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1.
P. Theodorou T.A. Spanholtz P. Amini C.A. Maurer T.Q.V. Phan W. Perbix R. Lefering G. Spilker 《Burns : journal of the International Society for Burn Injuries》2009
Objective
To evaluate demographic and socioeconomic factors associated with assault burn injuries.Background
Assault by burning demonstrates a rare but severe public health issue and accounts for unique injury characteristics in the burn intensive care unit (BICU).Methods
We conducted a retrospective cohort study involving patients with thermal injuries admitted to the BICU of a university hospital. The patient cohort was divided into two groups (ABI group: patients with assault burns, n = 41; Control group: population of all other burned patients admitted to the BICU, n = 1202). Bivariate and multivariate analyses including demographic and socioeconomic data were used to identify factors associated with assault burns.Results
Forty-one assault-related burn victims were identified in the study period. This represents 3.3% of all significant burns admitted. Comparing battery victims with the control population, assault patients were more likely to be young (mean age 36.2 years vs. 42.2 years) and immigrants (41.5% vs. 15.1%). Furthermore, marital status (65.9% vs. 40.8% singles), employment status (36.6% vs. 9.7% unemployed) and insurance status (41.5% vs. 12.3% social insurance) were significantly different in the bivariate analysis. Logistic regression evaluation identified three variables that were independently associated with assault burns: younger age (≤25 years) (odds ratio, 2.54 [95% confidence interval, 1.29–5.02]; p = 0.007), ethnic minority (odds ratio, 3.71 [95% confidence interval, 1.91–7.20]; p < 0.001) and unemployment (odds ratio, 4.02 [95% confidence interval, 2.03–7.97]; p < 0.001).Conclusions
The high incidence of youngsters, unemployment and the great proportion of immigrants in victims of assault might provide several opportunities for community-based psychosocial and occupational programs. A multidisciplinary approach targeting issues specific to the violent nature of the injury and the socioeconomic background of the victims may be of benefit to improve their perspectives for rehabilitation. 相似文献2.
Staphylococcus aureus bacteremia after thermal injury: The clinical impact of methicillin resistance
Panagiotis Theodorou Rolf Lefering Walter Perbix Timo A. Spanholtz Marc Maegele Gerald Spilker Oliver C. Thamm 《Burns : journal of the International Society for Burn Injuries》2013
Objective
To evaluate the impact of methicillin resistance in Staphylococcus aureus bacteremia (SAB) on mortality and length of stay in burn patients.Design
Retrospective cohort study.Setting
A 750-bed tertiary care university hospital in Cologne, Germany.Patients
Patients registered in the database of the burn intensive care unit (BICU) between 1989 and 2009 with complete data sets (n = 1688).Results
Over the 21-year study period, 74 patients with SAB were identified; 33 patients had methicillin-resistant S. aureus (MRSA) and 41 methicillin-susceptible S. aureus (MSSA). Comparing the MRSA with the MSSA population the following parameters were significantly different in the univariate analysis: BMI (27.2 kg/m2 vs. 23.6 kg/m2; P = 0.05), extent of deep partial thickness burns (17.8% vs. 9.0% of total body surface area; P = 0.007), antibiotic requirement on admission (45.5% vs. 22.0%; P = 0.046), median length of hospitalization prior SAB (24 days vs. 7 days; P < 0.001), packed red blood cells administration (47.6 units vs. 26.1 units; P = 0.003), intubation requirement (100% vs. 80.5%; P = 0.007), intubation period (43.5 days vs. 26.8 days; P = 0.008), catecholamine requirement (90.9% vs. 61.0%; P = 0.004), sepsis (60.6% vs. 34.1%; P = 0.035) and organ failures (81.8% vs. 39.0%; P < 0.001). Regarding outcome parameters, methicillin resistance was not significantly related with mortality (adjusted OR 1.55, 95% CI 0.56–4.28; P = 0.40) and length of BICU stay after SAB (Kaplan–Meier analysis log-rank test P = 0.32; Cox's proportional hazards regression HR 1.22, 95% CI 0.65–2.27, P = 0.535) in the univariate and multivariate analyses.Conclusion
Our data suggest that methicillin resistance is not associated with significant increases in mortality and length of BICU stay among burn patients with SAB. 相似文献3.
Theodorou P Maurer CA Spanholtz TA Phan TQ Amini P Perbix W Maegele M Lefering R Spilker G 《Burns : journal of the International Society for Burn Injuries》2009,35(3):405-411
Objective
To investigate the incidence and predisposing factors of acalculous cholecystitis (AAC) in severely burned patients.Background data
Although some studies report on AAC in critically ill patients, very little is known about AAC after severe burns.Methods
We conducted a retrospective cohort study involving patients with burns admitted to the burn intensive care unit (BICU) of a university hospital. The patient cohort was divided into two groups (AAC group: burned patients with histological proven acalculous cholecystitis, n = 15; Control group: population of all other burned patients admitted to the BICU, n = 1225). Univariate and multivariate analyses were used to identify predisposing factors for the development of AAC.Results
Fifteen patients with acalculous cholecystitis were identified in the study period. This represents 1.2% of all significant burns admitted. Comparing the AAC group with the Control population the following patients’ characteristics, therapeutic measures and outcome parameters were significantly different in the univariate analysis: mean age (54.0 years vs. 42.0 years), BMI (28.9 kg/m2 vs. 25.6 kg/m2), abbreviated burn severity index (8.3 vs. 6.4), total body surface area burn deep partial thickness (12.0% vs. 6.2%) and full thickness (10.2% vs. 6.8%), concomitant inhalation injury (80.0% vs. 28.9%), sepsis (46.7% vs. 14.9%), catecholamine (100% vs. 30.4%) and antibiotic requirement (100% vs. 58.2%), non-biliary tract operations (4.9 vs. 1.5), BICU length of stay (63.4 days vs. 21.0 days), ventilator days (50.3 vs. 11.9), packed red blood cells (PRBCs) administration (70.0 units vs.13.0 units) and mortality (53.3% vs. 19.7%). In the multivariate analysis however, only age, the number of administered units of PRBCs and the duration of mechanical ventilation turned out to be independent predictors for the occurrence of AAC.Conclusion
AAC is a rare complication of severely burned patients and may reflect the severity of the patient’s general conditions. Predisposing factors for AAC are advanced age, the need of blood transfusions and prolonged mechanical ventilation. In the presence of these predisposing factors, early monitoring may help to detect AAC earlier and to initiate appropriate intervention. 相似文献4.
Christopher J. Dennis Kevin K. Chung Seth R. Holland Brian S. Yoon Daun J. Milligan Stephanie L. Nitzschke Christopher V. Maani Jacob J. Hansen James K. Aden Evan M. Renz 《Burns : journal of the International Society for Burn Injuries》2012
Background
When urgently intubating patient in the burn intensive care unit (BICU), various induction agents, including propofol, are utilized that may induce hemodynamic instability.Methods
A retrospective review was performed of consecutive critically ill burn patients who underwent urgent endotracheal intubation in BICU. Basic burn-related demographic data, indication for intubation, and induction agents utilized were recorded. The primary outcomes of interest were clinically significant hypotension requiring immediate fluid resuscitation, initiation or escalation of vasopressors immediately after intubation. Secondary outcomes included ventilator days, stay length, and in-hospital mortality.Results
Between January 2003 and August 2010, we identified 279 urgent intubations in 204 patients. Of these, the criteria for presumed sepsis were met in 60% (n = 168) of the intubations. After intubation, 117 patients (42%) experienced clinically significant hypotension. Propofol (51%) was the most commonly utilized induction agent followed by etomidate (23%), ketamine (15%), and midazolam (11%). On multiple logistic regression, %TBSA (OR 1.016, 95% CI 1.004–1.027, p < 0.001) and presumed sepsis (OR 1.852, 95% CI 1.100–3.117, p = 0.02) were the only significant predictors of hypotension. None of the induction agents, including propofol, were significantly associated with hypotension in patients with or without presumed sepsis.Conclusions
In critically ill burn patients undergoing urgent endotracheal intubation, specific induction agents, including propofol, were not associated with clinically significant hypotension. Presumed sepsis and %TBSA were the most important risk factors. 相似文献5.
Elizabeth L. Dale Melissa A. Mueller Li Wang Mary D. Fogerty Jeffrey S. Guy Peter M. Nthumba 《Burns : journal of the International Society for Burn Injuries》2013
Introduction
In order to implement effective burn prevention strategies, the WHO has called for improved data collection to better characterize burn injuries in low and middle income countries (LMIC). This study was designed to gather information on burn injury in Kenya and to test a model for such data collection.Methods
The study was designed as a retrospective case series study utilizing an electronic data collection tool to assess the scope of burn injuries requiring operation at Kijabe Hospital from January 2006 to May 2010. Data were entered into a web-based tool to test its utility as the potential Kenya Burn Repository (KBR).Results
174 patients were included. The median age was 10 years. There was a male predominance (59% vs. 41%). Findings included that timing of presentation was associated with burn etiology (p = 0.009). Length of stay (LOS) was associated with burn etiology (p < 0.001). Etiology differed depending on the age group, with scald being most prominent in children (p = 0.002).Conclusions
Burn injuries in Kenya show similarities with other LMIC in etiology and pediatric predominance. Late presentation for care and prolonged LOS are areas for further investigation. The web-based database is an effective tool for data collection and international collaboration. 相似文献6.
A. Gevaart-Durkin D. Swart Z. Chowdhury 《Burns : journal of the International Society for Burn Injuries》2014
Introduction
Burn and ingestion injuries are common in developing countries because of poor access to safe energy sources, crowded living conditions, and insufficient knowledge of potential risks. The purpose of this study is to understand the scope of burn and ingestion injuries due to various energy source usages in South Africa.Methods
Patients at 16 regional hospitals throughout South Africa presenting with an energy-related injury between 2006 and 2012 were interviewed to obtain demographics and injury characteristics.Results
A total of 12,443 patients were included in this study. Children aged 1–2 years predominantly experienced burn and ingestion injuries (21%). Liquid burns (30%) were more common than flame burns (14%). Chi-squared tests show that age was significantly related to degree of burn, type of burn, and severity of burn (p < 0.001). Non-intentional injuries (45%) were more frequent than self-inflicted or assault injuries. Temporal and seasonal injury trends reflect usage patterns. Burn injuries result in longer hospital length of stay than ingestion injuries.Conclusion
Non-intentional liquid burns and ingestions to infants and babies were most common in this study, with many injuries also occurring among young adults. It is advised that interventions targeting low-income communities be conducted to increase awareness of burn and ingestion injuries. 相似文献7.
P.B. Sherren J. Hussey R. Martin T. Kundishora M. Parker B. Emerson 《Burns : journal of the International Society for Burn Injuries》2013
Background
Acute traumatic coagulopathy is well described in the trauma population. Major burns are characterised by a similar endothelial injury and cellular hypoperfusion. These features could be a driver for an acute burn induced coagulopathy (ABIC).Methods
Patients admitted to a regional burn centre over a 71 months period with a total body surface area burn of 30% or more were identified. The metavision electronic patient database was scrutinised for a predetermined list of demographics, interventions and admission investigations to identify any clinically significant ABIC.Results
On admission 39.3% of the 117 patients analysed met our criteria for a coagulopathy. Of the patients with a coagulopathy, 71.7% had an elevated Prothrombin Time (PT), 2.2% had an elevated Activated Partial Thromboplastin time (APPT) and 26.1% had an elevation of both. Patients with a coagulopathy received a similar volume of fluid (p = 0.08). There was a statistically significant correlation between the PT and the abbreviated burn severity index (p = 0.0013, r = 0.292) and serum lactate (p = 0.0013, r = 0.292). ABIC was an independent predictor of 28 day mortality, OR 3.42(1.11–10.56).Conclusion
In patients with major thermal injuries a clinically significant ABIC exists. Early diagnosis and treatment of ABIC should be considered particularly in those undergoing total burn wound excision. 相似文献8.
Raimo Palmu Kirsi Suominen Jyrki Vuola Erkki Isometsä 《Burns : journal of the International Society for Burn Injuries》2010
Objective
To investigate mental disorders among acute hospitalized burn patients.Method
Consecutive acute adult burn patients (n = 107) admitted to Helsinki Burn Centre were interviewed by an experienced psychiatrist with the Structured Clinical Interview for DSM-IV-TR for Axis I and II mental disorders assessed in three time frames (lifetime, the month prior to burn, and in acute care). Information on clinical features, psychiatric symptoms, personality traits, and burn severity (total body surface area, TBSA) was gathered.Results
The mean TBSA was 9%. Most (61%) acute burn patients had at least one lifetime Axis I or II mental disorder. Prevalences of lifetime substance-related disorders (47%), psychotic disorders (10%), and Axis II personality disorders (23%) were high. The overall prevalence of Axis I mental disorders increased significantly (Q = 6.40, df = 1, p = 0.011) from the month prior to burn (40%) to acute care (48%). The prevalence of delirium for this period was significantly higher (0.9% vs. 13%; Q = 13.00, df = 1, p < 0.001) in acute care.Conclusions
Mental disorders, particularly substance use disorders, psychotic disorders, and personality disorders are common among acute burn patients before injury. These disorders may predispose to burns. Burn itself may also predispose to mental disorders, particularly delirium. 相似文献9.
Background
In Pakistan the practice of managing extensive burns in dedicated intensive care units is not well established. This audit aims to define the characteristics of the victims of major burns and factors that increase mortality and outcome of the protocol-based management in a dedicated burns intensive care unit (BICU).Patients and methods
This prospective audit included all patients admitted to the BICU of Suleiman Dawood Burns Unit in Karachi from 1st September 2002 to 31st August 2011. Demographic information, type and place of burn, total body surface area burn (TBSA), type of organ support provided, length of ICU stay, any associated medical diseases, and out outcome were documented.Results
A total of 1597 patients were admitted to the BICU in 9 years. Median age of the patients was 22 (IQR = 32–7). 32% victims were children <14 years and only 7% were >50 years old. Male to female ratio was 1.4:1. Fire was the leading cause of burns in adults (64%) and scald burns were most common in (64%) in children. 72.4% of the accidents happened at home, where kitchen was the commonest location (597 cases). Mean TBSA burnt was 32.5% (SD ± 22.95%, 95%CI: 31.36–33.61). 27% patients needed ventilatory support, 4% were dialyzed and split skin graftings were performed in 20% patients. Average length of ICU stay was 10.42 days. Epilepsy, psychiatric illness and drug addiction were not common associations with burns. Overall mortality was 41.30% but it decreased over the years from 75% to 27%.Conclusions
Groups of people most vulnerable to sustain burn are young females getting burnt in the kitchen, young males getting burnt at work, and small children falling in pots of hot water stored for drinking or bathing. TBSA >40%, age >50 years, fire burn and female gender were associated with a higher risk of death.Carefully planned, protocol based management of burn patients by burn teams of dedicated healthcare professionals, even with limited resources reduced mortality.Recommendations
Burn hazard awareness, prevention and educational programmes targeted at the vulnerable population, i.e. women and young children at home and men at their work place is the single most cost-effective way of reducing the incidence of burns in developing countries. 相似文献10.
E. O’Halloran J. Duke S. Rea F. Wood 《Burns : journal of the International Society for Burn Injuries》2013
Aim
The aims of this study were to determine whether a change occurred in the pattern of assault burn injury cases hospitalised to the adult state burns unit, Western Australia, from 2004 to mid-year of 2012, and to compare patient and burn characteristics of adult assault burns with those admitted for unintentional burns.Methods
Study data were obtained from the Royal Perth Hospital (RPH) Burns Minimum Dataset (BMDS). Aggregated data of unintentional burn admissions during the same period were provided by the BMDS data manager to enable comparisons with assault burn patients.Results
Assault burn admissions during 2004–2012 accounted for approximately 1% of all adult burn hospitalisations. All assault victims were burned by either thermal or scald agents. A high rate of intubation (24%) and ICU admission (1 in 3 cases) was observed in the fire assault group. The six assault cases undergoing intubation were severe burns, median TBSA 50%, most commonly affecting the face, head and torso, half of these cases had inhalational injuries and also required escharotomies.Comparison of admissions by calendar period showed no statistically significant differences in demographic, burn cause or TBSA%. However, statistically significant differences were found for pre-morbid psychiatric history (15% vs. 58%, p = 0.025) and concomitant fractures or dislocations (46% vs. 2%), p = 0.011).Conclusions
While the proportion of assault burn admissions per total burn admissions steadily increased from 0.4% in 2009 to 1.5% in mid-2012, this proportion did not exceed that peak level observed of 2.1% for 2004. 相似文献11.
Bruce H. Ackerman Cynthia L. ReigartMegan Stair-Buchmann Linwood R. Haith Jr.Mary L. Patton Robert E. Guilday 《Burns : journal of the International Society for Burn Injuries》2013
Background
Nebulized antibiotics are used to locally treat colonizations of multi-resistant organisms. Prior systemic nephrotoxic antibiotic use with serum creatinine rises warranted an alternative therapy in 69 ventilator-dependent patients with persisting sputum cultures and need for ventilatory support.Materials and methods
Following IRB approval, retrospective patient data were reviewed. Analysis included comparison of these 69 patients (71 treatments) to 142 Gram-negative infected burn patients matched for age and burn size.Results
Mean pooled age and burn wound percent for the 71 triplicates (n = 211 patients) were 55.6 ± 18.3 years and 27.4 ± 22.3% burns. Fifty-seven of 69 (83%) patients had inhalation injuries and 54 of 69 (78%) patients survived. Nebulizations averaged 6.8 ± 3.3 days (range 3–12 days). Serum creatinine rose in 2 patients receiving colistimethate nebulizations, known to cause nephrotoxicity following nebulization. Triplicate comparisons via ANOVA noted prolonged ventilatory support (F = 13.39; p ? 0.05) and length of stay (F = 6.11; p ? 0.5). Variance was attributed to the sicker nebulized patients. Twenty-four inhalation injury-only triplicates further confirmed that nebulized patient subgroup was more ill.Conclusion
Short duration antibiotic nebulization may allow higher intra-tracheal antibiotic concentrations and may facilitate weaning from the ventilator by reducing bacterial bioburden. 相似文献12.
Jonathan C. Wilton Mark O. HardinJohn D. Ritchie Kevin K. ChungJames K. Aden Leopoldo C. CancioSteven E. Wolf Christopher E. White 《Burns : journal of the International Society for Burn Injuries》2013
Objective
Adult burn patients who experience in-hospital cardiac arrest (CA) and undergo cardiopulmonary resuscitation (CPR) represent a unique patient population. We believe that they tend to be younger and have the added burden of the burn injury compared to other populations. Our objective was to determine the incidence, causes and outcomes following cardiac arrest (CA) and cardio-pulmonary resuscitation (CPR) within this population.Methods
We conducted a retrospective review at the US Army Institute of Surgical Research (ISR) burn intensive care unit (BICU). Charts from 1st January 2000 through 31st August 2009 were reviewed for study. Data were collected all on adult burn patients who experienced in-hospital CA and CPR either in the BICU or associated burn operating room. Patients undergoing CPR elsewhere in our burn unit were excluded because we could not validate the time of CA since they are not routinely monitored with real-time rhythm strips. The study population included civilian burn patients from the local catchment area and burn casualties from the conflicts in Iraq and Afghanistan, but patients with do-not-resuscitate (DNR) orders were excluded.Results
We found 57 burn patients who had in-hospital CA and CPR yielding an incidence of one or more in-hospital CA of 34 per 1000 admissions (0.34%). Fourteen of these patients (25%) survived to discharge while 43 (75%) died. The most common initial cardiac rhythm was pulseless electrical activity (50.9%). The most common etiology of CA among burn patients was respiratory failure (49.1%). The most significant variable affecting survival to discharge was duration of CPR (P < 0.01) with no patient surviving more than 7 min of CPR.Conclusions
CPR in burn patients is sometimes effective, and those patients who survive are likely to have good neurological outcomes. However, prolonged CPR times are unlikely to result in return of spontaneous circulation and may be considered futile. Further, those who experience multiple CA are unlikely to survive to discharge. 相似文献13.
Muhammad Farhan Khaliq Muhammad Muslim Noorani Uzair Ahmed Siddiqui Ehmer Al Ibran Masood Hussain Rao 《Burns : journal of the International Society for Burn Injuries》2013
Objective
Burns are important contributors toward mortality in trauma related injuries in Karachi, Pakistan. The aim of the present study was to delineate the factors contributing to the duration of hospitalization and mortality in such patients.Methods
We performed a single center retrospective study of patients admitted during a 2 year period (January 2009 till December 2010) in Burns Center, Karachi. Patients with incomplete record were excluded. Variables included were age and gender of the patient, the percent total body surface area (%TBSA) burn, the cause of the burn and the body parts affected along with the micro-organisms isolated from the burn wounds. The relationship of these variables with the duration of hospitalization and the outcome of patients was assessed by means of Pearson Chi Square test in SPSS version 14.Results
Mean age of patients was 26.64 years (±13.430). More males (56.6%) were admitted than females (43.4%), giving a male to female ratio of 1.3:1. Mean percent total body surface area (%TBSA) burnt and mortality were 24.69% and 26.38% respectively with both having higher values in females (p < 0.001). Males had a mean longer duration of hospitalization compared to females (35.94 days vs. 27.63 days). The most common micro-organism colonizing the wounds was found to be Staphylococcus aureus. Factors significantly (p < 0.05) associated with increased duration of hospitalization and mortality include the age and gender of the patient, the cause of burn, inhalation injury, the region affected and %TBSA burnt.Conclusion
The relationship of age and gender of the patient, the cause of burn, inhalation injury, the region affected and %TBSA burnt are important factors in determining the duration of hospitalization of the patients and whether the patients will survive or succumb to injuries. 相似文献14.
Amalia Cochran Wiley Thuet Brennen Holt Iris Faraklas Randall J. Smout Susan D. Horn 《Burns : journal of the International Society for Burn Injuries》2013
Introduction
The anabolic agent oxandrolone (OX) has been found to decrease length of stay (LOS) following 20–60% total body surface area (TBSA) burn injury. This study uses the Comprehensive Severity Index (CSI) to control for severity of illness and explores the relationship between OX and LOS in a more broadly selected sample of burn patients and a natural practice setting.Methods
A practice-based evidence study was conducted at a single regional burn center. Maximum severity of illness (MCSIC) was measured using a burn-specific version of CSI. Data on 167 consecutive surviving patients with TBSA ≥ 15% were analyzed using case-control matching for MCSIC, TBSA, and age. Thirty-eight patients received OX.Results
Median patient age for the entire patient sample was 42.7 years. Using a 1:1 match based upon MCSIC, TBSA, then age, mean LOS for patients who received OX was 33.6 days, as opposed to 43.4 days for those who were not managed with OX (p = 0.03). If patients were matched >1:1 for controls: cases, mean LOS was 40.9 days (controls) versus 31.6 days (cases).Conclusions
OX is associated with shorter LOS after controlling for MCSIC, TBSA, and age. Future comparative effectiveness studies should better define which patients derive the greatest benefits from receipt of OX during their recovery from major burn injury. 相似文献15.
Hadley K.H. Wesson Abdulgafoor M. Bachani Patricia Mtambeka Dorothy Schulman Chiedza Mavengere Kent A. Stevens Alastair John Ward Millar Adnan A. Hyder Arjan Bastiaan van As 《Injury》2013
Introduction
Burns are a significant burden of pediatric injuries, particularly in low and middle-income countries, were more than 90% of burn-related pediatric deaths occur. This study explores pediatric burn-related injuries over a fifteen year time period in South Africa through an analysis of a pediatric trauma surveillance system.Methods
This retrospective observational study used data collected by Childsafe South Africa from the Red Cross War Memorial Children's Hospital (RCH) trauma registry in Cape Town, South Africa between 1995 and 2009 for children less than 13 years of age who presented with burn injuries to the hospital's casualty department. Demographic data and Abbreviated Injury Scores (AISs) were first assessed, followed by an analysis of time trends using Poisson regression. Logistic regression models were used to analyse factors related to hospital admissions.Results
Between 1995 and 2009, 9438 children with burn-related injuries presented to RCH, of which nearly three-quarters resulted from scalds (73%; n = 7024). The mean age of the injured children was 3.1 ± 2.9 years 58% were male. 11 deaths occurred in the hospital's casualty department. 39% of injuries were minor, 56% were moderate, and 5% were severe. During the 15-year study period, moderate burn injuries increased by 3%, while minor injuries decreased by 10% (p < 0.05). 49% of all children were admitted to the hospital. Hospital admissions increased by 3% (p < 0.05) during the study period.Conclusions
Pediatric burn injuries are a significant contributor to the burden of child diseases in developing county hospitals. Pediatric surveillance systems, such as Childsafe South Africa's, are important to study epidemiologic changes in burn injuries. Findings suggest the need for targeted interventions to address the prevention of specific burn-related injuries. 相似文献16.
Yolanda Zayakova Ivailo Vajarov Anton Stanev Natalia Nenkova Hristo Hristov 《Burns : journal of the International Society for Burn Injuries》2014
Objective
The purpose of the study was to identify the basic epidemiological characteristics of burn patients in East Bulgaria, as well as to analyze trends in burns in the region over the last decade.Methods
Retrospective data of burn patients treated at Military Hospital-Varna, in the period January 2002–December 2011, was reviewed and statistically interpreted in terms of patients and burn demographics; etiology; place of incidents; hospital stay and mortality. Trends were observed for the entire period and comparative analyses of patients’ data were made between two periods: first – 2002–2006 and second 2007–2011.Results
A total of 2627 burn patients, median age 41 years (IQR 9–61) were admitted to our burn unit. For the entire period the most affected age groups were ≤4 years (21.6%) and ≥65 years (21.1%). Hospitalized patients increased in the second period (n = 1701) compared to the first one (n = 926), while the size of total burn surface area decreased (first period – 9.8% vs. second period – 10.6%). Scald (51%) and flame (23.8%) were the most frequent aetiological agents for both periods. Work related burns reduced in the second period (9.4% vs. 4.9%), while home burns (90.6 vs. 95.1%) increased. Hospital stay declined from 17days (2002–2006) to 7days (2007–2011), whereas mortality rate slightly increased (first period – 2.3% vs. second period – 3.6%).Conclusion
Burns remain a significant health problem in Bulgaria. The future preventive actions should take into account the observed changes in burn demographics and target the most vulnerable groups. 相似文献17.
E. Matuszczak M. Tylicka W. Dębek A. Hermanowicz H. Ostrowska 《Burns : journal of the International Society for Burn Injuries》2014
Aim of the study
To characterize burn-induced changes following burn in children by analyzing circulating proteasome (c-proteasome) activity in the plasma in correlation with total protein and c-reactive protein levels in the plasma, and the severity of the burn.Methods
Fifty consecutive children scalded by hot water who were managed at the Department of Pediatric Surgery after primarily presenting with burns in 4–20% TBSA were included into the study. The children were aged 9 months up to 14 years (mean age 2.5 ± 1 years). Patients were divided into groups according to the pediatric injury severity score used by American Burns Association. Plasma proteasome activity was assessed using Suc-Leu-Leu-Val-Tyr-AMC peptide substrate, 2–6 h, 12–16 h, 3 days, 5 days, and 7 days after injury. 20 healthy children consecutively admitted for planned inguinal hernia repair served as controls.Results
Statistically significant elevation of plasma c-proteasome activity was noted in all groups of burned children 12–16 h after the injury. We found a strong negative correlation of c-proteasome activity with total protein levels, and positive correlation with CRP levels 12–16 h after burn. We also found stronger correlation between c-proteasome activity and severity of burn, than CRP level and severity of burn 12–16 h, and 3 days after the burn. Correlations were statistically significant.Conclusions
This study characterized circulating 20S proteasome activity levels after burn. C-proteasome activity elevate after burn and correlate negatively with plasma total protein level, thus plasma 20S proteasome activity could be additional biomarker of tissue damage in burn in pediatric population. 相似文献18.
Background
This study evaluated 30-day morbidity and mortality and assessed pancreas-specific complications in patients with major pancreatic injuries who underwent a distal pancreatectomy.Study design
Records of 107 consecutive patients who underwent a distal pancreatectomy at a Level 1 Trauma Centre in Cape Town between January 1982 and December 2011 were reviewed. Primary endpoints were postoperative morbidity and death. Complications were graded according to the Clavien–Dindo severity classification and the International Study Group of Pancreatic Surgery (ISGPS) definitions.Results
A total of 107 patients [94 men, median age 26, median RTS 7.8, 69 penetrating injuries (63 gunshot wounds, 6 stabs wounds), 38 blunt injuries] underwent distal pancreatectomy. Overall mortality was 12%, 16% for gunshot injuries, 8% for blunt trauma and 0% in patients who had stab wounds. Eighty patients had a post-operative complication. A pancreatic leak (n = 26) was the most common pancreatic related complication. Median postoperative stay in 28 patients with no or grade I complications was 9 days; in 11 patients with grade II complications was 18 days; in 14 grade IIIa, 31 days; in 19 grade IIIb, 38 days; in 8 grade IVa, 33 days in 14 grade IVb, and in 13 grade V the duration of postoperative stay was 14 ± 39.4 days.Conclusions
Overall mortality for distal pancreatectomy was 12%. Pancreatic leak was a common cause of morbidity. Length of hospitalisation increased with increasing Clavien–Dindo severity grading. There was a significant difference in the duration of hospitalisation in patients with no or grade I complications compared to those with grade II–IV injuries (p < 0.05). 相似文献19.
Introduction
Prehospital guidelines advise advanced life support in all patients with severe traumatic brain injury (TBI). In the Netherlands, it is recommended that prehospital advanced life support is particularly provided by a physician-based helicopter emergency medical service (P-HEMS) in addition to paramedic care (EMS). Previous studies have however shown that a substantial part of severe TBI patients is exclusively treated by an EMS team. In order to better understand this phenomenon, we evaluated P-HEMS deployment characteristics in severe TBI in a multicenter setting.Methods
The database included patient demographics, prehospital and injury severity parameters and determinants of EMS or EMS/P-HEMS dispatch in 334 patients with severe TBI admitted to level 1 trauma centres in the Netherlands.Results
P-HEMS was deployed in 62% of patients with severe TBI. Patients treated by the P-HEMS had a higher injury severity score (29 (20–38)) vs. (25 (16–30); P < 0.001), more frequently required blood product transfusions (41% vs. 29%; P = 0.03) and recurrently suffered from TBI with extracranial injuries (33% vs. 6%; P < 0.001) than patients solely treated by an EMS. The prehospital endotracheal intubation rate was higher in the P-HEMS group in isolated TBI (93% vs. 19%; P < 0.001) or TBI with extracranial injuries (96% vs. 43%; P < 0.001) compared to the EMS group. In the EMS group, more patients were secondary referred to a level 1 trauma centre (32% vs. 4%; P < 0.001 vs. P-HEMS). Despite higher injury severity levels in P-HEMS patients, 6-month mortality rates were similar among groups, irrespective of the presence of extracranial injuries in addition to TBI. Deployment of P-HEMS estimated 52% and 72% (P < 0.001) in urban and rural regions, respectively, with comparable endotracheal intubation rates among regions.Conclusions
This study shows that a physician-based HEMS was more frequently deployed in patients with severe TBI in the presence of extracranial injuries, and in rural trauma regions. Treatment of severe TBI patients by a paramedic EMS only was associated with a higher incidence of secondary referrals to a level I trauma centre. Our data support adjustment of local prehospital guidelines for patients with severe TBI to the geographical context. 相似文献20.
Oliver C. Thamm Walter Perbix Max J. Zinser Paola Koenen Arasch Wafaisade Marc Maegele Rolf Lefering Edmund A. Neugebauer Panagiotis Theodorou 《Burns : journal of the International Society for Burn Injuries》2013