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Brekke RL, Almeland SK, Hufthammer KO, Guttormsen AB, Hansson E, Onarheim H. Critical appraisal of the "one-day-per-percent" rule - A register-based observational study. Burns 2024:S0305-4179(24)00229-8. [PMID: 39181770 DOI: 10.1016/j.burns.2024.07.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Revised: 06/29/2024] [Accepted: 07/28/2024] [Indexed: 08/27/2024]
Abstract
BACKGROUND The "one-day-per-percent" rule states that for burn patients, one day of hospital stay can be expected for each percentage of burned body surface. This study aimed to test the rule's predictive value. METHODS The study is a register-based observational study on all burns treated in the Norwegian National Burn Center 2000-22. All children and adults admitted and actively treated in this period were included (2269 patients). Patients receiving palliative care were not included (55). Age when injured, sex, year of admittance, LOS (length of stay), %TBSA (total body surface area), discharged alive/dead, and palliative care: yes/no were extracted from the registry. Quantile regression was used to estimate the quantiles of LOS/%TBSA as a function of %TBSA. RESULTS For injuries < 15 %TBSA, the median LOS/%TBSA values were above 1.0, and the ratio increased as the injury size decreased. The median LOS/%TBSA values were close to 1.0 for patients with injuries ≥ 15 %TBSA (Table 2, Figure 2). The quantile regression analysis revealed a considerable spread in estimated values for both adults and children. Children had a lower median LOS/%TBSA than adults and a value below 1.0 for injuries 15-30 %TBSA. When survivors and non-survivors were compared, a higher median LOS/%TBSA was found for survivors with injuries > 60 %TBSA. DISCUSSION The "one-day-per-percent" rule does not seem applicable for injuries < 15 %TBSA. Even for more extensive injuries, the large spread in estimated values in different quantiles renders it poor at predicting length of hospital stay. There also seem to be many caveats when it is used to measure an institution's efficacy or when comparing different institutions. CONCLUSION The predictive value of the "one-day-per-percent" rule is deficient when considering individual patients. It does not fit for injuries < 15 %TBSA, and the significant variation for patients with injuries of a similar extent renders it not viable as a forecasting tool.
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Affiliation(s)
- R L Brekke
- Norwegian National Burn Center, Department of Plastic, Hand, and Reconstructive Surgery, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Norway.
| | - S K Almeland
- Norwegian National Burn Center, Department of Plastic, Hand, and Reconstructive Surgery, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Norway
| | - K O Hufthammer
- Centre for Clinical Research, Haukeland University Hospital, Bergen, Norway
| | - A B Guttormsen
- Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Norway; Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway
| | - E Hansson
- Department of Plastic Surgery, Institute of Clinical Sciences, The Sahlgrenska Academy, Gothenburg University, Gröna Stråket 8, SE-413 14 Gothenburg, Sweden; Region Västra Götaland, Sahlgrenska University Hospital, Department of Plastic and Reconstructive Surgery, Gröna Stråket 8, SE-413 45, Gothenburg, Sweden
| | - H Onarheim
- Norwegian National Burn Center, Department of Plastic, Hand, and Reconstructive Surgery, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Norway
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Ingram J, Williams AY, Bright AC, Caleb Butts C. Use of lateral femoral cutaneous nerve blocks by landmark technique is ineffective in decreasing narcotic usage after skin grafts: A retrospective case-control study. Burns 2024; 50:997-1002. [PMID: 38331662 DOI: 10.1016/j.burns.2024.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 12/24/2023] [Accepted: 01/10/2024] [Indexed: 02/10/2024]
Abstract
INTRODUCTION Cutaneous burns are commonly treated with autologous skin grafts. Following skin grafting, many patients complain of pain at the donor site. Donor sites are taken most commonly from the lateral thigh, which is innervated by the lateral femoral cutaneous nerve (LFCN). Use of a LFCN blocks should decrease nociception from the donor site. METHODS Our group began utilizing LFCN blocks in 2019. Utilizing anatomic landmarks, LFCN blocks were performed on all patients who received autologous skin grafts to reduce perioperative pain. A retrospective cohort study was performed on all patients with 10% or less total body surface areas burns who received an autologous skin graft. A similar cohort from 2016, prior to use of any local or regional analgesia, was used as a historical control. Post-operative enteral and parenteral narcotic analgesics were collected for each post-operative day up to day 5 or discharge (whichever came first) and converted to morphine milligram equivalents (MME) to quantify analgesia after surgery. RESULTS Chart review identified 55 patients in the 2020 cohort. Fifty-five patients from the 2016 cohort were matched based upon size of skin graft, total body surface area (TBSA) burned, gender, and age. There were no statistically significant differences between the two groups in terms of size of graft, TBSA burned, age, gender, or type of burn. When examining narcotics usage in the immediate perioperative period (days 0-2), we found no difference between the two groups for total MME (113 vs 133, p = 0.28) or IV MME (38 vs 33, p = 0.45). Similar relationships existed in the extended post-operative period (days 1-5) for total MME (149 vs. 188, t = 0.22) or IV MME (37 vs. 50, t = 0.25). Examining daily narcotic usage also yielded no statistically different values. CONCLUSION Our data shows that use of LFCN block by landmark technique did not reduce narcotic usage in patients that undergo skin grafting procedures. Future studies should consider ultrasound-guided LFCN blocks.
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Affiliation(s)
- Jordan Ingram
- University of South Alabama College of Medicine, 5795 USA Drive North, CSAB 170, Mobile, AL 36688, USA.
| | - Ashley Y Williams
- University of South Alabama College of Medicine, Division of Trauma, Acute Care Surgery, and Burns, Department of Surgery, 2451 University Hospital Drive, Mobile, AL 36617, USA
| | - Andrew C Bright
- University of South Alabama College of Medicine, Division of Trauma, Acute Care Surgery, and Burns, Department of Surgery, 2451 University Hospital Drive, Mobile, AL 36617, USA
| | - C Caleb Butts
- University of South Alabama College of Medicine, Division of Trauma, Acute Care Surgery, and Burns, Department of Surgery, 2451 University Hospital Drive, Mobile, AL 36617, USA
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Choong E, Jurat D, Sandeep B, Rainnie B, Manzanero S, Dowsey M, McPhail S, Choong PF, Wood F. The impact of infection on length of stay in adult burns: A scoping review. Burns 2024; 50:797-807. [PMID: 38307765 DOI: 10.1016/j.burns.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 11/29/2023] [Accepted: 01/10/2024] [Indexed: 02/04/2024]
Abstract
BACKGROUND The disruption to the immune system and profound metabolic response to burn injury gives rise to a unique susceptibility to infection. Indeed, infection is one of the most frequently encountered post-burns complications placing significant burden on patients and healthcare system. Advancements in burn care have led to marked improvements in burn-related mortality and morbidity; however, scarce hospital resources hamper adequate burn-related care, and patient length of stay (LOS) in hospital is an important drain on such resources. The aim of this review was to assess and evaluate the existing literature relating to the impact of infections on LOS in hospitalised, adult burn patients. METHODS Electronic searches were performed in Medline and Embase. Eligible studies were those reporting on LOS and infection in adult burn populations. Articles published before 2000 were excluded to ensure that the analysis was focused on contemporary literature that reflects current, clinical management of burn patients. RESULTS Nineteen studies (54,397 burn patients) were included in the review. All studies were retrospective, with the majority undertaken in North America (14 studies). The mean age range was 38-67 years and the majority of patients were male. Inhalation injury was recorded in eleven studies. The most common types of infection included pneumonia, blood stream infections (BSI) and burn wound infections. Overall, there was a trend towards a positive association between infection and LOS. CONCLUSION The results of this scoping review provide an overview of the existing literature on the relationship between infection and LOS in adult burn populations. However, significant gaps remain in knowledge which call for further high-quality research. Standardised definitions for the collection of infection data and the use of burns specific infection control guidelines are also critical to understanding and improving patient outcomes.
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Affiliation(s)
- Emma Choong
- Infection Collaboration in trAuma, orthopaedics and burns (ICARAUS), Australia; St Vincent's Hospital Melbourne, Fitzroy 3065, Victoria, Australia; University of Melbourne, Department of Surgery, St. Vincent's Hospital Melbourne, Victoria, Australia.
| | - Danika Jurat
- Infection Collaboration in trAuma, orthopaedics and burns (ICARAUS), Australia; State Burns Unit, Fiona Stanley Hospital, Murdoch 6150, Western Australia, Australia
| | - B Sandeep
- Infection Collaboration in trAuma, orthopaedics and burns (ICARAUS), Australia; State Burns Unit, Fiona Stanley Hospital, Murdoch 6150, Western Australia, Australia
| | - Briana Rainnie
- Infection Collaboration in trAuma, orthopaedics and burns (ICARAUS), Australia; Royal Brisbane and Women's Hospital, Herston 4029, Queensland, Australia
| | - Silvia Manzanero
- Infection Collaboration in trAuma, orthopaedics and burns (ICARAUS), Australia; Jamieson Trauma Institute, Metro North Health, Butterfield Street, Herston, Brisbane, QLD 4029, Australia; School of Clinical Sciences, Queensland University of Technology, Brisbane, QLD 4059, Australia
| | - Michelle Dowsey
- Infection Collaboration in trAuma, orthopaedics and burns (ICARAUS), Australia; University of Melbourne, Department of Surgery, St. Vincent's Hospital Melbourne, Victoria, Australia
| | - Steven McPhail
- Infection Collaboration in trAuma, orthopaedics and burns (ICARAUS), Australia; Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Kelvin Grove 4059, Queensland, Australia; Digital Health and Informatics Directorate, Metro South Health, Woolloongabba 4102, Queensland, Australia
| | - Peter Fm Choong
- Infection Collaboration in trAuma, orthopaedics and burns (ICARAUS), Australia; University of Melbourne, Department of Surgery, St. Vincent's Hospital Melbourne, Victoria, Australia
| | - Fiona Wood
- Infection Collaboration in trAuma, orthopaedics and burns (ICARAUS), Australia; State Burns Unit, Fiona Stanley Hospital, Murdoch 6150, Western Australia, Australia
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Duan D, Deng H, Chen Y, Wang Y, Xu W, Hu S, Liu D, Mao Y, Zhang Z, Xu Q, Han C, Zhang H. Associated predictors of prolonged length of stay in patients surviving extensive burns: A large multicenter retrospective study. Burns 2024; 50:413-423. [PMID: 37865601 DOI: 10.1016/j.burns.2023.09.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 08/25/2023] [Accepted: 09/27/2023] [Indexed: 10/23/2023]
Abstract
BACKGROUND Patients with extensive burns are critically ill and have long treatment periods. Length of stay (LOS) is a good measure for assessing treatment. This study sought to identify predictors of prolonged LOS in patients with extensive burns (≥50% TBSA). METHODS This retrospective multicenter cohort study included adults aged ≥ 18 years who survived extensive burns in three burn centers in Eastern China between January 2016 and June 2022. Epidemiological, demographic and clinical outcomes data were extracted from electronic medical records and compared between patients with/without prolonged LOS, which was defined as LOS greater than the median. Logistic regression analysis was used to identify predictors of prolonged LOS. RESULTS The study sample included 321 patients, of whom 156 (48.6%) had an LOS of 58 days (IQR 41.0-77.0). Univariate regression analysis showed that increased total burn area and increased full-thickness burn area; electrical, chemical and other burns; increased erythrocytes, leukocytes, platelets or serum creatinine within 24 h of admission; concomitant inhalation injury, pulmonary edema, sepsis, bloodstream infection, wound infection, pulmonary infection, urinary tract infection, or HB < 70 g/L during hospitalization were associated with prolonged LOS in patients with extensive burns. Increased number of surgical operations, mechanical ventilation and renal replacement therapy were also associated with prolonged LOS (P < 0.05 or P < 0.001). Multivariate regression analysis revealed that increased total burn area (ratio 1.032, 95%CI 1.01-1.055; P = 0.004), electrical and chemical or other burns (3.282, 1.335-8.073; P = 0.01), development of wound infection (2.653 1.285-5.481; P = 0.008) and increased number of operative procedures (1.714, 1.388-2.116, P < 0.001) were significant predictors. CONCLUSIONS Increased area of full-thickness burn,occurrence of electrical and chemical or other burns,occurrence of wound infection and increased number of surgeries are the best predictors of prolonged LOS in patients with extensive burns. Clarifying relevant predictors of burn patients' LOS provides a reliable reference for clinical treatment.
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Affiliation(s)
- Deqing Duan
- Department of Burns, the First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Hongao Deng
- Department of Burns, the First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yong Chen
- Department of Burns, the First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yiran Wang
- Department of Burns & Wound Care Center, Second Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Wanting Xu
- Department of Burn Injury, the First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - ShiQiang Hu
- Department of Burns, the First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Dewu Liu
- Department of Burns, the First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yuangui Mao
- Department of Burns, the First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Zhongwei Zhang
- Department of Burns, the First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Qinglian Xu
- Department of Burn Injury, the First Affiliated Hospital of Anhui Medical University, Hefei, China.
| | - Chunmao Han
- Department of Burns & Wound Care Center, Second Affiliated Hospital of Zhejiang University, Hangzhou, China.
| | - Hongyan Zhang
- Department of Burns, the First Affiliated Hospital of Nanchang University, Nanchang, China.
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Mauck MC, Zhao Y, Goetzinger AM, Tungate AS, Spencer AB, Lal A, Barton CE, Beaudoin F, McLean SA. Incidence of persistent opioid use following traumatic injury. Reg Anesth Pain Med 2024; 49:79-86. [PMID: 37364919 DOI: 10.1136/rapm-2022-103662] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 05/11/2023] [Indexed: 06/28/2023]
Abstract
INTRODUCTION Major traumatic injuries are a known risk factor for persistent opioid use, but data describing the relationship between specific traumatic injuries and opioid use is lacking. METHODS We used insurance claims data from January 1, 2001 to December 31, 2020 to estimate the incidence of new persistent opioid use in three hospitalized trauma populations: individuals hospitalized after burn injury (3809, 1504 of whom required tissue grafting), individuals hospitalized after motor vehicle collision (MVC; 9041), and individuals hospitalized after orthopedic injury (47, 637). New persistent opioid use was defined as receipt of ≥1 opioid prescriptions 90-180 days following injury in an individual with no opioid prescriptions during the year prior to injury. RESULTS New persistent opioid use was observed in 12% (267/2305) of individuals hospitalized after burn injury with no grafting, and 12% (176/1504) of burn injury patients requiring tissue grafting. In addition, new persistent opioid use was observed in 16% (1454/9041) of individuals hospitalized after MVC, and 20% (9455/47, 637) of individuals hospitalized after orthopedic trauma. In comparison, rates of persistent opioid use in all trauma cohorts (19%, 11, 352/60, 487) were greater than the rates of persistent opioid use in both non-traumatic major surgery (13%) and non-traumatic minor surgery (9%). CONCLUSIONS These data demonstrate that new persistent opioid use frequently occurs in these common hospitalized trauma populations. Improved interventions to reduce persistent pain and opioid use in patients hospitalized after these and other traumas are needed.
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Affiliation(s)
- Matthew C Mauck
- Institute for Trauma Recovery, The University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
- Anesthesiology, The University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Ying Zhao
- Anesthesiology, The University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Amy M Goetzinger
- Anesthesiology, The University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Andrew S Tungate
- Institute for Trauma Recovery, The University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
- Anesthesiology, The University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Alex B Spencer
- Anesthesiology, The University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Asim Lal
- Institute for Trauma Recovery, The University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
- Anesthesiology, The University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Chloe E Barton
- Institute for Trauma Recovery, The University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
- Anesthesiology, The University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Francesca Beaudoin
- Department of Emergency Medicine, Brown University Warren Alpert Medical School, Providence, Rhode Island, USA
| | - Samuel A McLean
- Institute for Trauma Recovery, The University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
- Emergency Medicine, The University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
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Keshavarzi A, Akrami R, Zarshenas MM, Zareie S, Ghadimi T, Najafi A, Rostami Chijan M, Dehghan A, Zarenezhad E. Evaluation of the Effect of Cichorium intybus L. on the Liver Enzymes in Burn Patients: A Randomized Double-Blind Clinical Trial. Int J Clin Pract 2024; 2024:1016247. [PMID: 38239768 PMCID: PMC10796187 DOI: 10.1155/2024/1016247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 09/02/2023] [Accepted: 12/30/2023] [Indexed: 01/22/2024] Open
Abstract
Burn injuries are considered an important public health problem in the world. Burns are considered the fourth most common kind of trauma in the world, after traffic accidents, falls, and interpersonal violence. Various biochemical agents are involved in the burn healing process such as cytokines (such as IL-6 and TNF-α), antioxidants, and liver and kidney damage biomarkers. Cichorium intybus L. and milk thistle extracts showed a wide range of pharmacological activities such as significant antimicrobial effect and antioxidant activity, as well as anti-inflammatory, antidiabetic, antiproliferative, antiprotozoal, and hepatoprotective effect. Also, these two herbs possess blood-cleansing, detoxifying, laxative, and invigorating activities. Some research confirmed that the preparations of the extract are very suitable for the treatment of nonalcoholic fatty liver disease. This is a double-blind randomized controlled clinical trial. Patients with 2nd and 3rd degree burns have been selected to participate in the study according to the inclusion criteria. A total of 60 patients were selected and divided into intervention and control groups (30 patients in each group). Patients in the intervention group received chicory seed syrup 10 cc three times a day and 1 placebo capsule, and those in the control group received placebo syrup (10 cc three times a day) and one Livergol (140 mg of silymarin in each capsule) capsule. Lab data such as liver function tests, albumin, creatinine, BUN, and hemoglobin were checked every 3 days and 1 week after discharge. The treatment lasted for 4 weeks. According to the results of the study, although the average of liver enzymes at the end of the study does not show a significant difference between the two groups, the level of liver enzymes in each group decreased on the 15th day of the study compared to the first day. This trial is registered with IRCT20180609040016N1.
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Affiliation(s)
- Abdolkhalegh Keshavarzi
- Shiraz Burn and Wound Healing Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Rahimeh Akrami
- Shiraz Burn and Wound Healing Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad M. Zarshenas
- Traditional Medicine and Hydrotherapy Research Center, Ardabil University of Medical Sciences, Ardabil, Iran
- Department of Phytopharmaceuticals (Traditional Pharmacy), School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Saeid Zareie
- Nurse of Intensive Care Unit (ICU) of Amir Al-Momenin Burn Injury Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Tayyeb Ghadimi
- Department of Plastic and Reconstructive Surgery, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Ali Najafi
- Shiraz Burn and Wound Healing Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mahsa Rostami Chijan
- Department of Persian Medicine, Fasa University of Medical Sciences, Fasa, Iran
- Noncommunicable Diseases Research Center, Fasa University of Medical Sciences, Fasa, Iran
| | - Azizallah Dehghan
- Noncommunicable Diseases Research Center, Fasa University of Medical Sciences, Fasa, Iran
| | - Elham Zarenezhad
- Noncommunicable Diseases Research Center, Fasa University of Medical Sciences, Fasa, Iran
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Bagheri Toolaroud P, Attarchi M, Afshari Haghdoust R, Feizkhah A, Esmailzadeh M, Rimaz S, Pirooz A, Mobayen M. Epidemiology of work-related burn injuries: A ten-year retrospective study of 429 patients at a referral burn centre in the north of Iran. Int Wound J 2023; 20:3599-3605. [PMID: 37220994 PMCID: PMC10588356 DOI: 10.1111/iwj.14238] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 05/07/2023] [Accepted: 05/09/2023] [Indexed: 05/25/2023] Open
Abstract
Work-related burns can have a destructive impact; however, knowledge of the epidemiology of work-related burn injuries in Iran is limited. This study aimed to describe epidemiological characteristics of work-related burn injuries in a burn centre in the north of Iran. This study was a retrospective single-centre study of the medical records of work-related burns between 2011 and 2020. Data collection was done using the hospital information system (HIS). The data were analysed by using descriptive statistical methods and SPSS 24.0 software. Of the 9220 cases treated in the burn centre, 429 (4.65%) had work-related burns. There was an increasing trend of work-related burns during the ten years. The mean age of patients was 37.53 (SD = 13.72). Most patients were male (n = 377, 87.9%), with a male-to-female ratio of 7.25/1. The mean total body surface area burn was 23.39% (SD = 20.03). Most work-related burns occurred in the summer season (46.9%, n = 201), and the upper limb was the most common anatomical site of burns (n = 123, 28.7%). The most common mechanism of injury was fire & flames (266, 62.0%). Inhalation injury was observed in 52 (12.1%) patients, and mechanical ventilation was undertaken in 71 (16.6%) patients. The mean length of stay in the hospital was 10.38 (SD = 10.37) days, and the overall mortality rate was 11.2%. The most common activities associated with burns at the time of the incidents were food preparation and serving related (108, 25.2%), followed by welders (n = 71, 16.6%) and electricians (n = 61, 14.2%). This research is the basis for evaluating work-related burns and identifying the causes of these injuries to develop education and prevention programmes, especially for young male workers.
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Affiliation(s)
- Parissa Bagheri Toolaroud
- Burn and Regenerative Medicine Research CenterGuilan University of Medical SciencesRashtIran
- Health Information Management Research CenterKashan University of Medical SciencesKashanIran
| | | | | | - Alireza Feizkhah
- Department of Medical Physics, School of MedicineGuilan University of Medical SciencesRashtIran
| | - Mojdeh Esmailzadeh
- Burn and Regenerative Medicine Research CenterGuilan University of Medical SciencesRashtIran
| | - Siamak Rimaz
- Burn and Regenerative Medicine Research CenterGuilan University of Medical SciencesRashtIran
| | - Amir Pirooz
- Clinical Research Development Unit of Poursina HospitalGuilan University of Medical SciencesRashtIran
- Razi Clinical Research Development Unit, Razi HospitalGuilan University of Medical SciencesRashtIran
| | - Mohammadreza Mobayen
- Burn and Regenerative Medicine Research CenterGuilan University of Medical SciencesRashtIran
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8
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Abarca L, Guilabert P, Martin N, Usúa G, Barret JP, Colomina MJ. Epidemiology and mortality in patients hospitalized for burns in Catalonia, Spain. Sci Rep 2023; 13:14364. [PMID: 37658072 PMCID: PMC10474035 DOI: 10.1038/s41598-023-40198-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 08/07/2023] [Indexed: 09/03/2023] Open
Abstract
Burn injuries are one of the leading causes of morbidity worldwide. Although the overall incidence of burns and burn-related mortality is declining, these factors have not been analysed in our population for 25 years. The aim of this study has been to determine whether the epidemiological profile of patients hospitalized for burns has changed over the past 25 years. We performed a retrospective cohort study of patients hospitalised between 1 January 2011 and 31 December 2018 with a primary diagnosis of burns. The incidence of burns in our setting was 3.68/105 population. Most patients admitted for burns were men (61%), aged between 35 and 45 years (16.8%), followed by children aged between 0 and 4 years (12.4%). Scalding was the most prevalent mechanism of injury, and the region most frequently affected was the hands. The mean burned total body surface (TBSA) area was 8.3%, and the proportion of severely burned patients was 9.7%. Obesity was the most prevalent comorbidity (39.5%). The median length of stay was 1.8 days. The most frequent in-hospital complications were sepsis (16.6%), acute kidney injury (7.9%), and cardiovascular complications (5.9%). Risk factors for mortality were advanced age, high abbreviated burn severity index score, smoke inhalation, existing cardiovascular disease full-thickness burn, and high percentage of burned TBSA. Overall mortality was 4.3%. Multi-organ failure was the most frequent cause of death, with an incidence of 49.5%. The population has aged over the 25 years since the previous study, and the number of comorbidities has increased. The incidence and severity of burns, and the percentage of burned TBSA have all decreased, with scalding being the most prevalent mechanism of injury. The clinical presentation and evolution of burns differs between children and adults. Risk factors for mortality were advanced age, smoke inhalation, existing cardiovascular disease, full-thickness burn, and high percentage of burned TBSA.
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Affiliation(s)
- L Abarca
- Anesthesia and Critical Care Department, Hospital Universitari Vall d'Hebron, 08035, Barcelona, Spain.
| | - P Guilabert
- Anesthesia and Critical Care Department, Hospital Universitari Alicante, Alicante, Spain
| | - N Martin
- Anesthesia and Critical Care Department, Hospital Clinic, Barcelona, Spain
| | - G Usúa
- Anesthesia and Critical Care Department, Hospital Universitari Vall d'Hebron, 08035, Barcelona, Spain
| | - Juan P Barret
- Plastic Surgery Department and Burn Centre, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Maria J Colomina
- Department of Anesthesia, Critical Care and Pain Clinic, Hospital Universitari de Bellvitge, Barcelona, Spain
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9
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Lam N, Hung N, Khanh N. Cost Analysis and Influencing Factors Amongst Severe Burn Patients. ANNALS OF BURNS AND FIRE DISASTERS 2023; 36:183-188. [PMID: 38680437 PMCID: PMC11041904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 07/03/2022] [Indexed: 05/01/2024]
Abstract
This study analyzed the structure and determined the factors affecting the cost of treatment of severe burns patients. The results showed that the average total costs for a patient was 3275.9 USD. The daily cost of hospitalization was 113.3 USD, the treatment cost for 1% burn surface area was 109.5 USD with the highest proportion for medication and consumable medical equipment (43.2%), followed by surgery and procedures (30.2%). The treatment costs increased with increasing age, burn extent and deep burn area (p < .05) and were significantly higher in the group of patients with inhalation injury, electrical burns and in non-survivors (p < .01). Multivariate regression analysis found that burn extent, deep burn area and inhalation injury independently influenced the treatment cost of burn patients.
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Affiliation(s)
- N.N. Lam
- Le Huu Trac National Burn Hospital, Viet Nam
- Medical Military University, Viet Nam
| | - N.T. Hung
- Le Huu Trac National Burn Hospital, Viet Nam
- Medical Military University, Viet Nam
| | - N.N. Khanh
- Hanoi - Amsterdam High School for the Gifted, Viet Nam
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10
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Thornburg DA, Swanson S, Spadafore P, Kowal-Vern A, Foster KN, Matthews MR. Burn Center Patients at Risk for Upper Extremity Amputations. Plast Surg (Oakv) 2023; 31:229-235. [PMID: 37654535 PMCID: PMC10467439 DOI: 10.1177/22925503211042863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 07/08/2021] [Accepted: 07/14/2021] [Indexed: 09/02/2023] Open
Abstract
Introduction Burn center patients present not only with burn injuries but also necrotizing infections, purpura fulminans, frostbite, toxic epidermal necrolysis, chronic wounds, and trauma. Burn surgeons are often faced with the need to amputate when limb salvage is no longer a viable option. The purpose of this study was to determine factors which predispose patients to extremity amputations. Methods: This retrospective registry review (2000-2019) compared patients who required upper extremity amputations with those who did not. Cases were pair-matched by age, sex, percent total body surface area (%TBSA), and type/location of injury to control for possible confounding variables. Results: There were 77 upper extremity amputee patients (APs) and 77 pair-matched non-amputees (NAPs) with the median age 45- and 43-years, %TBSA 21 and 10, respectively; second and third degree burn injuries were similar in the 2 groups. The AP group had longer hospitalizations (median 40 vs 15 days) P < .0001, with more intensive care unit days (median 28 vs 18 days). APs presented with significantly more cardiac, renal, and pulmonary comorbidities, acquired infections (61 [64%] vs 35 [36%]), escharotomies, and fasciotomies than the NAP, P < .0001. Mortality was similar (AP 14 [18.2%] vs NAP 9 [11.7%]), P = .26. Conclusions: Escharotomies, fasciotomies, sepsis, pneumonia, wound, and urinary tract infections contributed to prolonged hospitalizations and increased risk for upper extremity amputations in the AP group.
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Affiliation(s)
| | | | - Philomene Spadafore
- Mayo Clinic Arizona, Phoenix, AZ, USA
- Valleywise Health Medical Center, Phoenix, AZ, USA
| | - Areta Kowal-Vern
- Mayo Clinic Arizona, Phoenix, AZ, USA
- Valleywise Health Medical Center, Phoenix, AZ, USA
- The Arizona Burn Center, Phoenix, AZ
| | - Kevin N. Foster
- Mayo Clinic Arizona, Phoenix, AZ, USA
- Valleywise Health Medical Center, Phoenix, AZ, USA
| | - Marc R. Matthews
- Mayo Clinic Arizona, Phoenix, AZ, USA
- Valleywise Health Medical Center, Phoenix, AZ, USA
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11
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Carson JS, Carter JE, Hickerson WL, Rae L, Saquib SF, Wibbenmeyer LA, Becker RV, Sparks JA, Walsh TP. Analysis of real-world length of stay data and costs associated with use of autologous skin cell suspension for the treatment of small burns in U.S. centers. Burns 2022; 49:607-614. [PMID: 36813602 DOI: 10.1016/j.burns.2022.11.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 11/09/2022] [Accepted: 11/29/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Autologous skin cell suspension (ASCS) is a treatment for acute thermal burn injuries associated with significantly lower donor skin requirements than conventional split-thickness skin grafts (STSG). Projections using the BEACON model suggest that among patients with small burns (total body surface area [TBSA]<20 %), use of ASCS± STSG leads to a shorter length of stay (LOS) in hospital and cost savings compared with use of STSG alone. This study evaluated whether data from real-world clinical practice corroborate these findings. MATERIALS AND METHODS Electronic medical record data were collected from January 2019 through August 2020 from 500 healthcare facilities in the United States. Adult patients receiving inpatient treatment with ASCS± STSG for small burns were identified and matched to patients receiving STSG using baseline characteristics. LOS was assumed to cost $7554/day and to account for 70 % of overall costs. Mean LOS and costs were calculated for the ASCS± STSG and STSG cohorts. RESULTS A total of 151 ASCS± STSG and 2243 STSG cases were identified; 63.0 % of patients were male and the average age was 44.2 years. Sixty-three matches were made between cohorts. LOS was 18.5 days with ASCS± STSG and 20.6 days with STSG (difference: 2.1 days [10.2 %]). This difference led to bed cost savings of $15,587.62 per ASCS± STSG patient. Overall cost savings with ASCS± STSG were $22,268.03 per patient. CONCLUSIONS Analysis of real-world data shows that treatment of small burn injuries with ASCS± STSG provides reduced LOS and substantial cost savings compared with STSG, supporting the validity of the BEACON model projections.
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Affiliation(s)
| | | | | | - Lisa Rae
- Temple Burn Center, Philadelphia, PA, USA
| | - Syed F Saquib
- UMC Lions Burn Care Center & Kirk Kerkorian School of Medicine at UNLV, Las Vegas, NV, USA
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12
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Bajwa MS, Sohail M, Ali H, Nazir U, Bashir MM. Predicting Thermal Injury Patient Outcomes in a Tertiary-Care Burn Center, Pakistan. J Surg Res 2022; 279:575-585. [DOI: 10.1016/j.jss.2022.06.044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 06/15/2022] [Accepted: 06/17/2022] [Indexed: 12/01/2022]
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13
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Burn Injury Management in Academic Medical Center with Periodic Transfer Siege due to Acts of War: A Retrospective Analysis of 3085 Burn Patients. BURNS OPEN 2022. [DOI: 10.1016/j.burnso.2022.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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14
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Cobert J, Sheckter C, Pham TN. A National Analysis of Discharge Disposition in Older Adults with Burns—Estimating the Likelihood of Independence at Discharge. J Burn Care Res 2022; 43:1221-1226. [DOI: 10.1093/jbcr/irac104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Whereas older age predicts higher burn mortality, the impact of age on discharge disposition is less well defined in older adults with burns. This investigation assesses the relationship between older age and discharge disposition after burns in a nationally representative sample. We queried the 2007-2015 National Trauma Data Bank for non-fatal burn hospitalizations in older adults. Pre-defined age categories were 55-64 years (working-age comparison group), 65-74 years (young-old), 75-84 years (middle-old), and 85+ years (old-old). Covariables included inhalation injury, comorbidities, burn total body surface area, injury mechanism, and race/ethnicity. Discharge to non-independent living (nursing home, rehabilitation, and other facilities) was the primary outcome. Logistic regression assessed the association between older age and discharge to non-independent living. There were 25,840 non-fatal burn hospitalizations in older adults during the study period. Working-age encounters comprised 53% of admissions, young-old accounted for 28%, middle-old comprised 15% and old-old comprised 4%. Discharge to non-independent living increased with burn TBSA and older age in survivors. Starting in young-old, the majority (65 %) of patients with burns ≥20% TBSA were discharged to non-independent living. Adjusted odd ratios for discharge to non-independent living were 2.0 for young-old, 3.3 for middle-old and 5.6 for old-old patients, when compared to working-age patients (all p<0.001). Older age strongly predicts non-independent discharge after acute burn hospitalization. Matrix analysis of discharge disposition indicates a stepwise rise in discharge to non-independent living with higher age and TBSA, providing a realistic discharge framework for treatment decisions and expectations about achieving independent living after burn hospitalization.
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Affiliation(s)
- Jason Cobert
- University of Rochester, 500 Joseph C. Wilson Blvd, Rochester , New York 14627, USA
| | - Clifford Sheckter
- Department of Surgery; Stanford University, 770 Welch Road, Suite 400 , Palo Alto, California 94304, USA
| | - Tam N Pham
- Department of Surgery; University of Washington-Harborview Medical Center, 325 Ninth Ave, Box 359796 , Seattle, Washington 98104, USA
- Harborview Injury Prevention and Research Center, 325 Ninth Ave, Box 359960 , Seattle, Washington 98104, USA
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15
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Perrault D, Cobert J, Gadiraju V, Sharma A, Gurtner G, Pham T, Sheckter C. Foot Burns in Persons with Diabetes—Outcomes from the National Trauma Data Bank. J Burn Care Res 2022; 43:541-547. [DOI: 10.1093/jbcr/irac021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Diabetes Mellitus (DM) complicates the treatment of burn injuries. Foot burns in diabetic patients are challenging problems with unfavorable outcomes. National-scale evaluations are needed, especially with regard to limb salvage. We aim to characterize lower extremity burns in persons with DM and evaluate the likelihood of amputation. The National Trauma Data Bank (NTDB) was queried from 2007-2015 extracting encounters with primary burn injuries of the feet using International Classification of Diseases (ICD) 9 th Edition codes. Logistic regression modeled predictors of lower extremity amputation. Covariables included age, sex, race/ethnicity, comorbidities including DM, % burn total body surface area (TBSA), mechanism, and region of burn center. Poisson regression evaluated temporal incidence rate changes in DM foot burns. Of 116,796 adult burn encounters, 7,963 (7%) had foot burns. Of this group, 1,308 (16%) had DM. 5.6% of encounters with DM foot burns underwent amputation compared to 1.5% of non-DM encounters (p<0.001). Independent predictors of lower extremity amputation included DM (OR 3.70, 95% CI 2.98 – 4.59), alcohol use, smoking, chronic kidney disease, burn size >20%, African American/Black race, male sex, and age>40 years (all p<0.01). The incidence of DM foot burns increased over the study period with an incidence rate ratio (IRR) of 1.07 (95% CI 1.05 – 1.10, p<0.001). In conclusion, DM was associated with nearly a 4-fold increase in amputation after adjusting for covariables. Furthermore, the incidence of DM foot burns is increasing. Strategies for optimizing care in persons with DM foot burns are need to improve limb salvage.
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Affiliation(s)
| | | | | | | | | | - Tam Pham
- Department of Surgery. University of Washington
- Harborview Injury Prevention and Research Center (HIPRC). University of Washington
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16
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Mohammed HA, Qureshi KA, Ali HM, Al-Omar MS, Khan O, Mohammed SAA. Bio-Evaluation of the Wound Healing Activity of Artemisia judaica L. as Part of the Plant’s Use in Traditional Medicine; Phytochemical, Antioxidant, Anti-Inflammatory, and Antibiofilm Properties of the Plant’s Essential Oils. Antioxidants (Basel) 2022; 11:antiox11020332. [PMID: 35204215 PMCID: PMC8868479 DOI: 10.3390/antiox11020332] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 02/03/2022] [Accepted: 02/04/2022] [Indexed: 01/27/2023] Open
Abstract
Artemisia judaica (ArJ) is a Mediterranean aromatic plant used traditionally to treat gastrointestinal ailments, skin diseases, atherosclerosis, and as an immuno-stimulant. This study describes ArJ essential oil constituents and investigates their wound healing activity. The in vitro antioxidant and antibiofilm activities of ArJ essential oil were investigated. The in vivo pro/anti-inflammatory and oxidative/antioxidant markers were compared with standard silver sulfadiazine (SS) in a second-degree skin burn experimental rat model. The gas chromatography-equipped flame ionization detector (GC-FID) analysis of ArJ essential oil revealed the major classes of compounds as oxygenated monoterpenes (>57%) and cinnamic acid derivatives (18.03%). The antimicrobial tests of ArJ essential oil revealed that Bacillus cereus, Candida albicans, and Aspergillus niger were the most susceptible test organisms. Two second-degree burns (each 1 inch square in diameter) were created on the dorsum of rats using an aluminum cylinder heated to 120 °C for 10 s. The wounds were treated either with ArJ or SS ointments for 21 days, while the negative control remained untreated, and biopsies were obtained for histological and biochemical analysis. The ArJ group demonstrated a significant increase in antioxidant superoxide dismutase (SOD) and catalase (CAT) enzymatic activities, while lipid peroxide (LP) levels remained insignificant compared to the negative control group. Additionally, ArJ and SS groups demonstrated a significant decrease in inflammatory levels of tumor necrosis factor α (TNF-α) compared to the negative group, while interleukin 1 beta (IL-1b) and IL-6 were comparable to the negative group. At the same time, anti-inflammatory IL-10 and transforming growth factor beta 1 (TGF-b1) markers increased significantly in the ArJ group compared to the negative control. The ArJ results demonstrated potent wound healing effects, comparable to SS, attributable to antioxidant and anti-inflammatory effects as well as a high proportion of oxygenated monoterpenes and cinnamate derivatives.
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Affiliation(s)
- Hamdoon A. Mohammed
- Department of Medicinal Chemistry and Pharmacognosy, College of Pharmacy, Qassim University, Buraydah 51452, Saudi Arabia;
- Department of Pharmacognosy, Faculty of Pharmacy, Al-Azhar University, Cairo 11371, Egypt
- Correspondence: (H.A.M.); (S.A.A.M.)
| | - Kamal A. Qureshi
- Department of Pharmaceutics, Unaizah College of Pharmacy, Qassim University, Unaizah 51911, Saudi Arabia;
| | - Hussein M. Ali
- Department of Pharmacology and Toxicology, College of Pharmacy, Qassim University, Buraydah 51452, Saudi Arabia;
- Department of Biochemistry, Faculty of Medicine, Al-Azhar University, Assiut 71524, Egypt
| | - Mohsen S. Al-Omar
- Department of Medicinal Chemistry and Pharmacognosy, College of Pharmacy, Qassim University, Buraydah 51452, Saudi Arabia;
- Department of Medicinal Chemistry and Pharmacognosy, Faculty of Pharmacy, Jordan University of Science and Technology (JUST), Irbid 22110, Jordan
| | - Omar Khan
- Department of Pharmaceutics, College of Pharmacy, Qassim University, Buraydah 51452, Saudi Arabia;
| | - Salman A. A. Mohammed
- Department of Pharmacology and Toxicology, College of Pharmacy, Qassim University, Buraydah 51452, Saudi Arabia;
- Correspondence: (H.A.M.); (S.A.A.M.)
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17
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Carter JE, Carson JS, Hickerson WL, Rae L, Saquib SF, Wibbenmeyer LA, Becker RV, Walsh TP, Sparks JA. Length of Stay and Costs with Autologous Skin Cell Suspension Versus Split-Thickness Skin Grafts: Burn Care Data from US Centers. Adv Ther 2022; 39:5191-5202. [PMID: 36103088 PMCID: PMC9472178 DOI: 10.1007/s12325-022-02306-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 08/18/2022] [Indexed: 01/30/2023]
Abstract
INTRODUCTION Autologous skin cell suspension (ASCS) significantly reduces donor skin requirements versus conventional split-thickness skin grafts (STSG) for thermal burn treatment. In analyses using the Burn-medical counter measure Effectiveness Assessment Cost Outcomes Nexus (BEACON) model, ASCS was associated with shorter hospital length of stay (LOS) and cost savings versus STSG. This study hypothesized that daily practice data from the USA would support these findings. METHODS Electronic medical record data from 500 healthcare facilities (January 2019-August 2020) were used to match adult patients who received inpatient burn treatment with ASCS (± STSG) to patients treated with STSG alone on the basis of sex, age, percent total body surface area (TBSA), and comorbidities. Based on BEACON analyses, LOS was assumed to represent 70% of total costs and used as a proxy to assess the data. Mean LOS, costs, and the incremental revenue associated with inpatient capacity changes were calculated. RESULTS A total of 151 ASCS and 2443 STSG patients were identified: 63.0% were male and average age was 44.5 years. Eight-one matches were made between cohorts. LOS was 21.7 days with ASCS and 25.0 days with STSG alone (difference 3.3 days [13.2%]). LOS was lower with ASCS than STSG in four of five TBSA intervals. The LOS difference led to hospital bed cost savings of $25,864 per ASCS patient; overall cost savings were $36,949 per patient. Similar cost savings were observed in TBSA groupings < 20% and ≥ 20%. The reduced LOS with ASCS translated into an increased capacity of 2.2 inpatients/bed annually, which increased hospital revenue by $92,283/burn unit bed annually. CONCLUSIONS Real-world data show that ASCS (± STSG) is associated with reduced LOS and cost savings versus STSG alone across all burn sizes, supporting the validity of the BEACON analyses. ASCS use may also increase patient capacity and throughput, leading to increased hospital revenue.
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Affiliation(s)
| | | | | | - Lisa Rae
- Temple Burn Center, Philadelphia, PA USA
| | - Syed F. Saquib
- UMC Lions Burn Care Center and Kirk Kerkorian, School of Medicine at UNLV, Las Vegas, NV USA
| | | | | | - Thomas P. Walsh
- AVITA Medical, 28159 Avenue Stanford, Suite 220, Valencia, CA 91355 USA
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18
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Carter JE, Amani H, Carter D, Foster KN, Griswold JA, Hickerson WL, Holmes JH, Jones S, Khandelwal A, Kopari N, Litt JS, Savetamal A, Schupp JW, Sood R, Ferrufino CP, Vadagam P, Kowal S, Walsh T, Sparks J. Evaluating real-world national and regional trends in definitive closure in US burn care: A survey of US Burn Centers. J Burn Care Res 2021; 43:141-148. [PMID: 34329478 PMCID: PMC8737084 DOI: 10.1093/jbcr/irab151] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
To better understand trends in burn treatment patterns related to definitive closure, this study sought to benchmark real-world survey data with national data contained within the National Burn Repository version 8.0 (NBR v8.0) across key burn center practice patterns, resource utilization, and clinical outcomes. A survey, administered to a representative sample of U.S. burn surgeons, collected information across several domains: burn center characteristics, patient characteristics including number of patients and burn size and depth, aggregate number of procedures, resource use such as autograft procedure time and dressing changes, and costs. Survey findings were aggregated by key outcomes (number of procedures, costs) nationally and regionally. Aggregated burn center data were also compared to the NBR to identify trends relative to current treatment patterns. Benchmarking survey results against the NBR v8.0 demonstrated shifts in burn center patient mix, with more severe cases being seen in the inpatient setting and less severe burns moving to the outpatient setting. An overall reduction in the number of autograft procedures was observed compared to NBR v8.0, and time efficiencies improved as the intervention time per TBSA decreases as TBSA increases. Both nationally and regionally, an increase in costs was observed. The results suggest resource use estimates from NBR v8.0 may be higher than current practices, thus highlighting the importance of improved and timely NBR reporting and further research on burn center standard of care practices. This study demonstrates significant variations in burn center characteristics, practice patterns, and resource utilization, thus increasing our understanding of burn center operations and behavior.
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Affiliation(s)
| | - H Amani
- Lehigh Valley Health Network Regional Burn Center, Allentown PA
| | | | - Kevin N Foster
- Arizona Burn Center at Valleywise Health Medical Center, Phoenix AZ
| | | | - William L Hickerson
- University of Tennessee Health Science Center: Firefighters Regional Burn Center, Memphis TN
| | | | | | | | - Nicole Kopari
- . University of California San Francisco Fresno, Fresno CA
| | | | - Alisa Savetamal
- Connecticut Burn Center at Bridgeport Hospital, Bridgeport CT
| | | | - Rajiv Sood
- Richard M. Fairbanks Burn Center at Eskenazi Health, Indianapolis IN
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19
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Mauck MC, Barton CE, Tungate A, Shupp JW, Karlnoski R, Smith DJ, Williams FN, Jones SW, McGrath KV, Cairns BA, McLean SA. Peritraumatic Vitamin D levels predict chronic pain severity and contribute to racial differences in pain outcomes following Major Thermal Burn Injury. J Burn Care Res 2021; 42:1186-1191. [PMID: 33564878 DOI: 10.1093/jbcr/irab031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Major thermal burn injuries result in approximately 40,000 hospitalizations in the United States each year. Chronic pain affects up to 60% of burn survivors, Black Americans have worse chronic pain outcomes than White Americans. Mechanisms of chronic pain pathogenesis after burn injury, and accounting for these racial differences, remain poorly understood. Due to socioeconomic disadvantage and differences in skin absorption, Black Americans have an increased prevalence of Vitamin D deficiency. We hypothesized that peritraumatic Vitamin D levels predict chronic pain outcomes after burn injury and contribute to racial differences in pain outcomes. Among burn survivors (n=77, 52% White, 48% Black, 77% male), peritraumatic Vitamin D levels were more likely to be deficient in Blacks vs. Whites (27/37 (73%) vs. 14/40 (35%), p<.001). Peritraumatic Vitamin D levels were inversely associated with chronic post-burn pain outcomes across all burn injury survivors, including those who were and were not Vitamin D deficient, and accounted for approximately 1/3 of racial differences in post-burn pain outcome. Future studies are needed to evaluate potential mechanisms mediating the effect of Vitamin D on post-burn pain outcomes and the potential efficacy of Vitamin D in improving pain outcomes and reducing racial differences.
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Affiliation(s)
- Matthew C Mauck
- Institute for Trauma Recovery.,Anesthesiology, University of North Carolina, Chapel Hill, NC
| | - Chloe E Barton
- Institute for Trauma Recovery.,Anesthesiology, University of North Carolina, Chapel Hill, NC
| | - Andrew Tungate
- Institute for Trauma Recovery.,Anesthesiology, University of North Carolina, Chapel Hill, NC
| | - Jeffrey W Shupp
- The Burn Center, MedStar Washington Hospital Center, Washington, DC
| | - Rachel Karlnoski
- Department of Plastic Surgery, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - David J Smith
- Department of Plastic Surgery, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | | | - Samuel W Jones
- Jaycee Burn Center, University of North Carolina Chapel Hill, NC
| | - Kyle V McGrath
- Institute for Trauma Recovery.,Anesthesiology, University of North Carolina, Chapel Hill, NC
| | - Bruce A Cairns
- Jaycee Burn Center, University of North Carolina Chapel Hill, NC
| | - Samuel A McLean
- Institute for Trauma Recovery.,Anesthesiology, University of North Carolina, Chapel Hill, NC.,Emergency Medicine, University of North Carolina, Chapel Hill, NC
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20
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Schweizer R, Pedrazzi N, Klein HJ, Gentzsch T, Kim BS, Giovanoli P, Plock JA. Risk Factors for Mortality and Prolonged Hospitalization in Electric Burn Injuries. J Burn Care Res 2020; 42:505-512. [PMID: 33137191 DOI: 10.1093/jbcr/iraa192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Electrical injuries are rare, but very destructive with high morbidity and mortality, prolonged hospital length of stay and need for repeated procedures. The aim of study was to investigate characteristics and management of electrical injuries and predisposing factors for mortality and prolonged length of stay. Patient charts were reviewed retrospectively to identify patients admitted with electrical injuries at the Zurich Burns Center (2005-2019). Patient characteristics, management, and outcome were analyzed and risk factors for mortality and prolonged hospitalization were assessed. Eighty-nine patients were included, mostly males (86.5%), between 21 and 40 years (50.6%), with high-voltage (74.2%) occupational injuries (66.3%). Median intensive care unit and hospital stays were 6 (first and third IQR: 2.0; 30.0) and 18 (9.0; 48.0) days. Low-voltage patients had a median of 2 (1.5; 3.0) procedures, compared to 4 (2.0; 10.8) in high-voltage. The amputation rate was 13.5%, and a total of 46 flaps were required. Fifty-four patients had at least one serious complication. Mortality was 18% in high-voltage patients, mostly after multiple organ failure (35%). High total body surface area (TBSA), renal failure and cardiovascular complications were risk factors for mortality (P < .001) in multivariate regression models. Determinants for prolonged hospital stay were TBSA and sepsis (P < .01), and additionally abdominal complications and limb loss for intensive care unit stay (P < .05). Electrical injuries are still cause of significant morbidity and mortality, mostly involve young men in their earning period. Several risk factors for in-hospital mortality and prolonged stay were identified and can support physicians in the management and decision making in these patients.
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Affiliation(s)
- Riccardo Schweizer
- Department of Plastic Surgery and Handsurgery, Burn Center, UniversitätsSpital Zürich, Switzerland
| | - Nadine Pedrazzi
- Department of Plastic Surgery and Handsurgery, Burn Center, UniversitätsSpital Zürich, Switzerland
| | - Holger J Klein
- Department of Plastic Surgery and Handsurgery, Burn Center, UniversitätsSpital Zürich, Switzerland
| | - Tony Gentzsch
- Department of Plastic Surgery and Handsurgery, Burn Center, UniversitätsSpital Zürich, Switzerland.,Department of Plastic Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt, Germany
| | - Bong-Sung Kim
- Department of Plastic Surgery and Handsurgery, Burn Center, UniversitätsSpital Zürich, Switzerland
| | - Pietro Giovanoli
- Department of Plastic Surgery and Handsurgery, Burn Center, UniversitätsSpital Zürich, Switzerland
| | - Jan A Plock
- Department of Plastic Surgery and Handsurgery, Burn Center, UniversitätsSpital Zürich, Switzerland
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