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Cuijpers MD, Meij-de Vries A, van Zuijlen PPM, Baartmans MGA, Nieuwenhuis M, van Baar ME, Pijpe A. The prevalence and predictors of reconstructive surgery in pediatric burn care. Burns 2024:S0305-4179(24)00217-1. [PMID: 39317543 DOI: 10.1016/j.burns.2024.07.017] [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: 01/25/2024] [Revised: 05/23/2024] [Accepted: 07/13/2024] [Indexed: 09/26/2024]
Abstract
OBJECTIVE This study aimed to examine the prevalence and predictors of reconstructive surgery among pediatric burn patients in the Netherlands. METHODS Pediatric burn patients were identified through the Dutch Burn Repository R3. Eligibility criteria included a burn requiring hospital admission or surgical treatment at one of the Dutch burn centers in 2009-2019. First, patient, burn, and treatment characteristics were summarized using descriptive statistics. Second, time to the first reconstructive surgery was modelled using Kaplan Meier curves. Third, a prediction model was developed using univariate and multivariate logistic regression. The model's performance was assessed using calibration, discrimination, and explained variance. Fourth, internal validation was performed using bootstrapping. RESULTS Approximately three percent (n = 84) of pediatric patients (n = 3072) required reconstructive surgery between the initial burn-related hospital admission and September 2021. Median time to the first reconstructive surgery was 1.2 (0.7-1.6) years. Most surgeries were performed on the face, arm, neck, hand, or anterior trunk, owing to contractures or hypertrophic scarring. Predictors of reconstruction included the etiology, anatomical site, extent of full-thickness burn, surgical treatment in the acute phase, and length of hospital stay. CONCLUSION Our study provided an overview of the prevalence and independent predictors of reconstructive surgery in the pediatric burn population.
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Affiliation(s)
- M D Cuijpers
- Association of Dutch Burn Centers, Burn Center, Red Cross Hospital, Beverwijk, the Netherlands; Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Location VU University Amsterdam, De Boelelaan 1117, Amsterdam, the Netherlands; Amsterdam Movement Sciences (AMS) Institute, Amsterdam UMC, Amsterdam, the Netherlands.
| | - A Meij-de Vries
- Association of Dutch Burn Centers, Burn Center, Red Cross Hospital, Beverwijk, the Netherlands; Department of Surgery, Red Cross Hospital, Beverwijk, the Netherlands; Pediatric Surgical Center, Emma Children's Hospital, Amsterdam UMC, Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
| | - P P M van Zuijlen
- Association of Dutch Burn Centers, Burn Center, Red Cross Hospital, Beverwijk, the Netherlands; Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Location VU University Amsterdam, De Boelelaan 1117, Amsterdam, the Netherlands; Amsterdam Movement Sciences (AMS) Institute, Amsterdam UMC, Amsterdam, the Netherlands; Pediatric Surgical Center, Emma Children's Hospital, Amsterdam UMC, Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands; Department of Plastic, Reconstructive, and Hand Surgery, Red Cross Hospital, Beverwijk, the Netherlands
| | - M G A Baartmans
- Department of Pediatrics, Maasstad Hospital, Rotterdam, the Netherlands; Association of Dutch Burn Centers, Burn Center, Maasstad Hospital, Rotterdam, the Netherlands
| | - M Nieuwenhuis
- Department of Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands; Association of Dutch Burn Centers, Burn Center, Martini Hospital, Groningen, the Netherlands; Research group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Groningen, the Netherlands
| | - M E van Baar
- Association of Dutch Burn Centers, Burn Center, Maasstad Hospital, Rotterdam, the Netherlands; Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - A Pijpe
- Association of Dutch Burn Centers, Burn Center, Red Cross Hospital, Beverwijk, the Netherlands; Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Location VU University Amsterdam, De Boelelaan 1117, Amsterdam, the Netherlands.
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Heuer M, Stiti M, Eras V, Scholz J, Ahmed N, Berrocal E, Brune JC. High-Speed Fluorescence Imaging Corroborates Biological Data on the Influence of Different Nozzle Types on Cell Spray Viability and Formation. J Funct Biomater 2024; 15:126. [PMID: 38786637 PMCID: PMC11122036 DOI: 10.3390/jfb15050126] [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: 04/04/2024] [Revised: 04/29/2024] [Accepted: 05/09/2024] [Indexed: 05/25/2024] Open
Abstract
Treating severe dermal disruptions often presents significant challenges. Recent advancements have explored biological cell sprays as a promising treatment, but their success hinges on efficient cell delivery and complete wound coverage. This requires a good spray distribution with a small droplet size, high particle number, and ample surface coverage. The type of nozzle used with the spray device can impact these parameters. To evaluate the influence of different nozzles on spray characteristics, we compared air-assisted and unassisted nozzles. The unassisted nozzle displayed small particle size, high particle number, good overall coverage, high cell viability, preserved cell metabolic activity, and low cytotoxicity. Air-assisted nozzles did not perform well regarding cell viability and metabolic activity. Flow visualization analysis comparing two different unassisted nozzles using high-speed imaging (100 kHz frame rate) revealed a tulip-shaped spray pattern, indicating optimal spray distribution. High-speed imaging showed differences between the unassisted nozzles. One unassisted nozzle displayed a bi-modal distribution of the droplet diameter while the other unassisted nozzle displayed a mono-modal distribution. These findings demonstrate the critical role of nozzle selection in successful cell delivery. A high-quality, certified nozzle manufactured for human application omits the need for an air-assisted nozzle and provides a simple system to use with similar or better performance characteristics than those of an air-assisted system.
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Affiliation(s)
- Miriam Heuer
- German Institute for Cell and Tissue Replacement (DIZG, gemeinnützige GmbH), Haus 42, Köpenicker Str. 325, 12555 Berlin, Germany
| | - Mehdi Stiti
- Division of Combustion Physics, Department of Physics, Lund University, P.O. Box 118, 22100 Lund, Sweden
- Institut de Mécanique des Fluides de Toulouse (IMFT), CNRS, Université de Toulouse, 31400 Toulouse, France
| | - Volker Eras
- German Institute for Cell and Tissue Replacement (DIZG, gemeinnützige GmbH), Haus 42, Köpenicker Str. 325, 12555 Berlin, Germany
| | - Julia Scholz
- German Institute for Cell and Tissue Replacement (DIZG, gemeinnützige GmbH), Haus 42, Köpenicker Str. 325, 12555 Berlin, Germany
| | - Norus Ahmed
- German Institute for Cell and Tissue Replacement (DIZG, gemeinnützige GmbH), Haus 42, Köpenicker Str. 325, 12555 Berlin, Germany
| | - Edouard Berrocal
- Division of Combustion Physics, Department of Physics, Lund University, P.O. Box 118, 22100 Lund, Sweden
| | - Jan C Brune
- German Institute for Cell and Tissue Replacement (DIZG, gemeinnützige GmbH), Haus 42, Köpenicker Str. 325, 12555 Berlin, Germany
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Leclerc T, Sjöberg F, Jennes S, Martinez-Mendez JR, van der Vlies CH, Battistutta A, Lozano-Basanta JA, Moiemen N, Almeland SK. European Burns Association guidelines for the management of burn mass casualty incidents within a European response plan. Burns 2023; 49:275-303. [PMID: 36702682 DOI: 10.1016/j.burns.2022.12.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 12/19/2022] [Indexed: 12/27/2022]
Abstract
BACKGROUND A European response plan to burn mass casualty incidents has been jointly developed by the European Commission and the European Burn Association. Upon request for assistance by an affected country, the plan outlines a mechanism for coordinated international assistance, aiming to alleviate the burden of care in the affected country and to offer adequate specialized care to all patients who can benefit from it. To that aim, Burn Assessment Teams are deployed to assess and triage patients. Their transportation priority recommendations are used to distribute outnumbering burn casualties to foreign burn centers. Following an appropriate medical evacuation, these casualties receive specialized care in those facilities. METHODS The European Burns Association's disaster committee developed medical-organizational guidelines to support this European plan. The experts identified fields of interest, defined questions to be addressed, performed relevant literature searches, and added their expertise in burn disaster preparedness and response. Due to the lack of high-level evidence in the available literature, recommendations and specially designed implementation tools were provided from expert opinion. The European Burns Association officially endorsed the draft recommendations in 2019, and the final full text was approved by the EBA executive committee in 2022. RECOMMENDATIONS The resulting 46 recommendations address four fields. Field 1 underlines the need for national preparedness plans and the necessary core items within such plans, including coordination and integration with an international response. Field 2 describes Burn Assessment Teams' roles, composition, training requirements, and reporting goals. Field 3 addresses the goals of specialized in-hospital triage, appropriate severity criteria, and their effects on priorities and triage. Finally, field 4 covers medical evacuations, including their timing and organization, the composition of evacuation teams and their assets, preparation, and the principles of en route care.
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Affiliation(s)
- Thomas Leclerc
- Percy Military Teaching Hospital, Clamart, France; Val-de-Grâce Military Medical Academy, Paris, France
| | | | - Serge Jennes
- Charleroi Burn Wound Center, Skin-burn-reconstruction Pole, Grand Hôpital de Charleroi, Charleroi, Belgium
| | | | - Cornelis H van der Vlies
- Department of Trauma and Burn Surgery, Maasstad Hospital, Rotterdam, the Netherlands; Trauma Research Unit Department of Surgery, Erasmus MC, Rotterdam, the Netherlands
| | - Anna Battistutta
- Directorate-General for European Civil Protection and Humanitarian Aid Operations (DG-ECHO), European Commission, Brussels, Belgium
| | - J Alfonso Lozano-Basanta
- Emergency Response Coordination Center, Directorate-General for European Civil Protection and Humanitarian Aid Operations (DG-ECHO), European Commission, Brussels, Belgium
| | - Naiem Moiemen
- University Hospitals Birmingham Foundation Trust, Birmingham, UK; University of Birmingham, College of Medical and Dental Sciences, Birmingham, UK
| | - Stian Kreken Almeland
- Norwegian National Burn Center, Department of Plastic, Hand, and Reconstructive Surgery, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Norway; Norwegian Directorate of Health, Department of Preparedness and Emergency Medical Services, Oslo, Norway.
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4
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Changes in epidemiology and care strategies at the Norwegian National Burn Centre over 35 years (1986–2020). BURNS OPEN 2023. [DOI: 10.1016/j.burnso.2022.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
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Cobert J, Sheckter C, Pham TN. A National Analysis of Discharge Disposition in Older Adults with Burns—Estimating the Likelihood of Independence at Discharge. J Burn Care Res 2022; 43:1221-1226. [DOI: 10.1093/jbcr/irac104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Whereas older age predicts higher burn mortality, the impact of age on discharge disposition is less well defined in older adults with burns. This investigation assesses the relationship between older age and discharge disposition after burns in a nationally representative sample. We queried the 2007-2015 National Trauma Data Bank for non-fatal burn hospitalizations in older adults. Pre-defined age categories were 55-64 years (working-age comparison group), 65-74 years (young-old), 75-84 years (middle-old), and 85+ years (old-old). Covariables included inhalation injury, comorbidities, burn total body surface area, injury mechanism, and race/ethnicity. Discharge to non-independent living (nursing home, rehabilitation, and other facilities) was the primary outcome. Logistic regression assessed the association between older age and discharge to non-independent living. There were 25,840 non-fatal burn hospitalizations in older adults during the study period. Working-age encounters comprised 53% of admissions, young-old accounted for 28%, middle-old comprised 15% and old-old comprised 4%. Discharge to non-independent living increased with burn TBSA and older age in survivors. Starting in young-old, the majority (65 %) of patients with burns ≥20% TBSA were discharged to non-independent living. Adjusted odd ratios for discharge to non-independent living were 2.0 for young-old, 3.3 for middle-old and 5.6 for old-old patients, when compared to working-age patients (all p<0.001). Older age strongly predicts non-independent discharge after acute burn hospitalization. Matrix analysis of discharge disposition indicates a stepwise rise in discharge to non-independent living with higher age and TBSA, providing a realistic discharge framework for treatment decisions and expectations about achieving independent living after burn hospitalization.
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Affiliation(s)
- Jason Cobert
- University of Rochester, 500 Joseph C. Wilson Blvd, Rochester , New York 14627, USA
| | - Clifford Sheckter
- Department of Surgery; Stanford University, 770 Welch Road, Suite 400 , Palo Alto, California 94304, USA
| | - Tam N Pham
- Department of Surgery; University of Washington-Harborview Medical Center, 325 Ninth Ave, Box 359796 , Seattle, Washington 98104, USA
- Harborview Injury Prevention and Research Center, 325 Ninth Ave, Box 359960 , Seattle, Washington 98104, USA
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6
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Bache SE, Barnes D. Improving the comparability and quality of burn research. BMJ MEDICINE 2022; 1:e000273. [PMID: 36936560 PMCID: PMC9978667 DOI: 10.1136/bmjmed-2022-000273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 06/16/2022] [Indexed: 11/03/2022]
Affiliation(s)
- Sarah E Bache
- Adult and Paediatric Burns Centre, St Andrew's Centre of Plastic Surgery and Burns, Broomfield Hospital, Chelmsford, Essex, UK
| | - David Barnes
- Adult and Paediatric Burns Centre, St Andrew's Centre of Plastic Surgery and Burns, Broomfield Hospital, Chelmsford, Essex, UK
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7
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Hazeldine J, McGee KC, Al-Tarrah K, Hassouna T, Patel K, Imran R, Bishop JRB, Bamford A, Barnes D, Wilson Y, Harrison P, Lord JM, Moiemen NS. Multicentre, longitudinal, observational cohort study to examine the relationship between neutrophil function and sepsis in adults and children with severe thermal injuries: a protocol for the Scientific Investigation of the Biological Pathways Following Thermal Injury-2 (SIFTI-2) study. BMJ Open 2021; 11:e052035. [PMID: 34686556 PMCID: PMC8543641 DOI: 10.1136/bmjopen-2021-052035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Burn-induced changes in the phenotype and function of neutrophils, cells which provide front-line protection against rapidly dividing bacterial infections, are emerging as potential biomarkers for the early prediction of sepsis. In a longitudinal study of adult burns patients, we recently demonstrated that a combined measurement of neutrophil phagocytic capacity, immature granulocyte (IG) count and plasma cell-free DNA (cfDNA) levels on the day of injury gave good discriminatory power for the prediction of later sepsis development. However, limited by a small sample size, single-centre design and focus on adult burns patients, these biomarkers require prospective validation in a larger patient cohort. The Scientific Investigation of the Biological Pathways Following Thermal Injury-2 study aims to prospectively validate neutrophil phagocytic activity, IG count and plasma cfDNA levels as early prognostic biomarkers of sepsis in thermally injured adult and paediatric patients. METHODS AND ANALYSIS This multicentre, longitudinal, observational cohort study will enrol 245 paediatric and adult patients with moderate to severe burns within 24 hours of injury. Blood samples will be obtained at 19 postinjury time points (days 1-14, day 28, months 3, 6, 12 and 24) and analysed for neutrophil phagocytic activity, IG count and cfDNA levels. Patients will be screened daily for sepsis using the 2007 American Burn Association diagnostic criteria for sepsis. In addition, daily multiple organ dysfunction syndrome and Sequential Organ Failure Assessment Scores will be recorded relationships between neutrophil phagocytic activity, IG count and plasma cfDNA levels on day 1 of injury and the development of sepsis will be examined using logistic regression models. ETHICS AND DISSEMINATION This study received ethics approval from the West Midlands, Coventry and Warwickshire Research Ethics Committee (REC reference:16/WM/0217). Findings will be presented at national and international conferences, and submitted for publication in peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT04693442.
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Affiliation(s)
- Jon Hazeldine
- National Institute for Health Research Surgical Reconstruction and Microbiology Research Centre, University of Birmingham, Birmingham, UK
- Institute of Inflammation and Ageing, University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Kirsty C McGee
- Institute of Inflammation and Ageing, University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Khaled Al-Tarrah
- Institute of Inflammation and Ageing, University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Tarek Hassouna
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Krupali Patel
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Rizwana Imran
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Jonathan R B Bishop
- National Institute for Health Research Surgical Reconstruction and Microbiology Research Centre, University of Birmingham, Birmingham, UK
| | - Amy Bamford
- National Institute for Health Research Surgical Reconstruction and Microbiology Research Centre, University of Birmingham, Birmingham, UK
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - David Barnes
- St Andrews Centre for Plastic Surgery and Burns, Mid and South Essex NHS Foundation Trust, Essex, UK
| | - Yvonne Wilson
- Birmingham Children's Hospital NHS Foundation Trust, Birmingham, UK
| | - Paul Harrison
- Institute of Inflammation and Ageing, University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
- Scar Free Foundation, Birmingham, UK
| | - Janet M Lord
- National Institute for Health Research Surgical Reconstruction and Microbiology Research Centre, University of Birmingham, Birmingham, UK
- Institute of Inflammation and Ageing, University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
- Scar Free Foundation, Birmingham, UK
| | - Naiem S Moiemen
- National Institute for Health Research Surgical Reconstruction and Microbiology Research Centre, University of Birmingham, Birmingham, UK
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Scar Free Foundation, Birmingham, UK
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8
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Addition of admission lactate levels to Baux score improves mortality prediction in severe burns. Sci Rep 2021; 11:18038. [PMID: 34508143 PMCID: PMC8433150 DOI: 10.1038/s41598-021-97524-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 08/23/2021] [Indexed: 12/15/2022] Open
Abstract
Risk adjustment and mortality prediction models are central in optimising care and for benchmarking purposes. In the burn setting, the Baux score and its derivatives have been the mainstay for predictions of mortality from burns. Other well-known measures to predict mortality stem from the ICU setting, where, for example, the Simplified Acute Physiology Score (SAPS 3) models have been found to be instrumental. Other attempts to further improve the prediction of outcome have been based on the following variables at admission: Sequential Organ Failure Assessment (aSOFA) score, determinations of aLactate or Neutrophil to Lymphocyte Ratio (aNLR). The aim of the present study was to examine if estimated mortality rate (EMR, SAPS 3), aSOFA, aLactate, and aNLR can, either alone or in conjunction with the others, improve the mortality prediction beyond that of the effects of age and percentage total body surface area (TBSA%) burned among patients with severe burns who need critical care. This is a retrospective, explorative, single centre, registry study based on prospectively gathered data. The study included 222 patients with median (25th–75th centiles) age of 55.0 (38.0 to 69.0) years, TBSA% burned was 24.5 (13.0 to 37.2) and crude mortality was 17%. As anticipated highest predicting power was obtained with age and TBSA% with an AUC at 0.906 (95% CI 0.857 to 0.955) as compared with EMR, aSOFA, aLactate and aNLR. The largest effect was seen thereafter by adding aLactate to the model, increasing AUC to 0.938 (0.898 to 0.979) (p < 0.001). Whereafter, adding EMR, aSOFA, and aNLR, separately or in combinations, only marginally improved the prediction power. This study shows that the prediction model with age and TBSA% may be improved by adding aLactate, despite the fact that aLactate levels were only moderately increased. Thereafter, adding EMR, aSOFA or aNLR only marginally affected the mortality prediction.
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Demir S, Oztorun CI, Erturk A, Guney D, Ertoy A, Doruk H, Tanriverdi F, Azili MN, Senel E. Approaches of Emergency Department Physicians to Pediatric Burns: A Survey Assessment. J Burn Care Res 2021; 43:115-120. [PMID: 34132812 DOI: 10.1093/jbcr/irab087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Burned children generally arrive at emergency departments before referring to specialized burn centers. Their initial treatments are performed by non-burn doctors who work in emergency departments. The aim of this study was to evaluate emergency department doctors' knowledge regarding the initial interventions and transfer of pediatric burn patients. There were 196 participants who completed the survey: 59 were emergency medicine specialists, 46 were general practitioners, and 91 were emergency medicine residents. Sixty-five stated that they always calculate the burn surface areas, and 144 stated that the Parkland formula should be used to calculate the fluid requirements for the first 24 hours. Of all participants, only 21 marked the correct choice as the Lund-Browder scheme to calculate the total burned surface area in children. Only 52 participants marked the correct choice as the Lactated Ringer's of the fluid given in the first 24 hours. Only 108 correctly recognized inhalation injury. To the question "What is the first intervention that doctors should do at the emergency room to burned children?," 127 participants stated correctly as the assessment of airway maintenance. Among the participants, 124 stated that they use lidocaine pomades when covering burned children's wounds. Incorrect interventions with burned children increase morbidity and mortality. This survey shows that non-burn doctors working in emergency departments have insufficient knowledge about pediatric burns and require further training. Therefore, they should be trained continuously and regularly on the approach to both adult and childhood burns.
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Affiliation(s)
- Sabri Demir
- Ankara Bilkent City Hospital, Children Hospital, Pediatric Burn Centre, Turkey.,Ankara Bilkent City Hospital, Children Hospital, Department of Pediatric Surgery, Turkey
| | - Can Ihsan Oztorun
- Ankara Bilkent City Hospital, Children Hospital, Pediatric Burn Centre, Turkey.,Ankara Yildirim Beyazit University, Medical Faculty, Department of Pediatric Surgery, Turkey
| | - Ahmet Erturk
- Ankara Bilkent City Hospital, Children Hospital, Pediatric Burn Centre, Turkey.,Ankara Bilkent City Hospital, Children Hospital, Department of Pediatric Surgery, Turkey
| | - Dogus Guney
- Ankara Bilkent City Hospital, Children Hospital, Pediatric Burn Centre, Turkey.,Ankara Yildirim Beyazit University, Medical Faculty, Department of Pediatric Surgery, Turkey
| | - Ayse Ertoy
- Ankara Bilkent City Hospital, Children Hospital, Pediatric Burn Centre, Turkey.,Ankara Bilkent City Hospital, Children Hospital, Department of Pediatric Surgery, Turkey
| | - Hayal Doruk
- Ankara Bilkent City Hospital, Children Hospital, Pediatric Burn Centre, Turkey.,Ankara Bilkent City Hospital, Children Hospital, Department of Pediatric Surgery, Turkey
| | - Fatih Tanriverdi
- Ankara Yildirim Beyazit University, Medical Faculty, Department of Emergency Medicine, Turkey
| | - Mujdem Nur Azili
- Ankara Bilkent City Hospital, Children Hospital, Pediatric Burn Centre, Turkey.,Ankara Yildirim Beyazit University, Medical Faculty, Department of Pediatric Surgery, Turkey
| | - Emrah Senel
- Ankara Bilkent City Hospital, Children Hospital, Pediatric Burn Centre, Turkey.,Ankara Yildirim Beyazit University, Medical Faculty, Department of Pediatric Surgery, Turkey
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10
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Meuli JN, Pantet O, Berger MM, Waselle L, Raffoul W. Massive burns: retrospective analysis of changes in outcomes indicators across 18 years. J Burn Care Res 2021; 43:232-239. [PMID: 33886955 PMCID: PMC8737114 DOI: 10.1093/jbcr/irab072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The treatment and management of massive burns, defined as burns affecting≥ 50% of total body surface area (TBSA) has considerably changed since the 90s. This study aimed at analyzing if the length of intensive care unit (ICU) stay, the success of skin grafting operations and the mortality changed in the last 18 years. METHODS Between 2000 and 2018, 77 patients were admitted for massive burns to the ICU of a university hospital. Transfers and early care withdrawal precluded inclusion for 38 patients, leaving 39 for analysis. Study variables were year of admission, demographics, burn characteristics, critical care treatment (fluid resuscitation, ventilation and nutrition) and surgical therapy. Association between outcomes and year of admission were assessed through correlation and logistic regression analysis. Potential confounders were assessed through stepwise linear regression. RESULTS Patients' characteristics were stable over time with a median age of 36[25.0, 48.0] years, burns 65% [55.0, 83.0] TBSA and deep burns 55% [50.0, 68.0] TBSA . Length of ICU stay remained stable at 0.97 [0.6, 1.5] days/%TBSA. Mortality was stable as well. Energy and carbohydrate delivery decreased in parallel with the number of infectious episodes per patient. Number of operations was stable but the take rate of skin grafts increased significantly. The multivariate analysis retained year of admission, weight, total number of infections, daily lipid intakes and fluid resuscitation as independent predicting variables. CONCLUSION Length of ICU stay and mortality did not change over time but skin grafts take rates improved significantly.
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Affiliation(s)
- Joachim N Meuli
- Department of Plastic, Reconstructive and Hand Surgery, Lausanne University Hospital, Switzerland
| | - Olivier Pantet
- Department of Adult Intensive Care Medicine and Burns, Lausanne University Hospital, Switzerland
| | - Mette M Berger
- Department of Adult Intensive Care Medicine and Burns, Lausanne University Hospital, Switzerland
| | - Laurent Waselle
- Cell Production Center, Lausanne University Hospital, Switzerland
| | - Wassim Raffoul
- Department of Plastic, Reconstructive and Hand Surgery, Lausanne University Hospital, Switzerland
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11
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Lahdenperä NI, Repo JP, Aartolahti E, Tollow P, Griffiths C, Harcourt D, Vuola J, Lindford A. The CARe Burn Scale-Adult Form: Translation and linguistic validation into Finnish. Burns 2021; 47:1922-1928. [PMID: 33814216 DOI: 10.1016/j.burns.2021.02.017] [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: 07/08/2020] [Revised: 02/16/2021] [Accepted: 02/22/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND Burn injury can dramatically deteriorate health-related quality of life. Effective burn care may minimize the impact of the burn injury and ensure optimal functional outcome. This requires continuous improvement in burn care and assessment of treatment results. The aim of this study was to translate, culturally adapt and linguistically validate the CARe Burn Scale-Adult Form, a burn-specific patient-reported outcome measure, into Finnish. METHODS The translation process followed the International Society for Pharmacoeconomics and Outcomes Research guidelines consisting of forward and backward translations, pilot-testing and cognitive debriefing interviews of five burn patients, and proofreading before finalizing. The process involved expert panel meetings and continuous discussion between the developers of the Scale and the research group. RESULTS In the forward translation 10 amendments were required. After the backward translation, 12 items were reworded. Cognitive debriefing interviews led to three alterations enhancing the comprehensiveness and accuracy of the translation. The translation was reviewed by burn occupational therapists for practicality, resulting in 12 modifications. Minor grammatical changes were made after proofreading. CONCLUSION The Finnish version is the first foreign translation of the CARe Burn Scale. It is equivalent to the original Scale and ready for psychometric validation with burn patients in Finland.
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Affiliation(s)
- Noora-Ilona Lahdenperä
- Helsinki Burn Centre, Department of Plastic Surgery, Helsinki University Hospital and University of Helsinki, P.O. Box 800, FI-00029 HUS Helsinki, Finland.
| | - Jussi P Repo
- Department of Orthopaedics and Traumatology, Unit of Musculoskeletal Surgery, Tampere University Hospital, P.O. Box 2000, FI-33521 Tampere, Finland
| | - Eeva Aartolahti
- Faculty of Sport and Health Sciences, University of Jyväskylä, P.O. Box 35, FI-40014, Finland
| | - Philippa Tollow
- Centre for Appearance Research, Department of Health and Social Sciences, University of the West of England, Frenchay Campus, Coldharbour Lane, Bristol BS16 1QY, UK
| | - Catrin Griffiths
- Centre for Appearance Research, Department of Health and Social Sciences, University of the West of England, Frenchay Campus, Coldharbour Lane, Bristol BS16 1QY, UK
| | - Diana Harcourt
- Centre for Appearance Research, Department of Health and Social Sciences, University of the West of England, Frenchay Campus, Coldharbour Lane, Bristol BS16 1QY, UK
| | - Jyrki Vuola
- Helsinki Burn Centre, Department of Plastic Surgery, Helsinki University Hospital and University of Helsinki, P.O. Box 800, FI-00029 HUS Helsinki, Finland
| | - Andrew Lindford
- Helsinki Burn Centre, Department of Plastic Surgery, Helsinki University Hospital and University of Helsinki, P.O. Box 800, FI-00029 HUS Helsinki, Finland
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Qiu L, Jin X, Wang JJ, Tang XD, Fang X, Li SJ, Wang F, Chen XL. Plasma Neutrophil-to-Lymphocyte Ratio on the Third Day Postburn is Associated with 90-Day Mortality Among Patients with Burns Over 30% of Total Body Surface Area in Two Chinese Burns Centers. J Inflamm Res 2021; 14:519-526. [PMID: 33658827 PMCID: PMC7917389 DOI: 10.2147/jir.s294543] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 02/03/2021] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION Neutrophil-to-lymphocyte ratio (NLR) is a marker of inflammation. This study aimed to evaluate the potential role of NLR to predict 90-day mortality. METHODS Data of 577 patients with burns over 30% of total body surface area were collected and retrospectively analyzed. The risk factors for 90-day mortality were evaluated using logistic regression analyses. Receiver operating characteristic (ROC) curve analysis of the 3rd day NLR was performed and the optimal cut-off value was calculated. The 90-day mortality rates were compared between high and low NLR groups using Kaplan-Meier analysis. RESULTS Age, mechanical ventilation, burn index, 3rd day NLR, and 7th day red blood cell and platelet (PLT) counts were found to be independent predictive values for 90-day mortality. In contrast, percentage of total body surface area burned, inhalation injury, 1st day white blood cell and neutrophil counts, the 3rd day lymphocytes and PLT counts, and 7th day hemoglobin level were not independently associated with 90-day mortality. The area under the ROC curve of the 3rd day NLR for severe burn-delayed death prediction was 0.665 (95% confidence interval, 0.591-0.739), and the optimal cut-off value of the 3rd day NLR was 10.50. The 90-day mortality rates differed significantly between the NLR >10.5 group and the NLR ≤ 10.5 group (17.03% vs 5.92%, respectively; P < 0.01). CONCLUSION These results suggested that the 3rd day NLR was associated with an increased risk of death in severely burned patients; thus, it can provide useful information to predict 90-day mortality.
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Affiliation(s)
- Le Qiu
- Department of Burns, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, People’s Republic of China
| | - Xu Jin
- Department of Burns, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, People’s Republic of China
| | - Jun-Jie Wang
- Department of Burns, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, People’s Republic of China
| | - Xu-Dong Tang
- Department of Burns, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, People’s Republic of China
| | - Xiao Fang
- Department of Burns, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, People’s Republic of China
| | - Shi-Ji Li
- Department of Burns, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, People’s Republic of China
| | - Fei Wang
- Department of Burns, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, People’s Republic of China
| | - Xu-Lin Chen
- Department of Burns, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, People’s Republic of China
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Rouzfarakh M, Deldar K, Froutan R, Ahmadabadi A, Mazlom SR. The effect of rehabilitation education through social media on the quality of life in burn patients: a randomized, controlled, clinical trial. BMC Med Inform Decis Mak 2021; 21:70. [PMID: 33618721 PMCID: PMC7901117 DOI: 10.1186/s12911-021-01421-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 02/04/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Burn is one of the most brutal harms to the human body and mind and its wide-ranging complications have many adverse effects on the patients' quality of life. The present study was conducted to investigate the effect of rehabilitation education through social media on burn patients' quality of life. METHODS The present randomized, controlled, clinical trial was conducted on 60 patients admitted to Imam Reza Hospital Burn Center in the city of Mashhad, Iran, who were randomly assigned to either the intervention or control groups (n = 30 per group). The researcher then created a WhatsApp channel to provide educational content and a WhatsApp group for burns patients to join and get their questions answered. The intervention group patients pursued their post-discharge education through the social media for a month. The control group patients received their discharge education according to the ward's routine procedures through pamphlets and face-to-face training by the personnel. As the study's main variable, the Burn Specific Health Scale-Brief was completed by both groups before and 1 and 2 months after the intervention. Data were analyzed using the ANCOVA and repeated-measures ANOVA. RESULTS There was no significant differences between the intervention and control groups in terms of the QOL score and any of the domains at baseline. The results indicated the significant effect of the intervention both 1 and 2 months post-intervention on the QOL score and all the domains (P < 0.05), except for body image (Pmodel1 = .550 and Pmodel2 = .463) and skin sensitivity (Pmodel1 = .333 and Pmodel2 = .104). CONCLUSION The post-discharge rehabilitation education of burns patients through social media improves their quality of life and can be used as an appropriate educational and follow-up method in different stages of the rehabilitation of burn patients. TRIAL REGISTRATION NO. : IRCT20190622043971N1, 05-10-2019.
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Affiliation(s)
- Maryam Rouzfarakh
- School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Kolsoum Deldar
- School of Paramedicine, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Razieh Froutan
- Nursing and Midwifery Care Research Center, Mashhad University of Medical Sciences, Mashhad, Iran. .,Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Ali Ahmadabadi
- Surgical Oncology Research Centre, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Seyed Reza Mazlom
- Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
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14
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Seo YJ, Kong YG, Yu J, Park JH, Kim SJ, Kim HY, Kim YK. The prognostic nutritional index on postoperative day one is associated with one-year mortality after burn surgery in elderly patients. BURNS & TRAUMA 2021; 9:tkaa043. [PMID: 33709002 PMCID: PMC7935376 DOI: 10.1093/burnst/tkaa043] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 09/13/2020] [Indexed: 06/10/2023]
Abstract
BACKGROUND Burn injury in elderly patients can result in poor outcomes. Prognostic nutritional index (PNI) can predict the perioperative nutritional status and postoperative outcomes. We aim to evaluate the risk factors, including PNI, for one-year mortality after burn surgery in elderly patients. METHODS Burn patients aged ≥65 years were retrospectively included. PNI was calculated using the following equation: 10 × serum albumin level (g/dL) + 0.005 × total lymphocyte count (per mm3). Cox regression, receiver operating characteristic curve and Kaplan-Meier survival analyses were performed to evaluate the risk factors for postoperative one-year mortality. RESULTS Postoperative one-year mortality occurred in 71 (37.6%) of the 189 elderly burn patients. Risk factors for one-year mortality were PNI on postoperative day one (hazard ratio (HR) = 0.872; 95% CI = 0.812-0.936; p < 0.001), Sequential Organ Failure Assessment score (HR = 1.112; 95% CI = 1.005-1.230; p = 0.040), American Society of Anesthesiologists physical status (HR = 2.064; 95% CI = 1.211-3.517; p = 0.008), total body surface area burned (HR = 1.017; 95% CI = 1.003-1.032; p = 0.015) and preoperative serum creatinine level (HR = 1.386; 95% CI = 1.058-1.816; p = 0.018). The area under the curve of PNI for predicting one-year mortality after burn surgery was 0.774 (optimal cut-off value = 25.5). Patients with PNI ≤25.5 had a significantly lower one-year survival rate than those with PNI >25.5 (32.1% vs 75.9%, p < 0.001). CONCLUSIONS PNI on postoperative day one was associated with postoperative one-year mortality in elderly burn patients. The postoperative one-year survival rate was lower in patients with PNI ≤25.5 than in those with PNI >25.5. These findings indicate the importance of identifying elderly burn patients with low PNI, thereby reducing the mortality after burn surgery.
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Affiliation(s)
- Young Joo Seo
- Department of Anesthesiology and Pain Medicine, Hangang Sacred Heart Hospital, Hallym University College of Medicine, 12, Beodeunaru-ro 7-gil, Yeongdeungpo-gu, Seoul 07247, Republic of Korea
| | - Yu-Gyeong Kong
- Department of Anesthesiology and Pain Medicine, Hangang Sacred Heart Hospital, Hallym University College of Medicine, 12, Beodeunaru-ro 7-gil, Yeongdeungpo-gu, Seoul 07247, Republic of Korea
| | - Jihion Yu
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea
| | - Ji Hyun Park
- Department of Anesthesiology and Pain Medicine, National Medical Center, 245, Euljiro, Jung-gu, Seoul 04564, Republic of Korea
| | - Su-Jin Kim
- Department of Anesthesiology and Pain Medicine, National Medical Center, 245, Euljiro, Jung-gu, Seoul 04564, Republic of Korea
| | - Hee Yeong Kim
- Department of Anesthesiology and Pain Medicine, National Medical Center, 245, Euljiro, Jung-gu, Seoul 04564, Republic of Korea
| | - Young-Kug Kim
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea
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15
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Stefani K, Wagstaff MJD, Damkat I, Greenwood JE. Mortality data 2004-2019: an audit of the Royal Adelaide Hospital Adult Burn Service. ANZ J Surg 2020; 91:77-82. [PMID: 33135870 DOI: 10.1111/ans.16349] [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: 06/25/2020] [Revised: 08/30/2020] [Accepted: 09/04/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Burns are complex, multifaceted injuries that can pose significant challenges to the treating team. The Royal Adelaide Hospital (RAH) Burns Service has undergone a major evolution over the past two decades, with perceived improvement in outcomes. We present here a longitudinal audit of the RAH Burns Service Mortality Data between 2004 and 2019. METHODS An audit was conducted of all index admissions to the RAH Burns Unit from 1 January 2004 to 31 December 2019. Age at admission, total body surface area, burn depth, presence of inhalation injury and outcome were recorded. Baux and revised Baux Scores were calculated. Lethal Area 50% for different time points and age groups, Baux50/100 and Revised Baux50/100 values were then calculated using logistical regression. RESULTS During 2004-2019, there were 5653 index admissions to the RAH Burns Unit. The mean total body surface area of burn injuries admitted was 5.1% and the survival rate was 99.17%. The Lethal Area 50% for the study period was 74%, with an improvement from 70% (2004-2011) to 80% (2012-2019). The Baux50 score for the time period was 120 and the Revised Baux50 was 129. CONCLUSION The RAH results are comparable with other high-income country Burn Services and demonstrated significant improvement across the study period. The data also highlight areas for ongoing focus such as the elderly burns patient.
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Affiliation(s)
- Kristian Stefani
- Adult Burn Service, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Marcus J D Wagstaff
- Adult Burn Service and Department of Plastic and Reconstructive Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Ivo Damkat
- Strategic Analyst, Department of Education, SA Government, Adelaide, South Australia, Australia
| | - John E Greenwood
- Adult Burn Service, Royal Adelaide Hospital, Adelaide, South Australia, Australia
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16
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Chacon MA, Haas J, Hansen TC, Mushin OP, Bell DE. Thin and Ultra-Thin Split-Thickness Skin Grafts Are Safe and Efficacious in the Burn Population. J Burn Care Res 2020; 41:849-852. [PMID: 31867613 DOI: 10.1093/jbcr/irz208] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Split-thickness skin-grafts are a mainstay of burn management. Studies suggest no benefit to using thick (0.025 inch) over standard (0.012-0.020 inch) grafts, and some support the use of thin (0.008 inch) over standard thickness. Data on the use of even thinner grafts is scarce. This study reviewed outcomes of burn patients treated with thin (0.008-0.011 inch) and ultra-thin (≤0.007 inch) grafts. Retrospective review of records from July 2012 to June 2016 included patients who sustained operative burns treated by a single surgeon. Patients were excluded for nonoperative injuries, inhalational injuries, or prolonged hospitalizations. Outcome measures were compared between thin and ultra-thin groups. One-hundred twenty-eight patients met inclusion criteria; 35 received thin split-thickness skin-grafts while 93 received ultra-thin. Cohort analysis demonstrated equivalent graft-take, time to reepithelialization, and functional outcomes. Time to donor-site healing was significantly faster in the ultra-thin cohort (P = .04). Of those with functional outcomes recorded, 88.1% had good-excellent function and 11.9% retained a limitation in function as designated in physical therapy notes. There were fewer complications overall (P = .004) and a lower incidence of hypertrophic scarring (P = .025) in the ultra-thin cohort. This study presents a single-surgeon experience with thin and ultra-thin split-thickness skin-grafts. These grafts are exhibit excellent graft-take and few complications. There was no correlation between thickness and functional outcome at the time of physical therapy discharge. Donor-site reepithelialization was faster with ultra-thin grafts, which may be important in patients with large burns and limited donor sites.
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Affiliation(s)
- Miranda A Chacon
- Department of Surgery, Division of Plastic Surgery, Rochester, New York
| | - Jacqueline Haas
- Department of Surgery, Division of Plastic Surgery, Rochester, New York
| | - Trevor C Hansen
- Department of Surgery, Division of Plastic Surgery, Rochester, New York
| | - Oren P Mushin
- Department of Surgery, Division of Plastic Surgery, Rochester, New York
| | - Derek E Bell
- Department of Surgery, Division of Plastic Surgery, Rochester, New York
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17
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Standardized mortality ratio (SMR) is a more precise and realistic quality indicator than the lethal area 50 percent (LA50) for burn centers. Burns 2020; 46:1481-1482. [PMID: 32402476 DOI: 10.1016/j.burns.2020.03.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 03/20/2020] [Indexed: 11/21/2022]
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18
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Legrand M, Barraud D, Constant I, Devauchelle P, Donat N, Fontaine M, Goffinet L, Hoffmann C, Jeanne M, Jonqueres J, Leclerc T, Lefort H, Louvet N, Losser MR, Lucas C, Pantet O, Roquilly A, Rousseau AF, Soussi S, Wiramus S, Gayat E, Blet A. Management of severe thermal burns in the acute phase in adults and children. Anaesth Crit Care Pain Med 2020; 39:253-267. [PMID: 32147581 DOI: 10.1016/j.accpm.2020.03.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVES To provide recommendations to facilitate the management of severe thermal burns during the acute phase in adults and children. DESIGN A committee of 20 experts was asked to produce recommendations in six fields of burn management, namely, (1) assessment, admission to specialised burns centres, and telemedicine; (2) haemodynamic management; (3) airway management and smoke inhalation; (4) anaesthesia and analgesia; (5) burn wound treatments; and (6) other treatments. At the start of the recommendation-formulation process, a formal conflict-of-interest policy was developed and enforced throughout the process. The entire process was conducted independently of any industry funding. The experts drew up a list of questions that were formulated according to the PICO model (Population, Intervention, Comparison, and Outcomes). Two bibliography experts per field analysed the literature published from January 2000 onwards using predefined keywords according to PRISMA recommendations. The quality of data from the selected literature was assessed using GRADE® methodology. Due to the current paucity of sufficiently powered studies regarding hard outcomes (i.e. mortality), the recommendations are based on expert opinion. RESULTS The SFAR guidelines panel generated 24 statements regarding the management of acute burn injuries in adults and children. After two scoring rounds and one amendment, strong agreement was reached for all recommendations. CONCLUSION Substantial agreement was reached among a large cohort of experts regarding numerous strong recommendations to optimise the management of acute burn injuries in adults and children.
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Affiliation(s)
- Matthieu Legrand
- Department of Anaesthesia and Perioperative Care, University of California, San Francisco, United States.
| | - Damien Barraud
- Hôpital de Mercy, Intensive Care Medicine and Burn Centre, CHR Metz-Thionville, Ars-Laquenexy, France
| | - Isabelle Constant
- Anaesthesiology Department, Hôpital Armand-Trousseau, Sorbonne Université, Assistance publique-Hôpitaux de Paris, Paris, France
| | | | - Nicolas Donat
- Burn Centre, Percy Military Teaching Hospital, Clamart, France
| | - Mathieu Fontaine
- Burn Intensive Care Unit, Saint-Joseph Saint-Luc Hospital, 20, quai Claude-Bernard, 69007 Lyon, France
| | - Laetitia Goffinet
- Paediatric Burn Centre, University Hospital of Nancy, 54511 Vandœuvre-Lès-Nancy, France
| | | | - Mathieu Jeanne
- CHU Lille, Anaesthesia and Critical Care, Burn Centre, 59000 Lille, France; University of Lille, Inserm, CHU Lille, CIC 1403, 59000 Lille, France; University of Lille, EA 7365 - GRITA, 59000 Lille, France
| | - Jeanne Jonqueres
- Burn Intensive Care Unit, Saint-Joseph Saint-Luc Hospital, 20, quai Claude-Bernard, 69007 Lyon, France
| | - Thomas Leclerc
- Burn Centre, Percy Military Teaching Hospital, Clamart, France
| | - Hugues Lefort
- Department of emergency medicine, Legouest Military Teaching Hospital, Metz, France
| | - Nicolas Louvet
- Anaesthesiology Department, Hôpital Armand-Trousseau, Sorbonne Université, Assistance publique-Hôpitaux de Paris, Paris, France
| | - Marie-Reine Losser
- Hôpital de Mercy, Intensive Care Medicine and Burn Centre, CHR Metz-Thionville, Ars-Laquenexy, France; Paediatric Burn Centre, University Hospital of Nancy, 54511 Vandœuvre-Lès-Nancy, France; Inserm UMR 1116, Team 2, 54000 Nancy, France; University of Lorraine, 54000 Nancy, France
| | - Célia Lucas
- Department of Anaesthesiology, Critical Care and Burn Centre, Lariboisière-Saint-Louis Hospitals, DMU Parabol, AP-HP Nord, University of Paris, Paris, France
| | - Olivier Pantet
- Service of Adult Intensive Care Medicine and Burns, Lausanne University Hospital (CHUV), BH 08-651, Rue du Bugnon 46, 1011 Lausanne, Switzerland
| | - Antoine Roquilly
- Department of Anaesthesia and Critical Care, Hôtel-Dieu, University Hospital of Nantes, Nantes, France; Laboratoire UPRES EA 3826 "Thérapeutiques cliniques et expérimentales des infections", University of Nantes, Nantes, France
| | | | - Sabri Soussi
- Department of Anaesthesiology, Critical Care and Burn Centre, Lariboisière-Saint-Louis Hospitals, DMU Parabol, AP-HP Nord, University of Paris, Paris, France; Interdepartmental Division of Critical Care, Keenan Research Centre for Biomedical Science and Institute of Medical Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Sandrine Wiramus
- Department of Anaesthesia and Intensive Care Medicine and Burn Centre, University Hospital of Marseille, La Timone Hospital, Marseille, France
| | - Etienne Gayat
- Department of Anaesthesiology, Critical Care and Burn Centre, Lariboisière-Saint-Louis Hospitals, DMU Parabol, AP-HP Nord, University of Paris, Paris, France; Inserm UMR-S 942, Cardiovascular Markers in Stress Conditions (MASCOT), University of Paris, Paris, France
| | - Alice Blet
- Department of Anaesthesiology, Critical Care and Burn Centre, Lariboisière-Saint-Louis Hospitals, DMU Parabol, AP-HP Nord, University of Paris, Paris, France; Inserm UMR-S 942, Cardiovascular Markers in Stress Conditions (MASCOT), University of Paris, Paris, France; Department of Research, University of Ottawa Heart Institute, Ottawa, ON, Canada
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19
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Potential role of adipose tissue and its hormones in burns and critically III patients. Burns 2020; 46:259-266. [DOI: 10.1016/j.burns.2019.01.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Revised: 12/17/2018] [Accepted: 01/30/2019] [Indexed: 12/26/2022]
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20
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Ehrl D, Heidekrueger PI, Rubenbauger J, Ninkovic M, Broer PN. Impact of Prehospital Hypothermia on the Outcomes of Severely Burned Patients. J Burn Care Res 2020; 39:739-743. [PMID: 29931071 DOI: 10.1093/jbcr/irx033] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
When treating burn injuries, to date, there still remains significant disagreement whether presence of hypothermia (HT) on burn centers' intensive care unit (BICU) admission improves or worsens outcomes. The presented single burn center experiences set out to further evaluate the incidence, cause, and potential effects of HT on outcomes in severely burned patients. Between January 2015 and February 2017, 142 severely burned patients were admitted to a BICU. Temperature at BICU admission of <36.0°C was defined as HT and ≥36.0°C as normothermia (NT). The cases were divided into two groups: HT vs NT. Fifty-four patients met inclusion criteria and were analyzed retrospectively regarding encountered complications, time of hospitalization, and overall survival. The overall incidence of HT on arrival was 62.9%. Mean duration from burn accident to BICU admission did not differ significantly, but the groups showed significant differences regarding total body surface area (TBSA; P < .05). Both groups showed a similar distribution, regarding number of surgeries, duration until first burn excision, length of ventilation, and mortality rate of patients (P > .05). However, time until death was significantly shorter in the HT group. HT at admission remains a common problem following burn injury. Main risk factors include inappropriate temperature management after injury and during transport, extent of TBSA burn, and quantity of resuscitation. Given the high incidence, the involved health care and, especially, also prehospital providers should be further educated about existing recommendations and guidelines to prevent HT.
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Affiliation(s)
- Denis Ehrl
- Hand Surgery, Ludwig-Maximilians-University, Munich, Germany.,Plastic Surgery, Ludwig-Maximilians-University, Munich, Germany.,Aesthetic Surgery, Ludwig-Maximilians-University, Munich, Germany.,Department of Plastic, Reconstructive, Hand and Burn Surgery, Bogenhausen Academic Teaching Hospital, Munich, Germany
| | - Paul I Heidekrueger
- Department of Plastic, Reconstructive, Hand and Burn Surgery, Bogenhausen Academic Teaching Hospital, Munich, Germany.,Department of Plastic, Hand and Reconstructive Surgery, University Medical Center, Regensburg, Germany
| | - Johannes Rubenbauger
- Department of Plastic, Reconstructive, Hand and Burn Surgery, Bogenhausen Academic Teaching Hospital, Munich, Germany
| | - Milomir Ninkovic
- Department of Plastic, Reconstructive, Hand and Burn Surgery, Bogenhausen Academic Teaching Hospital, Munich, Germany
| | - P Niclas Broer
- Department of Plastic, Reconstructive, Hand and Burn Surgery, Bogenhausen Academic Teaching Hospital, Munich, Germany
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21
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Dinsdale RJ, Hazeldine J, Al Tarrah K, Hampson P, Devi A, Ermogenous C, Bamford AL, Bishop J, Watts S, Kirkman E, Dalle Lucca JJ, Midwinter M, Woolley T, Foster M, Lord JM, Moiemen N, Harrison P. Dysregulation of the actin scavenging system and inhibition of DNase activity following severe thermal injury. Br J Surg 2019; 107:391-401. [PMID: 31502663 PMCID: PMC7079039 DOI: 10.1002/bjs.11310] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 05/21/2019] [Accepted: 06/08/2019] [Indexed: 01/25/2023]
Abstract
Background Circulating cell‐free DNA (cfDNA) is not found in healthy subjects, but is readily detected after thermal injury and may contribute to the risk of multiple organ failure. The hypothesis was that a postburn reduction in DNase protein/enzyme activity could contribute to the increase in cfDNA following thermal injury. Methods Patients with severe burns covering at least 15 per cent of total body surface area were recruited to a prospective cohort study within 24 h of injury. Blood samples were collected from the day of injury for 12 months. Results Analysis of blood samples from 64 patients revealed a significant reduction in DNase activity on days 1–28 after injury, compared with healthy controls. DNase protein levels were not affected, suggesting the presence of an enzyme inhibitor. Further analysis revealed that actin (an inhibitor of DNase) was present in serum samples from patients but not those from controls, and concentrations of the actin scavenging proteins gelsolin and vitamin D‐binding protein were significantly reduced after burn injury. In a pilot study of ten military patients with polytrauma, administration of blood products resulted in an increase in DNase activity and gelsolin levels. Conclusion The results of this study suggest a novel biological mechanism for the accumulation of cfDNA following thermal injury by which high levels of actin released by damaged tissue cause a reduction in DNase activity. Restoration of the actin scavenging system could therefore restore DNase activity, and reduce the risk of cfDNA‐induced host tissue damage and thrombosis.
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Affiliation(s)
- R J Dinsdale
- Scar Free Foundation, Birmingham Centre for Burns Research, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.,Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - J Hazeldine
- National Institute for Health Research Surgical Reconstruction and Microbiology Research Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.,Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - K Al Tarrah
- Scar Free Foundation, Birmingham Centre for Burns Research, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.,Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - P Hampson
- Scar Free Foundation, Birmingham Centre for Burns Research, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.,Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - A Devi
- Scar Free Foundation, Birmingham Centre for Burns Research, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.,Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - C Ermogenous
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - A L Bamford
- Scar Free Foundation, Birmingham Centre for Burns Research, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - J Bishop
- National Institute for Health Research Surgical Reconstruction and Microbiology Research Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - S Watts
- Chemical, Biological and Radiological (CBR) Division, Defence Science and Technology Laboratory, Porton Down, Salisbury, UK
| | - E Kirkman
- Chemical, Biological and Radiological (CBR) Division, Defence Science and Technology Laboratory, Porton Down, Salisbury, UK
| | - J J Dalle Lucca
- Translational Medical Division, Department of Chemical and Biological Technologies, Defense Threat Reduction Agency, Fort Belvoir, Virginia, USA
| | - M Midwinter
- School of Biomedical Sciences, University of Queensland, Brisbane, Queensland, Australia
| | - T Woolley
- ICT Centre, Birmingham Research Park, Birmingham, UK.,Chemical, Biological and Radiological (CBR) Division, Defence Science and Technology Laboratory, Porton Down, Salisbury, UK
| | - M Foster
- National Institute for Health Research Surgical Reconstruction and Microbiology Research Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.,Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - J M Lord
- Scar Free Foundation, Birmingham Centre for Burns Research, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.,National Institute for Health Research Surgical Reconstruction and Microbiology Research Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.,Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - N Moiemen
- Scar Free Foundation, Birmingham Centre for Burns Research, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.,Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - P Harrison
- Scar Free Foundation, Birmingham Centre for Burns Research, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.,Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
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Sánchez-García A, Vanaclocha N, García-Vilariño E, Salmerón-González E, Vicente-Pardo A, Pérez-Del Caz MD. Use of the Meek Micrografting Technique for Coverage of Extensive Burns: A Case Report. Plast Surg Nurs 2019; 39:44-47. [PMID: 31136557 DOI: 10.1097/psn.0000000000000262] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Traditional mechanical meshing methods have generally been the first-choice treatment of patients with extensive burns (>20% total body surface area). The limited availability of donor areas has sparked the development of resources such as the Meek micrografting technique. We present the case of a 43-year-old male patient with an 85% total body surface area third-degree flame burn. After the initial stabilization, there was a need for rapid and effective coverage of as much burned surface as possible. Thus, Meek micrografting was chosen. Its results in this patient are presented and discussed. The Meek technique is a useful method of skin expansion. It is indicated in patients with extensive burns, where donor areas are limited. The high rates of graft take and quality of the coverage attained make this technique appealing, albeit at a greater economic cost than with traditional mechanical meshing methods.
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Affiliation(s)
- Alberto Sánchez-García
- Alberto Sánchez-García, MD, is a plastic surgeon at Plastic and Reconstructive Surgery Department, University and Polytechnic Hospital La Fe, Valencia, Spain. Nieves Vanaclocha, MD, is a plastic surgeon at Plastic and Reconstructive Sur-gery Department, University and Polytechnic Hospital La Fe, Valencia, Spain. Elena García-Vilariño, MD, is a plastic surgeon at Plastic and Reconstructive Surgery Department, University and Polytechnic Hospital La Fe, Valencia, Spain. Enrique Salmerón-González, MD, is a plastic surgeon at Plastic and Reconstructive Surgery Department, University and Polytechnic Hospital La Fe, Valencia, Spain. Andrea Vicente-Pardo, MD, is a plastic surgeon at Plastic and Reconstructive Surgery Department, University and Polytechnic Hospital La Fe, Valencia, Spain. María D Pérez-del Caz, MD, is at the head of the Burn Care Unit at University and Polytechnic Hospital La Fe, Valencia, Spain
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Determination of risk factors for burn mortality based on a regional population study in Taiwan. Burns 2018; 44:1591-1601. [DOI: 10.1016/j.burns.2018.02.030] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 02/26/2018] [Accepted: 02/27/2018] [Indexed: 11/24/2022]
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Lethal area 50 percent (LA50) or standardized mortality ratio (SMR): Which one is more conclusive? Burns 2018; 44:1468-1474. [DOI: 10.1016/j.burns.2018.04.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 03/30/2018] [Accepted: 04/05/2018] [Indexed: 11/17/2022]
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Perioperative Research into Memory (PRiMe): Cognitive impairment following a severe burn injury and critical care admission, part 1. Burns 2018; 44:1167-1178. [PMID: 29752016 DOI: 10.1016/j.burns.2018.04.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 03/20/2018] [Accepted: 04/10/2018] [Indexed: 12/14/2022]
Abstract
INTRODUCTION An investigation into long-term cognitive impairment and Quality of Life (QoL) after severe burns. METHODS A proof of principle, cohort design, prospective, observational clinical study. Patients with severe burns (>15% TBSA) admitted to Burns ICU for invasive ventilation were recruited for psychocognitive assessment with a convenience sample of age and sex-matched controls. Participants completed psychological and QoL questionnaires, the Cogstate® electronic battery, Hopkins Verbal Learning, Verbal Fluency and Trail making tasks. RESULTS 15 patients (11M, 4F; 41±14 years; TBSA 38.4%±18.5) and comparators (11M, 4F; 40±13 years) were recruited. Burns patients reported worse QoL (Neuro-QoL Short Form v2, patient 30.1±8.2, control 38.7±3.2, p=0.0004) and cognitive function (patient composite z-score 0.01, IQR -0.11 to 0.33, control 0.13, IQR 0.47-0.73, p=0.02). Compared to estimated premorbid FSIQ, patients dropped an equivalent of 8 IQ points (p=0.002). Cognitive function negatively correlated with burn severity (rBaux score, p=0.04). QoL strongly correlated with depressive symptoms (Rho=-0.67, p=0.009) but not cognitive function. CONCLUSIONS Severe burns injuries are associated with a significant, global, cognitive deficit. Patients also report worse QoL, depression and post-traumatic stress. Perceived QoL from cognitive impairment was more closely associated with depression than cognitive impairment.
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Pompermaier L, Steinvall I, Elmasry M, Thorfinn J, Sjöberg F. Burned patients who die from causes other than the burn affect the model used to predict mortality: a national exploratory study. Burns 2018; 44:280-287. [DOI: 10.1016/j.burns.2017.07.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 05/09/2017] [Accepted: 07/14/2017] [Indexed: 11/25/2022]
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Ehrl D, Heidekrueger PI, Ninkovic M, Broer PN. Effect of primary admission to burn centers on the outcomes of severely burned patients. Burns 2018; 44:524-530. [PMID: 29463463 DOI: 10.1016/j.burns.2018.01.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Revised: 12/23/2017] [Accepted: 01/04/2018] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Burns represent a special form of severe trauma. Due to long hospitalization, rehabilitation, and extensive scar treatment, severe burn injuries rank among the most expensive traumatic injuries regarding associated health care costs. The presented single-burn-center experiences evaluated the effects of primary versus secondary burn intensive care unit (BICU) admissions on outcomes in severely burned patients. METHODS Within 30 months, 186 patients were admitted to the BICU. The cases were divided into two groups depending on their admission type: "primary" vs. "secondary". All patients were analyzed retrospectively regarding the need for surgery, encountered complications, time of hospitalization and overall survival. RESULTS The incidence of primary BICU-admissions was 65.1%. Both patient groups were comparable regarding demographics, comorbidities, % TBSA burn, associated inhalation injuries, ABSI scores and intubation rates (p>0.05). Both groups received similar numbers of operations and had overall comparable mortality rates (p>0.05). However, duration until first burn excision, length of ventilation, as well as BICU- and overall hospital length of stay were significantly shorter in the "primary"- compared to the "secondary" group (p<0.05). CONCLUSION Several burn societies have published precise criteria of when a patient needs to be referred to a burn center. In the presented series, patients that were primarily treated at a BICU showed significantly better outcomes regarding several parameters. In order to further optimize treatment of burn patients it therefore appears that precise initial assessment and if appropriate respective primary transport to dedicated burn centers needs to be re-emphasized, especially among first- and emergency care providers.
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Affiliation(s)
- Denis Ehrl
- Department of Hand, Plastic and Aesthetic Surgery, Ludwig-Maximilians-University Munich, Germany; Department of Plastic, Reconstructive, Hand and Burn Surgery, Bogenhausen Academic Teaching Hospital, Munich, Germany.
| | - Paul I Heidekrueger
- Department of Plastic, Reconstructive, Hand and Burn Surgery, Bogenhausen Academic Teaching Hospital, Munich, Germany; Department of Plastic, Hand, and Reconstructive Surgery, University Medical Center, Regensburg, Germany
| | - Milomir Ninkovic
- Department of Plastic, Reconstructive, Hand and Burn Surgery, Bogenhausen Academic Teaching Hospital, Munich, Germany
| | - P Niclas Broer
- Department of Plastic, Reconstructive, Hand and Burn Surgery, Bogenhausen Academic Teaching Hospital, Munich, Germany
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Kuo G, Lee CC, Yang SY, Hsiao YC, Chuang SS, Chang SW, Tu KH, Fan PC, Tian YC, Chen YC, Chang CH. Hyperphosphatemia is associated with high mortality in severe burns. PLoS One 2018; 13:e0190978. [PMID: 29315336 PMCID: PMC5760089 DOI: 10.1371/journal.pone.0190978] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 12/23/2017] [Indexed: 12/25/2022] Open
Abstract
Introduction Phosphate level is often deranged during acute illness, regardless of the presence of kidney injury or not. A few studies described that hypophosphatemia may associated with outcome in patients admitted to the burn unit, but the literatures for hyperphosphatemia is limited. Our study aims to evaluate if hyperphosphatemia, one of the sign of severe tissue damage or kidney injury, will associate with mortality of patients with severe burns. Materials and methods The study was a post hoc analysis of prospectively collected data from patients admitted to the burn unit between September 2006 and December 2011. Patients were stratified into normophosphatemic or hyperphosphatemic group by baseline plasma phosphate level. The primary endpoint is 90-day mortality. Results Total 301 patients were included (hyperphosphatemia: n = 52; normophosphatemia: n = 249). The hyperphosphatemic group had lower Glasgow Coma Scale, mean arterial blood pressure, hemoglobin level, albumin, and higher TBSA of burns, APACHE II score, ABSI score, Acute kidney injury (AKI), and creatinine. The 90-day mortality was higher in the hyperphosphatemic group than in the normal group (53.8% vs 18.1%, P < .001) and this difference was still significant when adjusting for several confounding factors (hazard ratio, 2.05; 95% CI, 1.17–3.59). Multivariable Cox analysis showed risk factors of mortality included TBSA of burns, hyperphosphatemia, reduced urine output, and APACHE II score. Conclusions Our study found in addition to TBSA of burns and inhalation injury, baseline hyperphosphatemia in patients with severe burns is also associated with higher mortality.
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Affiliation(s)
- George Kuo
- Kidney Research Center, Department of Nephrology, Change Gung Memorial Hospital, Linkou branch, Taoyuan, Taiwan
| | - Cheng-Chia Lee
- Kidney Research Center, Department of Nephrology, Change Gung Memorial Hospital, Linkou branch, Taoyuan, Taiwan
| | - Shih-Yi Yang
- Linkou Burn Center, Department of Plastic Surgery, Chang Gung Memorial Hospital, Taipei, Taiwan
| | - Yen-Chang Hsiao
- Linkou Burn Center, Department of Plastic Surgery, Chang Gung Memorial Hospital, Taipei, Taiwan
| | - Shiow-Shuh Chuang
- Linkou Burn Center, Department of Plastic Surgery, Chang Gung Memorial Hospital, Taipei, Taiwan
| | - Su-Wei Chang
- Clinical Informatics and Medical Statistics Research Center, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Division of Allergy, Asthma, and Rheumatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Kun-Hua Tu
- Kidney Research Center, Department of Nephrology, Change Gung Memorial Hospital, Linkou branch, Taoyuan, Taiwan
| | - Pei-Chun Fan
- Kidney Research Center, Department of Nephrology, Change Gung Memorial Hospital, Linkou branch, Taoyuan, Taiwan
- Graduate Institute of Clinical Medicine Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ya-Chung Tian
- Kidney Research Center, Department of Nephrology, Change Gung Memorial Hospital, Linkou branch, Taoyuan, Taiwan
- Graduate Institute of Clinical Medicine Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yung-Chang Chen
- Graduate Institute of Clinical Medicine Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Nephrology, Chang Gung Memorial Hospital, Keelung Branch, Keelung, Taiwan
| | - Chih-Hsiang Chang
- Kidney Research Center, Department of Nephrology, Change Gung Memorial Hospital, Linkou branch, Taoyuan, Taiwan
- Graduate Institute of Clinical Medicine Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- * E-mail: ,
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Keshavarzi A, Kardeh S, Pourdavood A, Mohamadpour M, Dehghankhalili M. Determinants of the Lethal Area 50 Index (LA50) in Burn Patients Admitted to a Tertiary Referral Burn Center in Southern Iran. Bull Emerg Trauma 2018; 6:59-63. [PMID: 29379811 DOI: 10.29252/beat-060109] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Objective To evaluate the lethal area 50 (LA50) and determinants of mortality in burn patients admitted to a single burn center. Methods This retrospective cross-sectional study was conducted in a tertiary burn center affiliated with Shiraz University of Medical Sciences, Shiraz, Iran, during a 1-year period from 2015 to 2016. To determine prognostic factors in fatal burns, medical records of eligible burn patients were reviewed for demographic and clinical variables, as well as patient outcome. Also, LA50 was calculated using Probit analysis. Results Overall 559 patients with the mean age of 27.2±23.65 years and including 343 (61.4%) males and 216 (38.6%) females were enrolled in this study. The average burn TBSA% was 31.38±24.41% (1-100%). Duration of hospital stay ranged from 1 to 67 days (15.11±10.64). With 93 expired patients, the mortality rate was calculated to be 16.6%. The total LA50 was 66.55% (58.4-79.3). Fire was the most common cause of burn injury. Conclusion Compared to developed countries, in our burn center the LA50 and survival rate of burn patients are lower. This indicates an urgent need for prompt attention in order to improve current policies regarding this public health issue to reduce mortality.
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Affiliation(s)
| | - Sina Kardeh
- Burn and Wound Healing Research Center, Shiraz University of Medical Science, Shiraz, Iran.,Student Research Committee, Shiraz University of Medical Science, Shiraz, Iran.,Cellular and Molecular Medicine Student Research Group, School of Medicine, Shiraz University of Medical Science, Shiraz, Iran
| | - Amirhosein Pourdavood
- Clinical Research Unit, Shafa Hospital, Kerman University of Medical Sciences, Kerman, Iran
| | - Mana Mohamadpour
- Burn and Wound Healing Research Center, Shiraz University of Medical Science, Shiraz, Iran
| | - Maryam Dehghankhalili
- Burn and Wound Healing Research Center, Shiraz University of Medical Science, Shiraz, Iran.,Student Research Committee, Shiraz University of Medical Science, Shiraz, Iran
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Ter Horst B, Chouhan G, Moiemen NS, Grover LM. Advances in keratinocyte delivery in burn wound care. Adv Drug Deliv Rev 2018; 123:18-32. [PMID: 28668483 PMCID: PMC5764224 DOI: 10.1016/j.addr.2017.06.012] [Citation(s) in RCA: 126] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 06/14/2017] [Accepted: 06/23/2017] [Indexed: 12/19/2022]
Abstract
This review gives an updated overview on keratinocyte transplantation in burn wounds concentrating on application methods and future therapeutic cell delivery options with a special interest in hydrogels and spray devices for cell delivery. To achieve faster re-epithelialisation of burn wounds, the original autologous keratinocyte culture and transplantation technique was introduced over 3 decades ago. Application types of keratinocytes transplantation have improved from cell sheets to single-cell solutions delivered with a spray system. However, further enhancement of cell culture, cell viability and function in vivo, cell carrier and cell delivery systems remain themes of interest. Hydrogels such as chitosan, alginate, fibrin and collagen are frequently used in burn wound care and have advantageous characteristics as cell carriers. Future approaches of keratinocyte transplantation involve spray devices, but optimisation of application technique and carrier type is necessary.
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Affiliation(s)
- Britt Ter Horst
- School of Chemical Engineering, University of Birmingham, Edgbaston B15 2TT, United Kingdom; University Hospital Birmingham Foundation Trust, Burns Centre, Mindelsohn Way, B15 2TH Birmingham, United Kingdom
| | - Gurpreet Chouhan
- School of Chemical Engineering, University of Birmingham, Edgbaston B15 2TT, United Kingdom
| | - Naiem S Moiemen
- University Hospital Birmingham Foundation Trust, Burns Centre, Mindelsohn Way, B15 2TH Birmingham, United Kingdom
| | - Liam M Grover
- School of Chemical Engineering, University of Birmingham, Edgbaston B15 2TT, United Kingdom.
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Fan X, Ma B, Zeng D, Fang X, Li H, Xiao S, Wang G, Tang H, Xia Z. Burns in a major burns center in East China from 2005 to 2014: Incidence and outcome. Burns 2017; 43:1586-1595. [DOI: 10.1016/j.burns.2017.01.033] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 01/21/2017] [Accepted: 01/24/2017] [Indexed: 11/26/2022]
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Young A, Brookes S, Rumsey N, Blazeby J. Agreement on what to measure in randomised controlled trials in burn care: study protocol for the development of a core outcome set. BMJ Open 2017; 7:e017267. [PMID: 28669969 PMCID: PMC5734442 DOI: 10.1136/bmjopen-2017-017267] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 04/27/2017] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION In 2004, nearly 11 million severely burn-injured patients required medical care worldwide. Burns cause prolonged hospitalisation and long-term disability. Although mortality has been reduced, morbidity remains significant.Burn care is costly and decision-making is challenging. A range of procedures are performed at different times after injury; new technology is emerging and alternate care pathways are regularly introduced. Data to guide evidence-based decision-making are lacking. Researchers use different outcomes to assess recovery, so it is not possible to combine trial information to draw meaningful conclusions. Early recovery measures include length of hospital stay, healing time and treatment complications. Longer-term outcomes include issues with function, cosmesis and psychological health. Reporting an agreed set of the most important outcomes (core outcome set (COS)) in randomised controlled trials (RCTs) will allow effective evidence synthesis to support clinical decisions. Patient input will ensure relevance. METHODS AND ANALYSIS The aim is to produce a burn COS for RCT reporting. A long list of outcomes will be identified through systematic reviews of clinical and patient-reported outcomes. Additional outcomes will be identified from interviews with patients over 10 years, parents of children of any age and multidisciplinary professionals. A two-stage modified Delphi exercise will be undertaken to prioritise and condense the list, with patients (n=150) at different stages of recovery. We will also include nursing, therapy (n=100) and medical staff (n=100). A reduced list will be taken to consensus meetings with families and clinical staff to achieve a final COS. ETHICS AND DISSEMINATION A COS will reduce outcome reporting heterogeneity in burn care research, allowing more effective use of research funding and facilitating evidence synthesis and evidence-based clinical decision-making. Stakeholders will include journal editors, health commissioners, researchers, patients and professionals. The study has ethical approval and is registered with Core Outcome Measures in Effectiveness Trials Initiative (http://www.comet-initiative.org/studies/details/798?result=true).
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Affiliation(s)
- Amber Young
- School of Social and Community Medicine, Faculty of Health Sciences, University of Bristol, Bristol, UK
| | - Sara Brookes
- School of Social and Community Medicine, Faculty of Health Sciences, University of Bristol, Bristol, UK
| | - Nichola Rumsey
- Centre for Appearance Research, Department of Health & Social Sciences, Faculty of Health & Applied Sciences, Frenchay Campus, University of the West of England, Frenchay Campus, Bristol, UK
| | - Jane Blazeby
- School of Social and Community Medicine, Faculty of Health Sciences, University of Bristol, Bristol, UK
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Changes in novel haematological parameters following thermal injury: A prospective observational cohort study. Sci Rep 2017; 7:3211. [PMID: 28607467 PMCID: PMC5468303 DOI: 10.1038/s41598-017-03222-w] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 04/24/2017] [Indexed: 12/15/2022] Open
Abstract
The mortality caused by sepsis is high following thermal injury. Diagnosis is difficult due to the ongoing systemic inflammatory response. Previous studies suggest that cellular parameters may show promise as diagnostic markers of sepsis. The aim of this study was to evaluate the effect of thermal injury on novel haematological parameters and to study their association with clinical outcomes. Haematological analysis was performed using a Sysmex XN-1000 analyser on blood samples acquired on the day of the thermal injury to 12 months post-injury in 39 patients (15–95% TBSA). Platelet counts had a nadir at day 3 followed by a rebound thrombocytosis at day 21, with nadir values significantly lower in septic patients. Measurements of extended neutrophil parameters (NEUT-Y and NEUT-RI) demonstrated that septic patients had significantly higher levels of neutrophil nucleic acid content. A combination of platelet impedance count (PLT-I) and NEUT-Y at day 3 post-injury exhibited good discriminatory power for the identifying septic patients (AUROC = 0.915, 95% CI [0.827, 1.000]). Importantly, the model had improved performance when adjusted for mortality with an AUROC of 0.974 (0.931, 1.000). A combination of PLT-I and NEUT-Y show potential for the early diagnosis of sepsis post-burn injury. Importantly, these tests can be performed rapidly and require a small volume of whole blood highlighting their potential utility in clinical practice.
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Abdelrahman I, Elmasry M, Steinvall I, Fredrikson M, Sjoberg F. Improvement in mortality at a National Burn Centre since 2000: Was it the result of increased resources? Medicine (Baltimore) 2017; 96:e6727. [PMID: 28640072 PMCID: PMC5484180 DOI: 10.1097/md.0000000000006727] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The aim of this study was to find out whether the charging costs (calculated using interventional burn score) increased as mortality decreased.During the last 2 decades, mortality has declined significantly in the Linköping Burn Centre. The burn score that we use has been validated as a measure of workload and is used to calculate the charging costs of each burned patient.We compared the charging costs and mortality in 2 time periods (2000-2007 and 2008-2015). A total of 1363 admissions were included. We investigated the change in the burn score, as a surrogate for total costs per patient. Multivariable regression was used to analyze risk-adjusted mortality and burn score.The median total body surface area % (TBSA%) was 6.5% (10-90 centile 1.0-31.0), age 33 years (1.3-72.2), duration of stay/ TBSA% was 1.4 days (0.3-5.3), and 960 (70%) were males. Crude mortality declined from 7.5% in 2000-2007 to 3.4% in 2008-2015, whereas the cumulative burn score was not increased (P = .08). Regression analysis showed that risk-adjusted mortality decreased (odds ratio 0.42, P = .02), whereas the adjusted burn score did not change (P = .14, model R 0.86).Mortality decreased but there was no increase in the daily use of resources as measured by the interventional burn score. The data suggest that the improvements in quality obtained have been achieved within present routines for care of patients (multidisciplinary/orientated to patients' safety).
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Affiliation(s)
- Islam Abdelrahman
- Plastic Surgery Unit, Surgery Department, Suez Canal University, Ismailia, Egypt
- The Burn Centre, Department of Plastic Surgery, Hand Surgery, and Burns
- Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Moustafa Elmasry
- Plastic Surgery Unit, Surgery Department, Suez Canal University, Ismailia, Egypt
- The Burn Centre, Department of Plastic Surgery, Hand Surgery, and Burns
- Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Ingrid Steinvall
- The Burn Centre, Department of Plastic Surgery, Hand Surgery, and Burns
- Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Mats Fredrikson
- Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Folke Sjoberg
- The Burn Centre, Department of Plastic Surgery, Hand Surgery, and Burns
- Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
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Neutrophil Dysfunction, Immature Granulocytes, and Cell-free DNA are Early Biomarkers of Sepsis in Burn-injured Patients. Ann Surg 2017; 265:1241-1249. [DOI: 10.1097/sla.0000000000001807] [Citation(s) in RCA: 110] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Jiang Q, Chen ZH, Wang SB, Chen XD. Comparative effectiveness of different wound dressings for patients with partial-thickness burns: study protocol of a systematic review and a Bayesian framework network meta-analysis. BMJ Open 2017; 7:e013289. [PMID: 28336737 PMCID: PMC5372024 DOI: 10.1136/bmjopen-2016-013289] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Selecting a suitable wound dressing for patients with partial-thickness burns (PTBs) is important in wound care. However, the comparative effectiveness of different dressings has not been studied. We report the protocol of a network meta-analysis designed to combine direct and indirect evidence of wound dressings in the management of PTB. METHODS AND ANALYSIS We will search for randomised controlled trials (RCTs) evaluating the wound-healing effect of a wound dressing in the management of PTB. Searches will be conducted in MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, the Cochrane Wounds Group Specialised Register and CINAHL. A comprehensive search strategy is developed to retrieve articles reporting potentially eligible RCTs. Besides, we will contact the experts in the field and review the conference proceedings to locate non-published studies. The reference lists of articles will be reviewed for any candidate studies. Two independent reviewers will screen titles and abstracts of the candidate articles. All eligible RCTs will be obtained in full text to perform a review. Disagreement on eligibility of an RCT will be solved by group discussion. The information of participants, interventions, comparisons and outcomes from included RCTs will be recorded and summarised. The primary outcome is time to complete wound healing. Secondary outcomes include the proportion of burns completely healed at the end of treatment, change in wound surface area at the end of treatment, incidence of adverse events, etc. ETHICS AND DISSEMINATION The result of this review will provide evidence for the comparative effectiveness of different wound dressings in the management of PTB. It will also facilitate decision-making in choosing a suitable wound dressing. We will disseminate the review through a peer-review journal and conference abstracts or posters. TRIAL REGISTRATION NUMBER PROSPERO CRD42016041574; Pre-results.
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Affiliation(s)
- Qiong Jiang
- Fujian Burns Institute, Union Hospital, Fujian Medical University, Fuzhou, China
| | - Zhao-Hong Chen
- Fujian Burns Institute, Union Hospital, Fujian Medical University, Fuzhou, China
| | - Shun-Bin Wang
- Fujian Burns Institute, Union Hospital, Fujian Medical University, Fuzhou, China
| | - Xiao-Dong Chen
- Fujian Burns Institute, Union Hospital, Fujian Medical University, Fuzhou, China
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Long-term survival after burns in a Swedish population. Burns 2016; 43:157-161. [PMID: 27613474 DOI: 10.1016/j.burns.2016.07.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2016] [Revised: 07/14/2016] [Accepted: 07/19/2016] [Indexed: 11/23/2022]
Abstract
INTRODUCTION As widely reported, the progress in burn care during recent decades has reduced the hospital mortality. The effect of the burns on long-term outcome has not received so much attention, and more study is indicated. The aim of this retrospective study was to investigate the long-time survival among patients who had been treated for burns. METHODS We studied 1487 patients who were discharged alive from the Linköping University Hospital Burn Centre during the period 1993 until the end of December 2012. We used Cox's regression analysis to study the effect of burns on long-term survival after adjustment for different factors. RESULTS Age and a full-thickness burn were significantly associated with mortality after discharge (p<0.001), whereas percentage of total body surface area burned (TBSA %), need for mechanical ventilation, and gender were not. Less than 1% of the patients with burns (13/1487) died within 30 days of discharge and a total of 176/1487 (12%) died during follow-up. CONCLUSION Age and full-thickness burns reduce the long-time survival after discharge from the Burn Centre, whereas the effect of TBSA% and need for artificial ventilation ends with discharge.
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Sadideen H, Goutos I, Kneebone R. Burns education: The emerging role of simulation for training healthcare professionals. Burns 2016; 43:34-40. [PMID: 27576935 DOI: 10.1016/j.burns.2016.07.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 06/10/2016] [Accepted: 07/14/2016] [Indexed: 11/18/2022]
Abstract
Burns education appears to be under-represented in UK undergraduate curricula. However current postgraduate courses in burns education provide formal training in resuscitation and management. Simulation has proven to be a powerful modality to advance surgical training in both technical and non-technical skills. We present a literature review that summarises the format of current burns education, and provides detailed insight into historic, current and novel advances in burns simulation for both technical and non-technical skills, that can be used to augment surgical training. Addressing the economic and practical limitations of current immersive surgical simulation is important, and this review proposes future directions for integration of innovative simulation strategies into training curricula.
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Affiliation(s)
- Hazim Sadideen
- Department of Surgery and Cancer, Imperial College London, Chelsea and Westminster Hospital, London SW10 9NH, UK.
| | - Ioannis Goutos
- Centre for Cutaneous Research, Blizard institute, Queen Mary University of London, 4 Newark Street, London E1 2AT
| | - Roger Kneebone
- Department of Surgery and Cancer, Imperial College London, Chelsea and Westminster Hospital, London SW10 9NH, UK
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Hardwicke J. The influence of outcomes on the provision and practice of burn care. Burns 2016; 42:307-15. [DOI: 10.1016/j.burns.2015.07.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2015] [Accepted: 07/06/2015] [Indexed: 01/10/2023]
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Steinvall I, Elmasry M, Fredrikson M, Sjoberg F. Standardised mortality ratio based on the sum of age and percentage total body surface area burned is an adequate quality indicator in burn care: An exploratory review. Burns 2015; 42:28-40. [PMID: 26700877 DOI: 10.1016/j.burns.2015.10.032] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Revised: 10/28/2015] [Accepted: 10/29/2015] [Indexed: 11/27/2022]
Abstract
Standardised Mortality Ratio (SMR) based on generic mortality predicting models is an established quality indicator in critical care. Burn-specific mortality models are preferred for the comparison among patients with burns as their predictive value is better. The aim was to assess whether the sum of age (years) and percentage total body surface area burned (which constitutes the Baux score) is acceptable in comparison to other more complex models, and to find out if data collected from a separate burn centre are sufficient for SMR based quality assessment. The predictive value of nine burn-specific models was tested by comparing values from the area under the receiver-operating characteristic curve (AUC) and a non-inferiority analysis using 1% as the limit (delta). SMR was analysed by comparing data from seven reference sources, including the North American National Burn Repository (NBR), with the observed mortality (years 1993-2012, n=1613, 80 deaths). The AUC values ranged between 0.934 and 0.976. The AUC 0.970 (95% CI 0.96-0.98) for the Baux score was non-inferior to the other models. SMR was 0.52 (95% CI 0.28-0.88) for the most recent five-year period compared with NBR based data. The analysis suggests that SMR based on the Baux score is eligible as an indicator of quality for setting standards of mortality in burn care. More advanced modelling only marginally improves the predictive value. The SMR can detect mortality differences in data from a single centre.
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Affiliation(s)
- Ingrid Steinvall
- The Burn Centre, Department of Plastic Surgery, Hand Surgery, and Burns, Linköping University, Linköping, Sweden; Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
| | - Moustafa Elmasry
- The Burn Centre, Department of Plastic Surgery, Hand Surgery, and Burns, Linköping University, Linköping, Sweden; Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden; The Plastic Surgery Unit, Surgery Department, Suez Canal University, Ismailia, Egypt
| | - Mats Fredrikson
- Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Folke Sjoberg
- The Burn Centre, Department of Plastic Surgery, Hand Surgery, and Burns, Linköping University, Linköping, Sweden; Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden; Department of Anaesthesiology and Intensive Care, Linköping University, Linköping, Sweden
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Inclusion of coexisting morbidity in a TBSA% and age based model for the prediction of mortality after burns does not increase its predictive power. Burns 2015; 41:1868-1876. [PMID: 26507519 DOI: 10.1016/j.burns.2015.09.017] [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: 04/02/2015] [Revised: 09/09/2015] [Accepted: 09/23/2015] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Several models for predicting mortality have been developed for patients with burns, and the most commonly used are based on age and total body surface area (TBSA%). They often show good predictive precision as depicted by high values for area under the receiver operating characteristic curves (AUC). However the effect of coexisting morbidity on such prediction models has not to our knowledge been thoroughly examined. We hypothesised that adding it to a previously published model (based on age, TBSA%, full thickness burns, gender, and need for mechanical ventilation) would further improve its predictive power. METHODS We studied 772 patients admitted during the period 1997-2008 to the Linköping University Hospital, National Burn Centre with any type of burns. We defined coexisting morbidity as any of the medical conditions listed in the Charlson list, as well as psychiatric disorders or drug or alcohol misuse. We added coexisting medical conditions to the model for predicting mortality (age, TBSA%, and need for mechanical ventilation) to determine whether it improved the model as assessed by changes in deviances between the models. RESULTS Mean (SD) age and TBSA% was 35 (26) years and 13 (17) %, respectively. Among 725 patients who survived, 105 (14%) had one or more coexisting condition, compared with 28 (60%) among those 47 who died. The presence of coexisting conditions increased with age (p<0.001) among patients with burns. The AUC of the mortality prediction model in this study, based on the variables age, TBSA%, and need for mechanical ventilation was 0.980 (n=772); after inclusion of coexisting morbidity in the model, the AUC improved only marginally, to 0.986. The model was not significantly better either. CONCLUSION Adding coexisting morbidity to a model for prediction of mortality after a burn based on age, TBSA%, and the need for mechanical ventilation did not significantly improve its predictive value. This is probably because coexisting morbidity is automatically adjusted for by age in the original model.
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Wearn CM, Hardwicke J, Moiemen N. Burns in the elderly: Mortality is still a relevant outcome. Burns 2015; 41:1617-8. [PMID: 26382825 DOI: 10.1016/j.burns.2015.08.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Accepted: 08/25/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Christopher M Wearn
- Healing Foundation Centre for Burns Research, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham B15 2WB, UK; University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - Joseph Hardwicke
- Healing Foundation Centre for Burns Research, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham B15 2WB, UK; University of Birmingham, Edgbaston, Birmingham B15 2TT, UK.
| | - Naiem Moiemen
- Healing Foundation Centre for Burns Research, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham B15 2WB, UK; University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
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Small C, Stone R, Pilsbury J, Bowden M, Bion J. Virtual restorative environment therapy as an adjunct to pain control during burn dressing changes: study protocol for a randomised controlled trial. Trials 2015; 16:329. [PMID: 26242401 PMCID: PMC4526294 DOI: 10.1186/s13063-015-0878-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 07/17/2015] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND The pain of a severe burn injury is often characterised by intense background pain, coupled with severe exacerbations associated with essential procedures such as dressing changes. The experience of pain is affected by patients' psychological state and can be enhanced by the anxiety, fear and distress caused by environmental and visual inputs. Virtual Reality (VR) distraction has been used with success in areas such as burns, paediatrics and oncology. The underlying principle of VR is that attention is diverted from the painful stimulus by the use of engaging, dynamic 3D visual content and associated auditory stimuli. Functional magnetic resonance imaging (fMRI) studies undertaken during VR distraction from experimental pain have demonstrated enhancement of the descending cortical pain-control system. METHODS/DESIGN The present study will evaluate the feasibility of introducing a novel VR system to the Burns Unit at the Queen Elizabeth Hospital Birmingham for dressing changes: virtual restorative environment therapy (VRET). The study will also explore the system's impact on pain during and after the dressing changes compared to conventional analgesia for ward-based burn dressing changes. A within-subject crossover design will be used to compare the following three conditions: 1. Interactive VRET plus conventional analgesics. 2. Passive VRET with conventional analgesics. 3. Conventional analgesics alone. Using the Monte Carlo method, and on the basis of previous local audit data, a sample size of 25 will detect a clinically significant 33 % reduction in worst pain scores experienced during dressing changes. DISCUSSION The study accrual rate is currently slower than predicted by previous audits of admission data. A review of the screening log has found that recruitment has been limited by the nature of burn care, the ability of burn inpatients to provide informed consent and the ability of patients to use the VR equipment. Prior to the introduction of novel interactive technologies for patient use, the characteristics and capabilities of the target population needs to be evaluated, to ensure that the interface devices and simulations are usable. TRIAL REGISTRATION Current Controlled Trials ISRCTN23330756 . Date of Registration 25 February 2014.
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Affiliation(s)
- Charlotte Small
- School of Clinical and Experimental Medicine, The Medical School, Vincent Drive, University of Birmingham, Birmingham, B15 2TT, UK.
| | - Robert Stone
- School of Electronic, Electrical and Systems Engineering, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
| | - Jane Pilsbury
- Anaesthetic Department, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, B15 2WB, UK.
| | - Michael Bowden
- Anaesthetic Department, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, B15 2WB, UK.
| | - Julian Bion
- The Medical School, Vincent Drive, University of Birmingham, Birmingham, B15 2TT, UK.
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The Birmingham Burn Centre archive: A photographic history of post-war burn care in the United Kingdom. Burns 2015; 41:680-8. [DOI: 10.1016/j.burns.2015.01.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Accepted: 01/12/2015] [Indexed: 11/16/2022]
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Wearn C, Hardwicke J, Kitsios A, Siddons V, Nightingale P, Moiemen N. Outcomes of burns in the elderly: revised estimates from the Birmingham Burn Centre. Burns 2015; 41:1161-8. [PMID: 25983286 DOI: 10.1016/j.burns.2015.04.008] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Revised: 02/22/2015] [Accepted: 04/17/2015] [Indexed: 11/18/2022]
Abstract
Outcomes after burn have continued to improve over the last 70 years in all age groups including the elderly. However, concerns have been raised that survival gains have not been to the same magnitude in elderly patients compared to younger age groups. The aims of this study were to analyze the recent outcomes of elderly burn injured patients admitted to the Birmingham Burn Centre, compare data with a historical cohort and published data from other burn centres worldwide. A retrospective review was conducted of all patients ≥65 years of age, admitted to our centre with cutaneous burns, between 2004 and 2012. Data was compared to a previously published historical cohort (1999-2003). 228 patients were included. The observed mortality for the study group was 14.9%. The median age of the study group was 79 years, the male to female ratio was 1:1 and median Total Body Surface Area (TBSA) burned was 5%. The incidence of inhalation injury was 13%. Median length of stay per TBSA burned for survivors was 2.4 days/% TBSA. Mortality has improved in all burn size groups, but differences were highly statistically significant in the medium burn size group (10-20% TBSA, p≤0.001). Burn outcomes in the elderly have improved over the last decade. This reduction has been impacted by a reduction in overall injury severity but is also likely due to general improvements in burn care, improved infrastructure, implementation of clinical guidelines and increased multi-disciplinary support, including Geriatric physicians.
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Affiliation(s)
- Christopher Wearn
- Healing Foundation Centre for Burns Research, University Hospital Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham B15 2WB, UK; University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - Joseph Hardwicke
- Healing Foundation Centre for Burns Research, University Hospital Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham B15 2WB, UK; University of Birmingham, Edgbaston, Birmingham B15 2TT, UK.
| | | | | | - Peter Nightingale
- Wellcome Trust Clinical Research Facility Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham B15 2WB, UK
| | - Naiem Moiemen
- Healing Foundation Centre for Burns Research, University Hospital Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham B15 2WB, UK; University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
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Lord JM, Midwinter MJ, Chen YF, Belli A, Brohi K, Kovacs EJ, Koenderman L, Kubes P, Lilford RJ. The systemic immune response to trauma: an overview of pathophysiology and treatment. Lancet 2014; 384:1455-65. [PMID: 25390327 PMCID: PMC4729362 DOI: 10.1016/s0140-6736(14)60687-5] [Citation(s) in RCA: 481] [Impact Index Per Article: 48.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Improvements in the control of haemorrhage after trauma have resulted in the survival of many people who would otherwise have died from the initial loss of blood. However, the danger is not over once bleeding has been arrested and blood pressure restored. Two-thirds of patients who die following major trauma now do so as a result of causes other than exsanguination. Trauma evokes a systemic reaction that includes an acute, non-specific, immune response associated, paradoxically, with reduced resistance to infection. The result is damage to multiple organs caused by the initial cascade of inflammation aggravated by subsequent sepsis to which the body has become susceptible. This Series examines the biological mechanisms and clinical implications of the cascade of events caused by large-scale trauma that leads to multiorgan failure and death, despite the stemming of blood loss. Furthermore, the stark and robust epidemiological finding--namely, that age has a profound influence on the chances of surviving trauma irrespective of the nature and severity of the injury--will be explored. Advances in our understanding of the inflammatory response to trauma, the impact of ageing on this response, and how this information has led to new and emerging treatments aimed at combating immune dysregulation and reduced immunity after injury will also be discussed.
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Affiliation(s)
- Janet M Lord
- MRC-ARUK Centre for Musculoskeletal Ageing Research, School of Immunity and Infection, University of Birmingham, Birmingham, UK; NIHR Surgical Reconstruction and Microbiology Research Centre, University of Birmingham, Birmingham, UK
| | - Mark J Midwinter
- NIHR Surgical Reconstruction and Microbiology Research Centre, University of Birmingham, Birmingham, UK; School of Health and Population Sciences, University of Birmingham, Birmingham, UK
| | - Yen-Fu Chen
- NIHR Surgical Reconstruction and Microbiology Research Centre, University of Birmingham, Birmingham, UK; School of Health and Population Sciences, University of Birmingham, Birmingham, UK; Division of Health Sciences, University of Warwick, Coventry, UK
| | - Antonio Belli
- NIHR Surgical Reconstruction and Microbiology Research Centre, University of Birmingham, Birmingham, UK; Neurotrauma and Neurodegeneration Section, University of Birmingham, Birmingham, UK
| | - Karim Brohi
- Centre for Trauma Sciences, Blizard Institute, Queen Mary University of London, London, UK
| | - Elizabeth J Kovacs
- Loyola University Chicago Health Sciences Campus, Stritch School of Medicine, Department of Surgery, Burn and Shock Trauma Institute, Maywood, IL, USA
| | - Leo Koenderman
- University Medical Centre Utrecht, Department of Respiratory Medicine, Utrecht, Netherlands
| | - Paul Kubes
- University of Calgary, Department of Physiology and Pharmacology, Calvin Phoebe and Joan Snyder Institute for Chronic Disease, Calgary, Canada
| | - Richard J Lilford
- School of Health and Population Sciences, University of Birmingham, Birmingham, UK; Division of Health Sciences, University of Warwick, Coventry, UK.
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Zhang Y, Cai B, Jiang H, Yan H, Yang H, Peng J, Wang W, Ma S, Wu X, Peng X. Use of 1H-nuclear magnetic resonance to screen a set of biomarkers for monitoring metabolic disturbances in severe burn patients. Crit Care 2014; 18:R159. [PMID: 25059459 PMCID: PMC4220088 DOI: 10.1186/cc13999] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Accepted: 07/01/2014] [Indexed: 12/04/2022] Open
Abstract
Introduction To establish a plasma metabolomics fingerprint spectrum for severe burn patients and to use it to identify a set of biomarkers that could be used for clinical monitoring. Methods Twenty-one severe burn patients and three healthy control individuals were enrolled in this study, and the plasma samples from patients and healthy individuals were collected for nuclear magnetic resonance (NMR) measurements. The NMR spectra were analyzed using principal component analysis (PCA) and partial least squares (PLS) in order to establish the metabolomics fingerprint representing the changes in metabolism and to select the major biomarkers. Results NMR spectra of the plasma samples showed significant differences between burn patients and healthy individuals. Using metabolomics techniques, we found an Eigen-metabolome that consists of 12 metabolites, which are regulated by 103 enzymes in a global metabolic network. Among these metabolites, α-ketoisovaleric acid, 3-methylhistidine, and β-hydroxybutyric acid were the most important biomarkers that were significantly increased during the early stage of burn injury. These results suggest that the mitochondrial damage and carbohydrate, protein and fatty acid metabolism disturbances occur after burn injury. Our analysis also show that histone deacetylases, which are protein transcription suppressors, were remarkably increased and indicate that protein transcription was inhibited and anabolism was restrained during the early stage of burn injury. Conclusions Metabolomics techniques based on NMR can be used to monitor metabolism in severe burn patients. Our study demonstrates that integrated 1H-NMR metabolome and global metabolic network analysis is useful for visualizing complex metabolic disturbances after severe burn injury and may provide a new quantitative injury severity evaluation for future clinical use. Trial registration Chinese Clinical Trial Registry ChiCTR-OCC-12002145. Registered 25 April 2012.
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DiVita MA, Mix JM, Goldstein R, Gerrard P, Niewczyk P, Ryan CM, Kowalske K, Zafonte R, Schneider JC. Rehabilitation Outcomes Among Burn Injury Patients With a Second Admission to an Inpatient Rehabilitation Facility. PM R 2014; 6:999-1007. [DOI: 10.1016/j.pmrj.2014.05.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Revised: 05/12/2014] [Accepted: 05/16/2014] [Indexed: 10/25/2022]
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Brand S, Otte D, Stübig T, Petri M, Ettinger M, Mueller CW, Krettek C, Haasper C, Probst C. Mechanisms of motor vehicle crashes related to burns--an analysis of the German In depth Accident Study (GIDAS) database. Burns 2013; 39:1535-40. [PMID: 24169314 DOI: 10.1016/j.burns.2013.09.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Revised: 08/18/2013] [Accepted: 09/05/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Patients of motor vehicle crashes (MVCs) suffering burns are challenging for the rescue team and the admitting hospital. These patients often face worse outcomes than crash patients with trauma only. Our analysis of the German In-depth Accident Study (GIDAS) database researches the detailed crash mechanisms to identify potential prevention measures. METHODS We analyzed the 2011 GIDAS database comprising 14,072 MVC patients and compared individuals with (Burns) and without (NoBurns) burns. Only complete data sets were included. Patients with burns obviously resulting of air bag deployment only were not included in the Burns group. Data acquisition by an on call team of medical and technical researchers starts at the crash scene immediately after the crash and comprises technical data as well as medical information until discharge from the hospital. Statistical analysis was done by Mann-Whitney-U-test. Level of significance was p < 0.05. RESULTS 14,072 MVC patients with complete data sets were included in the analysis. 99 individuals suffered burns (0.7%; group "Burns"). Demographic data and injury severity showed no statistical significant difference between the two groups of Burns and NoBurns. Injury severity was measured using the Injury Severity Score (ISS). Direct frontal impact (Burns: 48.5% vs. NoBurns: 33%; p < 0.05) and high-energy impacts as represented by delta-v (m/s) (Burns: 33.5 ± 21.4 vs. NoBurns: 25.2 ± 15.9; p < 0.05) were significantly different between groups as was mortality (Burns: 12.5% vs. NoBurns: 2.1%; p < 0.05). Type of patients' motor vehicles and type of crash opponent showed no differences. CONCLUSIONS Our results show, that frontal and high-energy impacts are associated with a frequency of burns. This may serve automobile construction companies to improve the burn safety to prevent flames spreading from the motor compartment to the passenger compartment. Communities may impose speed limits in local crash hot spots.
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Affiliation(s)
- S Brand
- Department of Trauma, Hannover Medical School, Germany.
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