596 Homeless Tent Fires: A Descriptive Analysis of Tent Fires in the Homeless Population

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S149-S150
Author(s):  
Samantha Huang ◽  
Katherine J Choi ◽  
Christopher H Pham ◽  
Zachary J Collier ◽  
Justin Dang ◽  
...  
Keyword(s):  
Descriptive Analysis ◽  
Total Body Surface Area ◽  
Skin Grafting ◽  
Inhalation Injury ◽  
Burn Injuries ◽  
Homeless Population ◽  
Health Crisis ◽  
Total Body ◽  
Injury Burden

Abstract Introduction Homelessness is a rising concern as insufficient housing and significant barriers to shelter has led to more individuals seeking shelter in tents. Within this demographic there has been an increased trend of burn injuries from tent fires in regions with large homeless populations. This represents a public health crisis given the long-term psychosocial and functional sequela of burn injuries and existing data that suggest worse outcomes in the homeless population. To our knowledge, homeless related tent fire burns have not previously been studied in the literature. The aim of this study is to describe the characteristics and outcomes of tent fire burn injuries in the homeless population. Methods A retrospective cohort study was conducted involving two verified regional burn centers with patients admitted for tent fire burns between January 1, 2019 to July 31, 2020. Patients were identified as either domiciled or homeless based on medical records at the time of injury. Variables recorded include demographics, injury characteristics, hospital course, and patient outcomes. Results A total of 45 patients were identified. The most common mechanisms of injury were by portable stove accident (29%), assault (27%), bonfire (22%), and tobacco or methamphetamine paraphernalia-related (16%). Median percent total body surface area (%TBSA) burned was 5.5 (IQR 5.5). Maximum depth of injury was second degree in 62% (n=28) of patients and third degree in 38% (n=17) of patients. Burns to the upper extremities were present in 84% of patients and burns to the lower extremities were present in 53% of patients. Median hospital LOS was 9.5 days (IQR=10) and median ICU LOS was 2 days (IQR=4.8), with inhalation injury present in 16% (n=7) of patients. Surgical intervention was required in 40% (n=18) of patients, which included debridement, skin grafting, and escharotomy. In-hospital mortality occurred in 5% (n=2) of patients. Conclusions Burn injuries from tent fires incur significant injury burden to an already vulnerable population, with risk factors that predispose them to poor burn outcomes. Injuries in our cohort were severe enough to require inpatient and ICU level of care. We saw a high proportion of injuries to the extremities, which pose functional and psychosocial challenges to the wellbeing of these patients. Further resources are needed to better prevent tent fires and care for this population.

Homeless Tent Fires: A Descriptive Analysis of Tent Fires in the Homeless Population

2021 ◽  
Author(s):  
Samantha Huang ◽  
Katherine J Choi ◽  
Christopher H Pham ◽  
Zachary J Collier ◽  
Justin M Dang ◽  
...  
Keyword(s):  
Descriptive Analysis ◽  
Total Body Surface Area ◽  
Skin Grafting ◽  
Hospital Length ◽  
Inhalation Injury ◽  
Hospital Length Of Stay ◽  
Homeless Population ◽  
The Us ◽  
Upper And Lower Extremities ◽  
Total Body

Abstract Tent fires are a growing issue in regions with large homeless populations given the rise in homelessness within the US and existing data that suggest worse outcomes in this population. The aim of this study is to describe the characteristics and outcomes of tent fire burn injuries in the homeless population. A retrospective review was conducted involving two verified regional burn centers with patients admitted for tent fire burns between January 2015 and December 2020. Variables recorded include demographics, injury characteristics, hospital course, and patient outcomes. Sixty-nine patients met the study inclusion criteria. The most common mechanisms of injury were by portable stove accident, assault, and tobacco or methamphetamine-related. Median percent total body surface area (%TBSA) burned was 6% (IQR 9%). Maximum depth of injury was partial thickness in 65% (n=45) and full thickness in 35% (n=24) of patients. Burns to the upper and lower extremities were present in 87% and 54% of patients, respectively. Median hospital Length-of-Stay (LOS) was 10 days (IQR=10.5) and median ICU LOS was 1 day (IQR=5). Inhalation injury was present in 14% (n=10) of patients. Surgical intervention was required in 43% (n=30) of patients, which included excision, debridement, skin grafting, and escharotomy. In-hospital mortality occurred in 4% (n=3) of patients. Tent fire burns are severe enough to require inpatient and ICU level of care. A high proportion of injuries involved the extremities and pose significant barriers to functional recovery in this vulnerable population. Strategies to prevent these injuries are paramount.

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 Petrol-related burn injuries presenting to the Victorian Adult Burns Service

2019 ◽  
Vol 2 (2) ◽  
pp. 28-32
Author(s):  
Sadhishaan Sreedharan ◽  
Hana Menezes ◽  
Heathe Cleland ◽  
Stephen Goldie
Keyword(s):  
At Risk ◽  
Total Body Surface Area ◽  
Leisure Activity ◽  
Risk Groups ◽  
Burn Injuries ◽  
Alfred Hospital ◽  
The Mean ◽  
Total Body ◽  
Injury Burden

Introduction: Burns fuelled by petrol are a major cause of injury in Australia and New Zealand. The same quality of explosive ignition that makes petrol so valuable as a fuel can cause injuries when handled carelessly or used for a purpose for which it was not intended. Methods: This was a retrospective cohort study that examined the epidemiology of patients admitted to the Victorian Adult Burns Service (VABS) based at the Alfred Hospital, Melbourne. Data were extracted from the VABS Database on patients presenting over a seven-year period, between 1st July 2009 to 30th June 2016.  Results: During the study period, 378 out of 1927 burns (19.6%) admissions were related to petrol use. Males aged 20 – 29 years were most at risk, contributing to 25.4% of petrol related burn injuries. A large portion of burns, 31.0%, occurred during a leisure activity. The mean total body surface area burnt in this cohort was 19.3% and surgery was required in 70.4% of cases. Petrol related burns injuries is estimated to cost AU$ 5,484,834 annually and had a mortality rate of 7.4%. Conclusion: Misuse of petrol contributed to a substantial injury burden to Victorians. Raising community awareness through preventive strategies targeted at high-risk groups of at-risk behaviours is warranted to reduce the incidence of petrol related burn injuries.

Bromelain-based enzymatic debridement of e-cigarette burns: a single unit experience

2019 ◽  
Vol 28 (11) ◽  
pp. 758-761
Author(s):  
Weiguang Ho ◽  
Christopher D. Jones ◽  
Daniel Widdowson ◽  
Hilal Bahia
Keyword(s):  
Total Body Surface Area ◽  
Case Series ◽  
Skin Grafting ◽  
Burn Injuries ◽  
Chemical Burns ◽  
Burn Wound ◽  
Total Body ◽  
Partial Thickness Burns ◽  
Enzymatic Debridement

Objective: It is widely accepted that the early debridement of burns improves outcome. There is increasing evidence that enzymatic debridement is an effective technique for removal of full-thickness and deep-dermal burns, reducing blood loss and often the need for autologous skin grafting by avoiding over excision of the burn. We aim to highlight the potential use of this form of debridement as an alternative to surgical management in patients with electronic cigarette (e-cigarette)-associated flame burn injuries. Methods: This case series presents the use of Nexobrid (MediWound Ltd, Israel), a non-surgical, bromelain-based enzymatic debridement technique, in patients with deep partial-thickness burns (range: 1–3% total body surface area), avoiding the need for autologous skin grafting. Results: Burn wounds in two patients healed within 14 days without complications or the need for further surgical intervention. Another patient required further dressings after discharge but failed to attend follow-up appointments. These results are comparable with those reported by others using conservative management of e-cigarette burns. Conclusion: The authors wish to raise awareness of the potential for a combination of thermal and chemical burns related to e-cigarette explosions. Chemical burns should be excluded by pH testing of the burn wound. From our experience, small e-cigarette-associated flame burns can be considered for management with enzymatic debridement.

scholarly journals Five Years Experience With Meek Grafting in the Management of Extensive Burns in an Adult Burn Center

2018 ◽  
Vol 27 (1) ◽  
pp. 44-48 ◽  
Author(s):  
Khosrow Siamak Houschyar ◽  
Christian Tapking ◽  
Ina Nietzschmann ◽  
Susanne Rein ◽  
Kristian Weissenberg ◽  
...  
Keyword(s):  
Total Body Surface Area ◽  
Skin Grafting ◽  
Operative Management ◽  
Burn Injuries ◽  
Burn Center ◽  
Total Body ◽  
Operative Notes ◽  
Extensive Burns ◽  
Skin Coverage ◽  
Extensive Burn

Background: In extensive burn injuries with lack of donor sites for skin grafting, the Meek technique of skin expansion can be an efficient and effective method in covering extensive wounds. The aim of this retrospective study was to present our experience with the Meek technique of grafting. Methods: We performed a retrospective analysis of patients from our burn center who underwent Meek grafting between 2012 and 2016. Demographics, burn details, clinical course, operative management, and outcomes were collected and analyzed from patient records and operative notes. Outcome measures, including graft take rate, complications and need for further surgery, were recorded. Results: Twelve patients had Meek grafting. The average age was 38 years (range: 15-66). The average percent total body surface area burned was 54.3% (range: 31%-77%). Eighty-three percent of grafted areas healed well, and no regrafting was necessary. In the remaining 17%, infection and hematoma were the leading cause of graft failure. Conclusions: Meek grafting constitutes a rapid and efficient surgical approach for the skin coverage of extensive full-thickness burn injuries with limited autograft donor sites.

scholarly journals Myostatin serum concentration as an indicator for deviated muscle metabolism in severe burn injuries

2018 ◽  
Vol 108 (4) ◽  
pp. 297-304 ◽  
Author(s):  
C. Wallner ◽  
J. M. Wagner ◽  
S. Dittfeld ◽  
M. Drysch ◽  
M. Lehnhardt ◽  
...  
Keyword(s):  
Muscle Strength ◽  
Serum Concentration ◽  
Surface Area ◽  
Body Surface ◽  
Burn Injury ◽  
Total Body Surface Area ◽  
Muscle Metabolism ◽  
Burn Injuries ◽  
Total Body

Introduction: Patients experiencing thermal injuries with an extent of over 20% of total body surface area suffer from systemic catabolic disease. The thermal trauma-induced loss of muscle mass causes a higher incidence for comorbidities and subsequently a higher mortality. In this study, we aimed to investigate the role of myostatin in the interplay with follistatin during muscle cachexia. Methods: Patients with burn injuries (>10% total body surface area) between the ages of 18 and 75 were prospectively included within the first 48 h after trauma to determine deviations of parameters connected to muscle catabolism. In the chronic state of burn injury (9–12 months after trauma), we re-evaluated myostatin and follistatin concentrations as well as muscle strength of the non-dominant forearm. Results: We were able to show a time-dependent alteration (9–12 months after burn injury) of myostatin with an initial decrease ( p < 0.001) and long-term increase ( p < 0.001) after thermal injury in blood serum. For follistatin, a reciprocal correlation was observed ( r = −0.707, p = 0.001). Accordingly, muscle strength of the non-dominant hand and forearm was significantly decreased 9–12 months after injury in post-burn patients compared with healthy patients with a significant correlation to myostatin levels ( r = −0.899, p < 0.001). In addition, initial myostatin serum concentration was predictive for long-term muscle strength impairment. Conclusion: With regard to the muscle metabolism after thermal trauma, our data suggest an acute anabolic response, presumably to spare muscle mass, which is converted to catabolic conditions accompanied by muscle strength reduction in the chronic phase. Myostatin plays a crucial role in this orchestration and initial myostatin concentration may predict the long-term muscle strength.

scholarly journals Mortality from Burn: An Autopsy Based Study from Nepal

2021 ◽  
Vol 6 (2) ◽  
pp. 1496-1500
Author(s):  
Madan Prasad Baral ◽  
Sidarth Timsinha
Keyword(s):  
Total Body Surface Area ◽  
Public Health Problem ◽  
Burn Injuries ◽  
Major Public Health Problem ◽  
Post Injury ◽  
Burn Prevention ◽  
Neurogenic Shock ◽  
Total Body ◽  
Level Hospital

Introduction: In developing countries like Nepal burn deaths are a major public health problem due to their increased mortality, morbidity and long-term disability. A few clinical studies on burns have been reported from Nepal however, autopsy based studies on burns are limited. Objectives: To study the socio-demographic characteristics of victims of burns and evaluate the cause and magnitude of fatal burn injuries retrospectively. Methodology: A two years retrospective analysis of burn deaths brought for autopsy was conducted from January 2017 to December 2018 in a central level hospital of Nepal. Results: Out of 775 total cases autopsied 38 (4.90%) cases were burn related deaths. The majority of the deaths 17(44.70%) occurred in the age group 21-30 years with a preponderance in females 22(57.89%). Majority of the victims were married females 25(65.78%) and most of them were housewives 14(36.84%). Flame burn 23(60.52%) was the most common cause of all burns. The Total Body Surface Area (TBSA) Burn between 50-69% was observed in majority of the cases 27(71.05%).Most of the victims 15(39.47%) survived over 10 days post injury. Burn incidents were mainly accidental 33(86.84%) in nature followed by suicidal burns 5(13.15%). The main cause of burn death was septicemic shock 16(42.10%) followed by neurogenic shock 10(26.31%). Conclusion: The results of this study show that burns injuries are mostly accidental in nature; therefore, the risks of burn injuries should be rightly addressed and appropriate burn prevention strategies should be developed to reduce the frequency and burn related deaths.

scholarly journals Restrictive Transfusion Strategy Is More Effective in Massive Burns: Results of the TRIBE Multicenter Prospective Randomized Trial

2019 ◽  
Vol 184 (Supplement_1) ◽  
pp. 11-15 ◽  
Author(s):  
Tina L Palmieri ◽  
James H Holmes ◽  
Brett Arnoldo ◽  
Michael Peck ◽  
Amalia Cochran ◽  
...  
Keyword(s):  
Wound Healing ◽  
Burn Injury ◽  
Total Body Surface Area ◽  
Inhalation Injury ◽  
Transfusion Strategy ◽  
Restrictive Transfusion ◽  
Blood Utilization ◽  
Outcome Differences ◽  
Total Body ◽  
Restrictive Transfusion Strategy

Abstract Objectives Studies suggest that a restrictive transfusion strategy is safe in burns, yet the efficacy of a restrictive transfusion policy in massive burn injury is uncertain. Our objective: compare outcomes between massive burn (≥60% total body surface area (TBSA) burn) and major (20–59% TBSA) burn using a restrictive or a liberal blood transfusion strategy. Methods Patients with burns ≥20% were block randomized by age and TBSA to a restrictive (transfuse hemoglobin &lt;7 g/dL) or liberal (transfuse hemoglobin &lt;10 g/dL) strategy throughout hospitalization. Data collected included demographics, infections, transfusions, and outcomes. Results Three hundred and forty-five patients received 7,054 units blood, 2,886 in massive and 4,168 in restrictive. Patients were similar in age, TBSA, and inhalation injury. The restrictive group received less blood (45.57 ± 47.63 vs. 77.16 ± 55.0, p &lt; 0.03 massive; 11.0 ± 16.70 vs. 16.78 ± 17.39, p &lt; 0.001) major). In massive burn, the restrictive group had fewer ventilator days (p &lt; 0.05). Median ICU days and LOS were lower in the restrictive group; wound healing, mortality, and infection did not differ. No significant outcome differences occurred in the major (20–59%) group (p &gt; 0.05). Conclusions: A restrictive transfusion strategy may be beneficial in massive burns in reducing ventilator days, ICU days and blood utilization, but does not decrease infection, mortality, hospital LOS or wound healing.

scholarly journals The predisposing factors of AKI for prophylactic strategies in burn care

PeerJ ◽  
2020 ◽  
Vol 8 ◽  
pp. e9984
Author(s):  
Shin-Yi Tsai ◽  
Chon-Fu Lio ◽  
Shou-Chuan Shih ◽  
Cheng-Jui Lin ◽  
Yu-Tien Chen ◽  
...  
Keyword(s):  
Burn Injury ◽  
Laboratory Data ◽  
Total Body Surface Area ◽  
Kidney Injury ◽  
Inhalation Injury ◽  
Predisposing Factors ◽  
Dust Explosion ◽  
Burn Care ◽  
Hospital Patients ◽  
Total Body

Background Acute kidney injury (AKI) is one of the most severe complications of burn injury. AKI with severe burn injury causes high mortality. This study aims to investigate the incidence of and predisposing factors for AKI in burn patients. Methods This is a single-center, retrospective, descriptive criterion standard study conducted from June 27, 2015, to March 8, 2016. We used Kidney Disease Improving Global Outcomes criteria to define and select patients with AKI. The study was conducted by recruiting in hospital patients who suffered from the flammable cornstarch-based powder explosion and were treated under primary care procedures. A total of 49 patients who suffered from flammable dust explosion-related burn injury were enrolled and admitted on June 27, 2015. The patients with more than 20% total body surface area of burn were transferred to the intensive care unit. Patients received fluid resuscitation in the first 24 hours based on the Parkland formula. The primary measurements were the incidence of and predisposing factors for AKI in these patients. Demographic characteristics, laboratory data, and inpatient outcomes were also evaluated. The incidence of AKI in this cohort was 61.2% (n = 30). The mortality rate was 2.0% (n = 1) during a 59-day follow-up period. The multivariate analysis revealed inhalation injury (adjusted OR = 22.0; 95% CI [1.4–358.2]) and meeting ≥3 American Burn Association (ABA) sepsis criteria (adjusted OR = 13.7; 95% CI [1.7–110.5]) as independent risk factors for early advanced AKI. Conclusions The incidence rate of AKI was higher in this cohort than in previous studies, possibly due to the flammable dust explosion-related burn injury. However, the mortality was lower than that expected. In clinical practice, indicators of inflammation, including ABA sepsis criteria may help in predicting the risk of AKI in patients with burn injury.

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

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