Epidemiological and clinical characteristics of burns in the older person: a seven-year retrospective analysis of 693 cases at a burn center in south-west China

Epidemiological and clinical characteristics of burns in adults: a 6-year retrospective study in a major burn center in Suzhou, China

Background

Burns are a prevalent form of unintentional injury and a significant public health concern in developing countries. We aimed to investigate the epidemiological and clinical characteristics of adult burn patients at a major center in Eastern China.

Methods

This 6-year retrospective study analyzed patients with varying degrees of burns between January 2017 and December 2022 at the Suzhou Burns and Trauma Center. The study extracted demographic, clinical, and epidemiological data from electronic medical records for analysis.

Results

The study included 3,258 adult patients, of which 64.3% were male. The largest age group affected 30-59-year-old adults (63.04%). Scalds were the leading cause of burns (1,346, 41.31%), followed by flames (1,271, 39.01%). The majority of burn hospitalizations were those with moderate burns (1791, 54.97%). The morbidity rate was low at 0.68%, while mortality was strongly associated with age, etiology, and total body surface area. Patients with certain types of burns, such as explosions, hot crush injuries, and electric burns had more operations, longer lengths of hospital stay, and higher costs compared to those with scalds and flame injuries.

Conclusion

Different prevention strategies should be formulated according to different etiologies, ages, and genders.

Characterization and prevention of flame burns caused by electric bicycle battery chargers: results from a 7-year experience

OBJECTIVE

With the recent exponential increase in express deliveries across China, the number of patients with flame burns caused by electric bicycle battery chargers (BEBBC) has markedly increased in burn units. In this study, we aimed to characterize BEBBC to systematically explore measures to prevent their occurrence.

METHODS

We performed a retrospective chart review of patients with flame burns who visited the Burn Department of Rui Jin Hospital between January 2015 and December 2021.

RESULTS

Sixty-three patients with BEBBC and 1412 with types of other flame burn were included in this study. Fifty-six of the 63 BEBBC cases occurred between 9 pm and 7 am. BEBBC incidents involved a higher incidence of group burn in which multiple individuals were affected. Non-local patients with BEBBC were significantly younger than their local counterparts. BEBBC had a higher mortality than types of other flame burn.

CONCLUSIONS

The rising incidence of BEBBC calls for greater attention because of the associated high mortality and heavy burden on society. Enacting related legislation, disseminating information to the public, and improving treatment to control infection can help prevent BEBBC, increase its cure rate, and reduce patient mortality.

Clinical Outcomes Among Elderly People With Burns

Burns in the elderly are a public health concern. This study aimed to analyze etiology, clinical characteristics, and independent risk factors for outcomes of burns in elderly patients. This retrospective study included elderly patients (65 years and over) admitted to a major burn unit between 2006 and 2016. Demographic data, clinical characteristics and outcomes were analyzed. One hundred and thirty patients were included. Most were female (56.2%) and the highest incidence was among those aged 75-84 years. The median burn area was 10.5%. The incidence in winter (50%) was higher (p<0.001) and flame burns predominated (p<0.001). The mortality rate was 32.3%. Independent risk factors for death were older age, larger extent burns, need for escharotomy, and cardiac disease as comorbidity. Amongst the survivors, the median length of stay was 36 days. Development of pressure sores, need for skin grafts, larger extent burns, presence of full-thickness burns, and cardiac disease were shown to be significantly associated with increased length of stay amongst survivors. Preventive measures should target women aged between 75-84 years. Flame burns occurred more frequently in winter. Prognosis is related to age, extent of burns, need for escharotomy at admission, and cardiac disease.

Epidemiological and clinical characteristics of older adults with burns: a 15-year retrospective analysis of 2554 cases in Wuhan Institute of Burns

BACKGROUND

With the increase of geriatric burns, it's urgent to summarize its characteristics. The aim of this study was to analyze the epidemiological and clinical characteristics of older adults with burns in a large center, and to provide suggestions for the prevention and treatment of geriatric burns.

METHODS

This retrospective study was conducted at Wuhan Institute of Burns which is the largest burn center in central China between 2004 to 2018. Demographic and clinical data of the 60 years or above older burn inpatients were collected from medical records, analyzed and compared among groups.

RESULTS

This study analyzed 2554 elderly burns, which included 50.9% in young geriatric group (60-69 years old), 32.9% in middle geriatric group (70-79 years old) and 16.2% in the oldest geriatric group (80 years old or above). The most common causes of elderly burns were flames (1081, 42.3%) and scalding (1041, 40.8%). Elderly burns with total body surface area (TBSA) of 0-9% accounted for 60.6% and the larger TBSA, the fewer number of patients. The majority of patients (70.5%) injured at home.The median of time interval from injury to admission was 7 h and the oldest geriatric group (24 h) was highest. One hundred and twenty-one cases (8.5%) were treated by cooling treatment, and 72.7% of these patients were treated less than 10 min. The median number of pre-injury diseases was one. Ninety patients (6.3%) had inhalation injury.The median length of stay (LOS) was 14 days.The median hospital cost was 10,410 CNY or 2137 CNY per % TBSA, which was correlated with TBSA, LOS, surgery, inhalation injury, number of pre-injury diseases and etiology. The mortality rate was 3.0% and correlated with TBSA, inhalation injury, pulmonary disease and Alzheimer's disease. The lethal area 50% (LA₅₀) for total admitted elderly burns was 78.3% TBSA (95% confidence interval [CI] = 69.8 ~ 89.9% TBSA).

CONCLUSION

Geriatric burns was still common and even increasing in central China, with flame burns and scalds the most common causes, majority of whom injured at home and often had problems such as few cooling treatment, improper emergency management and delayed admission. TBSA, etiology, pre-injury diseases and inhalation injury were the risk factors of length of stay, hospital cost and treatment outcomes.

Cost analysis of severe burn victims in Southwest China: A 7-year retrospective study

Background

Severe burn injury can be a life-threatening experience and can also lead to financial issues for suffers. The purpose of the current study was to analyze the direct hospitalization costs of severe burn inpatients in Southwest China.

Methods

Data related to all inpatients admitted with severe burns [total body surface area (TBSA) ≥30%] pooled from 2015 to 2021 were reviewed retrospectively at the Institute of Burn Research of Army Medical University. Demographic parameters, medical economics, and clinical data were obtained from medical records.

Results

A total of 668 cases were identified. The average age was 37.49 ± 21.00 years, and 72.3% were men. The average TBSA was 51.35 ± 19.49%. The median length of stay of inpatients in the burn intensive care unit was 14 [interquartile range (IQR): 5.0-34.8] days, and the median length of stay (LOS) was 41 (IQR: 22.0-73.8) days. The mortality rate was 1.6%. The median total cost was 212,755.45 CNY (IQR: 83,908.80-551,621.57 CNY) per patient varying from 3,521.30 to 4,822,357.19 CNY. The direct cost of scald burns was dramatically lower compared with that of other types of burns, with 11,213.43 to 2,819,019.14 CNY. Medical consumables presented the largest portion of total costs, with a median cost of 65,942.64 CNY (IQR: 18,771.86-171,197.97 CNY). The crucial risk factors for medical cost in our study were TBSA, surgical frequency, LOS, depth of burn, and outcome.

Conclusion

We conclude that an effective burn prevention program, shorter hospital stays, and facilitating the healing of wounds should be focused on with tailored precautionary protocols to reduce the medical costs of inpatients with severe burns.

IL-1β/NF-κB signaling inhibits IGF-1 production via let-7f-5p in dendritic epidermal T cells

Dendritic epidermal T cells (DETCs) are the main source of insulin-like growth factor-1 (IGF-1) in epidermal tissue, which promote re-epithelialization and wound healing. In refractory wounds, IL-1β has been shown to activate NF-κB and suppress IGF-1 expression in DETCs. Nevertheless, the underlying mechanisms remain unclear. In this study, chromatin immunoprecipitation analysis revealed that IL-1β did not inhibit NF-κB binding to IGF-1 promoter, indicating that IL-1β/NF-κB may suppress IGF-1 expression by alternative mechanisms. MiRNAs negatively regulate gene expression predominantly by base pairing to the 3' untranslation region (UTR) of target mRNAs. Let-7f-5p, miR-1a-3p, and miR-98-5p have been identified as IGF-1-specific miRNAs that can bind directly to the 3'UTR of IGF-1 mRNA and dysregulate IGF-1 mRNA and protein levels. In IL-1β-treated epidermis around wounds or DETCs in vitro, NF-κB promoted the expression of let-7f-5p, and IGF-1 expression was impeded via NF-κB/let-7f-5p pathway. As pre-let-7f-5p, let-7f-1 is located in the 3'UTR of LOC118568094, and let-7f-2 is located in the intron of HUWE1. We discovered that NF-κB p65 bound to the promoters of LOC118568094 and HUWE1 to accelerate let-7f-5p expression, but NF-κB p65 did not affect the methylation levels of LOC118568094 and HUWE1 CpG islands. Injections of Let-7f-5p antagomir into IL-1β-treated and ischemic wound margins restored IGF-1 secretion in DETCs and promoted wound healing. In conclusion, we demonstrated that NF-κB signaling pathway activated by IL-1β could increase let-7f-5p expression to inhibit IGF-1 production in DETCs and delay wound healing. And let-7f-5p antagomir utilized in wound margin could effectively promote refractory wound healing.

Elderly burns: Clinical frailty scale and functional ambulation classification in predicting prognosis

BACKGROUND

The study was to investigate the role of mobility and frailty in predicting the prognosis of elderly burns along with the burn severity.

METHODS

In this retrospective study, 67 patients aged 65 and over who were hospitalized between October 1, 2017, and Septem-ber 30, 2020 in our burn center are included in the study. The demographic data, etiological data, clinical variables, the percentage of burned total body surface area (TBSA), Abbreviated Burn Severity Index (ABSI), Functional ambulation classification (FAC) scores, and Clinical frailty scale (CFS) scores are evaluated.

RESULTS

Mean age of the study population was 71.58±7.4 years and most of the patients were female (65.7%). The percentage of TBSA was 11.34±12.2. The flame burns were the most common etiology (87.5%) of deaths (n=8), whereas 52.5% of the survivors were scalds. Most of the survived patients were functional ambulatory (93.2%). On the other hand, only 25% of patients who died were functional ambulatory (p<0.001). Also, 83% of the survivors were normal according to CFS scoring, whereas 25% of the patients who did not survive were vulnerable and 75% was frail (p<0.001).

CONCLUSION

The percentage of elderly burns is low, yet the mortality is high in these patients which emphasize the importance of elderly burns. The ABSI is of great help, but ambulation status and comorbid diseases should be taken into consideration in terms of elderly burns. The current study demonstrated that FAC and CFS will be helpful to better predict the outcomes of elderly burn patients along with ABSI.

Epidemiology of hospitalized burns in Romania: A 10-year study on 92,333 patients

BACKGROUND

No epidemiological information is available of the number of burns treated in the past 30 years in Romania. The aim of the present study is to investigate the extent of burn injuries in Romania, as well as to detect and analyze the essential epidemiological characteristics.

METHODS

A comprehensive retrospective study was conducted over a period of 10 years (1.01.2006 to 31.12.2015). Patient-related data were obtained from the Diagnosis-related group (DRG) Center of National School of Public Health, Management and Professional Development, which is the only official national structure that collects and manages data concerning all the hospitalized patients in Romania.

RESULTS

Included in this study were all 92,333 patients with burn injury as the main International Classification of Diseases (ICD-10) code of discharge from Romanian hospitals. The data was analyzed using SPSS V.24, IBM Statistics Package. The annual number of burns decreased gradually from 10,547 in 2006 to 7313 in 2015, reaching statistical significance (p = 0.001). The incidence decreased from 47 cases per 100,000 in 2006 to 36.93 per 100,000 in 2015. The seasonal evolution showed that the number of burns increases in July-August (8.8% and 9.1% of annual burns). The mean length of stay (LoS) was 10.59 days, with the highest value in 2012 (11.00) and the lowest in 2014 (10.30). The median LoS and the mean LoS values during the 10 years period have a plateau-type evolution, with no tendency for improvement. We found a significant correlation (r = 0.708, p = 0.0118) between increased mortality and the year of study.

CONCLUSIONS

This is the first nationwide epidemiological study concerning hospitalized burns in Romania. It provides insight in demographical characteristics but also uncovers a worrying trend of increasing mortality rates, which requires further investigation. This study cannot make any reference to the severity of burns (surface and depth) or towards major burns events which unfolded during the studied period, due to lack of data. Consequently, it should raise awareness towards policymakers and caregivers that for a durable burns management strategy in Romania, it would be extremely useful to implement a national burn registry.

Epidemiology and clinical characteristics of burns in mainland China from 2009 to 2018

Background

Burn injuries place a heavy burden on the global healthcare system. However, there is still a lack of nationwide studies on the epidemiological characteristics of burn patients in mainland China. The present study aims to accurately analyze the clinical characteristics of burn patients by collecting data in mainland China from 2009 to 2018, which will provide effective strategies for healthcare systems and the government in mainland China.

Methods

Patients admitted for burn injuries to 196 hospitals in 31 provinces, autonomous regions and municipalities in mainland China from 2009 to 2018 were included. The data collected included sex, age, month distribution, etiology, region, clinical outcome, injury anatomical location, total burn surface area and mortality. SPSS 19.0 software was used to analyze the data.

Results

From 2009 to 2018, the burn patients were 333,995 (0.76%), which included 222,480 (66.61%) males and 111,515 (33.39%) females. From 2009 to 2018, the number of individuals admitted to hospitals for burns showed a downward trend year by year. The burn patients accounted for the highest proportion of inpatients in 0–10 years (38.10%), followed by 40–50 years (13.14%). The highest cure ratio of burn inpatients was in the 20–30 age group (31 394, 71.53%). Among 31 provinces, autonomous regions and municipalities, the province with the highest proportion of total inpatients caused by burns was Inner Mongolia (4.61%), followed by Zhejiang (3.17%), Hainan (2.88%) and Xinjiang (2.64%). Summer (29.16%) was the season with the highest incidence of burn patients admitted to hospitals, followed by spring (25.6%). Scalding (60.19%) was the most frequent kind of burn treated, followed by fire (20.45%). The patients had multiple burn sites (68.89%) most often, followed by burns on the lower limbs (10.91%). From 0% to 10% total body surface area (TBSA) accounted for the highest ratio (37.19%), followed by 90–100% TBSA (21.74%).

Conclusions

The present study is the first to describe the associated situation and trends of burn patients in mainland China from 2009 to 2018. Our findings will serve as the latest clinical evidence for healthcare planning and prevention efforts in China and other countries.