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Davies B, du Toit C, Hlela MBKM. Fire deaths in Cape Town, South Africa: A retrospective review of medico-legal and toxicological findings (2006 - 2018). Burns 2024; 50:1011-1023. [PMID: 38290966 DOI: 10.1016/j.burns.2024.01.001] [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: 05/15/2023] [Revised: 12/07/2023] [Accepted: 01/08/2024] [Indexed: 02/01/2024]
Abstract
BACKGROUND In South Africa, fire-related deaths are common, particularly within dense informal housing settlements. Published data on deaths from fire incidents in Cape Town is sparse. Additionally, little emphasis has been placed on the role of toxicological investigations in these deaths, despite the known risk of alcohol and drug impairment to burn injury. METHODS A retrospective, descriptive analysis of post-mortem case reports from Salt River Mortuary was conducted to investigate all deaths in which fires were involved in the west metropole of Cape Town, between 2006 to 2018. Demographic, circumstantial, and toxicological data were analyzed using R software. RESULTS In total 1370 fire deaths occurred over 13 years, with a mean of 106 (SD ± 18) cases per annum (≈3% of the annual caseload and a mortality rate of 5.5 per 100,000). Males (70.4%), adults (mean=30.7 years), and toddlers (1-4 years old) were notably at risk. Deaths typically occurred in the early morning (00h00 - 06h00) (45.7%), during winter (32.1%), and in lower socioeconomic areas with highly dense informal settlements (65.6%), with 29% of deaths occurring in multi-fatality incidents. Ethanol was detected (≥0.01 g/100 mL) in 55.1% of cases submitted for analysis (71.5%), with a mean of 0.18 g/100 mL, and with 93.8% of positive cases > 0.05 g/100 mL. Carboxyhaemoglobin (COHb) analysis was requested in 76.4% of cases, with 57% of cases having a %COHb of ≥ 20%. Toxicology results (for drugs other than ethanol) from the national laboratory were outstanding in 34.4% of the cases at the conclusion of the study. BAC and %COHb were significantly higher in deaths from burns and smoke inhalation (usually accidents) than deaths from combined trauma and burns (typically homicides). Fire deaths with high COHb levels were more likely to display cherry-red discoloration (OR=3.1) and soot in the airways (OR=2.7) at autopsy. CONCLUSION This article provides an updated description of fire deaths in the west metropole of Cape Town. The importance of BAC and COHb testing in these cases was noted, and the authors call for an investigation of the role of drug impairment (specifically frequently misused drugs methamphetamine and methaqualone) as a risk factor in these deaths. Areas of high-density informal settlements, where open flames are used to heat, light, and cook, were noted as high risk.
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Affiliation(s)
- Bronwen Davies
- Division of Forensic Medicine and Toxicology, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory, Cape Town, 7935, South Africa; Forensic Toxicology Unit, Forensic Pathology Service, Western Cape Department of Health, Cape Town, South Africa.
| | - Chanté du Toit
- Division of Forensic Medicine and Toxicology, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory, Cape Town, 7935, South Africa; Forensic Toxicology Unit, Forensic Pathology Service, Western Cape Department of Health, Cape Town, South Africa
| | - Marie Belle Kathrina Mendoza Hlela
- Division of Forensic Medicine and Toxicology, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory, Cape Town, 7935, South Africa; Forensic Toxicology Unit, Forensic Pathology Service, Western Cape Department of Health, Cape Town, South Africa
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Ademola SA, Michael AI, Iyun AO, Isamah CP, Aderibigbe RO, Olawoye OA, Oluwatosin OM. Current Trend in the Epidemiology of Thermal Burn Injury at a Tertiary Hospital in South Western Nigeria. J Burn Care Res 2024; 45:190-199. [PMID: 37721894 PMCID: PMC11023490 DOI: 10.1093/jbcr/irad143] [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: 05/22/2023] [Indexed: 09/20/2023]
Abstract
Worldwide, thermal burn is the leading etiological type of burn injury accounting for 86% of burn injuries requiring admissions. Flame, Scald, and contact burn are the leading causes of thermal burn. Changes in the sociodemographic characteristics of societies have led to alterations in the epidemiology of burn. An understanding of such changes in the epidemiology of burn is essential in formulating and executing adequate burn prevention programs. We sought to establish the current trend in the etiology, gender distribution, age, occurrence of inhalation injury, burn surface area, burn depth, and mortality rate of thermal burns at Ibadan. This was a retrospective study carried out between January 2013 and December 2022. Thermal burns constitute 92% of burn injuries. The male-to-female ratio was 1.4:1. There were 265 (45%) patients in the pediatric age group and 323 adults (55% of the patients). The proportion of flame, scald, and contact burns were 378 (58%), 203 (32%), and 14 (2%), respectively. Flame burns resulting from liquified petroleum gas (LPG) explosion show a rising trend, with a decline in flame burns from kerosene (P < .001). One hundred and ninety (32%) patients had inhalation injury. The overall mortality was 19% (N = 114). Kerosene flame, 38% (17 of 45 patients), and LPG, 32% (41 of 130 patients), were the most lethal causes of flame injuries (P < .043). The study shows the increasing contribution of LPG to the etiology of thermal burn injuries. Burn prevention programs should target safe use of LPG stoves and cylinders.
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Affiliation(s)
- Samuel Adesina Ademola
- Department of Plastic, Reconstructive, and Aesthetic Surgery, University College Hospital Ibadan, Ibadan, Oyo, Nigeria
- Department of Surgery, College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria
| | - Afieharo Igbibia Michael
- Department of Plastic, Reconstructive, and Aesthetic Surgery, University College Hospital Ibadan, Ibadan, Oyo, Nigeria
- Department of Surgery, College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria
| | - Ayodele Olukayode Iyun
- Department of Plastic, Reconstructive, and Aesthetic Surgery, University College Hospital Ibadan, Ibadan, Oyo, Nigeria
- Department of Surgery, College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria
| | - Chinsunum Peace Isamah
- Department of Plastic, Reconstructive, and Aesthetic Surgery, University College Hospital Ibadan, Ibadan, Oyo, Nigeria
| | - Rotimi Opeyemi Aderibigbe
- Department of Plastic, Reconstructive, and Aesthetic Surgery, University College Hospital Ibadan, Ibadan, Oyo, Nigeria
| | - Olayinka Adebanji Olawoye
- Department of Plastic, Reconstructive, and Aesthetic Surgery, University College Hospital Ibadan, Ibadan, Oyo, Nigeria
- Department of Surgery, College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria
| | - Odunayo Moronfoluwa Oluwatosin
- Department of Plastic, Reconstructive, and Aesthetic Surgery, University College Hospital Ibadan, Ibadan, Oyo, Nigeria
- Department of Surgery, College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria
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Carolissen SW, Kleintjes W, Gool F, Gilbert S. Outcomes of complex burn injury patients managed at two primary and one tertiary level burns facilities in the Western Cape province of South Africa - a retrospective review. S AFR J SURG 2023; 61:221–231. [PMID: 38450695 DOI: 10.36303/sajs.4061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2023]
Abstract
BACKGROUND This study aimed to compare factors contributing to a positive outcome of adult burn injury patients managed at two primary and one tertiary level Western Cape hospitals. These patients from the primary hospitals (PLHs) met the referral criteria for specialised care at the Tygerberg Hospital burns unit (TBU) but were not accepted or were accepted late. METHODS A total of 1034 adult burn injury patients seen at two primary level ("A" and "B") hospitals and the TBU between 2016 and 2019 were retrospectively analysed. One hundred and eleven (111) primary level patients ("A" 71, "B" 40) met the criteria for referral to the TBU. The outcomes and factors contributing to positive outcome of these patients were compared with the 859 patients treated at the TBU during the same period. RESULTS Patients treated at the TBU showed longer theatre waiting times, more operations, and higher complication and death rates than their primary level counterparts. The PLHs showed no factors significantly contributing to hospital discharge. At TBU, pregnancy status, younger age, hot water burns, lower abbreviated burns severity index (ABSI) score, and longer time to theatre were associated with hospital discharge. A shortage of beds was the main reason for denial of admission to the TBU. CONCLUSION The PLHs showed good outcomes in managing severe burn injuries, although no significant contributors to a positive outcome were identified. Patient- and facility-related factors contributed to positive outcomes at the TBU. Upgrading both the Western Cape's primary level capabilities and the TBU's accessibility and efficiency are necessary to improve burns services.
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Affiliation(s)
- S W Carolissen
- Department of Plastic and Reconstructive Surgery, Stellenbosch University, South Africa
| | - W Kleintjes
- Western Cape Adult Provincial Tertiary Burns Unit, Tygerberg Hospital, South Africa
- Division of Surgical Services, Department of Plastic and Reconstructive Surgery, Faculty of Medicine and Health, Stellenbosch University, South Africa
| | - F Gool
- Mitchells Plain District Hospital, South Africa
| | - S Gilbert
- Khayelitsha District Hospital, South Africa
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Wild H, Marfo C, Mock C, Gaarder T, Gyedu A, Wallis L, Makasa E, Hagander L, Reynolds T, Hardcastle T, Jewell T, Stewart B. Operative Trauma Courses: A Scoping Review to Inform the Development of a Trauma Surgery Course for Low-Resource Settings. World J Surg 2023; 47:1662-1683. [PMID: 36988651 DOI: 10.1007/s00268-023-06985-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2023] [Indexed: 03/30/2023]
Abstract
BACKGROUND A multitude of operative trauma courses exist, most of which are designed for and conducted in high-resource settings. There are numerous barriers to adapting such courses to low- and low-middle-income countries (LMICs), including resource constraints and contextual variations in trauma care. Approaches to implementing operative trauma courses in LMICs have not been evaluated in a structured manner. METHODS We conducted a scoping review of the literature including databases (e.g., PubMed, Web of Science, EMBASE), grey literature repositories, and structured queries of publicly available course materials to identify records that described operative trauma courses offered since 2000. RESULTS The search identified 3,518 non-duplicative records, of which 48 relevant reports were included in analysis. These reports represented 23 named and 11 unnamed operative trauma courses offered in 12 countries. Variability existed in course format and resource requirements, ranging from USD 40 to 3,000 per participant. Courses incorporated didactic and laboratory components, which utilized simulations, cadavers, or live animals. Course content overlapped significantly but was not standardized. Data were lacking on course implementation and promulgation, credentialing of instructors, and standardized evaluation metrics. CONCLUSIONS While many operative trauma courses have been described, most are not directly relatable to LMICs. Barriers include cost-prohibitive fees, lack of resources, limited data collection, and contextual variability that renders certain surgical care inappropriate in LMICs. Gaps exist in standardization of course content as well as transparency of credentialing and course implementation strategies. These issues can be addressed through developing an open-access operative trauma course for low-resource settings.
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Affiliation(s)
- Hannah Wild
- Department of Surgery, University of Washington, 1959 NE Pacific St., Seattle, WA, 98195, USA.
| | - Chris Marfo
- Department of Surgery, University of Washington, 1959 NE Pacific St., Seattle, WA, 98195, USA
| | - Charles Mock
- Department of Surgery, University of Washington, 1959 NE Pacific St., Seattle, WA, 98195, USA
| | - Tina Gaarder
- Department of Gastrointestinal Surgery, Oslo University Hospital, Oslo, Norway
| | - Adam Gyedu
- Department of Surgery, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Private Mail Bag, University Post Office, Kumasi, Ghana
- University Hospital, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Lee Wallis
- World Health Organization, Geneva, Switzerland
| | - Emmanuel Makasa
- Department of Surgery, School of Medicine, University of Witwatersrand, Johannesburg, South Africa
| | - Lars Hagander
- Pediatric Surgery and Global Pediatrics, Department of Pediatrics, Clinical Sciences Lund, Lund University, Lund, Sweden
| | | | - Timothy Hardcastle
- Nelson R Mandela School of Medicine, Surgery (Trauma), University of KwaZulu-Natal, Durban, South Africa
- Inkosi Albert Luthuli Central Hospital, Durban, South Africa
| | - Teresa Jewell
- Health Science Library, University of Washington, Seattle, WA, USA
| | - Barclay Stewart
- Department of Surgery, University of Washington, 1959 NE Pacific St., Seattle, WA, 98195, USA
- Global Injury Control Section, Harborview Injury Prevention and Research Center, Seattle, WA, USA
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Boissin C. Clinical decision-support for acute burn referral and triage at specialized centres - Contribution from routine and digital health tools. Glob Health Action 2022; 15:2067389. [PMID: 35762795 PMCID: PMC9246103 DOI: 10.1080/16549716.2022.2067389] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Specialized care is crucial for severe burn injuries whereas minor burns should be handled at point-of-care. Misdiagnosis is common which leads to overburdening the system and to a lack of treatment for others due to resources shortage. OBJECTIVES The overarching aim was to evaluate four decision-support tools for diagnosis, referral, and triage of acute burns injuries in South Africa and Sweden: referral criteria, mortality prediction scores, image-based remote consultation and automated diagnosis. METHODS Study I retrospectively assessed adherence to referral criteria of 1165 patients admitted to the paediatric burns centre of the Western Cape of South Africa. Study II assessed mortality prediction of 372 patients admitted to the adults burns centre by evaluating an existing score (ABSI), and by using logistic regression. In study III, an online survey was used to assess the diagnostic accuracy of burn experts' image-based estimations using their smartphone or tablet. In study IV, two deep-learning algorithms were developed using 1105 acute burn images in order to identify the burn, and to classify burn depth. RESULTS Adherence to referral criteria was of 93.4%, and the age and severity criteria were associated with patient care. In adults, the ABSI score was a good predictor of mortality which affected a fifth of the patients and which was associated with gender, burn size and referral status. Experts were able to diagnose burn size, and burn depth using handheld devices. Finally, both a wound identifier and a depth classifier algorithm could be developed with relatively high accuracy. CONCLUSIONS Altogether the findings inform on the use of four tools along the care trajectory of patients with acute burns by assisting with the diagnosis, referral and triage from point-of-care to burns centres. This will assist with reducing inequities by improving access to the most appropriate care for patients.
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Affiliation(s)
- Constance Boissin
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
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Nezerwa Y, Miranda E, Velin L, Shyaka I, Mukagaju F, Busomoke F, Nsanzimana JDD, Mukeshimana M, Mushimiyimana D, Mukambasabire B, Uwimana L, Ntirenganya F, Furaha C, Riviello R, Pompermaier L. Referral of Burn Patients in the Absence of Guidelines: A Rwandan Study. J Surg Res 2022; 278:216-222. [DOI: 10.1016/j.jss.2022.04.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 04/11/2022] [Accepted: 04/22/2022] [Indexed: 11/29/2022]
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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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Leontyev АE, Pavlenko IV, Kovalishena ОV, Saperkin NV, Tulupov АА, Beschastnov VV. Application of Phagotherapy in the Treatment of Burn Patients (Review). Sovrem Tekhnologii Med 2021; 12:95-103. [PMID: 34795985 PMCID: PMC8596250 DOI: 10.17691/stm2020.12.3.12] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Indexed: 12/22/2022] Open
Abstract
Treatment of patients with a burn injury is a complex process involving multicomponent multidirectional intensive therapy of the majority of organs and systems damaged by thermal effects on the skin, alternating with repeated surgical interventions aimed at removing nonviable tissues with subsequent plastic closure of wound defects. After the recovery from the burn shock, local infectious complications are considered to be the leading problem that decelerates the process of recovery and is the main cause of lethal outcomes. Since the skin integrity is broken, microorganisms penetrate readily into the internal environment of the human organism resulting in a septic state with multiple organ failure. A widespread and often uncontrollable use of antibacterial drugs in medical practice has led to the emergence of multiple drug resistance (MDR) in microorganisms. Introduction of drugs made on the basis of bacteriophages into practice is presently becoming increasingly important. This is confirmed by the growing interest in this field of pharmacology, the development of special programs aimed at studying the processes of phage and bacterial cell interaction. This review presents the main types of bacteria pertaining to MDR pathogens, principles of their classification, and the risk factors for infecting patients. The mechanisms of the selective action of phage particles on a bacterial cell and the possibility of using phage therapy in the treatment of burn injury (experimental and clinical data) based on the analysis of foreign literature are demonstrated as well as new positive properties of phages related to the changes in the macroorganism immune status caused by the interaction with bacteriophage particles.
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Affiliation(s)
- А E Leontyev
- Researcher, Group for Thermal Trauma Study, University Clinic; Privolzhsky Research Medical University, 10/1 Minin and Pozharsky Square, Nizhny Novgorod, 603005, Russia
| | - I V Pavlenko
- Junior Researcher, Group for Thermal Trauma Study, University Clinic; Privolzhsky Research Medical University, 10/1 Minin and Pozharsky Square, Nizhny Novgorod, 603005, Russia
| | - О V Kovalishena
- Professor, Head of the Department of Epidemiology, Microbiology, and Evidence-Based Medicine; Privolzhsky Research Medical University, 10/1 Minin and Pozharsky Square, Nizhny Novgorod, 603005, Russia
| | - N V Saperkin
- Associate Professor, Department of Epidemiology, Microbiology, and Evidence-Based Medicine
| | - А А Tulupov
- Junior Researcher, Group for Thermal Trauma Study, University Clinic; Privolzhsky Research Medical University, 10/1 Minin and Pozharsky Square, Nizhny Novgorod, 603005, Russia
| | - V V Beschastnov
- Researcher, Group for Thermal Trauma Study, University Clinic Privolzhsky Research Medical University, 10/1 Minin and Pozharsky Square, Nizhny Novgorod, 603005, Russia
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Murhula GB, Musole PB, Nama Kafupi B, Tshibwid A Zeng F, Garhalangwamuntu Mayeri D, Cikomola FG, Pompermaier L. Factors associated with outcomes after burn care: A retrospective study in Eastern Democratic Republic of Congo. J Burn Care Res 2021; 43:85-92. [PMID: 33773491 DOI: 10.1093/jbcr/irab051] [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
OBJECTIVE In low income countries, incidence of burns is high and severe burns are frequently managed at peripheral facilities. Outcome after burn care is poorly studied although it might help identify risk-group and improve treatment strategies. This study aimed to study factors associated with in-hospital outcomes in a burn cohort in the Democratic Republic of Congo. METHODS In this retrospective study we included burn patients admitted to the surgical department at the Hôpital Provincial Général de Référence de Bukavu between January 2013 and December 2018. Differences between groups were tested using χ2 test or Fisher's exact tests or Wilcoxon rank sum test, as appropriate. Multivariate logistic regression was used to analyze the effect of patients and of burn characteristics on in-hospital mortality, prolongated length of stay (=LOS≥25days) and occurrence of complications. RESULTS The study population consisted of 100 patients, mainly young male with rural origin, moderate sized but deep burns. Of them, 46 developed complications, 12 died. Median LOS was 25 days (IQR: 15-42). In-hospital death was independently associated with Total Burn Surface Area percentage "TBSA%" (OR=3.96; 95% CI=1.67-9.40) and Full thickness Burns "FTB" (10.68; 1.34-84.74); prolongated LOS with FTB (3.35; 1.07-10.49), and complication with rural origin (5.84; 1.51-22.53), TBSA% (3.96; 1.67-9.40), FTB (4.08; 1.19-14.00) and burns on multiple sites (4.38; 1.38-13.86). CONCLUSION In-hospital death was associated with TBSA% and FTB, prolongated LOS with FTB, and complication with burns characteristics and rural origin of the patients. Further studies are necessary to investigate the effect of provided burn care on outcomes.
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Affiliation(s)
| | - Patrick Bugeme Musole
- Faculty of Medicine, Catholic University of Bukavu, Bukavu, Democratic Republic of Congo
| | - Bienfait Nama Kafupi
- Faculty of Medicine, Catholic University of Bukavu, Bukavu, Democratic Republic of Congo
| | - Florent Tshibwid A Zeng
- Faculty of Medicine, Department of Surgery, University of Lubumbashi, Democratic Republic of Congo
| | | | - Fabrice Gulimwentuga Cikomola
- Faculty of Medicine, Catholic University of Bukavu, Bukavu, Democratic Republic of Congo.,Hôpital Provincial Général de Référence de Bukavu, Bukavu, Democratic Republic of Congo
| | - Laura Pompermaier
- Department of Hand Surgery, Plastic Surgery and Burns, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
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The effect of burn mechanism on pediatric mortality in Malawi: A propensity weighted analysis. Burns 2020; 47:222-227. [PMID: 33277092 DOI: 10.1016/j.burns.2019.12.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Revised: 11/24/2019] [Accepted: 12/31/2019] [Indexed: 11/22/2022]
Abstract
INTRODUCTION The burden of global trauma disproportionately affects low- and middle-income countries, with a high incidence in children. Thermal injury represents one of the most severe forms of trauma and is associated with remarkable morbidity and mortality. The predictors of burn mortality have been well described (age, % total body surface area burn [TBSA], and presence of inhalation injury). However, the contribution of the burn mechanism as a predictor of burn mortality is not well delineated. METHODS This is a retrospective analysis of prospectively collected data, utilizing the Kamuzu Central Hospital (KCH) Burn Surveillance Registry from May 2011 to August 2019. Pediatric patients (≤12 years) with flame and scald burns were included in the study. Basic demographic variables including sex, age, time to presentation, %TBSA, surgical intervention, burn mechanism, and in-hospital mortality outcome was collected. Bivariate analysis comparing demographic, burn characteristics, surgical intervention, and patient outcomes were performed. Standardized estimates were adjusted using inverse-probability of treatment weights (IPTW) to account for confounding. Following weighting, logistic regression modeling was performed to determine the odds of in-hospital mortality based on burn mechanism. RESULTS During the study period, 2364 patients presented to KCH for burns and included in the database with 1794 (75.9%) pediatric patients. Of these, 488 (27.6%) and 1280 (72.4%) were injured by flame and scald burns, respectively. Males were 47.2% (n = 230) and 59.2% (n = 755) of the flame and scald burn cohorts, respectively (p < 0.001.) Patients presenting with flame burns compared to scald burns were older (4. 7 ± 3.1 vs. 2.7 ± 2.3 years, p < 0.001) with greater %TBSA burns (17.8 [IQR 10-28] vs 12 [IQR 7-20], p < 0.001). Surgery was performed for 42.2% (n = 206) and 19.9% (n = 140) of the flame and scald burn cohorts, respectively (p < 0.001.) Flame burns had a 2.6x greater odds of in-hospital mortality compared to scald burns (p < 0.001) after controlling for sex, %TBSA, age, time to presentation, and surgical status. CONCLUSION In this propensity-weighted analysis, we show that burn mechanism, specifically flame burns, resulted in a nearly 3-fold increase in odds of in-hospital mortality compared to scald burns. Our results emphasize flame and scald burns have major differences in the inflammatory response, metabolic profile over time, and outcomes. We may further utilize these differences to develop specialized treatments for each burn mechanism to potentially prevent metabolic dysfunction and improve clinical outcomes.
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den Hollander D, Albertyn R, Amber J. Palliation, end-of-life care and burns; concepts, decision-making and communication - A narrative review. Afr J Emerg Med 2020; 10:95-98. [PMID: 32612916 PMCID: PMC7320205 DOI: 10.1016/j.afjem.2020.01.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 12/31/2019] [Accepted: 01/06/2020] [Indexed: 12/03/2022] Open
Abstract
Palliative care is the turn from cure as the priority of care to symptom relief and comfort care. Although very little is published in the burn literature on palliative care, guidelines can be gleaned from the general literature on palliative care, particularly for acute surgical and critical care patients. Palliative care may be started because of futility, on request of the patient, or because of limited resources. The SPIKES acronym is a useful guide to avoid errors in communication with terminal patients and their relatives.
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Affiliation(s)
- Daan den Hollander
- Burns Unit Inkosi Albert Luthuli Central Hospital, Durban, South Africa
- Department of Surgery, University of KwaZulu Natal, South Africa
| | - Rene Albertyn
- Red Cross Memorial Children's Hospital, South Africa
| | - Julia Amber
- Palliative Care Practitioner, Department of Pediatrics, Inkosi Albert Luthuli Central Hospital, Durban, South Africa
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Govender R, Hornsby N, Kimemia D, Van Niekerk A. The role of concomitant alcohol and drug use in increased risk for burn mortality outcomes. Burns 2019; 46:58-64. [PMID: 31843286 DOI: 10.1016/j.burns.2019.11.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 09/16/2019] [Accepted: 11/05/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND Burn injuries are a major cause of mortality and morbidity in low- and middle-income countries, with high rates in Sub-Saharan Africa. The risks may be heightened for persons who present with concomitant use of alcohol and illicit substances, which increase the risk for injury and severely compromise prognosis following injury. METHODS This study utilised a national dataset on hospitalised burns in South Africa to explore the risk for mortality relative to morbidity. To assess the influence of alcohol and drugs in mortality outcomes, the analysis was restricted to adult cases, 18 years and older (N = 918). The primary statistical procedures used in the analysis were logistic regression models. FINDINGS The results indicate that burn victims with full thickness and partial thickness burn degree and more than 30% TBSA had a significantly increased risk of mortality. In addition, the risk for mortality was increased ten times when concomitant alcohol and drugs were indicated compared to cases where these were absent. The length of stay in hospital diminished the risk for mortality by about 10%. INTERPRETATION The findings may be explained by the role of skin as the main barrier against infections and the concurrent increase in risk of infection based on the degree and extent of any damage. The combined presence of both alcohol and drugs may predispose towards more severe burns and greatly compromise liver function with heightened risk for sepsis and death.
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Affiliation(s)
- Rajen Govender
- Institute for Social and Health Sciences, University of South Africa, Johannesburg, South Africa.
| | - Nancy Hornsby
- Violence, Injury and Peace Research Unit, South African Medical Research Council and University of South Africa, Tygerberg, South Africa
| | - David Kimemia
- Institute for Social and Health Sciences, University of South Africa, Johannesburg, South Africa; Violence, Injury and Peace Research Unit, South African Medical Research Council and University of South Africa, Tygerberg, South Africa
| | - Ashley Van Niekerk
- Institute for Social and Health Sciences, University of South Africa, Johannesburg, South Africa; Violence, Injury and Peace Research Unit, South African Medical Research Council and University of South Africa, Tygerberg, South Africa
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