Scald Burn Research Articles

Length of Stay per Total Body Surface Area Burn Relative to Mechanism: A Pediatric Injury Quality Improvement Collaborative Study.

Studies on length of stay (LOS) per total body surface area (TBSA) burn in pediatric patients are often limited to single institutions and are grouped in ranges of TBSA burn which lacks specific detail to counsel patients and families. A LOS to TBSA burn ratio of 1 has been widely accepted but not validated with multi-institution data. The objective of this study is to describe the current relationship of LOS per TBSA burn and LOS per TBSA burn relative to burn mechanism with the use of multi-institutional data. Data from the Pediatric Injury Quality Improvement Collaborative (PIQIC) were obtained for patients across five pediatric burn centers from July 2018 to September 2020. LOS per TBSA burn ratios were calculated. Descriptive statistics and generalized linear regression which modeled characteristics associated with LOS per TBSA ratio are described. Among the 1267 pediatric burn patients, the most common mechanism was scald (64%), followed by contact (17%) and flame (13%). The average LOS/TBSA burn ratio across all cases was 1.2 (SD = 2.1). In adjusted models, scald burns and chemical burns had similar LOS/TBSA burn ratios of 0.8 and 0.9, respectively, whereas all other burns had a significantly higher LOS/TBSA burn ratio (p<0.0001). LOS/TBSA burn ratios were similar across races, although Hispanics had a slightly higher ratio at 1.4 days. These data establish a multi-institution LOS per TBSA ratio across PIQIC centers and demonstrate a significant variation in the LOS per TBSA burn relative to the burn mechanism sustained.

Epidemiological Study about Children Burns Injury in the North of Morocco

Children are a population particularly at risk of burns, associated with high mortality in developing countries, associated with poverty, and poor infrastructure. The study of the epidemiology of burns in these countries aims to target prevention campaigns. The objective of our study is to study the epidemiological aspects of burns in the infant population in the region of Tangier-Tetouan-Al Hoceima, to determine the etiopathogenic aspects, and to describe the methods of prevention. This study was carried out retrospectively, by collecting the most frequent etiologies, the sex, and the site of the accident in 76 children admitted for burns to the emergency rooms of the regional hospital of Tangier, over 6 months from April 2021 to September 2021. The ages of our children ranged from 1 to 12 years old. The average age was 4 years and 2 months. A male predominance was found with 56 boys (73.68%) and 20 girls (26.32%). The scalding burn was observed 65 times (85.53%), by flame 8 times (10.53%), and another mechanism 3 times (3,95%). All of the burns occurred at home (100%). The causative agent was hot water in 48 cases (63.16%), other liquids in 17 cases (22,36%). Explosions of a small gas cylinder were also observed in 4 cases (5.26%) or a gas oven in 4 cases (5.26%), And another cause was observed in 3 cases (3,95%). It is necessary to know that the burn is a frequent trauma, making it a real public health problem, Hot liquids are the most implicated causative agent in the pediatric population. The flame is also frequently responsible for burns. The management must be intense; early and multidisciplinary to improve the vital and functional prognosis of these patients. Prevention remains the way to avoid serious burns, especially the education of mothers.

Biological dressing is a paradigm shift in children’s scald burn: our experience

Background: Burn injury has multiple causes but scald burn is the most common type of burn in children. Prototype of scald burn is hot water burn. Change of burn dressing in children is challenging. Biological collagen dressing has totally changed the management of scald burn or it is a paradigm shift in the management of scald burn in children. Aim of this study was to achieve early wound healing with less complication and to prevent change of frequent dressings in children.Methods: A prospective study was done in 30 patients of scald burn under 12 years of age between November 2020 to July 2021. Meticulous debridement and deroofing of all blisters and removal of dead skin were performed. Bovine meshed wet collagen dressing was thoroughly rinsed with normal saline three times to remove the preservative isopropyl alcohol. After that collagen dressing applied over the raw area. Paraffin with chlorhexidine impregnated gauze dressing applied over the collagen. First dressing was changed at post operative day five.Results: All burn wounds healed well between 10-14 days without any complications. In follow up no hypertrophy of skin and almost same skin color had noted.Conclusions: We conclude that collagen dressing is a paradigm shift in the management of scald burn. It is cost effective, pain less, requires less frequent change of dressing with good match of skin color.

Comparison of accidental pediatric scald burns in a tertiary care center: hot cauldron burns versus accidental spill burns.

Background: Scald burns result from exposure to high-temperature fluids and are more common in the pediatric age group. They occur mainly by two mechanisms: (i) spill and (ii) immersion (hot cauldron) burns. These two patterns differ in clinical characteristics and outcomes. Scalds cause significant morbidity and mortality in children. The objective of this study was to compare accidental spill burns and hot cauldron burns in a hospital setting. Methods: An analytical cross-sectional study was conducted by reviewing the secondary data of scald cases admitted during the years 2019 and 2020 in a burn-dedicated tertiary care center. Total population sampling was adopted. Data analysis was done partly using SPSS, version-23, and Stata-15. Mann Whitney U-test and Chi-square/Fisher's exact test were done appropriately to find associations between different variables. Regression analysis was performed taking mortality events as the outcome of interest. Results: Out of 108 scald cases, 43 (39.8%) had hot cauldron burns and 65 (60.2%) had accidental spill burns. Overall mortality was 16 (14.8%), out of which hot cauldron burns and accidental spill burns comprised 12 (75.0%) and 4 (25.0%), respectively. Multinomial logistic regression analysis showed the type of scald, age, and Baux score found to be associated with mortality. Every one-year increment in age had a 29% lower odds of occurrence of mortality event (adjusted odds ratio [OR], 0.71; 95% confidence interval [CI], 0.50-0.99, p=0.042). Likewise, every one-point increment in Baux score was associated with 19% higher odds of mortality (adjusted OR, 1.190; 95% CI, 1.08-1.32; p<0.001). Conclusions: Accidental spill burns were more common but mortality was significantly higher for hot cauldron burns. The majority of burn injuries occurred inside the kitchen emphasizing appropriate parental precautions. The risk of mortality was significantly higher in burn events occurring outside the house, and burns involving back, buttocks, perineum, and lower extremities.

Paediatric Burns of the Hand: Our Experience Over Three Years.

Background and aimContact burn injuries to the hand are common in the paediatric population, with the most common aetiology involving touching hot surfaces in the household. The hand is also often involved in paediatric scald injuries. The aim of this study was to determine the different presentations of hand burn injuries and analyse the outcomes in the paediatric population at Royal Aberdeen Children’s Hospital (RACH).MethodsAnonymised clinic data for paediatric patients with hand burns presenting to our burn centre from 2017 to 2020 were retrospectively reviewed. A total of 52 patients (65 affected hands) were included in the study. Clinic letters stored on NHS Grampian’s electronic patient record system were reviewed for burn surface area, time to healing, management measures including medications prescribed and sequelae of the burn injury.ResultsThe average patient age was three years and four months old. There were 31 male patients and 21 female patients. Paediatric hand burns were most commonly confined to the palm only, followed by the fingers only. Contact with a hob was the most common aetiology, followed by scald burns. The average time to healing was 10 days (range 2-28 days). No correlation was found between length of stay on initial hospital admission and time to complete healing. A total of 86.5% (n=45) of patients were managed with dressings and 13.5% (n=7) of patients underwent surgical management. Of these seven patients, four had surgical debridement of burn tissue, washout, and dressing, and the remaining three had an excision and grafting with thick split-thickness skin grafts. Of these three patients, one patient had to undergo secondary reconstruction with a full-thickness skin graft.ConclusionIt has been found that most patients in this study completely healed with primarily conservative measures of dressing care and regular check-ups. Isolated hand burns in the paediatric population present a low rate of sequelae and palms are the most common area of burn injury in this demographic.

Cases of Lower Extremity and Perianal Burns at the Burn Center in the Southeast Anatolia of Turkey.

Introduction: In this study, the aim is to discuss the cases of lower extremity and perianal burns at the burn center in the southeast Anatolia of Turkey. Material and methods: A 4-year retrospective study was conducted on 775 patients who had been admitted to Gazi Yaşargil Training and Research Hospital Burn Centre with lower extremity and perianal burn injuries between January 2016 and January 2020. Results: Of the patients, 427 were male and 348 were female. Scald burns are most commonly affect the perianal and lower extremities. The right lower extremity was affected in 602 (77.7%) patients, the left lower extremity was affected in 574 (74.1%) patients and the perineum was affected in 70 (9.0%) patients. Most burn injuries occur in individuals between 0 to 4 years old, and the rate of burn injuries gradually decreases in individuals outside of this age range. No patient underwent colostomy for perianal burns. Conclusion: Early, aggressive and extensive debridement, in addition to adequate antimicrobial therapy, should be performed as the basis of treatment.

Enzymatic debridement in scalds is not as effective as in flame burns regarding additional eschar excision: A retrospective matched-control study

ObjectiveEnzymatic debridement of burn eschar became an accepted and widely used technique for burn wound treatment over the last years. However, this practice is not exempt from failure and recent experimental studies indicate that it may not be as efficient in scalds as in flame burns. MethodsPatients that were admitted to the burn intensive care unit between June 2017 and February 2021 and received enzymatic debridement within the first 72 h after scald and flame burn were included. Patients with scald burns were matched regarding age, sex and per cent total body surface area (%TBSA) burned in a 1:2 ratio with patients presenting with flame burns. ResultsEighteen patients with scald burns were matched with 36 with flame burns. After matching, both groups were similar in terms of age (flame burns 44.5 ± 21.1 years vs. scald 41.8 ± 22.6 years, p = 0.666), and %TBSA burned (11.0 ± 8.2% vs. 10.6 ± 9.6%, p = 0.851). Patients with scald burns significantly more often underwent further surgical eschar excision compared to controls (scald 16 (88.9%) vs. flame 19 (52.8%), p = 0.016). Length of stay per %TBSA was significantly longer in scald burns (scald 7.8 ± 9.2 days vs. flame 3.7 ± 3.8, p = 0.013). ConclusionThis study indicates that enzymatic debridement may not be as effective in scalds as in flame burns. It was shown that patients with scalds and subsequent enzymatic debridement more frequently underwent additional surgical intervention and that the size of the transplanted area was larger compared to control. Moreover, those patients had a longer length of stay at the hospital per %TBSA burned.

Patterns and Outcomes of High-Voltage vs Low-Voltage Pediatric Electrical Injuries: An 8-Year Retrospective Analysis of a Tertiary-Level Burn Center.

Although electrical injuries (EIs) are rare traumas in the pediatric age group, they are considered one of the most devastating injuries. We aimed to evaluate the patterns and outcomes of pediatric high-voltage injuries (HVIs) vs low-voltage injuries (LVIs), admitted to the burn center within the efforts of determining evidence-based data for contributing to burn prevention strategies. A retrospective study was conducted on children with EIs hospitalized in the Burn Center of Adana City Training and Research Hospital for 8 years (2013-2020). Data including the patients' clinical and demographic characteristics, the percentage of total body surface area with burns (%TBSA), length of hospital stay, exposure place, electrical current type, and treatment results were collected and analyzed. EIs were detected in 57 (2.5%) of 2243 acute pediatric burn injury admissions. EIs were most frequently observed in the form of HVIs, among children within the age range of 13 to 18 years, mostly in residential outdoor environments, where the high-power lines still passing close to the home roofs and balconies, resulting from contact with them. Besides, to a lesser extent in LVIs, in the home environment among children younger than 5 years, which was caused by connection with substandard electrical cords/poor-quality electrical devices and inserting an object into the electric sockets. Concerning the mean of %TBSA, HVIs suffered more extensive burns than LVIs. The most frequently affected anatomical regions among HVIs and LVIs were the upper limb, followed by the lower limb. While superficial partial- and deep partial-thickness burns were significantly more common among the LVIs, full-thickness burns were more prevalent among the HVIs. The amputation rate was 12% of which only one of them was major amputation (forearm above the elbow joint). HVIs had more elevated creatine kinase (CK) and CK-myocardial band (CK-MB) levels than LVIs but were not correlated with electrocardiography findings. Only one death (caused by HVI) was observed, with a mortality rate of 1.8%. Pediatric EIs are less common than scald or fire flame-related burns in this age group but can cause significant morbidity and even mortality, especially in severe burns. It is possible to prevent possible morbidity and mortality by strengthening compliance with safety precautions, especially with parental education and raising social awareness. In this context, taking necessary precautions for passing high-voltage power lines under the ground, the standardization of electrical cables by the relevant legal regulations, the use of socket covers in homes, promoting the widespread use of residual current relays, and arrangements to be taken against the use of illegal electricity are among measures for the prevention strategy.

Carotid smooth muscle contractility changes after severe burn

Severe burns result in cardiovascular dysfunction, but responses in the peripheral vasculature are unclear. We hypothesize that severe burns disturb arterial contractility through acute changes in adrenergic and cholinergic receptor function. To address this, we investigated the changes in carotid artery contractility and relaxation following a severe burn. Thirty-four adult Sprague–Dawley male rats received a 40% total body surface area (TBSA) scald burn and fluid resuscitation using the Parkland formula. Control animals received sham burn procedure. Animals were serially euthanized between 6 h and 14 days after burn and endothelium-intact common carotid arteries were used for ex vivo force/relaxation measurements. At 6 h after burn, carotid arteries from burned animals demonstrated a > 50% decrease in cumulative dose-responses to norepinephrine (p < 0.05) and to 10−7 M angiotensin II (p < 0.05). Notably, pre-constricted carotid arteries also demonstrated reduced relaxation responses to acetylcholine (p < 0.05) 6 h after burn, but not to sodium nitroprusside. Histologic examination of cross-sectional planes revealed significant increases in carotid artery wall thickness in burned rats at 6 h versus 3 days, with increased collagen expression in tunica media at 3 days (p < 0.05). Carotid artery dysfunction occurs within 6 h after severe burn, demonstrating decreased sensitivity to adrenergic- and angiotensin II-induced vasoconstriction and acetylcholine-induced relaxation.

Abstract P370: The Role Of PJ-34 In The Protection Of Burn-induced Cardiomyopathy

Burn injury results in adverse myocardial remodeling and heart failure through circulatingcatecholamines and androgen and cytokine cascades. The DNA binding protein PARP1(poly ADP ribose polymerase 1) catalyzes a post translational modification to generatePARylation proteins,which changes the normal function of the modified proteins. Bothof PARP-1 and SIRT1 (sirtuin1) are NAD + dependent. In this study, we propose that PJ34 (PARP-1 inhibitor) would protect the function of burn-remodeled cardiomyocytes.Commercial rats were obtained and were subject to 60% total surface body area (TSBA)scald burns by immersing the abdomen and back in boiling water. They were immediatelytreated with the PJ34 post injury. Separately, the cardiomyocytes (Ac16) were exposedto burn-serum replaced culture medium with or without treatment of lentivirus-PARP1 KOand/or SIRT-PGC-1α agonists in vitro . The in vivo experiments showed that burn-ratsexhibited cardiac hypertrophy, fibrosis and an increase in the inflammatory markers IL-1β, IFN-γ and TNFα. Burned rats had an increased oxidative stress, concomitant withelevated PARP-1 activity and reduced Sirtuin-1 (SIRT1) expression. PJ34 treatment ledto increased SIRT1 and Peroxisome proliferator-activated receptor gamma coactivator 1-α (PGC-1α) levels and attenuated oxidative stress, inflammation, and fibrosis. In vitro tests demonstrated that the treatments of PJ34 and SIRT1-PGC-1α axis agonists incardiomyocytes exposed to burn-serum replaced culture medium led to a significantreduction in mit ROS and mitochondrial dysfunction. In Conclusion, PARP1 depletion byPJ34 in vivo and Letivirus-PARP1 KO Ac16 in vitro attenuated cardiomyopathic featuresin burn-rats through the activation of SIRT1 and its downstream antioxidant defensemechanisms. The results of this study suggest a pivotal role of PARP-1 inhibition intreating burn-induced cardiomyopathy. Keywords: Burn injury; PJ34; PARP1; Cardiomyocyte; Lentivirus.

Ethanol Intoxication and Burn Injury Increases Intestinal Regulatory T Cell Population and Regulatory T Cell Suppressive Capability.

Traumatic injuries, such as burn, are often complicated by ethanol intoxication at the time of injury. This leads to a myriad of complications and post-burn pathologies exacerbated by aberrant immune responses. Recent findings suggest that immune cell dysfunction in the gastrointestinal system is particularly important in deleterious outcomes associated with burn injuries. In particular, intoxication at the time of burn injury leads to compromised intestinal T cell responses, which can diminish intestinal immunity and promote bacterial translocation, allowing for increased secondary infections in the injured host and associated sequelae, such as multiple organ failure and sepsis. Regulatory T cells (Treg) have been identified as important mediators of suppressing effector T cell function. Therefore, the goal of this study was to assess the effects of ethanol intoxication and burn injury on Treg populations in small intestinal immune organs. We also evaluated the suppressive capability of Tregs isolated from injured animals. Male C57BL/6 mice were gavaged with 2.9 g/kg ethanol before receiving a ∼12.5% total body surface area scald burn. One day after injury, we identified a significant increase in Tregs number in small intestine Peyer's patches (∼×1.5) and lamina propria (∼×2). Tregs-producing cytokine IL-10 were also increased in both tissues. Finally, Tregs isolated from ethanol and burn-injured mice were able to suppress proliferation of effector T cells to a greater degree than sham vehicle Tregs. This was accompanied by increased levels of IL-10 and decreased levels of pro-proliferative cytokine IL-2 in cultures containing ethanol + burn Tregs compared with sham Tregs. These findings suggest that Treg populations are increased in intestinal tissues 1 day following ethanol intoxication and burn injury. Tregs isolated from ethanol and burn-injured animals also exhibit a greater suppression of effector T cell proliferation, which may contribute to altered T cell responses following injury.

Evaluating an urban pediatric hospital\u2019s scald burn prevention program

BackgroundOver 450,000 individuals are hospitalized with burns annually and roughly 35% are scald burns. Children younger than 5 years of age are at the greatest risk of scald burn injury. Caregiver burn prevention programs have been found to reduce the prevalence of injuries in young children; however, low-income and underserved populations seldomly have access to these programs. The impact of scald burn prevention programs in underserved populations remains unexplored. The objective of the current study was to evaluate the efficacy of a scald burn prevention program at a Level One Pediatric Trauma Center in a low-income, underserved community.MethodsOur hospital developed a one-hour scald burn prevention program for caregivers with children 5 years of age or younger. The program educated caregivers on ways to prevent scald burns and create safeguards in their home. Caregivers completed a pre-post survey to measure their ability to identify hot or cold objects, as well as respond to items about their perceptions of the program’s utility, their willingness to share it with others, and the likelihood that they would use the information in the future. Data was analyzed using a paired t-test.ResultsTwo-hundred and sixty-nine (N = 269) caregivers participated in the program. Before the program, caregivers could identify potentially hot objects 83.17% of the time, and after the program, they were able to identify these items 92.31% of the time: t (268) = 12.46, p < .001, d = 1.07. Additionally, 95% of caregivers indicated that the program was helpful, 99% stated that they were likely to share this information with others, and 100% indicated that they would use the information from the program.ConclusionsEducation is a critical component to prevent scald burns. Results indicate that a hospital-led scald burn prevention program can positively impact a caregiver’s ability to identify possible scald-burn risks. Providing education to caregivers who typically do not receive this information could lower the prevalence of scald burns not only institutionally, but in communities that are disproportionately impacted by this mechanism of injury.

Severe burn injury from the common Asian practice of heat application in patients with diabetic neuropathy.

This was the first study to analyse patients who sustained severe self‐induced burns from this common Asian practice. There is a need to raise public awareness and physician attention about the consequences of preventable burn injuries and the importance of first aid in patients with diabetic neuropathy. Retrospective data on 16 consecutive patients who had diabetes and neuropathy admitted to the plastic surgery ward at the Tri‐Service General Hospital from January 1, 2015, to February 2, 2021 with burn injuries because of heat applications were collected and analysed for this study. Age, gender, season, first aid adequacy, comorbidity, interventions, total body surface area (TBSA), degree of burn, aetiology, length of stay (LOS), and status at discharge were reviewed. The mean age of the 16 patients was 65.13 years. The most common burn aetiology was contact (50%), followed by scald (37.5%) and radiation burns (12.5%). TBSA burn averaged ± standard deviation 1.54 ± 1.22. Seven patients (44%) had wound infections, and three patients underwent amputations. The average LOS was 28.2 days. Asian practice of heat application is the common aetiology of severe and preventable burn injuries. Education about neuropathy and the consequences of a burn injury should be provided to patients with diabetes.

An Exploratory Study Demonstrating That Salivary Cytokine Profiles Are Altered in Children With Small Area Thermal Injury.

Serum can be used to investigate changes in cytokine concentration following burn injury in children; however, for children receiving treatment in an outpatient setting, blood is not routinely collected and therefore cannot be used for monitoring. The aim of this study was to investigate the use of saliva as a noninvasive tool for predicting burn outcomes by measuring the concentration of salivary cytokines in children with small area burns. A multiplex cytokine assay was used to measure 17 cytokines in the saliva of pediatric patients with burns (n = 20) and healthy controls (n = 20). After the removal of cytokines that had >30% of samples below the assay lower detection limit, six cytokines including IL-1β, IL-4, IL-7, IL-8, MCP-1, and TNFα were analyzed for association with burns. IL-1β and IL-4 were found to be significantly elevated in the pediatric burn patients compared to healthy controls. Interestingly, IL-1β was also significantly elevated in scald burns, compared to contact burns. In addition, biologically meaningful differences in cytokine concentration were identified in patients with different burn characteristics, which warrant further investigation. This exploratory study provides evidence that cytokines can be detected in the saliva of children and that salivary cytokine profiles differ between healthy controls and children with burns. Overall, this study demonstrates the value of saliva for the investigation of cytokines and its potential application in pediatric diagnostics, specifically in situations where blood collection is not appropriate.

The status quo of early burn wound excision: Insights from the German burn registry

BackgroundThere is a common, well-known and established recommendation to excise burn wounds within 24–72 h in order to mitigate the systemic inflammatory and immunomodulatory response, shorten length of hospitalization through early grafting and optimize patient survival. Despite this apparent consensus, surprisingly few systematic studies have evaluated the actual adherence to this practice and its implications on patient outcomes. In this registry study, we sought to objectify the current status of early burn wound excision, its influencing factors and impact on patient outcomes for all German burn centers. MethodsThe German burn registry (‘Deutsches Verbrennungsregister’) was queried for 3 consecutive years for all patients, who received at least one surgical intervention. Patients were stratified based on whether the first surgical procedure was performed early (EE, within 72 h) or late (LE, after 72 h) post-burn. Descriptive statistics and univariate regressions were performed to quantify fraction of EE vs. LE and to evaluate factors which might favor one over the other (i.e. age, inhalation injury, burn severity by total body surface area (TBSA), scald vs. other burns, obesity, time of admission). Key patient outcomes were analyzed for each group (i.e. mortality, length of hospitalization, number of surgeries) and multifactorial regression analyses were carried out to model the impact of EE on mortality. Statistical significance was accepted at p < 0.05. ResultsAfter initial screening, 1494 complete records were included for final analysis and were stratified into EE and LE. Only 670 (44%) underwent EE within 72 h. Increasing TBSA burned (i.e. [TBSA > 30%]: 53.8% EE, [TBSA < 30%]: 43.5% EE, p < 0.01) and admission on a weekday between Sunday and Wednesday were associated with higher probability of EE (51.5% EE) versus Thursday to Sunday (37.3%, p < 0.001). Age, inhalation injury, cause of burn, and obesity had no effect on EE vs. LE. Patients with EE had significantly shorter median lengths of hospitalization (EE: 18 d, LE: 21 d, p < 0.01). The median number of operations was comparable for both groups. Gross mortality appeared higher in the EE group, but turned out to be comparable to LE after correction for age, TBSA and sex in multifactorial regression analysis. ConclusionDespite apparent consensus among burn physicians, early excision of burn wounds is performed in less than 50% of cases in German burn centers. The relationship of EE to TBSA burned is expected and clinically sound, while a dependence on admission weekday raises administrative and infrastructural questions, especially when patients who receive EE have significantly shorter hospital stays. More analyses from other burn repositories are needed to compare and benchmark the international status quo of early burn wound excision.

Pattern of Burn Injury in Children Presented to Dhaka Shishu (Children) Hospital

Background: Children are mostly affected in burn injury at our country like other low and middle income countries (LMICs). Approximately 90% of the burns occur in under developed countries, which generally lack the necessary infrastructure to reduce the incidence and severity of burns.&#x0D; Objectives: This study was done to investigate the pattern of burn cases admitted to Dhaka Shishu (Children) Hospital (DSH).&#x0D; Methods: This was a retrospective study conducted over the period of one year from January 2019 to December 2019 at Dhaka Shishu (Children) Hospital, Dhaka, Bangladesh. The data was collected from the patients record section of the hospital. Patients characteristics (e.g. age, sex), causes and severity of injury, outcome, hospital stay and seasonal variation were analized in this study.&#x0D; Results: A total of 91 patients were admitted during study period of one year. This study consisted of 53 male patients (58.24%) and 38 female patients (41.76%) with male to female ratio of 1.3:1. The most frequently hospitalized burn patients were in the age group 3-5 years, which accounted for 30.77% of patients. Burns were more common during winter season followed by autumn season, with 43 cases (47.25%) and 18 cases (19.78%) respectively. The highest number of admissions was during the month of December. Scald burn was the most common cause of burn injury in our study which accounted for 83 cases out of 91 cases (91.2%). Flame burn occured in 3(3.29%) patients. There were 2 cases of electric burn and 2 cases of contact burn during this study period. One patient was with chemical burn. Scald burn was the most common cause of burn injury in this study which accounted for 83 cases out of 91 cases (91.2%). Flame burn occured in 3(3.29%) patients. There were 2 cases of electric burn and 2 cases of contact burn during this study period. One patient was with chemical burn.&#x0D; Conclusion: The most frequently hospitalized burn patients were in the age group 3-5 years and more common during winter season. Most of the burn occured in children are scald in our country due to accidental fall of worm liquid. Superficial epidermal and dermal burns are treated conservatively, but deep burns may require surgical treatment.&#x0D; DS (Child) H J 2020; 36(2): 134-137

Adherence of Burn Outpatient Clinic Referrals to ABA Criteria in a Tertiary Center: Creating Unnecessary Referrals?

Initial assessment and triage of burns are guided by the American Burn Association criteria for referral to a burn center. These criteria are sensitive but not specific and can potentially lead to over-triage and “unnecessary” clinic visits. We are a Level 1 trauma center with burn subspecialty care, and due to the COVID-19 pandemic, referrals to our multidisciplinary outpatient burn clinic required triaging for virtual care appointments. In order to improve the triage process, we retrospectively reviewed our outpatient burn clinic referrals over a 2-year period, 2018 to 2019, for adherence to American Burn Association criteria. We collected data pertaining to patient and burn characteristics, as well as treatment outcome, to characterize referrals not requiring an in-person appointment. Of the 244 patients referred, 73% met the referral criteria, with 45% of these patients being healed at the first visit and 14.6% requiring surgical management. Mean time from injury to first visit was 9.7 days (mode 6), and the average number of visits was 2. Overall, mean burn size was 2%, with the majority of injuries being partial thickness (71%), located in the hand or extremity (77%). There was a fairly equal distribution of contact (36%), flame (21%), and scald (26%) burns. This study highlights the nonspecific nature of the American Burn Association referral criteria. We found that pediatric and hand burns in particular were over-triaged and lead to “unnecessary” appointments. This information is useful to help adjust referral criteria and to guide triaging of appointments with the evolution of telehealth and virtual care.

Use of negative pressure wound therapy as a bolster over skin grafts in patients with severe burn injuries at a tertiary care burn centre in India

BackgroundManagement of deep burn requires aggressive debridement of non-viable burnt tissue and closure with skin grafts or flaps but challenge is to manage wound exudates and patient discomfort and to avoid shear force and pain cause by frequent dressing changes. This observational case series assessed outcomes of negative pressure wound therapy (NPWT) use as a bolster in pilot surgery (primary surgery) over skin grafts in patients with severe burns in a burn center in Indore, India in term of wound healing, pain, caregivers and nurses workload. MethodsPatients with extensive burns (≥30% total body surface area [TBSA]) were admitted to the burn unit between January and December 2020. Acute burn victims (burns present <24 h from burn injury) and patients over the age of 18 were included in this study. All patients received primary standard burn care including debridement of non-viable tissue, wound closure with homograft or autografts, and application of NPWT as a bolster in first sitting (Pilot surgery). NPWT dressings were changed every three to four days. Skin graft healing was monitored during dressing changes. Patient reported pain was recorded using the 10-point Likert pain scale. ResultsThirteen patients with an average TBSA of 42.6% (range 30–63%) underwent treatment. A total of 8 patients suffered from flame burns, 4 from electrical burns, and 1 from scald burns. The average length of hospital stay was 18.1 ± 6.2 days with wound closure in 9.1 ± 4.3 days. An average of 3.5 ± 1.3 dressing changes occurred. All patients were discharged without requiring re-grafting. No complications were observed, except small non-healing burn wounds in four patients that required further standard wound care to reach complete re-epithelisation. The overall patient reported pain was 3.4 ± 1.2. ConclusionsUse of NPWT as a bolster in patients with severe burns resulted in decreased wound healing time, pain score, workload of nursing staff and caregivers and early rehabilitation of survivor.

English

BACKGROUND The skin is the largest organ of our body with a complex function. Burn injuries result in damage to the skin by electrical, chemical, thermal or radiation energies or a combination of them, by far the most common being the thermal injuries. However, most burn injuries are preventable and hence need preventive strategies. Outcome is dependent on various factors. The focus of this study is to provide an overview of various factors and clinical presentation of burn injury and their correlation of these various factors with outcome of burn injury. METHODS A retrospective facility-based document review analytical study was conducted on 215 patients admitted in the emergency (burn ward) department of Government Medical College and Hospital, Srinagar, Kashmir from September 2019 to September 2020. RESULTS In our study, out of total 215 hospitalized burn patients, 101 (47 %) were female and 114 (53 %) were males. In 103 (47.9 %) patients, burn injury was caused by scald burn, kangri burn was present in 3 (1.4 %) patients; 207 (96.3 %) patients had accidental burns and 8 (3.7 %) patients had suicidal burn injuries; 181 (84.2 %) had received good pre-hospital intervention; 165 (76.7 %) patients were discharged without complications. Various parameters – degree of burn, cause of burn, nature of burn, nutritional status and antibiotic coverage show statistical significance with P-value &lt; 0.05. CONCLUSIONS Kashmir is a valley surrounded by mountains, has cold weather for about threequarters of year. People here are more prone to burn injuries especially thermal injuries. Outcome of burn injuries is better for lesser degree of burns and mortality increases with severe degree of burns. Patients without complications, patients with good nutritional status at presentation and patients with proper antibiotic coverage had good outcome. KEYWORDS Burn Injury, Kangri, Outcome of Burn

108 Length of Stay per Total Body Surface Area Relative to Burn Mechanism: A Pediatric Injury Quality Improvement Collaborative (PIQIC) Study

Abstract Introduction Studies on length of stay (LOS) per total body surface area (TBSA) burn in pediatric patients have been performed at single institutions and based on ranges of TBSA burn. A LOS to TBSA burn ratio of 1:1 has also been widely accepted but not confirmed over time across numerous institutions. The objective of this study was to use multi-institutional pediatric burn data to describe benchmarks associated with LOS per TBSA burn. Methods Data from the Pediatric Injury Quality Improvement Collaborative (PIQIC) were obtained for 1004 patients (n=1004) treated at five pediatric burn centers from July 2018-March 2020. LOS/TBSA burn ratios were calculated for each site. LOS/TBSA burn by institution and mechanism were analyzed. Generalized linear regression models were used to model the effect of hospital and burn mechanism on the LOS/TBSA ratio. Results Among the 1004 injuries, the most common burn mechanism was by scald (64%), followed by contact (16%) and flame (13%). The average LOS/TBSA burn ratio across all cases was 1.3 days (SD 2.2). Flame burns had a higher LOS/TBSA burn ratio than scald burns with a mean LOS/TBSA burn of 1.63 compared to 0.84. In adjusted models, scald burns, and chemical burns had the lowest LOS/TBSA burn ratio and electrical and friction burns had the highest LOS/TBSA burn ratio. The LOS/TBSA burn ratio was comparable across hospitals after adjustment for mechanism, with just Hospital 4 having a lower average LOS/TBSA burn of 0.49 days. Conclusions These data establish a multi-institutional ratio for the overall performance in LOS for pediatric burn patients. A LOS per TBSA ratio of about 1 was observed across PIQIC centers, except for a lower ratio at one center. Additionally, it provides evidence on the variance in LOS per TBSA burn relative to the sustained burn mechanism. Further collaborative data analysis will allow us to recognize specific patterns and outcomes in pediatric burn care, which is essential for the implementation of quality improvement standards.