Burn prevention mechanisms and outcomes: pitfalls, failures and successes

Burns are responsible for significant mortality and morbidity worldwide and are among the most devastating of all injuries, with outcomes spanning the spectrum from physical impairments and disabilities to emotional and mental consequences. Management of burns and their sequelae even in well-equipped, modern burn units of advanced affluent societies remains demanding and extremely costly. Undoubtedly, in most low and middle income countries (LMICs) with limited resources and inaccessibility to sophisticated skills and technologies, the same standard of care is obviously not possible. Unfortunately, over 90% of fatal fire-related burns occur in developing or LMICs with South-East Asia alone accounting for over half of these fire-related deaths. If burn prevention is an essential part of any integrated burn management protocol anywhere, focusing on burn prevention in LMICs rather than treatment cannot be over-emphasized where it remains the major and probably the only available way of reducing the current state of morbidity and mortality. Like other injury mechanisms, the prevention of burns requires adequate knowledge of the epidemiological characteristics and associated risk factors, it is hence important to define clearly, the social, cultural and economic factors, which contribute to burn causation. While much has been accomplished in the areas of primary and secondary prevention of fires and burns in many developed or high-income countries (HICs) such as the United States due to sustained research on the epidemiology and risk factors, the same cannot be said for many LMICs. Many health authorities, agencies, corporations and even medical personnel in LMICs consider injury prevention to have a much lower priority than disease prevention for understandable reasons. Consequently, burns prevention programmes fail to receive the government funding that they deserve. Prevention programmes need to be executed with patience, persistence, and precision, targeting high-risk groups. Depending on the population of the country, burns prevention could be a national programme. This can ensure sufficient funds are available and lead to proper coordination of district, regional, and tertiary care centres. It could also provide for compulsory reporting of all burn admissions to a central registry, and these data could be used to evaluate strategies and prevention programmes that should be directed at behavioural and environmental changes which can be easily adopted into lifestyle. Particularly in LMICs, the emphasis in burn prevention should be by advocating change from harmful cultural practices. This needs to be done with care and sensitivity. The present review is a summary of what has already been accomplished in terms of burn prevention highlighting some of the successes but above all the numerous pitfalls and failures. Recognizing these failures is the first step towards development of more effective burn prevention strategies particularly in LMICs in which burn injury remains endemic and associated with a high mortality rate. Burn prevention is not easy, but easy or not, we have no options; burns must be prevented.     

Burn injuries in primary care in the Netherlands: Risk factors and trends

BackgroundResearch to date has mainly focused on burn injuries treated in secondary care. This study aims to provide knowledge on the epidemiology of burn injuries in primary care, to give directions for burn prevention.MethodsData were derived from routine electronic health records of general practices and their out-of-hours service organisations in the Netherlands that participated in the Nivel Primary Care Database 2010–2015. We studied risk factors and trends.ResultsThe average burn injury prevalence rate was 4.40 (95% CI 4.27–4.53) per 1000 person-years in daytime general practice care and 1.47 (95% CI 1.46–1.49) per 1000 inhabitants in out-of-hours care. Children of 0?4 years old, especially boys, and young adult women had a higher risk. Burn injury risk was higher during the summer months and around New Year’s Eve. Living in low socioeconomic and strongly urbanised neighbourhoods was associated with a higher risk of burn injury than living in other neighbourhoods.ConclusionDutch general practitioners have a large share in burn care and therefore can play a significant role in burn prevention. Prevention may be most effective in the summer and around New Year’s Eve, and specific attention seems to be warranted for low socioeconomic groups and strongly urbanised neighbourhoods.     

Exploring the Burn Model System National Database: Burn injuries,substance misuse,and the CAGE questionnaire

Burn survivors who misuse alcohol and/other substances have been associated with poorer long-term outcomes and clinical complications following injury. The self-reported CAGE questionnaire (Cut down, Annoyed, Guilty, and Eye-opener) is an outcomes assessment tool used to screen for potential substance misuse. Understanding the persistence and emergence of potential substance misuse through examination of CAGE scores may provide important information about this population. Using data collected from the Burn Model System National Database, demographic and clinical characteristics of individuals who reported positive CAGE scores (total score of ≥2) and those who reported negative CAGE scores (total score of 0 or 1) for either alcohol or other drugs were compared.     

Burn treatment in the elderly

The population of elderly patients is expected to rise continuously over the next decades due to global demographic changes.     

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.     

Tap water scalds among seniors and the elderly: socio-economics and implications for prevention

INTRODUCTION: Tap water scalds among those >or=60 years old are often attributed to physical impairments with aging. This study assesses socio-economics associated with tap water scalds among seniors and the elderly. METHODS: Charts of patients admitted to an urban Burn Center between 7/00 and 6/04 for treatment of tap water scalds were reviewed. Demographics, injury details, co-morbidities, surgical interventions/critical care requirements, length of stay (LOS), disposition and related economics were reviewed. RESULTS: During the study period, 68 patients >or=60 years were hospitalized for treatment of these scalds. Mean age and burn size were 78+/-1 years and 7+/-0.9% TBSA. Over 98% of patients were admitted with pre-existing co-morbidities; 60% required ICU care for 40+/-5 days; 22% required mechanical ventilation and 71% required surgery. LOS was 34+/-4 days. Most patients received government assistance income. Pre-injury, 32% resided alone. Post-injury, 10% of patients returned home alone; mortality was 22%. Per patient hospital costs approximated $113,000. CONCLUSION: These findings report that tap water scalds result in significant morbidity, mortality and health care costs for local seniors and the elderly. Socio-economic factors play a significant role in these injuries and must be assessed when planning prevention efforts.     

Eosinophilic recruitment in thermally injured older animals is associated with worse outcomes and higher conversion to full thickness burn

BackgroundPartial burn injury in older patients is associated with higher rates of morbidity, mortality, and conversion to full thickness burn (Finnerty et al., 2009; Pham et al., 2009). Both human and mouse models demonstrate an altered systemic immune response in older subjects, however less is known about the localized response (Jeschke et al., 2016; Farinas et al., 2018; Mohs et al., 2017). We hypothesized that a mouse model could demonstrate differences in the localized inflammatory response of the old.MethodsSix old (66 weeks) and young (8 weeks) mice received partial thickness thermal burns. Localized and systemic expression of nine chemokines (TNFalpha, MCP-1, MIP-2, S100A9, EGF, IL-10, RANTES, G-CSF, and EOTAXIN) were evaluated at day 3 after burn using Luminex analysis. Vimentin immunostaining was used to evaluate injury depth.ResultsVimentin staining demonstrated increased burn depth in old mice (449 ± 38 μm) as compared to young (166 ± 18 μm) (p < 0.05). Both groups exhibited increased localized expression of EOTAXIN after burn (p < 0.05), however expression in old mice (83.6 ± 6.1 pg/ml) was lower than that of young (126.8 ± 18.7 pg/ml) (p < 0.05). Systemically, however, old mice had increased baseline EOTAXIN expression (1332.40 ± 110.78 pg/ml) compared to young (666.12 ± 45.8 pg/ml) (p < 0.005).ConclusionsEOTAXIN is one of the primary chemoattractants for selective eosinophilic recruitment and activation. While eosinophils are important for wound healing, a hyperactive eosinophilic response can result in tissue damage. We hypothesize that the increased baseline serum EOTAXIN in the old may prime their hyperactive response, and may contribute to their worse clinical outcomes. Long-term eosinophil activation requires further study, however our findings indicate a role for EOTAXIN and eosinophils in burn response.     

湿润烧伤膏治疗烧伤患者的临床疗效及安全性

目的 探讨湿润烧伤膏用于治疗烧伤患者的疗效及安全性。方法 选择河北省沧州中西医结合医院东院区2020年1月-2021年12月收治的40例烧伤患者,根据治疗方法的不同将其分为观察组和对照组,各20例。对照组采用磺胺嘧啶银乳膏治疗,观察组采用湿润烧伤膏治疗,比较两组临床疗效、恢复时间、疼痛程度以及瘢痕情况。结果 观察组治疗总有效率为95.00%,高于对照组的70.00%（P＜0.05）;观察组创面愈合时间、肉芽生长时间均短于对照组（P＜0.05）;两组治疗后VAS疼痛评分均降低,且观察组低于对照组（P＜0.05）;观察组瘢痕发生率及瘢痕严重程度低于对照组（P＜0.05）。结论 为烧伤患者提供湿润烧伤膏进行治疗,可提升临床疗效,缓解疼痛程度,缩短患者创面愈合时间和肉芽生长时间,降低瘢痕发生率,其疗效及安全性均得到保障。     

Burn first aid knowledge in Germany and the influences of social-economic factors

BackgroundOptimal management of burns always starts with the first aid. Results of numerous studies carried out in different countries indicated in general a low awareness of first aid of burns irrespective of whether the income of the country was high, middle or low. The aim of the study was to investigate the knowledge in burn first aid in Germany and compare it to an Australian study from 2013.MethodsFrom January 2016 until August 2017 patients, visitors and medical personnel in the emergency room of two large hospitals in Southern and the Western part of Germany were asked to take part in a paper based multiple-choice survey.ResultsAltogether 1229 people took part in the questionnaire, 588 from Bavaria and 641 from North Rhine-Westphalia; 45,2% males and 54.8% females. Their age ranged from 19 to 52 with a mean of 37.2 years. Hereby participants that had taken part in first aid training and people working in health care had significant more correct answers. Overall, only approximately a third of the given answers were correct.ConclusionOur study suggests that there is room for improvement since only a minority of the German population is familiar with first aid principles dealing with burns. Although more than 40% had taken part in a first aid training, the questioned people gave less correct answers than the Australians in 2013.     

Burn wounds in the young versus the aged patient display differential immunological responses

Background

Individuals in the geriatric age range are more prone than younger individuals to convert their partial thickness thermal burns into full thickness injuries. We hypothesized that this often observed clinical phenomenon is strongly related to differential local injury responses mediated by the immune system.

社区骨质疏松症高危人群筛查与预防的研究进展

骨质疏松症以骨强度及骨密度下降为特征,极易发生骨折,导致患者伤残及生活质量下降。骨质疏松症不仅就诊率低,而且骨质疏松性骨折的治疗与护理带来巨大的家庭、社会及经济负担,预防尤为重要。早期识别与筛查出骨质疏松症高危人群,从微观和宏观系统对骨质疏松症高危人群实施早期干预,以期降低骨质疏松症以及骨质疏松性骨折的发生。笔者简要阐述了骨质疏松症预防的重要性,回顾了社区骨质疏松症高危人群的风险筛查方法以及社区骨质疏松症高危人群的预防策略。     

Burn disasters in the middle belt of Ghana from 2007 to 2008 and their consequences

Aim

To study the survival and mortality trends in four fire disasters in the middle belt of Ghana from 2007 to 2008 and to explore measures that could minimize the risk of future disasters.

Methods

Data were collected from clinical records from the Burns Intensive Care Unit and the Casualty Unit of the Komfo Anokye Teaching Hospital, Kumasi, Ghana and from the various disaster sites and the Ghana Police Service.

Results

A total of 212 were injured from four burn disasters; 37 (17%) died on the spot; 175 (83%) reported to the Casualty Unit out of which 46 (26%) were admitted. The victims admitted had mean age 24.6 years with male to female ratio 2.3:1; 25 (54%) of the admitted victims died. The average burned surface area of the admitted victims was 63%, with a mean survival rate of 46%. Statistical analysis for mortality when the surface area of the burn was >70% was 0.0005 (P-value).

Conclusion

The four petrol-related fire disasters showed variable mortality rates. Death and severe disability of victims of future disasters can be avoided if intensive road accident preventive measures and massive public education are encouraged.     

2019-2021 年烧伤整形科住院患者情况的回顾性分析

目的 回顾性分析2019-2021年清远市人民医院烧伤整形科住院患者情况的变化。方法 应用清 远市人民医院大数据平台,回顾性收集医院2019、2020、2021年烧伤整形科住院患者就诊数据,比较近3年 住院人数、年龄及病种占比的差异。结果 近3年住院患者平均年龄逐渐增高,其中2021年与2019年相比住 院患者平均年龄增高,差异有统计学意义（P＜0.05）;2020、2021年住院总人数分别下降45.16%和 55.97%;与2019年相比,2020、2021年因压疮、慢性创面住院人数比例增加,差异有统计学意义 （P＜0.05）。结论 近3年来烧伤整形科患者住院数量及就诊病种发生较大改变,因压疮、慢性创面住院的 老龄患者比例增加幅度较大。     

围术期脑血管意外的防治现状

在手术麻醉过程中,脑血管功能的保护是一个重要的目的,因为麻醉并发的脑血管意外,属严重围术期中枢神经系统并发症之一,由此而影响到病人的愈后,有些可能致残,严重的可能死亡。为了在麻醉过程中有良好的脑血管功能保护,防止中枢神经系统并发症,让病人平稳地度过围手术期,目前尽管已经在各方面都有了脑保护的研究,但从脑血管水平来研究脑功能的保护的文献却很少,了解脑循环的病理生理基础以及麻醉对脑循环的影响,有助于防止隔术期继发性脑损害的发生。因此,此文主要从对脑血管功能的保护来实现对脑保护作一综述。