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Morgan M, Deuis JR, Frøsig-Jørgensen M, Lewis RJ, Cabot PJ, Gray PD, Vetter I. Burn Pain: A Systematic and Critical Review of Epidemiology, Pathophysiology, and Treatment. PAIN MEDICINE 2019; 19:708-734. [PMID: 29036469 DOI: 10.1093/pm/pnx228] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Objective This review aims to examine the available literature on the epidemiology, pathophysiology, and treatment of burn-induced pain. Methods A search was conducted on the epidemiology of burn injury and treatment of burn pain utilizing the database Medline, and all relevant articles were systemically reviewed. In addition, a critical review was performed on the pathophysiology of burn pain and animal models of burn pain. Results The search on the epidemiology of burn injury yielded a total of 163 publications of interest, 72 of which fit the inclusion/exclusion criteria, with no publications providing epidemiological data on burn injury pain management outcomes. The search on the treatment of burn pain yielded a total of 213 publications, 14 of which fit the inclusion/exclusion criteria, highlighting the limited amount of evidence available on the treatment of burn-induced pain. Conclusions The pathophysiology of burn pain is poorly understood, with limited clinical trials available to assess the effectiveness of analgesics in burn patients. Further studies are needed to identify new pharmacological targets and treatments for the effective management of burn injury pain.
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Affiliation(s)
- Michael Morgan
- Centre for Pain Research, Institute for Molecular Bioscience, The University of Queensland, St Lucia, Queensland, Australia
| | - Jennifer R Deuis
- Centre for Pain Research, Institute for Molecular Bioscience, The University of Queensland, St Lucia, Queensland, Australia
| | - Majbrit Frøsig-Jørgensen
- Centre for Pain Research, Institute for Molecular Bioscience, The University of Queensland, St Lucia, Queensland, Australia
| | - Richard J Lewis
- Centre for Pain Research, Institute for Molecular Bioscience, The University of Queensland, St Lucia, Queensland, Australia
| | - Peter J Cabot
- School of Pharmacy, The University of Queensland, Wooloongabba, Queensland, Australia
| | - Paul D Gray
- Tess Cramond Multidisciplinary Pain Centre, Royal Brisbane & Women's Hospital, Metro North Health, Herston, Queensland, Australia.,School of Medicine, The University of Queensland, Herston, Queensland, Australia
| | - Irina Vetter
- Centre for Pain Research, Institute for Molecular Bioscience, The University of Queensland, St Lucia, Queensland, Australia.,School of Pharmacy, The University of Queensland, Wooloongabba, Queensland, Australia
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Bailey ME, Sagiraju HKR, Mashreky SR, Alamgir H. Epidemiology and outcomes of burn injuries at a tertiary burn care center in Bangladesh. Burns 2019; 45:957-963. [PMID: 30612889 DOI: 10.1016/j.burns.2018.12.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 11/15/2018] [Accepted: 12/13/2018] [Indexed: 10/27/2022]
Abstract
Globally, burns are among some of the most devastating injuries and account for more than 265,000 deaths worldwide. In Bangladesh alone, nearly 3000 people die annually from burn-related injuries. This study was conducted at the National Institute of Burn and Plastic Surgery in Dhaka, Bangladesh in June of 2016. Data included conducting surveys of hospitalized burn patients (N=66) and a chart review of deceased burn patients (N=88). In addition to reporting on the demographic profile of patients, information was also obtained on clinical measures during hospitalization. For non-fatal burns, high risk groups included young adult males (early 30s) of lower socioeconomic status. Among children, the most vulnerable group was found to be children less than eight years old. The most common non-fatal types of burn injuries were flame (35%), electrical (31%) and scald (24%). Discharged patients had an average hospital stay of around 30days with half of all patients requiring surgical intervention, thus indicating the severity of those cases and the need for resource-intensive care. Among the discharged patient population, factors significantly associated with a longer duration of hospital stay included severity of injury, not having received prior treatment before admission and whether or not patients required surgery during hospitalization. Among the mortality cases, the high-risk groups also included young adult males and children of around eight years of age. The average total body surface area (TBSA) sustained in these cases was 46.4%, with 65% of deaths attributable to complications from flame burns. These findings highlight the frequency and severity of burn injuries, identify vulnerable population groups and list common causes of burns in this large developing country of 160 million people. Furthermore, these findings may be applicable to the epidemiology and outcome of burns in similar low and middle income countries.
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Affiliation(s)
- M E Bailey
- School of Medicine, University of Texas Health Science Center San Antonio, 7733 Louis Pasture San Antonio, TX 78229, USA; The University of Texas School of Public Health, 7411 John Smith Dr, #1100 San Antonio, TX 78229, USA.
| | - H K R Sagiraju
- The University of Texas School of Public Health, 7411 John Smith Dr, #1100 San Antonio, TX 78229, USA
| | - S R Mashreky
- Centre for Injury Prevention and Research, Bangladesh (CIPRB), House # B-162, Road # 23, New DOHS, Mohakhali, Dhaka, 1206, Bangladesh
| | - H Alamgir
- New York Medical College, 40 Sunshine Cottage Rd, Valhalla, NY 10595, USA
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Kumar P, Choudhary V, Kumar P, Kumar P, Kumar S. Epidemiological study of burn admissions in a tertiary burn care center of Bihar, India. INDIAN JOURNAL OF BURNS 2019. [DOI: 10.4103/ijb.ijb_21_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Ahmadijouybari T, Najafi F, Moradinazar M, Karami-matin B, Karami-matin R, Ataie M, Hatami M, Purghorbani S, Amee V. Two-year hospital records of burns from a referral center in Western Iran: March 2010-March 2012. J Inj Violence Res 2013; 6:31-6. [PMID: 23831739 PMCID: PMC3865453 DOI: 10.5249/jivr.v6i1.276] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2012] [Accepted: 01/23/2013] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Burns are among the most common injuries affecting a great number of people worldwide annually. In Iran, especially in its western region and in Kermanshah province, burns have a relatively high incidence. The present study was aimed at investigating epidemiological characteristics in Western Iran. METHODS Within a cross-sectional study, the data on all patients attending the Burns Center at Imam Khomeini Hospital (Kermanshah, Iran) during 2010-2011 and 2011-2012 (24 months) were collected. Then, age, gender, cause of burns, total body surface area, and time of the occurrence were extracted from the hospital records. The data were analyzed using the SPSS statistical package (Version 19, for Windows). We used chi-squared test when we compared the categorical responses between two or more groups. For comparing means between two groups we used t-test. In addition, trends were investigated using linear regression. RESULTS Overall 13,248 people were referred to the Burns Center at Imam Khomeini Hospital (Kermanshah, Iran) during the period of study, including 328 cases of self-immolation. The mean age of the patients was 27±19 years and 29±13 years for unintentional burns and self-immolation respectively. Out of the total number of unintentional cases, 6,519 (50.5%) were men, while the corresponding percentage of men among the self-immolation cases was 16.6% (p less than 0.001). Trends in the number of cases were cyclic, with the highest and lowest number of burns cases being in March and May. Overall, hot liquids and flammable materials were the two most important causes of unintentional burns. However, flammable materials were the main cause of burns among self-immolation cases. During hospital admission, 168 (51%) self-immolation victims and 43 (0.33%) unintentional burn victims died. CONCLUSIONS While major preventive measures are not adequately used in developing countries, burns and their burden can be significantly reduced by increasing public awareness and by applying simple preventive measures.
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Affiliation(s)
| | - Farid Najafi
- School of Public Health, Kermanshah University of Medical Sciences, Kermanshah, Iran.
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Mashreky SR, Rahman A, Svanström L, Khan TF, Rahman F. Burn mortality in Bangladesh: findings of national health and injury survey. Injury 2011; 42:507-10. [PMID: 20031124 DOI: 10.1016/j.injury.2009.11.020] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2009] [Revised: 11/16/2009] [Accepted: 11/30/2009] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The study was designed to explore the epidemiology of burn mortality in Bangladesh. METHODS A population-based cross-sectional survey was conducted between January and December 2003. Nationally representative data was collected from 171,366 rural and urban households, comprising of a total population of 819,429. RESULTS Overall mortality burn rate was 2.2 per 100,000 populations per year. The rate was higher amongst females. Most of the deaths were accidental in nature, only 5% of deaths were from self-inflected burn. The rate was higher amongst the rural population compared to the urban population. About 90% of the burn incidences were at home with the kitchen the most frequent place at home for burn incidence to occur. A majority, 89%, of the deaths were caused by flame burn. Cooking fire, heating fire and fire from kerosene lamps were the major sources of flames. The majority of burn deaths occurred during winter season. CONCLUSION Burn is a considerable cause of death in Bangladesh. Females, rural dwellers and populations of low socioeconomic condition are more vulnerable to burn injury. With simple intervention many of the deaths due to burn can be prevented. Considering the magnitude of the problem it is very important to address it as a public health problem and develop a national burn prevention program.
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Affiliation(s)
- S R Mashreky
- Centre for Injury Prevention and Research Bangladesh, Bangladesh.
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Ha JF, Italiano CM, Heath CH, Shih S, Rea S, Wood FM. Candidemia and invasive candidiasis: a review of the literature for the burns surgeon. Burns 2010; 37:181-95. [PMID: 20395056 DOI: 10.1016/j.burns.2010.01.005] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2009] [Revised: 12/05/2009] [Accepted: 01/06/2010] [Indexed: 10/19/2022]
Abstract
Advances in critical care, operative techniques, early fluid resuscitation, antimicrobials to control bacterial infections, nutritional support to manage the hypermetabolic response and early wound excision and coverage has improved survival rates in major burns patients. These advances in management have been associated with increased recognition of invasive infections caused by Candida species in critically ill burns patients. Candida albicans is the most common species to cause invasive Candida infections, however, non-albicans Candida species appear to becoming more frequent. These later species may be less fluconazole susceptible than Candida albicans. High crude and attributable mortality rates from invasive Candida sepsis are multi-factorial. Diagnosis of invasive candidiasis and candidemia remains difficult. Prophylactic and pre-emptive therapies appear promising strategies, but there is no specific approach which is well-studied and clearly efficacious in high-risk burns patients. Treatment options for invasive candidiasis include several amphotericin B formulations and newer less toxic antifungal agents, such as azoles and echinocandins. We review the currently available data on diagnostic and management strategies for invasive candidiasis and candidemia; whenever possible providing reference to the high-risk burn patients. We also present an algorithm for the management of candidemia and invasive candidiasis in burn patients.
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Affiliation(s)
- Jennifer F Ha
- Telstra Burns Unit, Department of Plastic Surgery, Royal Perth Hospital, Perth, Western Australia, Australia.
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Othman N, Kendrick D. Epidemiology of burn injuries in the East Mediterranean Region: a systematic review. BMC Public Health 2010; 10:83. [PMID: 20170527 PMCID: PMC2841676 DOI: 10.1186/1471-2458-10-83] [Citation(s) in RCA: 150] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2009] [Accepted: 02/20/2010] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Burn injuries remain one of the leading causes of injury morbidity and mortality in the World Health Organization's East Mediterranean Region. To provide an overview on the epidemiology of burn injuries in this region, a systematic review was undertaken. METHODS Medline, Embase and CINAHL were searched for publications on burns in this region published between 01/01/1997 and 16/4/2007. Data were extracted to a standard spreadsheet and synthesised using a narrative synthesis. No attempt has been made to quantitatively synthesise the data due to the large degree of clinical heterogeneity between study populations. RESULTS Seventy one studies were included in the review, from 12 countries. Burn injuries were found to be one of the leading causes of injury morbidity and mortality. The reported incidence of burns ranged from 112 to 518 per 100,000 per year. Burn victims were more frequently young and approximately one third of the victims were children aged 0-5 years. Hospital mortality ranged from 5 to 37%, but was commonly above 20%. Intentional self-harm burns particularly involving women were common in some countries of the region and were associated with a very high mortality of up to 79%. CONCLUSION Burn injuries remain an important public health issue in the East Mediterranean Region therefore further research is required to investigate the problem and assess the effectiveness of intervention programmes.
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Affiliation(s)
- Nasih Othman
- School of Community Health Sciences, University of Nottingham, Nottingham, UK
| | - Denise Kendrick
- School of Community Health Sciences, University of Nottingham, Nottingham, UK
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Parment K, Zetterberg A, Ernerudh J, Bakteman K, Steinwall I, Sjoberg F. Long-term immunosuppression in burned patients assessed by in vitro neutrophil oxidative burst (Phagoburst®). Burns 2007; 33:865-71. [PMID: 17537580 DOI: 10.1016/j.burns.2006.11.011] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2006] [Accepted: 11/21/2006] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To assess the duration and magnitude of immunosuppression induced by burns as measured by the neutrophil oxidative burst in vitro. DESIGN Prospective exploratory cohort study. SETTING Tertiary referral unit, University Hospital, Linkoping, Sweden (National Burn Unit). PATIENTS AND HEALTHY VOLUNTEERS (CONTROLS): Twenty-eight subjects consecutively admitted to the Burn Unit. The mean total burn surface area (TBSA%) was 36 (range 13-87) and mean age 44 years (range 14-89). Patients' data were collected prospectively in the burn unit, which also included sequential organ failure assessment (SOFA) score. INTERVENTIONS None. MEASUREMENTS AND RESULTS To assess the changes in the oxidative capacity of neutrophils after the burn, blood samples for the Phagoburst analysis were taken on admission and at least once every second week for the duration of stay in hospital and thereafter monthly up to 12 months after the burn. Neutrophils were stimulated in vitro by Escherichia coli, phorbol 12-phorbol myristate 13-acetate (PMA), and peptide N-formyl-Met-Leu-Phe (fMLP). Oxidative burst was measured by flow cytometry. Oxidative capacity of the neutrophils decreased similarly for all three stimulants: there was a pathological decrease shortly after admission, with the lowest value occurring between days 7 and 10, followed by a gradual recovery during the ensuing months. Full recovery (to the values of the controls) was seen first 3.5 months after the burn. Using multiple regression, we found that only age and time since the burn significantly (p<0.05) affected the oxidative burst. White cell count (WCC) and C-reactive protein (CRP) values returned to reference ranges long before the oxidative burst. CONCLUSIONS This study provides evidence that immunosuppression in those injured by burns, as assessed by the in vitro oxidative burst of neutrophils, remains long after the event of the burn (up to 3.5 months after burn). Absence of correlations to TBSA%, FTB%, blood transfusion, opiates provided, and multiple organ failure score and laboratory infection variables together with the finding that decreased oxidative burst was uniform after the injury, suggesting that this immunosuppression is primarily due to the general metabolic response rather than recurring infections.
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Affiliation(s)
- Karin Parment
- The Burn Unit, Department of Hand and Plastic Surgery, Faculty of Health Sciences, Linkoping University Hospital, S-581 85 Linkoping, Sweden
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Lopes JA, Jorge S, Neves FC, Costa AGD, Prata MM, Caneira M, Ferreira AC. Acute renal failure in severely burned patients. Resuscitation 2007; 73:318. [PMID: 17298861 DOI: 10.1016/j.resuscitation.2006.10.029] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2006] [Revised: 10/17/2006] [Accepted: 10/17/2006] [Indexed: 11/24/2022]
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Sharma PN, Bang RL, Al-Fadhli AN, Sharma P, Bang S, Ghoneim IE. Paediatric burns in Kuwait: Incidence, causes and mortality. Burns 2006; 32:104-11. [PMID: 16406370 DOI: 10.1016/j.burns.2005.08.006] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2005] [Accepted: 08/11/2005] [Indexed: 11/29/2022]
Abstract
From a prospective study on burn patients admitted at the Burn Center in Kuwait during 1993-2001, 826 paediatric burn cases, in 0-14 years age group, were retrieved to study incidence, causes, and mortality among children. The demographic characteristics, clinical features, and outcome constituted our data file in Statistical Software, SPSS. Overall incidence rate was 17.5/100,000 children aged 0-14 years, being almost twice (34/100,000) among those between 0 and 4 years, constituting 70.8% of all paediatric burns. Scald was the main cause of burn (67%), followed by flame (23%). Mean age (6.4 years) of children with flame burns, was significantly higher (p < 0.001) than those with scalds, or other causes. A positive significant correlation existed between duration of hospital stay and TBSA% (r = 0.56, p < 0.001). Overall mortality rate was 0.23/100,000 children, maximum (0.52/100,000) being in children below 5 years. Among 11 (1.3%) non-survivors, flame burns caused nine fatalities. Multiple logistic regression mooring predicted children aged < 5 years, flame burns and TBSA >or= 70%, (OR = 29.2, p < 0.001), as main contributing factors to fatal outcome among children. Gender and nationality had no influence on incidence or mortality. These findings will hopefully stimulate development of targeted and sustainable interventions for reducing burns occurrence among identified paediatric high-risk groups.
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Sharma PN, Bang RL, Ghoneim IE, Bang S, Sharma P, Ebrahim MK. Predicting factors influencing the fatal outcome of burns in Kuwait. Burns 2005; 31:188-92. [PMID: 15683691 DOI: 10.1016/j.burns.2004.09.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2004] [Indexed: 11/19/2022]
Abstract
A prospective study was carried out on a total of 2111 burn patients admitted at the Burn Center in Kuwait, during 1993 to 2001, with the purpose of predicting the risk factors influencing the fatal outcome. A total of 111 (5.3%) patients died, giving an annual average of 12 deaths, and a mortality rate of 0.64/100,000 population. The data, from the in-patient records, included the most commonly available demographic features viz. age, gender and nationality, as well as best recorded clinical factors, such as cause of burn, total body surface area (TBSA), duration of hospital stay and outcome, for analysis. Kolmogorov-Smirnov z test showed the median age (30 years) and TBSA (80%) significantly higher (p < 0.001) among those died as compared to 24 years and 10%, respectively in patients survived. The Chi-square test revealed a fatal outcome associated with gender and cause of burn. The multiple logistic regression model predicted patients, aged 60 years and above (OR: 9.9, p < 0.001), female gender (OR: 2.2, p < 0.016), Flame burns (OR: 3.5, p < 0.035), and TBSA > 90% (OR: 23.5, p < 0.001), as the most influencing risk factors for a fatal outcome at this burn center. Patients with these characteristics need to be given special attention during in-patient care.
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Vanni HEC, Gordon BR, Levine DM, Sloan BJ, Stein DR, Yurt RW, Saal SD, Parker TS. Cholesterol and interleukin-6 concentrations relate to outcomes in burn-injured patients. THE JOURNAL OF BURN CARE & REHABILITATION 2003; 24:133-41. [PMID: 12792232 DOI: 10.1097/01.bcr.0000066812.96811.28] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The goal of this study was to determine the relationship among lipid concentrations, cytokine concentrations, and clinical outcomes of burn patients. Twenty-eight patients admitted within 24 hours of burn injury, segregated based on burn size, had blood samples drawn 24 and 48 hours after burn injury and then weekly for 3 weeks. Measurements included total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triglyceride, interleukin (IL)-6, soluble IL-2 receptor, and soluble necrosis factor p55 and p75 receptors. Infection, length of stay (LOS), and survival were monitored. Cholesterol and lipoprotein concentrations decreased by at least 40% in patients with burns >20% total body surface area and inversely correlated with IL-6. Lower cholesterol and higher IL-6 values correlated with higher infection rates and longer LOS. IL-6 was the strongest predictor for LOS. In conclusion, outcomes after burn injury are related to low cholesterol and elevated IL-6 levels.
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