Abbreviated Burn Severity Index Score Research Articles

Risk factors for in-hospital acquisition of carbapenem-resistant Enterobacterales in patients with severe burns

Although patients with severe burns are prone to severe infections with antibiotic-resistant bacteria and inevitably have some risk factors for carbapenem-resistant Enterobacterales (CRE) acquisition, risk factors for CRE infection or colonization in these patients have not been investigated. To identify the independent risk factors for CRE acquisition in patients with severe burns. Patients admitted to the burn intensive care unit (BICU) for acute burn care were categorized based on culture results during BICU care into the CRE group and non-CRE group, which included the carbapenem-susceptible Enterobacterales (CSE) and control groups. Clinical and microbiological factors were compared between the CRE and non-CRE groups, and between the CRE and CSE groups to identify independent risk factors for in-hospital CRE acquisition. Among the included 489 patients, 101 (20.7%) and 388 (79.3%) patients were classified in the CRE and non-CRE groups, respectively. The non-CRE group included 91 (18.6%) and 297 (60.7%) patients in the CSE and control groups, respectively. In multivariate analysis between the CRE and non-CRE groups, exposure to other CRE-acquired patients (P= 0.018), abbreviated burn severity index score ≥9 (P= 0.012), and mechanical ventilation (P < 0.001) were associated with CRE acquisition. In multivariate analysis between the CRE and CSE groups, exposure to other CRE-acquired patients was associated with CRE acquisition (P= 0.048). Considering the limitation of controlling the burn severity in hospitalized patients, enhanced infection control measures for preventing in-hospital CRE transmission among patients with severe burns should be emphasized.

Revalidating the prognostic relevance of the Abbreviated Burn Severity Index (ABSI): A twenty-year experience examining the performance of the ABSI score in consideration of progression and advantages of burn treatments from a single center in Vienna

BackgroundThe Abbreviated Burn Severity Index (ABSI) is a five-variable scale to help evaluate burn severity upon initial assessment. As other studies have been conducted with comparatively small patient populations, the purpose of this study is to revalidate the prognostic relevance of the ABSI in our selected population (N = 1193) 4 decades after its introduction, considering the progress in the treatment of severe burn injuries over the past decades. In addition, we evaluate whether comorbidities influence the survival probability of severely burned patients. MethodsThis retrospective study presents data from the Center for Severely Burned Patients of the General Hospital in Vienna. We included 1193 patients for over 20 years. Regression models were used to describe the prognostic accuracy of the ABSI. ResultsThe ABSI can still be used as a prognostic factor for the probability of survival of severely burned patients. The odds of passing increases by a factor of 2.059 for each unit increase in the ABSI with an area under the curve value of 0.909. Over time, the likelihood of survival increased. The existence of chronic kidney disease negatively impacts the survival probability of severely burned patients. ConclusionThe ABSI can still be used to provide accurate information about the chances of survival of severely burned patients; however, further exploration of the impact of chronic kidney disease on the survival probability and adding variables to the ABSI scale should be considered. The probability of survival has increased over the last 20 years.

Diagnostic and Prognostic Value of Thrombocytopenia in Severe Burn Injuries.

Burn injuries are the most severe type of trauma, with complex biological consequences associated with high rates of morbidity and mortality. Prompt recognition and management of burn-related complications are imperative for improving the vital and functional prognosis of the patient. Changes in biological parameters can be essential determinants in the prognosis of the burned patient. Thrombocytopenia in critically ill patients is linked to an elevated risk of mortality. We sought to investigate the significance of thrombocytopenia in severely burned patients while considering the limited available data in the literature. A two-year retrospective study was conducted on 90 patients with severe burns admitted to our Burn Centre. Demographic data, burn lesion characteristics, and daily total blood counts, including platelet assessment, complications, and mortality, were recorded and analyzed. Patients with extensive burns in our study had a poor prognosis based on their Abbreviated Burn Severity Index score (ABSI), age, percentage of total body surface area (TBSA) burned, presence of third-degree burns, and inhalation injuries. Regardless of the moment, patients with thrombocytopenia in our study died significantly more frequently. Compared with the survivors, the platelet count was significantly lower at any given time in the non-survivors group. Significant statistical associations between thrombocytopenia and ABSI score, burn surface area, presence of third-degree burns, and inhalation injuries were identified at different timeframes post-burn injury. Sepsis was encountered in one-third of the patients. Thrombocytopenia was more frequent in patients with sepsis who did not survive compared to survivors and did not normalize until the time of death. Thrombocytopenia represents an early indicator of severe complications and outcome predictor in severely burned patients. It is correlated with recognized negative prognostic factors and also with sepsis occurrence. Future research efforts should focus on refining early detection parameters and interventions to improve the prognosis of burn patients.

Prevalence and outcome of acute kidney injury in burn victims at a tertiary centre in Cape Town, South Africa.

Burn victims commonly experience acute kidney injury (AKI), which can lead to significant morbidity and mortality. To investigate the prevalence of AKI in burn patients, the causes of AKI and the rate of in-hospital mortality. A retrospective cohort study was conducted on patients admitted to the Tygerberg Hospital Burn Unit between 1 April 2018, and 31 March 2019. The study included all burn patients >18 years old, except for those with end-stage kidney disease or cold burn wounds, skin donors or readmissions. AKI was defined using the Kidney Disease Improving Global Outcomes criteria, and multivariable logistic regression was used to identify predictors of AKI and death, along with Kaplan-Meier survival analysis. The prevalence of AKI was 27% (58/215). The most common causes of burns were open fires (37%) and shack fires (17%). Patients with AKI had higher scores on the abbreviated burn severity index (ABSI) (7 v. 5, p<0.01), required more mechanical ventilation (69% v. 33%, p<0.01) and experienced more sepsis (35% v. 12%, p<0.01). Predictors of AKI included ABSI score (adjusted odds ratio (aOR) 1.48, 95% confidence interval (CI) 1.21 - 1.80, p<0.01), mechanical ventilation (aOR 7.75, 95% CI 1.23 - 48.65, p=0.03) and high admission lactate (aOR 1.57, 95% CI 1.04 - 2.39, p=0.03). Mortality was higher in patients with AKI (34% v. 6%, p<0.01). ABSI score (aOR 2.16, 95% CI 1.56 - 2.99, p<0.01) and vasopressor use (aOR 7.71, 95% CI 2.15 - 27.60, p<0.01) were identified as predictors of death. The survival analysis revealed that AKI was associated with higher mortality (log rank, p<0.01). The study highlights the high prevalence of AKI among burn victims requiring tertiary care and its association with high mortality rates. Improving living conditions in informal settlements could help prevent burns and their complications.

Epidemiology and mortality in patients hospitalized for burns in Catalonia, Spain

Burn injuries are one of the leading causes of morbidity worldwide. Although the overall incidence of burns and burn-related mortality is declining, these factors have not been analysed in our population for 25 years. The aim of this study has been to determine whether the epidemiological profile of patients hospitalized for burns has changed over the past 25 years. We performed a retrospective cohort study of patients hospitalised between 1 January 2011 and 31 December 2018 with a primary diagnosis of burns. The incidence of burns in our setting was 3.68/105 population. Most patients admitted for burns were men (61%), aged between 35 and 45 years (16.8%), followed by children aged between 0 and 4 years (12.4%). Scalding was the most prevalent mechanism of injury, and the region most frequently affected was the hands. The mean burned total body surface (TBSA) area was 8.3%, and the proportion of severely burned patients was 9.7%. Obesity was the most prevalent comorbidity (39.5%). The median length of stay was 1.8 days. The most frequent in-hospital complications were sepsis (16.6%), acute kidney injury (7.9%), and cardiovascular complications (5.9%). Risk factors for mortality were advanced age, high abbreviated burn severity index score, smoke inhalation, existing cardiovascular disease full-thickness burn, and high percentage of burned TBSA. Overall mortality was 4.3%. Multi-organ failure was the most frequent cause of death, with an incidence of 49.5%. The population has aged over the 25 years since the previous study, and the number of comorbidities has increased. The incidence and severity of burns, and the percentage of burned TBSA have all decreased, with scalding being the most prevalent mechanism of injury. The clinical presentation and evolution of burns differs between children and adults. Risk factors for mortality were advanced age, smoke inhalation, existing cardiovascular disease, full-thickness burn, and high percentage of burned TBSA.

Establishment and validation of a risk prediction model for disseminated intravascular coagulation patients with electrical burns

Establishment and validation of a risk prediction model for disseminated intravascular coagulation patients with electrical burns

Application of selected biochemical parameters in prediction of acute kidney injury risk at the early stage of burn disease

Introduction and objectiveAcute kidney injury (AKI) is a common, severe complication of burn disease, developing in the first days after a massive thermal injury and worsening the prognosis of patients. Early diagnosis of AKI plays a crucial role in improving health of patients and therapeutic results. Detection of AKI based on the standard parameters of renal function is insufficient due to too late changes in their values. The aim of the study is to evaluate the relationship between the selected non-renal biochemical parameters and the risk of AKI in this group of patients.Material and methodsThe prospective study involved a group of 33 adult patients (22 men, 11 women) hospitalized after massive burns. The patients were intensively monitored for the first 7 days after the injury, daily assessing the parameters of renal function. The selected parameters were also measured: platelet count (PLT), sodium (Na), potassium (K), albumin (ALB), aspartate aminotransferase (AST), creatine kinase (CK), arterial blood pH, arterial blood bicarbonate (HCO3-), 24-hour urinary sodium excretion (24hUNa) and fractional excretion of sodium (FENa).ResultsAKI was diagnosed in 15 (45.5%) patients. Statistical differences in the obtained average values of selected parameters between the AKI and non-AKI groups were confirmed. A significant univariate relationship was found between CK, AST and ALB in the blood serum and an increased risk of developing AKI in the following days. However, after adjustment for The Abbreviated Burn Severity Index score, only CK remained significant.ConclusionsThe potential clinical benefit of monitoring AST and ALB in blood serum and especially CK was confirmed. The other routine parameters did not seem to be related to the risk of AKI and require further analysis.

Emergency Care for Burn Patients-A Single-Center Report.

We performed a retrospective observational study of 2021. All patients admitted to our six-bed intensive care unit (ICU) were included. The following data were collected for further analysis: demographics, burn pattern (etiology, size, depth, affected body region), type of ventilation, ABSI (Abbreviated Burn Severity Index) score, comorbidities, bioumoral parameters, and hospitalization days. There were 93 burned patients included in our study that were divided into two groups: alive patients' group (63.4%) and deceased patients' group (36.6%). The mean age was 55.80 ± 17.16 (SD). There were 65.6% male patients, and 39.8% of the patients were admitted by transfer from another hospital. Further, 59 patients presented third-degree burns, from which 32.3% died. Burns affecting >37% of the total body surface area (TBSA) were noticed in 30 patients. The most vulnerable regions of the body were the trunk (p = 0.003), the legs (p = 0.004), the neck (p = 0.011), and the arms (p = 0.020). Inhalation injury was found in 60.2% of the patients. The risk of death in a patient with an ABSI score > 9 points was 72 times higher. Comorbidities were present in 44.1% of the patients. We observed a median LOS (length of stay) of 23 days and an ICU-LOS of 11 days. Logistic regression analysis showed that admission protein, creatinkinase, and leukocytes were independent risk factors for mortality. The general mortality rate was 36.6%. A thermal factor was responsible for the vast majority of burns, 94.6% of cases being accidents. Extensive and full-thickness burns, burns affecting the arms, inhalation injuries, the need for mechanical ventilation, and a high ABSI score represent important risk factors for mortality. Considering the results, it appears that prompt correction of protein, creatinkinase, and leukocytes levels may contribute to improvement in severe burn patients' outcomes.

Evaluation of clinical outcomes and comparison of prediction models in the burn population hospitalized from the emergency department: Can burn mortality scores be used in a post-conflict area such as northwest Syria?

Burns are a global health problem, especially in low- and middle-income countries. The use of models to predict mortality is more common in developed countries. In northern Syria, internal unrest has continued for 10 years. A lack of infrastruc-ture and difficult living conditions increase the incidence of burns. This study in northern Syria contributes to the predictions of health services provided in conflict regions. The first objective of this study specific to northwestern Syria was to assess and identify risk factors in the burn victim population hospitalized as emergencies. The second objective was to validate the three well-known burn mortality prediction scores to predict mortality: the Abbreviated Burn Severity Index (ABSI) score, Belgium Outcome of Burn Injury (BOBI) score, and revised Baux score. This was a retrospective analysis of the database of patients admitted to the burn center in northwestern Syria. Patients who were admitted to the burn center as emergencies were included in the study. Bivariate logistic regression analysis was performed to compare the effectiveness of the three included burn assessment systems in determining the risk of patient death. A total of 300 burn patients were included in the study. Of them, 149 (49.7%) were treated in the ward, and 46 (15.3%) in the intensive care unit; 54 (18.0%) died, and 246 (82.0%) survived. The median revised Baux scores, BOBI scores, and ABSI scores of the deceased patients were significantly higher than those of the surviving patients (p=0.000). The cut-off values for the revised Baux, BOBI, and ABSI scores were set at 105.50, 4.50, and 10.50, respectively. For predicting mortality at these cut-off values, the revised Baux score had a sensitivity of 94.4% and a specificity of 91.9%, and the ABSI score had a sensitivity of 68.8% and a specificity of 99.6%. However, the cut-off value of the BOBI scale, calculated as 4.50, was found to be low (27.8%). The low sensitivity and negative predictive value of the BOBI model suggest that it was a weaker predictor of mortality than the others. The revised Baux score was successful in predicting burn prognosis in northwestern Syria, a post-conflict region. It is reasonable to assume that the use of such scoring systems will be beneficial in similar post-conflict regions where limited opportunities exist.

Comparison of Abbreviated Burn Severity Index (ABSI) Score with R-Baux Score as a predictor of mortality in burn patients

Several studies regarding the mortality predictor model in burn patients have been carried out in several cities and countries. However, none have ever happened in Dr. Soetomo General Academic Hospital, Surabaya, Indonesia. This study aims to analyze the R-Baux Score and Abbreviated Burn Severity Index (ABSI) Score as a mortality predictor model in burn patients, which are relevant and useable in services at Dr. Soetomo General Academic Hospital. This study used quantitative research with a cross-sectional design and retrospective design utilizing secondary data. It was found that 263 patients met the inclusion criteria; with 73 patients died, 60.27% of whom were male, 50% with inhalation trauma, 19.18% were in the age range of 56-65 years old, 24.66% had a burn area of 61-70%, and 35.62% with a full-thickness burn. The results showed that the sensitivity value from the ABSI Score (p&lt;0.001) was 82.19%, with a specificity of 82.11%, a positive predictive value of 63.83%, and a negative predictive value of 92.31%. The R-Baux Score (p &lt;0.001) showed that the sensitivity value obtained was 80.82%, with a specificity of 80.00%, a positive predictive value of 60.83%, and a negative predictive value of 91.57%. There was no significant difference between the R-Baux Score and the ABSI Score as the predictor of mortality in burn (p&gt;0.05). Therefore, both the R-Baux Score and the ABSI Score can be used as model predictors of death in burn patients at Dr. Soetomo General Academic Hospital.

Attempted Suicide by Burning: A Cross-sectional Analysis at a Regional Burn Center in Germany.

Attempted suicide by self-immolation or burning constitutes an uncommon form of attempted suicide in high income countries, presenting substantial challenges to burn units. The aim of this study was to analyze the epidemiologic characteristics and outcomes in intensive care burn patients treated for attempted suicide by burning. For this purpose, we examined intensive care burn patients admitted to a single major burn unit between March 2007 and December 2020. Demographic, clinical, epidemiological, and mortality data were collected and analyzed. Major psychiatric comorbidities were evaluated according to ICD-9 and ICD-10 classifications. A total of 1325 intensive care unit burn patients were included. Suicide by burning was attempted in 45 cases (3.4%). Attempted suicide victims presented with significantly higher burn severity, reflected by higher abbreviated burn severity index scores, and larger TBSA affected. Burned TBSA ≥30% and inhalation injuries were observed more frequently in suicidal patients. These patients also experienced prolonged hospital and intensive care unit length of stay, required surgical interventions and mechanical ventilation more frequently, and had significantly longer periods on ventilation, causing an overall higher mortality rate (24.4%). Psychiatric comorbidities were present in 75.6% of patients who attempted suicide. Despite the low prevalence, burn severity and mortality are considerably high in patients who attempted suicide by burning, presenting a significant challenge for healthcare providers. The majority of patients had a history of psychiatric disorder, highlighting the importance of identifying patients at high-risk who may profit from increased psychiatric intervention.

COMPARISON OF ASSESSMENT OF ABBREVIATED BURN SEVERITY INDEX (ABSI) AND BELGIAN OUTCOME OF BURN INJURY (BOBI) AT H. ADAM MALIK GENERAL HOSPITAL

Background: Assessment of length of stay and mortality in patients with burn injuries is essential to support clinicians in making clinical decisions. In Indonesia, there are several scoring systems used by hospital centers to assess the mortality of burn patients, such as the Belgian Outcome of Burn Injury (BOBI) and the Abbreviated Burn Severity Index (ABSI). However, different results were obtained in studies that examined the comparison of the results of the scoring system.&#x0D; Method: The type of research used in this research is unpaired comparative analysis research using a cross-sectional design. The data to be used is secondary data taken from medical records.&#x0D; Results: Respondents with death status were found in the serious, severe, and maximum ABSI categories, p=0.001 (p&lt;0.05) and the BOBI 50% category as many as three people and 85% as many as one person, p=0.0001 (0&lt;0.05). Length of stay based on the ABSI score for the length of stay was 23 days with an ABSI score of 12-13 (maximum), and based on the BOBI Score, the majority was 28 days with a BOBI score of 8 (85%). ABSI in this study had a sensitivity of 100% and a specificity of 86.4%, while the use of BOBI in this study had a sensitivity of 100% and a specificity of 88.1%.&#x0D; Discussion: The BOBI scoring system is more accurate than the ABSI. This difference may occur due to differences in demographics and quality of service in each region. Therefore, the analysis of the validity of the scoring model before the research is carried out in a new population is considered crucial to be carried out.

Infections in Burn Patients: A Retrospective View over Seven Years.

Backgroundand objectives: Burn patients represent a challenging cohort because the injuries entail a vulnerability to colonisation by microorganisms. The ensuing infections can lead to serious complications and, in many cases, to the death of the burn patient. Surgical intervention and wound dressings, as well as antibiotic treatment, are crucial for optimising the treatment of the patient. Material and Methods: In this retrospective analysis, we analysed the treatment course, antibiotic therapy, and general complications of 252 burn patients with second- or third-degree burns over a time span of 7 years. Results: Patients who developed infections tended to have, on average, a higher total body surface area (TBSA), higher abbreviated burn severity index (ABSI) scores, and longer hospital stays. Patients who were admitted to the burn unit after 2006 had significantly shorter stays in the burn unit. TBSA and ABSI scores were lower in the patient cohort admitted after 2006. Patients exhibiting a TBSA greater than 30% had significantly longer hospital stays and antibiotic treatment periods. TBSA and ABSI scores were significantly higher in patients who died. The results of binary logistic regression indicate that a higher ABSI score increases the odds ratio of developing an infection. Bacteria number had no significant effect on the odds of patient death but positively influenced the odds ratio of developing an infection. TBSA was negatively associated with the risk of developing an infection and was an insignificant predictor of mortality. Conclusions: To gauge the optimal treatment for a burn patient, it is crucial for practitioners to correctly select, dose, and time antibiotics for the patient. Monitoring bacterial colonisation is vital to nip rising infection in the bud and ensure the correct antibiotic selection. This will help prevent the development of multi-resistant bacteria.

Prediction of Mortality in Acute Thermal Burn Patients Using the Abbreviated Burn Severity Index Score: A Single-Center Experience.

BackgroundBurn injuries are highly variable and dynamic. The outcome of patients is influenced by various factors and requires prompt therapeutic interventions, including fluid resuscitation, for a favorable result. Although having varying shortcomings, many scoring indexes are developed and validated in Western countries to predict mortality in a burn patient. The Abbreviated Burn Severity Index (ABSI) estimates survival expectancy in a burn patient via various negative prognostic factors. This study describes the pattern of burn injuries to validate the ABSI as an outcome predictor in burnt patients.MethodologyFrom January to December 2018, 100 patients participated in this observational research conducted in the Department of Surgery at Mahatma Gandhi Hospital’s Burn Ward, a part of Dr. Sampurnanand Medical College, Jodhpur. Risk factors for death from a burn were patients’ age and gender, the depth of the burn, the inhalation burn, and the total burned body surface area (TBSA). The area under the receiver operating curve (AUROC) was used to determine how well it could predict burn deaths.ResultsThis study included 100 patients (69 men and 31 women, with a ratio of 2.22:1). In total, 73 patients survived, and 27 died (a mortality rate of 27%). The fatality rate increased with increased burn surface area, reaching 100% in patients with >80% burns (p < 0.0001). Additionally, those with an ABSI of >11 expressed 100% mortality rate (p < 0.0001).ConclusionsIn this study, older age, high burned surface area, concomitant inhalational burns, full-thickness burns, and a higher ABSI were found to be significant predictors of mortality.

Comparison between ABSI and BOBI Score for Burns Mortality Prediction in Indonesia’s National Referral Burn Center: A 5-year study

ObjectivesThe aim of this study is to test the validity of each burn mortality prediction model and to compare the accuracy between Abbreviated Burn Severity Index (ABSI) and Belgian Outcome for Burn Injury (BOBI) for mortality prediction in our burn unit. MethodsA retrospective cohort study was conducted enrolling burn patients during the period of 2016 to 2020 in burn unit of dr. Cipto Mangunkusumo Hospital. We specified our inclusion criteria to acute burn (≤48 h) within the age range of 17 to 58 years, and percentage of burned total body surface area (TBSA) 10–60%. Age, burn depth, gender, total TBSA and inhalation injury were variables accountable to ABSI and BOBI, thus were further analyzed statistically. ResultsA total of 220 patients were enrolled (133 males and 87 females) with mean age of 37.5 years and mean percentage of burned TBSA was 33.2%. The overall rate of mortality in this study was 25.9%. Full-thickness burn was observed in 133 subjects (60.45%) and inhalation trauma was experienced by 29 subjects (13.18%). Univariate and multivariate analysis were done on each variables. Full-thickness burn (p = 0.039), inhalation injury (p = 0.041), and 35.75% TBSA (p < 0.001) remained as significant variables for mortality prediction. Goodness-of-fit statistics done using the Hosmer-Lemeshow (HL) test for ABSI and BOBI showed p = 0.718 and p = 0.001. Performance discrimination for both ABSI and BOBI were analyzed by area under curve (AUC) of 0.84 (CI 95%; 0.785–0.896) and 0,79 (CI 95%; 0.731–0.859), respectively. DiscussionFull-thickness burn, inhalation injury, and %TBSA were identified as significant mortality predictors. Further analysis showed that ABSI score model fit well to actual outcomes observed in our unit. Furthermore, ABSI had better AUC value when compared with BOBI score in predicting burn mortality. ConclusionABSI score is valid for predicting mortality in our burn unit and can be used as clinical adjuncts to escalate the quality of burn patients management. In addition, ABSI was more accurate than BOBI in predicting burn mortality in our burn unit.

Microbiological characteristics of patients with severe burns caused by blast and application of meta- genomics next-generation sequencing in the detection of pathogenic microorganisms

Microbiological characteristics of patients with severe burns caused by blast and application of meta- genomics next-generation sequencing in the detection of pathogenic microorganisms

Analysis of risk factors of early enteral nutrition intolerance in extremely severe burn patients

Objective: To explore the risk factors of early enteral nutrition intolerance in extremely severe burn patients. Methods: A retrospective case-control study was performed. From January 2018 to December 2020, seventy-six adult patients with extremely severe burns who met the inclusion criteria were admitted to Hwa Mei Hospital of University of Chinese Academy of Sciences, including 55 males and 21 females, aged (45±11) years with burns of 62% (52%, 82%) total body surface area. Depending on the patient's tolerance to early enteral nutrition, they were divided into tolerance group (47 patients) and intolerance group (29 patients), and their clinical data were statistically analyzed, including age, sex, body mass index (BMI), underlying disease, total burn area, full-thickness burn area, abbreviated burn severity index (ABSI) score, implementation of mechanical ventilation on the day of admission, stable shock state, vomiting before feeding. The following data were recorded including the onset time, duration length, and frequency of enteral nutrition intolerance of patients in intolerance group, and the number of operations, the length of hospitalization, the occurrence of sepsis within 2 weeks after injury, the outcome, as well as the serum hypersensitive C-reactive protein (hs-CRP), albumin, fasting blood glucose, alanine aminotransferase (ALT), aspartate aminotransferase (AST), and γ-glutamyl transpeptidase (γ-GT) on post burn day (PBD) 1, 5, 9, and 13 of patients in the two groups. Data were statistically analyzed with independent sample t test, Mann-Whitney U test, and chi-square test to screen the related factors of early enteral nutrition intolerance of the patients. Binary univariate and multivariate logistic regression analysis were used to analyze the independent risk factors of early enteral nutrition intolerance of the patients. Results: There were no statistically significant differences in age, sex, BMI, and percentage of underlying disease of patients between the two groups (P>0.05). The total burn area, full-thickness burn area, ABSI score, mechanical ventilation percentage on the day of admission, percentage of unstable shock period, percentage of vomiting before feeding of patients in intolerance group were significantly higher than those in tolerance group (Z=-4.559, -3.378, -4.067, χ2=18.375, 23.319, 8.339, P<0.01). In intolerance group, the onset time of intolerance was (9±4) d after injury, and the duration length was 4 (2, 6) d, with a total of 46 times occurred. Compared with tolerance group, the percentage of sepsis and mortality of patients in intolerance group were significantly higher within 2 weeks after injury (χ2=16.571, 12.665, P<0.01). The number of operation and length of hospitalization of patients in the two groups were similar (P>0.05); however the length of hospitalization of patients in the intolerance group was significantly more than that in tolerance group after excluding the death cases (Z=-2.266, P<0.05). On PBD 1, the level of fasting blood glucose and AST of patients in intolerance group were significantly higher than those in tolerance group (t=3.070, Z=-3.070, P<0.01). On PBD 5, the levels of hs-CRP, albumin, fasting blood-glucose, ALT, AST, and γ-GT of patients in the two groups were similar (P>0.05). On PBD 9, the level of hs-CRP of patients in intolerance group was significantly higher than that in tolerance group (t=2.836, P<0.01), and the levels of ALT and γ-GT of patients in intolerance group were significantly lower than those in tolerance group (Z=-3.932, -2.052, P<0.05 or P<0.01). On PBD 13, the level of hs-CRP of patients in intolerance group was significantly higher than that in tolerance group (t=3.794, P<0.01), and the levels of fasting blood glucose, ALT, and γ-GT of patients in intolerance group were significantly lower than those in tolerance group (t=-2.176, Z=-2.945, -2.250, P<0.05 or P<0.01). Binary univariate logistic regression analysis showed that total burn area, full-thickness burn area, ABSI score, implementation of mechanical ventilation on the day of admission, unstable shock period, vomiting before feeding, and fasting blood-glucose on PBD 1 of patients were related to early enteral nutrition intolerance (odds ratio=1.086, 1.052, 1.775, 9.167, 12.797, 10.125, 1.249, 95% confidence interval=1.045-1.129, 1.019-1.085, 1.320-2.387, 3.132-26.829, 4.199-39.000, 2.003-51.172, 1.066-1.464, P<0.01). Multivariate logistic regression analysis showed that the large total burn area, unstable shock period, vomiting before feeding, and high fasting blood-glucose on PBD 1 of patients were the independent risk factors of early enteral nutrition intolerance in patients (odds ratio=1.073, 6.390, 9.004, 1.246, 95% confidence interval=1.021-1.128, 1.527-26.734, 1.134-71.496, 1.007-1.540, P<0.05 or P<0.01). Conclusions: The percentage of early enteral nutrition intolerance is very high in extremely severe burn patients, which is closely related to poor prognosis. Large total burn area, vomiting before feeding, unstable shock phase, high fasting glucose on PBD 1 of patients are the independent risk factors for early enteral nutrition intolerance in extremely severe burn patients. The benefits and risks should be carefully evaluated before starting enteral nutrition in such patients, and early enteral nutrition should not be blindly pursued.

Delayed enzymatic debridement in severe burns: Proof of concept

IntroductionEnzymatic debridement (ED) is a novel powerful therapy for debridement of severe burns. Standard ED is usually performed within 72 h after injury following a presoaking phase. Little evidence exists on the effectiveness of ED later than 72 h after trauma. In this retrospective study, we compared outcomes of burn patients treated within versus later than 72 h after injury. Patients and Methods110 patients with severe burns treated with ED between 2016 and 2020 were evaluated. Patients treated later than 72 h after trauma were identified and matched to a control group treated within 72 h. Matching criteria included age, area treated with ED, and localization of ED. Exclusion criteria were abbreviated burn severity index (ABSI) greater than 12 and death within the first 10 days after burn injury. Primary outcomes were time to full epithelialization and number of secondary surgical interventions. Results16 patients (11 female, 5 male) matched the inclusion criteria and were assigned to the late treatment group. Mean age was 54.0 ± 19.0 years, the = and mean ABSI score 6.3 ± 3.2. 16 matched patients were assigned to the early ED group. Secondary surgical procedures were performed in 62.5% of cases in both groups with a mean of 1.7 (late treatment) vs. 2.2 (control; p = 0.29) secondary procedures in each group, respectively. No significant difference between groups regarding time to complete epithelialization (28.2 days vs. 27.3 days, p = 0.45) was observed. Infection rate was higher (18.8% vs. 6.3%, p = 0.28) in the delayed group. ConclusionDelayed ED is a feasible procedure as part of personalized care in burn surgery. In our retrospective study, we could not identify r safety issues except a slightly higher infection rate. This may however be attributed to delayed initiation of burn treatment itself.

Clinical outcome and comparison of burn injury scoring systems in burn patient in Indonesia.

IntroductionThe purpose of this study was to explore and compare the performance of four burn injury scoring systems in Indonesia. In a retrospective study, data of all burn patients admitted to the emergency centre (EC) were collected. The following clinical outcome and four burn injury scoring systems were used to assess each patient: Abbreviated Burn Severity Index (ABSI), Belgian Outcome in Burn Injury (BOBI), the Ryan model, and revised Baux Score.MethodsFrom April 2017 to April 2018, clinical outcome and burn injury score for every admitted patient were calculated to evaluate burn prognosis. Demographic information, ABSI score, full-thickness total body surface area (TBSA), overall TBSA, hospital stay, and inhalation injury were noted for analysis. Discriminative ability and goodness-of-fit of the prediction models were determined by receiver operating characteristic curve analysis and Hosmer–Lemeshow tests.ResultsWe included 72 patients (mean age: 40.79 ± 16.30 years, average TBSA: 23.59% ± 24.84). Only 1 (1.4%) of them was diagnosed with inhalation injury. Mortality rate was 25%. Deceased patients had significantly higher mean age, %TBSA, and number of inhalation injuries. The ABSI model with sensitivity was 81.6, specificity was 92.5, accuracy was 87.3 and under the Receiver Operator Characteristics curve (AUC) was 0.93 (SE = 0.03).ConclusionsThe best estimation of predicted mortality was obtained with the ABSI model.

Comparison of ABSI and Full-Thickness Burns Indexes in the Prediction of Hospital Mortality in Burn Patients

The aim of this study was to evaluate the abbreviated burn severity index (ABSI) score and the percentage of full-thickness burn in the prediction of hospital mortality in burn patients admitted to Sina Hospital in Tabriz. A total of 250 burn patients admitted to burn, and ICU wards during December 2016-Sep 2018 entered the present cross-sectional descriptive study. The collected data included age, gender, burn percentage, anatomical location of the burn, cause of the burn, severity of the burn, mucosal or inhalation injury, underlying disease, length of stay (day), and the hospital outcome of the patient. There was a significant difference between the two genders in terms of the cause of burns (P&lt;0.0001). The most common cause of burn-in women and men was hot liquids and fire, respectively. 40% TBSA with 92% sensitivity and 94% specificity and 20% full-thickness burns with 98% sensitivity and 88% specificity was obtained in predicting mortality of patients. ABSI score of 9 with 85% sensitivity and 95% specificity was obtained in predicting mortality in patients. By increasing one unit in the ABSI score, the odds ratio increases by 17.5 times in terms of mortality probability. The present study showed a significant difference between the two genders in terms of the cause of the burn, and it is evidently affected by the culture and lifestyle of our country. On the other hand, an investigation of the cause of death in patients with ABSI&gt;9 and taking appropriate measures to reduce their mortality is recommended. Also, it is recommended to use more simple criteria such as burn percentage or full-thickness burns to predict mortality rate in case of burning injury patients.