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PREDICTING MORTALITY IN BURN PATIENTS: LITERATURE REVIEW OF RISK FACTORS FOR BURN MORTALITY AND APPLICATION IN SCORING SYSTEMS
(Wardhana A., Wibowo J. - Indonesia)
Despite advances in medical technology, mortality due to burn injuries remains significant. Scoring systems are aimed at allowing physicians to effectively and accurately predict the mortality of a given patient. Patients at a higher risk of death from burns include older patients over the age of 65, highseverity burn, presence of co-morbidities, and presence of inhalation injury. Constructing a burn prediction model also needs its own methodological standards. Hence, choosing a prediction model for predicting burn mortality requires careful analysis of its methodology. Attention towards mortality risk factors should be taken when treating burn patients. Tools such as burn prediction models prove helpful in aiding physicians to accurately and effectively predict a patient's mortality, stratify patient severity, and allocate resources appropriately, especially in settings where resources are scarce, such as natural disasters. Additionally, prediction models are used to monitor patient care and for research purposes.
ANALYSIS OF INCIDENCE, RISK FACTORS AND OUTCOMES ASSOCIATED WITH ABDOMINAL HYPERTENSION IN MAJOR BURN PATIENTS
(Tsuda M., Tanita M.T., Talizin T.B., Mezzaroba A.L., Cardoso L.T.Q., Grion C.M.C. - Brazil)
The objective of this study is to analyze incidence and risk factors for intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) in major burn patients. A prospective cohort study was conducted at a Burns Treatment Center, including all patients with a burned body surface area ?20% admitted from August 2015 to January 2018. Intra-abdominal pressure was measured periodically during the first week of ICU stay. Sixty-four patients were analyzed, with median age of 39 years (interquartile range ITQ: 28-53) and 66% were male. Median burned body surface area was 30% (ITQ: 20-46). Twenty-eight (56%) patients presented criteria for IAH and seven (14%) developed clinical signs compatible with ACS. Burn severity was greater in the group that developed IAH, represented by the ABSI score. This group also presented higher values of creatinine and positive fluid balance. The group of patients with ACS showed a higher frequency of alterations in renal and respiratory functions. The organ systems most frequently affected in groups with diagnostic criteria for IAH and ACS were renal, cardiovascular and respiratory. Mortality rate at hospital outcome was 56%. In conclusion, the incidence of IAH during the study period was high in patients with extensive burns. The occurrence of ACS was associated with organic dysfunctions of the respiratory, cardiovascular and renal systems. The factors associated with intra-abdominal hypertension were age, extension of burned body surface, inhalation injury, and need for mechanical ventilation.
ESTIMATION OF TOTAL BODY SURFACE AREA BURNED: A COMPARISON BETWEEN BURN UNIT AND REFERRING FACILITIES
(Ho H.L., Halim A.S., Sulaiman W.A.W., Fatimah M.J. - Malaysia)
Accuracy of burn size estimation is critical in acute burn management because it directly affects the patient's outcome and prognosis. This study aims to quantify the discrepancies of total body surface area (TBSA) burned between the burn unit (TBSAb) and the referring facilities (TBSAr). Data of all referred adult and paediatric patients admitted to the Hospital Universiti Sains Malaysia Burn Unit within 24 hours post burn were retrospectively reviewed from 2015 to 2019. %TBSA discrepancies were calculated by the differences between TBSAb and TBSAr. A total of 208 patients (111 adults and 97 paediatric patients) were recruited in this study. Of these, the TBSA was overestimated in 60.58% cases, underestimated in 13.46% cases, accurate in 7.69% cases, and in 18.27% cases the referrals had no TBSAr stated. The %TBSA discrepancy was the highest in severe burns (mean 10.80% in adults and 7.59 in paediatric patients; P<0.001). The time interval between referral and reassessment and patients' body mass index (BMI) were not statistically significant for the magnitude of TBSA discrepancy. The number of burn areas involved correlated with the %TBSA discrepancies, with the highest recorded discrepancy being 21.50% in whole body involvement. There were significant discrepancies in TBSA estimations between the referring facilities and those of the Hospital Universiti Sains Malaysia (USM) burn unit, especially among the paediatric patients and those with severe burns. Implementation of educational programs by burn care experts and agreement on a universal method of TBSA assessment are necessary in reducing the discrepancies.
PREVALENCE OF THROMBOCYTOPENIA IN THE FIRST WEEK AFTER BURN INJURY AND ITS RELATIONSHIP WITH BURN SEVERITY IN SHAHID MOTAHARI HOSPITAL OVER A PERIOD OF 6 MONTHS IN 2017
(Salehi H., Moienian E., Rahbar A., Salehi S.A.H., Momeni M. - Iran)
A platelet count of less than 150,000 per microliter of blood is called thrombocytopenia. Platelet count monitoring is essential in the care of burn patients. The aim of this study was to evaluate platelet count in groups of patients with different percentage of burns on the body surface and its relationship with the severity of burns and mortality. This retrospective descriptive cross-sectional study was performed on patients admitted to Shahid Motahari Hospital over a period of six months. The study was conducted on burn patients who were admitted to the hospital on the first day after injury. Patients were divided into two groups of with or without thrombocytopenia in the first week. Demographic information and treatment information about the patients were recorded. SPSS V.26 software was used for the statistical analysis of data. In this study, the prevalence of thrombocytopenia in the first week after burns was 36%. The variables of age, sex, duration of hospitalization, burn agent, percentage of burns and use of silver sulfadiazine ointment were significantly different in the two groups of patients. The group without thrombocytopenia had a mortality rate of 5.1%, while the group with thrombocytopenia had a rate of 32.2%. Based on the results of this study, thrombocytopenia is significantly associated with mortality in burn patients. Furthermore, the results of this study indicate that age, sex, burn agent, percentage of burns, and the use of silver sulfadiazine ointment have a clear impact on the thrombocytopenic status of patients.
INHALATION SCORE - A NOVEL TECHNIQUE FOR ASSESSING SEVERITY OF INHALATIONAL BURNS IN CORRELATION TO BRONCHOSCOPIC FINDINGS
(Thussu T., Tiwari V.K., Suri J.C., Sarabahi S. - India)
Airway edema following burns is a typical occurrence. It poses a threat, independent of percent Total Burn Surface Area (TBSA), to the life of the patient. Fiber optic bronchoscopy is the gold standard in its diagnosis and is preferred if the facilities are present. Its availability remains a problem in the majority of burn centers in developing countries like India. A scoring system based on clinical findings, if formulated in a manner that reflects bronchoscopy results, may help not only with diagnosis but also with airway management in inhalation burns. One hundred patients suffering from facial burns were included in the study. They were observed clinically and bronchoscopically and airway was managed on the basis of clinical, biochemical and bronchoscopic findings. Fifty patients who showed significant bronchoscopic findings on day 1 were followed up. Clinicobronchoscopic correlation revealed a positive correlation of various clinical variables as well as bronchoscopic grading with subsequent need for endotracheal intubation. Edema of tongue/floor of the mouth and palatal edema showed a positive correlation with subsequent need for tracheostomy. This clinicobronchoscopic correlation was then used retrospectively to formulate the Safdarjung Hospital 'INHALATION' score. This score can be used for predicting impending airway compromise when bronchoscopy facilities are not readily available.
PREDICTOR OF BURN WOUND CONVERSION AS A REFERENCE FOR CONSERVATIVE AND OPERATIVE MANAGEMENT: REVIEW OF IMAGEJ, FLIR ONE® AND DEVELOPMENT OF A RISK FACTOR SCORE MODEL
(Wardhana A., Sukasah C.L., Muradi A., Siregar N.C. - Indonesia)
Burn wound conversion describes the process by which superficial-partial thickness burns convert into deeper burns within 3-7 days after burn. Autophagy, inflammation, ischemia, infection and reactive oxygen species are thought to have a role in pathogenesis of burn wound conversion. This study aims to assess risk factors for burn conversion and develop a scoring system to predict it. The study was conducted using nested case control method, in burn patients treated in Dr. Cipto Mangunkusumo Hospital and Jakarta Islamic Hospital Cempaka Putih. Subjects were recruited by consecutive sampling in February 2019-August 2020. The role of clinical characteristics, local and systemic examination as predictors of burn wound conversion were assessed. Risk factors were analysed using bivariate and multivariate analysis. There were 40 subjects in the case group and 20 subjects in the control group. Involvement of trunk, limbs, burn extent measured using ImageJ, ? 9.49%TBSA, wound surface temperature measured using Flir one® thermography ? -1.55o C, procalcitonin level ? 0.075 ng/mL, and blood lactate level ? 1.75 mmol/L had a significant relationship with burn wound conversion. Three scoring models were developed: model 1 to be applied in tertiary health facilities, and model 2 and 3 to be applied in primary and secondary health facilities with sensitivity and specificity of 92.5% and 85%, 95% and 70% and 92.5% and 85%, respectively. The scoring models can be used in daily practice, especially as a reference for conservative and operative management.
THE EVALUATION OF A GOLDEN PERIOD OF FASCIOTOMY FOR HIGH VOLTAGE ELECTRICAL BURN INJURY PATIENTS WITH COMPARTMENT SYNDROME
(Putri A.C., Tobing J.N., Hasibuan L., Faried A., Mose J. - Indonesia)
Electrical burn injuries can cause various acute manifestations that require surgeons to make an early decision, such as fasciotomy for compartment syndromes. Early decompression can become a 'golden period' for limb salvation. This study evaluates the duration of burn to fasciotomy (B-F time) and amputation. A cross-sectional study was performed on medical records. Inclusion criteria were patients with high voltage electrical injuries and compartment syndrome. Exclusion criteria were patients whose extremities were already non-vital on admission and those lost to follow up. Demographic information, burn surface area and B-F time for patients amputated above the elbow (group A amputation), below the elbow (group B amputation), and no amputation (non-amputated) were investigated. More than 50% patients underwent amputation and 60% had less than 18 hours B-F time. Mean B-F time for non-amputated patients was 18 hours and for amputated patients 20.38 hours. Mean burn to amputation (B-A) time and fasciotomy to amputation (F-A) time in group B was about double compared to group A. The B-A time range of group A was 4.2-7.3 days. Our study showed 18 hours maximum to be the golden period of burn to fasciotomy. The window period of muscle injury evaluation is maximum 7 days to permit limb salvation at the lowest level possible.
HIGH-INTENSITY FOCUSED ULTRASOUND THERMOTHERAPY FOR SCAR TREATMENT
(Anastasova V.N., Georgiev A.A., Zanzov E.I., Velkova K.G., Krasteva E.S. - Bulgaria)
The formation of pathological scars is a common medical and aesthetic problem worldwide. Surgical interventions, burns and injuries are the most common cause. Treating these scars is a challenge for any surgeon. The Clinic of Plastic-Reconstructive and Aesthetic Surgery with Thermal Trauma and Imaging Diagnostics applied an innovative method of thermotherapy with high-intensity, focused ultrasound in 20 patients with hypertrophic scars and keloids of different age, etiology and parameters. After a series of procedures, we got excellent results, reducing scar size, pigmentation, pain and itching. This type of thermotherapy is successfully applied to pathological scars. In this way, a change in scar density is achieved by converting hard collagen into a gelatin-like mass. As a subsequent procedure, moderately compressive massages are applied for faster resorption of the pathological collection. Our results show that high-intensity focused ultrasound thermotherapy of pathological scars is a non-invasive method of treatment with reasonably good results as regards both aesthetic and functional aspects.
IBUPROFEN LYELL'S SYNDROME IN AN EIGHT-YEAR-OLD CHILD
(Koffi N.R., Pete Y., N'Da K.C., Ory O.A., One J.L., Ogondon B., Kouadio S., Able E., Irie B., Kouame K.E., Brouh Y. - Côte d'Ivoire)
Lyell's syndrome or toxic epidermal necrolysis (TEN) is a rare but serious drug-like toxiderma. Treated as a recent extensive burn in intensive care, its management must be urgent, and adapted in order to improve the vital prognosis of patients and reduce their mortality. We report a severe case of Lyell's syndrome occurring 24 hours after oral administration of an anti-inflammatory drug (ibuprofen) as a self-medication in an eight-year-old child.
LOCAL ANAESTHESIA FOR ENZYMATIC DEBRIDEMENT OF CUTANEOUS BURNS: A PROSPECTIVE ANALYSIS OF 27 CASES
(Berwick D., Young L., Lee A., Lancaster D., Dheansa B. - UK)
Enzymatic debridement (ED) is increasingly used for cutaneous burns. Compared with surgical debridement, ED has better preservation of viable dermis, less blood loss and autografting, however ED is painful. Current recommendations suggest local anaesthesia (LA) is useful for minor burns, but the evidence base is minimal. In our centre, we routinely use LA with good analgesic effect. This study was a single-centre, prospective analysis conducted at the Queen Victoria Hospital (UK). Patients had at least superficial partial thickness burns and received subcutaneous LA prior to ED during a 1-year period (October 2019-September 2020). Pain was assessed using a numeric scale of 1-10, recorded before, during and after the procedure. In total, 27 patients were included (n=17 males) with a median age of 47 (18-88 years). The mean total burn surface area was 1.5% (0.3-5.0). Treated sites included head and neck (1), trunk (5), upper limb (9) and lower limb (16). The most used LA was bupivacaine 0.25% (n=25), followed by lidocaine 1% (n=2). Some required additional oral analgesia (n=8) or a regional blockade (n=2). Average pain score during debridement was 1.9 We have found LA effective, with favourable pain scores in comparison to previous studies with oral analgesia or regional blockade. LA is quick and easy to perform, as opposed to nerve blocks, which require trained personnel with ultrasound guidance. LA is a useful analgesic for patients with minor cutaneous burns undergoing ED. In some cases, it is sufficient without additional oral analgesia or regional blockade.
L'ACCIDENT ET LES BRÛLURES DU DUC-ROI STANISLAS, LE TRAITEMENT MÉDICAMENTEUX APPLIQUÉ À CELLES-CI, ET LA MORT DU MONARQUE. LUNÉVILLE, 5-23 FÉVRIER 1766
(Labrude P. - France)
Le 5 février 1766, tôt le matin, Stanislas Leczinski, duc de Lorraine et de Bar, âgé de quatrevingt-huit ans, et dont la santé est assez délabrée, tombe très près de la cheminée de sa chambre dans les appartements royaux du château de Lunéville. L'absence de son personnel à ce moment le conduit à rester assez longtemps exposé aux flammes et donc à subir de graves brûlures. Le personnel médical appelé à lui prodiguer des soins ne peut que constater la gravité de son état. Durant les neuf premiers jours, les praticiens appliquent un traitement local constitué de pansements imbibés de produits cicatrisants et desséchants. Ils y associent alors des remèdes d'usage interne et en particulier du quinquina. Des signes de septicémie se manifestent après environ deux semaines. L'état du roi s'aggrave à partir du 20 février. Des stimulants sont alors utilisés. Stanislas entre en léthargie le 21. Il meurt dans l'après-midi du 23 février.
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