Effect of Growth Hormone on Outcome of Pediatric Burn Patients

Background A burn is a thermal injury caused by biological, chemical, electrical and physical agents with local and systemic repercussions. There are several ways of classifying burns: Classification by mechanism or cause, Classification by the degree and depth of a burn, Classification by extent of burn the extent of burn. Objectives The objective of this study was to determine the safety and efficacy of using recombinant human growth hormone (rhGH) in the treatment of pediatric burn victims and their ICU length of stay, mortality and morbidity. Patients and Methods This study was an Interventional randomized controlled Double Blind Study in which Patients subdivided randomly into 2 groups: Group A received somatotropine hormone after their 3 days of resuscitation besides their conventional treatment during their stay in the Burn ICU. Group B received the conventional treatment only in the Burn ICU. Results The comparison between the GH group and the control group showed that the mean ICU stay in days in GH group was 10.88 while in the control group 13.59 with P value 0.018 as a significant result as the GH group showed a less ICU stay time than the control group with approximately 20%. Mortality in the GH group was 6.2% from the total number of the group while in control group 18.8% from the total number of the group with P value 0.033 as a significant result yet the mortality may also depend on other factors as the degree of burn and the area of burn and the associated events like inhalational injury or delay post burn or any other co-morbidity. Morbidity results seen was 0% in control group and 4.7% in GH group with P value 0.080 as a non-significant result, morbidity was in the form of hyperglycemia. Conclusion The use of recombinant Growth hormone with a dose of 0.2 mg/Kg SQ 2 days per week with 3 days time interval in pediatric burn patients after their primary resuscitation from the burn injury, shows a marvelous improvement concerning the ICU stay time as the patient received the growth hormone showed an approximately 20% time less ICU stay than the control group this may be accounted for the faster wound healing and readiness for grafting and even faster graft healing, also a decreased mortality in a significant way, although mortality may depend on many factors in burn patients like degree of burn and the area of burn and the associated events like inhalational injury or any other co-morbidity.

Delayed Inhalational Injury due to Accidental Muriatic Acid Poisoning

Muriatic acid is the commonly used toilet bowl cleaner in India. It is delivered industrially and is utilized for cleaning, pickling, electroplating metals, in refining mineral metals, in petrol well extraction, in cowhide tanning, in the refining of fats, cleansers, and consumable oils. Inhalation is the most common exposure of muriatic acid contamination. In this article, medical studies about a case of delayed inhalational injury due to muriatic acid poisoning has been reported.

Spontaneous pneumomediastinum in accidental chlorine gas inhalational injury: case report and review of literature

A young man presented in emergency department with shortness of breath and cough after accidental inhalation of chlorine gas. Initial presentation was unremarkable; therefore, he was kept under observation for 8 hours and was later discharged. After 5 hours, the patient presented again in emergency department with sudden-onset shortness of breath and chest discomfort. On examination, subcutaneous crepitation around the neck and chest was found. Chest and neck X-ray revealed subcutaneous emphysema and pneumomediastinum. CT neck and chest was done, which revealed subcutaneous emphysema and pneumomediastinum and a linear air density in close approximation to right posterolateral wall of trachea at the level of superior margin of sternum was reported. These findings raised the possibility of tracheal injury which was later confirmed by fiberoptic laryngoscopy. The patient was intubated due to hypercapnic respiratory failure resulting from hypoventilation and respiratory distress. Bilateral chest tube insertion was done due to worsening subcutaneous emphysema, high ventilator parameters and prevention of progression to pneumothorax. He was extubated after 5 days; bilateral chest tubes were removed before discharge and underwent uneventful recovery.

Predicting thermal injury patient outcomes in a Tertiary-Care Burn Centre, Pakistan

Objectives: To explore candidate parameters for their ability to predict survival and length of hospital stay (LOS) in thermal burns patients, to prepare multivariate predictive models for these two outcomes, and to compare performance of native models to other models. Methods: A retrospective cohort study was undertaken based on record review. Data was extracted from files of patients admitted to a tertiary-care burn centre in Lahore, Pakistan from January 1, 2020 to October 31, 2020. Univariate preselection was used to prepare multivariate logistic regression models for each outcome of interest (survival and LOS). Multivariate models were tested and compared to other models. Results: Increasing TBSA of burn was positively associated with reduced survival and prolonged length of stay. Advancing age and full-thickness burns independently predicted decreased survival. Burn etiology showed prognostic value: petrol-flame burns predicted decreased survival and prolonged LOS; scald was associated with improved survival-odds and shorter LOS. The Survival-model consisted of (1) Baux score, (2) TBSA>40% and (3) serum albumin <3.5g/dl (AUC=0.968, Nagelkerke R^2=0.797). The LOS-model consisted of (1) TBSA^2 and (2) serum albumin concentration (AUC= 0.832, Nagelkerke R^2 =0.408). In tests of discrimination and calibration, native models prepared for survival and LOS outcomes outperformed other models applicable to our dataset. Conclusion: Data from a South Asian burn center has been used to explore factors influencing prognosis for their utility in predictive models for survival and the duration of hospital stay. The significant prognostic roles of TBSA, age, inhalational injury, burn-depth, etiology of burn, anatomic site of burn, hypoalbuminemia and other biochemical parameters were observed. These tools hold significance in guiding healthcare policy and in communications with patients and their families.

76 Survival Outcomes from Burn Injury in Rural Africa

Introduction Burn injuries contribute a considerable burden of disease in variable-resource settings, often resulting in mortality. Despite contributing a substantial burden, outcomes from burn injuries in rural Africa are rarely described. The objective of this study was to examine factors associated with mortality from burn injury in rural Africa. Methods A retrospective chart review was conducted for all patients with burn injury from January 1, 2014 to December 31, 2017 at a 300-bed faith-based, teaching hospital in eastern Africa. Bivariate analysis was used to compare patients who survived the hospital stay with those who did not. Using total body surface area (TBSA), the LD50 (Lethal Dose 50, burn size with a lethality of 50% of patients), and the modified-Baux score were calculated. Due to small sample size, lasso inference techniques for logistic regression were utilized to avoid overfitting a model and to determine relevant risk factors for mortality, by evaluating burn severity, age, sex, location of residence, payer status, time from injury to arrival, distance from hospital, presence of full thickness burns, inhalational injury, and referral status. Results A total 171 burn injury patients were reviewed for this study; two were excluded due to missing data. Among 169 patients, 14.8% (n=25) experienced mortality prior to hospital discharge. Fifty patients suffered an adverse event (29.6%) including: 17 wound infections, 10 urinary tract infections, 10 with sepsis, and 25 with respiratory complications. The LD50 for TBSA was 42%. The LD50 for the modified-Baux score was 81. Non-survivors had higher average TBSA (31.0±5.0% vs 11.5±0.8%; p&lt; 0.01), more inhalational injury (44% vs 2.8%, p&lt; 0.01), full-thickness burns (56.5% vs 23.9%, p&lt; 0.01), and complications (88% vs 19.4%, p&lt; 0.01). Odds of mortality increased 1.06 times for every percent increase in TBSA burn (95%CI: 1.02, 1.11; p&lt; 0.01) and 13.9 times with inhalational injury (95%CI: 3.4, 56.4; p &lt; 0.01). Conclusions Mortality from burn injury represents a substantial portion of patients at a hospital in rural Africa. Factors of larger TBSA and inhalational injury represent the greatest risk.

25 Baseline Copper Levels are Associated with Worse Outcome in Burn Patients with Overweight and Obesity

Introduction While copper (Cu) has been shown to be beneficial in wound healing, high levels of circulating Cu are also associated with increased oxidative stress. Interestingly, elevated baseline Cu levels have been seen in obese patients, and theoretically, this is associated with higher baseline oxidative stress. Overweight (OW) and Obesity (OB) are common conditions in the US; therefore, a significant proportion of burn patients will be potentially affected. We examined the interactive effects of Cu and obesity on outcomes of burn patients; specifically, we hypothesized that higher baseline Cu levels in OW and OB burn patients are associated with worse clinical outcomes. Methods A retrospective review of patients with burns ≥20% TBSA between 2015–2019. Patients were grouped according to body mass index (BMI) (i.e., NW:18–24.9; OW:25–29.9; and OB: ≥ 30 kg/m2). Baseline characteristics were compared using ANOVA and χ 2 tests. The interactions between baseline Cu and BMI groups on 1) lengths of ICU stay (ICUS), 2) overall hospital stay (LOS), and 3) the number of operative procedures, were examined in a series of multiple regression models in R. Results Data of 160 patients met eligibility (NW: OW: OB = 53: 38: 69). BMI groups did not differ significantly on demographics, TBSA, degree of burn, inhalational injury, or mortality. Regression models revealed that NW patients with high baseline Cu levels had shorter ICUS (p&lt; 0.001) and LOS (p=0.003) and also had fewer operations (p = 0.001). While OW and OB were protective at low Cu levels, patients with OW or OB who had high baseline Cu levels had longer ICUS (p&lt; 0.001 and p=0.033), LOS (p=0.001 and p=0.063), and a greater number of operations (p&lt; 0.001 and p=0.066) (Table 1). Conclusions High baseline Cu seems to be beneficial for NW burn patients, yet associated with adverse outcomes in burn patients with OW and OB. While further evidence is needed to confirm this notion, caution is advised when supplementing Cu for burn patients with OW and OB.

An Analysis of Airway Interventions in the Setting of Smoke Inhalation Injury on the Battlefield

Introduction The Committee on Tactical Combat Casualty Care and Capabilities Development and Integration Directorate cite airway burn injuries as an indication for prehospital cricothyrotomy. We sought to build on previously published data by describing for the first time the incidence of prehospital airway interventions in combat casualties who received airway management in the setting of inhalational injuries.15,26 We hypothesized that (1) airway interventions in combat casualties who suffered inhalational injury would have a higher mortality rate than those without airway intervention and (2) prehospital cricothyrotomy was used with greater incidence than endotracheal intubation. Materials and Methods Using a previously described Department of Defense Trauma Registry dataset from January 2007 to August 2016, unique casualties with documented inhalational injury were identified. Results Our predefined search codes captured 28,222 (72.8% of all encounters in the registry) of those subjects. A total of 347 (1.2%) casualties had a documented inhalational injury, 27 (7.8%) of those with at least 1 prehospital airway intervention inhalational injuries (0.09% of our dataset [n = 28,222]). Within the subset of patients with an inhalation injury, 23 underwent intubation, 2 underwent cricothyrotomy, 3 had placement of an airway adjunct not otherwise specifically listed, and 1 casualty had both a cricothyrotomy and intubation documented. No casualties had a supraglottic, nasopharyngeal, or oropharyngeal airway listed. Contrary to our hypotheses, of those with an airway intervention, 74.0% survived to hospital discharge. In multivariable regression models, when adjusting for confounders, there was no difference in survival to discharge in those with an airway intervention compared to those without. Conclusions Casualties undergoing airway intervention for inhalation injuries had similar survival adjusting for injury severity, supporting its role when indicated. Without case-specific data on airway status and interventions, it is challenging to determine if the low rate of cricothyrotomy in this population was a result of rapid transport to a more advanced provider capable of performing intubation or cricothyrotomy may not be meeting the needs of the medics.