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.

32 Major Psychiatric Illness and Drug Dependence Both Influence Burn Outcomes, but Not in the Same Way

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S23-S23
Author(s):  
Kathleen S Romanowski ◽  
Tina L Palmieri ◽  
Soman Sen ◽  
David G Greenhalgh
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Length Of Stay ◽  
Surface Area ◽  
Body Surface ◽  
Drug Dependence ◽  
Psychiatric Illness ◽  
Total Body Surface Area ◽  
Burn Patients ◽  
Total Body

Abstract Introduction Studies of trauma patients indicated that as many as 17% of patients have major mental illness. The prevalence of mental illness in burns is not well known, but is thought to be similar to that seen in trauma. In this study we aim to examine the effect of mental health on outcomes following burns less than 20% total body surface area (%TBSA). We hypothesize that mental illness is associated with longer length of stay (LOS), length of stay per % TBSA (LOS/TBSA), and number of readmissions. Methods Following IRB approval, a 2-year (2016–2018) retrospective chart review was conducted of burn patients with burns less than 20% admitted to the burn center. Data collected include: age, sex, % TBSA, LOS, LOS/TBSA, discharge disposition, mortality, presence of mental health diagnoses (Drug Dependence, and Major Psychiatric Illness). Statistical analysis with chi-square for categorical variables and student’s t-test for continuous variables was conducted. Values expressed as mean ± standard deviation. Results A total of 961 patients with a mean age of 46.2±17.4 years, 717 men and 244 women, were analyzed. Mean total body surface area burn (TBSA) was 6.72±5.5%, and 6.14% had inhalation injury. In this study population 27.6% had drug dependence, and 15.4% had major psychiatric illness. The mean length of stay was 11.4±16.7 days, and 12 patients (1.25%) died. In examining the effects of major psychiatric illness, there was no difference in age (46.4 vs. 46.2 years, p=0.87), no difference in %TBSA (6.30% vs. 6.77%, p=0.328). Length of stay (LOS) (15.2 vs. 10.7 days, p=0.0009) and LOS/TBSA (4.03 vs. 2.90 days, p = 0.03) were increased in patients with major psychiatric illness. There was no difference in the rate of readmissions (8.11% vs. 6.56%, p=0.49). In examining the effects of drug dependence, patients were younger (40.4 vs. 48.4 years, p< 0.0001), suffered a larger %TBSA (7.70% vs. 6.31%, p=0.0008), and had a longer length of stay (13.7 vs. 10.5 days, p=0.04). There were no differences in LOS/TBSA (2.94 vs. 3.12 days, p = 0.66), and rate of readmissions (6.04% vs. 7.09%, p=0.56). Conclusions In burns < 20% TBSA, both major psychiatric illness and drug dependence influence patient’s outcomes. Major psychiatric illness does not affect burn size but does increase length of stay. Drug dependence leads to larger burn size which secondarily increases length of stay. Based on these increases in length of stay, it is likely that hospital costs are also higher for these patients. Further work must be done to mitigate the effects of mental illness on burn outcomes, even in small burns. Applicability of Research to Practice Many burn patients have mental health problems. These can influence their recovery from burn injury. We should work to minimize the effects of their mental illness on their outcomes.

The Impact of No Next of Kin Decision Makers on End-of-Life Care

2020 ◽  
Author(s):  
Ryan K Ota ◽  
Maxwell B Johnson ◽  
Trevor A Pickering ◽  
Warren L Garner ◽  
T Justin Gillenwater ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Surface Area ◽  
Body Surface ◽  
Total Body Surface Area ◽  
Burn Patients ◽  
Next Of Kin ◽  
Medical Decisions ◽  
Comfort Care ◽  
Burn Care ◽  
Total Body

Abstract For critically ill burn patients without a next of kin, the medical team is tasked with becoming the surrogate decision maker. This poses ethical and legal challenges for burn providers. Despite this frequent problem, there has been no investigation of how the presence of a next of kin affects treatment in burn patients. To evaluate this relationship, a retrospective chart review was performed on a cohort of patients who died during the acute phase of their burn care. Variables collected included age, gender, length of stay, total body surface area, course of treatment, and presence of a next of kin. In total, 67 patients met the inclusion criteria. Of these patients, 14 (21%) did not have a next of kin involved in medical decisions. Patients without a next of kin were significantly younger (P = .02), more likely to be homeless (P < .01), had higher total body surface area burns (P = .008), had shorter length of stay (P < .001), and were five times less likely to receive comfort care (P = .01). Differences in gender and ethnicity were not statistically significant. We report that patients without a next of kin present to participate in medical decisions are transitioned to comfort care less often despite having a higher burden of injury. This disparity in standard of care demonstrates a need for a cultural shift in burn care to prevent the suffering of these marginalized patients. Burn providers should be empowered to reduce suffering when no decision maker is present.

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

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.

scholarly journals Multimodal Analgesia and Discharge Opioid Requirements in Burn Patients

2020 ◽  
Vol 41 (5) ◽  
pp. 963-966
Author(s):  
Michael Wright ◽  
Jin A Lee
Keyword(s):  
Surface Area ◽  
Body Surface Area ◽  
Body Surface ◽  
Total Body Surface Area ◽  
Multimodal Analgesia ◽  
Burn Patients ◽  
Area Burned ◽  
Total Body ◽  
The Impact

Abstract Analgesia in burn patients is challenging given the complexity of burn pain and prolonged need beyond hospital admission. Given the risks of opioids, the impact of multimodal analgesia postdischarge needs to be further elucidated in this population. This retrospective, single-center cohort study evaluated adult burn patients who were consecutively admitted to the burn service with at least 10% total body surface area burned and subsequently followed in the burn clinic between February 2015 and September 2018. Subjects were separated into two cohorts based on discharge pain regimens: multimodal and nonmultimodal. The primary outcome was the change in opioid requirements (measured in oral morphine equivalents) between discharge and first follow-up interval. Secondary outcomes included the classes of multimodal agents utilized and a comparison of opioid requirements between the last 24 hours of admission and discharge. A total of 152 patients were included for analysis, 76 in the multimodal cohort and 76 in the nonmultimodal cohort. The multimodal cohort was noted to have increased total body surface area burned and prolonged number of days spent in the intensive care unit at baseline; however, the multimodal cohort exhibited a more significant decrease in opioid requirements from discharge to first follow-up interval when compared with the nonmultimodal cohort (106.6 vs 75.4 mg, P = .039).

scholarly journals Epidemiology and outcome of acute burn patients at a new dedicated burn centre in Nepal

2020 ◽  
Vol 23 (1) ◽  
pp. 19-29
Author(s):  
Budhi Nath Adhikari Sudhin ◽  
Sanjit Adhikari ◽  
Sushma Khatiwada
Keyword(s):  
Surface Area ◽  
Body Surface Area ◽  
Body Surface ◽  
Total Body Surface Area ◽  
Winter Season ◽  
College Teaching ◽  
Burn Patients ◽  
Permanent Disability ◽  
Total Body ◽  
Epidemiological Characteristics

Introduction: Burn injury remains one of the biggest health concerns in the developing world. It has been regarded as a formidable public health issue in terms of mortality, morbidity and permanent disability. We aim to provide an overview of the basic epidemiological characteristics of burn patients admitted at a dedicated burn center in Chitwan, Nepal. Methods: This was a retrospective, hospital-based observational study conducted at Chitwan Medical College Teaching Hospital (CMCTH) burn ward from September 2017 to August 2019. Patients’ records from admission/discharge book, admission/discharge summaries as well as patient’s individual files were reviewed to obtain the necessary data. Demographic data, clinical characteristics, treatments and outcomes were statistically analyzed. Results: Among the 202 patients, the number of males slightly predominated that of females with a ratio of 1.02:1. The median age was 24 years, and the median total body surface area (TBSA) burned was 15%.  Children less than 10 years comprised one third of all patients while more than one fifth were elderly. The commonest etiological factor was flame burn, closely followed by scald. The mortality rate was 12.38% for the period under review. Majority of the patients spent less than 10 days on admission and around one fifth needed surgical intervention aimed at earlier coverage. Binary logistic regression analysis showed that age, Body Mass Index (BMI) and total body surface area (TBSA) burnt were the major predictors of burn mortality. Conclusions: The outcome of burn injuries is poor. Appropriate preventive & therapeutic measures need to be taken in terms of social education & provision of quality healthcare to reduce the incidence & improve the survival outcome of burn patients which should focus on children and elderly especially during the winter season.

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.

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