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1.
J Trauma Acute Care Surg ; 91(2S Suppl 2): S233-S240, 2021 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-34324475

RESUMO

BACKGROUND: Role 2 medical treatment facilities (MTFs) are frequently located in austere settings and have limited resources. A dedicated assessment of burn casualties treated at this level of care has not been performed. Therefore, the objective of this study was to characterize burn casualties presenting to role 2 MTFs in Afghanistan, along with the procedures they required, complications, and mortality to begin understanding the resources consumed by their care. METHODS: We identified burn casualties from the Department of Defense Trauma Registry (DODTR). The inclusion criteria were (1) experienced burn injuries in Afghanistan between October 2005 and April 2018 and (2) had documentation of treatment at role 2 in the DODTR. We excluded casualties with only first-degree burns, not otherwise specified burns, or only corneal burns. Casualty demographics, injury characteristics, procedures, and outcomes were reported. RESULTS: We identified 453 burn casualties with a median (interquartile range) Injury Severity Score of 10 (4-22) and percent total body surface area burned of 11 (5-30). There were 123 casualties (27.2%) with inhalation injury, and the casualties experienced 3,343 additional traumatic injuries and needed 2,530 procedures. Casualties with documentation of resuscitation information received a median (interquartile range) of 1.9 (0.7-3.7) L of crystalloid fluids. Complications were documented in 53 casualties (11.7%). Final mortality was reported in 36 casualties (8.0%), and mortality at role 2 MTFs was reported in 7 casualties (1.5%). CONCLUSION: Burn casualties had many injuries and needed many procedures, including those related to airway management, resuscitation, and wound care. Given the urgency of these procedures, ensuring that there is enough equipment and supplies will be important in the future. Although infrequent, some casualties experienced complications. Factors that may influence resuscitation include injury severity, concomitant traumatic injuries, and available supplies. Obtaining more contextual information on the patient care environment will be useful going forward. LEVEL OF EVIDENCE: Epidemiological, level III.


Assuntos
Queimaduras/epidemiologia , Adulto , Campanha Afegã de 2001- , Afeganistão/epidemiologia , Queimaduras/mortalidade , Queimaduras/patologia , Queimaduras/terapia , Criança , Pré-Escolar , Feminino , Humanos , Escala de Gravidade do Ferimento , Masculino , Estudos Retrospectivos , Lesões Relacionadas à Guerra/epidemiologia , Lesões Relacionadas à Guerra/mortalidade , Lesões Relacionadas à Guerra/patologia , Lesões Relacionadas à Guerra/terapia , Adulto Jovem
2.
J Trauma Acute Care Surg ; 91(4): 736-747, 2021 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-34252062

RESUMO

BACKGROUND: Sepsis, major trauma, and severe burn injury are life-threatening critical illnesses that remain significant contributors to worldwide morbidity and mortality. The three underlying etiologies share pathophysiological similarities: hyperinflammation, hypermetabolism, and acute immunomodulation. The aims of this study were to assess the current state of long-term outcome research and to identify key outcome parameters between the three forms of critical illness. METHODS: This systematic review and meta-analysis (MA) were conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. PubMed was searched from January 1, 1975, to December 31, 2019. Studies were assessed for eligibility by independent reviewers. Inclusion criteria were studies reporting at least a 6-month follow-up of health-related quality of life and organ-specific sequelae within the three etiologies: severe burn injury, sepsis, and major trauma. RESULTS: In total, 125 articles could be included in the systematic review and 74 in the MA. The mean follow-up time was significantly longer in burn studies, compared with sepsis and trauma studies. The majority of patients were from the sepsis group, followed by burns, and major trauma studies. In the overall health-related quality of life, as assessed by Short Form 36 and European Quality-of-Life Index, the three different etiologies were comparable with one another. CONCLUSION: The effects of critical illness on survivors persist for years after hospitalization. Well-reported and reliable data on the long-term outcomes are imperative, as they can be used to determine the treatment choice of physicians and to guide the expectations of patients, improving the overall quality of care of three significant patient cohorts. LEVEL OF EVIDENCE: Systematic review and MA, level III.


Assuntos
Queimaduras/psicologia , Estado Terminal/psicologia , Qualidade de Vida , Sepse/psicologia , Sobreviventes/psicologia , Queimaduras/diagnóstico , Queimaduras/mortalidade , Queimaduras/terapia , Estado Terminal/mortalidade , Estado Terminal/terapia , Humanos , Unidades de Terapia Intensiva , Sepse/diagnóstico , Sepse/mortalidade , Sepse/terapia , Índice de Gravidade de Doença , Índices de Gravidade do Trauma , Resultado do Tratamento
3.
J Zoo Wildl Med ; 52(2): 555-563, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34130398

RESUMO

In recent decades, wildfires have increased in frequency and geographic scale across the globe. The human health implications and ecological succession after wildfires are well documented and studied, but there is a lack of empirical research about the direct effects of wildfires on wildlife. Recent wildfires have demonstrated the need to better understand animal burn injuries and innovations in veterinary burn treatment. An online survey was distributed to wildlife rehabilitation facilities internationally to collect baseline information about the number and type of burned wildlife cases admitted, treatments used, and survivorship of wildlife affected by wildfires. Approximately 80% (n = 49) of all respondents (n = 61) reported admitting cases of burned wildlife from 2015 to 2018. Respondents included facilities from six different countries and roughly 43% of facilities reported having a veterinarian on staff. Electrical burns were most commonly reported with 89% of respondents stating that they had seen electrical burns while 38% of respondents reported seeing wildfire-source thermal burns in wildlife patients. Respondents were asked about their frequency of use of different treatment methods. Bandages, colloid fluids, and opioids were used at significantly higher rates at facilities with veterinarians compared with facilities that did not report having a veterinarian; however, survival of burned wildlife patients did not significantly differ based on the factor of having a veterinarian on staff. Long-term and short-term complications were commonly reported for wildlife burn patients; 88% of facilities reported scarring, 81% reported alopecia, and 61% reported sepsis. Burned animals admitted to facilities were reported to have equal odds of dying and surviving. Burn care recommendations have changed considerably in recent decades. This study provided a unique opportunity to compare contemporary recommendations in human medicine with current methods used in wildlife rehabilitation facilities to identify potential areas of further investigation and improvement for wildlife medicine.


Assuntos
Animais Selvagens , Queimaduras/veterinária , Incêndios Florestais , Animais , Queimaduras/mortalidade , Queimaduras/patologia , Queimaduras/terapia , Coleta de Dados , Internacionalidade
4.
J Wound Care ; 30(6): 492-496, 2021 Jun 02.
Artigo em Inglês | MEDLINE | ID: mdl-34121430

RESUMO

OBJECTIVE: Stevens-Johnson syndrome (SJS) and its more severe counterpart, toxic epidermal necrolysis (TEN), are skin hypersensitivity reactions defined by epidermal blistering and necrosis. The exact pathophysiology of SJS/TEN is yet to be deciphered, but a number of risk factors have been identified including adverse drug reactions. The diagnosis of SJS/TEN is made on a clinical basis, and treatment consists of supportive care and occasionally immunosuppressants, such as cyclosporin, high-dose intravenous immunoglobulins and/or corticosteroids. Mortality rates can reach 20-25% in adults but are reduced with early intervention. To identify optimal treatment regimens, to better understand the patient cohort affected, and to help identify key risk factors for mortality, we report our experience with the treatment and management of SJS/TEN patients. METHODS: A retrospective review of consecutive patients with SJS and/or TEN admitted to a single burns centre in Germany, between 2008 and 2018, was conducted. The primary outcomes of demographics, clinical course, treatment and patient-reported outcomes were recorded and compared with a control group of patients with burns without a diagnosis of SJS/TEN. RESULTS: A total of 23 patients with SJS/TEN met the inclusion criteria: 17 (74%) with TEN; four (17%) with SJS/TEN overlap; and two (9%) with SJS. Of the patients, 14 (61%) were female and nine (39%) were male. Patient age ranged from 32-78 years (mean: 52 years). A matched cohort of 23 patients with burns served as the control group. All patients received standard of care with a multidisciplinary team. Compared with the control group, SJS/TEN patients had higher mortality rates (n=6, 26% versus n=8, 35%, respectively). The average age of death was 69 years in SJS/TEN patients versus 63 years in control group patients. Age and SCORTEN scores were significant predictors of mortality. CONCLUSIONS: SJS and TEN are rare but extreme reactions of the skin and mucosa, associated with high disease mortality rates. This 10-year single-centre retrospective review contributes to the bank of information for reviews evaluating the management of SJS/TEN patients.


Assuntos
Corticosteroides/uso terapêutico , Queimaduras/terapia , Imunoglobulinas Intravenosas/uso terapêutico , Imunossupressores/uso terapêutico , Síndrome de Stevens-Johnson/tratamento farmacológico , Cicatrização , Adulto , Idoso , Unidades de Queimados , Queimaduras/mortalidade , Feminino , Alemanha/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Síndrome de Stevens-Johnson/mortalidade , Resultado do Tratamento
5.
J Surg Res ; 265: 1-10, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-33862353

RESUMO

BACKGROUND: Severe burn injury activates shock, inflammation, and blood cell system, but inappropriate reactions may lead to adverse outcomes. Soluble Fas ligand (sFasL) participates in apoptosis and inflammatory response. The circulating sFasL levels we investigated in association with the burn severity, shock, inflammation, blood cells, and mortality in patients with severe burns. METHODS: A total of 56 patients with severe burns were recruited. The levels of sFasL and the biomarkers reflecting shock, organ damage, inflammation, and blood cells at 48 h postburn were analyzed. We compared the practical situation of patients that stratified by median sFasL levels and investigated the predictive value of sFasL for mortality. RESULTS: High circulating sFasL levels were associated with the higher degrees of burn index, shock index, lactate, N-terminal probrain natriuretic peptide, total bilirubin, blood urea nitrogen, creatinine, tumor necrosis factor-α, interleukin-1ß, interleukin-8, intercellular adhesion molecule 1, and complement 3, and the lower degrees of oxygenation index, lymphocytes, and platelets. Multiple linear regression analysis showed that the higher tumor necrosis factor-α (P < 0.001) and the lower oxygenation index (P = 0.031) and lymphocytes (P = 0.043) were associated with the higher sFasL. High sFasL (a unit is 50 ng/L) (odds ratio [OR] 5.50 [95% CI 1.04-29.20], P = 0.045) was an independent predictor of increased mortality by multivariate logistic regression analysis. CONCLUSIONS: High circulating sFasL at 48 h postburn in patients with severe burns reflect shock, proinflammatory response, organ damage, and lymphocyte reductions and predict 30-day mortality.


Assuntos
Queimaduras/sangue , Proteína Ligante Fas/sangue , Choque Traumático/sangue , Adulto , Biomarcadores/sangue , Queimaduras/mortalidade , Queimaduras/terapia , Estudos de Casos e Controles , China/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Ressuscitação , Índice de Gravidade de Doença , Choque Traumático/mortalidade , Choque Traumático/terapia
6.
J Forensic Sci ; 66(3): 940-946, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33522609

RESUMO

Data about homicidal burns remain scarce. Intentional burns are a challenging situation in the case of an individual found dead in a fire zone with no witness of the fatal act. This study aimed to analyze the victim profiles of homicidal burns in Northern Tunisia. It was a descriptive cross-sectional study with a retrospective data collection over 15 years (January 2005-December 2019). In total, 60 cases of homicidal burns were collected. The mean age was 40.22 ± 18.1 years (range 4-82 years). We noted a male predominance (sex ratio M/F = 1.3). Most of the victims were married (48.3%), unemployed (40%), and living in an urban area (63.3%). Homicidal burns occurred most frequently in private homes for female victims (80.8%) and in public places for male victims (31.4%) (p < 0.001). The reported motive varied according to the victim's sex; males were mostly assaulted by an acquaintance in an interpersonal conflict (47.1%), and females were mostly assaulted by an intimate partner while in a dispute (42.3%; p = 0.001). The median total body surface area (TBSA) that was burned was 60.4%, and burn injuries were observed mainly in the anterior part of the body. In 19 cases, the burns were associated with another type of trauma, from which the most common association was burning and stab wounds (12 cases). The identified pattern of homicidal burn casualties was similar to the reported data in Western countries and to homicides in general in Tunisia, suggesting that prevention measures should address those of intentional interpersonal violence.


Assuntos
Queimaduras/mortalidade , Vítimas de Crime/estatística & dados numéricos , Homicídio/estatística & dados numéricos , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Masculino , Estado Civil/estatística & dados numéricos , Pessoa de Meia-Idade , Motivação , Estudos Retrospectivos , Distribuição por Sexo , Tunísia/epidemiologia , Desemprego/estatística & dados numéricos , População Urbana/estatística & dados numéricos , Adulto Jovem
7.
Qual Life Res ; 30(7): 2071-2080, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-33638744

RESUMO

PURPOSE: To examine agreement between pediatric burn survivor self- and caregiver proxy-report on multiple PROMIS domains and examine factors associated with differences between self- and proxy-reports. METHODS: Children 8-17 years of age and their caregivers completed PROMIS measures (physical function, depression, peer relationships, pain interference, and anger) between 6 months and 15 years after injury. Self- and proxy-report scores were compared using Wilcoxon sign rank test, Cohen's effect size, and intraclass correlation coefficients (ICC) and by agreement across severity of symptoms based on recommended cutoffs. Ordinary least squares regression analyses examined child- (self-report score, age, gender, and ethnicity) and proxy-related (relationship to child) factors associated with score differences. RESULTS: Two hundred and seventy four child-caregiver pairs completed the PROMIS measures. Mean child age was 13.0 (SD:3) years. Caregivers reported significantly worse scores than the child on physical function, pain, and anger (all p ≤ 0.01). The effect sizes were small across all domains except physical function. Similarly, ICCs were all of moderate agreement. The percentage of dyads in agreement by severity groups was high with only 5%-9% of pairs discordant. Only higher self-report score was associated (all p < 0.05) with greater differences across all domains in regression analyses. CONCLUSIONS: This study supports the use of pediatric proxy PROMIS depression, physical function, peer relationships, pain interference, and anger scales in pediatric burn patients. Although agreement was moderate to good, assessing proxy-report alone as a surrogate should only be considered when self-report is not possible or practical. Caregivers typically report slightly worse severity of symptoms than children across all domains.


Assuntos
Queimaduras/psicologia , Vida Independente/normas , Pesquisa de Reabilitação/organização & administração , Adolescente , Queimaduras/mortalidade , Criança , Feminino , Humanos , Masculino , Qualidade de Vida/psicologia , Autorrelato , Inquéritos e Questionários , Sobreviventes , Estados Unidos
8.
Medicine (Baltimore) ; 100(5): e23968, 2021 Feb 05.
Artigo em Inglês | MEDLINE | ID: mdl-33592850

RESUMO

INTRODUCTION: This meta-analysis aimed to systematically review and evaluate randomized controlled trials (RCTs) and cohort studies examining the efficacy and safety of blood purification in the treatment of patients with deep burns. METHODS: The PubMed, Cochrane Library, and Embase databases and relevant references were systematically searched for RCTs and cohort studies published until the end of September 2020 to investigate the potential of blood purification in improving the prognosis of severely burned patients. The primary outcome of this systematic review was overall patient mortality; secondary outcomes included the incidence of sepsis and infection prevention (vital signs and routine blood tests). RESULTS: A total of 6 RCTs and 1 cohort study were included, with a total of 538 burn patients (274 patients who received blood purification and 264 control patients). Compared with patients who received conventional treatment, those treated with blood purification displayed significant 2-day reduction in mortality and sepsis with relative risks of 0.62 and 0.41, respectively (95% confidence intervals [CIs], 0.74-0.82 and 0.25-0.67, respectively; P < .05). In terms of vital signs and blood biochemistry, the respiratory rates and blood urea nitrogen levels of patients in the blood purification group 3 days post-treatment were significantly higher than those in the control group (randomized standard deviations (SMDs), 0.78 and 0.77, respectively; 95% CIs, 0.33-1.23 and 1.22-0.31, respectively; P < .05). However, there were no significant differences between groups on day 3 with regard to temperature (P = .32), heart rate (P = .26), white blood cell count (P = .54), or neutrophil count (P = .74), potentially owing to the small sample size or the relatively short intervention time. Heterogeneous differences existed between the groups with respect to blood urea nitrogen (SMD = -1.22; 95% CI, -2.16 to -0.40; P < .00001) and Cr (SMD = -3.13; 95% CI, -4.92 to -1.33; P < .00001) on day 7. No systematic adverse events occurred. CONCLUSIONS: Blood purification treatment for deep burn patients can significantly reduce the mortality rate and the incidence of complications.


Assuntos
Queimaduras/terapia , Hemofiltração/mortalidade , Plasmaferese/mortalidade , Adulto , Análise Química do Sangue , Queimaduras/complicações , Queimaduras/mortalidade , Estudos de Coortes , Feminino , Hemofiltração/métodos , Humanos , Incidência , Masculino , Plasmaferese/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto , Sepse/etiologia , Sepse/mortalidade , Resultado do Tratamento
9.
BMC Emerg Med ; 21(1): 1, 2021 01 06.
Artigo em Inglês | MEDLINE | ID: mdl-33407163

RESUMO

BACKGROUND: The progression of biomarkers over time is considered an indicator of disease progression and helps in the early detection of disease, thereby reducing disease-related mortality. Their ability to predict outcomes has been evaluated using conventional cross-sectional methods. This study investigated the prognostic performance of biomarkers over time. METHODS: Patients aged > 18 years admitted to the burn intensive care unit within 24 h of a burn incident were enrolled. Information regarding longitudinal biomarkers, including white blood cells; platelet count; lactate, creatinine, and total bilirubin levels; and prothrombin time (PT), were retrieved from a clinical database. Time-dependent receiver operating characteristic curves using cumulative/dynamic and incident/dynamic (ID) approaches were used to evaluate prognostic performance. RESULTS: Overall, 2259 patients were included and divided into survival and non-survival groups. By determining the area under the curve using the ID approach, platelets showed the highest c-index [0.930 (0.919-0.941)] across all time points. Conversely, the c-index of PT and creatinine levels were 0.862 (0.843-0.881) and 0.828 (0.809-0.848), respectively. CONCLUSIONS: Platelet count was the best prognostic marker, followed by PT. Total bilirubin and creatinine levels also showed good prognostic ability. Although lactate was a strong predictor, it showed relatively poor prognostic performance in burns patients.


Assuntos
Queimaduras/mortalidade , Biomarcadores , Estudos Transversais , Humanos , Prognóstico , Curva ROC , Estudos Retrospectivos
10.
J Surg Res ; 258: 265-271, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33039634

RESUMO

BACKGROUND: This global burden of burn injury is suffered disproportionately by people in low-income and middle-income countries, where 70% of all burns occur. Models based in high-income countries to prognosticate burn mortality treat age as a linearly increasing risk factor. It is unclear whether this relationship is similar in resource-limited settings. METHODS: We analyzed patients from the Kamuzu Central Hospital Burn Registry in Lilongwe, Malawi, from 2011 to 2019. We examined the relationship between burn-associated mortality and age using adjusted survival analysis over 60 d, categorized into four groups: (1) younger children <5 y; (2) older children 5-17 y; (3) adults 18-40 y; and (4) older adults >40 y. RESULTS: A total of 2499 patients were included. Most patients were <5 y old (n = 1444) with only 133 patients >40 y. Older adults had the highest crude mortality at 34.6% and older children with the lowest at 13%. Compared to younger children, the hazard ratio adjusted for sex, percent total body surface area, and operative intervention was 0.59 (95% confidence interval, 0.44, 0.79) for older children and 0.55 (95% confidence interval, 0.40, 0.76) for adults. Older adults were statistically similar to younger children. CONCLUSIONS: We show in this cohort study of burn-injured patients in a resource-limited environment that the relationship between mortality and age is not linear and that the use of age-categorized mortality prediction models is more accurate in delineating mortality characteristics. Categorizing age based on local burn epidemiology will help describe burn mortality characteristics more accurately, leading to better-informed management strategies aimed at attenuating burn mortality for different populations.


Assuntos
Queimaduras/mortalidade , Países em Desenvolvimento/estatística & dados numéricos , Mortalidade Hospitalar , Adolescente , Adulto , Fatores Etários , Criança , Pré-Escolar , Feminino , Humanos , Malaui/epidemiologia , Masculino , Estudos Retrospectivos , Adulto Jovem
11.
Burns ; 47(1): 228-233, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33280955

RESUMO

INTRODUCTION: There is increasing evidence that sex differences may influence pathophysiology after thermal injury and affect clinical outcomes. This study aimed to assess the relationships between sex, thermal injury, and inpatient mortality in a pediatric burn cohort in a resource-limited setting. METHOD: This is a retrospective analysis of data collected from the Kamuzu Central Hospital Burns Unit, in Lilongwe, Malawi, from May 2011 to December 2019 on all pediatric patients (≤12 years). We performed a bivariate analysis by sex comparing demographics, burn characteristics, surgical intervention, and mortality. Standardized estimates were adjusted using the inverse probability of treatment weights to account for confounding. Following weighting, odds of mortality based on sex were obtained via logistic regression modeling. RESULTS: A total of 1904 children were admitted with a male preponderance (n = 1065, 55.9 %). Overall, the median age was 3 years (IQR1-4). Females had a higher percent total body surface area (%TBSA) burn than males, 15 % vs. 13 % (p = 0.03), respectively. Flame burns were more frequent in females compared to males, 32 % and 23 %, respectively (p < 0.001). There were higher rates of surgical intervention in females than males (20.9 % vs. 16.7 %, p = 0.02). The propensity score weighted logistic regression predicting mortality revealed no difference in the odds of mortality based on sex (OR 1.12, 95 % CI 0.82-1.52, p = 0.5). CONCLUSION: We show males are just as likely to die from burns compared to females with similar injuries in this propensity-matched analysis. A lack of difference in mortality may be attributable to the similarities in the hormonal profile in the prepubescent child.


Assuntos
Queimaduras/mortalidade , Caracteres Sexuais , Adolescente , Superfície Corporal , Unidades de Queimados/organização & administração , Unidades de Queimados/estatística & dados numéricos , Queimaduras/epidemiologia , Criança , Pré-Escolar , Estudos de Coortes , Correlação de Dados , Feminino , Humanos , Lactente , Tempo de Internação/estatística & dados numéricos , Modelos Logísticos , Malaui/epidemiologia , Masculino , Pediatria/métodos , Pediatria/estatística & dados numéricos , Pontuação de Propensão , Estudos Retrospectivos
12.
Burns ; 47(1): 222-227, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33277092

RESUMO

INTRODUCTION: The burden of global trauma disproportionately affects low- and middle-income countries, with a high incidence in children. Thermal injury represents one of the most severe forms of trauma and is associated with remarkable morbidity and mortality. The predictors of burn mortality have been well described (age, % total body surface area burn [TBSA], and presence of inhalation injury). However, the contribution of the burn mechanism as a predictor of burn mortality is not well delineated. METHODS: This is a retrospective analysis of prospectively collected data, utilizing the Kamuzu Central Hospital (KCH) Burn Surveillance Registry from May 2011 to August 2019. Pediatric patients (≤12 years) with flame and scald burns were included in the study. Basic demographic variables including sex, age, time to presentation, %TBSA, surgical intervention, burn mechanism, and in-hospital mortality outcome was collected. Bivariate analysis comparing demographic, burn characteristics, surgical intervention, and patient outcomes were performed. Standardized estimates were adjusted using inverse-probability of treatment weights (IPTW) to account for confounding. Following weighting, logistic regression modeling was performed to determine the odds of in-hospital mortality based on burn mechanism. RESULTS: During the study period, 2364 patients presented to KCH for burns and included in the database with 1794 (75.9%) pediatric patients. Of these, 488 (27.6%) and 1280 (72.4%) were injured by flame and scald burns, respectively. Males were 47.2% (n = 230) and 59.2% (n = 755) of the flame and scald burn cohorts, respectively (p < 0.001.) Patients presenting with flame burns compared to scald burns were older (4. 7 ± 3.1 vs. 2.7 ± 2.3 years, p < 0.001) with greater %TBSA burns (17.8 [IQR 10-28] vs 12 [IQR 7-20], p < 0.001). Surgery was performed for 42.2% (n = 206) and 19.9% (n = 140) of the flame and scald burn cohorts, respectively (p < 0.001.) Flame burns had a 2.6x greater odds of in-hospital mortality compared to scald burns (p < 0.001) after controlling for sex, %TBSA, age, time to presentation, and surgical status. CONCLUSION: In this propensity-weighted analysis, we show that burn mechanism, specifically flame burns, resulted in a nearly 3-fold increase in odds of in-hospital mortality compared to scald burns. Our results emphasize flame and scald burns have major differences in the inflammatory response, metabolic profile over time, and outcomes. We may further utilize these differences to develop specialized treatments for each burn mechanism to potentially prevent metabolic dysfunction and improve clinical outcomes.


Assuntos
Queimaduras/mortalidade , Causalidade , Unidades de Queimados/organização & administração , Unidades de Queimados/estatística & dados numéricos , Queimaduras/epidemiologia , Criança , Pré-Escolar , Correlação de Dados , Feminino , Humanos , Incidência , Lactente , Tempo de Internação/estatística & dados numéricos , Malaui/epidemiologia , Masculino , Pontuação de Propensão , Estudos Prospectivos , Estudos Retrospectivos
13.
Burns ; 47(4): 930-943, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33148488

RESUMO

INTRODUCTION: Statistical and epidemiological data taken throughout decades show trends of the pathology of burns and its treatment. The aim of this study is to analyze the summarized epidemiological and clinical data of severe burn patients during the period 2009-2019 in order to acquire an accurate and recent picture of this pathology. This can create a basis for improving community health outcomes. MATERIAL AND METHOD: The study retrospectively analyzes the data of severe burn patients admitted in the Intensive Care Unit (ICU) of the Service of Burns and Plastic Surgery of the University Hospital Center in Tirana, Albania, from 2009 to 2019. SPSS 23 software is used for the conduction of the Descriptive and Inferential Statistics. Statistical significance is defined as p<0.05. RESULTS: Incidence rate of burn admissions which need ICU treatment in our data was 5.2 patients/100,000population/year. The mean age of our population was 24.9±25.5 years. The most frequent causes of burns in all patients were scalds (49.6%) followed by flame (39.5%), electrical (5.1%), chemical (5%) and with unknown cause (0.7%). Death rate from fire and burns for the period 2009-2019 was 0.3 patients per 100,000population/year. Overall mortality was 6.8%. The ABSI, Baux and R Baux scoring system remain accurate and valuable tools in the prediction of burn patient mortality. A probability of death chart for our service has been developed based on age and BSA (%) burned which needs to validate in the future. CONCLUSIONS: Etiology of burns have changed toward an increase in proportion of flame burns especially in adults and elderly population. Survival following severe burns has improved over the past 11 years even in patients with three risk factors (age ≥60, BSA (%) burned ≥40% and presence of inhalation burn). LA 50 for all patients was 80%. LOS/BSA (%) ratio is a more valuable indicator than LOS alone. Improvement in the treatment of severe burns is a combination of preventive health care, appropriate treatment protocols and improvements in equipment and infrastructure.


Assuntos
Queimaduras/complicações , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Albânia/epidemiologia , Área Sob a Curva , Superfície Corporal , Unidades de Queimados/organização & administração , Unidades de Queimados/estatística & dados numéricos , Queimaduras/epidemiologia , Queimaduras/mortalidade , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Unidades de Terapia Intensiva/organização & administração , Unidades de Terapia Intensiva/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Curva ROC , Estudos Retrospectivos
14.
Burns ; 47(1): 42-51, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33092898

RESUMO

OBJECTIVE: Despite improved mortality rates after burn injury, many patients face significant long-term physical and psychosocial disabilities. We aimed to determine whether commonly used mortality prognostication scores predict long-term, health-related quality of life after burn injury. By doing so, we might add evidence to support goals of care discussions and facilitate shared decision-making efforts in the hours and days after a life-changing injury. METHODS: We used the multicenter National Institute of Disability, Independent Living and Rehabilitation Research Burn Model System database (1994-2019) to analyze SF-12 physical (PCS) and mental component (MCS) scores among survivors one year after major burn injury. Ninety percent of the observations were randomly assigned to a model development dataset. Multilevel, mixed-effects, linear regression models determined the relationship between revised Baux and Ryan Scores and SF-12 measures. Additionally, we tested a model with disaggregated independent and other covariates easily obtained around the time of index admission: age, sex, race, burn size, inhalation injury. Residuals from the remaining 10% of observations in the validation dataset were examined. RESULTS: The analysis included 1606 respondents (median age 42 years, IQR 28-53 years; 70% male). Median burn size was 16% TBSA (IQR 6-30) and 13% of respondents sustained inhalation injury. Higher revised Baux and Ryan Scores and age, burn size, and inhalation injury were significantly correlated with lower PCS, but were not correlated with MCS. Female sex, black race, burn size, and inhalation injury correlated with lower MCS. All models poorly explained the variance in SF-12 scores (adjusted r2 0.01-0.12). CONCLUSION: Higher revised Baux and Ryan Scores negatively correlated with long-term physical health, but not mental health, after burn injury. Regardless, the models poorly explained the variance in SF-12 scores one year after injury. More accurate models are needed to predict long-term, health-related quality of life and support shared decision-making during acute burn care.


Assuntos
Queimaduras/mortalidade , Efeitos Adversos de Longa Duração/psicologia , Mortalidade/tendências , Adolescente , Adulto , Idoso , Queimaduras/epidemiologia , Feminino , Nível de Saúde , Humanos , Efeitos Adversos de Longa Duração/etiologia , Masculino , Pessoa de Meia-Idade , Modelos Biológicos , Prognóstico , Qualidade de Vida/psicologia , Sistema de Registros/estatística & dados numéricos , Sobreviventes/psicologia
15.
J Burn Care Res ; 42(1): 9-13, 2021 02 03.
Artigo em Inglês | MEDLINE | ID: mdl-33037435

RESUMO

For critically ill burn patients without a next of kin, the medical team is tasked with becoming the surrogate decision maker. This poses ethical and legal challenges for burn providers. Despite this frequent problem, there has been no investigation of how the presence of a next of kin affects treatment in burn patients. To evaluate this relationship, a retrospective chart review was performed on a cohort of patients who died during the acute phase of their burn care. Variables collected included age, gender, length of stay, total body surface area, course of treatment, and presence of a next of kin. In total, 67 patients met the inclusion criteria. Of these patients, 14 (21%) did not have a next of kin involved in medical decisions. Patients without a next of kin were significantly younger (P = .02), more likely to be homeless (P < .01), had higher total body surface area burns (P = .008), had shorter length of stay (P < .001), and were five times less likely to receive comfort care (P = .01). Differences in gender and ethnicity were not statistically significant. We report that patients without a next of kin present to participate in medical decisions are transitioned to comfort care less often despite having a higher burden of injury. This disparity in standard of care demonstrates a need for a cultural shift in burn care to prevent the suffering of these marginalized patients. Burn providers should be empowered to reduce suffering when no decision maker is present.


Assuntos
Queimaduras/mortalidade , Tomada de Decisões , Família , Assistência Terminal , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
16.
Burns ; 47(4): 805-811, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33168267

RESUMO

BACKGROUND: The presence of acute coagulopathy and its effect on prognosis in burn patients are unclear. No studies are extant verifying early coagulopathy before fluid administration in burn patients. The current study focused on arrival coagulopathy before volume resuscitation was begun in earnest. METHODS: Data from 137 burn patients transported directly to the hospital without fluid administration from January 2006 to December 2019 were analyzed retrospectively. RESULTS: The non-survival group had significantly increased age, total burn surface area (TBSA) burned, various scoring systems, prothrombin time-international normalized ratio (PT-INR), activated partial thromboplastin time (APTT), the presence of coagulopathy, and lactate levels compared to the survival group. In the logistic regression analysis, the incidence of coagulopathy was independently associated with mortality. The coagulopathy group had significant increases in TBSA burned, various scoring systems, PT-INR, APTT, lactate levels, and the mortality than the noncoagulopathy group. The prognostic burn index (PBI) was significantly correlated with PT-INR and APTT. We also found a significant correlation between the serum lactate and the PT-INR, APTT, and PBI. CONCLUSIONS: Acute coagulopathy of burn patients might be present on arrival to the hospital before fluid replacement which is an independent risk factor for in-hospital mortality.


Assuntos
Transtornos da Coagulação Sanguínea/mortalidade , Coagulação Sanguínea/fisiologia , Queimaduras/mortalidade , Queimaduras/terapia , Hidratação/normas , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Área Sob a Curva , Coagulação Sanguínea/efeitos dos fármacos , Transtornos da Coagulação Sanguínea/epidemiologia , Transtornos da Coagulação Sanguínea/etiologia , Queimaduras/epidemiologia , Feminino , Hidratação/métodos , Hidratação/estatística & dados numéricos , Humanos , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Curva ROC , Estudos Retrospectivos , Estatísticas não Paramétricas
17.
Burns ; 47(4): 863-872, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33248805

RESUMO

Risk stratification is of utmost importance in burn therapy. However, suitable bedside biomarkers to evaluate the emerging inflammatory response following burn injuries are missing. Serum cholinesterase (butyrylcholinesterase, BChE) has been shown to be a clinically relevant biomarker in acute inflammatory diseases including burns. In this observational cohort study BChE activity was measured by using point-of-care testing (POCT), a novel method in acute burn care. POCT measurements were performed at emergency room admission (ERA) of 35 patients and repeated 12, 24 and 48 h later. All patients or their legal designees gave informed consent. Patients with burn injuries showed sustained BChE activity reduction following hospital admission. BChE activity correlated negatively with burn injury severity, organ failure severity and intensive care unit resource requirements. BChE activity measured at ERA and 12 h later identified survivors and predicted 28-day patient outcome with noninferior efficacy compared to the abbreviated burn severity index (ABSI) scoring. Finally, POCT-measured BChE activity might complement ABSI scoring and possibly improve early risk stratification in acute burn care therapy.


Assuntos
Queimaduras/complicações , Colinesterases/análise , Técnicas e Procedimentos Diagnósticos/instrumentação , Avaliação de Resultados em Cuidados de Saúde/normas , Adulto , Idoso , Superfície Corporal , Unidades de Queimados/organização & administração , Unidades de Queimados/estatística & dados numéricos , Queimaduras/mortalidade , Colinesterases/sangue , Estudos de Coortes , Técnicas e Procedimentos Diagnósticos/normas , Técnicas e Procedimentos Diagnósticos/estatística & dados numéricos , Serviço Hospitalar de Emergência/organização & administração , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde/métodos , Avaliação de Resultados em Cuidados de Saúde/estatística & dados numéricos , Sistemas Automatizados de Assistência Junto ao Leito , Valor Preditivo dos Testes , Medição de Risco/métodos , Medição de Risco/normas , Medição de Risco/estatística & dados numéricos
18.
J Burn Care Res ; 42(1): 3-8, 2021 02 03.
Artigo em Inglês | MEDLINE | ID: mdl-32841333

RESUMO

Sarcopenia and frailty are associated with aging. In older burn patients, frailty has been associated with mortality and discharge disposition, but sarcopenia has not been examined. This study aims to investigate the relationship between frailty and computed tomography (CT)-derived sarcopenia with length of stay and mortality in older burn patients. Burn patients ≥60 years old admitted between 2008 and 2017 who had chest or abdomen CT scans within 1 week of admission were evaluated. Frailty was assessed using the Canadian Study of Health and Aging Clinical Frailty Scale (CFS). Sarcopenia was assessed on CT exams by measuring skeletal muscle index (SMI) of paraspinal muscles at T12 and all skeletal muscles at L3. The relationship between frailty scores and SMI with length of stay (LOS) and mortality was determined using logistic regression. Eighty-three patients (59 men; mean age 70.2 ± 8.5 years) had chest (n = 50) or abdomen (n = 60) CT scans. Mean TBSA = 14.3 ± 14.0%, LOS = 25.8 ± 21.3 days, CFS = 4.36 ± 0.99. Sixteen patients (19.3%) died while in the hospital. CT-derived measurement of SMI at T12 was significantly associated with LOS (P < .05), but not with mortality (P = .561). CT-derived metrics at L3 were not significantly associated with outcomes. CFS was not associated with LOS (P = .836) or mortality (P = .554). In older burn patients, low SMI of the paraspinal muscles at T12 was associated with longer LOS.


Assuntos
Queimaduras/complicações , Tempo de Internação/estatística & dados numéricos , Sarcopenia/diagnóstico por imagem , Sarcopenia/etiologia , Tomografia Computadorizada por Raios X , Idoso , Queimaduras/mortalidade , Feminino , Fragilidade , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes
19.
Burns ; 47(3): 576-586, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-32861535

RESUMO

Despite criteria to guide intubation from the American Burn Association (ABA), concerns remain regarding over-intubation of burns patients. The purpose of this study was to review appropriateness of intubation at a UK regional burns centre over a 5-year period. A 5-year retrospective review of adult patients admitted to the Manchester Burns Centre who underwent intubation at or prior to admission was performed. Intubations for non-burn indications or burns >40%TBSA were excluded. Patient demographic and burn characteristics data were extracted from medical records. Indications for intubation were compared to ABA and Denver criteria. 47 patients were identified, of which 40 met inclusion criteria for analysis. 72.5% and 95% of these patients met ABA or Denver criteria respectively. 30.8% of patients were extubated within 48 h. 50% patients extubated within 48 h had ≤1 indication for intubation or negative laryngoscopy. Complications related to intubation and ventilation were noted in 37.5% of patients, with ventilation associated pneumonia (VAP) being the most common occurring in 27.5%. 95% of patients fulfilled recognised criteria for intubation. However, 30% were extubated within 48 h, suggesting potentially avoidable intubation. This study suggests current intubation criteria may over-estimate risk of airway compromise and supports results from non-UK studies that a proportion of patients may be suitable for close observation rather than early intubation.


Assuntos
Unidades de Queimados/estatística & dados numéricos , Queimaduras/terapia , Intubação Intratraqueal/estatística & dados numéricos , Adolescente , Adulto , Idoso , Unidades de Queimados/organização & administração , Queimaduras/epidemiologia , Queimaduras/mortalidade , Inglaterra/epidemiologia , Feminino , Humanos , Intubação Intratraqueal/métodos , Laringoscopia/instrumentação , Laringoscopia/métodos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
20.
Burns ; 47(3): 714-720, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-32878699

RESUMO

BACKGROUND: Previous studies about burns mortality are often exclusively based on hospital and burn centre data. National population-based reports on this topic are rather limited. The aim of this study was to analyse sex- and age-specific mortality rates of burns in Spain during the period 1979-2018. METHODS: Age-standardised burns mortality rates were calculated from death records and mid-year population data were provided by the Spanish National Statistics Institute. Joinpoint regression analyses were used to identify significant points of change in trends over time and to compute average annual per cent change (AAPC). Age, period and cohort effects were also analysed. RESULTS: Mortality due to burn injury decreased in both sexes between 1979 and 2018: from the first quinquennium of this period up to the last one age-adjusted mortality rates decreased from 1.37 to 0.49 per 100,000 in men and from 0.96 to 0.26 per 100,000 in women. CONCLUSIONS: Burns mortality rates in Spain have been decreasing during the last decades. Promotion of primary prevention measures should continue.


Assuntos
Fatores Etários , Queimaduras/mortalidade , Mortalidade/tendências , Fatores Sexuais , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Unidades de Queimados/organização & administração , Unidades de Queimados/estatística & dados numéricos , Queimaduras/epidemiologia , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Espanha/epidemiologia
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