Until now, studies based either on single hospital data or on the sampling of specific groups of hospitalized burns victims in Taiwan have provided only minimal epidemiological information. The purpose of this study is to provide additional data on the epidemiology of hospitalized burns patients in this country. The data come from information supplied by 34 contracted hospitals. The study time course covered the 2-yr period July 1997-June 1999. Patient characteristics (age, sex, education level, etc.), causes and severity of injury, and medical care measures were considered. Altogether, 4741 patients were included in the study. The majority of hospitalized patients (67%) were male. The age distribution showed peaks in the age groups 0-5 and 35-44 yr. Regarding time of day of the burns, injuries occurred more frequently from 10 to 12 a.m. and from 4 to 6 p.m. Injuries suspected to be the result of suicide, homicide, or child abuse accounted for 4.8% of hospitalized cases. More than 48% of the cases occurred in the home. The main category of burn injury was scalding, followed by naked flame, explosion, electrical burns, and chemical burns due to caustic or corrosive substances. The mean percentage of total body surface area for adults was 19% and for young children 12%. The average length of hospital stay was 18 days. In conclusion, it can be said that children under 5 yr and adults between 35 and 44 yr are two high-risk groups for burn injuries. Prevention programmes for reducing the risk of burn injuries during cooking and eating procedures are required, especially for parents with young children.
Chien W.-C., Pai L., Lin C.-C., Chen H.-C.
Burns, 29: 582-8, 2003
Nitric oxide is a diatomic mediator liberated on oxidation of L-arginine by the nitric oxide synthase family of enzymes. Possessing complex, wide-ranging functions in vivo, it has been implicated in the development of the profound inflammatory response that occurs following cutaneous burn injury. Also, dysregulation of nitric oxide synthase activity has been associated with multiple organ failure in human burn patients and it may therefore represent a novel therapeutic target in such circumstances. This article considers the role of nitric oxide in inflammation, with particular reference to the acute post-burn inflammatory response. The maintenance of microvascular haemostasis, leukocyte recruitment, and remote organ dysfunction following thermal injury are discussed.
Rawlingson A.
Burns, 29: 631-40, 2003
Impairment ratings are often reported for traumas and various other conditions but seldom for burns. This study sets out to report impairment considered prospectively at our burns centre, to relate this impairment to assessments of psychosocial and functional outcome, and to compare these data to similar data from another burns centre in order to verify that rating impairments are standardized and that the impairments are similar. We studied 139 patients from the University of Washington Burn Center and 100 patients from the University of Texas Southwestern Burn Center. The average whole person impairment ratings at the University of Washington were 17%, and this correlated with total body surface area burned and days off work, but did not correlate with the Brief Symptom Inventory, the Functional Independence Measure, the Short-Form 36-Item Health Survey, the Satisfaction With Life Scale, or the Community Integration Questionnaire. Average whole person impairment ratings at the University of Texas Southwestern Burn Center were similar in 19% of cases. However, several components of the impairment ratings differed at the two institutions. To minimize this variation, we recommend the use of the skin impairment definitions contained in the fifth edition of the Guides to the Evaluation of Permanent Impairment (or more recently published versions of the Guides) and the inclusion of sensory impairment in healed burns and skin grafts in skin impairment.
Costa B.A., Engrav L.H., Holavanahalli R., Lezotte D.C., Patterson D.R., Kowalske K.J., Esselman P.C.
Burns, 29: 671-5, 2003
Fibrin glue is a very good template for cellular migration. It has been shown to be an effective delivery system for cultured autologous keratinocytes. We investigated whether fibrin glue produced any benefit on the percentage of epithelial cover when culture autologous keratinocytes were sprayed onto a freshly debrided wound bed. Three pigs were used in the study. These were used to provide 18 full-thickness, vertically orientated wounds, each 4 cm in diameter and isolated in polytetrafluoroethylene chambers in order to prevent re-epithelialization from the wound margins. Eight wounds were sprayed with cultured autologous keratinocytes suspended in 2 ml culture medium, and eight wounds were sprayed with cultured autologous keratinocytes suspended in 1 ml of the fibrin/aprotinin component of Tisseel fibrin glue (Baxter) mixed with 1 ml of culture medium. In the latter group, the thrombin component of the fibrin glue kit was applied to the wound bed immediately before grafting. The remaining two wounds were used as controls and sprayed with culture medium or fibrin glue without cells. The epithelial cover was calculated in whole-wound biopsies after three weeks, using image analysis, histology, and immunohistochemistry. The fibrin glue cell suspension appeared to spread more evenly over the wound surface, with no pooling in the wound’s lower aspect. The mean epithelial area after three weeks in the fibrin group was however 1.6 cm2 per wound compared with 1.8 cm2 in the non-fibrin group, as measured by image analysis of digital photographs. No statistically significant difference was observed between the two groups (p = 0.802). This unexpected result was confirmed by the histological analysis of the wound biopsies, with a good correlation between histological and image analysis data (R = 0.967). There was no perceptible difference in the quality of the epithelium on histological and immunohistological analysis of either group.
Currie L.J., Martin R., Sharpe J.R., James E.
Burns, 29: 677-85, 2003
Statistics from Egypt have recently shown that elderly persons make up 5.8% of the general population. Elderly patients remain a high-risk group in all burn units. This prospective study considered geriatric burn patients (60 years and older) attended in our centre between May 1995 and October 2001. Of the 4220 patients seen during this period, 97 (2.3%) were elderly, and 63 (7.1%) of the total number admitted (880) were geriatric. Of the 97 elderly burn patients treated during the study period, 31 died (mortality rate, 31.9%). Other epidemiological data - duration of hospitalization, seasonal and day/hour variation in burn incidence, burn causes and accident sites - are presented, and suggestions for management and prevention are also made.
Mabrouk A., Maher A., Nasser S.
Burns, 29: 687-90, 2003
For the last nine years, the Prefecture of Akita has had the highest suicide rate in all Japan. In order to gather further information on suicide attempts by self-immolation in Akita, we performed a statistical analysis of patients in this prefecture who had attempted to burn themselves. Over the past six years, 541 patients suffering from burns were transferred to medical emergency units. Of these, 35 (6.5%) had attempted self-immolation. The majority were aged between 20 and 60 years, with women over 50 years of age outnumbering men in the same age group. All the 35 patients had sustained flame burns. The total burn surface area, burn index, rate of inhalation injury, and mortality rate were all significantly higher in patients who had attempted self-immolation than in those with non-suicidal burns. Most of the self-immolation attempts (68.6%) were made indoors. As the Japanese are not, generally speaking, a very religious people, training to help them to cultivate a philosophy of life and educating them in moral science to help them form a personal view of life and death may be necessary to prevent suicides.
Hajime Nakae, Ya Juan Zheng, Hiroshi Wada, Kimitaka Tajimi, Shigeatsu Endo
Burns, 29: 691-6, 2003
The objective of this paper was to compare insulin-like growth factor (IGF-I) levels obtained in two groups with different methods of assessing compliance. Children who had suffered burns children randomly received a daily injection of 0.05-0.1 mg/kg per day of recombinant human growth hormone (rhGH) or a placebo. The study involved 125 children (age range, 6 months-17 yr) with total body surface area burns > 40%. Baseline levels of IGF-I were obtained at the time of hospital discharge, when daily injections of rhGH or the placebo were initiated. The assessment of IGF-I levels was repeated at 3-month intervals for one year. A directly monitored group met research staff every day and witnessed the preparation and injection of the study drug. A self-reported group completed a Self-Reported Compliance Questionnaire (SRCQ), which assessed compliance with the drug regimen. A compliance of at least 85% (injections reported administered/maximal total injections possible) was accepted as being compliant. The data were analysed using a one-way ANOVA followed by a Student Newman-Kuels test, the results being given as means ± S.E.M. It was found that the percentage change in IGF-I levels between 6 and 9 months in the self-reported (22.7 ± 7.9%) and the monitored groups (21.9 ± 8.6%) was similar. In contrast, the percentage change in IGF-I levels in the placebo group was significantly decreased (-5.6 ± 6.3%). It is concluded that self-reported scores via an SRCQ is a potentially useful and valid method of assessing compliance of rhGH injections, considering that both reported and directly monitored methods yielded similar changes in IGF-I levels.
Burns, 29: 697-701, 2003
Wilkins J.P., Suman O.E., Benjamin D.A., Herndon D.N.
Among the most innovative and promising new developments in the treatment of partial- and mixed-thickness burns are membranous dressings. This study presents data regarding a randomized prospective comparative study on a carboxymethylcellulose-based dressing, Hydrofibre®, and glycerolized human allograft skin. Over a two-year period, 80 patients (40 for each material) were enrolled in the trial. Study wounds (< 10% TBSA) that had not re-epithelialized after 14 ± 3 days were debrided and grafted or, if small enough, managed with a topical antimicrobial agent. The mean total TBSA was 8.3 ± 5.2%, study burn was 3.7 ± 2.0% in the Hydrofibre® group and 7.3 ± 4.3% total, 3.4 ± 2.1% study burn in the allograft skin group. There were no significant differences between the groups as regards the number of patients with superficial/deep burns. In both groups about two-thirds of the patients healed completely with the dressings applied (24/40 versus 27/40 for Hydrofibre® versus allograft skin, respectively). A higher incidence of post-study excision and grafting was however observed in the Hydrofìbre® group (45% versus 15% in the allograft skin group, p = 0.004, Mann-Whitney). At 10 weeks, there were no significant differences in scar colour, pigmentation, pliability, height, or itching. Skin elasticity was significantly better in the allograft group (p = 0.010, Wilcoxon). These differences were not found at 6 months and one year. The incidence of hypertrophy after 6 months was higher (but not significantly) in the Hydrofibre® group than in the allograft skin group (52.5% versus 30%, p = 0.09, chi-square). In view of these results, we prefer to use allograft skin for the category of larger burns of mixed depth that we usually see in burn centres. However, in partial-thickness and small burns, Hydrofibre® can be the first choice in treatment.
Vloemans A.F.P.M., Soesman A.M., Suijker A., Kreis R.W., Middelkoop E.
Burns, 29: 702-10, 2003
Although Stenotrophomonas maltophilia is rarely responsible for clinical infections, it constitutes a significant nosocomial pathogen, especially in immunocompromised patients. This paper presents the first case of a generalized infection caused by S. maltophilia that included bacteraemia and wound and respiratory tract infection in a patient suffering from burns. Given the emergence of S. maltophilia nosocomial infections, especially in burn patients, isolation of the bacterium from blood cultures should prompt the initiation of adequate antibiotic treatment.
Dalamaga M., Karmaniolas K., Chavelas C., Liatis S., Matekovits H., Migdalis I.
Burns, 29: 711-3, 2003
Domestic vacuum cleaners can cause harm in various ways. Like any electric appliance they can cause both electrical and thermal injuries, and there have also been recent reports of friction burns due to the brush system that lifts dust from the carpet. An account is given in this article of the management of seven children with vacuum-cleaner friction burns. Six of the children sustained full-thickness burns, and four were treated operatively. Some indications for surgery are outlined and important accident prevention strategies are highlighted.
Grob M., Josty I.C., Soldin M.G., Dickson W.A.
Burns, 29: 714-6, 2003