National study of Emergency Department visits for burn injuries, 1993 to 2004.

No studies have examined U.S. burn epidemiology from the perspective of the Emergency Department. We sought to describe patient characteristics, injury types, and Emergency Department practice patterns. Data were collected from the National Hospital Ambulatory Medical Care Survey between 1993 and 2004. Emergency Department visit rates for burn injury decreased from 1993 to 2004 with a peak of 2.8 (95% confidence interval [CI] 2.1-3.4) per 1000 U.S. population in 1995 and a nadir of 1.6 (95% CI 1.2-2.0) per 1000 in 2004. The Emergency Department visit rate for burn injuries was greater for men than women (2.7 [95% CI 2.4-3.0] vs 1.8 [95% CI 1.6-2.0] per 1000) and for black than white subjects (3.4 [95% CI 2.8-3.9] vs 2.1 [95%CI 1.9-2.3] per 1000), though all these groups showed decreases. Emergency Department visit rates for burns were greatest in the first and third decades (3.3 [95% CI 2.8-3.7] and 3.5 [95% CI 3.0-4.0] per 1000, respectively) and decreased thereafter. The upper extremity was the most commonly burned part of the body (37% of total) and most burns of specified depth were partial thickness (48% of total). Less than half of patients received analgesics (47%) or topical antibiotics (38%). Emergency Department visits for burns are declining, but rates remain high in men, black individuals, and children. Burn-prevention efforts should target these groups. Upper-extremity and partial-thickness injuries are common, and less than half of patients receive analgesics or topical antibiotics. Collaboration between burn specialists and Emergency Department personnel should focus on the care of these types of injuries.     

Burn injuries requiring hospitalization for infants younger than 1 year

To investigate burn injuries requiring hospitalization sustained during the first year of life, clinical data collected during hospital treatment of infants younger than 1 year were reviewed. The principal aim was to chart the etiology and mechanism of burn injuries in this group to focus on the necessary preventive measures. The authors also review literature focusing especially on children younger than 1 year. Patients identified in the electronic database were referred to the Hospital for Children and Adolescents, Helsinki University Hospital, Helsinki, Finland, from January 2005 to December 2009. Specific inclusion criteria yielded a cohort of 20 patient records, which accounted for 3% of the 692 admissions due to pediatric burn injury during the 5-year study period. The male to female ratio was 1:1.5 and the mean age was 6.3 months. Most burns were sustained at home during domestic tasks and were most often witnessed. The etiology in the majority of the cases was scalding (85%), while contact burns accounted for the remaining. The final TBSA ranged from 0.5 to 40% (mean 8.5%). In 13 cases (65%), the initial TBSA was overestimated. Overall, it was concluded that burn injuries in this age group are most often witnessed and take place while the infant is being held at the same time as the hot item. Parental education on typical situations in which burn injuries happen in preambulatory infants may help reduce the number of burn injuries.     

Electric burns of the oral cavity

Low-voltage electric burns are the leading cause of electric burn injury in childhood and can result in an injury to the oral cavity that can heal with a noticeable deformity. The mechanisms of burn injuries to the oral cavity are either due to the electric arc or current or both. Electric burns of the oral cavity can involve the lip, tongue, mucous membranes, and underlying bone. Therapy for these injuries should include management of systemic sequelae and treatment of the local burn injury. Our therapeutic approach to this injury is dictated by the pathophysiology of the electric burn of the oral cavity.     

A descriptive summary of New Jersey's 1985 burn population

Data obtained from the New Jersey State Department of Health on the 1985 hospitalized patients with burns and data collected from the National Burn Victim Foundation's standard burn reporting form were analyzed to gather information about the epidemiology of burns. Children (0 to 4 years of age) continue to be the largest percentage of the 0- to 18-year-old age group who sustain burn injuries, and 67% of those injuries are sustained by children under the age of 5. Males accounted for 69% of the total burn population; 58% of admissions were white; 69% of patients were admitted for partial-thickness burns, and 31% were admitted for full-thickness burns; the largest primary payer was third-party payers; and 92% of patients with burns were discharged to home or self-care. Data were also analyzed by examination of selected age groups to determine individual needs of specific groups. An analysis of burn injuries reported to the National Burn Victim Foundation confirmed previous reports that the home is the most likely place for a burn injury to occur and that flame and scald injuries predominate; scald injuries comprise 50% of all sustained burns. Gasoline vapors accounted for 54% of burn injuries caused by flames. The data supported efforts to develop programs that address the needs of the urban child, the 17- to 19-year-old age groups, and the elderly. The information that was collected served to redefine objectives for burn prevention programs.     

Osteocutaneous pedicle flap of the foot for salvage of below-knee amputation level after burn injury

Lower extremity amputations are occasionally required after high-voltage electric and deep thermal burns. The extensive loss of skin and soft tissue after these injuries may make it difficult to fashion below-knee amputation that will readily tolerate a prosthesis. We have found an osteocutaneous pedicle fillet flap of the foot useful in the salvage of below-knee amputation after severe burn injury. Three patients have undergone this procedure after burn injury, 1 with burn secondary to high-voltage electric injury and 2 after deep thermal burns. All became ambulatory with artificial prostheses. There were no postoperative infections and no need for further revisions. The osteocutaneous pedicle fillet flap of the foot has proven to be a reliable form of below-knee stump coverage in patients with extensive soft tissue necrosis after burn injury.     

A survey of risk factors for burns in the elderly and prevention strategies

Elderly burn patients suffer from greater morbidity and mortality than younger patients with similar burn extents. The purpose of this study was to identify risk factors for burn injuries in the elderly to develop an effective preventive program. A cross-sectional survey was conducted among 20 elderly (> or =65 years of age) burn survivors on the circumstances surrounding their burn injury and on burn prevention. A control group of 20 nonburned elderly completed a similar survey only on burn prevention. The majority of burned subjects believed that their injury was preventable (85%). The home was the commonest location for burn injury (70%), and scalds (50%) and flame burns (25%) were the most common etiologies. Most subjects felt that a burn prevention program would be useful (95%) and television, news, and posters were the preferred sources of prevention information. Compared with the burn group, the control group had more risk factors for burn injury. However, the control group also took more active preventive measures. Burn prevention campaigns for elderly should focus on reducing flame and scald burns that occur in the home, preferably using television, news, and poster media.     

Burns caused by automobile radiators: a continuing problem.

In spite of the fact that injury warning labels have been placed on radiator caps for the last 15 years, automobile radiator scald burns continue to be a burn prevention problem. The temperature of radiator fluid may be as high as 100 degrees F to 250 degrees F in a properly functioning car and higher in an overheated vehicle. From 1974 to 1990, 100 patients with burns that were caused by automobile radiators have been admitted to the Parkland Memorial Hospital Burn Unit (1.5% of acute admissions). Eighty-two percent of the injuries occurred in the summer months, and 93% of the patients were male. Mean age was 31 +/- 17 years (range, 8 months to 79 years), and mean burn size was 11.3% total body surface area (TBSA) (range, 1% to 32%) with a mean full-thickness burn size of 0.6% TBSA. Length of stay was 7 +/- 7.4 days (range, 1 to 38 days). Burns to the face, neck, and trunk necessitated most admissions. Although there were no deaths, five patients required intensive care for airway monitoring; mean length of stay was 6 days. One patient required endotracheal intubation for a total of 11 days. Ten patients required one or more skin grafting procedures, and three patients required burn resuscitation. Four patients sustained minor ocular injuries. A subgroup of patients demands special review: 10 children younger than 10 years of age (mean age, 4.1 years) of which 70% were boys. Mean burn size was 15.5% TBSA; mean full-thickness burn size was 2.4% (four times larger than the mean burn size for the adult population).(ABSTRACT TRUNCATED AT 250 WORDS)     

Burns in southern Turkey: electrical burns remain a major problem

In Turkey, burns represent a relatively small number of injuries overall, but they continue to be a major public health problem. Our aim in this study was to identify risk factors that affect outcome in burn patients hospitalized in the southern part of our country, with special emphasis on electrical burns. The database for 109 burn patients who were admitted to our burn center from April, 2000, through August, 2001, was retrospectively analyzed. Electrical injury was the cause of burn in 23 (21%) of the 109 cases. The burn causes differed among age groups and between the sexes, with males constituting 95% of the electrical burn patients. The mortality rate for the electrical burn group was lower than the rate for the rest of the burn patients (1/23 vs 17/86, respectively; P <.001); however, the opposite was true for complication rate (10/23 vs 5/86, respectively; P <.001), cost of treatment (8351 US dollars vs 5122 US dollars, respectively; P =.009), and length of hospital stay (39.9 vs 26.2 days, respectively; P < 0.001). The rate of electrical burn injury in Turkey has changed very little in the past two decades. This underlines the need for stronger efforts aimed at prevention, such as better public education and strict regulations regarding the distribution and use of electricity.     

碳素钓鱼杆致高压电烧伤5例报道

文章总结了科室自2001年5月至8月连续收治的5例由于钓鱼杆致高压电烧伤患者的诊治情况，这5例患者皆合并有电流损伤和电弧光烧伤。其中4男1女，年龄8－61岁，致伤电压1－1．1万伏。平均烧伤面积54％TBSA，深度为深2－3度，其中一例70％烧伤均为3度创面，伴深处肌肉，神经和血管严重损伤，有4例合并轻至重度吸入性损伤，3例特重度烧伤患者早期出现肝肾，消化道功能异常及电解质紊乱，1例经削痂后换药治疗痊愈，2例经早期双上肢切开减压，气管切开插管抢救成功存活，早期切痂植皮后经后期补植及皮瓣转移痊愈。2例由于重度吸入性损伤，G^-败血症合并多器官功能衰竭死亡，由于在一些高压电线周围缺乏应有的标记，许多钓鱼者也缺少必要的安全知识，往往导致这类严重损伤的发生，因此预防非生产性高压电烧伤的发生还有赖于各方面的共同努力。     

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.     

Burn centers should be involved in prevention of occupational electrical injuries

Electrical injuries are uncommon, comprising 10% of our regional burn center admissions during a 9-year period. The purpose of this study was to determine the incidence, type, and location of occupation-related electrical injuries in an attempt to focus our injury prevention and outreach efforts. We retrospectively reviewed the medical records of patients with electrical injuries admitted to our burn center from January 1992 through March 2000, with focused analysis on those patients admitted with occupation-related electrical injuries. Of the 95 patients admitted for electrical burns, 81% (n = 77) were occupational injuries. This rate of injury suggests that prevention efforts should be directed at work sites and partnerships should be developed between burn centers and businesses to reduce the incidence of injuries.     

Epidemiology of electrical burns and its impact on quality of life - the developing world scenario

BACKGROUNDElectrical burns are devastating injuries and can cause deep burns with significant morbidity and delayed sequelae. Epidemiological data regarding the etiology, socioeconomic differences and geographic variation are necessary to assess the disease burden and plan an effective preventive strategy. These severe injuries often lead to amputations and thus hamper quality of life in the long termAIMTo identify the population at maximum risk of sustaining electrical burns. We also studied the impact of electrical burns on these patients in terms of quality of life as well as return to work. METHODSThe study was conducted at a tertiary referral teaching hospital over a period of eighteen months. All patients with a history of sustaining electrical burns and satisfying the inclusion criteria were included in the study. All relevant epidemiological parameters and treatment details were recorded. The patients were subsequently followed up at 3 mo, 6 mo and 9 mo. The standardized Brief Version of the Burn Specific Health Scale (BSHS-B) was adopted to assess quality of life. Statistical analysis was conducted using IBM SPSS statistics (version 22.0). A P value of < 0.05 was considered statistically significant. RESULTSA total of 103 patients were included in the study. The mean age of the patients was 31.83 years (range 18-75 years). A significant majority (91.3%) of patients were male. The mean total body surface area (TBSA) in these patients was 21.1%. In most of the patients (67%), the injury was occupation-related. High voltage injuries were implicated in 72.8% of patients. Among the 75 high voltage burn patients, 31 (41%) required amputation. The mean number of surgeries the patients underwent in hospital was 2.03 (range 1 to 4). The quality of life parameters amongst the patients sustaining high voltage electrical burns were poorer when compared to low voltage injuries at all follow-up intervals across nine domains. In eight of these domains, the difference was statistically significant. Similarly, the scores among the amputees were poorer when compared to non-amputees. The difference was statistically significant in six domains. CONCLUSIONElectrical burns remain a problem in the developing world. Most injuries are occupation-related. The quality of life in patients with high voltage burns and amputees remains poor. Work resumption was almost impossible for amputees. These patients could not regain pre-injury status. Steps should be taken to create awareness and to implement an effective preventive strategy to safeguard against electrical injuries.     

Amputations resulting from electrical injury: a review of 22 cases

Twenty-two cases of electrical injury with a combined total of 43 major amputations are reviewed. Electrical injury resulting from contact with high-voltage current (greater than 1000 volts) commonly results in significant systemic damage. The purpose of this study was to develop statistical data on the rehabilitation and eventual outcome of these patients. Most of the injuries were job related and involved young male adults. Upper-extremity amputations were predominant, and more than 50% of the patients had two or more limbs amputated. In addition to major amputations, other obstacles to rehabilitation included skin burns and limitation of joint motion. The length of hospitalization in a rehabilitation facility for these amputees was greater than for patients with amputations due to other causes. Prostheses were fitted for 95% of the amputated limbs. At the follow-up stage of rehabilitation, 50% of the patients were either employed or pursuing career training or educational goals.     

Return to work after low voltage electrical injury

Low voltage electrical injury is associated with minor or no cutaneous burns and its symptoms rarely appear on initial examination. The purpose of this study was to determine the ability to return to work among patients with low voltage electrical injury. A retrospective hospital chart review was conducted among patients with low voltage electrical injury admitted to the outpatient burn clinic of a rehabilitation hospital between January 1, 2002 and March 21, 2006. Symptoms at follow-up visits and return to work status were compared between patients with electrical contact injuries and those with electrical flash injuries using Student's t-test and chi analysis with a P < 0.05 considered significant. Values are presented as mean +/- SD. Forty patients were treated for low voltage electrical injury, and all injuries occurred at work. There were 34 men (85%) and 6 women (15%) with a mean age of 37.3 +/- 11.2 years and a mean total body surface area burned of 13.0% +/- 17.6%. Most patients had neurological (92.5%), psychological (90.0%), and musculoskeletal (72.5%) symptoms, which were documented on average 303.7 days after injury. Twenty-five (62.5%) patients had electrical contact injury and 15 (37.5%) patients had electrical flash injuries. Patients with electrical contact injuries were younger (34.2 +/- 9.9 years vs 42.4 +/- 11.6 years, P = 0.030), complained of more psychological symptoms (25 vs 11, P = 0.006), more neurological symptoms (25 vs 12, P = 0.020), and more fatigue (10 vs 1, P = 0.022) than patients with electrical flash injuries. Twenty-three patients (57.5%, 14 electrical contact and 9 electrical flash) attempted to return to work on average 107.7 days after injury, but only 13 patients (32.5%, six electrical contact and seven electrical flash) successfully returned to work 59.38 days after injury. Of them 7 (53.8%) return to the same job, 5 (38.5%) returned to a modified job, and 1 (7.7%) to a new job. Low voltage electrical injury can significantly impact a patient's ability to return to work because of the psychological, neurological, and musculoskeletal symptoms, which are observed. Recognition of low voltage injury as a potentially permanent source of symptoms is important and has to date not been well established. More effective preventive measures should be implemented at work to reduce the risk of these injuries.     

Carotid rupture following electrical injury: a report of two cases

Electrical injuries often result in extensive tissue damage where vascular damage may occur and result in thrombosis and spontaneous rupture of blood vessels. Rupture of the brachial, radial, ulnar, internal mammary, and obturator arteries has been reported in the literature. The authors present two cases of carotid artery rupture following high-voltage electrical injuries. The first case is a 21-year-old man who was climbing a fence near a high-voltage power line when a gold chain he was wearing around his neck caught on the power line, resulting in a 10% circumferential electrical injury to his neck. He presented with visible arterial bleeding from the large neck wound and was taken to the operating room, where a 1-cm laceration to the carotid artery was repaired with a vein patch. On the second postoperative day, the patch dislodged, and a spontaneous rupture of the common carotid artery occurred. The damaged artery was subsequently ligated. The patient recovered with no neurological sequelae. The second case is a 43-year-old man who suffered a high-voltage injury while working on an electrical panel, resulting in a 50% TBSA full-thickness burn to the face, scalp, trunk, and extremities. Four weeks after admission, a latissimus dorsi myocutaneous free flap was used for coverage of exposed outer table of the skull. Intraoperatively, the carotid artery spontaneously ruptured proximal to where the dissection was being carried out. The patient recovered with no neurological sequelae. High-voltage electrical injury results in significant damage to blood vessels via a number of mechanisms. Rupture of a major vessel is a rare, life-threatening sequelae of electrical injury.     

Comparing a Single Institution's Experience With Electrical Injuries to the Data Recorded in the National Burn Repository

Electrical injuries usually represent a small proportion of a burn center's admissions. Although burn size may be small, internal tissue damage is sometimes extensive. This study reviews a single institution's experience with electrical injuries and compares it to the multi-institutional data of the National Burn Repository (NBR). The 2009 NBR and the records of a large urban burn center (single institution) were queried for adult electrical injuries over an 8-year period. Data examined included demographics, %TBSA burn, length of stay (LOS), injury circumstance, and disposition. Multiple linear regression models were created to determine factors related to LOS. One hundred ninety-one single-institution patients and 2837 multi-institution patients met the criteria. Both cohorts were mostly white males approximately 30 years of age and injuries where often work-related. Single-institution patients had a mean injury size of 4% TBSA, while multi-institution patients had 7%. The most common exposure source was domestic wiring for single-institution patients and electrical power plants/lines for multi-institution patients. Single-institution data showed that females had a shorter LOS than males (P < .0001). Single-institution data showed that independent risk factors for an increased LOS were infection, amputation, fasciotomy, and being Hispanic. Independent risk factors for multi-institution patients were being Hispanic and large %TBSA burn. There was no difference in mortality, gender, age, LOS, or intensive care unit LOS between the cohorts. In this analysis, there was no statistical difference between outcomes in the single- or multi-institutional groups. However, injuries reported in the NBR were slightly larger. In both cohorts, an increase in LOS was associated with %TBSA, as expected. Interestingly, Hispanic ethnicity correlated with an increased LOS. Future work will be aimed at understanding this correlation to determine whether it is specific to electrical injury or burns in general.     

己酮可可碱对高压电烧伤病人创面微循环的影响

目的 探讨己酮可可碱(PTX)对高压电烧伤病人创面微循环的影响,观察其临床疗效.方法 对已经明确诊断的高压电烧伤病人58例,其中男32例,女26例,平均年龄32.12±10.34岁,随机分为常规治疗组(对照组)和PTX治疗组(治疗组),每组29例.治疗组给予PTX(每次0.1g静点,每日一次,共7d)治疗,其余治疗两组均一致.用激光多普勒微循环图像仪检测2组病人入院时治疗前及治疗后24h、48h、3d、5d、7d后六个时相创面微循环血液灌流值(MPD),对观测结果 进行对比分析.结果 两组组间比较:治疗前创面MPD分别是(1.2±0.38)V、(1.36±0.33)V,无显著性差异(P＞ 0.05);治疗后各时相创面MPD值比较,有显著性差异(P＜0.05),治疗组创面血运明显优于对照组创面血运.结论 PTX 对高压电烧伤病人创面微循环有改善作用.     

Cement-related injuries: review of a series, the National Burn Repository, and the prevailing literature.

The spectrum of cement-related injuries encompasses contact dermatitis, abrasions, ulcerations, chemical burns, and burns from explosions during the manufacturing process. The purpose of this study was to compile cement-related conditions seen in two burn units (1999-2005), literature case reports and series (1950-2006) and the (1989-2001) National Burn Repository (NBR). There were 3597 admissions in two Midwestern burn units, of which 12 cases (0.8%) were cement burns. They occurred in men, aged 15 to 64 years with a burn range of 0.25 to 10% TBSA, exposure time of 1 to 6 hours, treatment delay of 1 day to 2 weeks, hospitalization (2-14 days). Literature review of 109 cases indicated that cement-related injuries were predominantly seen in men, aged 26 to 45 years; with a cement-exposure time of 1.5 to 4 hours, treatment delay (1 day to 5 weeks), hospitalization (10-33 days), and healing time (2-7 weeks). There were 52,219 burn admissions in the NBR, of which 44 (0.08%) were cement-related burns; 95% were men with a mean age of 41 years, 6% TBSA cement burn and an 8-day hospital stay. The demographic characteristics of the burn units and NBR cases were similar to those in the literature. This preventable injury occurred primarily in the working age male patient and was associated with long healing times. Public awareness and enhanced manufacturer package warnings and education may decrease future cement-related injuries.     

Occupation-related burn injuries

Unlike household burn injuries, the characteristics of burn injuries in the workplace have not been well described. In an effort to understand the causes and effects of occupation-related burn injuries and to aid in prevention, we sought to describe work-related burn injuries by frequency, burn type, age of the patients, body parts burned, and occupation of the patients. This was a statewide, cross-sectional study of all burns that occurred in the workplace during 1994. Data on fatal injuries were obtained from the National Census of Fatal Occupational Injuries. Survey data from the North Carolina Department of Labor were used for nonfatal injuries. Burns caused 34 deaths (15.3%) and 1720 injuries in the workplace in 1994. Of the nonfatal injuries, 1363 (79.2%) were caused by exposure to caustic substances or hot objects or substances. The head and upper extremities were the most frequently injured body parts (936 injuries; 57.6%). The average age of those burned was 30.7 years; most of the patients ranged from 25 to 35 years old. High-risk occupations included vehicle and equipment cleaners, food service personnel, and millwrights (11.3%, 5.3%, and 5.2% of burn injuries, respectively). Unlike the flame burns that occur in homes, exposure to caustics and hot objects and substances caused the majority of on-the-job burn injuries. Protective gear for the head and upper extremities may prevent a significant number of burns. Education and prevention programs may best be directed at workers with high-risk occupations and workers in the 25- to 35-year age range.