The effect of instruction on burn prevention in eighth-grade students in preparation for babysitting.

New parents quickly discover that the greatest resource for child care at the least cost are teenage babysitters. These sitters assume the responsibility for burn prevention of young children. This study tested the effect of a burn prevention presentation on pre- and posttest scores of eighth-grade students (N = 119) from five sections of a science class. Students were between the ages of 12 and 14 years and 99 of them (83.2%) were babysitters. Multiple analysis of variance was calculated, and differences were seen between information regarding burns from hot bath water, cigarette lighters, and baby bottles that were heated in microwave ovens; however, the differences were not significant. This study concluded that eighth-grade students learned burn prevention before they entered the eighth grade but that there is a need to update these babysitters on burn prevention and new hazards such as cigarette lighters and microwave ovens.     

Self-inflicted burns in Athens, Greece: a six-year retrospective study

Self-inflicted burns represent a major social and medical problem. The aim of this study was to record the epidemiology, mortality and etiology of suicide attempts by burning, in Athens, Greece. Over a 6-year period from April 1997 to April 2003, all the medical charts of the patients who were admitted to the Burn Center of the General State Hospital of Athens, Greece, with self-inflicted burns were retrospectively studied. Of the 1435 burn patients, 53 (3.69%) had attempted suicide by self-inflicted burn. Their ages ranged from 18 to 90 years old (mean 53.5 years). Females (57%) outnumbered males (43%). The mean total body surface area (TBSA) burned was 41.6% (range: 15-100%). The overall mortality rate was very high (75.4%). A preexisting psychiatric disorder was present in 43.3% of the patients. In conclusion, the extent and the depth of the burn injuries could explain the high mortality rate seen in these patients, in correlation with their negativism to the treatment. Burn care professionals should be familiar with self-inflicted burn patients who constitute a considerable proportion of major burns and require constant psychiatric support in addition to burn care.     

Sensibility after burn injury

Summary. Thresholds for touch, temperature, pain and two-point discrimination were examined in 27 healthy subjects and in 36 burn patients. Three groups of injuries were examined; superficial dermal burns, which were allowed to heal spontaneously, deep dermal and subdermal burns treated by either early or late excision and skin grafting. Uninjured areas on the contralateral side served as control. In spontaneously healed superficial burns, the sensibility recovered to normal, except for touch. In deep dermal or subdermal burns all thresholds were significantly higher than in the corresponding control areas. There was no recovery beyond one month after the injury. The sensibility was better on the upper than on the lower extremities and also in deep dermal than in subdermal burns. There was no significant difference in sensibility between burns excised and grafted early or late, respectively. The results indicate that current treatment of deep dermal and subdermal burns is not followed by complete recovery of cutaneous sensation. Furthermore, even superficial burns results in incomplete recovery of touch sensibility.     

The epidemiology, management, outcomes and areas for improvement of burn care in central Malawi: an observational study

This report describes the epidemiology of burn injuries and quantifies the appropriateness of use of available interventions at Kamuzu Central Hospital, Malawi, between July 2008 and June 2009 (370 burn patients). Burns accounted for 4.4% of all injuries and 25.9% of all burns presenting to the hospital were admitted. Most patients (67.6%) were < 15 years old and 56.2% were male. The most frequent cause was scalding (51.4%). Burns occurred most frequently in the cool, dry season and in the evening. The mean burn surface area (second/third degree) was 14.1% and most burns (74%) presented within 8 h. The commonest procedure was debridement and/or amputation. The mean hospital stay was 21.1 days, in-hospital mortality was 27% and wound infection rate was 31%. Available interventions (intravenous fluids, nutrition therapy, physiotherapy) were misapplied in 59% of cases. It is concluded that primary prevention should address paediatric and scald burns, and secondary prevention should train providers to use available interventions appropriately.     

Epidemiology of pediatric burn injuries in southern Turkey

The aim of this study was to identify the epidemiological features of pediatric burn injuries in southern part of Turkey. In this retrospective study, 137 hospitalized pediatric patients (85 men and 52 women) who were admitted to our burn unit during a period of 3 years were analyzed. Pediatric patients were categorized into three groups: the infants and toddlers (0-2 years), early childhood (3-6 years), and late childhood (7-15 years). Epidemiological data included age, sex, location, the cause and type, and place of burn. In the first two groups, scalding (95.1% and 86.7%, respectively) was the predominant cause of burn whereas in late childhood electric burns (51.4%) were a more common occurrence. No differences were found between the groups with respect to mean TBSA and full-thickness burns. A total of 15 (10.1%) patients died during the study period. A total of 74.4% of burn injuries occurred at home, and almost all were preventable, with 16 % of the burns occurring in the autumn; however, 42% occurred in the summer. These findings will be used as a basis for developing targeted preventive programs to protect children from burns. We also consider it is necessary to educate children and their parents about the prevention of burn injuries.     

Hydrofluoric acid burns: a 15-year experience

Hydrofluoric acid (HF) is a strong inorganic acid commonly used in many domestic and industrial settings. It is one of the most common chemical burns encountered in a burn center and frequently engenders controversy in its management. We report our 15 year experience with management of HF burns. We reviewed our experience from 1990 to 2005 for patients admitted with HF burns. Primary treatment was with calcium gluconate gel. Arterial infusion of calcium and fingernail removal were reserved for unrelenting symptoms. There were 7944 acute burn admissions to our center during this study period, 204 of which were chemical burns. HF burns comprised 17% of these chemical burn admissions (35 patients). All were men, with a mean burn size of 2.1 +/- 1.5% (range, 1-6%) and hospital stay of 1.6 +/- 0.7 days (range, 0-3 days). The most common seasonal time of injury was in the summer. Twelve patients (34%) were admitted to the intensive care unit for a total of 14 intensive care unit days, primarily for arterial infusions. Ventilator support was not required in any patient. No electrolyte abnormalities occurred. All burns were either partial thickness or small full thickness with no operative intervention required and no deaths. The upper extremity was most commonly involved (29 patients, 83%). The most common cause was air conditioner cleaner (8 patients, 23%). HF is a common cause of chemical burns. Although hospital admission is usually required for vigorous treatment and pain control, burn size is usually small and does not cause electrolyte abnormalities, significant morbidity, or death.     

Management of multiple burn casualties in a high volume ED without a verified burn unit

The objective of the study was to evaluate the effectiveness of triage, treatment, and transfer interventions on multiple burn casualties managed in a high volume ED that does not have a verified in-hospital burn unit. The charts of 11 male patients injured in a 1999 foundry explosion and brought to Baystate Medical Center (BMC), a level I trauma center, were reviewed. All patients sustained deep partial and full thickness burns. The injury severity score (ISS) ranged from 9 to 75. Five patients had total body surface area (TBSA) burns of 10% to 50% and 6 patients had TBSA burns of 70% to 95%. Transfer times from the scene to BMC ranged from less than 5 minutes to 22 minutes. All 11 were initially triaged, resuscitated, and evaluated at BMC. Of the 9 patients transferred to verified burn units, 8 were intubated, 6 of 6 had negative abdominal ultrasounds, 4 had undergone escharatomies, and 1 had undergone bronchoscopy before transfer. Nine critically injured burn patients with ISS of 9 to 75 were transferred from BMC to verified burn units. For 8 of these patients, the average time from triage, evaluation, and treatment to transfer was 2 hours. The ninth patient was initially admitted overnight then promptly transferred after re-evaluation of his hand burns indicated a need for more specialized care. Two of 9 transferred patients, both with ISS of 75 died. Although 7 other patients had prolonged and complex courses, none of their subsequent complications were referable to missed injuries from this transferring facility. The resources and expertise of a high volume ED without an in-hospital burn unit can be effectively used in the initial resuscitation and treatment of multiple burn casualties. Coordinated responses among emergency medicine, trauma, anesthesia, and nursing personnel are instrumental to the rapid triage, resuscitation, and treatment of critically injured burn patients. Future disaster planning should incorporate a clearly demarcated, ED command center led by an easily identifiable "captain of the ship," as well as more accurate patient identification systems and improved communications with family members.     

Home oxygen therapy: adjunct or risk factor?

The use of home oxygen therapy has become increasingly commonplace and is frequently prescribed by medical specialists. In this study, we have identified a generally unexpected risk of home oxygen therapy. We performed a retrospective review of 3673 consecutive patients treated at our adult burn center over a 10-year period from 1992 to 2001. We identified 27 patients with burns directly attributable to oxygen therapy and also noted an increased incidence of these injuries over the study period. The average age of the patients was 68.1 +/- 9.2 years (range, 40-82 years). Twenty-three were using oxygen at home, three in nursing homes, and one was an inpatient in an acute care facility. Twenty-five patients (93%) were receiving oxygen therapy for the diagnosis of chronic obstructive pulmonary disease. Twenty-four patients (89%) were smoking while using oxygen, two were lighting pilot lights, and one was lighting his wife's cigarette. Four patients (15%) sustained burns greater than 10% TBSA. Seventeen patients (63%) had only partial thickness burns. Thirteen patients (48%) required admission for treatment of their burn injuries. The average length of stay for those admitted was 4.4 days. The average hospital charge for admitted patients was US dollars 8055. There were four deaths (15%), all of which were correlated only with the extent of injury. Although intuitively obvious to most health care professionals, not all patients understand that oxygen therapy and cigarettes or open flame can result in a significant injury. Although some practitioners have advocated not prescribing home oxygen for those who continue to smoke, an alternative means of reducing the incidence of this preventable complication appears warranted. Prevention efforts should focus on the counseling of patients and their caregivers as well as educating primary care physicians, nurses, and home health providers as to the dangers of oxygen use.     

Pediatric burn patients with respiratory failure: predictors of outcome with the use of extracorporeal life support

Extracorporeal life support (ECLS) for pediatric burn patients is a viable option for respiratory failure that is unresponsive to maximal conventional therapy. No criteria have been identified that are predictive of the success of the use of ECLS for these patients. This article presents a retrospective review of the pediatric burn patients placed on ECLS at a single pediatric medical center. It was found that 12 patients (mean age, 30.3 months; range 6 to 69 months) were placed on ECLS because of profound pulmonary failure that was unresponsive to aggressive ventilatory support. The mean size of the burns of these patients was 50.2% of the total body surface area (average size of full-thickness burns, 41.8% total body surface area), with 6 patients having scald burns and 6 having flame burns. The overall survival was 67% (8 of 12). Nonsurvivors had greater positive end-expiratory pressure, mean airway pressure, peak inspiratory pressure, and oxygenation index before ECLS. It is felt that ECLS is a life-saving therapy for pediatric patients with thermal injury. Greater ventilator requirements before ECLS are associated with nonsurvival. Early institution of ECLS in pediatric burn patients with severe respiratory failure may prevent excessive barotrauma and thus discourage the onset of irreversible lung injury.     

Predisposing factors for self-inflicted burns

Self-inflicted burn injuries, although uncommon, are a significant source of morbidity and mortality. The purpose of this study was to delineate the characteristics of these burns and to examine their impact on society. Records of 32 adult patients admitted for self-inflicted burns at our regional burn center between January 1996 and August 2001 were retrospectively reviewed. The mean burn size was 34 +/- 29% TBSA, with the majority of burns being the result of self-immolation using a flammable liquid. There was a slight male predominance (59%) and a significant mortality rate (25%). Ninety-one percent of patients had an active psychiatric diagnosis, with 47% having had a previous suicide attempt. Two thirds had a chronic stressor, such as a chronic medical illness and/or long-term disability. Only four patients had private insurance, whereas the remainder relied on underfunded state- and county-sponsored programs or were uninsured. In addition to well-described psychiatric factors, common characteristics predisposing to self-inflicted burns include chronic medical illnesses, long-term disability, and a lack of access to adequate mental health care. Better treatment of mental illness in the underfunded population might ultimately save the high costs of these burn injuries.     

Axillary burns: extended grafting and early splinting prevents contractures

The development of contractures is a common complication after burn injuries. Axillary burns often result in limited abduction of the arm and present a major hindrance in rehabilitation. To prevent axillary contractures after burn injury, we perform a special grafting technique. In this study we treated 17 patients with 23 axillary burns using this technique. Patients were splinted early, and an intensive physiotherapy program was started 5 days after splinting. After 12 months, the mean abduction of the successfully treated axillary burns was 152 degrees. A secondary reconstruction was needed in only 5 of the 23 treated axillary burns. For the treatment of axillary burns, we recommend the described grafting technique in combination with early splinting and intensive physiotherapy.     

Skeletal and dental disturbances in children after facial burns and pressure garment use: a 4-year follow-up.

Pressure garment use alters facial growth during rehabilitation after a facial burn injury. We previously studied 3 children with full facial burns and 3 children with partial facial burns who wore pressure garments for 1 year, and we found that maxillary horizontal growth and mandibular anterior-inferior growth are inhibited during the time of pressure garment use. The purpose of this follow-up study was to prospectively document skeletal and dental changes after pressure garment use was discontinued. We found that although the growth and development of the facial bones seem to return to normal, lasting changes remain. The use of pressure garments after skin grafting is still recommended. However, it is also recommended that an orthodontist be included in the team of burn care specialists for children with facial burns to monitor facial and dental development. Close attention to facial development during and after pressure garment use is necessary to maintain normal dental and facial relationships.     

The management of burns to the perineum and genitals

A review of 1987 patients treated during the years 1981 to 1986 was conducted to answer the following questions about perineal burns: (1) Are Foley catheters necessary for all patients? (2) Is there any advantage to early excision of the perineal burn wound? (3) What are the complications of perineal wounds? One hundred three patients with perineal burns were identified; mean burn size was 36% of total body surface area. There were 29 deaths in this group but none were related to the perineal burns. Of the 74 survivors 36 (49%) needed Foley catheters. However, the catheters were in place for the period of resuscitation only. There were no urethral complications associated with catheterization. Only three patients required surgery: one had a urethral meatotomy and two had split-thickness skin grafts. In conclusion, we found no genitourinary complications associated with perineal burns. Almost all perineal and genital burns were managed without indwelling catheters. Early excision of the perineal burn wound is not necessary, and most of these wounds will heal satisfactorily without grafting.     

Pain control in a randomized, controlled, clinical trial comparing moist exposed burn ointment and conventional methods in patients with partial-thickness burns

Conventional management of partial-thickness burn wounds includes the use of paraffin gauze dressing, frequently with topical silver-based antibacterial creams. Some creams form an overlying slough that renders wound assessment difficult and are painful upon application. An alternative to conventional management, moist exposed burn ointment (MEBO), has been proposed as a topical agent that may accelerate wound healing and have antibacterial and analgesic properties. One hundred fifteen patients with partial-thickness burns were randomly assigned to conventional (n = 58) or MEBO treatment (n = 57). A verbal numerical rating score of pain was made in the morning, after burn dressing, and some 8 hours later. Patient pain profiles were summarized by locally weighted regression smoothing technique curves and the difference between treatments estimated using multilevel regression techniques. Mean verbal numerical rating scale pain levels (cm) in week 1 for all patients were highest at 3.2 for the after dressing assessment, lowest in the evening at 2.6, and intermediate in the morning at 3.0. This pattern continued at similar levels in week 2 and then declined by a mean of 0.5 in all groups in week 3. There was little evidence to suggest a difference in pain levels by treatment group with the exception of the postdressing pain levels in the first week when those receiving MEBO had a mean level of 0.7 cm (95% confidence interval, 0.2 to 1.1) lower than those on conventional therapy. MEBO appeared to bring greater pain relief for the postdressing assessment during the first week after burns. This initial relief, together with comparable pain levels experienced on other occasions, indicates that MEBO could be an alternative to conventional burns management.     

Epidemiology and outcome analysis of severe extensive burns: a 12-year summary of 103 cases in a burn center in China

The purpose of this article is to improve the treatment of severe extensive burns (SEB) patients by summarizing treatment experience in recent 12 years in China and analyzing the follow-up quality of life (QOL) in these patients. Clinical data and rescue measures of 103 SEB patients (≥70% TBSA) admitted in a burn center in Shanghai between 1997 and 2009 were reviewed, and QOL and hand function of those who survived more than 2 years were assessed by Brief Version of Burn Specific Health scale-B and Michigan Hand Outcome Questionnaire. Of these, 76.7% were caused by flames and 15.5% caused by scald. The median burn area was 87.5% (interquartile range, 77.0-95.0%) TBSA, of which third-degree burns accounted for 56.5% (interquartile range, 25.8-80.0%) TBSA; 71.8% were complicated by inhalation injury. The occurrence of in-hospital complications was 75.7%, with the respiratory system complications predominating (49.5%). The fatality rate was 28.2%, mainly due to sepsis and multiple organ dysfunction syndrome. Work, body image, and heat sensitivity got the lowest Brief Version of Burn Specific Health scale-B scores in all nine domains, and Michigan Hand Outcome Questionnaire scores were also relatively poor. Flame burns remain to be the main cause of SEB in China in recent 12 years. Treatment is still challenged because of the depth and extensive burn area and high occurrence of multiple system complications. How to ameliorate QOL of SEB patients, intensify the functional rehabilitation, and improve their physical appearance in particular remain to be a crux.     

The assessment and management of burns

Each year many people seek medical advice or hospital treatment for burn or scald injuries. There is limited data on the number of burns patients seen in primary care, however a recent national survey suggested that there are 250,000 presentations of burn injuries to primary care teams in the UK per year (National Burn Care Review, 2001). This article discusses the nursing management of burns in the community, outlining the initial assessment of the burns patient in terms of trauma management, and focusing primarily on those patients with non-complex burns. A full patient assessment incorporates the patient's general condition, the type, cause, depth and extent of the burn and the effects on the individual patient. Good patient management is an essential element of care and the focus of this is the management of pain, prevention of infection, provision of evidence based wound care and onward referrals as appropriate. However not all patients can be managed solely in the community and the nurse needs to know when to refer and to whom to refer. The article outlines the recommendations from the National Burn Care Review in terms of patient referral.     

The efficacy of bioelectrostimulation in treating patients with burn injuries]

The paper describes the data obtained by Soviet and American physicians who took part in the treatment of patients burnt in the Bashkiria accident (an outburst of petroleum products). It was established that in deep burns bioelectrostimulation combined with early necrectomy and autodermoplasty yielded the best therapeutic results.     

基于行为转变理论的康复干预措施在颜面部烧伤患者中的应用效果

目的 探究基于行为转变理论的康复干预措施在颜面部烧伤患者中的临床效果。方法 选取江南大学附属医院2020年3月至2021年3月收治的颜面部烧伤患者120例作为研究对象,随机分为对照组和观察组,各60例。对照组给予常规干预措施,观察组给予基于行为转变理论的康复干预措施,比较两组患者的负性情绪、歧视感评分、伤残接受度及生活质量。结果 干预前,两组以上指标差异均无统计学意义(均P>0.05);干预后,观察组负性情绪轻于对照组,歧视感评分低于对照组,伤残接受度高于对照组,生活质量优于对照组(均P<0.05)。结论 给予颜面部烧伤患者基于行为转变理论的康复干预措施,可有效缓解其负性情绪,降低其受歧视的感受,提高其伤残接受度与生活质量。     

257例小儿烧伤特点分析

目的:了解小儿烧伤特征及发病规律,以寻求相应的预防措施。方法:对我院6年收治小儿烧伤住院病例257例,按年龄、致伤原因、发病季节、烧伤面积和部位及地域进行回顾分析。结果:小儿烧伤有一定规律性,婴幼儿期163例(63·4%),高于其他年龄期(P<0·01)。家庭是发病的主要场所,热液烫174例(67·7%)多于其他致伤原因(P<0·01)。发病季节在夏天及冬天多见,分别占32·68%、及33·46%。城乡分布有别,农村较城市多,农村小儿151例(58·74%)。面积以轻中度(烧伤面积小于30%)为主,占73·64%。烧伤深度以单纯浅Ⅱ°43例(16·73%),深Ⅱ°为主的175例(68·09%),有Ⅲ°烧伤的39例(15·17%)。烧伤部位无显著差异,一般是多部位。结论:小儿烧伤多数是可预防,加强安全防护意识,对降低小儿烧伤发生率有重要意义。