Cambios epidemiológicos en niños quemados, a 10 años de seguimiento / Epidemiological changes in burned children. A 10-year follow-up

Introducción El objetivo de este estudio fue comparar la incidencia de quemaduras y características epidemiológicas en niños de una comuna de Santiago de Chile en 10 años. Pacientes y método Estudio analítico, mediante revisión de fichas clínicas de menores de 15 años provenientes de la comuna de Pudahuel, que consultaron por quemaduras en Corporación de Ayuda al Niño Quemado (COANIQUEM) de Santiago durante 2011. Se compara con resultados de otro similar realizado en 2001 en esta misma zona. Resultados En 2011 ingresaron 440 niños, tasa de incidencia de 700/100.000 < 15 años (IC 95%: 635-765), con disminución de 25% respecto al 2001 (tasa de incidencia 933/100.000; IC 95%: 856-1.010). El 52% era de sexo masculino, 64,5% menores de 5 años; un 88% se quemó en el hogar propio, del vecino o de un familiar. Hubo un cambio significativo del agente causal, aumentando su importancia relativa objeto caliente (27,1%), situación que se refleja en el mecanismo de la quemadura, al aumentar el contacto con la estufa o el calefactor y emerger el contacto con la plancha de pelo y el tubo de escape de la moto. Localización más frecuente fue la mano, aumentando 30,3%. Un 66,4% presentó una extensión de la quemadura < 1% de la superficie corporal total (2001, 61%). Hubo un descenso significativo del 54% de las quemaduras profundas. El 23,2% ingresó en rehabilitación, proporción similar al año 2001. La tasa de hospitalización y/o injerto disminuyó de 104/100.000 a 62/100.000 < 15 años (IC 95%: 43-82). Conclusiones La incidencia de quemaduras disminuyó en el periodo estudiado y el objeto caliente adquiere predominancia como agente causal. La disminución de la tasa de hospitalización y/o injerto indica una menor gravedad de las quemaduras.

Introduction The aim of the study was to compare the incidence and epidemiological characteristics of burns suffered by children in a district of Santiago of Chile over a period of ten years. Patients and method An analytical study was conducted by checking through the medical files of children under 15 years of age from Pudahuel district who were admitted with burns to the Santiago Aid to Burned Children Corporation (COANIQUEM) during 2011. A comparison was made with the results obtained in a similar study performed in the same district in 2001. Results In 2011, 440 children were admitted, with an incidence rate of 700/100,000 < 15 years old (95% CI: 635-765), a decrease of 25% compared to 2001(Incidence rate of 933/100,000; 95% CI: 856-1010). There were 52% males, 64.5% under 5 years old of age, 88% burned at home, or at other houses where they are been taking care of. There was a significant change in the causative agent, and included, increasing by their relative importance; hot objects (27.1%). The mechanism that mostly increased in occurrence were contact with stoves or heaters, and also emerge that caused by hair iron, and motorcycle exhaust. The most common location was the hand, increasing by 30.8%, and 66.4% showed an extension of the burn of < 1% total body surface area (2001, 61%). A significant decline of 54% of deep burns was observed, and 23.2% were admitted to rehabilitation, a similar proportion to 2001. The rate of hospitalization and/or skin graft decreased from 104/100,000 to 62/100,000 < 15 years old (95% CI: 43-82). Conclusions Burns incidence has decreased. Hot objects are now the main causal agent. The decrease in the rate of hospitalization and/or graft indicates a lower severity of burns.

Epidemiología del paciente gran quemado adulto en Chile: experiencia del Servicio de Quemados del Hospital de la Asistencia Pública de Santiago / Sociodemographic/clinical characteristics and outcomes of patients admitted to the National Burn Center of Chile

Background: Approximately 150 subjects per year suffer severe burns in Chile. Aim: To analyze sociodemographic/clinical features and outcomes of severely burned patients. Material and Methods: Retrospective cohort study of 936 patients aged 47 ± 20 years (66% males), admitted to the National Burn Center of Chile between 2006 and 2010. Sociodemographic/clinical and burn variables and outcomes were studied. Results: Mean total percentage of body surface area burned was 27 + 20%. A quarter of the patients had social features that could jeopardize rehabilitation. Fire was the burning agent in 73%, which along with electricity presented greater lethality (p < 0.01). Inhalation injury was diagnosed in 22% of the patients. Twenty eight percent of patients had impaired consciousness at the moment of the accident, leading to larger burns, higher incidence of inhalation injury and greater lethality. Lethality for severe, critical and exceptional survival groups was 8.4,37.7 and 70.4%, respectively. Conclusions: Severely burned patients in Chile are mainly males at working age. Fire is the main agent and 28% had impaired consciousness, which was associated with an increase in the severity of burns. Knowledge of the characteristics and outcomes of the patients is important to implement prevention and treatment strategies adjusted to the national reality.

El GES promueve la equidad en el tratamiento del gran quemado de la tercera edad / Analysis of the explicit guarantees of health inclusion criteria for elderly burned patients

Background: The guidelines for the treatment of severely burned patients, ineluded in the explicit guarantees in health care (GES), accept having a Garces' index over 70, among others, as an inclusion criterion. This criterion allows elderly patients with small total burn surface area (TBSA) to have access to GES. Aim: To analyze if a universal access to GES for this group of patients is justified. Material and Methods: Revision of medical records of adult patients admitted to a burn service. Causative agent, TBSA, associated illnesses and outcome were compared between 218 subjects aged 65 years or more and 720 subjects aged less than 65 years. Results: Older subjects had smaller TBSA, a lower prevalence of inhalation injury and more associated diseases. Their lethality was three times greater than that of younger subjects and their risk of dying. When adjusting for TBSA, presence of inhalation injury and associated diseases was 11 times greater. Conclusions: The inclusion of older people with lower TBSA in the explicit guarantees in health is fully justified, considering the lethality of burns in this age group.

Aspectos evolutivos da cicatrizaçäo em queimaduras cutâneas tratadas com curativos hidrocolóides: estudo experimental em cobaias / Evolutive aspects of healing in cutaneous burns treated with hydrocolloid dressings: experimental study in guinea pigs

O objetivo da pesquisa foi estudar os efeitos dos curativos hidrocolóides em queimaduras cutâneas profundas tratadas com curativos hidrocolóides. Foram utilizadas 80 cobaias divididas em dez grupos de dez cada, estudados com 7, 14, 21 e 28 dias de evoluçäo após a queimadura. O curativo hidrocolóide foi colocado em uma das duas queimaduras provocadas por placa de cobre aquecida por quinze segundos, atingindo a temperatura de 120ºC e mantida sobre a área dorsal do animal por quinze segundos. A outra área permaneceu exposta. A posiçäo do curativo foi alternada e metade da amostra recebeu o curativo hidrocolóide caudalmente, e a outra cefalicamente. A cada sete dias realizou-se a troca do curativo e observaram-se os aspectos macroscópicos cicatrizaçäo e desbridamento da escara, que foram mais precoces nas lesöes tratadas. O estudo microscópico revelou reaçöes inflamatórias agudas e crônica abreviadas e menos intensas, fibrose discreta e regeneraçäo epitelial mais representativa no grupo tratado em relaçäo ao grupo controle