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Background Burns continue to be a serious public health problem in India. It persists as an endemic disease in spite of implementing various preventive measures at the individual and community levels. Etiology and factors influencing burns are varied. There is a paucity of data regarding the clinico-demographic profile of burns disease, especially from emergency tertiary care settings in India. Objective To assess the proportion of burn patients having longer hospital stays (>1 week) and the influence of clinico-demographic factors associated with it among the burn patients presenting to the emergency department of a tertiary care institute in south India. Methodology An institution-based cross-sectional analytical study was conducted among burns patients attending the Emergency Medicine Department (EMD) of a tertiary care center between January 2017 and December 2017. Information on clinico-demographic profile and duration of hospital stay were captured using semi-structured data collection proforma. Results All the 327 burns injury patients who presented to our EMD during the study period were included. Among the 327 patients, 259 (79%) were admitted to the EMD. Among 259 admitted patients, 142 (55%) patients were discharged home. Among these 142 patients, 106 (74.6%; 95%CI 66.8-81.2) had longer hospital stays (more than one week). Female gender and facial/inhalational burns were found to have an independent effect on the length of hospital stay even after adjusted analysis. Conclusion Length of hospital stay is independently influenced by female gender and facial/inhalational burns. This study also identified the need for better home safety, child-proofing, proper pre-hospital care, and dedicated burns units in the community.
RESUMO
INTRODUCTION: Airway management is the first critical step to be addressed in the airway, breathing, and circulation algorithm for stabilizing critically ill patients. Since the emergency department (ED) is the primary contact of these patients in health care, doctors in the ED should be trained to perform advanced airway management. In India, emergency medicine has been recognized as a new specialty by the Medical Council of India (now the National Medical Commission) since 2009. Data related to airway management in the ED in India is sparse. METHODS: We conducted a one-year prospective observational study to establish descriptive data regarding endotracheal intubations performed in our ED. Descriptive data related to intubation was collected using a standardized proforma that was filled by the physician performing intubation. RESULTS: A total of 780 patients were included, of which 58.8% were intubated in the first attempt. The majority (60.4%) of the intubations were performed in non-trauma patients and the remaining 39.6% in trauma patients. Oxygenation failure was the most common indication (40%) for intubation followed by a low Glasgow coma scale (GCS) score (35%). Rapid sequence intubation (RSI) was performed in 36.9% of patients, and intubation was done with sedation only in 36.9% of patients. Midazolam was the most commonly used drug - either alone or in combination with other drugs. We found a strong association of first-pass success (FPS) with the method of intubation, Cormack-Lehane grading, predicted difficulty in intubation, and experience of the physician performing the first attempt of intubation (P<0.05). Hypoxemia (34.6%) and airway trauma (15.6%) were the most commonly encountered complications. CONCLUSION: Our study showed an FPS of 58.8%. Complications were seen in 49% of intubations. Our study highlights the areas for quality improvement in intubation practices in our ED, like the use of videolaryngoscopy, RSI, airway adjuncts like stylet and bougie, and intubation by more experienced physicians in patients with anticipated difficult intubation.