Demographics and clinical outcomes of adult burn patients admitted to a single provincial burn centre: A 40-year review.

INTRODUCTION: This study evaluated trends in demographics and outcomes of cutaneous burns over a forty-year period at a Canadian burn centre. METHODS: Retrospective review was performed of all consecutive adult burn admissions to the Vancouver General Hospital (VGH) between 1976 and 2015. Comparison was made to the 2016 American Burn Association - National Burn Repository. RESULTS: There were 4105 admissions during study period. Both overall admissions and admissions per 100,000 BC residents declined (p < 0.0001). Males represented three quarters of admissions. There was a decrease in large burns (p < 0.05). Flame burns were most commonly associated with larger TBSA, ICU stays, and mortality. Mortality decreased from 11.3% to 2.8% (p < 0.05). Factors found to affect mortality included: increased length of stay, age and burn size, male gender, and number of complications. Baux50 and rBaux50 increased, from 102.8 to 116.7 and 112.2 to 125.3 respectively (p < 0.05, respectively). CONCLUSIONS: This study represents the largest report on burn epidemiology in Canada. The incidence of burns has decreased significantly over the last forty years. Mortality has improved over this time frame, as evident by increases in Baux50 and rBaux50 scores. Further data is largely in concurrence with that of the National Burn Repository's amalgamation of US centres.

Referencias históricas en la evolución del tratamiento de las quemaduras / Historical references in the evolution of burn treatment

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Evolución histórica del tratamiento del paciente quemado / Historic evolution of burn care

El tratamiento de las quemaduras es una ciencia tan antigua como los conflictos humanos, que ha debido refinarse y adaptarse a las mejoras de la tecnología armamentística a lo largo de la historia. El fuego ha sido probablemente una de las primeras armas de doble filo con las que el ser humano ha topado durante su desarrollo tecnológico. Históricamente, este elemento ha servido tanto para mejorar las condiciones de vida de las sociedades como para destruirlas y ocasionar terribles sufrimientos. En este trabajo realizamos una exposición cronológica de la evolución del tratamiento de las quemaduras, presentando a las figuras científicas más relevantes de cada momento y sus aportaciones. Además, destacamos los conflictos y desastres coincidentes en el tiempo de vida de cada uno de estos médicos, ya que, en muchos casos, fue el trabajo desarrollado durante estas catástrofes lo que permitió la progresión de este ámbito. El objetivo de esta revisión histórica es proporcionar al lector cierto conocimiento sobre el camino que esta ciencia del tratamiento de las quemaduras ha seguido hasta alcanzar el punto de desarrollo actual, Desde el primer registro histórico sobre tratamientos para las quemaduras en un papiro egipcio del 1500 a.C., cada figura relevante de la Medicina en su tiempo ha propuesto su propio remedio para las quemaduras; la mayoría de ellos sin fundamento científico según los paradigmas actuales. No obstante, desde el siglo XVI ha habido aportaciones puntuales hasta alcanzar un importante desarrollo durante los siglos XIX y XX, coincidiendo en el tiempo con la revolución industrial y científica de las Grandes Guerras, en las que la cantidad de víctimas por quemaduras fue inmensa, proporcionando un extenso campo observacional y experimental. Gracias a todo ello, los pacientes quemados alcanzan actualmente unas tasas de supervivencia impensables hace siglos. Ponemos pues en evidencia que la adversidad, estudiada desde un enfoque científico, puede servir como oportunidad para mejorar la calidad de vida de las generaciones venideras

Burn treatment is such an ancient science as human conflicts, and it has had to be refined and adapted to the improvements in military technology throughout history. Fire has probably been one of the first double sided weapons developed by humanity during its technologic development. This element has both served to improve life conditions of societies, and to destroy them causing terrible suffering. In this article, we perform a chronological exposition of the evolution of burn treatment, presenting the more relevant scientific figures of each time, and their contributions. Also, conflicts and disasters that coincided with these scientists are described, as in most cases, the work developed during those catastrophes eased the advancement of this field. The objective of this historical review is to provide the reader with certain knowledge about the path this science has followed until reaching its actual state. The first existing reference to burn treatment goes back to an egyptian papyrus written around the year 1500 b.C. Since then, each relevant figure in the field of Medicine of their time proposed their own treatment for burns; which in most cases, had no scientific basis according to current paradigms. However, since the 16th century, certain advancements in different fields of burn care were described, reaching an important development during the 19th and 20th centuries, when industrial and scientific revolution coexisted with the Great Wars, which provided wide experimental and observational fields. Therefore, and thank to scientific discoveries of the last centuries, burned patients present survival rates that were unconceivable years ago. We remark that highlighting that adversity, studied through scientific methodology, might serve as an opportunity to improve quality of life of upcoming generations

The crowd-out effect of a mass casualty incident: Experience from a dust explosion with multiple burn injuries.

A mass casualty incident (MCI) can have an enormous impact on an already crowded emergency department (ED), affecting the quality of health care provided to non-MCI ED patients. On June 26, 2015, a burn MCI (BMCI) occurred due to a cornstarch explosion at a party at a water park. The competing needs of the BMCI patients might have crowded out the needs of the non-BMCI patients. Although crowd-out effects have been previously documented in a variety of health care situations, they have not been extensively evaluated during MCIs. We aimed to determine whether the outcomes of the non-MCI patients were compromised during this incident.We conducted a retrospective observational study comparing several health care parameters and outcomes between non-BMCI patients and historical controls during the designated period using institutional electronic records and the National Health Insurance Research Database.On the night of the incident, 53 patients were sent to our ED; most of them arrived within 3 hours after the BMCI. There was a significant increase in the wait time for ICU beds among non-BMCI patients compared to the wait times during the corresponding week of the previous year (8.09 ±â€Š4.21 hours vs 3.77 ±â€Š2.15 hours, P = .008). At the hospital level, there was a significantly increased length of hospital stay (LOS) in the ICU after the MCI compared with the LOS in the ICU in the same week of the preceding year (median days: 15 vs 8, P ≤ .001). At the regional level, there were no significant differences between the 2 periods in the LOS in acute care, LOS in the ICU or mortality rates at the involved medical centers.Crowd-out effects from the MCI occurred in the ED and at the institutional level. Although there was an increased wait time for admission to the ICU and a longer LOS in the ICU, the LOS in acute care beds, treatment of time-sensitive diseases, and mortality rates were not compromised by the current MCI protocol at either the institutional or regional levels.

[Deep recall of distinguished professor Basil A. Pruitt in burn and trauma field].

We are shocked and deeply saddened to learn of the passing of distinguished professor Basil A. Pruitt in the afternoon of March 17th, 2019, at the age of 88, in the United States of America. On behalf of the society of Burn Surgery of Chinese Medical Doctor Association and the Editorial Board of Chinese Journal of Burns, I express our deep condolences and prayers!

[Reflection on rescue and treatment of mass burn casualties in 21st century].

The rescue and treatment of mass burn casualties is a test for both the burn treatment level and the disaster emergency response ability of a country or a region. In recent years, burn disasters happened occasionally around the world despite of the improvement of safety level in production and the awareness of fire prevention. On one hand, mass burn casualty events caused catastrophic damages to human health. On the other hand, they also promoted the development of burn treatment and disaster medicine. This paper may provide some references for further improving the management of mass burn casualties in the future by reviewing several typical cases of burn disaster rescue and treatment in the world since the 21st century.

The Allan Burns mummies: A history and future prospect of an anatomical collection.

Acquiring adequate resources for anatomy education has represented a challenge throughout the discipline's long history. A significant number of collections housed in anatomy departments contain human tissue of unknown provenance with some obtained in morally dubious ways. This paper outlines the history and future prospects of one such anatomical assemblage - the Burns Anatomical Collection, currently housed at the University of Maryland (UM). The collection originally contained more than 1000 anatomically prepared mummified human remains. They were produced by the renowned Scottish anatomist Allan Burns in Glasgow in the late eighteenth and early nineteenth centuries. The prepared cadavers became a commodity and after Burns' death, were acquired by his pupil Granville Pattison, who later sold them to the UM. While the origin of these human remains is unknown, historical data suggests that most of the cadavers for the collection were obtained through grave robbing. While intensely used in anatomy teaching in the nineteenth century, specimens from the collection should now be treated primarily as historical artifacts, appropriate only for teaching medical history and ethics. Other perspectives may include repatriating and reburying the human remains and providing a memorial service. Most importantly, this collection and others similar to it should initiate dialog and reflection on the ethical aspects of the past and present medical practice.

Burn Injuries: Prevention, Advocacy, and Legislation.

Each year in the United States and Canada, thousands of individuals seek medical care for a burn injury. Some individuals are burned significantly enough they require treatment at specialized burn care facilities. Most of these injuries are preventable. This article presents an historical perspective related to burn prevention and elements of successful burn prevention programs and explores ways in which the plastic surgeon can promote burn prevention through education, advocacy, and the legislative process. Prevention efforts undertaken by the surgeon can increase awareness, ensure a safe environment, and reduce burn injuries.

Burn care in the 1800s.

The 1800s show a wide range of both understanding and misinterpretation of the pathophysiology and treatment of burns. The objective of this paper was to describe the key advancements in the study and treatment of burns in the 1800s. We reviewed primary and secondary sources of ancient to modern burn care manuscripts. Prior to the 1800s, burn care was different iterations of poultices and oils placed over acute burns in the hope the patient would survive. The 1800s showed the discoveries of the Curling and Marjolin's ulcers as well as the first understanding of inhalation injury and advancements in skin grafting, leading to further understanding of the disease process.

The fire at Cocoanut Grove.

On November 28, 1942, a fire broke out at The Cocoanut Grove Nightclub, in Boston, Massachusetts. The fire claimed the lives of hundreds, and injured 170 patients who were treated at either Boston City Hospital or the Massachusetts General Hospital. With extraordinary leadership and scientific focus, this tragedy led to many important advances in burn management, including improvements in burn wound care, the first descriptions of inhalation injury, formulas to guide fluid resuscitation, and the initial studies of antimicrobial therapy with burns. This overview describes the treatment of the Cocoanut Gove victims, and how it transformed the management of burns forever.

Silver in medicine: a brief history BC 335 to present.

Silver is a naturally occurring element. Similar to other metals, the ionized form of silver (Ag(+1)) has known antimicrobial properties. A number of wound dressings incorporating silver ion or silver compounds have recently been developed and marketed. In addition, the antimicrobial effects of silver are currently being promoted in consumer products such as clothing and household appliances. The present use of silver in medical and consumer products has prompted concerns for potential toxicity and ecological effects, including induction of microbial resistance to antibiotics. These concerns ignore the fact that silver has been used for medicinal purposes for several thousand years. A historical review of the uses of silver in medicine is presented.

[Forensic aspects of thermal changes in human head hair]. / Thermische Veränderungen an menschlichen Kopfhaaren aus Sicht der forensischen Medizin.

Under experimental conditions, head hairs of individuals of different age were exposed to defined increases of temperature up to 450 degrees C and examined by transmitted- and reflected-light microscopy with and without polarization. Preliminary tests had shown that the hair changes alone do not allow conclusions as to the temperature acting on the hair. Especially in the range of 200 to 300 degrees C, the temperature gradient during the heating process and the exposure time were additional influencing factors. Thick hair and hair with a high water content showed more pronounced thermal changes than thin hair. Elasticity and permeability of the cuticle and the cementing substance (cell membrane complex CMC) are also relevant factors. When heating head hairs lacking a medulla, a multiform pseudo-medulla formed under certain conditions. In the presence of thermally induced structural disturbances (e.g. by using hair straighteners), foreign substances can penetrate more easily into the hair shaft from outside. The possibility of such exogenous contamination has to be taken into consideration when performing chemical and toxicological analyses of hair.