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Chang CW, Ho CY, Lai F, Christian M, Huang SC, Chang DH, Chen YS. Application of multiple deep learning models for automatic burn wound assessment. Burns 2023; 49:1039-1051. [PMID: 35945064 DOI: 10.1016/j.burns.2022.07.006] [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: 02/16/2022] [Revised: 06/24/2022] [Accepted: 07/14/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE Accurate assessment of the percentage of total body surface area (%TBSA) burned is crucial in managing burn injuries. It is difficult to estimate the size of an irregular shape by inspection. Many articles reported the discrepancy of estimating %TBSA burned by different doctors. We set up a system with multiple deep learning (DL) models for %TBSA estimation, as well as the segmentation of possibly poor-perfused deep burn regions from the entire wound. METHODS We proposed boundary-based labeling for datasets of total burn wound and palm, whereas region-based labeling for the dataset of deep burn wound. Several powerful DL models (U-Net, PSPNet, DeeplabV3+, Mask R-CNN) with encoders ResNet101 had been trained and tested from the above datasets. With the subject distances, the %TBSA burned could be calculated by the segmentation of total burn wound area with respect to the palm size. The percentage of deep burn area could be obtained from the segmentation of deep burn area from the entire wound. RESULTS A total of 4991 images of early burn wounds and 1050 images of palms were boundary-based labeled. 1565 out of 4994 images with deep burn were preprocessed with superpixel segmentation into small regions before labeling. DeeplabV3+ had slightly better performance in three tasks with precision: 0.90767, recall: 0.90065 for total burn wound segmentation; precision: 0.98987, recall: 0.99036 for palm segmentation; and precision: 0.90152, recall: 0.90219 for deep burn segmentation. CONCLUSION Combining the segmentation results and clinical data, %TBSA burned, the volume of fluid for resuscitation, and the percentage of deep burn area can be automatically diagnosed by DL models with a pixel-to-pixel method. Artificial intelligence provides consistent, accurate and rapid assessments of burn wounds.
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Affiliation(s)
- Che Wei Chang
- Graduate Institute of Biomedical Electronics & Bioinformatics, National Taiwan University, Taipei, Taiwan; Division of Plastic and Reconstructive Surgery, Department of Surgery, Far Eastern Memorial Hospital, New Taipei, Taiwan.
| | - Chun Yee Ho
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Far Eastern Memorial Hospital, New Taipei, Taiwan
| | - Feipei Lai
- Graduate Institute of Biomedical Electronics & Bioinformatics, National Taiwan University, Taipei, Taiwan; Department of Computer Science & Information Engineering, National Taiwan University, Taipei, Taiwan
| | - Mesakh Christian
- Department of Computer Science & Information Engineering, National Taiwan University, Taipei, Taiwan
| | - Shih Chen Huang
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Far Eastern Memorial Hospital, New Taipei, Taiwan
| | - Dun Hao Chang
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Far Eastern Memorial Hospital, New Taipei, Taiwan; Department of Information Management, Yuan Ze University, Taiwan
| | - Yo Shen Chen
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Far Eastern Memorial Hospital, New Taipei, Taiwan
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Brekke RL, Almeland SK, Hufthammer KO, Hansson E. Agreement of clinical assessment of burn size and burn depth between referring hospitals and burn centres: A systematic review. Burns 2023; 49:493-515. [PMID: 35843804 DOI: 10.1016/j.burns.2022.05.007] [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: 11/25/2021] [Revised: 04/14/2022] [Accepted: 05/09/2022] [Indexed: 11/02/2022]
Abstract
BACKGROUND The quality of burn care is highly dependent on the initial assessment and care. The aim of this systematic review was to investigate the agreement of clinical assessment of burn depth and %TBSA between the referring units and the receiving burn centres. METHODS Included articles had to meet criteria defined in a PICO (patients, interventions, comparisons, outcomes). Relevant databases were searched using a predetermined search string (November 6th 2021). Data were extracted in a standardised fashion. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach for test accuracy was used to assess the certainty of evidence. The QUADAS-2 tool was used to assess the risk of bias of individual studies as 'high', 'low' or 'unclear'. RESULTS A total of 412 abstracts were retrieved and of these 28 studies with a total of 6461 patients were included, all reporting %TBSA and one burn depth. All studies were cross-sectional and most of them comprising retrospectively enrolled consecutive cohort. All studies showed a low agreement between %TBSA calculations made at referring units and at burn centres. Most studies directly comparing estimations of %TBSA at referring institutions and burn centers showed a proportion of overestimations of 50% or higher. The study of burn depth showed that 55% were equal to the estimates from the burn centre. Most studies had severe study limitations and the risk of imprecision was high. The overall certainty of evidence for accuracy of clinical estimations in referring centres is low (GRADE ⊕⊕ОО) for %TBSA and very low (GRADE ⊕ООО) for burn depth and resuscitation. CONCLUSION Overestimation of %TBSA at referring hospitals occurs very frequently. The overall certainty of evidence for accuracy of clinical estimations in referring centres is low for burn size and very low for burn depth. The findings suggest that the burn community has a significant challenge in educating and communicating better with our colleagues at referring institutions and that high-quality studies are needed.
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Affiliation(s)
- Ragnvald Ljones Brekke
- Department of Plastic, Hand and Reconstructive Surgery, Norwegian National Burn Center, Haukeland University Hospital, Haukelandsveien 22, NO-5021 Bergen, Norway; Department of Clinical Medicine, University of Bergen, Jonas Lies vei 87, NO-5021 Bergen, Norway.
| | - Stian Kreken Almeland
- Department of Plastic, Hand and Reconstructive Surgery, Norwegian National Burn Center, Haukeland University Hospital, Haukelandsveien 22, NO-5021 Bergen, Norway; Department of Clinical Medicine, University of Bergen, Jonas Lies vei 87, NO-5021 Bergen, Norway
| | - Karl Ove Hufthammer
- Centre for Clinical Research, Haukeland University Hospital, PO Box 1400, NO-5021 Bergen, Norway
| | - Emma Hansson
- Department of Plastic Surgery, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gröna Stråket 8, SE-413 45 Gothenburg, Sweden; Department of Plastic Surgery, Sahlgrenska University Hospital, Gröna Stråket 8, SE-413 45 Gothenburg, Sweden
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Leclerc T, Sjöberg F, Jennes S, Martinez-Mendez JR, van der Vlies CH, Battistutta A, Lozano-Basanta JA, Moiemen N, Almeland SK. European Burns Association guidelines for the management of burn mass casualty incidents within a European response plan. Burns 2023; 49:275-303. [PMID: 36702682 DOI: 10.1016/j.burns.2022.12.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 12/19/2022] [Indexed: 12/27/2022]
Abstract
BACKGROUND A European response plan to burn mass casualty incidents has been jointly developed by the European Commission and the European Burn Association. Upon request for assistance by an affected country, the plan outlines a mechanism for coordinated international assistance, aiming to alleviate the burden of care in the affected country and to offer adequate specialized care to all patients who can benefit from it. To that aim, Burn Assessment Teams are deployed to assess and triage patients. Their transportation priority recommendations are used to distribute outnumbering burn casualties to foreign burn centers. Following an appropriate medical evacuation, these casualties receive specialized care in those facilities. METHODS The European Burns Association's disaster committee developed medical-organizational guidelines to support this European plan. The experts identified fields of interest, defined questions to be addressed, performed relevant literature searches, and added their expertise in burn disaster preparedness and response. Due to the lack of high-level evidence in the available literature, recommendations and specially designed implementation tools were provided from expert opinion. The European Burns Association officially endorsed the draft recommendations in 2019, and the final full text was approved by the EBA executive committee in 2022. RECOMMENDATIONS The resulting 46 recommendations address four fields. Field 1 underlines the need for national preparedness plans and the necessary core items within such plans, including coordination and integration with an international response. Field 2 describes Burn Assessment Teams' roles, composition, training requirements, and reporting goals. Field 3 addresses the goals of specialized in-hospital triage, appropriate severity criteria, and their effects on priorities and triage. Finally, field 4 covers medical evacuations, including their timing and organization, the composition of evacuation teams and their assets, preparation, and the principles of en route care.
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Affiliation(s)
- Thomas Leclerc
- Percy Military Teaching Hospital, Clamart, France; Val-de-Grâce Military Medical Academy, Paris, France
| | | | - Serge Jennes
- Charleroi Burn Wound Center, Skin-burn-reconstruction Pole, Grand Hôpital de Charleroi, Charleroi, Belgium
| | | | - Cornelis H van der Vlies
- Department of Trauma and Burn Surgery, Maasstad Hospital, Rotterdam, the Netherlands; Trauma Research Unit Department of Surgery, Erasmus MC, Rotterdam, the Netherlands
| | - Anna Battistutta
- Directorate-General for European Civil Protection and Humanitarian Aid Operations (DG-ECHO), European Commission, Brussels, Belgium
| | - J Alfonso Lozano-Basanta
- Emergency Response Coordination Center, Directorate-General for European Civil Protection and Humanitarian Aid Operations (DG-ECHO), European Commission, Brussels, Belgium
| | - Naiem Moiemen
- University Hospitals Birmingham Foundation Trust, Birmingham, UK; University of Birmingham, College of Medical and Dental Sciences, Birmingham, UK
| | - Stian Kreken 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; Norwegian Directorate of Health, Department of Preparedness and Emergency Medical Services, Oslo, Norway.
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Stewart S, Juang D, Aguayo P. Pediatric burn review. Semin Pediatr Surg 2022; 31:151217. [PMID: 36370620 DOI: 10.1016/j.sempedsurg.2022.151217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Shai Stewart
- Department of Surgery, Children's Mercy Kansas City, Kansas City, MO USA; University of Missouri-Kansas City School of Medicine, Kansas City, MO USA
| | - David Juang
- Department of Surgery, Children's Mercy Kansas City, Kansas City, MO USA; University of Missouri-Kansas City School of Medicine, Kansas City, MO USA
| | - Pablo Aguayo
- Department of Surgery, Children's Mercy Kansas City, Kansas City, MO USA; University of Missouri-Kansas City School of Medicine, Kansas City, MO USA.
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Holm S, Engström O, Petäjä I, Huss F. Does the estimation of burn extent at admission differ from the assessment at discharge? Scars Burn Heal 2021; 7:20595131211019403. [PMID: 34221453 PMCID: PMC8221698 DOI: 10.1177/20595131211019403] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Estimation of total body surface area (TBSA) burnt and burn depth are among the most central parts of acute burn assessment/treatment as they determine the level and type of care needed. Traditional methods for determining burn extent on admission often lead to inaccurate estimations, especially in paediatric or overweight patients. AIM To compare %TBSA at admission with validated %TBSA at discharge in different patient populations to investigate if significant over- or underestimation occurs. METHOD This retrospective observational study is based on a patient registry of all the patients (n = 863) treated at the Uppsala University Hospital's Burn Centre between 2010 and 2018. The patients were divided into subgroups based on age, gender, body mass index (BMI) and validated burn extent. The %TBSA estimated at admission was compared to the validated %TBSA in all groups separately. RESULTS As has been published before, we also found that the %TBSA in paediatric patients was more often overestimated as were the smaller injuries, whereas larger injuries were often underestimated. BMI did not clearly affect the estimations and there was no clear difference between the genders in estimated %TBSA. CONCLUSION Inaccurate estimations of %TBSA are common, particularly for paediatric patients and small or large injuries. We recommend a careful accurate approach when calculating %TBSA in the paediatric population to avoid over- and under-resuscitation. Increased education and training are recommended to improve accurate estimation in the future. LAY SUMMARY The correct estimation of both extent and depth of burn is very important. This assessment guides the lever of care needed, the necessary amount of fluid resuscitation, the predicted outcome and more. It has been proven notably difficult to correct assess, especially the extent of a burn. Despite different tools as the "Rule of Nine" (body area divided into multiples of 9% body surfaces), the "Rule of Palm" (Patient's palm, fingers included, approximates 1% of body surfaces), the Lund & Browder chart (detailed, age-specific body areas) and different more technical solutions. Often inaccurate estimations are done which thus affect the treatment. This depth and extent estimation is usually performed when the patient is admitted. However, it is known that burns change appearance during the first few days of care. In our Burn Center we have also performed this estimation when the patient is discharged. At this point it is known the true extent and depth of the initial burn. In this retrospective observational study, we compared the burn extent estimated on admission with the one on discharge to investigate whether the initial assessment is accurate. This study highlights the issue of frequent inaccurate burn extent estimations, especially in subgroups as overweight patient or pediatric patients.
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Affiliation(s)
- Sebastian Holm
- Burn Center, Department of Plastic and Maxillofacial Surgery, Uppsala University Hospital, Sweden
| | - Olof Engström
- Burn Center, Department of Plastic and Maxillofacial Surgery, Uppsala University Hospital, Sweden
| | - Ida Petäjä
- Department of Surgical Sciences, Plastic Surgery, Uppsala University, Uppsala, Sweden
| | - Fredrik Huss
- Burn Center, Department of Plastic and Maxillofacial Surgery, Uppsala University Hospital, Sweden
- Department of Surgical Sciences, Plastic Surgery, Uppsala University, Uppsala, Sweden
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Harshman J, Roy M, Cartotto R. Emergency Care of the Burn Patient Before the Burn Center: A Systematic Review and Meta-analysis. J Burn Care Res 2020; 40:166-188. [PMID: 30452685 DOI: 10.1093/jbcr/iry060] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Good burn care starts with correct management of the burn patient before transfer to a burn center. The purpose of this study was to perform a systematic review of the medical literature describing preburn center care. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed for this review. Studies were included if they were published from a burn center and they measured or evaluated any aspect of preburn center care of adult or pediatric acute burn patients referred to that burn center. A comprehensive search of MEDLINE, EMBASE, and Cochrane databases was performed from their inception to May 28, 2018. Outcomes of interest included errors in burn size estimation, airway management, fluid resuscitation, dressings and wound care, use of systemic antibiotics, core temperature monitoring and preservation, and analgesia provision. Meta-analysis of the discrepancy between preburn center and burn center burn size estimation was conducted. From 3768 initially identified titles, 37 studies were included in this systematic review. Burn size estimation was frequently inaccurate. The ratio of overestimation to underestimation in burn size ranged between 2.2:1 and 19:1. The pooled mean absolute error in % total body surface area burn was 6.28 (95% CI: 4.72, 7.85). The average relative percent error in burn size estimation by referring providers ranged between 75% and 3500%. Unnecessary endotracheal intubation was performed in 28% to 53% of transfers. Over-estimation and over-delivery of fluid resuscitation volumes was prevalent, but other problems pertaining to resuscitation included administration of the wrong fluid and failure to titrate fluids. Wounds were not consistently covered with simple dry dressings or sheets. Core temperature was not consistently monitored or preserved. Analgesics were often not given or were of insufficient dose. Many elements of preburn center care need improvement. These findings should be used to form the foundation of future initiatives between burn professionals and emergency providers to improve care of the burn patient before transfer to a burn center.
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Affiliation(s)
- Jamie Harshman
- Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre, University of Toronto, Canada
| | - Mélissa Roy
- Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre, University of Toronto, Canada
| | - Robert Cartotto
- Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre, University of Toronto, Canada
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Pham C, Collier Z, Gillenwater J. Changing the Way We Think About Burn Size Estimation. J Burn Care Res 2020; 40:1-11. [PMID: 30247559 DOI: 10.1093/jbcr/iry050] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Burn size estimation is a crucial component of acute burn management that guides referral to burn centers, fluid resuscitation parameters, hospital resource distribution, and mortality-based interventions. Referring providers often misestimate the total BSA (TBSA) of burn injury, which contributes to unnecessary healthcare costs, misappropriation of limited resources, and delay in provision of appropriate patient care. A systematic literature review of articles available on PubMed, Scopus, Google Scholar, OvidSP Medline, and Web of Science was performed. All articles were evaluated in a standardized fashion by a panel of reviewers to assess applicability to the research question. Twenty-six relevant articles identified pervasive TBSA miscalculations ranging from 5% to 339% regardless of provider level with < 20% TBSA burns being disproportionately overestimated. This resulted in up to 77% of burns being inappropriately transferred to burn centers from referring hospitals. Improper use of TBSA estimation tools (palm, hand, Rule of 9s) without considering patient body mass index, race, age, and sex standards contributes to TBSA misestimation. Few studies with limited sample sizes argue that TBSA misestimations significantly affect fluid resuscitation volume, although the findings suggest that small burns (<20% TBSA) are over-estimated and over-resuscitated-the opposite of larger burns. TBSA misestimation is associated with an increased incidence of inappropriate transfers to burn centers and the associated costs. The data remains lacking, however, and larger studies are required to further elucidate the clinical impact of such errors. A systematic approach with telemedicine-facilitated computer-based burn assessments is required.
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Affiliation(s)
- Christopher Pham
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles
| | - Zachary Collier
- Division of Plastic Surgery, Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles
| | - Justin Gillenwater
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles.,Division of Plastic Surgery, Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles
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Legrand M, Barraud D, Constant I, Devauchelle P, Donat N, Fontaine M, Goffinet L, Hoffmann C, Jeanne M, Jonqueres J, Leclerc T, Lefort H, Louvet N, Losser MR, Lucas C, Pantet O, Roquilly A, Rousseau AF, Soussi S, Wiramus S, Gayat E, Blet A. Management of severe thermal burns in the acute phase in adults and children. Anaesth Crit Care Pain Med 2020; 39:253-267. [PMID: 32147581 DOI: 10.1016/j.accpm.2020.03.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVES To provide recommendations to facilitate the management of severe thermal burns during the acute phase in adults and children. DESIGN A committee of 20 experts was asked to produce recommendations in six fields of burn management, namely, (1) assessment, admission to specialised burns centres, and telemedicine; (2) haemodynamic management; (3) airway management and smoke inhalation; (4) anaesthesia and analgesia; (5) burn wound treatments; and (6) other treatments. At the start of the recommendation-formulation process, a formal conflict-of-interest policy was developed and enforced throughout the process. The entire process was conducted independently of any industry funding. The experts drew up a list of questions that were formulated according to the PICO model (Population, Intervention, Comparison, and Outcomes). Two bibliography experts per field analysed the literature published from January 2000 onwards using predefined keywords according to PRISMA recommendations. The quality of data from the selected literature was assessed using GRADE® methodology. Due to the current paucity of sufficiently powered studies regarding hard outcomes (i.e. mortality), the recommendations are based on expert opinion. RESULTS The SFAR guidelines panel generated 24 statements regarding the management of acute burn injuries in adults and children. After two scoring rounds and one amendment, strong agreement was reached for all recommendations. CONCLUSION Substantial agreement was reached among a large cohort of experts regarding numerous strong recommendations to optimise the management of acute burn injuries in adults and children.
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Affiliation(s)
- Matthieu Legrand
- Department of Anaesthesia and Perioperative Care, University of California, San Francisco, United States.
| | - Damien Barraud
- Hôpital de Mercy, Intensive Care Medicine and Burn Centre, CHR Metz-Thionville, Ars-Laquenexy, France
| | - Isabelle Constant
- Anaesthesiology Department, Hôpital Armand-Trousseau, Sorbonne Université, Assistance publique-Hôpitaux de Paris, Paris, France
| | | | - Nicolas Donat
- Burn Centre, Percy Military Teaching Hospital, Clamart, France
| | - Mathieu Fontaine
- Burn Intensive Care Unit, Saint-Joseph Saint-Luc Hospital, 20, quai Claude-Bernard, 69007 Lyon, France
| | - Laetitia Goffinet
- Paediatric Burn Centre, University Hospital of Nancy, 54511 Vandœuvre-Lès-Nancy, France
| | | | - Mathieu Jeanne
- CHU Lille, Anaesthesia and Critical Care, Burn Centre, 59000 Lille, France; University of Lille, Inserm, CHU Lille, CIC 1403, 59000 Lille, France; University of Lille, EA 7365 - GRITA, 59000 Lille, France
| | - Jeanne Jonqueres
- Burn Intensive Care Unit, Saint-Joseph Saint-Luc Hospital, 20, quai Claude-Bernard, 69007 Lyon, France
| | - Thomas Leclerc
- Burn Centre, Percy Military Teaching Hospital, Clamart, France
| | - Hugues Lefort
- Department of emergency medicine, Legouest Military Teaching Hospital, Metz, France
| | - Nicolas Louvet
- Anaesthesiology Department, Hôpital Armand-Trousseau, Sorbonne Université, Assistance publique-Hôpitaux de Paris, Paris, France
| | - Marie-Reine Losser
- Hôpital de Mercy, Intensive Care Medicine and Burn Centre, CHR Metz-Thionville, Ars-Laquenexy, France; Paediatric Burn Centre, University Hospital of Nancy, 54511 Vandœuvre-Lès-Nancy, France; Inserm UMR 1116, Team 2, 54000 Nancy, France; University of Lorraine, 54000 Nancy, France
| | - Célia Lucas
- Department of Anaesthesiology, Critical Care and Burn Centre, Lariboisière-Saint-Louis Hospitals, DMU Parabol, AP-HP Nord, University of Paris, Paris, France
| | - Olivier Pantet
- Service of Adult Intensive Care Medicine and Burns, Lausanne University Hospital (CHUV), BH 08-651, Rue du Bugnon 46, 1011 Lausanne, Switzerland
| | - Antoine Roquilly
- Department of Anaesthesia and Critical Care, Hôtel-Dieu, University Hospital of Nantes, Nantes, France; Laboratoire UPRES EA 3826 "Thérapeutiques cliniques et expérimentales des infections", University of Nantes, Nantes, France
| | | | - Sabri Soussi
- Department of Anaesthesiology, Critical Care and Burn Centre, Lariboisière-Saint-Louis Hospitals, DMU Parabol, AP-HP Nord, University of Paris, Paris, France; Interdepartmental Division of Critical Care, Keenan Research Centre for Biomedical Science and Institute of Medical Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Sandrine Wiramus
- Department of Anaesthesia and Intensive Care Medicine and Burn Centre, University Hospital of Marseille, La Timone Hospital, Marseille, France
| | - Etienne Gayat
- Department of Anaesthesiology, Critical Care and Burn Centre, Lariboisière-Saint-Louis Hospitals, DMU Parabol, AP-HP Nord, University of Paris, Paris, France; Inserm UMR-S 942, Cardiovascular Markers in Stress Conditions (MASCOT), University of Paris, Paris, France
| | - Alice Blet
- Department of Anaesthesiology, Critical Care and Burn Centre, Lariboisière-Saint-Louis Hospitals, DMU Parabol, AP-HP Nord, University of Paris, Paris, France; Inserm UMR-S 942, Cardiovascular Markers in Stress Conditions (MASCOT), University of Paris, Paris, France; Department of Research, University of Ottawa Heart Institute, Ottawa, ON, Canada
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Assessment of a quality improvement intervention to improve the consistency of total body surface area burn estimates between referring facilities and a pediatric burn center. Burns 2019; 45:1827-1832. [DOI: 10.1016/j.burns.2019.07.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 06/14/2019] [Accepted: 07/18/2019] [Indexed: 11/22/2022]
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10
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Moehrlen T, Landolt MA, Meuli M, Moehrlen U. Non intentional burns in children: Analyzing prevention and acute treatment in a highly developed country. Burns 2019; 45:1908-1917. [PMID: 31601428 DOI: 10.1016/j.burns.2019.05.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Revised: 05/27/2019] [Accepted: 05/28/2019] [Indexed: 11/26/2022]
Abstract
The objective of this study was to evaluate where and when pediatric burn injuries occurred. Furthermore the quality of first aid treatment, ratio of skin grafting and length of hospital stay were evaluated. The patient records of 749 children with acute burns admitted to the University Children's Hospital of Zurich, Switzerland, were retrospectively reviewed over an 11-year period. Burn injuries in children with an immigrant background were overrepresented in our study population, whereby the proportion of immigrants decreased with rising age. Sixty-five percent of all patients received some form of first aid. Of those 4.5% did not comply with the current guidelines. Furthermore initial assessment of total body surface area (TBSA) by the first line physician was overestimated in 76% of cases. Flame injuries occurred mainly in summertime in outdoor settings and needed significant more often skin grafts than scalds, which mainly occurred indoors and in wintertime. As a result, patients with flame injuries had to stay significantly longer in hospital (flames: 21 days (range: 1-259 days; median: 30; interquartile range (IQR): 30) versus scalds: 7 days (range: 1-130 days; median: 7; IQR: 12); p < 0.001). Furthermore high voltage injuries often resulted in lower-leg amputations (n = 3; 43%). Based on these facts, targets for the improvement of a prevention campaign and the treatment for burned children were named.
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Affiliation(s)
- Theres Moehrlen
- Department of Pediatric Surgery, University Children's Hospital Zurich, Switzerland
| | - Markus A Landolt
- Department of Psychosomatics and Psychiatry, University Children's Hospital Zurich, Switzerland; Division of Child and Adolescent Health Psychology, Department of Psychology, University of Zurich, Zurich, Switzerland
| | - Martin Meuli
- Department of Pediatric Surgery, University Children's Hospital Zurich, Switzerland
| | - Ueli Moehrlen
- Department of Pediatric Surgery, University Children's Hospital Zurich, Switzerland.
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McCulloh C, Nordin A, Talbot LJ, Shi J, Fabia R, Thakkar RK. Accuracy of Prehospital Care Providers in Determining Total Body Surface Area Burned in Severe Pediatric Thermal Injury. J Burn Care Res 2017; 39:491-496. [DOI: 10.1093/jbcr/irx004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Christopher McCulloh
- Department of Pediatric Surgery, Nationwide Children’s Hospital, Children’s Drive, Columbus, OH
| | - Andrew Nordin
- Department of Pediatric Surgery, Nationwide Children’s Hospital, Children’s Drive, Columbus, OH
| | - Lindsay J Talbot
- Department of Pediatric Surgery, Nationwide Children’s Hospital, Children’s Drive, Columbus, OH
| | - Junxin Shi
- Center for Pediatric Trauma Research, The Research Institute at Nationwide Children’s Hospital, Children’s Drive, Columbus, OH
- Center for Injury Research and Policy, The Research Institute at Nationwide Children’s Hospital, Children’s Drive, Columbus, OH
| | - Renata Fabia
- Department of Pediatric Surgery, Nationwide Children’s Hospital, Children’s Drive, Columbus, OH
- Center for Pediatric Trauma Research, The Research Institute at Nationwide Children’s Hospital, Children’s Drive, Columbus, OH
- The Department of Surgery, The Ohio State University College of Medicine, Columbus, OH
| | - Rajan K Thakkar
- Department of Pediatric Surgery, Nationwide Children’s Hospital, Children’s Drive, Columbus, OH
- Center for Pediatric Trauma Research, The Research Institute at Nationwide Children’s Hospital, Children’s Drive, Columbus, OH
- The Department of Surgery, The Ohio State University College of Medicine, Columbus, OH
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