Trends in the epidemiology of major burn injury among hospitalized patients: A population-based analysis

The economic burden of burned patients for hospitalization in Canada

BACKGROUND

Burn injuries pose a significant burden on both patients and healthcare systems. Yet, costs arising from the consumption of resources by these patients are rarely examined in Canada.

OBJECTIVE

The objective of this study was to assess real-world costs resulting from the initial hospitalization of patients admitted to a major burn unit in Quebec, Canada.

METHODS

A cost study based on a retrospective cohort was undertaken using in-hospital economic data matched to hospital chart data. Our cohort included all burn-injured patients admitted between April 1, 2017, and March 31, 2021, to the hospital's major burn unit during their initial hospitalization. Descriptive statistics were tabulated for sociodemographic and economic data. Costing data were analyzed unstratified and stratified according to burn severity (i.e., ≥ 20% of total body surface area [TBSA] vs. < 20%). Costs were presented in CAD 2021.

RESULTS

Our cohort included 362 patients, including 65 (18%) with TBSA ≥ 20%. The average initial hospitalization cost was $32,360 ($22,783 for < 20% TBSA and $76,121 for ≥ 20% TBSA).

CONCLUSION

Findings reveal that the total cost of the initial hospitalization, from a public hospital perspective, was $11,714,348. Our study underlines the substantial burden associated with burns and highlights the need for long-term cost evaluations.

Addressing Burn Hypertrophic Scar Symptoms Earlier: Laser Scar Revision May Begin as Early as 3-6 Months After Injury

OBJECTIVES

Fractional ablative CO2 laser (FLSR) is used to treat hypertrophic scars (HTSs) resulting from burn injuries, which are characterized by factors, such as erythema, contracture, thickness, and symptoms of pain and itch. Traditionally, waiting a year after injury for scar maturation before starting laser treatment has been recommended; however, the potential benefits of earlier intervention have gained popularity. Still, the optimal timing for beginning laser intervention in patients with HTSs remains uncertain. This study aims to evaluate the ideal timing for the initiation of FLSR for HTSs using several qualitative and quantitative assessment measures. It was hypothesized that early intervention would lead to similar improvement trends as later intervention, however, would be more ideal due to the shortened time without symptom relief for patients.

METHODS

Patients who received three or more laser treatment sessions and completed both pre- and posttreatment evaluations were included in this analysis (n = 69). FLSR treatment was administered at 4-8-week intervals. Patients starting treatment before 6 months after injury were classified as the early-stage intervention group and those beginning treatment at 6-12 months after injury were classified as the late-stage intervention group. Demographic data, including the age of patients at the time of first treatment, age of scars at the time of first treatment, biological sex, ethnicity, Fitzpatrick skin type, and use of laser-assisted drug delivery, were collected by retrospective chart review. Patients were evaluated on six subjective scales and objectively for scar stiffness with durometry. For all scales, higher scores indicate worse scars. A two-way ANOVA, Student's t-test, and Mann-Whitney U-test were used to compare scores from the pre- to posttreatment evaluations.

RESULTS

There were no significant differences between the groups for any of the demographic or scar-specific variables; thus, differences in outcome can be attributed to the timing of intervention. Both groups demonstrated an improvement in scars with treatment over time (p < 0.05). Both early- and middle-stage initiation showed scar symptom improvement in five out of six scales. In the late-stage intervention, the Patient and Observer Scar Assessment Scale-Patient average score did not show improvement. In the early-stage intervention, the Vancouver Scar Scale total did not show improvement. Quantitative evaluation of scar stiffness by durometry did not show symptom improvement in either group. The Scar Comparison Scale demonstrated the greatest improvement across groups.

CONCLUSION

Laser treatment led to scar improvement in at least one scale at each stage of initiation. Both intervention timelines resulted in equivalent outcomes, and early intervention should be considered when initiating FLSR treatment in burn scars to alleviate symptoms earlier.

Major burns in adults: a practice review

There are approximately 180 000 deaths per year from thermal burn injury worldwide. Most burn injuries can be treated in local hospitals but 6.5% require specialist burn care. The initial ED assessment, resuscitation and critical care of the severely burned patient present significant challenges and require a multidisciplinary approach. The management of these patients in the resuscitation room impacts on the effectiveness of continuing care in the intensive care unit. The scope of the present practice review is the immediate management of the adult patient with severe burns, including inhalation injury and burn shock. The article uses an illustrative case to highlight recent developments including advanced airway management and the contemporary approach to assessment of fluid requirements and the type and volume of fluid resuscitation. There is discussion on new options for pain relief in the ED and the principles governing the early stages of burn intensive care. It does not discuss minor injuries, mass casualty events, chemical or radiation injuries, exfoliative or necrotising conditions or frost bite.

Routinely collected burn clinical data in Canada: Determining the knowledge gap

Unlike other developed countries that hold national burn registries to monitor burn injury and care, Canada relies on single-centre secondary datasets and administrative databases as surveillance mechanisms. The objective of this study was to determine the knowledge gap faced in Canada for not having a dedicated burn registry. A comprehensive scoping review was conducted to identify the burn literature that has arisen from secondary datasets in Canada. Literature of all study designs was included with the exception of case reports and cases series. Once data extraction was concluded, a thematic framework was constructed based on the information that arose from nations that hold national burn registries. Eighty-eight studies were included. Twelve studies arose from national datasets, and 18 from provincial databases, most of which were from Ontario and British Columbia. Only seven studies were conducted using a combination of Canadian units' single-centre datasets. The majority of included studies (58%) resulted from non-collaborative use of single-centre secondary datasets. Research efforts were predominantly conducted by burn units in Ontario, British Columbia, Manitoba and Alberta. A significant number of the included studies were outdated and several provinces/territories had no published burn data whatsoever. Efforts should be made towards the development of systems to surveil burn injury and care in Canada. This study supports the development of a nation-wide burn registry to bridge this knowledge gap.

Exploring the Demographic and Social Correlates of Burn Injuries: A Comprehensive Study From a Regional Burn Center in Pakistan

Burn injuries pose significant challenges to both patients and healthcare systems globally. This retrospective observational study, conducted at the burn center in a tertiary care hospital in Rawalpindi, Pakistan, aimed to delineate the patterns of burn injuries and correlate them with demographic and clinical presentations. A total of 99 patients were included, with 54 males and 45 females, ranging in age from three months to 70 years. Flame burns were the most common type (n=69), with the majority being accidental (n=87). Limbs were the most frequently affected body parts (n=32), often with lesser-degree burns (n=28). Notably, self-inflicted injuries were predominantly observed in males (n=7), while assault cases were more common in females (n=4). Statistical analysis revealed significant associations between the degree of burn and the body parts affected, as well as between the mode of injury and the affected body parts. Burn injuries due to assault or self-infliction tended to have higher morbidity rates, often resulting in fatalities. Additionally, the cause of burn injury showed significant associations with the affected body parts, with contact and electric burns affecting limbs and chemical burns mainly affecting the head and face. These findings underscore the need for targeted burn prevention programs, emphasizing first aid education and addressing specific risk factors in high-risk groups and settings. By implementing preventive strategies and evaluating their effectiveness, the burden of burn injuries can be reduced, leading to improved patient outcomes and quality of life.

Novel Design and Implementation of an Integrated Burn Rehabilitation Clinical Fellowship

ABSTRACT

Postgraduate medical burn rehabilitation training has been limited, with very few academic physiatrists specializing in burn rehabilitation. As a result, there are no existing models for postgraduate burn rehabilitation education. A 12-mo comprehensive clinical fellowship in burn rehabilitation was offered through a tertiary burn center with formal university accreditation. In this article, the clinical, educational, and skill-based goals developed and implemented for this novel fellowship was outlined to serve as a blueprint for future fellowships in burn rehabilitation, as well as reflections on the experience.

Cost analysis of severe burn victims in Southwest China: A 7-year retrospective study

Background

Severe burn injury can be a life-threatening experience and can also lead to financial issues for suffers. The purpose of the current study was to analyze the direct hospitalization costs of severe burn inpatients in Southwest China.

Methods

Data related to all inpatients admitted with severe burns [total body surface area (TBSA) ≥30%] pooled from 2015 to 2021 were reviewed retrospectively at the Institute of Burn Research of Army Medical University. Demographic parameters, medical economics, and clinical data were obtained from medical records.

Results

A total of 668 cases were identified. The average age was 37.49 ± 21.00 years, and 72.3% were men. The average TBSA was 51.35 ± 19.49%. The median length of stay of inpatients in the burn intensive care unit was 14 [interquartile range (IQR): 5.0-34.8] days, and the median length of stay (LOS) was 41 (IQR: 22.0-73.8) days. The mortality rate was 1.6%. The median total cost was 212,755.45 CNY (IQR: 83,908.80-551,621.57 CNY) per patient varying from 3,521.30 to 4,822,357.19 CNY. The direct cost of scald burns was dramatically lower compared with that of other types of burns, with 11,213.43 to 2,819,019.14 CNY. Medical consumables presented the largest portion of total costs, with a median cost of 65,942.64 CNY (IQR: 18,771.86-171,197.97 CNY). The crucial risk factors for medical cost in our study were TBSA, surgical frequency, LOS, depth of burn, and outcome.

Conclusion

We conclude that an effective burn prevention program, shorter hospital stays, and facilitating the healing of wounds should be focused on with tailored precautionary protocols to reduce the medical costs of inpatients with severe burns.

A systematic review assessing the effectiveness of hand therapy programmes in adults with burns using the International Classification of Functioning, Disability and Health framework

This systematic review aimed to confirm the effectiveness of hand therapy programmes using the International Classification of Functioning, Disability and Health framework for each of the three phases of the wound healing process in adults with burns. A systematic review was conducted to determine the efficacy of different hand therapy programmes in the management of burnt hands. Two independent reviewers conducted a literature search using the PubMed and Cumulative Index to Nursing and Allied Health Literature databases for original articles reporting effectiveness of hand therapy programmes for adults with burns. Only randomized and non-randomized controlled trials were selected using the Mixed Methods Appraisal Tool. Demographic and clinical data including medical history, burn depth, and hand therapy programme were extracted. Outcome measures were reviewed based on the International Classification of Functioning, Disability and Health framework for acute, convalescence, and chronic phases of rehabilitation. Sixteen articles and 15 hand therapy programmes were identified, which included studies showing improvements in different parameters in the framework. In the acute and convalescence phases, improvements were found in health condition, body functions and structures, activities, and participation. In the chronic phase, improvements were shown only in body functions and structures. Environmental factors in the framework were not reported for all the phases. This review demonstrated the efficacy of hand therapy programmes in adults with burns in terms of the health condition, body function, activities, and participation during acute and convalescence phases but only the body function in the chronic phase.

The Trend of Burn Injury Patients in Ningbo between 2012 and 2021: A Clinical Study

Objective

This study was designed to understand the local changes of burn injuries in recent 10 years, so as to provide reliable reference data and viewpoints for prevention and vigilance of local burn injuries.

Methods

In this study, 184 patients with a burn injury admitted to our hospital from 2012 to 2021 were enrolled and analyzed retrospectively. According to their information in the electronic database, the number of patients with burn injuries and the location of each disaster each year were analyzed, and the age, sex, hospital stay and hospitalization expense of each patient were collected. With 5 years as the boundary, the patients were divided into a 2012-2016 group and a 2017-2021 group and the differences of the two groups in the abovementioned aspects were compared.

Results

During 2012-2021, the incidence rate of burn injuries in men was higher than that in women and workplaces had a higher burn injury rate than residents' homes. Compared with the period of 2012-2016, the number of fires or explosions and the number of patients with a burn injury during 2017-2028 both increased, but there was no significant change in disaster location, male-female ratio, age, average hospital stay, and average hospitalization expense.

Conclusion

In the face of the increasing prevalence of burn injuries, we should strengthen fire-fighting knowledge-related education and fire prevention management and actively explore post-burn injury treatment strategies and potential treatment targets to promote the development of burn injury management and treatment strategies.

Choosing wisely in burn care

BACKGROUND

The Choosing Wisely Campaign was launched in 2012 and has been applied to a broad spectrum of disciplines in almost thirty countries, with the objective of reducing unnecessary or potentially harmful investigations and procedures, thus limiting costs and improving outcomes. In Canada, patients with burn injuries are usually initially assessed by primary care and emergency providers, while plastic or general surgeons provide ongoing management. We sought to develop a series of Choosing Wisely statements for burn care to guide these practitioners and inform suitable, cost-effective investigations and treatment choices.

METHODS

The Choosing Wisely Canada list for Burns was developed by members of the Canadian Special Interest Group of the American Burn Association. Eleven recommendations were generated from an initial list of 29 statements using a modified Delphi process and SurveyMonkey™.

RESULTS

Recommendations included statements on avoidance of prophylactic antibiotics, restriction of blood products, use of adjunctive analgesic medications, monitoring and titration of opioid analgesics, and minimizing 'routine' bloodwork, microbiology or radiological investigations.

CONCLUSIONS

The Choosing Wisely recommendations aim to encourage greater discussion between those involved in burn care, other health care professionals, and their patients, with a view to reduce the cost and adverse effects associated with unnecessary therapeutic and diagnostic procedures, while still maintaining high standards of evidence-based burn care.

The effect of COVID-19 pandemic on the number of patients in burns services

This study was conducted to examine the effects of the coronavirus disease 2019 (COVID‐19) pandemic on the epidemiological characteristics and causes of burns in patients admitted to burns services. A total of 629 patients who applied to the burn center of our hospital on March 11 to June 11, 2019, and March 11 to June 11, 2020, were included in this single‐center, retrospective study. The demographic information of the patients, causes of burns, burn degrees, affected anatomical areas, admission times and burn surface areas were recorded retrospectively according to patient records. The findings of our study suggest that gender, age, causes of burns, affected anatomical areas and application times did not differ before and after the COVID‐19 pandemic. The number of cases has significantly decreased during the COVID‐19 pandemic compared with that of the previous year. As a result, burn trauma is an emergency; it is preventable and cannot be ignored. The COVID‐19 pandemic has had many effects on social, cultural and economic fields, as well as on the field of health.

Epidemiological and Clinical Characteristics of 5,569 Pediatric Burns in Central China From 2013 to 2019

Background

Pediatric burns of all the ages are prevalent worldwide, posing a severe health risk to children. This study aims to examine pediatric burns' clinical characteristics and epidemiology in central China.

Methods

The pediatric patients of the Burn Research Center, Department of the First People's Hospital of Zhengzhou City from 2013 to 2019 were retrospectively studied and the relevant data were collected from the hospitalized medical records [e.g., demographic, etiology, length of stay (LOS), age, gender, burn area and depth, number of surgeries, cost, and outcome].

Results

A total of 5,569 pediatric burn patients were included, accounting for 43.9% of the total burn population. Electric burns represented a relatively small proportion (1.17%) but were more likely to lead to disabilities or death than scalds (90.63%) and flames (5.12%). The median age was 2 years [interquartile range (IQR): 1–4] and the boys/girls ratio ranged from 1.3:1 to 1.6:1. The most commonly burnt anatomic sites were the limbs (38.3%), with a median %TBSA (total body surface area) of 6 (IQR: 4–10). The complications of shock and pneumonia accounted for 7.6 and 19.2%, respectively. The peak months of pediatric burns included January, May, and August and the rural/urban ratio reached 1.61:1. The percentage of burn wounds treated surgically increased considerably from 2013 to 2019 (3.8 vs. 37.8%). The median hospital LOS was 15 days (IQR: 8–28 days), with the three high-risk factors (e.g., more surgeries, more %TBSA, full-thickness skin burns). The median cost of hospitalization was 1,511 USD (IQR: 848–2,648 USD) and the main risk factors consisted of full-thickness burns, more %TBSA, longer LOS, and more surgical procedures. Among all the patients, LA50 was 78.63% (95% CI = 75.12–83.45) and the overall mortality reached 0.1% since seven deaths were recorded.

Conclusion

Scalds, flames, contact, and chemicals are the main causes of burns among children aged 1–5 years in central China. Accordingly, various prevention strategies should be employed depending upon the cause of the burn.

Developing a national trauma research action plan: Results from the Burn Research Gap Delphi Survey

BACKGROUND

The 2016 National Academies of Science, Engineering and Medicine call for a national integrated, military-civilian trauma action plan to achieve zero preventable deaths and disability after injury included a proposal to establish a National Trauma Research Action Plan to "strengthen trauma research and ensure that the resources available for this research are commensurate with the importance of injury and the potential for improvement in patient outcomes." The Department of Defense funded the Coalition for National Trauma Research to generate a comprehensive research agenda spanning the continuum of trauma/burn care from prehospital to rehabilitation. The Burn/Reconstructive Surgery group represents one focus area for this research agenda development.

METHODS

Experts in burn and reconstructive surgery research identified gaps in knowledge, generated research questions and prioritized questions using a consensus driven Delphi survey approach. Participants were identified using established Delphi recruitment guidelines to ensure heterogeneity and generalizability with military and civilian representatives. Literature reviews informed the panel. Panelists were encouraged to use a PICO format to generate research questions: Patient/Population; Intervention; Compare/Control; Outcome. Participants ranked the priority of each question on a nine-point Likert scale, which was categorized to represent low, medium, and high priority items. Consensus was defined based on ≥60% panelist agreement.

RESULTS

Subject matter experts generated 949 research questions in 29 Burn & 26 Reconstruction topics. Five hundred ninety-seven questions reached consensus. Of these, 338 (57%) were high-priority, 180 (30%), medium-priority, and 78 (13%) low-priority questions.

CONCLUSION

Many high-priority questions translate to complex wound management and outcomes. Panel recognition that significant gaps in knowledge exist in understanding functional outcomes after injury underscores the importance of long-term recovery metrics even when studying acute injury or interventions such as resuscitation or inhalation injury. Funding agencies and burn/reconstructive surgery researchers should consider these gaps when they prioritize future research.

LEVEL OF EVIDENCE

Expert consensus, Level IV.

Study on the Effect and Mechanism of Antibacterial Adhesive Hydrogel on Wound Healing

Bleeding and infection can cause significant increases in mortalities. Hydrogel sealants have attracted extensive attention for their ability to control bleeding. In this study, the adjuvant treatment with antibacterial adhesive hydrogel dressings was applied to patients with deep second-degree burns/scalds. The traditional medical dressing was regarded as control adjuvant treatment. The results indicated that the total positive rate of bacteria in wound secretions and the pain during dressing change in patients who used antibacterial adhesive hydrogel dressings were significantly reduced. The number of fibroblasts and new capillaries in the granulation tissue of the wound increased, and the patient's wound healing is accelerated. The overall clinical effectiveness has been significantly improved. It is proven that the antibacterial adhesive hydrogel dressing has a significant effect on wound healing.

Epidemiology And Outcomes Of Radiator Burns At A High Throughput Burns Centre

Indoor radiator burns can cause significant morbidity and mortality, especially in vulnerable patients. However, the epidemiology and clinical outcomes are poorly characterized. A retrospective study of all radiator burns referred to a tertiary regional burns centre between 2013-2019 was conducted. Four hundred and forty-seven patients (median age 25.6 years, male:female ratio 1.4:1) were referred; 109 (24%) admitted, 201 (45%) managed in outpatients and 137 (31%) managed locally. The incidence of burns leading to referral was 0.65/100,000/year, but increased annually. Contact burns consisted of 99.6%. Age distribution was bimodal: <5 years (43%), >65 years (27%), although all ages were affected. Median TBSA was 0.75% (0.1-11.5%), but 79% had injuries <2%. Childhood burns were predominantly superficial dermal grab injuries, usually manageable as outpatients. Elderly patients had larger burns usually secondary to falls or impaired sensorium, and were more likely to die (p<0.05). Burns due to impaired sensorium were deeper and more likely to require surgery (p<0.05). Sixty-three (14%) patients required surgery. Thirty-day mortality was 1.1%. Age was the only significant predictor of mortality. This study quantifies the epidemiology and outcomes of a growing problem. It identifies at risk populations (extremes of age), and important features of the clinical assessment.

The effect of COVID-19 in a newly established burn center

Objective

This study aims to investigate the effects of COVID-19 on epidemiological features, burn agent, burn percentage, and hospitalization time in a burn center.

Methods

This single-center, retrospective study included a total of 401 patients admitted to our study center between October 2019 and July 2020. The patients who were admitted before March 1, 2020, were considered the pre-March group, and those who were admitted after March 1, 2020, were considered the post-March group. According to their age, the patients were further divided into groups as those aged ≤ 18 years and those aged > 18 years. Demographic and clinical characteristics of patients, burn agent, burn surface area, COVID-19 status, and treatment and follow-up data were recorded.

Results

Our study results showed no significant difference in the number of patient admission, age, and sex of patients, burn agents and length of hospital stay before and after the COVID-19 outbreak.

Conclusions

Burn centers can work safely in COVID-19 outbreak, paying special attention to precautions mandated by the national and global health authorities. However, the increase in pandemic burden may force the burn centers to be converted into alternate COVID-19 facilities. In such cases, the care of burn patients may pose a great problem.

Dexmedetomidine use and mortality in mechanically ventilated patients with severe burns: A cohort study using a national inpatient database in Japan

BACKGROUND

Dexmedetomidine is an alpha 2-adrenergic receptor agonist. Apart from its sedative effects, dexmedetomidine can potentially reduce mortality through its anti-inflammatory effect. However, the impact of dexmedetomidine on in-hospital outcomes of patients with severe burns remains unclear. Therefore, we aimed to elucidate the association between dexmedetomidine use and mortality in mechanically ventilated patients with severe burns, using a Japanese nationwide database of in-hospital patients.

METHODS

We included adults with severe burns (burn index ≥ 10) who were registered in the Japanese Diagnosis Procedure Combination national inpatient database from 2010 to 2018, started mechanical ventilation within 3 days of admission, and received any sedative drug (dexmedetomidine, midazolam, or propofol). One-to-one propensity score matching was performed between patients who received dexmedetomidine on the day of mechanical ventilation initiation (dexmedetomidine group) and those who did not receive dexmedetomidine (control group). The primary outcome was all-cause 30-day in-hospital mortality. Secondary outcomes were length of hospital stay and duration of mechanical ventilation in patients and survivors.

RESULTS

Eligible patients (n = 1888) were classified into the dexmedetomidine group (n = 371) or the control group (n = 1517). After one-to-one propensity score matching, we compared 329 patients from both groups. No significant difference was observed in the 30-day mortality between patients in the dexmedetomidine and control groups (22.8% vs. 22.5%, respectively; odds ratio, 1.02; 95% confidence interval, 0.71-1.46). Moreover, there were no significant differences between patients in the dexmedetomidine and control groups in terms of the length of hospital stay or the duration of mechanical ventilation.

CONCLUSIONS

We found no significant association between dexmedetomidine use and in-hospital outcomes (mortality, length of hospital stay, and length of mechanical ventilation) in mechanically ventilated patients with severe burns. Dexmedetomidine use may not improve the aforementioned outcomes; therefore, its selection should be based on the patient's general condition and the target level of sedation.

Cross-Sectional Assessment of Burn Center and Nonburn Center Patient Care: A Multi-Database Comparison

The practice of burn care is complex and continues to be a rapidly evolving field. To assess how differences in management affect hospital stay characteristics and outcomes, the authors sought to compare outcomes data from two sources, such as burn center and nonburn center data. The National Burn Repository (NBR, version 8) and the 2014 Nationwide Readmission Database (NRD) were compared based on ICD-9 948-series burn-related diagnosis codes, generating a total of 83,068 and 14,131 burn patients from the NBR and NRD, respectively. Patients were stratified by burn size and compared based on demographic factors and hospital stay characteristics. t-Test and chi-squared statistics were performed with SAS, version 9.4. Burn patient populations from the NBR and NRD databases, when stratified by patient demographic factors, were found to have similar sex distributions, 68% and 64% male, respectively. The average age was significantly higher in the NRD data at 39.5 ± 23.6 compared with 30.9 ± 22.3 years. Hospital stay characteristics, including length of stay and mortality, were not found to differ significantly. Differences were identified in the number of trips to the OR, which was significantly greater in the NBR population as well as the total cost of care, which was significantly less in the NBR population at $92k compared with $125k. This study has shown through the interpretation of multiple databases that not only do demographics differ between burn and nonburn center populations, but also do management strategies, particularly in operative intervention and cost.

Epidemiology and trend of US pediatric burn hospitalizations, 2003-2016

BACKGROUND

Thermal injury is a leading cause of unintentional pediatric trauma morbidity and mortality.

METHODS

This retrospective analysis of the 2003-2016 Kids' Inpatient Database (KID) included children <18 years old with a burn principal diagnosis. The objectives were to describe the trend of US pediatric burn hospital admissions and the patient and hospital characteristics of admitted children in 2016. The trends (2003-2012) and (2012-2016) were evaluated separately due to the 2015 implementation of International Classification of Diseases, Tenth Revision (ICD-10).

RESULTS

The population rate of pediatric burn admissions decreased by 4.6% from 2003 to 2012, but the proportion of admissions to hospitals with burn pediatric patient volumes≥100 increased by 63.9%. The overall mortality rate of hospitalized burn patients decreased by 48.1%. Median length of stay increased slightly for patients with a burn ≥20% total body surface area (TBSA) but decreased for patients with TBSA burn <20%. From 2012 to 2016, the population rate decreased by 13.4%. In 2016, an estimated 8160 children were admitted with a burn principal diagnosis, and 41.4% transferred in from other facilities. Children age 1-4 years were the most commonly admitted age group (49.7%). Patients with ≥20% TBSA burns accounted for 7.8% of admissions (95% confidence interval [CI]: 5.1-10.4%). Burn-related complications were documented in 5.9% of admissions (95% CI: 4.6-7.1%).

CONCLUSION

Pediatric burn hospitalizations and burn-related mortality have decreased over time. The increases in transfers and admissions to hospitals with high pediatric burn volumes suggest increasing regionalization of care.

Multi-Drug-Resistant Organisms in Burn Infections

Background: Infection is the most frequent complication after severe burns and remains the predominant cause of death. Burn patients may require multiple courses of antibiotics, lengthy hospitalizations, and invasive procedures that place burn patients at especially high risk for infections with multi-drug-resistant organisms (MDROs). Methods: The published literature on MDROs in burn patients was reviewed to develop a strategy for managing these infections. Results: Within a burn unit meticulous infection prevention and control measures and effective antimicrobial stewardship can limit MDRO propagation and decrease the antibiotic pressure driving the selection of MDROs from less resistant strains. Several new antimicrobial agents have been developed offering potential therapeutic options, but familiarity with their benefits and limitations is required for safe utilization. Successful management of MDRO burn infections is supported by a multifactorial approach. Novel non-antibiotic therapeutics may help combat MDRO infections and outbreaks. Conclusions: Multi-drug-resistant organisms are being identified with increasing frequency in burn patients. Effective sensitivity testing is essential to identify MDROs and to direct appropriate antibiotic choices for patient treatment.

Mortality analysis of adult burn patients in Uruguay

Objective

To determine the independent risk factors associated with mortality in adult burn patients.

Methods

This was a retrospective, observational study performed at the Centro Nacional de Queimados do Uruguai. All patients with skin burns admitted to the unit since its opening on July 1, 1995 through December 31, 2018 were included. The demographic data, burn profiles, length of stay, mechanical ventilation duration and hospital mortality were studied. A multivariate logistic regression was used to identify the risk factors for mortality. The standardized mortality ratio was calculated by dividing the number of observed deaths by the number of expected deaths (according to the Abbreviated Burn Severity Index).

Results

During the study period, 3,132 patients were included. The median total body surface area burned was 10% (3%-22%). The Abbreviated Burn Severity Index was 6 (4 - 7). Invasive mechanical ventilation was required in 60% of the patients for a median duration of 6 (3 - 16) days. The median length of stay in the unit was 17 (7 - 32) days. The global mortality was 19.9%. Crude mortality and standardized mortality ratio decreased from 1995 through 2018. The global standardized mortality ratio was 0.99. A need for mechanical ventilation (OR 8.80; 95%CI 5.68 - 13.62), older age (OR 1.07 per year; 95%CI 1.06 - 1.09), total body surface area burned (OR 1.05 per 1%; 95%CI 1.03 - 1.08) and extension of third-degree burns (OR 1.05 per 1%; 95%CI 1.03 - 1.07) were independent risk factors for mortality.

Conclusion

The need for mechanical ventilation, older age and burn extension were independent risk factors for mortality in the burned adult Uruguayan population.

Burn Infection and Burn Sepsis

Background: Infection is the most common complication and cause of death in patients suffering burn injuries. These patients are susceptible to infection and burn wound sepsis secondary to the alterations in their physiology. Diagnosis and management of infections rely on physical examination, cultures, and the pathology of the burn wound. Method: We performed an electronic search for articles in the Google Scholar and PubMed databases using the search terms "burn sepsis," "burn infection," and "burn critical care." Results: Multiple factors increase burn patients' risk of invasive infection and sepsis, including underlying factors and co-morbidities, the percent total body surface area of the burn, delays in burn wound excision, and microbial virulence/bacterial count. Organisms causing burn wound infection differ, depending on the time since injury and its location; and diagnosis is multi-factorial. The most common pathogens remain Staphylococcus and Pseudomonas spp. Conclusion: Overall, the recognition of burn sepsis is based on clinical findings. Treatment consists of a combination of local dressings, early burn excision, and systemic antimicrobial therapy. The mortality rate has decreased significantly over the past 10 years, but continued efforts at timely management and infection prevention are essential.

Demographics and clinical patterns of burns requiring emergency hospitalization at a regional north-eastern us burn center

BACKGROUND

There are known demographic and clinical patterns related to burn injuries and care associated with national and global geography. Still, limited data sources exist to facilitate the study of trends in the regionalization of burn care.

OBJECTIVES

The current study aims to investigate the demographics and clinical characteristics of patients that presented to the Emergency Department (ED) and were subsequently admitted for treatment to the inpatient unit of a regional burn center.

METHODS

This retrospective, single-center study was conducted between 1 February 2018 and 31 July 2019, of ED patients who presented with a burn injury and were subsequently admitted to the hospital.

RESULTS

We identified 329 patients with burn injuries requiring hospitalization. The median age was 22 years [IQR 2-53], and 195 (59%) subjects were males. Monthly and seasonal variations in admissions were identified. The majority of burns occurred at home (84%) and secondary to a scalding injury (59%). The lower extremity was the most common site of injury (29%). Most subjects received antibiotics (59%) and narcotic analgesia (56%) in the ED. The median hospital length of stay was four days [IQR 2-11]. Many subjects did not require surgical intervention (64%) and did not experience complications (79%).

CONCLUSIONS

In this study, we describe the demographics and clinical characteristics of patients that presented to the ED and were subsequently admitted to a regional burn center. Analyzing the epidemiological information and clinical management of burns may better prepare healthcare providers to offer care to patients with burn injuries.

Epidemiology and outcome analysis of 3030 burn patients with an ICD-10 approach

The present study aims to document the epidemiologic features and outcomes of burn injuries in Southeastern Iran based on International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10) guidelines. This retrospective cross-sectional study was carried out at Khatam-Al-Anbiya Hospital. Patient demographics, including burn injury data and outcome data were collected from medical records and analyzed through descriptive and analytical statistics using SPSS software. A total of 3,030 burn patients were included in this study. A total of 55% of the subjects were males. The largest age group included patients aged 15-44 (61%). The majority of burns were caused by flame (70.5%), and most of them were third-degree burns (73%). Mean affected total body surface area (TBSA) was 43.98%±30.75% in all subjects and 80.85%±21.41% in the deceased individuals. Most of the burns were accidental (66.2%), and 37% of them occurred in winter. Mean hospital stay was 4.49±4.67 days (within the range of 1-113 days). A quarter of all patients admitted to the hospital died (24.9%). The number of admitted patients, mean length of stay (LOS), and the mortality rate showed a decreasing trend from 2007 to 2016. In contrast, the total mortality rate was high. The significant predictors of mortality included being female, flame burns, longer LOS, a larger TBSA, burns of higher degrees, as well as burn complications. The documentation of burn data, based on ICD-10 directives, standardizes findings from burn injury analyses and leads to the comparability of data at different national and international levels.

A Scoping Review on the Long-Term Outcomes in Persons with Adult-Acquired Burn Injuries

Adult-acquired burn injuries are a life-altering event that can lead to debilitating functional or psychological impairments. With advancements in health care resulting in decreased mortality rates, survivors of burn injuries can expect to live longer. This warrants a shift in focus to better understand what happens to adults once they are discharged from the hospital into the community. Therefore, the purpose of this scoping review was to map the literature regarding the long-term outcomes of community-dwelling adult-acquired burn survivors. A computer-assisted literature search was conducted on literature from January 1, 2000 to August 31, 2018 utilizing four large databases (MEDLINE, EMBASE, CINHAL, and PsycINFO). Articles were included if they had a minimum of five individuals with a burn injury as a result of an accidental injury who were at least 18 years of age at the time of injury. Fifty-four articles were found suitable for inclusion in this review. The majority of studies were conducted in the United States and were longitudinal in design. Four themes were apparent from the articles: postburn complications, psychosocial outcomes, quality of life, and community participation. Data are lacking with respect to outcomes more than 5 years postburn as well as qualitative research. Furthermore, more literature is needed to understand the impact of postburn complications, coping strategies, and posttraumatic growth as well as barriers to community participation. Overall, there is an emerging body of literature that describes the long-term outcomes of adult-acquired burn survivors up to 5 years postburn.