Patients over 75 years admitted to the National Burn Centre, Haukeland University Hospital, 2000-19. / Pasienter over 75 år innlagt ved Brannskadeavdelinga, Haukeland universitetssjukehus 2000­19.

BACKGROUND: The number of burn patients over the age of 75 receiving advanced treatment, including extensive surgery and intensive care, is increasing. We aimed to describe the treatment and outcomes for burn patients over the age of 75 admitted to the National Burn Centre at Haukeland University Hospital. We also wanted to investigate whether frailty scores can be a predictor of the treatment outcome. MATERIAL AND METHOD: All patients ≥ 75 years admitted to the National Burn Centre at Haukeland University Hospital in the period 2000-19 were included in the study. Frailty scores were calculated retrospectively based on patients' medical records. RESULTS: Our study included 101 patients (50 women and 51 men). The number of admissions of older burn patients increased from an average of 3.3 per year in 2000-14 to 10.2 in the period 2015-19. The median total body surface area with burns was 11 % (range 0.9-80 %). Seventeen patients received palliative care, and 12 patients receiving active treatment died in hospital. In 68 of 84 (81 %) actively treated patients, tangential excision and split-thickness skin grafting were performed. The remainder received conservative treatment (non-surgical) with wound care and application of a silver dressing. Patients who died in hospital had a significantly higher total body surface area with burns (p < 0.0001) and higher frailty scores (p = 0.003) than patients who survived. INTERPRETATION: The yearly number of patients over the age of 75 treated at the National Burn Centre tripled during the period. More than two-thirds of the patients were discharged alive. Extent of burn injury and frailty score are associated with mortality and may be useful for adjusting therapy.

Vasoactive and/or inotropic drugs in initial resuscitation of burn injuries: A systematic review.

BACKGROUND: According to current guidelines, initial burn resuscitation should be performed with fluids alone. The aims of the study were to review the frequency of use of vasoactive and/or inotropic drugs in initial burn resuscitation, and assess the benefits and harms of adding such drugs to fluids. METHODS: A systematic literature search was conducted in PubMed, Embase, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, UpToDate, and SveMed+ through 3 December 2021. The search included studies on critically ill burn patients receiving vasoactive and/or inotropic drugs in addition to fluids within 48 h after burn injury. RESULTS: The literature search identified 1058 unique publications that were screened for inclusion. After assessing 115 publications in full text, only two retrospective cohort studies were included. One study found that 16 out of 52 (31%) patients received vasopressor(s). Factors associated with vasopressor use were increasing age, burn depth, and % total body surface area (TBSA) burnt. Another study observed that 20 out of 111 (18%) patients received vasopressor(s). Vasopressor use was associated with increasing age, Baux score, and %TBSA burnt in addition to more frequent dialysis treatment and increased mortality. Study quality assessed by the Newcastle-Ottawa quality assessment scale was considered good in one study, but uncertain due to limited description of methods in the other. CONCLUSION: This systematic review revealed that there is a lack of evidence regarding the benefits and harms of using vasoactive and/or inotropic drugs in addition to fluids during early resuscitation of patients with major burns.

Patients with burn injuries admitted to Norwegian hospitals - a population-based study. / Brannskadede innlagt i norske sykehus ­ en populasjonsbasert studie.

BACKGROUND: The objective of this article is to elucidate the scope of burn injuries in Norway, on the basis of those patients who had sustained a burn injury that caused hospitalisation through a calendar year. MATERIAL AND METHOD: The article is based on data retrieved from the Norwegian Patient Registry on patients discharged from Norwegian hospitals in 2012 with a burn injury as their main diagnosis, supplemented with activity data for children admitted to the Burn Unit, Haukeland University Hospital, Bergen, during the period 2013 ­ 15. RESULTS: In 2012, altogether 620 people (12.4/100 000 inhabitants) were hospitalised with burn injuries. Of these patients, 393 (63.4 %) were men. A total of 375 patients (60 %) were hospitalised more than once, and 124 (20 %) were admitted to more than one hospital. Altogether 367 patients (59 %) were hospitalised for less than eight days. Average hospitalisation time for the group as a whole was 11.3 days (SD 18.8 days). Many of the burn-injured patients were young: the average age was 27.4 years (SD 26.0 years). As many as 183 patients (30 %) were less than three years old. Children in this age group were admitted for burn injuries 12 times more frequently than children ≥ 5 years and adults. INTERPRETATION: We found no definite reduction in burn injuries as a cause for admission to Norwegian hospitals in 2012 when compared to results from previous studies for the period 1992 ­ 2007. There ought to be a major potential for more effective prevention of burn injuries in the age group < 3 years, in which scalding (78 %) and contact with hot surfaces (most often stoves) (17 %) are the main mechanisms of injury.

[Treatment of serious burns]. / Behandling av alvorlige brannskader.

BACKGROUND: Treatment of patients with large burns is challenging. MATERIAL AND METHOD: The article is based on clinical experience, and a non-systematic review in PubMed. RESULTS: In patients with burns covering more than 10 - 15 % of the total body surface area, fluid resuscitation should be initiated early. Fluid induces edema, and facial burns may necessitate early orotracheal intubation to secure the airways. Reduced ventilation and-/or peripheral circulation due to deep burns should be managed by early escharotomy (and, more seldom, fasciotomy) at the primary hospital. Respiratory distress is most often due to vigorous fluid resuscitation, secretions, pneumonia and-/or sepsis. Fiber bronchoscopy may reveal inhalation injury and enables removal of secreted material from the airways. In the acute initial phase, hypotension is usually caused by hypovolemia. Subsequently a massive inflammatory response (SIRS) causes vasodilatation, hypotension and increased cardiac output. Wound and airway infections are common. SIRS may cause CRP levels above 100 and a body temperature of 38 - 39 degrees C, which makes it difficult to find the right time to start antibiotic treatment. Nevertheless, prophylactic use of antibiotics is not encouraged. Definitive surgery, excision and transplantation, should be performed early, preferably within the first week. INTERPRETATION: Patients with large burns should be treated according to general principles for intensive medical care, preferably in units with special experience in treatment of burns.

The epidemiology of patients with burn injuries admitted to Norwegian hospitals in 2007.

OBJECTIVES: To study the incidence and outcome of burns in Norway in 2007, and to establish estimates for effective length of stay, mortality and economical costs. METHODS: Data from the Norwegian Patient Registry on all patients discharged from all somatic hospitals in Norway in 2007 with main or subsidiary diagnosis of burn injury (ICD-10: T20-31) were collected. RESULTS: Seven hundred and twenty-six patients (65.0% male) with acute burns were admitted to Norwegian hospitals in 2007, requiring 8157 in-hospital days and resulting in a mean length of hospitalization per burn case of 11.3 days (S.D. 15.2). The mean age of the patients was 26.9 years (S.D. 25.5), and the mortality was 2.1%. For children below 5 years of age the incidence of burns admitted to hospital was 82.5/100,000/year. The annual total cost for in-hospital burn care exceeded 10.5 million euros (2,200,000 euros/million inhabitants) CONCLUSION: Compared to similar data from Norway (1992) the rate of admission for burns in 2007 (15.5/100,000/year) appeared as high as in 1992, whereas the mean length of stay was reduced by 26%. Children under the age of 5 had a seven times higher incidence compared the rest of the population.

[Burn treated at the Haukeland University Hospital Burn Centre--20 years of experience]. / Brannskadebehandling gjennom 20 år ved Haukeland Universitetssykehus.

BACKGROUND: The Burn Centre at Haukeland University Hospital has had a national burn function since 1984. PATIENTS AND METHODS: The following data were reviewed: area injured, age, sex, length of stay, mortality and county of residence for all admissions in the period 1984-2004. RESULTS: 1294 acute admissions for burns, chemical injuries or high-voltage injuries were identified. 71% of the patients were male. The mean age was 29.6 years; 24% were below 3 years of age. The mean (SD) area of injury was 19.5 +/- 18.3 % of the body surface area. 458 patients (35%) had burns involving less than 10% of the body surface area. The mean length of hospitalisation was 19.5 +/- 19.8 days. 140 patients (10.8%) died before discharge; these had a significantly higher age and injured area than the 1154 survivors. Every year there were 2-3 patients who had such extensive burns or substantial comorbidity that they only received palliative treatment. The probability of survival after a burn affecting 60% of the body surface, was around 50 % for all ages combined. On average 1.17 patients per 100.000 inhabitants were transferred annually from other parts of Norway for specialized treatment at this burn centre. INTERPRETATION: Despite societal focus on burn prevention measures there has been no reduction in the number of patients transferred to the burn centre during the 20-year period.

Time course variations of haemodynamics, plasma volume and microvascular fluid exchange following surface cooling: an experimental approach to accidental hypothermia.

OBJECTIVE: To describe how surface cooling influences fluid distribution, vascular capacity and haemodynamic variables. METHODS: Seven anaesthetised pigs, following normothermic stabilization for 60 min, were cooled to 27.8+/-1.6 degrees C. Fluid balance, haemodynamics, colloid osmotic pressures (plasma/interstitial fluid), haematocrit [s-albumin/protein] were recorded and plasma volume measured together with tissue perfusion during normothermia, cooling and stable hypothermia (coloured microspheres). Fluid shifts and changes in albumin and protein masses were calculated. At the end tissue water content was assessed. RESULTS: Haemodynamic variables changed with the start of cooling in parallel with a decreasing cardiac output. During hypothermia the haematocrit increased from 0.31+/-0.01 to 0.35+/-0.01 (P < 0.01). Plasma volume decreased from 1139.0+/-65.4 ml at start of cooling to 882.0+/-67.5 ml 3 h later (P < 0.05). In parallel the plasma albumin and protein masses decreased from 37.8+/-2.5 g and 54.6+/-4.0 g to 28.0+/-2.7 g (P < 0.05) and 41.2+/-4.1 g (P > 0.05), respectively. The main changes occurred 120-180 min after start of each experiment. In this period the fluid extravasation rate was elevated (P < 0.05) without influencing the colloid osmotic pressure of plasma/interstitial fluid. The increased fluid filtration was reflected by an increase in tissue water content. CONCLUSION: Our results are in favour of a shift of plasma from circulation to the interstitial space during surface cooling. This conclusion is based on the parallel losses of fluid and proteins from circulation with unchanged colloid osmotic pressures (plasma/interstitial fluid). Inflammation may be involved.

High risk for accidental death in previously burn-injured adults.

This study investigated the long-term mortality in 1182 burn patients admitted at a single burn centre in 1984-2003. One thousand and forty-nine patients were discharged alive, of which 999 (95.2% of all discharged) were available for follow-up (mean observation time: 9.6+/-5.5 (S.D.) years). One hundred and twenty-two patients had died after discharge but before follow-up. For 111 patients, the official information recorded from their death certificates revealed that 83 patients (mainly in the higher age groups) had died due to a variety of natural causes. Twenty-three patients (M:F=18:5) (age: 37.7+/-11.3 years), previously hospitalised for burns, had later suffered accidental or violent deaths, including suicide (5), assault (2), and deaths related to substance and/or alcohol abuse (12). Additionally, five other deaths were recorded as sudden death, with no additional specific information as to the cause of death. This study shows that the rates of accidental or violent death in previously burned adult patients (around 40 deaths per 1000 years at risk) may be an order of magnitude higher than that in the average Norwegian population.

[Hospital admissions for burns]. / Sykehusopphold for brannskade.

BACKGROUND: We wanted to investigate the incidence of burns and the volume of in-hospital burn treatment in Norway. MATERIAL AND METHODS: Data for 1999 were compiled from hospital admissions as reported to the Norwegian Patient Register. Selection was based on ICD-10 codes for burns, though caustic injuries, reconstructive procedures, and patients discharged alive with length-of-stay less than 1 day were not included. RESULTS: 707 admissions requiring 9444 days in hospital were identified. The incidence of burns admitted to hospital was 13.5/100,000 inhabitants/year. Additionally, 102 admissions were coded as post-burn reconstructive cases. 50% all admissions and 40 % of all days in hospital for burns were in hospitals without a department of plastic surgery. 24 burn patients died before discharge; 50% of those who died were above 80 years of age. 29% of all stays included a code representing surgical procedures involving skin excision and grafting. INTERPRETATION: The incidence of burns admitted to hospitals in 1999 was reduced by 20% compared to a 1977 survey. The number of reconstructive procedures was low; these options should probably be offered to more patients. We suggest that early transfer to a specialised burn centre should be considered for a somewhat larger proportion of patients.

Outcome after acute respiratory failure is more dependent on dysfunction in other vital organs than on the severity of the respiratory failure.

INTRODUCTION: The incidence and outcome of acute respiratory failure (ARF) depend on dysfunction in other organs. As a result, reported mortality in patients with ARF is derived from a mixed group of patients with different degrees of multiorgan failure. The main goal of the present study was to investigate patient outcome in single organ ARF. PATIENTS AND METHOD: From 1 January 2000 to 1 July 2002, all adult patients (>16 years) in the intensive care unit (ICU) at Haukeland University Hospital were scored daily using the Sequential Organ Failure Assessment (SOFA) score for organ failure. ARF was defined by the SOFA criteria: ratio of arterial oxygen tension to fractional inspired oxygen, with a value < 26.6 kPa (200 mmHg) in more than one recording during the ICU stay (SOFA score 3 or 4). Patients with ARF alone and in combination with other severe organ failure (SOFA score 3 or 4) were included. Survival was recorded on discharge from the ICU, at hospital discharge and at 90 days after ICU discharge. RESULTS: During the period of study, 832 adult patients were treated and 529 (63.0%) had ARF. The ICU, hospital and 3-month mortality rates were lowest in single organ ARF (3.2, 14.7 and 21.8%, respectively), with increasing mortality with each additional organ failure. When ARF occurred with four or five additional organ failures, the 3-month mortality rate was 75%. No significant differences in mortality were found between early and late ARF. CONCLUSION: The prognosis for ICU patients with single organ ARF is good, both in the short and long terms. The high overall mortality rate observed is caused by dysfunction in other organs.