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DEMİR YİĞİT Y, ÖZTAŞ T. Low- and High-Voltage Electrical Burns in Children: Ten Years of Experience. KAHRAMANMARAŞ SÜTÇÜ İMAM ÜNIVERSITESI TIP FAKÜLTESI DERGISI 2022. [DOI: 10.17517/ksutfd.1039637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Objective
Burn injuries are an important public health problem for all ages. Due to electrical burns high mortality and morbidity rates, their should be evaluated differently from burns from other sources. This study aims to determine factors associated with high- and low-voltage electrical burns in children.
Material and Methods
The records of 72 patients who were treated for electrical burns were analysed. Electrical burns were divided into two groups: low and high voltage. Demographic data, treatment, outcomes were compared between the two groups.
Results
The frequency of electrical burns was 1.5%. Low-voltage electrical burns were detected in 79.2% of the patients, and high-voltage electrical burns were detected in 20.8% of the patients. High-voltage burns were more common in rural residents (p < 0.05). Low-voltage electrical burns mostly occurred as a result of home accidents (89.5%), while high-voltage injuries were mostly caused by work accidents (66.6%), (p
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Affiliation(s)
| | - Tülin ÖZTAŞ
- UNIVERSITY OF HEALTH SCIENCES, DİYARBAKIR GAZİ YAŞARGİL HEALTH RESEARCH CENTER, DEPARTMENT OF SURGICAL MEDICAL SCIENCES, DEPARTMENT OF PEDIATRIC SURGERY
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Woolard A, Hill NTM, McQueen M, Martin L, Milroy H, Wood FM, Bullman I, Lin A. The psychological impact of paediatric burn injuries: a systematic review. BMC Public Health 2021; 21:2281. [PMID: 34906121 PMCID: PMC8670283 DOI: 10.1186/s12889-021-12296-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 11/23/2021] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To review and synthesise qualitative literature regarding the psychological outcomes following paediatric burn injuries, and to determine if children and adolescents who experience a burn injury have elevated risk of psychopathology following the injury. DESIGN Systematic review of quantitative and qualitative studies. DATA SOURCES Informit health, Medline, Embase, and PsycINFO were searched from January 2010 to December 2020. DATA EXTRACTION AND SYNTHESIS Two reviewers screened articles, and one reviewer extracted data (with cross-checking from another reviewer) from the included studies and assessed quality using an established tool. Narrative synthesis was used to synthesise the findings from the quantitative studies, and thematic synthesis was used to synthesise the findings of included qualitative studies. RESULTS Searches yielded 1240 unique titles, with 130 retained for full-text screening. Forty-five studies from 17 countries were included. The psychological outcomes included in the studies were mental health diagnoses, medication for mental illness, depression, anxiety, stress, fear, post-traumatic stress, post-traumatic growth, emotional issues, self-harm, self-esteem, self-concept, stigmatisation, quality of life, level of disability, resilience, coping, and suicidality. CONCLUSIONS Our findings highlight paediatric burn patients as a particularly vulnerable population following a burn injury. Studies suggest elevated anxiety and traumatic stress symptoms, and higher rates of psychopathology in the long-term. Further research is recommended to determine the psychological outcomes in the other mental health domains highlighted in this review, as findings were mixed. Clinical care teams responsible for the aftercare of burn patients should involve psychological support for the children and families to improve outcomes.
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Affiliation(s)
- Alix Woolard
- Telethon Kids Institute, Perth Children's Hospital, 15 Hospital Avenue, Nedlands, Australia.
- The University of Western Australia, Perth, Australia.
| | - Nicole T M Hill
- Telethon Kids Institute, Perth Children's Hospital, 15 Hospital Avenue, Nedlands, Australia
| | - Matthew McQueen
- Telethon Kids Institute, Perth Children's Hospital, 15 Hospital Avenue, Nedlands, Australia
| | - Lisa Martin
- Fiona Wood Foundation, Perth, Australia; Child and Adolescent Health Service, Perth Children's Hospital, University of Western Australia, Perth, Western Australia, Australia
| | - Helen Milroy
- The University of Western Australia, Perth, Australia
| | | | - Indijah Bullman
- Telethon Kids Institute, Perth Children's Hospital, 15 Hospital Avenue, Nedlands, Australia
| | - Ashleigh Lin
- Telethon Kids Institute, Perth Children's Hospital, 15 Hospital Avenue, Nedlands, Australia
- The University of Western Australia, Perth, Australia
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Tapking C, Kilian K, Hundeshagen G, Haug V, Teufel A, Houschyar KS, Kneser U, Hirche C. Hepatic functional pathophysiology and morphological damage following severe burns: a systematic review and meta-analysis. J Burn Care Res 2021; 43:1074-1080. [PMID: 34894242 DOI: 10.1093/jbcr/irab239] [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: 11/13/2022]
Abstract
INTRODUCTION Severe burns are devastating injuries affecting multiple organ systems. Little is known about the influence on the hepatic system and its physiology. This systematic review aimed to assess the current state of research on morphologic liver damage following severe burns. METHODS A search was conducted in Pubmed, Web of Science and Cochrane databases using PRISMA guidelines. Outcomes included serum levels of transaminases, fatty infiltration and necrosis. Weighted individual study estimates were used to calculate pooled transaminase levels and necrosis/fatty infiltration rates using a random-effects approach. Risk ratios (RRs) or Odds ratios (ORs) and 95% confidence intervals (CIs) were used to describe pooled estimates for risk factors. RESULTS The literature search retrieved 2548 hits, of which 59 studies were included into qualitative synthesis, and finally ten studies were included into meta-analysis. Studies were divided into those reporting autopsies and those reporting changes of serum transaminase levels. The majority of liver autopsies showed fatty infiltration 82% (95% CI39%-97%) or necrosis of the liver 18% (95% CI13%-24%). DISCUSSION Heterogeneity in studies on hepatic functional damage following severe burns was high. Only few were well-designed and published in recent years. Many studies could not be included because of insufficient numerical data. There is a high number of patients deceasing from burns that present with fatty infiltration or necrosis of hepatic tissue. Transaminases were elevated during the first days after burn. Further research on how severe burns affect the hepatic function and outcome, especially long-term, is necessary.
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Affiliation(s)
- C Tapking
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Unfallklinik Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany
| | - K Kilian
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Unfallklinik Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany
| | - G Hundeshagen
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Unfallklinik Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany
| | - V Haug
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Unfallklinik Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany
| | - A Teufel
- Department of Medicine II, Division of Hepatology, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.,Clinical Cooperation Unit Health Metabolism, Center for Preventive Medicine and Digital Health Baden-Württemberg (CPDBW), Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - K S Houschyar
- Department of Dermatology and Allergology, University Hospital of RWTH Aachen, Aachen, Germany
| | - U Kneser
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Unfallklinik Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany
| | - C Hirche
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Unfallklinik Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany.,Department of Plastic, Hand- and Reconstructive Microsurgery, Handtrauma- and Replantation Center BG Unfallklinik Frankfurt am Main gGmbH, Frankfurt/Main, Germany
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Radulovic N, Mason SA, Rehou S, Godleski M, Jeschke MG. Acute and long-term clinical, neuropsychological and return-to-work sequelae following electrical injury: a retrospective cohort study. BMJ Open 2019; 9:e025990. [PMID: 31092649 PMCID: PMC6530314 DOI: 10.1136/bmjopen-2018-025990] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
OBJECTIVE To determine acute and long-term clinical, neuropsychological, and return-to-work (RTW) effects of electrical injuries (EIs). This study aims to further contrast sequelae between low-voltage and high-voltage injuries (LVIs and HVIs). We hypothesise that all EIs will result in substantial adverse effects during both phases of management, with HVIs contributing to greater rates of sequelae. DESIGN Retrospective cohort study evaluating EI admissions between 1998 and 2015. SETTING Provincial burn centre and rehabilitation hospital specialising in EI management. PARTICIPANTS All EI admissions were reviewed for acute clinical outcomes (n=207). For long-term outcomes, rehabilitation patients, who were referred from the burn centre (n=63) or other burn units across the province (n=65), were screened for inclusion. Six patients were excluded due to pre-existing psychiatric conditions. This cohort (n=122) was assessed for long-term outcomes. Median time to first and last follow-up were 201 (68-766) and 980 (391-1409) days, respectively. OUTCOME MEASURES Acute and long-term clinical, neuropsychological and RTW sequelae. RESULTS Acute clinical complications included infections (14%) and amputations (13%). HVIs resulted in greater rates of these complications, including compartment syndrome (16% vs 4%, p=0.007) and rhabdomyolysis (12% vs 0%, p<0.001). Rates of acute neuropsychological sequelae were similar between voltage groups. Long-term outcomes were dominated by insomnia (68%), anxiety (62%), post-traumatic stress disorder (33%) and major depressive disorder (25%). Sleep difficulties (67%) were common following HVIs, while the LVI group most frequently experienced sleep difficulties (70%) and anxiety (70%). Ninety work-related EIs were available for RTW analysis. Sixty-one per cent returned to their preinjury employment and 19% were unable to return to any form of work. RTW rates were similar when compared between voltage groups. CONCLUSIONS This is the first investigation to determine acute and long-term patient outcomes post-EI as a continuum. Findings highlight substantial rates of neuropsychological and social sequelae, regardless of voltage. Specialised and individualised early interventions, including screening for mental health concerns, are imperative to improvingoutcomes of EI patients.
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Affiliation(s)
- Nada Radulovic
- School of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Stephanie A Mason
- Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Sarah Rehou
- Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Matthew Godleski
- Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Physical Medicine and Rehabilitation, St. John's Rehab Hospital, Toronto, Ontario, Canada
| | - Marc G Jeschke
- Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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Paredes Molina CS, Berry S, Nielsen A, Winfield R. PTSD in civilian populations after hospitalization following traumatic injury: A comprehensive review. Am J Surg 2018; 216:745-753. [PMID: 30103902 DOI: 10.1016/j.amjsurg.2018.07.035] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Revised: 06/01/2018] [Accepted: 07/17/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND Injuries and their comorbidities affect victims far beyond their physical recovery period. Some study-measures show that more than half of patients hospitalized for a traumatic injury suffer from Acute Stress Disorder, alcohol dependence, and recurrent trauma. Overall, this literature review serves to review risk factors for PTSD, screening tools, follow-up strategies, and gaps in the literature for achieving feasible patient-centered interventions for the prevention of PTSD after a traumatic injury. DATA SOURCES A literature review was performed from August 1, 2017 to March 19, 2018, from 3 Databases: PubMed, CINAHL and Cochrane, with keywords: "PTSD", "Post-traumatic Stress Disorder", "Civilians", "Traumatic", "Injury", "Follow-up", "Treatment", "Referral", "surgery", "surgical", "Intervention", and "Insured", "underinsured". CONCLUSIONS Reported risk factors for PTSD were: prior psychiatric disorder, gunshots, and lack of social support. Most articles use the Posttraumatic Stress Disorder Checklist - Civilian version. Follow-up strategies mainly focus on multidisciplinary intervention protocols, including social workers, behavioral health specialists, and psychiatrists. Finally, gaps in the literature show the need for bilingual/bicultural patient-centered care for elderly, diverse ethnic backgrounds, and insured vs. uninsured patients.
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Affiliation(s)
| | - Stepheny Berry
- The University of Kansas Medical Center, 3901 Rainbow Blvd., Kansas City, KS, 66160, USA
| | - Alexandra Nielsen
- The University of Kansas Medical Center, 3901 Rainbow Blvd., Kansas City, KS, 66160, USA
| | - Robert Winfield
- The University of Kansas Medical Center, 3901 Rainbow Blvd., Kansas City, KS, 66160, USA.
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Capek KD, Sousse LE, Hundeshagen G, Voigt CD, Suman OE, Finnerty CC, Jennings K, Herndon DN. Contemporary Burn Survival. J Am Coll Surg 2018; 226:453-463. [PMID: 29530306 PMCID: PMC6027619 DOI: 10.1016/j.jamcollsurg.2017.12.045] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 12/19/2017] [Indexed: 10/17/2022]
Abstract
BACKGROUND The standard of burn treatment today reflects major advances. We sought to quantitate the impact of these advances on burn survival via age-stratified mortality ratios compared with other reported mortality analyses in burns. STUDY DESIGN Age, percent of the total body surface area (TBSA) burned, presence of inhalation injury, length of stay, and survival status were recorded at admission and at discharge for all new burn admissions between 1989 and 2017. The expected mortality probability was calculated using historical multiple regression techniques and compared with observed data. We developed a prediction model for our observed data. RESULTS Between 1989 and 2017, there were 10,384 consecutive new burn admissions, with 355 mortalities (median age, 13 years; median percent TBSA burn, 11%). We saw a significant decrease in our observed mortality data compared to historical predictions (p < 0.0001), and a 2% reduction per year in mortality during the 3 decades. The prediction model of mortality for the data is as follows: Pr(dying) = ex/(1 + ex) where x = -6.44 - 0.12 age + 0.0042 age2 - 0.0000283 age3 + 0.0499 TBSA + 1.21 Inhalation Injury + 0.015 third degree TBSA. CONCLUSIONS The reduction in mortality over time may be attributed to successful changes in standard of care protocols in the burn center that improved the outlook for burned individuals, including protocols for management of inhalation injury, nutrition, resuscitation, and early excision and grafting.
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Affiliation(s)
- Karel D Capek
- Department of Surgery, University of Texas Medical Branch, Galveston, TX; Shriners Hospitals for Children-Galveston, Galveston, TX
| | - Linda E Sousse
- Department of Surgery, University of Texas Medical Branch, Galveston, TX; Shriners Hospitals for Children-Galveston, Galveston, TX
| | - Gabriel Hundeshagen
- Department of Surgery, University of Texas Medical Branch, Galveston, TX; Shriners Hospitals for Children-Galveston, Galveston, TX
| | - Charles D Voigt
- Department of Surgery, University of Texas Medical Branch, Galveston, TX; Shriners Hospitals for Children-Galveston, Galveston, TX
| | - Oscar E Suman
- Department of Surgery, University of Texas Medical Branch, Galveston, TX; Shriners Hospitals for Children-Galveston, Galveston, TX
| | - Celeste C Finnerty
- Department of Surgery, University of Texas Medical Branch, Galveston, TX; Shriners Hospitals for Children-Galveston, Galveston, TX; Institute for Translational Sciences, University of Texas Medical Branch, Galveston, TX; Sealy Center for Molecular Medicine, University of Texas Medical Branch, Galveston, TX
| | - Kristofer Jennings
- Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, TX
| | - David N Herndon
- Department of Surgery, University of Texas Medical Branch, Galveston, TX; Shriners Hospitals for Children-Galveston, Galveston, TX; Institute for Translational Sciences, University of Texas Medical Branch, Galveston, TX.
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Bryant RA. Acute stress disorder. Curr Opin Psychol 2017; 14:127-131. [PMID: 28813311 DOI: 10.1016/j.copsyc.2017.01.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2016] [Revised: 12/30/2016] [Accepted: 01/11/2017] [Indexed: 12/28/2022]
Abstract
Acute stress disorder (ASD) was introduced in DSM-IV to describe posttraumatic stress disorder (PTSD) symptoms that (a) occur in the initial month after trauma and (b) predict subsequent PTSD. Longitudinal studies have shown that most people who develop PTSD do not initially meet ASD criteria, which led to the decision in DSM-5 to limit the ASD diagnosis to describing acute stress reactions without any predictive function. Controlled trials have shown that trauma-focused cognitive behavior therapy is the treatment of choice for ASD, and is superior to pharmacological interventions. Recent longitudinal studies have challenged previous conceptualizations of the course of posttraumatic stress, and highlighted that people follow different trajectories of adaptation that are influenced by events that occur after the acute posttraumatic period.
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Affiliation(s)
- Richard A Bryant
- School of Psychology, University of New South Wales, Sydney, NSW 2052, Australia.
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