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Carvalho EN, Paggiaro AO, Nicolosi JT, Gemperli R, de Carvalho VF. Retrospective Evaluation of Characteristics of Patients with Burn Injuries Treated at the Largest Reference Hospital in Brazil. PLASTIC AND AESTHETIC NURSING 2023; 43:22-28. [PMID: 36583585 DOI: 10.1097/psn.0000000000000471] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Burn injuries are a significant cause of morbidity and mortality in the Brazilian population. We conducted this study in a tertiary hospital in Brazil to discover the epidemiological characteristics of patients with burn injuries. We conducted a cohort review of patients admitted to the burn unit of our institute during a 5-year period. For each patient, we collected data that included age, gender, total percentage of burned body surface area, burn location, burn mode, and burn cause. We analyzed the data using the R programming language. We included a total of 496 patients in our study. The mean age of the patients was 28 ± 14.7 years. The median length of hospital stay was 2 weeks. We found a significant correlation between the total percentage of burned body surface area and the length of hospitalization (p < .001) and the length of hospitalization in the intensive care unit (p < .001). A total of 427 patients (86%) were discharged from the hospital after successful treatment. In contrast, 43 patients (8.67%) died. The mortality rate was highest in patients who had more than 70% of their total body surface area burned. The average length of hospitalization aligned with global and national statistics presented in the literature. The main causes of the burn injuries were thermal (e.g., fire, hot liquids). We found inhalation injuries present in more than one third of the patients who were hospitalized in the intensive care unit with thermal burns.
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Affiliation(s)
- Elisangela Nunes Carvalho
- Elisangela Nunes Carvalho, MS, is a biologist at Guarulhos University, São Paulo, Brazil
- André Oliveira Paggiaro, PhD, MD, a professor in the nursing postgraduate program at Guarulhos University, São Paulo, Brazil, and a plastic surgeon in the Plastic Surgery Division, Faculty of Medicine, University of São Paulo, Brazil
- Júlia Teixeira Nicolosi, PhD, RN, is a professor in the nursing postgraduate program at Guarulhos University, São Paulo, Brazil, and at Rua Maria Leonete da Silva Nóbrega, São Paulo, Brazil
- Rolf Gemperli, PhD, MD, is a professor in the Plastic Surgery Division, Faculty of Medicine at University of São Paulo, Brazil
- Viviane Fernandes de Carvalho, PhD, RN, is a professor in the nursing postgraduate program at Guarulhos University, São Paulo, Brazil
| | - André Oliveira Paggiaro
- Elisangela Nunes Carvalho, MS, is a biologist at Guarulhos University, São Paulo, Brazil
- André Oliveira Paggiaro, PhD, MD, a professor in the nursing postgraduate program at Guarulhos University, São Paulo, Brazil, and a plastic surgeon in the Plastic Surgery Division, Faculty of Medicine, University of São Paulo, Brazil
- Júlia Teixeira Nicolosi, PhD, RN, is a professor in the nursing postgraduate program at Guarulhos University, São Paulo, Brazil, and at Rua Maria Leonete da Silva Nóbrega, São Paulo, Brazil
- Rolf Gemperli, PhD, MD, is a professor in the Plastic Surgery Division, Faculty of Medicine at University of São Paulo, Brazil
- Viviane Fernandes de Carvalho, PhD, RN, is a professor in the nursing postgraduate program at Guarulhos University, São Paulo, Brazil
| | - Júlia Teixeira Nicolosi
- Elisangela Nunes Carvalho, MS, is a biologist at Guarulhos University, São Paulo, Brazil
- André Oliveira Paggiaro, PhD, MD, a professor in the nursing postgraduate program at Guarulhos University, São Paulo, Brazil, and a plastic surgeon in the Plastic Surgery Division, Faculty of Medicine, University of São Paulo, Brazil
- Júlia Teixeira Nicolosi, PhD, RN, is a professor in the nursing postgraduate program at Guarulhos University, São Paulo, Brazil, and at Rua Maria Leonete da Silva Nóbrega, São Paulo, Brazil
- Rolf Gemperli, PhD, MD, is a professor in the Plastic Surgery Division, Faculty of Medicine at University of São Paulo, Brazil
- Viviane Fernandes de Carvalho, PhD, RN, is a professor in the nursing postgraduate program at Guarulhos University, São Paulo, Brazil
| | - Rolf Gemperli
- Elisangela Nunes Carvalho, MS, is a biologist at Guarulhos University, São Paulo, Brazil
- André Oliveira Paggiaro, PhD, MD, a professor in the nursing postgraduate program at Guarulhos University, São Paulo, Brazil, and a plastic surgeon in the Plastic Surgery Division, Faculty of Medicine, University of São Paulo, Brazil
- Júlia Teixeira Nicolosi, PhD, RN, is a professor in the nursing postgraduate program at Guarulhos University, São Paulo, Brazil, and at Rua Maria Leonete da Silva Nóbrega, São Paulo, Brazil
- Rolf Gemperli, PhD, MD, is a professor in the Plastic Surgery Division, Faculty of Medicine at University of São Paulo, Brazil
- Viviane Fernandes de Carvalho, PhD, RN, is a professor in the nursing postgraduate program at Guarulhos University, São Paulo, Brazil
| | - Viviane Fernandes de Carvalho
- Elisangela Nunes Carvalho, MS, is a biologist at Guarulhos University, São Paulo, Brazil
- André Oliveira Paggiaro, PhD, MD, a professor in the nursing postgraduate program at Guarulhos University, São Paulo, Brazil, and a plastic surgeon in the Plastic Surgery Division, Faculty of Medicine, University of São Paulo, Brazil
- Júlia Teixeira Nicolosi, PhD, RN, is a professor in the nursing postgraduate program at Guarulhos University, São Paulo, Brazil, and at Rua Maria Leonete da Silva Nóbrega, São Paulo, Brazil
- Rolf Gemperli, PhD, MD, is a professor in the Plastic Surgery Division, Faculty of Medicine at University of São Paulo, Brazil
- Viviane Fernandes de Carvalho, PhD, RN, is a professor in the nursing postgraduate program at Guarulhos University, São Paulo, Brazil
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Assessment and Management of Pain in Patients Sustaining Burns at Emergency Department Kenyatta National Hospital, Kenya: A Descriptive Study. TRAUMA CARE 2022. [DOI: 10.3390/traumacare2010007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Poorly managed burn pain affects the victim by delayed healing, psychological disturbances, and chronic pain. Burn injuries are the fourth leading cause of injuries worldwide. The incidence of thermal burns in Kenya is 3%. Pain assessment and control are integral parts of management that a burn victim should be offered. We lack data on pain management in burn patients during setup. Methods: A descriptive study was carried out at the emergency department (ED) of Kenyatta National Hospital. We enrolled patients who sustained thermal burns until a sample 138 patients was reached. Enrollment of patients was done from February to August 2015. The pain level was assessed using a visual analogue scale, and the Lund and Browder chart was used to record the depth and extent of the burn. Data on the type of analgesia prescribed and its route of administration was collected. Data was analyzed using STATA v.11. Results: The median age of the sample was 28 years with a male to female ratio 1.8:1. The majority of the victims (38%) sustained flame burns. The median total body surface area was 19.5%. Pain assessment was done in 2% with a visual analogue scale and face pain recognition scale. Mean Visual Analogue score was 7. Analgesia was offered to 96% of participants, and it was unimodal in the majority, 76.7%, and the preferred drug of choice was morphine. The majority of all burn patients had sustained moderate to major burns. The tools used to assess pain in this hospital were Face Pain Recognition Scale and Visual Analogue Scale; however, pain assessment was done on a meagre 2% of the sample. Conclusions: A minority of the patients had any sort of pain assessment done at the emergency department. As a result, burn pain was inappropriately managed. There is a need to improve the assessment of burn pain and improve its management by encouraging training of ED burn care providers by burn surgeons and pain therapists.
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Wong L, Rajandram R, Allorto N. Systematic review of excision and grafting in burns: Comparing outcomes of early and late surgery in low and high-income countries. Burns 2021; 47:1705-1713. [PMID: 34303572 DOI: 10.1016/j.burns.2021.07.001] [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] [Received: 10/12/2020] [Revised: 04/08/2021] [Accepted: 07/02/2021] [Indexed: 12/29/2022]
Abstract
INTRODUCTION While the benefits of early excision in burn surgery are clear, the advantages may be lost in low income countries with limited resources. It is important to identify the right timing of excision in different groups of patients, particularly those in low-income countries (LIC), as the burden of disease contributes to the highest global mortality and has the least resources. This systematic review and meta-analysis aims to determine the timing of excision in LICs and the outcomes associated with surgery: (1) mortality, (2) sepsis and (3) length of stay (LOS) compared to high income countries (HICs). METHODOLOGY The PRISMA guidelines and MOOSE checklist were followed for this review. Publications in English from year 1990 to 2017 that included data on the timing and type of burn surgery and outcomes were included. Searches were done using Web of Science, Cochrane collaboration and Pubmed using keywords "Burn and surgery", "Burn and excision", "Burn and excision and grafting" and "burn and skin grafting". Trial quality was evaluated using the Newcastle-Ottawa scale. Outcomes compared for early and late excisions were length of stay (LOS), sepsis and mortality between LICs and HICs. RESULTS From 278 citations, we selected 41 for full text evaluation, and identified 16 eligible trials. LOS is shorter in early excision compared to late excision in both LICs and HICs. Mortality is lower in late excision compared to early excision in both LICs and HICs. Further subgroup analysis of elderly patients in HICs confirmed that mortality is lower in late excision and unchanged if the elderly are excluded. Early excision reduces sepsis in both LIC and HIC. DISCUSSION The variable definitions of age, timing of excision, variable nature of % TBSA comparison, mixed inclusion of inhalation injury, co-morbidities and unquantified access to resources make the data difficult to interpret and it is not possible to draw accurate conclusions on the role of early excision for burns in low-middle income countries. A prospective study is needed in order to answer this question.
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Affiliation(s)
- Lingwei Wong
- Trauma Sciences, Queen Mary University of London, Mile End Rd, Bethnal Green, London E1 4NS, United Kingdom.
| | - Retnagowri Rajandram
- Department of Surgery, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia.
| | - Nikki Allorto
- Department of Surgery, Pietermaritzburg Metropolitan Complex, University of Kwa-zulu Natal, South Africa.
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Bathaei T, Khazaei S, Shirani F, Afshari M, Jenabi E, Hamzei Z, Torabi M. Etiology and outcome of burns in Hamadan, Iran: A registry-based study. ARCHIVES OF TRAUMA RESEARCH 2019. [DOI: 10.4103/atr.atr_47_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Mashreky SR, Shawon RA, Biswas A, Ferdoush J, Unjum A, Rahman AKMF. Changes in burn mortality in Bangladesh: Findings from Bangladesh Health and Injury Survey (BHIS) 2003 and 2016. Burns 2018; 44:1579-1584. [PMID: 29887350 DOI: 10.1016/j.burns.2018.01.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 12/27/2017] [Accepted: 01/08/2018] [Indexed: 01/01/2023]
Abstract
PURPOSE This paper is focused to reflect the changes in burn mortality and events leading to fatal burn injuries. METHODS Two national community-based cross sectional health and injury surveys were done in Bangladesh during 2003 and 2016. Similar methodology had been followed in both the surveys. Multistage cluster sampling method considering probability-proportional-to-size strategy was used in both the surveys to obtain the desired sample. A pretested semi-structured questionnaire was deployed to identify causes of mortality and morbidity among the population. Verbal autopsy method was used to ascertain the cause of death. RESULTS An estimated 5000 deaths occurred during 2002 due to burn, whereas, around 9000 deaths were caused by burn in 2015 reflected by the death rates 3.5 and 5.7 per 100,000 population in respective years. This study found an increase in death rates in all age groups from 2002 to 2015. Electrocution caused the highest burn deaths in this country, especially among males and in rural areas. The death toll by this particular mechanism has increased by more than two folds within a decade. The place of occurrence of fatal burn injuries has also shifted from home to the outside of the home especially in the agricultural fields. CONCLUSION Burn death is an emerging cause of injury deaths in Bangladesh. Further researches are required to explore the epidemiology of electrocution deaths in Bangladesh and design effective interventions.
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Affiliation(s)
- Saidur Rahman Mashreky
- Centre for Injury Prevention and Research Bangladesh, Dhaka, Bangladesh; Department of Non-Communicable Diseases, Bangladesh University of Health Sciences, Bangladesh.
| | - Riffat Ara Shawon
- Centre for Injury Prevention and Research Bangladesh, Dhaka, Bangladesh.
| | - Animesh Biswas
- Centre for Injury Prevention and Research Bangladesh, Dhaka, Bangladesh.
| | - Junnatul Ferdoush
- Centre for Injury Prevention and Research Bangladesh, Dhaka, Bangladesh.
| | - Afrida Unjum
- Centre for Injury Prevention and Research Bangladesh, Dhaka, Bangladesh.
| | - A K M Fazlur Rahman
- Centre for Injury Prevention and Research Bangladesh, Dhaka, Bangladesh; Department of Epidemiology, Bangladesh University of Health Sciences, Bangladesh.
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Alonge O, Agrawal P, Talab A, Rahman QS, Rahman AF, Arifeen SE, Hyder AA. Fatal and non-fatal injury outcomes: results from a purposively sampled census of seven rural subdistricts in Bangladesh. LANCET GLOBAL HEALTH 2018; 5:e818-e827. [PMID: 28716352 DOI: 10.1016/s2214-109x(17)30244-9] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 05/15/2017] [Accepted: 06/02/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND 90% of the global burden of injuries is borne by low-income and middle-income countries (LMICs). However, details of the injury burden in LMICs are less clear because of the scarcity of data and population-based studies. The Saving of Lives from Drowning project, implemented in rural Bangladesh, did a census on 1·2 million people to fill this gap. This Article describes the epidemiology of fatal and non-fatal injuries from the study. METHODS In this study, we used data from the baseline census conducted as part of the Saving of Lives from Drowning (SoLiD) project. The census was implemented in 51 unions from seven purposively sampled rural subdistricts of Bangladesh between June and November, 2013. Sociodemographic, injury mortality, and morbidity information were collected for the whole population in the study area. We analysed the data for descriptive measures of fatal and non-fatal injury outcomes. Age and gender distribution, socioeconomic characteristics, and injury characteristics such as external cause, intent, location, and body part affected were reported for all injury outcomes. FINDINGS The census covered a population of 1 169 593 from 270 387 households and 451 villages. The overall injury mortality rate was 38 deaths per 100 000 population per year, and 104 703 people sustained major non-fatal injuries over a 6-month recall period. Drowning was the leading external cause of injury death for all ages, and falls caused the most number of non-fatal injuries. Fatal injury rates were highest in children aged 1-4 years. Non-fatal injury rates were also highest in children aged 1-4 years and those aged 65 years and older. Males had more fatal and non-fatal injuries than females across all external causes except for burns. Suicide was the leading cause of injury deaths in individuals aged 15-24 years, and more than 50% of the suicides occurred in females. The home environment was the most common location for most injuries. INTERPRETATION The burden of fatal and non-fatal injuries in rural Bangladesh is substantial, accounting for 44 050 deaths and 21 million people suffering major events annually. Targeted approaches addressing drowning in children (especially those aged 1-4 years), falls among the elderly, and suicide among young female adults are urgently needed to reduce injury deaths and morbidity in Bangladesh. FUNDING Bloomberg Philanthropies.
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Affiliation(s)
- Olakunle Alonge
- Johns Hopkins International Injury Research Unit, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Priyanka Agrawal
- Johns Hopkins International Injury Research Unit, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Abu Talab
- Center for Injury Prevention and Research, Mohakhali, Dhaka, Bangladesh
| | - Qazi S Rahman
- International Center for Diarrheal Disease Research, Bangladesh, Mohakhali, Dhaka, Bangladesh
| | - Akm Fazlur Rahman
- Center for Injury Prevention and Research, Mohakhali, Dhaka, Bangladesh
| | - Shams El Arifeen
- International Center for Diarrheal Disease Research, Bangladesh, Mohakhali, Dhaka, Bangladesh
| | - Adnan A Hyder
- Johns Hopkins International Injury Research Unit, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Grudziak J, Snock C, Mjuweni S, Gallaher J, Cairns B, Charles A. The effect of pre-existing malnutrition on pediatric burn mortality in a sub-Saharan African burn unit. Burns 2017; 43:1486-1492. [DOI: 10.1016/j.burns.2017.03.022] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 03/10/2017] [Accepted: 03/25/2017] [Indexed: 11/15/2022]
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Wardhana A, Basuki A, Prameswara ADH, Rizkita DN, Andarie AA, Canintika AF. The epidemiology of burns in Indonesia’s national referral burn center from 2013 to 2015. BURNS OPEN 2017. [DOI: 10.1016/j.burnso.2017.08.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Epidemiology and outcome of hospitalized burns patients in tertiary care center in Nepal: Two year retrospective study. BURNS OPEN 2017. [DOI: 10.1016/j.burnso.2017.03.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Rybarczyk MM, Schafer JM, Elm CM, Sarvepalli S, Vaswani PA, Balhara KS, Carlson LC, Jacquet GA. A systematic review of burn injuries in low- and middle-income countries: Epidemiology in the WHO-defined African Region. Afr J Emerg Med 2017; 7:30-37. [PMID: 30456103 PMCID: PMC6234151 DOI: 10.1016/j.afjem.2017.01.006] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Revised: 11/03/2016] [Accepted: 01/10/2017] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION According to the World Health Organization (WHO), burns result in the loss of approximately 18 million disability adjusted life years (DALYs) and more than 250,000 deaths each year, more than 90% of which are in low- and middle-income countries (LMICs). The epidemiology of these injuries, especially in the WHO-defined African Region, has yet to be adequately defined. METHODS We performed a systematic review of the literature regarding the epidemiology of thermal, chemical, and electrical burns in the WHO-defined African Region. All articles indexed in PubMed, EMBASE, Web of Science, Global Health, and the Cochrane Library databases as of October 2015 were included. RESULTS The search resulted in 12,568 potential abstracts. Through multiple rounds of screening using criteria determined a priori, 81 manuscripts with hospital-based epidemiology as well as eleven manuscripts that included population-based epidemiology were identified. Although the studies varied in methodology, several trends were noted: young children appear to be at most risk; most individuals were burned at home; and hot liquids and flame are the most common aetiologies. DISCUSSION While more population-based research is essential to identifying specific risk factors for targeted prevention strategies, our review identifies consistent trends for initial efforts at eliminating these often devastating and avoidable injuries.
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Affiliation(s)
- Megan M. Rybarczyk
- Department of Emergency Medicine, Boston Medical Center, Boston, MA, United States
| | - Jesse M. Schafer
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Courtney M. Elm
- Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN, United States
| | - Shashank Sarvepalli
- Department of Internal Medicine, Cleveland Clinic, Cleveland, OH, United States
| | - Pavan A. Vaswani
- Department of Medicine, Brigham and Women’s Hospital, Boston, MA, United States
| | - Kamna S. Balhara
- Department of Emergency Medicine, The Johns Hopkins Hospital, Baltimore, MD, United States
| | - Lucas C. Carlson
- Department of Emergency Medicine, Brigham and Women’s Hospital, Boston, MA, United States
| | - Gabrielle A. Jacquet
- Department of Emergency Medicine, Boston Medical Center, Boston, MA, United States
- Boston University School of Medicine, Boston, MA, United States
- Boston University Center for Global Health and Development, Boston, MA, United States
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Examination of the Life Expectancy of Patients with Burns over 20% of Their Total Body Surface Area in Comparison to the Rest of the Population. J Burn Care Res 2017; 38:e906-e912. [DOI: 10.1097/bcr.0000000000000519] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Chiwaridzo M, Zinyando VJ, Dambi JM, Kaseke F, Munambah N, Mudawarima T. Perspectives of caregivers towards physiotherapy treatment for children with burns in Harare, Zimbabwe: A cross-sectional study. BURNS & TRAUMA 2016; 4:31. [PMID: 27981055 PMCID: PMC5134272 DOI: 10.1186/s41038-016-0057-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 07/19/2016] [Indexed: 12/02/2022]
Abstract
Background Physiotherapy is an integral part of treatment for paediatric burns. In Zimbabwe, children are admitted in paediatric burn unit with their caregivers, who play important roles such as providing explanation and obtaining cooperation of the child during physiotherapy, which is often uncomfortable or painful to the patient. The aim of this study was to determine the perspectives of caregivers towards physiotherapy interventions administered to hospitalized children at central hospitals in Harare, Zimbabwe. Methods A descriptive cross-sectional study was conducted using self-administered questionnaires. The study was carried out at two large central hospitals (Parirenyatwa Hospital and Harare Central Hospital). The study targeted all the caregivers of children below the age of 12 years with a diagnosis of burns, irrespective of severity or area affected, who were admitted in the two paediatric burn units. Of the 34 caregivers eligible to participate, 31 (91.1 %) questionnaires had complete data and were analysed. The analyses were done using Statistica version 12.0. Results The median age of the caregivers was 28 years (IQR = 24–33 years). Female caregivers constituted 90.3 % of the sample. The majority of the caregivers (n = 26, 83.9 %) were biological mothers to the hospitalised child. The majority of children (n = 20, 64.5 %) hospitalised were between 0 and 4 years. The commonest cause of burns was scalding (n = 19, 61.2 %). The burns were mainly in the upper extremities (n = 11, 35.5 %). Physiotherapy for the burns was mainly active and passive joint range of motion exercises (n = 30, 96.8 %). The caregivers’ perceptions towards physiotherapy were mainly positive (n = 20, 64.5 %) indicating that physiotherapy plays an important role in burn management. Of the 21 caregivers given a ward exercise programme, 13 (61.9 %) were not compliant. Conclusions Caregivers’ perspectives towards physiotherapy were largely positive and are similar to those found in other studies. The majority of the caregivers indicated that physiotherapy was important in the overall management of burns leading to proper healing of the wounds without complications.
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Affiliation(s)
- Matthew Chiwaridzo
- Department of Rehabilitation, College of Health Sciences, University of Zimbabwe, P.O Box A178, Avondale, Harare, Zimbabwe
| | | | - Jermaine Matewu Dambi
- Department of Rehabilitation, College of Health Sciences, University of Zimbabwe, P.O Box A178, Avondale, Harare, Zimbabwe
| | - Farayi Kaseke
- Department of Rehabilitation, College of Health Sciences, University of Zimbabwe, P.O Box A178, Avondale, Harare, Zimbabwe
| | - Nyaradzai Munambah
- Department of Rehabilitation, College of Health Sciences, University of Zimbabwe, P.O Box A178, Avondale, Harare, Zimbabwe
| | - Tapfuma Mudawarima
- Department of Rehabilitation, Harare Central Hospital, P.O Box ST 14, Southerton, Harare, Zimbabwe
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Nthumba PM. Burns in sub-Saharan Africa: A review. Burns 2015; 42:258-66. [PMID: 25981292 DOI: 10.1016/j.burns.2015.04.006] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Revised: 02/25/2015] [Accepted: 04/17/2015] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Burns are important preventable causes of morbidity and mortality, with a disproportionate incidence in sub-Saharan Africa. The management of these injuries in sub-Saharan Africa is a challenge because of multiple other competing problems such as infectious diseases (HIV/AIDS, tuberculosis and malaria), terrorist acts and political instability. There is little investment in preventive measures, pre-hospital, in-hospital and post-discharge care of burns, resulting in high numbers of burns, high morbidity and mortality. Lack of data that can be used in legislation and policy formulation is a major hindrance in highlighting the problem of burns in this sub-region. METHODS An online search of publications on burns from sub-Saharan countries was performed. RESULTS A total of 54 publications with 32,862 patients from 14 countries qualified for inclusion in the study. The average age was 15.3 years. Children aged 10 years and below represented over 80% of the burn patient population. Males constituted 55% of those who suffered burns. Scalds were the commonest cause of thermal injuries, accounting for 59% of all burns, while flame burns accounted for 33%. The burn mortality averaged 17%, or the death of one of every five burn victims. CONCLUSIONS These statistics indicate the need for an urgent review of burn policies and related legislation across the sub-Saharan region to help reduce burns, and provide a safe environment for children.
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Kalantar Motamedi MH, Heydari M, Heydari M, Ebrahimi A. Prevalence and Pattern of Facial Burns: A 5-Year Assessment of 808 Patients. J Oral Maxillofac Surg 2015; 73:676-82. [DOI: 10.1016/j.joms.2014.11.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Revised: 11/11/2014] [Accepted: 11/15/2014] [Indexed: 11/16/2022]
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Burns at KCMC: Epidemiology, presentation, management and treatment outcome. Burns 2014; 40:1024-9. [DOI: 10.1016/j.burns.2013.10.019] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2012] [Revised: 08/21/2013] [Accepted: 10/23/2013] [Indexed: 11/22/2022]
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Epidemiology of operative burns at Kijabe Hospital from 2006 to 2010: pilot study of a web-based tool for creation of the Kenya Burn Repository. Burns 2012; 39:788-95. [PMID: 23040425 DOI: 10.1016/j.burns.2012.09.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2012] [Revised: 08/27/2012] [Accepted: 09/04/2012] [Indexed: 11/22/2022]
Abstract
INTRODUCTION In order to implement effective burn prevention strategies, the WHO has called for improved data collection to better characterize burn injuries in low and middle income countries (LMIC). This study was designed to gather information on burn injury in Kenya and to test a model for such data collection. METHODS The study was designed as a retrospective case series study utilizing an electronic data collection tool to assess the scope of burn injuries requiring operation at Kijabe Hospital from January 2006 to May 2010. Data were entered into a web-based tool to test its utility as the potential Kenya Burn Repository (KBR). RESULTS 174 patients were included. The median age was 10 years. There was a male predominance (59% vs. 41%). Findings included that timing of presentation was associated with burn etiology (p=0.009). Length of stay (LOS) was associated with burn etiology (p<0.001). Etiology differed depending on the age group, with scald being most prominent in children (p=0.002). CONCLUSIONS Burn injuries in Kenya show similarities with other LMIC in etiology and pediatric predominance. Late presentation for care and prolonged LOS are areas for further investigation. The web-based database is an effective tool for data collection and international collaboration.
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Ahn CS, Maitz PKM. The true cost of burn. Burns 2012; 38:967-74. [PMID: 22795515 DOI: 10.1016/j.burns.2012.05.016] [Citation(s) in RCA: 99] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2012] [Revised: 04/01/2012] [Accepted: 05/26/2012] [Indexed: 11/18/2022]
Abstract
It is difficult to define the true cost of a burns injury, however there has always been a consensus that the costs associated with burns care are high. This study aims to achieve an accurate calculation of the cost of acute burns care in an Australian context. A retrospective review of 20 adult burn patients treated at our Centre was performed. An itemized price list was prepared based on items, services and equipment actually utilized in the care of burns patients. Case records were reviewed for a count of quantities to calculate costs for each item. Regression analysis was performed to produce a cost vs %TBSA curve for cost prediction. A cost breakdown was also performed for analysis of the most significant areas of expenditure and their trends with %TBSA. The cost calculated for an average adult burns patient was AU$71,056 (US$73,532). The total cost of all 20 patients was AU$2,449,112 (US$2,534,464). %TBSA injured was confirmed as the primary determinant of cost. Hospital length of stay, operative costs, dressings and staffing were found to be the most significant components of cost and increased most prominently with %TBSA. Compared to our findings, expenditure for prevention and education programs is minimal. There is limited conclusive evidence that changes in management protocols have had successful impact on the cost of burns treatment. Future progress in burns management may effect factors such as hospital length of stay, however until such changes, resource allocation should recognize the importance of prevention and its success at reduction of injury severity for real reductions in cost of burns care.
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Affiliation(s)
- Chris S Ahn
- Sydney Medical School, University of Sydney, NSW Severe Burn Injury Service, Concord Repatriation General Hospital, New South Wales, Australia.
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20
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Maritz D, Wallis L, Van Der Merwe E, Nel D. The aetiology of adult burns in the Western Cape, South Africa. Burns 2012; 38:120-7. [DOI: 10.1016/j.burns.2010.12.007] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2010] [Revised: 11/25/2010] [Accepted: 12/05/2010] [Indexed: 10/15/2022]
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21
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Samuel JC, Campbell ELP, Mjuweni S, Muyco AP, Cairns BA, Charles AG. The epidemiology, management, outcomes and areas for improvement of burn care in central Malawi: an observational study. J Int Med Res 2011; 39:873-9. [PMID: 21819720 DOI: 10.1177/147323001103900321] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This report describes the epidemiology of burn injuries and quantifies the appropriateness of use of available interventions at Kamuzu Central Hospital, Malawi, between July 2008 and June 2009 (370 burn patients). Burns accounted for 4.4% of all injuries and 25.9% of all burns presenting to the hospital were admitted. Most patients (67.6%) were < 15 years old and 56.2% were male. The most frequent cause was scalding (51.4%). Burns occurred most frequently in the cool, dry season and in the evening. The mean burn surface area (second/third degree) was 14.1% and most burns (74%) presented within 8 h. The commonest procedure was debridement and/or amputation. The mean hospital stay was 21.1 days, in-hospital mortality was 27% and wound infection rate was 31%. Available interventions (intravenous fluids, nutrition therapy, physiotherapy) were misapplied in 59% of cases. It is concluded that primary prevention should address paediatric and scald burns, and secondary prevention should train providers to use available interventions appropriately.
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Affiliation(s)
- J C Samuel
- Department of Surgery, Kamuzu Central Hospital, Lilongwe, Malawi.
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Chalya PL, Mabula JB, Dass RM, Giiti G, Chandika AB, Kanumba ES, Gilyoma JM. Pattern of childhood burn injuries and their management outcome at Bugando Medical Centre in Northwestern Tanzania. BMC Res Notes 2011; 4:485. [PMID: 22070934 PMCID: PMC3270007 DOI: 10.1186/1756-0500-4-485] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2011] [Accepted: 11/09/2011] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Burn injuries constitute a major public health problem and are the leading cause of childhood morbidity and mortality worldwide. There is paucity of published data on childhood burn injuries in Tanzania, particularly the study area. This study was conducted to describe the pattern of childhood burn injuries in our local setting and to evaluate their management outcome. METHODS A cross sectional study was conducted at Bugando Medical Centre (in Northwestern Tanzania) over a 3-year period from January 2008 to December 2010. Data was collected using a pre-tested coded questionnaire and statistical analyses performed using SPSS software version 15.0. RESULTS A total of 342 burned children were studied. Males were mainly affected. Children aged = 2 were the majority accounting for 45.9% of cases. Intentional burn injuries due to child abuse were reported in 2.9% of cases. Scald was the most common type of burns (56.1%). The trunk was the most commonly involved body region (57.3%). Majority of patients (48.0%) sustained superficial burns. Eight (2.3%) patients were HIV positive. Most patients (89.8%) presented to the hospital later than 24 h. The rate of burn wound infection on admission and on 10th day were 32.4% and 39.8% respectively.Staphylococcus aureus were more common on admission wound swabs, with Pseudomonas aeruginosa becoming more evident after 10th day. MRSA was detected in 19.2% of Staphylococcus aureus. Conservative treatment was performed in 87.1% of cases. Surgical treatment mainly skin grafting (65.9%) was performed in 44 (12.9%) of patients. The overall average of the length of hospital stay (LOS) was 22.12 ± 16.62 days. Mortality rate was 11.7%. Using multivariate logistic regression analysis; age of the patient, type of burn, delayed presentation, clothing ignition, %TBSA and severity of burn were found to be significantly associated with LOS (P < 0.001), whereas mortality rate was found to be independently and significantly related to the age of the patient, type of burn, HIV positive with stigmata of AIDS, CD4 count, inhalation injury, %TBSA and severity of burn (P < 0.001). CONCLUSION Childhood burn injuries still remain a menace in our environment with virtually unacceptable high morbidity and mortality. There is need for critical appraisal of the preventive measures and management principles currently being practiced.
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Affiliation(s)
- Phillipo L Chalya
- Department of Surgery, Weill-Bugando University College of Health Sciences, Mwanza, Tanzania
| | - Joseph B Mabula
- Department of Surgery, Weill-Bugando University College of Health Sciences, Mwanza, Tanzania
| | - Ramesh M Dass
- Department of Surgery, Weill-Bugando University College of Health Sciences, Mwanza, Tanzania
| | - Geofrey Giiti
- Department of Surgery, Weill-Bugando University College of Health Sciences, Mwanza, Tanzania
| | - Alphonce B Chandika
- Department of Surgery, Weill-Bugando University College of Health Sciences, Mwanza, Tanzania
| | - Emmanuel S Kanumba
- Department of Surgery, Weill-Bugando University College of Health Sciences, Mwanza, Tanzania
| | - Japhet M Gilyoma
- Department of Surgery, Weill-Bugando University College of Health Sciences, Mwanza, Tanzania
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23
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The emergency management and treatment of severe burns. Emerg Med Int 2011; 2011:161375. [PMID: 22046536 PMCID: PMC3195355 DOI: 10.1155/2011/161375] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2011] [Accepted: 05/10/2011] [Indexed: 11/18/2022] Open
Abstract
Burn injuries continue to cause morbidity and mortality internationally. Despite international collaborations and preventative measures, there are still many cases reported in high- and low-income countries. The treatment of these patients is often protracted and requires extensive resources. The adequate resuscitation of these patients coupled with meticulous wound care can have a huge impact on their outcome. The authors present a simple guideline for the initial management of severe burns which is utilised by the South African Burn Society and is based on the guidelines of the American Burn Association and the Australian and New Zealand Burn Association.
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Mashreky SR, Rahman A, Chowdhury SM, Svanström L, Shafinaz S, Khan TF, Rahman F. Health seeking behaviour of parents of burned children in Bangladesh is related to family socioeconomics. Injury 2010; 41:528-32. [PMID: 19539286 DOI: 10.1016/j.injury.2009.05.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2009] [Revised: 05/07/2009] [Accepted: 05/18/2009] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The study was design to explore the health seeking behaviour of Bangladeshi parents for their children during burn injuries. METHODS A population-based cross-sectional survey was conducted between January and December 2003 in Bangladesh. Nationally representative data were collected from 171,366 rural and urban households comprising of a total population of 819,429, including 351,651 children of 0-18 years. Mothers or heads of households were interviewed with a structured questionnaire in obtaining the information. RESULTS About sixty percent parents seek health care from unqualified service providers for their children during a childhood burn injury. Educated and the higher income groups parents choose qualified service provider at significantly higher rate compared to illiterate and poor. Higher proportion of parents of urban residence chooses qualified service provider compared to rural. No significant difference of health seeking behaviour of parent in choosing care provider was found in relation to sex of the children. CONCLUSION Education, economic condition and place of residence were found as the contributory factors in choosing service provider. Education to the parents can contribute in changes in health seeking behaviour which ultimately contribute in reducing morbidity and mortality from childhood burn injuries. Including parent's education a national burn prevention program needs to be developed to combat the devastating child injury, burn.
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Affiliation(s)
- S R Mashreky
- Centre for Injury Prevention and Research Bangladesh (CIPRB), Dhaka, Bangladesh.
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Mashreky SR, Rahman A, Khan TF, Svanström L, Rahman F. Determinants of childhood burns in rural Bangladesh: A nested case-control study. Health Policy 2010; 96:226-30. [PMID: 20202714 DOI: 10.1016/j.healthpol.2010.02.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2009] [Revised: 02/06/2010] [Accepted: 02/07/2010] [Indexed: 11/18/2022]
Abstract
BACKGROUND Burn is one of the major causes of childhood illnesses in Bangladesh and is the third leading cause of illness of 1- to 4-year-old children. Rural children are more at risk compared to urban-dwelling children. OBJECTIVE The study was designed to identify the risk factors of childhood burn in rural Bangladesh. METHODS This nested case-control study was conducted in rural Bangladesh. The study population was children of less than 10 years old in three sub-districts of Bangladesh. RESULTS Children of families who did not have a household with a separate kitchen, a common occurrence in rural areas, were at significantly higher risk of burn (OR 1.65; 95% CI 1.22-2.24). A kitchen without a door was also found to create a more hazardous environment compared to a kitchen with a door. The traditional kerosene lamp (kupi bati) was found to be one of the major determinants of childhood burn in rural Bangladesh (OR 3.16; 95% CI 1.58-6.35). No use or restricted use of kupi bati significantly reduces the risk of childhood burn. Children of nuclear families were at significantly higher risk of burn compared to combined families. CONCLUSION Cooking in an open place and use of the traditional kerosene lamp are the major determinants of childhood burn in rural Bangladesh. A combined family environment reduces the risk of childhood burn. Childhood burn can be reduced by prohibiting use of kupi bati and limiting children's access to the cooking area. Promoting combined family could be an initiative of childhood burn prevention program.
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Affiliation(s)
- Saidur R Mashreky
- Centre for Injury Prevention and Research, Bangladesh (CIPRB), Dhaka 1206, Bangladesh.
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26
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Burn prevention programs for children in developing countries require urgent attention: A targeted literature review. Burns 2010; 36:164-75. [DOI: 10.1016/j.burns.2009.06.215] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2009] [Accepted: 06/15/2009] [Indexed: 11/19/2022]
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27
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Taghavi M, Rasouli MR, Boddouhi N, Zarei MR, Khaji A, Abdollahi M. Epidemiology of outpatient burns in Tehran: an analysis of 4813 cases. Burns 2010; 36:109-13. [PMID: 19818561 DOI: 10.1016/j.burns.2009.02.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2008] [Revised: 02/05/2009] [Accepted: 02/16/2009] [Indexed: 02/08/2023]
Abstract
This study aims to demonstrate the epidemiologic characteristics of outpatient burn injuries in Tehran. This cross-sectional study was performed over a 1-year period in a referral burn centre in Tehran and included all outpatient burns. The required data were recorded by two trained physicians. Of the 4813 studied patients, including 293 infants, 2901 patients (60%) were male (P<0.001). The mean age of the adult patients was 31.3+/-18.3 years, while for infants it was 10.68+/-2.27 months. In all age groups and both genders, scalding was the most common aetiology. Majority of the burns were non-intentional (n=4808) and 70.5% of the injuries occurred at home. Housewives consisted of 24% of the burn patients. With respect to the site of burn, multiple injuries were the most frequent (53%) followed by upper extremities (37%). Most of the burns (96%) were partial thickness. Significant association was present between the aetiology and depth of burn (P<0.001). The mean affected total body surface area (TBSA) was 3.16+/-2.92% and there was significant association between burnt TBSA and the mechanism of injury (P<0.001). In conclusion, it seems that women aged 21-30 years and children younger than 10 years are at greater risk of these injuries and therefore should be the target for preventive strategies.
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Affiliation(s)
- Morteza Taghavi
- Division of Surgery, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
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28
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Dissanaike S, Rahimi M. Epidemiology of burn injuries: highlighting cultural and socio-demographic aspects. Int Rev Psychiatry 2009; 21:505-11. [PMID: 19919203 DOI: 10.3109/09540260903340865] [Citation(s) in RCA: 96] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Burns are devastating injuries that disproportionately affect people in developing countries, including children. In addition to a high mortality rate, survivors are burdened with life-long physical and emotional scars. The etiology and nature of burn injuries varies significantly by country, and this chapter explores the predominant causes and patterns of burn injury in both the developing and industrialized worlds. Gender differences play a significant role in the risk of burn injuries, across a spectrum with a predominance of women injured in fires from cooking and heating fuels in the developing world and industrial accidents primarily affecting men in developed nations. Children are particularly vulnerable to burn injuries, accounting for almost 50% of all burn patients in some studies. A majority of pediatric burns are scald injuries usually affecting very young children below the age of 5 years, and we discuss the behavioral patterns underlying this finding. Finally, the elderly form a rapidly increasing proportion of the population in many countries, and are often burdened with comorbidities that are likely to pose significant challenges in burn care.
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Affiliation(s)
- Sharmila Dissanaike
- Division of Trauma and Burn Care, Department of Surgery, and Texas Tech University Health Sciences Center, Lubbock, Texas 79430, USA.
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29
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Kai-Yang L, Shi-Hui Z, Hong-Tai T, Yi-Tao J, Zhao-Fan X, Dao-Feng B, Wei L, Guang-Qing W, Guang-Yi W, Shi-Chu X, Da-Sheng C, Bing M, Jian-Rong Z. The direct hospitalisation costs of paediatric scalds: 2-Year results of a prospective case series. Burns 2009; 35:738-45. [DOI: 10.1016/j.burns.2008.12.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2008] [Revised: 11/20/2008] [Accepted: 12/12/2008] [Indexed: 10/21/2022]
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30
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Ahmadi A, Mohammadi R, Schwebel DC, Khazaie H, Yeganeh N, Almasi A. Demographic risk factors of self-immolation: A case–control study. Burns 2009; 35:580-6. [DOI: 10.1016/j.burns.2008.06.012] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2008] [Accepted: 06/30/2008] [Indexed: 11/29/2022]
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31
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Christodoulou C, Papadopoulos IN, Douzenis A, Kanakaris N, Leukidis C, Gournellis R, Vlachos K, Papadopoulos FC, Lykouras L. Seasonality of violent suicides in the Athens greater area. Suicide Life Threat Behav 2009; 39:321-31. [PMID: 19606923 DOI: 10.1521/suli.2009.39.3.321] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The aim of the study was to ascertain suicide seasonality in the Greek population and to associate this seasonal variation with age, sex, and suicide method. Studying seasonality can be of help in establishing a public health policy, related with suicide prevention. This is an epidemiologic study based on forensic evidence. We studied the deaths caused by self-injury (trauma), namely deaths by violent suicide (not self-poisoning). Statistically significant suicide seasonality was established with a peak in May. This seasonal variation is attributed mainly to males. As for the method, suicide by hanging peaks in June and by shooting in April. It was also observed that seasonality for individuals above the age of 45 peaks in early May.
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Affiliation(s)
- C Christodoulou
- Second Department of Psychiatry, University of Athens Medical School, "Attikon" Hospital, Athens, Greece.
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Allorto NL, Oosthuizen GV, Clarke DL, Muckart DJ. The spectrum and outcome of burns at a regional hospital in South Africa. Burns 2009; 35:1004-8. [PMID: 19447554 DOI: 10.1016/j.burns.2009.01.004] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2008] [Revised: 01/19/2009] [Accepted: 01/19/2009] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Burns remain a major cause of morbidity and mortality in Southern Africa. The more vulnerable of our population, namely the urban poor, children and epileptics, are most often affected. This audit documents our experience with burns in a busy regional hospital in Southern Africa. PATIENTS AND METHODS A prospective data base was maintained from September 2006 to February 2008 of all burn wound patients admitted in Edendale hospital. Standard demographic data, detailed description of the burn, surgical intervention, outcome and length of stay are recorded. The size and depth of the burn, as well as the initial fluid management are also recorded. RESULTS A total of 450 patients were admitted. Two hundred and thirty-five were male. There were 203 burnt children with an average age of 3 years (range 6 months to 12 years). Average age for adults was 40 years (range 13-82 years). The average surface area burnt in children was 7.5% versus 23% in adults. Of those who died, the average surface area burnt was 54%. In adults the average burn depth was superficial in 30%, deep dermal in 20% and full thickness in 50%. The aetiology of the burn was flame 70%, hot water 25% and miscellaneous 5%. In children the breakdown of burn depth was superficial in 77%, deep dermal in 15% and full thickness in 8%. The aetiology was hot water 83%, fire 6%, electrical 6% and miscellaneous 5%. The last mentioned included hot oil or porridge (15), electrical (10), chemical (6), flash burns (8) and lightning (4). Fifty percent of adults were epileptic and had sustained their burn wound during a seizure. In this group, over 40% had previously sustained burns. Fifteen percent had a delayed presentation on an average of 11 days. Hospital stay averaged 68 days (3.5 days per percent burn: range 1-161 days). Two hundred and two (45%) patients required skin grafting. The average time from burn to graft was 51 days (range 12-138). There were 40 deaths (9%) with an average age of 50 years (range 6 months to 82 years) and an average total burn surface area of 50% (range 14-85%). Aetiology of the burn in the deaths was fire in 30, lightning 4 and hot water 6. Cause of death was burn wound sepsis in 38 and inadequate resuscitation in 2. CONCLUSION Young children and epileptics are particularly vulnerable to sustaining burns. Our hospital sees a large number of burns predominantly involving smaller surface areas. Patients with small burns have a prolonged hospital stay and delayed grafting due to a conservative surgical approach and lack of resources. Large burns are fatal in our hands.
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Affiliation(s)
- N L Allorto
- Pietermaritzburg Metropolitan Complex, Edendale Hospital, Department of General Surgery, University of Kwa-Zulu Natal, Nelson R. Mandela School of Medicine, South Africa
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Profile of Self-Inflicted Burn Patients Treated at a Tertiary Burn Center in Istanbul. J Burn Care Res 2009; 30:427-31. [DOI: 10.1097/bcr.0b013e3181a28d6c] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Mashreky S, Rahman A, Chowdhury S, Giashuddin S, Svanström L, Khan T, Cox R, Rahman F. Burn injury: economic and social impact on a family. Public Health 2008; 122:1418-24. [DOI: 10.1016/j.puhe.2008.06.007] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2008] [Revised: 05/15/2008] [Accepted: 06/18/2008] [Indexed: 11/16/2022]
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35
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Frans F, Keli S, Maduro A. The epidemiology of burns in a medical center in the Caribbean. Burns 2008; 34:1142-8. [DOI: 10.1016/j.burns.2008.05.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2007] [Accepted: 05/12/2008] [Indexed: 11/15/2022]
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36
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Mashreky S, Rahman A, Chowdhury S, Giashuddin S, Svanström L, Linnan M, Shafinaz S, Uhaa I, Rahman F. Consequences of childhood burn: Findings from the largest community-based injury survey in Bangladesh. Burns 2008; 34:912-8. [DOI: 10.1016/j.burns.2008.05.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2007] [Accepted: 05/11/2008] [Indexed: 11/26/2022]
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37
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Mashreky S, Rahman A, Chowdhury S, Giashuddin S, SvanstrÖm L, Linnan M, Shafinaz S, Uhaa I, Rahman F. Epidemiology of childhood burn: Yield of largest community based injury survey in Bangladesh. Burns 2008; 34:856-62. [DOI: 10.1016/j.burns.2007.09.009] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2007] [Accepted: 09/27/2007] [Indexed: 10/22/2022]
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38
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Gosselin RA, Kuppers B. Open versus closed management of burn wounds in a low-income developing country. Burns 2008; 34:644-7. [PMID: 18226462 DOI: 10.1016/j.burns.2007.09.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2007] [Accepted: 09/24/2007] [Indexed: 11/16/2022]
Abstract
Over a 38 month period, 264 patients were admitted for management of burns at the Emergency referral hospital in the resource-poor West African country of Sierra Leone. 244 charts and records were available for review, and 196 met the study's inclusion criteria. For the first 27 months, 158 patients were treated with the closed method and for the last 11 months of the study, 86 patients were treated with the open (exposure) method. Overall, the open method had as good or better early outcomes than the closed method, at significantly lower costs, and is the recommended treatment for burns in this particular type of environment.
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Burd A, Ahmed K. Mosquito-net burns and the prevention hexagon. Burns 2006; 33:261-3. [PMID: 17084533 DOI: 10.1016/j.burns.2006.06.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2006] [Accepted: 06/05/2006] [Indexed: 11/17/2022]
Affiliation(s)
- Andrew Burd
- Division of Plastic & Reconstructive Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong.
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40
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Albertyn R, Bickler SW, Rode H. Paediatric burn injuries in Sub Saharan Africa—an overview. Burns 2006; 32:605-12. [PMID: 16713683 DOI: 10.1016/j.burns.2005.12.004] [Citation(s) in RCA: 99] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2005] [Accepted: 12/12/2005] [Indexed: 10/24/2022]
Abstract
Paediatric burn injuries in Sub Saharan Africa are common and often lead to devastating consequences. Unfortunately relevant and accurate data regarding these injuries is sketchy and incomplete. This paper reviews the available information on the epidemiology of paediatric burns in Africa, associated health problems and contributing environmental factors responsible for these burns. The current status of burn care, the lack of infrastructure, and traditional methods of treatment, further contribute to the unsatisfactory status of overall burn management, prevention, and rehabilitation of burn survivors. A strategy for improving burn care in Africa has been formulated. The management of childhood burns will only be successful if educational, social, fiscal and infrastructure standards are improved. Traditional beliefs and methods cannot be discarded as they play an important role in the management of these children. It is furthermore essential that local and central government organisations support these initiatives. Clearly, the children of Africa deserve better burn care.
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Affiliation(s)
- R Albertyn
- Division of Paediatric Surgery, Red Cross War Memorial Children's Hospital, University of Cape Town, Rondebosch 7700, Cape Town, South Africa
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41
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Forjuoh SN. Burns in low- and middle-income countries: A review of available literature on descriptive epidemiology, risk factors, treatment, and prevention. Burns 2006; 32:529-37. [PMID: 16777340 DOI: 10.1016/j.burns.2006.04.002] [Citation(s) in RCA: 266] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2006] [Accepted: 04/04/2006] [Indexed: 11/21/2022]
Abstract
Burn prevention requires adequate knowledge of the epidemiological characteristics and associated risk factors. While much has been accomplished in the areas of primary and secondary prevention of fires and burns in many developed or high-income countries (HICs), such as the United States, due to sustained research on the descriptive epidemiology and risk factors, the same cannot be said of developing or low- and middle-income countries (LMICs). To move from data to action and assist preventive efforts in LMICs, a review of the available literature was conducted to assess the current status of burn preventive efforts. A MEDLINE search (1974-2003) was conducted on empirical studies published in English on the descriptive epidemiology, risk factors, treatment, and prevention of burns in LMICs. Review of the 117 identified studies revealed basically the same descriptive epidemiological characteristics but slightly different risk factors of burns including the presence of pre-existing impairments in children, lapses in child supervision, storage of flammable substances in the home, low maternal education, and overcrowding as well as several treatment modalities and preventive efforts including immediate application of cool water to a burned area. Continuous evaluation of promising interventions and those with unknown efficacy that have been attempted in LMICs, along with testing interventions that have proven effective in HICs in these LIMC settings, is needed to spearhead the move from data to action in preventing burns in LMICs.
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Affiliation(s)
- S N Forjuoh
- Department of Family & Community Medicine, Scott & White Memorial Hospital, Scott & White Santa Fe-Century Square, 1402 West Avenue H, Temple, TX 76504, USA.
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Kut A, Basaran O, Noyan T, Arda IS, Akgün HS, Haberal M. Epidemiologic Analysis of Patients With Burns Presenting to the Burn Units of a University Hospital Network in Turkey. J Burn Care Res 2006; 27:161-9. [PMID: 16566559 DOI: 10.1097/01.bcr.0000197061.60593.f8] [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
This retrospective study analyzed risk factors in addition to the demographic and epidemiological features of 813 burn patients who were admitted to the burn units of a University Hospital Network in Turkey during a 6-year period. The study consisted of 436 men (53.6%) and 377 women (46.4%; mean age, 31; range, 0-87 years). The age distribution of the patients peaked at 1 to 6 years and at 35 to 44 years. The most common types of burns were scalds (63.8%) and flame burns (22.1%). The mean TBSA burned was 9.4 +/- 15.3% in adults and 19.8 +/- 18.6% in children. The median and mean hospital stays were 16 and 22.8 days, respectively (range, 1-114 days). A total of 813 patients were evaluated, leaving only 255 hospitalized patients. Of the hospitalized patients, 100 (74.6%) underwent autografting, 8 (6.0%) underwent amputation, 113 (84.3%) underwent débridment, and 76 (56.7%) underwent escharotomy. The mortality rate among hospitalized patients was 14.1%. Although this study provides information about the population within close proximity to our burn units, there remains a need for a countrywide database of burn incidents.
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Affiliation(s)
- Altug Kut
- Department of Family Medicine, Faculty of Medicine, Adana Teaching and Medical Research Center, Başkent University, Ankara, Turkey
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Tung KY, Chen ML, Wang HJ, Chen GS, Peck M, Yang J, Liu CCH. A seven-year epidemiology study of 12,381 admitted burn patients in Taiwan--using the Internet registration system of the Childhood Burn Foundation. Burns 2005; 31 Suppl 1:S12-7. [PMID: 15649611 DOI: 10.1016/j.burns.2004.10.006] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This study described the epidemiological characteristics of the 12,381 admitted burn patients in Taiwan. The data was from 43 contracted hospitals of the Childhood Burn Foundation, in the years from 1997 to 2003. This descriptive study included 8172 males and 4206 females, with a male to female ratio of 1.94 and an average age of 29.3 years. There were 3993 (33.4%) patients under 18 years old; and 26.4% of the patients were children under 7 years old. First and second years of life were the peak of incidence. The mean extent of burn was 14.0% total body surface area with 950 patients (7.7%) suffering from a burn extent >/=40% TBSA. Scalds resulted in 5085 admissions (43.2%) and flame burns accounted for 3825 admissions (32.5%). In patient group under 18 years old, 76.8% were scald burn and 14.1% were flame burn. The majority of the burn injuries (53.3%) occurred in the dwelling place; 1122 patients had inhalation injuries and required admission to the burn center for pulmonary support. In addition, suicide attempts were recorded in 2.4% (300 cases) of all burn patients with a mean burn size of 40.7% total body surface and mortality rate of 29.3%. The overall mortality rate is 381 out of 12,381 patients (3.1%). The LA(50) was around 80% TBSA. The significant effects of risk factors, such as old age, large burn extent, combined inhalation injury and suicide were demonstrated. Adequate first aid by water cooling affected the outcome of the patient group with burn extent less than 30% TBSA, which was shown by the decrease of length of stay. These results showed some unique distributions that reflected certain socio-economic and cultural background of Taiwan.
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Burd A, Yuen C. A global study of hospitalized paediatric burn patients. Burns 2005; 31:432-8. [PMID: 15896504 DOI: 10.1016/j.burns.2005.02.016] [Citation(s) in RCA: 97] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2004] [Accepted: 02/18/2005] [Indexed: 11/20/2022]
Abstract
The global incidence of hospitalized paediatric burn patients is unknown. In order to determine a working estimate of the size of the problem, one approach is to extrapolate from relevant published studies. A literature search of the Medline database was performed to identify epidemiological papers published since 1990, which addressed paediatric burn admissions. Extrapolation from population-based studies allowed global figures to be estimated. The highest incidence of hospitalized paediatric burns patients is in Africa, the lowest in the Americas. Europe, the Middle East and Asia share similar figures, but the considerably larger population of Asia indicates that it bears over half of the world's paediatric burn population. It is unfortunate that despite many published studies describing burn admission, few meet criteria that allow for comparative epidemiological data. More attention needs to be focused on uniformity in data collection and presentation to enhance the value of the data available.
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Affiliation(s)
- Andrew Burd
- Division of Plastic and Reconstructive Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong.
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Tsati E, Iconomou T, Tzivaridou D, Keramidas E, Papadopoulos S, Tsoutsos D. Self-Inflicted Burns in Athens, Greece: A Six-Year Retrospective Study. ACTA ACUST UNITED AC 2005; 26:75-8. [PMID: 15640739 DOI: 10.1097/01.bcr.0000150304.30777.c8] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Self-inflicted burns represent a major social and medical problem. The aim of this study was to record the epidemiology, mortality and etiology of suicide attempts by burning, in Athens, Greece. Over a 6-year period from April 1997 to April 2003, all the medical charts of the patients who were admitted to the Burn Center of the General State Hospital of Athens, Greece, with self-inflicted burns were retrospectively studied. Of the 1435 burn patients, 53 (3.69%) had attempted suicide by self-inflicted burn. Their ages ranged from 18 to 90 years old (mean 53.5 years). Females (57%) outnumbered males (43%). The mean total body surface area (TBSA) burned was 41.6% (range: 15-100%). The overall mortality rate was very high (75.4%). A preexisting psychiatric disorder was present in 43.3% of the patients. In conclusion, the extent and the depth of the burn injuries could explain the high mortality rate seen in these patients, in correlation with their negativism to the treatment. Burn care professionals should be familiar with self-inflicted burn patients who constitute a considerable proportion of major burns and require constant psychiatric support in addition to burn care.
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Affiliation(s)
- Evangelia Tsati
- Department of Plastic Surgery, Microsurgery and Burn Center, General State Hospital of Athens G. Gennimatas, Greece
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Sjöberg T, Mzezewa S, Jönsson K, Salemark L. Immune response in burn patients in relation to HIV infection and sepsis. Burns 2004; 30:670-4. [PMID: 15475140 DOI: 10.1016/j.burns.2004.03.014] [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] [Accepted: 03/17/2004] [Indexed: 10/26/2022]
Abstract
The post-burn immune dysfunction predisposes patients to sepsis and multiple organ failure leading to increased mortality. HIV infection also results in a depressed immune response. The combination of burn injury and HIV might therefore lead to an increased morbidity and mortality as compared to non-HIV infected burn patients. Twenty burn patients and 10 healthy volunteers were included in a prospective study. To evaluate their immune status, CD4+ and CD8+ T-lymphocyte counts were determined in peripheral blood. HIV serology samples were obtained on admission. Bacteriological cultures were obtained from wound surface samples and wound tissue biopsies. Six burn patients were HIV infected. Clinical signs of sepsis were observed in 10 patients. The number of CD4+ T-lymphocytes were lower in burn patients compared to healthy volunteers (P < 0.05). HIV infected burn patients had lower CD4+ lymphocyte counts than non-HIV infected patients (P < 0.05). Patients with clinical signs of sepsis had lower CD4+ counts compared to patients without sepsis (P < 0.05). There was no difference in the mortality rate or the length of hospitalisation between patient groups. Burn injury, HIV infection and sepsis independently result in immunosuppression.
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Affiliation(s)
- T Sjöberg
- Department of Surgery, University of Zimbabwe, Harare, Zimbabwe.
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Greenbaum AR, Donne J, Wilson D, Dunn KW. Intentional burn injury: an evidence-based, clinical and forensic review. Burns 2004; 30:628-42. [PMID: 15475134 DOI: 10.1016/j.burns.2004.03.019] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2004] [Indexed: 10/26/2022]
Abstract
Burn injury can be inflicted intentionally either by one person to another whenever one has the ability to physically control the other, or it can be self-inflicted. There is scant evidential basis for much that is written about and practiced in the evaluation and care of patients that have sustained intentional burn injuries. Yet this is an area in which medical personnel must necessarily be trained in both the therapeutic and forensic aspects of a complex problem. Failure to appreciate the complexity of medical and forensic interactions may have far reaching effects. A missed diagnosis can result in inappropriate medical care, on-going abuse and future fatality. Inept management can result on the one hand, in blame levelled inappropriately placing incomparable strain on family units and innocent parties, and on the other, allow abusers to continue unchecked. This is the first review on the subject in which lawyers and doctors collaborate to produce a holistic approach to this subject. In it we describe the legal considerations that medical staff must appreciate when approaching patients who may have suffered intentional burns. We analyse the various scenarios in which intentional burning can be found and challenge the clinical dogma with much of the management of paediatric inflicted burns has become imbued. We suggest a rational and balanced approach to all intentional burn injuries-especially when children are involved. In the light of current case law in which dogmatic medical evidence has been implicated in wrongful convictions for child abuse in the UK, it is imperative that medical professionals gather evidence carefully and completely and apply it with logic and impartiality. This paper will aid clinicians who may not be experienced in dealing with burn injuries, but find themselves in the position of seeing a burn acutely, to avoid common mistakes.
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Affiliation(s)
- Adam R Greenbaum
- North West Region Burn Unit, Wythenshawe Hospital, Southmoor Road, Manchester M23 9LT, UK.
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Mzezewa S, Jönsson K, Aberg M, Sjöberg T, Salemark L. A prospective double blind randomized study comparing the need for blood transfusion with terlipressin or a placebo during early excision and grafting of burns. Burns 2004; 30:236-40. [PMID: 15082350 DOI: 10.1016/j.burns.2003.11.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2003] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Early excision and skin grafting has become the standard of good burn management, but it is associated with major blood loss. AIM To determine the haemostatic effect of terlipressin compared with placebo. MATERIAL AND METHODS Fifty-one patients with burns of 10-20% total body surface area had early excision and split skin grafting of deep burns. The surface area of the burn wound and of the healed graft were measured by planimetry. The patients were randomly allocated to medication, either terlipressin or placebo. Blood loss and number of transfused units of blood were recorded. RESULTS Twenty-one patients received terlipressin, 13 received terlipressin late (cross-over) and 17 received placebo. Six out of 21 patients exposed to terlipressin were transfused with eleven units of packed red blood cells. Seven out of 13 patients crossed over from placebo to terlipressin (late terlipressin) were transfused with 17 units of blood. Eight out of 17 patients exposed to the placebo were transfused with 22 units of blood (P < 0.05). Graft healing was 1055 +/- 609 cm2 out of 1452 +/- 11 cm2 in terlipressin and 914 +/- 633 cm2 out of 1288 +/- 720 cm2 in the placebo group (n.s.). CONCLUSION Terlipressin reduced the need for blood transfusion by a factor of 2.5 compared to a placebo without impairment of graft healing.
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Affiliation(s)
- S Mzezewa
- Department of Surgery, University of Zimbabwe, Harare, Zimbabwe
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Mzezewa S, Jönsson K, Sibanda E, Aberg M, Salemark L. HIV infection reduces skin graft survival in burn injuries: a prospective study. ACTA ACUST UNITED AC 2003; 56:740-5. [PMID: 14615247 DOI: 10.1016/j.bjps.2003.08.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
UNLABELLED Impaired survival of skin grafts has been noted in human immunodeficiency virus (HIV) infected patients, but the reason is not known. Alterations in inflammatory response, which might be recorded as an imbalance in cytokine production, have been implicated. The aim of this study was to determine the impact of HIV infection in patients with burn injuries by comparison of split skin graft survival, T lymphocyte count and cytokine levels in HIV-infected and non HIV-infected patients in relation to healthy and HIV-infected nonburnt volunteers.Fifty-four patients with deep dermal burns were included. Fifteen patients' were HIV-infected. Thirteen healthy and 15 HIV-infected, volunteers were recruited as controls. The burnt surface area was traced on a transparent plastic sheet and converted to area. Graft survival on day of discharge/regraft for non HIV-infected patients was 69%, and in HIV-infected 22%, (p<0.05). The median length of hospital stay for early excision among non HIV-infected patients was 21 (12-53) days and for HIV-infected, 41 days (p<0.05). Serum protein levels in HIV-infected patients were elevated compared to non HIV-infected patients (p<0.05). CD4+ lymphocytes were depressed in HIV-infected volunteers and HIV-infected burn patients compared to healthy volunteers (p<0.05). CD8+ lymphocytes were elevated in HIV-infected volunteers compared to non HIV-infected burn patients. Pro-inflammatory cytokine levels of Interleukin-2 (IL-2), Interleukin-6 (IL-6), Interferon-gama (IFN-gamma) and tumour necrosis factor alpha (TNF-alpha) were depressed in HIV-infected volunteers compared to healthy volunteers and non HIV-infected burn patients. The pro-inflammatory cytokine IFN-gamma did not increase after burn injury in HIV-infected burns patients as did IL-2, IL-6 and TNF-alpha (p<0.05). Anti-inflammatory cytokine levels of IL-4 were elevated in HIV-infected volunteers compared to healthy volunteers and burn patients (p<0.05). CONCLUSION Graft survival after split skin grafting of burn wounds in HIV-infected patients is impaired and hospital stay is prolonged. HIV infection result in immune dysregulation, which might be related to impaired skin graft survival.
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Affiliation(s)
- S Mzezewa
- Department of Surgery, University of Zimbabwe, Harare, Zimbabwe
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Sjöberg T, Mzezewa S, Jönsson K, Robertson V, Salemark L. Comparison of Surface Swab Cultures and Quantitative Tissue Biopsy Cultures to Predict Sepsis in Burn Patients: A Prospective Study. ACTA ACUST UNITED AC 2003; 24:365-70. [PMID: 14610420 DOI: 10.1097/01.bcr.0000095507.45481.76] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This study aimed at evaluating the possibility of predicting septicemia in burn patients by using wound surface and tissue culture techniques as well as blood cultures. Fifty patients with full-thickness burn wounds covering at least 10% of the total body surface area were included. Signs of septicemia were noted in 21 patients (42%) and 29 patients died (58%). The bacterial colonization of the burn wounds consisted mainly of Staphylococcus aureus and Pseudomonas aeruginosa. Sepsis was better correlated to quantitative burn tissue biopsy cultures than surface swab cultures but the time needed for processing limits its predictive and therapeutic value.
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Affiliation(s)
- T Sjöberg
- Department of Surgery, University of Zimbabwe, Harare, Zimbabwe
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