Ibadan, Ibadan, 200005, Nigeria
| | - Rotimi Opeyemi Aderibigbe
- Department of Plastic, Reconstructive, and Aesthetic Surgery, University College Hospital Ibadan, Ibadan, 200212, Nigeria
| | - Odunayo Moronfoluwa Oluwatosin
- Department of Plastic, Reconstructive, and Aesthetic Surgery, University College Hospital Ibadan, Ibadan, 200212, Nigeria
- Department of Surgery, College of Medicine, University of Ibadan, Ibadan, 200005, Nigeria
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Durham D, Rennie C, Reindel K. Examination of Pediatric Burn Incidence and the Impact of Social Determinants of Health in Florida. Cureus 2024; 16:e57035. [PMID: 38681297 PMCID: PMC11046372 DOI: 10.7759/cureus.57035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Accepted: 03/27/2024] [Indexed: 05/01/2024] Open
Abstract
Introduction Burn injuries are a major mechanism of trauma worldwide, caused by friction, cold, heat, radiation, chemical, or electric sources. Most often, burn injuries occur due to heat contact from hot liquids, solids, or fire, termed scald burns and flame burns, respectively. These types of injuries are complex and carry major injury and mortality risks, especially in pediatric populations. Burn trauma prevention has been a major focus in the US, with initiatives to increase public health outreach and safety measures. Unfortunately, children in socioeconomically disadvantaged situations may face these types of injuries at disproportionately higher rates, and we aim to highlight these disparities, if any, within our Florida community. Materials and methods This study was designed as a retrospective observational analysis using publicly available data from the Florida Health Community Health Assessment Resource Tool Set (CHARTS). Data was extracted for nonfatal burn injuries resulting in ED visits in the years 2018-2020. This data was limited to those ranging from 0 to 19 years old and converted to rates of burn injuries per 100,000. Sociodemographic details for each county were recorded from County Health Rankings & Roadmaps and compared with burn data in each respective county. Frequencies were generated for categorical data, and statistical analyses for burn rates and sociodemographic details were performed with a generalized linear model using a Poisson distribution and bivariate correlation for a p < 0.05. Results In Florida, the median annual burn rate per 100,000 was 136 (IQR: 96-179), with Jackson county holding the highest rate of 323 and Glades, Hardee, and Lafayette each holding a rate of 0. Of the 18 socioeconomic factors examined, a total of five were found to have no statistically significant effect on nonfatal burn injury ED visits: severe housing problems, percentage of Asians, teen births, percentage of children (<18 years) in poverty, and severe housing cost burden. The two most important factors to be found in nonfatal burn ED visits of pediatric patients were the percentage of those younger than 19 years old without health insurance and the average grade level performance of third-grader reading scores. When adjusting for the small sample size using Firth's bias-adjusted estimates and overdispersion, both reading scores and those without insurance play a significant role in pediatric burn injuries. For each increase in a single point in reading scores, the incidence rate ratio decreases by 97.1% (95% CI). For every percentage increase in children insured, there is a 28.8% decrease in pediatric burn injuries (95% CI). Conclusions This analysis highlights increased pediatric burn rates across multiple social determinants of health (SDOH) in all 67 Florida counties. The findings here demonstrate that there may continue to be a disproportionate distribution of burn rates among lower and higher sociodemographic areas. This study further highlights this trend within the Florida community, and continued research will be necessary to meet the needs of lower sociodemographic areas to improve burn rates in vulnerable populations, such as children, who are at increased risk of injury.
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Affiliation(s)
- Devon Durham
- Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Clearwater, USA
| | - Christopher Rennie
- Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Clearwater, USA
| | - Kelsey Reindel
- Osteopathic Principles and Practice, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Clearwater, USA
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Ademola SA, Michael AI, Iyun AO, Isamah CP, Aderibigbe RO, Olawoye OA, Oluwatosin OM. Current Trend in the Epidemiology of Thermal Burn Injury at a Tertiary Hospital in South Western Nigeria. J Burn Care Res 2024; 45:190-199. [PMID: 37721894 PMCID: PMC11023490 DOI: 10.1093/jbcr/irad143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Indexed: 09/20/2023]
Abstract
Worldwide, thermal burn is the leading etiological type of burn injury accounting for 86% of burn injuries requiring admissions. Flame, Scald, and contact burn are the leading causes of thermal burn. Changes in the sociodemographic characteristics of societies have led to alterations in the epidemiology of burn. An understanding of such changes in the epidemiology of burn is essential in formulating and executing adequate burn prevention programs. We sought to establish the current trend in the etiology, gender distribution, age, occurrence of inhalation injury, burn surface area, burn depth, and mortality rate of thermal burns at Ibadan. This was a retrospective study carried out between January 2013 and December 2022. Thermal burns constitute 92% of burn injuries. The male-to-female ratio was 1.4:1. There were 265 (45%) patients in the pediatric age group and 323 adults (55% of the patients). The proportion of flame, scald, and contact burns were 378 (58%), 203 (32%), and 14 (2%), respectively. Flame burns resulting from liquified petroleum gas (LPG) explosion show a rising trend, with a decline in flame burns from kerosene (P < .001). One hundred and ninety (32%) patients had inhalation injury. The overall mortality was 19% (N = 114). Kerosene flame, 38% (17 of 45 patients), and LPG, 32% (41 of 130 patients), were the most lethal causes of flame injuries (P < .043). The study shows the increasing contribution of LPG to the etiology of thermal burn injuries. Burn prevention programs should target safe use of LPG stoves and cylinders.
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Affiliation(s)
- Samuel Adesina Ademola
- Department of Plastic, Reconstructive, and Aesthetic Surgery, University College Hospital Ibadan, Ibadan, Oyo, Nigeria
- Department of Surgery, College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria
| | - Afieharo Igbibia Michael
- Department of Plastic, Reconstructive, and Aesthetic Surgery, University College Hospital Ibadan, Ibadan, Oyo, Nigeria
- Department of Surgery, College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria
| | - Ayodele Olukayode Iyun
- Department of Plastic, Reconstructive, and Aesthetic Surgery, University College Hospital Ibadan, Ibadan, Oyo, Nigeria
- Department of Surgery, College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria
| | - Chinsunum Peace Isamah
- Department of Plastic, Reconstructive, and Aesthetic Surgery, University College Hospital Ibadan, Ibadan, Oyo, Nigeria
| | - Rotimi Opeyemi Aderibigbe
- Department of Plastic, Reconstructive, and Aesthetic Surgery, University College Hospital Ibadan, Ibadan, Oyo, Nigeria
| | - Olayinka Adebanji Olawoye
- Department of Plastic, Reconstructive, and Aesthetic Surgery, University College Hospital Ibadan, Ibadan, Oyo, Nigeria
- Department of Surgery, College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria
| | - Odunayo Moronfoluwa Oluwatosin
- Department of Plastic, Reconstructive, and Aesthetic Surgery, University College Hospital Ibadan, Ibadan, Oyo, Nigeria
- Department of Surgery, College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria
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Abubakar AI, Okpechi SC, Euguagie OO, Ikpambese AA. Demographics and Clinical Characteristics of Burn Injuries in Nigeria: A Tertiary Hospital Cohort. Niger J Clin Pract 2023; 26:1916-1920. [PMID: 38158361 DOI: 10.4103/njcp.njcp_470_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 07/31/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Burn injuries account for 4.8% of trauma deaths in Nigeria and annually for 20,000 deaths. AIM This study was to catalogue the demographics of patient who presented at a referral center in Nigeria. PATIENTS AND METHODS In a retrospective study, we reviewed the records of all burn patients who presented over a 36-month period (January 2018 to December 2020). The clinical and demographic data was extracted using a self-designed questionnaire. Information obtained included biodata, etiology, time of presentation, first aid used, TBSA, length of hospital stay (LOHS), and outcome which was analyzed with SPSS version 28. RESULTS A total of 112 burn patients presented at our facility, 87 male and 25 female (m: f = 3.5:1). Forty-four percent were children 10 years old and below. Though scalding with hot liquids was the commonest cause of injury in children, flame burn was the commonest etiology (57.1%). Inhalational injuries occurred in 14.2%. Raw eggs and pap were used as first aid by 23%. Most patients were discharged home, and 19.6% died. CONCLUSION The prevalence of burn injuries remains high in developing countries. Most causes of burns are preventable. Dangerous traditional practices add to patient morbidity. Education on effective prevention strategies is important in reducing morbidity and mortality.
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Affiliation(s)
- A I Abubakar
- Department of Surgery, University of Abuja, Abuja, Nigeria
| | - S C Okpechi
- Department of Surgery, University of Abuja Teaching Hospital, Abuja, Nigeria
| | - O O Euguagie
- Department of Surgery, University of Abuja Teaching Hospital, Abuja, Nigeria
| | - A A Ikpambese
- Department of Surgery, University of Abuja Teaching Hospital, Abuja, Nigeria
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Puvanachandra P, Ssesumugabo C, Balugaba BE, Ivers R, Kobusingye O, Peden M. The epidemiology and characteristics of injuries to under 5's in a secondary city in Uganda: a retrospective review of hospital data. Int J Inj Contr Saf Promot 2022; 29:550-555. [PMID: 35797975 DOI: 10.1080/17457300.2022.2089686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Child injuries are largely preventable yet cause significant mortality and morbidity globally. Injury data from low-income countries is limited for children under the age of 5 and therefore the current understanding of the magnitude of injuries in this age group is low. Hospital-based registries are one mechanism by which injury data can be gathered. This paper presents findings from a retrospective hospital record review of 4 hospitals in Jinja, a rural setting in Uganda, involving the extraction of data for children under the age of 5-years who sustained an injury during a 6-month period in 2019. A total of 225 injury cases were retrieved from the hospitals. Over half (57.3%) of the events occurred among males. The majority (92%) suffered one injury per injury event. Most of the injuries occurred among those aged 13 to 24 months (32.9%). Burns (32%) and cuts (20%) were the most common cause of injury. This study presents a hospital-based analysis of injuries amongst under 5's in rural Uganda. It provides information on the characteristics of children entering healthcare facilities in Uganda and highlights the burden of paediatric injuries in the hospital setting.
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Affiliation(s)
- P Puvanachandra
- The George Institute for Global Health, UK, Imperial College London, London, UK
| | - C Ssesumugabo
- School of Public Health, Makerere School of Public Health, Kampala, Uganda
| | - B E Balugaba
- School of Public Health, Makerere School of Public Health, Kampala, Uganda
| | - R Ivers
- School of Population Health, University of New South Wales, Sydney, Australia
| | - O Kobusingye
- School of Public Health, Makerere School of Public Health, Kampala, Uganda
| | - M Peden
- The George Institute for Global Health, UK, Imperial College London, London, UK
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The effect of burn mechanism on pediatric mortality in Malawi: A propensity weighted analysis. Burns 2020; 47:222-227. [PMID: 33277092 DOI: 10.1016/j.burns.2019.12.018] [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: 09/07/2019] [Revised: 11/24/2019] [Accepted: 12/31/2019] [Indexed: 11/22/2022]
Abstract
INTRODUCTION The burden of global trauma disproportionately affects low- and middle-income countries, with a high incidence in children. Thermal injury represents one of the most severe forms of trauma and is associated with remarkable morbidity and mortality. The predictors of burn mortality have been well described (age, % total body surface area burn [TBSA], and presence of inhalation injury). However, the contribution of the burn mechanism as a predictor of burn mortality is not well delineated. METHODS This is a retrospective analysis of prospectively collected data, utilizing the Kamuzu Central Hospital (KCH) Burn Surveillance Registry from May 2011 to August 2019. Pediatric patients (≤12 years) with flame and scald burns were included in the study. Basic demographic variables including sex, age, time to presentation, %TBSA, surgical intervention, burn mechanism, and in-hospital mortality outcome was collected. Bivariate analysis comparing demographic, burn characteristics, surgical intervention, and patient outcomes were performed. Standardized estimates were adjusted using inverse-probability of treatment weights (IPTW) to account for confounding. Following weighting, logistic regression modeling was performed to determine the odds of in-hospital mortality based on burn mechanism. RESULTS During the study period, 2364 patients presented to KCH for burns and included in the database with 1794 (75.9%) pediatric patients. Of these, 488 (27.6%) and 1280 (72.4%) were injured by flame and scald burns, respectively. Males were 47.2% (n = 230) and 59.2% (n = 755) of the flame and scald burn cohorts, respectively (p < 0.001.) Patients presenting with flame burns compared to scald burns were older (4. 7 ± 3.1 vs. 2.7 ± 2.3 years, p < 0.001) with greater %TBSA burns (17.8 [IQR 10-28] vs 12 [IQR 7-20], p < 0.001). Surgery was performed for 42.2% (n = 206) and 19.9% (n = 140) of the flame and scald burn cohorts, respectively (p < 0.001.) Flame burns had a 2.6x greater odds of in-hospital mortality compared to scald burns (p < 0.001) after controlling for sex, %TBSA, age, time to presentation, and surgical status. CONCLUSION In this propensity-weighted analysis, we show that burn mechanism, specifically flame burns, resulted in a nearly 3-fold increase in odds of in-hospital mortality compared to scald burns. Our results emphasize flame and scald burns have major differences in the inflammatory response, metabolic profile over time, and outcomes. We may further utilize these differences to develop specialized treatments for each burn mechanism to potentially prevent metabolic dysfunction and improve clinical outcomes.
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Gallaher J, Purcell LN, Banda W, Reid T, Charles A. Re-evaluation of the Effect of Age on In-hospital Burn Mortality in a Resource-Limited Setting. J Surg Res 2020; 258:265-271. [PMID: 33039634 DOI: 10.1016/j.jss.2020.08.074] [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: 04/17/2020] [Revised: 08/05/2020] [Accepted: 08/26/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND This global burden of burn injury is suffered disproportionately by people in low-income and middle-income countries, where 70% of all burns occur. Models based in high-income countries to prognosticate burn mortality treat age as a linearly increasing risk factor. It is unclear whether this relationship is similar in resource-limited settings. METHODS We analyzed patients from the Kamuzu Central Hospital Burn Registry in Lilongwe, Malawi, from 2011 to 2019. We examined the relationship between burn-associated mortality and age using adjusted survival analysis over 60 d, categorized into four groups: (1) younger children <5 y; (2) older children 5-17 y; (3) adults 18-40 y; and (4) older adults >40 y. RESULTS A total of 2499 patients were included. Most patients were <5 y old (n = 1444) with only 133 patients >40 y. Older adults had the highest crude mortality at 34.6% and older children with the lowest at 13%. Compared to younger children, the hazard ratio adjusted for sex, percent total body surface area, and operative intervention was 0.59 (95% confidence interval, 0.44, 0.79) for older children and 0.55 (95% confidence interval, 0.40, 0.76) for adults. Older adults were statistically similar to younger children. CONCLUSIONS We show in this cohort study of burn-injured patients in a resource-limited environment that the relationship between mortality and age is not linear and that the use of age-categorized mortality prediction models is more accurate in delineating mortality characteristics. Categorizing age based on local burn epidemiology will help describe burn mortality characteristics more accurately, leading to better-informed management strategies aimed at attenuating burn mortality for different populations.
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Affiliation(s)
- Jared Gallaher
- Department of Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina.
| | - Laura N Purcell
- Department of Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Wone Banda
- Department of Surgery, Kamuzu Central Hospital, Lilongwe, Malawi
| | - Trista Reid
- Department of Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Anthony Charles
- Department of Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina; Department of Surgery, Kamuzu Central Hospital, Lilongwe, Malawi
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Thomson IK, Iverson KR, Innocent SHS, Kaseje N, Johnson WD. Management of paediatric burns in low- and middle-income countries: assessing capacity using the World Health Organization Surgical Assessment Tool. Int Health 2020; 12:499-506. [PMID: 31613329 DOI: 10.1093/inthealth/ihz068] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 04/18/2019] [Accepted: 07/07/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Burns are a leading cause of global disease burden, with children in low- and middle-income countries (LMICs) disproportionately affected. Effective management improves outcomes; however, the availability of necessary resources in LMICs remains unclear. We evaluated surgical centres in LMICs using the WHO Surgical Assessment Tool (SAT) to identify opportunities to optimize paediatric burn care. METHODS We reviewed WHO SAT database entries for 2010-2015. A total of 1121 facilities from 57 countries met the inclusion criteria: facilities with surgical capacity in LMICs operating on children. Human resources, equipment and infrastructure relevant to paediatric burn care were analysed by WHO Regional and World Bank Income Classifications and facility type. RESULTS Facilities had an average of 147 beds and performed 485 paediatric operations annually. Discrepancies existed between procedures performed and resource availability; 86% of facilities performed acute burn care, but only 37% could consistently provide intravenous fluids. Many, particularly tertiary, centres performed contracture release and skin grafting (41%) and amputation (50%). CONCLUSIONS LMICs have limited resources to provide paediatric burn care but widely perform many interventions necessary to address the burden of burns. The SAT may not capture innovative and traditional approaches to burn care. There remains an opportunity to improve paediatric burn care globally.
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Affiliation(s)
| | - Katie R Iverson
- Program in Global Surgery and Social Change, Harvard Medical School, Cambridge, MA, USA.,University of California Davis Medical Center, Sacramento, CA, USA
| | | | - Neema Kaseje
- Global Initiative for Children's Surgery, CH.,Tropical Institute of Community Health and Development, Kisumu, KE
| | - Walter D Johnson
- Emergency and Essential Surgical Care Programme, World Health Organization, Geneva, CH
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Epidemiology and outcomes of in-hospital acute burn-patients in Togo: A retrospective analysis. BURNS OPEN 2019. [DOI: 10.1016/j.burnso.2019.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Treatment of burned children using dermal regeneration template with or without negative pressure. Burns 2019; 45:1075-1080. [DOI: 10.1016/j.burns.2018.08.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 06/21/2018] [Accepted: 08/07/2018] [Indexed: 01/10/2023]
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Grudziak J, Snock C, Mjuweni S, Gallaher J, Cairns B, Charles A. The effect of pre-existing malnutrition on pediatric burn mortality in a sub-Saharan African burn unit. Burns 2017; 43:1486-1492. [DOI: 10.1016/j.burns.2017.03.022] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 03/10/2017] [Accepted: 03/25/2017] [Indexed: 11/15/2022]
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Rybarczyk MM, Schafer JM, Elm CM, Sarvepalli S, Vaswani PA, Balhara KS, Carlson LC, Jacquet GA. A systematic review of burn injuries in low- and middle-income countries: Epidemiology in the WHO-defined African Region. Afr J Emerg Med 2017; 7:30-37. [PMID: 30456103 PMCID: PMC6234151 DOI: 10.1016/j.afjem.2017.01.006] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Revised: 11/03/2016] [Accepted: 01/10/2017] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION According to the World Health Organization (WHO), burns result in the loss of approximately 18 million disability adjusted life years (DALYs) and more than 250,000 deaths each year, more than 90% of which are in low- and middle-income countries (LMICs). The epidemiology of these injuries, especially in the WHO-defined African Region, has yet to be adequately defined. METHODS We performed a systematic review of the literature regarding the epidemiology of thermal, chemical, and electrical burns in the WHO-defined African Region. All articles indexed in PubMed, EMBASE, Web of Science, Global Health, and the Cochrane Library databases as of October 2015 were included. RESULTS The search resulted in 12,568 potential abstracts. Through multiple rounds of screening using criteria determined a priori, 81 manuscripts with hospital-based epidemiology as well as eleven manuscripts that included population-based epidemiology were identified. Although the studies varied in methodology, several trends were noted: young children appear to be at most risk; most individuals were burned at home; and hot liquids and flame are the most common aetiologies. DISCUSSION While more population-based research is essential to identifying specific risk factors for targeted prevention strategies, our review identifies consistent trends for initial efforts at eliminating these often devastating and avoidable injuries.
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Affiliation(s)
- Megan M. Rybarczyk
- Department of Emergency Medicine, Boston Medical Center, Boston, MA, United States
| | - Jesse M. Schafer
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Courtney M. Elm
- Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN, United States
| | - Shashank Sarvepalli
- Department of Internal Medicine, Cleveland Clinic, Cleveland, OH, United States
| | - Pavan A. Vaswani
- Department of Medicine, Brigham and Women’s Hospital, Boston, MA, United States
| | - Kamna S. Balhara
- Department of Emergency Medicine, The Johns Hopkins Hospital, Baltimore, MD, United States
| | - Lucas C. Carlson
- Department of Emergency Medicine, Brigham and Women’s Hospital, Boston, MA, United States
| | - Gabrielle A. Jacquet
- Department of Emergency Medicine, Boston Medical Center, Boston, MA, United States
- Boston University School of Medicine, Boston, MA, United States
- Boston University Center for Global Health and Development, Boston, MA, United States
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The efficacy and safety of oxandrolone treatment for patients with severe burns: A systematic review and meta-analysis. Burns 2016; 42:717-27. [DOI: 10.1016/j.burns.2015.08.023] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2015] [Revised: 07/18/2015] [Accepted: 08/16/2015] [Indexed: 11/23/2022]
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Smith MTD, Allorto NL, Clarke DL. Modified first world mortality scores can be used in a regional South African burn service with resource limitations. Burns 2016; 42:1340-4. [PMID: 27143339 DOI: 10.1016/j.burns.2016.03.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Revised: 03/18/2016] [Accepted: 03/30/2016] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Survival following a major burn is highly dependent on the availability of scare and expensive resources such as critical care services, modern dressings and access to operating theatres. Scoring systems, which predict mortality have been developed and can be used to identify patients in whom the outlay of these resources is futile. The aim of this study was to analyse the mortality at a regional South African burn service and to see if these scoring models developed in a resource rich environment were applicable to our setting. METHODS Consecutive admissions to the Edendale burn service, South Africa were collected from patient records over a 2-year period from July 2013 to June 2015. Demographic, burn details and final outcome (lived or died) were captured for statistical analysis. Each patient was scored using the Modified Baux, Coste et al., Belgian Outcome of Burn Injury (BOBI) and Abbreviated Burn Severity Index (ABSI) scores. Validation of models and inferential statistics were done to determine new breakpoints more applicable to our sample. RESULTS A total of 748 patients were included in the sample, with a mortality rate of 7.1%. The mean Modified Baux score was 27 (range 1-134), with the new breakpoint of 40 predicting 74% of the mortalities compared to the 42% predicted by the old breakpoint of 75. The mean ABSI score was 4 (range 2-15), with a lower break point of 6 predicting 75% of deaths compared to 42% with the old breakpoint of 8. The mean Coste score for the sample was 12 (range 0-100). With a suggested break point of 85 (predicting 50% mortality), only 6% of mortalities were predicted. The new break point of 17 predicted 91% of deaths. The original break point for the BOBI score was 6 (range 0-7). This included 42% of deaths. With a new breakpoint of 1, 74% of deaths were predicted. DISCUSSION Our data has shown that in our environment a significant number of fatalities occur in patients with potentially salvageable burns, and the breakpoints for the mortality prediction scores such as, the Modified Baux score, Coste et al. score, BOBI and ABSI scores are much lower than high-income countries. However these mortality predictive scores can be used in a resource scarce South African setting to triage patients into risk categories by lowering the breakpoints. This may facilitate early and more aggressive management of high-risk burn patients, improving survival rates, as well as efficient and judicious use of critical care and other resources.
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Affiliation(s)
- M T D Smith
- Department of Surgery, Pietermaritzburg Metropolitan Complex, University of Kwa-Zulu Natal, South Africa
| | - N L Allorto
- Department of Surgery, Pietermaritzburg Metropolitan Complex, University of Kwa-Zulu Natal, South Africa.
| | - D L Clarke
- Department of Surgery, Pietermaritzburg Metropolitan Complex, University of Kwa-Zulu Natal, South Africa
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Sadeghi-Bazargani H, Mohammadi R, Amiri S, Syedi N, Tabrizi A, Irandoost P, Safiri S. Individual-level predictors of inpatient childhood burn injuries: a case-control study. BMC Public Health 2016; 16:209. [PMID: 26931103 PMCID: PMC4774193 DOI: 10.1186/s12889-016-2799-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 02/01/2016] [Indexed: 11/24/2022] Open
Abstract
Background Burn injuries are considered one of the most preventable public health issue among children; however, are a cause of significant morbidity and mortality in Iran. The aim of this study was to assess individual-level predictors of severe burn injuries among children leading to hospitalization, in East Azerbaijan Province, in North-West of Iran. Methods The study was conducted through a hospital based case–control design involving 281 burn victims and 273 hospital-based controls who were frequency matched on age, gender and urbanity. Both bivariate and multivariate methods were used to analyze the data. Results Mean age of the participants was 40.5 months (95 % CI: 37–44) with the majority of burns occurring at ages between 2 months-13.9 years. It was demonstrated that with increase in the caregiver’s age there was a decrease in the odds of burn injuries (OR = 0.94, 95 % CI: 0.92-0.97). According to the multivariate logistic regression there were independent factors associated with burn injuries including childhood ADHD (OR = 2.82, 95 % CI: 1.68 - 4.76), child’s age (OR = 0.73, 95%CI: 0.67 - 0.80), flammability of clothing (OR = 1.60, 95 % CI: 1.12 - 2.28), daily length of watching television (OR = 1.31, 95 % CI: 1.06 - 1.61), playing outdoors (OR = 1.32, 95 % CI: 1.16 - 1.50) and increment in the economic status (OR = 1.37, 95 % CI: 1.18 - 1.60). Conclusion Major risk predictors of burn injuries among the Iranian population included childhood ADHD, child’s age, watching television, playing outdoors, high economic status and flammable clothing.
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Affiliation(s)
- Homayoun Sadeghi-Bazargani
- Road Traffic Injury Research Center, Department of Statistics & Epidemiology, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Reza Mohammadi
- WHO Collaborating Center on Community Safety Promotion, Karolinska Institute, Stockholm, Sweden
| | - Shahrokh Amiri
- Research Center of Psychiatry and Behavioral Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Naeema Syedi
- School of Pharmacy and Medical Sciences, Sansom Institute for Health Research, University of South Australia, South Australia, Australia
| | - Aydin Tabrizi
- Child Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Poupak Irandoost
- Child Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Saeid Safiri
- Managerial Epidemiology Research Center, Department of Public Health, School of Nursing and Midwifery, Maragheh University of Medical Sciences, Maragheh, Iran. .,Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
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17
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Stewart BT, Lafta R, Esa Al Shatari SA, Cherewick M, Burnham G, Hagopian A, Galway LP, Kushner AL. Burns in Baghdad from 2003 to 2014: Results of a randomized household cluster survey. Burns 2015; 42:48-55. [PMID: 26526376 DOI: 10.1016/j.burns.2015.10.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 09/30/2015] [Accepted: 10/01/2015] [Indexed: 01/05/2023]
Abstract
PURPOSE Civilians living amid conflict are at high-risk of burns. However, the epidemiology of burns among this vulnerable group is poorly understood, yet vital for health policy and relief planning. To address this gap, we aimed to determine the death and disability, healthcare needs and household financial consequences of burns in post-invasion Baghdad. METHODS A two-stage, cluster randomized, community-based household survey was performed in May 2014 to determine the civilian burden of injury from 2003 to 2014 in Baghdad. In addition to questions about cause of household member death, households were interviewed regarding burn specifics, healthcare required, disability, relationship to conflict and resultant financial hardship. RESULTS Nine-hundred households, totaling 5148 individuals, were interviewed. There were 55 burns, which were 10% of all injuries reported. There were an estimated 2340 serious burns (39 per 100,000 persons) in Baghdad in 2003. The frequency of serious burns generally increased post-invasion to 8780 burns in 2013 (117 per 100,000 persons). Eight burns (15%) were the direct result of conflict. Individuals aged over 45 years had more than twice the odds of burn than children aged less than 13 years (aOR 2.42; 95%CI 1.08-5.44). Nineteen burns (35%) involved ≥ 20% body surface area. Death (16% of burns), disability (40%), household financial hardship (48%) and food insecurity (50%) were common after burn. CONCLUSION Civilian burn in Baghdad is epidemic, increasing in frequency and associated with household financial hardship. Challenges of healthcare provision during prolonged conflict were evidenced by a high mortality rate and likelihood of disability after burn. Ongoing conflict will directly and indirectly generates more burns, which mandates planning for burn prevention and care within local capacity development initiatives, as well as humanitarian assistance.
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Affiliation(s)
- Barclay T Stewart
- Department of Surgery, University of Washington, Seattle, WA, USA; School of Public Health, Kwame Nkrumah University, Kumasi, Ghana; Department of Interdisciplinary Health Sciences, Stellenbosch University, Cape Town, South Africa.
| | - Riyadh Lafta
- Department of Community Medicine, Al Munstansiriya University, Baghdad, Iraq; Department of Global Health, University of Washington, Seattle, WA, USA
| | | | - Megan Cherewick
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Gilbert Burnham
- Department of International Health, Center for Refugee and Disaster Response, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Amy Hagopian
- Department of Global Health, University of Washington, Seattle, WA, USA; Department of Health Services, University of Washington, Seattle, WA, USA
| | - Lindsay P Galway
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Adam L Kushner
- Surgeons OverSeas (SOS), New York, NY, USA; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Surgery, Columbia University, New York, NY, USA
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Nthumba PM. Burns in sub-Saharan Africa: A review. Burns 2015; 42:258-66. [PMID: 25981292 DOI: 10.1016/j.burns.2015.04.006] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Revised: 02/25/2015] [Accepted: 04/17/2015] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Burns are important preventable causes of morbidity and mortality, with a disproportionate incidence in sub-Saharan Africa. The management of these injuries in sub-Saharan Africa is a challenge because of multiple other competing problems such as infectious diseases (HIV/AIDS, tuberculosis and malaria), terrorist acts and political instability. There is little investment in preventive measures, pre-hospital, in-hospital and post-discharge care of burns, resulting in high numbers of burns, high morbidity and mortality. Lack of data that can be used in legislation and policy formulation is a major hindrance in highlighting the problem of burns in this sub-region. METHODS An online search of publications on burns from sub-Saharan countries was performed. RESULTS A total of 54 publications with 32,862 patients from 14 countries qualified for inclusion in the study. The average age was 15.3 years. Children aged 10 years and below represented over 80% of the burn patient population. Males constituted 55% of those who suffered burns. Scalds were the commonest cause of thermal injuries, accounting for 59% of all burns, while flame burns accounted for 33%. The burn mortality averaged 17%, or the death of one of every five burn victims. CONCLUSIONS These statistics indicate the need for an urgent review of burn policies and related legislation across the sub-Saharan region to help reduce burns, and provide a safe environment for children.
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