Predictors of Mortality in Patients With Necrotizing Fasciitis: A Literature Review and Multivariate Analysis.

Background: Necrotizing fasciitis (NF) is a life-threatening infectious disease that can result in significant morbidity and mortality. Previously identified factors have not been verified in a large population. The objective of this study is to further examine the relationship of patient factors in NF mortality. Methods: This study is a retrospective review on patients ≥18 years old diagnosed with NF at the provincial referral centres from 2004 to 2016. The following data were examined: demographics, comorbidities, laboratory values, length of stay, and inhospital mortality. Results: Three hundred forty patients satisfied the inclusion criteria: 297 survived and were discharged, 43 died in hospital. In multivariate analysis, a prognostic model for NF mortality identified age >60 years, elevated creatinine, abnormal blood platelets, and group A ß-hemolytic Streptococcus (GABS) infection. Conclusions: Multiple factors were associated with mortality in NF. The strongest univariate association with mortality was age >60 years. In addition, a history of hypertension and/or dyslipidemia, renal disease, and the presence of GABS contributed to a predictive model for inhospital NF mortality.

Contexte: La fasciite nécrosante (FN) est une maladie infectieuse mettant la vie en danger et pouvant déboucher sur une morbidité et mortalité significatives. Les facteurs précédemment identifiés n'ont pas été vérifiés dans une large population. Cette étude avait pour objectif d'examiner plus en détail le rapport entre les facteurs liés au patient dans la mortalité de la FN. Méthodes: Il s'agit d'une étude rétrospective sur des patients âgés de ≥ 18 ans ayant eu un diagnostic de FN dans des centres de référence provinciaux de 2004 à 2016. Les données suivantes ont été examinées: Données démographiques, comorbidités, résultats des tests de laboratoire, durée du séjour à l'hôpital et mortalité à l'hôpital. Résultats: 340 patients ont satisfait les critères d'inclusion: 297 patients ont survécu et ont reçu leur congé; 43 patients sont décédés à l'hôpital. Un modèle pronostique pour la mortalité dans la FN a identifié dans une analyse multifactorielle un âge > 60 ans, une élévation de la créatinine, des plaquettes sanguines anormales et une infection par des streptocoques ß hémolytiques du groupe A (SGA). Conclusions: De nombreux facteurs sont associés à la mortalité dans la FN. L'association unifactorielle la plus forte avec la mortalité était un âge > 60 ans. De plus, des antécédents d'hypertension et/ou de dyslipidémie, une maladie rénale, et la présence de SGA ont contribué au modèle prédictif de la mortalité hospitalière liée à la FN.

Association of drug overdoses and user characteristics of Canada's national mobile/virtual overdose response hotline: the National Overdose Response Service (NORS).

BACKGROUND: Several novel overdose response technology interventions, also known as mobile overdose response services (MORS), have emerged as adjunct measures to reduce the harms associated with the drug poisoning epidemic. This retrospective observational study aims to identify the characteristics and outcomes of individuals utilizing one such service, the National Overdose Response Service (NORS). METHODS: A retrospective analysis was conducted using NORS call logs from December 2020 to April 2023 imputed by operators. A variety of variables were examined including demographics, substance use and route, location, and call outcomes. Odds ratios and 95% confidence intervals were calculated around variables of interest to test the association between key indicators and drug poisonings. RESULTS: Of the 6528 completed calls on the line, 3994 (61.2%) were for supervised drug consumption, 1703 (26.1%) were for mental health support, 354 (5.42%) were for harm reduction education or resources, and 477 (7.31%) were for other purposes. Overall, there were 77 (1.18%) overdose events requiring a physical/ in-person intervention. Of the total calls, 3235 (49.5%) were from women, and 1070 (16.3%) were from people who identified as gender diverse. Calls mostly originated from urban locations (n = 5796, 88.7%) and the province of Ontario (n = 4137, 63.3%). Odds ratios indicate that using opioids (OR 6.72, CI 95% 3.69-13.52), opioids in combination with methamphetamine (OR 9.70, CI 95% 3.24-23.06), multiple consumption routes (OR 6.54, CI 95% 2.46-14.37), and calls occurring in British Columbia (B.C) (OR 3.55, CI 95% 1.46-7.33) had a significantly higher likelihood of a drug poisoning. No deaths were recorded and only 3 false callouts had occurred. The overall drug poisoning event incidence to phone calls was 1.2%. CONCLUSION: NORS presents a complimentary opportunity to access harm reduction services for individuals that prefer to use alone or face barriers to accessing in-person supervised consumption services especially gender minorities with high-risk use patterns.

Environmental scan of mental health supports across Canadian burn centers: A healthcare providers' perspective.

BACKGROUND: Early mental health care and psychosocial support after burn injury provided by a variety of specialists and non-mental health professionals is instrumental in prevention of long-term mental health sequalae such as post-traumatic stress, depressive or substance use disorders. Diversity of mental health supports available to burn survivors vary across geography, resulting in variation of long-term mental health outcomes following burn injury. METHODS: A mixed-methods study utilizing a semi-structured questionnaire to explore resources available for burn survivors in Canada as an inpatient, outpatient, and more broadly in the aftercare community. Interviews were completed with 17 Canadian burn centers, with a variety of burn care professionals. RESULTS: In the continuum of burn care, a lack of available mental health professionals in certain regions and in the outpatient and community phases was observed. Emerging themes demonstrated the need for regular screening for mental health concerns among burn survivors and providing up to date discharge resources. In addition, increasing educational opportunities available to burn care staff with respect to burn survivor mental health was emphasized. Lastly, the importance of proactive and prolonged psychological support for burn survivors as they progress through an outpatient, rehabilitation and community setting was underlined. CONCLUSIONS: Identification of burn care practices and resources across Canada provides the opportunity to compare, unify and improve gaps in care that exist across the Canadian burn network.

Narrative discourse of burn injury and recovery on peer support websites: A qualitative analysis.

Although advances have been made in burn care and recovery, less is known about the experience of living with severe burn injury. Like other patient groups, burn survivors are now turning to social media and shared web-based peer support resources during recovery and continuing long after discharge. Ongoing peer support is often part of the reclamation process after-burn injury. Peer support and event sharing helps foster hope, motivation and reassurance. OBJECTIVES: To: 1) Examine and further understand the narrative discourse of burn survivorship in peer support social media content, 2) establish commonalities in the sharing community and key themes related to recovery and adaptation. METHODS: This qualitative enquiry began with a comprehensive overview of burn narratives on survivor peer generated websites. We conducted a purposeful sampling of 21 biographies posted on burn survivor peer and patient support websites. Participants with greater than 30% burn injury were included that provided narrative and discourse regarding burn recovery and survivorship. Underlying story arcs, meaning behind sentences and shared language of the experience were investigated using thematic analysis. RESULTS: Four themes were identified: retelling of the traumatic event; social support; body image, the new normal; and rebirth and transformation. Accounts reflected the traumatic nature of the event with slowed downtime, attention to details and heightened recall. The value of peer and family support was a common theme. There was attention to the challenges related to changed body image and regaining confidence in body appearance. Most stories also documented transitioning and rebirth and other more positive aspects of trauma recovery. CONCLUSIONS: Accounting the burn experience and recovery is part of the reclamation process. Biographies document the trauma recovery process. Storying the event is an integral component of burn survivor community content. These online communities have become a mainstream resource and part of the reclamation process.

Interrupted Nutrition Support in Patients With Burn Injuries: A Single-Centre Observational Study.

BACKGROUND: Enteral nutrition (EN) is essential to meet the increased metabolic requirements of burn-injured patients. However, feeds are often suspended for care. This study examines the interruptions in EN (IEN). OBJECTIVE: To determine the frequency and duration of IEN and whether these interruptions are predictable or unpredictable. DESIGN: This retrospective chart review of 27 adult burn patients examined age, sex, body mass index, percentage of total body surface area, length of hospital stay, predicted energy requirements from equations and indirect calorimetry, EN start time, time EN reached goal rate, and interruptions to EN. RESULTS: Predictable interruptions accounted for 74.5% (frequency) and 81.6% (duration) of total interruptions. The most frequent and time-consuming interruptions were perioperative period, extubation, and tests/procedures (predictable) versus high gastric residual volume, emesis/nausea, and feeding tube displacement (unpredictable). CONCLUSIONS: Most IEN were due to predictable events. Based on these findings, compensating for predictable interruptions to meet nutritional requirements in burn patients is recommended.

HISTORIQUE: L'alimentation entérale (AE) est essentielle pour répondre aux besoins métaboliques accrus des patients brûlés. Cependant, elle est souvent suspendue pour procéder aux soins. La présente étude se penche sur les interruptions de l'AN (IAN). OBJECTIF: Déterminer la fréquence et la durée de l'IAN et établir si elles sont prévisibles ou non. MÉTHODOLOGIE: La présente analyse rétrospective des dossiers de 27 patients adultes brûlés a porté sur l'âge, le sexe, l'indice de masse corporelle (IMC), le pourcentage de la surface corporelle totale, la durée d'hospitalisation, les besoins énergétiques prévus à partir d'équations et de la calorimétrie indirecte, l'heure de début de l'AN, le temps pour parvenir au taux d'atteinte des objectifs d'AN et les interruptions à l'AN. RÉSULTATS: Les interruptions prévisibles représentaient 74,5 % (fréquence) et 81,6 % (durée) des interruptions totales. La période périopératoire, l'extubation et les tests et interventions (prévisibles) étaient les interventions les plus fréquentes et les plus chronophages, par rapport au volume gastrique résiduel élevé, aux nausées et aux vomissements, de même qu'au déplacement de la sonde gastrique (imprévisibles). CONCLUSIONS: La plupart des interruptions d'AN étaient attribuables à des événements prévisibles. D'après ces observations, il est recommandé de compenser les interruptions prévisibles pour répondre aux besoins nutritionnels des patients brûlés.

Social Complexity and Risk for Pediatric Burn Injury: A Systematic Review.

Social complexity in health outcomes has been attributed to greater risk of injury, adverse health consequences, and early death in a variety of populations. To determine what social complexity factors associated with burn injury in children, a systematic review of the literature was performed. Two different databases (PubMed and SCOPUS) were searched for articles related to environmental and social determinants of burn injury. Selected literature examined social complexity factors to establish the strength of evidence in relation to incidence of burn injury in children. The extent of factors and the most common social complexities were reviewed. The 641 manuscripts found in PubMed and 327 from SCOPUS were initially reviewed for duplication and English language. Subsequently, manuscripts were selected for relevance based on titles followed by abstracts. Forty-seven manuscripts were reviewed in their entirety. The literature supports a relationship between an increased incidence of pediatric burns in lower income families, children with behavioral disorders, fewer years of parental education and children residing in a rural setting. The majority of reports came from Europe followed by Australia, and scattered information from other countries. Social complexity factors in the environment of the child are associated with an increased risk of burn injury in children. The literature supports the influence of lower income, lower parental education, behavioral disorders and living rurally with an increased incidence of injury. By identifying children at increased risk, it is possible to develop targeted burn prevention and education programs to mitigate burn injury.

Pediatric frostbite: A 10-year single-center retrospective study.

OBJECTIVE: To describe frostbite (freezing cold injured tissue) in children and intrinsic (psychological and behavioral) and extrinsic (meteorological and safety hazard) factors related to the injury. METHODS: Retrospective chart review of children <18 years old referred to a regional pediatric hospital for frostbite, to determine the demographics, environment, and risk factors related to injuries. RESULTS: 47 patients met the inclusion criteria. Median age was 15 years (IQR 12-16). All injuries occurred between November and March. 49% were admitted to the hospital and frostbite was associated with use of alcohol (53%), cigarettes (34%), marijuana (23%), and symptoms of depression (with and without suicidal ideation) (32%). Frostbite injury treated with conservative wound management presented at <-6°C and injury that underwent surgical procedures occurred at temperatures ≤-23°C (p=0.001). Longer exposure duration also significantly increased the likelihood of a surgical procedure (p<0.001). Intoxication and lack of supervision were two common factors, with lack of supervision at time of injury most common among patients 0-12 years (64%), and intoxication most common among patients ages 13-17 (61%). CONCLUSION: Frostbite injuries in children begins at temperatures <-6°C; with risk of tissue loss increasing at temperatures below -23°C. Lack of supervision and intoxication are major risk factors for frostbite in children. Two-thirds of younger children were unsupervised, whereas intoxication was frequently related to frostbite in adolescents. Both of these factors can be addressed through an education-based prevention program.

The Relationship Between Income and Burn Incidence in Winnipeg, Manitoba, Canada: A Population Health Study.

Burns continue to be a common cause of morbidity around the world, and socioeconomic status has been linked to high-burn risk in developed and developing countries. The purpose of this study was to define in Winnipeg, Manitoba, Canada: 1) demographics of adult patients with severe burns; 2) the relationship between household income and burn incidence; and 3) specific geographic areas that may benefit from targeted burn prevention strategies. We conducted a retrospective study of adult (>18 years) patients in Winnipeg, with burns severe enough to require at least 1 day of hospitalization between 2006 and 2016. Area-level median household income data at two geographic levels were collected from 2011 Census based on patient postal codes. Of 207 patients that met study criteria, 156 (75.4%) were male. Mean age was 44.5 ± 16.9 years, and the most common cause of burns was fire/flame (52.2%). The analysis of income data revealed that lower area-level income groups had a higher incidence of burns, with the lowest income quintile group having 5.4 times higher incidence than highest income quintile group. Spatial analysis software was used to map the incidence rates, and clusters of high-risk burns were identified in and around the city center region. Overall, our study showed an inverse relationship between area-level income and burn injury incidence. The identification and mapping of high incidence hotspots will allow policy makers to target groups who will benefit most from burn prevention strategies.