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Ul Ain N, Bhatti DS, Mehmood M, Khan H. Exploring the Demographic and Social Correlates of Burn Injuries: A Comprehensive Study From a Regional Burn Center in Pakistan. Cureus 2024; 16:e59619. [PMID: 38832197 PMCID: PMC11145362 DOI: 10.7759/cureus.59619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2024] [Indexed: 06/05/2024] Open
Abstract
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.
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Affiliation(s)
- Nur Ul Ain
- Plastic and Reconstructive Surgery Department, Rawalpindi Medical University, Rawalpindi, PAK
- Plastic and Reconstructive Surgery Department, PostGraduate Medical Institute, Lahore, PAK
| | - Dujanah S Bhatti
- Surgery Department, Rawalpindi Medical University, Rawalpindi, PAK
| | - Muzna Mehmood
- Surgery Department, Rawalpindi Medical University, Rawalpindi, PAK
| | - Husnain Khan
- Plastic and Reconstructive Surgery Department, Rawalpindi Medical University, Rawalpindi, PAK
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Phillips W, Southern E, Cattell C, Owens P, Jaques M, Melbourne G, Kezhekkekara S, Frost SA. Do they stay, or do they go? Children presenting to five emergency departments across New South Wales, Australia with acute burn injuries: a retrospective review. BMJ Open 2024; 14:e079306. [PMID: 38458804 DOI: 10.1136/bmjopen-2023-079306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/10/2024] Open
Abstract
OBJECTIVE The overall objective of the study was to describe the disposition status of children presenting with a burn injury to five emergency departments (ED) across New South Wales (NSW), Australia. DESIGN A retrospective study design was used to review routinely collected ED data. SETTING Study sites included five acute hospitals across NSW, Australia. PARTICIPANTS During the 5-year study period between 1 January 2015 to 31 December 2020, there were 5213 paediatric burn injury presentations. RESULTS The mean age of burn injury presentations was 24 months (Inter-Quartile-Range (IQR) 12-84), of which 57% (2951/5213) were males. The most common presentation time was between 16:00 and 23:59 hours (63%, 3297/5213), and the median time spent in the ED was 3 hours (IQR 1-4). The majority (80%, 4196/5213) of the burn injuries presentations did not require hospital admission. The most common principal diagnoses were 'Burn body region unspecified' (n=1916) and 'Burn of wrist and hand' (n=1060). CONCLUSION Most children who presented to the hospital with a burn injury were not admitted. Often the details of these burns were poorly recorded and a complete picture of the true burden of burn injury in children, especially the ongoing care given outside the acute hospital setting, is missing. This information is crucial, as it would inform future models of care as the paradigm shifts rapidly towards primary, ambulatory and outpatient models of care.
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Affiliation(s)
- Wayne Phillips
- Paediatrics, Fairfield Hospital, Sydney, New South Wales, Australia
- South Western Sydney Nursing and Midwifery Research Alliance, Ingham Institute of Applied Medical Research, Liverpool, New South Wales, Australia
| | - Erin Southern
- Paediatrics, Campbelltown Hospital, Campbelltown, New South Wales, Australia
| | - Carol Cattell
- Wagga Wagga Base Hospital, Wagga Wagga, New South Wales, Australia
| | - Penny Owens
- Wyong Hospital, Hamlyn Terrace, New South Wales, Australia
| | - Madeleine Jaques
- Westmead Children's Hospital, Western Sydney University, Westmead, New South Wales, Australia
| | - Gregory Melbourne
- South Western Sydney Nursing and Midwifery Research Alliance, Ingham Institute of Applied Medical Research, Liverpool, New South Wales, Australia
| | - Shwetha Kezhekkekara
- South Western Sydney Nursing and Midwifery Research Alliance, Ingham Institute of Applied Medical Research, Liverpool, New South Wales, Australia
| | - Steven A Frost
- Paediatrics, Fairfield Hospital, Sydney, New South Wales, Australia
- South Western Sydney Nursing and Midwifery Research Alliance, Ingham Institute of Applied Medical Research, Liverpool, New South Wales, Australia
- Paediatrics, Campbelltown Hospital, Campbelltown, New South Wales, Australia
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Kornhaber R, Pan R, Cleary M, Hungerford C, Malic C. Violence by Burning Against Women and Girls: An Integrative Review. TRAUMA, VIOLENCE & ABUSE 2023; 24:1063-1077. [PMID: 34624204 DOI: 10.1177/15248380211048445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Violence against women and girls by burning is a serious and confronting form of gender-based violence. Often, perpetrators aim to disfigure their victims or cause great pain, rather than kill them. Little is known about the characteristics of females who are subjected to violence by burning. This study aimed to review the literature concerning the prevalence, demographic profile, injury event, contributing factors and health outcomes for women and girls who have experienced burn-related violence. A search across five databases (PubMed, CINAHL, PsycINFO, Scopus and LILACS) was conducted up to April 2021 to identify original peer-review research, with a focus on violence by burning against women and girls. The review was guided by the five-stage approach to integrative reviews developed by Whittemore and Knafl (2005). Fifteen studies were identified. Victims were predominantly married, with low socio-economic status, limited education, and high emotional and financial dependency on their partners or families. Burn injuries were mostly caused by flame or acid, with significant morbidity or high mortality. Motives included family/marital issues or property/financial disputes. This review identified the limited evidence available in the peer-reviewed literature related to burn-related violence against women and girls worldwide. Findings suggest the need for further research to provide a clearer understanding of the complex issues involved.
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Affiliation(s)
- Rachel Kornhaber
- College of Health and Medicine, 3925University of Tasmania, Sydney, AU-NSW, Australia
- National Burns Center, 26744Sheba Medical Center, Tel Hashomer, Israel
| | - Raquel Pan
- Department of Nursing in Hospital Assistance, 74395Federal University of Triângulo Mineiro, Uberaba, Brazil
| | - Michelle Cleary
- School of Nursing, Midwifery and Social Sciences, 6939CQUniversity, Sydney, AU-NSW, Australia
| | | | - Claudia Malic
- 6363University of Ottawa, Ottawa, ON, Canada
- Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
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Zeng Z, Li N, Yang L, Feng X, Zuo F, Luo G, Peng Y, Yuan Z. Cost analysis of severe burn victims in Southwest China: A 7-year retrospective study. Front Public Health 2023; 10:1052293. [PMID: 36699890 PMCID: PMC9868295 DOI: 10.3389/fpubh.2022.1052293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 12/06/2022] [Indexed: 01/11/2023] Open
Abstract
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.
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Mulatu D, Zewdie A, Zemede B, Terefe B, Liyew B. Outcome of burn injury and associated factor among patient visited at Addis Ababa burn, emergency and trauma hospital: a two years hospital-based cross-sectional study. BMC Emerg Med 2022; 22:199. [PMID: 36494642 PMCID: PMC9733383 DOI: 10.1186/s12873-022-00758-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 11/28/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Burn is one of the critical health problems worldwide. Developing countries with sub-Saharan and Asian populations are affected more. Its mortality and non-fatal complications depend on several factors including age, sex, residency, cause, the extent of the burn, and time and level of care given. OBJECTIVE The purpose of this study was to assess the outcome of burn injury and its associated factor among patients who visited Addis Ababa burn emergency and trauma hospital. METHODS The institutional-based, retrospective cross-sectional study design was conducted from April 1, 2019, to March 30, 2021. After checking the data for its consistency the data were entered and analyzed by using SPSS version 25. A total of 241 patients who had visited Addis Ababa burn, emergency and trauma Hospitals after sustained burn injury were recruited through convenience sampling method for final analysis. Model goodness-of-fit was checked by Hosmer and Lemeshow test (0.272). After checking multi-collinearity both the bi-variable and multivariable logistic regression model was fitted and variables having a p-value less than or equal to 0.05 at 95% CI in the multivariable analysis were considered statistically significant. RESULT Adults (age 15 to 60 years) are the most affected groups accounting for 55.2% followed by pediatric age groups (age <15 years) (43.6%) and the elderly (age > 60 years) (1.2%). Scald burn was the major cause accounting for 39 % followed by Flame burn (33.6%), Electrical burn (26.6%), and chemical burn (0.8%). The mean TBSA% was 15.49%, ranging from1% to 64%. Adult males are more affected by electrical burns while adult females and the elderly encounter flame burn. 78.4% of patients were discharged without complications, 14.9% were discharged with complications and 6.6% died. The commonest long-term complication is the amputation of the extremity (19, 7.9%). Age greater than 60 years and TBSA% greater than 30% is a strong predictors of mortality with odds of 2.2 at 95% CI of [1.32, 3.69] and 8.7 at 95% CI of [1.33, 57.32] respectively. CONCLUSION AND RECOMMENDATION The mortality rate show decrement from previous studies. Overall scald burn is common in all age groups but electrical burns and flame burns affected more adult and elderly age groups. Extremities were by far, the commonest affected body parts. The extent of burn injury and the age of the patient independently predict mortality. Early intervention will reduce mortality and complications.
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Affiliation(s)
- Damena Mulatu
- grid.59547.3a0000 0000 8539 4635Department of internal medicine, School of medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Ayalew Zewdie
- grid.460724.30000 0004 5373 1026Department of Emergency Medicine and Critical Care, St Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Biruktawit Zemede
- grid.460724.30000 0004 5373 1026Department of Emergency Medicine and Critical Care, St Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Bewuketu Terefe
- grid.59547.3a0000 0000 8539 4635Department of Community Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Bikis Liyew
- grid.59547.3a0000 0000 8539 4635Department of Emergency and Critical Care Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, P.O.BOX 196, Gondar, Ethiopia
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Han D, Wei Y, Li Y, Zha X, Li R, Xia C, Li Y, Yang H, Xie J, Tian S. Epidemiological and Clinical Characteristics of 5,569 Pediatric Burns in Central China From 2013 to 2019. Front Public Health 2022; 10:751615. [PMID: 35425744 PMCID: PMC9001893 DOI: 10.3389/fpubh.2022.751615] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 03/03/2022] [Indexed: 11/21/2022] Open
Abstract
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.
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Affiliation(s)
- Dawei Han
- Department of Burns, Zhengzhou First People's Hospital, Zhengzhou, China
| | - Ying Wei
- Department of Burns, Zhengzhou First People's Hospital, Zhengzhou, China
| | - Yancang Li
- Department of Burns, Zhengzhou First People's Hospital, Zhengzhou, China
| | - Xinjian Zha
- Department of Burns, Zhengzhou First People's Hospital, Zhengzhou, China
| | - Rui Li
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Chengde Xia
- Department of Burns, Zhengzhou First People's Hospital, Zhengzhou, China
| | - Yun Li
- Department of Burns, Zhengzhou First People's Hospital, Zhengzhou, China
| | - Huanna Yang
- Department of Burns, Zhengzhou First People's Hospital, Zhengzhou, China
| | - Jiangfan Xie
- Department of Burns, Zhengzhou First People's Hospital, Zhengzhou, China
| | - Shemin Tian
- Department of Burns, Zhengzhou First People's Hospital, Zhengzhou, China
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Sanjaya IGPH, Hamid ARRH, Adnyana IMS, Samsarga GW, Tanuwijaya LY, Putri GW, Rudyan J. The Epidemiology of Unintentional Burn Case in Sanglah General Hospital, Denpasar, from 2014 to 2018. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.8213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Burn injury is one of the serious public health problems. Many of burn patients end up with experiencing disability (morbidity). Meanwhile, the epidemiology of burn patients in eastern part of Indonesia is rarely reported.
AIM: We aimed to investigate the sociodemographic characteristic of burn patients in Sanglah General Hospital as the center referral hospital for eastern part of Indonesia.
MATERIALS AND METHODS: Viable data were collected from burn patients admitted to Burn Center of Sanglah Hospital between January 2014 and December 2018. A cross-sectional study design was used with statistical analysis which was performed using IBM Statistics 23 for Windows.
RESULTS: A total of 725 subjects were involved in this study. Subjects were divided into two groups of emergency (n = 607, 83.72%) and non-emergency (n = 118, 17.28%). There were 525 (72.4%) burn subjects who were ≥17 years old with combustion caused by flame as the most common case (n = 264, 56.9%), whereas 200 (27.6%) subjects were <17 years old, while the group of age 0–5 years old (n = 115, 57.5%) gave largest proportion admission in pediatric group of scalding as the main cause (n = 100, 69.4%).
CONCLUSION: We found that adults and elders had the highest risk of acquiring combustion caused by flame. Scalding was the most burns case found in the pediatric population.
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Magnus D, Bhatta S, Mytton J, Joshi E, Bhatta S, Manandhar S, Joshi S. Epidemiology of paediatric injuries in Nepal: evidence from emergency department injury surveillance. Arch Dis Child 2021; 106:1050-1055. [PMID: 34462264 PMCID: PMC8543225 DOI: 10.1136/archdischild-2020-321198] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 07/01/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Globally, injuries cause >5 million deaths annually and children and young people are particularly vulnerable. Injuries are the leading cause of death in people aged 5-24 years and a leading cause of disability. In most low-income and middle-income countries where the majority of global child injury burden occurs, systems for routinely collecting injury data are limited. METHODS A new model of injury surveillance for use in emergency departments in Nepal was designed and piloted. Data from patients presenting with injuries were collected prospectively over 12 months and used to describe the epidemiology of paediatric injury presentations. RESULTS The total number of children <18 years of age presenting with injury was 2696, representing 27% of all patients presenting with injuries enrolled. Most injuries in children presenting to the emergency departments in this study were unintentional and over half of children were <10 years of age. Falls, animal bites/stings and road traffic injuries accounted for nearly 75% of all injuries with poisonings, burns and drownings presenting proportionately less often. Over half of injuries were cuts, bites and open wounds. In-hospital child mortality from injury was 1%. CONCLUSION Injuries affecting children in Nepal represent a significant burden. The data on injuries observed from falls, road traffic injuries and injuries related to animals suggest potential areas for injury prevention. This is the biggest prospective injury surveillance study in Nepal in recent years and supports the case for using injury surveillance to monitor child morbidity and mortality through improved data.
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Affiliation(s)
- Dan Magnus
- Centre for Academic Child Health, University of Bristol, Bristol, UK
| | - Santosh Bhatta
- Centre for Academic Child Health, University of the West of England, Bristol, UK
| | - Julie Mytton
- Centre for Academic Child Health, University of the West of England, Bristol, UK
| | - Elisha Joshi
- Nepal Injury Research Centre, Kathmandu Medical College, Kathmandu, Nepal
| | - Sumiksha Bhatta
- Nepal Injury Research Centre, Kathmandu Medical College, Kathmandu, Nepal
| | | | - Sunil Joshi
- Nepal Injury Research Centre, Kathmandu Medical College, Kathmandu, Nepal
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Chen L, He X, Xian J, Liao J, Chen X, Luo Y, Wang Z, Li N. Development of a framework for managing severe burns through a 17-year retrospective analysis of burn epidemiology and outcomes. Sci Rep 2021; 11:9374. [PMID: 33931691 PMCID: PMC8087787 DOI: 10.1038/s41598-021-88507-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 04/07/2021] [Indexed: 11/09/2022] Open
Abstract
Burns are one of the most common injuries in daily life for all ages of population. This study was to investigate the epidemiology and outcomes among burn patients in one of the largest burn centers in the southwest of China. The study was performed at the Institute of Burn Research in the first affiliated with the Army Medical University (AMU). A total of 17,939 burn patients were included in this retrospective study. Information regarding burn epidemiology and outcomes in 17 years were collected, calculated and compared. The age ranged from 257 days to 95 years old. Scalding and flame were the two most common causes to burn injuries, comprising of 91.96% in total. Limbs, head/face/neck, and trunk were the most frequently occurred burn sites, with the number and the percent of 12,324 (68.70%), 7989 (44.53%), and 7771 (43.32%), respectively. The average total body surface area (TBSA) was 13.64 ± 16.83% (median 8%) with a range of 0.1–100%. A total of 874 (4.9%) patients had TBSA > 50%. The presence of a burn with an inhalation injury was confirmed in 543 patients (3.03%). The average LOS was 32.11 ± 65.72 days (median: 17 days). Eventually, the retrospective analysis resulted in the development of a burn management continuum used for developing strategies to prevent and manage severe burns. The annual number of burn injuries has kept decreasing, which was partially attributed to the increased awareness and education of burn prevention and the improved burn-preventative circumstances. However, the burn severity and the economic burden were still in a high level. And the gender difference and age difference should be considered when making individualized interventions and rehabilitative treatments.
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Affiliation(s)
- Ling Chen
- Department of Emergency, The 958th Hospital of PLA, The Affiliated Hospital of Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, 400020, People's Republic of China
| | - Xiaochong He
- School of Nursing, Third Military Medical University (Army Medical University), Chongqing, 400038, People's Republic of China
| | - Jishu Xian
- Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, 400038, People's Republic of China
| | - Jianmei Liao
- Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, 400038, People's Republic of China
| | - Xuanji Chen
- School of Public Health and Management, Chongqing Medical University, Chongqing, 400016, People's Republic of China
| | - Yue Luo
- Institute of Burn Research, Southwest Hospital, Third Military Medical University (Army Medical University), Gaotanyan Street No.30, Shapingba District, Chongqing, 400038, People's Republic of China
| | - Zonghua Wang
- School of Nursing, Third Military Medical University (Army Medical University), Chongqing, 400038, People's Republic of China.
| | - Ning Li
- Institute of Burn Research, Southwest Hospital, Third Military Medical University (Army Medical University), Gaotanyan Street No.30, Shapingba District, Chongqing, 400038, People's Republic of China.
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Li K, Mehta K, Wright A, Lee J, Yadav M, Pham TN, Rai SM, Nakarmi K, Stewart B. Identifying Hospitals in Nepal for Acute Burn Care and Stabilization Capacity Development: Location-Allocation Modeling for Strategic Service Delivery. J Burn Care Res 2021; 42:621-626. [PMID: 33891676 DOI: 10.1093/jbcr/irab064] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
In Nepal, preventable death and disability from burn injuries are common due to poor population-level spatial access to organized burn care. Most severe burns are referred to a single facility nationwide, often after suboptimal burn stabilization and/or significant care delay. Therefore, we aimed to identify existing first-level hospitals within Nepal that would optimize population-level access as "burn stabilization points" if their acute burn care capabilities are strengthened. A location-allocation model was created using designated first-level candidate hospitals, a population density grid for Nepal, and road network/travel speed data. Six models (A-F) were developed using cost-distance and network analyses in ArcGIS to identify the three vs five candidate hospitals at ≤2, 6, and 12 travel-hour thresholds that would optimize population-level spatial access. The baseline model demonstrated that currently 20.3% of the national population has access to organized burn care within 2 hours of travel, 37.2% within 6 travel-hours, and 72.6% within 12 travel-hours. If acute burn stabilization capabilities were strengthened, models A to C of three chosen hospitals would increase population-level burn care access to 45.2, 89.4, and 99.8% of the national population at ≤2, 6, and 12 travel-hours, respectively. In models D to F, five chosen hospitals would bring access to 53.4, 95.0, and 99.9% of the national population at ≤2, 6, and 12 travel-hours, respectively. These models demonstrate developing capabilities in three to five hospitals can provide population-level spatial access to acute burn care for most of Nepal's population. Organized efforts to increase burn stabilization points are feasible and imperative to reduce the rates of preventable burn-related death and disability country-wide.
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Affiliation(s)
- Kevin Li
- Department of Bioinformatics and Medical Education, University of Washington, Seattle, USA
| | - Kajal Mehta
- Department of Surgery, University of Washington, Seattle, USA
| | - Ada Wright
- Carleton College, Northfield, Minnesota, USA
| | - Joohee Lee
- Public Health Concern Trust Nepal, Kathmandu, Nepal
| | - Manish Yadav
- Public Health Concern Trust Nepal, Kathmandu, Nepal.,Department of Burns, Plastic, and Reconstructive Surgery, Kirtipur Hospital, Kathmandu, Nepal
| | - Tam N Pham
- Division of Trauma, Burn, and Critical Care Surgery, Department of Surgery, University of Washington and UW Medicine Regional Burn Center, Seattle, USA
| | - Shankar M Rai
- Public Health Concern Trust Nepal, Kathmandu, Nepal.,Department of Burns, Plastic, and Reconstructive Surgery, Kirtipur Hospital, Kathmandu, Nepal
| | - Kiran Nakarmi
- Public Health Concern Trust Nepal, Kathmandu, Nepal.,Department of Burns, Plastic, and Reconstructive Surgery, Kirtipur Hospital, Kathmandu, Nepal
| | - Barclay Stewart
- Division of Trauma, Burn, and Critical Care Surgery, Department of Surgery, University of Washington and UW Medicine Regional Burn Center, Seattle, USA.,Harborview Injury Prevention & Research Center, Seattle, Washington, USA
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Evaluation of an Antimicrobial Stewardship Program for Wound and Burn Care in Three Hospitals in Nepal. Antibiotics (Basel) 2020; 9:antibiotics9120914. [PMID: 33339283 PMCID: PMC7766399 DOI: 10.3390/antibiotics9120914] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 12/10/2020] [Accepted: 12/12/2020] [Indexed: 01/01/2023] Open
Abstract
Antimicrobial stewardship (AMS) programs can decrease non-optimal use of antibiotics in hospital settings. There are limited data on AMS programs in burn and chronic wound centers in low- and middle-income countries (LMIC). A post-prescription review and feedback (PPRF) program was implemented in three hospitals in Nepal with a focus on wound and burn care. A total of 241 baseline and 236 post-intervention patient chart data were collected from three hospitals. There was a significant decrease in utilizing days of therapy per 1000 patient days (DOT/1000 PD) of penicillin (p = 0.02), aminoglycoside (p < 0.001), and cephalosporin (p = 0.04). Increases in DOT/1000 PD at post-intervention were significant for metronidazole (p < 0.001), quinolone (p = 0.01), and other antibiotics (p < 0.001). Changes in use of antibiotics varied across hospitals, e.g., cephalosporin use decreased significantly at Kirtipur Hospital (p < 0.001) and Pokhara Academy of Health Sciences (p = 0.02), but not at Kathmandu Model Hospital (p = 0.59). An independent review conducted by infectious disease specialists at the Henry Ford Health System revealed significant changes in antibiotic prescribing practices both overall and by hospital. There was a decrease in mean number of intravenous antibiotic days between baseline (10.1 (SD 8.8)) and post-intervention (8.8 (SD 6.5)) (t = 3.56; p < 0.001), but no difference for oral antibiotics. Compared to baseline, over the 6-month post-intervention period, we found an increase in justified use of antibiotics (p < 0.001), de-escalation (p < 0.001), accurate documentation (p < 0.001), and adherence to the study antibiotic prescribing guidelines at 72 h (p < 0.001) and after diagnoses (p < 0.001). The evaluation data presented provide evidence that PPRF training and program implementation can contribute to hospital-based antibiotic stewardship for wound and burn care in Nepal.
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Bahçe ZŞ, Öztaş T. Epidemiological analysis of patients with burns in third-line hospitals in Turkey. Int Wound J 2020; 17:1439-1443. [PMID: 32515905 PMCID: PMC7948584 DOI: 10.1111/iwj.13426] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 05/20/2020] [Accepted: 05/21/2020] [Indexed: 12/26/2022] Open
Abstract
Burns are a major health problem worldwide. Burn injury resulting from making contact with hot objects, direct or indirect contact with flame, and exposure to chemical agents or electric current is usually preventable. In this study, epidemiological data of the patients who had been hospitalised in the burn unit was assessed. The records of 1453 patients who were admitted to the burn unit of Diyarbakir Gazi Yaşargil Training and Research Hospital between July 2008 and April 2018 were retrospectively examined. Out of 1453 cases, 81.7% (1187) were children and 18.3% (266) were adults, 58.3% of the cases were male (847) and 41.7% (606) were females. Patients had a mean age of 11 ± 5 years (1-81 years). The most common cause of burns was contact with hot liquids (82.86%) while other causes were flame burns (12.04%), electrical contact burn (3.02%) contact with chemical substances (2.06%). Most of the cases were found to have burned 10% to 20% of the body surface. Localization was most frequently seen in the lower extremity and less frequently in the upper limb, trunk, head and neck, and perineal regions. The majority of burn injuries are preventable. Therefore, epidemiological studies in the field of burns will provide vital preventive information to develop strategies to reduce injury frequency and spend on health. Because burns are a social problem, prevention efforts require social co-operation. Promotional meetings in schools are important to increase family-school cooperation to inform children of school age, to give lectures and first aid measures to rural areas.
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Affiliation(s)
- Zeynep Şener Bahçe
- Department of General Surgery, Gazi Yaşargil Training and Research HospitalUniversity of Health SciencesDiyarbakirTurkey
| | - Tülin Öztaş
- Department of Pediatric Surgery, Gazi Yaşargil Training and Research HospitalUniversity of Health SciencesDiyarbakirTurkey
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Phuyal K, Ogada EA, Bendell R, Price PE, Potokar T. Burns in Nepal: a participatory, community survey of burn cases and knowledge, attitudes and practices to burn care and prevention in three rural municipalities. BMJ Open 2020; 10:e033071. [PMID: 32114463 PMCID: PMC7050363 DOI: 10.1136/bmjopen-2019-033071] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES As part of an ongoing, long-term project to co-create burn prevention strategies in Nepal, we collected baseline data to share and discuss with the local community, use as a basis for a co-created prevention strategy and then monitor changes over time. This paper reports on the method and outcomes of the baseline survey and demonstrates how the data are presented back to the community. DESIGN A community-based survey. SETTING Community based in three rural municipalities in Nepal. PARTICIPANTS 1305 households were approached: the head of 1279 households participated, giving a response rate of 98%. In 90.3% of cases, the head of the household was male. RESULTS We found that 2.7% (CI 1.8 to 3.7) of 1279 households, from three representative municipalities, reported at least one serious burn in the previous 12 months: a serious burn was defined as one requiring medical attention and/or inability to work or do normal activities for 24 hours. While only 4 paediatric and 10 adult cases in the previous 12 months reached hospital care, the impact on the lives of those involved was profound. Only one patient was referred on from primary to secondary/tertiary care; the average length of hospital stay for those presenting directly to secondary/tertiary care was 21 days. A range of first-aid behaviours were used, many of which are appropriate for the local context while a few may be potentially harmful (eg, the use of dung). CONCLUSION The participatory approach used in this study ensured a high response rate. We have demonstrated that infographics can link the pathway for each of the cases observed from initial incident to final location of care.
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Affiliation(s)
| | - Edna Adhiambo Ogada
- Centre for Global Burn Injury Policy and Research, College of Human and Health Sciences, Swansea University, Swansea, UK
| | | | - Patricia E Price
- Centre for Global Burn Injury Policy and Research, College of Human and Health Sciences, Swansea University, Swansea, UK
- Interburns, Swansea, UK
| | - Tom Potokar
- Centre for Global Burn Injury Policy and Research, College of Human and Health Sciences, Swansea University, Swansea, UK
- Interburns, Swansea, UK
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Setoodehzadeh F, Ansari H, Zarei T, Surodi Z, Arbabi Z, Khammarnia M. Factors affecting mortality in burn patients in the poorest region of Iran; a case control study. INTERNATIONAL JOURNAL OF BURNS AND TRAUMA 2019; 9:66-72. [PMID: 31333897 PMCID: PMC6627790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Accepted: 05/20/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Burns is one of the most important health issues as well as the most expensive injuries that take place at all ages. It also considers a disaster for society, family, and person. The aim of the study was to examining fatal burns and associated factors' in burn unit patients in Iran. METHODS a case-control study was carried out in the poorest region of Iran. The research population consisted of all patients in a burn unit in Zahedan public hospital during 2013-2018. Using systematic random sampling method, 430 persons (215 dead persons, 215 released persons) were entered into the study. The data form and SPSS software were used for data gathering and the data analyzing, respectively. RESULTS about 41.4% of dead patients were at the age of 25-44 and 60.5% of dead patients were women. Also, 96.3% of expired patients were on level 3 burns. The cause of the burns in 46% of death was flame, oil, and gasoline. Moreover, there is a significant relationship between burns and the age, gender, residence place, history of the previous disease, the cause of burns, burns percentage and the burn level in both case and control group. CONCLUSION in the poorest region of Iran, younger (as the labor force) and women were at high risk of death due to burn. Developing gas infrastructures in this region could decrease the incidence and severity of burns.
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Affiliation(s)
- Fatemeh Setoodehzadeh
- Health Promotion Research Center, Zahedan University of Medical SciencesZahedan, Iran
| | - Hossein Ansari
- Health Promotion Research Center, Zahedan University of Medical SciencesZahedan, Iran
| | - Tayyebeh Zarei
- Student Research Committee, Zahedan University of Medical SciencesZahedan, Iran
| | - Zainab Surodi
- Student Research Committee, Zahedan University of Medical SciencesZahedan, Iran
| | - Ziba Arbabi
- Student Research Committee, Zahedan University of Medical SciencesZahedan, Iran
| | - Mohammad Khammarnia
- Health Promotion Research Center, Zahedan University of Medical SciencesZahedan, Iran
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Pujji OJS, Nakarmi KK, Shrestha B, Rai SM, Jeffery SLA. The Bacteriological Profile of Burn Wound Infections at a Tertiary Burns Center in Nepal. J Burn Care Res 2019; 40:838-845. [DOI: 10.1093/jbcr/irz096] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
AbstractIn Nepal, burn is the third most common injury after falls and road traffic accidents. Infection is the leading cause of mortality in burn injury. A profile exploring predominant flora and antimicrobial sensitivity is important to facilitate treatment ahead of microbiology results and to aid prevention of multidrug-resistant organisms. The aim of this study was to document epidemiological and bacteriological data of burn wound infections at a tertiary level burns center in Nepal. Samples were collected from January 2017 to May 2017, over a period of 5 months. Patient notes were referred to and information regarding baseline characteristics and burn wound infection data was collected. A total of 76 patients were included in the study during the 5-month period, which resulted in 113 samples being included for review. Females were injured most with burns 70% (n = 53) compared with males 30% (n = 23). Only 6 (8%) of 77 patients lived locally in Kathmandu. The average distance traveled by patients was 233 km (median 208, range 0–765, SD 181). Average TBSA% of burn was 22% (median 20, range 3–50, SD 12). Gram-negative organisms predominated, with Acinetobacter spp. in 42 cases (55%), Pseudomonas aeruginosa in 26 cases (34%), and Enterobacter spp. in 16 cases (21%). Colistin, polymyxin B, and tigecycline were found to be most sensitive covering 108, 98, and 94 organisms. Gram-negative bacteria colonized the majority of burn wounds. Colistin, polymyxin B, and tigecycline were the most sensitive to gram-negative bacteria. Gram-positive Staphylococcus aureus was sensitive most to vancomycin and tigecycline.
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Affiliation(s)
| | - Kiran Kishor Nakarmi
- Department of Burns, Plastic and Reconstructive Surgery, Kirtipur Hospital, Nepal
| | | | - Shankar Man Rai
- Department of Burns, Plastic and Reconstructive Surgery, Kirtipur Hospital, Nepal
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ALfadli M, El-Sehsah EM, Ramadan MAM. Risk factors and distribution of MDROs among patients with healthcare associated burn wound infection. Germs 2018; 8:199-206. [PMID: 30775339 DOI: 10.18683/germs.2018.1147] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 11/07/2018] [Accepted: 11/15/2018] [Indexed: 11/08/2022]
Abstract
Introduction Patients with burn wounds are more susceptible to develop healthcare associated (HA) infection. Bacterial isolates from HA burn wound infection vary from one place to the other and also differ in terms of antimicrobial susceptibility pattern. The aim of our study was to assess the incidence of HA burn wound infection, risk factors and to determine the microbiological profile and antimicrobial susceptibility pattern of isolated pathogens. Methods This was a one-year retrospective descriptive study conducted between January 2017 and December 2017, in Al-Babtain Burn and Plastic Surgery center, Kuwait. The identification of bacterial isolates was conducted by conventional biochemical methods according to standard microbiological techniques and commercially available kits using analytical profile index procedure. Results Total body surface area >35% affected and length of stay more than 14 days were statistically significant risk factors for HA burn infection (RR of 10.057 and 5.912, respectively). Analysis of microbiological profile of these positive cultures indicated that the most common isolated organism was Acinetobacter baumannii followed by Klebsiella pneumoniae. Multidrug resistant organisms composed 65.85% of the positive isolates. Vancomycin, tigecycline, teicoplanin and linezolid showed 100% effectiveness for all Gram positive isolates. For Gram negative organisms, imipenem and meropenem showed 38.71% and 41.93% efficacy, respectively. Conclusion Identification of antimicrobial susceptibility patterns helps to tailor the required antibiotic policy to minimize the acquired infections among these vulnerable patients.
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Affiliation(s)
- Mariam ALfadli
- PhD, Director of Infection Control Directorate, Ministry of Health, Sabbah health region, P.O.Box: 12414 Alshamiya, Kuwait
| | - Eman M El-Sehsah
- PhD, Lecturer at Microbiology and Immunology Department, Faculty of medicine, Mansoura University, Egypt, Specialist of Infection Control at Infection Control Directorate, Ministry of Health, Sabbah health region, P.O.Box: 12414 Alshamiya, Kuwait
| | - Moustapha Ahmed-Maher Ramadan
- PhD, Fellow at Community Medicine Department, Faculty of Medicine, Alexandria University, Egypt, Specialist of Infection Control at Infection Control Directorate, Ministry of Health, Sabbah health region, P.O.Box: 12414 Alshamiya, Kuwait
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Tian H, Wang L, Xie W, Shen C, Guo G, Liu J, Han C, Ren L, Liang Y, Tang Y, Wang Y, Yin M, Zhang J, Huang Y. Epidemiologic and clinical characteristics of severe burn patients: results of a retrospective multicenter study in China, 2011-2015. BURNS & TRAUMA 2018; 6:14. [PMID: 29850643 PMCID: PMC5964711 DOI: 10.1186/s41038-018-0118-z] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 04/26/2018] [Indexed: 12/26/2022]
Abstract
Background Severe burns injury is a serious pathology, leading to teratogenicity and significant mortality, and it also has a long-term social impact. The aim of this article is to describe the hospitalized population with severe burns injuries in eight burn centers in China between 2011 and 2015 and to suggest future preventive strategies. Methods This 5-year retrospective review included all patients with severe burns in a database at eight institutions. The data collected included gender, age, month distribution, etiology, location, presence of inhalation injury, total burn surface area, depth of the burn, the length of hospitalization, and mortality. SPSS 19.0 software was used to analyze the data. Results A total of 1126 patients were included: 803 (71.3%) male patients and 323 (28.7%) female patients. Scalds were the most common cause of burns (476, 42.27%), followed by fire (457, 40.59%). The extremities were the most frequently affected areas, followed by the trunk. The median length of hospitalization was 30 (15, 52) days. The overall mortality rate was 14.21%. Conclusions Although medical centers have devoted intensive resources to improving the survival rates of burn patients, expenditures for prevention and education programs are minimal. Our findings suggest that more attention should be paid to the importance of prevention and the reduction of injury severity. This study may contribute to the establishment of a nationwide burn database and the elaboration of strategies to prevent severe burns injury.
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Affiliation(s)
- Hao Tian
- 1Institute of Burn Research, State Key Laboratory of Trauma, Burn and Combined Injury, Southwest Hospital, Third Military Medical University (Army Medical University), Gaotanyan Street no.29, Shapingba District, Chongqing, People's Republic of China
| | - Liangxi Wang
- Institute of Burn and Plastic Surgery, the 97th Hospital of PLA, Xuzhou, , Jiangsu People's Republic of China
| | - Weiguo Xie
- 3Department of Burns, Wuhan Third Hospital, Tongren Hospital of Wuhan University, Wuhan, Hubei People's Republic of China
| | - Chuanan Shen
- 4The Department of Burns and Plastic Surgery, First Affiliated Hospital of People's Liberation Army General Hospital, Beijing, People's Republic of China
| | - Guanghua Guo
- 5The Department of Burns and Plastic Surgery, First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006 People's Republic of China
| | - Jiaqi Liu
- Institute of Burn Research Center of PLA, Xijin Hospital, Forth Military Medical University, Xi'an, Shaanxi 710032 People's Republic of China
| | - Chunmao Han
- 7Department of Burns and Wound Center, Second Affiliated Hospital, College of Medicine, Zhejiang University, Hang Zhou, Zhejiang, 310009 People's Republic of China
| | - Licheng Ren
- 8Department of Burn Reconstruction Surgery, Xiangya Hospital, Central South University, Changsha, Hunan People's Republic of China
| | - Yi Liang
- 1Institute of Burn Research, State Key Laboratory of Trauma, Burn and Combined Injury, Southwest Hospital, Third Military Medical University (Army Medical University), Gaotanyan Street no.29, Shapingba District, Chongqing, People's Republic of China
| | - Yong Tang
- 1Institute of Burn Research, State Key Laboratory of Trauma, Burn and Combined Injury, Southwest Hospital, Third Military Medical University (Army Medical University), Gaotanyan Street no.29, Shapingba District, Chongqing, People's Republic of China
| | - Yuan Wang
- 1Institute of Burn Research, State Key Laboratory of Trauma, Burn and Combined Injury, Southwest Hospital, Third Military Medical University (Army Medical University), Gaotanyan Street no.29, Shapingba District, Chongqing, People's Republic of China
| | - Meifang Yin
- 1Institute of Burn Research, State Key Laboratory of Trauma, Burn and Combined Injury, Southwest Hospital, Third Military Medical University (Army Medical University), Gaotanyan Street no.29, Shapingba District, Chongqing, People's Republic of China
| | - Jiaping Zhang
- 1Institute of Burn Research, State Key Laboratory of Trauma, Burn and Combined Injury, Southwest Hospital, Third Military Medical University (Army Medical University), Gaotanyan Street no.29, Shapingba District, Chongqing, People's Republic of China
| | - Yuesheng Huang
- 1Institute of Burn Research, State Key Laboratory of Trauma, Burn and Combined Injury, Southwest Hospital, Third Military Medical University (Army Medical University), Gaotanyan Street no.29, Shapingba District, Chongqing, People's Republic of China
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Tripathee S, Basnet SJ. Erratum to: Epidemiology of burn injuries in Nepal: a systemic review. BURNS & TRAUMA 2017; 5:15. [PMID: 28546988 PMCID: PMC5442673 DOI: 10.1186/s41038-017-0081-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 05/09/2017] [Indexed: 11/10/2022]
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