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Zia N, Mashreky SR, He H, Patel N, Ahmed FA, Hashmi M, Al-Ibran E, Rahman AF, Khondoker S, Hyder AA, Latif A. Factors associated with emergency department disposition among burn injury patients: Analysis of prehospital and emergency care characteristics using South Asia Burn Registry (SABR) data. Burns 2024; 50:874-884. [PMID: 38245393 PMCID: PMC11055681 DOI: 10.1016/j.burns.2024.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 12/17/2023] [Accepted: 01/10/2024] [Indexed: 01/22/2024]
Abstract
INTRODUCTION Improvement in burn injury data collections and the quality of databanks has allowed meaningful study of the epidemiologic trends in burn care. The study assessed factors associated with disposition of burn injury patients from emergency department accounting for pre-hospital care and emergency care. METHODS This prospective observational pilot study of the South Asia Burn Registry project was conducted at selected public sector burn centers in Bangladesh and Pakistan (September 2014 - January 2015). All age groups with an initial presentation to the burn centers were enrolled. Descriptive and regression analysis is presented. RESULTS A total of 2749 patients were enrolled. The mean age was 21.7 ± 18.0 years, 55.3% were males, and about a quarter were children < 5 years. About 46.9% of the females were housewives. Scald burns were common among children (67.6%) while flame burns were common among adults (44.3%). About 75% of patients were brought in via non-ambulance mode of transport. More than 55% of patients were referrals from other facilities or clinics. The most common first aid given pre-hospital was the use of water or oil. About 25% were admitted for further care. The adjusted odds of being admitted compared to being sent home were highest for children < 5 yrs, those with higher total body surface area burnt, having arrived via ambulance, scald and electrical burn, having an associated injury and inhalational injury. CONCLUSION The study provides insight into emergency burn care and associated factors that influenced outcomes for patients with burn injuries.
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Affiliation(s)
- Nukhba Zia
- Johns Hopkins International Injury Research Unit, Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | | | - Huan He
- Johns Hopkins International Injury Research Unit, Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Nishit Patel
- Johns Hopkins International Injury Research Unit, Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Fasih Ali Ahmed
- Division of Surgical Oncology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Madiha Hashmi
- Department of Critical Care Medicine, Ziauddin University Hospital, Karachi, Pakistan
| | | | | | - Sazzad Khondoker
- National Institute of Burn and Plastic Surgery, Dhaka, Bangladesh
| | - Adnan A Hyder
- Center on Commercial Determinants of Health and Department of Global Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Asad Latif
- Johns Hopkins International Injury Research Unit, Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Anesthesiology, Aga Khan University, Karachi, Pakistan
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Muacevic A, Adler JR, Tanaka Y, Mishiro T, Sano C. Difficulty in Diagnosing Anti-neutrophil Cytoplasmic Antibody-Related Vasculitis With Interstitial Pneumonia and in Ascertaining the Cause of Associated Hematochezia: A Case Report. Cureus 2023; 15:e34091. [PMID: 36843755 PMCID: PMC9946153 DOI: 10.7759/cureus.34091] [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: 01/23/2023] [Indexed: 01/24/2023] Open
Abstract
The diagnosis of rheumatological diseases is challenging among older patients with multimorbidity. Rheumatological diseases in older patients show varied symptoms, such as fatigue, fever, and appetite loss. We encountered an older woman with anti-neutrophil cytoplasmic antibody (ANCA)-related vasculitis complicated by cytomegalovirus (CMV) infection. The case was further complicated by hematochezia and was eventually diagnosed as CMV infection with adverse reactions to medications. This case highlights the difficulty of diagnosing ANCA-related vasculitis and dealing with the complications arising due to the side effects of therapy.
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Sayeed SI, Oakman J, Dillon MP, Stuckey R. Disability, economic and work-role status of individuals with unilateral lower-limb amputation and their families in Bangladesh, post-amputation, and pre-rehabilitation: A cross-sectional study. Work 2022; 73:1405-1419. [DOI: 10.3233/wor-211064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND: Amputation has significant negative impacts on physical, psychological, social and economic wellbeing of individuals and families. This is potentially compounded by significant delays to rehabilitation in Bangladesh. OBJECTIVE: To quantify disability, occupation and socioeconomic status of people with unilateral lower-limb amputation (LLA) and their families in Bangladesh, post-amputation and pre-rehabilitation. METHODS: Between November 2017 and February 2018, people with unilateral LLA attending two locations of Center for the Rehabilitation of the Paralyzed, Bangladesh, for prosthetic rehabilitation were surveyed pre-rehabilitation, using the World Health Organization Disability Assessment Schedule (WHODAS-2.0) with additional socio-economic questions. Data were analysed descriptively, using cross-tabulation with Chi-square and Fisher’s exact tests. RESULTS: Seventy-six individuals participated. The majority had traumatic (64.5%), transtibial amputation (61.8%), were young adults (37.92±12.35 years), in paid work prior to LLA (80%), married (63.2%), male (81.6%), from rural areas (78.9%), with primary/no education (72.4%). After LLA mobility (WHODAS score 74.61±13.19) was their most negatively affected domain. Most (60.5%) did not return to any occupation. Acute healthcare costs negatively impacted most families (89.5%), over 80% becoming impoverished. Nearly 70% of previous income-earners became economically dependent changing traditional family roles. CONCLUSIONS: Following LLA, most participants experienced significant mobility impairment and became economically dependent. The impact of LLA extends beyond the individual, to families who often face challenges to traditional primary earner gendered roles. Improved access to timely and affordable rehabilitation is required to reduce the significant personal and societal costs of disability after LLA.
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Affiliation(s)
- Shapin Ibne Sayeed
- Ergonomics, Safety and Health, Department of Public Health, La Trobe University, Melbourne, VIC, Australia
| | - Jodi Oakman
- Ergonomics, Safety and Health, Department of Public Health, La Trobe University, Melbourne, VIC, Australia
| | - Michael P. Dillon
- Department of Physiotherapy, Podiatry, Prosthetics & Orthotics, La Trobe University, Melbourne, VIC, Australia
| | - Rwth Stuckey
- Ergonomics, Safety and Health, Department of Public Health, La Trobe University, Melbourne, VIC, Australia
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Platt E, Doe M, Kim NE, Chirengendure B, Musonda P, Kaja S, Grimes CE. Economic impact of surgery on households and individuals in low income countries: A systematic review. Int J Surg 2021; 90:105956. [PMID: 33940199 DOI: 10.1016/j.ijsu.2021.105956] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 04/01/2021] [Accepted: 04/22/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Surgical disease in Low Income Countries (LIC) is common, and overall provision of surgical care is poor. A key component of surgical health systems as part of universal health coverage (UHC) is financial risk protection (FRP) - the need to protect individuals from financial hardship due to accessing healthcare. We performed a systematic review to amalgamate current understanding of the economic impact of surgery on the individual and household. Our study was registered on Research registry (www.researchregistry.com). METHODS We searched Pubmed and Medline for articles addressing economic aspects of surgical disease/care in low income countries. Data analysis was descriptive in light of a wide range of methodologies and reporting measures. Quality assessment and risk of bias analysis was performed using study design specific Joanna-Briggs Institute checklists. This study has been reported in line with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and AMSTAR (Assessing the methodological quality of systematic reviews) Guidelines. RESULTS 31 full text papers were identified for inclusion; 22 descriptive cross-sectional studies, 4 qualitative studies and 5 economic analysis studies of varying quality. Direct medical, direct non-medical and indirect costs were variably reported but were substantial, resulting in catastrophic expenditure. Costs had far reaching economic impacts on individuals and households, who used entire savings, took out loans, reduced essential expenditure and removed children from school to meet costs. CONCLUSION Seeking healthcare for surgical disease is economically devastating for individuals and households in LICs. Policies directed at strengthening surgical health systems must seek ways to reduce financial hardship on individuals and households from both direct and indirect costs and these should be monitored and measured using defined instruments from the patient perspective.
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Affiliation(s)
- Esther Platt
- Imperial College Healthcare NHS Trust, South Wharf Road, Paddington, W2 INY, UK.
| | | | | | - Bright Chirengendure
- Consultant General Surgeon, Ndola Teaching Hospital, Zambia; Copperbelt Medical University, Zambia.
| | - Patrick Musonda
- Consultant General Surgeon, Ndola Teaching Hospital, Zambia.
| | - Simba Kaja
- Consultant Orthopaedic Surgeon, Ndola Teaching Hospital, Zambia.
| | - Caris E Grimes
- King's Centre for Global Health and Health Partnerships, School of Population Health and Environmental Sciences, King's College London, London, SE5 9RJ, UK; Medway NHS Foundation Trust, Windmill Road, Gillingham, Kent, ME7 5NY, UK.
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The cost of inpatient burn management in Nepal. Burns 2021; 47:1675-1682. [PMID: 33947601 DOI: 10.1016/j.burns.2021.01.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 12/18/2020] [Accepted: 01/22/2021] [Indexed: 11/22/2022]
Abstract
INTRODUCTION The management of burns is costly and complex with inpatient burns accounting for a high proportion of the costs associated with burn care. We conducted a study to estimate the cost of inpatient burn management in Nepal. Our objectives were to identify the resource and cost components of the inpatient burn care pathways and to estimate direct and overhead costs in two specialist burn units in tertiary hospitals in Nepal. METHODS We conducted fieldwork at two tertiary hospitals to identify the cost of burns management in a specialist setting. Data were collected through semi-structured in-depth interviews (IDIs) and focus group discussions (FGDs) with burn experts; unit cost data was collected from hospital finance departments, laboratories and pharmacies. The study focused on acute inpatient burn cases admitted to specialist burn centres within a hospital-setting. RESULTS Experts divided inpatient burn care pathways into three categories: superficial partial-thickness burns (SPT), mixed depth partial-thickness burns (MDPT) and full thickness burns (FT). These pathways were confirmed in the FGDs. A 'typical' burns patient was identified for each pathway. Total resource use and total direct costs along with overhead costs were estimated for acute inpatient burn patients. The average per patient pathway costs were estimated at NRs 102,194 (US$ 896.4), NRs 196,666 (US$ 1725), NRs 481,951 (US$ 4,227.6) for SPT, MDPT and FT patients respectively. The largest cost contributors were surgery, dressings and bed charges respectively. CONCLUSION This study is a first step towards a comprehensive estimate of the costs of severe burns in Nepal.
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Biswas A, Abdullah ASM, Dalal K, Deave T, Rahman F, Mashreky SR. Exploring perceptions of common practices immediately following burn injuries in rural communities of Bangladesh. BMC Health Serv Res 2018; 18:467. [PMID: 29914495 PMCID: PMC6006944 DOI: 10.1186/s12913-018-3287-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 06/11/2018] [Indexed: 11/16/2022] Open
Abstract
Background Burns can be the most devastating injuries in the world, they constitute a global public health problem and cause widespread public health concern. Every year in Bangladesh more than 365,000 people are injured by electrical, thermal and other causes of burn injuries. Among them 27,000 need hospital admission and over 5600 people die. Immediate treatment and medication has been found to be significant in the success of recovering from a burn. However, common practices used in the treatment of burn injuries in the community is not well documented in Bangladesh. This study was designed to explore the perception of local communities in Bangladesh the common practices used and health-seeking behaviors sought immediately after a burn injury has occurred. Methods A qualitative study was conducted using Focus Group Discussions (FGD) as the data collection method. Six unions of three districts in rural Bangladesh were randomly selected and FGDs were conducted in these districts with six burn survivors and their relatives and neighbours. Data were analyzed manually, codes were identified and the grouped into themes. Results The participants stated that burn injuries are common during the winter in Bangladesh. Inhabitants in the rural areas said that it was common practice, and correct, to apply the following to the injured area immediately after a burn: egg albumin, salty water, toothpaste, kerosene, coconut oil, cow dung or soil. Some also believed that applying water is harmful to a burn injury. Most participants did not know about any referral system for burn patients. They expressed their dissatisfaction about the lack of available health service facilities at the recommended health care centers at both the district level and above. Conclusions In rural Bangladesh, the current first-aid practices for burn injuries are incorrect; there is a widely held belief that using water on burns is harmful.
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Affiliation(s)
- Animesh Biswas
- Reproductive and Child Health Department, Centre for Injury Prevention and Research, Bangladesh (CIPRB), House B 162, Road 23, New DOHS, Mohakhali, Dhaka, 1206, Bangladesh.
| | - Abu Sayeed Md Abdullah
- Reproductive and Child Health Department, Centre for Injury Prevention and Research, Bangladesh (CIPRB), House B 162, Road 23, New DOHS, Mohakhali, Dhaka, 1206, Bangladesh
| | - Koustuv Dalal
- Department of Public Health Science, School of Health and Medical Sciences, Örebro University, Örebro, Sweden
| | - Toity Deave
- Centre for Child & Adolescent Health, Faculty of Health & Applied Sciences, University of the West of England, Bristol, UK
| | - Fazlur Rahman
- Reproductive and Child Health Department, Centre for Injury Prevention and Research, Bangladesh (CIPRB), House B 162, Road 23, New DOHS, Mohakhali, Dhaka, 1206, Bangladesh.,Bangladesh University of Health sciences (BUHS), Dhaka, Bangladesh
| | - Saidur Rahman Mashreky
- Reproductive and Child Health Department, Centre for Injury Prevention and Research, Bangladesh (CIPRB), House B 162, Road 23, New DOHS, Mohakhali, Dhaka, 1206, Bangladesh.,Bangladesh University of Health sciences (BUHS), Dhaka, Bangladesh
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