Effectiveness Of Early Excisional Debridement In Burn Injuries To Sepsis Incidence And Mortality Rate At Burn Unit Of Hasan Sadikin Hospital

Background: Sepsis is an important cause of mortality in patients with burn, although many factors influence it. Early excision debridement as source control treatment has been done routinely in our center. It was intended to prevent sepsis and decrease mortality rate. Methods: We performed a retrospective, cross sectional study over 4 years (2012-2014) among patients with flame burns in Burn Unit Dr. Hasan Sadikin Hospital who underwent early excisional debridement. The criteria of patients were adult, with full thickness burn, without inhalation injury and co morbid disease. The mortality, length of stay, and incidence of sepsis were analyzed by simple regression linier statistics using SPSS 16.0 for Windows. Results: Mortality rate of all patients was 43.3%, and 42.3% was directly caused by sepsis. Thirty-nine patients matched the criteria, 20 patients had early excision (< 3 days) and 19 patients had late excision (> 3 days). In early excision group, 75% got sepsis and 55% died. Mortality and incidence of sepsis wasn’t significantly different in both groups (p=0.252 and p=0.855). Both groups have same length of stay (mean : 13.1 and p=0.236). Sex as confounding factor wasn’t significantly different (p=0.774). The extent of TBSA and age were significant factors causing mortality rate (p < 0.05). Conclusion: There are many factors that contribute to the success of treating burn patient. Excision debridement was proven by this study not a major factor and ineffective to decrease sepsis and mortality in burned patients.

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Epidemiology And Mortality Of Burn Injury In Ciptomangunkusumo Hospital, Jakarta: A 5 Year Retrospective Study

Jurnal Plastik Rekonstruksi ◽

10.14228/jpr.v6i1.270 ◽

2020 ◽

Vol 6 (1) ◽

pp. 234-242

Author(s):

Aditya Wardhana ◽

Gammaditya Adhibarata Winarno

Keyword(s):

Mortality Rate ◽

Length Of Stay ◽

Burn Injury ◽

Average Length ◽

Demographic Data ◽

Cross Sectional Study ◽

Inhalation Injury ◽

Payment Method ◽

Cross Sectional ◽

Burn Unit

Background : Burns is a significant cause of morbidity and mortality worldwide. Particularly in low- and middle-income countries (LMICs), burns account for an estimated 180.000 deaths every year. Burn-related mortality rates are exceptionally high in South-East Asia (11.6 deaths per 100 000 population per year) compare with much lower rates of 1.0 deaths per 100.000 people per year in high-income countries. This study aims to investigate the demographic data, etiology, and outcome of the patients treated in burn unit Ciptomangunkusumo Hospital, Jakarta, Indonesia. Method: This is a retrospective cross-sectional study, collecting epidemiologic data from the medical record through Electronic Health Record. A total of 709 patients admitted to burn unit between 2013-2017 were reviewed based on age, sex, total burn surface area (TBSA), burn grade, inhalation injury, etiology, length of stay, outcome, and payment method. Inclusion criteria are patients that were admitted to burn unit of Ciptomangunkusumo Hospital between 2013-2017, while there are no exclusion criteria in this study. Result : Admission of patients between 2013-2017 has inclined throughout the year, from 97 in 2013 to 166 in 2017. Average patient admission per year, reaching 141,8±26,761. Jakarta, and its suburb Bogor, Depok, Tangerang, and Bekasi, has dominated the proportion of referring hospital with 538(75.9%) The most amount of payment method is NHI (JKN/BPJS) with 534(75.3%) population. A total of 465 were male, and 244 were female, with a ratio of 1.9:1. The highest incidence in terms of age group is 16-35 years old (269, with the average age of patients, is 29±19. The highest incidence of burn injury is caused by a stove gas explosion with 253(35.7%), followed by flame 189(26.7%). There are 63 out of 709 patients with inhalation injury, where the incidence rate is 8.9%. Patients admitted to the Ciptomangunkusumo burn unit has an average length of stay of 15 days hospitalization. The most frequent population of extent, staying >14 days is 21-30% TBSA (88). The mortality rate in the Ciptomangunkusumo burn unit is 25.8% (183), with the highest number of death came from TBSA >40% (136). Conclusion: A total of 709 patients were admitted to the Ciptomangunkusumo burn unit in Jakarta, Indonesia, over 5 years, with an average of 141 patients per year and an increase of 171% from 2013 to 2017. Most patients were diagnosed with >40% TBSA and 2nd-3rd grade burn injury. An average of 15 days of hospitalization for patients leading up to 25.8% mortality rate, they are with septic shock as the most common condition causing death in the burn unit.

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The Effect of Early Tangential Excision and Split Thickness Skin Graft in Reducing Length of Stay in Burns Patients in Jakarta Islamic Hospital Cempaka Putih

Jurnal Plastik Rekonstruksi ◽

10.14228/jprjournal.v8i1.309 ◽

2021 ◽

Vol 8 (1) ◽

pp. 15-20

Author(s):

Gammaditya Adhibarata Winarno ◽

Aditya Wardhana ◽

Sanjaya Faisal Tanjunga ◽

A. S Augiani ◽

An’umillah Arini Zidna

Keyword(s):

Length Of Stay ◽

Skin Graft ◽

Burn Injury ◽

Study Groups ◽

Cross Sectional Study ◽

Burn Injuries ◽

Split Thickness Skin Graft ◽

Burn Patients ◽

Cross Sectional ◽

Thickness Skin

Introduction: Early tangential excision (TE) and split-thickness skin graft (STSG) have increased the outcome in burn patients treated at specialized burn centers. This study was conducted to compare the length of stay (LOS) in burn patients undergoing early TE & STSG and delayed TE & STSG. Method: This is a retrospective cross-sectional study including 42 patients with varied burn degrees, and TBSA admitted to Jakarta Islamic Hospital Cempaka Putih (JIHCP) Burn Unit. Patients were assigned to two study groups, the early TE & STSG group including 32 patients and the delayed TE & STSG group including 10 patients. All data were collected from the medical record and compared between two study groups. Result: The mean of LOS in a group with early TE & STSG was shorter (9.81±6.41 days) than LOS in the delayed TE & STSG group (15.80±5.67 days). The data of LOS between these groups were compared using an independent T-test. The LOS in the early TE & STSG group was significantly shorter than the delayed TE & STSG group (p=0.012). Conclusion: In patients with burn injuries, early TE & STSG is associated with a shorter length of stay than the delayed TE & STSG. Our study indicates that early excision within five days after burn injury is optimal to reduce the length of stay in burn patients.

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Risk Factors, Pattern and Outcome of Motorcycle-associated Head Injury in Sokoto: An Analysis of 184 Cases

Indian Journal of Neurotrauma ◽

10.1055/s-0040-1722553 ◽

2021 ◽

Author(s):

Henry Olayere Obanife ◽

Nasiru Jinjiri Ismail ◽

Ali Lasseini ◽

Bello B. Shehu ◽

Ega J. Otorkpa

Keyword(s):

Developing Countries ◽

Head Injury ◽

Road Traffic ◽

Negative Impact ◽

Cross Sectional Study ◽

Cross Sectional ◽

Female Ratio ◽

Incidence And Mortality ◽

Male Female Ratio ◽

Significant Negative Impact

Abstract Background Road traffic accident (RTA) is the eighth leading cause of death worldwide. Motorcycle-associated head injury is the leading cause of road traffic associated morbidity and mortality in developing countries. Even though the incidence and mortality of head injury from motor cycle crash is on the increase in developing countries, especially in the African continent, most of the studies published in the literature on this subject matter took place in the developed Western countries. Methods This is a retrospective cross-sectional study of data from patients managed in our institution between December 2014 and November 2016. Results One hundred and eighty-four patients were analyzed. None of the patients used safety helmet for protection. The mean age was 27.6 ± 17.2 years with male female ratio of 6.7:1. Lone crash by cyclists and collisions accounted for 66.8% and 33.1% of the cases, respectively. Passengers and riders comprised 75% of the patients, while 25% were vulnerable pedestrians. The most frequently abused substance by the patients was tramadol (65.52%). Severe head injury and pupillary abnormality were found in 23.9% and 45.5% of the patients, respectively. Cranial CT scan showed abnormalities in 40.2% of the patients. Surgery was done in 28.3% of the patients with mortality rate of 20.7%. Conclusions The use of motorcycle as a mean of transportation has caused significant negative impact on the society. Young people, who constitute the workforce, are majorly affected, and this invariably leads to a serious economic burden on the concerned families and communities.

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Cross-sectional study of prevalence and risk factors, and a cost-effectiveness evaluation of screening and preventive treatment strategies for latent tuberculosis among migrants in Singapore

BMJ Open ◽

10.1136/bmjopen-2021-050629 ◽

2021 ◽

Vol 11 (7) ◽

pp. e050629

Author(s):

Vanessa W Lim ◽

Hwee Lin Wee ◽

Phoebe Lee ◽

Yijun Lin ◽

Yi Roe Tan ◽

...

Keyword(s):

Risk Factors ◽

Cost Effectiveness ◽

Length Of Stay ◽

Latent Tuberculosis ◽

Cross Sectional Study ◽

Secondary Outcome ◽

Sectional Study ◽

Cross Sectional ◽

Ltbi Prevalence ◽

The Cost

ObjectivesWHO recommends that low burden countries consider systematic screening and treatment of latent tuberculosis infection (LTBI) in migrants from high incidence countries. We aimed to determine LTBI prevalence and risk factors and evaluate cost-effectiveness of screening and treating LTBI in migrants to Singapore from a government payer perspective.DesignCross-sectional study and cost-effectiveness analysis.SettingMigrants in Singapore.Participants3618 migrants who were between 20 and 50 years old, have not worked in Singapore previously and stayed in Singapore for less than a year were recruited.Primary and secondary outcome measuresCosts, quality-adjusted life-years (QALYs), threshold length of stay, incremental cost-effectiveness ratios (ICERs), cost per active TB case averted.ResultsOf 3584 migrants surveyed, 20.4% had positive interferon-gamma release assay (IGRA) results, with the highest positivity in Filipinos (33.2%). Higher LTBI prevalence was significantly associated with age, marital status and past TB exposure. The cost-effectiveness model projected an ICER of S$57 116 per QALY and S$12 422 per active TB case averted for screening and treating LTBI with 3 months once weekly isoniazid and rifapentine combination regimen treatment compared with no screening over a 50-year time horizon. ICER was most sensitive to the cohort’s length of stay in Singapore, yearly disease progression rates from LTBI to active TB, followed by the cost of IGRA testing.ConclusionsFor LTBI screening and treatment of migrants to be cost-effective, migrants from high burden countries would have to stay in Singapore for ~50 years. Risk-stratified approaches based on projected length of stay and country of origin and/or age group can be considered.

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Temporal Trends in the Severity and Mortality of Neonatal Hypoxic-Ischemic Encephalopathy in the Era of Hypothermia

Neonatology ◽

10.1159/000518654 ◽

2021 ◽

pp. 1-8

Author(s):

Cristina Vega-Del-Val ◽

Juan Arnaez ◽

Sonia Caserío ◽

Elena Pilar Gutiérrez ◽

Marta Benito ◽

...

Keyword(s):

Temporal Trends ◽

Cross Sectional Study ◽

Annual Incidence ◽

Hypoxic Ischemic Encephalopathy ◽

Cross Sectional ◽

Incidence And Mortality ◽

Changes Over Time ◽

Ischemic Encephalopathy ◽

Annual Decline ◽

Over Time

Introduction: There is a paucity of studies examining temporal trends in the incidence and mortality of moderate-to-severe hypoxic-ischemic encephalopathy (HIE) during the last decade of therapeutic hypothermia (TH). Methods: Multicenter cross-sectional study of all infants ≥35 weeks gestational age diagnosed with moderate-to-severe HIE within 6 h of birth in an extensive region of Spain between 2011 and 2019, in order to detect trend changes over time in the (1) annual incidence, (2) severity of neurological and systemic organ involvement, and (3) neonatal death from HIE. Results: Annual incidence rate of moderate-to-severe HIE was 0.84 (95% confidence interval [CI] 0.7–0.97) per 1,000 births, without trend changes over time (p = 0.8), although the proportion of severe HIE infants showed an average annual decline of 0.86 points (95% CI 0.75–0.98). There were 102 (70%) infants diagnosed with moderate HIE and 44 (30%) with severe HIE. TH was offered to 139/146 (95%) infants. Infants with clinical and/or electrical seizures showed a decreasing trend from 56 to 28% (p = 0.006). Mortality showed a nonstatistically significant decline (p = 0.4), and the severity of systemic damage showed no changes (p = 0.3). Obstetric characteristics remained unchanged, while higher perinatal pH values (p = 0.03) and Apgar scores (p = 0.05), and less need for resuscitation (p = 0.07), were found over time. Conclusion: The annual incidence of moderate-to-severe HIE has stabilized at around 1 per 1,000 births, with a temporal trend toward a decrease in severe HIE infants and a slight decline of mortality. No association was found between temporal trends and changes in perinatal/obstetric characteristics over time.

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Investigating the Factors Affecting the Length of Stay of Patients Admitted To Psychiatry Hospital at North of Iran

Iranian Journal Of Health Sciences ◽

10.18502/jhs.v7i4.2204 ◽

2020 ◽

Author(s):

Pezhman Hadinezhad ◽

Javad Setareh ◽

Mahmood Moosazadeh

Keyword(s):

Length Of Stay ◽

Psychiatric Disorders ◽

Psychotic Disorders ◽

Psychiatric Hospitals ◽

Final Diagnosis ◽

Cross Sectional Study ◽

Cross Sectional ◽

Factors Affecting ◽

Quality Of Control ◽

North Of Iran

Background and Purpose: Length of stay is one of the most useful indicators, which can be used for aims, such as managing hospital, determining quality of control and available resources of the hospital. Concerning the high prevalence of psychiatric disorders in the community, studying the factors affecting the length of stay of these patients in psychiatric hospitals seemed to be useful and significant. Materials and methods: The present research was a cross-sectional study. The sample consisted of 152 patients with psychiatric disorders hospitalized in the Psychiatry Hospital of Mazandaran University of Medical Sciences. The final diagnosis of psychiatric disorder based on the DSM-V criteria and the length of stay at the end was recorded. The collected data were then analyzed by SPSS Software ver. 16 Results: Length of stay was significantly higher in men than women (p <0.001). In terms of diagnosis, the maximum duration of hospitalization was related to psychotic disorders (p = 0.001), and the length of stay increased significantly 0.21 day for each time of hospitalization. (p=0.008) Conclusion: The length of stay in men with psychotic disorders and more frequent hospitalization was found to be higher than others. Hence, it seemed necessary to consider plans about these patients.

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Analisis zat gizi dan biaya sisa makanan pada pasien dengan makanan biasa

Jurnal Gizi Klinik Indonesia ◽

10.22146/ijcn.17379 ◽

2005 ◽

Vol 1 (3) ◽

pp. 108

Author(s):

Mihir Djamaluddin ◽

Endy Paryanto Prawirohartono ◽

Ira Paramastri

Keyword(s):

Length Of Stay ◽

Food Waste ◽

Economic Value ◽

Food Service ◽

Cross Sectional Study ◽

Chi Square ◽

Cross Sectional ◽

Regular Diet ◽

The Difference ◽

The Cost

Background: The quality of food service in a hospital can be assessed from the inpatients’ nutritional status. Food waste is an indicator of food service among inpatients. Besides its therapeutic value, food has a significant economic value. The wasting cost in term of food waste affects the total availability of food costs.Objective: This study analyzes the nutrient quantity and the cost of food waste among inpatients with regular diet at Dr. Sardjito Hospital, Yogyakarta.Method: This was a cross sectional study. The subjects were inpatients aged 17 to 60 years old who got regular diet with length of stay was at least three days, and were willing to take part in this study (n=100). The amount of food waste was measured using the Comstock visual estimation. The cost of food waste was calculated as the proportion of food waste from cost per serving. The quantity of nutrients in food waste was calculated using the Food Processor 2 software. The data were analyzed using Chi-square test.Results: There was a difference of food waste according to gender. Rice waste was found more frequent among female (p<0,005). There was a difference of food waste according to ward class. There were more waste of meat and vegetables among inpatients in class II and the difference was significant (p<0,05). There were more waste of meat and vegetables among patients with length stay of 7 – 14 days and > 15 days (p<0,05). The vegetables and rice waste were more frequent among surgery and cancer inpatients (p<0,05). In average the nutritional value of food waste was 19,85% - 9,33% of a patient’s RDA, while the wasting cost per day was Rp 1265,08 or 10,79% of all food cost per day. The annual wasting cost of food waste was Rp 45.543.120 or 4,4% of the available budget of Rp 1.038.605.333,00.Conclusion: There were differences of food waste according to gender, ward class, length of stay, and kind of disease, especially rice, meat, and vegetables.

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Prevalence of biologic, behavioral and psychosocial determinant of tuberculosis in tuberculosis patients of Semnan city; a five-year cross-sectional study

Journal of Preventive Epidemiology ◽

10.34172/jpe.2020.24 ◽

2020 ◽

Vol 5 (2) ◽

pp. e24-e24

Author(s):

Naim Sadat Kia ◽

Mohammad Nassaji Zavareh ◽

Elnaz Sarkheil ◽

Elaheh Ghods

Keyword(s):

Demographic Data ◽

Cross Sectional Study ◽

Alcoholic Beverages ◽

Cross Sectional ◽

Factors Affecting ◽

Incidence And Mortality ◽

The Social ◽

Household Crowding ◽

Clinical Records ◽

The Impact

Introduction: Tuberculosis (TB) is one of the most common and lethal infectious diseases. Objectives: Due to the impact of biological, behavioral, socio-economic factors on the incidence of TB and the risks of the disease, we aimed to investigate the factors affecting TB in TB patients in Semnan. Patients and Methods: All patients with confirmed TB, who were referred to primary healthcare centers in Semnan for receiving medication, enrolled in the study (2012 to 2016). Data collected from clinical records and in-person interviews. The questionnaire consisted of two parts; the first part was demographic data and the other was related to the risk factors for TB. Results: The household crowding index was 1.86 ± 0.88. Most of patients (48.1%) were elderly (≥60 years old), female (59.7%), housewife (48.1%), had a pre-diploma education (63.6%), low-monthly income (62.3%) and married (63.6%). Around13.0% had diabetes. 20.8% drug abuser, 16.9% cigarettes and tobacco smokers, and 1.3% consumed alcoholic beverages. Besides, 40.3% were Afghans and 1.3% had the Pakistani nation. Conclusion: Identifying and controlling the social, geographical and biological factors affecting the incidence and mortality of TB in different regions can help to formulate appropriate strategies for achieving global goals. These factors differ among native and non-native population.

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Physical activity levels in hospitalised adults with burn injuries

Journal of Burn Care & Research ◽

10.1093/jbcr/irab233 ◽

2021 ◽

Author(s):

Anita Plaza ◽

Julie Adsett ◽

Angela Byrnes ◽

Prue McRae

Keyword(s):

Physical Activity ◽

Total Body Surface Area ◽

Physical Activity Behaviour ◽

Cross Sectional Study ◽

Hospital Length ◽

Burn Injuries ◽

Hospital Length Of Stay ◽

Activity Levels ◽

Cross Sectional ◽

Activity Behaviour

Abstract Physical activity behaviour has not been previously described in hospitalised adults with burn injuries. This prospective, cross-sectional study used a standardised behavioural mapping protocol to observe patient behaviour related to physical activity over a 12-hour period on one weekday in a quaternary referral specialist burn centre. Structured observations were recorded for each of four domains: 1) patient location, 2) position, 3) activity performed and 4) the presence of others. Observations were summarised across all participants as median (IQR) proportion of time. Participants (n=17) were predominantly male (82%) with a mean age of 44.3 (SD 15.2) years, a mean burn size of 34.9% (SD 26.7) total body surface area and a median hospital length of stay of 18 (IQR 6-49) days at time of observation. Participants spent a median of 83% (IQR 73-93) of time in their bedroom, 92% (IQR 68-97) of time in or on their bed and a median of 5% (IQR 3-13) of time mobilising. Exercise accounted for 10% (IQR 8-17) of activity related observations. A median of 68% (IQR 39-83) of time was spent alone. Results suggest time spent engaging in physical activity is low. Further studies are required to investigate motivators and barriers to performing physical activity in this population. This will consequently inform the development and implementation of appropriate strategies to improve physical activity behaviour in this cohort.

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102 Wildfire Burns: Implications for Burn Care

Journal of Burn Care & Research ◽

10.1093/jbcr/iraa024.105 ◽

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.

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