Prevalence of intra-abdominal hypertension and markers for associated complications among severe burn patients: a multicenter prospective cohort study (BURNIAH study).

PURPOSE: Severely burned patients are at risk for intra-abdominal hypertension (IAH) and associated complications such as organ failure, abdominal compartment syndrome (ACS), and death. The aim of this study was to determine the prevalence of IAH among severely burned patients. The secondary aim was to determine the value of urinary intestinal fatty acid binding protein (I-FABP) as early marker for IAH-associated complications. METHODS: A prospective observational study was performed in two burn centers in the Netherlands. Fifty-eight patients with burn injuries ≥ 15% of total body surface area (TBSA) were included. Intra-abdominal pressure (IAP) and urinary I-FABP, measured every 6 h during 72 h. Prevalence of IAH, new organ failure and ACS, and the value of urinary intestinal fatty acid binding protein (I-FABP) as early marker for IAH-associated complications were determined. RESULTS: Thirty-one (53%) patients developed IAH, 17 (29%) patients developed new organ failure, but no patients developed ACS. Patients had burns of 29% (P25-P75 19-42%) TBSA. Ln-transformed levels of urinary I-FABP and IAP were inversely correlated with an estimate of - 0.06 (95% CI - 0.10 to - 0.02; p = 0.002). Maximal urinary I-FABP levels had a fair discriminatory ability for patients with IAH with an area under the ROC curve of 74% (p = 0.001). Urinary I-FABP levels had no predictive value for IAH or new organ failure in severe burn patients. CONCLUSIONS: The prevalence of IAH among patients with ≥ 15% TBSA burned was 53%. None of the patients developed ACS. A relevant diagnostic or predictive value of I-FABP levels in identifying patients at risk for IAH-related complications, could not be demonstrated. LEVEL OF EVIDENCE: Level III, epidemiologic and diagnostic prospective observational study.

Using fibrin sealant for skin graft fixation to avoid sedation in children with burns: a prospective study.

OBJECTIVE: To investigate whether a fibrin sealant, Fitrix (Sanquin Blood Supply Foundation, The Netherlands), for fixation of skin grafts in children with burn wounds is less invasive and equally effective in comparison with skin staples. METHOD: A single-centre prospective observational cohort study was conducted. Children requiring skin grafting after burns were included and received the fibrin sealant. This group was compared with a retrospective control group of children whose skin grafts were fixed with skin staples. Study outcomes were graft take, graft dislocation, other wound complications, healing and need for sedation. RESULTS: In the fibrin sealant and the control groups, 17 and 27 patients were included, respectively. The percentage of total body surface area (%TBSA) grafted was smaller (p=0.028) in the fibrin sealant group (median 1.0, interquartile range (IQR) 1.5 versus 2.0, IQR 2.5). There was no significant difference in graft take or wound healing. There were two graft dislocations in the fibrin sealant group and none in the control group. Other complications included a patient with graft failure in the fibrin sealant group, and another patient with a vanishing graft and wound infection in the control group. There were fewer sedations in the fibrin sealant group compared with the control group (one versus 20, p<0.0001). CONCLUSION: The fibrin sealant used in this study was non-inferior for the fixation of skin grafts in comparison with skin staples, and avoided sedation procedures.

Effective enzymatic debridement of burn wounds depends on the denaturation status of collagen.

The treatment of burn wounds by enzymatic debridement using bromelain has shown promising results in our burn center. However, inadequate debridement occurred in a few cases in which the etiology of the burn was attributed to relatively low temperature burns. We hypothesized that bromelain is ineffective in burns in which collagen denaturation, which occurs approximately at 65°C, has not taken place. Our objective was to assess whether there is a relationship between the denaturation of collagen and the ability of bromelain to debride acute scald burn wounds of different temperatures. Ex vivo human skin from four different donors was cut into 1x1 cm samples, and scald burns were produced by immersion in water at temperatures of 40°C, 50°C, 60°C, 70°C, and 100°C for 20 minutes. Denaturation of collagen was assessed with histology, using hematoxylin and eosin (H&E) staining and a fluorescently labeled collagen hybridizing peptide (CHP), and with second harmonic generation (SHG) microscopy. Burned samples and one control sample (room temperature) were weighed before and after application of enzymatic debridement to assess the efficacy of enzymatic debridement. After enzymatic debridement, a weight reduction of 80% was seen in the samples heated to 70°C and 100°C, whereas the other samples showed a reduction of 20%. Unfolding of collagen, loss of basket-weave arrangement, and necrosis was seen in samples heated to 60°C or higher. Evident CHP fluorescence, indicative of collagen denaturation, was seen in samples of 60°C, 70°C and 100°C. SHG intensity, signifying intact collagen, was significantly lower in the 70°C and 100°C group (P <.05) compared to the lower temperatures. In conclusion, denaturation of collagen in skin samples occurred between 60°C and 70°C and strongly correlated with the efficacy of enzymatic debridement. Therefore, enzymatic debridement with the use of bromelain is ineffective in scald burns lower than 60°C.

Bacterial Species and Load Increase During Negative Pressure Wound Therapy: A Prospective Cohort Study.

INTRODUCTION: The course of both the bacterial species and load and the incidence of infection during negative pressure wound therapy (NPWT) are unclear, with published studies presenting contradicting results. OBJECTIVE: The aim of the study is to assess the changes in both bacterial species and load, as well as the incidence of infection, before and after NPWT in a patient population with a variety of wounds. METHODS: Surgical patients 18 years of age or older who needed NPWT were included in this multicenter, prospective cohort study. A wound swab culture was taken before NPWT and either immediately following NPWT or 6 weeks of follow-up. The change of bacterial species, bacterial load, and rate of infection were determined before and after the start of NPWT. RESULTS: In total, 104 patients were analyzed. The number of positive cultures increased from pre- to post-NPWT. The most cultured pathogenic bacterium was Staphylococcus aureus. The bacterial load was moderately higher at the end of NPWT than at the start (P ⟨ .0001). It was noted that 2 swabs contained multidrug-resistant bacteria, 1 pre-NPWT and 1 post-NPWT. Prior to NPWT, 26 patients had a wound infection, 5 of which had a persisting infection at the end of the study. Post-NPWT, 14 patients developed a wound infection. CONCLUSIONS: The number of S aureus strains and overall bacterial load increased during NPWT, and the incidence of infection remained the same. Further studies should be conducted to determine whether the increase in bacterial load influences other wound outcome parameters.

Long-term quality of life and cost-effectiveness of treatment of partial thickness burns: A randomized controlled trial comparing enzyme alginogel vs silver sulfadiazine (FLAM study).

The clinical effectiveness and scar quality of the randomized controlled trial comparing enzyme alginogel with silver sulfadiazine (SSD) for treatment of partial thickness burns were previously reported. Enzyme alginogel did not lead to faster wound healing (primary outcome) or less scar formation. In the current study, the health-related quality of life (HRQoL), costs, and cost-effectiveness of enzyme alginogel compared with SSD in the treatment of partial thickness burns were studied. HRQoL was evaluated using the Burn Specific Health Scale-Brief (BSHS-B) and the EQ-5D-5L questionnaire 1 week before discharge and at 3, 6, and 12 months postburn. Costs were studied from a societal perspective (health care and nonhealth-care costs) for a follow-up period of 1 year. A cost-effectiveness analysis was performed using cost-effectiveness acceptability curves and comparing differences in societal costs and Quality Adjusted Life Years (QALYs) at 1 year postburn. Forty-one patients were analyzed in the enzyme alginogel group and 48 patients in the SSD group. None of the domains of BSHS-B showed a statistically significant difference between the treatment groups. Also, no statistically significant difference in QALYs was found between enzyme alginogel and SSD (difference -0.03; 95% confidence interval [CI], -0.09 to 0.03; P = .30). From both the health care and the societal perspective, the difference in costs between enzyme alginogel and SSD was not statistically significant: the difference in health-care costs was €3210 (95% CI, €-1247 to €7667; P = .47) and in societal costs was €3377 (95% CI €-6229 to €12 982; P = .49). The nonsignificant differences in costs and quality-adjusted life-years in favor of SSD resulted in a low probability (<25%) that enzyme alginogel is cost-effective compared to SSD. In conclusion, there were no significant differences in quality of life between both treatment groups. Enzyme alginogel is unlikely to be cost-effective compared with SSD in the treatment of partial thickness burns.

Growth Factor Quantification of Platelet-Rich Plasma in Burn Patients Compared to Matched Healthy Volunteers.

Platelet rich plasma (PRP) is blood plasma with a platelet concentration above baseline. When activated, PRP releases growth factors involved in all stages of wound healing, potentially boosting the healing process. To expand our knowledge of the effectiveness of PRP, it is crucial to know the content and composition of PRP products. In this study, growth factor quantification measurements of PRP from burn patients and gender- and age-matched controls were performed. The PRP of burn patients showed levels of growth factors comparable to those of the PRP of healthy volunteers. Considerable intra-individual variation in growth factor content was found. However, a correlation was found between the platelet count of the PRP and most of the growth factors measured.

Flaminal® versus Flamazine® in the treatment of partial thickness burns: A randomized controlled trial on clinical effectiveness and scar quality (FLAM study).

Although partial thickness burns are the most frequently reported burn injuries, there is no consensus on the optimal treatment. The objective of this study was to compare the clinical effectiveness and scar quality of Flaminal® Forte to silver sulfadiazine (Flamazine®) in the treatment of partial thickness burns. In this two-arm open label multicenter randomized controlled trial, adult patients with acute partial thickness burns and an affected total body surface area of less than 30% were randomized between Flaminal® Forte and Flamazine® and followed for 12 months. Dressing changes in the Flamazine® group were performed daily, and in the Flaminal® group during the first 3 days post burn and thereafter every other day until complete wound healing or surgery. Forty-one patients were randomly allocated to Flaminal® Forte and 48 patients to Flamazine®. The primary outcome was time to wound healing, which did not differ between the groups: median 18 days with Flaminal® Forte (range 8-49 days) versus 16 days with Flamazine® (range 7-48 days; p = 0.24). Regarding the secondary outcomes during hospital admission, there were no statistically significant differences between the groups concerning need for surgery, pain scores, pruritus, or pain-related and anticipatory anxiety. More patients in the Flaminal® group developed wound colonization (78% versus 32%, p < 0.001), but the treatment groups did not differ regarding the incidence of local infections and use of systemic antibiotics. In terms of scar quality, no statistically significant differences between both treatment groups were found regarding subjective scar assessment (Patient and Observer Scar Assessment Scale (POSAS)), scar melanin and pigmentation (DermaSpectrometer®), and scar elasticity and maximal extension (Cutometer®) during 12 month postburn. In conclusion, time to wound healing did not differ, but the use of Flaminal® Forte seemed favorable because less dressing changes are needed which lowers the burden of wound care.

Course and Predictors of Pruritus Following Burns: A Multilevel Analysis.

Itch is a common problem after burns. Although the topic receives increasing attention, the number of prospective studies is limited. The aim of this study was to assess the influence of acute traumatic stress symptoms, controlled for injury characteristics, age and sex, on itch over a period of 18 months using multilevel analysis. A total of 226 respondents provided itch scores. Participants completed the Burn Itch Questionnaire during admission (n = 208) and at 3 (n =179), 12 (n =143) and 18 (n =99) months post-burn. They completed the Impact of Event Scale to assess acute traumatic stress symptoms during admission. Skin graft requirement, a higher level of acute traumatic stress symptoms and younger age were statistically significant predictors of a higher itch score. Younger age was particularly associated with higher itch scores during admission, whereas the effect of skin grafting was particularly observed at 3 months post-burn. This study replicates the predictive role of traumatic stress symptoms, which warrants further research.

Nadroparin or fondaparinux versus no thromboprophylaxis in patients immobilised in a below-knee plaster cast (PROTECT): A randomised controlled trial.

BACKGROUND: The immobilisation of the lower leg is associated with deep vein thrombosis (DVT). However, thromboprophylaxis in patients with a below-knee plaster cast remains controversial. We examined the efficacy and safety of nadroparin and fondaparinux to ascertain the need for thromboprophylaxis in these patients. METHODS: PROTECT was a randomised, controlled, single-blind, multicentre study that enrolled adults with an ankle or foot fracture who required immobilisation for a minimum of four weeks. The patients were randomly assigned (1:1:1) to a control group (no thromboprophylaxis) or to one of the intervention groups: daily subcutaneous self-injection of either nadroparin (2850 IE anti-Xa=0.3ml) or fondaparinux (2.5mg=0.5ml). A venous duplex sonography was performed after the removal of the cast or earlier if thrombosis was suspected. The primary outcome was the relative risk of developing DVT in the control group compared with that in both intervention groups. This trial is registered at ClinicalTrials.gov, number NCT00881088. RESULTS: Between April 2009 and December 2015, 467 patients were enrolled and assigned to either the nadroparin group (n=154), the fondaparinux group (n=157), or the control group (n=156). A total of 273 patients (92, 92, and 94 patients, respectively) were analysed. The incidence of DVT in the nadroparin group was 2/92 (2.2%) compared with 11/94 (11.7%) in the control group, with a relative risk of 5.4 (95% CI 1.2-23.6; p=0.011). The incidence of DVT in the fondaparinux group was 1/92 (1.1%), yielding a relative risk of 10.8 (95% CI 1.4-80.7; p=0.003) compared with that in the control group. No major complications occurred in any group. CONCLUSION: Thromboprophylaxis with nadroparin or fondaparinux significantly reduces the risk of DVT in patients with an ankle or foot fracture who were treated in a below-knee cast without any major adverse events.

Windsurfing vs kitesurfing: Injuries at the North Sea over a 2-year period.

AIM: To analyze all windsurfing and kitesurfing (kiteboarding) injuries presented at our coastal hospital over a 2-year period. METHODS: Twenty-five windsurfers (21 male; aged 31 ± 8 years) and 32 kitesurfers (23 male; aged 29 ± 11 years) presented at our hospital during the 2-year study period. Various injury data were recorded, including transport to hospital and treatment. After a median follow-up of 16 mo (range, 7-33 mo), 18 windsurfers (72%) and 26 kitesurfers (81%) completed questionnaires on the trauma mechanisms, the use of protective gear, time spent on windsurfing or kitesurfing, time to return to sports, additional injuries, and chronic disability. RESULTS: Most patients sustained minor injuries but severe injuries also occurred, including vertebral and tibial plateau fractures. The lower extremities were affected the most, followed by the head and cervical spine, the upper extremities, and the trunk. The injury rates were 5.2 per 1000 h of windsurfing and 7.0 per 1000 h of kitesurfing (P = 0.005). The injury severity was the same between groups (P = 1.0). Less than 30% of the study population used protective gear. Kitesurfers had a higher number of injuries, and required transport by ambulance, inpatient hospital stay and operative treatment more often than windsurfers, but these differences were not statistically significant (P > 0.05). The median time to return to windsurfing and kitesurfing was 5 and 4 wk, respectively (P = 0.79). Approximately one-third of the patients in each group experienced chronic symptoms. CONCLUSION: Kitesurfing results in a significantly higher injury rate than windsurfing in the same environmental conditions but the severity of the injuries does not differ.

The scalp as a donor site for skin grafting in burns: retrospective study on complications.

BACKGROUND: Split skin grafting (SSG) is the cornerstone in the treatment of deep burns and large skin defects. Frequently used donor sites are the thigh, abdomen and buttocks. The scalp is less common while considered as a reliable donor site. Advantages are a large surface area, rapid wound healing, cosmetically favourable results and multiple harvests from the same donor site. Complications include scab formation, chronic folliculitis and alopecia but have been recorded sporadically in previous studies. This article evaluates the complication rate of the scalp donor site in the treatment of deep burns in the Beverwijk Burn Centre. METHODS: A retrospective study was performed of all patients who received a skin graft from the scalp at the Beverwijk Burn Centre between January 2004 and December 2012. Data were collected from medical files of included patients, including gender, age, type of burn (scald, flame, other) and total body surface area (TBSA) burned at the time of first surgery. Postoperative variables were healing time of the donor site and incidence of complications. During follow-up, the incidence of late complications was reviewed. RESULTS: A total number of 105 grafts were analysed in 93 patients: 58 males (62 %) and 35 females (38 %), with a median age of 2 years and 3 months old. Of the patients, 30 (32 %) had flame burns and 57 (61 %) had scald burns. Eighty-seven percent of patients had a TBSA burned of 5 % or less. All donor sites healed within 14 days. No alopecia or scar hypertrophy developed at the donor sites. Two patients (2.2 %) developed folliculitis; one patient (1.1 %) showed scab formation. CONCLUSIONS: The scalp as a donor site in our Burn Centre shows a comparable short-term complication rate to the previous literature, with quick healing and no long-term complications. Therefore, we propose the consideration of the scalp as a primary donor site, especially in young children, where the scalp offers a larger donor site area than the buttocks or thighs.

The application of platelet-rich plasma in the treatment of deep dermal burns: A randomized, double-blind, intra-patient controlled study.

Platelet-rich plasma (PRP) is a fraction of blood with a platelet concentration above baseline. When platelets get activated, growth factors involved in wound healing are released. The application of PRP has shown good results in wound care, however, up to date no substantial research has been performed on the effect of PRP in burn treatment. This randomized double blind intra-patient controlled study investigates the effect of autologous PRP on wound healing in burns that require surgery with a meshed split skin graft (SSG). Fifty-two patients with various areas of deep dermal to full thickness burns, receiving surgery with a SSG were included after informed consent. Comparable study areas A and B (intra-patient) were appointed, randomized and either treated with a SSG and PRP or with a SSG alone. At day 5 to 7 postoperative, the epithelialization and graft take rate were assessed. Three, six, and twelve months postoperative, follow-up measurements were performed in the form of POSAS-questionnaires, DermoSpectroMeter, and Cutometer measurements. There was no statistically significant difference between the mean take rate nor the mean epithelialization rate at day 5-7 between the PRP-treated and control areas. However, PRP-treated wound areas showed more often better or equal epithelialization and take rates at day 5-7 than the standard treated areas. Minor effects were also seen in the reoperated and early operated subgroups. At 3, 6, and 12 months postoperative, POSAS scores from the patients and the observers, Dermaspectro-, and Cutometer measurements did not depict a significant difference between the PRP and standard treated areas. Concluding, the addition of PRP in the treatment of burn wounds did not result in improved graft take and epithelialization, nor could we demonstrate better scar quality. There was, however, a considerable variation in our clinical population.

[Hydrofluoric acid burns]. / Verbranding door waterstoffluoride: Een chemische verbranding met potentieel systemische effecten.

Hydrofluoric acid is increasingly used as a rust remover and detergent. Dermal contact with hydrofluoric acid results in a chemical burn characterized by severe pain and deep tissue necrosis. It may cause electrolyte imbalances with lethal consequences. It is important to identify high-risk patients. 'High risk' is defined as a total affected body area > 3% or exposure to hydrofluoric acid in a concentration > 50%. We present the cases of three male patients (26, 31, and 39 years old) with hydrofluoric acid burns of varying severity and describe the subsequent treatments. The application of calcium gluconate 2.5% gel to the skin is the cornerstone of the treatment, reducing pain as well as improving wound healing. Nails should be thoroughly inspected and possibly removed if the nail is involved, to ensure proper healing. In high-risk patients, plasma calcium levels should be evaluated and cardiac monitoring is indicated.

Clinical effectiveness, quality of life and cost-effectiveness of Flaminal® versus Flamazine® in the treatment of partial thickness burns: study protocol for a randomized controlled trial.

BACKGROUND: Partial thickness burns are painful, difficult to manage and can have a negative effect on quality of life through scarring, permanent disfigurement and loss of function. The aim of burn treatment in partial thickness burns is to save lives, stimulate wound healing by creating an optimumly moist wound environment, to have debriding and analgesic effects, protect the wound from infection and be convenient for the patient and caregivers. However, there is no consensus on the optimal treatment of partial thickness wounds. Flaminal® and Flamazine® are two standard treatment options that provide the above mentioned properties in burn treatment. Nevertheless, no randomized controlled study has yet compared these two common treatment modalities in partial thickness burns. Thus, the aim of this study is to evaluate the clinical effectiveness, quality of life and cost-effectiveness of Flaminal® versus Flamazine® in the treatment of partial thickness burns. METHODS/DESIGN: In this two-arm open multi-center randomized controlled trial, 90 patients will be randomized between Flaminal® and Flamazine® and followed for 12 months. The study population will consist of competent or temporarily non-competent (because of sedation and/or intubation) patients, 18 years of age or older, with acute partial thickness burns and a total body surface area (TBSA) of less than 30 %. The main study outcome is time to complete re-epithelialization (greater than 95 %). Secondary outcome measures include need for grafting, wound colonization/infection, number of dressing changes, pain and anxiety, scar formation, health-related quality of life (HRQoL), and costs. DISCUSSION: This study will contribute to the optimal treatment of patients with partial thickness burn wounds and will provide evidence on the (cost-)effectiveness and quality of life of Flaminal® versus Flamazine® in the treatment of partial thickness burns. TRIAL REGISTRATION: Netherlands Trial Register NTR4486 , registered on 2 April 2014.

Diagnostic performance of the Bernese versus Ottawa ankle rules: Results of a randomised controlled trial.

PURPOSE: The Ottawa ankle rules (OAR) brought about a reduction of radiographs on the Emergency Department (ED). However, still 50% of patients with ankle injuries undergo unnecessary radiography. Compared to the OAR, the Bernese ankle rule (BAR) has an acclaimed 84% reduction in radiography without loss of sensitivity. The primary aim of this study was to compare the diagnostic accuracy and reproducibility of both rules. Furthermore, the ability of triage nurses to accurately interpret the BAR was assessed. METHODS: Participants were assessed by both the ED resident and the triage nurse, applying the OAR and the BAR. After standardised data collection, ankle and foot radiographs were performed in all patients. Sensitivity and specificity of both tests applied by both observers were obtained and compared by McNemar's test. Reproducibility was calculated with Cohen's kappa. RESULTS: A total of 203 patients with ankle trauma were included. For the OAR obtained by the ED residents, the sensitivity and specificity were 0.97 and 0.29, respectively. For the BAR, the sensitivity and specificity of the ED residents were 0.69 and 0.45, respectively. For the triage nurses, the OAR sensitivity and specificity were 0.86 and 0.25, respectively. The BAR sensitivity and specificity for the nurses were 0.86 and 0.40, respectively. The reproducibility of the OAR was 0.45, and for the BAR, it was 0.48. CONCLUSION: Both rules showed comparable reproducibility. Although the BAR showed a superior specificity compared to the OAR, its sensitivity was too low to promote clinical use. The triage nurses demonstrated too low sensitivity on both rules to allow safe application. Therefore, the OAR remain the decision rules of choice for ankle injuries despite its modest 'ruling out' capacity.

WARRIOR-trial - is routine radiography following the 2-week initial follow-up in trauma patients with wrist and ankle fractures necessary: study protocol for a randomized controlled trial.

BACKGROUND: Extremity fractures such as wrist and ankle fractures are a common and costly healthcare problem. The management of these fractures depends on fracture type and loss of congruity of the joint, resulting in cast immobilization or operative treatment. Loss of congruity or displacement leading to uneven joint loading, osteoarthritis and an increased probability of a poor functional outcome should be identified within the first 2 weeks post-trauma, based upon radiographs to determine optimal treatment. After this period, routine radiographs are scheduled for monitoring the bone-healing process. Current protocols describe imaging at 1, 2, 6 and 12 weeks post-trauma. However, it is questionable whether routine radiography following the initial follow-up ( 2-weeks post-trauma) is cost effective. The aim of this study is to determine whether a modification of the radiographic follow-up protocol can be conducted with no worse outcome and less cost than the current standard of care for patients with a wrist or ankle fracture. METHODS/DESIGN: In a multicenter randomized controlled trial, 697 patients aged 18 years or older will be included: 385 wrist fracture- and 312 ankle fracture patients. Patients will be randomized into two groups: Group 1 receives usual care, consisting of radiographs 1, 2, 6 and 12 weeks post-trauma; Group 2 receives radiographs beyond the initial follow-up only when clinically indicated. The primary outcome is the overall extremity-specific function. For wrist fractures, this includes the Disabilities of the Arm, Shoulder and Hand Score; for the ankle fractures, this includes the Olerud and Molander ankle score. Secondary outcomes include: healthcare cost, the specific function measured with the Patient Rated Wrist and Hand Evaluation for wrist fractures and American Academy of Orthopaedic Surgeons foot and ankle questionnaire for ankle fractures, pain-intensity, health-related quality of life, self-perceived recovery, and complications. Both groups will be monitored at 1, 2, and 6 weeks and 3, 6, and 12 months. DISCUSSION: This study will provide data on (cost) effectiveness of routine radiography in the follow-up of wrist and ankle fractures, and could pave the way for a change in (inter)national protocols. TRIAL REGISTRATION: Netherlands Trial Register NTR4610 , registration date 22 June 2014.

Epidemiology of clinically relevant bacterial pathogens in a burn center in the Netherlands between 2005 and 2011.

The aim of this study was to analyze the epidemiology in the bacteriological profile and susceptibility of clinically relevant bacterial pathogens in a burn center in the Netherlands over a 7-year period. The swab results of 693 patients of the period 2005 to 2008 and 539 patients of the period 2009 to 2011 were studied for change of microorganisms and antibiotic resistance. Definitions according to the Working Party on Infection Prevention were used as a tool for assessing the scale of the resistance problem at a local level. Between the studied periods only small changes were found in the bacteriological profile. Staphylococcus aureus showed a slight increase of prevalence in inventory swabs during the second period. In both inventory and wound swabs, S. aureus is the most frequently isolated clinically relevant bacterial pathogen. Resistance for ciprofloxacin in Escherichia coli increased from 3% in 2005 to 2008 to 7% in 2009 to 2011 (P = .028). Resistance for cefotaxim in E. coli increased from 4% in 2005 to 2008 to 14% in 2009 to 2011, although this decrease was not statistically significant (P = .24). The prevalence of highly resistant microorganisms (HRMOs) remained low in both time periods, 4.9% in 2005 to 2008 and 7.4% in 2009 to 2011 (P = .063). The Netherlands is considered a low-prevalence country for antimicrobial resistance, and the occurrence of HRMOs in our center is relatively rare. A large percentage of HRMO isolates were extended spectrum ß-lactamase producers, indicating the rapid increase in the production of this resistance mechanism in recent years. The transmission of HRMOs in our center is controlled effectively, using well-established transmission-based precautions.

Mortality and causes of death of Dutch burn patients during the period 2006-2011.

INTRODUCTION: Mortality of burn patients has decreased in the last decades. Literature indicates that the leading cause of death in late mortality is multiple organ failure (MOF), but literature is not clear about the cause of early mortality. The aim of this study was to determine the mortality and causes of death of burn patients in Dutch burn centers between January 2006 and December 2011. METHODS: A retrospective study was performed in patients who died between January 2006 and December 2011 in the burn centers of Rotterdam and Beverwijk, the Netherlands. In this period 2730 patients were admitted. RESULTS: Of these 2730 patients, 88 patients died as a result of their burn injury. The overall mortality rate was 3.2%. The palliative care group, defined as patients receiving no curative ('active') care and leading to early death (<48h), consisted of 28 patients (31.8%, 28 out of 88 patients). The most common cause of late mortality (>48h, in 60 out of 88 patients, 68.2%) was MOF (38.3%, 23 out of 60 patients). One important significant difference between the early and late mortality groups was a higher Baux score in the palliative care group compared to the withdrawal of and active treatment groups. There were no significant differences when the groups were compared regarding the presence of inhalation trauma. CONCLUSIONS: Mortality in burn patients has decreased. Most deaths occur early, in patients who receive only palliative care. In late mortality, MOF is the most common cause of death.

Epidemiology of foot burns in a Dutch burn centre.

BACKGROUND: Although the feet involve a small percentage of the total body surface area, they can have major effects in daily life, caused by prolonged bed rest, hospitalization and high risk of both early and late complications. The aim of this study was to define the aetiology, treatment and outcomes of foot burns, with special interest in paediatric patients, patients with diabetic disease and burns acquired at the workplace. METHODS: This is a retrospective cohort study of 82 patients who were admitted to one of the three burn centres in the Netherlands during the period 2004 to 2013. The patients had a median age of 43.5 years (range 0.01-85.9), and included 14 children and 8 diabetics. Data were collected from the hospital records. RESULTS: Scalding was the most common cause of the injury. Almost all patients required surgical management. It is notable that most of hospitalized patients (82 %) were not admitted on the day of injury. Children had a significantly shorter length of stay compared to adults (p = 0.01). The eight patients with diabetes had a significantly longer length of hospital stay, more complications and more often residual defects compared to the non-diabetic patients. In 13 patients, the injury took place at work. Half of these burns were caused by scalding, and foot burns caused by chemicals at work were rare (two patients). CONCLUSIONS: Although the incidence of foot burns is low, there is a significant morbidity due to complications and long hospital stay. The following three points are suggested. Immediate referral to a burn centre is essential. It is important to educate diabetic patients on the risk of complications and adverse outcomes after burn injury. Preventative measures at the workplace are worth considering.