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Çinar MA, Ölmez E, Erkiliç A, Bayramlar K, Er O. Machine learning models for early prediction of mortality risk in patients with burns: A single center experience. J Plast Reconstr Aesthet Surg 2024; 89:14-20. [PMID: 38118361 DOI: 10.1016/j.bjps.2023.11.048] [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: 09/29/2023] [Revised: 11/12/2023] [Accepted: 11/26/2023] [Indexed: 12/22/2023]
Abstract
Mortality rate is considered as the most important outcome measure for assessing the severity of burn injury. A scale or model that accurately predicts burn mortality can be useful to determine the clinical course of burn injuries, discuss treatment options and rehabilitation with patients and their families, and evaluate novel, innovative interventions for the injuries. This study aimed to use machine learning models to predict the mortality risk of patients with burns after their first admission to the center and to compare the performances of these models. Overall, 1064 patients hospitalized in burn intensive care and burn service units between 2016 and 2022 were included in the study. In total, 40 parameters, including demographic characteristics and biochemical parameters of all patients, were analyzed in the study. Furthermore, the dataset was randomly divided into two clusters with 70% of the data used for artificial neural networks (ANNs) training and 30% for model success testing. The ANN model proposed in this study showed high success across all machine learning methods tried in different variants, with an accuracy of 95.92% in the test set. Machine learning models can be used to predict the mortality risk of patients with burns. This study may help validate the use of machine learning models for applications in clinical practice. Conducting multicenter studies will further contribute to the literature.
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Affiliation(s)
- Murat Ali Çinar
- Hasan Kalyoncu University, Faculty of Health Science, Department of Physiotherapy and Rehabilitation, Gaziantep, Turkey.
| | - Emre Ölmez
- İzmir Bakırçay University, Biomedical Engineering Department, Menemen, İzmir, Turkey
| | - Ahmet Erkiliç
- 25 December State Hospital, Burn Center, General Surgery, Gaziantep, Turkey
| | - Kezban Bayramlar
- Hasan Kalyoncu University, Faculty of Health Science, Department of Physiotherapy and Rehabilitation, Gaziantep, Turkey
| | - Orhan Er
- İzmir Bakırçay University, Computers Engineering Department, Menemen, İzmir, Turkey
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Shokre ES, Mohammed SEM, Elhapashy HMM, Elsharkawy NB, Ramadan OME, Abdelaziz EM. The effectiveness of the psychosocial empowerment program in early adjustment among adult burn survivors. BMC Nurs 2024; 23:45. [PMID: 38225570 PMCID: PMC10790373 DOI: 10.1186/s12912-024-01700-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 01/01/2024] [Indexed: 01/17/2024] Open
Abstract
BACKGROUND Burns constitute a major global health challenge, causing not only physical trauma, but also significant psychosocial and emotional disturbances. The complexity of these injuries requires comprehensive rehabilitation programs that address both the physical and psychosocial aspects of recovery. Despite advances in medical care, there is a lack of standardized, accessible, and sustainable psychosocial interventions for burn survivors, particularly in the transition from hospital to home. This study aimed to develop and evaluate a nurse-led psychosocial empowerment intervention for early adjustment among burn survivors after hospital discharge. METHODS The study adopted a quasi-experimental framework. A convenient sample of 80 adult burn survivors was randomly divided into an intervention group, receiving the psychosocial empowerment program, and a control group, continuing standard care from November 2022 to May 2023. The effectiveness of the program was evaluated using various tools that measure satisfaction with appearance, coping abilities, and symptoms of post-traumatic stress disorder (PTSD). The intervention focused on enhancing resilience, self-efficacy, and adaptive coping, through targeted skill building in stress management, adaptability to coping, social reintegration, emotion regulation, and problem-solving. RESULTS Participants in the intervention group demonstrated significant improvements in body image satisfaction, coping abilities, and symptoms of PTSD compared to the control group. CONCLUSIONS The psychosocial empowerment program effectively addressed the psychosocial needs of burn survivors and enhanced their early adjustment after hospital discharge. The findings highlight the critical role of psychosocial support in the rehabilitation of burn survivors and underscore the need to integrate such interventions into standard post-discharge care. Future research should focus on the long-term effects of these interventions and their applicability in diverse settings.
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Affiliation(s)
- Evon S Shokre
- Department of Psychiatric Mental Health Nursing, Faculty of Nursing, Fayoum University, Fayoum, Egypt.
| | | | | | - Nadia Bassuoni Elsharkawy
- College of Nursing, Jouf University, Sakaka, 72388, Saudi Arabia
- Department of Maternal and New-born Health Nursing, Faculty of Nursing, Cairo University, Cairo, 11562, Egypt
| | - Osama Mohamed Elsayed Ramadan
- College of Nursing, Jouf University, Sakaka, 72388, Saudi Arabia
- Department of Paediatric Nursing, Faculty of Nursing, Cairo University, Cairo, 11562, Egypt
| | - Enas Mahrous Abdelaziz
- College of Nursing, Jouf University, Sakaka, 72388, Saudi Arabia
- Department of Psychiatric Mental Health Nursing, Faculty of Nursing, Cairo University, Cairo, 11562, Egypt
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Yu J, Kong YG, Park JY, Kim HY, Kwon M, Han YJ, Lee N, Seo YJ, Kim YK. Chart-Derived Frailty Index and 90-Day Mortality After Burn Surgery. J Surg Res 2024; 293:291-299. [PMID: 37806214 DOI: 10.1016/j.jss.2023.08.041] [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: 02/21/2023] [Revised: 07/31/2023] [Accepted: 08/29/2023] [Indexed: 10/10/2023]
Abstract
INTRODUCTION Frailty is a reduced physiological reserve condition associated with postoperative morbidity and mortality. The chart-derived frailty index (CFI) can measure frailty using demographic and laboratory values. We evaluated the association of preoperative CFI with 90-d mortality after burn surgery. METHODS This large retrospective study included burn intensive care unit (ICU) patients between 2012 and 2021 and calculated CFI using the sum of the following five variables: age >70 y, body mass index <18.5 kg/m2, hematocrit <35%, albumin <3.4 g/dL, and creatinine >2.0 mg/dL; high CFI was a score of 3-5. Postoperative 90-d mortality rate, major adverse cardiac events (MACE), pneumonia, continuous renal replacement therapy (CRRT) requirement, and prolonged ICU stay (>60 d) were evaluated. RESULTS Of 1118 patients, 147 (13.1%) had high CFI. High CFI patients had a higher 90-d mortality rate than did low CFI patients (38.8% versus 22.6%, P < 0.001). A high CFI was significantly associated with postoperative 90-d mortality (hazard ratio = 4.124, 95% confidence interval = 2.980-5.707, P < 0.001) in multivariate Cox regression analysis. Kaplan-Meier analysis revealed significantly different postoperative 90-d mortality rates between patients with high and low CFIs (log-rank test, P < 0.001). Incidences of postoperative MACE, pneumonia, the need for CRRT, and prolonged ICU stay were significantly higher in patients with high CFIs than in those with low CFIs. CONCLUSIONS Preoperative high CFI was associated with increased 90-d mortality, MACE, pneumonia, CRRT requirement, and ICU stay following burn surgery.
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Affiliation(s)
- Jihion Yu
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Yu-Gyeong Kong
- Department of Anesthesiology and Pain Medicine, CHA Gangnam Medical Center, CHA University School of Medicine, Seoul, Republic of Korea
| | - Jun-Young Park
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hee Yeong Kim
- Department of Anesthesiology and Pain Medicine, National Medical Center, Seoul, Republic of Korea
| | - Miyoung Kwon
- Department of Anesthesiology and Pain Medicine, National Medical Center, Seoul, Republic of Korea
| | - Yun Jae Han
- Department of Anesthesiology and Pain Medicine, National Medical Center, Seoul, Republic of Korea
| | - Narae Lee
- Department of Anesthesiology and Pain Medicine, Hangang Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Young Joo Seo
- Department of Anesthesiology and Pain Medicine, Hangang Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea.
| | - Young-Kug Kim
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
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Shao J, Zhu Z, Xu B, Wang S, Jin R, Yang M, Zhang W, Han C, Wang X. Triage and Evaluation of Blast-Injured Patients in Wenling Liquefied Petroleum Gas Tanker Explosion. J Burn Care Res 2023; 44:1492-1501. [PMID: 37184046 DOI: 10.1093/jbcr/irad068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Indexed: 05/16/2023]
Abstract
On June 13, 2020, a liquefied petroleum gas tanker exploded in Wenling. Here, the authors describe the mass casualty emergency response to the explosion. The authors collected the medical records of 176 inpatients at 8 hospitals in Taizhou and Hangzhou. The 176 inpatients with blast injuries comprised 70 females and 106 males, with an average age of 45.48 ± 19.96 years, and more than half of the patients were farmers. They were transported to six hospitals distributed around the explosion site in Taizhou in the initial rescue period and were grouped according to their new injury severity score as having mild, moderate, severe, or extremely severe injuries. Most patients with severe and extremely severe injuries were admitted to a superior hospital for postsecondary triage. Forty-four patients experienced primary blast injuries, 137 experienced secondary blast injuries, 37 experienced tertiary blast injuries, and 40 patients experienced quaternary blast injuries. Multiple blast injuries were suffered by 62 patients. Most patients (95.45%) suffered external injuries, with the chest, extremities, and face as the main affected areas. Burns were diagnosed in 26 adults, of whom 15.38%, 19.23%, 7.70%, and 57.69% suffered mild, moderate, severe, and extremely severe cases. Sixteen burn patients suffered from burn-blast injuries. Upper limbs and the head/face/neck area, as exposed areas, were more likely to experience a burn injury. Inhalation was the main accompanying injury. Of the eight patients who died in the prehospital session, seven had burn injuries. This report on the accident and injury characteristics of an open-air LPG-related explosion will facilitate responses to subsequent catastrophes.
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Affiliation(s)
- Jiaming Shao
- Department of Burns & Wound Care Center, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, China
- Key laboratory of The Diagnosis and Treatment of Severe Trauma and Burn of Zhejiang Province, Zhejiang Provincial Clinical Research Center for Emergency and Critical Disease
| | - Zhikang Zhu
- Department of Burns & Wound Care Center, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, China
- Key laboratory of The Diagnosis and Treatment of Severe Trauma and Burn of Zhejiang Province, Zhejiang Provincial Clinical Research Center for Emergency and Critical Disease
| | - Bin Xu
- Department of Burns & Wound Care Center, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, China
- Key laboratory of The Diagnosis and Treatment of Severe Trauma and Burn of Zhejiang Province, Zhejiang Provincial Clinical Research Center for Emergency and Critical Disease
| | - Shuangshuang Wang
- Department of Burns & Wound Care Center, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, China
- Key laboratory of The Diagnosis and Treatment of Severe Trauma and Burn of Zhejiang Province, Zhejiang Provincial Clinical Research Center for Emergency and Critical Disease
- Department of Burns, The First People's Hospital of Wenling, Taizhou, 317525, China
| | - Ronghua Jin
- Department of Burns & Wound Care Center, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, China
- Key laboratory of The Diagnosis and Treatment of Severe Trauma and Burn of Zhejiang Province, Zhejiang Provincial Clinical Research Center for Emergency and Critical Disease
| | - Min Yang
- Department of Burns & Wound Care Center, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, China
- Key laboratory of The Diagnosis and Treatment of Severe Trauma and Burn of Zhejiang Province, Zhejiang Provincial Clinical Research Center for Emergency and Critical Disease
| | - Wei Zhang
- Department of Burns & Wound Care Center, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, China
- Key laboratory of The Diagnosis and Treatment of Severe Trauma and Burn of Zhejiang Province, Zhejiang Provincial Clinical Research Center for Emergency and Critical Disease
| | - Chunmao Han
- Department of Burns & Wound Care Center, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, China
- Key laboratory of The Diagnosis and Treatment of Severe Trauma and Burn of Zhejiang Province, Zhejiang Provincial Clinical Research Center for Emergency and Critical Disease
| | - Xingang Wang
- Department of Burns & Wound Care Center, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, China
- Key laboratory of The Diagnosis and Treatment of Severe Trauma and Burn of Zhejiang Province, Zhejiang Provincial Clinical Research Center for Emergency and Critical Disease
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Cords CI, van Baar ME, Pijpe A, Nieuwenhuis MK, Bosma E, Verhofstad MHJ, van der Vlies CH, Gardien K, Middelkoop E, Polinder S, Scholten SMHJ, Damen J, Boudestein K, van Zuijlen PPM, Mattace-Raso FUS, Boekelaar A, Roodbergen D, Stoop MM, van Zuijlen PPM, Lucas Y, van Es A, Eshuis H, Hiddingh J, Scholten-Jaegers SMHJ, Middelkoop E, Novin A. Short-term and long-term increased mortality in elderly patients with burn injury: a national longitudinal cohort study. BMC Geriatr 2023; 23:30. [PMID: 36650431 PMCID: PMC9843907 DOI: 10.1186/s12877-022-03669-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 12/02/2022] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND The population of elderly patients with burn injuries is growing. Insight into long-term mortality rates of elderly after burn injury and predictors affecting outcome is limited. This study aimed to provide this information. METHODS A multicentre observational retrospective cohort study was conducted in all three Dutch burn centres. Patients aged ≥65 years, admitted with burn injuries between 2009 and 2018, were included. Data were retrieved from electronic patient records and the Dutch Burn Repository R3. Mortality rates and standardized mortality ratios (SMRs) were calculated. Multivariable logistic regression was used to assess predictors for in-hospital mortality and mortality after discharge at 1 year and five-year. Survival analysis was used to assess predictors of five-year mortality. RESULTS In total, 682/771 admitted patients were discharged. One-year and five-year mortality rates were 8.1 and 23.4%. The SMRs were 1.9(95%CI 1.5-2.5) and 1.4(95%CI 1.2-1.6), respectively. The SMRs were highest in patients aged 75-80 years at 1 year (SMRs 2.7, 95%CI 1.82-3.87) and five-year in patients aged 65-74 years (SMRs 10.1, 95%CI 7.7-13.0). Independent predictors for mortality at 1 year after discharge were higher age (OR 1.1, 95%CI 1.0-1.1), severe comorbidity, (ASA-score ≥ 3) (OR 4.8, 95%CI 2.3-9.7), and a non-home discharge location (OR 2.0, 95%CI 1.1-3.8). The relative risk of dying up to five-year was increased by age (HR 1.1, 95%CI 1.0-1.1), severe comorbidity (HR 2.3, 95%CI 1.6-3.5), and non-home discharge location (HR 2.1, 95%CI 1.4-3.2). CONCLUSION Long-term mortality until five-year after burn injury was higher than the age and sex-matched general Dutch population, and predicted by higher age, severe comorbidity, and a non-home discharge destination. Next to pre-injury characteristics, potential long-lasting systemic consequences on biological mechanisms following burn injuries probably play a role in increased mortality. Decreased health status makes patients more prone to burn injuries, leading to early death.
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Affiliation(s)
- Charlotte I. Cords
- grid.416213.30000 0004 0460 0556Association of Dutch Burn Centres, Maasstad Hospital, Rotterdam, the Netherlands ,grid.5645.2000000040459992XTrauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Margriet E. van Baar
- grid.416213.30000 0004 0460 0556Association of Dutch Burn Centres, Maasstad Hospital, Rotterdam, the Netherlands ,grid.5645.2000000040459992XDepartment of Public Health, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - Anouk Pijpe
- grid.415746.50000 0004 0465 7034Association of Dutch Burn Centres, Red Cross Hospital, Beverwijk, the Netherlands ,grid.509540.d0000 0004 6880 3010Department of Plastic Reconstructive and Hand Surgery, Amsterdam Movement Sciences (AMS) Institute, Amsterdam UMC, Location VUmc, Amsterdam, the Netherlands
| | - Marianne K. Nieuwenhuis
- grid.416468.90000 0004 0631 9063Association of Dutch Burn Centres, Martini Hospital, Groningen, the Netherlands ,grid.411989.c0000 0000 8505 0496Hanze University of Applied Sciences, Research Group Healthy Ageing, Allied Health Care and Nursing, Groningen, the Netherlands ,grid.4830.f0000 0004 0407 1981Department of Human Movement Sciences, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - Eelke Bosma
- grid.416468.90000 0004 0631 9063Association of Dutch Burn Centres, Martini Hospital, Groningen, the Netherlands
| | - Michael H. J. Verhofstad
- grid.5645.2000000040459992XTrauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Cornelis H. van der Vlies
- grid.5645.2000000040459992XTrauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands ,grid.416213.30000 0004 0460 0556Department of Trauma and Burn Surgery, Maasstad Hospital, Rotterdam, the Netherlands
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Dissolvable zinc oxide nanoparticle-loaded wound dressing with preferential exudate absorption and hemostatic features. Polym Bull (Berl) 2022. [DOI: 10.1007/s00289-022-04358-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Staud CJ, Zaussinger M, Holzbauer M, Christ A, Beiglböck H, Unterberger K, Radtke C. Intensive care in an older population: Influence of age, comorbidities and sex in 304 plastic and reconstructive surgical patients older than 75 years. Geriatr Gerontol Int 2022; 22:597-602. [PMID: 35764597 DOI: 10.1111/ggi.14422] [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: 06/12/2021] [Revised: 03/24/2022] [Accepted: 05/25/2022] [Indexed: 11/29/2022]
Abstract
AIM An aging population will lead to an increasing demand for critical care resources. Hence, we evaluated the potential influence of age, comorbidities and sex in plastic and reconstructive patients ≥75 years that were admitted to the intensive care unit (ICU). METHODS We included 304 patients who required intensive care between 2000 and 2019. Besides patient demographics, medical case characteristics were statistically evaluated. RESULTS In this study, 184 patients were female (61%) (120 male), the median age was 81.8 years (25th and 75th percentiles: 77.4-87.2) with a range of 75.0-98.9 years. The median length of stay in the ICU was 12 days (25th and 75th percentiles: 3-28) with a range of 0-382 days. The reasons for admission were burn injury (n = 230, 76%), necrotizing fasciitis (n = 34, 11%), non-combustion-related traumas (n = 22, 7%) and postoperative observation after plastic surgery procedures (n = 18, 6%). In total, 108 patients (36%), who were significantly older (P = 0.005) and had a significantly shorter stay (P < 0.001) compared with the surviving cohort, died during their stay in the ICU. Our multivariable logistic regression model revealed that age (odds ratio: 1.05 [1.01, 1.09]; P = 0.017) and number of operations (odds ratio: 0.75 [0.60, 0.96]; P = 0.023) were significant predictors for death in the ICU. DISCUSSION Age plays a critical role in determining fatal outcome of old patients requiring intensive care. In contrast, sex and number of comorbidities shows no significant influence. Geriatr Gerontol Int 2022; ••: ••-••.
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Affiliation(s)
- Clement J Staud
- Department of Plastic and Reconstructive Surgery, Medical University of Vienna, Vienna, Austria
| | - Maximilian Zaussinger
- Department of Plastic and Reconstructive Surgery, Medical University of Vienna, Vienna, Austria
| | - Matthias Holzbauer
- Department of Orthopedics and Traumatology, Kepler University Hospital, Linz, Austria
| | - Alexandra Christ
- Department of Plastic and Reconstructive Surgery, Medical University of Vienna, Vienna, Austria
| | - Hannes Beiglböck
- Division of Endocrinology and Metabolism, Medical University of Vienna, Vienna, Austria
| | - Karin Unterberger
- Department of Plastic and Reconstructive Surgery, Medical University of Vienna, Vienna, Austria
| | - Christine Radtke
- Department of Plastic and Reconstructive Surgery, Medical University of Vienna, Vienna, Austria
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Sasaki J, Matsushima A, Ikeda H, Inoue Y, Katahira J, Kishibe M, Kimura C, Sato Y, Takuma K, Tanaka K, Hayashi M, Matsumura H, Yasuda H, Yoshimura Y, Aoki H, Ishizaki Y, Isono N, Ueda T, Umezawa K, Osuka A, Ogura T, Kaita Y, Kawai K, Kawamoto K, Kimura M, Kubo T, Kurihara T, Kurokawa M, Kobayashi S, Saitoh D, Shichinohe R, Shibusawa T, Suzuki Y, Soejima K, Hashimoto I, Fujiwara O, Matsuura H, Miida K, Miyazaki M, Murao N, Morikawa W, Yamada S. Japanese Society for Burn Injuries (JSBI) Clinical Practice Guidelines for Management of Burn Care (3rd Edition). Acute Med Surg 2022; 9:e739. [PMID: 35493773 PMCID: PMC9045063 DOI: 10.1002/ams2.739] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 01/29/2022] [Accepted: 02/03/2022] [Indexed: 01/28/2023] Open
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Secanho MS, Rajesh A, Menezes Neto BF, de Oliveira Maciel ABP, Chequim MM, Rocha C, Palhares Neto AA. Epidemiology of Burn-Related Morbidity and Mortality in Patients Over Eighty Years of Age. J Burn Care Res 2021; 43:1042-1047. [PMID: 34687314 DOI: 10.1093/jbcr/irab205] [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: 11/14/2022]
Abstract
Burns cause greater morbidity and mortality in older patients owing to the physiological changes and functional status declines with age. We sought to characterize the epidemiology of burn injuries in the patient population aged over eighty years. A retrospective analysis of all patients aged >80 years admitted to a tertiary burn center in Brazil over a 10-year period was conducted. Multiple parameters including comorbidities, body surface area(BSA) burned, intensive care unit(ICU) admissions, inhalation injury and revised Baux score were analyzed to assess association with mortality. 26 patients were identified. The overall mortality rate was 42.3%. The mortality rate increased with the TBSA, with 100% mortality at >20% total BSA involvement(p<0.001). Inhalation injury occurred in 3(11.5%) patients, all of whom suffered mortality(p<0.001). ICU admission was necessary for 14(53.8%) patients, out of which 11(78.6%) did not survive(p<0.001). The revised Baux score had a significant impact on the mortality, with higher values among patients who did not survive(89.2 ± 6.2 versus 110.7 ± 17.9,p < 0.001). Burns cause high mortality in the octogenarian and nonagenarian populations. It is important to stratify patients at high risk, institute prompt treatment and discuss goals of care early on for optimal patient outcomes.
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Affiliation(s)
- Murilo Sagrbi Secanho
- Plastic Surgery Resident at Botucatu Medical School - São Paulo State University (UNESP)Discipline of Plastic Surgery - Department of Surgery and Orthopedic - Botucatu Medical School - São Paulo State University (UNESP)
| | - Aashish Rajesh
- Bachelor of Medicine and Bachelor of Surgery - General Surgery Resident at University of Texas - Department of Surgery - University of Texas Health Science Center at San Antonio
| | - Balduino Ferreira Menezes Neto
- Plastic Surgery Resident at Botucatu Medical School - São Paulo State University (UNESP)Discipline of Plastic Surgery - Department of Surgery and Orthopedic - Botucatu Medical School - São Paulo State University (UNESP)
| | | | | | | | - Aristides Augusto Palhares Neto
- Plastic Surgery at Botucatu Medical School - São Paulo State University (UNESP)Discipline of Plastic Surgery - Department of Surgery and Orthopedic - Botucatu Medical School - São Paulo State University (UNESP)
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Firchal EW, Sjoberg F, Fredrikson M, Pompermaier L, Elmasry M, Steinvall I. Long-term survival among elderly after burns compared with national mean remaining life expectancy. Burns 2021; 47:1252-1258. [PMID: 34103200 DOI: 10.1016/j.burns.2021.05.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 04/10/2021] [Accepted: 05/24/2021] [Indexed: 01/12/2023]
Abstract
INTRODUCTION As compared to younger adults, older people have a greater risk of domestic accidents, such as burns, and their prognosis is worsened by a diminished physiological ability to face a thermal trauma. The in-hospital mortality is adversely affected by old age and burn size, whereas less is known about the long-term-survival in elderly patients who survive a burn injury. The aim of this study was to investigate if elderly burn patients after discharge from a Swedish National Burn Centre have a shorter remaining life compared to the national population, by using calculated remaining Life Expectancy (rLE). METHODS In this retrospective study we included all patients who were admitted for burns to the Linköping Burn Centre during 1993-2016 and who were 60 years or older and alive, at the time of discharge. The control group was extracted from Statistics Sweden, the national statistics database, and consisted of all individuals from the Swedish population matched for each patient in the study group, by sex and age at the year of discharge. The proportion who died before reaching the rLE was compared between the study population and the control group by calculating risk ratio. RESULTS The study group consisted of 111 former patients and 77 of them (69%) died before reaching the rLE, with mean 4.7 years of life lost (YLL), which was 33% more than that (52%) of the control group (RR 1.33, 95% CI 1.18-1.51). Burn related factors, such as TBSA % or FTB % were not found to account for this effect. CONCLUSION We found that the long-time survival of elderly patients after burns is shorter than that of a national control, the magnitude of which is quantitatively important. The current study does not support that burn related factors account for this effect and the reason should therefore be sought in other factors, such as e.g., co-morbidity or psychosocial issues.
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Affiliation(s)
- Emmelie Westlund Firchal
- Department of Hand Surgery, Plastic Surgery and Burns in Linköping University, Sweden; Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Folke Sjoberg
- Department of Hand Surgery, Plastic Surgery and Burns in Linköping University, Sweden; Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden; Department of Anaesthesiology and Intensive Care, Linköping University, Linköping, Sweden.
| | - Mats Fredrikson
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Laura Pompermaier
- Department of Hand Surgery, Plastic Surgery and Burns in Linköping University, Sweden; Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Moustafa Elmasry
- Department of Hand Surgery, Plastic Surgery and Burns in Linköping University, Sweden; Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Ingrid Steinvall
- Department of Hand Surgery, Plastic Surgery and Burns in Linköping University, Sweden; Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
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Bayuo J, Aniteye P, Richter S, Agbenorku P. Exploring The Background, Context And Stressors Of Caregiving To Elderly Burned Patients: A Qualitative Inquiry. J Burn Care Res 2021; 43:196-201. [PMID: 33970253 DOI: 10.1093/jbcr/irab077] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Elderly persons are at risk of experiencing burns and require support from both formal and informal caregivers. Informal caregiving in this situation has been minimally explored. Guided by the Stress Process Model, this study aimed at exploring the background, context, and stressors of informal caregivers of elderly burned persons during hospitalisation. A qualitative descriptive design was utilised. Purposive sampling approach was used to recruit fourteen (14) informal caregivers who rendered care to elderly burned persons during hospitalisation. Interviews were conducted and transcribed verbatim following which directed content analysis was undertaken deductively. Three categories and six sub-categories emerged which characterise the background, context, and stressors of informal caregiving to elderly burn patients. All the injuries occurred in the home setting and its sudden nature led to varied post-burn emotional responses which characterised the context of burns caregiving. Primary stressors that emerged were related to the injury, actual caregiving demand, and concerns regarding increasing frailty levels. Secondary stressors identified were financial concerns and lifestyle changes. The findings suggest that the occurrence of burn injury served as a precursor to post-burn stress response among informal caregivers. Increasing frailty levels, adequacy of household safety measures and financial issues were key concerns which emphasise the need for psychosocial/ transitional support, innovative healthcare financing measures and continuing education on burns prevention in the home setting.
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Affiliation(s)
- Jonathan Bayuo
- Department of Nursing, Faculty of Health and Medical Sciences, Presbyterian University College- Ghana
| | | | | | - Pius Agbenorku
- School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.,Division of Plastic & Reconstructive Surgery, Department/Directorate of Surgery, Komfo Anokye Teaching Hospital, Kumasi, Ghana
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Yu J, Kim HY, Kong YG, Park JH, Seo YJ, Kim YK. De Ritis ratio as a predictor of 1-year mortality after burn surgery. Burns 2021; 47:1865-1872. [PMID: 33832798 DOI: 10.1016/j.burns.2021.02.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 01/06/2021] [Accepted: 02/05/2021] [Indexed: 01/04/2023]
Abstract
BACKGROUND Burn is an overwhelming injury. The De Ritis ratio, defined as aspartate aminotransferase to alanine aminotransferase ratio, can be used to predict poor outcomes. We evaluated the risk factors, including the De Ritis ratio, associated with 1-year mortality after burn surgery. METHODS Patients who underwent burn surgery from 2009 to 2019 were retrospectively evaluated. Multivariate Cox regression analysis was conducted to evaluate the risk factors for 1-year mortality after burn surgery. Receiver operating characteristic (ROC) curve analysis of the De Ritis ratio was performed to predict postoperative 1-year mortality. Kaplan-Meier survival analysis was also conducted. Other postoperative outcomes, such as durations of hospital and intensive care unit stays, acute kidney injury, and major adverse cardiac events, were evaluated. RESULTS One-year mortality after burn surgery occurred in 247 (19.9%) of 1244 patients. The risk factors for 1-year mortality after burn surgery were the De Ritis ratio, age, American Society of Anesthesiologists physical status, diabetes mellitus, total body surface area burned, inhalation injury, serum creatinine level, and serum albumin level. The area under the ROC curve for the De Ritis ratio was 0.716 (optimal cutoff=1.9). The 1-year mortality rate after burn surgery was significantly higher in patients with a De Ritis ratio >1.9 than in those with a De Ritis ratio ≤1.9 (35.8% vs. 11.8%, P<0.001). The survival rate was significantly higher in patients with a De Ritis ratio ≤1.9 than in those with a De Ritis ratio >1.9 (log-rank test, P<0.001). Intensive care unit stay, acute kidney injury, and major adverse cardiac events were significantly higher in patients with a De Ritis ratio >1.9 than in those with a De Ritis ratio ≤1.9 (P=0.006, P<0.001, and P<0.001, respectively). CONCLUSIONS The preoperative De Ritis ratio was a risk factor for 1-year mortality after burn surgery. The De Ritis ratio >1.9 was significantly associated with an increased 1-year mortality after burn surgery. These findings emphasized the importance of identifying burn patients with an increased De Ritis ratio to reduce the mortality after burn surgery.
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Affiliation(s)
- Jihion Yu
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hee Yeong Kim
- Department of Anesthesiology and Pain Medicine, National Medical Center, Seoul, Republic of Korea
| | - Yu-Gyeong Kong
- Department of Anesthesiology and Pain Medicine, Hangang Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Ji Hyun Park
- Department of Anesthesiology and Pain Medicine, National Medical Center, Seoul, Republic of Korea
| | - Young Joo Seo
- Department of Anesthesiology and Pain Medicine, Hangang Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea.
| | - Young-Kug Kim
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
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Seo YJ, Kong YG, Yu J, Park JH, Kim SJ, Kim HY, Kim YK. The prognostic nutritional index on postoperative day one is associated with one-year mortality after burn surgery in elderly patients. BURNS & TRAUMA 2021; 9:tkaa043. [PMID: 33709002 PMCID: PMC7935376 DOI: 10.1093/burnst/tkaa043] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 09/13/2020] [Indexed: 06/10/2023]
Abstract
BACKGROUND Burn injury in elderly patients can result in poor outcomes. Prognostic nutritional index (PNI) can predict the perioperative nutritional status and postoperative outcomes. We aim to evaluate the risk factors, including PNI, for one-year mortality after burn surgery in elderly patients. METHODS Burn patients aged ≥65 years were retrospectively included. PNI was calculated using the following equation: 10 × serum albumin level (g/dL) + 0.005 × total lymphocyte count (per mm3). Cox regression, receiver operating characteristic curve and Kaplan-Meier survival analyses were performed to evaluate the risk factors for postoperative one-year mortality. RESULTS Postoperative one-year mortality occurred in 71 (37.6%) of the 189 elderly burn patients. Risk factors for one-year mortality were PNI on postoperative day one (hazard ratio (HR) = 0.872; 95% CI = 0.812-0.936; p < 0.001), Sequential Organ Failure Assessment score (HR = 1.112; 95% CI = 1.005-1.230; p = 0.040), American Society of Anesthesiologists physical status (HR = 2.064; 95% CI = 1.211-3.517; p = 0.008), total body surface area burned (HR = 1.017; 95% CI = 1.003-1.032; p = 0.015) and preoperative serum creatinine level (HR = 1.386; 95% CI = 1.058-1.816; p = 0.018). The area under the curve of PNI for predicting one-year mortality after burn surgery was 0.774 (optimal cut-off value = 25.5). Patients with PNI ≤25.5 had a significantly lower one-year survival rate than those with PNI >25.5 (32.1% vs 75.9%, p < 0.001). CONCLUSIONS PNI on postoperative day one was associated with postoperative one-year mortality in elderly burn patients. The postoperative one-year survival rate was lower in patients with PNI ≤25.5 than in those with PNI >25.5. These findings indicate the importance of identifying elderly burn patients with low PNI, thereby reducing the mortality after burn surgery.
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Affiliation(s)
- Young Joo Seo
- Department of Anesthesiology and Pain Medicine, Hangang Sacred Heart Hospital, Hallym University College of Medicine, 12, Beodeunaru-ro 7-gil, Yeongdeungpo-gu, Seoul 07247, Republic of Korea
| | - Yu-Gyeong Kong
- Department of Anesthesiology and Pain Medicine, Hangang Sacred Heart Hospital, Hallym University College of Medicine, 12, Beodeunaru-ro 7-gil, Yeongdeungpo-gu, Seoul 07247, Republic of Korea
| | - Jihion Yu
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea
| | - Ji Hyun Park
- Department of Anesthesiology and Pain Medicine, National Medical Center, 245, Euljiro, Jung-gu, Seoul 04564, Republic of Korea
| | - Su-Jin Kim
- Department of Anesthesiology and Pain Medicine, National Medical Center, 245, Euljiro, Jung-gu, Seoul 04564, Republic of Korea
| | - Hee Yeong Kim
- Department of Anesthesiology and Pain Medicine, National Medical Center, 245, Euljiro, Jung-gu, Seoul 04564, Republic of Korea
| | - Young-Kug Kim
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea
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Gurbuz K, Demir M. The Descriptive Epidemiology and Outcomes of Hospitalized Burn Patients in Southern Turkey: Age-Specific Mortality Patterns. J Burn Care Res 2020; 42:743-751. [PMID: 33301559 DOI: 10.1093/jbcr/iraa206] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
The current descriptive analysis was designed to document the common epidemiologic characteristics and outcomes of burn injuries, and age-specific mortality patterns covering all age groups admitted for treatment to the Burn Center of Adana City Training and Research Hospital. Medical records were retrospectively analyzed. The patients were stratified into two age groups as pediatric and adults, and then into 10 sub-age groups. Among the 946 patients of the study population, there were 24 mortalities with a mortality rate of 2.5%. Patients within the age range of 70 to 79 years had the highest mortality rate of 33.3%; followed by 60 to 69, 80+, 18 to 29, 10 to 17, and <5 sub-age groups, whose mortality rates were 13.0%, 7.8%, 7.2%, 2.4%, and 0.5%, respectively. In terms of multivariate regression analysis of factors predicting mortality among burn patients in all age groups, fire-flame related burns, age ≥18 years, TBSA burned ≥20% (TBSA ≥20%), the existence of inhalation injury, deep partially/full-thickness burns were found to be significant prognostic factors of mortality. The strongest association was seen in TBSA ≥60% segment (P < .0001), which had 25.9 times more death risk. As expected, a similar trend was detected when the age groups stratified into age groups, and the strongest association was in the 60+ sub-age group (P < .0001), whose had 5.84 times more likely death; followed by 29 to 59 and 18 to 29 sub-age groups, with the odds ratios of 2.12 (95% confidence interval = 1.25-3.61) and 2.08 (95% confidence interval = 1.90-4.05), respectively. Oppose to these findings; the 0 to 17 sub-age group was not found to have a statistically significant effect in predicting mortality.
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Affiliation(s)
- Kayhan Gurbuz
- Burn Center, Department of General Surgery, Adana City Training and Research Hospital, Turkey
| | - Mete Demir
- Burn Center, Department of General Surgery, Adana City Training and Research Hospital, Turkey
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Perkins M, Abesamis GM, Cleland H, Gabbe BJ, Tracy LM. Association between gender and outcomes of acute burns patients. ANZ J Surg 2020; 91:83-88. [PMID: 33289226 DOI: 10.1111/ans.16426] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 10/15/2020] [Accepted: 10/19/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND Burn injuries are a complex and serious public health concern. Where the total body surface area of the burn exceeds 50%, mortality rates as high as 48% have been reported. While the association between gender and burn injury outcomes has been explored, findings are inconsistent. METHODS Adult patients (>15 years) admitted between 1 July 2009 and 30 June 2018 to intensive care units of burn centres that provide specialist burn care in Australia and New Zealand were included. Raw mortality rates were examined and a multivariable Cox proportional hazards regression was used to investigate the association between gender and time to in-hospital death. RESULTS There were 2227 eligible burn injury admissions. Men comprised the majority (77.6%). The proportion of women who died in hospital was greater than men and the adjusted odds of in-hospital mortality were 34% lower in men (odds ratio 0.66; 95% confidence interval (CI) 0.45-0.98). The unadjusted rate of in-hospital mortality for men was 44% lower than women (hazard ratio 0.56; 95% CI 0.41-0.76). After adjusting for confounders, there was no association between gender and survival time (hazard ratio 0.76; 95% CI 0.54-1.06). CONCLUSION After adjustment for key differences in case-mix between men and women, there was an association between gender and in-hospital mortality and no association between gender and time to death. Our findings indicate that the worse outcomes observed for women are associated with different age and patterns of injury, and provide further information to direct and inform targeted prevention measures for vulnerable populations.
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Affiliation(s)
- Monica Perkins
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Gerald M Abesamis
- Victorian Adult Burns Service, Alfred Hospital, Melbourne, Victoria, Australia
- UP-PGH Alfredo T. Ramirez Burn Center, Division of Burns, Department of Surgery, University of the Philippines-Philippine General Hospital, Manila, Philippines
| | - Heather Cleland
- Victorian Adult Burns Service, Alfred Hospital, Melbourne, Victoria, Australia
- Department of Surgery, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Belinda J Gabbe
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Health Data Research UK, Swansea University Medical School, Swansea University, Swansea, UK
| | - Lincoln M Tracy
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Abstract
Background: Infection is the greatest cause of mortality in burn patients. As our population ages, the need to care for elderly burn patients will increase, and with it our understanding of how infection affects older patients with burn injuries. This article presents a review of the available literature on the effect of aging on the physiologic response to burns, of the known effects of infection in the elder population, and of the contribution of underlying medical comorbidities to the outcomes for the elderly burn patient. The potential for more serious outcomes from multi-drug resistance in the elder population is also discussed. Methods: This article is a review of the available literature on infection in elderly burn patients. A literature search was performed for key words: elderly; geriatric; burn; infection; comorbidity; multi-drug resistance; central line; urinary tract infection; and burn sepsis. Relevant findings were included in each section. Results: Pre-existing conditions are common in the elderly and contribute to a higher rate of development of pneumonia, cellulitis, urinary tract infection, central line infections, and burn wound infections. Specific data pertaining to infections in the elderly burn population are scarce or confined to single-center reports. Conclusions: Because of the inherent susceptibility of the elder population to infection because of pre-existing medical conditions, immunosenescence, and potential exposure via frequent interaction with the medical system, vigilance must be maintained for preventing and treating infection in elderly burn patients. More research is needed to define the risks and extent of this increasingly important issue.
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Affiliation(s)
- Alisa Savetamal
- Department of Surgery Connecticut Burn Center, Bridgeport Hospital, Bridgeport, Connecticut, USA
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García-Díaz A, Durán-Romero AJ, PurificaciónGacto-Sánchez, Carbajal-Guerrero J, Gómez-Cía T, Pereyra-Rodríguez JJ. Trends in burn injury mortality in Spain (1979-2018): Sex-specific age-cohort-period effects. Burns 2020; 47:714-720. [PMID: 32878699 DOI: 10.1016/j.burns.2020.08.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 07/08/2020] [Accepted: 08/05/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Previous studies about burns mortality are often exclusively based on hospital and burn centre data. National population-based reports on this topic are rather limited. The aim of this study was to analyse sex- and age-specific mortality rates of burns in Spain during the period 1979-2018. METHODS Age-standardised burns mortality rates were calculated from death records and mid-year population data were provided by the Spanish National Statistics Institute. Joinpoint regression analyses were used to identify significant points of change in trends over time and to compute average annual per cent change (AAPC). Age, period and cohort effects were also analysed. RESULTS Mortality due to burn injury decreased in both sexes between 1979 and 2018: from the first quinquennium of this period up to the last one age-adjusted mortality rates decreased from 1.37 to 0.49 per 100,000 in men and from 0.96 to 0.26 per 100,000 in women. CONCLUSIONS Burns mortality rates in Spain have been decreasing during the last decades. Promotion of primary prevention measures should continue.
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Affiliation(s)
- Antonio García-Díaz
- Plastic Surgery Department, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | | | | | | | - Tomás Gómez-Cía
- Plastic Surgery Department, Hospital Universitario Virgen del Rocío, Sevilla, Spain
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