Queimaduras e COVID-19, qual o impacto da pandemia? Perfil epidemiológico de um centro de queimados entre 2018-2022 / Burns and COVID-19, what is the impact of the pandemic? Epidemiological profile of a burn center between 2018-2022

Introdução: Embora prevalente, a epidemiologia das queimaduras possui lacunas. Simultaneamente, a COVID-19 estabeleceu um cenário desafiador e com novos comportamentos humanos, que poderiam impactar nas características e na incidência de queimaduras. O objetivo geral do projeto foi descrever o perfil epidemiológico dos pacientes de uma Unidade de Tratamento de Queimados. Método: O estudo foi uma revisão prontuários de janeiro de 2018 até maio de 2022, incluindo uma amostra de 1164 admissões do Hospital Padre Albino (Catanduva-SP). A análise estatística foi realizada através do Google Sheets e JAMOVI, sendo aplicado o Teste U de Mann-Whitney para comparação de períodos de tempo antes e durante a pandemia. Antes da coleta de dados, o mesmo foi submetido e aprovado pelo Conselho de Ética em Pesquisa da instituição (parecer número 5.616.556, CAAE: 62621822.50000.5430). Resultados: As admissões apresentaram idade média de 31,38 anos e 17,88% de Superfície Corporal Queimada (SCQ), sendo 452 mulheres e 712 homens; a média de SCQ foi de 17 para mulheres e 18,6 para homens. O principal agente causador foi a escaldadura. No que tange à comparação por períodos, durante a pandemia a chama direta teve um aumento de 8% em relação ao período anterior (35%). A escaldadura ainda permaneceu com prevalência elevada, no entanto, apresentou queda de 2%, assim como as queimaduras por dermoabrasão, com queda de 10%. Conclusão: Os achados dos estudos possuem limites em termos de generalização e novos estudos precisam ser desenvolvidos. As mudanças observadas no período não foram significativas e sem relevância clínica.

Introduction: Although prevalent, the epidemiology of burns has gaps. At the same time, Covid-19 established a new scenario with new human behaviors, which could equally impact the characteristics and incidence of burns. The overall objective of the project was to describe the epidemiological profile of patients in a Burn Treatment Unit. Methods: The study was a chart review from January 2018 to May 2022, including a sample of 1164 admissions from Hospital Padre Albino (Catanduva, São Paulo, Brazil). Statistical analysis was performed using Google Sheets and JAMOVI, and Mann-Whitney U-test was applied for comparison of time periods before and during the pandemic. Before data collection, the study was submitted and approved by the Research Ethics Committee of the institution (document number 5.616.556, CAAE: 62621822.50000.5430). Results: The admissions presented a mean age of 31.38 years and 17.88% of body surface area burned, 452 women and 712 men, the mean age was 17 for women and 18.6 for men. The main agent was scalding. When it comes to period comparison, during the pandemic direct flaming had an 8% increase over the previous period (35%). The scalds still remained with high prevalence, however it presented a decrease of 2%, as well as the burns by dermabrasion, which had a decrease of 10%. Conclusion: The findings of the studies have limits in terms of generalization, and new studies need to be developed. The changes observed in the period were not significant and without clinical relevance.

Queimadura elétrica: Análise epidemiológica dos pacientes da Unidade de Queimados do Hospital de Clínicas da Universidade Federal de Uberlândia / Electrical burns: Epidemiological analysis of patients at the Burns Unit of the Hospital de Clínicas of the Federal University of Uberlândia

Introdução: O uso da corrente elétrica é imprescindível nas nossas atividades do cotidiano, porém, seu contato com tecidos vivos pode provocar queimaduras desde leves até graves ou fatais. Por se tratar de um problema de saúde pública, o conhecimento de sua epidemiologia é essencial para o desenvolvimento de programas em saúde. Método: Estudo transversal de dados registrados nos prontuários dos pacientes atendidos por queimadura elétrica na Unidade de Queimados do Hospital de Clínicas da Universidade Federal de Uberlândia entre os anos de 2013 e 2019. Resultados: Foram admitidos 26 pacientes, a maioria de sexo masculino (76,9%) e adultos (30,7%), vítimas de corrente de alta voltagem (65,4%) no trabalho (57,7%), que mais afetou as extremidades superiores (80,7%), sendo as crianças todas do sexo feminino (15,3%). O percentual médio de área queimada foi de 14,5% e o percentual de tratados com autoenxerto de pele foi de 53,8%. A média de permanência hospitalar foi de 40 dias e 3,8% deles foram para a Unidade de Terapia Intensiva. Não se registraram óbitos durante o período. Conclusão: A incidência de pacientes atendidos por queimadura elétrica é baixa, acometendo vítimas em todas as faixas etárias e com predomínio em indivíduos adultos do sexo masculino em seu local de trabalho. O tratamento cirúrgico mais realizado foi o autoenxerto de pele. As políticas de promoção, prevenção e proteção em saúde no que diz respeito aos perigos da corrente elétricas não estariam sendo praticadas e difundidas em nossa população doméstica, laboral ou empregadora, diferentemente como ocorre em grande parte dos países desenvolvidos.

Introduction: Using electric current is essential in our daily activities; however, its contact with living tissue can cause mild to severe or fatal burns. As it is a public health problem, knowledge of its epidemiology is essential for the development of health programs. Method: Cross-sectional study of data recorded in the medical records of patients treated for electrical burns at the Burns Unit of the Hospital de Clínicas of the Universidade Federal de Uberlândia between 2013 and 2019. Results: 26 patients were admitted, the majority of whom were male (76 .9%) and adults (30.7%), victims of high voltage current (65.4%) at work (57.7%), which most affected the upper extremities (80.7%), with children all female (15.3%). The average percentage of burned area was 14. 5% and the % of those treated with skin autograft was 53.8%. The average hospital stay was 40 days, and 3.8% went to the Intensive Care Unit. No deaths were recorded during the period. Conclusion: The incidence of patients treated for electrical burns is low, affecting victims in all age groups and with a predominance of adult males in their workplace. The most common surgical treatment was skin autograft. Health promotion, prevention, and protection policies regarding the dangers of electrical currents would not be practiced and disseminated among our domestic, working, or employing population, unlike what occurs in most developed countries.

Haemoglobin changes before and after packed red blood cells transfusion in burn patients: A retrospective cross-sectional study.

The present study aimed to investigate haemoglobin (Hb) changes before and after packed red blood cell (RBC) transfusion in burn patients. This study was a retrospective cross-sectional study that was conducted on burn patients in Velayat hospital in Rasht, Iran. The sampling method of this study was consecutive sampling. Data were collected using patient records, including age, gender, body mass index (BMI), total body surface area (TBSA) percentage, length of hospitalisation, Frequency of receiving packed RBCs, and Hb level before each packed RBC transfusion and 4 to 6 hours after transfusion. Paired t tests and analysis of variance (ANOVA) were used to compare the study variables. Pearson's correlation coefficient was used to investigate the relationship between Hb changes after the transfusion of packed RBCs and the study variables. A total of 110 burn patients participated in this study. The average Hb before and after transfusion was 8.07 (SD = 0.97) and 9.16 (SD = 1.01), respectively, which were significantly different (P = .0001). The results showed that there was a significant negative relationship between the variables of age (r = -0.188, P = .0001), BMI (r = -0.110, P = .035), and TBSA percentage (r = -0.122, P = .019) with changes in Hb after transfusion. Also, the duration of hospitalisation had a significant positive relationship with Hb changes after transfusion (r = 0.124, P = .017). In sum, Hb level compensation through packed RBC transfusion in elderly burn patients has more challenges. The number of changes in Hb level after receiving packed RBCs decreased with increasing TBSA, BMI, and age. Also, there was a positive correlation between the duration of hospitalisation and changes in Hb levels.

Quality indicators in burn care: An international burn care professionals survey to define them.

INTRODUCTION: Quality indicators (QIs) are tools for improving and maintaining the standard of care. Although burn injuries are a major global health threat, requiring standardized management, there is a lack of worldwide accepted quality indicators for burn care. This study aims to identify the best burn care-specific QIs as perceived by worldwide burn practitioners. METHODS: The ISBI Burn Care Committee developed a survey to analyze which burn care- specific QIs were relevant to international burn care professionals. The questionnaire was based on the three dimensions of the Donabedian model (i.e., Structure, Process, and Outcome) to evaluate the quality of care. The study was conducted from April to September 2021 and analyzed and reported following the Checklist for Reporting Results of Internet E-Surveys (CHERRIES). RESULTS: According to the 124 worldwide respondents, the most relevant QIs were: access to intensive care, burn surgeons, and dedicated burn care nurses (Structure category), 24-hours access to burn services, local protocols based on documented guidelines (Process category), and in-hospital mortality and incidence of severe infections (Outcome category). CONCLUSIONS: Specific QIs related to structures, clinical processes, and outcomes are needed to monitor the treatment of burn patients globally, assess the efficiency of the provided treatment, and harmonize the worldwide standard of burn care.

Características clínico Epidemiológicas de los pacientes con quemaduras antes y durante la pandemia por Covid-19 en el Instituto Nacional de Salud del Niño San Borja

Objetivo : Comparar las características clínicoepidemiológicas de pacientes pediátricos con quemaduras antes y durante la pandemia por COVID-19, en el Instituto Nacional de Salud del Niño San Borja. El estudio : Estudio analítico, retrospectivo. Se evaluó pacientes atendidos en el INSNSB, durante los períodos de marzo a diciembre 2019 y 2020. Se obtuvieron datos de las historias clínicas. Para la estadística se empleó el programa SPSS v25 (IC 95%). Hallazgos : Se analizaron 139 pacientes en cada periodo. El 60.4% y el 76.3% procedía de Lima, antes y durante la pandemia respectivamente. El grado de instrucción más frecuente del familiar responsable fue el de secundaria (42.3% y 58.2%). Además, las quemaduras menores mostraron un aumento antes y durante la pandemia (49.9% y 61%). Conclusiones: Se observó cambios significativos en la procedencia, grado de instrucción del familiar responsable y severidad de quemadura en ambos períodos

Objective: To compare the clinical-epidemiological characteristics of patients with burns before and during the COVID-19 pandemic treated at the "Instituto Nacional de Salud del Niño San Borja" . The study: Analytical, retrospective study. Patients treated at the INSNSB, during the periods from March to December 2019 and 2020. Data were collected from medical records. For statistical, the SPSS v25 program (95% CI) was used. Findings: 139 patients were analyzed in each period. 60.4% and 76.3% of patients came from Lima, before and during the pandemic, respectively; The most frequent level of education of the responsible family member was high school (42.3% and 58.2%). Also, minor burns showed an increase before and during the pandemic (49.9% and 61%). Conclusions: Significant changes were observed in the origin, degree of the responsible family member and the severity of burn between both periods.

A comparison of the epidemiology of isolated and non-isolated hand burns.

Hand burns are common and treatment individualized, however given large volumes in some centers, pattern recognition may help optimize service provision. We performed a single center retrospective review from 2014 to 2018 of hand burns in patients aged 16 and over. Burns confined to the hands were considered isolated. We found 1163 patients (790 male, 68%), with 853 isolated (9% bilateral) and 310 non-isolated (35% bilateral) hand burns, and 12% were sustained in industrial workplaces. Most isolated burns received first aid (72%) and were scalds (41%) or contact (23%). Many presented to hospital by car (73%) and most were treated as outpatients (92%). Non-isolated burns were mainly flash (38%) or flame burns (25%, p < 0.01), with 66% given first aid, 49% used ambulances (p < 0.01) and 54% underwent hospital admission (p < 0.01). Non-isolated injuries had more full thickness involvement (p < 0.01), 13% were resuscitation burns and 10% received intensive care. Isolated and non-isolated burns are distinct clinical entities, as are unilateral and bilateral injuries. Isolated burns are usually unilateral scalds or contact burns, suited to outpatient treatment. Non-isolated burns are often flash or flame, bilateral, often needing ambulances, admission, and interventions. First aid can be improved, and consideration given to inpatient rehabilitation of bilateral hand burns.

Avaliação dos custos de um Centro de Tratamento de Queimados / Cost assessment of a Burn Treatment Center

OBJETIVO: Avaliar o custo operacional do Centro de Tratamento de Queimados (CTQ) e calcular o custo paciente-dia. MÉTODO: Estudo transversal, com análise retrospectiva, quantitativa. Optou-se pelo sistema de microcusteio por absorção como método de apuração de custos através do sistema de informação de Compras Gerenciamento de Recursos Materiais e Serviço de Arquivo Médico no CTQ nos anos de 2019 e 2020. RESULTADOS: 824 internações incluindo enfermaria e Unidade Terapia Intensiva, com uma média de taxa de ocupação 73,4% e 91,4%, respectivamente. O perfil predominante foi do sexo masculino, de 0-9 anos, a maior taxa de mortalidade foi entre 60-80 anos, custo operacional R$15.547.698,81 e R$ 15.114.274,03, que gera um custo operacional mensal da unidade de R$ 1.277.582,21; os custos diretos representaram 58% e 54% nos anos de 2019 e 2020, respectivamente. Sendo assim, em média, o paciente-dia custou R$ 3.274,46 e uma taxa média de permanência de 13 dias de internação, portanto, pode-se fazer uma projeção de custos do tratamento de R$ 42.567,98, incluindo os custos indiretos e diretos. CONCLUSÕES: O custo operacional médio mensal foi de R$ 1.277.582,21 e paciente-dia teve um custo médio de R$ 3.274,46 para 13 dias de internação, projeta-se o custo total do tratamento R$ 42.567,98, incluindo os custos diretos e indiretos.

OBJECTIVE: To evaluate the operating cost of the Burn Treatment Center (CTQ) and to calculate the patient-day cost. METHODS: Cross-sectional study, with retrospective, quantitative analysis. The micro absorption costing system was chosen as a method of calculating costs through the Purchasing information system Material Resource Management and Medical Archive Service at the CTQ in 2019 and 2020. RESULTS: 824 hospitalizations including ward and Therapy Unit Intensive, with an average occupancy rate of 73.4% and 91.4%, respectively. The predominant profile was male, aged 0-9 years, the highest mortality rate was between 60-80 years, operating cost R$15,547,698.81 and R$15,114,274.03, which generates a monthly operating cost of unit of BRL 1,277,582.21, direct costs represented 58% and 54% in 2019 and 2020, respectively. Therefore, on average, the patient-day cost BRL 3,274.46 and an average hospital stay of 13 days, therefore, a treatment cost projection of BRL 42,567.98, including indirect and direct costs. CONCLUSIONS: The average monthly operating cost was R$ 1,277,582.21 and patient-day had an average cost of R$ 3,274.46 for 13 days of hospitalization, the total cost of treatment is projected to be R$ 42,567.98 including direct and indirect costs.

Perfil clínico-epidemiológico de queimaduras químicas em uma Unidade de Terapia de Queimados no Brasil / Clinical-epidemiological profile of chemical burns in a Burn Therapy Unit (BTU) in Brazil

Introdução: Substâncias químicas apresentam uma prevalência relativamente baixa dentre as causas de queimaduras. Porém, têm importância, pois a maioria dos acidentes ocorrem no âmbito do trabalho e em população economicamente ativa. O objetivo é realizar uma análise do perfil dos pacientes internados por queimaduras químicas em uma Unidade de Queimados. Métodos: Análise retrospectiva de pacientes internados na Unidade de Queimados do Hospital Estadual de Bauru, Bauru, SP, Brasil, entre os anos de 2008 e 2018. Múltiplas variáveis foram analisadas, como idade, sexo, agente químico, local onde ocorreu o acidente, necessidade de internação em UTI e dias de hospitalização. Resultados: No total, 40 (1,7%) pacientes foram internados devido a queimadura química. A média de idade foi de 35 anos, com predominância do sexo masculino, com 30 (75%) indivíduos. O principal local do trauma foi no ambiente de trabalho, em 20 casos (50%). Acidentes com base foram responsáveis por 20 (50%) internações. A superfície corporal queimada média foi de 7,5%. Queimadura ocular ocorreu em 11 (27,5%) pacientes. Leito de terapia intensiva foi necessário para 10 (25%) casos. Quando comparados os acidentes entre substâncias ácidas e bases, evidenciamos diferença no número de pacientes internados em UTI, com oito pacientes em lesões envolvendo bases e dois com ácidos (p=0,04). Conclusão: A casuística e resultados apresentados neste artigo são semelhantes à literatura mundial sobre o assunto. Evidenciamos a importância dessa queimadura no ambiente de trabalho e o acometimento de indivíduos em idade ativa, assim como a maior gravidade de acidentes com substância química.

Introduction: Chemicals have a relatively low prevalence among the causes of burns. However, they are important because most accidents occur in the scope of work and in an economically active population. The objective is to perform an analysis of the profile of patients hospitalized for chemical burns in a Burn Unit. Methods: Retrospective analysis of patients hospitalized in the Burn Unit of the State Hospital of Bauru, Bauru, SP, Brazil, between 2008 and 2018. Multiple variables were analyzed, such as age, gender, chemical agent, place where the accident occurred, need for ICU stay and days of hospitalization. Results: In total, 40 (1.7%) patients were hospitalized due to chemical burn. The mean age was 35 years, with predominance of males, with 30 (75%) individuals. The main site of trauma was in the workplace, in 20 cases (50%). Based accidents were responsible for 20 (50%) admissions. The mean burned body surface was 7.5%. Eye burn occurred in 11 (27.5%) patients. Intensive care bed was required for 10 (25%) cases. When comparing accidents between acid iced substances and bases, we noted a difference in the number of ICU patients, with eight patients in lesions involving bases and two with acids (p=0.04). Conclusion: The sample and results presented in this article are similar to the world literature on the subject. We evidenced the importance of this burn in the work environment and the involvement of individuals of active age, as well as the greater severity of accidents with chemical substance.

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

Objetivo: evidenciar os cuidados de enfermagem descritos na literatura nacional e internacional que são aplicados em pacientes queimados em terapia intensiva. Método: revisão integrativa, realizada no período de fevereiro a dezembro de 2020, nas bases de dados eletrônicas US National Library of Medicine, Medical Literature Analysis and Retrieval System Online e Biblioteca Virtual em Saúde. Resultados: foram selecionados oito artigos, os quais foram categorizados em Cuidados de Enfermagem com a pele em pacientes queimados, Cuidados de Enfermagem com a mobilidade em pacientes queimados e Cuidados de Enfermagem em pacientes queimados em relação à dor, dispositivos e prevenção de complicações. Conclusão: os cuidados de enfermagem para pacientes queimados em terapia intensiva estão intensamente atrelados aos cuidados com as lesões de pele e seus desdobramentos, assim como a prevenção de infecções.

Objective: to highlight the nursing care described in the National and International Literature that is applied to burned patients in intensive care. Methods: integrative review, carried out from February to December, 2020, using the following electronic bases: US National Library of Medicine, Medical Literature Analysis and Retrieval System Online and Biblioteca Virtual em Saúde. Results: it was selected eight articles, which were categorized into Nursing Care for skin in burned patients, Nursing Care for mobility in burned patients and Nursing Care for burned patients in relation to pain, devices and prevention of complications. Conclusion: nursing care for burned patients in intensive care is associated to the care of skin lesions and their consequences, as well as the prevention of infections.

Objetivo: destacar los cuidados de enfermería descritos en la literatura nacional e internacional que se aplican en pacientes quemados en cuidados intensivos. Método: revisión integradora, realizada de febrero a diciembre de 2020, en las bases de datos electrónicas US National Library of Medicine, Medical Literature Analysis and Retrieval System Online y Virtual Health Library. Resultados: se seleccionaron ocho artículos, los cuales se clasificaron en Cuidados de Enfermería con la Pelea en Pacientes Enfermos, Cuidados de Enfermería con la Movilidad en Pacientes Enfermos y Cuidados de Enfermería en Pacientes Enfermos en relación con el dolor, los dispositivos y la prevención de complicaciones. Conclusión: los cuidados de enfermería a los pacientes quemados en cuidados intensivos están intensamente ligados al cuidado de las lesiones cutáneas y sus desdoblamientos, así como a la prevención de infecciones.

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

Introducción: a partir de la pandemia por Covid19 se reportó variabilidad en la incidencia de las infecciones asociadas al cuidado de la salud (IACS). Con el objetivo de describir y comparar las tasas de IACS en la Unidad de Quemados de un hospital pediátrico de tercer nivel, antes y después del inicio de la pandemia se llevó a cabo este estudio. Material y métodos: estudio de cohorte, retrospectivo, descriptivo, de vigilancia epidemiológica. Se registraron todos los eventos de IACS en la Unidad de Quemados desde el 01/07/2018 hasta el 31/06/2021. Se compararon las tasas de las IACS entre el período I (PI) previo a la pandemia (07/2018-12/2019) y el período II (PII) posterior al inicio de la misma (01/2020- 06/2021). Resultados: se registraron 74 episodios de IACS, en un total de 8232 pacientes-día. Se registró una tasa global de IACS similar en ambos períodos, 10,08 ‰ pacientes-día (PI) vs 7,34 ‰ pacientes-día (PII), sin encontrarse diferencias estadísticamente significativas en las tasas de bacteriemia asociada a catéter venoso central (BSI-CVC) 3,32 ‰ días uso de CVC (PI) vs 3,20 ‰ (PII), neumonía asociada a ARM 1.43 ‰ días de uso de ARM (PI) vs un 2.02 ‰ (PII), ni infección urinaria asociada a sonda vesical (SV) 7,36 ‰ días de uso de SV (PI) vs 3,64 ‰ (PII). Conclusiones: no se observaron diferencias estadísticamente significativas en las tasas de IACS entre ambos períodos, lo cual podría justificarse con el estricto protocolo en control de infecciones implementado previo al inicio de la pandemia (AU)

Introduction: since the start of the Covid19 pandemic, variability in the incidence of healthcare-associated infections (HAIs) has been reported. This study was conducted to describe and compare the rates of HAIs in the burn unit of a tertiary pediatric hospital before and after the onset of the pandemic. Material and methods: a retrospective, descriptive, epidemiological surveillance cohort study was conducted. All HAI events in the burn unit from 01/07/2018 to 31/06/2021 were recorded. HAI rates between the pre-pandemic period I (PI) (07/2018- 12/2019) and post-pandemic period II (PII) (01/2020-06/2021) were compared. Results: 74 episodes of HAI were recorded in a total of 8232 patient-days. There was a similar overall rate of HAIs in both periods, 10.08 ‰ patient-days (PI) vs 7.34 ‰ patient-days (PII), with no statistically significant differences found in the rates of central venous catheter-related bloodstream infections (CVC-BSI) 3.32 ‰ days CVC use (PI) vs 3.20 ‰ (PII), ventilator-associated pneumonia 1. 43 ‰ days MV use (PI) vs a 2.02 ‰ (PII), or catheter-associated urinary tract infection 7.36 ‰ days catheter use (PI) vs 3.64 ‰ (PII). Conclusions: no statistically significant differences were observed in the rates of HAIs between both periods, which may be explained by the strict infection control protocol implemented prior to the onset of the pandemic (AU)

Perfil microbiológico em pacientes hospitalizados por queimaduras / Microbiological profile in patients hospitalized for burns

Introdução: As lesões por queimaduras são um problema de saúde global que atinge todas as faixas etárias, não só pela frequência com que ocorrem, mas também pela gravidade. Podem ser incapacitantes, ter alta mortalidade e, ao mesmo tempo, gerar um impacto econômico desfavorável para o país. O objetivo é descrever o perfil microbiológico de pacientes hospitalizados por queimaduras. Métodos: Estudo descritivo, longitudinal e prospectivo no Hospital Provincial Clínico Cirúrgico Celia Sánchez Manduley, Cuba, de julho de 2017 a junho de 2020. Foram estudadas amostras de cultura, positividade, microrganismos isolados e sensibilidade antimicrobiana. Resultados: O estudo mostrou que as amostras de lesões cutâneas por queimaduras (130) foram predominantes e delas 58,46% foram positivas; Staphylococcus aureus, com 51,73%, foi o germe mais isolado; sensibilidade à amicacina de 55,56% e vancomicina 51,11%; a sobrevida foi alta. Conclusão: Predominou a positividade nas amostras de cultura de pele queimada, principalmente Staphylococcus aureus, e uma alta sensibilidade a poucos antimicrobianos.

Introduction: Injuries caused by burns are a global health problem that affects all age groups, not only because of the frequency in which they occur but according to their severity. They can be disabling and have high mortality, and at the same time, generate an unfavorable economic impact on the country. The objective is to describe the microbiological profile of burned hospitalized patients. Methods: A descriptive, longitudinal, and prospective study was carried out at the Provincial Clinical Surgical Celia Sánchez Manduley Hospital from July 2017 to June 2020. Microbiology culture, positivity, isolated microorganisms, and antimicrobial sensitivity were studied. Results: The study showed that the culture microbiology of skin lesions due to burns (130 samples) were predominant, and of them, 58.46% were positive, Staphylococcus aureus with 51.73% was the most isolated germ; sensitivity to amikacin of 55.56% and vancomycin 51.11%; survival was high. Conclusions: The positivity in the culture microbiology of burned skin, mainly Staphylococcus aureus, and high sensitivity to few antimicrobials predominated.

Using the Diagnostic Odds Ratio to Select Patterns to Build an Interpretable Pattern-Based Classifier in a Clinical Domain: Multivariate Sequential Pattern Mining Study.

BACKGROUND: It is important to exploit all available data on patients in settings such as intensive care burn units (ICBUs), where several variables are recorded over time. It is possible to take advantage of the multivariate patterns that model the evolution of patients to predict their survival. However, pattern discovery algorithms generate a large number of patterns, of which only some are relevant for classification. OBJECTIVE: We propose to use the diagnostic odds ratio (DOR) to select multivariate sequential patterns used in the classification in a clinical domain, rather than employing frequency properties. METHODS: We used data obtained from the ICBU at the University Hospital of Getafe, where 6 temporal variables for 465 patients were registered every day during 5 days, and to model the evolution of these clinical variables, we used multivariate sequential patterns by applying 2 different discretization methods for the continuous attributes. We compared 4 ways in which to employ the DOR for pattern selection: (1) we used it as a threshold to select patterns with a minimum DOR; (2) we selected patterns whose differential DORs are higher than a threshold with regard to their extensions; (3) we selected patterns whose DOR CIs do not overlap; and (4) we proposed the combination of threshold and nonoverlapping CIs to select the most discriminative patterns. As a baseline, we compared our proposals with Jumping Emerging Patterns, one of the most frequently used techniques for pattern selection that utilizes frequency properties. RESULTS: We have compared the number and length of the patterns eventually selected, classification performance, and pattern and model interpretability. We show that discretization has a great impact on the accuracy of the classification model, but that a trade-off must be found between classification accuracy and the physicians' capacity to interpret the patterns obtained. We have also identified that the experiments combining threshold and nonoverlapping CIs (Option 4) obtained the fewest number of patterns but also with the smallest size, thus implying the loss of an acceptable accuracy with regard to clinician interpretation. The best classification model according to the trade-off is a JRIP classifier with only 5 patterns (20 items) that was built using unsupervised correlation preserving discretization and differential DOR in a beam search for the best pattern. It achieves a specificity of 56.32% and an area under the receiver operating characteristic curve of 0.767. CONCLUSIONS: A method for the classification of patients' survival can benefit from the use of sequential patterns, as these patterns consider knowledge about the temporal evolution of the variables in the case of ICBU. We have proved that the DOR can be used in several ways, and that it is a suitable measure to select discriminative and interpretable quality patterns.

Challenges in Burn Care during the COVID-19 Pandemic-A Scoping Review.

Objective: The aim of this review is to map and summarize the experiences of various burn centers worldwide during the COVID-19 pandemic, in order to enable future strategies with regard to the most effective measures in burn care during pandemics and to detect possible gaps in knowledge. Background: The coronavirus disease 2019 (COVID-19) pandemic had a major impact on economies, social interactions, and health systems worldwide. Burn units all over the world face a new challenge in maintaining the care of acute burn wounds and follow-up treatments while dealing with constantly changing regulations. Infrastructural changes, the establishment of efficient triage systems, protective measures, personnel resources, in addition to the maintenance of efficient patient care and the guarantee of supply chains, are challenging tasks to be addressed. This review provides an overview of recent developments regarding different strategies and methods used by burn units worldwide to safely overcome the COVID-19 pandemic outbreak. Methods: A scoping review of the literature was conducted using the electronic databases PubMed and Google Scholar. Publications were screened for the following key terms: burns, burn injuries, thermal injuries, burn center, burn unit, burn ward, in combination with COVID-19, COVID-19 pandemic, SARS-CoV-2, Corona, and Coronavirus. Articles dealing with the management of burn units during the pandemic were further analyzed and included. Results: Of the 136 publications, 10 were considered relevant to the key question and were included in the present review. Results were divided into six major topics, such as infrastructural and personnel management, triaging, severe burns and emergencies, elective surgeries, patient and visitor management, and outpatient management. Conclusion: Only a few studies about managing burn units during the COVID-19 pandemic have been published. Personnel resources and equipment needed to be redistributed to cope with country-specific challenges during the COVID-19 pandemic and to maintain adequate burn care. Since all of these articles refer to the period of the initial outbreak, a lack of clinical studies exists regarding the prevention measures taken by burn units during the COVID-19 pandemic. In addition, we identified gaps in knowledge about the impact of implemented measures on burn patient outcomes in the published literature. Further studies are mandatory in order to provide generally applicable guidelines regarding COVID-19 prevention measures at a burn unit.

Unidade de queimados do Hospital de Clínicas da Universidade Federal de Uberlândia, Brasil: estudo epidemiológico / Burns unit at the Hospital de Clínicas of the Universidade Federal de Uberlândia, Brazil: an epidemiological study

Introdução: As queimaduras, um problema de saúde pública, são lesões que podem ocorrer na pele ou outros tecidos do corpo decorrentes de trauma de origem térmica, podendo ocasionar lesões leves, graves e até mesmo o óbito. Assim, são estudadas as características epidemiológicas dos pacientes atendidos na Unidade de Queimados do Hospital de Clínicas da Universidade Federal de Uberlândia. Métodos: Estudo transversal de dados registrados nos prontuários dos pacientes atendidos por queimadura na Unidade de Queimados de 2016 até 2019. Resultados: Um total de 252 prontuários foram revisados, sendo mais atingido o gênero masculino da faixa etária adulta. O principal agente causal foi o líquido inflamável (42,4%), com predomínio do álcool (66,35), acontecendo no domicílio (59,9%). O percentual médio da superfície corporal queimada foi de 17,7%, precisando de enxerto ou debridamento cirúrgico 25% dos pacientes. A média de internaçação foi 23,3 dias, com 8,7% necessitando de Unidade de Terapia Intensiva. A tentativa de autoextermínio foi de 5,5%, sendo a taxa geral de óbito de 3,5%. Conclusões: Pacientes por queimadura atendidos na Unidade de Queimados do Hospital de Clínicas da Universidade Federal de Uberlândia abrangem mais a população jovem e adulta, sendo o álcool a causa predominante, com média de óbitos similar a outras regiões. Este estudo ajudará a criar medidas no sentido de reduzir o número de casos e adequar o atendimento de forma quantitativa e qualitativa, contribuindo para a elaboração de protocolos de cuidados, a fim de assegurar a qualidade da assistência dos pacientes e da população em geral.

Introduction: Burns, a public health problem, are injuries that can occur on the skin or other tissues of the body resulting from the trauma of thermal origin, which can cause mild, severe injuries and even death. Thus, the epidemiological characteristics of patients seen at the Burn unit of the Hospital de Clínicas of the Universidade Federal de Uberlândia are studied. Methods: Cross-sectional study of the data recorded in patients' medical records treated for the burn at the Burn Units from 2016 to 2019. Results: 252 medical records were reviewed, with the male gender of the adult group being most affected. The main causal agent was the flammable liquid (42.4%) with a predominance of alcohol (66.35), occurring at home (59.9%). The average percentage of burned body surface was 17.7%, requiring a graft or surgical debridement in 25% of the patients. The average hospital stay was 23.3 days, requiring 8.7% of the Intensive Care Unit. The attempt at self-extermination was 5.5%, with a general death rate of 3.5%. Conclusions: Burn patients treated at the Burn Unit of the Hospital de Clínicas of the Universidade Federal de Uberlândia encompasses more of the young and adult population, with alcohol being the predominant cause, with an average death rate like other regions. This study will help create measures in search of reducing the number of cases and adapting the care quantitatively and qualitatively, contributing to the elaboration of care protocols to ensure the quality of the care of the patients and the population.

Análise clínico-epidemiológica de pacientes HIV positivos internados em uma Unidade de Terapia de Queimados / Clinical-epidemiological analysis of HIV positive patients hospitalized in a Burn Therapy Unit

Introdução: A infecção pelo HIV e as queimaduras são um problema comum de saúde pública, principalmente em países de baixa e média renda. Há uma escassez na literatura sobre a epidemiologia de pacientes HIV positivos hospitalizados em unidades de queimados. O objetivo deste estudo é avaliar dados clínicoepidemiológicos de pacientes HIV positivos internados em uma Unidade de Terapia de Queimaduras. Métodos: Realizada análise retrospectiva de pacientes com diagnóstico de HIV internados na Unidade de Terapia de Queimados do Hospital Estadual de Bauru entre os anos de 2008 e 2018. Resultados: No total, foram revisados 2364 prontuários e encontrados 14 (0,6%) pacientes com diagnóstico de HIV. A idade média foi 43,1 anos. Quanto ao gênero, nove (64,3%) eram masculinos e cinco (35,7%) femininos. O mecanismo mais comum foi por chama direta em 11 (78,7%) casos. A etiologia foi álcool (42,9%) em seis pacientes, em três explosão (21,5%) e os demais foram gasolina, cigarro e contato com escapamento, todos com um (7,1%) caso. A causa mais comum foi acidente, em nove (64,3%) casos, dois (14,3%) tentativa de homicídio, um (7,1%) autoextermínio e dois (14,3%) casos sem informação. Em relação à superfície corporal queimada (%SCQ), cinco (37,5%) apresentavam queimaduras de 0-10%, três (21,4%) de 11-20% e cinco (35,7%) maiores que 20%, e em um era desconhecida. Quatro (28,6%) apresentaram lesões de vias aéreas. Dois (14,3%) pacientes foram a óbito. Conclusão: A prevalência de pacientes HIV positivos queimados internados em uma unidade especializada para este tratamento se assemelha à nacional, com características semelhantes em relação a idade e gênero.

Introduction: HIV infection and burns are common public health issues, especially in low- and middle-income countries. There is a paucity in the literature evaluating the epidemiology of burns hospitalization in HIV patients. This study aims to evaluate the clinical and epidemiological profile of HIV-positive patients hospitalized in a Burn Therapy Unit. Methods: A retrospective analysis of burn patients diagnosed with HIV was performed at the Therapy Unit of the State Hospital of Bauru between 2008 and 2018. Results: 2,364 medical records were reviewed, and 14 (0.6%) patients were diagnosed with HIV. The mean age was 43.1 years. Regarding gender, nine (64.3%) were male, and five (35.7%) were female. The most common mechanism was direct flame in 11 (78.7%) cases. The etiology was alcohol (42.9%) in six patients, in three explosions (21. 5%), and the others were gasoline, cigarettes and contact with exhaustion, all with one (7.1%) case. When the cause of these burns was evaluated, nine (64.3%) were due to accidents, either at work or home, two (14.3%) for attempted murder, one (7.1%) self-extermination, and two (14.3%) cases had no information. Regarding total burn surface area, five (37.5%) had burns of 0-10%, three (21.4%) 11-20% and five (35.7%) greater than 20%, and one was unknown. Four (28.6%) showed airway lesions. Two (14.3%) patients died. Conclusion: The prevalence of burned HIV-positive patients admitted to a specialized unit for this treatment is like the national one, with similar characteristics concerning age and gender.

Necesidades humanas básicas y sociales en la atención de enfermería a personas tratadas en Unidades de Tratamiento de Quemaduras: un estudio integrador / Basic and social human needs in nursing care for people treated in Burn Treatment Units: an integrative study

Objetivo: Identificar los indicadores empíricos de las necesidades humanas básicas y sociales que se encuentran en la atención de enfermería a las personas tratadas en las Unidades de Tratamiento de Quemaduras.Materiales y Método: Estudio descriptivo, transversal y exploratorio del tipo revisión integradora de literatura. Se identificaron 265 artículos, seleccionándose, tras el uso de los criterios de inclusión y exclusión, 16 estudios. Los datos recogidos se ingresaron en hojas de trabajo para el análisis estadístico descriptivo y de inferencia, analizándolos utilizando Microsoft Office Excel 2010 y el software Statistical Package for the Social Sciences (SPSS) versión 20.0. La distribución de indicadores empíricos se realizó, los cuales se discutieron basándose en producciones científicas en el área.Resultados: La búsqueda resultó en la identificación de 113 indicadores empíricos en total, 89 correspondientes a necesidades psicobiológicas, 21 a necesidades psicosociales y 03 a necesidades psico-espirituales. Las necesidades que más presentaron indicadores empíricos fueron Necesidad de regulación vascular (n=18) y Necesidad de oxigenación (n=16). Sin embargo, la necesidad de seguridad emocional mostró indicadores más frecuentes.Conclusión: Se encontró que la quemadura, además de afectar la integridad física, también afecta los aspectos emocionales, contribuyendo a los cambios en la integridad mental. La existencia de pocos estudios con el tema resalta la necesidad de producción científica relacionada con el tema, con el fin de contribuir a la práctica de la enfermería humana y holística (AU)

Objective: To identify the empirical indicators of basic and social human needs found in nursing care for people treated in Burn Treatment Units.Materials and Method: Descriptive, cross-sectional and exploratory study of the integrative literature review type. After applying inclusion and exclusion criteria, 16 of the 265 articles identified made up the sample. The data collected were inserted in spreadsheets for descriptive statistical analysis and inferences, analyzed using the Microsoft Office Excel 2010 program and the Statistical Package for the Social Sciences (SPSS) version 20.0 software. The distribution of empirical indicators was carried out, which were later discussed based on scientific productions in the area.Results: The search resulted in the identification of 113 empirical indicators, 89 corresponding to psychobiological needs, 21 to psychosocial needs and 03 to psycho-spiritual needs. The needs that most presented empirical indicators were Need for Vascular Regulation (n=18) and Need for Oxygenation (n=16). However, the Need for Emotional Security showed more frequent indicators.Conclusion: The burn, in addition to affecting physical integrity, also affects emotional aspects, contributing to changes in mental integrity. The existence of few studies with the theme highlights the need for scientific production related to the theme, in order to contribute to human and holistic nursing practice (AU)

Objetivo: Identificar os indicadores empíricos das necessidades humanas básicas e sociais encontrados na assistência de enfermagem à pessoa atendida em Unidades de Tratamento ao Queimado.Materiais e Método: Estudo descritivo, transversal e exploratório do tipo revisão integrativa da literatura. Foram identificados 265 artigos, que após os critérios de inclusão e exclusão, 16 estudos compuseram a amostra. Os dados coletados foram inseridos em planilhas para análises estatísticas descritivas e inferências, analisados utilizando o programa Microsoft Office Excel 2010 e o software Statistical Package for Social Sciences (SPSS) versão 20.0. Foi realizada a distribuição dos indicadores empíricos e, posteriormente, discutidos a partir de produções científicas da área.Resultados: A busca resultou na identificação de 113 indicadores empíricos no total, sendo 89 correspondendo às necessidades psicobiológicas, 21 às necessidades psicossociais e 03, às necessidades psicoespirituais. As necessidades que mais apresentaram indicadores empíricos foram Necessidade de Regulação Vascular (n=18) e Necessidade de Oxigenação (n=16). No entanto, a Necessidade de Segurança Emocional apresentou indicadores mais frequentes.Conclusão: Constatou-se que a queimadura além de afetar a integridade física atinge, também, aspectos emocionais, contribuindo para alterações da sua integridade mental. A existência de poucos estudos com a temática evidencia a necessidade da produção científica relacionada ao tema, a fim de contribuir para a prática humana e holística de enfermagem (AU)

Manejo da sede: perspectiva do paciente cirúrgico queimado / Thirst management: perspective of burnt surgical patient

Objetivo: explorar a percepção de um paciente cirúrgico queimado em relação à sede e seu manejo no período pré-operatório e pós-operatório imediato. Relato de caso: trata-se de um estudo com abordagem qualitativa, exploratória, do tipo estudo de caso. Os critérios de inclusão foram: paciente estar internado no centro de tratamento de queimados, ser submetido a procedimento cirúrgico ou balneoterapia, ter experenciado a sede no período pré-operatório ou pós-operatório e ter recebido o manejo da sede. Para a coleta de dados utilizou-se entrevista semiestruturada, gravada e transcrita. Paciente do sexo feminino, de 32 anos, admitida com queimaduras de segundo grau em extensão de tórax, membros superiores e pescoço por tentativa de autoextermínio com álcool. Passou por seis procedimentos e esteve internada por 15 dias até o momento da coleta. Experienciou o desconforto sede durante o jejum pré-operatório e pós-operatório, considerado intenso e muito estressante durante sua internação. Conclusão: a partir da identificação do desconforto sede, utilizou-se como estratégia o picolé de gelo, que fez diferença em seu tratamento. O modelo de manejo da sede é pioneiro no cuidado ao paciente queimado e apresenta benefícios para minorar a sede.

Objective: explore thirst perception of a burnt surgical patient and its management in the preoperative and immediate postoperative period. Case report: study with a qualitative and exploratory approach, named as case study. Inclusion criteria were: inpatient at burnt treatment unit, undergone surgical procedure or balneotherapy, experienced thirst in the preoperative or postoperative period and received thirst management. For data collection, semi-structured interviews were performed, recorded and transcribed. Female patient, 32 years old, admitted with second degree burns in extension of thorax, upper limbs and neck due to attempted self-extermination with alcohol. Underwent six procedures and was hospitalized for 15 days until the data collection. Experienced thirst discomfort during preoperative and postoperative fasting, which was considered intense and very stressful during his hospitalization. Conclusion: since the identification of thirst discomfort, the ice popsicle was used as a strategy, which made difference in her treatment. The thirst management model is pioneer in care of burnt patients and has benefits to alleviate thirst.

Social workers as members of burn care teams: A qualitative thematic analysis.

BACKGROUND: Social workers on interprofessional teams contribute to treating the psychosocial sequelae of burn trauma patients in cooperation with many other burn-treatment team members. However, the roles and skills exercised by social workers can vary between burn units as well as the skills social work students are taught in their academic programs. METHODS: A purposive sample of 13 burn unit social workers were interviewed online using semi-structured questions. This qualitative thematic analysis of data was conducted to identify how social workers perceive their roles, responsibilities, and knowledge as they relate to their work with patients and their families in a burn unit. RESULTS: Skills, challenges and barriers to rehabilitation, and resources were identified during thematic analysis within and across participant data as factors social workers found to be important for their work in burn units. CONCLUSION: By expanding the body of knowledge about factors that impact social work care for burn patients, Social work academic programs may better understand how to prepare medical social work students for best practices in the care of burn-injured patients, survivors, and families at inpatient and community levels.