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Eriksson S, Martin N, Smailes S, Dziewulski P. Cumulative sum (CUSUM) analysis: A 10 year experience of outcome monitoring in a regional burn centre. Burns 2024:S0305-4179(24)00235-3. [PMID: 39181769 DOI: 10.1016/j.burns.2024.07.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 06/19/2024] [Accepted: 07/28/2024] [Indexed: 08/27/2024]
Abstract
INTRODUCTION Outcome monitoring can identify fluctuations in healthcare. Cumulative sum (CUSUM) analysis can detect when mortality deviates from expected, allowing early intervention through targeted audit. We present a 10-year experience of the prospective use of CUSUM methodology in a regional burn centre. METHOD Prospective outcome monitoring was conducted for all admissions to the intensive care unit between 2012 and 2022. The revised Baux score was used for mortality risk prediction. Risk-adjusted CUSUM charts tracked mortality against that predicted by the revised Baux score. Deviations from expected outcomes triggered detailed structured analysis. Learning outcomes were identified from internal and external governance groups. RESULTS CUSUM analysis was triggered on eight occasions: one paediatric (excess deaths), six adult (four excess survivors, two excess deaths) and one elderly (excess survivors). Detailed analysis identified areas for continuous improvement and positive themes from excess survivors. CONCLUSION The use of CUSUM as an early warning trigger stimulates assessment of practice and critical appraisal of factors contributing to unexpected mortality or survival. The revised Baux score at its foundation needs to be carefully considered but remains a valid model. One benefit is positive reinforcement of team cohesion and morale during periods of care excellence leading to excess survivors.
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Affiliation(s)
- Sofia Eriksson
- St Andrew's Burn Service, Mid and South Essex NHS Foundation Trust, Chelmsford, UK; Karolinska University Hospital, Stockholm, Sweden.
| | - Niall Martin
- St Andrew's Burn Service, Mid and South Essex NHS Foundation Trust, Chelmsford, UK; Centre for Trauma Science, Blizard Institute, Queen Mary University of London, UK; Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Sarah Smailes
- St Andrew's Burn Service, Mid and South Essex NHS Foundation Trust, Chelmsford, UK
| | - Peter Dziewulski
- St Andrew's Burn Service, Mid and South Essex NHS Foundation Trust, Chelmsford, UK; St Andrew's Anglia Ruskin Research (StAAR) Group, Anglia Ruskin University, Chelmsford, UK
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Christ A, Staud CJ, Krotka P, Resch A, Neumüller A, Radtke C. Revalidating the prognostic relevance of the Abbreviated Burn Severity Index (ABSI): A twenty-year experience examining the performance of the ABSI score in consideration of progression and advantages of burn treatments from a single center in Vienna. J Plast Reconstr Aesthet Surg 2024; 94:160-168. [PMID: 38805847 DOI: 10.1016/j.bjps.2024.04.041] [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: 02/01/2024] [Revised: 04/07/2024] [Accepted: 04/11/2024] [Indexed: 05/30/2024]
Abstract
BACKGROUND The Abbreviated Burn Severity Index (ABSI) is a five-variable scale to help evaluate burn severity upon initial assessment. As other studies have been conducted with comparatively small patient populations, the purpose of this study is to revalidate the prognostic relevance of the ABSI in our selected population (N = 1193) 4 decades after its introduction, considering the progress in the treatment of severe burn injuries over the past decades. In addition, we evaluate whether comorbidities influence the survival probability of severely burned patients. METHODS This retrospective study presents data from the Center for Severely Burned Patients of the General Hospital in Vienna. We included 1193 patients for over 20 years. Regression models were used to describe the prognostic accuracy of the ABSI. RESULTS The ABSI can still be used as a prognostic factor for the probability of survival of severely burned patients. The odds of passing increases by a factor of 2.059 for each unit increase in the ABSI with an area under the curve value of 0.909. Over time, the likelihood of survival increased. The existence of chronic kidney disease negatively impacts the survival probability of severely burned patients. CONCLUSION The ABSI can still be used to provide accurate information about the chances of survival of severely burned patients; however, further exploration of the impact of chronic kidney disease on the survival probability and adding variables to the ABSI scale should be considered. The probability of survival has increased over the last 20 years.
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Affiliation(s)
- Alexandra Christ
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Vienna, Vienna, Austria.
| | - Clement J Staud
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Vienna, Vienna, Austria
| | - Pavla Krotka
- Section for Medical Statistics, Medical University of Vienna, Vienna, Austria
| | - Annika Resch
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Vienna, Vienna, Austria
| | - Albert Neumüller
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Vienna, Vienna, Austria
| | - Christine Radtke
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Vienna, Vienna, Austria
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Suzuki DRR, Santana LA, Ávila JEHG, Amorim FF, Modesto GP, Gottems LBD, Maldaner V. Quality indicators for hospital burn care: a scoping review. BMC Health Serv Res 2024; 24:486. [PMID: 38641612 PMCID: PMC11031897 DOI: 10.1186/s12913-024-10980-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 04/10/2024] [Indexed: 04/21/2024] Open
Abstract
BACKGROUND Burn treatments are complex, and for this reason, a specialised multidisciplinary approach is recommended. Evaluating the quality of care provided to acute burn patients through quality indicators makes it possible to develop and implement measures aiming at better results. There is a lack of information on which indicators to evaluate care in burn patients. The purpose of this scoping review was to identify a list of quality indicators used to evaluate the quality of hospital care provided to acute burn patients and indicate possible aspects of care that do not have specific indicators in the literature. METHOD A comprehensive scoping review (PRISMA-ScR) was conducted in four databases (PubMed, Cochrane Library, Embase, and Lilacs/VHL) between July 25 and 30, 2022 and redone on October 6, 2022. Potentially relevant articles were evaluated for eligibility. General data and the identified quality indicators were collected for each included article. Each indicator was classified as a structure, process, or outcome indicator. RESULTS A total of 1548 studies were identified, 82 were included, and their reference lists were searched, adding 19 more publications. Thus, data were collected from 101 studies. This review identified eight structure quality indicators, 72 process indicators, and 19 outcome indicators listed and subdivided according to their objectives. CONCLUSION This study obtained a list of quality indicators already used to monitor and evaluate the hospital care of acute burn patients. These indicators may be useful for further research or implementation in quality improvement programs. TRIAL REGISTRATION Protocol was registered on the Open Science Framework platform on June 27, 2022 ( https://doi.org/10.17605/OSF.IO/NAW85 ).
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Affiliation(s)
- Denise R Rabelo Suzuki
- Programa de Pós-Graduação em Ciências para a Saúde, Escola Superior de Ciências da Saúde (ESCS/FEPECS), SMNH Quadra 3 Conjunto A Bloco 01 Edifício Fepecs, Asa Norte, Brasília, Distrito Federal, Brazil.
- Secretaria de Saúde do Distrito Federal (SES-DF), Setor de Rádio e TV Norte (SRTVN) 701, Via W5 Norte, lote D, Brasília, Distrito Federal, Brazil.
- Unidade de Queimados, Hospital Regional da Asa Norte (HRAN), 3° andar. Setor Médico Hospitalar Norte Q 2, Brasília, Distrito Federal, 70710-100, Brazil.
| | - Levy Aniceto Santana
- Programa de Pós-Graduação em Ciências para a Saúde, Escola Superior de Ciências da Saúde (ESCS/FEPECS), SMNH Quadra 3 Conjunto A Bloco 01 Edifício Fepecs, Asa Norte, Brasília, Distrito Federal, Brazil
- Secretaria de Saúde do Distrito Federal (SES-DF), Setor de Rádio e TV Norte (SRTVN) 701, Via W5 Norte, lote D, Brasília, Distrito Federal, Brazil
| | - Juliana Elvira H Guerra Ávila
- Secretaria de Saúde do Distrito Federal (SES-DF), Setor de Rádio e TV Norte (SRTVN) 701, Via W5 Norte, lote D, Brasília, Distrito Federal, Brazil
- Programa de Pós-Graduação em Ciências da Saúde, Universidade de Brasília (UnB), Campus Universitário Darcy Ribeiro, Asa Norte, Brasília, Distrito Federal, Brazil
- Unidade de Queimados, Hospital Regional da Asa Norte (HRAN), 3° andar. Setor Médico Hospitalar Norte Q 2, Brasília, Distrito Federal, 70710-100, Brazil
| | - Fábio Ferreira Amorim
- Programa de Pós-Graduação em Ciências da Saúde, Universidade de Brasília (UnB), Campus Universitário Darcy Ribeiro, Asa Norte, Brasília, Distrito Federal, Brazil
| | - Guilherme Pacheco Modesto
- Programa de Pós Graduação em Ciências do Movimento Humano e Reabilitação, Universidade Evangélica de Goiás, Cidade Universitária, Avenida Universitária, Anápolis, Goiás, Brazil
| | - Leila Bernarda Donato Gottems
- Programa de Pós-Graduação em Ciências para a Saúde, Escola Superior de Ciências da Saúde (ESCS/FEPECS), SMNH Quadra 3 Conjunto A Bloco 01 Edifício Fepecs, Asa Norte, Brasília, Distrito Federal, Brazil
- Secretaria de Saúde do Distrito Federal (SES-DF), Setor de Rádio e TV Norte (SRTVN) 701, Via W5 Norte, lote D, Brasília, Distrito Federal, Brazil
| | - Vinicius Maldaner
- Programa de Pós Graduação em Ciências do Movimento Humano e Reabilitação, Universidade Evangélica de Goiás, Cidade Universitária, Avenida Universitária, Anápolis, Goiás, Brazil
- Universidade de Brasília (UnB), Ceilândia Sul Campus Universitário, Centro Metropolitano, Ceilândia, Distrito Federal, Brazil
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Boissin C. Clinical decision-support for acute burn referral and triage at specialized centres - Contribution from routine and digital health tools. Glob Health Action 2022; 15:2067389. [PMID: 35762795 PMCID: PMC9246103 DOI: 10.1080/16549716.2022.2067389] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Specialized care is crucial for severe burn injuries whereas minor burns should be handled at point-of-care. Misdiagnosis is common which leads to overburdening the system and to a lack of treatment for others due to resources shortage. OBJECTIVES The overarching aim was to evaluate four decision-support tools for diagnosis, referral, and triage of acute burns injuries in South Africa and Sweden: referral criteria, mortality prediction scores, image-based remote consultation and automated diagnosis. METHODS Study I retrospectively assessed adherence to referral criteria of 1165 patients admitted to the paediatric burns centre of the Western Cape of South Africa. Study II assessed mortality prediction of 372 patients admitted to the adults burns centre by evaluating an existing score (ABSI), and by using logistic regression. In study III, an online survey was used to assess the diagnostic accuracy of burn experts' image-based estimations using their smartphone or tablet. In study IV, two deep-learning algorithms were developed using 1105 acute burn images in order to identify the burn, and to classify burn depth. RESULTS Adherence to referral criteria was of 93.4%, and the age and severity criteria were associated with patient care. In adults, the ABSI score was a good predictor of mortality which affected a fifth of the patients and which was associated with gender, burn size and referral status. Experts were able to diagnose burn size, and burn depth using handheld devices. Finally, both a wound identifier and a depth classifier algorithm could be developed with relatively high accuracy. CONCLUSIONS Altogether the findings inform on the use of four tools along the care trajectory of patients with acute burns by assisting with the diagnosis, referral and triage from point-of-care to burns centres. This will assist with reducing inequities by improving access to the most appropriate care for patients.
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Affiliation(s)
- Constance Boissin
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
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Angelou IK, van Aswegen H, Wilson M, Grobler R. A profile of adult patients with major burns admitted to a Level 1 Trauma Centre and their functional outcomes at discharge: A retrospective review. SOUTH AFRICAN JOURNAL OF PHYSIOTHERAPY 2021. [DOI: 10.4102/sajp.v77i1.1543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Hassan Z, Burhamah W, Alabdulmuhsen S, Al Saffar A, Oroszlányová M, Aziz H. The analysis and accuracy of mortality prediction scores in burn patients admitted to the intensive care burn unit (ICBU). Ann Med Surg (Lond) 2021; 65:102249. [PMID: 33912341 PMCID: PMC8065182 DOI: 10.1016/j.amsu.2021.102249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 03/21/2021] [Accepted: 03/22/2021] [Indexed: 11/01/2022] Open
Abstract
Background To date, multiple scoring systems have been utilised in predicting outcomes in burn patients. The aim of this study is to determine the accuracy of three established scoring systems used for burn patients admitted to the intensive care unit and to determine the risk factors associated with poor outcomes. Methods A total of 211 patients who were admitted to the ICBU in a tertiary care centre in Kuwait from January 2017 to December 2019 were analysed retrospectively. Data were collected using patient medical records. The FLAMES, BOBI and revised Baux scores were calculated, and the survivor and non-survivor scores of patients were analysed to determine the sensitivity, specificity and Area Under the Receiver Operating Characteristics (AUROC) of the different scoring modalities. Results The majority of the analysed population were male patients (165/211) and the most common mechanism of burns was flame burns (166/211). Most of the patients admitted to the ICBU survived (188/211). Female gender was associated with a higher mortality rate, whilst inhalational injury and co-morbidities were not associated with a higher mortality rate. The revised Baux score had a sensitivity value of 96% and 90% specificity. The BOBI score had a sensitivity of 91% and 76% specificity. The FLAMES score had a sensitivity of 96% and the highest specificity of 99%. All 3 scores had AUC values exceeding 90%. Conclusion Statistically, FLAMES score had the highest accuracy of predicting outcomes in burn patients, however all three scores demonstrated acceptable predictive rates when it comes to practical application, permitting the use of either one of the studied scores with satisfactory prognostic outcomes.
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Affiliation(s)
- Zakariya Hassan
- AlBabtain Center for Burns and Plastic Surgery, Sabah Health Region, Kuwait
| | - Waleed Burhamah
- AlBabtain Center for Burns and Plastic Surgery, Sabah Health Region, Kuwait
| | | | - Abdullah Al Saffar
- AlBabtain Center for Burns and Plastic Surgery, Sabah Health Region, Kuwait
| | - Melinda Oroszlányová
- College of Engineering and Technology, American University of the Middle East, Kuwait
| | - Hasan Aziz
- AlBabtain Center for Burns and Plastic Surgery, Sabah Health Region, Kuwait
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Yoshimura Y, Saitoh D, Yamada K, Nakamura T, Terayama T, Ikeuchi H, Sasaki J, Nemoto M. Comparison of prognostic models for burn patients: A retrospective nationwide registry study. Burns 2020; 46:1746-1755. [PMID: 33148486 DOI: 10.1016/j.burns.2020.10.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 09/03/2020] [Accepted: 10/08/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Prognostic burn index (PBI) is a unique model utilized to predict mortality of burn patients in Japan. In contrast, other prediction models are rarely used in Japan, and their accuracy and predictive value are unknown. The present study aimed to compare commonly used burn prediction models and determine the appropriate model for mortality prediction in Japanese burn patients. METHODS Japanese burn patients registered in the nationwide burn registry of Japanese Society for Burn Injury between April 1, 2011 and March 31, 2019 were reviewed retrospectively. The prognostic performance of PBI was compared with Baux score, revised Baux score, abbreviated burn severity index (ABSI), Ryan score and Belgian outcome in burn injury score (BOBI). The primary outcome was in-hospital mortality. RESULTS The study included 7911 acute burn patients. The overall mortality rate was 10.7%, the median age was 52 (interquartile range, 26-72) years, and the median % total body surface area was 7% (interquartile range, 3%-17%). The areas under the receiver operating characteristic curve for PBI, Baux score, ABSI, revised Baux score, Ryan score, and BOBI were 0.940 (95% confidence interval [CI]: 0.931-0.948), 0.943 (95% CI: 0.934-0.951; p=0.002), 0.945 (95% CI: 0.937-0.953; p=0.058), 0.946 (95% CI: 0.937-0.953; p=0.002), 0.859 (95% CI: 0.846-0.870; p<0.001), and 0.896 (95% CI: 0.885-0.905; p<0.001), respectively. CONCLUSION Although the performance of PBI was good, it was not superior to the Baux score, revised Baux score, and ABSI. These three scores have a high prognostic accuracy. Hence, they are considered as alternative burn prognostic scores in Japan. The Baux score was an optimal prognostic model for patients with burns in Japan.
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Affiliation(s)
- Yuya Yoshimura
- Department of Traumatology and Critical Care Medicine, National Defense Medical College, Saitama, Japan; Department of Emergency and Acute Medicine, Saitama Medical University International Medical Center, Saitama, Japan.
| | - Daizoh Saitoh
- Department of Traumatology and Critical Care Medicine, National Defense Medical College, Saitama, Japan; Division of Traumatology, Research Institute, National Defense Medical College, Saitama, Japan
| | - Kohei Yamada
- Department of Traumatology and Critical Care Medicine, National Defense Medical College, Saitama, Japan
| | - Takahiro Nakamura
- Department of Mathematics, National Defense Medical College, Saitama, Japan
| | - Takero Terayama
- Department of Traumatology and Critical Care Medicine, National Defense Medical College, Saitama, Japan
| | - Hisashi Ikeuchi
- Department of Traumatology and Critical Care Medicine, National Defense Medical College, Saitama, Japan
| | - Junichi Sasaki
- Department of Emergency and Critical Care Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Manabu Nemoto
- Department of Emergency and Acute Medicine, Saitama Medical University International Medical Center, Saitama, Japan
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Allorto N, Rencken CA, Wall S, Pompermaier L. Factors impacting time to surgery and the effect on in-hospital mortality. Burns 2020; 47:922-929. [PMID: 33342553 DOI: 10.1016/j.burns.2020.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 08/26/2020] [Accepted: 09/24/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Early surgery improves outcomes after burn injuries but is often not available in limited resource settings (LRS), where a more conservative approach is widespread. This study aimed to analyze factors associated with delay in surgical treatment, and the impact on in-hospital mortality. METHODS All patients with burns treated with surgery between 2016 and 2019 at the Pietermaritzburg Burn Service, in South Africa, were included in this retrospective study. Early surgery was defined as patients who underwent surgery within 7 days from injury. The population was analyzed descriptively and differences between groups were tested using t-test, and χ2 test or Fisher's exact test, as appropriate. Multivariable logistic regression was used to analyze the effect of delay in surgical treatment on in-hospital mortality, after adjustment for confounders. RESULTS During the study period, 620 patients with burns underwent surgery. Of them, 16% had early surgery. The early surgery group had a median age and TBSA of 11 years (3-35) and 12.0% (5-22) compared to 7 years (2-32) and 6.0% (3-13) in the late surgery group (p=0.45, p<0.001). In logistic regression, female sex [aOR: 3.30 (95% CI: 1.47-7.41)], TBSA% [aOR: 1.09 (95% CI: 1.05-1.12)], and FTB [aOR: 3.21 (95% CI: 1.43-7.18)] were associated with in-hospital mortality, whereas having early surgery was not [aOR: 1.74 (95% CI: 0.76-3.98)]. CONCLUSION This study found that early surgery was not associated with in-hospital mortality. Independent predictors of in-hospital mortality were female sex, presence of full thickness burn, and larger burn size. Future studies should investigate if burn care capacity in LRS may influence the association between early excision and outcome.
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Affiliation(s)
- Nikki Allorto
- Pietermaritzburg Burn Service, University of KwaZulu-Natal, KZN, South Africa
| | | | - Shelley Wall
- Pietermaritzburg Burn Service, University of KwaZulu-Natal, KZN, South Africa; DRILL Fellow: Developing Research, Innovation, Localization and Leadership, Univeristy of KwaZulu-Natal, KZN, South Africa
| | - Laura Pompermaier
- Department of Hand Surgery, Plastic Surgery and Burns, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
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Bartels P, Thamm OC, Elrod J, Fuchs P, Reinshagen K, German Burn Registry, Koenigs I. The ABSI is dead, long live the ABSI - reliable prediction of survival in burns with a modified Abbreviated Burn Severity Index. Burns 2020; 46:1272-1279. [DOI: 10.1016/j.burns.2020.05.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 04/15/2020] [Accepted: 05/11/2020] [Indexed: 01/23/2023]
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Lamblin A, Derkenne C, Radavidson A. Burn wound care of civilians in Sahel region by French military surgical teams: ethical challenges and future training requirements. BMJ Mil Health 2020; 167:122-125. [PMID: 32086261 DOI: 10.1136/jramc-2019-001327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 11/19/2019] [Accepted: 11/26/2019] [Indexed: 11/04/2022]
Abstract
The primary mission of the French military surgical teams deployed in external operations in the Sahel is to provide support for combatants. However, many of their activities and of the limited human and material resources allocated to them are devoted to providing free medical assistance to the local population. The French military surgical teams are very often expected to take care of serious burns for the benefit of civil populations because of the absence of dedicated civilian medical structures. Surgical teams are faced with a necessary triage of patients to be taken care of because of the discrepancy between the high demand for care and the means at their disposal. But the triage can lead to ethical dilemmas when the values that come into play in the decision contradict each other or when they run up against the quota of available human and material resources, as well as the interests of the military institution. The challenge is then to become aware of these dilemmas in this particular context. A discussion of these ethical dilemmas would help carers to avoid developing fatalistic attitudes or developing chronic pathologies due to unresolved or unconscious predicaments. Solutions are proposed that place ethical reflection at the heart of the practices during external operations by the French surgical teams. The ethics of discussion must bring together all players in care management and also the military authorities, before, during and after the missions. Training programmes for ethical reflection would benefit surgical teams and help them approach and become aware of the dilemmas they will necessarily face.
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Affiliation(s)
- Antoine Lamblin
- Anesthésie-Réanimation, Hôpital d'Instruction des Armées Desgenettes, Lyon, France .,Adés, UMR 7268, Marseille, Provence-Alpes-Côte d'Azur, France
| | - C Derkenne
- Paris Fire Brigade, Paris, Île-de-France, France
| | - A Radavidson
- Anesthésie-Réanimation, Hôpital d'Instruction des Armées Desgenettes, Lyon, France
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Boissin C, Wallis LA, Kleintjes W, Laflamme L. Admission factors associated with the in-hospital mortality of burns patients in resource-constrained settings: A two-year retrospective investigation in a South African adult burns centre. Burns 2019; 45:1462-1470. [PMID: 30928024 DOI: 10.1016/j.burns.2019.03.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 02/27/2019] [Accepted: 03/03/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Little is known concerning the factors associated with in-hospital mortality of trauma patients in resource-constrained settings, not least in burns centres. We investigated this question in the adult burns centre at Tygerberg Hospital in Cape Town. We further assessed whether the Abbreviated Burn Severity Index (ABSI) is an accurate predictive score of mortality in this setting. METHODS Medical records of all patients admitted with fresh burns over a two-year period (2015 and 2016) were scrutinized to obtain data on patient, injury and admission-related characteristics. Association with in-hospital mortality was investigated for flame burns using logistic regressions and expressed as odds ratios (ORs). The mortality prediction of the ABSI score was assessed using sensitivity and specificity analyses. RESULTS Overall the in-hospital mortality was 20.4%. For the 263 flame burns, while crude ORs suggested gender, burn depth, burn size, inhalation injury, and referral status were all individually significantly associated with mortality, only the association with female gender, not being referred and burn size remained significant after adjustments (adjusted ORs = 3.79, 2.86 and 1.11 (per percentage increase in size) respectively). For the ABSI score, sensitivity and specificity were 84% and 86% respectively. CONCLUSION In this specialised centre, mortality occurs in one in five patients. It is associated with a few clinical parameters, and can be predicted using the ABSI score.
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Affiliation(s)
- Constance Boissin
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
| | - Lee A Wallis
- Division of Emergency Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Bellville, South Africa; Division of Emergency Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
| | - Wayne Kleintjes
- Surgery Department, Faculty of Medicine and Health Sciences, Stellenbosch University, Bellville, South Africa.
| | - Lucie Laflamme
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden; University of South Africa, Pretoria, South Africa.
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Newberry JA, Bills CB, Pirrotta EA, Barry M, Ramana Rao GV, Mahadevan SV, Strehlow MC. Timely access to care for patients with critical burns in India: a prehospital prospective observational study. Emerg Med J 2019; 36:176-182. [PMID: 30635272 PMCID: PMC6580756 DOI: 10.1136/emermed-2018-207900] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 12/07/2018] [Accepted: 12/20/2018] [Indexed: 11/16/2022]
Abstract
Background Low/middle-income countries carry a disproportionate burden of the morbidity and mortality from thermal burns. Nearly 70% of burn deaths worldwide are from thermal burns in India. Delays to medical care are commonplace and an important predictor of outcomes. We sought to understand the role of emergency medical services (EMS) as part of the healthcare infrastructure for thermal burns in India. Methods We conducted a prospective observational study of patients using EMS for thermal burns across five Indian states from May to August 2015. Our primary outcome was mortality at 2, 7 and 30 days. We compared observed mortality with expected mortality using the revised Baux score. We used Χ2 analysis for categorical variables and Wilcoxon two-sample test for continuous variables. ORs and 95% CIs are reported for all modelled predictor variables. Results We enrolled 439 patients. The 30-day follow-up rate was 85.9% (n=377). The median age was 30 years; 56.7% (n=249) lived in poverty; and 65.6% (n=288) were women. EMS transported 94.3% of patients (n=399) to the hospital within 2 hours of their call. Median total body surface area (TBSA) burned was 60% overall, and 80% in non-accidental burns. Sixty-eight per cent of patients had revised Baux scores greater than 80. Overall 30-day mortality was 64.5%, and highest (90.2%) in women with non-accidental burns. Predictors of mortality by multivariate regression were TBSA (OR 7.9), inhalation injury (OR 5.5), intentionality (OR 4.7) and gender (OR 2.2). Discussion Although EMS rapidly connects critically burned patients to care in India, mortality remains high, with women disproportionally suffering self-inflicted burns. To combat the burn epidemic in India, efforts must focus on rapid medical care and critical care services, and on a burn prevention strategy that includes mental health and gender-based violence support services.
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Affiliation(s)
- Jennifer A Newberry
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Corey B Bills
- Emergency Medicine, University of California San Francisco School of Medicine, San Francisco, California, USA
| | - Elizabeth A Pirrotta
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Michele Barry
- Internal Medicine, Stanford University School of Medicine, Stanford, California, USA
| | | | - Swaminatha V Mahadevan
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Matthew C Strehlow
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, California, USA
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Lethal area 50 percent (LA50) or standardized mortality ratio (SMR): Which one is more conclusive? Burns 2018; 44:1468-1474. [DOI: 10.1016/j.burns.2018.04.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 03/30/2018] [Accepted: 04/05/2018] [Indexed: 11/17/2022]
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