Median Total Body Surface Area Research Articles

Pediatric scalds: do cooking-related burns have a higher injury burden?

BackgroundPediatric scald burns result in frequent emergency room visits and hospitalizations. We investigated whether cooking-related burns produce greater morbidity requiring more extensive care than noncooking burns. MethodsWe performed a 6-y review at our free-standing children's hospital. Children aged <18 y admitted for accidental scald burns were included. Demographics, injury pattern, treatment, and outcome (contractures and/or limited mobility and nonhealing and/or infected wounds) data were analyzed comparing cooking versus noncooking burns. The Mann–Whitney U test, a chi-square test, and the negative binomial were used to compare continuous, categorical, and count data between groups. Bivariate analysis was performed to identify risk factors among patients with adverse outcomes. ResultsWe identified 308 patients; 262 (85%) cooking and 46 (15%) noncooking burns. Most patients were African–American males, with public insurance, and a median age of 2 y. Cooking burns preferentially occurred over the head, neck, and upper body; noncooking burns were distributed over the lower body (P < 0.02). Median total body surface area was equal for both groups (P > 0.11). In subgroup analysis, semisolid and grease burns resulted in increased rates of wound contractures and/or limited mobility when compared with noncooking burns (P = 0.05 and P = 0.008, respectively). Patients with complications were more likely to have third degree burns and required more consults, longer hospitalization, and more surgical debridements and clinic visits. ConclusionsMost accidental scald burns occurred in young children during food preparation. Greater long-term morbidity was found in patients with semisolid and grease burns. This subset of children has a higher injury burden and requires extensive care in the acute and long-term setting.

Outcomes of burns in the elderly: Revised estimates from the Birmingham Burn Centre

Outcomes after burn have continued to improve over the last 70 years in all age groups including the elderly. However, concerns have been raised that survival gains have not been to the same magnitude in elderly patients compared to younger age groups. The aims of this study were to analyze the recent outcomes of elderly burn injured patients admitted to the Birmingham Burn Centre, compare data with a historical cohort and published data from other burn centres worldwide. A retrospective review was conducted of all patients ≥65 years of age, admitted to our centre with cutaneous burns, between 2004 and 2012. Data was compared to a previously published historical cohort (1999–2003). 228 patients were included. The observed mortality for the study group was 14.9%. The median age of the study group was 79 years, the male to female ratio was 1:1 and median Total Body Surface Area (TBSA) burned was 5%. The incidence of inhalation injury was 13%. Median length of stay per TBSA burned for survivors was 2.4 days/% TBSA. Mortality has improved in all burn size groups, but differences were highly statistically significant in the medium burn size group (10–20% TBSA, p≤0.001). Burn outcomes in the elderly have improved over the last decade. This reduction has been impacted by a reduction in overall injury severity but is also likely due to general improvements in burn care, improved infrastructure, implementation of clinical guidelines and increased multi-disciplinary support, including Geriatric physicians.

Descriptive Epidemiology of Unintentional Burn Injuries Admitted to a Tertiary-Level Government Hospital in Nepal: Gender-Specific Patterns.

This study describes the epidemiology of unintentional adult burn injury admissions in a tertiary hospital in Nepal, from 2002 to 2013, focusing on gender-specific patterns. Chi-square tests and Wilcoxon Rank Sum tests were performed. There were 819 unintentional burn admissions: 52% were male and 58% younger than 35 years. The median percentage total body surface area burned (interquartile range) was greater in females than in males (P < .001): 28% (17-40) versus 20% (12-35), and female mortality was higher (32% vs 11%). A higher proportion females were illiterate than males (48% vs 17%). Burns occurred at home (67%), work (28%), and public places (5%); gender-specific patterns were observed. Flame burns accounted for 77%, electricity 13%, and scalds 8%. Kerosene (31%) and biomass (27%) were the major fuels. Cooking, heating, and lighting were the main activities associated with burn injury. Results support interventions to reduce the use of open fires and kerosene and to promote electrical safety.

Assessing the ability of comorbidity indexes to capture comorbid disease in the inpatient rehabilitation burn injury population.

Burn patients exhibit comorbidities that influence outcomes. This study examines whether existing comorbidity measures capture comorbidities in the burn inpatient rehabilitation population. Data were obtained from the Uniform Data System for Medical Rehabilitation from 2002 to 2011 for adults with burn injury. International Classification of Diseases, 9th Revision, codes were used to assess three comorbidity measures (Charlson Comorbidity Index, Elixhauser Comorbidity Index, Centers for Medicare and Medicaid Services Comorbidity Tiers). The number of subjects and unique comorbidity codes (>1% of frequency) captured by each comorbidity measure was calculated. The study included 5347 patients with a median total body surface area burn decile of 20%-29%, mean age of 51.6 yrs, and mean number of comorbidities of 7.6. There were 2809 unique International Classification of Diseases, 9th Revision, comorbidity codes. The Charlson Comorbidity Index, Elixhauser Comorbidity Index, and Centers for Medicare and Medicaid Services Comorbidity Tiers did not capture 67%, 27%, and 58% of the subjects, respectively. There were 107 unique comorbidities that occurred with a frequency of greater than 1%. Of these, 67% were not captured in all three comorbidity measures. Commonly used comorbidity indexes do not reflect the extent of comorbid disease in the burn rehabilitation population. Future work is needed to assess the need for comorbidity indexes specific to the inpatient rehabilitation setting.

The responsiveness of the Chelsea Critical Care Physical Assessment tool in measuring functional recovery in the burns critical care population: An observational study

IntroductionSevere burn leads to a state of hypercatabolism, resulting in rapid muscle loss and long-term disability. As survival rates from severe burn are improving, early rehabilitation is essential to facilitate functional recovery. However, there is no way of measuring the degree of disability in the acute stages, and hence, no marker of functional recovery. This hampers both communication and research into interventions to improve functional outcomes.The Chelsea Critical Care Physical Assessment tool (CPAx) is a simple objective measure of function, designed and validated in the general Intensive Care Unit (ICU) cohort. The aim of this study was to test the responsiveness of the CPAx in the burns ICU (BICU) cohort and validate its use. MethodsObservational study of 52 BICU patients admitted for over 48h. All patients were assessed on the CPAx retrospectively for pre-admission, and prospectively at ICU admission, ICU discharge (or final ICU assessment for non-survivors) and hospital discharge.Analysis of variance, post hoc between group differences in median CPAx score, and floor and ceiling effect (i.e. the percentage of patients scoring full marks (50), or zero) for the four time points were completed. Minimal clinically important difference (MCID) was estimated as half of the standard deviation of the CPAx score at ICU discharge. ResultsA total of 30 patients were included in the final analysis; mean age was 47.1 years (SD 21.2), 63.3% were male, with a median burn total body surface area (TBSA) of 30% (IQR 11.3–48.8). There was a significant difference in the analysis of variance in median CPAx scores at all four time points (p<.001). In survivors, the differences in CPAx scores post hoc were significant for all time points (p<.05), aside from ICU discharge and hospital discharge. The CPAx MCID for BICU patients was six.Twenty-three (86.7%) patients scored full marks or zero on the CPAx pre-admission. For survivors, no patients scored full marks or zero on the CPAx at ICU and hospital discharge. On ICU admission 66.7% (n=20) scored zero on the CPAx and no patients scored 50. ConclusionsThe CPAx score appears to be able to detect improvements in physical function as patients recover from acute severe burn. It has a limited floor and ceiling effect in the acute setting and a change in CPAx score of 6 represents clinically important progress. Further work is required in a larger cohort.

Chemical burns in children: Aetiology and prevention

BackgroundChemical burns account for a small proportion of total burns in children, but may require specific first aid and different modes of prevention. MethodsA retrospective study between 2006 and 2012 of children ≤16 years treated with chemical burns at a specialist paediatric burn centre. Data were extracted from a prospectively maintained database. Results56 episodes of chemical burns occurred during the study period. The majority (54%) occurred in boys. There were 39 (72%) patients <10 years and 17 (39%) ≥10 years. Median total body surface area burnt was 1% with nine (16%) patients requiring skin grafting. Only 24 (45%) had adequate first aid. The majority (n=46, 82%) of chemical burns occurred in the domestic setting, especially in the <10 years age group (P=0.052). Non-intentional exposure of chemicals by an unattended child accounted for half of all (n=22, 49%) chemical burns <10 years of age. Eight (47%) burns in patients ≥10 years resulted from self-harm. The most common aetiological agents were household cleaners and aerosols in the younger and older age groups respectively. ConclusionChemical burns remain infrequent but potentially preventable. These burns mainly occur in the domestic setting due to non-intentional exposure of household chemicals in children <10, and due to deliberate self-harm in children ≥10. The use of child-resistant packaging, similar to that used for medications, and improved parental practices could help decrease the incidence of burns in children <10.

Childhood burns in Sulaimaniyah province, Iraqi Kurdistan: A prospective study of admissions and outpatients

BackgroundWhile it is globally observed that young children are at a higher risk of burn injuries, little is known about childhood burns in Iraqi Kurdistan. This study was undertaken to describe the epidemiology of burns amongst pre-school children in this region. MethodsA prospective study was undertaken from November 2007 to November 2008 involving all children aged 0–5 years attending the burns centre in Sulaimaniyah province for a new burn injury whether treated as an outpatient or admitted to hospital. Results1,122 children attended the burns centre of whom 944 (84%) were interviewed (male 53%, female 47%). Mean age was 1.9 years with children aged 1 year comprising 32% and those aged 2 years comprising 21% of the sample. The incidence of burns was 1044/100,000 person-years (1030 in females and 1057 in males). Mechanisms of injury included scalds (80%), contact burns (12%) flames (6%) and other mechanisms (2%). Almost 97% of burns occurred at home including 43% in the kitchen. Winter was the commonest season (36%) followed by autumn (24%). There were 3 peak times of injury during the day corresponding to meal times. The majority of burns were caused by hot water (44%) and tea (20%) and the most common equipment/products responsible were tea utensils (41%). There were 237 admissions with an admission rate of 95 per 100,000 person-years. Scald injuries accounted for most admissions (84%). Median total body surface area affected by the burn or scald (TBSA) was 11% and median hospital stay was 7 days. In-hospital mortality was 8%. Mortality rate was 4% when TBSA was ≤25%, and 100% when TBSA was over 50%. ConclusionBurn incidence is high in young children especially those aged 1–2 years. Preventive interventions targeted at families with young children & focusing on home safety measures could be effective in reducing childhood burns.

Mucormycosis attributed mortality: A seven-year review of surgical and medical management

IntroductionHistorically, mucormycosis infections have been associated with high mortality. The purpose of this study was to determine the incidence, associated mortality, and management strategies of mucormycosis in a major burn center. MethodsA retrospective review was performed via obtaining all patients with mucormycosis admitted from January 2003 to November 2009 at our adult burn center was performed obtaining demographic data relevant to fungal burn wound infection or colonization. ResultsThe incidence of mucormycosis at our facility was 4.9 per 1000 admissions; specifically, 11 military casualties and one civilian were diagnosed with mucormycosis. The median percentage Total Body Surface Area (TBSA) burned, 11 patients, or open wound, one patient, was 60 (IQR, 54.1–80.0), and the incidence of documented inhalation injury was 66.7% (8 of 12). Ten patients had surgical amputations. A median of eight days (IQR, 3.5–74.5) elapsed from diagnosis of mucormycosis until death in the 11 patients who expired. The overall mortality was 92%; however, autopsy attributed mucormycosis mortality was 54.5% (6 of 11) with all six patients having invasive mucormycosis. ConclusionAggressive surgical intervention should be undertaken for invasive mucormycosis; additionally, implementation of standardized protocols for patients with large soft tissue injuries may mitigate mucormycosis superimposition.

Decadorial of a burn center in Central India

Introduction:Burn injuries are a serious public health problem. In our study we have identified different epidemiological factors based on 10 years of our experience at a burn unit in central India and recommend some strategies to prevent burn injuries.Materials and Methods:This is a retrospective analysis (2001-2010) of database from burn unit of S.S. Medical College, Rewa, India.Results:2499 patients with burn injury were analysed. 66.8% and 38.2% patients were females and males respectively, with a median age of 25 years. Flame (80.1%) was most common cause, home (96%) was most common place, traditional Indian stove (28.8%), kerosene lamp (26.7%), hot liquid (12.2%) and kerosene stove (10.4%) were common causes. Median Total Body Surface Area (TBSA) burn was 40.0%; females had significantly greater (P < 0.001) burn than males (median 50% vs 26.0%). High mortality (40.3%) seen; female sex (OR 3.22, 95% CI 2.65-3.92); young age (15-29 year) (OR 3.48, 95% CI 2.45-4.94); flame burn (OR 12.9, 95% CI 1.69-98.32); suicidal burn OR 6.82 95%CI 4.44-10.48) and TBSA > 76% (OR 3099, 95%CI 1302-7380) were significant risk factors for death. Median hospital stays was 8 days; shorter hospital stays seen among TBSA burn > 76% (2 days), suicidal intent (4 days), and those who expired (4 days). Septicemia (45.8%) and burn shock (41%) were the major cause for death.Conclusions:Cooking and lighting equipments are major cause of burn injury among females and young age group. Equipment modification to improve safety features and public awareness programs are necessary to reduce burn incidents.

Developing a burn injury severity score (BISS): Adding age and total body surface area burned to the injury severity score (ISS) improves mortality concordance

BackgroundThere is limited research validating the injury severity score (ISS) in burns. We examined the concordance of ISS with burn mortality. We hypothesized that combining age and total body surface area (TBSA) burned to the ISS gives a more accurate mortality risk estimate. MethodsData from the Royal Perth Hospital Trauma Registry and the Royal Perth Hospital Burns Minimum Data Set were linked. Area under the receiver operating characteristic curve (AUC) measured concordance of ISS with mortality. Using logistic regression models with death as the dependent variable we developed a burn-specific injury severity score (BISS). ResultsThere were 1344 burns with 24 (1.8%) deaths, median TBSA 5% (IQR 2–10), and median age 36 years (IQR 23–50). The results show ISS is a good predictor of death for burns when ISS≤15 (OR 1.29, p=0.02), but not for ISS>15 (ISS 16–24: OR 1.09, p=0.81; ISS 25–49: OR 0.81, p=0.19). Comparing the AUCs adjusted for age, gender and cause, ISS of 84% (95% CI 82–85%) and BISS of 95% (95% CI 92–98%), demonstrated superior performance of BISS as a mortality predictor for burns. ConclusionISS is a poor predictor of death in severe burns. The BISS combines ISS with age and TBSA and performs significantly better than the ISS.

Hypercoagulability after burn injury

Hypercoagulability is a homeostatic response to trauma, but relatively little information is available about coagulation changes after burn injury. Therefore, we tested the hypothesis that burn patients are hypercoagulable at admission and/or during recovery. A prospective observational trial was conducted at an American Burn Association verified Burn Center. Thromboelastography (TEG) was performed on blood drawn from indwelling catheters upon admission and weekly for those who remained hospitalized. Routine and special coagulation tests were performed on stored samples. Data are expressed as median (interquartile range). Twenty-four patients (88% male) were enrolled, with a median age of 49 (20) years and a median total body surface area burn of 29% (23%); 21 experienced thermal burns (4 inhalational injuries), and 3 had electrical burns. There were no significant differences in TEG or coagulation assays between patients with thermal versus electrical burn injury, but there were significant differences between men versus women and between those with or without inhalational injury. Sixteen patients had repeat samples 1 week after intensive care unit admission. The repeat TEG was more hypercoagulable (all p < 0.05). Fibrinogen and natural anticoagulation proteins (protein C, protein S, and antithrombin III) were also increased (all p < 0.05). Two patients (8%) developed venous thromboembolism (VTE); TEG reaction time, fibrinogen, and partial thromboplastin time were decreased (all p < 0.05) at admission compared with those with no VTE. All changes occurred despite pharmacologic thromboprophylaxis. There was no significant correlation between TEG and total body surface area or between TEG and fluid balance. In general, burn patients have normal coagulation parameters at admission but become hypercoagulable during recovery. However, those who are hypercoagulable at admission may have an increased risk of VTE. Additional monitoring and/or thromboprophylaxis may be indicated. Epidemiologic/prognostic study, level III.

Clinical outcome analysis of male and female genital burn injuries: A 15‐year experience at a Level‐1 Burn Center

The American Burn Association classifies a burn to the genitalia as a major injury. Isolated burns to the penis, scrotum or vulva are rare as a result of protection provided by the thighs and abdomen. Thus, burned genitalia represent an ominous sign of a more extensive total body surface area burn. A retrospective analysis of consecutive patients admitted to a Level-1 Burn Unit with a burn involving the genitalia from January 1995 to December 2009 comprised the study population. A total of 393 patients of 5878 patients (6.7%) admitted to the Burn Unit suffered a burn involving the genitalia, including 253 males (64.4%) and 140 females (35.6%). The median total body surface area was 12% (range 1-100%), the most common cause of genital burn was scald (n = 246, 62.9%) and median length of stay was 9 days (range 1-472 days). A total of 269 patients (68.4%) were discharged to home from the hospital, and in-hospital mortality was 20.9%. The typical profile for those sustaining a genital burn include younger patients (≤30 years-of-age), sustaining a median total body surface area burn of 12% from a scald injury, with extensive genitalia involvement. Length of stay for genital burns is usually extended and, as a result of concomitant injuries, is associated with a 20% in-hospital death rate.

Burns in older people. Epidemiology, surgical management and outcome in a university hospital referral burn unit, 1994–2004

BackgroundBurn injuries in older people are becoming more frequent as the population ages. Burn management in older people remains controversial. ObjectivesThe aim of this retrospective study was to describe the epidemiologic profile of older people in our university hospital burn unit, to report their surgical management, and to identify factors associated with the risk of death. MethodsWe included all patients aged 70years and over who were admitted between January 1994 and December 2004. ResultsThere were 84 men (43%) and 111 women (57%), with a median age of 79.0 (IQR 75.0–85.0) and a median total body surface area (TBSA)% of 12.3% (IQR 5.0–23.5). Most injuries occurred at home (85.1%). Most patients had pre-existing co-morbidities (78.5%). Conservative treatment was performed in 74 (37.9%) patients, while 121 (62.1%) patients underwent surgery. Early excision was performed in 17 (14.0%) patients, who were both significantly younger (P=0.02) and more severely burned (P=0.004). Forty-seven (24.1%) patients died in hospital. Factors associated with death were TBSA% (P<10−4), full-thickness TBSA% (P=0.0016), inhalation injury (P=0.02) and conservative treatment (P<10−4). The overall median length of hospital stay was 29.0 days (IQR 11.0–54.0, range 0.0–375.0). One-third of the 148 discharged patients were able to return home alone. ConclusionBurn prevention in older people, by adapting their daily living environment, is a major public health issue. Treatment modalities, i.e. conservative versus surgical, must be evaluated and planned specifically for each patient, depending on overall health status, which should ideally be assessed in collaboration with a geriatrician.

Responding to Major Burn Disasters in Resource-Limited Settings: Lessons Learned From an Oil Tanker Explosion in Nakuru, Kenya

On January 31, 2009, a fuel tanker exploded in rural Kenya, killing and injuring hundreds of people. This article describes the care of >80 burn victims at a rural hospital in Kenya, Nakuru Provincial General Hospital, and provides lessons for care of a large number of burned patients in a resource-limited setting. Data were obtained from retrospective review from hospital registers and patient files. Treatment was provided for 89 victims. Eighty-six (97%) were men; median age was 25 years (interquartile range [IQR], 19-32). Half of the patients (45) died, the majority (31, 69%) within the first week. The median total body surface area burned for those who died was 80% (IQR, 60-90%) compared with 28% (IQR, 15-43%) for those who survived (p < 0.001). Twenty patients were transfused a total of 73 units of blood including one patient who received 9 units. Eighty surgical interventions were performed on 31 patients and included 39 split-thickness skin grafts, 21 debridements, 7 escharotomies, 6 dressing changes, 4 contracture releases, and 3 finger amputations. Of the 44 survivors, 39 (89%) were discharged within 4 months of the event. Mortality after mass burn disasters is high in Africa. In areas where referral to tertiary centers is not possible, district hospitals should have mass disaster plans that involve collaboration with other organizations to augment medical and psychologic services. Even for patients who do not survive, compassionate care with analgesics can be given.

Suicidal and criminal immolations: An 18-year study and review of the literature

We aimed to examine our autopsy data in order to analyze epidemiological and injury characteristics in criminal and suicidal immolation cases. During the 18-year period, we recorded 29 suicides and three homicides due to fire burns. In suicide group there was a majority of men (gender ratio: 3.1:1) and the mean age was 42.8 years (range 20–72). In the homicide group, the victims were two men and one woman. Their mean age was 44 years (range 39–54). The location of self-immolation was mostly the deceased’s car or home and most suicides happened during the evening and the night. The main frequent motives for self-immolation were affective problems, financial problems, or both. One or several flammable fluids, usually petrol or alcohol, were used in 18 suicide cases and in one homicide. The median total body surface area burnt was 79.3% (range 10–100%) in self inflicted group and 83.3% (range 50–100%) in assault group. The sole of the feet was spared in all suicide cases. Blood CO-Hb level was measured in 27 self-immolation cases. It ranged between 1% and 10% in 11 cases and was superior to 10% in the remaining. Twenty-three self-immolation victims and one homicide victim had soot in their respiratory tracts. Soot in the respiratory tracts was associated to soot in the digestive tracts in six cases. Alcohol and drugs intoxication played a minor role. In six cases, the victim associated self incineration with one or more other methods of suicide (complex suicides). The presence of associated trauma raises the problem of vitality and interpretation of the lesions in determining the manner of death.

Incidence and mortality of burn injuries in Sulaymaniyah, Iraq

BackgroundLittle is known about burns in Iraq. This study was undertaken to investigate epidemiology of burn injuries in Sulaymaniyah province with 1.7 million people.MethodsA prospective study from November 2007 to...

Microalbuminuria: A marker of systemic endothelial dysfunction during burn excision

Introduction Systemic endothelial dysfunction characterises both burn injury and surgery and can be monitored by serial immunoassay of urine albumin (microalbuminuria). The aim of this study was to assess microalbuminuria before and during burn excision and identify factors that may influence it. Methods Serial half-hourly urine albumin/creatinine ratio (ACR, normal <2.3 mg/mmol) was measured in 25 adult patients during 44 burn-excision procedures, at a median of 5 days post-injury. Median total body surface area (TBSA) excised was 12%. Results Pre-operative median ACR was normal rising to 3.25 mg/mmol at 1.5 h of surgery ( p < 0.05). Per-operative ACR at 0.5, 1, 2 and 2.5 h were all associated with % TBSA burn excised ( p < 0.04). Median intraoperative ACR at 1 h was 2.3 mg/mmol for surgery within 48 h post-injury, 1.6 for surgery at 2–7 days and 25.5 during excisions later than 1 month after injury ( p < 0.05). ACR at 1 h was associated with CRP at 48 h post-surgery ( p = 0.04). Per-operative ACR was also significantly correlated with post-operative complications. Conclusion Systemic endothelial dysfunction of acute thermal injury assessed by microalbuminuria recurs with surgery, is minimal at 2–7 days post-burn and affected by % TBSA burn excised and post-operative complications.

Characteristics of burn patients at a major burn center in Shanghai

In China, burns are becoming a major cause of morbidity and mortality with large societal and economic implications. To date, there is little epidemiological data on burns in China to direct prevention efforts. This study describes the characteristics of burn patients admitted to a major burn center in Shanghai using a burn registry developed in Toronto, Canada. A retrospective review of burn patients discharged from the Shanghai's Rui Jin Hospital Burn Unit, between March 1st 2002 and April 30th 2003, was conducted. Of 527 patients discharged, 307 were acute burn patients and 302 (98.4%) had complete data to be included in the study. There were 214 (71%) males and 88 (29%) females with a male to female ratio of 2.4:1. The median age was 30 years, and the median total body surface area burned was 10%. The majority of burns occurred at work (58%), and the most frequent etiology was flames (39%) followed by scalds (31%) and contact with hot objects (15%). Sixteen (5%) patients had inhalation injury and six (2%) patients died. There were 70 (23%) children (0–14 years), 221 (73%) adults (15–59 years) and 11 (4%) seniors (60 years and above). Children had more scald burns (83%) and the majority (83%) occurred at home. Adults had more flame burns (46%) and the majority (79%) were work-related injuries. Seniors had more flame burns (73%) and the majority (55%) occurred in domestic incidents. Seniors had deeper burns (13%, p = 0.005), required more escharotomies (55%, p = 0.002), required more operations (2, p = 0.051) and had higher mortality (36%, p < 0.001) than other age groups. These results provide compelling evidence for performing population-based studies to identify risk factors that are susceptible to modification in each age group.

Characteristics of 1494 pediatric burn patients in Shanghai

To analyze the epidemiological characteristics of pediatric burn patients in Shanghai and to determine the targets for a pediatric burn prevention program, a retrospective review of all medical records of acute pediatric burn patients (age ≤ 14 years old) admitted to the Burn Center of the Ruijin Hospital between January 1980 and December 2002 was performed. Patient demographics, etiology of burn, mechanism of injury, extent and anatomical areas burned, number of operations, and length of hospital stay were recorded. A total of 1494 pediatric burn patients were admitted. Six hundred eighty-seven (46%) patients were from the migrant population (non-registered population of temporary workers from rural areas outside of Shanghai). Scalding was the main cause of pediatric burns in the age groups. Children 0–3-year-old were the most common victims of scalding, chemical burns, and contact burns. Domestic burns resulted in 1293 (86.5%) injuries followed by burns occurring while playing in public. The incidence of domestic burns has increased since the beginning of the study period, while the incidence of burns while playing in public has decreased. The median total body surface area was 4% for mild burns, 10% for moderate burns, and 18% for extensive burns. Predominant areas involved were the head, neck, anterior trunk, and right lower limb. Most children received conservative treatment, and their mean hospital stay was 16.1 ± 12.2 days. There were 17 (1.1%) deaths, mostly due to sepsis (82.4%). Migrant children are the majority of burn victims since 1996. The education of burn prevention should focus on the migrant population in an industrializing city.

Nosocomial infections in a Brazilian Burn Unit

In 1-year prospective study, bacterial and fungal infections presenting in burned patients were registered. Two-hundred and seventy-eight patients were included. The median total body surface area burned was 14% (range 1–100%). The median length of hospital stay was 12 days (range 1–86 days). Eighty-six patients had in all 148 infections. Seventy-two bloodstream infections (BSI) occurred in 57 patients; most common microorganisms were coagulase-negative staphylococci and methicillin-sensitive Staphylococcus aureus. Forty-nine (17.6%) patients had burn wound infections and 18 (6.5%) had pneumonia. Antibiotics were given to only 30% of the burn patients. Overall mortality rate was 5.0% (14/278). The database can be used to evaluate the effects of changes in burn treatment, staffing and design of burn units, and antimicrobial resistance development in relation to antibiotic usage.