Epidemiologic and clinical characteristics of severe burn patients: results of a retrospective multicenter study in China, 2011–2015

Abstract Background Severe burns injury is a serious pathology, leading to teratogenicity and significant mortality, and it also has a long-term social impact. The aim of this article is to describe the hospitalized population with severe burns injuries in eight burn centers in China between 2011 and 2015 and to suggest future preventive strategies. Methods This 5-year retrospective review included all patients with severe burns in a database at eight institutions. The data collected included gender, age, month distribution, etiology, location, presence of inhalation injury, total burn surface area, depth of the burn, the length of hospitalization, and mortality. SPSS 19.0 software was used to analyze the data. Results A total of 1126 patients were included: 803 (71.3%) male patients and 323 (28.7%) female patients. Scalds were the most common cause of burns (476, 42.27%), followed by fire (457, 40.59%). The extremities were the most frequently affected areas, followed by the trunk. The median length of hospitalization was 30 (15, 52) days. The overall mortality rate was 14.21%. Conclusions Although medical centers have devoted intensive resources to improving the survival rates of burn patients, expenditures for prevention and education programs are minimal. Our findings suggest that more attention should be paid to the importance of prevention and the reduction of injury severity. This study may contribute to the establishment of a nationwide burn database and the elaboration of strategies to prevent severe burns injury.

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17 Long-Term Pulmonary Sequelae After Inhalation Injury: A Retrospective Cohort Study

Journal of Burn Care & Research ◽

10.1093/jbcr/irab032.022 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

pp. S17-S17

Author(s):

Julian Wier ◽

Ian F Hulsebos ◽

Haig A Yenikomshian ◽

Justin Gillenwater

Keyword(s):

Pulmonary Disease ◽

Multinomial Logistic Regression ◽

Smoking Status ◽

Group Versus ◽

Inhalation Injury ◽

Primary Study ◽

Burn Patients ◽

Post Discharge ◽

Ventilated Patients

Abstract Introduction Inhalation injury (INHI) has strong associations with increased rates of in-patient mortality and pneumonia. Data describing long-term health outcomes after inhalation injury are scarce and the true sequelae are largely unknown. The aim of the study is to review long-term pulmonary outcomes in inhalation injury patients. We hypothesize that INHI patients are at greater risk of developing long-term pulmonary sequelae. Methods We present a retrospective case-control of burn patients admitted to an ABA certified facility. We included burn patients with or without medically confirmed INHI who were admitted between 06/2016 to 11/2019 and were part of the regional Department of Health Services (DHS) system. The experimental group was patients with bronchoscopy confirmed INHI. The control groups were ventilated patients with confirmed non-inhalation injury (V) and non-ventilated patients with confirmed non-inhalation injury (NV). These were matched for age, TBSA, sex, previous comorbid pulmonary disease, and smoking status. Primary study outcomes were rates of post-discharge pulmonary sequelae, including ineffective airway clearance, infections, shortness of breath, and malignancy. Secondary outcomes included rates of post-discharge surgeries and readmission, post-discharge non-pulmonary sequelae, and post-discharge days to pulmonary/non-pulmonary sequelae. Results The study population included 33 INHI, 45 V, and 50 NV patients. There were no significant differences in age (P=.98), sex (P=.68), TBSA (P=.18), pulmonary comorbidity (P=.5), or smoking status (P=.92). Outpatient pulmonary sequelae were significantly higher for both INHI and V groups as compared to NV (21% and 17% vs 4%, P=.023, .043). The number of days from discharge to pulmonary sequelae was significantly shorter in the INHI group versus the V group (162±139 days vs 513±314 days, P=.024). Multinomial logistic regression for both INHI and V groups using the variables comorbid pulmonary disease, smoking status, and inpatient course and complications, indicated no effect on post-discharge pulmonary sequelae (all P >.05). All other measures were not significant when comparing INHI to V or NV (all P >.05). Conclusions Both INHI and V groups resulted in higher rates of outpatient pulmonary sequelae independent of inpatient course as compared to NV. While outpatient pulmonary sequelae were not significantly different between INHI and V, the INHI patients presented with complaints earlier. Thus one can conclude that ventilation alone is a significant contributing factor for the long-term pulmonary sequelae reported in this patient population.

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A 3-Years Pneumonia Incidence in Burn Cases with Inhalation Injury at the Burn Center of Dr. Soetomo General Hospital Surabaya in 2015-2018

JUXTA: Jurnal Ilmiah Mahasiswa Kedokteran Universitas Airlangga ◽

10.20473/juxta.v13i12022.27-30 ◽

2022 ◽

Vol 13 (1) ◽

pp. 27

Author(s):

Salsabilla Gina Rania ◽

Lynda Hariani ◽

Helmia Hasan ◽

Iswinarno Doso Saputro

Keyword(s):

General Hospital ◽

Early Adulthood ◽

Secondary Data ◽

Inhalation Injury ◽

Burn Patients ◽

Risk Of Death ◽

Burn Center ◽

Specific Term ◽

Male Patients

Introduction: Inhalation injury is one of burns impact. Airway burns due to inhalation injury is a non-specific term which refer to all respiratory tract injuries occurred due to irritative chemicals, including heat and smoke during inspiration. Inhalation injury increases the risk of death in burns. Pneumonia is one of burns-related inhalation injury complications.Methods: This was a descriptive retrospective study aiming to determine the incidence of pneumonia in burn patients with inhalation injury using secondary data at Burn Center Dr. Soetomo General Hospital Surabaya in the period of January 2015 - December 2018.Results: There were 5 cases of pneumonia in 14 burn cases with inhalation injury (35.71%). Respectively, 2 and 3 cases were found in 2017 and 2018. There were 2 female (40%) and 3 male (60%) patients, with age varied within 28-73 years old. The burn area of burn patients with inhalation injury and pneumonia were found by 15%, 20%, 24%, 32% and 71%, or within the classification of 11-20% burn area, and most complication found was hypoalbuminemia, as much as 3 cases (60%).\Conclusion: Most pneumonia in burn cases with inhalation injury was occurred in 2018, dominated by male patients. The age of the patient were ranging from early adulthood to elderly. Most burns were in the range of 11-20% burn area with the most complication found was hypoalbuminemia.

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Development of a Framework for Managing Severe Burns Through a 17-year Retrospective Analysis of Burn Epidemiology and Outcomes

10.21203/rs.3.rs-145350/v1 ◽

2021 ◽

Author(s):

Ling Chen ◽

Xiaochong He ◽

Jishu Xian ◽

Jianmei Liao ◽

Xuanji Chen ◽

...

Keyword(s):

Retrospective Analysis ◽

Total Body Surface Area ◽

Inhalation Injury ◽

Burn Injuries ◽

Burn Severity ◽

Annual Number ◽

Age Difference ◽

Burn Patients ◽

Severe Burns ◽

High Level

Abstract Background Burns are one of the most common injuries in daily life for all ages of population. This study was to investigate the epidemiology and outcomes among burn patients in one of the largest burn centers in the southwest of China. Methods The study was performed at the Institute of Burn Research in the first affiliated with the Army Medical University (AMU). A total of 17939 burn patients were included in this retrospective study. Information regarding demographic, burn characteristics, and the burn severity of ABSI were collected, calculated and compared.Results The age ranged from 257 days to 95 years old. Scalding and flame were the two most common causes to burn injuries, comprising of 91.96% in total. Limbs, head/face/neck, and trunk were the most frequently occurred burn sites, with the number and the percent of 12324 (68.70%), 7989 (44.53%), and 7771 (43.32%), respectively. The average total body surface area (TBSA) was 13.64±16.83% (median 8%) with a range of 0.1~100%. A total of 874 (4.9%) patients had TBSA >50%. The presence of a burn with an inhalation injury was confirmed in 543 patients (3.03%). The average LOS was 32.11±65.72 days (median: 17days). Eventually, the retrospective analysis resulted in the development of a framework of burn management continuum used for developing strategies to prevent and manage severe burns.Conclusions The annual number of burn injuries has kept decreasing, which was partially attributed to the increased awareness and education of burn prevention and the improved burn-preventative circumstances. However, the burn severity and the economic burden were still in a high level. And the gender difference and age difference should be considered when making individualized interventions and rehabilitative treatments.

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Long-term pulmonary sequelae after inhalation injury: A retrospective case-control study

Journal of Burn Care & Research ◽

10.1093/jbcr/irab123 ◽

2021 ◽

Author(s):

Julian Wier ◽

Ian Hulsebos ◽

Leigh Spera ◽

Haig Yenikomshian ◽

T Justin Gillenwater

Keyword(s):

Smoking Status ◽

Group Versus ◽

Inhalation Injury ◽

Primary Study ◽

Burn Patients ◽

Post Discharge ◽

Retrospective Case ◽

Study Population ◽

Ventilated Patients

Abstract Inhalation injury (INHI) has strong associations with increased rates of in-patient mortality and pneumonia. This study’s aim is to review long-term pulmonary outcomes in inhalation injury patients. We present a retrospective cohort of burn patients admitted to an ABA certified burn unit. Burn patients with or without medically confirmed INHI who were admitted were studied. The control groups were ventilated patients with (V) and non-ventilated patients (NV). Primary study outcomes were rates of post-discharge pulmonary sequelae, including ineffective airway clearance, infections, shortness of breath, and malignancy. Secondary outcomes included rates of post-discharge surgeries and readmission, post-discharge non-pulmonary sequelae, and post-discharge days to pulmonary/non-pulmonary sequelae. The study population included 33 INHI, 45 V, and 50 NV patients. There were no significant differences in age (P=.98), sex (P=.68), % TBSA (P=.18), pulmonary comorbidity (P=.5), or smoking status (P=.92). Outpatient pulmonary sequelae were significantly higher for both INHI and V groups as compared to NV (21% and 17% vs 4%, P=.023, .043). The number of days from discharge to pulmonary sequelae was significantly shorter in the INHI group versus the V group (162±139 days vs 513±314 days, P=.024). All other measures were not significant when comparing INHI to V or NV (P>.05). Both INHI and V groups resulted in higher rates of outpatient pulmonary sequelae independent of inpatient course as compared to NV. While outpatient pulmonary sequelae were not significantly different between INHI and V, the INHI patients presented with complaints earlier.

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Long-Term Risk of Mortality and Pulmonary Morbidity after Inhalation Injury among Burn Patients

Journal of the American College of Surgeons ◽

10.1016/j.jamcollsurg.2017.07.111 ◽

2017 ◽

Vol 225 (4) ◽

pp. S56-S57 ◽

Cited By ~ 1

Author(s):

Cordelie E. Witt ◽

Ali Rowhani-Rahbar ◽

Frederick P. Rivara ◽

Monica S. Vavilala ◽

Tam N. Pham ◽

...

Keyword(s):

Inhalation Injury ◽

Burn Patients ◽

Risk Of Mortality ◽

Pulmonary Morbidity

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Nonmedical Factors Influencing Early Deaths in Burns: A Study of the National Burn Repository

Journal of Burn Care & Research ◽

10.1093/jbcr/irz139 ◽

2019 ◽

Author(s):

Rachel M Nygaard ◽

Frederick W Endorf

Keyword(s):

Socioeconomic Factors ◽

Burn Injury ◽

Total Body Surface Area ◽

Early Period ◽

Inhalation Injury ◽

Burn Patients ◽

Commercial Insurance ◽

Severe Burns ◽

Hispanic Patients ◽

Major Factors

Abstract It is well-established that survival in burn injury is primarily dependent on three factors: age, percent total-body surface area burned (%TBSA), and inhalation injury. However, it is clear that in other (nonburn) conditions, nonmedical factors may influence mortality. Even in severe burns, patients undergoing resuscitation may survive for a period of time before succumbing to infection or other complications. In some cases, though, families in conjunction with caregivers may choose to withdraw care and not resuscitate patients with large burns. We wanted to investigate whether any nonmedical socioeconomic factors influenced the rate of early deaths in burn patients. The National Burn Repository (NBR) was used to identify patients that died in the first 72 hours after injury and those that survived more than 72 hours. Both univariate and multivariate regression analyses were used to examine factors including age, gender, race, comorbidities, burn size, inhalation injury, and insurance type, and determine their influence on deaths within 72 hours. A total of 133,889 burn patients were identified, 1362 of which died in the first 72 hours. As expected, the Baux score (age plus burn size), and inhalation injury predicted early deaths. Interestingly, on multivariate analysis, patients with Medicare (p = .002), self-pay patients (p < .001), and those covered by automobile policies (p = .045) were significantly more likely to die early than those with commercial insurance. Medicaid patients were more likely to die early, but not significantly (p = .188). Worker’s compensation patients were more likely to survive the first 72 hours compared with patients with commercial insurance (p < .001). Men were more likely to survive the early period than women (p = .043). On analysis by race, only Hispanic patients significantly differed from white patients, and Hispanics were more likely to survive the first 72 hours (p = .028). Traditional medical factors are major factors in early burn deaths. However, these results show that nonmedical socioeconomic factors including race, gender, and especially insurance status influence early burn deaths as well.

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The Western Australia Population-based Burn Injury Project: Using record linkage to examine long-term effects of burn injury

International Journal for Population Data Science ◽

10.23889/ijpds.v1i1.227 ◽

2017 ◽

Vol 1 (1) ◽

Author(s):

Janine Duke ◽

James Boyd ◽

Sean Randall ◽

Mark Fear ◽

Fiona Wood

Keyword(s):

Western Australia ◽

Record Linkage ◽

Burn Injury ◽

Population Based ◽

Burn Patients ◽

Long Term Effects ◽

Admission Rates ◽

Severe Burns ◽

Disease Specific

ABSTRACTObjectivesWhile the most obvious impact of a burn is a visible scar, there are hidden impacts. The main contributors to adverse health outcomes after burns are the metabolic, inflammatory, immune and endocrine changes that occur in response to the initial injury. These responses have been shown to persist for at least three years after paediatric severe burns, with adverse effects to the circulatory and musculoskeletal systems. Recent evidence demonstrates that minor burns and severe burns can trigger these systemic responses. Currently, minimal data on the long-term effects of burns are available, and the data that do exist are primarily related to paediatric severe burns. We have used population-based record linkage to support a research program to shed light on the spectrum of long-term morbidity, expressed in terms of hospital admissions, experienced by burn patients to guide burn clinicians in the management of their patients. We report here our current findings of post-burn mortality and morbidity.ApproachA population-based longitudinal study using linked hospital morbidity and death data from Western Australia was undertaken of all persons hospitalised for a first burn injury (n=30,997) in 1980–2012 and a frequency matched non-injury comparison cohort, randomly selected from Western Australia’s birth registrations and electoral roll (n = 127,000). Crude admission rates and cumulative length of stay for disease-specific admissions were calculated. Negative binomial and Cox proportional hazards regression modelling were used to generate incidence rate ratios (IRR) and hazard ratios (HR), respectively, adjusting for sociodemographic and health factors. ResultsFor both paediatric and adult burn patients we identified increased long-term all-cause mortality (IRR, 95%CI: <15 years: 1.6, 1.3-2.0; 15-44 years: 1.8, 1.7-2.0; ≥ 45 years: 1.4, 1.3-1.5). Increased post-burn discharge health service use for cardiovascular diseases (IRR, 95%CI: <15 years: 1.3, 1.1-1.6; 15-44 years: 1.6, 1.4-1.7; ≥ 45 years: 1.5, 1.4-1.6) and musculoskeletal conditions (IRR, 95%CI: <20 years: 1.9, 1.7-2.1; ≥ 20 years: 2.0, 1.9-2.1) were also found. Analyses found significantly elevated admission rates for minor and severe burns. Adjusted HRs identified time periods after discharge where burn patients experienced significantly elevated disease-specific incident admissions (results not provided).ConclusionsBoth minor and severe burns were associated with increased long-term cardiovascular and musculoskeletal morbidity and mortality. These results identify treatment needs for burn patients for a prolonged time after discharge. Further research that links primary care and pharmaceutical data is required to facilitate identification of at-risk patients and appropriate treatment pathways to reduce post-burn morbidity.

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Long-term Tumor Control of Benign Intracranial Meningiomas After Radiosurgery in a Series of 4565 Patients

Neurosurgery ◽

10.1227/neu.0b013e31822d408a ◽

2011 ◽

Vol 70 (1) ◽

pp. 32-39 ◽

Cited By ~ 110

Author(s):

Antonio Santacroce ◽

Maja Walier ◽

Jean Régis ◽

Roman Liščák ◽

Enrico Motti ◽

...

Keyword(s):

Survival Rates ◽

Gamma Knife Radiosurgery ◽

Progression Free Survival ◽

Morbidity Rate ◽

Tumor Control ◽

Imaging Data ◽

Long Term Follow Up ◽

Male Patients

Abstract BACKGROUND Radiosurgery is the main alternative to microsurgical resection for benign meningiomas. OBJECTIVE To assess the long-term efficacy and safety of radiosurgery for meningiomas with respect to tumor growth and prevention of associated neurological deterioration. Medium- to long-term outcomes have been widely reported, but no large multicenter series with long-term follow-up have been published. METHODS From 15 participating centers, we performed a retrospective observational analysis of 4565 consecutive patients harboring 5300 benign meningiomas. All were treated with Gamma Knife radiosurgery at least 5 years before assessment for this study. Clinical and imaging data were retrieved from each center and uniformly entered into a database by 1 author (A.S.). RESULTS Median tumor volume was 4.8 cm3, and median dose to tumor margin was 14 Gy. All tumors with imaging follow-up > 24 months were excluded. Detailed results from 3768 meningiomas (71%) were analyzed. Median imaging follow-up was 63 months. The volume of treated tumors decreased in 2187 lesions (58%), remained unchanged in 1300 lesions (34.5%), and increased in 281 lesions (7.5%), giving a control rate of 92.5%. Only 84 (2.2%) enlarging tumors required further treatment. Five- and 10-year progression-free survival rates were 95.2% and 88.6%, respectively. Tumor control was higher for imaging defined tumors vs grade I meningiomas (P > .001), for female vs male patients (P > .001), for sporadic vs multiple meningiomas (P > .001), and for skull base vs convexity tumors (P > .001). Permanent morbidity rate was 6.6% at the last follow-up. CONCLUSION Radiosurgery is a safe and effective method for treating benign meningiomas even in the medium to long term.

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Development of a framework for managing severe burns through a 17-year retrospective analysis of burn epidemiology and outcomes

Scientific Reports ◽

10.1038/s41598-021-88507-x ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Ling Chen ◽

Xiaochong He ◽

Jishu Xian ◽

Jianmei Liao ◽

Xuanji Chen ◽

...

Keyword(s):

Retrospective Analysis ◽

Total Body Surface Area ◽

Inhalation Injury ◽

Burn Injuries ◽

Annual Number ◽

Age Difference ◽

Burn Patients ◽

Burn Prevention ◽

Severe Burns ◽

High Level

AbstractBurns are one of the most common injuries in daily life for all ages of population. This study was to investigate the epidemiology and outcomes among burn patients in one of the largest burn centers in the southwest of China. The study was performed at the Institute of Burn Research in the first affiliated with the Army Medical University (AMU). A total of 17,939 burn patients were included in this retrospective study. Information regarding burn epidemiology and outcomes in 17 years were collected, calculated and compared. The age ranged from 257 days to 95 years old. Scalding and flame were the two most common causes to burn injuries, comprising of 91.96% in total. Limbs, head/face/neck, and trunk were the most frequently occurred burn sites, with the number and the percent of 12,324 (68.70%), 7989 (44.53%), and 7771 (43.32%), respectively. The average total body surface area (TBSA) was 13.64 ± 16.83% (median 8%) with a range of 0.1–100%. A total of 874 (4.9%) patients had TBSA > 50%. The presence of a burn with an inhalation injury was confirmed in 543 patients (3.03%). The average LOS was 32.11 ± 65.72 days (median: 17 days). Eventually, the retrospective analysis resulted in the development of a burn management continuum used for developing strategies to prevent and manage severe burns. The annual number of burn injuries has kept decreasing, which was partially attributed to the increased awareness and education of burn prevention and the improved burn-preventative circumstances. However, the burn severity and the economic burden were still in a high level. And the gender difference and age difference should be considered when making individualized interventions and rehabilitative treatments.

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Transapical versus Conventional Aortic Valve Replacement�A Propensity-Matched Comparison

The Heart Surgery Forum ◽

10.1532/hsf98.20111084 ◽

2012 ◽

Vol 15 (1) ◽

pp. 4 ◽

Cited By ~ 23

Author(s):

David M. Holzhey ◽

William Shi ◽

A. Rastan ◽

Michael A. Borger ◽

Martin H�nsig ◽

...

Keyword(s):

Aortic Valve ◽

Survival Rates ◽

Long Term Results ◽

Term Survival ◽

Kaplan Meier ◽

Risk Patients ◽

Short And Long Term ◽

Good Treatment Option ◽

Matched Comparison

Introduction: The goal of this study was to compare the short- and long-term outcomes after aortic valve (AV) surgery carried out via standard sternotomy/partial sternotomy versus transapical transcatheter AV implantation (taTAVI).Patients and Methods: All 336 patients who underwent taTAVI between 2006 and 2010 were compared with 4533 patients who underwent conventional AV replacement (AVR) operations between 2001 and 2010. Using propensity score matching, we identified and consecutively compared 2 very similar groups of 167 patients each. The focus was on periprocedural complications and long-term survival.Results: The 30-day mortality rate was 10.8% and 8.4% (P = .56) for the conventional AVR patients and the TAVI patients, respectively. The percentages of postoperative pacemaker implantations (15.0% versus 6.0%, P = .017) and cases of renal failure requiring dialysis (25.7% versus 12.6%, P = .004) were higher in the TAVI group. Kaplan-Meier curves diverged after half a year in favor of conventional surgery. The estimated 3-year survival rates were 53.5% � 5.7% (TAVI) and 66.7% � 0.2% (conventional AVR).Conclusion: Our study shows that even with all the latest successes in catheter-based AV implantation, the conventional surgical approach is still a very good treatment option with excellent long-term results, even for older, high-risk patients.

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