STATISTICAL RETROSPECTIVE ANALYSIS OF BURN PATIENTS ADMITTED TO AUBMC BETWEEN 1982-87 (TOWARDS A CHANGING FUTURE IN BURN MANAGEMENT)

Jiz F, Kaddoura 1, Saba M.

American University of Beirut Medical Center, Lebanon

SUMMARY. Between the years 1982 and 1987, 330 cases of bum patients were admitted to the American University of Beirut Medical Center (AUBMC). A statistical analysis of these cases was performed. A retrospective study was carried out to analyse the incidence, bum aetiological factors, mode of treatment, hospital stay and mortality as related to the extent and the depth of the injury. This basic review will be the nidus for a future double blind prospective study over the coming two years using the "modem" early excision of bum. eschars and early grafting which has been implemented at the AUBMC since July 1987, the beginning of a uniform burn protocol management.

A retrospective study was conducted at the American University of Beirut - Medical Center to statistically analyse burn cases admitted between the years 1982-1987.
Criteria were set to accept or reject a case in this study (Table 1). These criteria included a complete chart, more than 10% Total Body Surface Area (TBSA) bum in patients less than 14 years of age, and more than 15% TBSA bum in patients 15 years old and above. The last criterion was admission to hospital at the most 48 hours after the injury. A few points should be mentioned about the treatment of bum patients in this period (Table 2).

1. Late surgical debridement of the burn wound, if any.
2. Erratic use of different formulae of fluid resuscitation.
3. Admitting patients to regular ward beds without intensive care facilities.
4. The routine pre-sepsis use of broad spectrum antibiotics.
5. Absence of proper bum team experts.
6. Absence of devoted bum management specialist nurses.

Out of 330 cases studied, only 165 fulfilled the above mentioned criteria (Fig. 1). The male to female ratio was 2:1 (Fig. 2). The distribution of cases according to age was nearly the same for the 0-14 years age group (36.4%), the 15-29 years age group (35.2%), and for the 29+ year age group (28.4%) (Fig. 3). The highest number of patients was in the 0-4 years age group (21.2%) (Fig. 4), probably because of referrals to AUBMC which is one of the very few hospitals capable of handling paediatric bum cases in Lebanon. More than 80% of the patients in this category sustained their bums by hot fluids.

Table 1 CRITERIA SET TO STUDY BURN CASES

• COMPLETE CHARTS
• MORE THAN 10% TI1SA BURN FOR PATIENTS UNDER 14 YEARS
• MORE THAN 15% TI1SA BURN FOR PATIENTS OLDER THAN 14 YEARS
• ADMISSION TO HOSPITAL LESS THAN 48 HOURS AFTER BURN

Table 2 PRE-1987 BURN TREATMENT

1. LATE SURGICAL DEBRIDEMENT OF THE BURN WOUND, IF ANY
2. ERRATIC USE OF DIFFERENT FORMULAE OF FLUIDRESUSCITATION
3. ADMITTING PATIENTS TO REGULAR WARD BEDS WITHOUT INTENSIVE CARE FACILITIES
4. THE ROUTINE PRE-SEPSIS USE OF BROAD SPECTRUM ANTIBIOTICS
5. ABSENCE OF PROPER BURN TEAM EXPERTS
6. ABSENCE OF DEVOTED BURN MANAGEMENT SPECIALIST NURSES

Twenty-five percent of patients fell in the 20-29 year age group reflecting the high incidence of burns in the working age groups. Of interest is that 50% of these patients had their bums secondary to blast injuries, a unique result of the turbulent Lebanese situation. The commonest bum patient admitted fell in the category of 15~19% TBSA bum, with almost 50% of patients falling in the 10-39% TBSA bum category of patients (Fig. 5).
The total cumulative hospital stay was 4580 days with an average of 27 days per patient. The longest hospital stay was 168 days. As the % TBSA Burn increases, the hospital stay decreases reflecting the increased mortality for major burns (Fig. 6).

Fig. 1. 330 burn cases admitted to AUBMC 1982-87. Fig. 2. Male to female ratio 2A. Fig. 3. Distribution of cases according to age groups. Fig. 4. Actual number of patients in each age group (1982-1987). Fig. 5. Actual number of patients in each category of % TI3SA bum. Fig. 6. Average hospital stay for each category of bum patients. Fig. 7. Outcome of burn cases. Fig. 8 GRID OF MORTALITY PROBABILITIES (1982-1987) FOR VARIOUS COMBINATIONS OF AGE AND AREA OF BURN AT AUBMC

The overall mortality rate in this series was 27.2% (Fig. 7) and a mortality probability grid was constructed to help in giving rough figures of mortality for new patients (Fig. 8).

In 1987, a burn treatment manual was introduced in our hospital to unify the acute management of bum patients. Along with this, early tangential excision of burn eschars and grafting was commenced. It is hoped that the unified treatment of the burn patients, early surgical treatment of their burns and a new team approach will improve survival and shorten hospital stay. A study to evaluate this modem regimeni of burn treatment is currently under way.

RÉSUMÉ. Pendant la période 1982/1987, 330 cas de brûlures ont été traités à l'American University of Beirut Medical Center (AUBMC). On a effectué une analyse statistique de ces cas ainsi qu'une étude rétrospective pour analyser l'incidence, les facteurs étiologiques, les modalités du traitement, la durée de l'hospitalisation et la mortalité en relation à l'étendue et à la profondeur de la brûlure. Ces résultats constitueront la base pour une étude perspective en double aveugle pendant les deux prochaines années, utilisant l'excision précoce "moderne" des escarres et la greffe précoce, ce qui représente - dès le mois de juillet 1987 - le commencement d'une gestion uniforme du protocole des brûlures.