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Karlsson M, Östholm Balkhed Å, Steinvall I, Elmasry M. Wound infection among children with moderate burns - An explorative review of the association between reported frequency and diagnosis. Burns 2024; 50:742-753. [PMID: 38245392 DOI: 10.1016/j.burns.2023.12.008] [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: 09/22/2022] [Accepted: 12/17/2023] [Indexed: 01/22/2024]
Abstract
INTRODUCTION The Linkoping burn centre in Sweden has, even though being a high income country, reported high burn wound infections (BWI) frequencies in scalded children compared to similar populations in other parts of the world. AIM The aim was to investigate possible explanations for differences in frequency of BWI among children with partial thickness burns treated at the Linköping burn centre in Sweden, and that reported in other studies. METHOD In order to investigate what BWI criteria that were used in similar studies a literature search on PubMed Central was done along with a retrospective analysis of children previously diagnosed as infected to confirm or reject the high infection frequency reported earlier. RESULT Of the 34 selected publications reporting on BWI frequency 16 (47%) did not define a criteria for the BWI diagnosis and almost a third did not report on wound culturing. Of those who did report the use a third do not mention any bacterial growth found is these cultures. The retrospective analysis on children at the centre did not show any decrease in infection frequency even with some disagreement on onset for the BWI. CONCLUSION The reporting of criteria and diagnosis of burn wound infection is highly variable making it difficult to interpret results and come to conclusions. The high frequency of BWI at the centre might be a result of close monitoring due to study participation, use of clean instead of sterile routine at dressing changes or low thresholds for the diagnosis in respect to changes in infection markers.
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Affiliation(s)
- Matilda Karlsson
- Department of Hand Surgery, Plastic Surgery and Burns, Linköping, Sweden; Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
| | - Åse Östholm Balkhed
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden; Department of Infectious Diseases, Östergötland, Sweden
| | - Ingrid Steinvall
- Department of Hand Surgery, Plastic Surgery and Burns, Linköping, Sweden; Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Moustafa Elmasry
- Department of Hand Surgery, Plastic Surgery and Burns, Linköping, Sweden; Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
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Phillips W, Southern E, Cattell C, Owens P, Jaques M, Melbourne G, Kezhekkekara S, Frost SA. Do they stay, or do they go? Children presenting to five emergency departments across New South Wales, Australia with acute burn injuries: a retrospective review. BMJ Open 2024; 14:e079306. [PMID: 38458804 DOI: 10.1136/bmjopen-2023-079306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/10/2024] Open
Abstract
OBJECTIVE The overall objective of the study was to describe the disposition status of children presenting with a burn injury to five emergency departments (ED) across New South Wales (NSW), Australia. DESIGN A retrospective study design was used to review routinely collected ED data. SETTING Study sites included five acute hospitals across NSW, Australia. PARTICIPANTS During the 5-year study period between 1 January 2015 to 31 December 2020, there were 5213 paediatric burn injury presentations. RESULTS The mean age of burn injury presentations was 24 months (Inter-Quartile-Range (IQR) 12-84), of which 57% (2951/5213) were males. The most common presentation time was between 16:00 and 23:59 hours (63%, 3297/5213), and the median time spent in the ED was 3 hours (IQR 1-4). The majority (80%, 4196/5213) of the burn injuries presentations did not require hospital admission. The most common principal diagnoses were 'Burn body region unspecified' (n=1916) and 'Burn of wrist and hand' (n=1060). CONCLUSION Most children who presented to the hospital with a burn injury were not admitted. Often the details of these burns were poorly recorded and a complete picture of the true burden of burn injury in children, especially the ongoing care given outside the acute hospital setting, is missing. This information is crucial, as it would inform future models of care as the paradigm shifts rapidly towards primary, ambulatory and outpatient models of care.
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Affiliation(s)
- Wayne Phillips
- Paediatrics, Fairfield Hospital, Sydney, New South Wales, Australia
- South Western Sydney Nursing and Midwifery Research Alliance, Ingham Institute of Applied Medical Research, Liverpool, New South Wales, Australia
| | - Erin Southern
- Paediatrics, Campbelltown Hospital, Campbelltown, New South Wales, Australia
| | - Carol Cattell
- Wagga Wagga Base Hospital, Wagga Wagga, New South Wales, Australia
| | - Penny Owens
- Wyong Hospital, Hamlyn Terrace, New South Wales, Australia
| | - Madeleine Jaques
- Westmead Children's Hospital, Western Sydney University, Westmead, New South Wales, Australia
| | - Gregory Melbourne
- South Western Sydney Nursing and Midwifery Research Alliance, Ingham Institute of Applied Medical Research, Liverpool, New South Wales, Australia
| | - Shwetha Kezhekkekara
- South Western Sydney Nursing and Midwifery Research Alliance, Ingham Institute of Applied Medical Research, Liverpool, New South Wales, Australia
| | - Steven A Frost
- Paediatrics, Fairfield Hospital, Sydney, New South Wales, Australia
- South Western Sydney Nursing and Midwifery Research Alliance, Ingham Institute of Applied Medical Research, Liverpool, New South Wales, Australia
- Paediatrics, Campbelltown Hospital, Campbelltown, New South Wales, Australia
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Karlsson M, Steinvall I, Elmasry M. Suprathel® or Mepilex® Ag for treatment of partial thickness burns in children: A case control study. Burns 2023; 49:1585-1591. [PMID: 36933986 DOI: 10.1016/j.burns.2023.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 01/30/2023] [Accepted: 03/06/2023] [Indexed: 03/12/2023]
Abstract
AIM The study aim was to investigate if Suprathel® can be an adequate alternative to Mepilex® Ag for the treatment of partial-thickness scalds in children. METHODS A retrospective study including 58 children admitted to The Burn Centre in Linköping, Sweden between year 2015 and 2022. Of the 58 children, 30 were dressed with Suprathel ® and 28 with Mepilex ® Ag. Outcomes investigated were healing time, burn wound infection (BWI), need for operations and number of dressing changes. RESULTS We found no significant differences in any of the outcomes. In the Suprathel ® group 17 children and in the Mepilex ® Ag group 15 children were healed within 14 days. Ten children from each group received antibiotics for suspected BWI and two from each group underwent an operation with skin grafting. Each group had on median four dressing changes. CONCLUSIONS Two different treatments were compared for children with partial-thickness scalds, and the data indicates that similar results are received with both dressings.
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Affiliation(s)
- Matilda Karlsson
- Department of Hand Surgery, Plastic Surgery and Burns, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
| | - Ingrid Steinvall
- Department of Hand Surgery, Plastic Surgery and Burns, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Moustafa Elmasry
- Department of Hand Surgery, Plastic Surgery and Burns, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
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Pompermaier L, Drake Af Hagelsrum E, Ydenius V, Sjöberg F, Steinvall I, Elmasry M. Patient Reported Experiences at a Swedish National Burn Centre. J Burn Care Res 2021; 43:249-255. [PMID: 34131732 PMCID: PMC8737083 DOI: 10.1093/jbcr/irab091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Previous studies have shown that burn patients were satisfied with the received care. Satisfaction was not strongly associated to burns or to psycho-social characteristics, suggesting that other factors, related to burn care specific aspects, may be important. The aim of this study was to analyze the independent effect of provided workload on the general satisfaction in adult patients at a Swedish national Burn Centre. The study population (n = 122) included patients ≥18 years, treated at the Linköping Burn Centre between 2016 and 2017. Experienced burn care was evaluated with the PS-RESKA survey (score range: 0–4), and provided workload was scored with the Burn Scoring System (BSC). Groups were compared with χ 2 test, MW test, or Fisher´s exact test. Multivariable logistic regression analyzed the independent effect of BSC on the outcome High Satisfaction (= score ≥3 to the survey-question: “How would you score your global experience at the Burn Centre?”). In-patients (n = 60) had more often larger burns and required more workload than out-patients (median[IQR]: TBSA% = 6.3 [3–12.3] % vs. 0.7 [0.3–2] %, p < .001; BSC = 65 [25.5–135.5] vs. 6 [4–9], p < .001). Both groups were highly satisfied with the experienced care (mean score [SD] = 3.68 [0.57] vs. 3.41 [0.77], p = .03). Neither characteristics of the patients (age, sex), nor TBSA% nor provided workload (BSC) were independently associated with High Satisfaction. Regardless of burn severity, demographics and provided workload, adult patients with burns were highly satisfied with the experienced burn care. This finding suggested that the reason of the satisfaction was multifactorial.
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Affiliation(s)
- Laura Pompermaier
- Department of Hand Surgery, Plastic Surgery and Burns, Department of Biomedical and Clinical Sciences, Linköping University, Sweden
| | - Emma Drake Af Hagelsrum
- Department of Hand Surgery, Plastic Surgery and Burns, Department of Biomedical and Clinical Sciences, Linköping University, Sweden
| | - Viktor Ydenius
- Department of Hand Surgery, Plastic Surgery and Burns, Department of Biomedical and Clinical Sciences, Linköping University, Sweden
| | - 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
| | - Ingrid Steinvall
- Department of Hand Surgery, Plastic Surgery and Burns, Department of Biomedical and Clinical Sciences, Linköping University, Sweden
| | - Moustafa Elmasry
- Department of Hand Surgery, Plastic Surgery and Burns, Department of Biomedical and Clinical Sciences, Linköping University, Sweden
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Superiority of silver-foam over porcine xenograft dressings for treatment of scalds in children: A prospective randomised controlled trial. Burns 2019; 45:1401-1409. [PMID: 31230798 DOI: 10.1016/j.burns.2019.04.004] [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: 01/28/2019] [Revised: 03/13/2019] [Accepted: 04/04/2019] [Indexed: 02/08/2023]
Abstract
AIM Our aim was to compare two different regimens for the treatment of children with partial-thickness scalds. These were treated with either a porcine xenograft (EZderm®, Mölnlycke Health Care, Gothenburg, Sweden) or a silver-foam dressing (Mepilex® Ag, Mölnlycke Health Care, Gothenburg, Sweden). METHODS We organised a prospective randomised clinical trial that included 58 children admitted between May 2015 and May 2018 with partial-thickness scalds to The Burn Centre in Linkoping, Sweden. The primary outcome was time to healing. Secondary outcomes were pain, need for operation, wound infection, duration of hospital stay, changes of dressings, and time taken. RESULTS The patients treated with silver-foam dressing had a significantly shorter healing time. The median time to 97% healing for this group was 9 (7-23) days compared to 15 (9-29) days in the porcine xenograft group (p = 0.004). The median time to complete healing for the silver-foam group was 15 (9-29) days and for the porcine xenograft group 20.5 (11-42) days (p = 0.010). Pain, wound infection, duration of hospital stay, and the proportion of operations were similar between the groups. Number of dressing changes and time for dressing changes were lower in the silver-foam dressing group (p = 0.03 for both variables). CONCLUSIONS We compared two different treatments for children with partial-thickness scalds, and the data indicate that wound healing was faster, fewer dressing changes were needed, and dressing times were shorter in the silver-foam group.
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Elmasry M, Mirdell R, Tesselaar E, Farnebo S, Sjöberg F, Steinvall I. Laser speckle contrast imaging in children with scalds: Its influence on timing of intervention, duration of healing and care, and costs. Burns 2019; 45:798-804. [DOI: 10.1016/j.burns.2019.02.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 02/01/2019] [Accepted: 02/07/2019] [Indexed: 12/24/2022]
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Santos JV, Viana J, Oliveira A, Ramalho A, Sousa-Teixeira J, Duke J, Amarante J, Freitas A. Hospitalisations with burns in children younger than five years in Portugal, 2011-2015. Burns 2019; 45:1223-1230. [PMID: 30686698 DOI: 10.1016/j.burns.2019.01.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 12/21/2018] [Accepted: 01/01/2019] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Paediatric population still represents a high burden of hospitalisations among burns inpatients. Children under five years old have a distinct aetiology distribution comparing to other age groups, representing in Portugal a fifth of all hospitalisations with burns. We aimed to describe the demographic and clinical burden of burns requiring hospitalization, as well as hospitalization charges, among this age group in Portugal. METHODS We performed a retrospective study including inpatients younger than five years-old and discharged between 2011 and 2015 in a public Portuguese hospital with a main or secondary diagnosis of burns (ICD-9-CM: 940.xx-949.xx). Clinical and demographics characteristics were assessed, as well as hospital reimbursement charges. RESULTS A total of 1217 hospitalisations with burns were found, with a hospitalization rate of 54.6 hospitalisations/100,000 inhabitants/year, higher among boys. Ninety percent of them were due to hot liquid or objects. There were three in-hospital deaths. There was a median length of stay of 9days and a mean hospitalization reimbursed charge of 3073 Euros (4918 I$). Non-rural: rural hospitalization rate ratio was of 0.42:1. Évora and Bragança were the districts with higher hospitalization rate with 116 and 107, respectively. DISCUSSION This Portuguese nation-wide study on hospitalisations with burns highlights that 90% of all burns were due to hot liquid or object and a major impact of patients younger than 2years old in this age group. Urban vs rural difference in hospitalization rate should also be considered for further health inequalities' studies. As conclusion, ongoing attention needs to be dedicated to paediatric burn prevention and safety cost-effective strategies, particularly in relation to scalds, to further reduce the incidence of burn hospitalisations in children and the associated hospital costs.
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Affiliation(s)
- João Vasco Santos
- MEDCIDS - Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Portugal; CINTESIS - Centre for Health Technology and Services Research, Portugal; Public Health Unit, ACES Grande Porto VIII - Espinho/Gaia, ARS Norte, Portugal.
| | - João Viana
- MEDCIDS - Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Portugal; CINTESIS - Centre for Health Technology and Services Research, Portugal
| | - Andreia Oliveira
- MEDCIDS - Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Portugal
| | - André Ramalho
- MEDCIDS - Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Portugal; CINTESIS - Centre for Health Technology and Services Research, Portugal; FGV Management (Getúlio Vargas Foundation), São Paulo, Brazil
| | - Joana Sousa-Teixeira
- MEDCIDS - Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Portugal
| | - Janine Duke
- Burn Injury Research Unit, Faculty of Health and Medical Sciences, The University of Western Australia, Australia
| | - José Amarante
- Department of Surgery, Faculty of Medicine, University of Porto, Portugal
| | - Alberto Freitas
- MEDCIDS - Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Portugal; CINTESIS - Centre for Health Technology and Services Research, Portugal
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Steinvall I, Karlsson M, Elmasry M. C-reactive protein response patterns after antibiotic treatment among children with scalds. Burns 2018; 44:718-723. [DOI: 10.1016/j.burns.2017.10.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 10/27/2017] [Accepted: 10/30/2017] [Indexed: 11/28/2022]
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Validation of the burn intervention score in a National Burn Centre. Burns 2018; 44:1159-1166. [PMID: 29475745 DOI: 10.1016/j.burns.2018.02.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Revised: 01/11/2018] [Accepted: 02/02/2018] [Indexed: 11/20/2022]
Abstract
The Linköping burn score has been used for two decades to calculate the cost to the hospital of each burned patient. Our aim was to validate the Burn Score in a dedicated Burn Centre by analysing the associations with burn-specific factors: percentage of total body surface area burned (TBSA%), cause of injury, patients referred from other (non-specialist) centres, and survival, to find out which of these factors resulted in higher scores. Our second aim was to analyse the variation in scores of each category of care (surveillance, respiration, circulation, wound care, mobilisation, laboratory tests, infusions, and operation). We made a retrospective analysis of all burned patients admitted during the period 2000-15. Multivariable regression models were used to analyse predictive factors for an increased daily burn score, the cumulative burn score (the sum of the daily burn scores for each patient) and the total burn score (total sum of burn scores for the whole group throughout the study period) in addition to sub-analysis of the different categories of care that make up the burn score. We retrieved 22301 daily recordings for inpatients. Mobilisation and care of the wound accounted for more than half of the total burn score during the study. Increased TBSA% and age over 45 years were associated with increased cumulative (model R2 0.43, p<0.001) and daily (model R2 0.61, p<0.001) burn scores. Patients who died had higher daily burn scores, while the cumulative burn score decreased with shorter duration of hospital stay (p<0.001). To our knowledge this is the first long term analysis and validation of a system for scoring burn interventions in patients with burns that explores its association with the factors important for outcome. Calculations of costs are based on the score, and it provides an indicator of the nurses' workload. It also gives important information about the different dimensions of the care provided from thorough investigation of the scores for each category.
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