Mortality in paediatric burns at the Women’s and Children’s Hospital (WCH), Adelaide,South Australia: 1960–2017

BackgroundBurn injuries are the third leading cause of preventable death in children worldwide, resulting in over 100 000 annual hospitalisations. In the paediatric population, scalds are the commonest mechanism and burn injuries of greater than 40% total burn surface area (TBSA) are associated with a high mortality and morbidity rate.AimsThe aim of this study was to review mortality in paediatric burns in a tertiary burns centre over a 60-year period, providing an understanding of local causes of mortality and directing future clinical research.MethodsWe reviewed data collected prospectively from patients treated for burn injuries at the WCH from 1960 to 2017. Data of age, gender, mechanism of injury and TBSA were collected. TBSA of 40% and greater were included in the study.ResultsAll patients with total burn surface area (TBSA) less than 40% survived. There were a total of 75 patients who sustained burns of or greater than 40% TBSA. Overall mortality was 34% (26 of 75) of which 24 occurred in the 1960s. Of the 21 patients who died of flame burn injuries, 12 of them were described as clothes catching alight from being in close proximity to the source of flame. Average length of stay for patients who did not survive was 7 days (1–26).ConclusionMortality has since declined and the prognosis for survival good, even in TBSA of greater than 90%. The investigations in fabric flammability led by Dr Thomas Pressley and Mr Murray Clarke prompted the rewriting of Australian standards for production of children’s clothing. This, in combination with advances in paediatric resuscitation, surgical techniques as well as wound care has improved survival rates and outcomes in extensive burn injuries. Future studies focus to see not only better survival rates, but also better aesthetic and functional outcomes in burn survivors.     

突发事件批量烧伤伤员12个月后心理健康状况调查分析

目的：调查分析突发事件批量烧伤伤员12个月后的心理健康状况及其影响因素。方法采用自行设计的一般情况调查表、症状自评量表（SCL-90）和社会支持评定量表,对该批量17例成年烧伤患者进行调查。结果该批量烧伤伤员症状自评量表各因子得分中,躯体化与焦虑因子得分高于国内常模（P＜0．01）;社会支持总分高于国内常模（P＜0．01）;社会支持的三个维度和SCL-90各因子均呈负相关（P＜0．01或P＜0．05）。结论该烧伤患者的心理健康状况良好,及时有效的心理干预与良好的社会支持能提高烧伤患者的治疗和康复效果。     

Amikacin population pharmacokinetics among paediatric burn patients

Introduction

The objectives of this study were to (1) determine the pharmacokinetics of amikacin among children with severe burn and (2) identify influential covariates.

Methods

Population-based pharmacokinetic modelling was performed in NONMEM 7.2 for hospitalized children who received amikacin at 10–20 mg/kg divided two, three, or four times per day as part of early empiric treatment of presumed burn-related sepsis.

Results

The analysis included data from 70 patients (6 months to 17 years) with 282 amikacin serum concentrations. Amikacin's mean C_max was 33.2 ± 9.4 μg/mL and the mean C_min was 3.8 ± 4.6 μg/mL. The final covariate model estimated clearance as 5.98 L/h/70 kg (4.97–6.99, 95% CI), the volume of distribution in the central compartment as 16.7 L/70 kg (14.0–19.4, 95% CI), the volume of distribution in the peripheral compartment as 40.1 L/70 kg (15.0–80.4, 95% CI), and the inter-compartmental clearance as 3.38 L/h/70 kg (2.44–4.32, 95% CI). In multivariate analyses, current weight (P < 0.001) was a significant covariate, while age, sex, height, serum creatinine, C-reactive protein, platelet count, the extent and type of burn, and concomitant vancomycin administration did not influence amikacin pharmacokinetics.

Discussion

Children with burn featured elevated amikacin clearance when compared to healthy adult volunteers. However, peak amikacin concentrations are comparable to those attained in other critically-ill children, suggesting that elevated amikacin clearance may not result in sub-therapeutic antibacterial effects. In this study, we found that amikacin displays two-compartment pharmacokinetics, with weight exerting a strong effect upon amikacin clearance. Further pharmacodynamic studies are needed to establish the optimal dosing regimen for amikacin in paediatric burn patients.     

Perineal burn care: French working group recommendations

Objectives

Burns to the perineum are frequently exposed to faeces. Diverting colostomy is often described to prevent faecal soiling. Because this technique is invasive with frequent complications, use of non-surgical devices including specifically designed faecal management systems has been reported in perineal burns.

Methods

In order to standardise the faecal management strategy in patients with perineal burns, a group of French experts was assembled. This group first evaluated the ongoing practice in France by analysing a questionnaire sent to every French burn centre. Based on the results of this study and on literature data, the experts proposed recommendations on the management of perineal burns in adults.

Results

Specifically designed faecal management systems are the first-line method to divert faeces in perineal burns. The working group proposed recommendations and an algorithm to assist in decisions in the management of perineal burns in four categories of patients, depending on total burn skin area, depth and extent of the perineal burn.

Conclusion

In France, non-surgical devices are the leading means of faecal diversion in perineal burns. The proposed algorithm may assist in decisions in the management of perineal burns. The expert group emphasises that large clinical studies are needed to better evaluate these devices.     

Psychiatric outcomes amongst adult survivors of childhood burns

Background

Research on the adult psychiatric outcomes of childhood burns is limited.

Aims

To examine the rates of DSM-IV psychiatric disorder amongst adult survivors of paediatric burns, and to explore factors likely to contribute to variation in outcomes. In line with Meyer and colleagues [1], it was expected that high levels of psychopathology would be found.

Method

Participants were 272 adults hospitalised for burns during childhood between the years 1980 and 1990. Structured interviews and self-report questionnaires were used to assess psychiatric symptoms.

Results

Lifetime prevalence of any DSM-IV disorder was 42%, 30% for depressive disorders, and 28% for anxiety disorders. Eleven percent had made a suicide attempt. Female gender, single relationship status, higher level of disfigurement, longer hospital stays and higher number of burn-related surgeries were associated with adverse psychiatric outcomes.

Conclusions

High rates of suicidality and depression were concerning in adults with a history of childhood burns. Factors found to predict psychiatric outcomes could be used to direct interventions and further research is needed to establish how this could best be done.     

Burn resuscitation on the African continent

A survey of members of the International Society of Burn Injuries (ISBI) and the American Burn Association (ABA) indicated that although there was difference in burn resuscitation protocols, they all fulfilled their functions. This study presents the findings of the same survey replicated in Africa, the only continent not included in the original survey.One hundred and eight responses were received. The mean annual number of admissions per unit was ninety-eight. Fluid resuscitation was usually initiated with total body surface area burns of either more than ten or more than fifteen percent. Twenty-six respondents made use of enteral resuscitation.The preferred resuscitation formula was the Parkland formula, and Ringer's Lactate was the favoured intravenous fluid. Despite satisfaction with the formula, many respondents believed that patients received volumes that differed from that predicted. Urine output was the principle guide to adequate resuscitation, with only twenty-one using the evolving clinical picture and thirty using invasive monitoring methods. Only fifty-one respondents replied to the question relating to the method of adjusting resuscitation. While colloids are not available in many parts of the African continent on account of cost, one might infer than African burn surgeons make better use of enteral resuscitation.     

Management of burns

Burns are common injuries that vary in severity from small superficial scalds to massive full-thickness flame burns with high morbidity and mortality. The purpose of this article is to review common burn presentations and the pathophysiology of these injuries. In addition it gives the reader an overview of burns management from the emergency department through to the specialist burns centre and describes the latest multi-disciplinary approach to treating these injuries.     

糖尿病患者手部深度烧伤创面修复临床疗效分析

目的讨论糖尿病患者手部深度烧伤创面修复临床疗效。方法选取2019年4月—2020年4月期间该院收治的118例手部深度烧伤患者作为该次研究对象,根据是否患有糖尿病分为糖尿病组和非糖尿病组,每组59例。两组患者均采用皮瓣、全厚皮和中厚皮进行创面修复治疗,观察两组患者的治疗效果。结果①干预前,糖尿病组和非糖尿病组患者的空腹血糖以及餐后2 h血糖水平差异有统计学意义(t=14.147、4.998,P<0.001);治疗后,糖尿病组空腹血糖为(5.9±1.2)mmol/L,非糖尿病组空腹血糖为(5.5±1.4)mmol/L,差异无统计学意义(t=1.666,P=0.098>0.05),说明糖尿病患者治疗后血糖水平接近正常值;糖尿病组餐后2 h血糖为(7.4±0.4)mmol/L,非糖尿病组餐后2 h血糖为(7.3±0.3)mmol/L,差异无统计学意义(t=1.563,P=0.127>0.05),说明糖尿病患者治疗后血糖水平接近正常值。②糖尿病组患者的手功能恢复优良率为86.4%,与非糖尿病组的98.3%,组间数据差异有统计学意义(χ²=4.330,P=0.037)。结论对于手部深度烧伤患者来讲,在采用相同的床修复方法时非糖尿病患者的治疗效果相对较好,糖尿病患者恢复效果则相对较差,临床对于糖尿病手部深度烧伤患者应给与高度关注,并积极进行进一步治疗。