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At least 1,423 records · Page 79Linked to original sources
PubMed2003

Antithrombin (human) concentrate infusion in pediatric patients with >50% TBSA burns.

BACKGROUND: Antithrombin (human) [AT(H)] concentrate infusions have been safely utilized in adult burn patients to counteract subclinical disseminated intravascular coagulopathy and pulmonary complications. OBJECTIVE: AT(H) concentrate was given to two thermally injured pediatric patients to evaluate safety and dosage requirements. DESIGN: The first patient was a 2-year-old with 83% total burn surface area (TBSA) full thickness flame burn and severe inhalation injury. The second patient was a 14-month-old who sustained 56% TBSA deep partial and full thickness scald injury. Each child received 10 infusions of AT(H) concentrate (106 units/kg) in the first 4 days post-injury. RESULT: For these two patients, the plasma AT level (normal range: 100+/-20%) increased, respectively, from 25 and 66% on admission to 224 and 217% on day 1, 114 and 116% on day 2, and 193 and 171% on day 3. Both patients tolerated the infusions well. In one patient, the eschar on all four extremities easily peeled off the subcutaneous tissues along a natural demarcation between viable and non-viable tissue with only a 40cc estimated blood loss (EBL). CONCLUSIONS: AT(H) concentrate is tolerated in the pediatric population in the acute phase of injury. Lack of bleeding during eschar removal may be of benefit to burn excision and grafting.

Antithrombins↗
PubMed1991

Incidence of medically treated burns in The Netherlands.

During the period January 1988 to December 1989, medically treated burn injuries in The Netherlands were recorded prospectively by three registration systems. These systems cover patients treated in burn units, in general and university hospitals, and by general practitioners. Incidence rates and 95 per cent confidence intervals were calculated, and basic epidemiological data about severity and localization of the burns and about accident circumstances were collected. The overall incidence rate of medically treated burns over all levels of medical care is estimated to be about 280 per 100,000 persons per year. This overall incidence figure appeared to be about three times as high for 0-4-year-old children: 775 per 100,000 per year. At all levels of medical care, scalds are the most frequent type of burn, resulting in an overall incidence rate among 0-4-year-old children of 430 per 100,000 per year. Incidence rates are lowest among the elderly (55 years and over), but this age group suffers a higher mortality from burns. Furthermore, it appeared that males are more prone to serious burns than females, whereas female are more often treated for less severe burns. Most of the accident circumstances for serious burns were related to professions, whereas most of the circumstances for less severe burns were related to household activities.

Adolescent↗
PubMed1991

Audit of thermally injured children under 5 years of age.

One-third of all admissions to the Wessex Regional Burns Unit (WRBU) are children under 5 years of age. These patients constitute a disproportionately large part of the workload in terms of nursing and medical care. A review of children admitted to the WRBU over a 5-year period was undertaken. Information was stored in a computer database (dBASE-IV) to simplify data analysis and to develop a system of data collection which can be used for audit. Eighty-one per cent of injuries were due to scalds. The mean burn surface area (BSA) was 8 per cent, and 78 per cent of injuries were smaller than 10 per cent BSA. Skin grafting was required in 44 per cent of patients. The mean time to operation was 13 days after injury. Significant hypertrophic scarring occurred in 60 per cent of patients and 12 per cent of patients were readmitted for further surgical procedures. There was one death. In an extension to the main database, associations between clinical and physiological observations and morbidity were sought. The data suggest that behavioural changes, 'shock', profound lymphocytopenia and pyrexia greater than 39.5 degrees C should be treated as strongly suggestive of the development of complications in the early stages after injury.

Age Factors↗
PubMed1984

Epidemiology of burns in childhood.

A survey was carried out on all burns admitted to a regional burns centre over a 3-year period. A total of 937 patients were admitted to the Unit, of whom 43 per cent were under 15 years of age and 31 per cent were less than 5 years old. A detailed computer analysis of those patients admitted under the age of 15 years is presented, with special emphasis on scalds in the pre-school child.

Adolescent↗
PubMed1997

Controlled mechanical hypoventilation in a paediatric burn patient as treatment of acute respiratory distress syndrome.

The paediatric patient we are describing suffered a scald injury covering 83 per cent of the total body surface area (TBSA). This injury was complicated by Klebsiella pneumoniae septicaemia resulting in multiorgan failure (MOF). Acute respiratory distress syndrome (ARDS), gastrointestinal insufficiency, hepathopathy and wound conversion to full thickness posed the main problems. The boy was ventilated with pressure-controlled mechanical ventilation. The concept of permissive hypercapnia (PHC) resulted in a complete resolution of ARDS within 4 weeks. From our experience, further lung injury among infants and children suffering from severe ARDS can be avoided by using controlled mechanical hypoventilation. It is a simple and safe technique that allows adequate oxygenation.

Accidents, Home↗
PubMed1997

A retrospective study of etiopathological and preventive factors in a burns unit in Saudi Arabia.

A 10-bed state-of-the-art burns unit was commissioned at King Fahd Specialist Hospital, Buraidah, Al-Qassim and the first 90 cases admitted to the unit over an 18-month period were analysed. The mean age (+/-SD) was 14.9 (+/-1.5) years with a range of 6 months-55 years. Fifty-one per cent were males, 52.2 per cent were children under 12 years of age and of these 85.1 per cent were under 5 years of age. Scalds and flames accounted for 90 per cent of the burns. Domestic burns formed the majority of cases, 64 (71 per cent), and most patients were admitted within the first 24 h (76 per cent). The mean (+/-SE) of the total body surface area (TBSA) was 23 per cent (+/-2.4) with a range of 3-98 per cent. The mean hospital stay for the whole group was 16.4 days. Overall mortality was five patients (5.6 per cent) while the mortality in critical burns was 14.3 per cent. TBSA was found to be the main factor influencing mortality. This study highlights the important factors that affect the outcome in this unit. Factors that can improve the morbidity and mortality rates in patients are highlighted. The study also reveals certain patterns and etiological factors in the Qassim region. Prevention by education through a national campaign remains the keystone in reducing the incidence of burns particularly in children and the maximization of resources.

Adolescent↗
PubMed1997

Skin replacement by cultured keratinocyte grafts: an Australian experience.

We have prepared and supplied cultured epithelial autografts (CEA) to treat 37 burn patients around Australia. The method is a modification of the original methods of Green et al. The confluent 75 cm2 secondary cultures, obtained after less than 3 weeks, are 8-10 cell layers thick after detachment and have a shrinkage of only 7-14 per cent. The patients had full-thickness skin loss to 55-95 per cent of their total body surface area (TBSA) or deep partial-thickness burns to 3-50 per cent TBSA owing to scald injuries. In the case of full-thickness burns the CEA take in the 17 surviving patients for which data was available averaged 53 per cent (range 10-100 per cent). The take for seven patients with partial-thickness burns averaged 73 per cent (range 25-100 per cent). The variability and early graft failure is attributed largely to the presence of infection. The durability and percentage take of CEA grafts is discussed together with future developments in the replacement of both dermis and epidermis in burns injury.

Adolescent↗
PubMed1997

Severe burns resulting from an exploding teat on a bottle of infant formula milk heated in a microwave oven.

Accidental injury to infants can result from the use of home microwave ovens. The spectrum of injury includes scald burns of the trachea, palate oropharynx and oesophagus due to aspiration and ingestion of foods that have been overheated. There is one previous case report of a child with second-degree burns of 6 per cent of his body area due to explosion of the plastic liner and nipple on a feeding bottle top. We present a case report of an infant who suffered 7 per cent full-thickness burns following explosion of the bottle teat and subsequent splattering with hot milk. He required mid-palmar amputation of his left hand including thumb, index and middle fingers. The full-thickness burns of left cheek and left shoulder were grafted but will result in significant scarring. It is common practice in many homes to heat infant feeds in the microwaves. We suggest that health professionals dealing with children need to be aware of the potential hazards so that appropriate education of parents can take place.

Accidents, Home↗
PubMed1997

Burn injuries in the 1995 Hanshin-Awaji earthquake.

In the 1995 Hanshin-Awaji earthquake, 504 deaths were listed as fire related, although many of the victims may have been crushed or suffocated before they were burned. Census data related to surviving burn victims, however, were unknown. This study was designed to examine the medical requirements of those burn patients following the earthquake. Medical records of 2718 patients with injuries admitted to 95 hospitals during the 15 days after the earthquake were retrospectively reviewed. Only 44 patients (1.9 per cent) were hospitalized with burns. Scalds with less than 20 per cent total burn surface area (TBSA) were mainly observed; flame burns from earthquake-associated fires were rare. Morbidity rates increased in patients over 40 years old. Associated injuries were observed in 11 cases. These included three soft tissue injuries, one rib, three spine, three pelvis and two extremity fractures, and two cases of crush syndrome. Intensive care was required for only 10 patients, five of whom were transferred to hospitals that were undamaged or outside the earthquake zone. No relationship was noted between the number of burned houses and that of hospitalized burn patients. These results suggest that the number of burn patients requiring medical care was less than might have been expected in view of the total number of fire-related deaths in this urban earthquake.

Burns↗
PubMedDate not supplied

Effects of N-acetylcysteine on lung glutathione levels in rats after burn injury.

This study was designed to determine the effect of N-acetyl-cysteine (NAC, a natural hydroxyl radical scavenger) treatment on levels of pulmonary malondialdehyde (MDA, the end product of lipid peroxidation) and glutathione (GSH, a natural antioxidant) in thermally injured rats. Severe skin scald injury (30 percent TBSA) caused a significant decrease in GSH levels, and a significant increase in MDA levels in lung tissue both at 1 h and 1 day postburn injury. Treatment of rats with NAC (15 mg/kg intraperitoneally, 15 min and 12 h following the burn) significantly improved GSH levels, and decreased ongoing lipid peroxidation at 1 day. This study showed that thermal injury resulted in increased pulmonary lipid peroxidation, and this remote organ injury was decreased by treatment with NAC. In addition NAC, a scavenger of hydroxyl radicals, improved GSH levels in the lungs. The higher level of GSH in the lungs of the burned rats treated with NAC could be due to either a decrease in the rate of degradation of GSH or to an increase in its synthesis. No data about these possibilities are provided.

Acetylcysteine↗
PubMed1998

Burn mortality in Chandigarh zone: 25 years autopsy experience from a tertiary care hospital of India.

An analysis of autopsy records of burn victims revealed that most burn deaths occurred in the age group 21-40 years (67 per cent) with female preponderance (61 per cent) in all age groups except in the extreme age groups. 62 per cent of burn cases originated in urban areas. The majority of subjects (99 per cent females and 76 per cent males) died as a result of flame burns. Kerosene was the most common factor (76 per cent) in burn deaths. 11 per cent of deaths were due to the stove bursting and 27 per cent of victims died due to leakage of oil from the stove. 39 per cent of subjects sustained burns when their clothes caught fire. Scalds (3.3 per cent), electrical (4.7 per cent) and chemical (2.3 per cent) burns were more commonly seen in males, mainly sustained at their working place. Accidental burns were observed in 80 per cent of subjects followed by suicidal (16.2 per cent) and homicidal burn assaults (4.1 per cent). Peak incidence of burns in females was observed between 5.01 a.m. and 11 a.m. (38 per cent), which was the time of least incidence in males (10.3 per cent). The opposite trend was seen between 11.01 p.m. and 5 a.m. Among males, burn deaths were more common (85 per cent) in those who were living alone, away from their families; whereas in women the incidence of burn deaths was higher (74 per cent) in those living with their families. The majority of deaths due to burns occurred within one week (77 per cent) of the incident. Septicaemia was the major cause of death (55 per cent).

Accidents↗
PubMed1998

Saving the zone of stasis in burns with recombinant tissue-type plasminogen activator (r-tPA): an experimental study in rats.

Hypercoagulability 2-3 h following scald injury and vessel thrombosis are well-known complications of burn injury. The present study was designed to determine the effect of recombinant tissue-type plasminogen activator (r-tPA) on vessels thrombosis in zones of stasis postburn. Twenty rats were assigned to experimental and control groups (N:10). After shaving the backs, a 'comb burn' was given bilaterally on the back of the rats 0.5 cm lateral and parallel to the midline by using a brass probe consisting of four rows (10 x 20 mm) and three interspaces (5 x 20 mm). Standardized full-thickness burns of the experimental group were treated with r-tPA via femoral veins 2 h after the burn, while the control group rats were infused the same volume of saline. Interspaces between the rows and vertical space area were evaluated as zone of stasis. The skin blood flow measurements of interspaces revealed a decreased level immediately and 2 h after the burn injury, averaging 11.3 and 9.8 perfusion units, respectively. On day 7, blood flow measurements of interspace and vertical space areas significantly differed between the groups, averaging 11.9 PU in the experimental and 1.8 PU in the control groups (P<0.05). To evaluate perfusion, each rat received 3 mCi of technetium-99m methoxyisobutylisonitrile on the first or seventh day postburn. After 30 min, the entire back skins including the panniculus carnosus muscle layer were dissected away. Gamma camera images revealed that in the experimental group the interspace areas took up 60-90 per cent more radioactivity than the burned areas while in the control group 20-50 per cent more activity was taken up by the interspace area when compared to burned areas. Autoradiography gave the exact borders of the necrotic and survived tissues. The percentage of live interspace and vertical space areas in the experimental group was 87.8 per cent on day 7, while it was 31.8 per cent in the control group (P<0.05). Dry/wet ratios did not reveal any significant difference at 24 h postburn. These results confirm that treatment with this selective fibrinolytic agent (r-tPA) after burn injury would have some benefits on saving the zone of stasis in burns.

Animals↗
PubMed1997

Baby walkers--still a major cause of infant burns.

Baby walkers have been implicated in many forms of paediatric trauma, ranging from finger tip entrapment to severe head injury. Their relationship to childhood burns has been documented previously. The Department of Trade and Industry published further warnings in 1984 and the British Standards Institution in 1989. We wished to determine if the degree or frequency of thermal injury had been lessened by these recommendations. All parents of children under 15 months of age admitted to this unit in 1994 were asked if their child was in a baby walker at the time of injury. Eight of the 32 infants, aged between 6 and 12 months, were burned in their walking aid. Half of the burns were contact and half scalds, and the average in-patient stay was 8 days. One patient required formal resuscitation and three were grafted. The incidence and severity of thermal injury sustained in baby walkers remains at a high level despite increased safety measures. Perhaps it is time to concur with the American Academy of Paediatrics and recommend a ban on these dangerous aids.

Burn Units↗
PubMed1998

Burn septicaemia: an analysis of 79 patients.

Out of 943 patients treated from June 92 to May 96 at the burns unit of the Al-Babtain Centre for Plastic Surgery and Burns, Kuwait, 280 (30%) required admission to the burns intensive care unit (ICBU) and were studied retrospectively. Seventy-nine (28.2%) developed clinically and microbiologically proven septicaemia. Forty-four (56%) were males, 35 (44%) females with a mean age of 26 years (range 45 days to 75 years) and mean total body surface area burn (TBSA) of 46% (range 10-90%). Sixty-two had flame burns, 16 a scald and one had an electric burn. These 79 patients had a total of 118 septicaemic episodes. Sixty (76%) had only one and 19 (24%) had multiple episodes of septicaemia. Fifty-four (68%) had their first episode within 2weeks, though the maximum number of episodes was between 6 and 10 days postburn. Septicaemia was also observed in 13% of patients within 3 days postburn. Out of the 118 episodes, 48 were due to methicillin resistant Staphylococcus aureus (MRSA), 17 due to methicillin resistant Staphylococcus epidemidis (MRSE), 15 to Pseudomonas, 12 to Acinetobacter, four to Streptococcus, another four to Enterococci, two to Klebsiella, one due to Serratia and 15 to more than one organism. Once the septicaemia was diagnosed appropriate therapy was instituted. Fifty-six (71%) patients had 143 sessions of skin grafting and the mortality was low in operated patients. Twenty-three (29.1%) patients died. The low mortality rate was probably due to factors such as continuous clinical and microbiological surveillance leading to quick detection of aetiology, appropriate antibiotic therapy, care for nutrition and early wound cover. This study suggests that flame burn patients are more vulnerable to sepsis. Onset of septicaemia may be as early as 3 days and commonly within 2 weeks. A surface wound is the likely source of entry to the blood stream. Gram positive organisms are dominant in the aetiology. Early detection and appropriate treatment including wound coverage result in a better outcome.

Adolescent↗
PubMed1998

Childhood burn injuries: circumstances of occurrences and their prevention in Ribeirão Preto, Brazil.

The objectives of this study were to verify which circumstances are present in burn accidents of patients under 12 years of age and to gather information to ground strategies to prevent those accidents. Parents or guardians of 26 patients aged under 12 years, admitted to the burns unit of the Clinical Hospital of Ribeirão Preto Medical School, Brazil, were interviewed, from March 1996 to March 1997. Fifty percent of the injured children were under 3 years of age and had suffered a scald. The kitchen and the backyard were identified as the places where the majority of accidents (84.6%) happened. At least one parent was present in 80.7% of cases. The results speak for the necessity of implementation of programs to prevent burn accidents, focusing on the domestic setting, chiefly activities in the kitchen.

Accidents, Home↗
PubMed1998

Epidemiology of childhood burns in the burn unit of Ain Shams University in Cairo, Egypt.

Childhood burns in Egypt are a significant problem, especially in families of low socioeconomic status. These families live in overcrowded flats, which lack proper hygiene and tend to use kerosene stoves, which lack any safety measures. Three hundred and five burned children presented to the burn unit of Ain Shams University over a 20 month period. Proportionately more boys than girls were injured. There was an increase in the incidence between the ages of 4 to 6 years. Scalds formed 56.7% of the cause of burns, while 38.6% were due to flame. In 3 and 1.6% the cause of burn was electrical and chemical, respectively. 20 patients were victims of industrial accidents showing a major problem of entrance of children between 8-15 years of lower socioeconomic class into the labor force. 87.2% of the patients had minor burns while 13 children (4.3%) died of the consequences of burns during the period of the study.

Adolescent↗
PubMed1998

The epidemiology of burns in secondary care, in a population of 2.6 million people.

The numbers of residents of the four counties in the west of Anglia and Oxford Region (UK) who were treated for burns (including scalds) in accident and emergency (A&E) departments or admitted to hospital in 1994-95 were obtained from A&E departments and district health authority records. Burns comprised about 1 per cent of the workload in the A&E departments. Using the data from district health authorities, the rate of admission with a main diagnosis of burns to any hospital was 0.14 per thousand population per year. Children under five had the highest rate of admission. Approximately half the patients admitted to hospital with burns were admitted to burns units, a quarter to plastic surgery wards and the rest to different specialties including trauma and orthopaedics, paediatrics, and ophthalmology. The median length of stay was 6 days for burns units and 3 days for plastic surgery units.

Adolescent↗
PubMed1999

The effect of indomethacin on the cytokine cascade and body temperature following burn injury in rats.

This study investigates the hypothesis that indomethacin's ability to prevent "fever" following burn injury in rats is mediated via decreased plasma concentrations of IL-6, the putative mediator of increased body temperature. Sprague-Dawley rats had radio transmitters and osmotic pumps containing indomethacin placed in the peritoneal cavity. Seven days later full thickness scald burns to 50% of the body surface area were produced. Following burn injuries, daily blood samples were obtained from a carotid catheter for assay of lipopolysaccharide (LPS), interleukin-1alpha (IL-1alpha), IL-1beta, tumor necrosis factor-alpha (TNF-alpha) and IL-6. In addition, body temperature (T(B)) and activity index were obtained every five minutes by telemetry. There were four experimental groups: burn + indomethacin (B-In); burn + polyethylene glycol (Peg) (B-Peg); control + indomethacin (C-In); and control + Peg (C-Peg). Burned animals demonstrated a significant two-fold increase in plasma IL-1alpha levels (p=0.004) and a seven-fold increment in IL-6 (p=0.0001) through the 7th PBD, and indomethacin administration had no significant effect upon the cytokine plasma levels. There were no significant increases in IL-1beta, TNF-alpha or LPS in any group. Indomethacin eliminated the chronic increase in T(B) following burn injury, and this effect was not produced by changes in plasma levels of the endogenous pyrogens IL-1alpha and IL-6.

Analysis of Variance↗