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As in many other countries, burn injuries are a challenging healthcare problem in Turkey. Initial management of burn patients is very important for future morbidity and mortality. Therefore, the Turkish Ministry of Health prepared "National Burns Treatment Algorithm" aided by the Scientific Burns Council. The basic aim of this algorithm is to guide...
Citations
... Assessing the total body surface area (TBSA) affected by burns is essential for directing treatment and determining patient prognosis [4,7]. The severity of burns, which includes the depth and extent of the injury, is a crucial factor that affects the need for hospitalisation and the length of hospital stay [8][9][10]. Although the average length of stay is generally estimated based on TBSA, it often exceeds these estimates due to variations in care practices and burn severity [11]. ...
... However, in patients who died, no significant relationship was found between burn surface area and length of stay (p = 0.093). This lack of correlation is likely because many factors other than burn size contribute to mortality, such as sepsis, inhalation injuries, and advanced age [7][8][9][10][11][12][13][14][15][16][17][18][19][20]. ...
... Therefore, the LAR alone cannot be suggested as a marker for risk stratification or for guiding clinical management decisions. However, considering that both lactate and albumin levels are routinely measured in patients with burn injuries, the LAR may still provide useful information when used in conjunction with the tests suggested by clinical practice guidelines 29,30 or with scores such as ABSI or Baux score 6,7 . Combining multiple markers and clinical assessments may improve prognostic accuracy, as relying solely on a single biomarker may not capture the complex pathophysiology of burn injuries. ...
Evaluate the prognostic performance of the lactate-to-albumin ratio (LAR) for complications in children 5 years of age or younger with second and/or third degree burn injuries during hospitalization in the intensive care unit of a hospital in Lima, Peru. In this retrospective cohort study, we conducted prognostic tests by analyzing the medical records of children aged ≤ 5 years who suffered second- and/or third-degree burn injuries and were subsequently admitted to the ICU of a Lima-based hospital between 2017 and 2022. The LAR was calculated using lactate and albumin values measured within the first 48 h post-burn. The area under the curve (AUC) was utilized to evaluate the prognostic performance of the LAR in predicting complications. A cohort of 258 patients aged ≤ 5 years with second- and/or third-degree burn injuries was examined. Among them, 63 patients experienced complications (24.4%). The estimated AUC ROC for the LAR was 0.63 (95% confidence interval [CI]: 0.54–0.71). After adjusting for confounders, values of LAR above the threshold were found to be associated with a significantly increased risk of complications (adjusted relative risk: 2.23; 95% CI 1.51–3.29; p < 0.001). The LAR exhibited limited prognostic capability for complications in pediatric burn patients. Nevertheless, a significant association was observed between values of LAR above the threshold and increased risk of complications.
... Opioids may be combined with adjuncts like benzodiazepines to manage pain (Carey et al., 2021). However, regularly assessing patient's pain and anxiety levels using established metrics is recommended (Yastı et al., 2015). It is crucial to educate staff, patients, and families on burn-related pain and its harmful consequences. ...
Burn injuries are the sixth leading cause of mortality globally and among the top five causes of injury in pediatrics. Therefore, this study aimed to review the methods and treatments for managing procedural pain in pediatric burnt patients, focusing on alleviating burning sensations effectively. Data were gathered from various electronic databases spanning 2015 to 2024 using keywords related to pain management, burn injuries, and intervention strategies. Utilizing frameworks like SPIDER, PICO, and ROBIS, 85 articles were selected for review, elucidating interventions, pain assessment criteria, and management guidelines. The review underscores the progress in effective therapies while aiming to determine the prevalence and treatment of procedural burn pain in pediatrics. Further, it encompasses treatment criteria, protocols, pharmacological and non-pharmacological interventions, and lifestyle modifications. This indicates that effective treatment options are progressing. This review concluded personalized, multimodal pain treatment methods for enhancing the health and efficiency of patients in vulnerable situations.
... 3 According to the depth, burns can be classified as first degree (superficial), second degree (partial thickness), or third degree (full thickness). [4][5][6] The damage of partial or full thickness burns goes beyond the epidermis and reaches the dermis, generating different degrees of necrosis and vascular stasis both in the affected area and in its periphery. 7 Epidermal discontinuity favors the invasion of pathogens and increases the risk of infection and septicemia. ...
... I G U R E 6 Descriptive microscopic analysis of the full thickness burn wound in rats with different treatments and experimental times (A), and histopathological representation of the criteria adopted for analysis (B): polymorphonuclear (1) and mononuclear (2) inflammatory cells, crust (3), neovascularization (4), fibroblast proliferation(5), and re-epithelialization(6). Histopathological criteria were represented using photomicrographs of the CÀgroup at 14 days. Magnification: 200Â. ...
Deep skin burn represents a global morbidity and mortality problem, and the limitation of topical treatment agents has motivated research to development new formulations capable of preventing infections and accelerating healing. The aim of this work was to develop and characterize an emulgel based on collagen (COL) and gelatin (GEL) extracted from fish skin associated with Chlorella vulgaris extract (CE) and silver nitrate (AgNO3). COL and GEL were characterized by physicochemical and thermal analyses; and CE by electrophoresis and its antioxidant capacity. Three emulgels formulations were developed: COL (0.5%) + GEL (2.5%) (E1), COL+GEL+CE (1%) (E2), and COL+GEL+CE + AgNO3 (0.1%) (E3). All formulations were characterized by physicochemical, rheology assays, and preclinical analyses: cytotoxicity (in vitro) and healing potential using a burn model in rats. COL and GEL showed typical physicochemical characteristics, and CE presented 1.3 mg/mL of proteins and antioxidant activity of 76%. Emulgels presented a coherent physicochemical profile and pseudoplastic behavior. Preclinical analysis showed concentration‐dependent cytotoxicity against fibroblast and keratinocytes. In addition, all emulgels induced similar percentages of wound contraction and complete wound closure in 28 days. The histopathological analysis showed higher scores for polymorphonuclear cells to E1 and greater neovascularization and re‐epithelialization to E3. Then, E3 formulation has potential to improve burn healing, although its use in a clinical setting requires further studies.
... The severity of burn was classified according to the National Burns Treatment Algorithm published by Yastı et al. [13] which combined the degree of burn and TBSA as: ...
Background
Acute kidney injury (AKI) is a common and important complication of burn injury. Although there are numerous adult studies, data regarding AKI in pediatric burn patients are scarce. Here, we aimed to evaluate the frequency, clinical features, and prognosis of AKI among pediatric burn injury patients.
Methods
This is a retrospective cohort study. Patients aged between 1 month and 18 years who had been followed up between the years 2011 and 2017 were included, and patients with previous kidney disease were excluded. Demographic data, laboratory and clinical variables, management strategies, and outcome data were obtained from the hospital records. Factors associated with AKI were determined by logistic regression analysis.
Results
A total of 697 patients had been followed up, and 87 (12.5%) had AKI. Older age, refugee status, prolonged duration between the incident and time of hospitalization, presence of sepsis, severity and type of burn, volume of fluid administration, intubation status, and accompanying organ failure were all associated with the development of AKI. According to multivariate logistic regression analysis, the most statistically significant factors associated with the development of AKI were older age and increased serum hemoglobin values. In terms of outcomes, length of stay and mortality increased in patients with AKI when compared with patients without AKI.
Conclusion
Similar to adults, AKI is an important and common complication of burn injury in pediatric burn patients and is associated with increased length of stay, morbidity, and mortality. Early recognition and prompt and appropriate management are crucial to avoid morbidity and mortality.
Graphical abstract
... 9,10 In Turkey, the criteria for transfer and hospitalization in burn units/centers have been determined by a national guideline. 11 The remaining patients are treated by family physicians, emergency rooms, or outpatient clinics affiliated with burn unit/centers. As we have a pediatric burn center (PBC) in our hospital, all outpatients are followed up and treated in the outpatient clinic of our burn center. ...
... Whether the patient would be treated as an inpatient or outpatient was decided according to the national burn treatment algorithm guidelines. 11 Accordingly, minor burn patients were planned to be treated as outpatients. ...
Burn injuries are a serious emergency. Most burn injuries in children can be treated as outpatients. The aim of this study was to present the clinical and epidemiologic characteristics of pediatric burn injuries treated in our outpatient burn clinic.
This study included pediatric patients treated in an outpatient burn clinic over an eight-year period. The demographic and clinical characteristics of the patients were retrospectively analyzed. The patients were divided into four groups according to their age groups, and the differences between the groups were investigated. Statistical analysis was performed using IBM SPSS Statistics, Version 25.0. P<0.05 was accepted as statistically significant.
Of the total 5,167 patients, 2,811 (54.4%) were male. Scald burns were the most common cause of burns (81.4%). Contact burns accounted for 12.2% of all burns. There were no differences between sexes for any variable. The highest incidence was seen in children in the 2–5-year-old age group (28.3%). There were differences between age groups in terms of sex, burn area, burn visit, burn type, burn location, need for wound dressing under anesthesia, and need for grafting. Among the patients, 4.9% were hospitalized due to the need for wound dressing under anesthesia. However, most of the patients (95.1%) were treated as outpatients.
In conclusion, the majority of pediatric burn patients can be treated as outpatients. This allows pediatric patients to complete treatment in a psychologically comfortable environment and have low complication rates. Outpatient treatment should become the standard for children who are suitable for outpatient follow-up and who have home support.
... The severity of burn was classi ed according to National Burns Treatment Algorithm published by Yasti et al [12] which combined the degree of burn and TBSA as: ...
Objective: Acute kidney injury (AKI) is a common and important complication of burn injury. Although there are numerous adult studies data regarding AKI in pediatric burn patients is scarce. In this study we aimed to evaluate the frequency, clinical features and prognosis of AKI among pediatric burn injury patients.
Methods: This is a retrospective cohort study. Patients aged between 1 month and 18 years followed in pediatric burn intensive care unit between years 2011 and 2017 were included in the study.Patients with known kidney disease were not included. Demographic data, laboratory and clinical variables, management strategies and prognosis were obtained from the hospital records of the patients. Factors associated with AKI were determined by logistic regression analysis.
Results: A total of 697 patients had been followed up and among them 87 (12.5%) had acute kidney injury. Older age, being a refugee, prolonged duration between the incident and time of hospitalization, presence of sepsis and severity and type of burn, the amount of fluid administered, being intubated, accompanying organ failure were all related with the development of AKI. According to multivariate logistic regression analysis the most important contributors of AKI were older age and increased serum hemoglobin values.
Conclusion: As observed in adults AKI is also an important and common complication of burn injury among pediatric burn patients. Early recognition and prompt and appropriate management is crucial to avoid morbidity and mortality.
... Proporsi cedera karena luka bakar di Indonesia sebesar 1,3% yang merupakan jumlah yang cukup tinggi dibandingkan dengan cedera lainnya (Kemenkes RI, 2018). Keparahan luka bakar dapat ditentukan berdasarkan kedalaman luka, luas luka/ Total Body Surface Area (TBSA), dan area tubuh yang terkena cedera (Yastı et al., 2015). ...
Burn injury is severe trauma that is mainly caused by fire that affects in various organ systems. The metabolic response caused by burn inury is catabolism of energy, protein, and lipid, so a high quality nutrition with high bioavailability is needed to accelerate wound healing process. The purpose of this study was to analyze the effect of food intervention of liquid food formula from catfish (Clarias gariepinus)-moringa (Moringa oleifera) that have been processed by nanoparticle technology and the effect of body weight and wound healing process through the number of fibroblasts in rats with burn. This study used an experimental design with completely randomized design with ethical number 203-2021 IPB. The samples were 3 month old male Sprague Dawley rats weighing 200-300 grams. There are 6 intervention treatments: control group (aquades), commercial liquid food formula 30%, non-nano liquid food formula 15%, non-nano liquid food formula 30%, nano liquid food formula 15%, and nano liquid food formula 30%. The intervention was carried out for 14 days. Statistical analysis for the difference test used One Way ANOVA. The body weight of rats continued to decrease from day 0,6 to 15. There was no significant difference between groups in the average body weight of rats on days 0,6, and 15 (p-value>0,05). There was a tendency that nano liquid food formula was accelerated the wound healing process in burn rats after 14 days of intervention, but no significantly (p-value>0,05).
... But one must know the differences in hematologic and physiologic characteristics in children from adults, especially during blood product and fluid resuscitation. [8] Yastı et al. [9] suggested Ringer's lactate solution for fluid resuscitation in the first 24 h and according to Galveston's formula "2000 mL/m 2 body surface area +5000 mL/m 2 burned TBSA" for pediatric burns. However, we resuscitate with Ringer's lactate solution according to The Parkland Formula "4 mL/kg/% burned TBSA" in our patients. ...
Objective
Pediatric burns pose difficult healthcare issues in underdeveloped nations. Due to the scarcity of pediatric burn care facilities and qualified burn-care staff, patients are frequently referred from a rural hospital. This study explores the burn-treatment approach that could be used in rural hospitals in the absence of a dedicated pediatric burn care facility.
Materials and Methods
A retrospective analysis of clinical data of 199 children who received treatment for burn-injury in an isolated general surgical ward. Wound debridement under anesthesia at the earliest was the cornerstone of the treatment plan for this cohort. Until the wounds healed, the treatment was repeated every alternate day. The patient's demographic data, number of surgical dressings, length of hospital stay, and outcome were analyzed.
Results
The mean age of the patients was 51.68 ± 23.79 months. The male-female ratio was 1.45:1. The survival rate was 99.00%. The disability rate was 4.52%. Univariate logistic regression identified the age group, total body surface area affected, depth of the wound, and time of intervention as statistically significant variables ( P < 0.05) predicting the disfigurement. Multivariate logistic regression identified the time intervals between surgical intervention and injury as an important predictor of morbidity. In addition, delayed presentation and delayed intervention led to a longer hospital stay, and more interventions than the early intervention cohort.
Conclusions
Early debridement accelerates recovery and lessens the need for future skin grafts or contracture procedures. This approach can be used in rural hospitals as well because pediatric burns can be manageable in an isolated general ward.
... Burn injury is treated by using advanced trauma life support (ATLS) protocols, and management of pain by analgesics, loss of fluids by fluid transfer by IV route, escharotomy and use of antibiotic dressing like silver sulfadiazine 9 .The primary closure of wound can be done by skin stretching or split skin grafting 10 . Treatment of burn involves a multidimensional approach involving surgical debridement of the tissue and tissue grafting for replacement. ...
Background: Burn of shoulder and axillary region are common affecting patient’s range of motion and his/her performance in his daily life. Because post burn if treatment is not given, contracture will ultimately form. Aim: To determine the comparative effectiveness of PNF (hold relax) VS early Dynamic stretching exercises for improving pain, range of motion and functional status in the shoulder joint and quality of functional recovery in burn patients. Methodology: A single blinded Randomized clinical trial was conducted at Mayo Hospital, Burn ward. Total 74 patients (Male and Female) were included in the study on the basis of inclusion and exclusion criteria. Participants were randomly allocated in two groups, 32 in each group by odd even method. Group 1 received PNF (hold-relax) protocol while group 2 received Dynamic stretching protocol, both the groups received the treatment along with conventional therapy on alternate days for 4 weeks. Pre and post treatment assessment VAS, Q-DASH score and ranges of motion were done. Data was analyzed using SPSS 23 version. Paired sample T-test and independent sample T test was used to assess within and between group analysis with having confidence interval CI 95% and p value 0.05. The purpose of paired T-test and independent t-test was to determine the difference within and between the groups in all clinical parameters (Q-DASH score, VAS score and ROM) during both pre and post treatment. Results: According to the findings, VAS, Q-DASH scoring and ranges of affected burn shoulder joint were significantly improved in both groups i.e., treated with PNF and Dynamic stretching protocol. However, on group comparison; statistically significant improvement in VAS, Q-DASH scoring and ranges of shoulder were observed in patients treated with PNF as compared to Dynamic stretching with p-value <0.05. Practical implication: The study provides the opportunity to physiotherapist to get aware of the role of PNF and dynamic stretching in preventing and treating post burn patients. It provides the statistical effectiveness of techniques in increasing the recovery rate of patients by using defined treatment protocol. Conclusion: This study proved that PNF and Early Dynamic Stretching both are effective in improving pain, range of motions and functional status among burn patients. However; PNF (hold relax) was more beneficial for improving functional status and treating pain and range of motion in shoulder joint of burn patients with p-value <0.05. Keywords: Axillary burns, Contractures, Early Dynamic Stretching exercises, Functional recovery, Range of motion(ROM).
