543 Escharotomy Incisions in the Burn Foot and Toe with Compartment Syndrome

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S120-S120
Author(s):  
Greg S Lifferth ◽  
Bryan J Roth ◽  
Marisse Lardizabal ◽  
Areta Kowal-Vern ◽  
Kevin N Foster ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Compartment Syndrome ◽  
Total Body Surface Area ◽  
Retrospective Chart Review ◽  
Burn Injuries ◽  
Metatarsal Bones ◽  
Fat Level ◽  
Total Body ◽  
Extremity Amputation ◽  
Effective Site

Abstract Introduction Patients with burn injuries are at risk for lower extremity compartment syndrome, especially if the injury is circumferential. The hypothesis was that two dorsal escharotomy incisions to release foot and toe compartment syndrome would be most efficacious in the prevention of lower extremity amputations. Methods This was a retrospective chart review of foot compartment syndrome in burn patients between January 2001 and May 2019. Results The study consisted of 59 feet from 32 patients who had been admitted to the Burn Center for thermal injury. The patient age was a mean±sd of 29±30 years, and 41±29 as the % total body surface area (%TBSA); there were 19 males and 13 females. All patients had received fluid resuscitation on admission. Twenty-one (66%) of the patients did not require amputations after undergoing a median of two incisions (range 1–5); 6 of 59 (11%) required fasciotomies. Compared to medial or dorsal or multiple echarotomies, the majority of patients who underwent two dorsal foot escharotomies did not require amputations, p = .0001. Significantly more patients were alive with no amputation 15 (50%) compared to 4 (13%) (dead with amputations), p = .02. Survivors were significantly younger than the non-survivors (median 20 and range1-69) compared to the non-survivors (48, 12–59), p =.04. The survivors also had significantly less severe %TBSA median 22 (range 2–75) versus 83 (35–95) %TBSA, p < .0002. Dorsal/Lateral incisions had the highest number of amputations. Conclusions Foot dorsal compartment release is the most effective site for escharotomies in the treatment of burn-induced compartment syndrome. It does not require more than two incisions at the skin/fat level and over the second and fourth metatarsal bones on the dorsal part of the foot to decrease the lower extremity amputation rate in the majority of cases.

725 Escharotomy Incisions in the Burn Foot and Toe with Compartment Syndrome

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S194-S194
Author(s):  
Gregory Lifferth ◽  
Bryan Roth ◽  
Marisse Lardizabal ◽  
Areta Kowal-Vern ◽  
Kevin N Foster ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Compartment Syndrome ◽  
Burn Injury ◽  
Total Body Surface Area ◽  
Retrospective Chart Review ◽  
Burn Injuries ◽  
Metatarsal Bones ◽  
Fat Level ◽  
Total Body ◽  
Effective Site

Abstract Introduction Patients with burn injuries are at risk for lower extremity compartment syndrome, especially if the injury is circumferential. The hypothesis was that two dorsal escharotomy incisions to release foot and toe compartment syndrome would be most efficacious in the prevention of lower extremity amputations. Methods This was a retrospective chart review of foot compartment syndrome in burn patients between January 2001 and May 2019. Results The study consisted of 59 feet from 32 patients who had been admitted to the Burn Center for thermal injury. The patient age was a mean±sd of 29±30 years, and 41±29 as the % total body surface area (%TBSA); there were 19 males and 13 females. All patients had received fluid resuscitation on admission. Twenty-one (66%) of the patients did not require amputations after undergoing a median of two incisions (range 1–5); 6 of 59 (11%) required fasciotomies. Compared to medial or dorsal or multiple echarotomies, the majority of patients who underwent two dorsal foot escharotomies did not require amputations, p = .0001. Significantly more patients were alive with no amputation 15 (50%) compared to 4 (13%) (dead with amputations), p = .02. Survivors were significantly younger than the non-survivors (median 20 and range1-69) compared to the non-survivors (48, 12–59), p =.04. The survivors also had significantly less severe %TBSA median 22 (range 2–75) versus 83 (35–95) %TBSA, p < .0002. Dorsal/Lateral incisions had the highest number of amputations. Conclusions Foot dorsal compartment release is the most effective site for escharotomies in the treatment of burn-induced compartment syndrome. It does not require more than two incisions at the skin/fat level and over the second and fourth metatarsal bones on the dorsal part of the foot to decrease the lower extremity amputation rate in the majority of cases. Applicability of Research to Practice This research was a critical appraisal of the safest escharotomy foot incisions for compartment syndrome to avoid possible amputations in burn injury.

Sun heated surfaces are an environmental hazard for young children

2019 ◽  
Vol 139 (5) ◽  
pp. 264-270
Author(s):  
YM Choi ◽  
T Chopra ◽  
D Smith ◽  
S Moulton
Keyword(s):  
Burn Injury ◽  
Healthcare Providers ◽  
Total Body Surface Area ◽  
Retrospective Chart Review ◽  
Burn Injuries ◽  
Contact Type ◽  
Common Causes ◽  
The Mean ◽  
Total Body ◽  
Mean Time

Aims: Children commonly sustain heat contact type burn injuries from sun heated surfaces during the summer months in hot, sunny climates. The aim of this study was to review the causes and outcomes in a series of heat contact type burns sustained by children who touched hot sun heated surfaces. Methods: A retrospective chart review was performed to identify all children who sustained burn injuries due to naturally heated surfaces and were treated between January 2012 and December 2017 at Children’s Hospital Colorado. Demographics of the subjects and clinical data regarding their burn injuries were collected. Results: A total of 58 children were identified over the study period, involving 118 burn wounds. The median age was 17 months (interquartile range = 14–23), and 33 were male (57%). Mean total body surface area (TBSA) was 1.4% (standard deviation = 1). A foot was the most commonly involved area, affecting 36 subjects (62%). The most common causes of these burn injuries were metal thresholds ( n = 7, 12%) and metal covers or lids ( n = 5, 9%) outside the home. The depth of the burn injury was partial thickness in 57 children (98%). The mean time to heal was 12 ± 6 days, and the majority of injuries occurred in June ( n = 28, 48%). Conclusion: Heat contact type burn injuries from sun heated surfaces commonly affect children ⩽2 years of age during the summer months, and the majority of these injuries occur around the home environment. They are preventable injuries, and this information should be used for prevention and education materials for parents and healthcare providers, who reside in hot, sunny climates.

Prevalence of Psychiatric Disorders in Burn Patients in a Tertiary Care Hospital

2021 ◽  
Vol 15 (11) ◽  
pp. 3389-3391
Author(s):  
Imran Khan ◽  
Taimur Khan ◽  
Shakil Asif ◽  
Syed Azhar Ali Kazmi ◽  
Subhan Ullah ◽  
...  
Keyword(s):  
Surface Area ◽  
Body Surface Area ◽  
Body Surface ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Total Body Surface Area ◽  
Burn Injuries ◽  
Care Hospital ◽  
Burn Patients ◽  
Total Body

Background and Aim: Burn injuries patients generally suffer from various psychological and mental disorders especially in lower socio-economic groups. It can adversely affect their wellbeing and health. Proper consultation and clinical diagnosis need to be carried out on burns injuries patients from the early critical phase to rehabilitation phase recovery. The current study's aim was to determine the prevalence of psychiatric disorders in burn patients in a tertiary care hospital. Materials and Methods: This cross-sectional study was conducted on 82 attempted burn suicides, adult patients in Khattak Medical Center Peshawar, Khyber Teaching Hospital Peshawar and Divisional Headquarter hospital, Mirpur AJK for duration of six months from June 2020 to December 2020. All the patients admitted with suicides burns were of either gender and had ages above 15 years. The convenience technique was used for sampling. The patients’ demographic details such as psychiatric illness, self-immolation act motivation, burn injury depth, burn total body surface area, inhalation injury, hospitalization duration, and mortality was recorded on pre-designed proforma. Data analysis was carried out with SPSS version 20. Results: The mean age of all 82 patients was 28.9±5.2 with an age range of 14 to 55 years. Of the total, 66 (80.5%) were female while 16 (19.5%) were male. In this study, the most frequent suicidal attempt was made by the marital conflicted patients 50 (61%) followed by love affair failure 8 (9.7%). An overall mean of 53.6±19.6 was observed for total body surface area affected with a range of 15-100%. The hospital duration mean was 8.2±5.9 with a range of 1-38 days. Young, married, and rural area illiterate housewives were the most common self-inflicted/suicide burn injuries. The prime cause of such injuries was getting married. The mortality rate was found at 82.3%. Conclusion: Our study concluded that patient’s well-being and mental health could be severely affected by burn injuries. Prevalent depression was noted among severe burn injuries patients. Depression related to deformity could be prevented with early grafting, wound management, proper splinting, coping ability, intense physiotherapy, and long-term rehabilitation. Keywords: Burn; Depressed mood, Psychiatric morbidity, Posttraumatic stress disorder

Burns and Electrical Injuries

2019 ◽  
pp. 409-414
Author(s):  
Brandon T. Nokes ◽  
Ayan Sen
Keyword(s):  
Critical Care ◽  
Surface Area ◽  
Body Surface ◽  
Burn Injury ◽  
Total Body Surface Area ◽  
Burn Injuries ◽  
Burn Severity ◽  
Thermal Burn ◽  
Total Body ◽  
Electrical Injuries

Burn injuries may cause morbidity and death, and patients may have widely variable presentations and outcomes. This chapter focuses on the critical care aspects of burn injury and management issues of burn and electrical injuries. Burns are classified according to the amount of total body surface area (TBSA) affected, the depth of burn, and the type of exposure associated with the burn. More specifically, burns can be chemical, electrical, or thermal. Burn severity is determined by the depth of involvement.

Microbiology and Infection Profile of Electric Burned Patients in a Referral Burn Hospital in Mexico City

2019 ◽  
Vol 41 (2) ◽  
pp. 390-397 ◽  
Author(s):  
Luis Esaú López-Jácome ◽  
Tatiana Chávez-Heres ◽  
Noé Becerra-Lobato ◽  
María de Lourdes García-Hernández ◽  
Edgar Samuel Vanegas-Rodríguez ◽  
...  
Keyword(s):  
Mexico City ◽  
Total Body Surface Area ◽  
Multidrug Resistant ◽  
Burn Injuries ◽  
Burn Patients ◽  
Gram Negative ◽  
Young Males ◽  
Total Body ◽  
Electric Burns ◽  
Complications And Mortality

Abstract Electrical burn injuries are one of the most severe forms of trauma. This study aims to investigate the infection complications in electrical burn patients in a referral hospital in Mexico City. A longitudinal retrospective study was conducted, involving electrical burn patients admitted from April 2011 to December 2016. Demographic and clinical data including type of electric burns, infection complications, and mortality was sought. Data were collected at admission and daily until discharge. Number and type of infections and microorganism isolations were sought. Risk factors for death were analyzed. A total of 111 patients were included, of which 96.4% were males, mean age of 31.6±16.22, most injuries were high voltage associated. The total body surface area average was 27.8% ± 19.63. The overall infection rate was 72.9 cases per 100 patients. Mortality was observed in 4 (3.6%) patients. About 59.1% (443/749) had growth for Gram-negative bacteria. Multidrug-resistant Pseudomonas aeruginosa was the most frequent microorganism isolated. Fungi were present in 4.9% of cases. Electrical burn injuries occurred in young males in our study. Infection was frequent, most of them caused by Gram-negative rods with an important rate of antimicrobial resistance; however, an important microbial diversity was present.

scholarly journals The epidemiology of burn injury among children during COVID-19 19 pandemic and WFH policy in Malang, East Java, Indonesia

2021 ◽  
Vol 10 (4) ◽  
pp. 744
Author(s):  
Herman Yosef Limpat Wihastyoko ◽  
Arviansyah Arviansyah ◽  
Erdo Puncak Sidarta
Keyword(s):  
Comparative Analysis ◽  
Body Surface ◽  
Clinical Characteristics ◽  
Burn Injury ◽  
Total Body Surface Area ◽  
Burn Injuries ◽  
Work From Home ◽  
Injury Group ◽  
Significant Difference ◽  
Total Body

Work from home (WFH) mandate is one of the major changes known during this pandemic, aimed as a preventive way to mitigate the spread of the COVID-19 virus. This study aimed to observe the characteristics of pediatric burn injury during COVID-19 pandemic and WFH mandate's impact on pediatric burn injury admission at some Hospital burn centers in Malang. Every patient’s age, gender, clinical characteristics, parent's background, and other variables such as the possession of siblings, response time using our burn registry form, and comparative analysis of the incident in WFH housewife mother were assessed. The majority were in the group age of under five years old group age (70%) with a mean of 5.5 years. The most frequent part of the burn injured is extremity 36.7%, and hot liquid dominates as the cause of the injury 73.3% with the total body surface area of burn injury group >10% is the most common 56.7%. The burn injury incident happened more frequently in mothers with children less than two in both groups. This study showed that the increase in increasement of the pediatric burn injury during COVID-19 pandemic between housewife mother and WFH mother has no significant difference also showed that parent especially mother unable to supervise the children during WFH. Strategies to mitigate pediatric burn injuries during WFH should be thoughtfully implemented.

720 Scalds and Contact Burns: Are They Really Different?

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S191-S191
Author(s):  
Adam Singer ◽  
Evyatar Baer ◽  
Henry Thode
Keyword(s):  
Total Body Surface Area ◽  
Retrospective Chart Review ◽  
Stepwise Logistic Regression ◽  
Full Thickness ◽  
Chi Square ◽  
Included Patient ◽  
Body Location ◽  
Total Body ◽  
Fire Flame ◽  
Burn Depth

Abstract Introduction Prior studies comparing scalds and contact burns rarely address the affect of burn etiology on burn depth. However, it is commonly believed that scalds tend to heal faster than similarly sized contact and flame burns. As a result, expectant therapy is often preferred after scald injuries. We compared the percentages of full-thickness burns based on burn etiology controlling for burn size, location and patient age. We hypothesized that the percentage of full thickness burns would be lower after scalds compared with contact and flame burns. Methods We performed a retrospective chart review of a prospectively collected burn registry of all patients admitted to a regional burn center between 2000–2010. Data collection included patient and burn characteristics including age, gender, body location, and burn etiology. We compared the percentages of full thickness burns among scald, contact and flame burns using Chi-square tests. Stepwise logistic regression was used to adjust for age, location, and burn size. Results There were 1038 patients in the study with either scald (n=537, 52%), fire/flame (n=434, 42%) or contact (n=67, 6%) burn. Mean (SD) age was 29 (25); 75% were male. Mean (SD) total body surface area (TBSA) was 11 (13)%. Mean (SD) length of stay was 10 (18) days. The percentages of full thickness burns by etiology were scalds 13.1%, fire/flame 34%, and contact burns 45% (P< 0.001). Patients with scalds were younger (22+/-24) than patients with contacts (32+/-28) and fire/flame (38+/-22) burns. Multivariate analysis for predicting full thickness burns found that compared with contact burns, scalds were less likely full thickness (OR 0.23, 95%CI 0.11–0.48) while fire/flame burns were as likely to be full thickness (OR 0.54, 95%CI 0.26–1.15). TBSA and age were also associated with full thickness burns (OR 1.06, 95%CI 1.04–1.09 and OR 1.015, 95%CI 1.007–1.024, respectively). Burns on the head and neck were less likely to be full thickness (OR 0.30, 95%CI, 0.11–0.82). Conclusions Scald burns are significantly less likely to be full thickness than contact or fire/flame burns. Applicability of Research to Practice Based on these results, expectant therapy may be more appropriate for scalds than contact or fire/flame burns.

scholarly journals Soluble CD163: A novel biomarker for the susceptibility to sepsis in severe burn injuries

2011 ◽  
Vol 44 (01) ◽  
pp. 118-124
Author(s):  
Andrzej Piatkowski ◽  
Gerrit Grieb ◽  
Rittuparna Das ◽  
Ahmet Bozkurt ◽  
Dietmar Ulrich ◽  
...  
Keyword(s):  
Time Course ◽  
Burn Injury ◽  
Total Body Surface Area ◽  
Serum Levels ◽  
Burn Injuries ◽  
Burn Patients ◽  
Serum Samples ◽  
Soluble Cd163 ◽  
Bivariate Correlation ◽  
Total Body

ABSTRACT Objective: Soluble CD163 (sCD163) has been previously shown to play a role in inflammatory and infectious diseases. This study, for the first time, investigates the characteristics and potential values of sCD163 in burn patients. A first look is taken on the changes of sCD163 levels in burn patients by comparing predefined subgroups at single time points. Materials and Methods: Serum samples of 18 patients with burn injuries were collected for biochemical analysis at the time of admission and in a chronological sequence of 12, 24, 48 and 120 h after the injury and were matched to clinical parameters. Statistical analysis was performed using the Mann-Whitney test, Wilcoxon signed rank and Pearson bivariate correlation. Results: Patients with sepsis showed a significant increase of sCD163 levels. sCD163 was correlated with leukocytes (P=0.035) over the time course of 120 h. Patients characterized by a burn size exceeding 25% of the total body surface area (TBSA) showed a significant increase of sCD163 between 12 and 48 h after burn injury (P=0.038). Conclusions: The first view on the characteristics of sCD163 in the serum of burn patients points out that sCD163 seems to be an early indicator for the susceptibility to sepsis. Furthermore, the changes in sCD163 serum levels within the first hours after burn trauma have great potential for early prediction of organ failure after burn injury.

97 Major Psychiatric Illness and Substance Use Disorder Influence Mortality in Major Burn Injury: A Secondary Analysis of the Transfusion Requirement in Burn Care Evaluation (TRIBE) Study

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S66-S67
Author(s):  
John A Andre ◽  
Soman Sen ◽  
David G Greenhalgh ◽  
Tina L Palmieri ◽  
Kathleen S Romanowski
Keyword(s):  
Psychiatric Illness ◽  
Transfusion Requirement ◽  
Total Body Surface Area ◽  
Secondary Analysis ◽  
Inhalation Injury ◽  
Burn Injuries ◽  
Burn Care ◽  
Major Burn ◽  
Total Body ◽  
Care Evaluation

Abstract Introduction Prior studies of burn patients with < 20% total body surface area (TBSA) burns have found that 15.4% of patients have major psychiatric illness (MPI) and 27.6% have Substance Use Disorder (SUD). In patients with small burns, SUD is associated with larger burn size and secondarily with longer length of stay while MPI is associated with longer lengths of stay while not increasing burn size. The purpose of this study was to determine whether MPI or SUD dependence affects outcomes such as mortality in patients with major burn injuries (≥20% TBSA). Methods A secondary analysis from the prospective, randomized, multicenter Transfusion Requirement in Burn Care Evaluation (TRIBE) study was conducted. Patients with MPI and SUD were compared with patients without these disorders. Statistical analysis with chi-square for categorical variables and student’s t-test for continuous variables was conducted. Mortality between those with and without MPI and SUD were analyzed with a multivariable regression analysis. Results A total of 347 patients with a mean age of 43±17 years, 274 men and 73 women, were analyzed. The mean total body surface area burn (TBSA) was 38±18%, and 23% had inhalation injury. In this study population, 29.1% had SUD, 7.5% had MPI, and 2.3% had both. There was no difference with respect to age, gender, TBSA, frailty, or assignment to the liberal or restrictive transfusion strategy based on the presence of MPI, SUD, or both. Inhalation injury was more common in patients with MPI (27%) or SUD (35%) when compared with patients without these comorbidities (18%) or those who have both (11%) (p=0.006). Patients with MPI were more likely to die of their burn injuries (27%) when compared with those with SUD (17%), both (11%), or neither (8%) (p=0.014). On multivariate analysis for mortality controlling for TBSA and inhalation injury, MPI was found to be an independent predictor of death with an odds ratio of 5 (95% confidence interval 1.7–15, p=0.003). Conclusions In burns >20% TBSA, both MPI and SUD influence patient’s likelihood of sustaining inhalation injury. MPI is also independently associated with mortality in the study. Further work must be done to mitigate the effects of mental illness on burn outcomes.

scholarly journals The Effect of Transfer on Outcomes in Burns

2021 ◽  
Author(s):  
Nathan E Bodily ◽  
Elizabeth H Bruenderman ◽  
Neal Bhutiani ◽  
Selena The ◽  
Jessica E Schucht ◽  
...  
Keyword(s):  
Total Body Surface Area ◽  
Infectious Complications ◽  
Burn Injuries ◽  
Burn Patients ◽  
Burn Care ◽  
Burn Center ◽  
Field Versus ◽  
High Acuity ◽  
Total Body ◽  
Inhalation Burn

Abstract Patients with burn injuries are often initially transported to centers without burn capabilities, requiring subsequent transfer to a higher level of care. This study aimed to evaluate the effect of this treatment delay on outcomes. Adult burn patients meeting American Burn Association (ABA) criteria for transfer at a single burn center were retrospectively identified. A total of 122 patients were evenly divided into two cohorts – those directly admitted to a burn center from the field, versus those transferred to a burn center from an outlying facility. There was no difference between the transfer and direct admit cohorts with respect to age, percent total body surface area burned, concomitant injury, or intubation prior to admission. Transfer patients experienced a longer median time from injury to burn center admission (1 vs. 8 hours, p &lt, 0.01). Directly admitted patients were more likely to have inhalation burn (18 vs. 4, p &lt, 0.01), require intubation after admission (10 vs. 2, p = 0.03), require an emergent procedure (18 vs. 5, p &lt, 0.01), and develop infectious complications (14 vs. 5, p = 0.04). There was no difference in ventilator days, number of operations, length of stay, or mortality. The results suggest that significantly injured, high acuity burn patients were more likely to be immediately identified and taken directly to a burn center. Patients who otherwise met ABA criteria for transfer were not affected by short delays in transfer to definitive burn care.

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