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.

Hand and wrist surgery on anticoagulants and antiplatelets: A systematic review and meta-analysis.

INTRODUCTION: Approximately 2% of the population are anticoagulated and over 50% of over 65-year-olds are prescribed antiplatelet agents. Several systematic reviews have shown the safety of interrupting anticoagulation and antiplatelets for non-emergency surgery, although such reviews excluded upper limb procedures and represents the rationale for this review. METHODS: The literature was systematically searched for studies concerning the outcomes of adult hand or wrist surgery on patients receiving anticoagulation or antiplatelet agents in direct comparison to controls (no anticoagulation or antiplatelet agents, or interruption of either). The primary outcome was reoperation for any complication related to postoperative bleeding, within 30 postoperative days. RESULTS: Nine cohort studies (3628 individuals; 3863 operations) were included. Based on very low-quality evidence, anticoagulation did not affect the risk of reoperation for bleeding (RR 2.4 [95% CI 0.1, 57]; 3 studies, n=443) or bruising (RR 2.5 [95% CI 1.0, 6.3]; n=124; I2=0%). Based on low quality evidence, antiplatelet agents did not affect the risk of reoperation for bleeding (RR 0.8 [95% CI 0.3, 1.8]; 6 studies, n=1885; I2=0%) or bruising (RR 3.2 [95% CI 0.2, 44]; n=571; I2=66%). A sensitivity analysis showed that carpal tunnel decompression on patients receiving anticoagulants or antiplatelets appeared to be safe (RR 0.8 [95% CI 0.3, 1.8]; 6 studies, n=2077; I2=0%). CONCLUSIONS: Given the sparsity of events (bleeding and bruising) and low-quality of the literature, no firm conclusions can be drawn. The decision to interrupt antiplatelets or anticoagulants should be made jointly with expert physicians and the patient. Registration: PROSPERO ID CRD42018087755.

Platelet count: A predictor of sepsis and mortality in severe burns.

BACKGROUND: Platelet cells, or thrombocytes, have additional roles to haemostasis. After burn injury, platelet counts drop to a nadir at days 2-5 then rise to a peak between days 10-18. The nadir has previously been associated with mortality but there is currently no thorough investigation of its potential to predict sepsis in adults. The primary objective of this study is to assess whether platelet count can predict survival and sepsis in adults with severe burn injuries. METHODS AND FINDINGS: A retrospective cohort analysis of platelet count and other blood parameters in 145 burn patients with a TBSA greater than 20%. AUROC analysis revealed that the platelet count and rBaux score together produce moderate discrimination for survival at less than 24h after injury (AUROC=0.848, 95%CI 0.765-0.930). Platelet count at day 3 combined with TBSA has a modest association with sepsis (AUROC=0.779, 95%CI 0.697-0.862). Multivariable Cox regression analysis revealed platelet peak was the strongest predictor of mortality. CONCLUSIONS: A reduced peak platelet count is a strong predictor of 50-day mortality. Platelet count nadir may have some association with sepsis.