ABSTRACT
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.
Subject(s)
Burn Units/statistics & numerical data , Burns/diagnosis , Intensive Care Units/statistics & numerical data , Nursing Care/methods , Pain/diagnosis , Infection Control/methods , Critical Care , Libraries, Digital , Degloving Injuries/diagnosisABSTRACT
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)
Subject(s)
Humans , Infant , Child, Preschool , Child , Adolescent , Burn Units/statistics & numerical data , Burns/complications , Burns/epidemiology , Cross Infection/epidemiology , Infection Control , Epidemiological Monitoring , COVID-19/epidemiology , Retrospective Studies , Cohort StudiesSubject(s)
Burn Units , Burns , COVID-19 , Infection Control , Infectious Disease Transmission, Patient-to-Professional , Personnel, Hospital , Wound Infection , Adult , Brazil/epidemiology , Burn Units/organization & administration , Burn Units/statistics & numerical data , Burns/complications , Burns/etiology , Burns/physiopathology , Burns/therapy , COVID-19/epidemiology , COVID-19/physiopathology , COVID-19/therapy , COVID-19/transmission , COVID-19 Testing/methods , COVID-19 Testing/statistics & numerical data , Comorbidity , Female , Humans , Infection Control/methods , Infection Control/organization & administration , Infection Control/standards , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Infectious Disease Transmission, Patient-to-Professional/statistics & numerical data , Male , Middle Aged , Trauma Severity Indices , Wound Infection/epidemiology , Wound Infection/therapyABSTRACT
BACKGROUND: Healthcare-associated infections (HAIs) remain a major challenge in burn research and care. We aimed to describe the epidemiology and timeline of HAIs and to estimate the association of demographics and clinical characteristics with time to HAI among burn patients. METHODS: A prospective cohort study was conducted in a referral burn unit in southwestern Colombia. Incidence rates were calculated for HAI types and microorganisms, using a Poisson regression model. Univariable and multivariable Cox proportional hazards regression was used to estimate the effect of risk factors on time to first HAI. RESULTS: Of 165 burn patients, 46 (27.9%) developed at least one HAI (incidence rate of 21.8 per 1000 patient-days). The most frequent HAIs were burn wound infections, followed by bloodstream infections. The most common microorganisms were Staphylococcus aureus, Pseudomonas spp., and Acinetobacter baumannii. Whereas gram-negative bacteria were the most common microorganisms causing HAIs, gram-positive bacteria were the first microorganisms isolated after hospital admission. The independent risk factors associated with time to first HAI were burn size (TBSA>20%), burn mechanism (flames and scalds), central venous catheter use, and mestizo race. CONCLUSION: These data have implications toward generating empirical antibiotic guidelines and preventive strategies targeting the patients at highest risk for HAI.
Subject(s)
Burns/complications , Cross Infection/etiology , Time Factors , Time-to-Treatment/statistics & numerical data , Adolescent , Adult , Aged , Aged, 80 and over , Burn Units/organization & administration , Burn Units/standards , Burn Units/statistics & numerical data , Burns/epidemiology , Chi-Square Distribution , Child , Child, Preschool , Cohort Studies , Colombia/epidemiology , Cross Infection/epidemiology , Female , Humans , Infant , Male , Middle Aged , Poisson Distribution , Proportional Hazards Models , Prospective Studies , Risk Factors , Time-to-Treatment/standardsABSTRACT
Introdução: O suicídio é um sério problema de saúde pública. Estima-se que para cada óbito existam 10 tentativas. Dentre os meios utilizados, as queimaduras têm destaque devido à gravidade das lesões, a alta taxa de letalidade e os grandes prejuízos funcionais, estéticos e psicológicos. As mulheres, por constituírem a maioria dos pacientes com história de tentativa de suicídio e morte por queimaduras, representam um grupo vulnerável que merece recorte para aprofundamento do estudo. Métodos: Estudo retrospectivo, de caráter descritivo de série temporal. Foi desenvolvido na Unidade Tratamento de Queimados e no Instituto de Medicina Legal em Brasília (DF), entre os anos de 2010 e 2015. Resultados: Foram identificadas 42 mulheres com história de suicídio por queimaduras, tentado ou consumado. Houve 15 óbitos relacionados diretamente à lesão térmica. Houve um predomínio da faixa etária entre 30 e 44 anos, seguida por 15 a 29 anos. Em 64,3% dos casos o evento aconteceu no DF. Em relação aos agentes etiológicos, o mais comum foi o álcool (71,4%). A média de superfície corporal queimada foi de 34,38%, sendo que as pacientes que faleceram apresentaram áreas queimadas maiores (59,53%) do que as que sobreviveram (20,4%). Conclusão: Os dados obtidos no DF corroboram informações da literatura. Apesar do progresso envolvendo manejo e tratamento dos pacientes queimados, a prevenção continua sendo a melhor atitude.
Introduction: Suicide is a serious public health problem. For every death, there are an estimated 10 suicide attempts. Among the means of suicide, burns are prominent due to the lesion severity, the high mortality rate, and the severe functional, aesthetic, and psychological damage. Women comprise the majority of patients with a history of attempting suicide and death by burns and represent a vulnerable group that deserves attention. Methods: This retrospective descriptive time-series study was performed in the Burn Treatment Unit at the Institute of Legal Medicine in Brasília, Distrito Federal (DF) between 2010 and 2015. Results: A total of 42 women with a history of suicide by burns, attempted or consummated, were identified; 15 deaths were directly related to the thermal injury. Suicide by burns was the most predominant among patients aged 30 to 44 years was observed, followed by those aged 15 to 29 years. In 64.3% of cases, the event occurred in the Brasília, Distrito Federal (DF). Alcohol was the most common etiological agent (71.4%). The average burned body surface area was 34.38%, and the patients who died presented larger burned areas (59.53%) than that in those who survived (20.4%). Conclusion: The data obtained from the Brasília, Distrito Federal (DF) corroborate information from the literature. Despite progress involving the management and treatment of burn patients, prevention remains the best strategy.
Subject(s)
Humans , Female , Adolescent , Adult , History, 21st Century , Suicide , Suicide, Attempted , Burn Units , Burns , Public Health , Essential Public Health Functions , Suicide/statistics & numerical data , Suicide, Attempted/psychology , Suicide, Attempted/statistics & numerical data , Burn Units/standards , Burn Units/statistics & numerical data , Burns/mortality , Burns/psychology , Burns/therapyABSTRACT
Introdução: As queimaduras são um grave problema de saúde pública. Os índices prognósticos estimam probabilidade prognóstica e ajudam a quantificar a gravidade do paciente. Objetivo:Avaliar o poder de discriminação dos índices Abbreviated Burn Severity Index (ABSI), Acute Physiology and Chronic Health Evaluation II (APACHE II), Sequential Organ Failure Assessment (SOFA) e Therapeutic Intervention Scoring System 28 (TISS 28) da admissão em pacientes de uma Unidade de Terapia Intensiva (UTI) especializada no tratamento de queimados. Casuística e Métodos:Estudo longitudinal prospectivo, realizado em uma Unidade de Terapia Intensiva especializada no atendimento ao paciente queimado, no período de maio de 2011 a maio de 2013. Foram excluídos pacientes com menos de 18 anos e com menos de 24 horas de internação. Foram coletados dados clínicos e demográficos e calculados os escores prognósticos estudados. A acurácia dos índices foi avaliada pela curva Receiver Operating Characteristic (ROC), discriminando o desfecho do paciente (sobrevivente e não sobrevivente). Foi calculada a área sob a curva (AUC). Resultados: Foram incluídos 180 pacientes no período de estudo, sendo 72,8% do sexo masculino (n=131). A mediana de idade foi de 40 anos (ITQ: 30 52,5). A mortalidade hospitalar foi de 37,2% (n=67). A maior AUC foi a do escore APACHE II, com valor de 0,837 (ponto de corte do escore = 14, sensibilidade de 83,6% e especificidade de 72,3%). Na análise de pontuação dos escores entre sobreviventes e não sobreviventes, observou-se diferença estatisticamente significativa entre os valores de todos os índices estudados. Conclusões: Os escores ABSI, APACHE II, SOFA e TISS 28 na admissão da UTI mostraram bom poder de discriminação para sobrevivência entre pacientes queimados.
Introduction: Burns are a serious public health problem. Prognostic indexes estimate prognostic probability and help to quantify disease severity. Objective: To evaluate the power of discrimination of Abbreviated Burn Severity Index (ABSI), Acute Physiology and Chronic Health Evaluation II (APACHE II), Sequential Organ Failure Assessment (SOFA) and Therapeutic Intervention Scoring System 28 (TISS 28) in an Intensive Care Unit (ICU) from a burn center. Patients and Methods: This is a prospective longitudinal study, carried out from May 2011 to May 2013. Patients under 18 years of age and with hospitalization for less than 24 hours were excluded. Clinical and demographic data were collected, and the prognostic scores were calculated. The accuracy of the scores was evaluated by the Receiver Operating Characteristic (ROC) curve, which discriminated against the outcome of the patient (survivor and non-survivor). The area under the curve (AUC) was calculated. Results: A total of 180 patients were included, and 72.8% of them were male (n = 131). The median age was 40 years (IQR: 30 - 52.5). Hospital mortality was 37.2% (n = 67). The highest AUC was from the APACHE II score, with a value of 0.837 (associated criterion = 14, sensitivity = 83.6% and specificity = 72.3%). In the analysis of the scores between survivors and non-survivors statistically significant differences were found in all studied scores. Conclusions: ABSI, APACHE II, SOFA and TISS 28 at ICU resulted in good power of discrimination for survival among burn patients.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Severity of Illness Index , Burn Units/statistics & numerical data , Intensive Care Units/statistics & numerical dataABSTRACT
OBJECTIVE: to evaluate the effectiveness of the adopted strategy and the care quality for pediatric trauma in the survival of patients attended after a disaster in a city in the interior of Minas Gerais state, compared to the expected results of studies on infant mortality in major burns. METHODS: retrospective observational analysis of ten patients who were burned and transferred to a trauma reference center. We used the modified R-Baux score to estimate the expected mortality. We compared the expected mortality predicted by R-Baux score and the actual mortality determined from one-ratio test. We also compared time of post-trauma admission with mortality and burned body surface area with mortality. RESULTS: mean R-Baux score was 75.2, which means an expected mortality of 5% among major burn patients. However, in this study, mortality in the group of children with large burned body surface area was of 60%, p=0.001, a rate far beyond that expected in literature. CONCLUSION: despite the innumerable variables, we consider the hypothesis of the pediatric trauma care infrastructure being inferior than the one needed in the state. This study suggests a greater incentive for public policies concerning pediatric trauma care, prepared referral center, well-established transfer agreements, and optimization of catastrophe plans, in order to reduce morbimortality of patients who survive the first hour after trauma.
OBJETIVO: avaliar a eficácia da estratégia adotada e a qualidade do atendimento em trauma pediátrico na sobrevivência dos pacientes atendidos após desastre em uma cidade do interior de Minas Gerais, em comparação a resultados esperados por estudos sobre mortalidade infantil em grandes queimados. MÉTODOS: análise retrospectiva observacional de dez pacientes que sofreram queimaduras e foram transferidos para um centro de referência de trauma. Utilizou-se o escore de R-Baux modificado para estimar a mortalidade esperada. Comparou-se a mortalidade esperada a partir do escore de R-Baux e a mortalidade real, a partir do teste de uma proporção. Comparou-se, também, tempo de admissão pós-trauma com mortalidade e grau de superfície corporal queimada com mortalidade. RESULTADOS: o R-Baux médio foi de 75,2, o que significa uma mortalidade esperada para grandes queimados de 5%. No entanto, a mortalidade do grupo com grande área de superfície corporal queimada desse estudo foi de 60%, valor p=0,001. Observou-se neste caso uma mortalidade muito além da esperada pela literatura. CONCLUSÃO: apesar das inúmeras variáveis, aventa-se a hipótese de infraestrutura de atendimento em trauma pediátrico aquém da necessária no Estado. Este estudo sugere maior incentivo à políticas públicas para atendimento de trauma pediátrico, centro de referência preparado, acordos de transferência bem estabelecidos e otimização de planos de catástrofe para diminuição da morbimortalidade para os pacientes que sobrevivem à primeira hora após o trauma.
Subject(s)
Burn Units/statistics & numerical data , Burns/mortality , Burns/therapy , Crime Victims/statistics & numerical data , Age Factors , Body Surface Area , Brazil , Child , Child, Preschool , Female , Hospital Mortality , Humans , Injury Severity Score , Male , Reference Values , Retrospective Studies , Survival AnalysisABSTRACT
RESUMO Objetivo: avaliar a eficácia da estratégia adotada e a qualidade do atendimento em trauma pediátrico na sobrevivência dos pacientes atendidos após desastre em uma cidade do interior de Minas Gerais, em comparação a resultados esperados por estudos sobre mortalidade infantil em grandes queimados. Métodos: análise retrospectiva observacional de dez pacientes que sofreram queimaduras e foram transferidos para um centro de referência de trauma. Utilizou-se o escore de R-Baux modificado para estimar a mortalidade esperada. Comparou-se a mortalidade esperada a partir do escore de R-Baux e a mortalidade real, a partir do teste de uma proporção. Comparou-se, também, tempo de admissão pós-trauma com mortalidade e grau de superfície corporal queimada com mortalidade. Resultados: o R-Baux médio foi de 75,2, o que significa uma mortalidade esperada para grandes queimados de 5%. No entanto, a mortalidade do grupo com grande área de superfície corporal queimada desse estudo foi de 60%, valor p=0,001. Observou-se neste caso uma mortalidade muito além da esperada pela literatura. Conclusão: apesar das inúmeras variáveis, aventa-se a hipótese de infraestrutura de atendimento em trauma pediátrico aquém da necessária no Estado. Este estudo sugere maior incentivo à políticas públicas para atendimento de trauma pediátrico, centro de referência preparado, acordos de transferência bem estabelecidos e otimização de planos de catástrofe para diminuição da morbimortalidade para os pacientes que sobrevivem à primeira hora após o trauma.
ABSTRACT Objective: to evaluate the effectiveness of the adopted strategy and the care quality for pediatric trauma in the survival of patients attended after a disaster in a city in the interior of Minas Gerais state, compared to the expected results of studies on infant mortality in major burns. Methods: retrospective observational analysis of ten patients who were burned and transferred to a trauma reference center. We used the modified R-Baux score to estimate the expected mortality. We compared the expected mortality predicted by R-Baux score and the actual mortality determined from one-ratio test. We also compared time of post-trauma admission with mortality and burned body surface area with mortality. Results: mean R-Baux score was 75.2, which means an expected mortality of 5% among major burn patients. However, in this study, mortality in the group of children with large burned body surface area was of 60%, p=0.001, a rate far beyond that expected in literature. Conclusion: despite the innumerable variables, we consider the hypothesis of the pediatric trauma care infrastructure being inferior than the one needed in the state. This study suggests a greater incentive for public policies concerning pediatric trauma care, prepared referral center, well-established transfer agreements, and optimization of catastrophe plans, in order to reduce morbimortality of patients who survive the first hour after trauma.
Subject(s)
Humans , Male , Female , Child, Preschool , Child , Burn Units/statistics & numerical data , Burns/mortality , Burns/therapy , Crime Victims/statistics & numerical data , Reference Values , Body Surface Area , Brazil , Injury Severity Score , Survival Analysis , Retrospective Studies , Age Factors , Hospital MortalityABSTRACT
Introduction: Infections are the most frequent complications in burn patients. Filamentous fungi have an uncertain place within the statistics, since in our media data regarding their prevalence, causal agents and outcome of those who suffer them remain scarce. The aim of this study was to evaluate the prevalence of fungal infection by filamentous fungi (IHF) in patients hospitalized in burn intensive care unit (BICU), and to review clinical, epidemiological, microbiological and evolutionary characteristics of these patients and to know the frequency and distribution of the isolated fungi. Materials and methods: Retrospective and descriptive study. It includes all individuals admitted in burns intensive care unit (2012-2015), with positive culture for filamentous fungi in skin biopsies and bedsores. Results: A total of 168 patients were admitted in the BICU in a period of 3 years. 90% were major burned and 17% of them developed IHF (29/168). Aspergillus spp (24%), Fusarium sp (14%), Mucor spp (3%) and various black fungus genera (58%) were the main genera found in cultives. About 24% of the patients with IHF died and Fusarium spp was found in 50% of the cases. The cause of death was irreversible cardiogenic shock with multiorgan failure. Conclusions: Filamentous fungal infection was present in 17% of burned patients. The main isolatte fungi in samples were dematiaceous mould. Mortality among patients was 24%, with Fusarium being the fungus found in the highest number of deaths (50%).
Antecedentes: Las infecciones son las complicaciones más frecuentes en los pacientes quemados. Los hongos filamentosos ocupan un lugar incierto dentro de las estadísticas nosocomiales; existen escasos datos sobre la prevalencia de las mismas, los agentes causales y el desenlace de los que las padecen. Objetivos: El objetivo fue evaluar prevalencia de la infección por hongos filamentosos (IHF) en pacientes internados en la unidad terapia intensiva de quemados (UTIQ), revisar algunas características clínicas, epidemiológicas, microbiológicas y evolución de estos pacientes; conocer la frecuencia y distribución de las especies fúngicas aisladas. Materiales y métodos: Estudio retrospectivo y descriptivo. Se incluyeron todos los individuos que ingresaron a la terapia intensiva de pacientes quemados (2012-2015), con cultivo positivo para hongos filamentosos en biopsias de piel y escaras. Resultados: Un total de 168 de pacientes ingresaron en la unidad intensiva de quemados en un período de 3 años. El 17% desarrolló IHF (29/168) y el 90% fueron grandes quemados. Se recuperaron 29 hongos filamentosos (93% de exámenes microscópicos positivos): Aspergillus spp (24%), Fusarium spp (14%), Mucor spp (3%) y diversos géneros de hongos negros (58%). El 95% presentó entre 1 y 4 infecciones bacterianas además de la infección fúngica en piel. El 24% de los pacientes con IHF falleció. La causa de la muerte fue shock cardiogénico irreversible con falla multiorgánica. Conclusiones: La infección por hongos filamentosos se presentó en el 17% de los pacientes quemados. Los principales hongos causantes de infección fúngica fueron dematiáceos. La mortalidad entre los pacientes fue del 24%, siendo Fusarium el hongo hallado en el mayor número de muertes (50%).
Subject(s)
Burn Units/statistics & numerical data , Burns/microbiology , Fungi/isolation & purification , Mycoses/epidemiology , Adult , Aspergillosis/epidemiology , Aspergillosis/microbiology , Aspergillus/isolation & purification , Female , Fusariosis/microbiology , Fusariosis/mortality , Fusarium/isolation & purification , Humans , Male , Middle Aged , Mycoses/microbiology , Prevalence , Retrospective Studies , Young AdultABSTRACT
Introdução: São muitos os pacientes queimados que, apesar de um complexo tratamento multidisciplinar, são levados ao óbito. O objetivo deste estudo é determinar o perfil epidemiológico, ressaltando as principais complicações que acometem os pacientes queimados. Métodos: Estudo retrospectivo que analisou prontuários de pacientes queimados atendidos no Hospital Metropolitano de Urgência e Emergência no Estado do Pará, no período de janeiro de 2007 até dezembro de 2012. Resultados: A maioria dos pacientes era do sexo masculino (69,1%), entre 18 e 30 anos (35,5%), procedente de outros hospitais (35,8%), trabalhador da construção civil (21,2%). As complicações mais encontradas foram insuficiência respiratória (69,4%), insuficiência renal (57,1%) e sepse (38,8%). Conclusões: Os dados obtidos são similares aos encontrados na literatura nacional e internacional, evidenciando a necessidade de prevenção e fiscalização de trabalhadores da construção civil, bem como de implementar protocolos de tratamento para melhorar a assistência ao paciente queimado.
Introduction: Despite complex multidisciplinary treatment, many burn patients die. This study aimed to determine epidemiologic profiles of burn patients, highlighting major complications. Methods: This retrospective study analyzed the medical records of burn patients managed at the Metropolitan Hospital for Urgent and Emergent Care, Pará State, between January 2007 and December 2012. Results: most patients were males (69.1%) aged 18 to 30 years (35.5%), referred from other hospitals (35.8%), and employed as construction workers (21.2%). The most frequent complications were respiratory (69.4%) and renal failure (57.1%), followed by sepsis (38.8%). Conclusions: The data obtained were similar to those reported in national and international literature, highlighting the need for burn prevention and inspection of construction sites, as well as implementation of treatment protocols to improve care for burn patients.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , History, 21st Century , Patients , Burn Units , Burns , Epidemiology , Cross-Sectional Studies , Mortality , Epidemiology and Biostatistics , Invasion of Deaths , Patients/statistics & numerical data , Burn Units/statistics & numerical data , Burns/surgery , Burns/complications , Burns/mortality , Burns/therapy , Burns/epidemiology , Cross-Sectional Studies/methods , Cross-Sectional Studies/statistics & numerical dataABSTRACT
ABSTRACT Objective: To report the use of virtual reality (VR) in pain intensity during dressing change of two burned children hospitalized in a Burn Treatment Center (BTC) in Southern Brazil. Method: Case report on the use of VR during dressing change of two burned children hospitalized in a BTC, from May to July 2016. For assessing pain, a facial pain rating scale was applied at four times: just before the dressing, during the dressing without the use of VR, during the dressing with the VR, and after the use of VR. Results: The use of goggles was easy to apply and well-accepted by the children, and also had a relevant effect reducing pain. Conclusion: VR can become an important nonpharmacological method for treating pain in burned children.
RESUMEN Objetivo: Relatar la utilización de la Realidad Virtual (RV) en disminución de intensidad del dolor durante cambio de vendajes de dos niños quemados, internados en un Centro de Tratamiento del Quemado (CTQ) del Sur de Brasil. Método: Relato de caso de utilización de RV durante cambio de vendajes de dos niños quemados internados en CTQ, de mayo a julio de 2016. Se evaluó el dolor utilizando escala numérica conjuntamente con la de faces, aplicándosela en cuatro momentos: inmediatamente antes del vendaje, durante el vendaje sin utilizar la RV, durante el vendaje utilizando RV y luego de la utilización de la RV. Resultado: El uso de los visores fue simple y bien recibido por los niños; además, hubo efectos relevantes en relación a la disminución del dolor. Conclusión: La RV puede constituir un importante método no farmacológico para el tratamiento del dolor en niños quemados.
RESUMO Objetivo: Relatar a utilização da Realidade Virtual (RV) na diminuição da intensidade dolorosa durante a troca de curativo de duas crianças queimadas internadas em um Centro de Tratamento ao Queimado (CTQ) do Sul do Brasil. Método: Relato de caso da utilização da RV durante a troca de curativos de duas crianças queimadas internadas em um CTQ, de maio a julho de 2016. Para avaliar a dor, foi utilizada escala numérica sobreposta à de faces, sendo aplicada em quatro momentos: imediatamente antes do curativo, durante o curativo sem uso da RV, durante o curativo com a RV e após a utilizaçãoda RV. Resultado: O uso dos óculos foi de fácil aplicação e bem aceito pelas crianças, além disso houce efeitos relevantes em relação à diminuição da dor. Conclusão: A RV pode se tornar um importante método não farmacológico no tratamento da dor em crianças queimadas.
Subject(s)
Humans , Male , Child , Bandages/adverse effects , Burns/therapy , Pain Management/standards , Virtual Reality , Pediatrics/methods , Pediatrics/standards , Pediatrics/statistics & numerical data , Brazil , Burn Units/organization & administration , Burn Units/statistics & numerical data , Pain Management/methodsABSTRACT
OBJECTIVE: To report the use of virtual reality (VR) in pain intensity during dressing change of two burned children hospitalized in a Burn Treatment Center (BTC) in Southern Brazil. METHOD: Case report on the use of VR during dressing change of two burned children hospitalized in a BTC, from May to July 2016. For assessing pain, a facial pain rating scale was applied at four times: just before the dressing, during the dressing without the use of VR, during the dressing with the VR, and after the use of VR. RESULTS: The use of goggles was easy to apply and well-accepted by the children, and also had a relevant effect reducing pain. CONCLUSION: VR can become an important nonpharmacological method for treating pain in burned children.
Subject(s)
Bandages/adverse effects , Burns/therapy , Pain Management/standards , Virtual Reality , Brazil , Burn Units/organization & administration , Burn Units/statistics & numerical data , Child , Humans , Male , Pain Management/methods , Pediatrics/methods , Pediatrics/standards , Pediatrics/statistics & numerical dataABSTRACT
Las quemaduras en la población pediátrica tienen alta morbimortalidad, con secuelas importantes. Estudios han analizado su patrón epidemiológico y postulan que su conocimiento permite anticipar la incidencia y mejorar el tratamiento. El objetivo de este trabajo es determinar el patrón epidemiológico de las quemaduras en la población del Hospital Roberto del Río.
Pediatric burns have high morbi-mortality, with important sequelae for children. Studies have analyzed their epidemiological pattern and suggest that this knowledge would help on burn prevention and treatment. The purpose of this investigation is to identify the epidemiological pattern on the Roberto del Río Hospital burned patients.
Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Burn Units/statistics & numerical data , Burns/epidemiology , Seasons , Temperature , Chile/epidemiology , Retrospective StudiesABSTRACT
BACKGROUND: Burns represent a serious problem around the world especially in low- and middle-income countries. The aim was to determine the epidemiological characteristics, causes and mortality rate of burn deaths in the Colombian pediatric population as well as to guide future education and prevention programs. METHODS: We conducted an observational, analytical, retrospective population-based study. It was based upon official death certificate data using diagnosis codes for burns (scalds, thermal, electrical, intentional self-harm and not specified), that occurred between January 1, 2000 and December 31, 2009. Official death certificates of the pediatric population of up to 15 years of age were obtained from the National Administrative Department of Statistics. RESULTS: A total of 1197 fatal pediatric injuries related to burns were identified. The crude and adjusted mortality rate for burns in the pediatric population in Colombia during the length of the study was 0.899 and 0.912 per 100,000, respectively. The mortality rate tended to decrease (-5.17% annual) during the duration of the study. Children under 5 years of age were the most affected group (59.5%). Almost half of them died before arriving at a health facility (47.1%). Fire is the principal cause of death attributable to burns in Colombia, followed by electric burns and hot liquids. CONCLUSIONS: This is a first step study in researching the epidemiological features of pediatric deaths after burns. The Public Health's strategies should be oriented toward community awareness about these kind of injuries, and to teach children and families about risk factors and first aid.
Subject(s)
Burns/epidemiology , Accidents, Home/statistics & numerical data , Adolescent , Age Distribution , Burn Units/statistics & numerical data , Burns/etiology , Burns/mortality , Child , Child, Preschool , Colombia/epidemiology , Death Certificates , Female , Fires/statistics & numerical data , Humans , Infant , Length of Stay/statistics & numerical data , Male , Retrospective Studies , Risk Factors , Sex DistributionABSTRACT
BACKGROUND: Patients burned intentionally experience extensive injuries with high rates of morbidity and mortality. Nonetheless, there is no consensus if these patients have worse outcomes than unintentional burns considering injury severity and other preexistent comorbidities. METHODS: We conducted a ten-year retrospective review on all patients treated at the Burn Unit of Hospital de Pronto Socorro, Porto Alegre, Brazil, between 2003 and 2012. The aim was to compare survival of self-inflicted burns and burns from assaults with unintentional injuries using a Multivariable Cox Regression Analysis. RESULTS: 1734 patients were included in the study, 87.7% non-intentional, 6.6% self-inflicted and 5.8% from aggression. Intentional injuries resulted in more severe injuries and were associated with psychiatric disorders and drug abuse. After controlling for injury severity, previous clinical comorbidities and previous psychiatric disorders, only self-inflicted burns correlated significantly with a higher risk of death (HR=1.59, CI 95% 1.05-2.41, p=0.03). CONCLUSIONS: Self-inflicted injuries were independently associated with a higher risk of death. Burns from aggression were not associated with higher mortality in this model. Prevention of these injuries must be priority and treating the main associated factors such as drug abuse and psychiatric disorders may lower its occurrence.
Subject(s)
Burns/mortality , Self-Injurious Behavior/mortality , Adolescent , Adult , Age Distribution , Aged , Aged, 80 and over , Brazil/epidemiology , Burn Units/statistics & numerical data , Burns/etiology , Child , Child, Preschool , Comorbidity , Female , Humans , Infant , Injury Severity Score , Length of Stay/statistics & numerical data , Male , Mental Disorders/epidemiology , Middle Aged , Retrospective Studies , Risk Factors , Self-Injurious Behavior/epidemiology , Sex Distribution , Survivors/statistics & numerical data , Young AdultABSTRACT
INTRODUÇÃO: As queimaduras autoinfligidas geram consequências físicas, psicológicas e financeiras não só para a vítima, mas também para familiares e para sociedade. A prevalência desse tipo de acidente tem ampla variedade na literatura. O trabalho tem como objetivo analisar o perfil epidemiológico, a conduta e a taxa de letalidade dos pacientes com queimaduras por autoagressão atendidos em centro de tratamento de queimados, como uma forma de contribuir para intervenção efetiva em fatores e comportamentos de risco para tais acidentes. MÉTODO: Estudo retrospectivo por meio da análise dos prontuários de pacientes internados na Unidade de Queimados do Hospital Regional da Asa Norte, Brasília - DF, no período de janeiro de 2008 a dezembro de 2012. RESULTADOS: Foram incluídos no estudo 88 pacientes autoinfligidos, 54,5% do gênero feminino, idade média de 33 anos, média da superfície corporal queimada de 36%. A média de tempo de internação foi de 23 dias. A chama aberta foi o agente etiológico das queimaduras em 97,7% dos casos e o álcool foi o agente acelerador em 68,2%. A taxa de letalidade foi de 32,9%. Sessenta pacientes apresentavam comorbidades, sendo os distúrbios psiquiátricos e o etilismo os principais. CONCLUSÃO: As vítimas de queimaduras por autoagressão são geralmente mulheres, com idade média de 33 anos, utilizando álcool como agente da queimadura, afetando em média 36% da superfície corporal, com distúrbios psiquiátricos associados em 32,9% e com taxa de letalidade de 32,9%. No âmbito social, deve-se pensar em medidas públicas que detectem os pacientes em potencial para que seja instituída terapêutica adequada.
INTRODUCTION: Self-inflicted burn injuries lead to physical, psychological, and economic consequences not only to the victims but also to their families and the society. The prevalence of this type of accident varies greatly throughout the existing literatures. This study aimed to analyze the epidemiological profile, behavior, and lethality rate in patients with self-inflicted burn injuries who received treatment in a burn unit, as a way to contribute to the effective intervention to minimize the effects of risk factors and behaviors associated with this type of accident. METHOD: We conducted a retrospective study in which we analyzed medical records of patients hospitalized in the burn unit of Asa Norte's Regional Hospital, DF, Brazil, during the period between January 2008 and December 2012. RESULTS: The study sample consisted of 88 patients with self-inflicted burn injuries, of whom 54.5% were female, with a mean age of 33 years and mean burned body surface area of 36%. The mean hospitalization time was 23 days. Open flame was the etiological agent in 97.7% of the burn cases, and alcohol was the accelerating agent in 68.2% of these cases. The lethality rate was 32.9%. Sixty patients had comorbidities, with psychiatric disorders and alcoholism being the most common. CONCLUSION: The patients with self-inflicted burn injuries were generally women, with a mean age of 33 years, who used alcohol as accelerating agent. The mean body surface area affected was 36%. Of the patients, 32.9% had associated psychiatric disorders. The lethality rate was 32.9%. From a social perspective, public measures should be established to detect potential patients in order to administer appropriate therapies.
Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , History, 21st Century , Suicide , Wounds and Injuries , Health Profile , Burn Units , Burns , Burns, Chemical , Health Behavior , Medical Records , Epidemiology, Descriptive , Retrospective Studies , Self-Injurious Behavior , Evaluation Study , Mental Disorders , Suicide/psychology , Wounds and Injuries/therapy , Burn Units/standards , Burn Units/statistics & numerical data , Burns/epidemiology , Burns, Chemical/epidemiology , Health Behavior/ethics , Medical Records/standards , Medical Records/statistics & numerical data , Self-Injurious Behavior/pathology , Self-Injurious Behavior/psychology , Mental Disorders/pathology , Mental Disorders/psychologyABSTRACT
OBJECTIVE: To describe the profile of pediatric burn victims hospitalized at Hospital-Escola Padre Albino (HEPA), in Catanduva, São Paulo, Brazil. METHODS: This was a cross-sectional, retrospective study analyzing 446 medical records of patient aged 0-18 years old hospitalized in the Burn Care Unit of HEPA, from 2002 to 2012. The following variables were recorded: demographic data, skin burn causes, lesions characteristics, complications, surgical procedures, length of hospital stay, and outcome. Descriptive statistics were used. RESULTS: 382 patients with full medical records were included in the study. Burns were more frequent in males (64.4%) and in children aged less than 6 years (52.9%). Most accidents occurred at home (67.3%) and hot liquids were responsible for 47.1% of them. Mean burnt body surface was 18% and the most affected body areas were chest and limbs. First- and second-degree burns were observed in 64.4% of the cases. Secondary infection and surgical procedures occurred in 6.5% and 45.0% of the patients, respectively. Mean length of hospital stay was 9.8 days. The mortality rate was 1.6%. CONCLUSIONS: Preschool children were the main victims of burns occurring at home, representing the largest contingent of hospitalizations due to this cause in individuals aged < 18 years. It is important to develop strategies to alert parents and general society through educational programs and preventive campaigns.
Subject(s)
Burn Units/statistics & numerical data , Burns/epidemiology , Patient Admission/statistics & numerical data , Adolescent , Child , Child, Preschool , Cross-Sectional Studies , Female , Humans , Infant , Male , Retrospective Studies , Rural HealthABSTRACT
Introdução: Apesar dos grandes avanços em seu tratamento, infecção de pele com queimadura continua a ser um grande desafio. O objetivo deste estudo é avaliar os aspectos microbiológicos do primeiro ano de funcionamento de uma unidade de queimadura em um Hospital Universitário. Métodos: Estudo retrospectivo. Dados microbiológicos foram coletados e analisados a partir de pacientes internados na Unidade de Queimadura (UTQ) do Hospital São Paulo, Hospital Universitário da Escola Paulista de Medicina (EPM) da Universidade Federal de São Paulo (UNIFESP), entre junho de 2009 e julho de 2010. Resultados: O tempo médio de permanência hospitalar foi de 13,8 dias, com uma taxa de mortalidade de 5,9%. A média da superfície corpórea queimada foi de 10,3%. Avaliou-se 159 culturas de 101 pacientes. Culturas de sangue foram as mais solicitadas (41%). Também foram acessadas 245 culturas de vigilância, coletadas de 75 pacientes. A análise microbiológica revelou um índice de positividade total de 34,5%. Os agentes mais prevalentes foram Staphylococcus coagulase-negativo - CoNS - (33%), Pseudomonas aeruginosa (24%), Acinetobacter spp. (22%) e Klebsiella pneumoniae (5%). Conclusão: A avaliação microbiológica do primeiro ano de funcionamento da UTQ da EPM/ UNIFESP revelou que, embora o agente mais prevalente tenha sido a CoNS, bacilos Gram negativos ainda são muito prevalentes, como a Pseudomonas aeruginosa e a Acinetobacter baumannii. Apesar de pouco tempo de operação, observou-se um grande número de microrganismos multirresistentes, que pode ser explicado por longa exposição a agentes antimicrobianos e alta taxa de transferência de outros hospitais.
Introduction: Despite great advances in treatment, burned skin infection remains a major challenge. The aim of this study is to evaluate the microbiological aspects of the first year's operation of a Burn Unit in a University Hospital. Methods: Retrospective study. Microbiological data were collected and analyzed from patients admitted to the Burn Unit of São Paulo Hospital, a University Hospital of the Paulista Medical School (EPM) of the Federal University of São Paulo (UNIFESP) from June 2009 to July 2010. Results: The average length of stay was 13.8 days with a mortality rate of 5.9%, and median of TBSA was 10.3%. Evaluated 159 cultures from 101 patients. Blood cultures were the most requested (41%). It was also accessed 245 surveillance cultures collected from 75 patients. The microbiological analysis revealed a total positivity rate of 34,5%. The most prevalent agents were Coagulase-negative Staphylococcus - CoNS - (33%), Pseudomonas aeruginosa (24%), Acinetobacter spp. (22%) and Klebsiella pneumoniae (5%). Conclusion: The microbiological evaluation of the first year's activity of EPM/UNIFESP Burn Care Unit revealed that, although the most prevalent agent was CoNS, Gram negative bacilli are still very prevalent, such as Pseudomonas aeruginosa and Acinetobacter baumannii. Despite the short time of operation, was observed large number of multiresistant microorganisms which can be explained by long exposure to antimicrobials and high transfer rate from other hospitals.
Subject(s)
Humans , Male , Female , History, 21st Century , Burn Units , Burns , Epidemiology , Biological Specimen Banks , Anti-Infective Agents , Bacterial Infections , Bacterial Infections/microbiology , Bacterial Infections/pathology , Burn Units/standards , Burn Units/statistics & numerical data , Burns/surgery , Burns/complications , Burns/microbiology , Burns/epidemiology , Epidemiologic Studies , Epidemiology/standards , Epidemiology/statistics & numerical data , Retrospective Studies , Biological Specimen Banks/standards , Evaluation Study , Inpatients , Inpatients/statistics & numerical data , Anti-Infective Agents/isolation & purification , Anti-Infective Agents/analysis , Anti-Infective Agents/therapeutic useABSTRACT
BACKGROUND: Approximately 150 subjects per year suffer severe burns in Chile. AIM: To analyze sociodemographic/clinical features and outcomes of severely burned patients. MATERIAL AND METHODS: Retrospective cohort study of 936 patients aged 47 ± 20 years (66% males), admitted to the National Burn Center of Chile between 2006 and 2010. Sociodemographic/clinical and burn variables and outcomes were studied. RESULTS: Mean total percentage of body surface area burned was 27 + 20%. A quarter of the patients had social features that could jeopardize rehabilitation. Fire was the burning agent in 73%, which along with electricity presented greater lethality (p < 0.01). Inhalation injury was diagnosed in 22% of the patients. Twenty eight percent of patients had impaired consciousness at the moment of the accident, leading to larger burns, higher incidence of inhalation injury and greater lethality. Lethality for severe, critical and exceptional survival groups was 8.4,37.7 and 70.4%, respectively. CONCLUSIONS: Severely burned patients in Chile are mainly males at working age. Fire is the main agent and 28% had impaired consciousness, which was associated with an increase in the severity of burns. Knowledge of the characteristics and outcomes of the patients is important to implement prevention and treatment strategies adjusted to the national reality.