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PubMed2005

Epidemiological and outcome characteristics of major burns in Tokyo.

The Tokyo Burn Unit Association (TBUA) was established in 1983 funded by the Tokyo Metropolitan Government, and is organized by 13 burn units in Tokyo. TBUA covers more than 90% of severe burn patients occurring in Tokyo, and all of the cases are registered according to the burn injury registration format. The purpose of this study is to analyze the registered data and to elucidate epidemiological and outcome characteristics of major burn injuries in Tokyo. The total of 6988 hospitalized patients had data for epidemiological analysis, and 6401 patients had complete data for outcome analysis as well, and were included in this study. The characteristic profiles for the analysis included age, sex, cause of burns, inhalation injury, %BSA, burn index (BI), length of burn unit stay, and outcome, and were analyzed by age groups. The mean age of the patients was 40.4 years, and 63% of them were male. It was noteworthy that 25% of the total patients were elderly patients over 60 years of age. Flame was the most common cause making up 45.6% followed by scalding (32.0%). The overall mortality rate was 15.4%. Inhalation injury was accompanied in 27.3% of burn patients. The mortality rate was 34.6% with inhalation injury, and 8.2% without inhalation injury. Causes of death showed that multiple organ failure made up 36.9% of total mortality, followed by sepsis 25.2 and shock 19.0%. The burn size (%BSA and BI) and inhalation injury were the factors for high mortality rate in all age groups whereas age was a predictor for high mortality in the patients older than 16 years of age. Gender was not a factor for high mortality in any age group. The mortality rate showed mildly decreasing tendency since 1995 for which implementation of skin bank was thought to be responsible.

Adolescent↗
PubMed2005

Epidemiology and mortality of hospitalized burn patients in Kohkiluye va Boyerahmad province (Iran): 2002-2004.

The Kohkiluye va Boyerahmad province is located in the south of Iran. The population of the province is about 615,000, living in 14,261 km(2). The total number of patients in the study was 235. There were admitted to the burn unit of Shahid Beheshti hospital (Yasuj) between 18 July 2002 and 17 July 2004. Of these patients, 149 (63.4%) were accidental and 86 (36.6%) were self-inflicted burns. The hospitalization rates for accidental and self-inflicted burns were 12.1 and 7.0 per 100,000 person-years, respectively. There is a significant difference in the sex ratio (males:females) between accidental (1.40) and suicidal (0.13) patient groups (P((2))<0.00001). The fatality rates for accidental and self-inflicted burns were 2.1 and 59.5%, respectively. The mortality rates for accidental and self-inflicted burns were 0.24 and 3.81 per 100,000 person-years, respectively. The overall mean and median ages for accidental patients were 19.4 and 13 years, and those for self-inflicted burns were 24.9 and 23 years, respectively. In the accidental patients, the BSA of the burns ranged from 5 to 95%, with a median of 15%. In the self-inflicted patients, the median of BSA was 65%. The majority of accidental burns were caused by scalds (43.2%) and of self-inflicted burns by kerosene (87.5%). The median hospital stay was 8 days with a range of 1-43 days for accidental patients. The median hospital stay was 4 days with a range from <1 to 36 days for fatal self-burning patients. In non-fatal self-burning cases, the median hospital stay was 20 days with a range of 4-53 days. There is significant difference between fatal and non-fatal self-burning cases for hospital stay (P((2))<0.0001). No definite correlation was found between the incidence of either accidental or self-inflicted burns and seasons (P((2))>0.05). Most of the burns occurred at home.

Adolescent↗
PubMed2005

Profile of pediatric burns Indian experience in a tertiary care burn unit.

Pediatric burns admitted to the tertiary care burn facility of Kanchi Kamakoti CHILDS Trust Hospital in Chennai (India) were retrospectively analysed between 1992 and 2003. Five hundred and thirty-five burn cases were admitted during these years. These children belonged to the age group of 0-18 years (as WHO has increased the pediatric age group range to 0 to 18 years). The etiology of these burns was looked into and the outcome of these patients in respect to etiology and complications were studied. After analysis, they were classified according to age, sex, TBSA and the occurrence of infection during the course of treatment. The complications that really affected the outcome were looked into and infection ranked first in fatal cases. Inhalation burns were not very common in our group and were associated only with large flame burns, which occur when a child is burnt while the mother commits suicide, or in cases of abuse of female children in a closed room with lots of inflammable upholstery. Scalds were the most common type of burn among children under 4 years of age. Flame burns predominated the older age group. Although there were 13 deaths among the entire group, the majority occurred within the 2-4 years age group. There was no significant gender difference with respect to mortality. Large burn size and infection were the strongest predictors of mortality.

Adolescent↗
PubMed2005

A retrospective analysis of 19,157 burns patients: 18-year experience from Hallym Burn Center in Seoul, Korea.

This is a retrospective, epidemiological study of 19,157 acute burn patients admitted to the Hallym Burn Centre, Hangang Sacred Heart Hospital, Seoul, Korea, during the period 1986-2003. The study was conducted to identify characteristics of burn patients that could lead to development of preventive programs to reduce both the frequency and mortality of burn injury. The majority of patients admitted had relatively minor burns, which were treated conservatively. Males predominated in all age groups with a summer peak seasonal variation. Typical burn in the children <5 years of age was a scald injury, occurring at home, affecting upper limbs and resulting in a relatively short hospital stay. Electrical burns due to steel chopsticks and steam burns due to electric rice cookers were also found in this age group. Adult burns, affecting upper and lower limbs, were caused by flames, hot liquids or electricity. Burns were sustained at the workplace and outdoors. Flame accidents in males were the leading cause of death with overall mortality of 8.2%. 13.9% of admissions needed intensive care and average length of hospital stay was 32.6 days. The annual number of patients undergoing burn related surgery has continuously increased reflecting a more aggressive surgical management. Our ongoing efforts are to promote prevention program and look for changes in the incidence of burn injury based on these epidemiologic features. Further study for implications of changes in management protocols and policies on treatment outcomes would improve the provision of appropriate care for the patients.

Accidents, Home↗
PubMed2005

Elderly patients discharged home from the emergency department with minor burns.

OBJECTIVES: To describe the risk factors, etiology and referral patterns of elderly patients treated for minor burns in an urban emergency department (ED). METHODS: A retrospective chart review was conducted of persons aged 65 years and older who were treated for a minor burn and discharged home from the ED. Medical records were reviewed for 77 burn patients that presented over a 6-year period. RESULTS: Burn patients had significant co-morbid medical illness. The etiology of the burns was scalds (58%), contact (27%) and flame (12%). Sixty-eight percent of the burns were cooking related. Heating pads, curling irons or hot pipes accounted for the majority of contact burns. Three percent of burn patients were referred to a home care agency for a home safety evaluation at the time of discharge from the ED. CONCLUSION: Cooking-related activities accounted for the majority of minor burns in this series. Common consumer items or environmental hazards were responsible for most contact burns. Elderly patients seen in the ED with minor burns were rarely referred to a home care agency.

Accidents, Home↗
PubMed2005

Treatment of second degree facial burns with allografts--preliminary results.

Facial burns are very common and have significant clinical impact. However, the treatment regimen for superficial to deep facial burns is not well defined. The purpose of this study was to investigate the effects of cadaver skin grafting in deep partial thickness facial burns in comparison to standard care. In a prospective open study design severely injured patients with superficial and deep partial thickness burns were randomized into the group receiving open treatment with silversulfadiazine (standard n=5) or into the group receiving early superficial debridement followed by coverage with glycerolized cadaver skin (n=5). The outcome measures were time and quality of wound healing, and incidence of hypertrophic scarring at 3 and 6 months post burn. There were no significant differences in demographics between groups. In the group treated with the allogenic material time to reepithelialization was 10.5 days, while it was 12.4 days in the silversulfadiazine group (p<0.05). Scar quality was found to be significantly improved in the allogenic treatment group. Three and 6 months postburn there were no patients with significant hypertrophic scarring in the allogenic group while there were two patients who developed hypertrophic scars in the silversulfadiazine group (p<0.05). In this study, we demonstrated that glyzerolized cadaver allograft skin represents a superior biological dressing for shallow and deep partial thickness facial burns. This is in concordance with other reports on scalds. It would be worthwhile to perform more clinical studies with a larger number of patients to further evaluate the effect and function of allogenic skin for facial burns.

Adult↗
PubMed2005

Leukotriene receptor blocker montelukast protects against burn-induced oxidative injury of the skin and remote organs.

Thermal injury elicits several systemic consequences, among them the systemic inflammatory response where the generation of reactive oxygen radicals and lipid peroxidation play important roles. In the present study, we investigated whether the leukotriene receptor blocker montelukast is protective against burn-induced remote organ injury. Under brief ether anaesthesia, shaved dorsum of the rats was exposed to 90 degrees C (burn group) or 25 degrees C (control group) water bath for 10 s. Montelukast (10 mg/kg) or saline was administered intraperitoneally immediately after and at the 12th hour of the burn injury. Rats were decapitated 24 h after burn injury and the tissue samples from lung, liver, kidney and skin were taken for the determination of malondialdehyde (MDA) and glutathione (GSH) levels, myeloperoxidase (MPO) activity and collagen contents. Tissues were also examined microscopically. Serum aspartate aminotransferase (AST), alanine aminotransferase (ALT) levels and creatinine, urea (BUN) concentrations were determined to assess liver and kidney function, respectively. Tumor necrosis factor-alpha (TNF-alpha) and lactate dehydrogenase (LDH) were also assayed in serum samples. Severe skin scald injury (30% of total body surface area) caused a significant decrease in GSH level, which was accompanied with significant increases in MDA level, MPO activity and collagen content of tissues. Similarly, serum ALT, AST and BUN levels, as well as LDH and TNF-alpha, were elevated in the burn group as compared to control group. On the other hand, montelukast treatment reversed all these biochemical indices, as well as histopathological alterations, which were induced by thermal trauma. Findings of the present study suggest that montelukast possesses an anti-inflammatory effect on burn-induced damage in remote organs and protects against oxidative organ damage by a neutrophil-dependent mechanism.

Acetates↗
PubMed2005

Epidemiology of burns at the Italian Red Cross Hospital in Baghdad.

This study describes the epidemiology and patterns of moderate to severe burn injuries (%BSA>or=20-90) treated at the Italian Red Cross Hospital in Baghdad, Iraq, during the medical mission of the tenth Italian Red Cross Contingent, from 3 April to 19 May 2004. Burn injuries sustained by members of the civilian population admitted to the Burns Unit, irrespective of age and sex, are analysed (n=48). Differences in risk distribution between different segments of the population are reported and typical injury patterns are identified. The six injury patterns identified are labelled "child scaldings", "domestic accidents", "unsafe working conditions", "suicide attempts", "injuries among children in role-play" and "war related injuries". The results show that burn injury incidence is particularly high for women and children. There is a pronounced difference between genders after adulthood (age 15 and up). The mortality rate is higher in females. Most of the burns occurred in the home: a public health education campaign might help reduce the incidence of these injuries.

Accidents, Home↗
PubMed2005

Knowledge, attitudes, and behavior of occupational physicians related to burn cases: a cross-sectional survey in Turkey.

The primary care of victims of burns at the workplace is provided by occupational physicians. In Turkey, the routine practice is to certify physicians for work in occupational medicine. The aim was to evaluate the knowledge, attitudes, and behavior of occupational physicians regarding burn cases. A total of 510 occupational physicians working in Ankara were surveyed by mail, and 101 (19.8%) physicians responded. Most of these physicians (n=67, 66.3%) had encountered burn cases within the prior year. The most frequent type of burn was scalds (n=55, 54.5%) followed by thermal burns (n=37, 36.6%). Of the respondents, 22 (21.8%) knew the most appropriate classification of burns. Regarding first-aid treatments prior to triage, only 4% chose the valid items. The mean rate of favourable attitudes of the participants toward first aid of different types of burn injuries was 70.8%. Only 31.7% of the physicians surveyed used up-to-date first-aid modalities. We conclude that Turkish occupational physicians have inadequate knowledge and inappropriate attitudes toward the first aid and primary care of burn victims. With the vital support of the Burn and Fire Disaster Institute at Başkent University, nationwide educational policies could be improved and assessed.

Adult↗
PubMed2005

Minor burn injuries in adults presenting to the regional burns unit in Western Australia: a prospective descriptive study.

INTRODUCTION: Western Australia is the largest state in Australia, accounting for approximately one third of the Australian continent. The adult Burns Unit in Western Australia is at Royal Perth Hospital, which provides for the whole adult population of approximately 1.8 million, 80% of which live in and around the state capital city, Perth (approx. 1.4 million). The unit also offers a minor burn care facility. METHODS: The aim of this study was to perform the first prospective review of minor burn injuries in Western Australia, to classify patient demographics, injury patterns and primary treatment. RESULTS AND CONCLUSION: Two hundred and twenty seven patients were referred to the minor burn facility at Royal Perth Hospital (RPH) during the study period. One hundred and three patients (45%) sustained a scald, a further 44 (19%) received a flame burn. Thirty-seven (16%) patients sustained a contact burn, 18 (7.8%) patients attended the clinic with a chemical burn. Sixty percent of all patients reviewed had burns less than one percent. Only 39% of all our patients received adequate first aid. Sixty one percent of all patients received inadequate or inappropriate first aid. This study highlights a number of important issues. The over representation of metropolitan patients coupled with the low numbers of aboriginal patients reinforces the need for rural burns education. The best service we can provide is education on burns prevention and primary management. There are a number of other areas we hope to address in the future, the high incidence of domestic accidents, home safety must be a priority, coupled with seasonal promotional campaigns to address issues such as car radiator injuries. The most striking, and perhaps the most worrying finding in this study is the poor application of basic first aid principles. This is something that is unacceptable, needs further investigation and the lack of basic knowledge needs to be addressed at all levels of the community.

Accident Prevention↗
PubMed2005

Hot beverage burns: an 11-year experience of the Yorkshire Regional Burns Centre.

A retrospective study was performed at the Yorkshire Regional Burns Centre from 1994 to 2004 inclusive to determine the changes in treatment and clinical outcomes of patients admitted with hot beverage burns and the effect of changes in referral patterns over this period. Although children under the age of 3 years accounted for 77.5% of all cases of hot beverage scalds, this injury was represented in all age groups. Children from 1 to 2 years of age had the highest incidence of this injury. Changes in referral patterns over this period resulted in a decrease in the mean total body surface area of injury, an increase in the number of admissions and an increase in the time interval from injury to admission to the Burns Centre for this period. The total body surface area given by referring facilities was often times inaccurate, as reported previously by this Burns Centre. The introduction of Biobrane in 2002 was effective in reducing the length of hospitalisation for patients with superficial partial thickness burns. Hot beverage burns remain a significant public health problem deserving of continuing efforts to maintain public awareness.

Adolescent↗
PubMed2005

Evaluation of a bi-layer wound dressing for burn care I. Cooling and wound healing properties.

Severe burns remain a significant cause of morbidity and mortality despite the availability of numerous therapies. We assessed the wound healing and skin-cooling properties of a DRDC hydrogel/polyurethane wound dressing using different pre-clinical models. Our results show that 85% of partial-thickness, non-contaminated porcine wounds treated with our dressing healed within 6 days. In contrast, 85% of the wounds treated with commercial dressings healed within 8 days. Application of a moist DRDC dressing (to simulate a condition of exudate absorption) on a scald burn covering 25% of the dorsal area in rats reduced skin temperature by 1.70 +/- 0.14 degrees C for 5 min, the skin temperature being comparable to that of control burned rats after 20 min. The application of a moist DRDC dressing did not induce significant differences in body temperatures compared with that of burned animals without dressing coverage throughout the 90-min experiment. While no change in body temperatures were observed when standard dressings (i.e., not pre-moistened) were applied, skin temperature increased gradually. These data show that our dressing is effective in promoting faster healing of the treated wound; and providing a transient, but beneficial cooling effect to the skin contact-site, without the adverse effect of inducing whole-body hypothermia.

Animals↗
PubMed2006

Stenotrophomonas maltophilia bacteremia in burn patients.

Stenotrophomonas maltophilia has been increasingly reported as a nosocomial opportunistic pathogen in debilitated patients, including burn patients. There is, however, only one published report in English that discusses S. maltophilia bacteremia in burns. We performed a retrospective chart review and statistical analysis of the incidence, the duration of hospital stays before a diagnosis of bacteremia, antimicrobial susceptibility, prognosis, and mortality risk factors in burn patients. From January 1996 to December 2004, 14 episodes of S. maltophilia bacteremia in 13 of 666 patients admitted to the burn center at our hospital were identified. The patients, nine males and four females, ranged in age from 1 to 76 years (mean: 42.9+/-24.4 years). Eleven injuries were from flame burns and two were from scald burns. The mean total burned surface area (TBSA) was 47+/-30.2% and mean prognostic burn index (PBI) was 81.7+/-31.3. The average annual incidence was 2.3 episodes per 1000 admissions, and no outbreak cluster was noticed. The mean hospital stay before bacteremia was 19.8+/-11.9 days. Most isolates were susceptible to ticarcillin-clavulanate (87.5%) and moxalactam (85.7%). The overall mortality was 30.7% (4/13) and correlated significantly with TBSA (P<0.01) and PBI (P<0.05). The incidence of S. maltophilia bacteremia was higher in hospitalized burn patients than in hospitalized non-burn patients. Different antimicrobial susceptibility patterns may exist, especially in different geographic regions. Awareness of the possibility of infection by this opportunistic pathogen and commencement of adequate antibiotics treatment, especially after 3 weeks of intensive care, should be incorporated into the strategy of treatment in major burn patients.

Adolescent↗
PubMed2006

Paediatric burn prevention: an epidemiological approach.

OBJECTIVE: To study the mechanism of burn in hospitalized paediatric burn patients in order to develop a focused burn prevention campaign. METHODS: Acute paediatric burn patients were identified from the unit admission records. Detailed medical records were reviewed to identify the key demographic and management information including the country of residence, age, gender, extent of injury, specific treatment and hospital stay. Parents were then contacted to provide detailed information about the mechanism of the accident, first aid given, living density and parent's educational level. RESULTS: Two hundred and eighty-four admissions were identified in a 5-year period. Two hundred and twenty-four of these patients came from a defined regional population served by the hospital. The median age of patients was 3 and male to female ratio 1:0.74. The most common age group for burns was 1-2 years. The most common type of burns were scalds. Domestic burns accounted for 84.7% of admissions. Median burn area was 4% of the total body surface area with a range of 0.2-45%. Fifty percent of patients had no first aid treatment prior to presentation at the hospital. More accidents happened in homes with a high living density and the majority of parents had both completed secondary education. The most dangerous location in the house was the living room, followed by the bathroom, kitchen then bedroom. The majority of burns were related to hot drinks, followed by hot food and then bathing. CONCLUSION: Detailed investigation of burn incidents can reveal repeated mechanisms of injury, which direct the focus of preventive strategies.

Accidents, Home↗
PubMed2006

Are paediatric burns more common in asylum seekers? An analysis of paediatric burn admissions.

The number of asylum seekers in Ireland has increased dramatically over the last 10 years. Based on our impression that the number of children admitted to our burn unit was disproportionately represented by children of asylum seekers we performed an audit to establish (1) what proportion of admissions are from this subgroup and (2) the characteristics of their burns. All paediatric burn admissions from May 2003 to April 2004 were reviewed. Data collected from a retrospective chart review included patient demographics and details of the burn injuries. The National Census of 2002 and the Office of the Refugee Applications Commissioner were consulted for population statistics. Total burn admissions for the period were 126: Irish nationals (n=107), non-national residents (n=2), asylum seekers (n=14) and patients of unknown asylum status (n=3, excluded from study). In the asylum seeker group, the median age was 18.6 months (range 10 months-5.3 years) with the majority less than 2 years (n=11). All burns occurred in the domestic setting. Scalds accounted for 13 cases, one contact burn occurred from a hot grill. The median total body surface area burned was 5.7% (range 1.5-26%). The National Census of 2002 recorded a population of 3,917,203. With less than 12,000 asylum seekers in the country, they comprise only approximately 0.3% of the population yet they account for 11.4% of the burn patients admitted to our unit, p<0.0001. Children of asylum seekers are over-represented in our series of paediatric admissions for burns and are more likely than Irish children to sustain a burn at a younger age and in the domestic setting. This may indicate an increased risk of injury and warrants further investigation.

Accidents, Home↗
PubMed2006

Childhood burns in Israel: a 7-year epidemiological review.

INTRODUCTION: Understanding the etiology of severe burns injuries and identifying high risk groups are essential for allotting resources for prevention and treatment. The objective of this study was to develop a profile of severe childhood burns in Israel. METHODS: A retrospective study of children (ages 0-14) hospitalized with a burn, between 1998 and 2004. Data from all five burn units in Israel was retrieved from the National Trauma Registry. RESULTS: Two thousand seven hundred and five children were hospitalized with burns (51% of all burn admissions). Infants (ages 0-1) had the highest prevalence (45%). Scalds caused 68% of burns. Burn extent in 83% of the patients was less than 20% TBSA, 3% suffered 40%TBSA burns. Surgical intervention increased from 6% in 1998 to 21% in 2002. Non-Jewish children sustained proportionally more burn injuries (48%). Among Jewish children an increase in burn injuries was noted on Thursdays and Fridays. CONCLUSION: Infants, boys and non-Jewish children were found to be at greatest risk for a burn injury, while older children were at higher risk for severe burns. Prevention programs should target these high risk groups, with an emphasis on the unique characteristics of each group. Policy makers should reassess the benefits of a pediatric burn unit in Israel. The increase in rates of surgical intervention should be further investigated.

Burns↗
PubMed2006

Propylthiouracil (PTU)-induced hypothyroidism alleviates burn-induced multiple organ injury.

Oxidative stress has an important role in the development of multiorgan failure after major burn. This study was designed to determine the possible protective effect of experimental hypothyroidism in hepatic and gastrointestinal injury induced by thermal trauma. Sprague Dawley rats were administered saline or PTU (10 mgkg(-1) i.p.) for 15 days, and hypothyroidism was confirmed by depressed serum T(3) and T(4) concentrations. Under brief ether anesthesia, shaved dorsum of rats was exposed to 90 degrees C (burn group) or 25 degrees C (control group) water bath for 10s. PTU or saline treatment was repeated at the 12th hour of the burn. Rats were decapitated 24h after injury and tissue samples from liver, stomach and ileum were taken for the determination of malondialdehyde (MDA) and glutathione (GSH) levels, myeloperoxidase (MPO) activity and collagen contents. Formation of reactive oxygen species in tissue samples was monitored by using chemiluminescence (CL) technique with luminol and lucigenin probes. Tissues were also examined microscopically. Tumor necrosis factor (TNF)-alpha and lactate dehydrogenase (LDH) were assayed in serum samples. Severe skin scald injury (30% of total body surface area) caused a significant decrease in GSH level, which was accompanied with significant increases in MDA level, MPO activity, CL levels and collagen content of the studied tissues (p<0.05-0.001). Similarly, serum TNF-alpha and LDH were elevated in the burn group as compared to control group. On the other hand, PTU treatment reversed all these biochemical indices, as well as histopathological alterations induced by thermal trauma. Our results suggest that PTU-induced hypothyroidism reduces oxidative damage in the hepatic, gastric and ileal tissues probably due to hypometabolism, which is associated with decreased production of reactive oxygen metabolites and enhancement of antioxidant mechanisms.

Animals↗
PubMed2006

Use of power Doppler ultrasound to monitor renal perfusion during burn shock.

BACKGROUND: Renal cortical blood flow can be quantified by means of power Doppler ultrasound (PDUS) image analysis. We hypothesized that renal cortical perfusion, estimated by PDUS image intensity (PDUSII), would decrease during burn shock and improve during resuscitation in a porcine model. METHODS: Eight anesthetized swine sustained a 75% scald injury. Resuscitation began 6h postburn. Renal cortical blood flow was measured directly using fluorescent microspheres (CORFLO), and was estimated noninvasively by PDUSII. PDUSII, CORFLO, and cardiopulmonary data were recorded every 2h. RESULTS: PDUSII decreased significantly from preburn to postburn hour 6, and increased with resuscitation by hour 8. CORFLO correlated well with PDUS image intensity (n=48, r(2)=0.696) but poorly with urine output (n=48, r(2)=0.252). CONCLUSION: PDUS in this study was superior to the urine output in assessing renal cortical microvascular blood flow during shock and resuscitation, and may be useful in the care of injured patients.

Animals↗