-
[show abstract]
[hide abstract]
ABSTRACT: To examine neuropsychological functioning in survivors of electrical injury with posttraumatic stress disorder (PTSD) and depression. This was a prospective research study that was done in an outpatient clinic of a rehabilitation hospital. Thirty participants were recruited for the study between January 2008 and December 2010. All participants completed questionnaires measuring depression, PTSD, and a series of standardized psychometric measures of neuropsychological functioning. Domains tested included verbal and visual memory, attention, and executive functioning. A correlation analysis was performed to explore association between variables. Based on the level of PTSD symptoms, subjects were divided into three groups: no PTSD, subclinical PTSD, and PTSD, and a series of one-way analyses of variance were done to explore this association further. A series of analyses of covariance were done to control for depression. PTSD had a significant (P < .05) negative association with immediate verbal memory and immediate and delayed visual memory. Subjects with PTSD had significantly (P < .05) worse scores on immediate and delayed verbal memory and visual memory than those with subclinical PTSD or no PTSD. Measures of attention, working memory, and executive functioning were not significantly different between PTSD groups. When depression was introduced as a covariate, verbal and visual memory scores were not significantly different between PTSD groups. The findings suggest that there is a negative association between PTSD and cognitive performance that may be related to depression among those with electrical injury. A larger sample size is warranted to explore this further.
Journal of burn care & research: official publication of the American Burn Association 02/2013; · 1.37 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The purpose of this study was to determine the efficacy of diagnostic tests and specialty consultations in aiding the diagnosis of long-term symptoms after low-voltage electrical injury (EI). A retrospective hospital chart review of low-voltage electrical-injured patients admitted to the outpatient burn clinic of a rehabilitation hospital was conducted (January 2002 to March 2006). Results of tests and specialty consultations were compared between patients with low-voltage contact injuries and patients with low-voltage flash injuries using Student's t-test and χ(2) with a P < .05 considered significant. Forty patients were treated for low-voltage EI, and all injuries occurred at work. Three patients were excluded due to lack of exact voltage documentation. Of the remaining 37 patients, there were 31 males (83.8%) and 6 females (16.2%) with a mean age of 36.7 ± 11.0 years and a mean TBSA of 7.7 ± 7.3%. Of 83 specialty consultations, the most frequents were psychology (38.6%), physiatry (21.7%), neurology (15.7%), and orthopedic (8.4%). Eighty percent of consultations were negative (no pathology). Patients with electrical contact injury had more specialty consultations (68.7 vs 31.3%, P = .003), especially neurology (21.1 vs 3.8%, P = .027), and more tests than patients with electrical flash injury (86.5 vs 13.5%, P < .001). Four (6.3%) CT scans and 14 (21.9%) magnetic resonance imaging scans were performed in electrical contact injury patients, but the majority of their results were negative (75 and 71.4%, respectively). Ultrasound, bone scan, and x-rays were negative: 80, 100, and 100%, respectively. Low-voltage electrical-injured patients are frequently referred for specialty consultations and tests, which are usually not effective to correlate their long-term symptoms with the initial EI.
Journal of burn care & research: official publication of the American Burn Association 10/2011; 33(2):199-205. · 1.37 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The purpose of this study was to determine the circumstances of electrical burn injuries caused by the use of multimeters among electricians and electrical apprentices in Ontario and to develop a burn prevention program to reduce them. A survey to investigate electrical injuries caused by multimeters was mailed in June 2004 to 5000 Ontario electricians and electrical apprentices. A high voltage laboratory tested the effectiveness of fused leads to reduce multimeters malfunction. The results of the survey and laboratory tests helped to implement a burn prevention program. Then, a mail fused leads multimeter exchange program was implemented, and proposals to improve the multimeters standard were made to the Canadian Standards Association. Nine hundred (18%) workers responded the survey. There were 801 (89%) electricians, 81 (9%) electrical apprentices, and 27 (3%) with other qualifications. Ninety-nine (11%) had a multimeter fail during use, and half of them suffered critical burns. Causes of the injury were operator error (59%), wrong category rating (21%), defective equipment (18%), and others (2%). More than 2000 electrical contractors acquired the new fused leads multimeters. There were no critical injuries caused by multimeters in the years 2006, 2007, and 2008 (January to August) in Ontario. Understanding the cause of electrical burn injuries by multimeters and engaging members of the integrated electrical safety system in a multifaceted prevention program were effective in reducing electrical burn injuries. Fused leads multimeters proved to be effective in preventing most common user errors and electrical burn injuries caused by multimeters.
Journal of burn care & research: official publication of the American Burn Association 02/2010; 31(2):333-40. · 1.37 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: This study aims to analyse the epidemiologic characteristics of severe burn in the elderly in Shanghai and to discusses a possible prevention programme for this population.
A retrospective review of all medical records of elderly patients (aged 60 and older) admitted with acute burns to the Burn Center of the RuiJin Hospital between January 1996 and December 2004 was carried out. Patient demographics, etiology of burn, mechanism of injury, burn extent, anatomical areas burned, number of operations, and outcomes were reviewed.
A total of 201 (5.8% of hospitalised patients) elderly patients (mean age (+/-SD) of 69.3+/-7.1 years (range 60-90 years)) were admitted. Majority of the patients were men (62.2%) and the most common etiologies were flames (52.7%) and scalds (39.8%). The majority of burns occurred at home (73.6%), followed by burns at workplace (15.9%) and public areas (10.5%). The median total body area burned was 11.7% (range 0-84%), and the majority of burns were classified as mild (60.2%) and moderate (32.8%). Predominant anatomical areas involved were the legs (76.1%), arms (67.2%), head and neck (49.8%) and hands (49.3%). The most common pre-injury conditions were cardiovascular diseases (25.9%), diabetes (8.5%) and neurological diseases (6%). Eighty-seven patients (43.3%) required surgical treatment. The most common complications were multiple organ failure (2%), pneumonia (1%) and wound infection (1%). Sixteen patients (8%) died: half of them in hospital, and the rest at home. There was a significant correlation between post-injury complications and death (r=0.69, p<0.001). The mean total hospitalisation cost was yen 22993.09 (US$ 3381.34).
Domestic and workplace burns with devastating consequences are very common in the elderly population in Shanghai. Burn prevention education and implementation of safety measures at home and at workplace would help reduce such incidences.
Burns: journal of the International Society for Burn Injuries 10/2009; 36(3):430-5. · 1.95 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: A lack of noninvasive tools to quantify edema has limited our understanding of burn wound edema pathophysiology in a clinical setting. Near-infrared spectroscopy (NIR) is a new noninvasive tool able to measure water concentration/edema in tissue. The purpose of this study was to determine whether NIR could detect water concentration changes or edema formation in acute partial-thickness burn injuries. Adult burn patients within 72 hours postinjury, thermal etiology, partial-thickness burn depth, and <20% TBSA were included. Burn wounds were stratified into partial-thickness superficial or deep wounds based on histology and wound healing time. NIR devices were used to quantify edema in a burn and respective control sites. The sample population consisted of superficial (n = 12) and deep (n = 5) partial-thickness burn injuries. The patients did not differ with respect to age (40 +/- 15 years), TBSA (5 +/- 4%), and mean time for edema assessment (2 days). Water content increased 15% in burned tissue compared with the respective control regions. There were no differences in water content at the control sites. At 48 hours, deep partial-thickness injuries showed a 23% increase in water content compared with 18% superficial partial-thickness burns. NIR could detect differences in water content or edema formation in partial-thickness burns and unburned healthy regions. NIR holds promise as a noninvasive, portable clinical tool to quantify water content or edema in burn wounds.
Journal of burn care & research: official publication of the American Burn Association 08/2009; 30(5):807-17. · 1.37 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The purposes of this study were to determine current mortality predictors in our thermally injured population, to develop and validate a new mortality predictive score, and to compare its predictive ability with those of the acute physiology and chronic health evaluation II (APACHE II) score, multiple organ dysfunction (MOD) score, and two burn-specific mortality predictive scores.
A retrospective chart review of acute thermally injured (flame or scald) patients admitted during a 12-year period (1991-2003) to an adult regional burn center was performed. Patients admitted between January 1991 and February 1995 (derivation population) were included in the development of a mortality risk predictive score along with the patient's APACHE II score, MOD score, Smith's score, and the Age-Risk score. The new mortality risk predictive score was validated in a separate group of thermally injured patients (validation population) admitted to the same burn center between March 1995 and December 2003.
Of 1,439 acute thermally injured patients admitted between 1991 and 2003, 96 (7%) were excluded because they received comfort measures only. Of the remaining 1,343 patients, 378 (28%) were included in the mortality risk score derivation, and 965 (72%) in its validation. In the derivation group, there were 260 (69%) flame burns and 118 (31%) scald burns, and 35 (9%) patients died in hospital. Increased age, day 1 APACHE II score, percent partial-thickness burn, percent full-thickness burn, and sex were the strongest predictors of mortality. With these factors, we developed the FLAMES score (Fatality by Longevity, APACHE II score, Measured Extent of burn, and Sex), which had an area under the receiver operating characteristic curve of 0.97 that was better (p < 0.001) than those of the APACHE II score (0.91), MOD score (0.89), Smith's score (0.93), and the Age-Risk score (0.94). The FLAMES score was tested in the validation population and the area under the receiver operating characteristic curve = 0.93 was better (p < 0.001) than those of the APACHE II score (0.83), Smith's score (0.91), and the Age-Risk score (0.72).
The ability of the FLAMES score in predicting hospital mortality risk was validated in a regional burn center population.
The Journal of trauma 10/2008; 65(3):636-45. · 2.48 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Low voltage electrical injury is associated with minor or no cutaneous burns and its symptoms rarely appear on initial examination. The purpose of this study was to determine the ability to return to work among patients with low voltage electrical injury. A retrospective hospital chart review was conducted among patients with low voltage electrical injury admitted to the outpatient burn clinic of a rehabilitation hospital between January 1, 2002 and March 21, 2006. Symptoms at follow-up visits and return to work status were compared between patients with electrical contact injuries and those with electrical flash injuries using Student's t-test and chi analysis with a P < 0.05 considered significant. Values are presented as mean +/- SD. Forty patients were treated for low voltage electrical injury, and all injuries occurred at work. There were 34 men (85%) and 6 women (15%) with a mean age of 37.3 +/- 11.2 years and a mean total body surface area burned of 13.0% +/- 17.6%. Most patients had neurological (92.5%), psychological (90.0%), and musculoskeletal (72.5%) symptoms, which were documented on average 303.7 days after injury. Twenty-five (62.5%) patients had electrical contact injury and 15 (37.5%) patients had electrical flash injuries. Patients with electrical contact injuries were younger (34.2 +/- 9.9 years vs 42.4 +/- 11.6 years, P = 0.030), complained of more psychological symptoms (25 vs 11, P = 0.006), more neurological symptoms (25 vs 12, P = 0.020), and more fatigue (10 vs 1, P = 0.022) than patients with electrical flash injuries. Twenty-three patients (57.5%, 14 electrical contact and 9 electrical flash) attempted to return to work on average 107.7 days after injury, but only 13 patients (32.5%, six electrical contact and seven electrical flash) successfully returned to work 59.38 days after injury. Of them 7 (53.8%) return to the same job, 5 (38.5%) returned to a modified job, and 1 (7.7%) to a new job. Low voltage electrical injury can significantly impact a patient's ability to return to work because of the psychological, neurological, and musculoskeletal symptoms, which are observed. Recognition of low voltage injury as a potentially permanent source of symptoms is important and has to date not been well established. More effective preventive measures should be implemented at work to reduce the risk of these injuries.
Journal of burn care & research: official publication of the American Burn Association 10/2008; 29(6):959-64. · 1.37 Impact Factor
-
Barbara Latenser,
Sidney Miller,
Palmer Bessey,
Susan Browning,
Daniel Caruso, Manuel Gomez,
James Jeng,
John Krichbaum,
Christopher Lentz,
Jeffrey Saffle,
Michael Schurr,
David Greenhalgh,
Richard Kagan
Journal of burn care & research: official publication of the American Burn Association 08/2007; Publish Ahead of Print. · 1.37 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Cambodia is a developing country of 13 million people where there are an estimated 20,000 burns and 2000 burn deaths annually. Two thirds of the burns occur to children under the age of 10 years. The purpose of this study was to determine the knowledge of burn prevention and first aid for burns in Grade 5 Cambodian school children, as baseline information to design a burn prevention campaign.
A 34-question survey regarding burn prevention and first-aid treatment for burn injuries was developed. Additional questions on TV watching habits were included to determine the feasibility of a targeted TV burn educational campaign. The survey was translated into Khmer language and tested on a trial class for accuracy and ease of administration. After obtaining the school director's permission and children's consent the survey was administered by Canadian medical students helped by trained translators and teachers to Grade 5 students from eight different elementary schools in the Kampot province.
A total of 420 students were surveyed. Average age was 12.5 years (range 9-17 years) and 55% were females. Seventy-four percent routinely cared for other children. Only 52% had TV at home but still 78% managed to watch TV for an average 2h per day. Even though 36% of students indicated they had received information about burn prevention and first aid, only 13% mentioned application of cool water as initial treatment, only 7% knew to roll on the ground if their clothes caught fire, and nearly 50% would pour water on a burning pot of oil. Half of students indicated that they would not believe a TV message promoting application of cold water on acute burns. Top reasons given were parental influence, belief in other treatments, and not trusting TV messages. Interestingly, 62% of these skeptics would change their mind if the TV message was endorsed by an authority figure such as a physician, teacher, parent, or the Ministry of Health. A set of five Public Service Announcements for Cambodian TV were developed and produced based on the results of this survey.
This survey identified significant inadequacies in Cambodian children's knowledge about burn prevention and first aid and suggested that a televised burn prevention campaign could be an effective method to improve their knowledge, especially if it was endorsed by an authority figure.
Burns 06/2007; 33(3):347-51. · 1.96 Impact Factor
-
Manuela G Neuman,
Neil H Shear,
Izabella M Malkiewicz,
Masud Taeri,
Lori E Shapiro,
Norberto Krivoy,
Julia Haber, Manuel Gomez,
Joel Fish,
Robert Cartotto,
Lawrence Cohen
[show abstract]
[hide abstract]
ABSTRACT: Cytokines play a role in the immunopathological and molecular mechanisms of sulfonamide-induced hypersensitivity reactions (HSRs). The objective of this study was to analyze the reliability and correlation between the clinical symptoms observed in affected patients (n = 86) because of a sulfonamide-induced HSR and their lymphocyte toxicity assay (LTA) values. Another goal was to determine the cytokine secretion in the patient's sera and their expression in the peripheral blood mononuclear cells (PBMCs) and to explore whether a correlation exists among positive LTA score, cytokine levels, and HSR occurrence. The final goal is to determine whether these measures could be used to predict the likelihood of a patient to experience an HSR during sulfonamide treatment. Such a predictive ability would be valuable to the clinician to know whether the patient would tolerate sulfonamides or whether an alternative antibiotic should be prescribed. The LTA showed a good correlation with the clinical involvement of patients with hypersensitivity syndromes. In addition, the pro-inflammatory cytokines presented significant differences in patients that had rash, fever, and organ involvement than in control patients or any of the other patient groups. Expression of tumor necrosis factor alpha (TNF-alpha) is significantly higher in patients presenting rash, fever, and organ involvement versus all other groups. It is concluded that a positive LTA is a predictor for sulfonamide-induced true HSR. In addition, T-helper cell 1 cytokines [TNF-alpha, interleukins (ILs) 1 and 2] as well as the chemokine regulated upon activation, normal T-cell expressed and secreted (RANTES) control the pathogenesis of sulfonamide-induced HSR and may be used in early diagnosis of the syndrome.
Translational Research 06/2007; 149(5):243-53. · 2.99 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: In China, burns are becoming a major cause of morbidity and mortality with large societal and economic implications. To date, there is little epidemiological data on burns in China to direct prevention efforts. This study describes the characteristics of burn patients admitted to a major burn center in Shanghai using a burn registry developed in Toronto, Canada. A retrospective review of burn patients discharged from the Shanghai's Rui Jin Hospital Burn Unit, between March 1st 2002 and April 30th 2003, was conducted. Of 527 patients discharged, 307 were acute burn patients and 302 (98.4%) had complete data to be included in the study. There were 214 (71%) males and 88 (29%) females with a male to female ratio of 2.4:1. The median age was 30 years, and the median total body surface area burned was 10%. The majority of burns occurred at work (58%), and the most frequent etiology was flames (39%) followed by scalds (31%) and contact with hot objects (15%). Sixteen (5%) patients had inhalation injury and six (2%) patients died. There were 70 (23%) children (0-14 years), 221 (73%) adults (15-59 years) and 11 (4%) seniors (60 years and above). Children had more scald burns (83%) and the majority (83%) occurred at home. Adults had more flame burns (46%) and the majority (79%) were work-related injuries. Seniors had more flame burns (73%) and the majority (55%) occurred in domestic incidents. Seniors had deeper burns (13%, p=0.005), required more escharotomies (55%, p=0.002), required more operations (2, p=0.051) and had higher mortality (36%, p<0.001) than other age groups. These results provide compelling evidence for performing population-based studies to identify risk factors that are susceptible to modification in each age group.
Burns 12/2006; 32(8):1037-43. · 1.96 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: To analyze the epidemiological characteristics of pediatric burn patients in Shanghai and to determine the targets for a pediatric burn prevention program, a retrospective review of all medical records of acute pediatric burn patients (age</=14 years old) admitted to the Burn Center of the Ruijin Hospital between January 1980 and December 2002 was performed. Patient demographics, etiology of burn, mechanism of injury, extent and anatomical areas burned, number of operations, and length of hospital stay were recorded. A total of 1494 pediatric burn patients were admitted. Six hundred eighty-seven (46%) patients were from the migrant population (non-registered population of temporary workers from rural areas outside of Shanghai). Scalding was the main cause of pediatric burns in the age groups. Children 0-3-year-old were the most common victims of scalding, chemical burns, and contact burns. Domestic burns resulted in 1293 (86.5%) injuries followed by burns occurring while playing in public. The incidence of domestic burns has increased since the beginning of the study period, while the incidence of burns while playing in public has decreased. The median total body surface area was 4% for mild burns, 10% for moderate burns, and 18% for extensive burns. Predominant areas involved were the head, neck, anterior trunk, and right lower limb. Most children received conservative treatment, and their mean hospital stay was 16.1+/-12.2 days. There were 17 (1.1%) deaths, mostly due to sepsis (82.4%). Migrant children are the majority of burn victims since 1996. The education of burn prevention should focus on the migrant population in an industrializing city.
Burns 08/2006; 32(5):613-8. · 1.96 Impact Factor
-
Tina L Palmieri,
Daniel M Caruso,
Kevin N Foster,
Bruce A Cairns,
Michael D Peck,
Richard L Gamelli,
David W Mozingo,
Richard J Kagan,
Wendy Wahl,
Nathan A Kemalyan, [......],
Nicole S Gibran,
Robert L Klein,
Lynn D Solem,
Jeffrey R Saffle,
Stephen E Morris,
James C Jeng,
David Voigt,
Pamela A Howard,
Fred Molitor,
David G Greenhalgh
[show abstract]
[hide abstract]
ABSTRACT: To delineate blood transfusion practices and outcomes in patients with major burn injury.
Patients with major burn injury frequently require multiple blood transfusions; however, the effect of blood transfusion after major burn injury has had limited study.
Multicenter retrospective cohort analysis.
Regional burn centers throughout the United States and Canada.
Patients admitted to a participating burn center from January 1 through December 31, 2002, with acute burn injuries of >or=20% total body surface area.
Outcome measurements included mortality, number of infections, length of stay, units of blood transfused in and out of the operating room, number of operations, and anticoagulant use.
A total of 21 burn centers contributed data on 666 patients; 79% of patients survived and received a mean of 14 units of packed red blood cells during their hospitalization. Mortality was related to patient age, total body surface area burn, inhalation injury, number of units of blood transfused outside the operating room, and total number of transfusions. The number of infections per patient increased with each unit of blood transfused (odds ratio, 1.13; p<.001). Patients on anticoagulation during hospitalization received more blood than patients not on anticoagulation (16.3+/-1.5 vs. 12.3+/-1.5, p<.001).
The number of transfusions received was associated with mortality and infectious episodes in patients with major burns even after factoring for indices of burn severity. The utilization of blood products in the treatment of major burn injury should be reserved for patients with a demonstrated physiologic need.
Critical Care Medicine 06/2006; 34(6):1602-7. · 6.33 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Determining burn patients' need for inpatient rehabilitation at discharge is difficult and an objective clinical indicator might aid in this decision. The functional independence measure (FIM) is a validated outcome measure that predicts the need for rehabilitation services. This study evaluated the utility of the FIM score for discharge planning in burn patients. A retrospective chart review and FIM score determination was performed on all major burn patients discharged from a regional adult burn centre between July 1, 1999 and June 30, 2000. From 164 adult burn patients discharged, 37 met the American Burn Association criteria for major burns. One patient had insufficient data. Therefore, 36 patients were studied (mean age 47.3 +/- 17.4 years, and mean body area burned 27.4 +/- 12.9%). All 17 patients with FIM scores greater than 110 were discharged home, and patients with FIM score of 110 or lower were discharged to another institution (rehabilitation hospital n = 14, other acute care hospital n = 4, or a nursing home n = 1) p < 0.0001. A discharge FIM score of 110 or lower was strongly associated with the need for inpatient rehabilitation, while a FIM score greater than 110 indicates the patient is independent enough to manage at home. Further prospective studies will be necessary to validate these findings.
Burns 03/2006; 32(1):20-3. · 1.96 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: To investigate the psychosocial outcomes following electrical burns, a cross-sectional survey of electrical burn patients was done using three outcome tools: the Burn Specific Health Scale brief version (BSHS-B), the Coping with Burns Questionnaire (CBQ), and the Pain Patient Profile (P3). Questionnaires were mailed to electrical burn patients discharged from an adult regional burn centre, and also distributed to attendants of an electrical utility conference in Toronto. Twenty-six of 88 patients who were discharged from the regional burn centre during the study period with updated residential information were contacted and 14 (54%) completed the questionnaires. Twenty questionnaires were also distributed at the conference and 8 (40%) were completed; leaving a total of 22 (48%) patients for the study. The average patient age was 44.0+/-11.7 years; 21 (96%) were men, and the average time from injury to survey completion was 5.3+/-4.9 years. Five (23%) of the 22 patients returned to the same work duties, 10 (45%) changed duties, and 7 (32%) did not return to work. BSHS-B scores were low for all patients. Participants with high voltage burns (>1000 V) had worse sexuality scores (p<0.05), while those with larger burns (>10% TBSA) had worse physical scores (p<0.05). Patients surveyed >5 years from injury showed improvement in physical scores. CBQ scores indicated that optimism was the most commonly used coping strategy. P3 showed significant levels of emotional distress in all patients, with anxiety being more common in high voltage injuries (p<0.05). The data suggests that electrical burn patients may have a limited ability to return to work and an overall poor quality of life. Emotional distress is the dominant feature influencing long-term outcome in these patients. Further studies are warranted to validate these findings.
Burns 03/2006; 32(2):159-64. · 1.96 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: High frequency oscillatory ventilation (HFOV) improves gas exchange while providing lung protective effects during the ventilation of patients with the acute respiratory distress syndrome (ARDS). The purpose of this study was to review our experience with HFOV in adult burn patients with oxygenation failure secondary to ARDS.
Retrospective cohort review of all burn patients treated with HFOV at a regional adult burn center.
All values are reported as the mean +/- standard deviation (S.D.). HFOV was used on 28 occasions in 25 patients (age 44 +/- 16 years, %TBSA burns 40 +/- 15, and a 28% incidence of inhalation injury) who had severe oxygenation failure from ARDS (PaO2/FiO2 ratio 98 +/- 26, and oxygenation index (OI) (FiO2 x 100 x mean airway pressure/PaO2) 27 +/- 10) following 4.8 +/- 4.4 days of conventional mechanical ventilation (CMV). After switching from CMV to HFOV, there were significant improvements in the PaO(2)/FiO2 ratio within 1h and in the oxygenation index within 24 h. The duration of HFOV was 6.1 +/- 5.8 days. HFOV was continued during 26 surgeries for 14 patients where a mean of 18 +/- 9% TBSA burns were excised and closed. The only complications related to HFOV were three episodes of severe hypercapnia. In-hospital mortality was 32%.
HFOV was safe, and was highly effective in correcting oxygenation failure associated with ARDS in burn patients, and can be successfully used as an intra-operative ventilation modality for burn patients.
Burns 09/2004; 30(5):453-63. · 1.96 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Toxic epidermal necrolysis (TEN) is a life-threatening adverse drug reaction (ADR) that is primarily the result of drug exposure (incidence 0.4-1.3 per million person-years). Life-threatening ADRs such as TEN should be reported to ADR monitoring programmes, which collect reports for suspected ADRs and alert the public and medical practitioners to new drug hazards. In Canada, reports are made to the Canadian Adverse Drug Reaction Monitoring Program (CADRMP).
To examine the extent of under-reporting for TEN in Canada.
A retrospective case series design was used to collect all TEN cases for the period January 1995 to December 2000.
The CADRMP and 22 burn centres across Canada were contacted for all TEN patients treated during the specified time period. PATIENT GROUPS STUDIED: The study population consisted of patients admitted to burn treatment sites across Canada, patient cases reported to the CADRMP and patient cases recorded by the Canadian Institute for Health Information (CIHI) hospital discharge summaries as the International Classification of Diseases Version 9 Clinical Modification (ICD-9-CM) code 695.1.
Twenty-five TEN cases (six fatal) were reported to CADRMP from January 1995 to December 2000. During this period, 14 (63.6%) burn treatment sites reported admission of 250 TEN cases. Hospital discharge summaries using the ICD-9-CM code 695.1 indicated that 4349 cases were admitted to hospital during this time period and it was estimated that 15.5% (n = 674) of these cases were TEN. Using the burn facility data as the denominator, 10% (25 of 250) of TEN cases were reported to CADRMP. Using CIHI data as a denominator, only 4% (25 of 674) of TEN cases were reported to CADRMP.
There is serious under-reporting of TEN. Lack of reporting of life-threatening ADRs can compromise population safety. There is a need to increase awareness of ADR reporting programmes.
Drug Safety 02/2004; 27(7):477-87. · 3.63 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Many burn injuries occur in the workplace. Previous research from this institution 10 years ago analyzed the incidence and nature of occupation-related burns admitted to our facility.
To compare the current incidence and patterns of work-related burn injuries treated at our adult regional burn center (Current group) with the findings of a similar study 10 years ago (Early group).
Retrospective study of all burn center admissions between 5 December 1998 and 31 December 2000 was completed. The data from the Early and Current groups was analyzed using the Chi-square test of homogeneity.
During the study period, 355 patients were hospitalized. After exclusions, 100 occupational burn cases were identified (28%). The mean age of patients was 39+/-12 years, 90% were male. The mean total body surface area (TBSA) burn was 11+/-13.7%. The most common mechanism of burn was electrical (32%), followed by flame (22%), scald (17%), tar (14%), contact (8%), and chemical (7%). Four patients (4%) died of their injuries. There were no significant differences between the Current group and the Early group in terms of incidence, age, gender, occupation, mechanism of burn, or mortality.
In the past 10 years no change was found in the incidence or pattern of work-related burn injuries treated at this institution. This suggests that existing prevention strategies have not been effective.
Burns 09/2003; 29(5):469-72. · 1.96 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Few studies have examined the cost associated with burn patients, and those which have been conducted have generally focused on overall hospitalization costs associated with these patients. No studies to date have examined the overall drug utilization and costs of medications used in the treatment of burn patients.
To describe the pattern of drug utilization and associated costs for the treatment of patients admitted to the Ross Tilley Burn Centre at Sunnybrook and Women's College Health Sciences Centre, Toronto, Ontario, Canada.
A retrospective chart review was conducted based on the medical records of 30 adult patients (>18 years old) consecutively admitted to the burn center between 1 August 1999 and 30 September 1999. Charts were examined to determine drugs administered, doses and duration of use. Medications administered in the operating room were excluded from the analysis. Drug costs were calculated using hospital acquisition costs (1999 Canadian dollars [$Can]) and medications were categorized by pharmacological class according to the American Hospital Formulary Service. Demographic information for the patients was extracted from the burn center's database. The economic analysis was performed from the perspective of the hospital burn center. A descriptive statistical analysis was completed for all variables; the Pearson correlation coefficient was used to examine the relationship between certain variables. A sensitivity analysis was conducted to examine the impact of patient subgroups on certain variables
Of the 28 patients included in the analysis, 19 were admitted with acute burn injuries, two with toxic epidermal necrolysis and seven for post-burn reconstructive surgery. Patients admitted for acute burns or toxic epidermal necrolysis had the highest associated drug costs. On average, patients received 13 different drugs representing four different pharmacological categories. The mean daily drug cost per patient was $Can18.39 and the mean expenditure per admission was $Can792.97. Opioid analgesics and sedatives accounted for the largest expenditure (50.9%), followed by anti-infective agents (23.4%). For patients admitted with acute burns, there was a good correlation between daily drug costs and mortality risk (r = 0.82, p < 0.001). The findings from this study group were used to extrapolate annual expenses for medications in the burn center and these were estimated to exceed $Can280 300 in 2003.
The findings of this retrospective analysis serve to elucidate the patterns of drug utilization within a population of burn patients and confirm the significant impact of a burn center on an institution's drug expenditure.
American Journal of Clinical Dermatology 01/2003; 4(12):861-7. · 1.71 Impact Factor
-
Canadian Journal of Anaesthesia 06/2002; 49(5):529-30. · 2.35 Impact Factor
