The Euro-Mediterranean Council for Burns and Fire Disasters

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Volume XXXIV	Number 3	September 2021

Summaries

213	EPIDEMIOLOGY AND RISK FACTORS FOR DEATH OF PEDIATRIC BURNS IN A DEVELOPING COUNTRY. AN EXPERIENCE FROM THE NATIONAL BURN HOSPITAL (Lam N.N., Hung N.T., Duc N.M., Luong N.V. - Vietnam) This retrospective study investigated burn features and predicted factors for death of pediatric burn patients in Vietnam. The results showed that pediatric burn accounted for 48.1% of total admitted burn patients. Preschool children and boys were predominant, burns were mostly caused by scald (76.2%) and the majority of patients lived in a rural area (64.1%). In addition, 94.5% had burn size less than 30% total body surface area and deep burn injury was seen in 45.5% patients. Moreover, a significantly higher incidence of deep burn injury was recorded in preschool age, patients living in a rural area, and non-scald burn. Overall LA50 was 81.5% and a significantly higher mortality rate was seen in non-scald burns, older children, extensive burn and inhalation injury. Multivariate logistic analysis indicated that only burn extent and inhalation injury were independent risk factors for death. An increased 1% of burn extent resulted in a .7 probability unit of death (OR=1.08) and this was 2.16 in the case of inhalation injury (OR=8.67). This health issue should be highlighted in order to develop appropriate policies and intervention measures in developing countries.
218	COLONISATION ET INFECTION À ACINETOBACTER BAUMANNII DANS UNE UNITÉ DE RÉANIMATION DES BRÛLÉS EN TUNISIE (Mellouli A., Maamar B., Bouzakoura F., Messadi A.A., Thabet L. - Tunisie) Acinetobacter baumannii est une bactérie opportuniste redoutée dans le centre des brûlés et peut poser un problème de traitement en raison de sa fréquente multirésistance. Notre objectif était d'étudier les densités d'incidence de la colonisation et de l'infection à Acinetobacter baumannii et l'antibiorésistance des souches isolées chez les patients hospitalisés dans le service de réanimation des brûlés du Centre de Traumatologie et des Grands Brûlés de Ben Arous en Tunisie. Notre étude rétrospective (1er janvier 2012- 30 septembre 2020) a inclus 1 517 souches non répétitives d'Acinetobacter baumannii, représentant un taux moyen de 12,2% de l'écologie du service. Les densités d'incidences de colonisation et de l'infection à Acinetobacter baumannii chez les brûlés étaient de 13,7? journées d'hospitalisation (JH) et 14,1? JH, respectivement. Une corrélation positive et significative entre colonisation et infection à Acinetobacter baumannii (rs=0,7 ; p=0,005) était observée. Les souches de colonisation étaient isolées surtout des cathéters centraux (71,2%) et des prélèvements cutanés (22,9%). Les infections étaient à type de bactériémies (47,6%) et d'infections respiratoires (25,4%). Les bactériémies étaient microbiologiquement documentées dans 53% des cas. Les cathéters centraux (60,8%), la porte d'entrée cutanée (22,2%) et pulmonaire (15,5%) étaient les portes d'entrée les plus fréquentes des bactériémies. Les taux de résistance d'Acinetobacter baumannii aux molécules testées étaient élevés : 85,2% à la ceftazidime (CAZ), 95,6% à la pipéracilline- tazobactam (TZP), 95,3% à l'imipénème (IPM), 91,1% à l'amikacine (AMK), 93,5% à la ciprofloxacine (CIP), 36,4% à la rifampicine (RIF) et 88,1% au cotrimoxazole (SXT). La résistance à la colistine (CST) était de 1,8%. Parmi les souches isolées, 96,6% étaient multirésistantes et 0,3% toto-résistantes.
226	TOXIC EPIDERMAL NECROLYSIS SYNDROME: MANAGEMENT AND OUTCOMES (Al-Benna S. - United Arab Emirates) Toxic epidermal necrolysis syndrome (TENS) is a rare medical emergency associated with high morbidity and mortality. At present, there is no agreement regarding specific treatments for this disease. The aim of this study is to determine the outcome of patients with TENS using a treatment protocol that did not include the use of intravenous immunoglobulin or systemic steroids. This is a retrospective study of all patients diagnosed with TENS admitted to a tertiary burns centre from 2015-2017. Twelve cases were identified with a mean age of 46±8 years. Mean total body surface area affected was 51±9%. The SCORTEN index was 3.4±0.3 (range 2-5) and predicted 3 deaths in this cohort. Overall mortality was 25%. This study casts no doubt on the prognostic validity of SCORTEN. No specific TENS treatment has been unequivocally proven to be effective.
231	EPILEPSY AND BURN: EPIDEMIOLOGICAL AND CLINICAL ASPECTS. THE EXPERIENCE OF A MOROCCAN BURN UNIT (Ait Benlaassel O., Elatiqi O., Zinedinne I., Yafi I., Mehrouch M., Gouatri M., Sahibi M., Elamrani M.D., Benchamkha Y. - Morocco) Epilepsy is a chronic neurological disorder, affecting 0.5 to 1% of the general population. The association of epilepsy and burns constitutes a real public health problem. The aim of this article is to shed light on the epidemiological and clinical aspects of burned epileptics, the follow-up of their pathology, and the complications noted as well as the multidisciplinarity of their care involving a collaboration of neurologists, plastic surgeons, psychotherapists, physiotherapists and, especially, the entourage that plays a principal and primordial role in the prevention of the triggering of epileptic seizures, especially in places at risk of the occurrence of burn.
235	EFFECTIVE MANAGEMENT OF TOPICAL NOSOCOMIAL ASPERGILLUS SPP. INFECTIONS IN THREE SEVERELY BURNED PATIENTS (Pantet O., Laurent A., Abdel-Sayed P., Hirt-Burri N., Michetti M., Raffoul W., Monod M., Applegate L.A., de Buys Roessingh A.S. - Switzerland) Nosocomial opportunistic fungal infections by Aspergillus spp. represent increasing morbidity and mortality factors for severely burned patients, who are fragile and immunocompromised. Voriconazole (VRC), a modern antifungal drug, is used as a first-line therapy against systemic mold and yeast infections. Little has been published about the place, relative importance and efficacy of voriconazole in the treatment protocols involving Aspergillus spp. in Burn Centers. The objective of the present work was to assess the place and importance of voriconazole for the treatment of burn patients presenting superficial Aspergillus spp. infections. We performed a retrospective evaluation of VRC treatment in three severely burned patients with superficial nosocomial Aspergillus spp. infections in our Burn Center. Results showed that VRC allowed for control and cure of topical nosocomial Aspergillus spp. infections. In two cases, treatment with VRC had to be discontinued because of hepatotoxicity. In two cases, following or during systemic treatment with VRC, a 1% terbinafine cream was applied to resolve the infection in order to continue standard wound management. Overall, VRC has been shown to be an effective antifungal agent and is an alternative to amphotericin B to fight Aspergillus spp. infections developing in the wounds of severely burned patients.
240	HYDROXOCOBALAMIN ADMINISTRATION AFTER INHALATION INJURY IS NOT ASSOCIATED WITH MESENTERIC ISCHEMIA (Engwall A.J., Blache A., Lintner A., Bright A., Kahn S. - USA) Hydroxocobalamin has been administered in the United States since 2006 by first responders and burn centers as a safe antidote for cyanide toxicity, a serious complication of smoke inhalation. There are no current contraindications to the use of this rescue measure. A recent retrospective French publication reported a potential correlation between hydroxcobalamin administration and acute mesenteric ischemia (AMI) in critically ill burn and inhalation injury patients. The purpose of this study is to characterize the risk of AMI related to hydroxocobalamin. A retrospective review of hydroxocobalamin administration among adult burn patients was conducted at a regional burn center over a 2-year period. Injury characteristics, demographics, and outcomes including presence of mesenteric ischemia (defined as presence of pneumatosis or perforation on CT scan or necrotic bowel on laparotomy) were recorded. Of 17 confirmed inhalation injuries, patients had a median (interquartile range) age, total body surface area (TBSA), and abbreviated burn severity (ABSI) index as follows: 60 (45, 65 IQR), 8.5 (1.8, 39 IQR), and 6 (5,7 IQR). Inhalation injury was diagnosed with bronchoscopy, carboxyhemoglobin, or clinical suspicion. Eighty-two percent of those with bronchoscopy had an inhalation grade of 2 or greater. None (0%) of the patients showed signs of mesenteric ischemia, tube feeding intolerance, pneumatosis/perforation on CT, or necrotic bowel on laparotomy. Aware of the study limitations, we conclude that hydroxocobalamin does not increase risk for AMI.
245	CORRÉLATION ENTRE LA CONSOMMATION D'ANTIBIOTIQUES ET LES TAUX D'ANTIBIORÉSISTANCE CHEZ P. ÆRUGINOSA DANS UN SERVICE DE RÉANIMATION DES BRÛLÉS TUNISIEN : ÉTUDE SUR 6 ANS (2014-2019) (Thabet L., Frigui S., Mellouli A., Gargouri M., Maamar B., Harzallal I., Boukadida J., Messadi A.A. - Tunisie) Les antibiotiques sont l'une des plus grandes avancées de la médecine moderne. L'antibiorésistance constitue l'une des plus graves menaces pesant sur la santé mondiale, aggravant le pronostic des patients immunodéprimés parmi lesquels les brûlés. Notre objectif était d'étudier la consommation des antibiotiques définis comme d'importance critique par l'OMS et la corrélation entre l'antibiorésistance chez Pseudomonas æruginosa et la consommation de ces antibiotiques. Notre étude rétrospective (1er janvier 2014- 31 décembre 2019) a eu lieu dans le Laboratoire de Biologie Médicale et Banque du Sang en collaboration avec le service de réanimation des brûlés, au Centre de Traumatologie et des Grands Brûlés en Tunisie. Pendant la période d'étude, 1 384 souches non répétitives de Pseudomonas æruginosa, responsables de colonisation ou d'infection ont été colligées. Pseudomonas æruginosa était la principale espèce bactérienne isolée dans le service, avec un taux moyen de 15,9% de l'écologie du service. Les taux de résistance aux antibiotiques testés étaient élevés : 77,1% à la pipéracilline- tazobactam (TZP), 56% à la ceftazidime (CAZ), 74,9% à l'imipénème (IPM), 78,8% à l'amikacine (AMK), 54,7% à la ciprofloxacine (CIP) et 32,8% à la fosfomycine (FOF). Parmi nos souches, 81,8% étaient multi résistantes. L'analyse de la corrélation entre le niveau de consommation des antibiotiques étudiés et les taux d'antibiorésistance chez les souches de Pseudomonas æruginosa montrait que l'augmentation de la consommation de TZP augmentait la résistance non seulement à TZP mais aussi à IPM et AMK ainsi que la multirésistance. De même, l'augmentation de la consommation de la FOF corrèle avec les résistances à la TZP et à IPM.
252	RIFLE CRITERIA FOR ACUTE KIDNEY INJURY IN BURN PATIENTS: PREVALENCE AND RISK FACTORS (Putra O.N., Saputro I.D., Diana D. - Indonesia) Acute kidney injury is one of the severe complications after burns. The purpose of this study was to identify prevalence, risk factors to the development of acute kidney injury (AKI) in burn patients and mortality, using RIFLE classification: risk (R), injury (I), failure (F), loss (L), and end-stage kidney disease (E). This 3-year retrospective study was conducted in burn patients admitted to the Dr. Soetomo Hospital Burn Center between January 2018 and September 2020. Burn patients aged >18 years old and diagnosed with acute kidney injury during hospitalization were enrolled in this study. Factors influencing AKI and its mortality were assessed using bivariate and multivariate logistic regression analysis. Eighty-nine burn patients were available for analysis, and 18 (20%) of them developed AKI according to the RIFLE classification: risk in 6 (33%), injury in 7 (39%) and failure in 5 (28%). Patients with AKI had a significantly higher age and % of TBSA than those without AKI (p-value <0.05). Age more than 60 years old was significantly associated as a risk factor to develop AKI (OR=25.553, p value=0.014). The mortality rate of patients with AKI was 83% (15 deaths from 18 patients), with the overall mortality of patients 16.8%. Chi-square analysis indicated inhalation injury, % of TBSA, and age as risk factors for mortality (p-value < 0.05). The conclusion of our study was that the incidence of AKI in burn patients was relatively high. Older age as a risk factor to develop AKI and inhalation injury, TBSA, and age were associated with mortality.
259	VERSATILITY OF SQUARE FLAPS IN POST-BURN CONTRACTURES INVOLVING UPPER LIMB (Dutta G., Dey S., Singh S., Rai A., Bhattacharya R.N. - India) . Post-burn contractures are a common problem and functionally limiting for upper limbs. Many different techniques have been described in the literature for their treatment. Z-plasty and release with SSG cover are the commonest procedures done for post-burn contractures. In this study we assess the use of the square flap technique in post-burn contractures of upper limb. Eleven patients with a total number of twelve upper limb contractures (mild to moderate) involving axilla, elbow and finger underwent release by standard square flap technique. All cases were followed up for at least 6 months and analyzed for range of motion and aesthetic outcome. Patient and surgeon satisfaction was recorded. All operated cases achieved a satisfactory range of movement post-operatively without any recurrence. The number of patients who were satisfied with the surgery were 7 out of 11, and 4 patients were somewhat satisfied with the results obtained. In contrast, the surgeons were satisfied in all cases. Square flap is shown to be an easy and reliable flap for mild to moderate contractures of the anterior or posterior axillary folds, elbow contractures and finger contractures with low recurrence rate.
264	ELECTRIC SCOOTER BATTERY DETONATION: A CASE SERIES AND REVIEW OF LITERATURE (Hsieh M.K.H., Lai M.C., Sim H.S.N., Lim X., Fok S.F.D, Joethy J., Kong T.Y., Lim G.J.S. - Singapore) Since 2016 there has been a 20-fold increase in known burns injury from personal mobility device (PMD) related fires. The root cause is the failure of high-density lithium ion (Li-ion) battery packs powering the PMDs. This failure process, known as thermal runaway, is well documented in applied science journals. Importantly, the liberation of hydrogen fluoride from failing Li-ion batteries may contribute to unrecognized chemical burns. A clinical gap in knowledge exists in the understanding of the explosive nature of Li-ion batteries. We reviewed the electrochemical pathophysiology of a failing Li-ion cell as it impacts clinical management of burn injuries. This retrospective study was carried out in two major institutions in Singapore. All admitted PMD-related burns and follow up appointments were captured and reviewed from 2016 - 2020. Thirty patients were admitted to tertiary hospitals, 43% of patients were in the pediatric population and 57% were adult patients, aged from 0.3 to 77 years. TBSA of burns ranged from 0 to 80% with a mean 14.5%. 73% of cases presented with inhalation injury, 8 of whom did not suffer any cutaneous burns. 50% of patients sustained both cutaneous and inhalation burn injuries. 27% of patients sustained major burns of >20% TBSA, with 2 in the pediatric group. Mortali ty rate was 10% from PMD-related fires. This cause of burn injury has proven to be fa tal. Prevention of PMD-related fires by ensuring proper battery utilization, adherence to PMD sanctions for battery standards and public education is vital to reducing the morbidity and mortality of this unique type of thermal injury.
277	LJUBLJANA MARSHES HOT AIR BALLOON CRASH: A MULTIPLE CASUALTY INCIDENT (Kisilak M., Fischinger A., Kristan A. - Slovenia) On August 23rd, 2012 at 7:54 am a hot air balloon crashed in Ljubljana Marshes, leaving 32 injured on site. This case report analyses the biggest multiple casualty incident attended by University Medical Centre Ljubljana in recent history. Analysis of all segments regarding the incident was conducted: mobilisation, arrivals, triage, work-up, identification, public relations and outcome. Issues such as mobilisation, diagnostics, communication, documentation and intensive care unit space are discussed. Twenty-one patients arrived over 63 minutes, 8 of those were immediate resuscitation cases and 10 of those suffered burns. The average Injury Severity Score was 15.7 (ranging 3 to 50), 28.1 for admitted patients. 90% of patients had x-ray, 23% CT and 38% ultrasound diagnostic procedures. 33% of patients required urgent surgery and 60% of admitted cases required intensive care units. A relatives and media territory was established. CT location, loss of communication, inadequate documentation and intensive care bed space were most problematic. At 7-year follow up, we had a roughly 5% hospital fatality rate, 74% of patients gained full recovery and 21% good recovery. Even though the event occurred on a weekday during regular hours, it still exposed many weaknesses. A new radio frequency system for intra-hospital communication has been implemented, the multiple casualty incident protocol has been revised, and regular drills are now performed. Our emergency department is currently undergoing renovation to include CT diagnostics on the same floor. Plans have been made to ease documentation with dictation modules, whereas bed space remains unchanged.
283	FUTURE STUDY OF FIRE DISASTER RISK IN IRAN USING A SCENARIO PLANNING APPROACH (Jafari H., Sheikhbardsiri H., Mohammadi M. - Iran) Fire disasters are one of the most common technological disasters in Iran. These disasters have killed many people and resulted in significant economic loss. The "Plasco" building fire in 2017 is one example of these catastrophic disasters, when most of Iran was affected by its tragic news. Regarding the increasing number of risk factors for fire disasters, we aimed to study future scenarios for such disasters in the country. The present study is a futuristic study with an exploratory approach that uses an intuitive logic scenario development approach. We used document analysis, semi-structured interviews, and the Delphi technique to identify driving forces and develop scenario stories, and finally those scenario stories were validated. In the document analysis phase, 22 documents were identified and analysed. After collecting information related to documents and analysing ten interviews, 41 of the driving forces were identified. By drawing the scenario matrix, four alternative scenarios for the future of fire disasters were developed. Two dimensions for scenario development were the correct application of fire prevention laws and access to driving technologies. Policymakers can concentrate on these key factors for best planning in the mitigation of fire disasters. In addition, studying scenarios can help managers and officials to better develop strategic plans for disaster risk reduction.

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