1
|
Anaya M, Feinberg GJ, Lopardo TL, Kheirbek T. Disparity in Risk of Readmission in Adult Burn Patients: Analysis of a Nationwide Readmission Database. J Surg Res 2024; 301:534-539. [PMID: 39047385 DOI: 10.1016/j.jss.2024.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 05/18/2024] [Accepted: 07/03/2024] [Indexed: 07/27/2024]
Abstract
INTRODUCTION Burn injuries remain a significant cause of disability, impacting long term quality-of-life and imposing large costs on our health systems. Readmission is a metric of quality and an important contributor to this economic burden. The association of socioeconomic and insurance status with burn readmission is not well established. The aim of our study is to develop a predictive risk model of factors associated with readmission after burns. METHODS Using the Healthcare Cost and Utilization Project's 2018 Nationwide Readmission Database, we identified patients ≥18 y of age with burns admitted between January and October 2018. We excluded patients who died during index admission. Our primary outcome was readmission within 60 d postdischarge. We performed a Lasso regression analysis with adaptive selection to generate a predictive model with least deviance using patients' demographics and socioeconomic status, burn location and severity, past medical history, and hospital characteristics. Weighted multiple logistic regression was performed to obtain population estimates of adjusted odds ratios (ORs) of each element in the model. RESULTS Our cohort included 11,380 burn patients. Of those, 1625 (14.3%) were readmitted and 67% were males. Readmitted patients were older (55 ± 17 versus 49 ± 18, P = 0.0001). Weighted logistic regression for the selected model showed higher odds of readmission for patients with lowest income quartile (OR: 1.19, 95% confidence interval [CI]: 1.04-1.36), Medicare or Medicaid insurance (OR: 1.35, 95% CI: 1.17-1.55), history of psychiatric illness (OR:1.19, 95% CI: 1.02-1.39), diabetes (OR: 1.46, 95% CI: 1.25-1.69), chronic kidney disease (OR: 1.66, 95% CI: 1.30-2.11), chronic obstructive pulmonary disease (OR: 1.55, 95% CI:1.26-1.89), and alcohol use disorder (OR: 1.33, 95% CI: 1.13-1.58). Third degree burns and foot burns had higher OR of readmission (OR: 1.21, 95% CI: 1.38-1.98 and 1.66, 95% CI: 1.02-1.45, respectively), while face and hand burns had lower OR of readmission (OR: 0.77, 95% CI: 0.66-0.90 and 0.84, 95% CI: 0.72-0.98, respectively). CONCLUSIONS Burn readmissions are multifactorial and directly related to the patient's comorbidities, including markers that reflect barriers to care such as socioeconomic characteristics, as well as the anatomical location of burn injuries. Early identification of these high-risk patients may aid in early intervention, resource allocation, and outreach program development in an attempt to reduce readmission rates and improve outcomes. Future prospective validation of these risk factors is warranted.
Collapse
Affiliation(s)
- Melanie Anaya
- Division of Trauma and Critical Care Surgery, Department of Surgery, Alpert Medical School Brown University, Providence, Rhode Island
| | - Griffin J Feinberg
- Division of Trauma and Critical Care Surgery, Department of Surgery, Alpert Medical School Brown University, Providence, Rhode Island
| | - Thomas L Lopardo
- Division of Trauma and Critical Care Surgery, Department of Surgery, Alpert Medical School Brown University, Providence, Rhode Island
| | - Tareq Kheirbek
- Division of Trauma and Critical Care Surgery, Department of Surgery, Alpert Medical School Brown University, Providence, Rhode Island.
| |
Collapse
|
2
|
Purola L, Vuola J, Palmu R. Self-harm in burn patients: An analysis of Finnish patient records (2011-2020). Burns 2024; 50:1083-1090. [PMID: 38538444 DOI: 10.1016/j.burns.2024.03.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 03/08/2024] [Accepted: 03/12/2024] [Indexed: 05/25/2024]
Abstract
AIM To collect data on self-harm burn patients at a national level in Finland and analyze patient characteristics. MATERIAL AND METHODS First, we went through The National Care Register for Health Care (Hilmo) records from 2011 to 2015 to find all patients in Finland with both burn and self-harm ICD10 codes. Then we investigated the medical records of all patients treated at the National Burn Centre (NBC) in Helsinki in the period 2011-2020. Patients admitted to the hospital because of self-harm burn injuries were compared to those without self-harm injuries. Patients below 18 years old were excluded. RESULTS The Hilmo register consisted of a total of 3391 adult burn patients admitted to any healthcare unit during the study period. Compared with non-self-harm patients, self-harm patients (N = 82) had lower mean age (41 years vs 54 years, p < 0.001) and longer hospitalization (18 days vs. 6 days, p < 0.05). Two-thirds of the self-harm patients (N = 38) admitted to the NBC in the period 2011-2020 had a pre-burn history of psychiatric care (66%) and one-third of them had a previous record of self-harm or suicide attempt. Men had more severe burns than women (mean TBSA 46% vs. 14%, p < 0.05), and seven of them died during the first 48 h of care, but this was not the case for any female patient. CONCLUSIONS Self-harm burn patients were younger and had longer hospitalization at all care levels than other burn patients. Based on medical records of hospitalized self-harm burn patients, we found clear gender differences in the severity of the burn injury and in mortality, with men suffering more severe injuries, in some cases leading to death. Recognizing high-risk patients pre-burn could have a strong preventive impact.
Collapse
Affiliation(s)
- Lotta Purola
- Department of Plastic Surgery, Oulu University Hospital, PO. Box 21, 90029 Oulu, Finland; Department of Plastic Surgery, Helsinki Burn Centre, Helsinki University Hospital, University of Helsinki, P.O. Box 800 FIN - 00029 HUCH, Helsinki, Finland.
| | - Jyrki Vuola
- Department of Plastic Surgery, Helsinki Burn Centre, Helsinki University Hospital, University of Helsinki, P.O. Box 800 FIN - 00029 HUCH, Helsinki, Finland
| | - Raimo Palmu
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, P.O. Box 590 (Välskärinkatu 12), FIN - 00029 HUS, Finland; Department of Public Health and Welfare, Finnish Institute for Health and Welfare (THL), P.O. Box 30 (Mannerheimintie 166), FI-00271 Helsinki, Finland
| |
Collapse
|
3
|
Peng F, Chung CH, Koh WY, Chien WC, Lin CE. Risks of mental disorders among inpatients with burn injury: A nationwide cohort study. Burns 2024; 50:1315-1329. [PMID: 38519375 DOI: 10.1016/j.burns.2024.02.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 01/29/2024] [Accepted: 02/26/2024] [Indexed: 03/24/2024]
Abstract
OBJECTIVE This investigation identified the association between burn injuries and the risk of mental disorders in patients with no documented pre-existing psychiatric comorbidities. We also examined the relationship of injury severity and the types of injury with the likelihood of receiving new diagnoses of mental disorders. METHODS This population-based retrospective cohort study used administrative data extracted from the Taiwanese National Health Insurance Research Database (NHIRD) between 2000 and 2013. In total, 10,045 burn survivors were matched with a reference cohort of 40,180 patients without burn injuries and were followed to determine if any mental disorder was diagnosed. Patients diagnosed with mental disorders in the five years before study initiation were excluded to ensure incident diagnoses throughout the research duration. Generalized estimating equations in Cox proportional hazard regression models were used for data analysis. RESULTS In general, burn injury survivors have a 1.21-fold risk of being diagnosed with new mental disorders relative to patients without burn injuries. Total body surface area (TBSA) of ≧ 30% (aHR: 1.49, 95% CI: 1.36-1.63) and third- or fourth-degree burns (aHR: 1.49, 95% CI: 1.37-1.63) had a significantly greater risk of being diagnosed with mental disorders in comparison to the reference cohort. Patients TBSA 10-29% (aHR: 0.85, 95% CI: 0.77-0.93) and first- or second-degree burn victims (aHR: 0.89, 95% CI: 0.81-0.97) had relatively lower risk of mental disorders than the reference cohort. CONCLUSION Burn injuries were associated with an increased risk of mental disorders. Additional research in this field could elucidate this observation, especially if the inherent limitations of the NHIRD can be overcome.
Collapse
Affiliation(s)
- Fan Peng
- Department of Psychiatry, Shuang-Ho Hospital, Taipei Medical University, New Taipei City, Taiwan, ROC; School of Post-baccalaureate Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC
| | - Chi-Hsiang Chung
- Department of Medical Research, Tri-Service General Hospital, Taipei, Taiwan, ROC; School of Public Health, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Wan-Ying Koh
- School of Post-baccalaureate Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC; Department of General Medicine, Shuang-Ho Hospital, Taipei Medical University, New Taipei City, Taiwan, ROC
| | - Wu-Chien Chien
- Department of Medical Research, Tri-Service General Hospital, Taipei, Taiwan, ROC; School of Public Health, National Defense Medical Center, Taipei, Taiwan, ROC; Graduate Institute of Life Science, National Defense Medical Center, Taiwan, ROC.
| | - Ching-En Lin
- Department of Psychiatry, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan, ROC; School of Medicine, Tzu Chi University, Hualien, Taiwan, ROC.
| |
Collapse
|
4
|
Abstract
BACKGROUND Self-immolation is one of the most brutal suicide methods and is a significant social and medical problem throughout the world. Self-immolation is more common in low-income countries than in high-income countries. AIM The aim is to evaluate the trends in self-immolation and examine its frequency in Iraq. METHODS The PRISMA guideline was used to conduct this systematic review study. We searched for publications in English, Arabic and Kurdish in PubMed and Google Scholar. A total of 105 publications were identified through the search; however, 92 were eliminated due to duplication and irrelevant content. Finally, 13 full articles were included for data extraction. The inclusion criteria were articles that investigated self-immolation. However, letters to editors and media reports on self-immolation were excluded. The retrieved studies were selected, reviewed and then quality assessed. RESULTS This study included 13 articles. According to the findings, self-immolation accounted for 26.38% of all burn admissions in the Iraqi provinces and the Kurdistan region, with 16.02% of those occurring in the middle and southern provinces of Iraq and 36.75% in the Kurdistan region. It is more common in women than in men, especially among young, married, illiterate, or poorly educated people. Sulaymaniyah had a higher percentage of self-immolation than other governorates in Iraq, accounting for 38.3% of burn admissions. Cultural and social norms, domestic violence, mental health problems, family conflicts and financial problems were identified as the most common causes of self-immolation. CONCLUSION The prevalence of self-immolation is high among the Iraqi population, compared to other countries, particularly among the Kurdish population and in Sulaymaniyah. Self-immolation is relatively common among women. There are sociocultural factors that could contribute to this problem. Families must be restricted from having easy access to kerosene, and high-risk individuals should have access to psychological consultation to reduce the risk of self-immolation.
Collapse
Affiliation(s)
- Darya Rostam Ahmed
- Department of Clinical Psychology, Faculty of Science and Health, Koya University, Koya, Kurdistan Region - F.R., Iraq
| |
Collapse
|
5
|
Zaki HA, Hamdi AH, Elgassim M, Albaroudi B, Fadul KY, Abdelrahman A, Basharat K, Al-Marri NDR, Elmegabar B, Elsayed WAE. Unmasking the Underlying Causes: A Cross-Sectional Analysis of Mortality From Intentional and Unintentional Injuries in the United Arab Emirates. Cureus 2023; 15:e46567. [PMID: 37933336 PMCID: PMC10625665 DOI: 10.7759/cureus.46567] [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: 10/05/2023] [Indexed: 11/08/2023] Open
Abstract
The United Arab Emirates (UAE) has experienced substantial development in infrastructure and transportation in the last few decades. Although available evidence suggests that the incidence of injuries has considerably increased in the previous few years, there is a scarcity of literature that comprehensively analyzed the mortality due to different types of injuries in the UAE. Therefore, the current study was designed to report mortality due to various intentional and unintentional injuries in the UAE. Secondary data was obtained from the World Health Organization (WHO) mortality database. We targeted injuries-specific mortality datasets. We applied a filter (UAE) to retrieve mortality data from unintentional and intentional injuries in the UAE. The latest data in the WHO mortality database was for 2020-21. A total of 10,357 death records from the UAE were present in the WHO mortality database. The percentage of injury-specific deaths out of total deaths was 8.69% (n=900). Injury-specific mortality rate per 100,000 population was 9.09. The percentage of injury-specific deaths was higher for males (87.3%, n=786) and the age group 25-34 years (n=323, 35.9%). Of the 900 injury-specific deaths, 449 (49.9%) were due to unintentional injuries, 216 (24.0%) were due to unintentional injuries, while the remaining (26.1%, n=235) deaths occurred due to Ill-defined injuries. More than half (53.7%, n=241) of unintentional injuries were because of road traffic injuries (RTIs) followed by fall (14.7%, n=66), exposure to mechanical forces (6.5%, n=29), drowning (6.0%, n=27) fire (1.1%, n=5), poisonings (1.1%, n=5), natural disasters (n=1, 0.2%) and other unintentional injuries (16.7%, n=75). More than three-quarters (83.3%, n=180) of intentional injuries were because of self-inflicted injuries while the remaining (16.7%, n=36) intentional injuries-specific deaths occurred due to violence. Many deaths in the UAE occur due to unintentional and intentional injuries. RTIs and falls are the leading causes of unintentional injury-specific deaths, while self-inflicted injuries and violence are the leading causes of intentional injury-specific deaths.
Collapse
Affiliation(s)
- Hany A Zaki
- Emergency Medicine, Hamad Medical Corporation, Doha, QAT
| | | | | | | | - Khalid Y Fadul
- Emergency Medicine, Hamad Medical Corporation, Doha, QAT
| | | | | | | | | | | |
Collapse
|
6
|
Ćertić B, Jovanović M, Karamarković M, Vasović D, Isaković-Subotić J, Živković M, Rašić D. The Impact of the COVID-19 Pandemic on Self-Inflicted Burn Injuries in Patients With Previously Diagnosed Bipolar Disorder. ANNALS OF BURNS AND FIRE DISASTERS 2023; 36:214-216. [PMID: 38680438 PMCID: PMC11041864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 05/16/2022] [Indexed: 05/01/2024]
Abstract
Here we present a case of a 52-year-old female patient who was admitted to the Clinic in December 2021 due to the presence of right side facial burns which were caused by a cigarette lighter under suspicious conditions. Her past medical history revealed she was diagnosed with bipolar disorder at the age of 20 and was hospitalized multiple times for the treatment of manic episodes. The last psychiatric hospitalization took place in October 2021. She had deep second-degree burns on the right side of the face, head and neck, with a total body surface area involvement of approximately 3%. On hospital day 18, she was found unresponsive, dyspnoic, with no palpable pulse and measurable tension. Electrocardiogram (ECG) monitoring revealed sinus bradycardia followed by cardiac asystole. After the first few minutes of cardiopulmonary resuscitation, heart and lung action was re-established. Due to the presence of ECG changes in the form of ST depression and negative T waves in V2-V6, D1 and aVL, also higher blood level of high sensitivity troponin T, she was urgently transported to the Coronary Unit where she was diagnosed with non-ST-elevation myocardial infarction. On hospital day 27, due to the presence of sub-febrile temperature and non-productive cough, she was tested for COVID-19 infection and transported to the COVID Hospital Batajnica. She was discharged with stable laboratory parameters and normal chest radiography 37 days following initial admission. Considering the great psychological impact related to the COVID-19 pandemic, extensive mental health support and regular monitoring of critical groups is indicated.
Collapse
Affiliation(s)
- B. Ćertić
- University Clinical Centre of Serbia Clinic for Burns, Plastic and Reconstructive Surgery, Belgrade, Serbia
| | - M. Jovanović
- University Clinical Centre of Serbia Clinic for Burns, Plastic and Reconstructive Surgery, Belgrade, Serbia
- School of Medicine University of Belgrade, Belgrade, Serbia
| | - M. Karamarković
- University Clinical Centre of Serbia Clinic for Burns, Plastic and Reconstructive Surgery, Belgrade, Serbia
| | - D. Vasović
- University Clinical Centre of Serbia Eye Hospital, Belgrade, Serbia
| | - J. Isaković-Subotić
- University Clinical Centre of Serbia Clinic for Burns, Plastic and Reconstructive Surgery, Belgrade, Serbia
| | - M. Živković
- University Clinical Centre of Serbia Clinic for Burns, Plastic and Reconstructive Surgery, Belgrade, Serbia
| | - D. Rašić
- University Clinical Centre of Serbia Eye Hospital, Belgrade, Serbia
- School of Medicine University of Belgrade, Belgrade, Serbia
| |
Collapse
|
7
|
Heard J, Cronin L, Romanowski K, Greenhalgh D, Palmieri T, Sen S. Massive Burn Injuries: Characteristics and Outcomes From a Single Institution. J Burn Care Res 2023; 44:925-930. [PMID: 36378582 DOI: 10.1093/jbcr/irac173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
Massive burn injuries are a unique patient population with unique treatment paradigms. Data from 155 adult patients, admitted from 2009 to 2019, with >50% total body surface area burns (TBSA) were collected and analyzed. Average burn size was 70% TBSA and 63% had a concomitant inhalation injury. Approximately 30% of patients (46/155) transitioned to comfort care-only measures within 24 hours of admission. Standard treatment patients were younger (37 ± 13 vs 60 ± 19 years; p < .00001), male (94% vs 28%; p = .001) and had smaller TBSA (66 ± 13 vs 80 ± 16; p < .00001). Of the standard treatment group, 72 (66%) survived to discharge. Survivors had smaller TBSA (64 ± 13 vs 71 ± 13; p = .003), less third-degree TBSA (48 ± 25 vs 71 ± 13; p = .003) and lower incidence of renal failure requiring dialysis (22% vs 73%, p < .00001). Multivariate regression analysis showed that age (OR 1.05; p = .025), total TBSA (OR 1.07; p = .005), and renal failure (OR 10.2; p = .00005) were independently associated with mortality. Inhalation injury was not significantly associated with mortality. About 23% (35/155) of patients had a psychiatric condition on admission and 19% (30/155) of patients were burned attempting suicide. Patients with psychiatric conditions spent more time in the hospital (62 vs 30 days; p = .004), more time on ventilator (31 vs 12 days; p = .046), underwent more surgery (4 vs 2 operations, p = .03), and were less likely to die (34% vs 59%; p = .02). In summary, age, burn size, and renal failure were independently associated with mortality, with renal failure being the strongest factor. Psychiatric conditions are prevalent pre-injury and tend to require more inpatient care.
Collapse
Affiliation(s)
- J Heard
- Burn Division, Department of Surgery University of California Davis, Sacramento, California, USA
| | - Laura Cronin
- Burn Division, Department of Surgery University of California Davis, Sacramento, California, USA
| | - K Romanowski
- Burn Division, Department of Surgery University of California Davis, Sacramento, California, USA
| | - D Greenhalgh
- Burn Division, Department of Surgery University of California Davis, Sacramento, California, USA
| | - T Palmieri
- Burn Division, Department of Surgery University of California Davis, Sacramento, California, USA
| | - S Sen
- Burn Division, Department of Surgery University of California Davis, Sacramento, California, USA
| |
Collapse
|
8
|
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.
Collapse
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
| |
Collapse
|
9
|
Harshitha K, Raghava V, Mahesh C. Social and psychological profile of pattern of female burn casualties. EGYPTIAN JOURNAL OF FORENSIC SCIENCES 2022. [DOI: 10.1186/s41935-022-00319-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Abstract
Background
Thermal injuries are one of the commonest causes of unnatural deaths in females in developing countries. However, there is a lack of adequate research into the social and psychological aspects that lead to such deaths. The suicidal death due to immolation by fire is a scourge on Indian society that is not being adequately addressed in all its aspects. There is an attempt in this study to bring awareness of the population under risk and to motivate prevention measures.
A retrospective cross-sectional study was conducted at the Victoria Hospital Mortuary for a period of 12 months between 2017 and 2018. Medicolegal and psychological autopsies were performed on 120 female burn victims over 15 years of age. The information gathered via medical records, police investigations, interviews with family, and postmortem findings was analyzed and compiled to obtain the following results.
Results
Most of the victims, i.e., 52% of the women, were illiterate. More than half of the victims, i.e., 53% of the women in this study, were found to be in the upper-lower socio-economic. Majority of the female victims (63.3%) were married for more than 7 years. Suicide was the commonest manner of death (52%). There was no alleged history of domestic abuse in most cases (73.3%). Only 2 cases, i.e., 1.7% of cases, were booked under Dowry Prohibition Act. Only 28.3% of cases were investigated by Magistrate’s Inquest. History of mental illnesses was reported only in 14.2% of victims. Alcohol was detected in only 2 of the victims (1.7%).
Conclusions
It is evident that in most cases of deaths in women due to thermal injuries, the entire narrative is not thoroughly investigated and any prior history of domestic abuse, dowry demands/harassment, and even mental illnesses gets under-reported or undocumented. Despite there being a plethora of information regarding the statistics as to how women die due to thermal injuries, very minimal data exists regarding the measures adopted to prevent it. There is a hope that this study inspires the concerned stakeholders to take stock and introduce measures to prevent such potential deaths among the vulnerable female population.
Collapse
|
10
|
Opioid use disorder in adult burn patients: Implications for future mental health, behavioral and substance use patterns. Burns 2022:S0305-4179(22)00209-1. [DOI: 10.1016/j.burns.2022.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 07/13/2022] [Accepted: 08/10/2022] [Indexed: 11/02/2022]
|
11
|
McGovern C, Quasim T, Puxty K, Shaw M, Ng W, Gilhooly C, Arkoulis N, Basler M, Macfarlane A, Paton L. Neuropathic agents in the management of pruritus in burn injuries: a systematic review and meta-analysis. Trauma Surg Acute Care Open 2021; 6:e000810. [PMID: 34722931 PMCID: PMC8547510 DOI: 10.1136/tsaco-2021-000810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 09/02/2021] [Indexed: 11/03/2022] Open
Abstract
Objectives Pruritus is a common and often distressing complication after a burn injury. The purpose of this review is to explore the efficacy of drugs classically used to treat neuropathic pain in the management of pruritus after burn injury. Methods A systematic literature search of medical databases was conducted to find studies investigating drugs listed in the National Institute for Health and Care Excellence (NICE) guideline (CG173, "neuropathic pain in adults") for the management of pruritus after burn injury in patients of any age. Controlled studies were stratified by the drug class studied and their risk of bias before conducting meta-analysis. A narrative review of case series or observational studies was presented. Severity of pruritus at any time point, with all quantitative and qualitative measures, was included. Results Fifteen studies were included in the final analysis, 10 investigated the use of gabapentinoids, 4 studied doxepin, and 1 local anesthetic agents. Meta-analysis of three randomized controlled trials (RCTs) demonstrated that the use of gabapentinoids was associated with an improvement in mean VAS (Visual Analog Scale) 0-10 scores of 2.96 (95% confidence interval (95% CI) 1.20 to 4.73, p<0.001) when compared with placebo or antihistamine. A meta-analysis of four RCTs investigating topical doxepin showed an improvement in mean VAS scores of 1.82 (95% CI 0.55 to 3.09, p<0.001). However, when excluding two studies found to be at high risk of bias, no such improvement was found (-0.32, 95% CI -1.64 to -0.99, p=0.83). Conclusion This study suggests that gabapentinoids are beneficial in the management of burn-related pruritus. There is a lack of evidence to suggest that doxepin is an effective treatment. Topical local anesthetic agents may be safe and beneficial, but studies are scarce. Level of evidence Systematic review, level II.
Collapse
Affiliation(s)
- Christopher McGovern
- Anaesthesia, Critical Care and Peri-operative Medicine, University of Glasgow, Glasgow, UK.,Anaesthesia & Critical Care, Glasgow Royal Infirmary, Glasgow, UK
| | - Tara Quasim
- Anaesthesia, Critical Care and Peri-operative Medicine, University of Glasgow, Glasgow, UK.,Anaesthesia & Critical Care, Glasgow Royal Infirmary, Glasgow, UK
| | - Kathryn Puxty
- Anaesthesia, Critical Care and Peri-operative Medicine, University of Glasgow, Glasgow, UK.,Anaesthesia & Critical Care, Glasgow Royal Infirmary, Glasgow, UK
| | - Martin Shaw
- Anaesthesia, Critical Care and Peri-operative Medicine, University of Glasgow, Glasgow, UK.,Department of Clinical Physics and Bioengineering, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Wijnand Ng
- Medical Student, University of Glasgow, Glasgow, UK
| | - Charlotte Gilhooly
- Anaesthesia, Critical Care and Peri-operative Medicine, University of Glasgow, Glasgow, UK.,Anaesthesia & Critical Care, Glasgow Royal Infirmary, Glasgow, UK
| | - Nikolaos Arkoulis
- Plastic and Burn Surgery, Glasgow Royal Infirmary, Glasgow, UK.,Honorary Clinical Senior Lecturer (Medicine), University of Glasgow, Glasgow, UK
| | - Michael Basler
- Anaesthesia and Pain Medicine, Glasgow Royal Infirmary, Glasgow, UK
| | - Alan Macfarlane
- Anaesthesia, Critical Care and Peri-operative Medicine, University of Glasgow, Glasgow, UK.,Anaesthesia and Pain Medicine, Glasgow Royal Infirmary, Glasgow, UK
| | - Lia Paton
- Anaesthesia & Critical Care, Glasgow Royal Infirmary, Glasgow, UK
| |
Collapse
|
12
|
McQuillan TJ, Franco JR, Sorg EM, Baller E, Quijije N, Rozental TD. Understanding and Addressing Psychiatric Comorbidities and Upper-Extremity Trauma: Surgeons in a Multidisciplinary Care Model. J Hand Surg Am 2021; 46:328-334. [PMID: 33637395 DOI: 10.1016/j.jhsa.2021.01.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 11/23/2020] [Accepted: 01/14/2021] [Indexed: 02/02/2023]
Abstract
Psychiatric disorders are a common cause of disability and represent an important risk factor for upper-extremity trauma. The review provides an overview of psychiatric illnesses as both contributors and sequelae of 4 major injury patterns: self-inflicted wrist lacerations, self-amputation, upper-extremity fractures, and burns. The authors develop a multidisciplinary model for upper-extremity surgeons to care for patients with psychiatric disorders, with an overview of capacity assessment, optimal psychiatric comanagement, and collaboration with allied health professionals.
Collapse
Affiliation(s)
| | | | - Emily M Sorg
- Department of Psychiatry, Harvard Medical School, Massachusetts General Hospital, Boston, MA
| | - Erica Baller
- Department of Psychiatry, Harvard Medical School, Massachusetts General Hospital, Boston, MA
| | - Nadia Quijije
- Department of Psychiatry, Harvard Medical School, Massachusetts General Hospital, Boston, MA
| | - Tamara D Rozental
- Department of Orthopaedic Surgery, Harvard Medical School, Beth Israel Deaconess, Boston, MA.
| |
Collapse
|
13
|
Ryder C, Mackean T, Hunter K, Rogers K, Holland AJA, Ivers R. Burn Injuries in Hospitalized Australian Children-An Epidemiological Profile. J Burn Care Res 2020; 42:381-389. [PMID: 32910200 DOI: 10.1093/jbcr/iraa159] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Globally, First Nations children sustain burns at a higher rate than other children. Little is understood about how health inequities contribute, especially from an Indigenous viewpoint. We analyzed data from the Burns Registry of Australian and New Zealand (BRANZ) for acute burns in children (<16 years) admitted to hospital between October 2009 and July 2018. Descriptive statistics examined equity variables in patient and injury characteristics. Poisson regression was used to describe factors associated with bacterial infection. Indigenous research methods were used throughout. Aboriginal and Torres Strait Islander children represented 10.4% of the study population. Health inequities were present for Aboriginal and Torres Strait Islander children with longer hospital length of stay (9.5 vs 4.6 days), rural residency (61.3% vs 13.9%), lower socioeconomic status (72.2% vs 34.9%), and more flame burns (19.5% vs 10.6%) compared to other Australian children. Streptococcus sp. infection risk was four times greater in Aboriginal and Torres Strait Islander children compared to other Australian children. Flame burns and high percentage total body surface area burns were a risk for Staphylococcus sp. and Streptococcus sp. infection in all children. The epidemiological profile for burn injuries managed in Australian burns centers differs between Aboriginal and Torres Strait Islander children and other children, indicating persistent health inequities. These differences should be considered in the development of injury prevention strategies and the clinical management of burn injuries for Aboriginal and Torres Strait Islander children and their families.
Collapse
Affiliation(s)
- Courtney Ryder
- Injury Division, The George Institute for Global Health Australia, University of New South Wales, Australia.,Aboriginal and Torres Strait Islander Health, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Tamara Mackean
- Injury Division, The George Institute for Global Health Australia, University of New South Wales, Australia.,Aboriginal and Torres Strait Islander Health, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Kate Hunter
- Injury Division, The George Institute for Global Health Australia, University of New South Wales, Australia
| | - Kris Rogers
- Injury Division, The George Institute for Global Health Australia, University of New South Wales, Australia.,Graduate School of Health, University of Technology Sydney, New South Wales, Australia
| | - Andrew J A Holland
- The University of Sydney School of Medicine, The Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, New South Wales, Australia
| | - Rebecca Ivers
- Injury Division, The George Institute for Global Health Australia, University of New South Wales, Australia.,School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
| |
Collapse
|
14
|
Bich CS, Kostev K, Baus A, Jacob L. Burn injury and incidence of psychiatric disorders: A retrospective cohort study of 18,198 patients from Germany. Burns 2020; 47:1110-1117. [PMID: 34024687 DOI: 10.1016/j.burns.2020.06.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 05/31/2020] [Accepted: 06/10/2020] [Indexed: 11/24/2022]
Abstract
AIMS The goal of this study was to investigate the association between burn injury and the incidence of psychiatric disorders in patients followed for up to five years in general practices in Germany. METHODS This study included patients receiving an initial diagnosis of burn injury in one of 1178 general practices in Germany between 2015 and 2018 (index date). Individuals without burn injury were matched (1:1) to those with burn injury by sex, age, index year, and general practice. For patients without burn injury, the index date was a randomly selected visit date between 2015 and 2018. Study variables included burn injury with body region, psychiatric disorders (i.e. depression, anxiety disorders, reaction to severe stress and adjustment disorders, and somatoform disorders), sex, age, and the Charlson Comorbidity Index. The association between burn injury and the incidence of psychiatric disorders was studied using Kaplan-Meier curves and multivariable Cox regression models. RESULTS The study included 9099 patients with and 9099 patients without burn injury (53.8% of subjects were women; mean [standard deviation] age was 45.4 [18.5] years). After five years of follow-up, 29.4% of patients with burn injury and 26.2% of those without burn injury were diagnosed with any psychiatric disorder (log-rank p-value < 0.001). Furthermore, there was a positive and significant association between burn injury and the incidence of psychiatric disorders (hazard ratio = 1.32, 95% confidence interval = 1.22-1.43). CONCLUSIONS Burn injury was positively associated with the incidence of psychiatric disorders in individuals followed for up to five years in general practices in Germany.
Collapse
Affiliation(s)
| | | | - Arnaud Baus
- Plastic Surgery Unit, Percy Military Hospital, Clamart, France
| | - Louis Jacob
- Faculty of Medicine, University of Versailles Saint-Quentin-en-Yvelines, Montigny-le-Bretonneux, France; Research and Development Unit, Parc Sanitari Sant Joan De Déu, CIBERSAM, Dr. Antoni Pujadas, 42, Sant Boi de Llobregat, Barcelona 08830, Spain
| |
Collapse
|
15
|
Bayuo J, Wong FKY, Agyei FB. "On the Recovery Journey:" An Integrative Review of the Needs of Burn Patients From Immediate Pre-Discharge to Post-Discharge Period Using the Omaha System. J Nurs Scholarsh 2020; 52:360-368. [PMID: 32445507 DOI: 10.1111/jnu.12563] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND To establish a conceptual understanding of the needs of burn patients, the specific research question asked is: "What are the needs of burn patients from 1-week pre-discharge to the post-discharge period?" METHODS Whittemore and Knafl's integrative review approach was used to answer the review question. The databases searched were the Cumulative Index to Nursing and Allied Health Literature (CINAHL), PubMed, Embase, and Scopus. Thirty-two primary studies were retained at the end of the screening process. Directed content analysis was undertaken, with the Omaha system as an organizing framework. RESULTS Recovery after burns is not a linear process, but an intricate one filled with varied needs in the physiological (pain, skin, neuro-musculo-skeletal, and infection), psychosocial (social contact, role changes, spirituality, grief, mental health, and sexuality), health-related behavior (nutrition, sleep and rest patterns, and physical activity), and environmental (income) domains of the Omaha system. The nature and intensity of these needs change over time, suggesting that recovery for the burn patient is an ongoing process. CONCLUSIONS Several needs exist from 1 week before discharge to the post-discharge period. The mutual relationship and evolving nature of these needs create an avenue for a flexible, regular, holistic transitional program, similar to the support offered to persons living with chronic conditions. CLINICAL RELEVANCE Hospital discharge does not imply an end to the recovery of burn patients, and burn survivors still require holistic care even after discharge. The review shows the applicability of the Omaha system in exploring and classifying the needs of burn survivors and situates nursing at the core of such a program. It is possible that a nurse-led program of care needs to be considered.
Collapse
Affiliation(s)
- Jonathan Bayuo
- PhD Candidate, School of Nursing, The Hong Kong Polytechnic University, Hong Kong
| | | | - Frank Bediako Agyei
- Lecturer, Department of Nursing, Faculty of Health and Medical Sciences, Presbyterian University College, Agogo, Ghana
| |
Collapse
|