Tertiary Burn Unit Research Articles

Oropharyngolaryngeal manifestations in severe toxic epidermal necrolysis: a single-center's retrospective case series.

Toxic epidermal necrolysis is a rare and life-threatening mucocutaneous disease. Although mucosal ear, nose, and throat (ENT) involvement is common, little is known about the characteristics, treatment modalities, and outcomes of these lesions. The aim of this study was to evaluate ENT mucosal lesions in severe toxic epidermal necrolysis patients and analyze their characteristics, treatment modalities, and outcomes, as well as proposing a management algorithm to prevent long-term debilitating sequalae of these lesions. This is a retrospective review of toxic epidermal necrolysis cases treated at the tertiary burns unit of the Lausanne University Hospital CHUV, Switzerland, between 2006 and 2019. Out of 19 patients with severe toxic epidermal necrolysis, 17 (89%) underwent a complete ENT examination at admission and 14 (82%) had ENT mucosal involvement. Five (26.3%) patients died during the stay in the intensive care unit. Of the 16 patients who received maximal care, 13 (81%) required orotracheal intubation for a median time of 16 (IQR: 14) days. Out of the 14 patients who survived, four (29%) had long-term ENT complications consisting of synechiaes necessitating subsequent endoscopic procedures. Those four patients all required mechanical ventilation with an orotracheal tube and suffered from hypopharyngeal synechiaes as well as oral and endonasal synechiaes in individual cases. This study suggests a high prevalence of ENT synechiaes in patients with severe toxic epidermal necrolysis and requiring orotracheal intubation. Periodic ENT examination could prevent mature synechiae formation in these patients. We propose an algorithm to prevent long-term sequalae in ENT mucosal involvement.

Management of Hydrocarbon Burns: Considering Mental Health and Biochemical Abnormalities.

Volatile substance misuse, particularly the inhalation of hydrocarbons, is a growing issue globally. Consequences of volatile substance misuse, both acute and chronic cause cardiovascular, respiratory, renal, metabolic, and central nervous system damage. Whilst the effects of hydrocarbon abuse have been reported, the combination of intoxication with hydrocarbon and burns sustained has not yet been presented. A retrospective case series of patients who presented in the last 5 years to the Royal Adelaide Hospital with hydrocarbon-related burns in the context of illicit use was undertaken. Our aims are to present to the wider scientific community the high morbidity and mortality of hydrocarbon burn injuries and why this tertiary Burns Unit feel it most appropriate to medically stabilize these patients prior to definitive surgery for their burn. All patients that presented with acute hydrocarbon intoxication and sustained concomitant burns had significant psychiatric disorder and substance abuse history and three of five had either not eaten in several days resulting in acute malnourishment, refeeding syndrome or had evidence of chronic malnourishment with deranged electrolytes and hypoalbuminemia. Their definitive burns surgery was delayed where appropriate in order to facilitate medical stabilization as they were too high risk of cardiac membrane instability, electrolyte derangement, and/or respiratory compromise to undergo safe general anesthetic and burns debridement. We propose a multidisciplinary team approach, utilizing not only our Burns Unit care model of physiotherapists, psychologists, social work, and burns trained nurses and surgeons but also Intensive Care, Toxicology, Addiction medicine and General Medical physicians in the management of these patients.

The Association Between Burn Unit Census and Operative Intervention in a Resource‐Limited Setting

The relationship between hospital volume and outcomes remains unclear in the delivery of burn care in resource-limited settings, where demand often exceeds capacity. We sought to characterize the association between burn patient volume and the use of operative intervention at a tertiary burn unit in Malawi. This study examined patients admitted to Kamuzu Central Hospital located in Lilongwe, Malawi, over years 2011-2019. We described the association between the census at the time of admission and the use of operative intervention, as well as the time to operation. Patient census was defined as low (≤ 15 patients), medium (16-29 patients), and high (≥ 30 patients). A total of 2484 patients were included. The mean daily burn unit census was 22.5 patients (SD 6.6) and varied significantly by season. For the medium and high census, the adjusted risk ratio of undergoing surgery was 0.79 (95% CI 0.64, 0.97) and 0.65 (95% CI 0.49, 0.85), respectively, adjusted for flame burn, age, %TBSA, and delayed presentation. At a low admission census, the adjusted mean time to operation was 17.2days (95% CI 14.4, 20.1) compared to 28.3days (95% CI 25.4, 31.2) at a high census. In a resource-limited setting, an increasing mean daily census significantly reduced the use of operative intervention and increased time to operation, potentially increasing burn-associated morbidity. In order to improve the quality of burn care in similar environments, improved resource allocation during busier seasons and targeted burn prevention efforts are imperative.

Ultrasound-Guided Fascia Iliaca Plane Block for the Treatment of Donor Site Pain in the Burn-Injured Patient: A Randomized Control Trial

Burn injuries requiring surgical intervention often result in split-thickness skin grafting procedures, with donor skin frequently harvested from the patient's anterolateral thigh. The donor site is often reported as the primary site of postoperative pain due to the damage sustained to localized nociceptors. A randomized control trial was undertaken to evaluate the impact an ultrasound-guided regional nerve block would have on patient-reported pain scores in donor site wounds, and associated rescue analgesia consumption. Twenty participants requiring split-skin grafting for burn injuries of <15% total body surface area were enrolled from a tertiary burns unit and randomized to control (10 participants) or intervention group (10 participants). The intervention group received the addition of an ultrasound-guided facia iliaca plane block prior to their surgery. Primary outcome was pain score in the donor site during the postoperative phase while secondary outcome was pain on day 1 post-surgery as measured by the numeric pain score (0-10). During the postoperative phase, the intervention group had a significantly lower median donor site pain score of 0 (interquartile range [IQR] 0-0), compared to the control group median 6 (IQR 4-7) (P < .001). Day 1 post-surgery the intervention group had a median pain score of 0 (IQR 0-4) compared to control group median 4.5 (IQR 2-6) (P = .043). The study findings demonstrated that regional anesthesia was an effective way to reduce pain scores and requirement for additional analgesics during the postoperative phase.

Retrospective Study of Patients With SJS/TEN Treated at a Tertiary Burn Unit in Canada: Overview of 17 Years of Treatment

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are adverse drug reactions. To learn about the clinical characteristics of patients with SJS/TEN including treatments provided, outcomes, and mortality. We conducted a retrospective chart review of patients who were hospitalized with the diagnosis of SJS/TEN at the Ross Tilley Burn Center between the years 1999 and 2015. A total of 43 patients were identified with a mean age of 54 ± 19 (58, 18-85). The most common offending medications were allopurinol and carbamazepine. The overall mortality rate in our study is 21% with the most common causes of death being multiorgan failure and sepsis. The majority of our patients had oral (84%), ocular (79%), and genital (60%) involvement during hospitalization. Our data revealed that combination treatment involving oral corticosteroids with intravenous immunoglobulin (IVIG) had the highest mortality rate in our study since 55% (6/11) of patients who were treated in this manner passed away compared to 11% (2/18) of patients passing away who were treated with solely IVIG and 33% (1/3) who were treated with only supportive care. Our study also demonstrates the addition of etanercept and cyclosporine treatment in the second time period we studied: 2008-2015 versus the earlier time period of 1999-2007. None of the patients in our study who were treated with therapies including cyclosporine and/or etanercept passed away. Our study sheds light on a possible beneficial role of cyclosporine and etanercept for the treatment of SJS and TEN and reinforces the necessity of a multidisciplinary care team for patients.

The effect of probiotics for environmental cleaning on hospital-acquired infection in a burn centre: The results of a non-randomised controlled prospective study

Background. A retrospective analysis was done to correlate recorded clinical infections with laboratory cultures to report on the incidence of hospital-acquired infections (HAIs) and the impact of probiotics for environmental cleaning in our burn centre. Objectives. To assess the effect of probiotics for environmental cleaning in a tertiary burn unit on HAIs. Methods. We used the electronic content management system of the hospital to access patient files for 2017 and February 2018. All patients with clinical records showing a new infection after admission for ≥48 hours and who required antibiotics were recorded as HAIs. Results. The total number of HAIs for 2017 was 167. If the two test months (TM) when probiotics were used are excluded for 2017, then the HAIs numbered 151 for the remaining control months (CM). Thus during 2017 there were 16 HAIs in the TMs. The percentage difference of the monthly average of HAIs for the TM and the CM is a 55.89% reduction, with a statistically significant p-value &lt;0.005. Conclusion. Our reduction in HAIs is consistent with the findings of other high-level-of-evidence studies in the literature. We can recommend the use of probiotics for environmental cleaning in a burn centre.

Burn Injury Characteristics and Outcomes among Hospitalized Patients in Tertiary Burn Unit

Background: Burn Injuries constituted an important high priority health problem especially in little andmedium salary republics including Iraq.Objective: Identify the characteristics of burn injuries and its outcomes among patients admitted to Al-HillaTeaching Hospital burn unit–Babylon Province Iraq.Method: This was observational cross sectional hospital based study, burn injury data were collected fromthe interview of burn patients admitted to burn unit of Al Hilla Teaching Hospital,Babylon Province, Iraqduring the last four months during the year 2019, using special data collection questionnaire included; burnpatients demographic characteristics, period of hospital stay (days), size of total body surface areas, degreesof burn injuries, types of treatment and the outcomes.Results: The highest proportion of cases were males, the majority of patients were young adults andchildren, about four fifth of cases were rural dwellers (78%). The means and standard deviations of durationof hospitalization and total surface areas were 5.72+53 days and 21,9+21.1 respectively, about two thirdsof the study group were second and or third degrees burn, only 12% of patients were treated surgically bywound excision and skin graft, 67% of patients were cured while the case fatality rate was 9%.Conclusion: Children, males and poorly educated patients were the majority of cases, about nine in tenthwere treated conservatively and about two thirds of cases were cured.

A prospective study comparing the FLIR ONE with laser Doppler imaging in the assessment of burn depth by a tertiary burns unit in the United Kingdom.

Introduction:Laser Doppler imaging (LDI) is the ‘gold standard’ tool for the assessment of burn depth. However, it is costly. The FLIR ONE is a novel, mobile-attached, thermal imaging camera used to assess burn wound temperature. This study compares the FLIR ONE and LDI in assessing burn depth and predicting healing times.Methods:Forty-five adult patients with burn wounds, presenting at 1–5 days, were imaged with the FLIR ONE and LDI. Infected, chemical and electrical burns were excluded. Healing potential was determined by comparing wound and normal skin temperature for the FLIR ONE and blood flow changes with the LDI. Healing potential was categorised into wounds healing in less than and over 21 days. Pearson’s test was used to determine the correlation between changes in wound temperature and healing potential.Results:Percent total body surface area (%TBSA) was in the range of 0.5–45. FLIR demonstrated a sensitivity of 66.67% and specificity of 76.67% in predicting healing within 21 days, while LDI demonstrated a sensitivity of 93.33% and specificity of 40%. The FLIR ONE showed a significant difference in the mean temperature changes between burns that healed in less than (0.1933 ± 0.3554) and over 21 days (–1 ± 0.4329) (P = 0.04904). Pearson’s test showed a significant correlation between the difference in wound and normal skin temperature with healing times (P = 0.04517).Conclusion:The inexpensive FLIR ONE shows a significant correlation between changes in wound temperature and healing times. It is useful in predicting healing within 21 days. However, evaporative cooling at the wound surface can lead to overprediction of healing times and overtreatment.Lay Summary Background Laser Doppler imaging is currently the main tool for burn depth assessment. It works by analysing the blood flow in a burn wound. Based on these findings, it can predict the depth of the burn injury and predict if it will heal in less than or over 21 days. The main problem is that it is costly. The FLIR ONE is a novel, mobile-attached, thermal imaging camera. It can be used to assess burn depth by comparing the temperature of the burn wound to the surrounding normal skin. This information can then be used to predict healing times into less than and over 21 days. The issue being explored The usefulness of the FLIR ONE in assessing burn depth and predicting healing time when compared to the LDI. How was the work conducted? Forty-five adult patients who sustained a burn injury within the last five days were imaged with both the FLIR ONE and LDI. Those with infected, electrical or chemical burns were excluded. Healing potential was determined by comparing the temperature of the burn wound with normal skin for the FLIR ONE and by changes in wound blood flow with the LDI. Healing potential was categorised into wounds healing in less than and over 21 days. The correlation between the temperature changes of the burn wound and healing time was evaluated for the FLIR ONE. What we learned from the study This study was able to demonstrate that the FLIR ONE showed a significant correlation between the temperature difference between the burn wound and normal skin with healing times. When compared with the LDI, the FLIR ONE was useful in predicting if a burn wound will heal in less than 21 days. The FLIR ONE has advantages over the LDI, it is low cost, portable and produces instantaneous images. Ultimately, this developing technology may increase access to higher standard burn care in centres where LDI is not affordable.

The scourge of burn contractures: Who will bell the cat?

IntroductionMajority of burn injuries occur in developing world. There have been many advances in burn care management. But this advance comes at a price of ever increasing burn sequel of scarring. Burn scar contractures, in spite of being preventable, continue to be a common reality in our world. This paper aims to evaluate the lacunae in burn care leading to formation of contractures, to evaluate common sites of contractures, practice of advising splintage and anti-deformity positioning. ProcedureThis retrospective observational study was conducted over a period of six years (January 2010–December 2015) at a tertiary Burn unit in Mumbai (India). The records of burn contracture patients were scrutinized to obtain the data regarding patient’s socio-demographic profile, details of burn injury, splinting and exercises advised and details of surgeries required. Data was tabulated and analysed. ResultsThere was a significantly lower prevalence of advice regarding splinting, mobilization exercises and pressure garments. The prevalence of early surgery was also found to be low. ConclusionsAttempt has been made to identify the factors affecting the prevalence of burn scar contractures. Authors recommend that efforts be made for improving the knowledge of the treating doctors. Also, efforts should be made to increase awareness of burn prevention and emergent management.

A study of unusual burns at a tertiary burn unit: a prospective study

Background: Unusual burns are not uncommon. They occur in the industrial as well as the domestic side. These are mainly burns due to chemicals, tar, fire walk and lightning burns. These burns occur as a result of improper handling of chemicals with poor safety measures or due to accidents. Here, we discuss about these burns, their epidemiology with treatment and preventive measures.Methods: The study was conducted at a tertiary care burn centre for a period of two years from Jan 2009 to Jan 2011. Forty-four patients with unusual burns were admitted and evaluated with a thorough history and clinical examination. Initial resuscitation was done followed by specific therapy in each of the cases.Results: The forty-four patients with unusual burns were categorized into chemical burns, lightning burns, tar burn, camphor burns, fire walk burns and miscellaneous types. These burns mostly involved adult males and were generally due to domestic reasons. 93% were due to accidents of which most of them were of the miscellaneous type (83%).Conclusions: Unusual burns are an important to know as these are occurring with regular frequency in the present days. These burns are usually accidental occurring in industries and in household setups. Proper education and safety measures could reduce the incidence of these unusual burns.

Analysis of psychiatric problems in burn patients in a tertiary burn unit: a prospective study

Background: Burn injuries in our part of the world generally occurs in the lower socio-economic groups. A large part of these patients suffers from underlying psychiatric disorders. This study is to see the prevalence rates and clinical diagnosis of psychiatric disorders and psychosocial problems as a predisposing factor to burns and squeal to burns in our population, hence necessitate the consultation with the psychiatric team management to improve the outcome from the time of critical phase recovery to the rehabilitation phase.Methods: 114 patients admitted with suicidal burns above the age of 15 years were included in the study at Dept. of Plastic, Reconstructive and Burn Surgery, Govt. Kilpauk Medical College and Hospital for a period of 2 years and evaluated.Results: The patients were mostly married females in the 2nd to 3rd decade of life. Most of them had some form of pre-morbid psychopathology. 60% of patients had &gt;50% burns and only 17% were survivors. After 1 year of psychotherapy, most patients had returned to normalcy.Conclusions: In our study deformity related depression were more after recovery hence prevention of deformity with usage of appropriate splintage, wound management, early grafting and intense physiotherapy will produce a drastic change in their wellbeing and coping ability and help long term rehabilitation and return to normalcy.

An algorithmic approach to reconstruction of complex scalp defects in electric burns

Introduction: Reconstruction of scalp defects due to electrical burns poses a challenge to the reconstructive surgeon and a lot of controversy exists in decision making with regards to the timing of surgery, debridement of the underlying bone, choice of flap cover and the role of trephining. There also is a paucity of literature on this subject probably because of its rare incidence. Proper management of these cases could prevent serious complications like osteomyelitis of the underlying bone, epidural abscess and cosmetic disfigurement. Materials and Methods: The study was conducted at a tertiary care burn unit. A retrospective analysis was done of the patients with electrical burns involving the scalp, between 2010 and 2015. Results: In the study period there were 135 cases of electrical burns. Out of these 9 patients had electrical burns involving the scalp. Two patients with scalp defects in which the pericranium was intact after debridement were managed with skin grafts, 4 patients with moderate sized scalp defects were managed with local flaps, and in 3 patients free flaps were used to reconstruct large scalp defects. Literature search showed only two other similar case series with free flap reconstruction. We have proposed a management protocol for scalp defects in electrical burns based on our experience and a review of the available literature. Conclusion: Meticulous debridement of infected/non-viable bone is the key to a good outcome. In view of progressive tissue necrosis in electrical burns delayed reconstruction is preferred. Free flaps are the standard of care for extensive scalp defects. Local flaps and skin grafting can be used for smaller scalp defects. Secondary procedures are required for management of the alopecia and optimal cosmetic outcome.

Universal contact precautions do not change the prevalence of antibiotic resistant organisms in a tertiary burn unit

ObjectiveThe prevalence of antibiotic-resistant organisms (ARO) in burn units is increasing worldwide and contributes significantly to morbidity and mortality. Study aims are to describe the burden of AROs in burn patients admitted to a tertiary burn unit, to evaluate the impact of contact precautions implemented after an outbreak of antibiotic-resistant Acinetobacter baumannii, and to identify possible predictors of ARO acquisition. MethodsData of burn inpatients between 2006 and 2010 were retrospectively reviewed. The antibiotic susceptibility profiles of ARO colonization/infection at or after admission were reviewed in detail. Organisms of interest included: methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus (VRE), extended-spectrum beta-lactamase-producing Escherichia coli, and carbapenem-resistant Pseudomonas and Acinetobacter. Univariate and multivariate logistic regression analysis was employed with the p-value set at 0.05. ResultsComplete data analysis was available for 340 patients. The mean age was 41.8 years with male predominance. Among the AROs, the most prevalent was MRSA from clinical specimens. Prior to contact precaution implementation, the prevalence of all AROs was 27.9%, compared to 27.6% afterwards. There was an increase in Pseudomonas and VRE isolates and a disappearance of Acinetobacter. The most common isolate sites were the burn wounds. ICU stay, burns >20% TBSA, and surgical management were significant predictors of ARO acquisition. ConclusionThis study describes the ARO profile of burn patients admitted to a tertiary burn unit. The results suggest that implementation of unit-wide contact precautions may not significantly reduce the frequency of AROs among burn patients. Contact precautions for patients transferred from the ICU, undergoing surgery, and large burns may be of benefit.

Telehealth for paediatric burn patients in rural areas: a retrospective audit of activity and cost savings

IntroductionSince 2005, the Western Australian paediatric burn unit has provided a state-wide clinical consultancy and support service for the assessment and management of acute and rehabilitative burn patients via its telehealth service. Since then, the use of this telehealth service has steadily increased as it has become imbedded in the model of care for paediatric burn patients. Primarily, the service involves acute and long term patient reviews conducted by the metropolitan-located burn unit in contact with health practitioners, advising patients and their families who reside outside the metropolitan area thereby avoiding unnecessary transfers and inpatient bed days. A further benefit of the paediatric burn service using telehealth is more efficient use of tertiary level burn unit beds, with only those patients meeting clinical criteria for admission being transferred. AimTo conduct a retrospective audit of avoided transfers and bed days in 2005/06–2012/13 as a result of the use of the paediatric Burns Telehealth Service and estimate their cost savings in 2012/13. MethodA retrospective chart audit identified activity, avoided unnecessary acute and scar review patient transfers, inpatient bed days and their associated avoided costs to the tertiary burn unit and patient travel funding. ResultsOver the period 2005/06–2012/13 the audit identified 4,905 avoided inpatient bed days, 364 avoided acute patient transfers and 1,763 avoided follow up review transfers for a total of 1,312 paediatric burn patients as a result of this telehealth service. This paper presents the derivation of these outcomes and an estimation of their cost savings in 2012/13 of AUD 1.89million. ConclusionThis study demonstrates avoided patient transfers, inpatient bed days and associated costs as the result of an integrated burns telehealth service.

12 Years Analysis of Bacterial Isolates and Their Antibiotics Sensitivity in a Tertiary Care Burns Unit

The aim of this study was to review the changes in distribution of bacterial populations and their antibiotic sensitivity over 12 years in a tertiary care burn unit. Understanding the periodic variation of isolated microorganisms and their antibiotic sensitivity helps in selecting the appropriate antimicrobial therapy before culture and sensitivity are reported. It also aids the design of antibiotics protocols. The study was retrospective. The data were obtained from the computerised hospital medical record system and the burn unit records. Overall, Pseudomonas aeruginosa was the most commonly isolated microorganism followed by Staphylococcus aureus, Meticillin-resistant Staphylococcus aureus (MRSA), and the genus Acinetobacter. Acinetobacter isolation rose rapidly and became more prevalent than P. aeruginosa over the last three years. Other organisms became isolated more frequently, such as Klebsiella pneumoniae, but their overall prevalence was low. Pseudomonas species frequency of isolation declined. P. aeruginosa, MRSA, and other microorganisms showed increasing sensitivity to a number of antibiotics. MRSA remained highly sensitive to vancomycin, and Acinetobacter showed high resistance to all antibiotics tested except colistin. K. pneumoniae was highly resistant to most of the antibiotics tested except the carbapenems, but the resistance to carbapenems increased over time.

Self-inflicted burn injuries in the Australian context.

The primary objective was to calculate the number of self-inflicted burn injuries of all admissions in an Australian hospital burns unit. The secondary objectives included examining the demographic profile, length of stay and co-morbidity of mental illness in these cases compared with the total admissions to the burns unit. A retrospective study of medical records was conducted at a tertiary burns unit over a 5-year period. A total of 33 self-inflicted burn injury cases were identified which represented 2.2% of all burns unit admissions. These patients were 70% male, the average age was 36.1 years and 11 were born overseas, which was similar to the profile of all admissions. Twenty-four (73%) patients were diagnosed with a mental illness, compared with 14% for all admissions. The average length of stay was 52 days, compared with the burns unit average of 12 days. While the percentage of self-inflicted burn cases of all burns unit admissions was low, these cases have a greater burden of care due to their longer admission time and higher frequency of co-morbid mental illness. This finding supports the need for close involvement of consultation liaison psychiatry teams within a burns unit.

Epidemiology and referral patterns of burns admitted to the Burns Centre at Inkosi Albert Luthuli Central Hospital, Durban

RationaleThe epidemiology, referral patterns and outcome of patients admitted to a tertiary burns unit in southern Africa were reviewed. Materials and methodsThe charts of all patients with thermal injury presenting to the Burns Centre at Inkosi Albert Luthuli Central Hospital (IALCH) between 1 January 2008 and 31 December 2010 were reviewed. Information collected included age, gender, past medical history, cause of burn, size of burn, presence of inhalation injury, time before admission, time to excision, length of hospital stay, complications and mortality. FindingsFour hundred and sixty two patients were admitted, 296 (58%) children and 193 (42%) adults. The female–male ratio was 1:1.13. The mean total body surface area (TBSA) burned was 12% (interquartile range 8–25%) for children and 18% (interquartile range 10–35%) for adults. Common causes for the burns were in children: hot liquids (71%) and open flame (24%). Major causes in adults were: open fire (68%) and hot liquids (25%). Epilepsy was a contributing factor in 12.7%. Inhalation injury was seen in 13.6% of adults and 14.3% of children with a flame burn.Forty-four percent of referrals from general surgical units were for burns <30% in adults, and 30% for burns <10% in children. More than one in four patients was referred between 1 and 6 weeks post-injury.Overall mortality was 9.1% (5.7% in children and 15.1% in adults). Complications occurred in 21.6% of children and 36.7% in adults, the most common being lung complications such as ARDS and infection, severe sepsis, skin graft failure and contractures. The length of stay was 1 day/% TBSA burn for all burns in children and for burns between 10 and 49% in adults. ConclusionsThe epidemiology and outcome of severe burns referred to the Burns Centre at IALCH is similar to those in other units in Africa. The management and referral of burns patients by other hospitals are inappropriate in a significant number of patients.

The increasing trend in alcohol-related burns: It's impact on a tertiary burn centre

Introduction The incidence of alcohol-related hospital admissions is a worldwide problem and currently costs the UK National Health Service approximately 4% of its annual budget. 40% of men and 22% of women drink over the recommended UK weekly allowance. The purpose of our study was to examine the trend in alcohol-related admissions to a tertiary burns unit over a 5-year period. Methodology All patients admitted were documented for alcohol-related burn, and history of alcohol dependence. Results 1293 patients admitted between 2003 and 2008 were included in the study. The number of alcohol-related burns were as follows: 2003: 6%; 2004: 10%; 2005: 16%; 2006: 9%; 2007: 19%; 2008: 19%. This increasing trend was highly significant ( p < 0.0001). Alcohol-related burns had a higher incidence of flame injury (60%) and a subsequent longer length of stay (12.5 vs. 7.9, p = 0.04). Alcohol dependence was noted in 54% of all alcohol-related burns and in 5% of the non-alcohol-related burns. Discussion The number of alcohol-related burns admitted to a tertiary burn unit is increasing and now comprises of nearly 20% of all admissions. This highlights the growing burden of alcohol on health and the need to address it at both a national and regional level.

Use of Colistin in a Pediatric Burn Unit in Argentina

The use of sulfomethate sodium colistin for the treatment of infections caused by multiple drug resistant (MDR) Gram-negative microorganisms were studied in a burn unit to evaluate the safety of this drug. A prospective chart review of pediatric patients treated with intravenous colistin in a tertiary burn unit between January 2005 and December 2006 was performed. Forty-five courses of intravenous colistin treatment administered to 45 children were evaluated in the study period. Fourteen patients (31%) were infected by Pseudomonas aeruginosa spp and 20 patients (44.5%) by Acinetobacter spp and an association of both bacteria was found in six patients (13.5%).The mean age of the patients was 52 months (range, 2 to 168 months), and 28 patients (62%) were men. The percentage of burnt body surface was between 9 and 87% (mean, 38%). Forty patients (89%) were infected by MDR organisms. Colistin was empirically indicated in five patients (11%) with burn wound sepsis 7 days after admission to the unit despite negative cultures. Burn wound sepsis was the most frequent focus of infection in 19 patients (42%). In 14 patients (31%), burn wound infection occurred without sepsis. Intravascular catheter-related bacteremia occurred in three patients (7%) and bacteremia in one (2%). Three patients had pneumonia (7%), three osteomyelitis (7%), and two urinary tract infection (4%).The length of treatment with colistin was between 3 and 92 days (median, 21 days). Only one patient (2%) died for reasons other than infection. None of the children developed increases in serum creatinine concentrations or neurological complications during treatment with colistin. Colistin seems to be a safe drug in selected cases of infections with MDR Gram-negative microorganisms. Further studies are needed to confirm these results.

A 12-year retrospective study of non-burn skin loss (burn-like syndromes) at a tertiary burns unit in a developing country

Background A retrospective study of the presentation, etiology, and prognosis of non-burn epidermal loss managed at the Lagos University Teaching Hospital Nigeria over a 12-year period. Materials and methods Admission records of patients managed for non-burn skin loss were retrieved from the medical records. Demographic details of the patients, the initial diagnosis, final diagnosis, treatment and outcome of treatment was noted. Results A total of 23 patients were identified, 17 (74%) had idiosyncratic drug reactions. Of this 17, 6 (26%) had Steven Johnson Syndrome, 6 (26%) had Steven Johnson Syndrome/toxic epidermal necrolysis while 5 (22%) presented with toxic epidermal necrolysis. Three of the five patients with toxic epidermal necrolysis died. The age range of patients with idiosyncratic adverse drug reactions was 2–28 years, mean, 10.18 ± 1.44 years and male to female ratio of 1:1.83. The body surface area involved ranged from 8 to 78%; mean 26.65 ± 6.08%. The agents suspected for the reactions were Co-trimoxazole (41.2%) and combination of Co-trimoxazole, and Fansidar ® (17.6%). Other conditions seen were two (9%) Staphylococcal Scalded Skin Syndrome, three (13%) had Necrotizing Faciitis, one of whom was HIV positive and died. One (4%) patient presented with pemphigus vulgaris. The presentation and management of the patients was discussed.