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Panayi AC, Didzun O, Nnabuko R, Sjöberg F, Knoedler S, Haug V, Palackic A, Tapking C, Ewerbeck N, Bigdeli AK, Kneser U, Hundeshagen G. The Epidemiology and Outcomes of Perineal and Genital Burn Injury in Low- and Middle- Income Countries: A Global Burn Registry Study. J Plast Reconstr Aesthet Surg 2024; 95:17-20. [PMID: 38865839 DOI: 10.1016/j.bjps.2024.05.034] [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: 02/12/2024] [Revised: 05/09/2024] [Accepted: 05/18/2024] [Indexed: 06/14/2024]
Abstract
INTRODUCTION The epidemiology, care, and outcomes of perineal and genital burns (PG) in high-income countries have been previously described, but an analysis of this topic in LMICs has yet to be performed. We use the World Health Organization's Global Burn Registry to fill this gap. METHODS The GBR was searched from inception to November 2023 to identify all burn patients, excluding cases from high-income countries. Demographics and mechanism of injury were retrieved. Primary outcomes were length of hospital stay (LOHS), surgical intervention, discharge with physical impairment, and mortality. A multivariate regression analysis was performed controlling for burnt total body surface area (TBSA), age, sex, inhalation injury, mechanism of burn and care center characteristics. RESULTS Of 9041 patients identified, 1213 (13.4 %) had PG burns with 136 (1.6 %) isolated to the PG region. PG patients had higher TBSA (p < 0.001) and more inhalation injury (p < 0.001). They had better access to rehabilitation and lower access to theater space for burns (p < 0.001). Multivariable analysis showed that PG patients had longer LOHS (p = 0.001), greater mortality (p < 0.001), were less likely to undergo surgery (p = 0.01) or be discharged home with physical impairment (p = 0.03). CONCLUSION Similarities and differences exist between high- and low/middle-income countries in terms of the patterns of injury, care, and recovery in patients with PG burns. The longer LOHS and higher mortality among PG patients, previously reported in high-income countries, are verified. This highlights the importance of greater vigilance when caring for such patients.
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Affiliation(s)
- Adriana C Panayi
- Department of Hand-, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany
| | - Oliver Didzun
- Department of Hand-, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany
| | - Richard Nnabuko
- Department of Plastic Surgery, National Orthopaedic Hospital, Enugu, Nigeria
| | - Folke Sjöberg
- Department of Hand Surgery, Plastic Surgery and Burns, Department of Biomedical and Clinical Sciences, Linköping University, Sweden; Department of Anaesthesiology and Intensive Care, Linköping University, Sweden
| | - Samuel Knoedler
- Department of Plastic Surgery and Hand Surgery, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Valentin Haug
- Department of Hand-, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany
| | - Alen Palackic
- Department of Hand-, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany
| | - Christian Tapking
- Department of Hand-, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany
| | - Nicolas Ewerbeck
- Department of Hand-, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany
| | - Amir K Bigdeli
- Department of Hand-, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany
| | - Ulrich Kneser
- Department of Hand-, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany
| | - Gabriel Hundeshagen
- Department of Hand-, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany.
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Bonaventura B, Panayi AC, Hummedah K, Palackic A, Tapking C, Haug V, Kilian K, Runkel A, Bliesener B, Kneser U, Hundeshagen G. Outcomes in patients with burns to the perineum, buttocks and genitalia: A retrospective cohort study. Burns 2024; 50:767-773. [PMID: 38036375 DOI: 10.1016/j.burns.2023.10.003] [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: 04/01/2023] [Revised: 09/26/2023] [Accepted: 10/09/2023] [Indexed: 12/02/2023]
Abstract
BACKGROUND Burns that involve the perineum, buttocks and genitals (PBG) have been associated with more challenging therapeutic needs and worse clinical outcomes. We aimed to investigate whether PBG burns are an independent predictor for mortality, morbidity and complications in a large, heterogenous patient collective and in comparison to patients without PBG burns. PATIENTS AND METHODS Patients admitted to a level one burn center between August 2014 and July 2022 were included and stratified based on the presence of PBG burns on admission (PBG & control group = CTR). Demographic baseline data, burn aetiology, inhalation trauma (IHT), full-thickness burns (FT), number of operations (NOR), mortality, length of ICU stay (LOS-ICU), length of in-hospital stay (LOHS) and bacteraemia were assessed to compare key clinical characteristics and outcomes between the groups. Multivariate regression analyses and a 1:1 propensity score matching were conducted for key clinical outcomes. RESULTS A total of 1024 patients were included in the analysis (PBG: n = 227; CTR: n = 797). PBG burns were older (median (IQR) 54 (34-72) vs. 44, (30-61) years, p < 0.0001), more frequently female (35% vs. 23%, p = 0.002) presented with larger total body surface area (TBSA) burns overall (27 (32-39) vs. 10 (13-15) %, p < 0.0001) and sustained FT burns more frequently (69% vs. 26% p < 0.0001). Scald burns were more frequently the cause of PBG burns (45% vs. 15%, p < 0.0001), PBG patients needed twice as many surgical procedures (Mean (SD) 2 (2.84) vs. 1 (1.6), p < 0.0001) as CTR. In multivariate analyses, a significant correlation was identified between length of ICU stay and presence of PBG burns. Following strict cohort matching to account for sex, age, cause of burn, TBSA %, presence of FT burn, inhalation trauma and bacteraemia, PBG burns were an independent predictor for mortality (p = 0.0003). CONCLUSION PBG burns are at risk for prolonged intensive care, hospitalization and complications during treatment. Furthermore, the presence of PBG burns appears to be a risk factor for mortality, irrespective of patient age, TBSA affected and other relevant covariates.
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Affiliation(s)
- Bastian Bonaventura
- Department of Hand-, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center, Ludwigshafen, Germany
| | - Adriana C Panayi
- Department of Hand-, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center, Ludwigshafen, Germany
| | - Kamal Hummedah
- Department of Hand-, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center, Ludwigshafen, Germany
| | - Alen Palackic
- Department of Hand-, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center, Ludwigshafen, Germany
| | - Christian Tapking
- Department of Hand-, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center, Ludwigshafen, Germany
| | - Valentin Haug
- Department of Hand-, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center, Ludwigshafen, Germany
| | - Katja Kilian
- Department of Hand-, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center, Ludwigshafen, Germany
| | - Alexander Runkel
- Department of Plastic and Hand Surgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Bjoern Bliesener
- Department of Hand-, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center, Ludwigshafen, Germany
| | - Ulrich Kneser
- Department of Hand-, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center, Ludwigshafen, Germany
| | - Gabriel Hundeshagen
- Department of Hand-, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center, Ludwigshafen, Germany.
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Kronstedt S, Boyle J, Fisher AD, April MD, Schauer SG, Grabo D. Male Genitourinary Injuries in Combat - A Review of United States and British Forces in Afghanistan and Iraq: 2001-2013. Urology 2023; 171:11-15. [PMID: 35882303 DOI: 10.1016/j.urology.2022.07.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 06/07/2022] [Accepted: 07/12/2022] [Indexed: 01/12/2023]
Abstract
As we look to the current conflict in Ukraine, our service members deploy to periphery Northern Atlantic Treaty Organization countries. At the same time, we see an increase in high-kinetic wounding patterns in the United States. We look to the important underrepresented topic of urologic trauma in combat casualties to prepare for the wounds of modern warfare. Genitourinary wounds are increasingly frequent and affect both military and civilian casualties; civilian urologists and deployed surgeons require proficiency in treating these wounds. We present this review of urologic trauma in Afghanistan and Iraq to inform considerations for urologic surgeons and first responders.
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Affiliation(s)
| | - Joseph Boyle
- Rutgers Robert Wood Johnson Medical School, Piscataway, NJ
| | - Andrew D Fisher
- Department of Surgery, University of New Mexico School of Medicine, Albuquerque, NM; Texas National Guard, Austin, TX
| | - Michael D April
- 40th Forward Resuscitation and Surgical Detachment, Fort Carson, CO; Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Steven G Schauer
- Uniformed Services University of the Health Sciences, Bethesda, MD; U.S. Army Institute of Surgical Research, JBSA Fort Sam Houston, TX; Brooke Army Medical Center, JBSA Fort Sam Houston, TX
| | - Daniel Grabo
- West Virginia University School of Medicine, Morgantown, WV
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Umar Farooq Baba P, Ahmad Shah R, Rasool A, Kaul A, Hafeez Wani A. PERINEAL BURNS EPIDEMIOLOGY, SEVERITY FACTORS, MANAGEMENT ISSUES AND OUTCOME. BURNS OPEN 2022. [DOI: 10.1016/j.burnso.2022.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Hoshino T, Enomoto Y, Inoue Y. Association Between Perineal Burns Injury and In-hospital Mortality: A Retrospective Observational Study from the Nation-Wide Burn Registry in Japan. J Burn Care Res 2021; 43:419-422. [PMID: 34151360 DOI: 10.1093/jbcr/irab098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Although perineal burn injury is included in the burn center referral criteria for Advanced Burn Life Support, clinical evidence that perineal burn injury increases mortality risk is limited, especially from Asian countries. The objective of this study was to investigate whether perineal burns affect in-hospital mortality. Using data from the nation-wide burn registry collected from April 1, 2011 to March 31, 2019, we retrospectively identified 10,179 hospitalized burn patients over 16 years of age. The in-hospital mortality rate between the patients with perineal burn and those with other burns was compared, and the adjusted odds ratio for in-hospital mortality was determined with multivariable logistic regression analysis controlling for age, gender, mechanism of burn injury, year of admission, total burn surface area, inhalation injury, hand injury, and transfers from another hospital. One thousand one hundred forty-nine patients with perineal burn were enrolled, and the in-hospital mortality of this group was higher than that of the group of patients with other types of burns (46 vs 5.2%, P < 0.001). Multivariable analysis found that the presence of perineal burns is associated with in-hospital mortality (odds ratio 2.11 [95% confidence intervals (CI) 1.64-2.71]; P < 0.001). Our data, as evidence, certified the referral criteria that perineal burn injury is associated with higher in-hospital mortality in Japan.
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Affiliation(s)
- Tetsuya Hoshino
- Department of Emergency and Critical Care Medicine, University of Tsukuba Hospital, Ibaraki, Japan
| | - Yuki Enomoto
- Department of Emergency and Critical Care Medicine, University of Tsukuba Hospital, Ibaraki, Japan.,Department of Emergency and Critical Care Medicine, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Yoshiaki Inoue
- Department of Emergency and Critical Care Medicine, University of Tsukuba Hospital, Ibaraki, Japan.,Department of Emergency and Critical Care Medicine, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
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Concannon E, Coghlan P, DamKat Thomas L, Solanki NS, Greenwood JE. Biodegradable Temporizing Matrix Reconstruction of Complex Perineal Burn Wound: A Case Report. J Burn Care Res 2021; 42:1038-1042. [DOI: 10.1093/jbcr/irab073] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Abstract
This case report details our experience using a two-stage Biodegradable Temporizing Matrix (NovoSorb® PolyNovo Ltd) and autograft for acute reconstruction of a complex perineal burn wound in an elderly comorbid patient. A 77-year-old man sustained 42% full-thickness burns extending circumferentially from bilateral thighs and buttocks, across the entire perineal and genital regions up to his mid-trunk, following self-immolation using an accelerant. Early total burn wound excision was carried out with acute application of Biodegradable Temporizing Matrix to all affected sites. Excellent integration and vascularization of Biodegradable Temporizing Matrix took place despite the challenge of intermittent fecal contamination affecting the perineal and buttock burn sites and matrix colonization with multidrug-resistant organisms. Delamination and serial split-thickness skin autografting were carried out 42 days after the first matrix application with complete and robust graft take. Perineal burns present a reconstructive challenge due to the proximity of specialized structures such as the genitalia, urethral, and anal orifices. Restoration of complex anatomy and function may be required after debridement with increased risks of infection, contracture formation, and mortality compared with burns affecting other anatomical sites. Two-stage Biodegradable Temporizing Matrix represents a reliable reconstruction option for complex extensive perineal wounds in frail elderly patients, despite an unfavorable local microbial environment.
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Affiliation(s)
| | - Patrick Coghlan
- Adult Burns Unit, Royal Adelaide Hospital, South Australia, Australia
| | | | | | - John E Greenwood
- Adult Burns Unit, Royal Adelaide Hospital, South Australia, Australia
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Jimbo M, Overholt TL, Cosma GL, Hudak SJ, Granberg CF, Gargollo PC. Full thickness genital burns independently increase the odds of death among pediatric burn patients. J Pediatr Urol 2020; 16:220.e1-220.e6. [PMID: 32098711 DOI: 10.1016/j.jpurol.2020.01.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Accepted: 01/18/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND There are limited published data characterizing pediatric burn patients with genital burns (GB). OBJECTIVE Assess prevalence of GB in pediatric burn patients and analyze clinical characteristics including predictors of mortality. STUDY DESIGN We queried American Burn Association's National Burn Repository to identify all pediatric burn patients who presented to North American burn centers over a 10-year period. We excluded all patients aged ≥18 years and patients with unknown sex, race, and/or mortality. We also excluded subsequent encounters for patients with multiple visits. Demographic and clinical characteristics were compared between patients with and without GB. Univariable and multivariable logistic regression analyses were performed to identify predictors of mortality. RESULTS Among 38 211 pediatric burn patients, 1244 (3.3%) suffered from second- or third-degree GB. Patients who suffered from third-degree GB (GB3) were significantly older than patients who suffered from second-degree GB (GB2) or patients without GB. Of the patients, 32.3% were aged 0-2 years. Scalding was the most common mechanism of injury for pediatric GB patients at 73.8%. Compared to non-GB patients, GB patients had significantly higher total body surface area (TBSA) burned (16.5% vs 7.0%), higher rates of associated inhalation injury (4.1% vs 2.6%), longer length of stay (LOS) (14.3 days vs 6.7 days), higher rates of urinary tract infection (UTI) (13.0% vs 2.8%) and sepsis (14.1% vs 2.3%), and higher mortality (3.5% vs 0.7%) (P < 0.0001 for all). The differences were more pronounced for the subset of patients who suffered from GB3 (TBSA 43.5%, associated inhalation injury 19.9%, LOS 42.9 days, 21.3% UTI, 33.3% sepsis, and 19.3% mortality). On multivariable analysis, the presence of GB3, TBSA, non-white ethnicity, and the presence of associated inhalation injury were significant predictors of mortality. Only 4.5% of pediatric GB patients underwent genital surgery, with the majority consisting of excision, reconstruction, or repair of the penis, vulva, or perineum. No patient required orchiectomy or suprapubic catheter placement. DISCUSSION This is the largest study to date of pediatric GB patients. A minority of pediatric burn patients present with GB. However, when they occur, GB are associated with significantly worse clinical outcomes. Importantly, the presence of GB3 is an independent predictor of mortality in pediatric burn patients. CONCLUSION The presence of GB appears to be a strong marker of severe burn injury. Pediatric GB patients need to be carefully assessed and aggressively managed for additional injuries, complications, surgical needs, and mortality risk.
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Affiliation(s)
- Masaya Jimbo
- Department of Urology, Mayo Clinic, Rochester, MN, USA
| | - Tyler L Overholt
- Department of Urology, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Gabriela L Cosma
- Department of Microbiology and Immunology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Steven J Hudak
- Urology Clinic, Department of Surgery, Brooke Army Medical Center, San Antonio, TX, USA
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Toft-Petersen AP, Ferrando-Vivas P, Harrison DA, Dunn K, Rowan KM. The organisation of critical care for burn patients in the UK: epidemiology and comparison of mortality prediction models. Anaesthesia 2018; 73:1131-1140. [PMID: 29762869 DOI: 10.1111/anae.14319] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2018] [Indexed: 12/23/2022]
Abstract
In the UK, a network of specialist centres has been set up to provide critical care for burn patients. However, some burn patients are admitted to general intensive care units. Little is known about the casemix of these patients and how it compares with patients in specialist burn centres. It is not known whether burn-specific or generic risk prediction models perform better when applied to patients managed in intensive care units. We examined admissions for burns in the Case Mix Programme Database from April 2010 to March 2016. The casemix, activity and outcome in general and specialist burn intensive care units were compared and the fit of two burn-specific risk prediction models (revised Baux and Belgian Outcome in Burn Injury models) and one generic model (Intensive Care National Audit and Research Centre model) were compared. Patients in burn intensive care units had more extensive injuries compared with patients in general intensive care units (median (IQR [range]) burn surface area 16 (7-32 [0-98])% vs. 8 (1-18 [0-100])%, respectively) but in-hospital mortality was similar (22.8% vs. 19.0%, respectively). The discrimination and calibration of the generic Intensive Care National Audit and Research Centre model was superior to the revised Baux and Belgian Outcome in Burn Injury burn-specific models for patients managed on both specialist burn and general intensive care units.
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Affiliation(s)
- A P Toft-Petersen
- Departments of Clinical Medicine and Anaesthesia and Intensive Care, Aalborg University Hospital, Aalborg, Denmark.,Intensive Care National Audit and Research Centre (ICNARC), London, UK
| | - P Ferrando-Vivas
- Intensive Care National Audit and Research Centre (ICNARC), London, UK
| | - D A Harrison
- Intensive Care National Audit and Research Centre (ICNARC), London, UK
| | - K Dunn
- Adult Burn Service, University Hospital of South Manchester, Manchester, UK
| | - K M Rowan
- Intensive Care National Audit and Research Centre (ICNARC), London, UK
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Tresh A, Baradaran N, Gaither TW, Fergus KB, Liaw A, Balakrishnan A, Hampson LA, Breyer BN. Genital burns in the United States: Disproportionate prevalence in the pediatric population. Burns 2018; 44:1366-1371. [PMID: 29576344 DOI: 10.1016/j.burns.2018.02.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Revised: 01/19/2018] [Accepted: 02/21/2018] [Indexed: 10/17/2022]
Abstract
INTRODUCTION AND OBJECTIVES To describe the epidemiology of genital burns in the U.S. and investigate the underlying etiology. METHODS The National Electronic Injury Surveillance System database was queried for individuals who sustained genital burns from 2000 to 2016. We collected data on age, gender, injury diagnosis, disposition, and causative agents. Multivariate analysis was performed to determine predictors of hospitalization. RESULTS We estimate 17,026 (95% CI 16,649-17,404) cases of genital burns presented to emergency departments nationally. Genital burns occurred more in males than females (12,295 vs 4,731). Scalding (57.9%) was the most common mechanism of injury and hot water (35.7%) the most common causative agent. Significant predictors of hospitalization on multivariate analysis were multi-surface (OR 4.4), scalding (OR 11.5) and thermal burns (OR 27.9). Children ages 0-2 had the highest prevalence of genital burns, and children ages 0-12 comprised 37.1% of the study. For children <5years of age, majority of the burns were caused by hot water in the bathroom. In age group 6-12, the most common causes of genital burns were cooking-related scalds due to hot foods and water. CONCLUSIONS Children sustain genital burns at a higher rate than adults and many appear to have a preventable mechanism. Improved product design for safety and educating caregivers about potential hazardous situations are needed.
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Affiliation(s)
- Anas Tresh
- Department of Urology, University of California-San Francisco, San Francisco, CA, United States
| | - Nima Baradaran
- Department of Urology, University of California-San Francisco, San Francisco, CA, United States
| | - Thomas W Gaither
- Department of Urology, University of California-San Francisco, San Francisco, CA, United States
| | - Kirkpatrick B Fergus
- Department of Urology, University of California-San Francisco, San Francisco, CA, United States
| | - Aron Liaw
- Department of Urology, University of California-San Francisco, San Francisco, CA, United States
| | - Ashwin Balakrishnan
- Department of Urology, University of California-San Francisco, San Francisco, CA, United States
| | - Lindsay A Hampson
- Department of Urology, University of California-San Francisco, San Francisco, CA, United States
| | - Benjamin N Breyer
- Department of Urology, University of California-San Francisco, San Francisco, CA, United States; Department of Biostatistics and Epidemiology, University of California-San Francisco, San Francisco, CA, United States.
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