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Introduction Burn injuries have profound implications, prompting the use of various mortality scoring systems. This study aimed to evaluate their effectiveness within our Appalachian burn referral center, which serves as the sole burn center in the state of West Virginia. Given this unique status, understanding the efficacy of mortality scoring systems within our center is crucial for resource allocation and optimizing patient outcomes in our region. Methods A retrospective analysis of patients admitted to Cabell Huntington Hospital Burn Intensive Care Unit (BICU) from January 2010 to June 2023 was conducted, assessing Baux (B), revised Baux (rB), Belgian Outcome in Burn Injury (BOBI), and Abbreviated Burn Severity Index (ABSI) scores. Logistic regression and receiver operating characteristic analysis were employed to examine survival status and determine optimal cut points. Results Among 1,104 patients, 57 died (5% mortality rate). Deceased patients had significantly higher B/rB/BOBI scores (mean: 98/98/92) than survivors (45/46/4.19) (p < 0.001), with ABSI showing no significance (p = 0.079). Each one-point increase in B/rB/BOBI scores correlated with a 1.09/1.09/2.34 times higher mortality risk (p < 0.001). The AUC for B score in predicting mortality was 0.926 (95% CI: 0.890, 0.962), with sensitivity and specificity values of 0.789 and 0.92, respectively, and an optimal cutoff point of 79. The AUC for the rB score was 0.927 (95% CI: 0.892, 0.962), with sensitivity and specificity values of 0.789 and 0.926, respectively, and an optimal cutoff point of 80. The AUC for the BOBI score was 0.901 (95% CI: 0.865, 0.937), with sensitivity and specificity values of 0.895 and 0.775, respectively, and an optimal cutoff point of 2. For patients with B scores above 79, their odds of mortality were 42.6 times higher than those with B scores of 79 or lower (95% CI: 22.6, 85.6, p < 0.001). Similarly, for patients with rB scores exceeding 80, their odds of mortality were 42.9 times higher than those with rB scores of 80 or lower (95% CI: 22.9, 84.8, p < 0.001). Finally, for patients with BOBI scores greater than 2, their odds of mortality were 17.8 times higher than those with BOBI scores of 2 or lower (95% CI: 9.88, 33.4, p < 0.001). Conclusion Our study underscores the vital role of mortality scoring systems in guiding clinical decision-making and resource allocation for burn patients, particularly within the Appalachian region served by the Cabell Huntington Hospital BICU. By leveraging tools such as the Baux, revised Baux, and BOBI scores, healthcare providers can identify high-risk patients early in their treatment course, facilitating personalized interventions and improving overall patient outcomes. Moreover, our findings highlight the significance of age and total body surface area burned as key determinants of mortality risk, emphasizing the need for tailored approaches to care for elderly patients and those with extensive burns. Continued research and refinement of mortality scoring systems are essential to further enhance their effectiveness and ensure optimal patient care in the challenging field of burn management.
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Background: Selective bromelain-based enzymatic debridement (BED) has emerged as a valid alternative for the treatment of extensive burns, with Total Body Surface Area (TBSA) > 20%. Autologous skin grafting represents the procedure of choice but the scarcity of donor sites remains the main reconstructive challenge. The modified Meek micro-grafting technique may represent a valid strategy to optimize the final outcome. Methods: A single-cohort retrospective analysis was performed, involving nine burn patients (TBSA > 20%) who underwent both BED and subsequently modified Meek technique. Demographic and clinical data (mechanism of injury, surgical treatment, complications, necessity of re-grafting, further surgery and esthetic outcome) were collected. Results: All patients had large burns of mixed and deep dermal thickness (first, second, and third degree). All burns were enzymatically debrided postadmission and covered by the modified Meek technique. Local infection due to poor general conditions was the main complication for all patients. All but two patients survived. The selectiveness of the enzymatic debridement and dermal preservation seemed to improve the quality of scars resulting from micro-grafting. Evaluations performed at 12 ± 2 months postburn showed superior scar quality compared to areas treated with traditional (sheet/mesh) grafts. Conclusion: Combined BED and Meek techniques may provide an effective synergic combination for the treatment of extensive burns.
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BACKGROUND: Pattern mining techniques are helpful tools when extracting new knowledge in real practice, but the overwhelming number of patterns is still a limiting factor in the health-care domain. Current efforts concerning the definition of measures of interest for patterns are focused on reducing the number of patterns and quantifying their relevance (utility/usefulness). However, although the temporal dimension plays a key role in medical records, few efforts have been made to extract temporal knowledge about the patient's evolution from multivariate sequential patterns. METHODS: In this paper, we propose a method to extract a new type of patterns in the clinical domain called Jumping Diagnostic Odds Ratio Sequential Patterns (JDORSP). The aim of this method is to employ the odds ratio to identify a concise set of sequential patterns that represent a patient's state with a statistically significant protection factor (i.e., a pattern associated with patients that survive) and those extensions whose evolution suddenly changes the patient's clinical state, thus making the sequential patterns a statistically significant risk factor (i.e., a pattern associated with patients that do not survive), or vice versa. RESULTS: The results of our experiments highlight that our method reduces the number of sequential patterns obtained with state-of-the-art pattern reduction methods by over 95%. Only by achieving this drastic reduction can medical experts carry out a comprehensive clinical evaluation of the patterns that might be considered medical knowledge regarding the temporal evolution of the patients. We have evaluated the surprisingness and relevance of the sequential patterns with clinicians, and the most interesting fact is the high surprisingness of the extensions of the patterns that become a protection factor, that is, the patients that recover after several days of being at high risk of dying. CONCLUSIONS: Our proposed method with which to extract JDORSP generates a set of interpretable multivariate sequential patterns with new knowledge regarding the temporal evolution of the patients. The number of patterns is greatly reduced when compared to those generated by other methods and measures of interest. An additional advantage of this method is that it does not require any parameters or thresholds, and that the reduced number of patterns allows a manual evaluation.
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Minería de Datos , Humanos , Oportunidad Relativa , Minería de Datos/métodos , Factores de Tiempo , Reconocimiento de Normas Patrones Automatizadas , Atención a la Salud , Registros Electrónicos de SaludRESUMEN
Introdução: Embora prevalente, a epidemiologia das queimaduras possui lacunas. Simultaneamente, a COVID-19 estabeleceu um cenário desafiador e com novos comportamentos humanos, que poderiam impactar nas características e na incidência de queimaduras. O objetivo geral do projeto foi descrever o perfil epidemiológico dos pacientes de uma Unidade de Tratamento de Queimados. Método: O estudo foi uma revisão prontuários de janeiro de 2018 até maio de 2022, incluindo uma amostra de 1164 admissões do Hospital Padre Albino (Catanduva-SP). A análise estatística foi realizada através do Google Sheets e JAMOVI, sendo aplicado o Teste U de Mann-Whitney para comparação de períodos de tempo antes e durante a pandemia. Antes da coleta de dados, o mesmo foi submetido e aprovado pelo Conselho de Ética em Pesquisa da instituição (parecer número 5.616.556, CAAE: 62621822.50000.5430). Resultados: As admissões apresentaram idade média de 31,38 anos e 17,88% de Superfície Corporal Queimada (SCQ), sendo 452 mulheres e 712 homens; a média de SCQ foi de 17 para mulheres e 18,6 para homens. O principal agente causador foi a escaldadura. No que tange à comparação por períodos, durante a pandemia a chama direta teve um aumento de 8% em relação ao período anterior (35%). A escaldadura ainda permaneceu com prevalência elevada, no entanto, apresentou queda de 2%, assim como as queimaduras por dermoabrasão, com queda de 10%. Conclusão: Os achados dos estudos possuem limites em termos de generalização e novos estudos precisam ser desenvolvidos. As mudanças observadas no período não foram significativas e sem relevância clínica.
Introduction: Although prevalent, the epidemiology of burns has gaps. At the same time, Covid-19 established a new scenario with new human behaviors, which could equally impact the characteristics and incidence of burns. The overall objective of the project was to describe the epidemiological profile of patients in a Burn Treatment Unit. Methods: The study was a chart review from January 2018 to May 2022, including a sample of 1164 admissions from Hospital Padre Albino (Catanduva, São Paulo, Brazil). Statistical analysis was performed using Google Sheets and JAMOVI, and Mann-Whitney U-test was applied for comparison of time periods before and during the pandemic. Before data collection, the study was submitted and approved by the Research Ethics Committee of the institution (document number 5.616.556, CAAE: 62621822.50000.5430). Results: The admissions presented a mean age of 31.38 years and 17.88% of body surface area burned, 452 women and 712 men, the mean age was 17 for women and 18.6 for men. The main agent was scalding. When it comes to period comparison, during the pandemic direct flaming had an 8% increase over the previous period (35%). The scalds still remained with high prevalence, however it presented a decrease of 2%, as well as the burns by dermabrasion, which had a decrease of 10%. Conclusion: The findings of the studies have limits in terms of generalization, and new studies need to be developed. The changes observed in the period were not significant and without clinical relevance.
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Introdução: O uso da corrente elétrica é imprescindível nas nossas atividades do cotidiano, porém, seu contato com tecidos vivos pode provocar queimaduras desde leves até graves ou fatais. Por se tratar de um problema de saúde pública, o conhecimento de sua epidemiologia é essencial para o desenvolvimento de programas em saúde. Método: Estudo transversal de dados registrados nos prontuários dos pacientes atendidos por queimadura elétrica na Unidade de Queimados do Hospital de Clínicas da Universidade Federal de Uberlândia entre os anos de 2013 e 2019. Resultados: Foram admitidos 26 pacientes, a maioria de sexo masculino (76,9%) e adultos (30,7%), vítimas de corrente de alta voltagem (65,4%) no trabalho (57,7%), que mais afetou as extremidades superiores (80,7%), sendo as crianças todas do sexo feminino (15,3%). O percentual médio de área queimada foi de 14,5% e o percentual de tratados com autoenxerto de pele foi de 53,8%. A média de permanência hospitalar foi de 40 dias e 3,8% deles foram para a Unidade de Terapia Intensiva. Não se registraram óbitos durante o período. Conclusão: A incidência de pacientes atendidos por queimadura elétrica é baixa, acometendo vítimas em todas as faixas etárias e com predomínio em indivíduos adultos do sexo masculino em seu local de trabalho. O tratamento cirúrgico mais realizado foi o autoenxerto de pele. As políticas de promoção, prevenção e proteção em saúde no que diz respeito aos perigos da corrente elétricas não estariam sendo praticadas e difundidas em nossa população doméstica, laboral ou empregadora, diferentemente como ocorre em grande parte dos países desenvolvidos.
Introduction: Using electric current is essential in our daily activities; however, its contact with living tissue can cause mild to severe or fatal burns. As it is a public health problem, knowledge of its epidemiology is essential for the development of health programs. Method: Cross-sectional study of data recorded in the medical records of patients treated for electrical burns at the Burns Unit of the Hospital de Clínicas of the Universidade Federal de Uberlândia between 2013 and 2019. Results: 26 patients were admitted, the majority of whom were male (76 .9%) and adults (30.7%), victims of high voltage current (65.4%) at work (57.7%), which most affected the upper extremities (80.7%), with children all female (15.3%). The average percentage of burned area was 14. 5% and the % of those treated with skin autograft was 53.8%. The average hospital stay was 40 days, and 3.8% went to the Intensive Care Unit. No deaths were recorded during the period. Conclusion: The incidence of patients treated for electrical burns is low, affecting victims in all age groups and with a predominance of adult males in their workplace. The most common surgical treatment was skin autograft. Health promotion, prevention, and protection policies regarding the dangers of electrical currents would not be practiced and disseminated among our domestic, working, or employing population, unlike what occurs in most developed countries.
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INTRODUCTION: Quality indicators (QIs) are tools for improving and maintaining the standard of care. Although burn injuries are a major global health threat, requiring standardized management, there is a lack of worldwide accepted quality indicators for burn care. This study aims to identify the best burn care-specific QIs as perceived by worldwide burn practitioners. METHODS: The ISBI Burn Care Committee developed a survey to analyze which burn care- specific QIs were relevant to international burn care professionals. The questionnaire was based on the three dimensions of the Donabedian model (i.e., Structure, Process, and Outcome) to evaluate the quality of care. The study was conducted from April to September 2021 and analyzed and reported following the Checklist for Reporting Results of Internet E-Surveys (CHERRIES). RESULTS: According to the 124 worldwide respondents, the most relevant QIs were: access to intensive care, burn surgeons, and dedicated burn care nurses (Structure category), 24-hours access to burn services, local protocols based on documented guidelines (Process category), and in-hospital mortality and incidence of severe infections (Outcome category). CONCLUSIONS: Specific QIs related to structures, clinical processes, and outcomes are needed to monitor the treatment of burn patients globally, assess the efficiency of the provided treatment, and harmonize the worldwide standard of burn care.
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Quemaduras , Indicadores de Calidad de la Atención de Salud , Humanos , Quemaduras/terapia , Encuestas y CuestionariosRESUMEN
The present study aimed to investigate haemoglobin (Hb) changes before and after packed red blood cell (RBC) transfusion in burn patients. This study was a retrospective cross-sectional study that was conducted on burn patients in Velayat hospital in Rasht, Iran. The sampling method of this study was consecutive sampling. Data were collected using patient records, including age, gender, body mass index (BMI), total body surface area (TBSA) percentage, length of hospitalisation, Frequency of receiving packed RBCs, and Hb level before each packed RBC transfusion and 4 to 6 hours after transfusion. Paired t tests and analysis of variance (ANOVA) were used to compare the study variables. Pearson's correlation coefficient was used to investigate the relationship between Hb changes after the transfusion of packed RBCs and the study variables. A total of 110 burn patients participated in this study. The average Hb before and after transfusion was 8.07 (SD = 0.97) and 9.16 (SD = 1.01), respectively, which were significantly different (P = .0001). The results showed that there was a significant negative relationship between the variables of age (r = -0.188, P = .0001), BMI (r = -0.110, P = .035), and TBSA percentage (r = -0.122, P = .019) with changes in Hb after transfusion. Also, the duration of hospitalisation had a significant positive relationship with Hb changes after transfusion (r = 0.124, P = .017). In sum, Hb level compensation through packed RBC transfusion in elderly burn patients has more challenges. The number of changes in Hb level after receiving packed RBCs decreased with increasing TBSA, BMI, and age. Also, there was a positive correlation between the duration of hospitalisation and changes in Hb levels.
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Quemaduras , Hemoglobinas , Humanos , Anciano , Estudios Retrospectivos , Estudios Transversales , Hemoglobinas/análisis , Eritrocitos/química , Quemaduras/terapiaRESUMEN
Objetivo : Comparar las características clínicoepidemiológicas de pacientes pediátricos con quemaduras antes y durante la pandemia por COVID-19, en el Instituto Nacional de Salud del Niño San Borja. El estudio : Estudio analítico, retrospectivo. Se evaluó pacientes atendidos en el INSNSB, durante los períodos de marzo a diciembre 2019 y 2020. Se obtuvieron datos de las historias clínicas. Para la estadística se empleó el programa SPSS v25 (IC 95%). Hallazgos : Se analizaron 139 pacientes en cada periodo. El 60.4% y el 76.3% procedía de Lima, antes y durante la pandemia respectivamente. El grado de instrucción más frecuente del familiar responsable fue el de secundaria (42.3% y 58.2%). Además, las quemaduras menores mostraron un aumento antes y durante la pandemia (49.9% y 61%). Conclusiones: Se observó cambios significativos en la procedencia, grado de instrucción del familiar responsable y severidad de quemadura en ambos períodos
Objective: To compare the clinical-epidemiological characteristics of patients with burns before and during the COVID-19 pandemic treated at the "Instituto Nacional de Salud del Niño San Borja" . The study: Analytical, retrospective study. Patients treated at the INSNSB, during the periods from March to December 2019 and 2020. Data were collected from medical records. For statistical, the SPSS v25 program (95% CI) was used. Findings: 139 patients were analyzed in each period. 60.4% and 76.3% of patients came from Lima, before and during the pandemic, respectively; The most frequent level of education of the responsible family member was high school (42.3% and 58.2%). Also, minor burns showed an increase before and during the pandemic (49.9% and 61%). Conclusions: Significant changes were observed in the origin, degree of the responsible family member and the severity of burn between both periods.
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Hand burns are common and treatment individualized, however given large volumes in some centers, pattern recognition may help optimize service provision. We performed a single center retrospective review from 2014 to 2018 of hand burns in patients aged 16 and over. Burns confined to the hands were considered isolated. We found 1163 patients (790 male, 68%), with 853 isolated (9% bilateral) and 310 non-isolated (35% bilateral) hand burns, and 12% were sustained in industrial workplaces. Most isolated burns received first aid (72%) and were scalds (41%) or contact (23%). Many presented to hospital by car (73%) and most were treated as outpatients (92%). Non-isolated burns were mainly flash (38%) or flame burns (25%, p < 0.01), with 66% given first aid, 49% used ambulances (p < 0.01) and 54% underwent hospital admission (p < 0.01). Non-isolated injuries had more full thickness involvement (p < 0.01), 13% were resuscitation burns and 10% received intensive care. Isolated and non-isolated burns are distinct clinical entities, as are unilateral and bilateral injuries. Isolated burns are usually unilateral scalds or contact burns, suited to outpatient treatment. Non-isolated burns are often flash or flame, bilateral, often needing ambulances, admission, and interventions. First aid can be improved, and consideration given to inpatient rehabilitation of bilateral hand burns.
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Quemaduras , Traumatismos de la Mano , Traumatismos de la Muñeca , Humanos , Masculino , Quemaduras/terapia , Hospitalización , Estudios Retrospectivos , Extremidad SuperiorRESUMEN
OBJETIVO: Avaliar o custo operacional do Centro de Tratamento de Queimados (CTQ) e calcular o custo paciente-dia. MÉTODO: Estudo transversal, com análise retrospectiva, quantitativa. Optou-se pelo sistema de microcusteio por absorção como método de apuração de custos através do sistema de informação de Compras Gerenciamento de Recursos Materiais e Serviço de Arquivo Médico no CTQ nos anos de 2019 e 2020. RESULTADOS: 824 internações incluindo enfermaria e Unidade Terapia Intensiva, com uma média de taxa de ocupação 73,4% e 91,4%, respectivamente. O perfil predominante foi do sexo masculino, de 0-9 anos, a maior taxa de mortalidade foi entre 60-80 anos, custo operacional R$15.547.698,81 e R$ 15.114.274,03, que gera um custo operacional mensal da unidade de R$ 1.277.582,21; os custos diretos representaram 58% e 54% nos anos de 2019 e 2020, respectivamente. Sendo assim, em média, o paciente-dia custou R$ 3.274,46 e uma taxa média de permanência de 13 dias de internação, portanto, pode-se fazer uma projeção de custos do tratamento de R$ 42.567,98, incluindo os custos indiretos e diretos. CONCLUSÕES: O custo operacional médio mensal foi de R$ 1.277.582,21 e paciente-dia teve um custo médio de R$ 3.274,46 para 13 dias de internação, projeta-se o custo total do tratamento R$ 42.567,98, incluindo os custos diretos e indiretos.
OBJECTIVE: To evaluate the operating cost of the Burn Treatment Center (CTQ) and to calculate the patient-day cost. METHODS: Cross-sectional study, with retrospective, quantitative analysis. The micro absorption costing system was chosen as a method of calculating costs through the Purchasing information system Material Resource Management and Medical Archive Service at the CTQ in 2019 and 2020. RESULTS: 824 hospitalizations including ward and Therapy Unit Intensive, with an average occupancy rate of 73.4% and 91.4%, respectively. The predominant profile was male, aged 0-9 years, the highest mortality rate was between 60-80 years, operating cost R$15,547,698.81 and R$15,114,274.03, which generates a monthly operating cost of unit of BRL 1,277,582.21, direct costs represented 58% and 54% in 2019 and 2020, respectively. Therefore, on average, the patient-day cost BRL 3,274.46 and an average hospital stay of 13 days, therefore, a treatment cost projection of BRL 42,567.98, including indirect and direct costs. CONCLUSIONS: The average monthly operating cost was R$ 1,277,582.21 and patient-day had an average cost of R$ 3,274.46 for 13 days of hospitalization, the total cost of treatment is projected to be R$ 42,567.98 including direct and indirect costs.
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OBJETIVO: Descrever o perfil de pacientes adultos internados por queimaduras que passaram por contrafluxo, retorno do paciente para uma unidade de maior complexidade assistencial por complicações ou deterioração clínica, durante a internação hospitalar e avaliar a relação existente entre a sua ocorrência, o Abbreviated Burn Severity Index (ABSI) e óbito. MÉTODO: Estudo retrospectivo de coorte aberta com dados secundários de um Centro de Tratamento de Queimados (CTQ) na Bahia, de janeiro de 2022 a junho de 2023. Os dados foram organizados no Excel, exportados e analisados no Stata. A significância estatística foi avaliada pelo teste Qui-quadrado ou exato de Fisher para variáveis categóricas. Este estudo foi aprovado pelo Comitê de Ética em Pesquisa. RESULTADOS: Das 658 internações no CTQ, 72 (10,9%) tiveram contrafluxo. Destas, 51,4% foram do sexo masculino, 68% estavam na faixa etária de 18 a 59 anos, predominando as queimaduras por calor/fogo. As unidades que mais receberam o contrafluxo foram a Unidade de Terapia Intensiva (UTI) para queimados (UAC), com 48 (66,7%), e UTIs Gerais, com 21 eventos (29,2%). Na população estudada, houve significância estatística na taxa de mortalidade, na taxa de contrafluxo segundo as faixas de gravidade e no contrafluxo e mortalidade segundo procedência, no qual foi identificado que os pacientes vindos da emergência sofreram contrafluxo e tiveram maior taxa de mortalidade. CONCLUSÕES: O contrafluxo representa um importante indicador a ser monitorado no CTQ em estudo, pois esteve relacionado com pior prognóstico em adultos grandes queimados, procedentes da emergência e vítimas de queimaduras térmicas.
OBJECTIVE: To describe the profile of adult patients hospitalized for burns that underwent contraflow, return the patient to a more complex care unit due to complications or clinical complications, during hospital stay and evaluate the relationship between their occurrence, the Abbreviated Burn Severity Index (ABSI) and death. METHODS: Retrospective open cohort study with secondary data from a Burn Treatment Center (BTC) in Bahia, from January 2022 to June 2023. Data were organized in Excel, exported and applied to Stata. Statistical significance was assessed using the Chi-square or Fisher's exact test for categorical variations. This study was approved by the Research Ethics Committee. RESULTS: Of the 658 admissions to the BTC, 72 (10.9%) had contraflow. Of these, 51.4% were male, 68% were aged between 18 and 59 years, with heat/fire burns predominating. The units that received the most contraflow were the burn ICU (UAC) with 48 (66.7%), and General ICUs with 21 events (29.2%). In the studied population, there was statistical significance in the mortality rate, in the contraflow rate according to the severity ranges and in the contraflow and mortality according to origin, where it was identified that patients coming from the emergency suffered contraflow and had higher mortality rates. CONCLUSIONS: Contraflow represents an important indicator to be monitored in the BTC under study, as it was related to worse prognoses in severely burned adults, those coming to emergencies and victims of thermal burns.
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Introdução: Substâncias químicas apresentam uma prevalência relativamente baixa dentre as causas de queimaduras. Porém, têm importância, pois a maioria dos acidentes ocorrem no âmbito do trabalho e em população economicamente ativa. O objetivo é realizar uma análise do perfil dos pacientes internados por queimaduras químicas em uma Unidade de Queimados. Métodos: Análise retrospectiva de pacientes internados na Unidade de Queimados do Hospital Estadual de Bauru, Bauru, SP, Brasil, entre os anos de 2008 e 2018. Múltiplas variáveis foram analisadas, como idade, sexo, agente químico, local onde ocorreu o acidente, necessidade de internação em UTI e dias de hospitalização. Resultados: No total, 40 (1,7%) pacientes foram internados devido a queimadura química. A média de idade foi de 35 anos, com predominância do sexo masculino, com 30 (75%) indivíduos. O principal local do trauma foi no ambiente de trabalho, em 20 casos (50%). Acidentes com base foram responsáveis por 20 (50%) internações. A superfície corporal queimada média foi de 7,5%. Queimadura ocular ocorreu em 11 (27,5%) pacientes. Leito de terapia intensiva foi necessário para 10 (25%) casos. Quando comparados os acidentes entre substâncias ácidas e bases, evidenciamos diferença no número de pacientes internados em UTI, com oito pacientes em lesões envolvendo bases e dois com ácidos (p=0,04). Conclusão: A casuística e resultados apresentados neste artigo são semelhantes à literatura mundial sobre o assunto. Evidenciamos a importância dessa queimadura no ambiente de trabalho e o acometimento de indivíduos em idade ativa, assim como a maior gravidade de acidentes com substância química.
Introduction: Chemicals have a relatively low prevalence among the causes of burns. However, they are important because most accidents occur in the scope of work and in an economically active population. The objective is to perform an analysis of the profile of patients hospitalized for chemical burns in a Burn Unit. Methods: Retrospective analysis of patients hospitalized in the Burn Unit of the State Hospital of Bauru, Bauru, SP, Brazil, between 2008 and 2018. Multiple variables were analyzed, such as age, gender, chemical agent, place where the accident occurred, need for ICU stay and days of hospitalization. Results: In total, 40 (1.7%) patients were hospitalized due to chemical burn. The mean age was 35 years, with predominance of males, with 30 (75%) individuals. The main site of trauma was in the workplace, in 20 cases (50%). Based accidents were responsible for 20 (50%) admissions. The mean burned body surface was 7.5%. Eye burn occurred in 11 (27.5%) patients. Intensive care bed was required for 10 (25%) cases. When comparing accidents between acid iced substances and bases, we noted a difference in the number of ICU patients, with eight patients in lesions involving bases and two with acids (p=0.04). Conclusion: The sample and results presented in this article are similar to the world literature on the subject. We evidenced the importance of this burn in the work environment and the involvement of individuals of active age, as well as the greater severity of accidents with chemical substance.
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Objetivo: evidenciar os cuidados de enfermagem descritos na literatura nacional e internacional que são aplicados em pacientes queimados em terapia intensiva. Método: revisão integrativa, realizada no período de fevereiro a dezembro de 2020, nas bases de dados eletrônicas US National Library of Medicine, Medical Literature Analysis and Retrieval System Online e Biblioteca Virtual em Saúde. Resultados: foram selecionados oito artigos, os quais foram categorizados em Cuidados de Enfermagem com a pele em pacientes queimados, Cuidados de Enfermagem com a mobilidade em pacientes queimados e Cuidados de Enfermagem em pacientes queimados em relação à dor, dispositivos e prevenção de complicações. Conclusão: os cuidados de enfermagem para pacientes queimados em terapia intensiva estão intensamente atrelados aos cuidados com as lesões de pele e seus desdobramentos, assim como a prevenção de infecções.
Objective: to highlight the nursing care described in the National and International Literature that is applied to burned patients in intensive care. Methods: integrative review, carried out from February to December, 2020, using the following electronic bases: US National Library of Medicine, Medical Literature Analysis and Retrieval System Online and Biblioteca Virtual em Saúde. Results: it was selected eight articles, which were categorized into Nursing Care for skin in burned patients, Nursing Care for mobility in burned patients and Nursing Care for burned patients in relation to pain, devices and prevention of complications. Conclusion: nursing care for burned patients in intensive care is associated to the care of skin lesions and their consequences, as well as the prevention of infections.
Objetivo: destacar los cuidados de enfermería descritos en la literatura nacional e internacional que se aplican en pacientes quemados en cuidados intensivos. Método: revisión integradora, realizada de febrero a diciembre de 2020, en las bases de datos electrónicas US National Library of Medicine, Medical Literature Analysis and Retrieval System Online y Virtual Health Library. Resultados: se seleccionaron ocho artículos, los cuales se clasificaron en Cuidados de Enfermería con la Pelea en Pacientes Enfermos, Cuidados de Enfermería con la Movilidad en Pacientes Enfermos y Cuidados de Enfermería en Pacientes Enfermos en relación con el dolor, los dispositivos y la prevención de complicaciones. Conclusión: los cuidados de enfermería a los pacientes quemados en cuidados intensivos están intensamente ligados al cuidado de las lesiones cutáneas y sus desdoblamientos, así como a la prevención de infecciones.
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Unidades de Quemados/estadística & datos numéricos , Quemaduras/diagnóstico , Unidades de Cuidados Intensivos/estadística & datos numéricos , Atención de Enfermería/métodos , Dolor/diagnóstico , Control de Infecciones/métodos , Cuidados Críticos , Bibliotecas Digitales , Lesiones por Desenguantamiento/diagnósticoRESUMEN
Introdução: As lesões por queimaduras são um problema de saúde global que atinge todas as faixas etárias, não só pela frequência com que ocorrem, mas também pela gravidade. Podem ser incapacitantes, ter alta mortalidade e, ao mesmo tempo, gerar um impacto econômico desfavorável para o país. O objetivo é descrever o perfil microbiológico de pacientes hospitalizados por queimaduras. Métodos: Estudo descritivo, longitudinal e prospectivo no Hospital Provincial Clínico Cirúrgico Celia Sánchez Manduley, Cuba, de julho de 2017 a junho de 2020. Foram estudadas amostras de cultura, positividade, microrganismos isolados e sensibilidade antimicrobiana. Resultados: O estudo mostrou que as amostras de lesões cutâneas por queimaduras (130) foram predominantes e delas 58,46% foram positivas; Staphylococcus aureus, com 51,73%, foi o germe mais isolado; sensibilidade à amicacina de 55,56% e vancomicina 51,11%; a sobrevida foi alta. Conclusão: Predominou a positividade nas amostras de cultura de pele queimada, principalmente Staphylococcus aureus, e uma alta sensibilidade a poucos antimicrobianos.
Introduction: Injuries caused by burns are a global health problem that affects all age groups, not only because of the frequency in which they occur but according to their severity. They can be disabling and have high mortality, and at the same time, generate an unfavorable economic impact on the country. The objective is to describe the microbiological profile of burned hospitalized patients. Methods: A descriptive, longitudinal, and prospective study was carried out at the Provincial Clinical Surgical Celia Sánchez Manduley Hospital from July 2017 to June 2020. Microbiology culture, positivity, isolated microorganisms, and antimicrobial sensitivity were studied. Results: The study showed that the culture microbiology of skin lesions due to burns (130 samples) were predominant, and of them, 58.46% were positive, Staphylococcus aureus with 51.73% was the most isolated germ; sensitivity to amikacin of 55.56% and vancomycin 51.11%; survival was high. Conclusions: The positivity in the culture microbiology of burned skin, mainly Staphylococcus aureus, and high sensitivity to few antimicrobials predominated.
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Introducción: a partir de la pandemia por Covid19 se reportó variabilidad en la incidencia de las infecciones asociadas al cuidado de la salud (IACS). Con el objetivo de describir y comparar las tasas de IACS en la Unidad de Quemados de un hospital pediátrico de tercer nivel, antes y después del inicio de la pandemia se llevó a cabo este estudio. Material y métodos: estudio de cohorte, retrospectivo, descriptivo, de vigilancia epidemiológica. Se registraron todos los eventos de IACS en la Unidad de Quemados desde el 01/07/2018 hasta el 31/06/2021. Se compararon las tasas de las IACS entre el período I (PI) previo a la pandemia (07/2018-12/2019) y el período II (PII) posterior al inicio de la misma (01/2020- 06/2021). Resultados: se registraron 74 episodios de IACS, en un total de 8232 pacientes-día. Se registró una tasa global de IACS similar en ambos períodos, 10,08 pacientes-día (PI) vs 7,34 pacientes-día (PII), sin encontrarse diferencias estadísticamente significativas en las tasas de bacteriemia asociada a catéter venoso central (BSI-CVC) 3,32 días uso de CVC (PI) vs 3,20 (PII), neumonía asociada a ARM 1.43 días de uso de ARM (PI) vs un 2.02 (PII), ni infección urinaria asociada a sonda vesical (SV) 7,36 días de uso de SV (PI) vs 3,64 (PII). Conclusiones: no se observaron diferencias estadísticamente significativas en las tasas de IACS entre ambos períodos, lo cual podría justificarse con el estricto protocolo en control de infecciones implementado previo al inicio de la pandemia (AU)
Introduction: since the start of the Covid19 pandemic, variability in the incidence of healthcare-associated infections (HAIs) has been reported. This study was conducted to describe and compare the rates of HAIs in the burn unit of a tertiary pediatric hospital before and after the onset of the pandemic. Material and methods: a retrospective, descriptive, epidemiological surveillance cohort study was conducted. All HAI events in the burn unit from 01/07/2018 to 31/06/2021 were recorded. HAI rates between the pre-pandemic period I (PI) (07/2018- 12/2019) and post-pandemic period II (PII) (01/2020-06/2021) were compared. Results: 74 episodes of HAI were recorded in a total of 8232 patient-days. There was a similar overall rate of HAIs in both periods, 10.08 patient-days (PI) vs 7.34 patient-days (PII), with no statistically significant differences found in the rates of central venous catheter-related bloodstream infections (CVC-BSI) 3.32 days CVC use (PI) vs 3.20 (PII), ventilator-associated pneumonia 1. 43 days MV use (PI) vs a 2.02 (PII), or catheter-associated urinary tract infection 7.36 days catheter use (PI) vs 3.64 (PII). Conclusions: no statistically significant differences were observed in the rates of HAIs between both periods, which may be explained by the strict infection control protocol implemented prior to the onset of the pandemic (AU)
Asunto(s)
Humanos , Lactante , Preescolar , Niño , Adolescente , Unidades de Quemados/estadística & datos numéricos , Quemaduras/complicaciones , Quemaduras/epidemiología , Infección Hospitalaria/epidemiología , Control de Infecciones , Monitoreo Epidemiológico , COVID-19/epidemiología , Estudios Retrospectivos , Estudios de CohortesRESUMEN
BACKGROUND: It is important to exploit all available data on patients in settings such as intensive care burn units (ICBUs), where several variables are recorded over time. It is possible to take advantage of the multivariate patterns that model the evolution of patients to predict their survival. However, pattern discovery algorithms generate a large number of patterns, of which only some are relevant for classification. OBJECTIVE: We propose to use the diagnostic odds ratio (DOR) to select multivariate sequential patterns used in the classification in a clinical domain, rather than employing frequency properties. METHODS: We used data obtained from the ICBU at the University Hospital of Getafe, where 6 temporal variables for 465 patients were registered every day during 5 days, and to model the evolution of these clinical variables, we used multivariate sequential patterns by applying 2 different discretization methods for the continuous attributes. We compared 4 ways in which to employ the DOR for pattern selection: (1) we used it as a threshold to select patterns with a minimum DOR; (2) we selected patterns whose differential DORs are higher than a threshold with regard to their extensions; (3) we selected patterns whose DOR CIs do not overlap; and (4) we proposed the combination of threshold and nonoverlapping CIs to select the most discriminative patterns. As a baseline, we compared our proposals with Jumping Emerging Patterns, one of the most frequently used techniques for pattern selection that utilizes frequency properties. RESULTS: We have compared the number and length of the patterns eventually selected, classification performance, and pattern and model interpretability. We show that discretization has a great impact on the accuracy of the classification model, but that a trade-off must be found between classification accuracy and the physicians' capacity to interpret the patterns obtained. We have also identified that the experiments combining threshold and nonoverlapping CIs (Option 4) obtained the fewest number of patterns but also with the smallest size, thus implying the loss of an acceptable accuracy with regard to clinician interpretation. The best classification model according to the trade-off is a JRIP classifier with only 5 patterns (20 items) that was built using unsupervised correlation preserving discretization and differential DOR in a beam search for the best pattern. It achieves a specificity of 56.32% and an area under the receiver operating characteristic curve of 0.767. CONCLUSIONS: A method for the classification of patients' survival can benefit from the use of sequential patterns, as these patterns consider knowledge about the temporal evolution of the variables in the case of ICBU. We have proved that the DOR can be used in several ways, and that it is a suitable measure to select discriminative and interpretable quality patterns.
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Objective: The aim of this review is to map and summarize the experiences of various burn centers worldwide during the COVID-19 pandemic, in order to enable future strategies with regard to the most effective measures in burn care during pandemics and to detect possible gaps in knowledge. Background: The coronavirus disease 2019 (COVID-19) pandemic had a major impact on economies, social interactions, and health systems worldwide. Burn units all over the world face a new challenge in maintaining the care of acute burn wounds and follow-up treatments while dealing with constantly changing regulations. Infrastructural changes, the establishment of efficient triage systems, protective measures, personnel resources, in addition to the maintenance of efficient patient care and the guarantee of supply chains, are challenging tasks to be addressed. This review provides an overview of recent developments regarding different strategies and methods used by burn units worldwide to safely overcome the COVID-19 pandemic outbreak. Methods: A scoping review of the literature was conducted using the electronic databases PubMed and Google Scholar. Publications were screened for the following key terms: burns, burn injuries, thermal injuries, burn center, burn unit, burn ward, in combination with COVID-19, COVID-19 pandemic, SARS-CoV-2, Corona, and Coronavirus. Articles dealing with the management of burn units during the pandemic were further analyzed and included. Results: Of the 136 publications, 10 were considered relevant to the key question and were included in the present review. Results were divided into six major topics, such as infrastructural and personnel management, triaging, severe burns and emergencies, elective surgeries, patient and visitor management, and outpatient management. Conclusion: Only a few studies about managing burn units during the COVID-19 pandemic have been published. Personnel resources and equipment needed to be redistributed to cope with country-specific challenges during the COVID-19 pandemic and to maintain adequate burn care. Since all of these articles refer to the period of the initial outbreak, a lack of clinical studies exists regarding the prevention measures taken by burn units during the COVID-19 pandemic. In addition, we identified gaps in knowledge about the impact of implemented measures on burn patient outcomes in the published literature. Further studies are mandatory in order to provide generally applicable guidelines regarding COVID-19 prevention measures at a burn unit.
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Introdução: As queimaduras, um problema de saúde pública, são lesões que podem ocorrer na pele ou outros tecidos do corpo decorrentes de trauma de origem térmica, podendo ocasionar lesões leves, graves e até mesmo o óbito. Assim, são estudadas as características epidemiológicas dos pacientes atendidos na Unidade de Queimados do Hospital de Clínicas da Universidade Federal de Uberlândia. Métodos: Estudo transversal de dados registrados nos prontuários dos pacientes atendidos por queimadura na Unidade de Queimados de 2016 até 2019. Resultados: Um total de 252 prontuários foram revisados, sendo mais atingido o gênero masculino da faixa etária adulta. O principal agente causal foi o líquido inflamável (42,4%), com predomínio do álcool (66,35), acontecendo no domicílio (59,9%). O percentual médio da superfície corporal queimada foi de 17,7%, precisando de enxerto ou debridamento cirúrgico 25% dos pacientes. A média de internaçação foi 23,3 dias, com 8,7% necessitando de Unidade de Terapia Intensiva. A tentativa de autoextermínio foi de 5,5%, sendo a taxa geral de óbito de 3,5%. Conclusões: Pacientes por queimadura atendidos na Unidade de Queimados do Hospital de Clínicas da Universidade Federal de Uberlândia abrangem mais a população jovem e adulta, sendo o álcool a causa predominante, com média de óbitos similar a outras regiões. Este estudo ajudará a criar medidas no sentido de reduzir o número de casos e adequar o atendimento de forma quantitativa e qualitativa, contribuindo para a elaboração de protocolos de cuidados, a fim de assegurar a qualidade da assistência dos pacientes e da população em geral.
Introduction: Burns, a public health problem, are injuries that can occur on the skin or other tissues of the body resulting from the trauma of thermal origin, which can cause mild, severe injuries and even death. Thus, the epidemiological characteristics of patients seen at the Burn unit of the Hospital de Clínicas of the Universidade Federal de Uberlândia are studied. Methods: Cross-sectional study of the data recorded in patients' medical records treated for the burn at the Burn Units from 2016 to 2019. Results: 252 medical records were reviewed, with the male gender of the adult group being most affected. The main causal agent was the flammable liquid (42.4%) with a predominance of alcohol (66.35), occurring at home (59.9%). The average percentage of burned body surface was 17.7%, requiring a graft or surgical debridement in 25% of the patients. The average hospital stay was 23.3 days, requiring 8.7% of the Intensive Care Unit. The attempt at self-extermination was 5.5%, with a general death rate of 3.5%. Conclusions: Burn patients treated at the Burn Unit of the Hospital de Clínicas of the Universidade Federal de Uberlândia encompasses more of the young and adult population, with alcohol being the predominant cause, with an average death rate like other regions. This study will help create measures in search of reducing the number of cases and adapting the care quantitatively and qualitatively, contributing to the elaboration of care protocols to ensure the quality of the care of the patients and the population.