Epidemiology of bedside stove burns in a retrospective cohort of 5089 pediatric patients.

OBJECTIVE: To retrospectively analyze the epidemiological characteristics of pediatric bedside stove burns (PBSB) in China and to explore prevention and control measures. METHODS: Data on pediatric burns from three hospitals located in the epidemic area were collected from January 1996 to December 2010 and were divided into the PBSB group and the control group. The epidemiological characteristics and related information for each patient were analyzed. RESULTS: A total of 16,595 pediatric burns were found, including 5089 PBSB and 11,506 other types of burns. The two groups differed significantly in terms of age, gender, body parts burned, degree of burn, delay of hospitalization, and treatment measures (Ps all<0.05). Risk factors for PBSB included being younger than 3 years old, living in a rural area, low literacy level of guardians, not receiving health education, and lack of a protective fence protection (Ps all<0.05). Furthermore, meal time and winter and spring seasons were high risk periods for PBSB. CONCLUSION: The risk factors for PBSB include age, region, time of occurrence, and literacy level of guardians. Health education and installation of a protective fence between the stove and the bed could reduce the incidence of PBSB.

Three-dimensional digitalized virtual planning for retrograde sural neurovascular island flaps: a comparative study.

BACKGROUND: The purpose of this study was to explore the effectiveness and safety of three-dimensional (3D) digitalized planning for the sural neurovascular island flap in repair of soft tissue defects in the ankle and foot. METHODS: This study included 40 patients with soft tissue defects of the ankle and foot who underwent soft tissue reconstruction between October 2008 and June 2012. The patients were randomly assigned into two groups: 3D-reconstruction group (Group A, n=20) and control group (Group B, n=20). Three-dimensional, digitalized virtual planning was performed in the patients in Group A, who underwent computed topographic angiography. The survival rate, operation time, and surgical accuracy were compared between the two groups. RESULTS: All flaps in Group A survived and the recipient site primarily healed, but 4 flaps in Group B had marginal necrosis after the operation. During the 6-12 month follow-up period, all flaps in Group A had good skin quality. In Group B, hard scarring and mild contracture occurred in 4 cases, and the patients experienced pain when walking. The survival rate of the flap in Group A (100%) was significantly higher than in Group B (70%). The operation time in Group A was significantly less than in Group B. The surgical accuracy in Group A was significantly better than in Group B. CONCLUSION: The preoperative use of 3D digitalized virtual planning for the sural neurovascular island flap improves the surgical accuracy, decreases the operation time, and increases the survival rate of the flap. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic III.

[Analysis of clinical data of 16 595 pediatric burn patients during fifteen years].

OBJECTIVE: To analyze the epidemiological characteristics of pediatric burn in the midwest region of Inner Mongolia and the related areas, and to provide reference for seeking pertinent measures of prevention and treatment. METHODS: Medical records of patients hospitalized in the 253rd Hospital of PLA, the 322nd Hospital of PLA, and the Inner Mongolia Autonomous Region Hospital from January 1996 to December 2010 were collected. Patients were divided into pediatric burn group with specific reason (group SF, with scald resulted from construction defect of Guo-lian-kang--a heatable brick bed linked to a cooking pot), and burn control group with other causes (group C) according to the main injury cause. Clinical data of patients in both groups, including general condition, family background, occurrence regularity, and outcome, were analyzed. The epidemiological trend of variation before and after taking preventive measures (1996 to 2001 and 2002 to 2010) was compared. Data were processed with chi-square test and rank sum test. RESULTS: (1) General condition: out of 16 595 pediatric burn patients, 15 816 cases (95.3%) suffered scald due to liquids with high temperature, and 779 cases (4.7%) suffered burns due to other causes. Patients in group SF (scald due to specific cause--Guo-lian-kang) accounted for 32.2% (5089/15 816) of the total suffered scald by liquids with high temperature, and 30.7% (5089/16 595) of all the inpatients the cause of burn was related to Guo-lian-kang (group SF). The patients in group SF admitted to the 322nd Hospital of PLA accounted for 34.2% of all the inpatients admitted to this hospital (1803/5267), more than the other two hospitals in this study. The number of patients in group C was 11 506, accounted for 69.3% of all the inpatients. The age of patients ranged from 8 months to 5 years in group SF and 1 month to 12 years in group C. The age of the majority of patients ranged from 1 to 3 years in both groups. The ratio of male to female was 2.1:1.0 in group SF and 1.4:1.0 in group C. The incidence of scald involving multiple body parts in group SF (3590 cases accounting for 70.5%) was obviously higher than that of group C (6311 cases accounting for 54.8%, χ(2) = 361.138, P < 0.01). In both group SF and group C, the incidence in different sites was ranked from high to low as follows: upper limbs, lower limbs, the head-face-neck region, and the trunk. The degree of injury in group SF was much more severe than that of group C (Z = 27.770, P < 0.01). The rate of patients without pre-hospital treatment was 31.2% (1588/5089) in group SF, which was obviously higher than that of group C (24.8%, 2857/11 506, χ(2) = 73.010, P < 0.01). The rate of patients treated with cryotherapy was obviously lower in group SF (14.7%, 747/5089) than in group C (19.6%, 2255/11 506, χ(2) = 57.636, P < 0.01). The rate of patients treated with delayed resuscitation (6 hours after injury) in group SF (31.5%, 1601/5089) was obviously higher than that of group C (7.8%, 897/11 506, χ(2) = 1545.234, P < 0.01). (2) Family background and occurrence regularity: in group SF, 67.3% (3424/5089) of the patients came from farming area, 22.1% (1123/5089) from villages and towns, and 10.7% (542/5089) from urban areas. In group C, 32.4% (3727/11 506) of the patients came from farming area, 48.4% (5570/11 506) from villages and towns, and 19.2% (2209/11 506) from urban areas. Most of the patients in group SF (77.8%, 3958/5089) were injured between October and March, while most of the patients in group C (58.2%, 6697/11 506) were injured between May and October. (3) Outcome and epidemiological variation: the cure rate of patients in group SF was 32.3% (1645/5089), which was obviously lower than that of group C (44.7%, 5143/11 506, χ(2) = 215.615, P < 0.01). The mortality of patients in group SF was 1.6% (79/5089), and it was obviously higher than that of group C (0.4%, 46/11 506, χ(2) = 62.700, P < 0.01). From 1996 to 2001, patients in group SF accounted for 42.5% (2213/5212), while patients in group C accounted for 57.5% (2999/5212) of the inpatients scalded by hot liquid. After taking preventive measures against injury due to Guo-lian-kang, incidence of scald injury in group SF was lowered to 27.1% (2876/10 604), while the incidence in group C remained at 72.9% (7728/10 604) of the inpatients with hot liquid scald from 2002 to 2010. The difference between the two periods was statistically significant (χ(2) = 376.695,P < 0.01). CONCLUSIONS: The defect of construction of Guo-lian-kang is one of the main factors that lead to a high incidence of pediatric burn in the midwest of Inner Mongolia. Installation of a protective bannister between the cooking pot and the "kang (heatable brick bed)" can obviously reduce the incidence of scald injury. Special injury-causing factors, unprofessional pre-hospital treatment of the wound, delayed resuscitation after shock are the main causes of increasing mortality and disability, and they constitute the key targets of prevention and treatment of such injury in future.