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Graner M, Gutierre M, Salgado LS, Mishaly A, Baptista J, Calheiros G, Buda AM, Bowder AN, Corlew DS, Botelho F, de Souza Gomez D, Alonso N, Pompermaier L. Who Gets Burned in Brazil? J Burn Care Res 2024; 45:926-931. [PMID: 37139956 DOI: 10.1093/jbcr/irad062] [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: 10/07/2022] [Indexed: 05/05/2023]
Abstract
Burns are preventable injuries that still represent a relevant public health issue. The identification of risk factors might contribute to the development of specific preventive strategies. Data of patients admitted at the Hospital due to acute burn injuries from May 2017 to December 2019, was extracted manually from medical records. The population was analyzed descriptively, and differences between groups were tested using the appropriate statistical test. The study population consisted of 370 patients with burns admitted to the Hospital burn unit during the study period. The majority of the patients were males (257/370, 70%), median age was 33 (IQR:18-43), median TBSA% was 13 (IQR 6.35-21.5 and range 0-87.5%), and 54% of patients had full-thickness burns (n = 179). Children younger than 13 years old represented 17% of the study population (n = 63), 60% of them were boys (n = 38), and scalds was the predominant mechanism of burn injury (n = 45). No children died, however 10% of adults did (n = 31). Self-inflicted burns were observed in 16 adults (5%), of whom 6 (38%) died during admission, however self-inflicted burns were not observed in children. Psychiatric disorders and substance misuse were frequent in this subgroup. White adults male from urban areas who had not completed primary school degree were the major risk group for burns. Smoking and alcohol misuse were the most frequent comorbidities. Accidental domestic flame burns were the predominant injuries in the adult population and scalds in the pediatric.
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Affiliation(s)
- Mariana Graner
- School of Medicine, University of São Paulo, São Paulo, SP, Brazil
| | - Marcela Gutierre
- School of Medicine, University of São Paulo, São Paulo, SP, Brazil
| | - Lucas S Salgado
- School of Medicine, União Educacional do Vale do Aço, Ipatinga, MG, Brazil
| | | | - João Baptista
- School of Medicine, University of São Paulo, São Paulo, SP, Brazil
| | | | - Alexandra M Buda
- Harvard Medical School-Program in Global Surgery and Social Change Boston, Massachusetts, USA
| | - Alexis N Bowder
- Harvard Medical School-Program in Global Surgery and Social Change Boston, Massachusetts, USA
| | - D Scott Corlew
- Harvard Medical School-Program in Global Surgery and Social Change Boston, Massachusetts, USA
| | | | | | - Nivaldo Alonso
- Department of Plastic Surgery, University of São Paulo, São Paulo, Brazil
| | - Laura Pompermaier
- Department of Hand Surgery, Plastic Surgery and Burns, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
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2
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Yin B, He Y, Zhang Z, Cheng X, Bao W, Li S, Wang W, Jia C. Global burden of burns and its association with socio-economic development status, 1990-2019. Burns 2024; 50:321-374. [PMID: 38102041 DOI: 10.1016/j.burns.2023.02.007] [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: 07/20/2022] [Revised: 02/06/2023] [Accepted: 02/19/2023] [Indexed: 03/06/2023]
Abstract
BACKGROUND Burns represent important global health problems. Whereas many studies are limited by the difficulties in estimating the burden of burns and instead focus on the causes of burns, such as fire, heat, and hot substances. Therefore, a complete assessment of the burden of all injuries leading to burns is essential to developing reasonable global intervention strategies. METHODS Data on three classes of burns, including "< 20 % total burned surface area without lower airway burns" (Moderate injury), "> =20 % total burned surface area or > = 10 % burned surface area if head/neck or hands/wrist involved w/o lower airway burns" (Major injury), "Lower airway burns" (Inhalation injury) were collected from the Global Burden of Disease 2019 database. Age-standardized incidence rates (ASR-I) and Years Lived with Disability (ASR-YLDs) for burns has been standardized by removing the influence of population size and age structure. They were extracted and stratified by cause, year, sex, age, socio-demographic index, country, and territory. RESULTS In terms of ASR-I and ASR-YLDs, burns showed a significant decrease from 1990 to 2019, especially for moderate and major injury. In 2019, the burden of moderate injury was positively correlated with socio-demographic index while major injury was negatively correlated (P < 0.05). We found no correlation between socio-demographic index and the burden for inhalation injury (P > 0.05). Fire, heat, and hot substances were the most important cause of burns except for inhalation injury. The most common association with inhalation injury was falls, which were also a major cause of moderate and major injury. CONCLUSIONS The Global Burden of Disease 2019 database data can be used to guide the allocation of resources to reduce ASR-I and ASR-YLDs of different burn classes.
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Affiliation(s)
- Bin Yin
- School of Medicine, Xiamen University, Xiamen, China
| | - Yan He
- School of Medicine, Xiamen University, Xiamen, China
| | - Zexin Zhang
- School of Medicine, Xiamen University, Xiamen, China
| | - Xialin Cheng
- School of Medicine, Xiamen University, Xiamen, China
| | - Wu Bao
- School of Medicine, Xiamen University, Xiamen, China
| | - Shu Li
- School of Medicine, Xiamen University, Xiamen, China
| | - Wenxuan Wang
- School of Medicine, Xiamen University, Xiamen, China
| | - Chiyu Jia
- The First Affiliated Hospital, Center of Burn & Plastic and Wound Healing Surgery, Hengyang Medical School, University of South China, Hengyang, Hunan 421001, China.
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3
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Mobayen M, Torabi H, Bagheri Toolaroud P, Tolouei M, Dehnadi Moghadam A, Saadatmand M, EslamiKenarsari H, Feizkhah A, Ghazanfari MJ, Osuji J, Ghorbani Vajargah P, Karkhah S. Acute burns during the COVID-19 pandemic: A one-year retrospective study of 611 patients at a referral burn centre in northern Iran. Int Wound J 2023; 20:3204-3211. [PMID: 37095647 PMCID: PMC10502268 DOI: 10.1111/iwj.14199] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 04/06/2023] [Accepted: 04/07/2023] [Indexed: 04/26/2023] Open
Abstract
Patients with acute burns are more vulnerable to COVID-19 because of physiologically weak immune systems. This study aimed to assess and compare individual characteristics, clinical features, and clinical outcomes of acute burn among COVID-19 and non-COVID-19 patients. A retrospective study, with data collected from 611 acute burn patients with or without a COVID-19 diagnosis referred to a burn centre in Iran. Data were collected from April 2020 to 2021. The mean age of acute burns patients with COVID-19 was higher compared with acute burns patients with non-COVID-19 (47.82 vs. 32.59 years, P < .001). Acute burns occurred more frequently in COVID-19 patients with comorbidities compared with non-COVID-19 patients (48.72% vs. 26.92%, P = .003). 58.97% of COVID-19 patients and 55.42% of non-COVID-19 patients had grade II & III and II burns, respectively (P < .001). The mean total body surface area of the burn was higher in COVID-19 patients compared with non-COVID-19 patients (32.69% vs. 16.22%, P < .001). Hospitalisation in the intensive care unit (ICU) was higher in COVID-19 patients than in non-COVID-19 patients (76.92% vs. 15.73%, P < .001). Length of stay in hospital and ICU, the cost of hospitalisation, and waiting time for the operating room was higher in COVID-19 patients compared with non-COVID-19 patients (15.30 vs. 3.88 days, P < .001; 9.61 vs. 0.75 days, P < .001; 30 430 628.717 vs. 10 219 192.44 rials, P = .011; 0.84 vs. 0.24 min, P < .001, respectively). Intubation and mortality in-hospital were higher in COVID-19 patients compared with non-COVID-19 patients (41.02% vs. 6.99%, P < .001; 35.90% vs. 6.12%, P < .001, respectively). Therefore, it is recommended that health managers and policymakers develop a care plan to provide high-quality care to acute burns patients with COVID-19, especially in low-income countries.
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Affiliation(s)
- Mohammadreza Mobayen
- Burn and Regenerative Medicine Research CenterGuilan University of Medical SciencesRashtIran
| | - Hossein Torabi
- Department of General Surgery, Poursina Medical & Educational CenterGuilan University of Medical SciencesRashtIran
| | | | - Mohammad Tolouei
- Department of General Surgery, Faculty of MedicineGuilan University of Medical SciencesRashtIran
| | | | - Mohammad Saadatmand
- Clinical Research Development Unit of Poursina HospitalGuilan University of Medical SciencesRashtIran
| | - Habib EslamiKenarsari
- Poursina Clinical Research Development UnitGuilan University of Medical SciencesRashtIran
| | - Alireza Feizkhah
- Burn and Regenerative Medicine Research CenterGuilan University of Medical SciencesRashtIran
- Department of Medical Physics, School of MedicineGuilan University of Medical SciencesRashtIran
| | - Mohammad Javad Ghazanfari
- Burn and Regenerative Medicine Research CenterGuilan University of Medical SciencesRashtIran
- Department of Medical‐Surgical Nursing, School of Nursing and MidwiferyShahid Beheshti University of Medical SciencesTehranIran
| | - Joseph Osuji
- School of Nursing and Midwifery, Faculty of Health, Community, and EducationMount Royal UniversityCalgaryAlbertaCanada
| | - Pooyan Ghorbani Vajargah
- Burn and Regenerative Medicine Research CenterGuilan University of Medical SciencesRashtIran
- Department of Medical‐Surgical Nursing, School of Nursing and MidwiferyGuilan University of Medical SciencesRashtIran
| | - Samad Karkhah
- Burn and Regenerative Medicine Research CenterGuilan University of Medical SciencesRashtIran
- Department of Medical‐Surgical Nursing, School of Nursing and MidwiferyGuilan University of Medical SciencesRashtIran
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Savage N, Doherty Z, Singer Y, Menezes H, Cleland H, Goldie SJ. A Review of Petrol Burns in Australia and New Zealand. J Burn Care Res 2023; 44:1162-1168. [PMID: 36715313 PMCID: PMC10483450 DOI: 10.1093/jbcr/irad008] [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: 10/18/2022] [Indexed: 01/31/2023]
Abstract
Petrol-related thermal burns cause significant morbidity and mortality worldwide and it has been established that they affect young males disproportionately. Beyond this, we sought to identify the difference in the characteristics and outcomes of burns between males and females in an international population. Such differences may highlight areas for future preventative strategies. The Burns Registry of Australia and New Zealand was used. Petrol burns that resulted in a hospital admission in those 16 years or older between January 2010 and December 2019 were included. A total of 2833 patients were included. The median age was 35 years with most patients being male (88%). Burns from a campfire or burnoffs were most common. Females were more likely to suffer burns due to assault or from deliberate self-harm. The total body surface area affected by burns was higher for females than males (10% vs 8%). Furthermore, females more frequently required ICU admission, escharotomies, and had a longer hospital length of stay. The unadjusted mortality rate for females was more than double the rate for males (5.8% vs 2.3%). This international study demonstrates that whilst men more frequently suffer petrol burns, women suffer more severe burns, require more intensive and longer hospitalizations and have a higher mortality rate. These findings may inform changes in preventative health policies globally to mitigate against these concerning findings.
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Affiliation(s)
- Nicholas Savage
- Victorian Adult Burns Service, Alfred Hospital, 55 Commercial Road, Melbourne, Victoria, Australia
| | - Zakary Doherty
- Victorian Adult Burns Service, Alfred Hospital, 55 Commercial Road, Melbourne, Victoria, Australia
| | - Yvonne Singer
- Victorian Adult Burns Service, Alfred Hospital, 55 Commercial Road, Melbourne, Victoria, Australia
| | - Hana Menezes
- Victorian Adult Burns Service, Alfred Hospital, 55 Commercial Road, Melbourne, Victoria, Australia
| | - Heather Cleland
- Victorian Adult Burns Service, Alfred Hospital, 55 Commercial Road, Melbourne, Victoria, Australia
- Department of Surgery, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Stephen J Goldie
- Victorian Adult Burns Service, Alfred Hospital, 55 Commercial Road, Melbourne, Victoria, Australia
- Department of Surgery, Central Clinical School, Monash University, Melbourne, Victoria, Australia
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
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5
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Sarkar R, Dipnall JF, Bassed R, Ozanne-Smith Ao J. Family violence homicide rates: a state-wide comparison of three data sources in Victoria, Australia. HEALTH INF MANAG J 2023; 52:135-143. [PMID: 34875905 DOI: 10.1177/18333583211060464] [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] [Indexed: 11/15/2022]
Abstract
BACKGROUND Family violence homicide (FVH) is a major public health and social problem in Australia. FVH trend rates are key outcomes that determine the effectiveness of current management practices and policy directions. Data source-related methodological problems affect FVH research and policy and the reliable measurement of homicide trends. OBJECTIVE This study aimed to determine data reliability and temporal trends of Victorian FVH rates and sex and relationship patterns. METHOD FVH rates per 100,000 persons in Victoria were compared between the National Coronial Information System (NCIS), Coroners Court of Victoria (CCoV) Homicide Register, and the National Homicide Monitoring Program (NHMP). Trends for 2001-2017 were analysed using Joinpoint regression. Crude rates were determined by sex and relationship categories using annual frequencies and Australian Bureau of Statistics population estimates. RESULTS NCIS closed FVH cases totalled 360, and an apparent downward trend in the FVH rate was identified. However, CCoV and NHMP rates trended upwards. While NCIS and CCoV were case-based, NHMP was incident-based, contributing to rate variations. The NCIS-derived trend was particularly impacted by unavailable case data, potential coding errors and entry backlog. Neither CCoV nor NHMP provided victim-age in their public domain data to enable age-adjusted rate comparison. CONCLUSION Current datasets have limitations for FVH trend determination; most notably lag times for NCIS data. IMPLICATIONS This study identified an indicative upward trend in FVH rates in Victoria, suggesting insufficiency of current management and policy settings for its prevention and control.
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Affiliation(s)
- Reena Sarkar
- Victorian Institute of Forensic Medicine, Southbank, VIC, Australia
- Department of Forensic Medicine, Monash University, Southbank, VIC, Australia
| | - Joanna F Dipnall
- Pre-hospital, Emergency and Trauma Research, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- School of Medicine, Deakin University, VIC, Australia
| | - Richard Bassed
- Victorian Institute of Forensic Medicine, Southbank, VIC, Australia
- Department of Forensic Medicine, Monash University, Southbank, VIC, Australia
| | - Joan Ozanne-Smith Ao
- Victorian Institute of Forensic Medicine, Southbank, VIC, Australia
- Department of Forensic Medicine, Monash University, Southbank, VIC, Australia
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6
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Tracy LM, Darton A, Gabbe BJ, Heath K, Kurmis R, Lisec C, Lo C, Singer Y, Wood FM, Cleland HJ. Examining the patient profile and variance of management and in-hospital outcomes for Australian adult burns patients. ANZ J Surg 2022; 92:2641-2647. [PMID: 36054463 PMCID: PMC9804322 DOI: 10.1111/ans.17985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 08/04/2022] [Accepted: 08/05/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND Burn injuries are a common subtype of trauma. Variation in models of care impacts clinical measures of interest, but a nation-wide examination of these measures has not been undertaken. Using data from the Burns Registry of Australia and New Zealand (BRANZ), we explored variation between Australian adult burn services with respect to treatment and clinical measures of interest. METHODS Data for admissions July 2016 to June 2020 were extracted. Clinical measures of interest included intensive care admission, skin grafting, in-hospital death, unplanned readmissions, and length of stay (LOS). Estimated probabilities, means, and corresponding 95% confidence intervals (CI) were calculated for each service. RESULTS The BRANZ recorded 8365 admissions during the study period. Variation between specialist burn services in admissions, demographics, management, and clinical measures of interest were observed. This variation remained after accounting for covariates. Specifically, the adjusted proportion (95% CI) of in-hospital mortality ranged from 0.15% (0.10-0.21%) to 1.22% (0.9-1.5%). The adjusted mean LOS ranged from 3.8 (3.3-4.3) to 8.2 (6.7-9.7) days. CONCLUSIONS A decade after its launch, BRANZ data displays variation between Australian specialist burn services. We suspect differences in models of care between services contributes to this variation. Ongoing research has begun to explore reasons underlying how this variation influences clinical measures of interest. Further engagement with services about models of care will enhance understanding of this variation and develop evidence-based guidelines for burn care in Australia.
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Affiliation(s)
- Lincoln M. Tracy
- School of Public Health and Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
| | - Anne Darton
- Statewide Burn Injury ServiceNew South Wales Agency for Clinical InnovationSydneyNew South WalesAustralia
| | - Belinda J. Gabbe
- School of Public Health and Preventive MedicineMonash UniversityMelbourneVictoriaAustralia,Health Data Research UK, Swansea University Medical SchoolSwansea UniversitySwanseaUK
| | - Kathryn Heath
- Adult Burns ServiceRoyal Adelaide HospitalAdelaideSouth AustraliaAustralia
| | - Rochelle Kurmis
- Adult Burns ServiceRoyal Adelaide HospitalAdelaideSouth AustraliaAustralia
| | - Carl Lisec
- Faculty of MedicineThe University of QueenslandBrisbaneQueenslandAustralia,Professor Stuart Pegg Adult Burns CentreThe Royal Brisbane And Women's HospitalBrisbaneQueenslandAustralia
| | - Cheng Lo
- Victorian Adult Burns ServiceThe AlfredMelbourneVictoriaAustralia,Department of Surgery, Central Clinical SchoolMonash UniversityMelbourneVictoriaAustralia
| | - Yvonne Singer
- Victorian Adult Burns ServiceThe AlfredMelbourneVictoriaAustralia
| | - Fiona M. Wood
- State Adult Burn UnitFiona Stanley HospitalMurdochWestern AustraliaAustralia,Burn Injury Research UnitUniversity of Western AustraliaPerthWestern AustraliaAustralia
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7
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Irvine R, Doan T, Bosley E, Colbeck M, Bowles KA. Paediatric Out-of-Hospital Cardiac Arrests: An Epidemiological Study. PREHOSP EMERG CARE 2022:1-10. [PMID: 35771687 DOI: 10.1080/10903127.2022.2096159] [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: 10/17/2022]
Abstract
Objective: To identify the epidemiological patterns of paediatric out-of-hospital cardiac arrests (OHCA) in Queensland, Australia and to investigate associations between patient variables and prehospital outcome.Methods: Included were paediatric (>4 days - 18 years) OHCA patients attended by paramedics in the state of Queensland (Australia) between January 2009 and December 2019. Patient and arrest characteristics were described. Factors associated with return of spontaneous circulation (ROSC) on hospital arrival were investigated.Results: A total of 1612 paediatric patients were included; 611 were deceased prior to paramedic arrival and 1001 received resuscitation attempts by paramedics. Approximately one quarter (26.8%) of resuscitation-attempted patients achieved ROSC on hospital arrival. Most arrests (49.7%) were due to medical causes. Arrests due to trauma had the lowest rate of ROSC on hospital arrival (9.6%), whereas those due to drug overdose had the highest rate (40%). Patients in rural areas had a lower rate of ROSC on hospital arrival than those in metropolitan areas (20.7% vs 32.5%, p < 0.001). The median response interval to all OHCA patients was 8 minutes. Trauma was considerably more prevalent in rural areas than in metropolitan areas, while all other aetiologies were comparable. Older paediatric age groups had higher rates of ROSC on hospital arrival than infants, particularly early adolescents (39.4% vs. 14.9%, p = 0.001). Aetiology, age, bystander witness, shockable initial rhythm, and geographic locality factors were independently associated with ROSC on hospital arrival.Conclusions: Approximately a quarter of paediatric prehospital OHCA achieved ROSC on hospital arrival. Prehospital outcome differs according to patient cohort and is associated with diverse patient demographic variables.
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Affiliation(s)
- Rachel Irvine
- Department of Paramedicine, Monash University, Victoria, Australia
| | - Tan Doan
- Queensland Ambulance Service, Brisbane, Queensland, Australia
| | - Emma Bosley
- Queensland Ambulance Service, Brisbane, Queensland, Australia
| | - Marc Colbeck
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Banyo, Queensland, Australia
| | - Kelly-Ann Bowles
- Department of Paramedicine, Monash University, Victoria, Australia
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8
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Lu P, Burrell A, Bailey M, Moore E, Pilcher D, Cleland H. Performance of BEAMS risk of death score for mortality prediction in Australian and New Zealand burns patients. J Burn Care Res 2022; 43:1434-1439. [PMID: 35460563 DOI: 10.1093/jbcr/irac053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The BEAMS (Burns Evaluation And Mortality Study) risk of death score was developed in 2013 as a mortality prediction tool for burns patients admitted to an ICU (Intensive Care Unit) in Australia and New Zealand. While it previously performed well, identifying high risk groups and allowing benchmarking, over time such scores may lose calibration or be superseded by improved scoring systems. Our aim was to assess the performance of the BEAMS score in a modern cohort of burns patient. Data was sourced from the Burns Registry of Australia and New Zealand (BRANZ) and the Australia New Zealand Intensive Care Society Centre for Outcome and Resource Evaluation (ANZICS CORE) databases. Data was linked using probabilistic methodology. BEAMS risk of death scores was calculated for all adult patients. Between 2009 and 2019, there were 2075 patients admitted to an Australian or New Zealand ICU with a burns related injury. Advanced age, female gender, higher %TBSA burns and inhalation injury were all associated with increased rate of mortality (p<0.05). Overall hospital mortality was 9.4% (n=195). The predicted risk of death from BEAMS was 8.7% and the score had an area under the receiver operating characteristic curve of 0.934. We found the BEAMS Risk of Death score continues to have excellent performance in a modern cohort of adult critically ill burns patients. It remains a valid tool for mortality prediction among adult burns patients admitted to ICU across Australia and New Zealand.
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Affiliation(s)
- Patrick Lu
- Department of Surgery, Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Victorian Adult Burns Service, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Aidan Burrell
- Intensive Care Unit, The Alfred Hospital, Melbourne, Victoria, Australia.,Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Michael Bailey
- Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Edwina Moore
- Department of Endocrine Surgery, Peninsula Private Hospital, Frankston, Victoria, Australia.,Department of Public Health and Preventative Medicine, Monash University, Melbourne, Victoria, Australia
| | - David Pilcher
- Intensive Care Unit, The Alfred Hospital, Melbourne, Victoria, Australia.,Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,The Australian and New Zealand Intensive Care Society (ANZICS) Centre for Outcome and Resources Evaluation, Camberwell, Victoria, Australia
| | - Heather Cleland
- Department of Surgery, Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Victorian Adult Burns Service, The Alfred Hospital, Melbourne, Victoria, Australia
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Abbasi H, Dehghani A, Mohammadi AA, Ghadimi T, Keshavarzi A. The Epidemiology of Chemical Burns Among the Patients Referred to Burn Centers in Shiraz, Southern Iran, 2008-2018. Bull Emerg Trauma 2021; 9:195-200. [PMID: 34692871 PMCID: PMC8525699 DOI: 10.30476/beat.2021.90754.1261] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 06/13/2021] [Accepted: 06/20/2021] [Indexed: 11/29/2022] Open
Abstract
Objective: To investigate the prevalence of chemical burns among the patients admitted to Shiraz burn treatment centers. Methods: It is a descriptive study that was conducted on 62 patients with chemical burns who were admitted between 2008 and 2018. The patients’ records were used in the research using the census sampling process. A questionnaire with questions about age, sex, the extent of the burn, the cause of the burn, duration of hospital stay, level of education, incident location, and clinical outcome was used to collect data (survival-death). The data was analyzed by using descriptive statistical methods. Results: The prevalence of chemical burns was 1% during 2008-2018. Acid and alkali burns were accounted for 93.5% and 6.5% of burns, respectively. 77.4% of patients were male, and 22.6% were female. The mean age of patients was 27 years. The average burn percentage was 16%. 70.6% of patients were illiterate or had primary education. Burns occurred at the workplace and home in 12.9% and 66.1% of cases, respectively. Moreover, Burns occurred due to accident (61%), acid attack (29%), and self-immolation (10%). The average length of hospital stay was 20 days. One patient (1.6%) died from burns. Conclusion: The study’s findings revealed that chemical burns were more common in men than women, and the majority of chemical burns occurred at home. To minimize the occurrence of chemical burns and acid attacks, teaching methods of preventing burns is important at home and work, as well as restricting non-specialists’ access to chemicals.
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Affiliation(s)
| | - Ali Dehghani
- Department of Nursing, Jahrom University of Medical Sciences, Jahrom, Iran
| | - Ali Akbar Mohammadi
- Burn and Wound Healing Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Tayyeb Ghadimi
- Burn Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Abdolkhalegh Keshavarzi
- Department of General Surgery, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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10
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Yamamoto R, Sato Y, Sasaki J. Sparsity of burn centers and prolonged length of hospital stay: A nationwide study. Burns 2021; 47:1478-1485. [PMID: 34465508 DOI: 10.1016/j.burns.2021.08.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 08/18/2021] [Accepted: 08/18/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The optimal distribution of burn centers remains unclear. We aimed to determine the appropriate number of burn centers per population (density) and examined a nationwide registry with the hypothesis that low-density burn centers would be associated with unfavorable outcomes. PATIENTS AND METHODS A retrospective study was conducted using the Japanese Society of Burn Injury registry (2011-2021). Burn center density was defined as the number of burn centers per one million population in each prefecture, and centers were trisected on the basis of density. Hospital-free days until day 30 were compared between patients at high-, middle-, and low-density centers. Inverse probability weighting was conducted to adjust baseline characteristics, including age, burn mechanism, and burn severity. RESULTS We included 6764, 6209, and 2200 patients at high-, middle-, and low-density burn centers, respectively. After adjusting for patient demographics and burn severity, patients at high- and middle-density centers (≥0.4 centers per one million population) had longer hospital-free days compared with those at low-density centers (11 [0-23] vs 11 [0-23] vs 8 [0-22] days; p < 0.001). CONCLUSIONS Low burn center density (<0.4 centers per one million population) was associated with longer hospital stay, whereas no higher limit was determined.
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Affiliation(s)
- Ryo Yamamoto
- Department of Emergency and Critical Care Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo 160-8582, Japan.
| | - Yukio Sato
- Department of Emergency and Critical Care Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo 160-8582, Japan.
| | - Junichi Sasaki
- Department of Emergency and Critical Care Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo 160-8582, Japan.
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11
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Bhatia M, Gaddam RR. Hydrogen Sulfide in Inflammation: A Novel Mediator and Therapeutic Target. Antioxid Redox Signal 2021; 34:1368-1377. [PMID: 33138636 DOI: 10.1089/ars.2020.8211] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Significance: Inflammation is a normal response to injury, but uncontrolled inflammation can lead to several diseases. In recent years, research has shown endogenously synthesized hydrogen sulfide (H2S) to be a novel mediator of inflammation. This review summarizes the current understanding and recent advances of H2S role with respect to inflammation in different diseases. Recent Advances: Promising early results from clinical studies suggest an important role of H2S in human inflammatory disease. Critical Issues: Defining the precise mechanism by which H2S contributes to inflammation is a complex challenge, and there is active ongoing research that is focused on addressing this question. Most of this work has been conducted on animal models of human disease and isolated/cultured cells, and its translation to the clinic is another challenge in the area of H2S research. Future Directions: Defining the mechanism by which H2S acts as an inflammatory mediator will help us better understand different inflammatory diseases and help develop novel therapeutic approaches for these diseases.
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Affiliation(s)
- Madhav Bhatia
- Department of Pathology and Biomedical Science, University of Otago, Christchurch, Christchurch, New Zealand
| | - Ravinder Reddy Gaddam
- Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA
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Tracy LM, Cameron PA, Singer Y, Earnest A, Wood F, Cleland H, Gabbe BJ. Venous thromboembolism prophylaxis practice and its association with outcomes in Australia and New Zealand burns patients. BURNS & TRAUMA 2021; 9:tkaa044. [PMID: 33654696 PMCID: PMC7901708 DOI: 10.1093/burnst/tkaa044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 09/04/2020] [Indexed: 11/14/2022]
Abstract
Background Patients with burn injuries are considered to have an increased risk of venous thromboembolism (VTE). While untreated VTEs can be fatal, no studies have examined chemoprophylaxis effectiveness. This study aimed to quantify the variation in prevalence of VTE prophylaxis use in patients in Australian and New Zealand burns units and whether prophylaxis use is associated with in-hospital outcomes following burn injury. Methods Admission data for adult burns patients (aged ≥16 years) admitted between 1 July 2016 and 31 December 2018 were extracted from the Burns Registry of Australia and New Zealand. Mixed effects logistic regression modelling investigated whether VTE prophylaxis use was associated with the primary outcome of in-hospital mortality. Results There were 5066 admissions over the study period. Of these patients, 81% (n = 3799) with a valid response to the VTE prophylaxis data field received some form of VTE prophylaxis. Use of VTE prophylaxis ranged from 48.6% to 94.8% of patients between units. In-hospital death was recorded in <1% of patients (n = 33). After adjusting for confounders, receiving VTE prophylaxis was associated with a decrease in the adjusted odds of in-hospital mortality (adjusted odds ratio = 0.21; 95% CI, 0.07–0.63; p = 0.006). Conclusions Variation in the use of VTE prophylaxis was observed between the units, and prophylaxis use was associated with a decrease in the odds of mortality. These findings provide an opportunity to engage with units to further explore differences in prophylaxis use and develop future best practice guidelines.
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Affiliation(s)
- Lincoln M Tracy
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, Victoria, 3004, Australia
| | - Peter A Cameron
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, Victoria, 3004, Australia.,Emergency and Trauma Centre, The Alfred Hospital, Commercial Road, Melbourne, Victoria, 3004, Australia
| | - Yvonne Singer
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, Victoria, 3004, Australia.,Victorian Adult Burns Service, Alfred Hospital, 55 Commercial Road, Melbourne, Victoria, 3004, Australia, Australia
| | - Arul Earnest
- Registry Sciences Unit, Department of Epidemiology and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, Victoria, 3004, Australia.,Biostatistics Unit, Department of Epidemiology and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, Victoria, 3004, Australia
| | - Fiona Wood
- Burn Injury Research Unit, University of Western Australia, 35 Stirling Highway, Perth, Western Australia, 6009, Australia
| | - Heather Cleland
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, Victoria, 3004, Australia.,Victorian Adult Burns Service, Alfred Hospital, 55 Commercial Road, Melbourne, Victoria, 3004, Australia, Australia
| | - Belinda J Gabbe
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, Victoria, 3004, Australia.,Health Data Research UK, Swansea University Medical School, Swansea University, Singleton Park, Swansea, UK
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13
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Gong J, Singer Y, Cleland H, Wood F, Cameron P, Tracy LM, Gabbe BJ. Driving improved burns care and patient outcomes through clinical registry data: A review of quality indicators in the Burns Registry of Australia and New Zealand. Burns 2021; 47:14-24. [PMID: 32811694 DOI: 10.1016/j.burns.2020.01.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 12/19/2019] [Accepted: 01/16/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND In 2009, the Burns Registry of Australia and New Zealand (BRANZ) published a set of clinical quality indicators (QIs) to monitor performance, improve quality of care, and inform and change policy. With several years of data collected since the initial development of the indicators for burns, the BRANZ QI Working Party reviewed the clinical QIs for relevance and meaning, and considered new QIs that had not been collected previously. METHOD Using published literature and expert opinion, the QI Working Party, consisting of multidisciplinary burn clinicians, reviewed the QIs for burn care to be included as routine data items in the BRANZ. RESULTS In July 2016, the list of clinical QIs in the BRANZ was updated to 23 QIs/data items, covering structure, process, and outcome measures. Four QIs were removed as they were not found to be useful, nine QIs/data items were revised, and eight new QIs/data items were added as they were considered to be clinically useful. CONCLUSION This review outlines the changes made to the QIs collected by the BRANZ four years since their development and implementation. Ongoing refinement of the BRANZ QIs will ensure that high quality data is collected to drive improvements in clinical and patient outcomes.
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Affiliation(s)
- Jennifer Gong
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, Victoria, 3004, Australia
| | - Yvonne Singer
- Victorian Adult Burns Service, Alfred Hospital, 55 Commercial Road, Melbourne, Victoria, 3004, Australia
| | - Heather Cleland
- Victorian Adult Burns Service, Alfred Hospital, 55 Commercial Road, Melbourne, Victoria, 3004, Australia
| | - Fiona Wood
- State Adult Burn Unit, Fiona Stanley Hospital, 11 Warren Drive, Murdoch, Western Australia, 6150, Australia; Burn Injury Research Unit, University of Western Australia, Perth, Western Australia, 6009, Australia
| | - Peter Cameron
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, Victoria, 3004, Australia; Emergency and Trauma Centre, Alfred Hospital, 55 Commercial Road, Melbourne, Victoria, 3004, Australia
| | - Lincoln M Tracy
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, Victoria, 3004, Australia
| | - Belinda J Gabbe
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, Victoria, 3004, Australia; Health Data Research UK, Swansea University Medical School, Swansea University, Singleton Park, Swansea, Wales, United Kingdom.
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14
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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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15
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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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Amirzade-Iranaq MH, Salamati P. Comparing burn-related mortalities among Australia, New Zealand, and Iran. Burns 2020; 46:1484-1485. [PMID: 32475798 DOI: 10.1016/j.burns.2020.04.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 04/23/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Mohammad Hosein Amirzade-Iranaq
- Universal Network of Interdisciplinary Research in Oral and Maxillofacial Surgery (UNIROMS), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Payman Salamati
- National Trauma Registry of Iran, Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran.
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Tracy LM, Singer Y, Schrale R, Gong J, Darton A, Wood F, Kurmis R, Edgar D, Cleland H, Gabbe BJ. Epidemiology of burn injury in older adults: An Australian and New Zealand perspective. Scars Burn Heal 2020; 6:2059513120952336. [PMID: 33062309 PMCID: PMC7534068 DOI: 10.1177/2059513120952336] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION The ageing global population presents a novel set of challenges for trauma systems. Less research has focused on the older adult population with burns and how they differ compared to younger patients. This study aimed to describe, and compare with younger peers, the number, causes and surgical management of older adults with burn injuries in Australia and New Zealand. METHODS The Burns Registry of Australia and New Zealand was used to identify patients with burn injuries between 1 July 2009 and 31 December 2018. Temporal trends in incidence rates were evaluated and categorised by age at injury. Patient demographics, injury severity and event characteristics, surgical intervention and in-hospital outcomes were investigated. RESULTS There were 2394 burn-injured older adults admitted during the study period, accounting for 13.4% of adult admissions. Scalds were the most common cause of burn injury in older adults. The incidence of older adult burns increased by 2.96% each year (incidence rate ratio = 1.030, 95% confidence interval = 1.013-1.046, P < 0.001). Compared to their younger peers, a smaller proportion of older adult patients were taken to theatre for a surgical procedure, though a larger proportion of older adults received a skin graft. DISCUSSION Differences in patient and injury characteristics, surgical management and in-hospital outcomes were observed for older adults. These findings provide the Australian and New Zealand burn care community with a greater understanding of burn injury and their treatments in a unique group of patients who are at risk of poorer outcomes than younger people. LAY SUMMARY The number and proportion of older persons in every country of the world is growing. This may create challenges for healthcare systems. While burn injuries are a unique subset of trauma that affect individuals of all ages, less is known about burns in older adults and how they differ from younger patients.We wanted to look at the number, type, management, and outcomes of burns in older adults in Australia and New Zealand. To do this, we used data from the Burns Registry of Australia and New Zealand, or BRANZ. The BRANZ is a database that collects information on patients that present to Australian and New Zealand hospitals that have a specialist burns unit.Our research found that one in eight adult burns patients was over the age of 65, and that the rate of burn injuries in older adults has increased over the last decade. Older adult burns patients were most commonly affected by scalds after coming in contact with wet heat such as boiling liquids or steam. Fewer older adults went to theatre for an operation or surgical procedure compared to their younger counterparts. However, a larger proportion of older adults that went to theatre had a skin graft (where skin is removed from an uninjured part of the body and placed over the injured part).This research provides important information about a unique and growing group of patients to the local burn care community. It also highlights potential avenues for injury prevention initiatives.
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Affiliation(s)
- Lincoln M Tracy
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Yvonne Singer
- Victorian Adult Burns Service, Alfred Hospital, Melbourne, VIC, Australia
| | - Rebecca Schrale
- Tasmanian Burns Unit, Royal Hobart Hospital, Hobart, TAS, Australia
| | - Jennifer Gong
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Anne Darton
- Statewide Burn Injury Service, NSW Agency for Clinical Innovation, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Fiona Wood
- Burn Injury Research Unit, University of Western Australia, Perth, WA, Australia
- State Adult Burn Unit, Fiona Stanley Hospital, Murdoch, WA, Australia
| | - Rochelle Kurmis
- Adult Burns Service, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Dale Edgar
- Burn Injury Research Unit, University of Western Australia, Perth, WA, Australia
- State Adult Burn Unit, Fiona Stanley Hospital, Murdoch, WA, Australia
- Burn Injury Research Node, The University of Notre Dame, Fremantle, WA, Australia
| | - Heather Cleland
- Victorian Adult Burns Service, Alfred Hospital, Melbourne, VIC, Australia
- Department of Surgery, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Belinda J Gabbe
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Health Data Research UK, Swansea University Medical School, Swansea University, Singleton Park, Swansea, Wales
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