207 Relationship of Total Body Surface Area Burn and Length of Stay to Multidrug Resistant Bacterial Infections

2019 ◽  
Vol 40 (Supplement_1) ◽  
pp. S84-S84
Author(s):  
A Jain ◽  
C Islas ◽  
K J Richey ◽  
R Santiago ◽  
J Taillon ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Surface Area ◽  
Body Surface Area ◽  
Body Surface ◽  
Bacterial Infections ◽  
Total Body Surface Area ◽  
Multidrug Resistant ◽  
Total Body ◽  
Relationship Of

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

2021 ◽  
Author(s):  
Kelli N Patterson ◽  
Amanda Onwuka ◽  
Kyle Z Horvath ◽  
Renata Fabia ◽  
Sheila Giles ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Length Of Stay ◽  
Surface Area ◽  
Body Surface Area ◽  
Body Surface ◽  
Total Body Surface Area ◽  
Common Mechanism ◽  
Quality Improvement Collaborative ◽  
Pediatric Injury ◽  
Total Body

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

The Wound Microbiology and the Outcomes of the Systemic Antibiotic Prophylaxis in a Mass Burn Casualty Incident

2020 ◽  
Vol 41 (1) ◽  
pp. 95-103
Author(s):  
Eng-Kean Yeong ◽  
Wang-Huei Sheng ◽  
Po-Ren Hsueh ◽  
Szu-Min Hsieh ◽  
Hui-Fu Huang ◽  
...  
Keyword(s):  
Antibiotic Prophylaxis ◽  
Surface Area ◽  
Body Surface Area ◽  
Body Surface ◽  
Total Body Surface Area ◽  
Blood Stream ◽  
Multidrug Resistant ◽  
Systemic Antibiotic ◽  
Total Body ◽  
Systemic Antibiotic Prophylaxis

Abstract This paper describes the wound microbiology and outcome of using systemic antibiotic prophylaxis (SAP) in mass burn casualties (MBC). The charts of 31 patients (mean age: 21 years, mean burn area: 42% of the total body surface area) injured in a dust explosion were reviewed for 1 month after the burn. Polymicrobial and rare pathogen wound infections (Acinetobacter junii, Aeromonas sobri, et al) were common in MBC due to sterility breech. Following the use of SAP for 2 to 14 days after admission, there was a reduction in wound infection rate from 45% at week 1 postburn to 10% at week 4. In addition, no blood stream infection occurred in the first week after the burns. Multidrug-resistant Acinetobacter baumannii, Klebsiella pneumoniae, and Candida albicans were the top three wound pathogens cultured. Multidrug-resistant microorganism infections were found in 39% of the patients, and the odds ratios for the these infections in burn patients with more than ≥40% total body surface area and in patients receiving two or more classes of antibiotics were 41.7 (95% confidence interval [CI] = 2.1–810.7, P = .01) and 9.9 (95% CI= 1.0–92.7, P = .04), respectively. Although SAP did not prevent wound or blood stream infections, no mortality occurred in our patients. A randomized controlled study is needed to investigate the impact of SAP on burn mortality in MBC.

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

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S72-S73
Author(s):  
Kelli N Patterson ◽  
Kyle Horvath ◽  
Amanda Onwuka ◽  
Renata Fabia ◽  
Sheila Giles ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Length Of Stay ◽  
Surface Area ◽  
Body Surface Area ◽  
Body Surface ◽  
Total Body Surface Area ◽  
Quality Improvement Collaborative ◽  
Burn Care ◽  
Pediatric Injury ◽  
Total Body

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

scholarly journals Mortality incidence among critically ill burn patients infected with multidrug-resistant organisms: A retrospective cohort study

2021 ◽  
Vol 7 ◽  
pp. 205951312110151
Author(s):  
Moustafa Ellithy ◽  
Hassan Mitwally ◽  
Mohamed Saad ◽  
Ranjan Mathias ◽  
Adila Shaukat ◽  
...  
Keyword(s):  
Intensive Care ◽  
Length Of Stay ◽  
Wound Infection ◽  
Surface Area ◽  
Body Surface ◽  
Total Body Surface Area ◽  
Multidrug Resistant ◽  
Burn Patients ◽  
Multidrug Resistant Organisms ◽  
Total Body

Introduction: Many risk factors have been reported to increase mortality among burn patients. Previously, a higher mortality incidence was reported in acute burn patients infected with multidrug-resistant organisms (MDROs) when compared to patients infected with non-MDROs. However, considering this as an independent risk factor for mortality in acute burn patients is not yet confirmed. Methods: We conducted an observational retrospective study in Qatar. We included adult patients admitted to the surgical intensive care unit (ICU) between January 2015 and December 2017 with burn injuries involving either at least 15% of the total body surface area (TBSA) or less than 15% with facial involvement. All patients developed infection with a positive culture of either MDRO or non-MDRO. The primary outcome was in-hospital mortality. Other outcomes included days of mechanical ventilation, ICU, length of stay in hospital, and requirement of vasoactive agents. Results: Fifty-eight patients were included in the final analysis: 33 patients in the MDRO group and 25 patients in the non-MDRO group. Six patients (18.2%) died in the MDRO group versus four patients (16%) in the non-MDRO group ( P = 1). No significant difference was observed between the two groups with regard to the ICU length of stay. However, there was a trend towards increased median length of stay in hospital in the MDRO group: 62 days versus 45 days in the non-MDRO group ( P = 0.057). No significant differences were observed in the other outcomes. Conclusion: In severely burned patients, infection with MDRO was not associated with increased mortality. There was a trend towards increased hospitalisation in MDRO-infected patients. Further studies with a larger sample size are needed to confirm these results. Lay Summary Many factors affect mortality in burn patients admitted to the intensive care unit, such as age, total body surface area involved in the injury, and others. In this retrospective study, we evaluated whether wound infection with a bacterial organism resistant to multiple classes of antibiotics (multidrug-resistant) is considered an independent risk factor for mortality in critically ill burn patients. We included 58 patients requiring intensive care admission with burn injuries involving 15% or more of the total body surface area or less than 15% but with facial involvement. A total of 33 patients were infected with multidrug-resistant organisms (MDROs) and 25 patients with non-MDROs. Six patients (18.2%) from the MDRO group died versus four (16%) in the non-MDRO group. The MDRO group required a longer stay in hospital and an average of one more day on a mechanical ventilator. We concluded that wound infection with MDROs might not increase mortality when compared to wound infection with non-MDROs, although other studies with a larger number of patients involved need to be conducted to validate these results.

Pediatric Treadmill Friction Burns to the Hand: Outcomes of an Initial Nonoperative Approach

2020 ◽  
Author(s):  
Nikita Batra ◽  
Yinan Zheng ◽  
Emily C Alberto ◽  
Omar Z Ahmed ◽  
Megan Cheng ◽  
...  
Keyword(s):  
Surface Area ◽  
Body Surface Area ◽  
Body Surface ◽  
Cox Regression ◽  
Total Body Surface Area ◽  
Wound Management ◽  
Cox Regression Analysis ◽  
Treatment Type ◽  
Total Body ◽  
Hand Burns

Abstract Treadmill burns that occur from friction mechanism are a common cause of hand burns in children. These burns are deeper and more likely to require surgical intervention compared to hand burns from other mechanisms. The purpose of this study was to identify the factors associated with healing time using an initial nonoperative approach. A retrospective chart review was performed examining children (<15 years) who were treated for treadmill burns to the hand between 2012 and 2019. Patient age, burn depth, total body surface area of the hand injury, and time to healing were recorded. Topical wound management strategies (silver sheet, silver cream, non-silver sheet, and non-silver cream) and associated treatment durations were determined. For patients with burns to bilateral hands, the features, treatment, and outcomes of each hand were assessed separately. Cox regression analysis was used to evaluate the association between time to healing and patient characteristics and treatment type. Seventy-seven patients with 86 hand burns (median age 3 years, range 1–11) had a median total body surface area per hand burn of 0.8% (range 0.1–1.5%). Full-thickness burns (n = 47, 54.7%) were associated with longer time to healing compared to partial-thickness burns (HR 0.28, CI 0.15–0.54, P < .001). Silver sheet treatment was also associated with more rapid time to healing compared to treatment with a silver cream (HR 2.64, CI 1.01–6.89, P = .047). Most pediatric treadmill burns can be managed successfully with a nonoperative approach. More research is needed to confirm the superiority of treatment with silver sheets compared to treatment with silver creams.

Professional Practice and Innovation:Level of Agreement between Coding Sources of Percentage Total Body Surface Area Burnt (%TBSA)

2011 ◽  
Vol 40 (1) ◽  
pp. 21-24 ◽  
Author(s):  
Dina Watterson ◽  
Heather Cleland ◽  
Natalie Picton ◽  
Pam M Simpson ◽  
Belinda J Gabbe
Keyword(s):  
Surface Area ◽  
Body Surface Area ◽  
Professional Practice ◽  
Body Surface ◽  
Total Body Surface Area ◽  
Total Body

scholarly journals The validation study on a three-dimensional burn estimation smart-phone application: accurate, free and fast?

2018 ◽  
Vol 6 ◽  
Author(s):  
A. K. W. Cheah ◽  
T. Kangkorn ◽  
E. H. Tan ◽  
M. L. Loo ◽  
S. J. Chong
Keyword(s):  
Surface Area ◽  
Body Surface Area ◽  
Body Surface ◽  
Validation Study ◽  
Total Body Surface Area ◽  
Three Dimensional ◽  
Smart Phone ◽  
Conventional Methods ◽  
Total Body ◽  
Smart Phone Application

Abstract Background Accurate total body surface area burned (TBSAB) estimation is a crucial aspect of early burn management. It helps guide resuscitation and is essential in the calculation of fluid requirements. Conventional methods of estimation can often lead to large discrepancies in burn percentage estimation. We aim to compare a new method of TBSAB estimation using a three-dimensional smart-phone application named 3D Burn Resuscitation (3D Burn) against conventional methods of estimation—Rule of Palm, Rule of Nines and the Lund and Browder chart. Methods Three volunteer subjects were moulaged with simulated burn injuries of 25%, 30% and 35% total body surface area (TBSA), respectively. Various healthcare workers were invited to use both the 3D Burn application as well as the conventional methods stated above to estimate the volunteer subjects’ burn percentages. Results Collective relative estimations across the groups showed that when used, the Rule of Palm, Rule of Nines and the Lund and Browder chart all over-estimated burns area by an average of 10.6%, 19.7%, and 8.3% TBSA, respectively, while the 3D Burn application under-estimated burns by an average of 1.9%. There was a statistically significant difference between the 3D Burn application estimations versus all three other modalities (p < 0.05). Time of using the application was found to be significantly longer than traditional methods of estimation. Conclusions The 3D Burn application, although slower, allowed more accurate TBSAB measurements when compared to conventional methods. The validation study has shown that the 3D Burn application is useful in improving the accuracy of TBSAB measurement. Further studies are warranted, and there are plans to repeat the above study in a different centre overseas as part of a multi-centre study, with a view of progressing to a prospective study that compares the accuracy of the 3D Burn application against conventional methods on actual burn patients.

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

RADIOISOTOPE RENOGRAPHY IN CHILDREN. I. THE RENOGRAM IN CHILDREN WITHOUT RENAL DISEASE

PEDIATRICS ◽  
1965 ◽  
Vol 36 (1) ◽  
pp. 120-127
Author(s):  
James E. Wenzl ◽  
W. Newlon Tauxe ◽  
Edmund C. Burke ◽  
James C. Hunt ◽  
Gunnar B. Stickler
Keyword(s):  
Renal Disease ◽  
Surface Area ◽  
Body Surface Area ◽  
Body Surface ◽  
Narrow Range ◽  
Total Body Surface Area ◽  
Radioisotope Renography ◽  
Peak Point ◽  
Total Body ◽  
Initial Peak

Isotope renograms (ortho-iodohippurate-I were obtained from 30 children who had no evidence of renal disease. Determinations were made by a standardized technique with the subjects in a state of relative dehydration; in 15 children the renogram was repeated under conditions of hydration (14 children) or further dehydration (1 child). Values for the point of initial peak (point A), point of maximal radioactivity (point B), and the differences between these points (B-A) were calculated. These values were plotted arithmetically against surface area to obtain regression lines and estimates of the variability of the observations about the line. The time from appearance of radioactivity to peak radioactivity was calculated and found to fall into a relatively narrow range. Similar attempts to correlate mathematically the height of timed segments of the decreasing slope of the renogram with surface area were successful in children with a body surface area of 1.15 m2 or greater. The state of hydration appeared to influence the excretory slope of the renogram; this effect was most pronounced in children whose total body surface area was less than 1.15 m2.

Sign in / Sign up

Export Citation Format

Share Document