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At least 19 recordsLinked to original sources
PubMed1995

Burns in young children: a study of the mechanism of burns in children aged 5 years and under in the Hamilton, Ontario Burn Unit.

This paper explores the burn agents involved among children admitted to the Hamilton General Hospital Burn Trauma Unit (BTU), and the severity of their burns. Charts were retrospectively reviewed for all burn cases aged 5 years and under admitted to the BTU between January 1986 and mid-November 1990. Descriptive statistics and one-way analysis of variance were employed. Of the 52 patients aged 5 years and under, two were excluded from the study. The majority (35, 70 per cent) were aged 2 years and under. The mean burn depth for all patients was equivalent to a deep partial thickness burn. Approximately two-thirds of cases resulted from either the preparation or consumption of food or hot liquids, while the remainder suffered from either flame burns or bath-tub scalds. Children burned during food preparation or consumption were younger (mean age 1.8 years) than those sustaining flame burns (mean age 2.7 years) (P = 0.02). Of those burns sustained from either the preparation or consumption of food, 44 per cent were scalds from a cup of hot beverage at the table, 19 per cent were scalds from an electric kettle, and an equal number from a coffee or tea pot sitting at the table. There was a significant difference in both the mean total body surface area of the burn, and the number of days spent in the BTU, according to the agent involved (P = 0.01 and P = 0.004, respectively). Flame and contact injuries were often the most severe. A disproportionate number of burn victims admitted to hospital are infants and toddlers.(ABSTRACT TRUNCATED AT 250 WORDS)

Analysis of Variance↗
PubMed1982

Mitochondria-toxic activity in burned human skin: relation to severity of burn and period after burn.

Toxic activity in the extracts of burned human skins impairing respiratory control of rat-liver mitochondria was compared in terms of the severity of burn injury and period after burn. The toxic activity was detected in the extracts from skins of third-degree burn, but not in those from skins of deep-dermal burn or of burn ulcers, in the present experimental conditions. In the case of third-degree burn, the toxic activity was not evident during the first few days post burn, but was significantly increased after 10 days. The results of this study suggest the effective period for early therapeutic débridement of the necrotized tissues in the management of severely burned patients.

Burns↗
PubMed1987

The National Burn Information Exchange. The use of a national burn registry to evaluate and address the burn problem.

The NBIE, a voluntary registry of specialized burn-care facilities that was founded in 1964, currently has 50 active participants representing 35 per cent of the nation's hospital beds for burned patients. Participating physicians submit information on the initial hospitalization of emergent and acute burn patients and, separately, on the reconstruction process for these patients. As of January 1986, a total of 94,594 patient's data are on file from 130 hospitals; 13,671 of these are reconstructive and 80,923 emergent and acute admissions. Information concerning new patients is submitted at a rate of about 6000 patients annually. The data are analyzed using INQUIRE, an original data retrieval system. Data on treatment methods and outcome have been used to establish baseline standards for the burned patient's care and survival. In addition, these data have been used to document institutional differences in mortality rates and indicate methods used by the more successful hospitals. The data also are being used to describe the long process of recovery from severe burns and to monitor changes in outcomes of burn accidents continually. The result of these analyses has been documentation of an overall improvement in survival and decline in hospitalization times at all levels of burn severity. Data also can be used with institution-specific data to look at organizational variables affecting survival. Use of this epidemiologic data allows prevention projects to be targeted at the groups at greatest risk. A newer application looks at the equity of the HCFA prospective payment system based on the DRGs assigned to burn severity. The NBIE is an example of how a voluntary, national registry, properly computerized and effectively managed, can contribute to resolving the problem it was established to study. The NBIE has been useful in increasing the understanding of health professionals and government decision makers of a complicated disease process. It has had a direct effect on the quality of patient care and on the process of controlling the incidence of burn injuries.

Adolescent↗
PubMed2001

Evaluating the role of alternative therapy in burn wound management: randomized trial comparing moist exposed burn ointment with conventional methods in the management of patients with second-degree burns.

CONTEXT: Moist exposed burn ointment (MEBO), from China, has been said to revolutionize burn management. OBJECTIVE: Our study was conducted to compare MEBO with conventional management (C) with respect to the rate of wound healing, antibacterial and analgesic effect, and hospital costs. DESIGN: This is a prospective, randomized, controlled clinical trial conducted between 1 March 1997 and 24 October 1998. SETTING: The trial was conducted in a specialized burn facility located in a tertiary referral hospital in a developed and industrialized island-state in Southeast Asia. PATIENTS: We randomly assigned 115 consecutive patients between the ages of 12 and 80 who had partial-thickness thermal burns covering less than 40% of body surface area (BSA) to receive either MEBO or C. Fifty-seven patients were assigned to MEBO and 58 patients to C. The latter group received twice-daily dressing changes; MEBO patients received MEBO every 4 hours. MAIN OUTCOME MEASURES: Patients were hospitalized until 75% BSA had healed. BSA was determined by visual inspection and charted on Lund and Browder charts regularly. Wound healing rate, bacterial infection rate, pain score, and hospitalization costs were recorded. RESULTS: The median time to 75% healing was 17.0 and 20.0 days with MEBO and C, respectively (HR = 0.67, 95% CI = 0.41-1.11, P =.11), suggesting similar efficacy between the 2 modalities. Bacterial infection rates were similar between the 2 groups (HR = 1.10, 95% CI = 0.59-2.03, P =.76). MEBO imparted a greater analgesic effect in the first 5 days of therapy and reduced hospital costs by 8%. CONCLUSIONS: MEBO is as effective as conventional management but is not the panacea for all burn wounds. The use of MEBO eases the management of face and neck burns and facilitates early institution of occupational therapy in hand burns. It confers better pain relief such that fewer opiates are used during the first 5 days after burn injury.

Adult↗
PubMed1995

Burns in the elderly in the south east of Scotland: review of 176 patients treated in the Bangour Burns Unit (1982-91) and burn inpatients in the region (1975-91).

One hundred and seventy-six patients aged 65 years and above, treated in Bangour Burns Unit during a 10-year period between 1982 and 1991 were studied in detail. Annual number of burn cases treated as inpatients in the South East of Scotland, within or outwith the Bangour burns unit, and all deaths due to burns, during the period from 1975 to 1991, among the estimated population were analysed to assess the trend in incidence and rates of burns in elderly persons in the community.

Aged↗
PubMedDate not supplied

Hospital and prehospital resources for optimal care of patients with burn injury: guidelines for development and operation of burn centers. American Burn Association.

Each year in the United States burn injuries result in more than 500,000 hospital emergency department visits and approximately 70,000 acute inpatient admissions. Most burn injuries are relatively minor, and patients are discharged following outpatient treatment at the medical facility where they are first seen. Of those patients with injuries serious enough to require hospitalization, about 20,000 are admitted directly or by referral to hospitals with special capabilities in the treatment of burn injury. Hospitals with these service capabilities are normally termed "burn centers." This document defines the system, organizational structure, personnel, program, and physical facilities involved in establishing the eligibility of hospitals with the capability of being identified as burn centers.

Burn Units↗
PubMed1982

Burns updated in China: II. Special burn injury and burns of special areas.

The pathogenesis, pathology, classification, clinical features and prognosis of pulmonary burn injury have been studied recently by Chinese surgeons. New methods to treat electrical contact burns and chemical burns are introduced in this paper. The initial attempt to use microvascular surgical technic for repairing the post-burned tissue defect has developed successfully in China.

Burns↗
PubMed1996

Quantitative microbiology in the management of burn patients. II. Relationship between bacterial counts obtained by burn wound biopsy culture and surface alginate swab culture, with clinical outcome following burn surgery and change of dressings.

The use of quantitative bacteriology in the burns unit has been thought to be efficient in predicting sepsis or graft loss. To examine the relationship between clinical outcome and bacterial densities on and in the burn wound, 69 biopsy/surface swab pairs were collected from 47 patients on 64 occasions, either immediately prior to excision and grafting, or at routine change of dressings. The mean per cent TBSA burn was 16 (range 1-65). There was a significant correlation between log total bacterial count by biopsy with total white cell count and age (P = 0.028), and a significant negative correlation between total bacterial count by swab with per cent TBSA (P = 0.006). There was no significant difference in bacterial counts between patients judged to be a clinical success or clinical failure (72 h follow-up), either after undergoing excision and grafting, or change of dressings, and no difference in counts between patients with perioperative bacteraemia and those without. With burns > 15 per cent TBSA, a relationship between bacterial counts and subsequent sepsis or graft loss still was not demonstrated. It is suggested that quantitative bacteriology by burn wound biopsy or surface swab does not aid the prediction of sepsis or graft loss.

Age Factors↗
PubMedDate not supplied

Sex differences in mortality after burn injury: results of analysis of the National Burn Repository of the American Burn Association.

Clinical and experimental studies have shown a decreased mortality for women after nonthermal injury. However, recently published data from this institution showed an increased mortality for female patients younger than 60 years of age with thermal injury. This study extended these observations to evaluate outcomes related to sex in thermal injury in a larger population of patients. The National Burn Repository (NBR) was used for this analysis. Patients admitted to burn centers between 1991 and 2001 were selected for inclusion (n = 49,079). Sex differences in demographic, injury, clinical, and outcome characteristics were compared. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated for the association between mortality and sex, both overall and stratified by age. In total, 34,470 men and 14,609 women were included in this study. Women had a 50% increased risk of death when compared with men (OR 1.5; 95% CI 1.3-1.6), which diminished slightly when adjustments were made for age, race, TBSA burn, and inhalation injury (OR 1.3; 95% CI 1.2-1.5). When stratified by age, women had an increased risk of death for all age groups between 10 and 70 years. This study confirmed earlier studies showing an association between sex and burn mortality. Further prospective studies analyzing differences in immune responses between men and women after burn injury may provide insight into the mechanism behind these divergent outcomes and identify targets for future therapy.

Adult↗
PubMed1995

Treatment of partial thickness burns of the hand with the preshaped, semipermeable Procel Burn Cover: results of a multicentre study in the burn centres of Berlin, Duisburg and Munich.

The results of a prospective clinical study conducted in three German burn centres are reported. The subject of the evaluation was to show the effectiveness of a new, preshaped, semipermeable burn dressing that is resistant to fluids and bacteria but highly permeable to vapour. The dressing was used in conjunction with 1 per cent silver sulphadiazine cream in treating partial thickness burns of the hand. In 49 patients, 72 partial thickness burned hands were treated. The application proved to be very easy. The time for a dressing change was short (5-10 min). The duration of treatment was 13 days on average. Complications due to infections did not occur. Because of the semipermeable properties of the dressing material, skin macerations occurred in only a few instances (13 per cent) as a result of inappropriate cream application or extremely high exudation rates, and these did not adversely affect the healing process. Patients achieved the ability to perform activities of daily living early with positive results for the patients, the physician and the nursing team.

Adolescent↗
PubMed1977

[Changes in liver metabolism following a standardized skin burn and intraperitoneal injection of a burn toxin isolated from burned mice skin. Studies on rat liver using isolation perfusion].

Parameters of liver metabolism were studied in the isolated perfused rat liver 5 days after a standard skin burn or an i.p. injection of a specific cutaneous burn toxin. Decreased values of the energy quotient ATP/ADP compared with normal controls were found. The absolute content of adenonucleotides was unchanged. The excretion of glucose and urea was also decreased in both groups and glucose synthesis after a lactate load was only slightly stimulated. The results show a direct influence of a burn toxin on hepatic metabolism suggesting a possible disturbance of oxydative phosphorylation.

Adenine Nucleotides↗
PubMed1978

Healing of experimentally induced burn wounds. A comparative study of the healing of exposed burn wounds and burn wounds covered with adhesive zinc-tape and a scanning electron microscopic study of the microvasculature of wound healing in the rabbit ear.

A comparative study of the healing of experimentally induced burn wounds on the inner side of the rabbit ear treated with either adhesive zinc-tape or exposure to the air is presented. During tape treatment, tissue necroses were dissolved, thus exposing the granulation tissue surface. In wounds treated with zinc-tape, fewer and smaller perforations to the opposite side of the ear were found, compared with those in exposed wounds. It is suggested that the frequency of perforations can be used as a simple measure of extension of tissue necroses after burning in relation to different methods of wound treatment. A microangiographic method is also presented for three-dimensional visualization of vascular events during healing using scanning electron microscopy on vascular casts.

Animals↗
PubMed2003

Epidemiology of burns admitted to Ain Shams University Burns Unit, Cairo, Egypt.

This study was prospectively carried out on 880 acutely burned patients admitted to the Burn Unit of Ain Shams University in Cairo, Egypt, during the period from the 1 May 1995 to the 31 October 2001, with the objective to analyze the epidemiological features of burned patients in our country. The means of age and percentage total body surface area burned (TBSB) were 27.8+/-2.9 years and 32+/-5.7%, respectively. Most of the patients were city dwellers and were self-referred to the Burn Unit. There were no significant yearly variations in hospital admissions. Seasonal variations in the form of peaks in winter and spring were noticed. Females (53.1%) were more prevalent than males (46.8%). Adults (61%) superceded children (39%). Male children (42.7%) population exceeded female children (35.8%). In contrast, adult females (64.1%) surpassed adult males (57.2%). The commonest burn location was home followed by outdoors then, work locations. Females were most commonly burned at home and mainly suffered from flame and scald burns. Males were most commonly burned in outdoor and work locations than at home and mainly sustained electric and flame burns. There was no difference in the mean percentage TBSB and burn depth in both sexes. Children were mostly burned at home and were mainly victims of scald and flame burns. They had lower rates of full thickness burns compared to adults. Adults were mostly burned in outdoor and work locations and mainly sustained flame and electrical injuries. The results of this study clearly highlighted the specific epidemiological features of burned patients in our area, and thus should provide the necessary information to develop proper burn prevention programs, thereby reducing the frequency of burns and burn-related deaths.

Accident Prevention↗
PubMedDate not supplied

Effects of fluid resuscitation, burn eschar excision, and blockade of afferent pain responses on bacterial translocation and acid-base balance after murine burn injury.

We tested effects of fluid resuscitation, early burn excision/grafting, and blockade of afferent stimuli from the burn wound on bacterial translocation and acid-base balance after murine burn injury. Burn excisions were performed with patients either 15 minutes or 2 hours after burn injury under anesthesia, and excised wounds were immediately closed with murine allograft skin. Twenty-four hours after 25% total body surface area (TBSA) burn injury and 48 hours after 32% TBSA injury, mesenteric lymph nodes were cultured. Incidences of bacterial translocation in 25% and 32% TBSA burns were 31.6% and 68.4% of animals, respectively. Burned animals were in severe shock, and metabolic acidosis reached a nadir 12 hours after burn injury, with base deficit -27.8 +/- 0.6 mEq/L; 5% to 10% of animals died acutely after burn injury. After excision/grafting of burned mice at 2 hours after burn injury, the incidence of bacterial translocation was unchanged (35.7% with 25% TBSA burn, 73.3% with 32% TBSA burn), and mortality did not change. When 32% TBSA excisions were performed exactly 10 minutes after burn injury, four of the 13 mice died within several hours, and five (55.5%) of the nine survivors translocated. Rates of bacterial translocation in mice receiving anesthesia or excision/grafting without burn injury were 15.0% and 20%, respectively (p = NS compared with normal mice). Subcutaneous implantation of normal or burned skin into normal animals neither elicited shock nor increased the incidence of bacterial translocation. Increasing amounts of fluid resuscitation in the 25% TBSA burn model provided only delayed improvement of acid-base balance; increased amounts of fluid did not decrease bacterial translocation.(ABSTRACT TRUNCATED AT 250 WORDS)

Acid-Base Equilibrium↗
PubMed2003

A review of emergency department fluid resuscitation of burn patients transferred to a regional, verified burn center.

The purpose of this study was to examine the adequacy of burn patient fluid resuscitation in relationship to the American Burn Association formula before arrival at a regional burn center. Further substratification of the data was undertaken to compare total burn surface area and fluid volume resuscitation as evaluated from the primary hospital's emergency department staff vs. the burn intensive care unit staff. The charts of all patients admitted to the burn center during 1 year were reviewed retrospectively. Data were compiled to calculate the time of injury, time of arrival in the referring emergency room, time in transit to the burn unit, and time of arrival in the burn unit. The total number of patients evaluated in the study was 41. Patients who were not referred from outside hospitals or who had incomplete charts were excluded. The average time from initial burn to transfer to the burn intensive care unit was 6.26 hours (range, 0.5-96 hours). The average total body surface area (TBSA) evaluated by the referring emergency department staff was 23.9% (range, 5-70%) compared with the burn intensive care unit staff evaluation average of 17.8% (range, 2-55%). Using the referring emergency department staff TBSA percentage, evaluation of the data revealed that only 23% of patients fell within the accepted range using the American Burn Association formula. Furthermore, 30% of patients were overresuscitated whereas 47% were underresuscitated. Of the overresuscitated patients, 1 patient was critically overresuscitated. In the group of underresuscitated patients, five were critically underresuscitated. Thirty-three percent of the patients' TBSA had a more than 50% discrepancy between the burn unit and the emergency department calculations. The authors conclude that better educating providers referring patients to regional burn centers can make a marked improvement in the overall care of burn patients. More important, early communication with the referring burn staff has been encouraged. Early communication permits review of estimated TBSA burn evaluations and permits cooperative calculations and optimal delivery of early fluid resuscitation. Burn center practitioners can improve care of patients before arrival by appropriately guiding the referring physician.

Adolescent↗
PubMed2006

Burns sustained in combat explosions in Operations Iraqi and Enduring Freedom (OIF/OEF explosion burns).

BACKGROUND: Burns comprise 5% of casualties evacuated from Operations Iraqi and Enduring Freedom (OIF and OEF). Many OIF/OEF burns result from the enemy's detonation of explosives. We reviewed these to evaluate mission impact and provide recommendations for improved combat burn protection. Data were compared to those from the Vietnam War. METHODS: All OIF/OEF patients with significant burns are treated at the U.S. Army Institute of Surgical Research (ISR). A review from April 2003 to April 2005 was undertaken. Records were obtained and demographics, burn severity and pattern, and early outcomes recorded. RESULTS: Two hundred and seventy-four OIF/OEF burn patients were treated, 142 (52%) sustained burns in explosions from hostile action. Age was 26+/-7 years (mean+/-S.D.). Mortality was 4%. The annual rate of combat explosion as a cause for burns increased from 18% to 69%, total body surface area burned increased from 15+/-12 to 21+/-23%, injury severity score rose from 8+/-11 to 17+/-18, and frequency of inhalation injury rose from 5% to 26%. Improvised explosive devices caused 55% of casualties, car bombs 16%, rocket-propelled grenades 15% and 14% other. The hands (80% of patients) and the face (77%) were the most frequently burned body areas. Burns were isolated to the hands in 6% of patients and to the face and hands in 15%. An average of 52+/-30% of the surface area of the hands and 45+/-26% of the face was burned. Mean length of stay was 24+/-25 days (median 14). Though 77% of patients were discharged without global disability, only 36% returned to full military duty. A similar pattern of injury and disposition was seen at the Army burn center in Vietnam (1966-1968), but mortality was higher (7.9%). CONCLUSION: Burns resulting from combat explosions increased in frequency, size and injury severity. Burns were concentrated on areas not protected by clothing or equipment. These injuries created long hospital stays and frequently prevented soldiers from returning to duty. While wound distribution has not changed, combat burn care has improved, and continued emphasis on military protective equipment for the hands and face is warranted.

Adolescent↗
PubMed2005

Comparative study on effects of burn-blast combined injury and burn-firearm combined injury complicated with seawater immersion on vascular endothelial cells.

OBJECTIVE: To comparatively study the effects and mechanisms of burn-blast combined injury and burn-firearm combined injury complicated with seawater immersion on vascular endothelial cells. METHODS: A total of 40 healthy adult hybrid dogs of both sexes, weighing 12-15 kg, were used in this study. Randomly-selected 20 dogs were established as models of burn-blast combined injury (the burn-blast injury group) and the other 20 dogs as models of burn-firearm combined injury (the burn-firearm injury group). Then the wounds of all the dogs were immediately immersed in seawater for 4 hours, and then they were taken out from the seawater. Blood samples were withdrawn from the central vein of the dogs before injury, and at 4, 7, 10, 20, and 28 hours after injury to measure the circulating endothelial cells and the von Willebrand factor. RESULTS: Circulating endothelial cells increased significantly at 4 hours after injury in all the dogs. But they reached peak at 7 hours after injury in the burn-blast injury group and at 28 hours after injury in the burn-firearm injury group. The changes of circulating endothelial cells in the burn-blast injury group were significantly different from those in the burn-firearm injury group at 4, 7, 20, and 28 hours after injury (P < 0.01). The von Willebrand factor reached peak at 4 hours after injury in the burn-blast injury group and at 28 hours in the burn-firearm injury group. The changes of von Willebrand factor in the burn-blast injury group were significantly different from those in the burn-firearm injury group at 4, 20, and 28 hours after injury (P < 0.01). CONCLUSIONS: In burn-blast injury combined with seawater immersion, the vascular endothelial cells changed most significantly at 4 hours or 7 hours after injury, while burn-firearm injury combined with seawater immersion have the same at 20 hours or 28 hours after injury.

Animals↗