scholarly journals Does the estimation of burn extent at admission differ from the assessment at discharge?

2021 ◽  
Vol 7 ◽  
pp. 205951312110194 ◽  
Author(s):  
Sebastian Holm ◽  
Olof Engström ◽  
Ida Petäjä ◽  
Fredrik Huss
Keyword(s):  
Observational Study ◽  
Total Body Surface Area ◽  
Paediatric Population ◽  
Retrospective Observational Study ◽  
Initial Assessment ◽  
Accurate Estimation ◽  
Paediatric Patients ◽  
Total Body ◽  
Correct Estimation ◽  
The One

Introduction: Estimation of total body surface area (TBSA) burnt and burn depth are among the most central parts of acute burn assessment/treatment as they determine the level and type of care needed. Traditional methods for determining burn extent on admission often lead to inaccurate estimations, especially in paediatric or overweight patients. Aim: To compare %TBSA at admission with validated %TBSA at discharge in different patient populations to investigate if significant over- or underestimation occurs. Method: This retrospective observational study is based on a patient registry of all the patients (n = 863) treated at the Uppsala University Hospital’s Burn Centre between 2010 and 2018. The patients were divided into subgroups based on age, gender, body mass index (BMI) and validated burn extent. The %TBSA estimated at admission was compared to the validated %TBSA in all groups separately. Results: As has been published before, we also found that the %TBSA in paediatric patients was more often overestimated as were the smaller injuries, whereas larger injuries were often underestimated. BMI did not clearly affect the estimations and there was no clear difference between the genders in estimated %TBSA. Conclusion: Inaccurate estimations of %TBSA are common, particularly for paediatric patients and small or large injuries. We recommend a careful accurate approach when calculating %TBSA in the paediatric population to avoid over- and under-resuscitation. Increased education and training are recommended to improve accurate estimation in the future. Lay Summary The correct estimation of both extent and depth of burn is very important. This assessment guides the lever of care needed, the necessary amount of fluid resuscitation, the predicted outcome and more. It has been proven notably difficult to correct assess, especially the extent of a burn. Despite different tools as the “Rule of Nine” (body area divided into multiples of 9% body surfaces), the “Rule of Palm” (Patient’s palm, fingers included, approximates 1% of body surfaces), the Lund & Browder chart (detailed, age-specific body areas) and different more technical solutions. Often inaccurate estimations are done which thus affect the treatment. This depth and extent estimation is usually performed when the patient is admitted. However, it is known that burns change appearance during the first few days of care. In our Burn Center we have also performed this estimation when the patient is discharged. At this point it is known the true extent and depth of the initial burn. In this retrospective observational study, we compared the burn extent estimated on admission with the one on discharge to investigate whether the initial assessment is accurate. This study highlights the issue of frequent inaccurate burn extent estimations, especially in subgroups as overweight patient or pediatric patients.

scholarly journals Understanding the characteristics of recurrent visits to the emergency department by paediatric patients: a retrospective observational study conducted at three tertiary hospitals in Korea

BMJ Open ◽  
2018 ◽  
Vol 8 (2) ◽  
pp. e018208 ◽  
Author(s):  
Byung-Soo Kim ◽  
Jung-Youn Kim ◽  
Sung-Hyuk Choi ◽  
Young-Hoon Yoon
Keyword(s):  
Emergency Department ◽  
Observational Study ◽  
Medical Condition ◽  
Paediatric Population ◽  
Retrospective Observational Study ◽  
Main Diagnosis ◽  
Paediatric Patients ◽  
Common Diagnosis ◽  
The Usa ◽  
Ed Visits

ObjectivesThe number of paediatric patients visiting the emergency department (ED) continues to rise. In South Korea, approximately 25% of the patients who visit the ED are paediatric patients. In the USA, about 20% of the paediatric population were found to have visited the ED in the past year. A recent study demonstrated that 4.5%–8% of patients account for 25% of all ED visits. Therefore, the aim of this study was to identify the characteristics of recurrent visits.MethodsDesign: retrospective observational study. Setting: this study examined and analysed medical record data involving three tertiary EDs. Participants: a total of 46 237 ED visits by patients <16 years during 1-year period. Main outcome measures: data collected included the number of recurrent ED patients, frequency of recurrent visits, age, sex, insurance status, period until recurrent visit (days), main diagnosis and ED discharge results.ResultsExcluding patients with multiple visits, the total number of paediatric patients who fit the study criteria was 33 765. Among these patients, 23 384 (69.2%) had no recurrent ED visits in the subsequent year after their first visit. A total of 15 849 (46.8%) patients were toddlers (between age 1 and 4 years). In the patient group without a recurrent visit, fever was the most common diagnosis.ConclusionsOur study reviewed medical records to inspect the characteristics of patients who return to care. Higher recurrent visit frequency was associated with using the 119 rescue centre service, having a medical condition, with younger age and a higher rate of hospitalisation. Analysis of the factors associated with frequent ED visits will help to improve care for paediatric patients who visit the ED.

scholarly journals Clinical and Microbiological Characteristics of Visceral Leishmaniasis Outbreak in a Northern Italian Nonendemic Area: A Retrospective Observational Study

2016 ◽  
Vol 2016 ◽  
pp. 1-7 ◽  
Author(s):  
E. Franceschini ◽  
C. Puzzolante ◽  
M. Menozzi ◽  
L. Rossi ◽  
A. Bedini ◽  
...  
Keyword(s):  
Visceral Leishmaniasis ◽  
Observational Study ◽  
Fever Of Unknown Origin ◽  
Unknown Origin ◽  
Mediterranean Area ◽  
Retrospective Observational Study ◽  
Attributable Mortality ◽  
Microbiological Characteristics ◽  
The One ◽  
Bone Marrow Blood

Background. Visceral leishmaniasis (VL) caused byLeishmania infantumis endemic in the Mediterranean area. In the last decades a northward spread of the parasite has been observed in Italy. This paper describes a VL outbreak in Modena province (Emilia-Romagna, Northern Italy) between 2012 and 2015.Methods. Retrospective, observational study to evaluate epidemiological, microbiological characteristics, and clinical management of VL in patients referring to Policlinico Modena Hospital.Results. Sixteen cases of VL occurred in the study period. An immunosuppressive condition was present in 81.3%. Clinical presentation included anemia, fever, leukopenia, thrombocytopenia, and hepatosplenomegaly. Serology was positive in 73.3% of cases, peripheral blood PCR in 92.3%, and bone marrow blood PCR in 100%. Culture was positive in 3/6 cases (50%) and all the isolates were identified asL. infantumby ITS1/ITS2 sequencing. The median time between symptom onset and diagnosis was 22 days (range 6–131 days). All patients were treated with liposomal amphotericin b. 18.8% had a VL recurrence and were treated with miltefosine. Attributable mortality was 6.3%.Conclusions. VL due toL. infantumcould determine periodical outbreaks, as the one described; thus it is important to include VL in the differential diagnosis of fever of unknown origin, even in low-endemic areas.

scholarly journals Relationship Between Patient Characteristics and Number of Procedures as well as Length of Stay for Patients Surviving Severe Burn Injuries: Analysis of the American Burn Association National Burn Repository

2020 ◽  
Vol 41 (5) ◽  
pp. 1037-1044 ◽  
Author(s):  
Eliza Kruger ◽  
Stacey Kowal ◽  
S Pinar Bilir ◽  
Eileen Han ◽  
Kevin Foster
Keyword(s):  
Length Of Stay ◽  
Total Body Surface Area ◽  
Patient Characteristics ◽  
The United States ◽  
Ordinary Least Squares ◽  
Inhalation Injury ◽  
Regression Methods ◽  
Diabetes Status ◽  
Total Body ◽  
The One

Abstract This study establishes important, national benchmarks for burn centers to assess length of stay (LOS) and number of procedures across patient profiles. We examined the relationship between patient characteristics such as age and total body surface area (TBSA) burned and number of procedures and LOS in the United States, using the American Burn Association National Burn Repository (NBR) database version 8.0 (2002–2011). Among 21,175 surviving burn patients (TBSA &gt; 10–60%), mean age was 33 years, and mean injury size was 19.9% TBSA. Outcomes included the number of debridement, excision, autograft procedures, and LOS. Independent variables considered were: age (linear, squared, and cubed to account for nonlinearity), TBSA, TBSAs of partial-thickness and mixed/full-thickness burns, sex, hospital-acquired infection, other infection, inhalation injury, and diabetes status. Regression methods included a mixed-effects model for LOS and ordinary least squares for number of procedures. A backward stepwise procedure (P &lt;0.2) was used to select variables. Number of excision and autografting procedures increased with TBSA; however, this relationship did not hold for debridement. After adjusting for sex, age, and comorbidities, predicted LOS for adults (18+) was 12.1, 21.7, 32.2, 43.7, and 56.1 days for 10, 20, 30, 40, and 50% TBSA, respectively. Similarly, predicted LOS for pediatrics (age &lt; 18) was 8.1, 18.8, 33.2, 47.6, and 56.1 days for the same TBSA groups, respectively. While average estimates for adults (1.12 days) and pediatrics (1.01) are close to the one day/TBSA rule-of-thumb, consideration of other important patient and burn features in the NBR can better refine predictions for LOS.

scholarly journals The “Safdarjung Method” of Estimation of Total Body Surface Area (TBSA) Burns in Major Amputees

2020 ◽  
Vol 53 (02) ◽  
pp. 303-305
Author(s):  
Neha Chauhan ◽  
Karoon Agrawal ◽  
Shalabh Kumar
Keyword(s):  
Surface Area ◽  
Body Surface Area ◽  
Body Surface ◽  
Fluid Therapy ◽  
Total Body Surface Area ◽  
High Volume ◽  
Accurate Estimation ◽  
New Delhi ◽  
Novel Method ◽  
Total Body

AbstractAccurate estimation of total body surface area (TBSA) burns is the cornerstone of initiating correct fluid therapy in burns. The current formulae are designed for patients with intact body. However, the authors having worked at a high-volume burns center (Safdarjung Hospital, New Delhi, India) have encountered patients with major amputations presenting with burns. The existing formulae are inaccurate for estimating TBSA in major amputees, leading to inaccurate fluid estimation in such cases. The authors have designed a novel method to estimate TBSA burns in patients with major amputations that involves a “correction factor” to account for the amputated parts.

scholarly journals Firework and sparkler burns in paediatric patients

2021 ◽  
Vol 4 (1) ◽  
pp. 30-34
Author(s):  
Daniel Ricciardello ◽  
Nam Kyu Yang ◽  
Kira Chamberlain ◽  
Andrew Holland
Keyword(s):  
New South ◽  
Total Body Surface Area ◽  
Significant Risk ◽  
Paediatric Population ◽  
South Wales ◽  
Common Area ◽  
The Mean ◽  
Total Body ◽  
Educational Campaigns ◽  
Burns Unit

Background: While the consumer sale of fireworks is illegal in New South Wales, the sale of sparklers is legal—however, both still pose a significant risk of harm in the paediatric population. Anecdotally, burns services are aware that the misuse of sparklers can result in burns but there appears to be a paucity of studies examining this incidence in the paediatric population in Australia.Method: A retrospective review of all burns related to the use of fireworks or sparklers referred to the Children’s Hospital at Westmead (CHW) Burns Unit (BU) from January 2004 to December 2019. Results: 96 patients were referred to the CHW BU with a burn as a result of a firework or sparkler. Sparklers accounted for 69 (72%) of burns, compared with 27 (28%) from fireworks. The mean age of those injured by sparklers was five years compared with eight years in the firework group. Average total body surface area (TBSA) affected for both mechanisms was similar—for sparkler burns (2.0%) firework burns (2.4%), with a range of 0.1–15 per cent. Hands were the most common area burnt in both groups comprising 41 (59%) of sparkler burns and 13 (48%) of firework burns. Twenty patients required a total of 32 visits to the operating theatre for acute management of their burns.Conclusion: This study demonstrates the potential for significant injuries as a result of fireworks and sparklers. These findings can be used to raise awareness regarding their dangers, direct targeted educational campaigns and guide safety advice regarding their use.

scholarly journals Drug utilization pattern in sick paediatric patients: analysis for rationality and other aspects

2017 ◽  
Vol 6 (12) ◽  
pp. 2815
Author(s):  
Ambrish Gupta ◽  
Prashant Maheshwari ◽  
K. K. Dokania ◽  
J. J. Tambe
Keyword(s):  
Observational Study ◽  
Drug Utilization ◽  
Pediatric Patients ◽  
Research Work ◽  
Retrospective Observational Study ◽  
Utilization Pattern ◽  
Rational Prescribing ◽  
Paediatric Patients ◽  
Specific Objective ◽  
Set Up

Background: The aim of this research work was to study the drug utilization pattern in the indoor paediatric patients with specific objective to analyse the rationality status of prescriptions and other aspects.Methods: A retrospective observational study was conducted for a period of 6 months. We analysed 120 prescriptions for the rationality status and different other parameters using Phadke’s criteria and W.H.O. prescribing indicators.Results: In our study out of total 120 prescriptions; 90 were rational followed by semi-rational and irrational. Average number of drugs prescribed was 5.39 drugs per prescription. Out of total FDCs prescribed 30% were irrational. Most commonly prescribed drug was anti-bacterial. Among anti-bacterial, most commonly prescribed anti-bacterial was from the cephalosporin group; which is categorized as “WATCH” category in W.H.O.-EML for children, March 2017.Conclusions: Though the results in present study reflect rational prescribing in pediatric patients in our hospital set up, there is still scope of improvement in prescription habits like avoid prescribing unnecessary drugs and irrational FDCs. There is also need of prescribing by generic names.

Is major burn injury associated with coagulopathy? The value of thrombelastometry in the detection of coagulopathy in major burn injury: A prospective observational study

2020 ◽  
Vol 76 (2) ◽  
pp. 299-308
Author(s):  
Daniel Lonic ◽  
Paul I. Heidekrueger ◽  
Talia Bosselmann ◽  
P. Niclas Broer ◽  
Ralph Gertler ◽  
...  
Keyword(s):  
Observational Study ◽  
Prospective Observational Study ◽  
Burn Injury ◽  
Total Body Surface Area ◽  
Initial Assessment ◽  
Burn Patients ◽  
Major Burn ◽  
Complex Picture ◽  
Coagulation Status ◽  
Burn Disease

BACKGRUND: The coagulation status of burn patients is generally impaired and is a major factor of the deteriorating burn patients’ overall situation. In trauma and other patient groups, the differential diagnosis of coagulation impairment has been largely improved by the use of rotational thromboelastometry (ROTEM®). The aim of this prospective observational study was the differentiated observation of coagulopathy in severely burned patients using standard parameters and ROTEM® thrombelastometry during the relevant stages of burn disease. PATIENTS AND METHODS: Twelve patients that sustained at least 20% third degree burns of total body surface area (TBSA) were included in the study. Standard and ROTEM® coagulation analyses were performed on admission and then twice daily during the first 14 days following burn trauma. RESULTS: Although the initial assessment of DIC was similar for both standard labs and ROTEM® measurements, more patients were detected to be in a state of worsening coagulation status for a longer time in ROTEM® than in standard measurements. In addition, one patient was rated in to be in decompensated DIC for 3 days according to ROTEM® measurements, while no patient was rated to be in a decompensated DIC based on standard parameters. CONCLUSION: This study points towards a more complex picture and higher occurrence of DIC in burn patients when thrombelastometric measurements like ROTEM® are taken into account in addition to standard coagulation parameters.

Is the nasal tampon a suitable treatment for epistaxis in Accident & Emergency? A comparison of outcomes for ENT and A&E packed patients

2004 ◽  
Vol 118 (1) ◽  
pp. 12-14 ◽  
Author(s):  
Andrew S. Evans ◽  
David Young ◽  
Richard Adamson
Keyword(s):  
Observational Study ◽  
Retrospective Observational Study ◽  
Initial Assessment ◽  
First Line ◽  
First Line Therapy ◽  
Line Therapy ◽  
Number Of Patients ◽  
Suitable Treatment ◽  
Multiple Treatments ◽  
Nasal Tampon

This retrospective observational study aimed to establish the outcome for patients packed with a nasal tampon as first-line therapy for epistaxis in Accident & Emergency compared to those packed by ENT. During our study period, 189 admissions were treated with a nasal tampon as first-line therapy; 89 were inserted by ENT and 100 by A&E. A significantly higher number of patients packed by A&E required further treatment to control bleeding (p = 0.004; 95 per cent CI 7–34) than those in the group packed by ENT. A significantly greater proportion from the A&E group required additional cautery alone to control bleeding (p = 0.005; 95 per cent CI 5–30). We suggest that this may be due to inadequate initial assessment and inappropriate first-line therapy in the A&E department. It is recommended that ENT review patients prior to packing, in order to reduce the morbidity associated with multiple treatments.

Patterns in Acute Referral to Hospital

1997 ◽  
Vol 42 (4) ◽  
pp. 105-107 ◽  
Author(s):  
J.S. Duffield ◽  
K. Craig ◽  
W.D. Plant
Keyword(s):  
Observational Study ◽  
General Practitioners ◽  
Telephone Call ◽  
Retrospective Observational Study ◽  
Initial Assessment ◽  
Factors Affecting

This retrospective observational study aimed to assess factors affecting acute referral and subsequent admission to hospital by general practitioners. Data concerning 2,303 consecutive acute referrals to hospital from all GPs in a defined study area were collected over one month. Fund holding practices cared for 13% of the population referred 13% ofall referrals resulting in 14% ofadmissions. Referral through the A&E resulted in significantly more patients being discharged upon initial assessment (p<0.001). A telephone call accompanying referral dramatically increased the chance ofhospital admission (p<0.001). Referral to hospital was more likely the more socially deprived the patient (p<0.001) but had no subsequent bearing on admission.

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