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Long B, Graybill JC, Rosenberg H. Just the facts: evaluation and management of thermal burns. CAN J EMERG MED 2021; 24:128-130. [PMID: 34727364 DOI: 10.1007/s43678-021-00222-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 10/04/2021] [Indexed: 11/24/2022]
Affiliation(s)
- Brit Long
- Department of Emergency Medicine, Brooke Army Medical Center, 3841 Roger Brooke Dr, Fort Sam Houston, TX, 78234, USA.
| | | | - Hans Rosenberg
- Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada
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2
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Muenzberg M, Kaeppler K, Hundeshagen G, Kenngott T, Ziegler B, Gruetzner PA, Kneser U, Hirche C. Thermo-mechanical combination injuries - A rare but life-threatening entity. J Burn Care Res 2021; 43:691-695. [PMID: 34537838 DOI: 10.1093/jbcr/irab176] [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
Thermo-mechanical-combination-injuries (TMCI) are feared for their demanding preclinical and clinical management and bear the risk of high mortality compared to the single injury of a severe burn or multiple traumata. There remains a significant lack of standardized algorithms for diagnostics, and therapy of this rare entity. The aim of the present study was to profile TMCI aiming at standardized procedures. In this study, TMCI were extracted from our burn database of a level 1 burn and trauma centre. From 2004 to 2017, all patients with TMCI were retrospectively analyzed. Further inclusion criteria were multiple trauma accompanied by burn with ≥10% TBSA. Patient and injury characteristics including ISS and outcome parameter were analyzed. A total of 45 patients matched the selective inclusion criteria of TMCI comprising of 4% of all burn injuries during the period. Average age was 38 years (range: 14-86), with a mean TBSA of 43% (range: 10-97%). The mean recorded temperature at admission was 34.8°C (range: 29.6 - 37.1) with 2215 ml volume (range: 500 - 8000) administered preclinically in total. The mean ISS was 16. The overall mortality rate was 22%. TMCI are rare and life-threatening events which require highly qualified management in combined level 1 trauma and burn centres to adress both burn and trauma treatment. The multiple injury pattern is diverse, complicating standardized management in view of burn care specific measures, as normothermia and restrictive volume management. The present study reveals further profiles and underlines the need for addressing TMCI in ABLS®; ATLS® and PHTLS® programs.
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Affiliation(s)
- Matthias Muenzberg
- Department for Rescue- and Emergency Medicine, BG Trauma Centre, Ludwigshafen/Rhine, Germany.,Department for Trauma- and Orthopaedic Surgery, BG Trauma Centre, Department of Trauma, University of Heidelberg, Ludwigshafen/Rhine, Germany
| | - Kathrin Kaeppler
- Department of Hand, Plastic and Reconstructive Surgery, Burn Centre, BG Trauma Centre Ludwigshafen/Rhine, Department of Hand and Plastic Surgery, University Heidelberg, Ludwigshafen/Rhine, Germany.,Department of Orthopaedics, Trauma Surgery and Paraplegiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Gabriel Hundeshagen
- Department of Hand, Plastic and Reconstructive Surgery, Burn Centre, BG Trauma Centre Ludwigshafen/Rhine, Department of Hand and Plastic Surgery, University Heidelberg, Ludwigshafen/Rhine, Germany
| | - Theresa Kenngott
- Department of Hand, Plastic and Reconstructive Surgery, Burn Centre, BG Trauma Centre Ludwigshafen/Rhine, Department of Hand and Plastic Surgery, University Heidelberg, Ludwigshafen/Rhine, Germany
| | - Benjamin Ziegler
- Department of Hand, Plastic and Reconstructive Surgery, Burn Centre, BG Trauma Centre Ludwigshafen/Rhine, Department of Hand and Plastic Surgery, University Heidelberg, Ludwigshafen/Rhine, Germany.,Department of Plastic, Hand and Reconstructive Microsurgery, Hand-Trauma and Replantation Centre, BG Unfallklinik Frankfurt am Main gGmbH, Goethe-University Frankfurt, Frankfurt, Germany
| | - Paul Alfred Gruetzner
- Department for Trauma- and Orthopaedic Surgery, BG Trauma Centre, Department of Trauma, University of Heidelberg, Ludwigshafen/Rhine, Germany
| | - Ulrich Kneser
- Department of Hand, Plastic and Reconstructive Surgery, Burn Centre, BG Trauma Centre Ludwigshafen/Rhine, Department of Hand and Plastic Surgery, University Heidelberg, Ludwigshafen/Rhine, Germany
| | - Christoph Hirche
- Department of Hand, Plastic and Reconstructive Surgery, Burn Centre, BG Trauma Centre Ludwigshafen/Rhine, Department of Hand and Plastic Surgery, University Heidelberg, Ludwigshafen/Rhine, Germany.,Department of Plastic, Hand and Reconstructive Microsurgery, Hand-Trauma and Replantation Centre, BG Unfallklinik Frankfurt am Main gGmbH, Goethe-University Frankfurt, Frankfurt, Germany
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3
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Jokuszies A, Martyniak L, Dastagir K, Weyand B, Vogt PM, Krezdorn N. [Reconstruction in polytraumatized burn patients]. Unfallchirurg 2021; 124:817-822. [PMID: 34283263 DOI: 10.1007/s00113-021-01053-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Polytraumatized burn patients represent a rare patient collective and necessitate an individualized treatment concept due to the particular combination of injuries. OBJECTIVE Against the background of this special injury pattern, especially with deep burns overlying the fracture zone, the question of a specific and interdisciplinary treatment algorithm arises. MATERIAL AND METHODS This article is based on a PubMed database search and experiences of a trauma center for severely injured burn patients at a university hospital, with presentation of the special therapeutic requirements and goals exemplified by a case report. RESULTS The evaluation of the literature search and own treatment results comes to the conclusion that the rate and extent of amputations and infections can be reduced by an early and interdisciplinary involvement of the plastic surgeon by early combined fracture stabilization, excision of necrotic tissue and immediate skin grafting. Furthermore, plastic reconstructive procedures enable a functional and esthetic reconstruction with optimized prosthesis fitting. CONCLUSION Polytraumatized severely burned patients necessitate an interdisciplinary treatment approach, whereby preservation of length, functionality and esthetic appearance of the affected extremities and concurrent avoidance of bone and soft tissue infections have utmost priority.
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Affiliation(s)
- Andreas Jokuszies
- Klinik für Plastische, Ästhetische, Hand- und Wiederherstellungschirurgie, Replantationszentrum, Schwerbrandverletztenzentrum, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland.
| | - L Martyniak
- Klinik für Plastische, Ästhetische, Hand- und Wiederherstellungschirurgie, Replantationszentrum, Schwerbrandverletztenzentrum, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
| | - K Dastagir
- Klinik für Plastische, Ästhetische, Hand- und Wiederherstellungschirurgie, Replantationszentrum, Schwerbrandverletztenzentrum, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
| | - B Weyand
- Klinik für Plastische, Ästhetische, Hand- und Wiederherstellungschirurgie, Replantationszentrum, Schwerbrandverletztenzentrum, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
| | - P M Vogt
- Klinik für Plastische, Ästhetische, Hand- und Wiederherstellungschirurgie, Replantationszentrum, Schwerbrandverletztenzentrum, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
| | - N Krezdorn
- Klinik für Plastische, Ästhetische, Hand- und Wiederherstellungschirurgie, Replantationszentrum, Schwerbrandverletztenzentrum, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
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Chang J, Hejna E, Fu CY, Bajani F, Tatabe L, Schlanser V, Kaminsky M, Dennis A, Starr F, Messer T, Poulakidas S, Bokhari F. Patients With Combined Thermal and Intraabdominal Injuries: More Salvageable Than Not. J Burn Care Res 2020; 41:835-840. [PMID: 32266403 DOI: 10.1093/jbcr/iraa052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
This study aims to better characterize the course and outcome of the uncommon subset of trauma patients with combined thermal and intraabdominal organ injuries. The National Trauma Data Bank was queried for burn patients with intraabdominal injury treated in all U.S. trauma centers from July 1, 2011 to June 30, 2015. General demographics, Glasgow coma scale (GCS), shock index (SI), Abbreviated Injury Scale (AIS) for burn, Injury Severity Score (ISS), blood transfusions, and abdominal surgery were evaluated. During the 5-year study period, there were 334 burn patients with intraabdominal injury, 39 (13.2%) of which received abdominal surgery. Burn patients who underwent operations had more severe injuries reflected by higher SI, AIS, ISS, blood transfusion, and worse outcomes including higher mortality, longer hospital and ICU length of stay, and more ventilator days compared to patients who did not undergo an operation. Nonsurvivors also exhibited more severe injuries, and a higher proportion received abdominal operation compared to survivors. Multivariate logistic regression analysis revealed that GCS on arrival, SI, AIS, ISS, blood transfusion, and abdominal operation to be independent risk factors for mortality. Propensity score matching to control covariables (mean age, systolic blood pressure on arrival, GCS on arrival, SI, ISS, time to operation, blood transfusion, and comorbidities) showed that of trauma patients who received abdominal operation, those with concomitant burn injury exhibited a higher rate of complications but no significant difference in mortality compared to those without burns, suggesting that patients with concomitant burns are not less salvageable than nonburned trauma patients.
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Affiliation(s)
- Jaimie Chang
- Department of Trauma and Burn Surgery, Cook County Health, Chicago, Illinois
| | - Emily Hejna
- Department of Trauma and Burn Surgery, Cook County Health, Chicago, Illinois
| | - Chih-Yuan Fu
- Department of Trauma and Burn Surgery, Cook County Health, Chicago, Illinois.,Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taiwan
| | - Francesco Bajani
- Department of Trauma and Burn Surgery, Cook County Health, Chicago, Illinois
| | - Leah Tatabe
- Department of Trauma and Burn Surgery, Cook County Health, Chicago, Illinois
| | - Victoria Schlanser
- Department of Trauma and Burn Surgery, Cook County Health, Chicago, Illinois
| | - Matthew Kaminsky
- Department of Trauma and Burn Surgery, Cook County Health, Chicago, Illinois
| | - Andrew Dennis
- Department of Trauma and Burn Surgery, Cook County Health, Chicago, Illinois
| | - Frederick Starr
- Department of Trauma and Burn Surgery, Cook County Health, Chicago, Illinois
| | - Thomas Messer
- Department of Trauma and Burn Surgery, Cook County Health, Chicago, Illinois
| | - Stathis Poulakidas
- Department of Trauma and Burn Surgery, Cook County Health, Chicago, Illinois
| | - Faran Bokhari
- Department of Trauma and Burn Surgery, Cook County Health, Chicago, Illinois
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Muire PJ, Mangum LH, Wenke JC. Time Course of Immune Response and Immunomodulation During Normal and Delayed Healing of Musculoskeletal Wounds. Front Immunol 2020; 11:1056. [PMID: 32582170 PMCID: PMC7287024 DOI: 10.3389/fimmu.2020.01056] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 05/01/2020] [Indexed: 12/20/2022] Open
Abstract
Single trauma injuries or isolated fractures are often manageable and generally heal without complications. In contrast, high-energy trauma results in multi/poly-trauma injury patterns presenting imbalanced pro- and anti- inflammatory responses often leading to immune dysfunction. These injuries often exhibit delayed healing, leading to fibrosis of injury sites and delayed healing of fractures depending on the intensity of the compounding traumas. Immune dysfunction is accompanied by a temporal shift in the innate and adaptive immune cells distribution, triggered by the overwhelming release of an arsenal of inflammatory mediators such as complements, cytokines and damage associated molecular patterns (DAMPs) from necrotic cells. Recent studies have implicated this dysregulated inflammation in the poor prognosis of polytraumatic injuries, however, interventions focusing on immunomodulating inflammatory cellular composition and activation, if administered incorrectly, can result in immune suppression and unintended outcomes. Immunomodulation therapy is promising but should be conducted with consideration for the spatial and temporal distribution of the immune cells during impaired healing. This review describes the current state of knowledge in the spatiotemporal distribution patterns of immune cells at various stages during musculoskeletal wound healing, with a focus on recent advances in the field of Osteoimmunology, a study of the interface between the immune and skeletal systems, in long bone fractures. The goals of this review are to (1) discuss wound and fracture healing processes of normal and delayed healing in skeletal muscles and long bones; (2) provide a balanced perspective on temporal distributions of immune cells and skeletal cells during healing; and (3) highlight recent therapeutic interventions used to improve fracture healing. This review is intended to promote an understanding of the importance of inflammation during normal and delayed wound and fracture healing. Knowledge gained will be instrumental in developing novel immunomodulatory approaches for impaired healing.
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Affiliation(s)
- Preeti J. Muire
- Orthopaedic Trauma Research Department, US Army Institute of Surgical Research, Fort Sam Houston, TX, United States
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6
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Bui D, Sivakumar BS, Ellis A. Collocated burn and fracture injuries in major trauma: a 10 year experience. Ann R Coll Surg Engl 2020; 102:256-262. [PMID: 32081026 DOI: 10.1308/rcsann.2020.0020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION Collocated burn and fracture injuries, defined as a burn overlying the site of a fracture, represent a serious subset of major burns and trauma. The literature pertaining to these rare injuries is inconclusive. Recent studies cast doubt on the safety of operative fixation in this population. No study to date has examined outcomes of collocated burn and fracture injuries compared with control. The aim of this study was to compare characteristics, injury patterns and complication rates in major burns and fracture patients with a collocated injury to those without. METHODS A retrospective chart review of all consecutive patients with dermal burns and major fractures were undertaken between January 2005 and December 2015 at a tertiary referral trauma hospital. Outcomes assessed included demographics, injury characteristics and complications, including infection. Orthopaedic infection was defined as orthopaedic surgical site infection or osteomyelitis. RESULTS Of the 40 patients identified, 21 subjects sustained collocated injuries. Patients with collocated injuries demonstrated a trend towards higher injury severity, higher percentage of total body surface area affected, longer length of stay and greater overall and orthopaedic complication rate. Significant predictors of orthopaedic infection were related to injury severity rather than collocation or operative management. CONCLUSION There are differences in the characteristics and complication rates between collocated and non-collocated burn and fracture injuries. Collocated injuries tend to result from greater energy mechanisms, undergo longer inpatient stays and demonstrate increased morbidity. Injury severity appears to be the most important factor in determining postoperative orthopaedic infection. These characteristics must be considered when managing these rare but significant injuries.
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Affiliation(s)
- D Bui
- Royal North Shore Hospital, Sydney, Australia
| | | | - A Ellis
- Royal North Shore Hospital, Sydney, Australia
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Battaloglu E, Iniguez MF, Lecky F, Porter K. Incidence of combined burns and major trauma in England and Wales. TRAUMA-ENGLAND 2020. [DOI: 10.1177/1460408618817107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction Within the United Kingdom’s major trauma networks, limited consideration is given to the management of concomitant burns and trauma injuries, prominently highlighted in the arrangement of specialist services for major trauma and burns care. The majority of the literature regarding this topic, based almost exclusively on North American studies, predicts between 5 and 7% of all patients admitted to burns centres will suffer from concomitant (non-thermal) trauma injuries, in addition to their burn injuries. The aim of this study is to understand the epidemiology and outcomes for patients sustaining burns and trauma injuries in England and Wales. Methods A retrospective review of patients sustaining concomitant burns and trauma injuries was made over a 71-month period from January 2010 to November 2016, using the national trauma registry for England and Wales, the Trauma Audit and Research Network database, identifying all patients with injury codes for burns and trauma (AIS >3). Data collected comprised patient demographic information, burn injury percentages, details of trauma injuries, details of hospital stay, and patient outcome. Comparison of information was made against the total burns and total trauma cohort to form a base standard for burns and trauma injuries, respectively. Results Over the period analysed, 188 patients were found to have concomitant burns and trauma injuries. The patients were stratified according to age and the percentage of total body surface area burned. Hospital length of stay for concomitant burns and trauma patients was found to be higher than that of patients with isolated burns injuries. Mortality rates, although low overall, were found to be relatively higher for patients with concomitant burns and trauma injuries. Conclusions This study demonstrated the rarity of this combination of injury pattern, in particular the occurrence of severe burns in the presence of major trauma, in UK. Improvements in burns care and trauma care hopefully contributes to the higher level of survival in concomitantly injured patients against data from previous literature. However, the synergistic effect of burns and trauma injuries appears to impact on the course of such patients, although larger scale analysis is required to determine the true prognostic factors.
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Affiliation(s)
- Emir Battaloglu
- Department of Trauma & Orthopaedics, University Hospitals Birmingham, UK
| | | | - Fiona Lecky
- Trauma Audit Research Network, Salford Royal NHS Foundation Trust
| | - Keith Porter
- Department of Trauma & Orthopaedics, University Hospitals Birmingham, UK
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8
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Ewbank C, Sheckter CC, Warstadt NM, Pirrotta EA, Curtin C, Newton C, Wang NE. Variations in access to specialty care for children with severe burns. Am J Emerg Med 2019; 38:1146-1152. [PMID: 31474377 DOI: 10.1016/j.ajem.2019.158401] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 08/09/2019] [Accepted: 08/18/2019] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Pediatric burns account for 120,000 emergency department visits and 10,000 hospitalizations annually. The American Burn Association has guidelines regarding referrals to burn centers; however there is variation in burn center distribution. We hypothesized that disparity in access would be related to burn center access. METHODS Using weighted discharge data from the Nationwide Inpatient Sample 2001-2011, we identified pediatric patients with International Classification of Diseases-9th Revision codes for burns that also met American Burn Association criteria. Key characteristics were compared between pediatric patients treated at burn centers and those that were not. RESULTS Of 54,529 patients meeting criteria, 82.0% (n = 44,632) were treated at burn centers. Patients treated at burn centers were younger (5.6 versus 6.7 years old; p < 0.0001) and more likely to have burn injuries on multiple body regions (88% versus 12%; p < 0.0001). In urban areas, 84% of care was provided at burn centers versus 0% in rural areas (p < 0.0001), a difference attributable to the lack of burn centers in rural areas. Both length of stay and number of procedures were significantly higher for patients treated at burn centers (7.3 versus 4.4 days, p < 0.0001 and 2.3 versus 1.1 procedures, p < 0.0001; respectively). There were no significant differences in mortality (0.7% versus 0.8%, p = 0.692). CONCLUSION The majority of children who met criteria were treated at burn centers. There was no significant difference between geographical regions. Of those who were treated at burn centers, more severe injury patterns were noted, but there was no significant mortality difference. Further study of optimal referral of pediatric burn patients is needed.
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Affiliation(s)
- Clifton Ewbank
- University of California San Francisco East Bay Department of Surgery, Oakland, CA, United States of America; University of California San Francisco Benioff Children's Hospital Oakland, Oakland, CA, United States of America.
| | - Clifford C Sheckter
- Stanford University Department of Surgery, Stanford, CA, United States of America
| | - Nicholus M Warstadt
- Stanford University School of Medicine, Stanford, CA, United States of America
| | | | - Catherine Curtin
- Stanford University Department of Surgery, Stanford, CA, United States of America
| | - Christopher Newton
- University of California San Francisco Benioff Children's Hospital Oakland, Oakland, CA, United States of America
| | - N Ewen Wang
- Stanford University Department of Emergency Medicine, Stanford, CA, United States of America
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9
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Why trauma must trump burn injuries: The spectre of missed injuries. BURNS OPEN 2019. [DOI: 10.1016/j.burnso.2019.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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10
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Using the injury severity score to adjust for comorbid trauma may be double counting burns: implications for burn research. Burns 2018; 44:1920-1929. [DOI: 10.1016/j.burns.2018.03.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2017] [Revised: 02/16/2018] [Accepted: 03/23/2018] [Indexed: 11/18/2022]
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Getzmann JM, Slankamenac K, Sprengel K, Mannil L, Giovanoli P, Plock JA. The impact of non-thermal injuries in combined burn trauma: A retrospective analysis over the past 35 years. J Plast Reconstr Aesthet Surg 2018; 72:438-446. [PMID: 30527710 DOI: 10.1016/j.bjps.2018.10.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 09/21/2018] [Accepted: 10/28/2018] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Combined burn trauma is rather uncommon and frequently difficult to manage. Historically combined burn trauma contributed to high mortality rates in severely injured patients. The purpose of this study was to determine the incidence, mechanisms and impact of non-thermal injuries in patients with severe burns. METHODS The charts of 2536 patients admitted to the Burn Center of the University Hospital Zurich between 1977 and 2013 were reviewed and retrospectively analyzed. Patients with additional injuries were identified and analyzed statistically. RESULTS Over 35 years from 1977 to 2013 a total of 100 burn patients (3.9%) with additional trauma were identified. Motor vehicle crash was the most common mechanism of injury (44%) from 1977 to 1995, compared to electrical injury (33%) from 1996 to 2013. Skeletal trauma including spinal and pelvic injury was the most common form (71%). Additional thoracic or abdominal trauma represented the highest risk factor for in-hospital mortality (adjusted RR 2.2, 95% CI 0.6-7.6). However, after 1995 the presence of any form of additional injury did not have a significant impact on in-hospital mortality (unadjusted RR 0.97, 95% CI 0.5-1.7, p = 0.914). CONCLUSIONS Concomitant trauma did not reveal a significant impact on in-hospital mortality in our burn center recently. Retrospectively, trauma mechanisms shifted from motor vehicle crashes to electrical injuries in our population. Safety measures for motor vehicles and adequate emergency room algorithms seem to have contributed to a reduction of severity of injury and mortality.
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Affiliation(s)
- Jonas M Getzmann
- Department of Plastic Surgery and Hand Surgery, Burn Center, University Hospital Zurich, Raemistrasse 100, CH-8091 Zurich, Switzerland; University of Zurich, Pestalozzistrasse 3, CH-8091 Zurich, Switzerland
| | - Ksenija Slankamenac
- Department of Emergency Medicine, University Hospital Zurich, Raemistrasse 100, CH-8091 Zurich, Switzerland
| | - Kai Sprengel
- Department of Trauma Surgery, University Hospital Zurich, Raemistrasse 100, CH-8091 Zurich, Switzerland
| | - Lijo Mannil
- Department of Plastic Surgery and Hand Surgery, Burn Center, University Hospital Zurich, Raemistrasse 100, CH-8091 Zurich, Switzerland
| | - Pietro Giovanoli
- Department of Plastic Surgery and Hand Surgery, Burn Center, University Hospital Zurich, Raemistrasse 100, CH-8091 Zurich, Switzerland; University of Zurich, Pestalozzistrasse 3, CH-8091 Zurich, Switzerland
| | - Jan A Plock
- Department of Plastic Surgery and Hand Surgery, Burn Center, University Hospital Zurich, Raemistrasse 100, CH-8091 Zurich, Switzerland; University of Zurich, Pestalozzistrasse 3, CH-8091 Zurich, Switzerland.
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Abstract
Although every disaster scenario is unique, certain themes have emerged repeatedly during management of burn disasters. These lessons learned are useful when planning an individual burn unit's role in future disaster response.
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Affiliation(s)
- Robert L Sheridan
- Boston Shriners Hospital for Children, 51 Blossom Street, Boston, MA 02114, USA.
| | - Jonathan Friedstat
- Boston Shriners Hospital for Children, 51 Blossom Street, Boston, MA 02114, USA
| | - Kaitlyn Votta
- Boston Shriners Hospital for Children, 51 Blossom Street, Boston, MA 02114, USA
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14
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Abstract
Care of burn-injured patients requires knowledge of the pathophysiologic changes affecting virtually all organs from the onset of injury until wounds are healed. Massive airway and/or lung edema can occur rapidly and unpredictably after burn and/or inhalation injury. Hemodynamics in the early phase of severe burn injury is characterized by a reduction in cardiac output and increased systemic and pulmonary vascular resistance. Approximately 2 to 5 days after major burn injury, a hyperdynamic and hypermetabolic state develops. Electrical burns result in morbidity much higher than expected based on burn size alone. Formulae for fluid resuscitation should serve only as guideline; fluids should be titrated to physiologic endpoints. Burn injury is associated basal and procedural pain requiring higher than normal opioid and sedative doses. Operating room concerns for the burn-injured patient include airway abnormalities, impaired lung function, vascular access, deceptively large and rapid blood loss, hypothermia, and altered pharmacology.
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Affiliation(s)
- Edward A Bittner
- From the Department of Anesthesiology, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts (E.A.B., E.S., J.A.J.M.); Shriners Hospitals for Children®, Boston, Massachusetts (E.A.B., E.S., J.A.J.M.); Department of Anesthesiology, University of Texas Medical Branch, Galveston, Texas (L.W.); and Shriners Hospitals for Children®, Galveston, Texas (L.W.)
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15
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AlQahtani SM, Alzahrani MM, Carli A, Harvey EJ. Burn Management in Orthopaedic Trauma: A Critical Analysis Review. JBJS Rev 2014; 2:01874474-201410000-00001. [PMID: 27490295 DOI: 10.2106/jbjs.rvw.n.00010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Saad M AlQahtani
- 1Division of Orthopaedic Surgery, McGill University Health Center, Montreal General Hospital, 1650 Cedar Avenue, Room B5.159.5, Montreal, Quebec, Canada H3G 1A4
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Abstract
Burn units provide a unique set of resources to patients with complex wounds, sepsis, and organ failures. This resource set is useful in a number of traumatic, infectious, and medical conditions as well. Further, many burn patients have sustained simultaneous non-burn trauma which will be managed in burn programs.
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Affiliation(s)
- Robert L Sheridan
- Boston Shriners Hospital for Children, 51 Blossom Street, Boston, MA 02114, USA.
| | - David Greenhalgh
- Department of Surgery, Shriners Hospitals for Children Northern California, University of California, Davis, 2425 Stockton Boulevard, Sacramento, CA 95817, USA
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17
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Is operative management of fractures safe in the collocated burn and fracture injury? Injury 2014; 46:1145-9. [PMID: 25174660 DOI: 10.1016/j.injury.2014.07.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Revised: 06/22/2014] [Accepted: 07/27/2014] [Indexed: 02/02/2023]
Abstract
AIMS To review the management of a collocated major fracture and dermal burn injury in adult multi-trauma patients. In particular, this study examines the methods and timing for fracture fixation and the fracture complications observed. METHODS A retrospective chart review of all patients admitted to the Alfred Hospital, Melbourne, Australia from January 2000 to December 2012 with a collocated dermal burn and major fracture. RESULTS Of the 22 patients included (median abbreviated injury score-98 of 22 and total burn surface area of 8%), 17 underwent operative fracture fixation. Eleven patients had internal fixation, two had external fixation and four had temporary external fixation with delayed internal fixation. Median time to operative fixation was 5.7h (interquartile range: 3.5-16.8), with 15 of the 17 patients undergoing fixation within 24h. Nine patients experienced a fracture complication. Five patients had an infective fracture complication (wound infection or osteomyelitis), and all of these patients had had internal fixation. No fracture complications occurred in patients managed conservatively. CONCLUSION Previous studies have supported the use of internal fixation for early mobility and simplified wound care. However, we observed a high rate of fracture complications with internal fixation, despite undergoing management within 24h of presentation. At this point, we are unable to conclude on the safety of utilising internal fixation in the collocated injury.
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Fernandes ACM, França JPD, Gaiba S, Aloise AC, Oliveira AFD, Moraes AADFS, França LPD, Ferreira LM. Development of experimental in vitro burn model. Acta Cir Bras 2014; 29 Suppl 2:15-20. [DOI: 10.1590/s0102-86502014001400004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
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Brand S, Otte D, Stübig T, Petri M, Ettinger M, Mueller CW, Krettek C, Haasper C, Probst C. Mechanisms of motor vehicle crashes related to burns--an analysis of the German In depth Accident Study (GIDAS) database. Burns 2013; 39:1535-40. [PMID: 24169314 DOI: 10.1016/j.burns.2013.09.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Revised: 08/18/2013] [Accepted: 09/05/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Patients of motor vehicle crashes (MVCs) suffering burns are challenging for the rescue team and the admitting hospital. These patients often face worse outcomes than crash patients with trauma only. Our analysis of the German In-depth Accident Study (GIDAS) database researches the detailed crash mechanisms to identify potential prevention measures. METHODS We analyzed the 2011 GIDAS database comprising 14,072 MVC patients and compared individuals with (Burns) and without (NoBurns) burns. Only complete data sets were included. Patients with burns obviously resulting of air bag deployment only were not included in the Burns group. Data acquisition by an on call team of medical and technical researchers starts at the crash scene immediately after the crash and comprises technical data as well as medical information until discharge from the hospital. Statistical analysis was done by Mann-Whitney-U-test. Level of significance was p < 0.05. RESULTS 14,072 MVC patients with complete data sets were included in the analysis. 99 individuals suffered burns (0.7%; group "Burns"). Demographic data and injury severity showed no statistical significant difference between the two groups of Burns and NoBurns. Injury severity was measured using the Injury Severity Score (ISS). Direct frontal impact (Burns: 48.5% vs. NoBurns: 33%; p < 0.05) and high-energy impacts as represented by delta-v (m/s) (Burns: 33.5 ± 21.4 vs. NoBurns: 25.2 ± 15.9; p < 0.05) were significantly different between groups as was mortality (Burns: 12.5% vs. NoBurns: 2.1%; p < 0.05). Type of patients' motor vehicles and type of crash opponent showed no differences. CONCLUSIONS Our results show, that frontal and high-energy impacts are associated with a frequency of burns. This may serve automobile construction companies to improve the burn safety to prevent flames spreading from the motor compartment to the passenger compartment. Communities may impose speed limits in local crash hot spots.
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Affiliation(s)
- S Brand
- Department of Trauma, Hannover Medical School, Germany.
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Mitsunaga Junior JK, Gragnani A, Ramos MLC, Ferreira LM. Rat an experimental model for burns: a systematic review. Acta Cir Bras 2013; 27:417-23. [PMID: 22666760 DOI: 10.1590/s0102-86502012000600010] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2012] [Accepted: 04/16/2012] [Indexed: 11/21/2022] Open
Abstract
PURPOSE To revise and systematize scientific knowledge of the experimental model for cutaneous burns in rats. METHODS A bibliographical review from 2008 up to January 2011 in PubMed, EMBASE and LILACS was undertaken. Were used the keywords: animal models, burns and rats. 221 studies were identified, and 116 were selected. RESULTS It was found that: 54/86 (62.7%) had third degree burns; 55/73 (75.3%) studied the back; 45/78 (57.6%) used heated water and 27/78 (35.9%) incandescent instruments; 39/78 (50%) studied systemic effects; 22/71 (31%) used ketamine associated with xylazine; 61/64 (95.3%) performed depilation with appropriate equipment; 36/72 (50%) used microscopy; more than 50% did not describe analgesia or antibiotics during the postoperative period; in 42/116 (36.2%) postoperative fluid therapy was performed; and the time interval after the burn, up to the beginning of the results analysis varied from 7s up to four weeks. Legislation issues on burn experiments are discussed. CONCLUSION The hot water was the main method to induce burns those of third degree on the back, with anesthesia using ketamine and xylazine, after depilation. These were evaluated microscopically, without using analgesia or an antibiotic during the postoperative period. The studies were not very reproducible.
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Sheridan RL, Schaefer PW, Whalen M, Fagan S, Stoddard FJ, Schneider JC, McConkey B, Cancio LC. Case records of the Massachusetts General Hospital. Case 36-2012. Recovery of a 16-year-old girl from trauma and burns after a car accident. N Engl J Med 2012; 367:2027-37. [PMID: 23171100 DOI: 10.1056/nejmcpc1200088] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Management of femoral fractures in the burned extremity. CURRENT ORTHOPAEDIC PRACTICE 2010. [DOI: 10.1097/bco.0b013e3181c2961c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Earthquakes present a major threat to mankind. Increasing knowledge about geophysical interactions, progressing architectural technology, and improved disaster management algorithms have rendered modern populations less susceptible to earthquakes. Nevertheless, the mass casualties resulting from earthquakes in Great Kanto (Japan), Ancash (Peru), Tangshan (China), Guatemala, Armenia, and Izmit (Turkey) or the recent earthquakes in Bhuj (India), Bam (Iran), Sumatra (Indonesia) and Kashmir (Pakistan) indicate the devastating effect earthquakes can have on both individual and population health. Appropriate preparation and implementation of crisis management algorithms are of utmost importance to ensure a large-scale medical-aid response is readily available following a devastating event. In particular, efficient triage is vital to optimize the use of limited medical resources and to effectively mobilize these resources so as to maximize patient salvage. However, the main priorities of disaster rescue teams are the rescue and provision of emergency care for physical trauma. Furthermore, the establishment of transport evacuation corridors, a feature often neglected, is essential in order to provide the casualties with a chance for survival. The optimal management of victims under such settings is discussed, addressing injuries of the body and psyche by means of simple diagnostic and therapeutic procedures globally applicable and available.
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Bittner E, Grecu L, Martyn JAJ. Emergency Room and Acute Care of the Critically III Burned Patient. Intensive Care Med 2007. [DOI: 10.1007/978-0-387-49518-7_69] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
OBJECTIVE Power lawnmowers can pose significant danger of injury to both the operator and the bystander, from direct contact with the rotary blades or missile injury. Our objective was to review our experience with paediatric lawnmower-associated trauma, and the safety recommendations available to operators of power lawnmowers. METHODS The patient cohort comprised paediatric (<16 years of age) patients treated for lawnmower-associated trauma, by the plastic surgery service, between 1996 and 2003. These patients were identified retrospectively. Age at the time of injury, location and extent of bony and soft tissue injuries sustained, treatment instituted and clinical outcome were recorded. Brochures and instruction manuals of six lawnmower manufacturers were reviewed, and safety recommendations noted. RESULTS Fifteen patients were identified. The majority of injuries occurred from direct contact with the rotary blades (93%); the remaining child sustained a burn injury. Fourteen children (93%) required operative intervention. Seven patients (46%) sustained injuries resulting in amputation, two of whom had major limb amputations. All children, except the burns patient, underwent wound debridement and received antibiotic therapy. Reconstructive methods ranged from primary closure to free tissue transfer. Many patients required multiple procedures. In all instruction manuals, instructions to keep children and pets indoors or out of the yard when mowing were found. CONCLUSIONS Lawnmower injuries can be devastating, particularly in children. Many victims have lasting deformities as a result of their injuries. Awareness of and stringent adherence to safety precautions during use of power lawnmowers can prevent many of these accidents.
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Affiliation(s)
- Nora Nugent
- Department of Plastic Surgery, Cork University Hospital, Wilton, Cork, Ireland.
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Fatusi OA, Fatusi AO, Olabanji JK, Alatise OI. Management Outcome and Associated Factors in Burn Injuries With and Without Facial Involvement in a Nigerian Population. J Burn Care Res 2006; 27:869-76. [PMID: 17091085 DOI: 10.1097/01.bcr.0000245769.92667.4a] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
There is a high potential for the occurrence of burns in Nigeria, yet very little is known about factors that are associated with management outcomes (death/survivorship) in burns affecting facial or other body areas among Nigerian populations. This study aimed at determining patterns of occurrences of burn injuries with and without facial involvement and the factors that are associated with mortality. A standardized data-collection instrument was designed and used to extract relevant information about burn patients that were seen at the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria, between 1998 and 2003. During the study period, fuel-related flames constituted the leading type of agent in both facial (71.1%) and nonfacial involved burns (65.3%). There was no significant difference in the incidence of contracture and inhalation injury between burns with facial involvement and burns without facial involvement, but cases of facial involvement have significantly lower incidences of wound infections. No significant difference was seen in the incidence of mortality between burns with facial involvement (31.6 %) and burns without facial involvement (30.7%). Significant bivariate correlates for mortality were age, flame as the agent of burns, depth of the burns and wound infections. Two correlates remained significant in the multivariate analysis (binary logistic regression): BSA involved and wound infection.
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Affiliation(s)
- Olawunmi A Fatusi
- Department of Oral & Maxillofacial Surgery, College of Health Sciences, Faculty of Dentistry, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria
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Kapur GB, Hutson HR, Davis MA, Rice PL. The United States twenty-year experience with bombing incidents: implications for terrorism preparedness and medical response. ACTA ACUST UNITED AC 2006; 59:1436-44. [PMID: 16394919 DOI: 10.1097/01.ta.0000197853.49084.3c] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Terrorist bombings remain a significant threat in the United States. However, minimal longitudinal data exists regarding the medical and public health impact because of bombings. METHODS We conducted a retrospective analysis of the number of incidents, injuries, and deaths because of explosive, incendiary, premature, and attempted bombings from January 1983 to December 2002. Morbidity and mortality by motives, target locations, and materials used were evaluated. RESULTS In the United States, 36,110 bombing incidents, 5,931 injuries, and 699 deaths were reported. There were 21,237 (58.8%) explosive bombings, 6,185 (17.1%) incendiary bombings, 1,107 (3.1%) premature bombings, and 7,581 (21.0%) attempted bombings. For explosive bombings with known motives, 72.9% of injuries and 73.8% of deaths were because of homicide. For incendiary bombings with known motives, 68.2% of injuries were because of extortion and revenge, and 53.5% of deaths were due to homicide. Private residences accounted for 29.0% of incidents, 31.5% of injuries, and 55.5% of deaths. Government installations accounted for 4.4% of incidents but were the site of 12.7% of injuries and 25.5% of deaths. In bombings with known materials, nitrate-based fertilizers accounted for 36.2% of injuries and 30.4% of deaths, and smokeless powder and black powder accounted for 33.2% of injuries and 27.1% of deaths. CONCLUSIONS Illegal bombings and related injuries commonly occur in the United States. Because of the easy availability of bombing materials, government agencies and healthcare providers should prepare for potential mass-casualty bombings.
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Affiliation(s)
- G Bobby Kapur
- Institute for International Emergency Medicine and Health, Harvard Medical School, Boston, MA, USA.
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Cairns BA, Stiffler A, Price F, Peck MD, Meyer AA. Managing a Combined Burn Trauma Disaster in the Post-9/11 World: Lessons Learned from the 2003 West Pharmaceutical Plant Explosion. ACTA ACUST UNITED AC 2005; 26:144-50. [PMID: 15756116 DOI: 10.1097/01.bcr.0000155527.76205.a2] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
At 1:37 pm on January 29, 2003, an explosion occurred at the West Pharmaceutical chemical plant in Kinston, North Carolina. The explosion killed three people at the scene and resulted in more than 30 admissions to area hospitals. The disaster resulted in 10 critically ill burn patients, who were all intubated with inhalation injuries, many with combined burn and trauma injuries. All 10 critically injured patients were admitted to a tertiary care facility 100 miles away with both a Level I trauma center and a verified burn center. Ultimately, 7 of 10 patients survived (a mortality rate of 30%), and none were transferred to another trauma or burn center. This article analyzes the unique challenges that combined burn and trauma patients present during a disaster, critically examines the response to this disaster, describes lessons learned, and presents recommendations that may improve the response to such disasters in the future.
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Affiliation(s)
- Bruce A Cairns
- North Carolina Jaycee Burn Center and Department of Surgery, University of North Carolina, Chapel Hill, North Carolina 27514, USA
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Hawkins A, Maclennan PA, McGwin G, Cross JM, Rue LW. The Impact of Combined Trauma and Burns on Patient Mortality. ACTA ACUST UNITED AC 2005; 58:284-8. [PMID: 15706189 DOI: 10.1097/01.ta.0000130610.19361.bd] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Combined trauma and burn injuries are uncommon and seldom studied. There is a presumption that these patients fare worse than their trauma- and burn-only counterparts, but the mortality risk has not been quantified. METHODS This was a retrospective cohort study using the 1994 to 2002 National Trauma Data Bank. Trauma- and burn-only patients were categorized according to Injury Severity Score (ISS) and burn severity (percentage body surface area burned [BSAB]), respectively, and combined trauma-burn patients were similarly categorized. Risk ratios (RRs) and 95% confidence intervals (CIs) were calculated comparing combined trauma-burn mortality to trauma-only and burn-only patients by corresponding trauma or burn severity. RRs were adjusted for age, gender, and ISS or burn severity. RESULTS Compared with minor trauma-only patients (ISS of 1-15), patients with minor trauma, when combined with burn injury, had significantly increased mortality (RR, 4.04; 95% CI, 3.51-4.66). Similarly, relative to minor burn-only patients (BSAB of 1-25%), combined trauma-burn patients with minor burns (RR, 5.00; 95% CI, 3.54-7.06) had significantly increased mortality. For combined trauma-burn patients with more severe burns or trauma, small but significant increased mortality risks were seen relative to major trauma-only patients (ISS of 26+; RR, 1.26; 95% CI, 1.05-1.51) and major burn-only patients (BSAB of 76+; RR, 1.45; 95% CI, 1.15-1.82). CONCLUSION The large increased risk of death for those with combined minor injuries is of clinical interest because the majority of combined patients fall into this category. Future research should characterize specific causes and types of injury of increased mortality in the patient with combined injuries.
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Affiliation(s)
- Ashley Hawkins
- Section of Trauma, Burns, and Surgical Critical Care, Division of General Surgery, Department of Surgery, School of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294, USA
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Sheridan RL, Schulz JT, Ryan CM, McGinnis PJ. Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 6-2004. A 35-year-old woman with extensive, deep burns from a nightclub fire. N Engl J Med 2004; 350:810-21. [PMID: 14973211 DOI: 10.1056/nejmcpc049001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Robert L Sheridan
- Burn and Trauma Services, Massachusetts General Hospital, Boston, USA
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Sheridan RL, Tompkins RG. What's new in burns and metabolism. J Am Coll Surg 2004; 198:243-63. [PMID: 14759783 DOI: 10.1016/j.jamcollsurg.2003.11.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2003] [Accepted: 11/10/2003] [Indexed: 12/31/2022]
Affiliation(s)
- Robert L Sheridan
- Burn Surgery Service, Shriners Hospital for Children, 51 Blossom Street, Boston, MA 02114, USA
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