Massive Pediatric Burn Injury : A ten-year review

2021 ◽  
Author(s):  
Sally Martens ◽  
Kathleen Romanowksi ◽  
Tina Palmieri ◽  
David Greenhalgh ◽  
Soman Sen
Keyword(s):  
Median Time ◽  
Surgical Procedures ◽  
Pediatric Patients ◽  
Burn Injury ◽  
The United States ◽  
Median Number ◽  
Inhalation Injury ◽  
Burn Injuries ◽  
The Mean ◽  
Time From Injury

Abstract Advances in the care of burn injured pediatric patients has improved mortality over the last 20 years. However, massive burn injuries (50% total body surface area or greater) in pediatric patients, while overall rare, have a significant morbidity and mortality. The primary aim for this study is to analyze treatment and outcomes in massive pediatric burn injuries. A retrospective study of children with burn injuries 50% TBSA or greater who were admitted to Shriners Hospital for Children Northern California, from May 1, 2009 to May 22, 2020 was conducted. Data was collected from the electronic health records through a comprehensive chart review that included: patient demographics, past medical history, treatment interventions and outcomes. This study included 69 patients (59.4% male) with a mean age of 8.7 ± 6 years old. The median time from injury to admission was 2 (1- 4) days. 63.8% of patients were from Mexico, 34.8% were from the United States and 1 patient was from American Samoa. The median time from injury to admission was 2 (1- 4) days. Mean TBSA was 66 ± 12 %. The median TBSA of second-degree burns was 0 (0- 6)%, and the mean TBSA of third-degree burns was 60 ± 16%. 40% of patients suffered an inhalation injury and 83% of patients received a tracheostomy. The median number of days requiring ventilator assistance was 26 (12-58) days. Mean length of hospitalization was 90 ± 60 days, with 61 ± 41 days spent in the ICU. The mean number surgical procedures were 6 ± 4. The time between surgical procedures was 12 ± 6 days. The median time from admission to the first surgical procedure was 1 (0-2) day. At the first procedure, a mean 42 ± 15% TBSA of the burn injury was excised. 62% of patients received autografting (22 ± 11% TBSA) and 52% of patients received allografting (27 ± 17% TBSA) during the first procedure. For survivors, the median number of inpatient occupational therapy encounters were 143.5 (83-215) and inpatient physical therapy encounters were 139.5 (81-215). 25% of the patients included in this study died as a result of their burn injury. Multivariate regression revealed that sustaining an inhalation injury was a significant and independent predictor of death (OR- 3.4, (1.05-11 95% CI), p=0.04). Massive burn injuries in children required a very high number of surgical procedures and hospital resources. Most children who died as a result of their massive burn injury, died within the first month of admission. Inhalation independently increases the risk of dying in pediatric patients with a massive burn injury.

518 Massive Burn Injury Outcomes in Children

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S106-S106
Author(s):  
Sally A Martens ◽  
Kathleen S Romanowski ◽  
Tina L Palmieri ◽  
David G Greenhalgh ◽  
Soman Sen
Keyword(s):  
Pediatric Patients ◽  
Burn Injury ◽  
The United States ◽  
American Samoa ◽  
Inhalation Injury ◽  
Burn Injuries ◽  
P Value ◽  
Significant Independent Predictor ◽  
Mean Values ◽  
Institutional Review

Abstract Introduction Advances in the care of burn injured pediatric patients has improved mortality over the last 20 years. However, massive burn injuries in pediatric patients, while overall rare, have a significant morbidity and mortality. The primary aim for this study is to analyze outcomes in massive pediatric burn injuries. Methods After institutional review board approval, a retrospective study of children with burn injuries 50% TBSA or greater who were admitted to our pediatric burn center from 2009 to 2019 was conducted. Data collected include age, gender, ethnicity, race, country of residence, % TBSA, degree of burn, presence of inhalation injury, hospital duration, intensive care duration, presence of tracheostomy, number and types of surgeries performed and discharge outcomes. All mean values are mean±standard deviation, all median values are median (interquartile range), and p-value < 0.05 were considered significant. Results This study included 84 patients (60.7% male) with a mean age of 8±6 years old. The median time from injury to admission was 2(1–4) days. 56% of patients were from Mexico, 43% were from the United States and 1 patient was from American Samoa. 21% of the patients died. There was no difference in the extent of burn injury between patients who died (68±14% TBSA) versus those who lived (66±12% TBSA). The median length of stay was significantly shorter in the patients who died (19(5–44) vs. 74(35–138) days p=0.0001). Patients who died also suffered more inhalation injury (61% vs. 21%, p=0.01). After adjusting for age and TBSA, inhalation was a significant independent predictor of death (OR- 4.3, (1.4-13 95% CI), p=0.01). Conclusions Over the past decade, nearly 80% of children with massive burn injuries survived. The children who died as a result of their massive burn injury, died within the first month of admission. Inhalation injury significantly and independently increases the risk of dying in pediatric patients with a massive burn injury.

Benchmarks for the Durations of Ambulatory Surgical Procedures in Otolaryngology

2011 ◽  
Vol 120 (11) ◽  
pp. 727-731 ◽  
Author(s):  
Neil Bhattacharyya
Keyword(s):  
United States ◽  
Operating Room ◽  
Surgical Procedures ◽  
Ambulatory Surgery ◽  
Secondary Analysis ◽  
The United States ◽  
Tube Placement ◽  
The Mean ◽  
Room Time ◽  
Ambulatory Procedures

Objectives: I undertook to determine benchmarks and variability for the surgical times associated with ambulatory otolaryngological procedures in the United States. Methods: I examined the 2006 release of the National Survey of Ambulatory Surgery and extracted all cases of otolaryngological surgery in which one, and only one, otolaryngological procedure was performed. The mean surgical times and operating room times were determined for each procedure that met reliability criteria for their estimates. A secondary analysis was computed for tonsillectomy and for tonsillectomy plus adenoidectomy according to a patient age of greater than 12 years. Results: An estimated 1.68 ± 0.23 million otolaryngological procedures were analyzed as solitary procedures, including 507,000 cases of myringotomy with ventilation tube placement, 136,000 cases of tonsillectomy, and 429,000 cases of tonsillectomy plus adenoidectomy. The mean (±SE) surgical times were 8.0 ± 0.5, 23.9 ± 1.8, and 20.3 ± 0.8 minutes, respectively. The total operating room times were 17.6 ± 0.9, 48.2 ± 2.0, and 40.7 ± 1.1 minutes, respectively. Septoplasty with turbinectomy was the most common rhinologic procedure performed (48,000 cases analyzed) and had surgical and operating room times of 49.6 ± 4.78 and 79.8 ± 5.8 minutes, respectively. The surgical times for tonsillectomy and tonsillectomy plus adenoidectomy did not differ significantly in magnitude according to standard age cutoffs, although the operating room time was slightly (11.7 minutes) longer for tonsillectomy in patients more than 12 years of age (p = 0.034). Conclusions: The surgical times for the performance of the most common otolaryngological ambulatory procedures are remarkably consistent in the United States. Given the volume and consistency of these surgical procedures, they are ideal candidates for studies of cost and efficiency.

102 Wildfire Burns: Implications for Burn Care

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S67-S67
Author(s):  
Tina L Palmieri ◽  
Kathleen S Romanowski ◽  
Soman Sen ◽  
David G Greenhalgh
Keyword(s):  
Length Of Stay ◽  
Burn Injury ◽  
Total Body Surface Area ◽  
Ventilatory Support ◽  
Mass Casualty ◽  
Inhalation Injury ◽  
Burn Injuries ◽  
Injury Incidence ◽  
Burn Centers ◽  
Burn Care

Abstract Introduction Climate change, the encroachment of populations into wilderness, and carelessness have combined to increase the incidence of wildfire injuries. With the increased incidence has come an increase in the number of burn injuries. Prolonged extrication, delays in resuscitation, and the extreme fire and toxic air environment in a wildfire has the potential to cause more severe burn injury. The purpose of this study is to examine the demographics and outcomes of wildfire injuries and compare those outcomes to non-wildfire injuries. Methods Charts of patients admitted to a regional burn center during a massive wildfire in 2018 were reviewed for demographic, treatment, and outcome. We then obtained age, gender, and burn size matched controls from within 2 years of the incident, analyzed the same measures, and compared treatment and outcomes between the two groups. Results A total of 20 patients, 10 wildfire (WF) burns and 10 non-wildfire (NWF) burns, were included in the study. Age (59.6±7.8 WF vs. 59.4±7.4 years), total body surface area burn (TBSA) (14.9±4.7 WF vs. 17.2±0.9 NWF) and inhalation injury incidence (2 WF and 2 NWF) were similar between groups. Days on mechanical ventilation (24.3±19.4 WF vs. 9.4±9.8 NWF), length of stay (49.9±21.8 WF vs. 28.2±11.7 days) and ICU length of stay (43.0±25.6 WF vs 24.4±11.2 NWF) were higher in the WF group. WF patients required twice the number of operations. Mortality was similar in both groups (1 death/group). Conclusions Wildfire burn injuries, when compared to age, inhalation injury, and burn size matched controls, require more ventilatory support and have more operations. As a result, they have longer lengths of stay and have a prolonged ICU course. Burn centers should be prepared for the increased resource utilization that accompanies wildfire injuries. Applicability of Research to Practice All burn centers must be prepared for the possibility of wildfires and the increased resource utilzation that accompanies mass casualty events.

scholarly journals Mother’s Characteristics, Knowledge and Practices about Children Burn Injury in Sulaimani City

2017 ◽  
Vol 2 (2) ◽  
pp. 6-12
Author(s):  
Abdulrahman M. Ibrahem ◽  
Kamal J. Rashed ◽  
Muhammed Babakir- Mina ◽  
Bakhtyar K. Muhamed
Keyword(s):  
Burn Injury ◽  
Good Practice ◽  
Burn Injuries ◽  
Local Health Authority ◽  
Local Health ◽  
Cross Sectional ◽  
Face To Face ◽  
Practice Level ◽  
Good Score ◽  
The Mean

Burn is described as one of the leading causes of injury throughout the world, and is one of the most frequent causes of hospitalization. The aim of this study was to determine mother’s characteristics, Knowledge and practices for burn injuries and burn infection prevention. A cross sectional descriptive study was undertaken in Sulaimani city, Iraq, from October 2015 to July 2016. Participants were evaluated using a structured questionnaire by face-to-face interview. Data were computerized and analyzed using Statistical Package for Social Sciences version 22.0 software. A total of 126 mothers who had burn injury in their children and admitted to burning hospital during the study period, the mean score knowledge of mothers was (3.63), the mean score practice of mothers accounted (4.63), the respondent practice score ranged from (1-8). They had poor, intermediate, and good score knowledge about burns injury and burn infection 79.37%, 18.25%, and 2.38% respectively. In regard to mother’s related practice, there were 66.67% within poor practice level, 30.95% of an intermediate level, and 2.38% had a good practice level. The study shows that mother knowledge and practice in Sulaimani city in relation to burn injury and infection among their children was at a low level and the local health authority should incorporate health education for parents, especially mothers in the prevention of pediatric burn at home involving hot liquid and flames also other domestic hazardous as well as the important activities after burn or pre-hospital admission.

The Practice of First Aid for Burn Injuries Among the Population of East Coast of Peninsular Malaysia for 2012–2016

2020 ◽  
Vol 41 (4) ◽  
pp. 905-907
Author(s):  
Sul Na Seow ◽  
Ahmad Sukari Halim ◽  
Wan Azman Wan Sulaiman ◽  
Arman Zaharil Mat Saad ◽  
Siti Fatimah Noor Mat Johar
Keyword(s):  
East Coast ◽  
Burn Injury ◽  
Tap Water ◽  
Public Health Problem ◽  
First Aid ◽  
Burn Injuries ◽  
Soy Sauce ◽  
Retrospective Audit ◽  
Life Years ◽  
The Mean

Abstract Burns are a devastating public health problem that result in 10 million disability-adjusted life-years lost in low- and middle-income countries. Adequate first aid for burn injuries reduces morbidity and mortality. The rate of proper first aid practices in other countries is 12% to 22%.1,2 A 5-year retrospective audit was performed on the database of the Burn Unit in Hospital Universiti Sains Malaysia for 2012–2016; this involved 485 patients from the east coast of Malaysia. The mean age of the patients is 17.3 years old. The audit on first aid practices for burn injury showed poor practice. Out of 485 burned patients, 261 patients (53.8%) claimed that they practiced first aid. However, only 24 out of 485 patients (5%) practiced the correct first aid technique where they run their burn wound under cool water for more than 20 minutes. Two hundred and twenty-two patients had not received any first aid. Two patients did not respond to the question on the first aid usage after burn injury. The mean age of patients who practiced first aid was 15.6 years old. Out of the 261 patients who practiced first aid, 167 (64%) run their wound under tap water for different durations. Others practiced traditional remedies such as the application of “Minyak Gamat” (6.5%), soy sauce (5.5%), other ointments (3.6%), milk (1.8%), and eggs (0.7%), as well as honey, butter, and cooking oil (0.4% each). First aid practices for burn injuries in the population of east coast Malaysia are still inadequate. The knowledge and awareness of school children and the general Malaysian population must be enhanced.

scholarly journals QOL-58. ASSESSING FATIGUE EXPERIENCED BY PEDIATRIC PATIENTS WITH INTRACRANIAL NEOPLASMS

2020 ◽  
Vol 22 (Supplement_3) ◽  
pp. iii441-iii441
Author(s):  
Eamon Eccles ◽  
Yan Han ◽  
Hao Liu ◽  
Jordan Holmes ◽  
Scott Coven
Keyword(s):  
Radiation Therapy ◽  
Pediatric Patients ◽  
The United States ◽  
Institutional Review Board ◽  
Proton Radiation ◽  
Indiana University ◽  
Cancer Related Fatigue ◽  
Fatigue Design ◽  
Institutional Review ◽  
The Mean

Abstract BACKGROUND Indiana University possessed one of the earliest clinical proton facilities in the United States. The purpose of this study was to assess fatigue and nausea/vomiting in children with central nervous system (CNS) tumors undergoing radiation therapy as part of their treatment regimen, and to understand what factors influence fatigue. DESIGN: The study was approved by the institutional review board at Indiana University and consent and/or assent from eligible participants was obtained prior to enrollment. The validated Fatigue Scale is scored on a 5-point Likert scale. Surveys were completed 1) prior to radiation therapy, 2) week three of radiation therapy, and 3) week six of radiation therapy. A score of 41 or higher for the Fatigue Scale-Parent (< 7 years), 12 or higher for the Fatigue Scale-Child (8–12 years), and 17 or higher for the Fatigue Scale-Adolescent (13–18 years), indicates significant cancer-related fatigue. RESULTS The study aimed to recruit a total of 50 patients during the eligible period; however, data on 31 individual participants were available for analysis. 25 patients underwent proton radiation therapy, while 6 patients underwent conventional photon therapy. The mean age of children was 8.8 years. Of the 31 patients, 22 recorded scores indicating significant cancer-related fatigue at some point during radiation therapy. CONCLUSIONS Cancer related fatigue continues to be a challenge, with limited understanding of factors that might predict clinically relevant fatigue This work demonstrates the feasibility of conducting symptom research for children undergoing radiation therapy; further research is needed to characterize predictors of fatigue.

Thermal Injuries

2015 ◽  
Author(s):  
Tatiana Havryliuk ◽  
Ryan Paterson
Keyword(s):  
Life Support ◽  
Chemical Exposure ◽  
The United States ◽  
Inhalation Injury ◽  
Burn Injuries ◽  
Initial Assessment ◽  
Advanced Trauma Life Support ◽  
Burn Patients ◽  
Medical Facilities ◽  
Thermal Injuries

In the United States, an estimated 450,000 patients with burns are treated in medical facilities annually. On assessment of burn patients, Advanced Trauma Life Support protocols should be followed because these patients often suffer from concomitant trauma; chemical exposure and airway compromise should also be considered in the initial assessment. Mortality from burn injuries increases with the patient’s age, the extent of the burn, and the presence of inhalation injury. This review covers the epidemiology, pathophysiology, assessment and stabilization, diagnosis, treatment and disposition, and outcomes of patients with burn injuries. Figures show the structure of the skin, and photographs of partial-thickness and full-thickness burns. Tables list burn classification by depth, indications for intubation, American Burn Association 2010 guidelines for calculating IV fluid resuscitation, indications for escharotomy in patients with circumferential trunk and extremity burns, and indications for burn center referral. This review contains 3 highly rendered figures, 5 tables, and 33 references.

Abstract TP18: Recanalization in Acute Stroke Interventions with Manual Aspiration Thrombectomy as a Stand Alone Technique

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Amin Aghaebrahim ◽  
Ashutosh P Jadhav ◽  
Guillermo Linares ◽  
Syed Zaidi ◽  
Mohammad Jumaa ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Median Time ◽  
Case Series ◽  
Cost Savings ◽  
Median Number ◽  
Aspiration Thrombectomy ◽  
University Of Pittsburgh ◽  
Alternative Means ◽  
The Mean ◽  
Clot Disruption

Background and Purpose: Manual aspiration thrombectomy (MAT) represents an alternative means to open occluded intracranial vessels. The technique involves advancing a large bore catheter into the thrombus and manually aspirating through a syringe. We have previously reported our experience with nearly 200 patients, however most cases involved the use of an adjunctive device such as the MERCI retriever to facilitate clot disruption or advancement of the catheter through the tortuous carotid siphon. This selected case series represents those patients treated with MAT alone. Methods: The University of Pittsburgh acute stroke database was retrospectively reviewed to evaluate those patients presenting with a large vessel intracranial occlusion who were treated with MAT. The decision to treat was based on the amount of brain still considered at risk based on CT, CTP, or MRI, and not on time from onset. Patients were excluded if an adjunctive device was used to facilitate catheter advancement or clot disruption/removal. These devices included the MERCI retriever, Penumbra aspiration system, Solitaire, TREVO, stent, or balloon. Intra-arterial thrombolytics or antiplatelets were allowed. Results: Forty-seven patients met the inclusion criteria. The mean/median NIHSS was 17/16. The mean/median time from last seen normal to groin puncture was 8.3/6.5 hours. The mean/median time from groin puncture to recanalization was 50/40 minutes. The target vessel was the basilar, M1, and ICA-terminus in 7, 30, and 10 patients respectively. The mean/median number of aspiration attempts was 1.7/1. All patients achieved at least TIMI 2 recanalization, owing to the fact that failure to achieve this result prompted the use of an adjunctive device. 42/47 patients achieved TICI 2B/3 recanalization. Conclusions: Pure MAT without the use of an adjunctive device represents another method to achieve intracranial recanalization with the potential for significant cost savings. Safety and outcomes must still be evaluated.

QIM19-117: Reducing Diagnostic Delays: Impact of a Novel Cancer Diagnostic Service

2019 ◽  
Vol 17 (3.5) ◽  
pp. QIM19-117
Author(s):  
Luke Arney ◽  
Ryan Leib ◽  
Louise Schneider ◽  
Cori Kostick ◽  
Kerry Kilbridge ◽  
...  
Keyword(s):  
Median Time ◽  
Significant Proportion ◽  
The United States ◽  
Median Number ◽  
Cancer Center ◽  
Diagnostic Service ◽  
Cancer Diagnostic ◽  
Patient Reported ◽  
Work Up ◽  
Diagnosis Date

Background: Although timeliness of care was one of the aims of quality improvement in the Institute of Medicine’s 2001 “Crossing the Quality Chasm” report, a significant proportion of patients with cancer still experience delays in diagnosis and treatment. For example, in a study of 3,831 older adults diagnosed with myeloma in the United States, the median time between the first myeloma-related symptom and diagnosis was 99 days (Friese CR, Leukemia & Lymphoma 2009). Such delays are associated with substantial anxiety, poor patient-reported outcomes, and increased cost. Methods: A novel adult cancer diagnostic service (CDS) was established by the Dana-Farber/Brigham and Women’s Cancer Center in October 2017. The clinic is embedded in the Department of Medicine at the Brigham and Women’s Hospital, with the aim of expediting the cancer diagnostic work-up and treatment for clinically complex patients with symptoms concerning for cancer, but for whom the next diagnostic steps are unclear. This clinic is comprised of an internist, a physician assistant, and a practice assistant. The clinic staff conduct a weekly phone conference with a multidisciplinary team—including a solid tumor oncologist, a hematologic oncologist, and a radiologist—to discuss the work-up for each patient. For every patient evaluated who receives a cancer diagnosis, we measure the diagnostic interval (days from CDS referral to diagnosis date). We define diagnosis date as the date the pathologic report is signed. We also measure the interval between CDS referral and first oncology appointment. Results: From the inception of the CDS to October 1, 2018, 221 patients were seen in the clinic and 91 (41.2%) were diagnosed with cancer. The top 3 cancer diagnoses were lymphoma (31%), gastrointestinal cancers (20%), and lung cancer (19%; Figure 1). The median number of days from CDS referral to diagnosis was 14 days (interquartile range [IQR], 10, 21; Table 1). Finally, the median time between referral to CDS and first oncology appointment was 20 days (IQR, 14, 27). Conclusion: This novel cancer diagnostic service substantially shorted the diagnostic trajectory (∼2 weeks) compared to existing literature with median diagnostic intervals often lasting more than 3 months (Friese CR, Leukemia & Lymphoma 2009). Our findings suggest that a cancer diagnostic care model, grounded in internal medicine, with engagement of oncologists and radiologists, has significant potential to improve delays in cancer diagnostic care.

scholarly journals Etiology and Outcome of Burns in Tabriz, Iran an Analysis of 2963 Cases

2005 ◽  
Vol 94 (1) ◽  
pp. 77-81 ◽  
Author(s):  
H. Maghsoudi ◽  
A. Pourzand ◽  
G. Azarmir
Keyword(s):  
Incidence Rates ◽  
Inhalation Injury ◽  
Burn Injuries ◽  
High Rate ◽  
Female Ratio ◽  
Burn Victims ◽  
Burn Center ◽  
Major Burn ◽  
Male Female Ratio ◽  
The Mean

Background and aims: Burn injuries still produce a significant morbidity and mortality in Iran. A 3-year retrospective review of burn victims hospitalized at a major burn center was conducted to determine the etiology and outcome of patients in Tabriz. Material and Methods: Two thousand nine hundred sixty + three patients were iden tified and stratified by age, sex, burn size, presence or absence of inhalation injury, cause of burn. There is one burn center in the East Azarbygan province serving 3.3 million people over an area of 47,830 sq.km. Results: The overall incidence rates of hospitalization and death were 30.5 % and 5.6 % per 100000 person years. The mean patient age was 22 years, and the male: female ratio was 1.275. There were 555 deaths altogether (18.7 %). The highest incidence of burns was in the 1–9 age group (29.2 %). Patients with less than 40 percent of burned surface constituted 79.8 % of injuries. The most common cause of burns was kerosene accident in adults and scald injuries in children. The mean length of hospitalization was 13 days. The mean body surface area burned was larger with higher mortality in females than in males (p < 0.001). Inhalation injuries were strongly associated with large burns and were present in all flame-burn fatalities. Conclusion: In our opinion, social factors are the main drive leading to an unacceptably high rate of burn injuries in our societies. Most of the burn injuries were caused by domestic accidents and were, therefore, preventable; educational programs might reduce the incidence of burn injuries.

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