The organisation of critical care for burn patients in the UK: epidemiology and comparison of mortality prediction models

The Revised Baux Score as a Predictor of Burn Mortality: A Systematic Review and Meta-Analysis

Mortality following a severe burn is influenced by both patient- and injury-factors, and a number of predictive models have been developed or applied. As there is no consensus on the optimal formula to use, we aimed to investigate the predictive value of the revised Baux score in comparison to other models when determining mortality risk in patients with burn injuries. A systematic review was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. The review yielded 21 relevant studies. The Prediction model Risk Of Bias ASsessment Tool quality appraisal checklist was used with many studies classified as "high" quality. All studies assessed the utility of the revised Baux score in comparison to other scoring systems such as the original Baux, Belgian Outcome in Burn Injury, Abbreviated Burn Severity Index, Acute Physiology and Chronic Health Evaluation II, Sequential Organ Failure Assessment, Boston Group/Ryan scores, the Fatality by Longevity, APACHE II score, Measured Extent of burn, and Sex model, and the Prognostic Burn Index. There was a range of 48 to 15975 participants per study, with a mean age range of 16 to 52 years old. The area under the curve (AUC) values of the rBaux score ranged from 0.682 to 0.99, with a summary AUC of 0.93 for all included studies (CI 0.91-0.95). This summary value demonstrates that the rBaux equation is a reliable predictor for mortality risk in heterogeneous populations. However, this study also identified that the rBaux equation has a diminished ability to predict mortality risk when applied to patients at both extremes of age, highlighting an important area for future research. Overall, the rBaux equation offers a relatively easy means to quickly assess the mortality risk from burn injury in a broad range of patient populations.

The effect of reflexology massage and passive music therapy intervention before burn dressing on pain, anxiety level and sleep quality

BACKGROUND

The pain, anxiety, and sleep disorders that burn patients experience due to burn dressing negatively affect their treatment process. The aim of this study was to determine the effect of reflexology massage and passive music therapy intervention before burn dressing on pain, anxiety level and sleep quality.

METHODS

This study was a randomized controlled trial. The study sample consisted of 36 patients who were hospitalized in the Burn Center of a University Hospital. After obtaining written consent, patients were enrolled to study according to inclusion criteria and then, divided into Reflexology Massage (n = 12), Reflexology Massage with Passive Music Therapy (n = 12) and Control (n = 12) groups using simple random allocation. In the experimental groups, in addition to standard care, interventions were performed for consecutive three days. Interventions were done before dressing for 40 min in the patient's room. The control group received only standard care during this time. Severity of pain in three groups was measured using "Visual Analog Scale" twice a day (before dressing change and 2 h after dressing change). Severity of state anxiety and sleep quality in three groups was measured using "State Anxiety Scale" and "Richards-Campbell Sleep Questionnaire" once a day (before dressing change). Severity of trait anxiety in three groups was measured using "Trait Anxiety Scale" for two times (before and after study). The drugs used by the patients for 3 days were recorded in the "Opioid and Analgesic Drug Form." Data were analyzed using Pearson Chi-square, Independent Samples T-test, One-Way ANOVA, Bonferroni, Paired Sample T-Test, Repeated Measures ANOVA tests were used.

RESULTS

The results showed no significant difference in severity of pain, anxiety, and sleep quality (p > 0,05) between the three groups on the first day. However, the mean pain scores showed a significant difference between the experimental and control groups in the third (p < 0,05) and fourth (p < 0001) days after intervention. Anxiety scores also showed a significant difference between the experimental and control groups on the fourth (p < 0001) day. Sleep quality of the experimental groups was higher than the control group on the fourth day (p < 00001). No significant difference using of opioid and analgesic drugs between the three groups (p > 0,05).

CONCLUSIONS

Our results showed reflexology massage and passive music therapy before burn dressing reduced pain and anxiety level, and increased sleep quality.

Characterization of severely burned patients and evaluation of factors associated to mortality. An observational retrospective cohort study in San Vicente Fundación Hospital

Introduction

Burns are common in developing countries and place a large burden on the medical and social care systems. However, information about management and outcomes from such countries is scarce. The purpose of this study was to analyze the epidemiology and main factors related to the mortality in severely burned patients at the Hospital Universitario San Vicente Fundación in Medellín, Colombia.

Methods

An observational retrospective cohort study was conducted. To establish prognostic factors associated with mortality, we analyzed variables such as age, sex, burned surface, and degree of burn, among others. Demographic, clinic, and management features as well as complications and factors associated with mortality were analyzed using logistic regression.

Results

4516 clinical histories were reviewed, 225 were included in the study. 76.9% were men, with a median age of 35 years; 64.9% were fire burns. The median burned body surface area was 42%. There were inhalation injuries in 135 patients and ocular in 106 patients. The main complication was infection followed by rhabdomyolysis. The overall hospital stay was 27 days, and the median length of stay at the intensive care unit was 7 days with in-hospital mortality of 30.7%. The variables associated with mortality were age, burned body surface area, degree of burn, and kidney injury. Surgical intervention was protective.

Conclusions

Severely burned patients in our hospital have similar outcomes and, in some cases, better outcomes than those reported in the literature in countries with similar characteristics, and we have seen that in the last years, there has been a better experience in the management of these patients. Elderly, extension, and depth of burnt tissue are markers of poor outcomes. Early surgery and intubation have shown better outcomes, probably due to infection control and removal of necrotic tissue, airway management, and ventilatory support for metabolic and hemodynamic derangement.

Effects of Carnosine, Ankaferd, and Silver Sulfadiazine on an Experimental Burn Model: Roles of Irisin and HSP70

In this study, the effects of carnosine, ankaferd, and 1% silver sulfadiazine applied topically on second-degree burns were investigated and the roles of irisin and Heat shock protein 70 (HSP70) in this healing process were evaluated. Ninety male albino rats were used and divided into five groups. The groups were classified as control, burn, burn + carnosine (CAR), burn + ankaferd (ABS), and burn + silver sulfadiazine (SS). It was found that level of irisin increased in the first week and decreased in the second week in the burn and CAR groups. In the ABS and SS groups, the level of irisin was determined that started to increase in the first week and continued to increase in the second week. The level of HSP70 was found to increased in the first week in burn and CAR groups and decreased in the second week, but started to increase in the second week in ABS and SS groups. Both levels of irisin and HSP70 were observed to decreased in all treatment groups in the third week. In this study, it was shown that ankaferd and silver sülfadiazine treatments cause an increase in the irisin levels in the early period and a gradually increase in HSP70 levels in the later period in burns. The inflammatory response was observed to be limited in the early period in the ankaferd and sulfadiazin groups. It was concluded that these findings were effective in early wound healing in burns.