Pediatric Burns - Who Requires Follow-up? A Study of Urban Pediatric Emergency Department Patients.

Introduction: Hundreds of children suffer burn injuries each day, yet care guidelines regarding the need for acute inpatient treatment vs outpatient follow-up vs no required follow-up remain nebulous. This gap in the literature is particularly salient for the emergency clinician, who must be able to rapidly determine appropriate disposition. Methods: This was a retrospective review of patients presenting to a Level II pediatric trauma center, January 1, 2017-December 31, 2019, and discharged with an International Classification of Diseases, Rev 10, burn diagnosis. We obtained and analyzed demographics, burn characteristics, and follow-up data using univariate and bivariate analysis as well as logistic regression modeling. Patients were stratified into three outcome groups: group 1-patients who underwent emergent evaluation at a burn center or were admitted at their first follow-up appointment; group 2-patients who followed up at a burn center (as an outpatient) or at the emergency department (and were discharged home); and group 3-patients with no known follow-up. Results: A total of 572 patients were included in this study; 58.9% of patients were 1-5 years of age. Sixty-five patients met group 1 criteria, 189 patients met group 2 criteria, and 318 patients met group 3 criteria. Sixty-five percent of patients met at least one American Burn Association criteria, and 79% of all burns were second-degree burns. Flame and scald burns were associated with increased odds (odds ratio [OR] 1.21, OR 1.12) of group 1 vs group 2 + group 3 (P = 0.02, P < 0.001). Second/third-degree burns and concern for non-accidental trauma were also associated with increased odds of group 1 vs 2 or 3 (OR = 1.11, 1.35, P ≤ 0.001, 0.001, respectively). Scald burns were associated with increased odds of group 2 compared to group 3 (OR 1.11, P = 0.04). Second/third degree burns were also associated with increased odds of group 2 vs 3 (OR 1.19, P ≤ 0.001). Conclusion: There were few statistically significant variables strongly associated with group 1 (emergent treatment/admission) vs group 2 (follow-up/outpatient treatment) vs group 3 (no follow- up). However, one notable finding in this study was the association of scald burns with treatment (admission or follow-up) suggesting that the presence of a scald burn in a child may signify to clinicians that a burn center consult is warranted.

Epidemiological and clinical characteristics of burns in adults: a 6-year retrospective study in a major burn center in Suzhou, China.

Background: Burns are a prevalent form of unintentional injury and a significant public health concern in developing countries. We aimed to investigate the epidemiological and clinical characteristics of adult burn patients at a major center in Eastern China. Methods: This 6-year retrospective study analyzed patients with varying degrees of burns between January 2017 and December 2022 at the Suzhou Burns and Trauma Center. The study extracted demographic, clinical, and epidemiological data from electronic medical records for analysis. Results: The study included 3,258 adult patients, of which 64.3% were male. The largest age group affected 30-59-year-old adults (63.04%). Scalds were the leading cause of burns (1,346, 41.31%), followed by flames (1,271, 39.01%). The majority of burn hospitalizations were those with moderate burns (1791, 54.97%). The morbidity rate was low at 0.68%, while mortality was strongly associated with age, etiology, and total body surface area. Patients with certain types of burns, such as explosions, hot crush injuries, and electric burns had more operations, longer lengths of hospital stay, and higher costs compared to those with scalds and flame injuries. Conclusion: Different prevention strategies should be formulated according to different etiologies, ages, and genders.

The Scalding Truth: Geospatial Analysis Identifies Communities at Risk for Pediatric Scald Burns.

INTRODUCTION: Pediatric scald burns account for 12% of all U.S. burn center admissions and are the most common type of burn in children. We hypothesized that geospatial analysis of burn registry data could identify specific geographic areas and risk factors to focus injury prevention efforts. METHODS: The burn registry of a U.S. regional burn center was used to retrospectively identify pediatric scald burn patients ages 0-17, from January 2018 to June 2023. Geocoding of patient home addresses with census tract data was performed. Area Deprivation Index (ADI) was assigned to patients at the census block group level. Burn incident hot spot analysis to identify statistically significant burn incident clusters was done using the Getis Ord Gi∗ statistic. RESULTS: There were 950 pediatric scald burn patients meeting study criteria. The cohort was 52% male and 36% White, with median age of 3 y and median total body surface area of 1.5%; 23.8% required hospital admission. On multivariable logistic regression, increased child poverty levels (P = 0.004) and children living in single-parent households (P = 0.009) were associated with increased scald burn incidence. Geospatial analysis identified burn hot spots, which were associated with higher ADI (P < 0.001). Black patients were more likely to undergo admission compared to White patients. CONCLUSIONS: Geospatial analysis of burn registry data identified geographic areas at high risk of pediatric scald burn. ADI, poverty, and children in single-parent households were the greatest predictors of injury. Addressing these inequalities requires targeted injury prevention education, enhanced outpatient support systems and more robust community resources.

One disaster two traumas: Being under rubble and burn injuries in the 2023 Maras, Turkey earthquakes.

INTRODUCTION: On February 6, 2023, two separate destructive earthquakes with magnitudes of 7.7 and 7.5 occurred in Kahramanmaras, Türkiye. More than 50,000 people lost their lives, and over 100,000 were reported injured. In this study, patients referred to hospitals with burn diagnosis and management of burn wounds following the disaster were evaluated. MATERIAL AND METHODS: Information on burn injury admissions related to the earthquake was collected from all burn facilities in the country within 15 days after the earthquake. The patients' demographics, being under rubble, rescue times, burn causes, grafting procedures, and deaths were recorded. RESULTS: Following the earthquake, burn victims were transferred to the 13 Burn Treatment Centers located in 10 provinces. A total of 191 patients were burned. Among the burn patients, 101 (52.9%) were rescued from the rubble 2-60 h after the earthquake. Eight patients who were hospitalized at the burn centers died. Scalding and flame burns were the most common etiologies. Burned total body surface area, concomitant crush injury, hospitalization, and mortality was higher among the patients trapped under rubble (p < 0.001, p < 0.001, p < 0.001, and p < 0.001, respectively). Victims who stayed longer time under the rubble required significantly more grafting procedures (p < 0.001). CONCLUSION: In a literature review, it was observed that there are a limited number of publications reporting earthquake-related burns. In the February, 6 Türkiye earthquake, flame burns were seen due to small fires that occurred in collapsed buildings during the earthquake. And also contact burns and hot liquid burns were seen in earthquake victims trapped under rubble. Bursting hot water pipes, overturned stoves, contact with hot central heating radiators, and heated construction irons caused scalding and contact burns. It is believed that prolonged entrapment may cause delays in burn treatment or lead to deeper burns due to prolonged contact with the burning agent, increasing hospitalization rates. This earthquake once again drew attention to burn injuries that could occur during and after earthquakes, including those that may occur under rubble.

Risk factors for in-hospital acquisition of carbapenem-resistant Enterobacterales in patients with severe burns.

BACKGROUND: Although patients with severe burns are prone to severe infections with antibiotic-resistant bacteria and inevitably have some risk factors for carbapenem-resistant Enterobacterales (CRE) acquisition, risk factors for CRE infection or colonization in these patients have not been investigated. AIM: To identify the independent risk factors for CRE acquisition in patients with severe burns. METHODS: Patients admitted to the burn intensive care unit (BICU) for acute burn care were categorized based on culture results during BICU care into the CRE group and non-CRE group, which included the carbapenem-susceptible Enterobacterales (CSE) and control groups. Clinical and microbiological factors were compared between the CRE and non-CRE groups, and between the CRE and CSE groups to identify independent risk factors for in-hospital CRE acquisition. FINDINGS: Among the included 489 patients, 101 (20.7%) and 388 (79.3%) patients were classified in the CRE and non-CRE groups, respectively. The non-CRE group included 91 (18.6%) and 297 (60.7%) patients in the CSE and control groups, respectively. In multivariate analysis between the CRE and non-CRE groups, exposure to other CRE-acquired patients (P = 0.018), abbreviated burn severity index score ≥9 (P = 0.012), and mechanical ventilation (P < 0.001) were associated with CRE acquisition. In multivariate analysis between the CRE and CSE groups, exposure to other CRE-acquired patients was associated with CRE acquisition (P = 0.048). CONCLUSION: Considering the limitation of controlling the burn severity in hospitalized patients, enhanced infection control measures for preventing in-hospital CRE transmission among patients with severe burns should be emphasized.

Burns in South Asia: Outcomes from South Asian Burn Registry (SABR).

BACKGROUND: South Asian region contributes 59 % to the global mortality due to burns. However, we find a paucity of literature on the outcomes of burns from low- and middle-income countries (LMICs). South Asian Burn Registry (SABR) is a facility-based burns registry that collected data on in-patient burn care. This study assesses factors associated with mortality, length of hospital stay at the burns center, and functional status of burn patients. METHODS: Prospective data was collected from two specialized public sector burn centers between September 2014 - January 2015 from Bangladesh and Pakistan. Multivariable logistic, linear, and ordinal logistic regression was conducted to assess factors associated with inpatient-mortality, length of hospital stay, and functional status at discharge, respectively. RESULTS: Data on 883 patients was analyzed. Increased association with mortality was observed with administration of blood product (OR:3, 95 % CI:1.18-7.58) and nutritional support (OR:4.32, 95 % CI:1.55-12.02). Conversely, antibiotic regimens greater than 8 days was associated with decreased mortality (OR:0.1, 95 % CI:0.03-0.41). Associated increase in length of hospital stay was observed in patients with trauma associated with their burn injury, history of seizures (CE:47.93, 95 % CI 12.05-83.80), blood product (CE:22.09, 95 % CI:0.83-43.35) and oxygen administration (CE:23.7, 95 % CI:7.34-40.06). Patients who developed sepsis (OR:6.89, 95 % CI:1.92-24.73) and received blood products during hospitalization (OR:2.55, 95 % CI:1.38- 4.73) were more likely to have poor functional status at discharge. CONCLUSION: This study identified multiple factors associated with worse clinical outcomes for burn patients in South Asia. Understanding these parameters can guide targeted efforts to improve the process and quality of burn care in LMICs.

The economic burden of burned patients for hospitalization in Canada.

BACKGROUND: Burn injuries pose a significant burden on both patients and healthcare systems. Yet, costs arising from the consumption of resources by these patients are rarely examined in Canada. OBJECTIVE: The objective of this study was to assess real-world costs resulting from the initial hospitalization of patients admitted to a major burn unit in Quebec, Canada. METHODS: A cost study based on a retrospective cohort was undertaken using in-hospital economic data matched to hospital chart data. Our cohort included all burn-injured patients admitted between April 1, 2017, and March 31, 2021, to the hospital's major burn unit during their initial hospitalization. Descriptive statistics were tabulated for sociodemographic and economic data. Costing data were analyzed unstratified and stratified according to burn severity (i.e., ≥ 20% of total body surface area [TBSA] vs. < 20%). Costs were presented in CAD 2021. RESULTS: Our cohort included 362 patients, including 65 (18%) with TBSA ≥ 20%. The average initial hospitalization cost was $32,360 ($22,783 for < 20% TBSA and $76,121 for ≥ 20% TBSA). CONCLUSION: Findings reveal that the total cost of the initial hospitalization, from a public hospital perspective, was $11,714,348. Our study underlines the substantial burden associated with burns and highlights the need for long-term cost evaluations.

Associations between burn care services and impairment at discharge after burn injury: Analysis of the Global Burn Registry.

BACKGROUND: Throughout the world, burn injury is a major cause of death and disability. In resource-limited countries, burn injury is one of the leading causes of permanent disability among children who survive traumatic injuries, and burn injury is the fourth leading cause of disability worldwide. This study applied Andersen's model of health care access to evaluate if patient characteristics (predisposing factors), burn care service availability (enabling factors) and injury characteristics (need) are associated with physical impairment at hospital discharge for patients surviving burn injuries globally. Specifically, access to rehabilitation, nutrition, operating theatre, specialized burn unit services, and critical care were investigated as enabling factors. The secondary aim was to determine whether associations between burn care service availability and impairment differed by country income level. METHODS: This is a cross-sectional secondary analysis of prospectively collected data from the World Health Organization, Global Burn Registry. The outcome of interest was physical impairment at discharge. Simple and multivariable logistic regressions were used to test the unadjusted and adjusted associations between the availability of burn care services and impairment at hospital discharge, controlling for patient and injury characteristics. Effect modification was analyzed with service by country income level interaction terms added to the models and, if significant, the models were stratified by income. RESULTS: The sample included 6622 patients from 20 countries, with 11.2% classified with physical impairment at discharge. In the fully adjusted model, patients had 89% lower odds impairment at discharge if the treatment facility provided reliable rehabilitation services compared to providing limited or no rehabilitation services (OR.11, 95%CI.08,.16, p < .01). However, this effect was modified by county income with the strong and significant association only present in high/upper middle-income countries. Sophisticated nutritional services were also significantly associated with less impairment in high/upper middle-income countries (OR=.04, 95% CI 0.203, 0.05, p < .01), but significantly more impairment in lower middle/low-income countries (OR=2.01, 95% CI 1.50, 2.69, p < .01). Patients had 444% greater odds of impairment if treated at a center with specialty burn unit services (OR 5.44, 95%CI 3.71, 7.99, p < .01), possibly due to a selection effect. DISCUSSION: Access to reliable rehabilitation services and sophisticated nutritional services were strongly associated with less physical impairment at discharge, but only in resource-rich countries. Although these findings support the importance of rehabilitation and nutrition after burn injury, they also highlight potential disparities in the quantity or quality of services available to burn survivors in poorer countries.

Self-harm in burn patients: An analysis of Finnish patient records (2011-2020).

AIM: To collect data on self-harm burn patients at a national level in Finland and analyze patient characteristics. MATERIAL AND METHODS: First, we went through The National Care Register for Health Care (Hilmo) records from 2011 to 2015 to find all patients in Finland with both burn and self-harm ICD10 codes. Then we investigated the medical records of all patients treated at the National Burn Centre (NBC) in Helsinki in the period 2011-2020. Patients admitted to the hospital because of self-harm burn injuries were compared to those without self-harm injuries. Patients below 18 years old were excluded. RESULTS: The Hilmo register consisted of a total of 3391 adult burn patients admitted to any healthcare unit during the study period. Compared with non-self-harm patients, self-harm patients (N = 82) had lower mean age (41 years vs 54 years, p < 0.001) and longer hospitalization (18 days vs. 6 days, p < 0.05). Two-thirds of the self-harm patients (N = 38) admitted to the NBC in the period 2011-2020 had a pre-burn history of psychiatric care (66%) and one-third of them had a previous record of self-harm or suicide attempt. Men had more severe burns than women (mean TBSA 46% vs. 14%, p < 0.05), and seven of them died during the first 48 h of care, but this was not the case for any female patient. CONCLUSIONS: Self-harm burn patients were younger and had longer hospitalization at all care levels than other burn patients. Based on medical records of hospitalized self-harm burn patients, we found clear gender differences in the severity of the burn injury and in mortality, with men suffering more severe injuries, in some cases leading to death. Recognizing high-risk patients pre-burn could have a strong preventive impact.

The changing pattern of pediatric burns in a territory burn center before and during the COVID-19 pandemic in China: A retrospective study.

BACKGROUND: Pediatric burn patients are an essential part of burn populations. However, there is limited publicly available data on the epidemiological impact of COVID-19 on pediatric burns in China. OBJECTIVE: In this paper, pediatric burn patients admitted to the Department of Burn Surgery of the First Hospital of Jilin University before and during COVID-19 were retrospectively investigated to determine the impact of COVID-19 on pediatric burn inpatients. METHODS: The information of inpatients from July 2017 to December 2019 (pre-COVID-19 group) and from January 2020 to June 2022 (COVID-19 group) in the Department of Burn Surgery at the First Hospital of Jilin University was retrospectively investigated. Demographic information of patients, length of hospital stay, total body surface area (TBSA) of burn injury, post-injury visit time, comorbidity, surgical methods, etc., were statistically analyzed. RESULTS: The COVID-19 group included 154 (10.2%) patients, and the pre-COVID-19 group included 335 (19.4%) patients (P＜0.001). There were no differences in gender, age, length of hospital stay, or etiology of burns between the two groups. Compared to the pre-COVID-19 group, patients in the pre-COVID-19 group experienced a significant delay in presentation (P＜0.001), had a larger TBSA of burn wound (P ＜ 0.001), were more prone to sustaining major burns (P ＜ 0.001), a higher likelihood of undergoing operations (P = 0.03), higher cost (P＜0.001) and more complications (P＜0.001). Additionally, upper extremities were the most commonly part involved in both groups (P = 0.004), with the lower extremities showed a significant increase to be involved in burn injury during COVID-19 pandemic (P = 0.007). Furthermore, the majority of guardians did not take first aid measures in both groups following burn injury (P = 0.102). CONCLUSIONS: During the COVID-19 pandemic period, scalds remained the main reason for hospitalization. The number of hospitalized patients has decreased dramatically, while the severity of burns has significantly increased, with a notable delay in hospital visits and an increased occurrence of complications.

Routinely collected burn clinical data in Canada: Determining the knowledge gap.

Unlike other developed countries that hold national burn registries to monitor burn injury and care, Canada relies on single-centre secondary datasets and administrative databases as surveillance mechanisms. The objective of this study was to determine the knowledge gap faced in Canada for not having a dedicated burn registry. A comprehensive scoping review was conducted to identify the burn literature that has arisen from secondary datasets in Canada. Literature of all study designs was included with the exception of case reports and cases series. Once data extraction was concluded, a thematic framework was constructed based on the information that arose from nations that hold national burn registries. Eighty-eight studies were included. Twelve studies arose from national datasets, and 18 from provincial databases, most of which were from Ontario and British Columbia. Only seven studies were conducted using a combination of Canadian units' single-centre datasets. The majority of included studies (58%) resulted from non-collaborative use of single-centre secondary datasets. Research efforts were predominantly conducted by burn units in Ontario, British Columbia, Manitoba and Alberta. A significant number of the included studies were outdated and several provinces/territories had no published burn data whatsoever. Efforts should be made towards the development of systems to surveil burn injury and care in Canada. This study supports the development of a nation-wide burn registry to bridge this knowledge gap.

Factors associated with emergency department disposition among burn injury patients: Analysis of prehospital and emergency care characteristics using South Asia Burn Registry (SABR) data.

INTRODUCTION: Improvement in burn injury data collections and the quality of databanks has allowed meaningful study of the epidemiologic trends in burn care. The study assessed factors associated with disposition of burn injury patients from emergency department accounting for pre-hospital care and emergency care. METHODS: This prospective observational pilot study of the South Asia Burn Registry project was conducted at selected public sector burn centers in Bangladesh and Pakistan (September 2014 - January 2015). All age groups with an initial presentation to the burn centers were enrolled. Descriptive and regression analysis is presented. RESULTS: A total of 2749 patients were enrolled. The mean age was 21.7 ± 18.0 years, 55.3% were males, and about a quarter were children < 5 years. About 46.9% of the females were housewives. Scald burns were common among children (67.6%) while flame burns were common among adults (44.3%). About 75% of patients were brought in via non-ambulance mode of transport. More than 55% of patients were referrals from other facilities or clinics. The most common first aid given pre-hospital was the use of water or oil. About 25% were admitted for further care. The adjusted odds of being admitted compared to being sent home were highest for children < 5 yrs, those with higher total body surface area burnt, having arrived via ambulance, scald and electrical burn, having an associated injury and inhalational injury. CONCLUSION: The study provides insight into emergency burn care and associated factors that influenced outcomes for patients with burn injuries.

Assaults by Scalding in British Prisons.

We describe the trends and severity of deliberate scald injuries from assaults within prisons presenting to Pinderfields Hospital in the United Kingdom. Data were obtained using local records of the International Burn Injury Database. Between 2003 and 2019, the hospital's Department of Plastic Surgery and Burns treated 22 cases from at least seven prisons, with 20 cases occurring in the last 4 years. Boiling water was used in most cases. Other substances included syrups of boiling water and sugar, and hot fat. Mean total body surface area was 2.8%, most commonly the face, neck, shoulders, and anterior chest. National data identified 267 cases with a similar rising trend. These injuries increase logistical and financial burdens on our burns service due to the need for added security and police escorts during treatment. "Copycat attacks" within same prisons, sometime on the same day, raise concerns that incidence of these injuries is likely to increase. Outreach nursing and telemedicine facilities may minimize the challenges during the management period.

Cuidados de enfermagem em pacientes queimados nas unidades de terapia intensiva / Nursing care in burned patients in intensive care units / Cuidados de enfermería en pacientes quemados en unidades de cuidados intensivos

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.

Infecciones asociadas al cuidado de salud en la unidad de quemados durante la pandemia SARS-CoV-2 / Healthcare-associated infections in the burn unit during the SARS-CoV-2 pandemic

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)

Gender-based disparities in burn injuries, care and outcomes: A World Health Organization (WHO) Global Burn Registry cohort study.

BACKGROUND: We aimed to describe the gender-based disparities in burn injury patterns, care received, and mortality across national income levels. METHODS: In the WHO Global Burn Registry (GBR), we compared patient demographics, injury characteristics, care and outcomes by sex using Chi-square statistics. Logistic regression was used to identify the associations of patient sex with surgical treatment and in-hospital mortality. RESULTS: Among 6431 burn patients (38 % female; 62 % male), females less frequently received surgical treatment during index hospitalization (49 % vs 56 %, p < 0.001), and more frequently died in-hospital (26 % vs 16 %, p < 0.001) than males. Odds of in in-hospital death was 2.16 (95 % CI: 1.73-2.71) times higher among females compared to males in middle-income countries. CONCLUSIONS: Across national income levels, there appears to be important gender-based disparities among burn injury epidemiology, treatment received and outcomes that require redress. Multinational registries can be utilized to track and to evaluate initiatives to reduce gender disparities at national, regional and global levels.

Prevalence and risk factors for acute stress disorder and posttraumatic stress disorder after burn injury.

BACKGROUND: Psychological consequences of burn injury can be profound. Acute stress disorder (ASD) and posttraumatic stress disorder (PTSD) are known sequelae, but routine identification is challenging. This study aims to identify patient characteristics associated with outpatient positive screens. METHODS: The Primary Care Posttraumatic Stress Disorder questionnaire (PC-PTSD-4) was administered at initial outpatient Burn Center visits between 5/2018-12/2018. Demographics, injury mechanism, and total body surface area (TBSA) were recorded. Those with ≥3 affirmative answers were considered positive. Patients with positive and negative screens were compared. RESULTS: Of 307 surveys collected, 292 (median TBSA 1.5 %, IQR 0.5-4.0 %) remained for analysis after exclusions. Of those, 24.0 % screened positive. Positive screens were associated with presence of a deep component of the injury, injury mechanism, upper extremity involvement, ICU admission, and prolonged hospital length of stay. CONCLUSIONS: Numerous factors distinguish burn injury from other traumatic mechanisms and contribute to disproportionate rates of traumatic stress disorders. Optimization of burn-oriented ASD and PTSD screening protocols can enable earlier intervention.

Sparsity of burn centers and prolonged length of hospital stay: A nationwide study.

INTRODUCTION: The optimal distribution of burn centers remains unclear. We aimed to determine the appropriate number of burn centers per population (density) and examined a nationwide registry with the hypothesis that low-density burn centers would be associated with unfavorable outcomes. PATIENTS AND METHODS: A retrospective study was conducted using the Japanese Society of Burn Injury registry (2011-2021). Burn center density was defined as the number of burn centers per one million population in each prefecture, and centers were trisected on the basis of density. Hospital-free days until day 30 were compared between patients at high-, middle-, and low-density centers. Inverse probability weighting was conducted to adjust baseline characteristics, including age, burn mechanism, and burn severity. RESULTS: We included 6764, 6209, and 2200 patients at high-, middle-, and low-density burn centers, respectively. After adjusting for patient demographics and burn severity, patients at high- and middle-density centers (≥0.4 centers per one million population) had longer hospital-free days compared with those at low-density centers (11 [0-23] vs 11 [0-23] vs 8 [0-22] days; p < 0.001). CONCLUSIONS: Low burn center density (<0.4 centers per one million population) was associated with longer hospital stay, whereas no higher limit was determined.

Chronic Nerve Pain after Burn Injury: An Anatomical Approach and the Development and Validation of a Model to Predict a Patient's Risk.

BACKGROUND: A model that predicts a patient's risk of developing chronic, burn-related nerve pain may guide medical and/or surgical management. This study determined anatomy-specific variables and constructed a mathematical model to predict a patient's risk of developing burn-related nerve pain. METHODS: A retrospective analysis was conducted from 1862 adults admitted to a burn center from 2014 to 2019. One hundred thirteen patients developed burn-related nerve pain. Comparisons were made using 11 anatomy-specific locations between patients with and without burn-related nerve pain. The modified Delphi technique was used to select 14 potential risk variables. Multivariate regression techniques, Brier scores, area under the curve, Hosmer-Lemeshow goodness-of-fit, and stratified K-fold cross-validation was used for model development. Chronic pain was defined as pain lasting 6 or more months after release from the Burn Center. RESULTS: Prevalence rates of burn-related nerve pain were similar in the development (6.1 percent) and validation (5.4 percent) cohorts [Brier score = 0.15; stratified K-fold cross-validation (K = 10): area under the curve, 0.75; 95 percent CI, 0.68 to 0.81; Hosmer-Lemeshow goodness-of-fit, p = 0.73; n = 10 groups]. Eight variables were included in the final equation. Burn-related nerve pain risk score = -6.3 + 0.02 (age) + 1.77 (tobacco use) + 1.04 (substance abuse) + 0.67 (alcohol abuse) + 0.84 (upper arm burn) + 1.28 (thigh burn) + 0.21 (number of burn operations) + 0.01 (hospital length-of-stay). Burn-related nerve pain predicted probability = 1 - 1/[1 + exp(burn-related nerve pain risk score)] for 6-month burn-related nerve pain risk score. As the number of risk factors increased, the probability of pain increased. CONCLUSIONS: Risk factors were identified for developing burn-related nerve pain at 11 anatomical locations. This model accurately predicts a patient's risk of developing burn-related nerve pain at 6 months. Age, tobacco use, substance abuse, alcohol abuse, upper arm burns, thigh burns, the number of burn operations, and hospital length of stay represented the strongest predictors. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.