Burn Admissions Research Articles

Evolution of a Burn Care Network.

A private burn center started in Augusta, GA, in 1978 has expanded into a burn care network of 7 comprehensive burn centers. We have analyzed 2 years of admissions to this network to assess growth and the network's level of participation in national burn care. Total admissions to the network were quantified for years 2015 and 2016. Growth during that 2-year period was calculated, and the network's admissions were evaluated as a percentage of national burn admissions. Total admission for 2015 came from 4713 patients; 5683 patients were admitted in 2016. These totals demonstrated a 15% increase. The 2-year total of 10,217 admissions represented 21% of the 46,892 burn admissions in the United States for that period. This network has achieved a large capacity for burn admission and currently accounts for 21% of US burn admissions. The network has capacity for continued growth and the development of clinical innovations and research.

Assessing burn care in Brazil: An epidemiologic, cross-sectional, nationwide study

BackgroundThe aim of this study was to describe the national epidemiology of burns in Brazil and evaluate regional access to care by defining the contribution of out-of-hospital mortality to total burn deaths. MethodsWe reviewed admissions data for Brazil's single-payer, free-at-point-of-care, public-sector provider and national death registry data abstracted from DATASUS for 2008–2014. Admissions, in-hospital mortality, hospital reimbursement, and total deaths from the death registry were assessed for records coded under ICD-10 codes corresponding to flame, scald, contact, and electrical burns. ResultsA total of 17,264 burn deaths occurred between 2008–2014 (mean annual 2,466 [SD 202]). Of all burns deaths 79.1% occurred out of hospital, with marked regional differences in the proportion of out-of-hospital deaths (P < 0.001), the greatest being in the North region. The mean annual number of admissions >24 hours was 18,551 (SD 1,504) with the greatest prevalence of flame burns overall (43.98%) and scalds prevailing in < 5 years (57.8%). Regional differences were found in per-capita admissions (P < 0.001) with the greatest number in the Central-West region. A mean of $1,022 (SD $94) US dollars was reimbursed per burn admission. ConclusionGiven that nearly 80% of burns mortalities occurred out of hospital, prevention of burns alongside interventions improving prehospital and access to care have potential for the greatest impact.

Are we headed for a shortage of burn care providers in Canada?

IntroductionSpecialized burn care is categorized as an essential component in the criteria for provincial/state and regional trauma systems. Studies in the United States and New Zealand found a need for more burn surgeons and anticipated a severe shortage in the future. The purpose of this study is to describe the current active workforce of burn surgeons in Canada and forecast any perceived shortages in the future. MethodsBurn care providers were identified from each metropolitan area across Canada. A survey was modified from a previous study and distributed electronically via SurveyMonkey™ to representatives from 26 centres. ResultsTwenty-six centres responded to the questionnaire (response rate=100%). Four of these centres self-identified as providing dedicated burn care, 19 identified themselves as being integrated into surgical programs at their institution, and two stated they no longer treated burn injuries. The mean number of acute burn admissions per year was 67.2 (range 2–290). Of the centres admitting over 75 burns per year, 44% (4/9) are currently looking for a surgeon, 56% (5/9) will be looking for another surgeon in five years, and 44% (4/9) are having or feel they will have trouble finding a surgeon to manage burns. DiscussionCanada is facing a shortage of burn care specialists similar to other developed nations. Active mentorship of surgical trainees is essential to maintain the delivery of high quality of burn care in Canada.

Epidemiology and Outcomes of Electric Burn Injury at SMS Medical College, Jaipur: A Retrospective Study

Background: Electrical burn injuries comprise a small fraction of the total burn admissions but they are potentially a mutilating type. The purpose of this study is to understand the epidemiological characteristics of burn injury and identify prevention measures. Methods: A retrospective epidemiological study was conducted on patients admitted in burn unit from January 2016 to June 2018 and data was analysed for demographic characteristics and outcomes and patterns of electric burn injury. Results: A total of 3883 admissions were made. Male to female ratio was 1.49:1.0. Rural: urban ratio was 2:1. Mode of injury was accidental (80.5%), suicidal (13.7%) and homicidal (5.8%). Flame burn (61.7%) topped the list of etiologic factors. Electric burn represented 24.85% which was quite significant when compared to other parts of the world. 1308 patients expired (33.69%). Out of the total electric burn admissions, 304 (31.5%) patients sustained low voltage ( 1000 kv) injury. Most of the injuries were work related and most involving age group was 20-40 years.The mean number of operation per person was more in high-voltage group (2.04±1.124) as compared with low-voltage group (1.91±1.023). Mortality rate was 12.8% and was attributed to respiratory failure, multiorgan dysfunction, disseminated intravascular coagulation and renal failure. Conclusions: Electric burn comprised a significant proportion of burn injury. This can be prevented by educating about safety principles to the parents and adults at workplace and improving infrastructure with enforcement of strict laws and training for all the electric department workers.

The Incidence and Significance of Raised Troponin Levels in Acute Burns.

The place and significance of troponin testing in acute burn injuries has not yet been established. The aims of this study were to determine the incidence and pattern of troponin testing within a large population of acute burn injuries and subsequently to determine the resultant clinical significance of the troponin test results. A retrospective analysis of all patients with acute burn admissions (n = 1,621 patients) to a busy tertiary adult burns center between July 2009 and July 2015. More than a third of our patients had at least one troponin test performed. Men, the elderly, and those with larger burns were more likely to be tested. The majority tested had the laboratory test done within 24 hours of admission. A positive troponin test strongly correlated with increased risk of acute cardiac complication and death, as did burns greater than 15% total body surface area (%TBSA) and age. Acute burns of ≥15% TBSA are associated with elevated troponin levels. Troponins should be tested in those ≥50 years old, with significant burns, and/or premorbid cardiac disease; positive results investigated as they affect cardiac and survival outcomes.

Accelerant-related burns and drug abuse: Challenging combination

BackgroundAccelerants are flammable substances that may cause explosion when added to existing fires. The relationships between drug abuse and accelerant-related burns are not well elucidated in the literature. Of these burns, a portion is related to drug manufacturing, which have been shown to be associated with increased burn complications. Objectives1) To evaluate the demographics and clinical outcomes of accelerant-related burns in a Provincial Burn Centre.2) To compare the clinical outcomes with a control group of non-accelerant related burns.3) To analyze a subgroup of patients with history of drug abuse and drug manufacturing. MethodsRetrospective case control study. Patient data associated with accelerant-related burns from 2009 to 2014 were obtained from the British Columbia Burn Registry. These patients were compared with a control group of non-accelerant related burns. Clinical outcomes that were evaluated include inhalational injury, ICU length of stay, ventilator support, surgeries needed, and burn complications. Chi-square test was used to evaluate categorical data and Student’s t-test was used to evaluate mean quantitative data with the p value set at 0.05. A logistic regression model was used to evaluate factors affecting burn complications. ResultsAccelerant-related burns represented 28.2% of all burn admissions (N=532) from 2009 to 2014. The accelerant group had higher percentage of patients with history of drug abuse and was associated with higher TBSA burns, ventilator support, ICU stay and pneumonia rates compared to the non-accelerant group. Within the accelerant group, there was no difference in clinical outcomes amongst people with or without history of drug abuse. Four cases were associated with methamphetamine manufacturing, all of which underwent ICU stay and ventilator support. ConclusionsAccelerant-related burns cause significant burden to the burn center. A significant proportion of these patients have history of drug abuse.

A prospective analysis of risk factors for pediatric burn mortality at a tertiary burn center in North India

BackgroundNone of the available mortality predicting models in pediatric burns precisely predicts outcomes in every population. Mortality rates as well as their risk factors vary with regions and among different centers within the regions. The aim of this study was to identify socio-demographic and clinical risk factors for mortality in pediatric burns in an effort to decrease the mortality in these patients.MethodsA prospective analytical study was conducted in patients up to the age of 18 years admitted for burn injuries in a tertiary care burn center in India from January to December 2014. Clinical and demographic data was collected through questionnaire-interview and patient follow-up during their stay in the hospital. Univariate and multivariate firth logistic regression was used to identify various risk factors for mortality in pediatric burns.ResultsA total of 475 patients were admitted during the study period. Overall mortality was 31.3% (n = 149) in this study. Mean age of the patients who died was 8.68 years. Of the 149 deaths, 74 were males and 75 were females (male to female ratio = 0.98). Mean total body surface area (TBSA) involved of the patients who expired was 62%. Inhalational injury was seen in 15.5% (n = 74) of pediatric burn admissions. Mortality was significantly higher (74.3%) in patients with inhalation injury. Mortality was highest in patients with isolates of Acinetobacter + Klebsiella (58.3%), followed by Pseudomonas + Klebsiella (53.3%), Acinetobacter (31.5%), and Pseudomonas (26.3%) (p < 0.0005). Factors found to be significant on univariate firth analysis were older age, female gender, suicidal burns, higher TBSA, presence of inhalation injury, increased depth of burn, and positive microbial cultures. On multivariate analysis, higher TBSA was identified as an independent risk factor for mortality. The adjusted odds ratios for TBSA involvement was 21.706 (25.1-50%), 136.195 (50.1-75%), and 1019.436 (75.1-100%), respectively.ConclusionTBSA is the most important factor predicting mortality in pediatric burns. The higher the TBSA, the higher is the risk of mortality. Other significant risk factors for mortality are female gender, deeper burns, positive wound cultures, and inhalation injury. Risk of mortality was significantly lower in children who belonged to urban areas, nuclear family, who sustained burn injury in the last quarter of the year, and who stayed in the hospital for longer period.

Impact of weekend admission on mortality and other outcomes among patients with burn injury: A nationwide analysis

ObjectiveTo study the relationship between day of admission and important outcomes among patients with burn injuries. MethodsThe 2014 National Inpatient Sample database was used. Inclusion criterion was a principal diagnosis of burn injury. Exclusion criteria were age <18years, superficial burn, and non-urgent admission. The primary outcome was in-hospital mortality. Secondary outcomes were morbidity (septic shock and prolonged mechanical ventilation), treatment metrics (time to surgery and parenteral or enteral nutrition (P/E-nutrition)) and resource utilization (length of stay (LOS) and total hospitalization charges and costs). Confounders were adjusted for using multivariate regression analysis. ResultsA total of 21,665 patients were included, 29% of whom were admitted on weekends. Weekend admission was an independent predictor of mortality only among patients >65years old (adjusted odds ratio (aOR): 2.66 (1.13–4.51), p=0.02). Although rates of septic shock were similar for both groups (aOR): 1.25 (0.74–2.09, p=0.40), weekends were associated with higher odds of prolonged mechanical ventilation (aOR: 1.28 (1.06–1.55), p=0.01). Time to surgery (adjusted mean difference (amDiff): 0.91 (−0.07 to 1.88) days, p=0.07) and time to P/E-nutrition (amDiff: 0.40 (−3.51 to 4.30) days, p=0.80) were similar for both groups. Finally, LOS was longer for weekend admission (amDiff: 1.36 (0.09–2.63) days, p=0.04), but total charges and costs were similar for both groups (amDiff: $16,268 ($-5093–$37,629), p=0.13 and $3275 ($-2337–$8888), p=0.25). ConclusionsWeekend admission is associated with increased mortality among patients with burn injury >65years old. Weekend admission is also associated with increased morbidity and prolonged length of stay.

The Contributing Risk of Tobacco Use for ARDS Development in Burn-Injured Adults With Inhalation Injury.

This study aims to determine the relationship between tobacco use, inhalation injury, and ARDS in burn-injured adults. This study was an observational cohort of 2,485 primary burn admissions to a referral burn center between January 1, 2008 and March 15, 2015. Subjects were evaluated by methods used to account for mediation and traditional approaches (multivariable logistic regression and propensity score analysis). Mediation analysis examined both the (1) indirect effect of tobacco use via inhalation injury as the mediator on ARDS development and (2) the direct effect of tobacco use alone on ARDS development. ARDS development occurred in 6.8% (n = 170) of the cohort. Inhalation injury occurred in 5.0% (n = 125) of the cohort, and ARDS developed in 48.8% (n = 83) of the subjects with inhalation injury. Tobacco use was 2-fold more common in subjects with ARDS. In the mediated model, the direct effect of tobacco use on ARDS, including interaction between tobacco use and inhalation injury, was not significant (odds ratio [OR] 1.63, 95% CI 0.91-2.92, P = .10). However, the indirect effect of tobacco use via inhalation injury as the mediator was significant (OR 1.61, 95% CI 1.25-2.07, P < .001), and the proportion of the total effect of tobacco use operating through the mediator was 55.6%. In the non-mediation models (multivariable logistic regression and propensity score analysis), which controlled for inhalation injury and other covariables, the OR for the association between tobacco use and ARDS was 1.84 (95% CI 1.22-2.81, P < .001) and 1.69 (95% CI 1.04-2.75, P = .03), respectively. In mediation analysis, inhalation injury was the overwhelming predictor for ARDS development, whereas tobacco use has its strongest effect indirectly through inhalation injury. Patients with at least moderate inhalation injury are at greatest risk for ARDS development despite baseline risk factors like tobacco use.

Mother’s Characteristics, Knowledge and Practices about Children Burn Injury in Sulaimani City

Burn is described as one of the leading causes of injury throughout the world, and is one of the most frequent causes of hospitalization. The aim of this study was to determine mother’s characteristics, Knowledge and practices for burn injuries and burn infection prevention. A cross sectional descriptive study was undertaken in Sulaimani city, Iraq, from October 2015 to July 2016. Participants were evaluated using a structured questionnaire by face-to-face interview. Data were computerized and analyzed using Statistical Package for Social Sciences version 22.0 software. A total of 126 mothers who had burn injury in their children and admitted to burning hospital during the study period, the mean score knowledge of mothers was (3.63), the mean score practice of mothers accounted (4.63), the respondent practice score ranged from (1-8). They had poor, intermediate, and good score knowledge about burns injury and burn infection 79.37%, 18.25%, and 2.38% respectively. In regard to mother’s related practice, there were 66.67% within poor practice level, 30.95% of an intermediate level, and 2.38% had a good practice level. The study shows that mother knowledge and practice in Sulaimani city in relation to burn injury and infection among their children was at a low level and the local health authority should incorporate health education for parents, especially mothers in the prevention of pediatric burn at home involving hot liquid and flames also other domestic hazardous as well as the important activities after burn or pre-hospital admission.

Descriptive epidemiological study of burn admissions to the Burns Intensive Care Unit of the Komfo Anokye Teaching Hospital, Kumasi-Ghana, 2009–2016

Objective: To determine the trends in burn admissions, and aetiology, severity and mortality of patients admitted to the Burns Intensive Care Unit of the Komfo Anokye Teaching Hospital from May 2009 to April 2016 (7 years). Methods: Patients' data used in this longitudinal and retrospective study were accessed from the records of the Reconstructive Plastic Surgery and Burns Unit. Processed data were depicted in tables and figures as appropriate. Univariate and multivariate analysis and Pearson's rank correlation were used in comparing relevant groups. Data analysis was conducted using Excel version 2013 and SPSS version 17.0. Results: A total of 681 patients, with a male to female ratio of 1.1:1.0, were analysed. The average annual incidence was 97.28 with a progressive decline in incidence. Mortality rate was 24.2%. Majority of the patients were children less than 10 years (43.5%) with scalds as the main aetiology in this group. Open flame was the major aetiology of burns (49.9%). Majority of the patients spent less than 10 days on admission (67.1%). Mean total body surface area was 30.54%. There was correlation between TBSA and disposition, total body surface area and aetiology and number of days in the Burns Intensive Care Unit, total body surface area and aetiology, and aetiology and number of days in the Burns Intensive Care Unit. Conclusions: Children below 10 years were the main victims. There was a shift from scald to open flame burns in this current study. Mean total body surface area and mortality rate have increased. There is urgent need for prevention campaign of flame burn and first aid education on intensive burns.

Geographic distribution of burn in an Australian setting

ObjectiveTo investigate the geographic distribution and temporal trends of burn admissions in an Australian setting. MethodsHealth administrative data of all persons hospitalised for a first burn in Western Australia for the period 2000–2012 were used. Crude and standardised incident rates were generated for each region. Maps of crude rates were generated for state regions and postcode-suburbs of Perth, the capital city. Standardised incidence rates were generated for Western Australia, total and regions, and for sub-cohorts defined by age (<20years; ≥20 years), TBSA burn severity and major causes of burns (fire, scalds and contact). Negative binomial regression was used to examine temporal changes and generate incidence rate ratios (IRR) with 95% confidence intervals (CI). ResultsPerth had the lowest burn admission rate per population; clusters of suburbs of lower social advantage and higher immigrant settlement were identified as being at high risk. While the highest observed admission rates were found in Kimberley and Goldfields (remote) regions, after adjustment for the regional demographic structures, the Wheatbelt and Mid-West (rural) regions were found to have the highest adjusted rates of burn admissions. Significant annual declines in admission rates were found for the Kimberley, Pilbara and Goldfields (remote regions); however, stable admission rates were identified for all other regions. ConclusionsThe Mid-West and Wheatbelt rural regions were found to have the highest risk of burn admissions raising concerns about farming-related injury. Safety awareness and burn prevention strategies need to be continued, with specific attention to these high risk areas, to reduce burn admissions in Western Australia.

Fracture admissions after burns: A retrospective longitudinal study

BackgroundSevere burn triggers systemic responses that result in reduced muscle mass and changes in bone formation, with recent evidence also suggesting systemic effects on bone after minor burns. The aim of this study was to assess if people hospitalised with a burn have increased admissions for fractures after discharge. MethodsA population-based longitudinal study using linked hospital morbidity and death data from Western Australia was undertaken of all persons hospitalised for a first burn (n=30,997) during the period 1980–2012. Australian population-based annual rates for fracture admissions for the period 1993–2012 were obtained from the Australian Institute of Health and Welfare. Rates of hospital admissions for fractures in the burn cohort and the Australian population were standardised, using the direct method, to the age and gender structure of the Western Australian population at the 2006. Annual standardised fracture admission rates for the period 1993–2012 were graphed with estimated 95% confidence intervals. Age and gender specific fracture rates were also examined. ResultsA total of 4004 members of the burn cohort had at least one fracture admission for a total of 6096. The median (IQR) time to the first fracture admission after burn was 6.9 years (2.8–13.6) and the median age (IQR) at first fracture admission was 31 years (20–49). The burn cohort experienced admissions for fractures at a rate approximately twice that of the Australian population. While rates were generally higher for males in the burn cohort when compared with males in the Australian population, female burn patients had significantly higher rates over the entire study period when compared with the female Australian population. Elevated rates were observed for those younger than 20 years at the time of the burn admission; however, rates were significantly and consistently elevated during the study period for those 20 years and older at the time of the burn. ConclusionsBurn patients experienced significantly higher age and gender standardised rates of admissions for fractures after discharge from hospital for their index burn. Further prospective research is indicated to clarify any underlyling pathogenic processes linked to the burn that may increase a patient’s risk of having a fracture serious enough to undergo admission.

Global general pediatric surgery partnership: The UCLA–Mozambique experience

Background/purposeThere has been increasing recognition of the disparities in surgical care throughout the world. Increasingly, efforts are being made to improve local infrastructure and training of surgeons in low-income settings. The purpose of this study was to review the first 5-years of a global academic pediatric general surgery partnership between UCLA and the Eduardo Mondlane University in Maputo, Mozambique. MethodsA mixed-methods approach was utilized to perform an ongoing needs assessment. A retrospective review of admission and operative logbooks was performed. Partnership activities were summarized. ResultsThe needs assessment identified several challenges including limited operative time, personnel, equipment, and resources. Review of logbooks identified a high frequency of burn admissions and colorectal procedures. Partnership activities focused on providing educational resources, on-site proctoring, training opportunities, and research collaboration. ConclusionThis study highlights the spectrum of disease and operative case volume of a referral center for general pediatric surgery in sub-Saharan Africa, and it provides a context for academic partnership activities to facilitate training and improve the quality of pediatric general surgical care in limited-resource settings. Level of evidenceLevel IV.

Economical Burden of Burn Injuries in a Developing Country.

Burn injuries have economical impacts on patients in several ways. Understanding the charges of burn treatment is very important for patients, families, governmental authorities, and insurance companies. During the protocol of their treatment, they may be admitted several times for treatment of acute burn and then for reconstructive treatments of burn's complications. Calculating the hospital burn charges can serve as an objective criteria for authorities to plan for a sufficient budget for acute burn treatment, for additional management for chronic complications, and as a guide for planning preventive and public educational programs. The authors used data of their burn registry program. During more than 3 years, the authors had 912 patients with multiple admissions for burns. All of hospital costs during several admissions were recorded. Men were 71% and women were 29% of the patients. Burns caused by flame were the most frequent (50.1%) followed by scald (34.0%). Mean hospital stay was 14.1 days (range, 0-64 days). Patients with TBSA equal to or less than 10% were 38.8%, TBSA between 11 and 22% were 29.1%, and TBSA more than 23% were 32.1%. Those who were admitted for 30 days or less were 34.1%, those between 31 and 131 days were 32.7%, and those with more than 132 days of admission were 33.2%. Mean hospital cost for all patients during the 3 years was about $2766 (range, from $143 to $33,566; median = 1586.93; SE = 93.84). The patients were admitted for treatment of acute burns and later admitted for reconstruction of the burn sequels. Total number of admissions was up to six times (median = 2). About 66.27% of the total charges were the cost of first admission, 19.39% the cost of second admission, 7.34% the cost of third admission, 3.56% for fourth admission, 2.3% for fifth admission, and 1.15% for last or sixth admission. The authors conducted a multiple linear regression test. Male sex, TBSA, length of stay, and number of admissions were significantly related to total treatment charges. But "age" did not influence the charges. Mean total cost of several burn admissions in one patient was around $2766. TBSA, length of stay, male sex, and number of admissions were significantly related to the hospital costs.

Jewelry Ring-Associated Electrothermal Burn Injuries: A Nine-Patient Case Series.

Ring-associated burns are infrequent, comprising only a small fraction of burn consults and admissions. However, because of the location of these burns and the propensity for circumferential wounds, small burn size may belie the severity of resultant injuries. Herein, the authors present their experience with this potentially severe type of burn. Records from a regional burn center were retrospectively analyzed during a 36-month period. All patients who sustained ring burns were included. Data points included demographics, burn location, need for surgical intervention, grafted area, hospital days (length of stay), percent graft take, complications, and time to re-epithelialization. Nine patients sustained ring-associated burns during the study period, accounting for 1.4% of all patients with burns seen during the same period. Average age was 41 years (range: 29-52 years). Seven (77%) ring-associated burns involved contact with a battery. All injuries were circumferential. Average burn TBSA was 0.07%. Two patients (22%) had third-degree injuries, both of which received split-thickness skin grafts. Grafted area was 4 and 5 cm, respectively. Average length of stay was 2.8 days. Mean graft take was 99.5 ± 1.5%. Average time to complete re-epithelialization was 12 days. One patient suffered temporary disability. No patients suffered from compartment syndrome. Ring-associated burns are an uncommon source of injury in the burn population. Despite small burn TBSA, these patients are more likely to require split-thickness skin grafts and suffer dysfunction compared with similarly-sized burns in other body regions. Expedient treatment and coordination with occupational therapy should be undertaken to achieve optimal outcomes.

A review of the peri-operative management of paediatric burns: Identifying adverse events.

Burn injuries are common in poverty-stricken countries. The majority of patients with large and complex burns are referred to burn centres. Of the children who qualify for admission, according to burn admission criteria, about half require some kind of surgical procedure to obtain skin cover. These range from massive full-thickness fire burns to skin grafts for small, residual unhealed wounds. Burn anaesthetic procedures are of the most difficult to perform and are known for high complication rates. Reasons include peri-operative sepsis, bleeding, issues around thermoregulation, the hypermetabolic state, nutritional and electrolyte issues, inhalation injuries and the amount of movement during procedures to wash patients, change drapes and access different anatomical sites. The appropriate execution of surgery is therefore of the utmost importance for both minor and major procedures. To review the peri-operative management and standard of surgical care of burnt children. This was a retrospective review and analysis of standard peri-operative care of burnt children at Red Cross War Memorial Children's Hospital, Cape Town, South Africa. A total of 558 children were operated on and supervised by the first author. Factors that could adversely affect surgical and anaesthetic outcomes were identified. There were 257 males and 301 females in this study, with an average age of 50.1 months and average weight of 19.5 kg. The total body surface area involved was 1 - 80%, with an average of 23.5%. Inhalational injury was present in 11.3%, pneumonia in 13.1%, wound sepsis in 20.8%, and septicaemia in 9.7%, and organ dysfunction in more than one organ was seen in 6.1%. The average theatre temperature during surgery was 30.0°C. Core temperatures recorded at the start, halfway through and at completion of surgery were 36.9°C, 36.8°C and 36.5°C, respectively. The average preoperative and postoperative haemoglobin levels were 11.28 g/dL and 9.64 g/dL, respectively. Blood loss was reduced by the use of clysis from 1.5 mL/kg/% burn to 1.4 mL/kg/% burn. Adverse intraoperative events were seen in 17.6% of children. Burn surgery is a high-risk procedure and comorbidities are common. Anaesthesia and surgery must be well planned and executed with special reference to temperature control, rapid blood loss, preceding respiratory illnesses and measures to reduce blood loss.

Sodium Hypochlorite-Induced Upper Extremity Chemical Burns: Case Series of Eight Patients and a Review of the Literature

Background: Sodium hypochlorite (NaClO) is a chemical compound that is widely used in bleaching, stain removal, disinfection, deodorizing and water treatment. Sodium hypochlorite-induced chemical burns have been described and are reported as relatively rare. We report our experience with such cases to illustrate important points regarding management of these burns. Methods: We retrospectively collected the data of NaClO-induced upper extremity chemical burn admissions at a military hospital during an eight-year period (2007 - 2015). Survey data included patient age, gender, burn area, burn depth, treatments and follow-up period. Results: Eight patients were admitted to our emergency department with complaints of NaClO-induced chemical burns of the upper extremity of skin over an eight-year period. All of the patients were male, with a mean age of 21.25 (19 - 23) years. Four of the burns were diagnosed as second-degree deep dermal chemical burns and the other four were second-degree superficial dermal chemical burns. Two of the patients with second-degree deep dermal chemical burn underwent debridement and skin grafting. All of the patients were then followed for three to nine months. Conclusions: We recommend the use of tap water for high-volume, long-term lavage. We are against using neutralization chemicals in order to prevent more unforeseeable catastrophic effects, because it is difficult to determine the composition of exposure from NaClO-derived household chemicals. After emergency department evaluation, patients should be hospitalized for at least the first 24 - 48 hours, according to the plastic surgeon’s decision.

Epidemiological studies of burn patients in a burn center in Ghana: any clues for prevention?

BackgroundBurn injuries are a serious problem worldwide, with most occurrences in low- and middle-income countries. Depending on the extent of injury, burn victims are faced with the challenges of fitting into society due to complications such as extensive scarring and contractures. The current study seeks to determine whether epidemiological studies of burn patients can provide guidelines to enhance burn prevention among the Ghanaian population.MethodsData from the Burns Registry of the Burns Intensive Care Unit (BICU) of Komfo Anokye Teaching Hospital (KATH) was obtained. Data on sex, age, aetiology, % total body surface area (TBSA), and admission outcomes from May 1, 2009, to April 30, 2013, were retrieved for a total of 487 patients during this period.ResultsData on burn admissions comprising 263 (54.0 %) males and 224 (46.0 %) females were obtained from the Burns Registry. Children 0–10 years were the most affected age group. The yearly mean % TBSA ranged from 24.74 % to 35.07 %. The majority of burns was caused by scalding. Mortality rates ranged from 8.4 % to 32.0 % during the period under review.ConclusionsThe study shows that children of 10 years old and below are the most affected group; this may be due to inattention to these children by parents/caretakers. Safety and safe working environments should be provided at home and workplaces, and promotion of education on burn prevention should be intensified.

The Parkland Burn Center experience with 297 cases of child abuse from 1974 to 2010

IntroductionPediatric burns due to abuse are unfortunately relatively common, accounting for 5.8–8.8% of all cases of abuse annually. Our goal was to evaluate our 36-year experience in the evaluation and management of the victims of abuse in the North Texas area. MethodsA prospectively maintained database containing records on all admissions from 1974 through 2010 was queried for all patients aged less than 18 years. Patients admitted for management of a non-burn injury were excluded from the analysis. ResultsOf 5,553 pediatric burn admissions, 297 (5.3%) were due to abuse. Children with non-accidental injuries tended to be younger (2.1 vs. 5.0 years, p<0.0001) and male (66.0 vs. 56.5%, p=0.0008). Scald was the most common mechanism of injury overall (44.8%), and was also the predominant cause of inflicted burns (89.6 vs. 42.3%, p<0.0001). Multivariate logistic regression identified age, gender, presence of a scald, contact, or chemical burn, and injury to the hands, bilateral feet, buttocks, back, and perineum to be significant predictors of abuse. Victims of abuse were also found to have worse outcomes, including mortality (5.4 vs. 2.3%, p=0.0005). After adjusting for age, mechanism of injury, and burn size, abuse remained a significant predictor of mortality (OR 3.3, 95% CI 1.5–7.2) ConclusionsClinicians should approach all burn injuries in young children with a high index of suspicion, but in particular those with scalds, or injuries to the buttocks, perineum, or bilateral feet should provoke suspicion. Burns due to abuse are associated with worse outcomes, including length of stay and mortality.