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Hegde P, Gibikote S, Kumar A, Thenmozhi M, Jehangir S. Knowledge of prevention and first aid in burn injuries among health care workers and non-health care persons in India. Burns 2024; 50:1024-1029. [PMID: 38280840 DOI: 10.1016/j.burns.2024.01.011] [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: 06/15/2023] [Revised: 12/22/2023] [Accepted: 01/10/2024] [Indexed: 01/29/2024]
Abstract
Appropriate and timely first aid reduces morbidity in burns. This study aims to assess the knowledge of first aid in burns among healthcare workers (HCW) and nonhealthcare workers. (NHCW). METHODS A survey, distributed in both paper and Google survey formats, presented five sample cases with multiple-choice answers. Participants recorded the most suitable first aid management for each scenario. Correct answers were provided on completion. RESULTS Out of the total 753 participants, only 89 (11.8%) got all five answers correct. 16% HCW and 6% NHCW could answer all 5 questions correctly (with a true HCW:NHCW ratio of 2.67:1). Providing care for individuals with burns substantially raised the probability of giving accurate responses (p = 0.0001). While attending the general First Aid Course did not affect the responses (p = 0.08), participation in the Burns First Aid Course demonstrated slightly improved results (p = 0.052). The scenario involving liquid petroleum gas leakage saw a high proportion of correct responses, likely influenced by media coverage. CONCLUSION We find a clear need for adequate training in burns first aid due to low awareness among healthcare workers (HCW) and non-healthcare workers (NHCW). Factors such as participation in burn first aid courses and gaining firsthand experience in treating burns were found to be linked to improved knowledge of burns prevention and first aid. Utilizing various media channels could be a valuable strategy to reach a broader audience, especially in remote and inaccessible areas.
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Affiliation(s)
- Priyanka Hegde
- Department of Paediatric Surgery, Christian Medical College, Vellore, Tamil Nadu 632004, India
| | - Siddharth Gibikote
- Department of Paediatric Surgery, Christian Medical College, Vellore, Tamil Nadu 632004, India
| | - Arun Kumar
- Department of Paediatric Surgery, Christian Medical College, Vellore, Tamil Nadu 632004, India
| | - M Thenmozhi
- Department of Biostatistics, Christian Medical College, Vellore, Tamil Nadu 632004, India
| | - Susan Jehangir
- Department of Paediatric Surgery, Christian Medical College, Vellore, Tamil Nadu 632004, India.
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2
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Holbert MD, Kimble RM, Watt K, Griffin BR. Barriers and facilitators to burn first aid practice in the prehospital setting: A qualitative investigation amongst emergency medical service clinicians. Burns 2024; 50:674-684. [PMID: 38065804 DOI: 10.1016/j.burns.2023.12.001] [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: 06/12/2023] [Revised: 10/15/2023] [Accepted: 12/01/2023] [Indexed: 04/08/2024]
Abstract
First aid cooling for burn injuries improves re-epithelialisation rates and reduces scarring. The objective of this research was to explore and describe barriers and facilitators to the provision of optimal first aid for acute burn patients in the prehospital setting. Emergency medical service (EMS) clinicians in Queensland were invited via email to participate in a survey designed to assess experience, knowledge, and attitudes regarding provision of optimal burn first aid in the prehospital setting (N = 4500). Barriers and facilitators to administering optimal first aid in the prehospital environment were assessed via two open-ended questions with free-text response boxes. An inductive approach to qualitative content analysis was used to analyze free-text data. In total, we included 326 respondents (7.2% response rate). Responses (n = 231) regarding barriers to first aid were classified into 12 categories, within five overarching dimensions. The most common of these was identified as pain. Similarly, free text responses (n = 276) regarding facilitators of burn first aid formed eight dimensions with 21 subcategories - most commonly fast and effective pain relief. Factors influencing burn first aid provision in the prehospital setting were wide-ranging and varied, with pain identified as the most prominent.
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Affiliation(s)
- Maleea D Holbert
- Centre for Children's Burns and Trauma Research, Centre for Children's Health Research, South Brisbane 4101, Queensland, Australia; Faculty of Medicine, The University of Queensland, Brisbane 4067, Queensland, Australia; Faculty of Health, School of Nursing and Midwifery, Griffith University, Brisbane 4111, Queensland, Australia.
| | - Roy M Kimble
- Centre for Children's Burns and Trauma Research, Centre for Children's Health Research, South Brisbane 4101, Queensland, Australia; Faculty of Medicine, The University of Queensland, Brisbane 4067, Queensland, Australia; Pegg Leditschke Children's Burns Centre, Queensland Children's Hospital, South Brisbane 4101, Queensland, Australia
| | - Kerrianne Watt
- Information Support, Research & Evaluation, Office of the Medical Director, Queensland Ambulance Service, Kedron 4031, Queensland, Australia; College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville 4810 Queensland, Australia
| | - Bronwyn R Griffin
- Centre for Children's Burns and Trauma Research, Centre for Children's Health Research, South Brisbane 4101, Queensland, Australia; Faculty of Health, School of Nursing and Midwifery, Griffith University, Brisbane 4111, Queensland, Australia; Pegg Leditschke Children's Burns Centre, Queensland Children's Hospital, South Brisbane 4101, Queensland, Australia
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3
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Zhao Y, Liu J, Ding Z, Ge W, Wang S, Zhang J. ATP-induced hypothermia improves burn injury and relieves burn pain in mice. J Therm Biol 2023; 114:103563. [PMID: 37344025 DOI: 10.1016/j.jtherbio.2023.103563] [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: 11/14/2021] [Revised: 03/05/2023] [Accepted: 04/02/2023] [Indexed: 06/23/2023]
Abstract
Thermal burn injury is a severe and life-threatening form of trauma that presents a significant challenge to clinical therapy. Therapeutic hypothermia has been shown to be beneficial in various human pathologies. Adenosine triphosphate (ATP) induces a hypothermic state that resembles hibernation-like suspended animation in mammals. This study investigates the potential protective role of ATP-induced hypothermia in thermal burn injury. Male C57BL/6 mice underwent a sham procedure or third-degree burn, and ATP-induced hypothermia was applied immediately or 1 h after burn injury. Our results show that ATP-induced hypothermia significantly improved burn depth progression and reduced collagen degradation. Moreover, hypothermia induced by ATP alleviated burn-induced hyperinflammatory responses and oxidative stress. Metabolomic profiling revealed that ATP-induced hypothermia reversed the shifts of metabolic profiles of the skin in burn mice. In addition, ATP-induced hypothermia relieved nociceptive and inflammatory pain, as observed in the antinociceptive test. Our findings suggest that ATP-induced hypothermia attenuates burn injury and provides new insights into first-aid therapy after thermal burn injury.
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Affiliation(s)
- Yang Zhao
- Center for Molecular Metabolism, Nanjing University of Science & Technology, Nanjing, 210094, China
| | - Junhao Liu
- Center for Molecular Metabolism, Nanjing University of Science & Technology, Nanjing, 210094, China
| | - Zhao Ding
- Center for Molecular Metabolism, Nanjing University of Science & Technology, Nanjing, 210094, China
| | - Wenhao Ge
- Center for Molecular Metabolism, Nanjing University of Science & Technology, Nanjing, 210094, China
| | - Shiming Wang
- Center for Molecular Metabolism, Nanjing University of Science & Technology, Nanjing, 210094, China
| | - Jianfa Zhang
- Center for Molecular Metabolism, Nanjing University of Science & Technology, Nanjing, 210094, China.
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4
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Jehangir S. Understanding burn injuries in Indian children- a step toward prevention and prompt first aid. Burns 2022; 49:735-736. [PMID: 36604279 DOI: 10.1016/j.burns.2022.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 11/29/2022] [Indexed: 12/24/2022]
Affiliation(s)
- Susan Jehangir
- Department of Paediatric Surgery, Christian Medical College, Vellore, TN 632004 India.
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5
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Burning Questions: What Should the Pharmacist Know about Managing Minor Burns? PHARMACY 2022; 10:pharmacy10040100. [PMID: 36005940 PMCID: PMC9414252 DOI: 10.3390/pharmacy10040100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 07/12/2022] [Accepted: 07/13/2022] [Indexed: 11/16/2022] Open
Abstract
Burn injuries are an endemic health concern in developing countries. Globally, Africa has the highest incidence of burn injuries per capita. A total of 2.3% of the South African population suffer burn injuries annually and may present at community pharmacies and primary healthcare (PHC) facilities. Pharmacists and PHC nurses must, therefore, remain abreast with the latest treatments for burn care. This commentary presents the most recent information for assessing burn wounds, first aid, referral guidelines, and identifying toxic shock syndrome in more severe burns cases. The successful management of patients with burns in an outpatient setting is contingent on patient selection. It is important for pharmacists and PHC nurses to know when to treat or refer a patient. Therefore, a set of guidelines for their use in PHC and community pharmacy settings is presented. Appropriate training on the use of these guidelines, would ensure a better assessment of burn wounds, leading to more positive patient outcomes. This commentary is a useful update to continuing professional development and can be utilised in community pharmacies and PHC settings in South Africa and across the African continent in the absence of formalised treatment guidelines for minor burns.
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Griffin B, Cabilan C, Ayoub B, Xu H(G, Palmieri T, Kimble R, Singer Y. The effect of 20 minutes of cool running water first aid within three hours of thermal burn injury on patient outcomes: A systematic review and meta-analysis. Australas Emerg Care 2022; 25:367-376. [DOI: 10.1016/j.auec.2022.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 05/31/2022] [Accepted: 05/31/2022] [Indexed: 10/18/2022]
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Moore C, Clover J, Gibson L. Evaluating parental knowledge of pediatric burns first aid in Ireland and the effectiveness of an educational intervention improving knowledge. Burns 2022; 48:672-682. [PMID: 34696953 DOI: 10.1016/j.burns.2021.05.022] [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: 11/04/2020] [Revised: 04/15/2021] [Accepted: 05/24/2021] [Indexed: 12/15/2022]
Abstract
AIM Burns represent a large portion of injuries attending emergency departments each year, with children accounting for the biggest proportion. Appropriate first aid has been shown to help improve the outcome of burns, and decrease the need for surgical intervention. Several studies outside of Ireland demonstrate inadequate parental knowledge of burns first aid, but few evaluated interventions to improve knowledge. Consequently our aim was to assess parental/caregiver knowledge in Ireland, and determine if knowledge levels could be raised following a short educational video intervention. METHODS An educational video based on current European and British best practice guidelines was produced and shown to parents/caregivers waiting in the Pediatric Outpatients Department after a previously validated pre-intervention questionnaire was completed. A post intervention questionnaire was completed following the video. Questionnaires assessed demographics, previous experience and included scenarios to test parental knowledge. RESULTS 112 parents/caregivers (81.3% female (n = 91), 18.8% male (n = 21)) were questioned. Baseline knowledge was found to be poor overall, however this significantly improved with a simple educational video (pre-score 31.9%, post-test mean score knowledge 92.1%). Pre- and post-test scores showed a statistical significance (x2 = 71.117, P < 0.001, 95% CI).No other variables analysed were shown to be statistically significant predictors of pre- or post-test scores (all p > 0.05). CONCLUSION The study found poor parental knowledge of burns first aid in Ireland and shows the use of an educational video was effective in raising knowledge levels.
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Affiliation(s)
| | - James Clover
- University College Cork, Ireland; Cork University Hospital, Cork, Ireland.
| | - Louise Gibson
- University College Cork, Ireland; Cork University Hospital, Cork, Ireland.
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8
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Public awareness of first aid treatment in acute burns. JOURNAL OF SURGERY AND MEDICINE 2022. [DOI: 10.28982/josam.971375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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9
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Djärv T, Douma M, Palmieri T, Meyran D, Berry D, Kloeck D, Bendall J, Morrison LJ, Singletary EM, Zideman D. Duration of cooling with water for thermal burns as a first aid intervention: A systematic review. Burns 2022; 48:251-262. [PMID: 34916091 DOI: 10.1016/j.burns.2021.10.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 09/13/2021] [Accepted: 10/18/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Cooling thermal burns with running water is a recommended first aid intervention. However, guidance on the ideal duration of cooling remains controversial and inconsistent across organisations. AIM To perform a systematic review of the evidence for the question; Among adults and children with thermal burn, does active cooling using running water as an immediate first aid intervention for 20 min or more, compared with active cooling using running water for any other duration, change the outcomes of burn size, burn depth, pain, adverse outcome (hypothermia) or complications? METHOD We searched Medline, Embase, Cochrane Database of Systematic Reviews and used ROBINS-I to assess for risk of bias. We used Grading of Recommendations, Assessment, Development and Evaluation methodology for determining the certainty of evidence. We included all studies that compared the selected outcomes of the duration of cooling of thermal burns with water in all patient ages. (PROSPERO registration number: CRD42021180665). From 560 screened references, we included four observational studies. In these studies, 48% of burns were cooled for 20 min or more. We found no benefit for a duration of 20 min or more of cooling when compared with less than 20 min of cooling for the outcomes of size and depth of burn, re-epithelialization, or skin grafting. The evidence is of very low certainty owing to limitations in study design, risk of bias and indirectness. CONCLUSION The optimal duration of cooling for thermal burns remains unknown and future prospective research is indicated to better define this treatment recommendation.
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Affiliation(s)
- Therese Djärv
- Department of Medicine Solna, Karolinska Institute and Division of Acute and Reparative Medicine, Karolinska University Hospital, Sweden.
| | - Matthew Douma
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Canada.
| | - Tina Palmieri
- Burn Division, University of California Davis and Shriners Hospital for Children Northern California, Sacramento, CA, USA.
| | - Daniel Meyran
- Bataillon de Marins Pompiers de Marseille, French Red Cross, France.
| | - David Berry
- Department of Kinesiology, Saginaw Valley State University, University Center, MI, USA.
| | - David Kloeck
- Department of Critical Care, University of the Witwatersrand, Johannesburg, South Africa.
| | - Jason Bendall
- Department of Rural Health, University of Newcastle, Newcastle, Australia.
| | - Laurie J Morrison
- Emergency Department, St Michael´s Hospital, Division of Emergency Medicine, Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
| | - Eunice M Singletary
- University of Virginia, Department of Emergency Medicine, Charlottesville, VA, USA.
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10
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Erste Hilfe. Notf Rett Med 2021. [DOI: 10.1007/s10049-021-00886-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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11
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Paediatric chemical burns: a clinical review. Eur J Pediatr 2021; 180:1359-1369. [PMID: 33403450 DOI: 10.1007/s00431-020-03905-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 11/05/2020] [Accepted: 12/08/2020] [Indexed: 10/22/2022]
Abstract
Although they account for a small proportion of burns in paediatrics, injuries from chemicals can be just as devastating as other mechanisms of burn injury. At least 25,000 chemicals exist which can cause burns: in children, they are often caused by household chemicals via accidental exposure. The mechanism by which corrosive substances produce chemical burns highlights the importance of early and plentiful irrigation of the burn area, removal of contaminated clothes and careful clinical assessment. Surgical intervention is uncommon but often follows the principles for thermal burns. This article reviews the aetiology, incidence, clinical presentation, management, complications and prevention of chemical burns. What is Known • Chemical burns in paediatrics are often caused by accidental exposure to chemicals available at home • Differences in the pathophysiology of chemical burns reinforces the need for early irrigation What is New • New irrigation fluids show promise in adults and need further study in children • The nature of chemical cutaneous burns can make assessment of wound depth difficult. Laser Doppler Imaging (LDI) is an accurate technique that can be used clinically to determine burn depth in thermal burns and is an area of future interest in the assessment of chemical burns.
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12
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Zideman DA, Singletary EM, Borra V, Cassan P, Cimpoesu CD, De Buck E, Djärv T, Handley AJ, Klaassen B, Meyran D, Oliver E, Poole K. European Resuscitation Council Guidelines 2021: First aid. Resuscitation 2021; 161:270-290. [PMID: 33773828 DOI: 10.1016/j.resuscitation.2021.02.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The European Resuscitation Council has produced these first aid guidelines, which are based on the 2020 International Consensus on Cardiopulmonary Resuscitation Science with Treatment Recommendations. The topics include the first aid management of emergency medicine and trauma. For medical emergencies the following content is covered: recovery position, optimal positioning for shock, bronchodilator administration for asthma, recognition of stroke, early aspirin for chest pain, second dose of adrenaline for anaphylaxis, management of hypoglycaemia, oral rehydration solutions for treating exertion-related dehydration, management of heat stroke by cooling, supplemental oxygen in acute stroke, and presyncope. For trauma related emergencies the following topics are covered: control of life-threatening bleeding, management of open chest wounds, cervical spine motion restriction and stabilisation, recognition of concussion, cooling of thermal burns, dental avulsion, compression wrap for closed extremity joint injuries, straightening an angulated fracture, and eye injury from chemical exposure.
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Affiliation(s)
| | | | - Vere Borra
- Centre for Evidence-based Practice, Belgian Red Cross, Mechelen, Belgium; Cochrane First Aid, Mechelen, Belgium
| | - Pascal Cassan
- International Federation of Red Cross and Red Crescent, France
| | - Carmen D Cimpoesu
- University of Medicine and Pharmacy "Grigore T. Popa", Iasi, Emergency Department and Prehospital EMS SMURD Iasi Emergency County Hospital "Sf. Spiridon" Iasi, Romania
| | - Emmy De Buck
- Centre for Evidence-based Practice, Belgian Red Cross, Mechelen, Belgium; Cochrane First Aid, Mechelen, Belgium; Department of Public Health and Primary Care, Faculty of Medicine, KU Leuven, Leuven, Belgium
| | - Therese Djärv
- Department of Medicine Solna, Karolinska Institute and Division of Acute and Reparative Medicine, Karolinska University Hospital, Sweden
| | | | - Barry Klaassen
- Emergency Medicine, Ninewells Hospital and Medical School Dundee, UK; British Red Cross, UK
| | - Daniel Meyran
- French Red Cross, Bataillon de Marins Pompiers de Marseille, France
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Holbert MD, Kimble RM, Chatfield M, Griffin BR. Effectiveness of a hydrogel dressing as an analgesic adjunct to first aid for the treatment of acute paediatric burn injuries: a prospective randomised controlled trial. BMJ Open 2021; 11:e039981. [PMID: 33402404 PMCID: PMC7786810 DOI: 10.1136/bmjopen-2020-039981] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE To compare the effectiveness of two acute burn dressings, Burnaid hydrogel dressing and plasticised polyvinylchloride film, on reducing acute pain scores in paediatric burn patients following appropriate first aid. DESIGN Single-centre, superiority, two-arm, parallel-group, prospective randomised controlled trial. PARTICIPANTS AND SETTING Paediatric patients (aged ≤16) presenting to the Emergency Department at the Queensland Children's Hospital, Brisbane, Australia, with an acute thermal burn were approached for participation in the trial from September 2017-September 2018. INTERVENTIONS Patients were randomised to receive either (1) Burnaid hydrogel dressing (intervention) or (2) plasticised polyvinylchloride film (Control) as an acute burn dressing. PRIMARY AND SECONDARY OUTCOMES Observational pain scores from nursing staff assessed 5 min post application of the randomised dressing, measured using the Face Legs Activity Cry and Consolability Scale was the primary outcome. Repeated measures of pain, stress and re-epithelialisation were also collected at follow-up dressing changes until 95% wound re-epithelialisation occurred. RESULTS Seventy-two children were recruited and randomised (n=37 intervention; n=35 control). No significant between-group differences in nursing (mean difference: -0.1, 95% CI -0.7 to 0.5, p=0.72) or caregiver (MD: 1, 95% CI -8 to 11, p=0.78) observational pain scores were identified. Moreover, no significant differences in child self-report pain (MD: 0.3, 95% CI -1.7 to 2.2, p=0.78), heart rate (MD: -3, 95% CI -11 to 5, p=0.41), temperature (MD: 0.6, 95% CI -0.13 to 0.24, p=0.53), stress (geometric mean ratio: 1.53, 95% CI 0.93 to 2.53, p=0.10), or re-epithelialisation rates (MD: -1, 95% CI -3 to 1, p=0.26) were identified between the two groups. CONCLUSIONS A clear benefit of Burnaid hydrogel dressing as an analgesic adjunct to first aid for the treatment of acute paediatric burns was not identified in this investigation. TRIAL REGISTRATION NUMBER Australian New Zealand Clinical Trials Registry (ACTRN12617001274369).
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Affiliation(s)
- Maleea Denise Holbert
- Centre for Children's Burns and Trauma Research, Centre for Children's Health Research, South Brisbane, Queensland, Australia
- Pegg Leditschke Paediatric Burns Centre, The Queensland Children's Hospital, Herston, Queensland, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Roy M Kimble
- Centre for Children's Burns and Trauma Research, Centre for Children's Health Research, South Brisbane, Queensland, Australia
- Pegg Leditschke Paediatric Burns Centre, The Queensland Children's Hospital, Herston, Queensland, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
- Faculty of Health, School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Mark Chatfield
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Bronwyn R Griffin
- Centre for Children's Burns and Trauma Research, Centre for Children's Health Research, South Brisbane, Queensland, Australia
- Pegg Leditschke Paediatric Burns Centre, The Queensland Children's Hospital, Herston, Queensland, Australia
- Faculty of Health, School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
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14
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Storey K, Kimble RM, Holbert MD. The Management of Burn Pain in a Pediatric Burns-Specialist Hospital. Paediatr Drugs 2021; 23:1-10. [PMID: 33447938 DOI: 10.1007/s40272-020-00434-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/10/2020] [Indexed: 10/22/2022]
Abstract
Appropriate pain management for children who have experienced an acute burn injury is critical to improve patient outcomes and reduce potential morbidities. With 60% of our patients being under the age of 4 years, pain management is crucial in reducing pain and anxiety in both patients and parents. It is imperative that appropriate pain relief is commenced from initial contact with healthcare workers as this will affect the success or failure of future wound procedures. Uncontrolled pain can negatively affect a patient, both short and long term. It may cause anticipatory anxiety for future medical procedures, increased pain and anxiety can decrease wound re-epithelialization which can lead to long-term consequences for growth and mobility, and increased pain can also influence the possibility of patients and families displaying signs of post-traumatic stress disorder. Pain management in the form of pharmaceuticals is imperative during burn wound treatment and should incorporate pain relief targeted at both background and procedural pain. It also requires a multimodal, individualized, and targeted approach combining both pharmaceutical and nonpharmaceutical techniques, including cold running water, multimodal distraction devices, hypnotherapy, and bubbles. We discuss the research and knowledge that our center has gained through treating pediatric patients with burns over the last 20 years.
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Affiliation(s)
- Kristen Storey
- Centre for Children's Burns and Trauma Research, Centre for Children's Health Research, South Brisbane, QLD, Australia. .,Pegg Leditschke Paediatric Burns Centre, The Queensland Children's Hospital, South Brisbane, QLD, Australia. .,Queensland University of Technology, Brisbane, QLD, Australia. .,Children's Health Queensland Hospital and Health Service, Queensland Children's Hospital, 501 Stanley Street, South Brisbane, QLD, 4101, Australia.
| | - Roy M Kimble
- Centre for Children's Burns and Trauma Research, Centre for Children's Health Research, South Brisbane, QLD, Australia.,Pegg Leditschke Paediatric Burns Centre, The Queensland Children's Hospital, South Brisbane, QLD, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia.,Queensland University of Technology, Brisbane, QLD, Australia
| | - Maleea D Holbert
- Centre for Children's Burns and Trauma Research, Centre for Children's Health Research, South Brisbane, QLD, Australia.,Pegg Leditschke Paediatric Burns Centre, The Queensland Children's Hospital, South Brisbane, QLD, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
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15
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Holzer JC, Tiffner K, Kainz S, Reisenegger P, Bernardelli de Mattos I, Funk M, Lemarchand T, Laaff H, Bal A, Birngruber T, Kotzbeck P, Kamolz LP. A novel human ex-vivo burn model and the local cooling effect of a bacterial nanocellulose-based wound dressing. Burns 2020; 46:1924-1932. [DOI: 10.1016/j.burns.2020.06.024] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 05/08/2020] [Accepted: 06/23/2020] [Indexed: 10/23/2022]
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16
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Frear CC, Griffin B, Kimble R. Adequacy of cool running water first aid by healthcare professionals in the treatment of paediatric burns: A cross-sectional study of 4537 children. Emerg Med Australas 2020; 33:615-622. [PMID: 33191592 PMCID: PMC9292905 DOI: 10.1111/1742-6723.13686] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 10/23/2020] [Accepted: 10/28/2020] [Indexed: 11/27/2022]
Abstract
Objective To determine the adequacy of cool running water first aid provided by healthcare professionals in the early management of children with thermal burn injuries. Methods A cross‐sectional study was undertaken using a prospectively collected registry of children who presented with a thermal burn to the only major paediatric burns centre in Queensland, Australia, from January 2013 to December 2018. Main outcome measures included the type and duration of first aid administered by paramedics, general practitioners and emergency providers at local general hospitals and a children's hospital. In accordance with current Australian guidelines, adequate cooling was defined as 20 min of cool running water within 3 h of the injury. Results Of the 4537 children who presented to the paediatric burns centre, 3261 (71.9%) received adequate first aid, including 1502 (33.1%) at the scene of injury. Paramedics and general practitioners administered adequate cooling to 184 (25.0%) and 52 (24.2%) of their patients, respectively. ED clinicians adhered to guidelines in the treatment of 1019 (56.3%) children at general hospitals and 411 (76.0%) at the children's hospital. Among ED patients who presented with incomplete prior first aid, the risk of inadequate cooling was significantly greater for those transported via ambulance (P < 0.001). Conclusion Deficiencies remain in the cooling of paediatric burns patients at all levels of initial management. There is a need in the healthcare community for improved education regarding the parameters and clinical benefits of cool running water first aid.
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Affiliation(s)
- Cody C Frear
- Centre for Children's Burns and Trauma Research, Centre for Children's Health Research, Brisbane, Queensland, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Bronwyn Griffin
- Centre for Children's Burns and Trauma Research, Centre for Children's Health Research, Brisbane, Queensland, Australia.,School of Nursing, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Roy Kimble
- Centre for Children's Burns and Trauma Research, Centre for Children's Health Research, Brisbane, Queensland, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,Department of Paediatric Surgery, Urology, Burns and Trauma, Queensland Children's Hospital, Brisbane, Queensland, Australia
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Batais MA, Alzahrani SA, Alzahrani NA, Alsolimi AF, Khan AA, Aldossari KK, Al-Zahrani JM, Alghamdi T, Almigbal TH. Knowledge and Practice of Burn First Aid Among Saudi Arabian Medical and Non-Medical University Students. INTERNATIONAL QUARTERLY OF COMMUNITY HEALTH EDUCATION 2020; 41:405-410. [PMID: 33176580 DOI: 10.1177/0272684x20972644] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Burns are serious injuries, resulting in high morbidity and healthcare costs. Effective first aid improves outcomes. The aim of this study was to assess the knowledge and practice of first aid for burn injuries among medical and non-medical students in Saudi Arabia. A cross-sectional study (N = 408) was conducted, in which a questionnaire was administered assessing students' experience with burns, as well as their hypothetical responses to vignettes involving patients with burn injuries. Although most students reported having personal experience with burns, and had received some information regarding burn first aid, only about half were able to provide correct responses regarding first aid techniques, and medical students were no more accurate than non-medical students in their responses. Results suggest that members of the Saudi Arabian population may lack appropriate knowledge about burn first aid, and education and public information resources may help to remedy this problem.
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Affiliation(s)
- Mohammed A Batais
- Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | | | | | | | - Anas A Khan
- Department of Emergency Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Khaled K Aldossari
- Family and Community Medicine Department, College of Medicine, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | - Jamaan M Al-Zahrani
- Family and Community Medicine Department, College of Medicine, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | - Talal Alghamdi
- Department of Family Medicine, College of Medicine, Majmaah University, Almajmaah, Saudi Arabia
| | - Turky H Almigbal
- Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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18
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Kilshaw AD, Jivan S. Smartphone apps on burns first aid: A review of the advice. Burns 2020; 47:171-174. [PMID: 33279340 DOI: 10.1016/j.burns.2020.04.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 03/16/2020] [Accepted: 04/11/2020] [Indexed: 11/18/2022]
Abstract
AIMS Many websites giving first aid advice are disappointingly inaccurate and at times dangerous in regard to burn injuries. With more patients relying on their smart phones to obtain online information the aim of this study was to compare first aid applications (apps) burn advice against those guidelines set by the British Burns Association (BBA). METHOD A content analysis of all freely available English written first aid apps from Google Play and the Apple Store was performed. The information was compared against BBA guidance which was split into 12 domains and scored appropriately. RESULTS 61 of the 103 first aid apps included in the study, had information on the treatment of burn injuries. The mean score for all apps was 3.3 out of 12. 85% of apps postulated the need to cool the burn. However, only 11% of apps stipulated the need for 20min of cooling, while 3% suggested the burn can be cooled up to 3h post injury. Disappointingly even apps produced by reputable first aid charities scored poorly. CONCLUSION Burns first aid is documented as being poorly given in the community. With easy access to the internet and specifically smart device apps, more needs to be done to improve burn first aid information online.
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Affiliation(s)
- Andrew David Kilshaw
- Department of Burns, Plastic and Reconstructive Surgery, Pinderfields General Hospital, Aberford Road, Wakefield WF14DG, UK.
| | - Sharmila Jivan
- Department of Burns, Plastic and Reconstructive Surgery, Pinderfields General Hospital, Aberford Road, Wakefield WF14DG, UK
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19
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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: 7] [Impact Index Per Article: 1.8] [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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20
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First aid is associated with improved outcomes in large body surface area burns. Burns 2019; 45:1743-1748. [PMID: 31606315 DOI: 10.1016/j.burns.2019.05.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 05/02/2019] [Accepted: 05/15/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND Animal studies indicate treating burn injuries with running water (first aid) for 20 min up to 3 h after burn reduces healing time and scarring. We have previously demonstrated the benefits of first aid in minor burn injuries with respect to a reduction in wound depth, faster healing, and decreased skin grafting utilisation. The purpose of this cohort study was to assess the effect of first aid on clinical outcomes in large body surface area burn injuries (≥20%). METHODS Data was prospectively collected for patients with ≥20% TBSA burns from 2004- 2018. Multivariate regression analysis was used to determine the association of adequate first aid with 8 outcomes - mortality, total length of stay, total body surface area (TBSA), percentage/proportion of TBSA that was full thickness [PFTI], TBSA grafted, number of re-grafting sessions, intensive care admission, and intensive care length of stay. Adequate first aid was defined as the application of 20 min of cool, running tap water up to 3 h following the burn injury. FINDINGS 390 patients were identified. Adequate first aid was received in 35.6% (139) of patients. There was a trend towards a reduction in mortality (OR 0.37; 95% CI 0.12-1.13; P = 0.08). Patients who received adequate first aid had a statistically significant 9.8% reduction in TBSA (95% CI -13.6% to -6.1%; P < 0.0001) as well as a 12% lower PTFI compared to patients who received inadequate first aid (95% CI -19% to -4%; P < 0.01). Whilst there was no significant effect of adequate first aid on the TBSA grafted (P = 0.37), adequate first aid was associated with a significantly less number of re-grafting sessions (95% CI --0.29 to -0.08; P < 0.001). INTERPRETATION Adequate first aid with 20 min of running water is associated with improved outcomes in large burn injuries. Significant benefits are seen in a reduction in TBSA, proportion of the burn wound that is full thickness, as well as decreased re-grafting. This has significant patient and health system benefits and adds to the body of evidence supporting 20 min of cooling in burns care.
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21
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Wright EH, Tyler M, Vojnovic B, Pleat J, Harris A, Furniss D. Human model of burn injury that quantifies the benefit of cooling as a first aid measure. Br J Surg 2019; 106:1472-1479. [PMID: 31441049 DOI: 10.1002/bjs.11263] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 03/18/2019] [Accepted: 05/13/2019] [Indexed: 02/11/2024]
Abstract
BACKGROUND Burn injuries are a major cause of morbidity and mortality worldwide. Cooling is widely practised as a first aid measure, but the efficacy of cooling burns in human skin has not been demonstrated. A safe, consistent, ethically acceptable model of burning and cooling in live human skin in vivo was developed, and used to quantify the effects of cooling. METHODS Novel apparatus was manufactured to create and cool burns in women who were anaesthetized for breast reconstruction surgery using a deep inferior epigastric artery perforator flap. Burns were excised between 1 and 3 h after creation, and analysed using histopathological assessment. RESULTS All 25 women who were approached agreed to take part in the study. There were no adverse events. Increased duration of contact led to increased burn depth, with a contact time of 7·5 s at 70°C leading to a mid-dermal burn. Burn depth progressed over time following injury, but importantly this was modified by cooling the burn at 16°C for 20 min. On average, cooling salvaged 25·2 per cent of the dermal thickness. CONCLUSION This study demonstrated the favourable effects of cooling on human burns. Public heath messaging should emphasize cooling as first aid for burns. This model will allow analysis of the molecular effects of cooling burns, and provide a platform for testing novel therapies aimed at reducing the impact of burn injury.
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Affiliation(s)
- E H Wright
- Department of Plastic Surgery, Stoke Mandeville Hospital, Aylesbury, UK
- Weatherall Institute of Molecular Medicine, John Radcliffe Hospital, Oxford, UK
| | - M Tyler
- Department of Plastic Surgery, Stoke Mandeville Hospital, Aylesbury, UK
| | - B Vojnovic
- Gray Institute for Radiation Oncology and Biology, University of Oxford, Oxford, UK
| | - J Pleat
- Department of Plastic Surgery, Southmead Hospital, Westbury-on-Trym, UK
| | - A Harris
- Weatherall Institute of Molecular Medicine, John Radcliffe Hospital, Oxford, UK
| | - D Furniss
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Science (NDORMS), Botnar Research Centre, Oxford, UK
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22
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Qing Y, Yongqiang X, Xiaoming F, Tuo S, Xiaona X, Yiheng H, Pengfei L, Xiaoyan H, Zhaofan X. First-aid knowledge regarding small area burns in children among 5814 caregivers: A questionnaire analysis. Burns 2019; 46:459-464. [PMID: 31481271 DOI: 10.1016/j.burns.2019.08.006] [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: 03/21/2019] [Revised: 07/07/2019] [Accepted: 08/13/2019] [Indexed: 12/01/2022]
Abstract
BACKGROUND To assess caregivers'knowledge of first aid for small-area thermal burns in children, and reduce burns-induced morbidity and damage in children. METHODS The multi-stage cluster random sampling method was used to recruit school-age children from different kinds of schools. For each child, we selected only one caregiver as our study participant. First-aid knowledge regarding small area burns in children and choices of medical treatment were investigated in the manner of questionnaires. RESULTS The effective response rate of questionnaire was 99.4% (5814/5850). Folk remedies and daily necessities were chosen by 17.8% (1,036/5814) and 48.9% (2841/5814), respectively. 39.8% (2,312/5814) of caregivers knew all standard burn first aid measures. Moreover, the proportion of knowing all five measures among caregivers with undergraduate education was significantly higher than the figures among those with other educational levels. CONCLUSIONS Child caregivers had poor knowledge of first aid for small area burns in children. Only a few caregivers knew all five standard first aid measures for managing small area burns. Many non-scientific and inappropriate home remedies are still widely applied among Shanghai citizens. Our study results suggest relevant scientific evidence-informed measures should be more widely disseminated to the citizens.
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Affiliation(s)
- Yu Qing
- Department of Burn Surgery, Changhai Hospital, The Navy Military Medical University, Shanghai, 200433, China
| | - Xiao Yongqiang
- Department of Burn Surgery, Changhai Hospital, The Navy Military Medical University, Shanghai, 200433, China
| | - Fan Xiaoming
- Department of Burn Surgery, Changhai Hospital, The Navy Military Medical University, Shanghai, 200433, China
| | - Shen Tuo
- Department of Burn Surgery, Changhai Hospital, The Navy Military Medical University, Shanghai, 200433, China
| | - Xu Xiaona
- Department of Burn Surgery, Changhai Hospital, The Navy Military Medical University, Shanghai, 200433, China
| | - Huang Yiheng
- College of Pharmacy, Fudan University, Shanghai, China
| | - Luo Pengfei
- Department of Burn Surgery, Changhai Hospital, The Navy Military Medical University, Shanghai, 200433, China.
| | - Hu Xiaoyan
- Department of Burn Surgery, Changhai Hospital, The Navy Military Medical University, Shanghai, 200433, China.
| | - Xia Zhaofan
- Department of Burn Surgery, Changhai Hospital, The Navy Military Medical University, Shanghai, 200433, China.
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23
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Griffin BR, Frear CC, Babl F, Oakley E, Kimble RM. Cool Running Water First Aid Decreases Skin Grafting Requirements in Pediatric Burns: A Cohort Study of Two Thousand Four Hundred Ninety-five Children. Ann Emerg Med 2019; 75:75-85. [PMID: 31474480 DOI: 10.1016/j.annemergmed.2019.06.028] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Revised: 06/11/2019] [Accepted: 06/27/2019] [Indexed: 10/26/2022]
Abstract
STUDY OBJECTIVE First-aid guidelines recommend the administration of cool running water in the early management of thermal injury. Our objective is to analyze the associations between first aid and skin-grafting requirements in children with burns. METHODS This cohort study used a prospectively collected registry of patients managed at a tertiary children's hospital. Multivariate logistic regression models were used to evaluate the relationship between first aid and the requirement for skin grafting. Secondary outcomes included time to re-epithelialization, wound depth, hospital admission and length of stay, and operating room interventions. Adequate first aid was defined as 20 minutes of cool running water within 3 hours of injury. RESULTS In our cohort of 2,495 children, 2,259 (90.6%) received first aid involving running water, but only 1,780 (71.3%) were given the adequate duration. A total of 236 children (9.5%) required grafting. The odds of grafting were decreased in the adequate first aid group (odds ratio [OR] 0.6; 95% confidence interval [CI] 0.4 to 0.8). The provision of adequate running water was further associated with reductions in full-thickness depth (OR 0.4; 95% CI 0.2 to 0.6), hospital admission (OR 0.7; 95% CI 0.3 to 0.9), and operating room interventions (OR 0.7; 95% CI 0.5 to 0.9), but not hospital length of stay (hazard ratio=0.9; 95% CI 0.7 to 1.2; P=.48). CONCLUSION Burn severity and clinical outcomes improved with the administration of cool running water. Adequate first aid must be prioritized by out-of-hospital and emergency medical services in the preliminary management of pediatric burns.
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Affiliation(s)
- Bronwyn R Griffin
- Queensland University of Technology Faculty of Health, Centre for Children's Burns and Trauma Research, South Brisbane, Queensland, Australia.
| | - Cody C Frear
- Queensland University of Technology Faculty of Health, Centre for Children's Burns and Trauma Research, South Brisbane, Queensland, Australia.
| | - Franz Babl
- Murdoch Children's Research Institute, Royal Children's Hospital, and Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Ed Oakley
- Murdoch Children's Research Institute, Royal Children's Hospital, and Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Roy M Kimble
- Queensland University of Technology Faculty of Health, Centre for Children's Burns and Trauma Research, South Brisbane, Queensland, Australia
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24
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Song M, Armstrong A, Murray A. Acid attacks: Broadening the multidisciplinary team to improve outcomes. Burns 2019; 46:514-519. [PMID: 31230799 DOI: 10.1016/j.burns.2019.03.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Revised: 01/26/2019] [Accepted: 03/26/2019] [Indexed: 11/26/2022]
Abstract
A rise in the current trend of corrosive substance attacks have been reported in the UK, causing devastating effects on victims. The optimal management of these patients requires the specialist skills of the burn multidisciplinary team (MDT) to address the resulting physical and psychological trauma experienced. However, burn care must commence in the pre-hospital setting. The public and first responders are invaluable resources in helping to limit the adverse effects of burns. Challenges of burn care outside the Burns Unit are not limited to the treatment of the injured patient and the rehabilitation of survivors. These challenges also encompass better education of the public and allied health professionals, as well as planning strategies to reduce the incidence of acid attacks. Prevention is always better than cure. This paper discusses the broadening of the MDT to improve outcomes in acid attacks by exploring the wider roles of the public, media, emergency services, police, legislation and better education.
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Affiliation(s)
- Marie Song
- Plastic Surgery Department, Stoke Mandeville Hospital, United Kingdom.
| | | | - Alexandra Murray
- Plastic Surgery Department, Stoke Mandeville Hospital, United Kingdom
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25
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Holbert MD, Griffin BR, McPhail SM, Ware RS, Foster K, Bertoni DC, Kimble RM. Effectiveness of a hydrogel dressing as an analgesic adjunct to first aid for the treatment of acute paediatric thermal burn injuries: study protocol for a randomised controlled trial. Trials 2019; 20:13. [PMID: 30612585 PMCID: PMC6322255 DOI: 10.1186/s13063-018-3057-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 11/16/2018] [Indexed: 01/13/2023] Open
Abstract
Background Burns are a painful and traumatic experience, particularly in children. Reduced pain and anxiety positively influences re-epithelialisation rates in paediatric burn patients, however current literature fails to fully explain the effects of pain and anxiety and their links with wound healing. This study will determine if Burnaid® hydrogel dressing is an effective treatment for reducing pain in the acute period of a burn injury. It is hypothesised that a reduction in pain will then improve re-epithelialisation time in comparison to plastic wrap, which is standard practice at our institution — a metropolitan tertiary paediatric hospital located in Brisbane, Australia. Methods/design A randomised controlled trial will be conducted to assess the effectiveness of Burnaid® as an analgesic adjunct to cold running water first aid for the treatment of paediatric burns. Participants will include children aged between 0 and 16 years with an acute thermal burn injury (total burn surface area < 20%) presenting to the Department of Emergency within 24 h of the burn occurring. Participants will be randomised into one of two groups: (1) Burnaid® hydrogel (intervention arm) or (2) plastic wrap (control arm). Participants will also be stratified into one of two groups based on factors that influence pain intensity: (1) high pain risk or (2) low pain risk. High pain risk factors include foot burns, hot coal/ash/fire pit burns, burn area greater than 5%, and circumferential burns. The primary outcome is the intervention’s effect on reducing acute pain. Secondary outcomes include days to re-epithelialisation, pulse rate, temperature, salivary cortisol and α-amylase, anxiety, and cost-effectiveness. Sample size calculations have shown that 36 participants will be recruited into each group. Discussion This study will provide comprehensive data on the analgesic properties of Burnaid® as an adjunct to first aid for the treatment of acute paediatric thermal burns. If the intervention is effective in reducing pain, Burnaid® will be integrated as standard practice within the hospital’s Department of Emergency. This study replicates a real-world scenario in order to identify clinically significant analgesic and wound-healing effects. Trial registration Australian New Zealand Clinical Trials Registry, ACTRN12617001274369. Prospectively registered on 5 Sept 2017. Electronic supplementary material The online version of this article (10.1186/s13063-018-3057-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Maleea D Holbert
- Centre for Children's Burns and Trauma Research, The University of Queensland, Brisbane, Australia. .,Pegg Leditschke Paediatric Burns Centre, Lady Cilento Children's Hospital, South Brisbane, Australia.
| | - Bronwyn R Griffin
- Centre for Children's Burns and Trauma Research, The University of Queensland, Brisbane, Australia.,Pegg Leditschke Paediatric Burns Centre, Lady Cilento Children's Hospital, South Brisbane, Australia.,School of Nursing, Queensland University of Technology, Brisbane, Australia
| | - Steven M McPhail
- Centre for Functioning and Health Research, Metro South Health, Buranda, Australia.,School of Public Health & Social Work and Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - Robert S Ware
- Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - Kelly Foster
- Paediatric Emergency Research Unit, Children's Health Queensland, South Brisbane, Australia
| | - Demi C Bertoni
- Pegg Leditschke Paediatric Burns Centre, Lady Cilento Children's Hospital, South Brisbane, Australia
| | - Roy M Kimble
- Centre for Children's Burns and Trauma Research, The University of Queensland, Brisbane, Australia.,Pegg Leditschke Paediatric Burns Centre, Lady Cilento Children's Hospital, South Brisbane, Australia
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26
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Harish V, Tiwari N, Fisher OM, Li Z, Maitz PKM. First aid improves clinical outcomes in burn injuries: Evidence from a cohort study of 4918 patients. Burns 2018; 45:433-439. [PMID: 30337155 DOI: 10.1016/j.burns.2018.09.024] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 08/23/2018] [Accepted: 09/13/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Animal studies indicate treating burn injuries with running water (first aid) for 20min up to 3h post-burn reduces healing time and scarring. There is a lack of human data to support such a recommendation. The purpose of this cohort study was to assess the effect of first aid on clinical outcomes. METHODS Data was prospectively collected for patients with <10% total body surface area (TBSA) burns from 2007-2012. Multivariate regression analysis was used to determine the association of adequate first aid with four outcomes - wound depth, requirement for skin grafting, healing time (in non-grafted patients), and TBSA not grafted (in grafted patients). Adequate first aid was defined as the application of 20min of cool, running tap water up to 3h following the burn injury. FINDINGS 4918 patients were identified. Adequate first aid was received in 58.1% (2859) of patients. It was associated with a statistically significant reduction in burn wound depth (OR 1.39; 95% CI 1.24-1.55; P<0.001) but was not associated with a reduction in TBSA (P=0.86) or requirement for grafting (P=0.47). In patients not requiring grafting, those who received adequate first aid were healed on average 10% (HR 1.10; 95% CI 1.03-1.18; P<0.01) or 1.9 days faster (95% CI -2.9 to -0.9; P<0.001). Adequate first aid in patients requiring grafting was associated with a 15% increase in TBSA that was not grafted (0.27%; 95% CI 0.01-0.52; P=0.04). INTERPRETATION Adequate first aid with 20min of running water is associated with improved outcomes. Benefits are seen in a reduction in wound depth, faster healing, and decreased grafting requirements. This has significant patient and health system benefits, and calls for promotion of 20min of running water globally in burns care.
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Affiliation(s)
- Varun Harish
- Burns Unit, Concord Repatriation General Hospital, Sydney, Australia; ANZAC Research Institute, Concord Repatriation General Hospital, Sydney, Australia.
| | - Neha Tiwari
- Burns Unit, Concord Repatriation General Hospital, Sydney, Australia
| | - Oliver M Fisher
- Department of Surgery, St George Hospital, Sydney, Australia; Department of Surgery, University of Notre Dame School of Medicine, Australia
| | - Zhe Li
- Burns Unit, Concord Repatriation General Hospital, Sydney, Australia; ANZAC Research Institute, Concord Repatriation General Hospital, Sydney, Australia; University of Sydney, Sydney, Australia
| | - Peter K M Maitz
- Burns Unit, Concord Repatriation General Hospital, Sydney, Australia; ANZAC Research Institute, Concord Repatriation General Hospital, Sydney, Australia; University of Sydney, Sydney, Australia
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Bennett CV, Maguire S, Nuttall D, Lindberg DM, Moulton S, Bajaj L, Kemp AM, Mullen S. First aid for children's burns in the US and UK: An urgent call to establish and promote international standards. Burns 2018; 45:440-449. [PMID: 30266196 DOI: 10.1016/j.burns.2018.09.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 09/05/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Appropriate first aid can reduce the morbidity of burns, however, there are considerable variations between international first aid recommendations. We aim to identify, and compare first aid practices in children who present to Emergency Departments (ED) with a burn. METHODS A prospective cross-sectional study of 500 children (0-16 completed years) presenting with a burn to a paediatric ED in the UK (Cardiff) and the USA (Denver, Colorado), during 2015-2017. The proportion of children who had received some form of first aid and the quality of first aid were compared between cities. RESULTS Children attending hospital with a burn in Cardiff were 1.47 times more likely (RR 1.47; CI 1.36, 1.58), to have had some form of first aid than those in Denver. Denver patients were 4.7 time more likely to use a dressing and twice as likely to apply ointment/gel/aloe vera than the Cardiff cohort. First aid consistent with local recommendations was only administered to 26% (128/500) of children in Cardiff and 6% (31/500) in Denver. Potentially harmful first aid e.g. application of food, oil, toothpaste, shampoo or ice was applied to 5% of children in Cardiff and 10% in Denver. CONCLUSION A low number of children received optimal burns first aid, with potentially harmful methods applied in a considerable proportion of cases. There is an urgent need for internationally agreed, evidence-based burn first aid recommendations.
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Affiliation(s)
- C Verity Bennett
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, CF14 4YS, United Kingdom.
| | - Sabine Maguire
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, CF14 4YS, United Kingdom
| | - Diane Nuttall
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, CF14 4YS, United Kingdom
| | - Daniel M Lindberg
- Department of Emergency Medicine, Children's Hospital Colorado, United States
| | - Steven Moulton
- Division of Paediatric Surgery, Children's Hospital Colorado, United States; Department of Surgery, University of Colorado School of Medicine, United States
| | - Lalit Bajaj
- Department of Emergency Medicine, Children's Hospital Colorado, United States
| | - Alison M Kemp
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, CF14 4YS, United Kingdom
| | - Stephen Mullen
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, CF14 4YS, United Kingdom; Paediatric Emergency Department, Royal Belfast Hospital for Sick Children, Falls Road, Belfast, BT12 6BA, United Kingdom
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Simpson MJ, McInerney S, Carr EJ, Cuttle L. Quantifying the efficacy of first aid treatments for burn injuries using mathematical modelling and in vivo porcine experiments. Sci Rep 2017; 7:10925. [PMID: 28883527 PMCID: PMC5589934 DOI: 10.1038/s41598-017-11390-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 08/23/2017] [Indexed: 01/19/2023] Open
Abstract
First aid treatment of burns reduces scarring and improves healing. We quantify the efficacy of first aid treatments using a mathematical model to describe data from a series of in vivo porcine experiments. We study burn injuries that are subject to various first aid treatments. The treatments vary in the temperature and duration. Calibrating the mathematical model to the experimental data provides estimates of the thermal diffusivity, the rate at which thermal energy is lost to the blood, and the heat transfer coefficient controlling the loss of thermal energy at the interface of the fat and muscle. A limitation of working with in vivo experiments is the difficulty of measuring variations in temperature across the tissue layers. This limitation motivates us to use a simple, single layer mathematical model. Using the solution of the calibrated mathematical model we visualise the temperature distribution across the thickness of the tissue. With this information we propose a novel measure of the potential for tissue damage. This measure quantifies two important factors: (i) the volume of tissue that rises above the threshold temperature associated with the accumulation of tissue damage; and (ii) the duration of time that the tissue remains above this threshold temperature.
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Affiliation(s)
- Matthew J Simpson
- School of Mathematical Sciences, Queensland University of Technology (QUT), Brisbane, Australia.
| | - Sean McInerney
- School of Mathematical Sciences, Queensland University of Technology (QUT), Brisbane, Australia
| | - Elliot J Carr
- School of Mathematical Sciences, Queensland University of Technology (QUT), Brisbane, Australia
| | - Leila Cuttle
- Centre for Children's Burns and Trauma Research, QUT, Institute of Health and Biomedical Innovation at the Centre for Children's Health Research, South Brisbane, Australia
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Read DJ, Tan SC, Ward L, McDermott K. Burns first aid treatment in remote Northern Australia. Burns 2017; 44:481-487. [PMID: 28811053 DOI: 10.1016/j.burns.2017.07.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 07/04/2017] [Accepted: 07/11/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND OBJECTIVE It is well demonstrated that adequate burns first aid treatment (BFAT) improves clinical outcomes for the injured but adequacy remains low in many studies. This study presents a twelve month assessment of the adequacy of burns first aid treatment for patients managed by the Burns Service, Royal Darwin Hospital (RDH). METHODS Prospective study design of all patients managed by the Burns Service, Royal Darwin Hospital. Data were collated from two sources; RDH Burns Registry, and the Burns Registry of Australia and New Zealand (BRANZ). Inclusion criterion was all patients managed by the Burns Service, Royal Darwin Hospital for the period 1 January 2014-31 December 2014. Variables collected and analysed include: demographics, burn mechanism, burn wound depth and adequacy of and circumstances around first aid. RESULTS Overall 310 cases were analysed. Most injuries involved adults (68%), 19% Indigenous persons and 70% of all patients had their burn injury occur in the urban region. Adequate BFAT occurred in 41% of cases. Adults, contact burns and those where the burn injury occurred in the remote regions were less likely to receive adequate BFAT. Indigenous persons were less likely to attempt any BFAT at all and when they did receive BFAT it was more likely applied by an emergency responder or health professional. CONCLUSION Overall adequacy of BFAT is low in the Top End of the Northern Territory. Remote dwellers and Indigenous persons are at increased risk of not applying or receiving adequate BFAT. The poor level of adequate BFAT demonstrated in this study suggests that the Top End community particularly remote and Indigenous persons would benefit from targeted BFAT education programs that are delivered in a culturally and linguistically appropriate fashion.
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Affiliation(s)
- David J Read
- National Critical Care and Trauma Response Centre, Royal Darwin Hospital, Northern Territory, Australia; Burns Service, Royal Darwin Hospital, Northern Territory, Australia.
| | - Swee Chin Tan
- Burns Service, Royal Darwin Hospital, Northern Territory, Australia.
| | - Linda Ward
- National Critical Care and Trauma Response Centre, Royal Darwin Hospital, Northern Territory, Australia; Menzies School of Health Research, Darwin, Northern Territory, Australia.
| | - Kathleen McDermott
- National Critical Care and Trauma Response Centre, Royal Darwin Hospital, Northern Territory, Australia.
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Nurmatov UB, Mullen S, Quinn-Scoggins H, Mann M, Kemp A. The effectiveness and cost-effectiveness of first aid interventions for burns given to caregivers of children: A systematic review. Burns 2017; 44:512-523. [PMID: 28784346 DOI: 10.1016/j.burns.2017.05.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 05/09/2017] [Accepted: 05/25/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVES the effectiveness and cost-effectiveness of burns first-aid educational interventions given to caregivers of children. METHODS Systematic review of eligible studies from seven databases, international journals, trials repositories and contacted international experts. RESULTS Of 985 potential studies, four met the inclusion criteria. All had high risk of bias and weak global rating. Two studies identified a statistically significant increase in knowledge after of a media campaign. King et al. (41.7% vs 63.2%, p<0.0001), Skinner et al. (59% vs 40%, p=0.004). Skinner et al. also identified fewer admissions (64.4% vs 35.8%, p<0.001) and surgical procedures (25.6% vs 11.4%, p<0.001). Kua et al. identified a significant improvement in caregiver's knowledge (22.9% vs 78.3%, 95% CI 49.2, 61.4) after face-to-face education intervention. Ozyazicioglu et al. evaluated the effect of a first-aid training program and showed a reduction in use of harmful traditional methods for burns in children (29% vs 16.1%, p<0.001). No data on cost-effectiveness was identified. CONCLUSION There is a paucity of high quality research in this field and considerable heterogeneity across the included studies. Delivery and content of interventions varied. However, studies showed a positive effect on knowledge. No study evaluated the direct effect of the intervention on first aid administration. High quality clinical trials are needed.
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Affiliation(s)
- Ulugbek B Nurmatov
- Division of Population Medicine, School of Medicine, Cardiff University, CF 14 4YS, Cardiff, Wales, UK.
| | - Stephen Mullen
- Paediatric Emergency Department, University Hospitals of Wales, CF 14 4XW, Cardiff, Wales, UK; The Scar Free Foundation Centre for Children's Burns Research, CF 14 4YS, Cardiff, Wales, UK.
| | - Harriet Quinn-Scoggins
- Division of Population Medicine, School of Medicine, Cardiff University, CF 14 4YS, Cardiff, Wales, UK; The Scar Free Foundation Centre for Children's Burns Research, CF 14 4YS, Cardiff, Wales, UK.
| | - Mala Mann
- Specialist Unit for Review Evidence, Cardiff University, CF 14 4YS, Cardiff, Wales, UK.
| | - Alison Kemp
- Division of Population Medicine, School of Medicine, Cardiff University, CF 14 4YS, Cardiff, Wales, UK; The Scar Free Foundation Centre for Children's Burns Research, CF 14 4YS, Cardiff, Wales, UK.
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Martin NA, Falder S. A review of the evidence for threshold of burn injury. Burns 2017; 43:1624-1639. [PMID: 28536038 DOI: 10.1016/j.burns.2017.04.003] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 03/05/2017] [Accepted: 04/02/2017] [Indexed: 01/24/2023]
Abstract
INTRODUCTION Burn injury is common and depth is one measure of severity. Although the depth of burn injury is determined by many factors, the relationship between the temperature of the injurious agent and exposure duration, known as the time-temperature relationship, is widely accepted as one of the cornerstones of burn research. Moritz and Henriques first proposed this relationship in 1947 and their seminal work has been cited extensively. However, over the years, readers have misinterpreted their findings and incorporated misleading information about the time-temperature relationship into a wide range of industrial standards, burn prevention literature and medicolegal opinion. AIM The purpose of this paper is to present a critical review of the evidence that relates temperature and time to cell death and the depth of burn injury. These concepts are used by researchers, burn prevention strategists, burn care teams and child protection professionals involved in ascertaining how the mechanism of burning relates to the injury pattern and whether the injury is consistent with the history. REVIEW METHODS This review explores the robustness of the currently available evidence. The paper summarises the research from burn damage experimental work as well as bioheat transfer models and discusses the merits and limitations of these approaches. REVIEW FINDINGS There is broad agreement between in vitro and in vivo studies for superficial burns. There is clear evidence that the perception of pain in adult human skin occurs just above 43°C. When the basal layer of the epidermis reaches 44°C, burn injury occurs. For superficial dermal burns, the rate of tissue damage increases logarithmically with a linear increase in temperature. Beyond 70°C, rate of damage is so rapid that interpretation can be difficult. Depth of injury is also influenced by skin thickness, blood flow and cooling after injury. There is less clinical evidence for a time-temperature relationship for deep or subdermal burns. Bioheat transfer models are useful in research and becoming increasingly sophisticated but currently have limited practical use. Time-temperature relationships have not been established for burns in children's skin, although standards for domestic hot water suggest that the maximum temperature should be revised downward by 3-4°C to provide adequate burn protection for children. CONCLUSION Time-temperature relationships established for pain and superficial dermal burns in adult human skin have an extensive experimental modeling basis and reasonable clinical validation. However, time-temperature relationships for subdermal burns, full thickness burns and burn injury in children have limited clinical validation, being extrapolated from other data, and should be used with caution, particularly if presented during expert evidence.
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Affiliation(s)
- N A Martin
- St. Andrews Centre for Burns and Plastic Surgery, Broomfield Hospital, Chelmsford, Essex CM1 7ET, UK.
| | - S Falder
- Department of Burns and Plastic Surgery, Alder Hey Children's NHS Foundation Trust, Liverpool L12 2AP, UK.
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Inaccurate, inadequate and inconsistent: A content analysis of burn first aid information online. Burns 2016; 42:1671-1677. [PMID: 27756588 DOI: 10.1016/j.burns.2016.09.017] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 09/14/2016] [Accepted: 09/15/2016] [Indexed: 11/21/2022]
Abstract
OBJECTIVE With the popularity of the Internet as a primary source of health-related information, the aim of this website content analysis was to assess the accuracy and quality of burn first aid information available on the Internet. METHODS Using the search term 'burn first aid' in four popular search engines, the first 10 websites from each search engine were recorded. From a total of 40 websites recorded, 14 websites were evaluated after removing duplicates. Websites were assessed on content accuracy by four independent reviewers with checks conducted on inter-rater reliability. Website quality was recorded based on Health on the Net Code of Conduct (HONcode) principles. RESULTS Country of origin for the 14 websites was the US (7), Australia (6), and New Zealand (1). The mean content accuracy score was 5.6 out of 10. The mean website quality score was 6.6 out of 12. Australasian websites scored lower for quality but higher for accuracy. The US websites scored higher for quality than accuracy. Website usability and accuracy in a crisis situation were also assessed. The median crisis usability score was 3 out of five, and the median crisis accuracy score was 3.5 out of five. CONCLUSIONS The inaccurate and inconsistent burn first aid treatments that appear online are reflected in the often-incorrect burn first aid treatments seen in patients attending emergency departments. Global consistency in burn first aid information is needed to avoid confusion by members of the public.
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Comparison of three cooling methods for burn patients: A randomized clinical trial. Burns 2016; 43:502-508. [PMID: 27707640 DOI: 10.1016/j.burns.2016.09.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 09/08/2016] [Accepted: 09/11/2016] [Indexed: 11/22/2022]
Abstract
Tap water may not be readily available in numerous places as a first aid for burns and, therefore, tea tree oil products are recommended alternatives. Our aim in this study was to compare the cooling effects of three burn-cooling methodologies, running tap water, Burnshield®, and Burn Cool Spray®, and suggest indications for each cooling method. This randomized, controlled, study enrolled patients with burns who used the emergency service of Seoul Bestian Hospital from June 2015 to October 2015. The allocation of the cooling methods was randomly generated using a computer. We cooled the burn wounds by applying one of the three methods and measured the skin surface temperature and pain level using a visual analog scale (VAS) scoring. Ninety-six patients were enrolled in this study. The variability in the median(IQR) skin temperatures of the three groups was from 33.5°C (31.5-35.0) to 28.7°C (25.9-30.9), 33.8°C (32.0-35.4) to 33.2°C (30.5-35.0), and 34.0°C (32.0-35.1) to 34.4°C (32.7-35.6) for the tap water, Burn Cool Spray®, and Burnshield®, respectively. The variability of the mean VAS pain scores was 6.9 to 4.8 (tap water), 5.6 to 4.5 (Burn Cool Spray®), and 5.5 to 3.3 (Burnshield®). The reduction of skin surface temperature by tap water was significantly greater than that by the other two methods. All three methods reduced the VAS pain score after 20min of treatment (p<0.001). The tap water had a similar effect to that of the Burn Cool Spray® but significantly better than that of Burnshield®. There was a significant difference in the skin surface temperature and VAS pain score reduction (p=0.014 and p=0.007, respectively) between the groups cooled by tap water below and above 24°C. The patients who visited the center within 30min showed a significantly higher skin temperature than those who came after 30min did (p=0.033). Tap water and Burn Cool Spray® reduced the skin surface temperature, but the Burnshield® slightly increased it. All three cooling methods were effective in relieving pain. The temperature of the tap water used was related to the reduction in skin surface temperature and VAS pain score. The patients who visited the hospital within 30min of their burn accident needed a longer cooling time to attain a comparable skin surface temperature to those who visited after 30min.
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Andrews CJ, Kempf M, Kimble R, Cuttle L. Development of a Consistent and Reproducible Porcine Scald Burn Model. PLoS One 2016; 11:e0162888. [PMID: 27612153 PMCID: PMC5017633 DOI: 10.1371/journal.pone.0162888] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 08/30/2016] [Indexed: 01/19/2023] Open
Abstract
There are very few porcine burn models that replicate scald injuries similar to those encountered by children. We have developed a robust porcine burn model capable of creating reproducible scald burns for a wide range of burn conditions. The study was conducted with juvenile Large White pigs, creating replicates of burn combinations; 50°C for 1, 2, 5 and 10 minutes and 60°C, 70°C, 80°C and 90°C for 5 seconds. Visual wound examination, biopsies and Laser Doppler Imaging were performed at 1, 24 hours and at 3 and 7 days post-burn. A consistent water temperature was maintained within the scald device for long durations (49.8 ± 0.1°C when set at 50°C). The macroscopic and histologic appearance was consistent between replicates of burn conditions. For 50°C water, 10 minute duration burns showed significantly deeper tissue injury than all shorter durations at 24 hours post-burn (p ≤ 0.0001), with damage seen to increase until day 3 post-burn. For 5 second duration burns, by day 7 post-burn the 80°C and 90°C scalds had damage detected significantly deeper in the tissue than the 70°C scalds (p ≤ 0.001). A reliable and safe model of porcine scald burn injury has been successfully developed. The novel apparatus with continually refreshed water improves consistency of scald creation for long exposure times. This model allows the pathophysiology of scald burn wound creation and progression to be examined.
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Affiliation(s)
- Christine J. Andrews
- Centre for Children’s Burns and Trauma Research, The University of Queensland, Centre for Children’s Health Research, South Brisbane, Queensland, Australia
| | - Margit Kempf
- Centre for Children’s Burns and Trauma Research, The University of Queensland, Centre for Children’s Health Research, South Brisbane, Queensland, Australia
| | - Roy Kimble
- Centre for Children’s Burns and Trauma Research, The University of Queensland, Centre for Children’s Health Research, South Brisbane, Queensland, Australia
| | - Leila Cuttle
- Centre for Children’s Burns and Trauma Research, Queensland University of Technology, School of Biomedical Sciences, Institute of Health and Biomedical Innovation at Centre for Children's Health Research, South Brisbane, Queensland, Australia
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Goodwin NS. "European Resuscitation Council 2015 burn 1st Aid recommendations-concerns and issues for first responders". Burns 2016; 42:1148-1150. [PMID: 27283732 DOI: 10.1016/j.burns.2016.01.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2016] [Accepted: 01/05/2016] [Indexed: 10/21/2022]
Abstract
As the lead author of a recently published systematic review on hydrogel burn dressings in pre-hospital, I was alarmed to read the claim by the authors to the effect no one method of burn wound cooling was superior to any other; "There is no evidence to recommend a specific temperature or method of cooling". The reputation and prominence of the ERC within the circle of resuscitation councils now delving into 1st Aid recommendations leads to the conclusion that misguided recommendations may cause confusion amongst first responders, may falsely misdirect 1st Aid providers to unsupported practices or alternatively create a window of opportunity for marketers or sellers of alternative burn 1st Aid technologies to make unsupported claims in respect of comparable efficacy of their own product versus "traditional" methods.
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Affiliation(s)
- Nicholas S Goodwin
- Ambulance Victoria, 375 Manningham Road, Doncaster 3108, Victoria, Australia.
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Alomar M, Rouqi FA, Eldali A. Knowledge, attitude, and belief regarding burn first aid among caregivers attending pediatric emergency medicine departments. Burns 2016; 42:938-43. [DOI: 10.1016/j.burns.2016.03.019] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Revised: 02/26/2016] [Accepted: 03/24/2016] [Indexed: 10/21/2022]
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Rural and Metropolitan Pediatric Burns in New South Wales and the Australian Capital Territory: Does Distance Make a Difference? J Burn Care Res 2016; 36:e231-7. [PMID: 26154516 DOI: 10.1097/bcr.0000000000000138] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
To determine if differences exist between children who sustain burns in rural areas and in metropolitan areas, an analysis of children presenting to the Burns Unit at The Children's Hospital at Westmead, from the January 1, 2008 to December 31, 2012 was performed. In all, 4326 children met the inclusion criteria, of which 21.2% came from rural regions. Just more than a quarter (26.0%) of rural children and 11.6% from metropolitan areas were Indigenous Australian (P < 0.0001). The average age of rural child was 4.5 years; metropolitan child was 3.9 years (P = 0.0001). Boys were more likely to sustain burns in both populations. Of the rural children, 40.8% sustained contact burns, 37.7% scald, and 12.5% flame. In contrast, 58.8% metropolitan children sustained scalds, 27.4% contact, and 4.5% flame. The home was the most common place for all burns to occur, but rural injuries commonly occurred outdoors. Burns were associated with risk-taking behavior in 15.3% rural and 8.7% metropolitan children (P < 0.0001). Nearly two thirds (65.9%) of children in both groups received adequate first aid (20 minutes of cool running water). Major burn injuries (≥10% Total BSA) occurred in 3.4% of rural and 2.1% metropolitan children (P = 0.02). Skin grafting was required in 28.3% rural and 16.3% metropolitan children (P = 0.0001). Nearly 32% of rural children required admission to the Burns Unit for >24 hours (15.9% metropolitan; P = 0.0001). Significant differences exist between burns sustained by rural and metropolitan children. This should be accounted for in burns prevention campaigns and the education of local health practitioners.
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Walsh K, Stiles K, Dheansa B. Letter in Response to: European Resuscitation Council's guidelines for resuscitation 2015. Resuscitation 2016; 99:e13. [DOI: 10.1016/j.resuscitation.2015.11.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Accepted: 11/15/2015] [Indexed: 11/28/2022]
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Concerns relating to the European resuscitation guidelines for the first aid management of burns. Burns 2016; 42:240-241. [DOI: 10.1016/j.burns.2015.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Accepted: 11/16/2015] [Indexed: 11/22/2022]
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Wood FM, Phillips M, Jovic T, Cassidy JT, Cameron P, Edgar DW. Water First Aid Is Beneficial In Humans Post-Burn: Evidence from a Bi-National Cohort Study. PLoS One 2016; 11:e0147259. [PMID: 26808839 PMCID: PMC4725848 DOI: 10.1371/journal.pone.0147259] [Citation(s) in RCA: 98] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 01/02/2016] [Indexed: 11/21/2022] Open
Abstract
Introduction Reported first aid application, frequency and practices around the world vary greatly. Based primarily on animal and observational studies, first aid after a burn injury is considered to be integral in reducing scar and infection, and the need for surgery. The current recommendation for optimum first aid after burn is water cooling for 20 minutes within three hours. However, compliance with this guideline is reported as poor to moderate at best and evidence exists to suggest that overcooling can be detrimental. This prospective cohort study of a bi-national burn patient registry examined data collected between 2009 and 2012. The aim of the study was to quantify the magnitude of effects of water cooling first aid after burn on indicators of burn severity in a large human cohort. Method The data for the analysis was provided by the Burn Registry of Australia and New Zealand (BRANZ). The application of first aid cooling prior to admission to a dedicated burn service, was analysed for its influence on four outcomes related to injury severity. The patient related outcomes were whether graft surgery occurred, and death while the health system (cost) outcomes included total hospital length of stay and admission to ICU. Robust regression analysis using bootstrapped estimation adjusted using a propensity score was used to control for confounding and to estimate the strength of association with first aid. Dose-response relationships were examined to determine associations with duration of first aid. The influence of covariates on the impact of first aid was assessed. Results Cooling was provided before Burn Centre admission for 68% of patients, with at least twenty minutes duration for 46%. The results indicated a reduction in burn injury severity associated with first aid. Patients probability for graft surgery fell by 0.070 from 0.537 (13% reduction) (p = 0.014). The probability for ICU admission fell by 0.084 from 0.175 (48% reduction) (p<0.001) and hospital length of stay (LOS) fell by 2.27 days from 12.9 days (18% reduction) (p = 0.001). All outcomes except death showed a dose-response relationship with the duration of first aid. The size of burn and age interacted with many of the relationships between first aid and outcome and these are described and discussed. Discussion & Conclusion This study suggests that there are significant patient and health system benefits from cooling water first aid, particularly if applied for up to 20 minutes. The results of this study estimate the effect size of post-burn first aid and confirm that efforts to promote first aid knowledge are not only warranted, but provide potential cost savings.
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Affiliation(s)
- Fiona M. Wood
- Burn Service of Western Australia, State Adult Burn Unit, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
- Burn Injury Research Unit, University of Western Australia, Crawley, Western Australia, Australia
- Fiona Wood Foundation, Murdoch, Western Australia, Australia
- * E-mail:
| | - Michael Phillips
- Perkins Institute of Medical Research, Royal Perth Hospital, Perth and University of Western Australia, Crawley, Western Australia, Australia
| | - Tom Jovic
- University of Edinburgh, Edinburgh, Scotland, United Kingdom
- Burn Service of Western Australia, Burn Unit, Royal Perth Hospital, Perth, Western Australia, Australia
| | - John T Cassidy
- Burn Service of Western Australia, Burn Unit, Royal Perth Hospital, Perth, Western Australia, Australia
- James Connolly Memorial Hospital, Blanchardstown, Dublin, Ireland
| | - Peter Cameron
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Dale W. Edgar
- Burn Service of Western Australia, State Adult Burn Unit, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
- Fiona Wood Foundation, Murdoch, Western Australia, Australia
- Burn Injury Research Node, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
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Hyland EJ, Lawrence T, Harvey JG, Holland AJA. Management and outcomes of children with severe burns in New South Wales: 1995-2013. ANZ J Surg 2015; 86:499-503. [PMID: 26678373 DOI: 10.1111/ans.13398] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND As a result of improvements in injury prevention, severe burns appear increasingly uncommon in Australian children. Such injuries continue to have devastating impacts, with major consequences for the patient, their family, treating clinicians and the caring institution. METHODS A retrospective review was undertaken of Australian children who presented to our institution between 1995 and 2013 with burn injuries ≥30% total body surface area (TBSA). RESULTS Ninety children were identified. Their median age was 3.9 years and 57% (n = 52) were male. Most injuries occurred at home (n = 63) due to fires (n = 49). The majority received inadequate first aid (n = 56) and 40 became hypothermic during initial resuscitation. A total of 79% were transferred from other institutions. The median TBSA burnt was 40% and the majority of burns were full thickness (n = 51). All but nine were managed in the Paediatric Intensive Care Unit with a mean initial hospital admission of 43.5 days. Two thirds of children were intubated, over half of those prior to transfer, with 26 having an inhalational injury and 33 escharotomies. Compared with estimated fluid requirements, most children were over-resuscitated by a median of 26.9 mL/kg. There were seven mortalities. Wound infections were common (n = 65) and 36 suffered sepsis. The median number of dressing changes was 13 (range 0-100), operations were six and packed cells transfused was 95.7 mL/kg. Overall, 54 developed hypertrophic scarring and 45 scar contractures that have required subsequent reconstructive surgery. CONCLUSION Severe burn injuries in children have significant morbidity and mortality. They would appear expensive to manage and impact substantially on health care resources.
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Affiliation(s)
- Ela J Hyland
- Children's Hospital Burns Research Institute, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Torey Lawrence
- Children's Hospital Burns Research Institute, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - John G Harvey
- Children's Hospital Burns Research Institute, The Children's Hospital at Westmead, Westmead, New South Wales, Australia.,Discipline of Paediatrics and Child Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Andrew J A Holland
- Children's Hospital Burns Research Institute, The Children's Hospital at Westmead, Westmead, New South Wales, Australia.,Discipline of Paediatrics and Child Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
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Varley A, Sarginson J, Young A. Evidence-based first aid advice for paediatric burns in the United Kingdom. Burns 2015; 42:571-7. [PMID: 26655279 DOI: 10.1016/j.burns.2015.10.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Accepted: 10/26/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Burn and scald injuries are common in children. First aid advice for paediatric burns is offered by a range of health organisations and charities in the UK. Despite this, children still present to emergency departments and burn services having received little or inadequate first aid. METHOD A survey was undertaken regarding the content and consistency of the advice given by a cross-section of UK health organisations involved in first aid prevention and education. The advice was subsequently examined to determine if it was evidence-based. RESULTS Our study has demonstrated inconsistencies in the content of the first aid advice provided by the 21 organisations included in the study. Seventy-one percent of the information was only available online. The temperature, method and duration of cooling varied substantially, as did the advice recommended for the removal of clothing and jewellery and methods for covering the burn immediately after injury. Results from the literature review concluded the following based on available evidence; cool the burn with running tap water for 20min, remove clothing and jewellery and cover the burn with cling film or a clean non-adhesive dressing. CONCLUSIONS This study highlights the lack of consistency between first aid guidance provided by health organisations and charities in the UK.
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Affiliation(s)
- Alice Varley
- The Healing Foundation Children's Burns Research Centre, Bristol Royal Hospital for Children, Paul O'Gorman Building, Upper Maudlin St., Bristol, BS2 8BJ, UK
| | - Julia Sarginson
- The Healing Foundation Children's Burns Research Centre, Bristol Royal Hospital for Children, Paul O'Gorman Building, Upper Maudlin St., Bristol, BS2 8BJ, UK
| | - Amber Young
- The Healing Foundation Children's Burns Research Centre, Bristol Royal Hospital for Children, Paul O'Gorman Building, Upper Maudlin St., Bristol, BS2 8BJ, UK.
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Abstract
The first aid for burns is to run cold water over the burn for 20 minutes. This is effective for up to three hours after the injury. Assess the affected body surface area using the rule of nines. Consult a burn unit if more than 5% of the total body surface area is burnt in a child or if more than 10% in an adult. Extensive or deep burns and burns to special areas, such as the hands, should be referred. Chemical or electrical burns should also be assessed by a burn unit. For minor burns, antimicrobial dressings are recommended, but oral antibiotics should be avoided unless there are signs of infection. As burns are tetanus prone, check the patient's immunisation status. Burns that become infected or are slow to heal should be discussed with a burn unit. The burn unit can also provide advice if there are uncertainties about how to manage a patient.
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Affiliation(s)
| | | | - Jade A Fox
- Burn unit, Children's Hospital at Westmead
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Wright EH, Harris AL, Furniss D. Cooling of burns: Mechanisms and models. Burns 2015; 41:882-9. [PMID: 25820085 DOI: 10.1016/j.burns.2015.01.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Revised: 10/24/2014] [Accepted: 01/10/2015] [Indexed: 01/06/2023]
Abstract
The role of cooling in the acute management of burns is widely accepted in clinical practice, and is a cornerstone of basic first aid in burns. This has been underlined in a number of animal models. The mechanism by which it delivers its benefit is poorly understood, but there is a reduction in burns progression over the first 48 h, reduced healing time, and some subjective improvements in scarring when cooling is administered after burning. Intradermal temperature normalises within a matter of seconds to a few minutes, yet the benefits of even delayed cooling persist, implying it is not simply the removal of thermal energy from the damaged tissues. Animal models have used oedema formation, preservation of dermal perfusion, healing time and hair retention as indicators of burns severity, and have shown cooling to improve these indices, but pharmacological or immunological blockade of humoural and cellular mediators of inflammation did not reproduce the benefit of cooling. More recently, some studies of tissue from human and animal burns have shown consistent, reproducible, temporal changes in gene expression in burned tissues. Here, we review the experimental evidence of the role and mechanism of cooling in burns management, and suggest future research directions that may eventually lead to improved treatment outcomes.
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Affiliation(s)
- E H Wright
- Department of Plastic Surgery, Stoke Mandeville Hospital, and the Department of Oncology, University of Oxford, Green Templeton College, 43 Woodstock Road, Oxford OX2 6HG, United Kingdom.
| | - A L Harris
- Medical Oncology, Department of Oncology, University of Oxford, Green Templeton College, 43 Woodstock Road, Oxford OX2 6HG, United Kingdom
| | - D Furniss
- Department of Plastic Surgery, Oxford University Hospitals, and the Botnar Research Centre, University of Oxford, Green Templeton College, 43 Woodstock Road, Oxford OX2 6HG, United Kingdom
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45
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Fadeyibi IO, Ibrahim NA, Mustafa IA, Ugburo AO, Adejumo AO, Buari A. Practice of first aid in burn related injuries in a developing country. Burns 2015; 41:1322-32. [PMID: 25805428 DOI: 10.1016/j.burns.2015.02.018] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Revised: 02/19/2015] [Accepted: 02/21/2015] [Indexed: 11/28/2022]
Abstract
INTRODUCTION First aid with cool running water reduces the severity of burn. Low level of knowledge of first aid in burns was shown in previous studies with few patients receiving first aid by water lavage. A study investigating the use of water lavage as first aid in patients presenting to hospital with burn in Lagos, Nigeria was carried out. METHODS Patients admitted to a University Teaching Hospital for treatment of burns were recruited for this prospective study. Data detailing demographics, scene and aetiology of burns, material used for first aid, who administered first aid, level of education and relationship of first-aider with patients, length of hospital stay, complications and outcome of treatment were collected and statistical analysis performed. RESULTS 168 patients; 73 (43.4%) children and 95 (56.6%) adults were seen. Burns were sustained at home in 95 (74.2%) cases and outside in 33 (25.8%). Water lavage was used in 49 (29.2%) cases, raw eggs in 21 (12.5%), pap in 16 (9.5%) and other materials in 48.8%. 40 (23.8%) patients had not received any form of first aid at presentation. Patients that received no water first aid had higher complication rate (35.3% versus 18.4%) compared with those that had water first aid. CONCLUSION AND RECOMMENDATIONS The use of water first aid in burns was shown to reduce complication rate in this study. People should be educated on the efficacy of water first aid in pre-hospital care of burns.
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Affiliation(s)
- Idowu Olusegun Fadeyibi
- Burn/Trauma Center, Lagos State University Teaching Hospital (LASUTH)/Burns and Plastic Surgery Unit, Department of Surgery, College of Medicine, Lagos State University (LASU), Ikeja-Lagos, Nigeria.
| | - Nasiru Akanmu Ibrahim
- General Surgery Unit, Department of Surgery, LASUTH/College of Medicine (LASU), Ikeja-Lagos, Nigeria
| | | | - Andrew Omotayo Ugburo
- Burns and Plastic Surgery Unit, Department of Surgery, College of Medicine, University of Lagos/Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria
| | | | - Adedayo Buari
- Burn/Trauma Center, Lagos State University Teaching Hospital (LASUTH)/Burns and Plastic Surgery Unit, Department of Surgery, College of Medicine, Lagos State University (LASU), Ikeja-Lagos, Nigeria
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46
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Treatment of Secondary Burn Wound Progression in Contact Burns—A Systematic Review of Experimental Approaches. J Burn Care Res 2015; 36:e176-89. [DOI: 10.1097/bcr.0000000000000131] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Fein M, Quinn J, Watt K, Nichols T, Kimble R, Cuttle L. Prehospital paediatric burn care: New priorities in paramedic reporting. Emerg Med Australas 2014; 26:609-15. [PMID: 25348749 DOI: 10.1111/1742-6723.12313] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The present study evaluates the prehospital care of paediatric burn patients in Queensland (QLD). As first aid (FA) treatment has been shown to affect burn progression and outcome, the FA treatment and the risk of associated hypothermia in paediatric patients were specifically examined in the context of paramedic management of burn patients. METHODS Data were retrospectively collected from electronic ambulance response forms (eARFs) for paediatric burn patients (0-5 years) who were attended by Queensland Ambulance Service (QAS) from 2008 to 2010. Data were collected from 117 eARFs of incidents occurring within the Brisbane, Townsville and Cairns regions. RESULTS Initial FA measures were recorded in 77.8% of cases, with cool running water FA administered in 56.4% of cases. The duration of FA was recorded in 29.9% of reports. The duration of FA was significantly shorter for patients in Northern QLD (median = 10 min, n = 10) compared with Brisbane (median = 15 min, n = 18), P = 0.005. Patient temperatures were recorded significantly more often in Brisbane than in other regions (P = 0.041); however, in total, only 24.8% of all patients had documented temperature readings. Of these, six (5%) were recorded as having temperatures ≤ 36.0°C. Burnaid(TM) was the most commonly used dressing and was applied to 55.6% of all patients; however, it was applied with a variety of different outer dressings. Brisbane paramedics applied Burnaid significantly less often (44.3%) compared with paramedics from Northern QLD (72.7%) and Far Northern QLD (60.9%), P = 0.025. CONCLUSIONS Despite FA and patient temperatures being important prognostic factors for burn patients, paramedic documentation of these was often incomplete, and there was no consistent use of burns dressings.
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Affiliation(s)
- Mikaela Fein
- Centre for Children's Burns and Trauma Research, Queensland Children's Medical Research Institute, University of Queensland, Brisbane, Queensland, Australia
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48
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Riedlinger DI, Jennings PA, Edgar DW, Harvey JG, Cleland MHJ, Wood FM, Cameron PA. Scald burns in children aged 14 and younger in Australia and New Zealand—an analysis based on the Burn Registry of Australia and New Zealand (BRANZ). Burns 2014; 41:462-8. [PMID: 25440854 DOI: 10.1016/j.burns.2014.07.027] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Revised: 07/23/2014] [Accepted: 07/30/2014] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Scalds are a common injury in children and a frequent reason for hospitalisation despite being a preventable injury. METHODS This retrospective two year study reports data from 730 children aged 14 years or younger who sustained a scald between 2009 and 2010 and were admitted to a burns centre in Australia or New Zealand. Data were extracted from the Burn Registry of Australia and New Zealand (BRANZ), which included data from 13 burns centres in Australia and New Zealand. RESULTS Scald injury contributed 56% (95% CI 53-59%) of all pediatric burns. There were two high risk groups; male toddlers age one to two, contributing 34% (95% CI 31-38%) of all scalds, and indigenous children who were over 3 times more likely to experience a scald requiring admission to a burns unit than their non-indigenous peers. First aid cooling by non-professionals was initiated in 89% (95% CI 86-91%) of cases but only 20% (95% CI 16-23%) performed it as recommended. CONCLUSION This study highlights that effective burn first aid reduces hospital stay and reinforces the need to encourage, carers and bystanders to deliver effective first aid and the importance of targeted prevention campaigns that reduce the burden of pediatric scald burns in Australia and New Zealand.
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Affiliation(s)
- Dorothee I Riedlinger
- Monash University, Department of Epidemiology and Preventive Medicine, Melbourne, VIC, Australia; Charite University Medicine, Berlin, Germany
| | - Paul A Jennings
- Monash University, Department of Community Emergency Health and Paramedic Practice, Melbourne, VIC, Australia.
| | | | - John G Harvey
- The Children's hospital at Westmead, Sydney, NSW, Australia; The Children's Hospital Burns Research Institute, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | | | - Fiona M Wood
- Royal Perth Hospital, Burns Unit, Perth, WA, Australia; University of Western Australia, Faculty of Medicine, Dentistry & Health Sciences, Burns Injury Research, Perth, WA, Australia
| | - Peter A Cameron
- Monash University, Department of Epidemiology and Preventive Medicine, Melbourne, VIC, Australia
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49
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Hyland EJ, Harvey JG, Holland AJA. First aid for burns: too little, too late and often wrong. Med J Aust 2014; 200:85. [DOI: 10.5694/mja13.11179] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Accepted: 10/17/2013] [Indexed: 11/17/2022]
Affiliation(s)
- Ela J Hyland
- The Children's Hospital at Westmead, Sydney, NSW
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50
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Zhou B, Zhou X, Ouyang LZ, Huang XY, Zhang PH, Zhang MH, Ren LC, Liang PF. An epidemiological analysis of paediatric burns in urban and rural areas in south central China. Burns 2014; 40:150-6. [DOI: 10.1016/j.burns.2013.04.020] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2013] [Revised: 03/27/2013] [Accepted: 04/30/2013] [Indexed: 10/26/2022]
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