The Euro-Mediterranean Council for Burns and Fire Disasters

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Volume XXXIII	Number 1	March 2020

Summaries

3	EPIDEMIOLOGY AND OUTCOME ANALYSIS OF 3030 BURN PATIENTS WITH AN ICD-10 APPROACH (Alipour J., Mehdipour Y., Karimi A. - Iran) The present study aims to document the epidemiologic features and outcomes of burn injuries in Southeastern Iran based on International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10) guidelines. Thisretrospective cross-sectionalstudy was carried out at Khatam-Al-Anbiya Hospital. Patient demographics, including burn injury data and outcome data were collected from medical records and analyzed through descriptive and analyticalstatistics using SPSS software.Atotal of 3,030 burn patients were included in this study. A total of 55% of the subjects were males. The largest age group included patients aged 15-44 (61%). The majority of burns were caused by flame (70.5%), and most of them were third-degree burns (73%). Mean affected total body surface area (TBSA) was 43.98%±30.75% in allsubjects and 80.85%±21.41% in the deceased individuals. Most ofthe burns were accidental(66.2%), and 37% ofthem occurred in winter. Mean hospital stay was 4.49±4.67 days (within the range of 1-113 days). A quarter of all patients admitted to the hospital died (24.9%). The number of admitted patients, mean length ofstay (LOS), and the mortality rate showed a decreasing trend from 2007 to 2016. In contrast, the total mortality rate was high. The significant predictors of mortality included being female,flame burns, longer LOS, a largerTBSA, burns of higher degrees, as well as burn complications. The documentation of burn data, based on ICD-10 directives,standardizesfindingsfrom burn injury analyses and leads to the comparability of data at different national and international levels.
14	LISBON BURN CENTRE EXPERIENCE WITH INTENTIONAL BURN INJURIES (Vieira L., Ribeiro L., Guimarães D., Sousa J., Varanda A. - Portugal) Burn injury as a form of hetero or auto-aggression accountsfor a significant amount of admissions to a Burn Care Unit, with epidemiologic and clinical specificities. To investigate the differences in risk factors, psychiatric comorbidities, injury severity and mortality among adult patients with accidental or intentional burns, we analyzed routinely collected data from a Central Hospital Burn Unit over a period of 6 years (January 1st , 2010 to December 31st , 2015). We identified 22 intentional burn patients (5%) among all the admissions to our Burn Unit. When compared to the accidental burns, the intentional burn patients are significantly younger (45.7±14.7 vs. 54.9±19.9), have a bigger percentage of body surface area burned (35% vs. 14%), have a higher incidence of inhalation burn (50% vs. 22.8%) and higher mortality (18.2% vs. 6.1%). Fifty-five percent of cases of intentional burns were self-inflicted. Self-inflicted burns have a worse prognosisthan hetero-aggressions(inhospital mortality 25% vs. 10%). Psychiatric comorbidities were largely more prevalent in the intentional burn patients (59% vs. 6.6%), namely mood disorders. Compared to patients with accidental burns, intentional burn patients have worse clinical condition and prognosis. A multidisciplinary preventive approach, looking at the specificities of the violent nature of the lesions and identifying risk groups may reduce the incidence and severity of this type of burns.
20	EFFECTS OF EMPIRICAL ANTIBIOTIC ADMINISTRATION ON THE LEVEL OF C-REACTIVE PROTEIN AND INFLAMMATORY MARKERS IN SEVERE BURN PATIENTS (Putra O.N., Saputro I.D., Nurrahman N.D., Herawati E.D., Dewi L.K. - Indonesia) Severe burns lead to a high level of inflammation and high risk of infection. Inflammatory biomarkers are usually used to predict the severity ofinflammation orinfection and to assessthe efficacy of antibiotics. The use of antibiotics in burns is still controversial. The aim of this study is to assess the effects of empirical antibiotics on level of C-reactive protein (CRP) and other inflammatory markers(leucocytes, neutrophils, lymphocytes, and ratio of neutrophils-lymphocytes) in severe burn patients. This cohortstudy was conducted in the burn unit of Dr. Soetomo Hospital between April and November 2019. CRP and other inflammatory markers were measured on admission, day 5, and day 7 after the administration of empirical antibiotics. Fifteen severe burn patients were enrolled in thisstudy.All patientsreceived Ceftazidime, 3x1 gram during seven days of hospitalization. CRP level reduced from 15,78±7,5 mg/dl to 14,98±10,29 mg/dl (p=0,705) by paired-t-test. There were no significant differencesin mean decline of CRP between day 0-5 and 0-7. There was no decrease in inflammatory markers, including leucocytes, neutrophils, lymphocytes and ratio of neutrophils-lymphocytes during seven days of empirical antibiotic administration. Our conclusions are that the administration of ceftazidime as an empirical antibiotic lowersCRPlevel, although notsignificantly, while there is no decrease in several inflammatory markers.
27	ANALYSIS OF BLOOD CULTURE RESULTS OF BURN SEPTICAEMIA PATIENTS OVER A PERIOD OF NINE YEARS IN THE BAGHDAD BURN MEDICAL CENTRE (Almajidy A.K., Jasim A.K., Almajidy R.K. - Iraq) Burn is one of the most devastating traumas that someone can encounter in their life. Burn wound sepsis is still the leading cause of death in burned patients. Appropriate knowledge of the causative pathogen in burn sepsis is important for successful patient management and for the reduction of the incidence of antibiotic resistance. A retrospective study was conducted between 2010 and 2018 at the Burn Specialty Hospital in Baghdad.Atotal of 320 blood culture samples were obtained from patients with sepsis orsuspected of having sepsis. Patient age ranged between 9 months to 70 years old, with a mean total burn surface area of 45.26%. The most common microorganisms isolated from those patients who had sepsis or suspicion of sepsis were Klebsiella (48 cases) followed by Pseudomonas (36 cases), Staphylococcus species (26 cases), Enterococcus (8 cases), Acinetobacter (11 cases), E-Coli (11 cases), Candida (4 cases), Proteus (2 cases), and Salmonella, Streptococcus pneumonia, Monilia, and Seriata one case for each. The most commonly isolated organism was Klebsiella: it was sensitive to Imipenem followed by Amikacin, Nitrofurantoin, Piperacillin, Ciprofloxacin, Co-trimoxazole, Chloramphenicol, Tetracycline, Azithromycin and Cefotaxime. Microbiological surveillance of burn patients with sepsis or suspicion of having sepsis over a period of 9 years in our hospital has shown that the most common microorganism isolated from blood cultures was Klebsiella. Klebsiella was sensitive to Imipenem mainly according to sensitivity testing using the disk diffusion method.
33	OPTIMIZING THE USE OF AQUACEL AG® FOR PEDIATRIC BURNS - WHEN TO START? (Kruchevsky D., Pikkel Y., Mattar S., Ramon Y., Ullmann Y. - Israel) Most pediatric burns are 2nd degree partial thickness, and most will heal spontaneously by providing a good healing environment, though there is no standardized treatment protocol. Aquacel Ag® has shown good clinical results in reducing the need for frequent dressing changes in the pediatric population. This study's goal was to review our experience using this dressing for pediatric partial thickness burns in order to optimize and customize its use. A retrospective study included all pediatric patients suffering from burns, admitted to our institution between July 2013 and May 2018. We investigated a total of 705 dressing changes in our cohort of 276 patients. The most prevalent dressing material was Aquacel Ag®, used in 48% of cases. We examined the pattern of using Aquacel Ag® dressings. The average time until dressing change was required proved to be much longer when applied on the 1st day after burn and onward in comparison to the day of injury (4.85 vs. 2.21 days, p<0.001). Moreover, when it was applied on the 1st day after burn, a dressing used on a superficial 2nd degree burn needed to be changed less often than when it was applied on a deep 2nd degree burn (4.95 vs. 2.29 days, p=0.024). To optimize its use and cost effectiveness, dressing with Aquacel Ag® should be initiated on the 1st day after burn, or on the 2nd day when a deep 2nd degree burn is suspected; until then a standard topical preparation should be used.
38	HEAD AND NECK SKIN EXPANSION: ASSESSMENT OF EFFICIENCY FOR THE TREATMENT OF LESIONS IN THE LOWER HALF OF THE FACE (Sabban R., Serror K., Levy J., Chaouat M., Mimoun M., Boccara D. - France) . The treatment ofsequelae for burns or other loss of perioral tissuesis complex due to the site where they occur, itsfunctional importance, and social and esthetic aspects. Functional consequences of burnsto this area are cutaneousretraction and a lack ofskin that can lead to an inability to close the oral aperture, compromising the provision of dental hygiene and intubation procedures. The aim of the present publication was to evaluate the efficacy of chin, labial and jugal cutaneous expansions for the treatment of perioral lesions and lesions of the lower half of the face in our retrospective series of patients.We collected data and photography from digital filesfor each patient. Proportion ofscarred skin that could be treated by one orseveral expansion procedures was evaluated.The main outcome wasthe resection of 50% or more initial lesions. Side effects were assessed. Out of a total of 33 expanders, 28 were at the jugal level, 5 were chin expanders, and none were labial expanders. This equated to the inclusion of fourteen patients. The average percentage of the lesion that was removed after the perioral expansion protocol was 68.9% (40%-100%). 85% of patients had a positive outcome. 12% of procedures were complicated by hematoma, infection or prosthesis exposure. Each time that the lesional area could be fully (i.e. 100%) treated, only a single expansion was used. Head and neck expansion is the technique of choice for reconstruction of the lower half of the face and the horizontal part of the neck in terms of efficiency and safety.
47	RECONSTRUCTIVE SURGERY OF UPPER EXTREMITY AFTER THERMAL BURNS: GUIDELINES OR EXPERIENCE? (Stritar A., Miksa M. - Slovenia) Hand burns are among the most common burns due to the fact that they are, apart from the face, most exposed to fire, and they are also used to protect the face against a severe trauma from fire. Although hand burns are relatively small with regard to the total body surface area affected, the severity of the damage goes beyond the affected area. Initial treatment is conservative, followed by surgical management. For deep burns, surgical treatment is required between three to five days after the trauma. There are different options for reconstruction of the necrotising tissue according to the principles of the reconstructive ladder.
53	REVIEW OF SCHOOL FIRES IN IRAN: THE CAUSES, CONSEQUENCES AND LESSONS LEARNED (Rezabeigi Davarani E., Nekoei-Moghadam M., Daneshi S., Khanjani N., Kiarsi M. - Iran) Fire in Iranian schools has led to death, serious injury and disability for dozens of students and teachers. The aim of this study was to explore the causes, consequences and lessons learned from school fires in Iran. The available literature, including scientific texts, previous research and media reports, was searched using English and Persian keywords. The keywords were: "students, school, Iran, fire, burn and incidents". No time limitation was imposed. Results showed that 62 school and student dormitory fires have been reported in Iran, of which 14 school fires and 2 student dormitory fires led to human injuries or casualties (25.8%). In these incidents, thirty students (19 girls and 11 boys) and one teacher died. More than 60 students, 8 teachers, and 2 staff suffered burn injuries or disabilities. The main causes of the fire incidents were use of non-standard kerosene heaters (38.7%) and faulty electrical wiring (35.4%). Lack of knowledge about dealing with accidents, inappropriate physical conditions of the school building, lack of fire extinguishers in the building, and carelessness were the main reasons for the deaths and injuries. In conclusion, it is essential to reduce the incidence of fire and prevent its casualties with proper management and standardization of school buildings.
62	COOKING GAS EXPLOSIONS AS CAUSE OF BURNS AMONG PATIENTS ADMITTED TO A REGIONAL BURN CENTRE IN NIGERIA (Belie O., Mofikoya B.O., Fadeyibi I.O., Ugburo A.O.,Buari A., Ugochukwu N.N. - Nigeria) Burn injury has become a major source of mortality and morbidity in countries with low socioeconomic status. World energy consumption is mainly based on fossil fuels. This source of energy, if not properly handled, can be a source of major accident to lives and properties. The aim of this study is to highlight cases and the outcome of management of burns from cooking gas explosions in Lagos, Nigeria. The study involved all patients who sustained burns following cooking gas explosion within the study period. The parameters considered included demography, spread, anatomical locations and presence of inhalational injury, and outcome of management. A total of 347 patients were treated for burns during the study period, and 49 had burns from cooking gas explosion. Male to female ratio was 1.04:1. Patients between the ages of 21-40 years were the most affected. Extremities were involved in nearly all the patients. The presence of inhalational injury and larger burn surface area were found to be poor prognostic indices. Mortalities occurred within the first two weeks of injury. Cooking gas is becoming increasingly popular in Nigeria. Prevalence of burns from gas explosion is also on the increase. People are however not aware of its safe handling. More public enlightenment is required.
69	HISTOIRE DU TRAITEMENT DES BRÛLURES EN FRANCE. LA PLACE DE L'HÔPITAL LÉON BÉRARD (HYÈRES) : RÉÉDUCATION, SOCIÉTÉ SAVANTE, ASSOCIATION DE PATIENTS (Queruel P., Leclerc J., Chauvineau V. - France) Dans les années 1950 et 60, avant l'apparition des centres de traitement des brûlés (CTB), les brûlés étaient essentiellement pris en charge dans des services de chirurgie. Puis ils étaient adressés dans des structures passant du statut de sanatorium à celui d'établissement de rééducation et réadaptation fonctionnelle (RRF), mais sans véritablement de service structuré. Au tout début des années 70, Jean-Pierre Jouglard, chirurgien des hôpitaux de Marseille, prenant la tête du CTB du Centre Hospitalier Universitaire de Marseille, va collaborer avec le Dr Madeleine Malavaud, dans un établissement de RRF, l'hôpital Léon Bérard à Hyères (Var), pour créer, en 1974 le premier service français dédié à la rééducation des patients brûlés. Le service de rééducation des brûlés de l'hôpital Léon Bérard, toujours actif, a participé dans les années 80 à la diffusion en France des nouvelles techniques venues des États-Unis d'Amérique en assurant la formation des jeunes médecins rééducateurs. Il a contribué, en 1979, à la création de la Société Française d'étude et de Traitement des Brûlures puis a permis aux patients de confronter leur expérience en favorisant, en 1983, la création de l'Association des Brûlés de France. Le service de rééducation des brûlés de l'hôpital Léon Bérard occupe donc une place prépondérante dans l'histoire de la rééducation des brûlés en France.

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