Successful outcomes in abuse cases are dependent upon close coordination of professional hospital staff with referring agencies including child protective services and the legal and judicial systems. A four-year retrospective study of 369 pediatric burn patients admitted to our Burn/Trauma Center was completed to: (1) assess demographic factors of patients and families that differentiate cases of child abuse from cases of children burned as a result of accidental injury, and (2) determine the impact of a multidisciplinary team approach to working with abused children and their families during the course of hospitalization. When medical evaluation reveals the possibility of child abuse, a social work assessment, including a developmental history of the child and psychosocial assessment of the family, is crucial. In addition, physicians must be well versed in the gathering of evidence for potential utilization by the legal system. This includes the obtainment of photographs and detailed documentation of the burn injury. A plan of evaluation and the effective coordination of services during hospitalization and following discharge have proven essential to meeting the best interests of the child.

Burns↗

PubMedDate not supplied

Acute septic cholecystitis in patients with burn injuries.

Acute cholecystitis continues to be a life-threatening complication in patients after trauma. In an 18-month period we have recognized and treated five patients with burn injuries who had acute cholecystitis. They ranged in age from 13 to 40 years. Four of the five patients had positive blood cultures and all five patients had positive bile cultures. The diagnosis was made on the basis of unexplained sepsis and an abnormal sonogram or hepatobiliary scan. Four patients underwent cholecystectomy and one patient underwent a cholecystostomy. Four patients survived and were discharged from the hospital. All five patients were receiving nutritional support. Factors such as prolonged fasting, dehydration, narcotic administration, and sepsis have been suggested as contributing factors in the development of acute cholecystitis. Acute cholecystitis is a serious complication in such patients and must be considered and treated promptly. Serial ultrasound studies have been helpful in managing patients suspected of having acute septic cholecystitis.

Adolescent↗

PubMedDate not supplied

Effect of aggressive surgical treatment in older patients with burns.

A group of 103 patients with burns, 65 years old and older, was compared with a similar group treated a decade ago. The survival rate of the early group was 37%, and the survival rate of the currently treated group is 52%. The length of stay in the hospital of surviving patients dropped from 42 to 22 days. Ten years ago 62% of surviving patients with burns in our series were operated on. In the more recently treated group with improved survival and decreased lengths of stay, 90% of the patients had one or more operations. We believe that early excision of eschar and early wound closure are associated with increased survival and decreased length of stay for older patients with burns.

Aged↗

PubMedDate not supplied

Sildimac: a new delivery system for silver sulfadiazine in the treatment of full-thickness burn injuries.

Wound care is painful for the patient with a burn injury and tedious for the burn unit staff but necessary to remove exudates and debris and to limit infections. In an effort to circumvent daily dressing changes while ensuring optimal wound protection, Sildimac (Marion Laboratories, Kansas City, Mo.), a new drug delivery system for silver sulfadiazine, was developed. When silver sulfadiazine, a topical antimicrobial commonly used for the treatment of burns, is incorporated into the delivery system, the drug is released in a sustained fashion. We report here the results of a multicenter evaluation of the safety and efficiency of Sildimac for treatment of full-thickness burn wounds. Sildimac, when left in place for up to 4 days, appears to be as effective as twice-daily wound cleansing and application of Silvadene cream 1% (Marion Laboratories, Kansas City, Mo.) for the treatment of full-thickness burns.

Acrylates↗

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Survey of treatment modalities for the prevention of hypertrophic facial scars.

The application of pressure to facial burns as a means of preventing or treating hypertrophic scar formation constitutes a major clinical challenge. Success depends on the experience of the therapist, choice of the pressure treatment, proper measurement technique, and adequate duration of therapy. A mail survey of therapists involved in the use of the various pressure modalities reveals a common trend with respect to the type of device used and the duration of therapy. The majority of therapists report that no one treatment produces uniformly excellent results.

Burns↗

PubMedDate not supplied

Bad advice; bad burn: a new problem in burn prevention.

Deep partial-thickness burns had been inflicted on the perineal area of an infant who was recently treated in our Burn Center. The burns were a result of advice to the patient's mother by a pediatrician. The doctor told her to use a hair dryer to prevent diaper rash. We surveyed pediatricians, well-baby clinics, and pediatric nurse practitioners in our area and found that approximately half of them advised the use of hair dryers to treat or prevent diaper rash. We tested four widely available hand-held hair dryers to determine potential for inflicting burn injury. All of the dryers are capable of delivering air heated to at least 53 degrees C after 2 minutes of use. We believe that warnings against the use of hair dryers for perineal hygiene should be included in burn prevention programs.

Burns↗

PubMedDate not supplied

Experience with Omiderm--a new burn dressing.

Explore the source record for details and available documents.

Burns↗

PubMedDate not supplied

Inhalation injury: a decade without progress.

Despite major advances in the management of patients with critical burn injuries, inhalation injury continues to be a major determinant of death resulting from burn injuries. Two cohort groups of victims with burn and inhalation injuries, separated by a decade, were retrospectively reviewed in an effort to determine the impact of newer treatment modalities. Patients were categorized as being at "high" or "low" risk on the basis of primary and secondary diagnostic criteria. Despite a statistically significant decrease in the percent of total body surface injury, no change in mortality rate was noted between the two groups. The advent of sophisticated diagnostic and management techniques does not appear to have decreased the mortality rate associated with inhalation injury.

Adolescent↗

PubMedDate not supplied

Omiderm as an initial burn dressing.

Explore the source record for details and available documents.

Burns↗

PubMedDate not supplied

Experience with patients with burns who refuse blood transfusion for religious reasons.

Patients with extensive full-thickness burns who refuse blood transfusion present a challenge to the burn team. We have recently treated four such patients, and we achieved a successful outcome in three. Staged excision and skin graft operations with minimal blood loss were performed. Two patients were treated with erythropoietin. Patient autonomy should be accepted by the burn team, but opportunity should exist for reassessment of treatment plans.

Adult↗

PubMedDate not supplied

A multicenter clinical trial of a biosynthetic skin replacement, Dermagraft-TC, compared with cryopreserved human cadaver skin for temporary coverage of excised burn wounds.

This multicenter study compared the use of a biosynthetic human skin substitute with frozen human cadaver allograft for the temporary closure of excised burn wounds. Dermagraft-TC (Advanced Tissue Sciences, Inc.) (DG-TC) consists of a synthetic material onto which human neonatal fibroblasts are cultured. Burn wounds in 66 patients with a mean age of 36 years and a mean burn size of 44% total body surface area (28% total body surface area full-thickness) were surgically excised. Two comparable sites, each approximately 1% total body surface area in size, were randomized to receive either DG-TC or allograft. Both sites were then treated in the same manner. When clinically indicated (> 5 days after application) both skin replacements were removed, and the wound beds were evaluated and prepared for grafting. DG-TC was equivalent or superior to allograft with regard to autograft take at postautograft day 14. DG-TC was also easier to remove, had no epidermal slough, and resulted in less bleeding than did allograft while maintaining an adequate wound bed. Overall satisfaction was better with DG-TC.

Adult↗

PubMedDate not supplied

An assessment of burn prevention knowledge in a high burn-risk environment: restaurants.

Our facility has seen an increase in the number of cases of children burned in restaurants. Fieldwork has revealed many unsafe serving practices in restaurants in our tristate area. The current research targets what appears to be an underexamined burn-risk environment, restaurants, to examine server knowledge about burn prevention and burn care with customers. Participants included 71 local restaurant servers and 53 servers from various restaurants who were recruited from undergraduate courses. All participants completed a brief demographic form as well as a Burn Knowledge Questionnaire. It was found that server knowledge was low (ie, less than 50% accuracy). Yet, most servers reported that they felt customer burn safety was important enough to change the way that they serve. Additionally, it was found that length of time employed as a server was a significant predictor of servers' burn knowledge (ie, more years serving associated with higher knowledge). Finally, individual items were examined to identify potential targets for developing prevention programs.

Adolescent↗