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Adhikari S, Gurung R, Bastakoti S, Alrasheedy AA, KC B. Burn pain management in a female patient with severe burn injuries in Nepal: a case study and review. Pain Manag 2024; 14:323-329. [PMID: 39101437 PMCID: PMC11340753 DOI: 10.1080/17581869.2024.2382072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Accepted: 07/16/2024] [Indexed: 08/06/2024] Open
Abstract
Burn injuries in low-resource settings like Nepal present significant public health challenges, leading to substantial morbidity, mortality and severe pain. This paper assesses burn pain management in Nepal, emphasizing the need for enhanced strategies. A case study of a female patient with severe burn injuries from a rural village in Western Nepal illustrates current challenges. Reviewing studies on burn pain management in Nepal shows limited access to specialized facilities, inadequate palliative care, medication shortages and insufficient healthcare professionals. Pharmacological interventions are impacted by financial constraints and a lack of protocols, while nonpharmacological approaches have not been explored and contextualized for the Nepalese context due to similar financial issues. Comprehensive burn pain management requires addressing resource constraints through collaborative health-aid partnerships.
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Affiliation(s)
- Sundar Adhikari
- Department of Pharmacy, Fishtail Hospital and Research Center, Pvt. Ltd., Gairapatan-4, Pokhara, Nepal
| | | | - Suresh Bastakoti
- Nepalese Army Institute of Health Sciences, Shree Birendra Hospital, Kathmandu, Nepal
| | | | - Bhuvan KC
- Discipline of Pharmacy, School of Clinical Sciences, Queensland University of Technology, Brisbane, Australia
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Hauc SC, Stögner VA, Ihnat JM, Hosseini H, Huelsboemer L, Kauke-Navarro M, Rivera JC, Williams M, Glahn JZ, Savetamal A, Pomahac B. Understanding the Drivers of Cost and Length of Stay in a Cohort of 21,875 Patients with Severe Burn. J Burn Care Res 2024; 45:425-431. [PMID: 37882472 DOI: 10.1093/jbcr/irad168] [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: 06/18/2023] [Indexed: 10/27/2023]
Abstract
Burn management has significantly advanced in the past 75 years, resulting in improved mortality rates. However, there are still over one million burn victims in the United States each year, with over 3,000 burn-related deaths annually. The impacts of individual patient, hospital, and regional demographics on length of stay (LOS) and total cost have yet to be fully explored in a large nationally representative cohort. Thus, this study aimed to examine various hospital and patient characteristics using a sample of over 20,000 patients. Inpatient data from the National Inpatient Sample from 2008 to 2015 were analyzed, and only patients with an ICD-9 code for second- or third-degree burns were included. In addition, a major operating room procedure must have been indicated on the discharge summary for patients to be included in the final dataset, ensuring that only severe burns requiring complex care were analyzed. Analysis of covariance models was used to evaluate the impact of various patient, hospital, and regional variables on both LOS and cost. The study found that skin grafts and fasciotomy significantly increased the cost of hospitalization. Having burns on the face, neck, and trunk significantly increased costs for patients with second-degree burns, while burns on the trunk resulted in the longest LOS for patients with third-degree burns. Infections in the hospital and additional procedures, such as flaps and skin grafts, also led to longer stays. The study also found that the prevalence of postoperative complications, such as electrolyte imbalance, was high among patients with burn surgery.
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Affiliation(s)
- Sacha C Hauc
- Department of Surgery, Plastic and Reconstructive Surgery, Yale School of Medicine, New Haven, 06511, CT, USA
| | - Viola Antonia Stögner
- Department of Surgery, Plastic and Reconstructive Surgery, Yale School of Medicine, New Haven, 06511, CT, USA
- Department of Plastic, Aesthetic, Hand and Reconstructive Surgery, Burn Center, Hannover Medical School, Hannover, Germany
| | - Jacqueline M Ihnat
- Department of Surgery, Plastic and Reconstructive Surgery, Yale School of Medicine, New Haven, 06511, CT, USA
| | - Helia Hosseini
- Department of Surgery, Plastic and Reconstructive Surgery, Yale School of Medicine, New Haven, 06511, CT, USA
| | - Lioba Huelsboemer
- Department of Surgery, Plastic and Reconstructive Surgery, Yale School of Medicine, New Haven, 06511, CT, USA
| | - Martin Kauke-Navarro
- Department of Surgery, Plastic and Reconstructive Surgery, Yale School of Medicine, New Haven, 06511, CT, USA
| | - Jean C Rivera
- Department of Surgery, Plastic and Reconstructive Surgery, Yale School of Medicine, New Haven, 06511, CT, USA
| | - Mica Williams
- Department of Surgery, Plastic and Reconstructive Surgery, Yale School of Medicine, New Haven, 06511, CT, USA
| | - Joshua Z Glahn
- Department of Surgery, Plastic and Reconstructive Surgery, Yale School of Medicine, New Haven, 06511, CT, USA
| | - Alisa Savetamal
- Department of Surgery, Plastic and Reconstructive Surgery, Yale School of Medicine, New Haven, 06511, CT, USA
| | - Bohdan Pomahac
- Department of Surgery, Plastic and Reconstructive Surgery, Yale School of Medicine, New Haven, 06511, CT, USA
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Gerstl JVE, Ehsan AN, Lassarén P, Yearley A, Raykar NP, Anderson GA, Smith TR, Sabapathy SR, Ranganathan K. The Global Macroeconomic Burden of Burn Injuries. Plast Reconstr Surg 2024; 153:743-752. [PMID: 37093034 DOI: 10.1097/prs.0000000000010595] [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: 04/25/2023]
Abstract
BACKGROUND Standardized estimates of global economic losses from burn injuries are lacking. The primary objective of this study was to determine the global macroeconomic consequences of burn injuries and their geographic distribution. METHODS Using the Institute of Health Metrics and Evaluation database (2009 and 2019), mean and 95% uncertainty interval (UI) data on incidence, mortality, and disability-adjusted life-years (DALYs) from injuries caused by fire, heat, and hot substances were collected. Gross domestic product (GDP) data were analyzed together with DALYs to estimate macroeconomic losses globally using a value of lost welfare approach. RESULTS There were 9 million global burn cases (95% UI, 6.8 to 11.2 million) and 111,000 deaths from burns (95% UI, 88,000 to 132,000 deaths) in 2019, representing a total of 7.5 million DALYs (95% UI, 5.8 to 9.5 million DALYs). This represented welfare losses of $112 billion (95% UI, $78 to $161 billion), or 0.09% of GDP (95% UI, 0.06% to 0.13%). Welfare losses as a share of GDP were highest in low- and middle-income countries (LMICs) of Oceania (0.24%; 95% UI, 0.09% to 0.42%) and Eastern Europe (0.24%; 95% UI, 0.19% to 0.30%) compared with high-income country regions such as Western Europe (0.06%; 95% UI, 0.04% to 0.09%). Mortality-incidence ratios were highest in LMIC regions, highlighting a lack of treatment access, with southern sub-Saharan Africa reporting a mortality-incidence ratio of 40.1 per 1000 people compared with 1.9 for Australasia. CONCLUSIONS Burden of disease and resulting economic losses because of burn injuries are substantial worldwide and are disproportionately higher in LMICs. Possible effective solutions include targeted education, advocacy, and legislation to decrease incidence and investing in existing burn centers to improve treatment access.
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Affiliation(s)
- Jakob V E Gerstl
- From the Departments of Neurosurgery
- University College London Medical School
| | - Anam N Ehsan
- Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School
| | | | | | - Nakul P Raykar
- Surgery, Brigham and Women's Hospital, Harvard Medical School
- Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School
| | - Geoffrey A Anderson
- Surgery, Brigham and Women's Hospital, Harvard Medical School
- Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School
| | | | - S Raja Sabapathy
- Department of Plastic Surgery, Hand, Reconstructive, and Burn Surgery, Ganga Hospital
| | - Kavitha Ranganathan
- Surgery, Brigham and Women's Hospital, Harvard Medical School
- Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School
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Sari H, Akkoc MF, Kilinç Z, Dayanir Çok FN, Özel M, Özel V. Investigation of morbidity, length of stay, and healthcare costs of inpatient paediatric burns. Int Wound J 2024; 21:e14385. [PMID: 37666243 PMCID: PMC10782072 DOI: 10.1111/iwj.14385] [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: 06/20/2023] [Revised: 08/23/2023] [Accepted: 08/24/2023] [Indexed: 09/06/2023] Open
Abstract
Burn injuries are the third most common cause of death in children due to trauma. Hospitalizations related to burn injuries are common. Prolonged hospitalization associated with burn treatment can result in increased resource utilization, leading to higher costs. Thus, it is essential to investigate these areas to reduce costs. The study investigated the morbidity and length of hospital stay of paediatric burn patients, as well as calculated the social security costs of hospitalization and treatment. The retrospective observational descriptive study examined the medical records of 774 paediatric patients treated in a burn intensive care unit at a tertiary medical faculty hospital between 01 March 2019 and 31 March 2022. The invoice records of payments made by the Social Security Institution to the hospital in return for health services provided to patients were examined. The healthcare costs were calculated. A total of 57.6% of the participants were boys and 79.2% were between the ages of 1-4. About 90% of the cases involved burns with a total body surface area (TBSA) of less than 20% and a 2nd-degree burn depth. Scalding was the most common cause of burns (88.2%). Among all patients, the mortality rate was 2.1% (n = 16). The mean length of hospital stay was 10.29 ± 9.59 days. The mean cost per day was 212.02 ± 190.94 US dollars ($US), and the cost per 1% TBSA was 241.70 ± 301.32 $US. According to the causes of burn injury, the mean cost of electricity was 5000.77 ± 8101.85 $US, fire 4818.02 ± 5852.22 $US, and chemical 3285.49 ± 4503.2 $US were observed in the first 3 ranks respectively. According to this study, paediatric burn cases occur due to preventable causes, and even though the mortality rate was low, the severity of burns, TBSA%, and presence of complications caused prolonged lengths of hospital stays, which caused social security costs to rise.
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Affiliation(s)
- Hıdır Sari
- Department of Public HealthDicle University Faculty of MedicineDiyarbakırTurkey
| | - Mehmet Fatih Akkoc
- Department of Plastic Reconstructive and Aesthetic SurgeryDicle University Faculty of MedicineDiyarbakırTurkey
| | - Zehra Kilinç
- Department of Public HealthDicle University Faculty of MedicineDiyarbakırTurkey
| | | | - Mehmet Özel
- Department of Emergency MedicineDiyarbakır Gazi Yasargil Training and Research Hospital, University of Health SciencesDiyarbakırTurkey
| | - Volkan Özel
- Department of Plastic Reconstructive and Aesthetic SurgeryDicle University Faculty of MedicineDiyarbakırTurkey
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Keshri VR, Peden M, Singh P, Norton R, Abimbola S, Jagnoor J. Health systems research in burn care: an evidence gap map. Inj Prev 2023; 29:446-453. [PMID: 37532304 DOI: 10.1136/ip-2023-044963] [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: 05/06/2023] [Accepted: 07/13/2023] [Indexed: 08/04/2023]
Abstract
BACKGROUND Burn injury is associated with significant mortality and disability. Resilient and responsive health systems are needed for optimal response and care for people who sustain burn injuries. However, the extent of health systems research (HSR) in burn care is unknown. This review aimed to systematically map the global HSR related to burn care. METHODS An evidence gap map (EGM) was developed based on the World Health Organization health systems framework. All major medical, health and injury databases were searched. A standard method was used to develop the EGM. RESULTS A total of 6586 articles were screened, and the full text of 206 articles was reviewed, of which 106 met the inclusion criteria. Most included studies were cross-sectional (61%) and were conducted in hospitals (71%) with patients (48%) or healthcare providers (29%) as participants. Most studies were conducted in high-income countries, while only 13% were conducted in low-and middle-income countries, accounting for 60% of burns mortality burden globally. The most common health systems areas of focus were service delivery (53%), health workforce (33%) and technology (19%). Studies on health policy, governance and leadership were absent, and there were only 14 qualitative studies. CONCLUSIONS Major evidence gaps exist for an integrated health systems response to burns care. There is an inequity between the burden of burn injuries and HSR. Strengthening research capacity will facilitate evidence-informed health systems and policy reforms to sustainably improve access to affordable, equitable and optimal burn care and outcomes.
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Affiliation(s)
- Vikash Ranjan Keshri
- The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
- Injury Division, The George Institute for Global Health India, New Delhi, Delhi, India
| | - Margaret Peden
- The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
- The George Institute for Global Health UK, Imperial College London, London, UK
| | - Pratishtha Singh
- Injury Division, The George Institute for Global Health India, New Delhi, Delhi, India
| | - Robyn Norton
- The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
- The George Institute for Global Health UK, Imperial College London, London, UK
| | - Seye Abimbola
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Jagnoor Jagnoor
- The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
- Injury Division, The George Institute for Global Health India, New Delhi, Delhi, India
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Handayani E, Wahyuningtyas ES, Nugroho HP. A scoping review of burn care in Southeast Asia. Br J Community Nurs 2023; 28:S24-S34. [PMID: 36809899 DOI: 10.12968/bjcn.2023.28.sup3.s24] [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: 02/24/2023]
Abstract
BACKGROUND Non-fatal burns are a major cause of morbidity, with incidents often occuring at home and at work. Almost all burn cases occur in the WHO region, precisely in African and Southeast Asian countries. Yet, the epidemiology of these injuries, especially in the WHO-defined Southeast Asian Region, has yet to be adequately defined. METHOD A scoping review of the literature was performed to identify epidemiology of thermal, chemical, and electrical burns in the WHO-defined Southeast Asian Region. The database search screened 1023 articles in total, of which 83 articles were assessed for eligibility at a full-text level, and 58 of these were excluded. Therefore, 25 full-text articles were included for data extraction and analysis. RESULTS Data analysed included demographics, injury details, burn mechanism, total body surface area burned, and in-hospital mortality. CONCLUSION Despite the steady increase on burns research, the Southeast Asian region is still limited in terms of burns data. This scoping review has shown that the largest set of articles on burns come from Southeast Asia, indicating the importance of reviewing data at a regional or local level, as global studies tend to be dominated by data from high-income countries.
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Affiliation(s)
- Estrin Handayani
- Nursing Lecturer at the Department of Medical Surgical Nursing, Faculty of Health Sciences, Universitas Muhammadiyah Magelang, Indonesia.,Wound Study Center (WOSCE), Magelang, Indonesia
| | - Eka Sakti Wahyuningtyas
- Nursing Lecturer at the Department of Medical Surgical Nursing, Faculty of Health Sciences, Universitas Muhammadiyah Magelang, Indonesia.,Wound Study Center (WOSCE), Magelang, Indonesia
| | - Hananto Ponco Nugroho
- Nursing Lecturer at the Department of Medical Surgical Nursing, Faculty of Health Sciences, Universitas Muhammadiyah Magelang, Indonesia
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The relationship between posttraumatic growth, self-efficacy, and social support in burn patients: A cross-sectional study. Burns 2022; 48:1626-1631. [DOI: 10.1016/j.burns.2022.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 06/20/2022] [Accepted: 08/22/2022] [Indexed: 11/21/2022]
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Venturi M, Bruzziches F, Orlandi C, Altini M, Rubegni P, Melandri D. Economic Burden of Denatured Alcohol-Induced Burns: A 20-Year Retrospective Study. Front Med (Lausanne) 2022; 9:914976. [PMID: 35783652 PMCID: PMC9241105 DOI: 10.3389/fmed.2022.914976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 05/02/2022] [Indexed: 11/13/2022] Open
Abstract
Burn care has rapidly improved over the past decades, but health innovations are expensive. We present the first study focusing on the economic burden of exclusive denatured alcohol-induced burns. The goal of this study was to determine costs for the public health system due to inpatients’ burn care because of these specific burns. Moreover, we aimed to observe the incidence of methylated spirit-related burns in the past 20 years. We performed an observational retrospective study in our burn unit including all patients with a denatured alcohol-related burn injury from 1 January 2001 to 31 December 2020. A total of 503 patients with a mean burn size of 24% were hospitalized; the mean annual total costs per patient was €43,879, varying from €31,518 to €63,274.00€; the total costs for denatured alcohol-related burns during the period 2001–2020 was €21,145,076. We noted an increasing incidence of denatured alcohol-related burns and related costs over the years, especially in the last decade. Our results highlight that burns by methylated spirits are still a real and expanding problem. Therefore, authorities should focus on sales rules, characteristics of the containers, and education of people who misuse denatured alcohol, based on historical habits of use. To reduce the socioeconomic costs of burns, future intervention strategies and studies from the dermatology community and burn specialists should focus on prevention programs and prompt wound healing to shorten the length of hospital stay, enable quick return to work, and improve the outcomes of patients with burns.
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Affiliation(s)
- Michela Venturi
- Dermatology Unit and Burn Center, Azienda Unità Sanitaria Locale (AUSL) Romagna, Bufalini Hospital, Cesena, Italy
| | - Francesco Bruzziches
- Dermatology Unit and Burn Center, Azienda Unità Sanitaria Locale (AUSL) Romagna, Bufalini Hospital, Cesena, Italy
- Dermatology Unit, Department of Medical, Surgical and Neurological Science, Santa Maria alle Scotte Hospital, University of Siena, Siena, Italy
| | - Catuscia Orlandi
- Dermatology Unit and Burn Center, Azienda Unità Sanitaria Locale (AUSL) Romagna, Bufalini Hospital, Cesena, Italy
| | - Mattia Altini
- Medical Direction, Azienda Unità Sanitaria Locale (AUSL) Romagna, Ravenna, Italy
| | - Pietro Rubegni
- Dermatology Unit, Department of Medical, Surgical and Neurological Science, Santa Maria alle Scotte Hospital, University of Siena, Siena, Italy
| | - Davide Melandri
- Dermatology Unit and Burn Center, Azienda Unità Sanitaria Locale (AUSL) Romagna, Bufalini Hospital, Cesena, Italy
- *Correspondence: Davide Melandri,
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