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Jacobson MJ, Masry ME, Arrubla DC, Tricas MR, Gnyawali SC, Zhang X, Gordillo G, Xue Y, Sen CK, Wachs J. Autonomous Multi-modality Burn Wound Characterization using Artificial Intelligence. Mil Med 2023; 188:674-681. [PMID: 37948279 DOI: 10.1093/milmed/usad301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 04/05/2023] [Accepted: 08/10/2023] [Indexed: 11/12/2023] Open
Abstract
INTRODUCTION Between 5% and 20% of all combat-related casualties are attributed to burn wounds. A decrease in the mortality rate of burns by about 36% can be achieved with early treatment, but this is contingent upon accurate characterization of the burn. Precise burn injury classification is recognized as a crucial aspect of the medical artificial intelligence (AI) field. An autonomous AI system designed to analyze multiple characteristics of burns using modalities including ultrasound and RGB images is described. MATERIALS AND METHODS A two-part dataset is created for the training and validation of the AI: in vivo B-mode ultrasound scans collected from porcine subjects (10,085 frames), and RGB images manually collected from web sources (338 images). The framework in use leverages an explanation system to corroborate and integrate burn expert's knowledge, suggesting new features and ensuring the validity of the model. Through the utilization of this framework, it is discovered that B-mode ultrasound classifiers can be enhanced by supplying textural features. More specifically, it is confirmed that statistical texture features extracted from ultrasound frames can increase the accuracy of the burn depth classifier. RESULTS The system, with all included features selected using explainable AI, is capable of classifying burn depth with accuracy and F1 average above 80%. Additionally, the segmentation module has been found capable of segmenting with a mean global accuracy greater than 84%, and a mean intersection-over-union score over 0.74. CONCLUSIONS This work demonstrates the feasibility of accurate and automated burn characterization for AI and indicates that these systems can be improved with additional features when a human expert is combined with explainable AI. This is demonstrated on real data (human for segmentation and porcine for depth classification) and establishes the groundwork for further deep-learning thrusts in the area of burn analysis.
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Affiliation(s)
- Maxwell J Jacobson
- Department of Computer Science, Purdue University, West Lafayette, IN 47907, USA
| | - Mohamed El Masry
- School of Medicine, Indiana University, Indianapolis, IN 46202, USA
| | | | - Maria Romeo Tricas
- Department of Computer Science, Purdue University, West Lafayette, IN 47907, USA
| | - Surya C Gnyawali
- School of Medicine, Indiana University, Indianapolis, IN 46202, USA
| | - Xinwei Zhang
- Department of Computer Science, Purdue University, West Lafayette, IN 47907, USA
| | - Gayle Gordillo
- School of Medicine, Indiana University, Indianapolis, IN 46202, USA
| | - Yexiang Xue
- Department of Computer Science, Purdue University, West Lafayette, IN 47907, USA
| | - Chandan K Sen
- School of Medicine, Indiana University, Indianapolis, IN 46202, USA
| | - Juan Wachs
- School of Industrial Engineering, Purdue University, West Lafayette, IN 47907, USA
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Burn Injury Management in Academic Medical Center with Periodic Transfer Siege due to Acts of War: A Retrospective Analysis of 3085 Burn Patients. BURNS OPEN 2022. [DOI: 10.1016/j.burnso.2022.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Mehra L, Mehra S, Tiwari N, Singh T, Rawat H, Belagavi S, Jaimini A, Mittal G. Fabrication, characterization and evaluation of the efficacy of gelatin/hyaluronic acid microporous scaffolds suffused with aloe-vera in a rat burn model. J Biomater Appl 2021; 36:1346-1358. [PMID: 34873947 DOI: 10.1177/08853282211061821] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Burn induced injuries are commonly encountered in civilian and military settings, leading to severe morbidity and mortality. Objective of this study was to construct microporous bioactive scaffolds of gelatin-hyaluronic acid suffused with aloe-vera gel (Gela/HA/AvG), and to evaluate their efficacy in healing partial-thickness burn wounds. Scaffolds were characterized using Fourier transform-infrared spectroscopy, Scanning electron microscopy, and Thermo-gravimetric analysis to understand intermolecular interactions and morphological characteristics. In-vitro fluid uptake ability and hemolytic index of test scaffolds were also determined. In-vitro collagenase digestion was done to assess biodegradability of scaffolds. Wound retraction studies were carried out in Sprague Dawley rats inflicted with partial-thickness burn wounds to assess and compare efficacy of optimized scaffolds with respect to negative and positive control groups. In-vivo gamma scintigraphy using Technetium-99m labeled Immunoglobulin-G (99mTc-IgG) as imaging agent was also performed to validate efficacy results. Histological and immunohistochemical comparison between groups was also made. Scaffolds exhibited mircoporous structure, with pore size getting reduced from 41.3 ± 4.3 µm to 30.49 ± 5.7 µm when gelatin conc. was varied from 1% to 5%. Optimized test scaffolds showed sustained in-vitro swelling behavior, were biodegradable and showed hemolytic index in range of 2.4-4.3%. Wound retraction study along with in-vivo gamma scintigraphy indicated that Gela/HA/AvG scaffolds were not only able to reduce local inflammation faster but also accelerated dermis regeneration. Immunohistochemical analysis, in terms of expression levels of epidermal growth factor and fibroblast growth factor-2 also corroborated in-vivo efficacy findings. Gela/HA/AvG scaffolds, therefore, can potentially be developed into an effective dermal regeneration template for partial-thickness burn wounds.
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Affiliation(s)
- Lalita Mehra
- Department of Combat Sciences, 93048DRDO Institute of Nuclear Medicine and Allied Sciences, Delhi, India
| | - Smritee Mehra
- Department of Biotechnology, RinggoldID:231547Manav Rachna International Institute of Research and Studies, Faridabad, Haryana, India
| | - Nidhi Tiwari
- Department of Combat Sciences, 93048DRDO Institute of Nuclear Medicine and Allied Sciences, Delhi, India
| | - Thakuri Singh
- Department of Combat Sciences, 93048DRDO Institute of Nuclear Medicine and Allied Sciences, Delhi, India
| | - Harish Rawat
- Department of Nuclear Medicine, 93048DRDO Institute of Nuclear Medicine and Allied Sciences, Delhi, India
| | - Shreeshail Belagavi
- Department of Cytopathology, 93048DRDO Institute of Nuclear Medicine and Allied Sciences, Delhi, India
| | - Abhinav Jaimini
- Department of Nuclear Medicine, 93048DRDO Institute of Nuclear Medicine and Allied Sciences, Delhi, India
| | - Gaurav Mittal
- Department of Combat Sciences, 93048DRDO Institute of Nuclear Medicine and Allied Sciences, Delhi, India
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Schauer SG, Naylor JF, Dion G, April MD, Chung KK, Convertino VA. An Analysis of Airway Interventions in the Setting of Smoke Inhalation Injury on the Battlefield. Mil Med 2021; 186:e474-e479. [PMID: 33169135 DOI: 10.1093/milmed/usaa370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 07/21/2020] [Accepted: 07/24/2020] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION The Committee on Tactical Combat Casualty Care and Capabilities Development and Integration Directorate cite airway burn injuries as an indication for prehospital cricothyrotomy. We sought to build on previously published data by describing for the first time the incidence of prehospital airway interventions in combat casualties who received airway management in the setting of inhalational injuries.15,26 We hypothesized that (1) airway interventions in combat casualties who suffered inhalational injury would have a higher mortality rate than those without airway intervention and (2) prehospital cricothyrotomy was used with greater incidence than endotracheal intubation. MATERIALS AND METHODS Using a previously described Department of Defense Trauma Registry dataset from January 2007 to August 2016, unique casualties with documented inhalational injury were identified. RESULTS Our predefined search codes captured 28,222 (72.8% of all encounters in the registry) of those subjects. A total of 347 (1.2%) casualties had a documented inhalational injury, 27 (7.8%) of those with at least 1 prehospital airway intervention inhalational injuries (0.09% of our dataset [n = 28,222]). Within the subset of patients with an inhalation injury, 23 underwent intubation, 2 underwent cricothyrotomy, 3 had placement of an airway adjunct not otherwise specifically listed, and 1 casualty had both a cricothyrotomy and intubation documented. No casualties had a supraglottic, nasopharyngeal, or oropharyngeal airway listed. Contrary to our hypotheses, of those with an airway intervention, 74.0% survived to hospital discharge. In multivariable regression models, when adjusting for confounders, there was no difference in survival to discharge in those with an airway intervention compared to those without. CONCLUSIONS Casualties undergoing airway intervention for inhalation injuries had similar survival adjusting for injury severity, supporting its role when indicated. Without case-specific data on airway status and interventions, it is challenging to determine if the low rate of cricothyrotomy in this population was a result of rapid transport to a more advanced provider capable of performing intubation or cricothyrotomy may not be meeting the needs of the medics.
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Affiliation(s)
- Steven G Schauer
- U.S. Army Institute of Surgical Research, JBSA Fort Sam Houston, TX 78234, USA.,59th Medical Wing, JBSA Lackland, TX 78236, USA.,Brooke Army Medical Center, JBSA Fort Sam Houston, TX 78234, USA.,Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Jason F Naylor
- Madigan Army Medical Center, Joint Base Lewis McChord, WA 98431, USA
| | - Gregory Dion
- U.S. Army Institute of Surgical Research, JBSA Fort Sam Houston, TX 78234, USA.,59th Medical Wing, JBSA Lackland, TX 78236, USA.,Brooke Army Medical Center, JBSA Fort Sam Houston, TX 78234, USA.,Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Michael D April
- 4th Infantry Division, 2nd Infantry Brigade Combat Team, Fort Carson, CO, USA.,Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Kevin K Chung
- Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Victor A Convertino
- U.S. Army Institute of Surgical Research, JBSA Fort Sam Houston, TX 78234, USA
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Rahman AS, Chao TE, Trelles M, Dominguez L, Mupenda J, Kasonga C, Akemani C, Kondo KM, Chu KM. The Effect of Conflict on Obstetric and Non-Obstetric Surgical Needs and Operative Mortality in Fragile States. World J Surg 2021; 45:1400-1408. [PMID: 33560502 DOI: 10.1007/s00268-021-05972-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Médecins Sans Frontières (MSF) provides surgical care in fragile states, which are more vulnerable to conflict. The primary objective of this study was to compare the indications for operative intervention in surgical projects in fragile states during periods of active conflict (CON) and non-conflict (NON-CON). In addition, risk factors for non-obstetric and obstetric operative mortality were identified. METHODS This was a retrospective analysis of MSF surgical projects in fragile states January 1, 2008-December 31, 2017. Variables considered in the analysis include age, gender, American Society of Anesthesiology physical status, emergency status, re-intervention status, indication for surgical intervention, and conflict/non-conflict time period. RESULTS There were 30 surgical projects in 13 fragile states with 87,968 surgical interventions in 68,667 patients. Obstetric needs were the most common indication for surgical intervention (n = 28,060, 31.9%) but were more common during NON-CON (n = 23,142, 35.7%) compared to CON periods (n = 4,918, 21.2%, p < 0.001). Trauma was more common during CON (42.0%) compared to NON-CON (23.0%) periods (p < 0.001). Non-obstetric operative mortality was similar during CON (0.2%) compared to NON-CON (0.2%, p = 0.920), but obstetric operative mortality was higher (0.5%) during CON compared to NON-CON (0.2%, p < 0.001) periods. Risk factors for obstetric and non-obstetric mortality included age ≥ 30 years, ASA greater than 1, and emergency intervention. CONCLUSION Humanitarian surgeons working in fragile states should be prepared to treat a range of surgical needs including trauma and obstetrics during conflict and non-conflict periods. The mortality in obstetric patients was higher during conflict periods, and further research to understand ways to protect this vulnerable group is needed.
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Affiliation(s)
- Arifeen S Rahman
- Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Tiffany E Chao
- Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA.,Department of Surgery, Santa Clara Valley Medical Center, San Jose, CA, USA
| | - Miguel Trelles
- Médecins Sans Frontières, Operational Centre Brussels, Brussels, Belgium
| | - Lynette Dominguez
- Médecins Sans Frontières, Operational Centre Brussels, Brussels, Belgium
| | - Jerome Mupenda
- Médecins Sans Frontières, Operational Centre Brussels, Brussels, Belgium
| | - Cheride Kasonga
- Médecins Sans Frontières, Operational Centre Brussels, Brussels, Belgium
| | - Clemence Akemani
- Médecins Sans Frontières, Operational Centre Brussels, Brussels, Belgium
| | - Kalla Moussa Kondo
- Médecins Sans Frontières, Operational Centre Brussels, Brussels, Belgium
| | - Kathryn M Chu
- Centre for Global Surgery, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie Van Zijl Dr, Tygerberg Hospital, Cape Town, 7505, South Africa.
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Clinical Translational Potential in Skin Wound Regeneration for Adipose-Derived, Blood-Derived, and Cellulose Materials: Cells, Exosomes, and Hydrogels. Biomolecules 2020; 10:biom10101373. [PMID: 32992554 PMCID: PMC7650547 DOI: 10.3390/biom10101373] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 09/22/2020] [Accepted: 09/24/2020] [Indexed: 12/13/2022] Open
Abstract
Acute and chronic skin wounds due to burns, pressure injuries, and trauma represent a substantial challenge to healthcare delivery with particular impacts on geriatric, paraplegic, and quadriplegic demographics worldwide. Nevertheless, the current standard of care relies extensively on preventive measures to mitigate pressure injury, surgical debridement, skin flap procedures, and negative pressure wound vacuum measures. This article highlights the potential of adipose-, blood-, and cellulose-derived products (cells, decellularized matrices and scaffolds, and exosome and secretome factors) as a means to address this unmet medical need. The current status of this research area is evaluated and discussed in the context of promising avenues for future discovery.
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Al-Shamsi M, Fuchs PC, Grigutsch D, Horter J, Seyhan H, Koenigs I, Siebdrath J, Schiefer JL. Are burn centers in German-speaking countries prepared to respond to a burn disaster? Survey-based study. Burns 2020; 46:1612-1619. [PMID: 32532478 DOI: 10.1016/j.burns.2020.04.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 04/19/2020] [Accepted: 04/24/2020] [Indexed: 11/26/2022]
Abstract
Burn disasters present a challenge not only to burn centers but the entire healthcare system. Most burn centers worldwide are unprepared to deal with a burn disaster as it is an uncommon event. We investigated the status of burn center preparedness in German-speaking countries to respond to a burn disaster. Self-administered survey questionnaires were sent to the directors of burn centers; the questions of survey used before in a similar way in Belgium were translated into German language. Of the 46 questioned burn centers, 32 (78%) responded, including all of the German adult burn centers. A clear difference in the preparation status of the burn centers in the three countries was observed due to geopolitical factors such as decentralized healthcare systems. However, the healthcare system is generally well-prepared concerning command, transfer, and capacity to provide sustained supplies to handle a massive influx of patients. Nevertheless, there are some gaps in the areas of planning and preparation, funding for disaster activities, and regular training of staff for burn disasters. We call for a unified burn disaster plan and increased cooperation between burn centers and civil defense regarding communication and training. We strongly recommend the implementation of a special disaster fund and telemedicine in disaster management to circumvent shortages in burn staff.
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Affiliation(s)
- Mustafa Al-Shamsi
- Clinic of Plastic, Reconstructive, Hand and Burn Surgery, Hospital Cologne Merheim, University of Witten-Herdecke, Germany
| | - Paul Christian Fuchs
- Clinic of Plastic, Reconstructive, Hand and Burn Surgery, Hospital Cologne Merheim, University of Witten-Herdecke, Germany
| | | | - Johannes Horter
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery - Burn Center -, University of Heidelberg, BG Trauma Center, Ludwigshafen, Germany
| | - Harun Seyhan
- Clinic of Plastic, Reconstructive, Hand and Burn Surgery, Hospital Cologne Merheim, University of Witten-Herdecke, Germany
| | - Ingo Koenigs
- Department of Pediatric Surgery, Burn Unit, Plastic and Reconstructive Surgery, Altona Children's Hospital, University Medical Center Hamburg-Eppendorf (UKE)
| | - Julian Siebdrath
- Clinic of Plastic, Reconstructive, Hand and Burn Surgery, Hospital Cologne Merheim, University of Witten-Herdecke, Germany
| | - Jennifer Lynn Schiefer
- Clinic of Plastic, Reconstructive, Hand and Burn Surgery, Hospital Cologne Merheim, University of Witten-Herdecke, Germany.
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Coping With a Mass Casualty: Insights into a Hospital's Emergency Response and Adaptations After the Formosa Fun Coast Dust Explosion. Disaster Med Public Health Prep 2019; 14:467-476. [PMID: 31439072 DOI: 10.1017/dmp.2019.69] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE The study provides a comprehensive insight into how an initial receiving hospital without adequate capacity adapted to coping with a mass casualty incident after the Formosa Fun Coast Dust Explosion (FFCDE). METHODS Data collection was via in-depth interviews with 11 key participants. This was combined with information from medical records of FFCDE patients and admission logs from the emergency department (ED) to build a detailed timeline of patients flow and ED workload changes. Process tracing analysis focused on how the ED and other units adapted to coping with the difficulties created by the patient surge. RESULTS The hospital treated 30 victims with 36.3% average total body surface area burn for over 5 hours alongside 35 non-FFCDE patients. Overwhelming demand resulted in the saturation of ED space and intensive care unit beds, exhaustion of critical materials, and near-saturation of clinicians. The hospital reconfigured human and physical resources differently from conventional drills. Graphical timelines illustrate anticipatory or reactive adaptations. The hospital's ability to adapt was based on anticipation during uncertainty and coordination across roles and units to keep pace with varying demands. CONCLUSION Adapting to beyond-surge capacity incident is essential to effective disaster response. Building organizational support for effective adaptation is critical for disaster planning.
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Mortality risk factors in war-related pediatric burns: A comparative study among two distinct populations. Burns 2018; 44:1210-1227. [DOI: 10.1016/j.burns.2018.02.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 02/07/2018] [Accepted: 02/09/2018] [Indexed: 01/19/2023]
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Dai A, Carrougher GJ, Mandell SP, Fudem G, Gibran NS, Pham TN. Review of Recent Large-Scale Burn Disasters Worldwide in Comparison to Preparedness Guidelines. J Burn Care Res 2018; 38:36-44. [PMID: 27654867 DOI: 10.1097/bcr.0000000000000441] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The US National Bioterrorism Hospital Preparedness Program indicates that each care facility must have "a plan to care for at least 50 cases per million people for patients suffering burns or trauma" to receive national funding disaster preparedness. The purpose of this study is to evaluate whether this directive is commensurate with the severity recent burn disasters, both nationally and internationally. We conducted a review of medical journal articles, investigative fire reports, and media news sources for major burn disasters dating from 1990 to present day. We defined a major burn disaster as any incident with ≥50 burn injuries and/or ≥ 30 burn-related deaths. We compared existing preparedness guidelines with the magnitude of recent burn disasters using as reference the 2005 U.S. Health and Human Services directive that each locale must "have a plan to care for at least 50 cases per million people for patients suffering burns or trauma." We reported the number of actual casualties for each incident, and estimated the number of burn beds theoretically available if the "50 [burn-injury] cases per million people" directive were to be applied to metropolitan areas outside the United States. Seven hundred fifty-two burn disaster incidents met our inclusion criteria. The majority of burn disasters occurred in Asia/Middle East. The incidence of major burn disasters from structural fires and industrial blasts remains constant in high-income and resource-restricted countries during this study period. The incidence of terrorist attacks increased 20-fold from 2001 to 2015 compared with 1990 to 2000. Recent incidents demonstrate that if current preparedness guidelines were to be adopted internationally, local resources including burn-bed availability would be insufficient to care for the total number of burn casualties. These findings underscore an urgent need to organize better regional, national, and international collaboration in burn disaster response.
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Affiliation(s)
- Andrea Dai
- From the Department of Surgery, University of Washington Medicine Regional Burn Center, Seattle
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The pattern of the Syrian refugee's injuries managed in King Abdullah University Hospital (Jordan). Eur J Trauma Emerg Surg 2017; 43:587-594. [PMID: 28258284 DOI: 10.1007/s00068-017-0761-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 01/07/2017] [Indexed: 10/20/2022]
Abstract
OBJECTIVE This study was conducted to assess the pattern, the magnitude, the severity, the distribution, and the results of the management of the injured Syrian refugees at King Abdullah University Hospital (KAUH). METHODS The medical records of 90 consecutive injured Syrian patients admitted to KAUH at the beginning of the Syrian conflict in 2012-2013 were reviewed. Information regarding the age, the sex, the antomical regions, the organs injured, the operations performed, the complications, and the weapons used were recorded. RESULTS Of the 90 cases, 86 (95.6%) were males and 4 (4.4%) were females. The age of patients ranged between 6 and 64 years with: 8 children (6-18) years old, 81 young adults (18-48) years old, and only 1elderly patient (64) years old. The distributions of the injuries were: 54.5% in extremities, 47.8% head and neck, 15.5% chest, and 14.4% abdomen with involvement of more than one injured region in several patients. The injuries were inflected by explosives in 49 cases, bullets in 45 cases, and both in 4 cases. The most frequently performed operations were: fractures fixations, fasciotomies, laparotomies, and craniotomies. Musculoskeletal and neurological deficits occurred in 11.1 and 8.8% of cases, respectively. The mortality rate was 2.2%. The average hospital stay was 19 days. The overall management costs were more than half million US Dollars. CONCLUSIONS Extremities and head and neck were the most injured regions. The referral from the forward centers and the procedures performed in our hospital improved the management outcomes. The management required long hospital stay and was costly.
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Tsai DM, Tracy LE, Lee CCY, Hackl F, Kiwanuka E, Minasian RA, Onderdonk A, Junker JPE, Eriksson E, Caterson EJ. Full-thickness porcine burns infected with Staphylococcus aureus or Pseudomonas aeruginosa can be effectively treated with topical antibiotics. Wound Repair Regen 2016; 24:356-65. [PMID: 26800421 DOI: 10.1111/wrr.12409] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 01/17/2016] [Indexed: 11/30/2022]
Abstract
Burn and blast injuries are frequently complicated by invasive infections, which lead to poor wound healing, delay in treatment, disability, or death. Traditional approach centers on early debridement, fluid resuscitation, and adjunct intravenous antibiotics. These modalities often prove inadequate in burns, where compromised local vasculature limits the tissue penetration of systemic antibiotics. Here, we demonstrate the treatment of infected burns with topical delivery of ultrahigh concentrations of antibiotics. Standardized burns were inoculated with Staphylococcus aureus or Pseudomonas aeruginosa. After debridement, burns were treated with either gentamicin (2 mg/mL) or minocycline (1 mg/mL) at concentrations greater than 1,000 times the minimum inhibitory concentration. Amount of bacteria was quantified in tissue biopsies and wound fluid following treatment. After six days of gentamicin or minocycline treatment, S. aureus counts decreased from 4.2 to 0.31 and 0.72 log CFU/g in tissue, respectively. Similarly, P. aeruginosa counts decreased from 2.5 to 0.0 and 1.5 log CFU/g in tissue, respectively. Counts of both S. aureus and P. aeruginosa remained at a baseline of 0.0 log CFU/mL in wound fluid for both treatment groups. The findings here demonstrate that super-therapeutic concentrations of antibiotics delivered topically can rapidly reduce bacterial counts in infected full-thickness porcine burns. This treatment approach may aid wound bed preparation and accelerate time to grafting.
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Affiliation(s)
- David M Tsai
- Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Lauren E Tracy
- Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Cameron C Y Lee
- Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Florian Hackl
- Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Elizabeth Kiwanuka
- Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Raquel A Minasian
- Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Andrew Onderdonk
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Johan P E Junker
- Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Elof Eriksson
- Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - E J Caterson
- Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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Hakimoglu S, Karcıoglu M, Tuzcu K, Davarcı I, Koyuncu O, Dikey İ, Turhanoglu S, Sarı A, Acıpayam M, Karatepe C. Avaliação do período perioperatório em civis feridos na Guerra Civil Síria. Braz J Anesthesiol 2015; 65:445-9. [DOI: 10.1016/j.bjan.2014.03.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Accepted: 03/10/2014] [Indexed: 10/24/2022] Open
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Stewart BT, Lafta R, Esa Al Shatari SA, Cherewick M, Burnham G, Hagopian A, Galway LP, Kushner AL. Burns in Baghdad from 2003 to 2014: Results of a randomized household cluster survey. Burns 2015; 42:48-55. [PMID: 26526376 DOI: 10.1016/j.burns.2015.10.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 09/30/2015] [Accepted: 10/01/2015] [Indexed: 01/05/2023]
Abstract
PURPOSE Civilians living amid conflict are at high-risk of burns. However, the epidemiology of burns among this vulnerable group is poorly understood, yet vital for health policy and relief planning. To address this gap, we aimed to determine the death and disability, healthcare needs and household financial consequences of burns in post-invasion Baghdad. METHODS A two-stage, cluster randomized, community-based household survey was performed in May 2014 to determine the civilian burden of injury from 2003 to 2014 in Baghdad. In addition to questions about cause of household member death, households were interviewed regarding burn specifics, healthcare required, disability, relationship to conflict and resultant financial hardship. RESULTS Nine-hundred households, totaling 5148 individuals, were interviewed. There were 55 burns, which were 10% of all injuries reported. There were an estimated 2340 serious burns (39 per 100,000 persons) in Baghdad in 2003. The frequency of serious burns generally increased post-invasion to 8780 burns in 2013 (117 per 100,000 persons). Eight burns (15%) were the direct result of conflict. Individuals aged over 45 years had more than twice the odds of burn than children aged less than 13 years (aOR 2.42; 95%CI 1.08-5.44). Nineteen burns (35%) involved ≥ 20% body surface area. Death (16% of burns), disability (40%), household financial hardship (48%) and food insecurity (50%) were common after burn. CONCLUSION Civilian burn in Baghdad is epidemic, increasing in frequency and associated with household financial hardship. Challenges of healthcare provision during prolonged conflict were evidenced by a high mortality rate and likelihood of disability after burn. Ongoing conflict will directly and indirectly generates more burns, which mandates planning for burn prevention and care within local capacity development initiatives, as well as humanitarian assistance.
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Affiliation(s)
- Barclay T Stewart
- Department of Surgery, University of Washington, Seattle, WA, USA; School of Public Health, Kwame Nkrumah University, Kumasi, Ghana; Department of Interdisciplinary Health Sciences, Stellenbosch University, Cape Town, South Africa.
| | - Riyadh Lafta
- Department of Community Medicine, Al Munstansiriya University, Baghdad, Iraq; Department of Global Health, University of Washington, Seattle, WA, USA
| | | | - Megan Cherewick
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Gilbert Burnham
- Department of International Health, Center for Refugee and Disaster Response, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Amy Hagopian
- Department of Global Health, University of Washington, Seattle, WA, USA; Department of Health Services, University of Washington, Seattle, WA, USA
| | - Lindsay P Galway
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Adam L Kushner
- Surgeons OverSeas (SOS), New York, NY, USA; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Surgery, Columbia University, New York, NY, USA
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16
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Hakimoglu S, Karcıoglu M, Tuzcu K, Davarcı I, Koyuncu O, Dikey İ, Turhanoglu S, Sarı A, Acıpayam M, Karatepe C. Assessment of the perioperative period in civilians injured in the Syrian Civil War. Braz J Anesthesiol 2014; 65:445-9. [PMID: 26614139 DOI: 10.1016/j.bjane.2014.03.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Accepted: 03/10/2014] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND wars and its challenges have historically afflicted humanity. In Syria, severe injuries occurred due to firearms and explosives used in the war between government forces and civilians for a period of over 2 years. MATERIALS AND METHODS the study included 364 cases, who were admitted to Mustafa Kemal University Hospital, Medicine School (Hatay, Turkey), and underwent surgery. Survivors and non-survivors were compared regarding injury site, injury type and number of transfusions given. The mortality rate found in this study was also compared to those reported in other civil wars. RESULTS the mean age was 29 (3-68) years. Major sites of injury included extremities (56.0%), head (20.1%), abdomen (16.2%), vascular structures (4.4%) and thorax (3.3%). Injury types included firearm injury (64.4%), blast injury (34.4%) and miscellaneous injuries (1.2%). Survival rate was 89.6% while mortality rate was 10.4%. A significant difference was observed between mortality rates in this study and those reported for the Bosnia and Lebanon civil wars; and the difference became extremely prominent when compared to mortality rates reported for Vietnam and Afghanistan civil wars. CONCLUSION among injuries related to war, the highest rate of mortality was observed in head-neck, abdomen and vascular injuries. We believe that the higher mortality rate in the Syrian Civil War, compared to the Bosnia, Vietnam, Lebanon and Afghanistan wars, is due to seeing civilians as a direct target during war.
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Affiliation(s)
- Sedat Hakimoglu
- Department of Anesthesiology and Reanimation, Mustafa Kemal University, Faculty of Medicine, Hatay, Turkey.
| | - Murat Karcıoglu
- Department of Anesthesiology and Reanimation, Mustafa Kemal University, Faculty of Medicine, Hatay, Turkey
| | - Kasım Tuzcu
- Department of Anesthesiology and Reanimation, Mustafa Kemal University, Faculty of Medicine, Hatay, Turkey
| | - Isıl Davarcı
- Department of Anesthesiology and Reanimation, Mustafa Kemal University, Faculty of Medicine, Hatay, Turkey
| | - Onur Koyuncu
- Department of Anesthesiology and Reanimation, Mustafa Kemal University, Faculty of Medicine, Hatay, Turkey
| | - İsmail Dikey
- Department of Anesthesiology and Reanimation, Mustafa Kemal University, Faculty of Medicine, Hatay, Turkey
| | - Selim Turhanoglu
- Department of Anesthesiology and Reanimation, Mustafa Kemal University, Faculty of Medicine, Hatay, Turkey
| | - Ali Sarı
- Department of Anesthesiology and Reanimation, Mustafa Kemal University, Faculty of Medicine, Hatay, Turkey
| | - Mehmet Acıpayam
- Department of Cardiovascular Surgery, Mustafa Kemal University, Faculty of Medicine, Hatay, Turkey
| | - Celalettin Karatepe
- Department of Cardiovascular Surgery, Mustafa Kemal University, Faculty of Medicine, Hatay, Turkey
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17
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Jeevaratnam JA, Pandya AN. One year of burns at a Role 3 Medical Treatment Facility in Afghanistan. J ROY ARMY MED CORPS 2013; 160:22-6. [DOI: 10.1136/jramc-2013-000100] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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