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Volume XXX |
Number 2 |
June 2017 |
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Summaries
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EPIDEMIOLOGY AND OUTCOME OF 2,590 BURNED PATIENTS IN NORTHWEST IRAN
(Hosseini S.N., Rashtchi V., Kamali K., Moghimi M.H. - Iran)
Burns are calamities with considerable morbidity and mortality rates. We attempted to examine the epidemiology of burns in Zanjan city, in northwest Iran, by a systematic study of existing information. The medical files of 2,590 thermal burn patients treated in our hospital in Zanjan city, Iran, from December 2010 to November 2016 were studied. Patient information, including age, sex, burn degree, season, cause of burn, hospital stay and treatment results were analyzed. About 65% of the patients were male (n=1691). Most burns (92.8%) were less than 30% total body surface area. Mean age and hospital stay were 25.4 years old and 9.1 days, respectively. The most common causes of burn were hot liquids, gas explosion and fire, respectively. Except for self-immolation, which was more common among men, there was no significant relationship between cause of burn and the studied variables. The six-year mortality rate was 2.9%, and was more common in the years 2011 to 2013. In addition, distribution of causes of burn had a significant trend (variation). Fire burn had a decreasing trend and gas and chemical burn had increasing trends in this period. In northwest Iran the causes of burn changed over the six years. Chemical burns, gas explosion burns and burn mortality increased. Some of these results were due to economic and pharmaceutical sanctions in Iran. Because of Iran's industrial development, it is recommended that preventive measures for chemical, gas and electrical burns be conducted.
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| 91 |
ÉTUDE DES ACCIDENTS ÉLECTRIQUES D'ORIGINE PROFESSIONNELLE À YAOUNDÉ
(Owona Manga L.J., Kouassi Yao M. - Cameroun)
Les caractéristiques des accidents électriques professionnels sont peu connues au Cameroun. Nous avons réalisé cette étude pour contribuer à l'amélioration des connaissances sur ce risque physique habituel en milieu de travail. L'étude qui s'est déroulée dans quatre hôpitaux centraux de la ville de Yaoundé, était basée sur une série de cas survenus entre le 1er janvier 2005 et le 31 décembre 2014. Tous les dossiers exploitables des victimes d'accidents électriques survenus pendant la période d'étude ont été colligés et analysés pour décrire les caractéristiques socioprofessionnelles des victimes, les caractéristiques des accidents et les indicateurs épidémiologiques. La fréquence des accidents électriques professionnels était égale à 4,22% de l'ensemble des accidents électriques et la létalité était égale à 6,7%. Il y avait 25 hommes et 5 femmes parmi les victimes. La moyenne d'âge était égale à 28±8,3ans. Plus de trois victimes sur quatre exerçaient des activités informelles (76,7%), les professionnels de l'électricité étaient les principales victimes (24%). Les accidents étaient survenus dans les ateliers (33,3%) et la cour (26,7%), pendant l'après-midi (40%) et dans la soirée (37%). Le courant électrique de basse tension était la cause de la majorité des cas (56,7%). Les victimes étaient des hommes jeunes, exerçant les métiers de l'électricité dans le secteur informel. L'éducation des professionnels de l'électricité pourrait améliorer la prévention de ces accidents.
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| 95 |
BURN INJURY: REVIEW OF PATHOPHYSIOLOGY AND THERAPEUTIC MODALITIES IN MAJOR BURNS
(Kaddoura I., Abu-Sittah G., Ibrahim A., Karamanoukian R., Papazian N. - Lebanon)
Despite a considerable decrease in their incidence worldwide, burn injuries remain one of the commonest forms of trauma and account for a weighty proportion of trauma cases in health-care emergencies around the globe. Although the latest data reveal a substantial decline in burn-related mortality and hospital admissions in the US over the past three decades, severe thermal injuries continue to trigger devastating morbidity and significant mortality while their management remains a dynamic challenge for the entire medical and paramedical community. Concrete evidence continues to be established regarding burn-associated pathophysiologic responses, and their destructive sequelae and deleterious effects in survivors at cellular, systemic as well as socio-economic level. Better understanding of these responses have contributed to advances in therapeutic strategies, improved long-term outcomes and catalyzed the reintegration of victims back into society. This paper describes the current understanding of the pathophysiology of a burn injury and characterizes both local and systemic pathophysiologic responses in terms of metabolic, hemodynamics, cardiac, renal, hepatic, gastro-intestinal, immunologic, endocrine as well as male reproductive systems in an attempt to understand the corresponding treatment modalities for this unique patient population.
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| 103 |
THE EFFECT OF COMORBIDITIES AND COMPLICATIONS ON THE MORTALITY OF BURNED PATIENTS
(Costa Santos D., Barros F., Gomes N., Guedes T., Maia M. - Portugal)
The World Health Organization has defined 'elderly' as 65 years or older. Age is a known major prognostic factor after burn injury. The objective of this study is to establish whether epidemiologic differences in the elderly contribute to higher mortality compared to younger patients. Patients admitted to the burn unit between 2011 and 2014 (229 patients) were included: 159 were under 65 years old and 70 (30.6%) were 65 or over. The elderly group had a higher mortality rate, 24.6% versus 8.2% (p=0.002). Patients over 65 presented more pre-existing co-morbidities (1.7 ± 1.1) than patients under 65 (1.1 ± 1.0), p<0.001, and COPD was significantly associated with higher mortality rate (p=0.014). Patients over and under 65 suffered similar TBSA, 15.7 versus 14.1, p=0.720. Regarding burn depth, deeper burns were significantly more prevalent in the over 65 group (17.1% vs. 5.0%, p=0.003). Patients over 65 developed more complications (0.9 ± 1.1) than the under 65s (0.5 ± 0.9), p=0.009, and sepsis was significantly associated with higher mortality rate (p=0.042). Over-65-year-old burn victims have a higher mortality risk than the under 65s. Elderly patients generally have more pre-existing comorbidities and develop more complications during hospital stay, which increase the mortality risk. Apparently, history of COPD or sepsis complication during hospital stay are independent risk factors for death in the elderly group. Although over-65-year-olds presented similar TBSA to the younger patients, the proportion of deep burns was higher, which suggests that burns might be more aggressive in the elderly.
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| 107 |
BACTERIAL AND ANTIMICROBIAL SUSCEPTIBILITY PROFILE AND THE PREVALENCE OF SEPSIS AMONG BURN PATIENTS AT THE BURN UNIT OF CIPTO MANGUNKUSUMO HOSPITAL
(Wardhana A., Djan R., Halim Z. - Indonesia)
Infection is a major cause of mortality and morbidity among burn patients. An effective measure to reduce infection is routine monitoring of bacterial infection and antimicrobial susceptibility patterns at the burn unit. This will help to create a burn centre-specific empirical antibiotic therapy protocol. A retrospective, descriptive study was conducted at the Cipto Mangunkusumo Hospital (RSCM) Burn Unit between September-November 2016. Data regarding bacterial culture isolates, antimicrobial susceptibility spectrum, and the number of burn patients diagnosed with sepsis were collected. There were 36 patients with positive bacterial cultures, with the isolates changing continuously between Klebsiella pneumonia (17%), Pseudomonas Aeruginosa (12%) and Acinetobacter baumannii (11%). High resistance was found for 10 antimicrobials, particularly cephalosporins. The three bacteria were only sensitive to carbapenem, aminoglycosides and tigecycline. Fourteen patients were diagnosed with sepsis (38.9%), 10 died. Two major sepsis-causing bacteria were P. aeruginosa (33.3%) and K. pneumoniae (28.9%). Bacterial isolates in our setting changed every month. Almost all bacterial isolates are multi-drug resistant, highly resistant to the empirical therapy given (ceftriaxone), leading to outbreaks of sepsis and increased mortality rates. Carbapenem (imipenem, meropenem and doripenem) and aminoglycosides (amikacin) combination was the selected empirical therapy.
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| 116 |
BACTERIAL INFECTIONS IN BURN WOUND PATIENTS AT A TERTIARY TEACHING HOSPITAL IN ACCRA, GHANA
(Forson O.A., Ayanka E., Olu-Taiwo M., Pappoe-Ashong P.J., Ayeh-Kumi P.F. - Ghana)
Intact human skin surface is essential for protection against infection, preservation of body fluid homeostasis and thermoregulation. Burn injury compromises the skin barrier and enables bacterial infection, hence delaying burn wound healing. This study aimed to determine the microbial profile of burn wounds, and resistance patterns of microbes with respect to the source of the injured patient's wound. Fifty wound swab samples were collected from fifty burn patients at the Korle-Bu Teaching Hospital, Accra (KBTH). Sterile swabs moistened with sterile saline were used to swab burn wounds. The swabs were plated on blood agar and MacConkey agar for 24 hrs at 37°C. Biochemical tests were carried out on the representative isolate on each plate, and antibacterial sensitivity pattern was determined using the Kirby-Bauer disc diffusion method. The study revealed that the main source of burns was gas flames (66%) and scalds (28%). Out of the 50 samples analysed, 86% were culture positive and 14% were culture negative for bacteria. The predominant organisms isolated were Pseudomonas sp. (30.2%) and Acinetobacter sp. (20.9%). Proteus mirabillis (2.3%) and Staphylococcus aureus (2.3%) were the least frequently isolated bacteria. Although Pseudomonas sp. showed varying resistance levels to gentamicin, cotrimoxazole and ciprofloxacin, all the Acinetobacter sp. were resistant to most of the tested antibiotics used. Resistant gram negative bacteria are the most common isolates associated with burn wounds in Accra, Ghana. Hence a careful selection of antibiotics to control the wound infection is required for proper management of burn wounds in order to help reduce morbidity and mortality.
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| 121 |
INHALATION INJURY IN A BURN UNIT: A RETROSPECTIVE REVIEW OF PROGNOSTIC FACTORS
(Monteiro D., Silva I., Egipto P., Magalhães A., Filipe R., Silva A., Rodrigues A., Costa J. - Portugal)
Inhalation injury (InI) is known to seriously affect the prognosis of burn patients, as it is strongly associated with high morbidity and mortality. Despite major advances in the treatment of burn patients in the past years, advances in the treatment of smoke InI have been somewhat limited; mortality reduction mostly results from improvements in critical care. It is difficult to separate the contribution of InI from other mechanisms that also affect respiratory tract and lungs. The aim of this study was to compare patients with and without InI and to identify prognostic factors among patients with smoke InI. Patients with InI displayed higher total body surface area (TBSA) burned, higher incidence of pneumonia and acute respiratory distress syndrome (ARDS), a higher rate of positive blood cultures and a significantly higher death rate. We could conclude that older age, higher TBSA, ARDS and pneumonia were independent predictive factors for mortality in our global study population. Older age and higher TBSA were the only independent factors found to be predictive of mortality in patients with InI.
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| 126 |
PREHOSPITAL HYDROXOCOBALAMIN FOR INHALATION INJURY AND CYANIDE TOXICITY IN THE UNITED STATES - ANALYSIS OF A DATABASE AND SURVEY OF EMS PROVIDERS
(Purvis M.V., Rooks H., Young Lee J., Longerich S., Kahn S.A. - USA)
Prehospital use of hydroxocobalamin as an antidote for cyanide toxicity, a serious complication of smoke inhalation, has yet to be universally adopted in the United States though its efficacy and safety have been demonstrated since 2006. The purpose of this study was to characterize practices of prehospital hydroxocobalamin administration via a survey of emergency medical services (EMS) and to report a case series from an EMS database to track use of hydroxocobalamin. The Fire Smoke Coalition Newsletter emailed a voluntary survey to EMS subscribers regarding hydroxocobalamin use. Survey responses were analyzed in addition to survival data from the Smoke Inhalation Treatment Database (SITD), a publically available, self-reported, online database for EMS regarding smoke inhalation patient outcomes. Analysis was compared to current published data from PubMed. The survey had a 14% response rate (284/2000). Only 38% reported prehospital utilization of a hydrogen cyanide antidote with 46% using hydroxocobalamin. 20% of responders reported a formal ALS protocol was in place for hydroxocobalamin use. For the SITD, 12 of 13 (92%) patients who received hydroxocobalamin for suspected inhalation survived. Other studies found a survival rate of 72% and 42% after administration of hydroxocobalamin for smoke inhalation. Prehospital administration of hydroxocobalamin for cyanide toxicity is uncommon in the United States, as evidenced by this analysis, despite well-documented safety and efficacy. Although a small sample, patients who received prehospital hydroxocobalamin had improved survival. This survival rate is significantly greater than those reported previously.
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| 129 |
INVESTIGATING THE RELATIONSHIP BETWEEN MICROALBUMINURIA AND PROGNOSIS OF PATIENTS WITH SEVERE BURNS IN THE MOTAHARI BURN HOSPITAL
(Roham M., Anbari K., Fatemi M.J., Momeni M. - Iran)
Microalbuminuria seems to be a reflection of increased vascular permeability caused by systemic inflammatory response, and is likely to be a predictor of mortality, sepsis and other outcomes of severe burn patients. We investigated the impact of microalbuminuria on the prognosis of patients with severe burns. This is a prospective study on severe burn patients (above 20%) admitted in the first 24 hours after burns to the Motahari Burn Hospital. Patients' microalbuminuria was measured at admission and 48 hours later, and its relationship with patient prognosis (sepsis, renal failure, death, inhalation injury and systemic inflammatory response syndrome) was analyzed. We concluded that microalbuminuria at admission in patients with severe burns was directly related to inhalation injury (P = 0.018), ARDS during hospitalization (P = 0.001) and length of hospital stay (P = 0.025). Moreover, microalbuminuria at 48 hours after admission had a direct connection with patient death (P = 0.001), sepsis (P = 0.001), renal failure (P = 0.001) and SIRS (P = 0.001). Microalbuminuria is a simple, noninvasive, fast and affordable test to predict sepsis, mortality, renal failure, systemic inflammatory response and a finding associated with inhalation injury in severe burn patients, making it a fast prognostic predictor that helps to improve the management of these patients.
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| 135 |
ANALGESIA, SEDATION AND AROUSAL STATUS IN BURN PATIENTS: THE GAP BETWEEN RECOMMENDATIONS AND CURRENT PRACTICES
(Lavrentieva A., Depetris N., Rodini I. - Greece)
Assessment and treatment of pain, agitation and delirium are integral parts of the management of critically ill patients. The purpose of this review is to describe how pain, delirium and agitation are managed in general intensive care units and in burn units, and to address whether management of these issues is compatible with internationally accepted recommendations. A substantial gap exists between the conception of the guidelines, clinical practice and physicians' statements regarding pain, sedation and delirium management. Specific training programs might be required to increase the implementation rate of guidelines and best practices on sedation, pain and delirium assessment and management in burn units.
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| 143 |
OLYMPIC TORCH FLAP: ONE-STOP OPTION FOR SIMULTANEOUS BROW, UPPER AND LOWER LID RECONSTRUCTION IN POST BURN PATIENTS
(Vathulya M., Chattopadhyay D., Koyama K. - India)
Facial units reconstruction in a post burn patient poses tough challenges. Simultaneous brow and lid reconstruction is one of them. This article presents a 45-year-old epileptic male with burn of complete face. The task of reconstructing the brow, upper and lower lids was successfully accomplished using a modification of the Guyuron postauricular fasciocutaneous flap, after initial grafting and radial forearm flap reconstruction of forehead and other parts of the face. The article gives a single-stop solution for simultaneous reconstruction of brow and lids using a random pattern extension of the traditional postauricular flap, thus proving the excellent vascularity and hence durability of the flap in spite of a 180 degrees change in the orientation of the flap with respect to the axis.
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| 146 |
MANAGEMENT OF SPLIT SKIN GRAFT DONOR SITE IN THE WEST AFRICAN SUB REGION: SURVEY OF PLASTIC SURGEONS' PRACTICE
(Olawoye O.A.,Ademola S.A., Iyun A.O., Michael A.I., Oluwatosin O.M. - Nigeria)
Split skin graft (SSG) is one of the most commonly performed operations on any Plastic Surgery service. Rate of donor site healing is affected by various factors including the type of dressing applied. The aim of this study was to survey the practice of plastic surgeons in the sub region with respect to management of SSG donor site and see how it conforms to international standards. Structured questionnaires on various aspects of the harvest and management of SSG donor sites were administered to plastic surgeons during the 53rd annual conference of the West African College of Surgeons (WACS) at Lome, Togo in March 2013. The data were analyzed using descriptive statistics. There were 47 respondents out of 55 plastic surgeons from four West African countries, which represented 85.4% of registered participants at the plastic surgery section of the conference. All the respondents performed SSG regularly, and the thigh was the most commonly used donor site. Different types of paraffin gauze remained the most commonly used primary donor site dressing. Only 17% of the respondents apply a topical local anaesthetic agent on the donor site. The choice of SSG donor site dressing in the sub region was driven mainly by availability. Concerted efforts must be made to access newer wound care products for optimum management of this commonly performed operation.
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| 150 |
CASE REPORT OF A HIGH VOLTAGE ELECTRICAL INJURY AND REVIEW OF THE INDICATIONS FOR EARLY FASCIOTOMY IN LIMB SALVAGE OF AN ELECTRICALLY INJURED LIMB
(Huei T.J., Mohd Yussof S.J., Lip H.T.C., Salina I. - Malaysia)
Electrical injuries make up a relatively small portion of burn injuries. Safety measures in place on domestic electricity supply have reduced the occurrence of high voltage electrical injuries. We present the case of a young man who sustained a high voltage electrical injury on all four limbs. Early fasciotomy was performed on both his hands and forearms. Despite early compartment release, the left upper limb deteriorated and required amputation. In this article we discuss the indications, outcomes and complications of early fasciotomy.
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