Influence of pre-existing medical condition and predicting value of modified Elixhauser comorbidity index on outcome of burn patients.

OBJECTIVES: To evaluate the impact of comorbidity and predicting value of the modified Elixhauser comorbidity index score on the outcome of burn patients. METHODS: A retrospective study was conducted on 5480 patients admitted during 24 h after burn to the National Burn Hospital from 1/1/2016 to 31/12/2018. Demographic data and pre-existing medical conditions were collected. Modified Elixhauser comorbidity index (ECI) score developed by Walravel et al. was calculated for each patient. The score was the weighted sum of comorbid conditions. Outcomes measured included hospitalization, complication and mortality. RESULTS: Among 5480 patients, 345(6.3%) had at least one pre-existing medical condition. Most common comorbidities were neurological disorder, diabetes, hypertension and psychoses. Pre-existing medical conditions were more common in elderly (25% vs. 4.8%; p < .001) and female (7.5% vs. 5.8%; p < .05). Moreover, significantly larger burn extent, higher rate of inhalation injury (p < .01) and complication (12.8% vs. 6.1%; p < .001), longer time of hospitalization (21.4 vs. 17.1 days; p < .001) were recorded in comorbidity group. It is noted that higher ECI score was remarkably higher in patients who developed complication (.6 vs. .3 respectively, p < .05) and death (.5 vs. .3; p < .05). Multivariate analysis indicated that apart from presence of inhalation injury, increased burn extent, full thickness burn area, ECI score was an independently predicted factor for prolonging the time of staying, for the development of complication and death. Each score of ECI results in increased probability unit of complication to .13 and probability unit of death to .11. CONCLUSION: Pre-existing medical conditions lead to more severe and worse outcomes among burn patients. Modified Elixhauser comorbidity index score should be used as a prognosis factor for outcomes of burn patients.

Long-term monitoring of atmospheric PCDD/Fs at Mount Lulin during spring season: PCDD/F source apportionment through a simultaneous measurement in Southeast Asia.

A long term assessment of atmospheric polychlorinated dibenzo-p-dioxins and dibenzofurans (PCDD/Fs) at Mt. Lulin, located in center of Taiwan was carried out from 2008 to 2013 (n = 81) assuming Mt. Lulin to be background area. During monitoring processes, PCDD/F samples collected in the field occasionally reached high concentration. To investigate this situation, simultaneous sample collection was carried out in Southeast Asia countries (i.e., Vietnam and Thailand) and Taiwan in 2013. The average concentration of atmospheric PCDD/Fs in biomass-burning source regions, namely Son La and Doi Ang Khang were 19.8 ± 12.1 fg I-TEQ m-3 (n = 19) and 17.8 ± 12.4 fg I-TEQ m-3 (n = 20), respectively. In the downwind area of Mt. Lulin, the average concentration of PCDD/Fs was found to be 4.64 ± 3.77 fg I-TEQ m-3 (n = 18). PCDD/F concentration in the source region was much higher than that in the downwind region. On March 19, 2013, the atmospheric PCDD/F concentrations increased dramatically from 7.71 to 484 fg I-TEQ m-3 at Mt. Lulin, which many times exceeded that of assumed source region in Southeast Asia. Moreover, mainland Southeast Asia and the southeast coast of China was suspected to be the main contributors of atmospheric PCDD/Fs and biomass markers, such as nonsea-salt K+ and NH4+, during the spring. WRF-Chem and Potential Source Contribution Function (PSCF) simulations have confirmed this correlation. It can be concluded that atmospheric PCDD/Fs observed at Mt. Lulin during spring mostly derived from the air mass transport not only from Southeast Asia but also the southeast coast of China.