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Volume XXX |
Number 3 |
Septmber 2017 |
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Summaries
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EPIDEMIOLOGY OF BURN INJURIES IN KOSOVO: A 10-YEAR REVIEW
(Arifi H., Ahmeti H., Zatriqi V., Buja Z., Duci Sh., Rexhaj Z., Arifi N. - Kosova)
Burns are the most devastating form of trauma. They are among the most devastating injuries a child can sustain, and coupled with prolonged aggressive and non-aggressive medical and nursing therapies, can result in long-term physical and psychological concerns. Data were obtained from medical records of burned patients treated in our clinic from January 1, 2006 to December 31, 2015. Subsequent details are examined, such as age, gender, etiologic factor, surface of the affected area, depth of burn, localization of injury by region, season when they happened the most, methods of treatment and duration of hospitalization. A total of 1268 patients with burns were admitted to the Clinic of Plastic Surgery Kosovo for treatment between 1 January 2006 and 31 December 2015. During the period of our research, male patients were predominant, accounting for 835 cases (65.85%) of burns while 433 (34.14%) patients were female. The average age in this study was 23 years. Our findings, even with the caveats known to this study, suggest that there is still a high number of patients with burn injury requiring hospital admission.
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| 167 |
THE EPIDEMIOLOGY OF BURNS IN BASRA, IRAQ
(Al-Shamsi M., Othman N. - Iraq)
Burns are a major cause of morbidity and mortality worldwide and an important public health problem in Iraq. The current study was undertaken to describe epidemiological characteristics of hospitalized burn patients and investigate in-hospital mortality. The study was undertaken at the Al-Fayhaa Burn Centre in Basra City through analyzing hospital records of patients admitted to the centre for a new burn injury between January and December 2016. Data were extracted from all accessible files, entered into Epidata and analyzed in Stata. Hospital records of 367 patients with an age range of 1 month to 77 years and a male to female ratio of 1:2 were analyzed. One third of admissions were children aged 0 to 5 years: the most common mechanisms of injury were flame (51%) and scalds (41.7%). Total body surface area (TBSA) burnt ranged from less than 1% to 100%, with a median of 30.0% (IQR 18.0, 45.0). Length of hospital stay ranged from 0 to 5 months, with a median of 8 days (IQR 4, 12.5). In-hospital mortality was 22% and the independent factors for death were TBSA and suicidal burns. Burns remain a major public health problem in Basra, especially in children, and require sustained multidisciplinary action for their prevention and management. Improving hospital records and computerizing them is essential for better assessment and follow-up of burn care practices.
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| 172 |
CORRELATION OF OCCURRENCE OF INFECTION IN BURN PATIENTS
(Latifi N.A., Karimi H. - Iran)
The study of burn flora is helpful in determining current antibiotic susceptibilities and locating development of multidrug resistant bacterial strains among the unit's usual flora. In this study, we aimed to determine the bacteriological pattern of blood, urine and sputum infections and their correlation with burn wound infections. We used data from our burn registry program. All data on demographics, burn wounds and burn wound infection, bacteria isolated, sensitivity to different antibiotics, burn wound culture, sputum culture, urine culture and catheter tip culture were recorded. We had 1721 hospitalized burn patients. Mean age was 26.3+/-20.25 years old. Mean hospital stay was 14.41 days (range 0-64 days). Mean (SD) TBSA was 16.48 (20.67) years. Mortality rate was 5.9%. Burn wound infection was present in 38.54%. The most frequent species was Staphylococcus spp. (55.1%), followed by Pseudomonas (14.29%), Enterococcus (12.24%), E. coli (4%), Klebsiella and Proteus (both 2%). Urine culture was positive in 27.9%, sputum culture was positive in 1.14%, catheter tip culture was positive in 12.3% and blood culture was positive in 7.6% of the cases. There were correlations between positive wound culture and blood and urine culture, most of them with one bacteria species. The most frequent disseminated bacteria was Pseudomonas aeruginosa and the most sensitive antibiotic was Amikacin. More than 39.2% of our positive culture patients had 3 or more positive cultures, and 36.5% had similar culture results for one bacteria, which was a sign of disseminated infection.
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| 177 |
A SIRS-BASED AUTOMATED ALARM SYSTEM FOR THE DIAGNOSIS OF SEPSIS AFTER BURN INJURY
(Gille J., Dietz A., Taha H., SablotzkiA. - Germany)
The present study examined the effectiveness of an automated systemic inflammatory response syndrome (SIRS)-based alarm system for the early detection of sepsis in adult burn patients. In addition, the relevance of the sepsis criteria from the American Burn Association (ABA) and the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) for this patient group was determined. In this prospective observational study, we included 41 consecutive patients who were admitted to our burn ICU within a one-year period. SIRS alarms were calculated for these patients according to predefined criteria using the PREDEC ALARM automated alarm system and alarms generated according to ABA criteria and daily Sequential Organ Failure Assessment (SOFA) results. The alarms were not visible to the treating doctors and nurses. The alarms identified were related to episodes of sepsis with positive blood cultures. Twenty-one sepsis events were recorded in 41 patients. The receiver operating characteristic (ROC) curve revealed an area under the curve (AUC) of 0.72 for alarms using 2 SIRS criteria, 0.77 for 3 SIRS criteria, and 0.61 for 4 SIRS criteria. AUC values of 0.53 and 0.59 were calculated for the ABA criteria and Sepsis-3 definition, respectively. An alarm system using 3 SIRS criteria proved to be suitable for the early detection of sepsis in burn patients. The frequent number of false alarms requires further refinement of the alarm system. Based on the results of our study, the ABA criteria and the Sepsis-3 definition provide no advantages over the SIRS criteria in the early diagnosis of sepsis after burn injury.
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| 185 |
PAEDIATRIC ELECTRICAL BURN INJURIES: EXPERIENCE FROM A TERTIARY CARE BURNS UNIT IN NORTH INDIA
(Srivastava S., Patil A.N., Bedi M., Tawar R.S. - India)
Electrical burn injuries in the paediatric age group constitute a small proportion of all burn cases and cause significant morbidity and long-term psychosocial impact. The objective of this study was to evaluate various aspects of electrical burn injuries in the paediatric age group in our region. A retrospective review was done of all paediatric electrical burns admitted to a tertiary care burns unit over a period of 12 months (January 2016 to December 2016). There were 77 cases of electrical burns under the age of 16 years. High voltage burns predominated and older age groups were more frequently affected. Male:female ratio was 4.1:1. Amputations were required in 18 (23%), skin grafting in 52 (67%) and flap cover in 29 (37%) patients. There were unfavourable outcomes in 32% patients with a mortality rate of 7.8%. Significant association was found between unfavourable outcomes and high voltage burn injuries and length of hospital stay. The impact of electrical burn injuries is substantial and can be reduced by simple preventive measures such as educating parents, improving health infrastructure and adherence to safety regulations.
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| 189 |
EFFECT OF EARLY GRAFTING ON IMPROVEMENT OF LETHAL AREA INDEX (LA50) IN BURN PATIENTS: A 7-YEAR INVESTIGATION IN A BURN REFERRAL CENTRE IN THE NORTH OF IRAN
(Mobayen M., Farzan R., Dadashi A., Rimaz S., Aghebati R. - Iran)
Burning is a major health challenge in all societies. In this descriptive cross-sectional study, health information about hospitalized burn patients was extracted from the hospital information system from April 2009 to February 2015. Logistic regression method was used to identify risk factors and mortality predictors. Lethal area index (LA50) was investigated to evaluate the quality of annual hospital medical care. A total of 7725 patient medical files were examined. Mean age of the patients was 32.3±22.5 years old. The most common cause of burning accidents was hot liquids. Mean percentage of total body surface area was 15.8±17.9%. The most and the least common affected areas were upper parts and posterior thorax, respectively. Total calculated LA50 was 56.22 (CI95% = 50.09-62.20). This index was 43.89%, 46.43%, 52.29%, 52.29%, 57.00%, 62.08% and 67.53% annually from 2009 to 2015, respectively. There was a statistically significant difference with regards to mortality rate in the different age groups, higher-degree burns, burn location and burn causes. Analysis of mortality predictors in a model adjusted by age and sex showed that old age (p<0.0001), inhalational injuries (p<0.0001) and burn percentage (P<0.0001) were the three mortality predictors in the multiple logistic regression model. The relationship between early grafting and decreased mortality and increased LA50 was nearly significant in statistical analyses. Burn patient survival rate and annual LA50 had an increasing trend in this hospital. Early grafting surgery seemed to be effective on this trend and decreased mortality risk to a large extent.
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| 193 |
PRESSURE GUIDED SURGERY OF COMPARTMENT SYNDROME OF THE LIMBS IN BURN PATIENTS
(Boccara D., Lavocat R., Soussi S., Legrand M., Chaouat M., Mebazaa A., Mimoun M., Blet A., Serror K. - France)
Compartment syndrome is a serious complication of high voltage electrical burns, limb carbonization and deep circular burns with delayed escharotomy. Without treatment, ischemic tissue damage leads to irreversible necrosis. Treatment is emergency surgical decompression. The burned patient is usually not searchable and cannot always be readily examined because of bulky dressings; diagnosis of compartment syndrome is always hard to make. The pressure transducer used in central arterial catheters is easy available. We used it to measure pressure in muscular compartments. We measured compartment pressure three times at different depths in all cases of electrical burn, carbonization and deep circumferential burns with delayed escharotomy. We also took the pressure in the uninjured limb. The pressure assessment device was composed of a blood pressure transducer commonly used in arterial catheters for arterial pressure monitoring with three connecting branches. The first branch was connected to the 'arterial pressure exit' in the monitoring device. The second, an IV tube, was connected to one litre of physiological serum in a pressure bag inflated to 200 mmHg. The third, also an IV tube with a sterile extension cable, was directly connected to an 18G standard straight needle to be inserted in the tissues for which interstitial pressure had to be measured. In patients with thermal burns, we measured pressure before and after escharotomy. Threshold intracompartmental pressure was 35 mmHg. We carried out pressure assessment of all muscular compartments during and at the end of surgery. The pressure transducer provides a pressure value in all muscular compartments with a time of installation and measuring of less than 5 minutes. Sensitivity is measured at +/- 1 mmHg. Operation is simple, non-operator dependent, and accessible to medical and paramedic teams. The pressure transducer allows accurate diagnosis of early or established compartment syndrome. It requires no additional equipment and its application does not delay therapeutic management. Its use helps with fasciotomy decision, especially after escharotomy, guides the surgeon in the exploration of different compartments and verifies the effectiveness of surgery.
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| 198 |
BROMELAIN-BASED ENZYMATIC DEBRIDEMENT AND MINIMAL INVASIVE MODALITY (MIM) CARE OF DEEPLY BURNED HANDS
(Purvis M.V., Rooks H., Young Lee J., Longerich S., Kahn S.A. - USA)
The objective was to critically review the data and assess the implications of NexoBrid [NexoBrid-NXB formerly Debrase Gel Dressing-DGD]a in the special field of deep hand burns. Detailed analysis of endpoints in the treatment of hand burn patients was conducted as part of a multi-center, open label, randomized, controlled two-arm study to evaluate the safety and efficacy of NXB enzymatic debridement, comparing it to the current standard of care (SOC). These results were compared to a large cohort of patients treated with NXB in a previous, single arm study. Thirty-one burned hands were treated with NXB and 41 hand burns were in the SOC group. In the NXB group, 4 out of 31 hand burns (12.9%) required some excisional debridement compared to 29 out of the 41 (70.7%) in the SOC group (p<0.0001). Mean percentage of burn wound area excised in the NXB group was 4.4 ± 13.1% compared to 52.0 ± 41.4% in the SOC group (p<0.0001). None of the NXB-treated hands required escharotomy compared to 4 out of the 41 (9.7%) in the SOC group. NXB enzymatic debridement demonstrated a statistically significant reduction in burn wound excision and auto-grafting compared to SOC, and seems to prevent the need for emergency escharotomy.
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| 205 |
THE SOCIOECONOMIC IMPACT OF BURNS IN LAGOS, NIGERIA: A ONE-YEAR PROSPECTIVE STUDY
(Ahachi C.N., Fadeyibi I.O., Chira M.K., Abikoye F.O., Okpara C.O. - Nigeria)
A one-year prospective study of burn patients presenting to the National Orthopaedic Hospital, Igbobi, Lagos from June 1, 2007 to May 31, 2008 was conducted to evaluate the socioeconomic impact of burn injuries sustained by the patients. A proforma reflecting the various data of interest was the main instrument of the study. The data was subjected to simple statistical analysis. A total of 52 patients with a mean age of 25 ± 17.1 years were studied. There were 27 males and 25 females giving a M:F ratio of 1.1:1. Man-hours were lost by 88.5% of the patients, 55.8% of whom were income earners. About 74% of the patients had returned to work or school at the conclusion of the study. The most common opportunity cost of treatment was a relative stopping work or school. Half of the patients were unsatisfied with their appearance and 26.9% desired cosmetic surgery. Social interactions were normal in 74.5% of the patients and none reported a poor quality of life. The study showed a significant socioeconomic burden from burns. It highlighted the importance of the informal sociocultural support system and the need for formal, well-structured social support systems.
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| 210 |
MASS BURN INJURIES: AN ANALYSIS OF CHARACTERISTICS AND OUTCOMES IN A DEVELOPING COUNTRY
(Lam N.N., Huong H.T.X., Tuan C.A. - Vietnam)
Our aim was to investigate characteristics and outcomes of patients with mass burn injuries admitted to the National Institute of Burns (NIB), Hanoi, Vietnam. A retrospective note audit was conducted on 83 episodes of mass burn injury (MBI) resulting in 332 patients being admitted to the NIB from 1/2009 to 1/2015. Evaluated criteria included occurrence time, causal agents, place, MBI size, and demographic information such as patient age, gender, burn surface area, full thickness burn area, inhalation injury, prehospital management and outcome. Single and multiple variable logistic analyses were performed to find out independent factors affecting the mortality rate of these patients. 66.3% of MBI were work-related accidents. Incidents were mainly located indoors (72.2%). The predominant groups appeared to be adult (92.3%) and male (74.9%). Average burn surface area was 31% total body surface area (TBSA) and average full thickness area was 12% TBSA. Inhalation injury was diagnosed in 24.6% of patients. More than half of the total victims were classified as having moderate and major burns with an overall mortality rate of 19.2%. According to available information, initial management prior to admission to NIB was not efficient. Full thickness burn area and inhalation injury were found to be independent factors affecting the mortality rate of mass burn injury patients. Our results indicate that most mass burn injury patients in Vietnam are male adults in the working environment. Inhalation injury and full thickness burn area were independent factors affecting mortality rate. Continuing medical education should be conducted to eliminate limitations in prehospital care.
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| 214 |
REFUGEE CAMPS, FIRE DISASTERS AND BURN INJURIES
(Atiyeh B.S., Gunn S.W.A. - Switzerland)
In the past five years, no fewer than 15 conflicts have brought unspeakable tragedy and misery to millions across the world. At present, nearly 20 people are forcibly displaced every minute as a result of conflict or persecution, representing a crisis of historic proportions. Many displaced persons end up in camps generally developing in an impromptu fashion, and are totally dependent on humanitarian aid. The precarious condition of temporary installations puts the nearly 700 refugee camps worldwide at high risk of disease, child soldier and terrorist recruitment, and physical and sexual violence. Poorly planned, densely packed refugee settlements are also one of the most pathogenic environments possible, representing high risk for fires with potential for uncontrolled fire spread and development over sometimes quite large areas. Moreover, providing healthcare to refugees comes with its own unique challenges. Internationally recognized guidelines for minimum standards in shelters and settlements have been set, however they remain largely inapplicable. As for fire risk reduction, and despite the high number of fire incidents, it is not evident that fire safety can justify a higher priority. In that regard, a number of often conflicting influences will need to be considered. The greatest challenge remains in balancing the various risks, such as the need/cost of shelter against the fire risk/cost of fire protection.
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CASE REPORT: AN ODD VERY EARLY MARJOLIN'S ULCER AFTER MINIMAL HAND BURN
(Olawoye O.A.,Ademola S.A., Iyun A.O., Michael A.I., Oluwatosin O.M. - Nigeria)
Marjolin's ulcer refers to any malignant transformation of chronic wounds. Different chronic wounds may be transformed into malignancies, although they usually have a latency period of between 25 to 40 years after the primary injury. We herein present an otherwise healthy man who developed squamous cell carcinoma (SCC) three weeks after burn injury. It is an interesting case because of this acute transformation into SCC, and may be considered as different to the usual presentation of Marjolin's ulcers.
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| 220 |
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)
A recent publication by Sánchez-Sánchez and colleagues investigated the incidence of acute kidney injury (AKI) in critically burned patients resuscitated with Ringer's solution supplemented with hydroxyethyl starch (HES). The authors report no differences in the incidence of AKI between patients resuscitated with or without HES. Based on these results, the authors conclude that the use of low doses of HES in burn injury may be safe and that further investigation is warranted. However, these results contradict a number of earlier studies and are also not in line with current guidance on the use of HES products. Furthermore the study has several limitations that raise questions regarding the validity of these findings.
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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)
Les infections pulmonaires liées aux soins surviennent par définition plus de 48 h après l'hospitalisation du patient, les Pneumopathies Acquises sous Ventilation Mécanique (PAVM), qui en représentent la grande majorité survenant après plus de 48 h de. ventilation mécanique. Ces infections sont les plus fréquentes de celles survenant en réanimation. Elles sont responsables de surmortalité, d'augmentation de la durée de séjour, d'augmentation des cures d'antibiothérapie, d'augmentation des résistances qui elles mêmes entraînent une augmentation de consommation des antibiotiques « de réserve », ce qui exacerbe les résistances (d'où cercle vicieux) et de surcoût. Les principaux paramètres physiopathologiques sont une invasion microbienne du tissu pulmonaire permise par une diminution des défenses locales et générales.
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