Epidemiologic investigation of burns in the elderly in Sichuan Province

Objective

This study analysed the epidemiology of burns in the elderly in Sichuan Province, China, with the objective of formulating a prevention programme.

Methods

A retrospective review of elderly patients admitted to the Burn Centre of West China Hospital during 2003–2009 was performed, including patient demographics, education and burn aetiology.

Results

A total of 103 patients, mean age 69.5 years (range 60–95 years; 58 male, 45 female) were admitted. The most common causes of burn were flames (51.5%), scalding (37.9%), electrical (4.9%) and chemical (2.9%), respectively. The majority occurred at home (68.9%), principally in the kitchen (35.9%), while 19.4% occurred in the workplace. Burns with total body surface area (TBSA) of 0–10% accounted for 52.5% of those admitted for treatment; 10–30% TBSA burns accounted for 20.3%; 30–50% TBSA burns accounted for 15.5%; and burns with a TBSA >50% accounted for 11.7%. Only 6% of patients received appropriate first aid, and 32% did not receive treatment until more than 24 h after injury. The education level was lower in the rural group. Both urban and rural groups had little knowledge of first aid for burns.

Conclusions

Burn-prevention programmes should promote improved living conditions and medical insurance, with prevention education for the elderly, especially in rural areas.     

Characteristics of 1494 pediatric burn patients in Shanghai

To analyze the epidemiological characteristics of pediatric burn patients in Shanghai and to determine the targets for a pediatric burn prevention program, a retrospective review of all medical records of acute pediatric burn patients (age相似文献   

Aetiology and outcome of burns in the elderly

INTRODUCTION: This retrospective study, analyses aetiology and factors affecting the outcome of burns in patients over 65 years of age. METHODS: Sixty-three consecutive patients, over 65 years of age, were admitted to a Burns Unit over a period of 3 years. Retrospective data was analyzed, taking into account aetiology, burn thickness and area, co-morbid factors. Also, surgery as a factor-affecting outcome was examined. RESULTS: There was a significant difference of total body surface area burn (TBSA), Abbreviated Burn Severity Index (ABSI), Baux score and the number of pre-existing co-morbid factors between survivors and non-survivors. Age and surgery were not significant to the outcome. Patients undergoing surgery had increased hospital stay without any difference in mortality. The timing of surgery did not have any impact on hospital stay or survival. CONCLUSION: This study shows a positive correlation between the number of co-morbid conditions and mortality. Early surgery after careful patient selection does not have any negative impact on patient survival.     

Ocular chemical burns in the workplace: Epidemiological characteristics

BackgroundEpidemiological studies focusing on occupational pathologies can be an important medium through which to bring about change with respect to workplace accidents, both in terms of prevention planning and management as well as the appropriate care following an accident. Ocular chemical burns benefit from urgent attention as, if not treated early and appropriately, the tissue of the eye and its functionality can be seriously compromised. The objective of this study was to collate epidemiological data on workplace ocular chemical burns which could in turn serve to identify key action points in terms of occupational health.MethodsCohort study with 604 cases of chemical burns to the eye occurring in the workplace between 2014 and 2015. Criteria inclusion were diagnosis of chemical burn, patient seen at the medical centre of the mutual society, workplace acquired ophthalmic pathology leading to the issuing of a sickness certificate. No exclusion criteria were defined.ResultsOcular chemical burns were the second most common workplace eye injury (12.68%) behind foreign bodies in the eye (43.42%). Men accounted for 68.54% of cases of ocular chemical burns. In around 75% of cases, sickness certification was for less than 7 days, although 6 patients suffered permanent disability. The occupational sector which was most affected particularly the industry service industry. The economic costs with these workplace injuries were extracted.ConclusionsAppropriate early medical assistance is essential. The production and distribution of clinical guides for health care workers could optimise first line assistance and mitigate possible training deficiencies.     

Epidemiological analysis of pediatric burns in the Dominican Republic reveals a demographic profile at significant risk for electrical burns

Objective

Pediatric burns are preventable with legislative and infrastructural changes. Although retrospective audits of many low- and middle-income countries have aided preventative efforts, the epidemiological status of burns in the Caribbean is not known. This study characterizes pediatric burns in the Dominican Republic (DR) and compares these to age-matched North American records captured by the National Burn Repository.

Severe burns in Australian and New Zealand adults: Epidemiology and burn centre care

IntroductionStudies describing the epidemiology of severe burns (>20% total body surface area) in adults are limited despite the extensive associated morbidity and mortality. This study aimed to describe the epidemiology of severe burn injuries admitted to burn centres in Australia and New Zealand.Materials and methodsData from the Burns Registry of Australia and New Zealand (BRANZ) were used in this study. Patients were eligible for inclusion if they were admitted between August 2009 and June 2013, were adults (18-years or older), and had burns of 20% total body surface area (TBSA) or greater. Demographics, burn characteristics and in-hospital mortality risk factors were investigated using multivariable Cox proportional hazards analysis.ResultsThere were 496 BRANZ registered patients who met the inclusion criteria. Over half of the patients were aged 18–40 years and most were male. The median (IQR) TBSA was 31 (25–47). Most (75%) patients had burns involving <50% TBSA, 58% sustained their burn injury at home, and 86% had sustained flame burns. Leisure activities, working for income and preparing food together accounted for over 48% of the activities undertaken at the time of injury. The in-hospital mortality rate was 17% and the median (IQR) length of stay was 24 (12–44) days. Seventy-two percent were admitted to an intensive care unit (ICU) and 40% of patients had an associated inhalation injury. Alcohol and/or drug involvement was suspected in 25% of cases.ConclusionThis study describes the demographics, burn injury characteristics and in-hospital outcomes of severe burn injuries in adults whilst also identifying key predictors of inpatient mortality. Key findings included the over-representation of young males, intentional self-harm injuries and flame as a cause of burns and highlights high risk groups to help aid in the development of targeted prevention strategies.     

The use of a frailty scoring system for burns in the elderly

Introduction

Burn in the elderly has a high mortality. Scoring systems incorporating age, and/or co-morbidities have been developed to assist in predicting outcomes in this high risk group. Life expectancy has increased in the general population and within the elderly age group medical co morbidity, physiological response to injury and socioeconomic factors give rise to the concept of biological versus chronological age. For a given age, baseline pre morbid state can vary. It is more valid to consider biological rather than chronological age when calculating risk. The Canadian Study of Health and Aging (CSHA) clinical frailty scale, incorporating fitness, co-morbidities and level of dependence was used to analyse our elderly burn patients admitted to Burns ITU, their surgical management and one-year survival.

Method

Data from patients with burns greater than 10% and aged over 65 years managed on the Burns ITU between 2005 and 2009 were obtained. A frailty score (1–7) was assigned to each patient based on the records of their admission assessment.42 patients met the study criteria for analysis. 18 (42.9%) patients, with mean age 74.9 years (range 65–95 years) survived (S) their ITU stay and of these, 83.3% survived at 1 year. 24 (57.2%) patients, mean age 78.4 years (range 66–95 years) died (D) whilst on ITU. There was no significant difference between the two groups with regard to age, percentage burn (30% TBSA range 10–85%) (P > 0.05 using T Test) or inhalational injury (p > 0.05 using Z test).Using Mann–Whitney U test analysis, the frailty score between the two groups showed a significant difference at p = 0.0001 (Mann–Whitney U test = 78), median = 3 (S) and median = 5 (D). This suggests patients with better pre-morbid capacity, as evaluated by the frailty scoring system, were more likely to survive their burn insult and treatment. Significantly, more patients in the group that survived underwent surgical debridement (Mann–Whitney U test = 111, p = 0.02).

Conclusion

Frailty scoring system appears to be a useful adjunct in predicting outcome in burns requiring admission to HDU/ITU in the senior population. The frailty score may predict which patients will benefit from surgery which also continues to be an important determinant of outcome in these patients.     

Elderly burn prevention: a novel epidemiological approach

OBJECTIVE: To develop burn prevention strategies for the elderly population in Hong Kong using a novel epidemiological approach. METHODS: Medical records of all patients aged 60 or above who were admitted to our hospital in a 6-year period were reviewed and demographic data, injury characteristics, details of management and outcome were obtained. Selected interviews were undertaken to determine the exact mechanisms of injury and further details of the medical and social background. RESULTS: Fifty-nine elderly patients were identified from the medical records with under half (42%) aged 75 and above. Male to female ratio was 1:1.68. Three-quarters of the injuries occurred at home, principally in the kitchen and bathroom. Two-thirds of the burns were scalds. Forty-eight percent of the admitted patients had surgery. Thirty-seven patients (or next of kin) were interviewed further. Of the subgroup only 12% had received appropriate first aid and 27% had treatment delayed for over 24 h before seeking medical help. The majority of patients had little or no formal education and one quarter were living alone. CONCLUSION: We identified common scenarios of elderly burns which could be used to focus prevention strategies.     

Microbiology and clinical characteristics of industrial oil burns

IntroductionInfections complicating burns generally transition from Gram-positive to Gram-negatives over the first couple weeks, but this depends on multiple factors. The microbiology of infections complicating crude oil (CO) and hydraulic fracturing (FRAC) burns is unknown.MethodsWe performed a retrospective study of patients with industrial thermal burns hospitalized >2 days with ≥1 day in the ICU between 4/2011–11/2016. Burns were oil-related (ORB; CO or FRAC) or non-oil related (NORB). Epidemiology and microbiology during the first 15 hospital days was compared.Results149 patients were included, with 11 FRAC and 24 CO. CO burns were more severely burned than those with FRAC and NORB (p < 0.05). Mortality was 17% and 18% for CO and FRAC burns compared to 3% in NORB (p < 0.01). More cultures were obtained from ORB than NORB (p < 0.05). ORB were associated with Stenotrophomonas maltophilia and FRAC associated with Serratia marcescens and Candida glabrata. Patients with FRAC, CO and NORB had a median of 13, 3.5, and 4 days to first positive culture respectively (p = 0.03).ConclusionORB were associated with more severe burns and unique microbiology. FRAC burns had longer to initial positive culture, potentially suggesting our current methodology is inadequate to diagnose infections associated with FRAC.     

Clinical factors affecting mortality in elderly burn patients admitted to a burns service

INTRODUCTION: The purpose of this retrospective study was to provide basic probabilistic predictors of mortality to assist in determining appropriate therapeutic aggression in elderly burns population. METHOD: Eighty patients over the age of 70 years were admitted to the Victorian Adult Burns Service in Melbourne, Australia, over a period of 4 years. Retrospective data was analysed, taking into account patient demographics, type, site, depth and area of burn, presence of inhalation injury, number of co-morbidities, survival time and the number of operations performed, withdrawal of care and implementation of comfort measures only. RESULTS: Comparing survivors and non-survivors, significant differences were found between age, percentage total burn surface area (TBSA%), percentage full thickness surface area (FTSA%), presence of inhalation injury, site of burn and number of operations. The number of co-morbidities and gender were not significant to outcome. FTSA%, presence of inhalation injury, site of burn, age and number of operations were all significantly related to survival time. When patients who obtained comfort care were excluded from analysis, age and the number of operations were not considered to be significantly related to mortality. CONCLUSION: This study indicates that TBSA%, FTSA%, inhalation injury and age are significant predictors of death in the elderly burns population, although only the first three remain significant when patients who receive comfort care measures only are excluded.     

A comparison of the epidemiology of isolated and non-isolated hand burns

Hand burns are common and treatment individualized, however given large volumes in some centers, pattern recognition may help optimize service provision. We performed a single center retrospective review from 2014 to 2018 of hand burns in patients aged 16 and over. Burns confined to the hands were considered isolated. We found 1163 patients (790 male, 68%), with 853 isolated (9% bilateral) and 310 non-isolated (35% bilateral) hand burns, and 12% were sustained in industrial workplaces. Most isolated burns received first aid (72%) and were scalds (41%) or contact (23%). Many presented to hospital by car (73%) and most were treated as outpatients (92%). Non-isolated burns were mainly flash (38%) or flame burns (25%, p < 0.01), with 66% given first aid, 49% used ambulances (p < 0.01) and 54% underwent hospital admission (p < 0.01). Non-isolated injuries had more full thickness involvement (p < 0.01), 13% were resuscitation burns and 10% received intensive care. Isolated and non-isolated burns are distinct clinical entities, as are unilateral and bilateral injuries. Isolated burns are usually unilateral scalds or contact burns, suited to outpatient treatment. Non-isolated burns are often flash or flame, bilateral, often needing ambulances, admission, and interventions. First aid can be improved, and consideration given to inpatient rehabilitation of bilateral hand burns.     

The management of major burns – a surgical perspective

In the UK, 1000 patients per year will need resuscitation and inpatient treatment for burns. The mortality has improved significantly over the last 50 years but over three hundred people die each year. A greater understanding of the pathophysiology together with improvements in resuscitation, critical care and surgical techniques have all contributed to survival. For larger burns (greater than 25% total body surface area) there is a profound release of cytokines and chemokines. This results in a marked systemic inflammatory response syndrome, leading to edema, effects on multiple organ systems, a hypermetabolic response and suppression of the immune system. Early surgical care is based around the ABCD philosophy (as guided by Advanced Trauma Life Support and also Emergency Management of Severe Burns). An assessment system based on depth is vital for clinical decision making and prognosis. Many centers now aim for early excision and grafting of burns. Early excision modifies the host responses by removing devitalized tissue that might otherwise invoke deleterious effects, but its removal in itself may also provide a major insult. Several variations in approach are possible to modify the impact of excision and an approach tailored to the individual is appropriate. Covering the excised burn area can be achieved with wide range of materials from allograft to synthetic skin substitutes. Key to successful burn care is a directed multi-disciplinary model for providing appropriate expertise on individual sites, together with the development of burn care networks to facilitate effective delivery of burns services across an entire region.     

Bangers, burgers and burns. A 10-year review of barbeque burns in South Wales

This is a retrospective study of the epidemiology of barbeque burns presenting to the Welsh Centre for burns from January 1994 to December 2004. A total of 68 were treated of which 57 are included in this study 25% are in the paediatric age group. The epidemiology varies between adults and paediatrics. Males are the most commonly injured in both groups. The paediatric group have a different aetiology compared with the adult group. All paediatric barbeque burns were caused by direct contact with either the barbeque or hot sand. This compares to the adult group, where 51% were caused by flash burns and only 40% were contact burns. Sixty-one percent of the paediatric group were burnt from low lying disposable barbeques compared to only 5% of adults. The hands were the most common sites of burn for adults (28%) compared to the feet in the paediatric group (36%). Barbeque burns in children seem to be increasing in the United Kingdom and we suspect that disposable barbeques are the causal factor as they are readily available, low-lying and cheap. We suggest preventative measures for such burns.     

A comparative analysis of liquefied petroleum gas (LPG) and kerosene related burns

Previous studies from our department reflected a trend of decreasing incidence of burns culminating from rising income levels, which were bringing about a change in the cooking fuel in many urban households [1] and [2]. These studies also indicated a changing scenario of increased incidence of burns from LPG mishaps [2]. In the absence of much information on the subject we felt it rather imperative to comparatively study the pattern of burn injuries resulting from LPG and kerosene. This prospective study was conducted on the clinical database of consecutive patients admitted with burns sustained due to LPG and kerosene from 1st January 2009 to 31st May 2010 (17 months). Data recorded for each patient included; age, gender, religion, socioeconomic status, literacy level, type of family unit, marital status, type of dwelling unit, mode of injury and its exact mechanism, place of incident, level of cooking stove, extent of burns (%TBSA), presence of features of inhalation injury, number of patients affected in a single mishap, size of LPG cylinder used, length of hospital stay and mortality. Of 731 flame burn patients in this study, 395 (54%) were due to kerosene burns and 200 (27.4%) from LPG mishaps. Significantly, the majority of injuries, in both the groups, occurred in lower middle class families living as nuclear units, in a single room dwelling, without a separate kitchen. Majority of LPG burns (70.5%, 141 patients) resulted from a gas leak and 25.5% were from cooking negligence (51 patients). 50.5% of kerosene accidents were from ‘stove mishaps’ and 49% due to cooking negligence. In all kerosene accidents the stove was kept at floor level but in LPG group 20.6% had the stove placed on a platform. There was a slight difference in mean TBSA burns; 51% in kerosene group compared to 41.5% TBSA in LPG group. There were nine episodes in LPG group in which there were more than three burn victims admitted for treatment. Very importantly, 77% patients in LPG group were from a large cylinder (14.2 kg), which uses a rubber connecting tube. Mortality in kerosene group (50.6%) was far higher than in LPG group (33.5%). This study, from 200 LPG burn admissions, for the first time details the profile from LPG mishaps. It is very interesting to note that of all burns in the world the inequitable distribution bias towards LMICs (low and middle income countries) extends further towards low middle class families within the LMIC. A major risk factor is constrained living condition of a single room dwelling unit. Almost all burns from LPG mishaps were potentially preventable if more care had been practiced to ensure safety. Since majority of LPG mishaps were from gas leaks, either from the rubber tube (Fig. 1) or the stove valve, the observation of floor level cooking in 79.4% of LPG cases may be an economic compulsion of a single room dwelling unit without much impact on the injury pattern. The small LPG cylinder (5 kg) in which the burner is placed directly over the cylinder, as one unit without a connecting tube, is safer because it reduces the chances of a gas leak from an ill-fitting or a cracked rubber connecting tube (Fig. 2).     

Breast burns are not benign: long-term outcomes of burns to the breast in pre-pubertal girls

Chest burns in pre-pubescent girl are commonly seen in paediatric burn units. These patients are at risk of significant long-term problems with scarring and breast development requiring reconstructive surgery many years after the initial burn. Admissions to our unit over a 20-year period were reviewed to determine the frequency of these burns. Patients whose burns required surgical debridement and split skin grafting, and who would now be post-pubertal were included in the study. We attempted to trace and contact these patients and were able to find 13 out of 22 patients, of whom 11 agreed to participate. The mechanism of injury in six was scalds and the other five had flame burns. Mean age of patients with scald was 18 months and for flame burns 4 years 8 months. These women required a variety of reconstructive procedures to improve breast appearance including contracture releases, dermabrasion, breast augmentation and contralateral breast reduction. Girls burned as young children require follow-up and appropriate referral long after the burn to ensure good cosmetic results are achieved during and after puberty.     

Effectiveness of Biobrane for treatment of partial-thickness burns in children

Purpose

Wound care for partial-thickness burns should alleviate pain, decrease hospital length of stay, and be readily applied to a variety of wounds. The effectiveness of Biobrane (UDL Laboratories, Rockford, IL) is compared with that of Beta Glucan Collagen (BGC; Brennan Medical, St. Paul, MN) in a retrospective cohort study.

Methods

A retrospective chart review of all children treated at a tertiary care pediatric hospital between 2003 and 2009 identified patients with partial-thickness burns treated with Biobrane. These patients were compared with historical controls treated with BGC.

Results

A total of 235 children between the ages of 4 weeks and 18 years with an average of 6.0% body surface area partial-thickness burns were treated with Biobrane. In a multivariate statistical analysis, patients treated with Biobrane healed significantly faster than those treated with BGC (Biobrane vs BGC: median, 9 vs 13 days; P = .019; hazard ratio, 1.68). In addition, patients who required inpatient treatment trended toward having shorter length of hospital stay in the Biobrane group (2.6 vs 4.1 days, P = .079).

Conclusion

Partial-thickness burn care consists of early debridement and application of a burn wound dressing. Biobrane dressings result in faster healing compared with BGC and may decrease hospital length of stay for patients requiring inpatient admission.     

Infant burns: A single institution retrospective review

Thermal injuries amongst infants are common and a cause of significant mortality and morbidity in South Africa. This has been attributed to the lack of an enabling environment (poverty-related lack of safe living conditions) and the cognitive and physical developmental immaturity of infants, who depend on their surroundings and adults to keep them safe. This is a retrospective observational study of 548 infant admissions over 48 months. Infant was defined as children below 13 months of age. The 548 infants constituted 23% of all paediatric burn admissions of ages 0–12 years. Three hundred and fourteen were males (57%) and 234 (42.7%) females. The infants were divided in a pre-ambulatory group of 143 (26%) infants of 0–6 months and an ambulatory group of 7 months to 12 months consisting of 457 (83.3%). The total body surface area (TBSA) ranged from 2–65%. Seventy-six percent (417 infants) occurred in the home environment. Scalds accounted for 86% (471 infants) and 6% (33 infants) were as a result of flame burns. Non-accidental injuries accounted for 1.2%. The anatomical distributions varied between the pre-ambulatory and ambulatory groups. Conservative management was done in 397 (72.4%) and 101(18.4%) infants underwent surgery. Infection was suspected in 76 (13.5%) infants with positive blood cultures in 15(20%) of the 76. ICU care was received in 46 (8.3%) infants and 15 (32.6%) of these had inhalation injuries. Of the inhalation injuries 11(23.9%) infants underwent mechanical ventilation of an average of 4.4 days. Ventilator associated pneumonia was diagnosed in 8(17%) of the ventilated children. The mortality rate was 0.36%. The surgically treated patients acquired more complications than the conservatively treated group. Special treatment considerations should be considered in this paediatric sub-group.     

Hydrocolloid dressing in pediatric burns may decrease operative intervention rates

Introduction

Partial-thickness scalds are the most common pediatric burn injury, and primary management consists of wound dressings to optimize the environment for reepithelialization. Operative intervention is reserved for burns that fail to heal using conservative methods. Worldwide, paraffin-based gauze (Jelonet) is the most common burn dressing; but literature suggests that it adheres to wounds and requires more frequent dressing change that may traumatize newly epithelialized surfaces. Hydrocolloid dressings (DuoDERM) provide an occlusive moist environment to optimize healing and are associated with less frequent dressing changes.

Aim

The aim of the study was to retrospectively analyze pediatric burns in a single tertiary referral center over a 10-year period comparing the impact of Jelonet and DuoDERM dressings relative to operative intervention rates.

Methods

All pediatric burns admitted between 1997 and 2007 were identified using the Hospital Inpatient Enquiry system. Demographics were collected from hospital records and theater logbooks. Acute, partial-thickness burns in patients younger than 15 years were analyzed according to dressing type applied (Jelonet or DuoDERM).

Results

Two hundred forty-eight pediatric burns were analyzed between 1997 and 2007. One hundred thirty-nine patients were treated with Jelonet dressings, and 109 were treated with DuoDERM. Debridement and grafting were required in 60 (43%) of the Jelonet patients compared with 10 (9%) of the DuoDERM patients (P < .05). The DuoDERM-managed patients maintained a significantly lower graft rate on subanalysis of scalds excluding early grafting within 5 days (P < .001).

Conclusion

Observational evidence suggests that DuoDERM leads to less operative intervention and should be preferentially used in pediatric burns.     

Electrical burns: A retrospective analysis across a 5-year period

This study aims to review the experience, at an institution, with patients who suffered electrical burns and study the peculiar characteristics of this type of burn as well as its complications and epidemiological aspects. The study includes medical records of patients with electrical burns who were admitted to the Burn Unit of Hospital das Clínicas in São Paulo, Brazil, from November 2001 to October 2006. They were classified into four categories: high voltage (≥1000 V), low voltage (<1000 V), ‘flash burn’ (in which there is no electrical current flow through the body of the patient) and burns caused by lightning. The complications were more severe and common in the high-voltage group, while longer hospital stays and more complex surgical procedures due to the greater depth of burns were also observed in this group. High-voltage burns are mainly labour-/occupation-related. The majority of the patients were young men at the beginning of their professional lives. This factor generates an important socio-economic impact due to the high incidence of sequelae, resulting in amputations, rendering them unable to maintain their occupations.     

Improving burn care and preventing burns by establishing a burn database in Ukraine

Background

Burns are a challenge for trauma care and a contribution to the surgical burden. The former Soviet republic of Ukraine has a foundation for burn care; however data concerning burns in Ukraine has historically been scant. The objective of this paper was to compare a new burn database to identify problems and implement improvements in burn care and prevention in this country.

Methods

Retrospective analyses of demographic and clinical data of burn patients including Tukey's post hoc test, analysis of variance, and chi square analyses, and Fisher's exact test were used. Data were compared to the American Burn Association (ABA) burn repository.

Results

This study included 1752 thermally injured patients treated in 20 hospitals including Specialized Burn Unit in Municipal Hospital #8 Lviv, Lviv province in Ukraine. Scald burns were the primary etiology of burns injuries (70%) and burns were more common among children less than five years of age (34%). Length of stay, mechanical ventilation use, infection rates, and morbidity increased with greater burn size. Mortality was significantly related to burn size, inhalation injury, age, and length of stay. Wound infections were associated with burn size and older age. Compared to ABA data, Ukrainian patients had double the length of stay and a higher rate of wound infections (16% vs. 2.4%).

Conclusion

We created one of the first burn databases from a region of the former Soviet Union in an effort to bring attention to burn injury and improve burn care.