scholarly journals Comparison of ABSI and Full-Thickness Burns Indexes in the Prediction of Hospital Mortality in Burn Patients

2021 ◽  
Author(s):  
Farzad Rahmani ◽  
Fereshteh Jamali ◽  
Behnam Moallemzadeh Vayghan ◽  
Haniyeh Ebrahimi Bakhtavar
Keyword(s):  
Hospital Mortality ◽  
Severity Index ◽  
Underlying Disease ◽  
Inhalation Injury ◽  
Burn Severity ◽  
Anatomical Location ◽  
Burn Patients ◽  
Full Thickness ◽  
Cross Sectional ◽  
Significant Difference

The aim of this study was to evaluate the abbreviated burn severity index (ABSI) score and the percentage of full-thickness burn in the prediction of hospital mortality in burn patients admitted to Sina Hospital in Tabriz. A total of 250 burn patients admitted to burn, and ICU wards during December 2016-Sep 2018 entered the present cross-sectional descriptive study. The collected data included age, gender, burn percentage, anatomical location of the burn, cause of the burn, severity of the burn, mucosal or inhalation injury, underlying disease, length of stay (day), and the hospital outcome of the patient. There was a significant difference between the two genders in terms of the cause of burns (P<0.0001). The most common cause of burn-in women and men was hot liquids and fire, respectively. 40% TBSA with 92% sensitivity and 94% specificity and 20% full-thickness burns with 98% sensitivity and 88% specificity was obtained in predicting mortality of patients. ABSI score of 9 with 85% sensitivity and 95% specificity was obtained in predicting mortality in patients. By increasing one unit in the ABSI score, the odds ratio increases by 17.5 times in terms of mortality probability. The present study showed a significant difference between the two genders in terms of the cause of the burn, and it is evidently affected by the culture and lifestyle of our country. On the other hand, an investigation of the cause of death in patients with ABSI>9 and taking appropriate measures to reduce their mortality is recommended. Also, it is recommended to use more simple criteria such as burn percentage or full-thickness burns to predict mortality rate in case of burning injury patients.

scholarly journals Epidemiological and clinical characteristics of burns in the older person: a seven-year retrospective analysis of 693 cases at a burn center in south-west China

2020 ◽  
Vol 8 ◽  
Author(s):  
Wei Qian ◽  
Song Wang ◽  
Yangping Wang ◽  
Xiaorong Zhang ◽  
Mian Liu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Clinical Characteristics ◽  
Total Body Surface Area ◽  
Inhalation Injury ◽  
Anatomical Location ◽  
Burn Patients ◽  
Full Thickness ◽  
Older Individuals ◽  
West China ◽  
South West

Abstract Background Burns are one of the major traumas that may affect older individuals. The purpose of this study was to investigate the epidemiological and clinical characteristics of geriatric burns at a major center in south-west China. Methods This retrospective study was conducted at the Institute of Burn Research, Southwest Hospital of Army Medical University between 2010 and 2016, and the data collected from medical records included admission date, age, gender, premorbid disease, burn etiology, injured anatomical location, burn area and depth, inhalation injury, number of surgeries, length of stay (LOS), clinical outcome, and medical cost. Results Of the 693 older burn patients included, 60.75% were male and 56.85% were aged 60–69 years. Burns peaked in December–March and June. Flame was the most common cause of burns, making up 51.95% of all cases, and also dominated in the burn patients aged 60–69 years. Limbs were the most common anatomical sites of burns (69.41%), and the median total body surface area (TBSA) was 5% (interquartile range [IQR]: 2%–15%). The percentage of the patients who underwent surgeries and number of surgeries significantly increased in the cases of contact burns, younger age and full-thickness burns. Six deaths resulted in a mortality of 0.9%. The median LOS was 16 days (IQR: 8–29 days), and the main risk factors were more surgeries, better outcomes, and full-thickness burns. The median cost was 20,228 CNY (IQR: 10,457– 46,581.5 CNY), and major risk factors included longer LOS, larger TBSA, and more surgeries. Furthermore, compared to the earlier data from our center, the proportion of older adults among all burns (7.50% vs. 4.15%), proportion of flame burns (51.95% vs. 33.90%), and mean age (69.05 years vs. 65.10 years) were significantly higher, while the proportion of premorbidities (16.9% vs. 83.9%), mortality (0.9% vs. 7.5%) and median TBSA (5% vs. 21%) were significantly lower. Conclusions This study suggested that closer attention should be paid to prevent burn injuries in older people aged 60–69 years, especially males, regarding incidents in the summer and winter, and flame burns. Moreover, tailored intervention strategies based on related risk factors should be under special consideration.

scholarly journals Extremely High-frequency Therapy in the Complex Treatment of Pneumonia in Patients with Burn and Inhalation Trauma

2019 ◽  
Vol 7 (4) ◽  
pp. 335-340
Author(s):  
V. A. Shchyotkin ◽  
E. A. Chukina ◽  
T. G. Spiridonova ◽  
N. V. Borovkova ◽  
E. A. Beresneva ◽  
...  
Keyword(s):  
High Frequency ◽  
Comparison Group ◽  
Venous Blood ◽  
Underlying Disease ◽  
Inhalation Injury ◽  
Wilcoxon Test ◽  
Burn Patients ◽  
Complex Treatment ◽  
Extremely High Frequency ◽  
Significant Difference

Background. The improvement of treatment tactics for nosocomial pneumonia in patients with burn and inhalation trauma is a relevant issue due to the frequency of this complication, which develops at any stage of treatment and aggravates the course of the underlying disease.Aim of study. To evaluate the effectiveness of extremely high frequency therapy (EHFT) in the complex treatment of pneumonia in patients with burn and inhalation injury.Material and methods. The results of extremely high-frequency therapy (EHFT) was compared, studying 23 burn patients with complex EHFT and 30 patients without EHFT.Results. EHFT reduces the signs of endogenous toxemia, as evidenced by a statistically significant decrease in elevated concentrations of dead leukocytes in venous blood from 147-106/L (98; 363-106/L) to 81.8-106/L (72; 150-106/L) (p=0.041, Wilcoxon test) on day 6-8 (after 5-6 procedures), whereas in the comparison group, on the contrary, an increase in the dead cells from 121-106/L (66; 210-106/L) up to 137.4-106/L (116; 207-106/L) was observed. When comparing this indicator in two groups on day 6-8 from the onset of pneumonia, a statistically significant difference was found (p=0.021, Mann-Whitney). The term of managing pneumonia in patients receiving EHFT was significantly shorter than in the comparison group, 18 (13; 23) versus 21 (18; 27) days (p=0.020, Mann-Whitney).Conclusion. EHFT reduced intensity of endogenous toxicosis and inflammation, approaching pneumonia relief for 3 days.

87 Evaluating Endothelial Dysfunction in Thermally-injured Patients with syndecan-1, Tissue Factor Pathway Inhibitor, and Thrombomodulin as Predictors of Mortality

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S57-S58
Author(s):  
John W Keyloun ◽  
Saira Nisar ◽  
Kathleen Brummel-Ziedins ◽  
Maria Bravo ◽  
Matthew Gissell ◽  
...  
Keyword(s):  
Tissue Factor ◽  
Tissue Factor Pathway Inhibitor ◽  
Burn Injury ◽  
Endothelial Damage ◽  
Inhalation Injury ◽  
Burn Patients ◽  
Mixed Effect ◽  
Significant Difference ◽  
Tissue Factor Pathway ◽  
Injured Patients

Abstract Introduction Endotheliopathy in burn patients is largely uncharacterized. Syndecan-1 (SDC-1), thrombomodulin (TM), and tissue factor pathway inhibitor (TFPI) are components of the vascular endothelial glycocalyx. Proteolytic cleavage of these moieties may yield biomarkers for endothelial damage. The aim of this study is to evaluate endotheliopathy after burn injury by monitoring plasma levels of these biomarkers over time to investigate potential relationship to mortality. Methods Burn injured patients presenting to a regional burn center from 2012 to 2017 were prospectively enrolled. Blood samples were collected at 0, 2, 4, 8, 12, 24, 36, 48, 60, and 72 hours from admission. Plasma SDC-1, TM, and TFPI levels were quantified by ELISA. Demographic data and injury characteristics were obtained from the medical chart. Patients with concomitant inhalation injury, trauma, or &lt; 10% total body surface area (TBSA) burns were excluded. Statistical analysis was performed using mixed-effect models with Sidak’s correction for multiple comparisons. Significance was set at p =0.05. Data are presented as mean ± standard deviation. Results A cohort of 22 patients was identified with an average age of 45±14 years, TBSA of 30±15%, with 6 patients who died from their injuries. The deceased group was older (59±13 vs. 40±10 years, p = 0.01), and there was no significant difference in burn size. Mean SDC-1 levels were higher in the deceased group at all time points (p=0.0004) and this difference was significant at hour 12 (106±11 vs. 41±31 ng/mL, p = 0.0002), hour 24 (160±39 vs. 35±20 ng/mL, p = 0.04) and hour 72 (100±3 vs. 35±38 ng/mL, p = 0.01). Mean soluble TM levels were higher in the deceased group after hour 12 (p = 0.04) and there was a trend towards higher TFPI levels after hour 12 in the deceased group. Conclusions Biomarkers are elevated in patients following burn injury who die, when inhalation injury and trauma are excluded. Given equivalent TBSA, older patients appear more sensitive to thermally induced glycocalyx degradation. SDC-1 shows the greatest promise as a prognostic indicator as levels tend to be higher among deceased patients on admission and are significantly higher as early as hour 12. Applicability of Research to Practice Reliable assessment of the patient’s endothelial damage may hold predictive value for clinicians and could assist in clinical decision making. Further research must investigate endotheliopathy in burn patients.

scholarly journals Multicenter longitudinal cross-sectional study comparing effectiveness of serratus anterior plane, paravertebral and thoracic epidural for the analgesia of multiple rib fractures

2020 ◽  
Vol 45 (5) ◽  
pp. 351-356 ◽  
Author(s):  
Laura Beard ◽  
Carl Hillermann ◽  
Emma Beard ◽  
Sue Millerchip ◽  
Rajneesh Sachdeva ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Negative Binomial ◽  
Rib Fractures ◽  
Serratus Anterior ◽  
Regional Analgesia ◽  
Cross Sectional ◽  
Thoracic Epidural ◽  
Pain Scores ◽  
Significant Difference ◽  
Anterior Plane

BackgroundThere is a paucity of data comparing effectiveness of various techniques for pain management of traumatic rib fractures. This study compared the quality of analgesia provided by serratus anterior plane (SAP) catheters against thoracic epidural (TEA) or paravertebral catheters (PA) in patients with multiple traumatic rib fractures (MRFs).Methods354 patients who received either SAP, TEA or PA at two tertiary referral major trauma centers in the UK were included (2016–2018). Primary outcome were change in inspiratory volumes and pain scores. Secondary outcomes included in-hospital mortality, along with the length of stay in hospital and critical care. Data were analyzed using linear, log-binomial and negative binomial regression models.Main resultsAcross all blocks, there was a mean (SD) increase in inspiratory volume postblock of 789.4 mL (479.7). Ninety-eight per cent of all participants reported moderate/severe pain prior to regional analgesia, which was reduced to 34% postblock. There was no significant difference in the change in inspiratory volume or pain scores between the TEA, PA or SAP groups. Overall crude mortality was 13.2% (95% CI 7.8% to 18.7%). In an adjusted analysis and compared with TEA, in-hospital mortality was similar between groups (relative risk (RR) 0.4, 95% CI 0.1 to 1.0) and (RR 0.5, 95% CI 0.2 to 1.6) for SAP and PA, respectively.ConclusionSAP, TEA and PA all appear to offer the ability to reduce pain scores and improve respiratory function.

Assessment of the Relationship between Sleep Disorders and Circadian Type in Nurses with Shift and Daytime Work

2020 ◽  
Author(s):  
Lahya Afshari Saleh ◽  
Amir Rezaei Ardani ◽  
Ehsan Rafeemanesh ◽  
Pegah Kheradmand
Keyword(s):  
Circadian Rhythms ◽  
Sleep Disorders ◽  
Shift Work ◽  
Sleep Problems ◽  
Work Group ◽  
Severity Index ◽  
Teaching Hospitals ◽  
Cross Sectional ◽  
Significant Difference ◽  
Circadian Type

Background and Objective: Chronotypes vary in different people, and the daily function outside of the framework of this rhythm can affect the quality of work. This study aimed to investigate the association between sleep disorders and chronotypes among the shift and day work nurses. Materials and Methods: This cross-sectional study was performed among nurses in two teaching hospitals in Mash-had, Iran, during 2016-2017. A total of 180 randomly-selected nurses were divided into shift work and day work groups. Participants completed demographic information form, Circadian Type Inventory (CTI), Insomnia Severity Index (ISI), Epworth Sleepiness Scale (ESS), Beck Anxiety Inventory (BAI), and Beck Depression Inventory (BDI). Results: A total of 180 female nurses (90 participants in each group) with a mean age of 35.62 ± 4.07 years were stud-ied. The prevalence of rigid circadian rhythm in the day work group (93.3%) was significantly (P = 0.004) higher than shift work group (78.9%). However, the groups did not show any significant difference regarding the languid/vigorous (LV) index of the CTI (P = 0.080). There was a significant difference in the mean score of CTI between individuals with rigid and flexible circadian rhythms in the shift work group (P = 0.021). Conclusion: In the present study, although there was no association between circadian type and sleep problems includ-ing insomnia and daytime sleepiness in shift work nurses, we observed the capability of coping with working in the rotating shifts in nurses with flexible circadian rhythms.  

scholarly journals Oral neglect as a marker of broader neglect: a cross-sectional investigation of orodental consultation letter of leukemic admitted patients in Iran

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Fatemeh Owlia ◽  
Amin Ansarinia ◽  
Hassanali Vahedian Ardakani
Keyword(s):  
Underlying Disease ◽  
Cross Sectional Study ◽  
Lymphocytic Leukemia ◽  
Oral Manifestations ◽  
Chi Square ◽  
Cross Sectional ◽  
Request Rate ◽  
Significant Difference ◽  
Chi Square Test ◽  
Consultation Request

Abstract Background Leukemia is the main malignant hematologic disease of children with different oral manifestations and clinical features. Attention to the oral manifestations is essential for better management. This study assessed the oral and dental consultations conducted in the admitted leukemic patients of an Iranian teaching hospital. Methods In this descriptive cross-sectional study, medical records of patients admitted in Yazd Shahid Sadoughi Hospital were evaluated. Records of 300 patients with leukemia were randomly selected. Data including demographic information on age, sex, type of oral problems, prescribed instructions and leukemia type were extracted from archived records and registered on the checklist. Finally, Data were analyzed by SPSS17 using Chi-square test. Results The results showed the average age ± SD of patients were 24.36 ± 23.91 with a range of 4 days to 86 years. Among 300 files, 167 belonged to males (55.7%) and 133 pertained to females (44.3%). The most prevalent type of underlying disease was ALL (Acute lymphocytic leukemia) with the frequency of 180 persons (60%). Only 12 (4%) of patients were referred to a specialist due to oral problems. Of all cases of consultation requests, 75% received consultation because of dental problems and 25% for mucosal problems. There was a statistically significant difference between age and consultation request (P = 0.002). Conclusions According to the results of this study, orodental consultation request rate for admitted leukemic patients was low. Pediatric hematologist and oncologists to some extent had more interest to consult due to oral and dental problems rather than others.

scholarly journals A descriptive study of the admitted patients for injuries in a large teaching hospital in 2016

2021 ◽  
pp. 151-157
Keyword(s):  
Teaching Hospital ◽  
Severity Index ◽  
Cross Sectional Study ◽  
Injury Incidence ◽  
Anatomic Site ◽  
Related Factors ◽  
Cross Sectional ◽  
Large Teaching Hospital ◽  
Significant Difference ◽  
June July

Introduction: Injuries are the causes of irreparable damages and costs in urban and rural settings. Preventive procedures are effective if correct related information is gathered and provided. Therefore, this study aimed to investigate the injury patterns and related factors in a large teaching hospital. Methods: The current cross-sectional study was conducted at Edalatian Emergency Center, Mashhad, Iran, in 2016. All study subjects were extracted from the Hospital Information System (HIS).The demographic characteristics and injuries-related factors of 6,350 patients were extracted from the HIS. The extracted variables were emergency severity index (ESI), type of referral, referral reason, insurance organizations, age, anatomic site of injuries, and month of referral. The data were analyzed in SPSS software (version 21) using the descriptive statistics method (frequency and percentage). Results: The majority of the study population was composed of males (%76.4). In total, 98.3% of the patients were classified into the semi-urgent and non-urgent levels, and 75.6% of the cases were affected in the right upper extremity. The most common age group was between 10-20 (69.4%) years, and the majority of the cases were admitted in June, July, and August. Conclusion: The current study determined the pattern and most important reasons for injuries' referral to an emergency department. Accordingly, the injuries were more frequent in the young people and active human force in our community. Furthermore, there was a significant difference among the frequencies of injury incidence in the summer holidays. It seems necessary to develop preventive procedures for injuries.

scholarly journals Development of A Framework for Managing Severe Burns Through A 17-Year Retrospective Analysis of Burn Epidemiology and Outcomes

2021 ◽  
Author(s):  
ling chen ◽  
xiaochong he ◽  
jishu xian ◽  
jianmei liao ◽  
yue luo ◽  
...  
Keyword(s):  
Retrospective Analysis ◽  
Medical Cost ◽  
Total Body Surface Area ◽  
Older Age ◽  
Burn Injuries ◽  
Burn Severity ◽  
Age Difference ◽  
Burn Patients ◽  
Full Thickness ◽  
Severe Burns

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). The gender of male, the older age and the full-thickness burns were significant contributors to high medical cost. The gender of male, the older age and the full-thickness burns were significantly associated with high medical cost and were contributors to the mortality. 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. Conclusion The annual number of burn injuries has kept decreasing while the cure rates of severe burns have improved; However, the burn severity and the economic burden were still in a high level. The gender difference and age difference should be considered when making individualized interventions and rehabilitative treatments.

scholarly journals Impact of stress-induced hyperglycemia on the outcome of children with trauma: A cross-sectional analysis based on propensity score-matched population

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Yi-Wen Tsai ◽  
Shao-Chun Wu ◽  
Chun-Ying Huang ◽  
Shiun-Yuan Hsu ◽  
Hang-Tsung Liu ◽  
...  
Keyword(s):  
Propensity Score ◽  
Hospital Mortality ◽  
Injury Severity ◽  
Pediatric Trauma ◽  
Trauma Patients ◽  
Cross Sectional ◽  
Icu Admission ◽  
Significant Difference ◽  
History Of ◽  
Sectional Analysis

Abstract This was a retrospective study of pediatric trauma patients and were hospitalized in a level-1 trauma center from January 1, 2009 to December 31, 2016. Stress-induced hyperglycemia (SIH) was defined as a hyperglycemia level ≥200 mg/dL upon arrival at the emergency department without any history of diabetes or a hemoglobin A1c level ≥6.5% upon arrival or during the first month of admission. The results demonstrated that the patients with SIH (n = 36) had a significantly longer length of stay (LOS) in hospital (16.4 vs. 7.8 days, p = 0.002), higher rates of intensive care unit (ICU) admission (55.6% vs. 20.9%, p < 0.001), and higher in-hospital mortality rates (5.6% vs. 0.6%, p = 0.028) compared with those with non-diabetic normoglycemia (NDN). However, in the 24-pair well-balanced propensity score-matched patient populations, in which significant difference in sex, age, and injury severity score were eliminated, patient outcomes in terms of LOS in hospital, rate of ICU admission, and in-hospital mortality rate were not significantly different between the patients with SIH and NDN. The different baseline characteristics of the patients, particularly injury severity, may be associated with poorer outcomes in pediatric trauma patients with SIH compared with those with NDN. This study also indicated that, upon major trauma, the response of pediatric patients with SIH is different from that of adult patients.

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