ArticleLiterature Review

Epidemiology of burns throughout the world. Part I: Distribution and risk factors

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Abstract

Globally in 2004, the incidence of burns severe enough to require medical attention was nearly 11 million people and ranked fourth in all injuries, higher than the combined incidence of tuberculosis and HIV infections. Fortunately, although burns and fires account for over 300,000 deaths each year throughout the world, the vast majority of burns are not fatal. Nonetheless, fire-related burns are also among the leading causes of disability-adjusted life years (DALYs) lost in low- and middle-income countries (LMIC). Morbidity and mortality due to fire and flames has declined worldwide in the past decades. However, 90% of burn deaths occur in LMIC, where prevention programs are uncommon and the quality of acute care is inconsistent. Even in high-income countries, burns occur disproportionately to racial and ethnic minorities such that socioeconomic status--more than cultural or educational factors--account for most of the increased burn susceptibility. Risk factors for burns include those related to socioeconomic status, race and ethnicity, age, and gender, as well as those factors pertaining to region of residence, intent of injury, and comorbidity. Both the epidemiology and risk factors of burns injuries worldwide are reviewed in this paper.

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... Burn injuries are a leading cause of death and disability among children globally (1)(2)(3)(4). The World Health Organization (WHO) estimates that burn injuries account for ∼180,000 deaths annually and are the fifth most common cause of nonfatal childhood injuries (5). ...
... Reports from Ghana, Nepal, Mexico, India, and Vietnam suggest that lack of emergency and critical care capabilities, and specialty trained personnel, are common barriers to successful outcomes (6,12,13). Outside of high-income countries, availability of burn care resources are variable and often limited (4,14,15). Although a significant body of research focuses on burn prevention, there is a dearth of information about the burn care capacity in a diversity of locations, specifically the unique needs of burninjured children. ...
... Although there is suggestion that burn care and outcomes for children are improving globally (26), the geographic and socioeconomic distribution of high-quality burn care remains inequitable (4,14,27,28). Currently, children under five years of age in sub-Saharan Africa have over twice the incidence of burn deaths compared to children under five worldwide (5). ...
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Background Burn injuries are a major cause of death and disability globally. The World Health Organization (WHO) launched the Global Burn Registry (GBR) to improve understanding of burn injuries worldwide, identify prevention targets, and benchmark acute care. We aimed to describe the epidemiology, risk factors, and outcomes of children with burns to demonstrate the GBR's utility and inform needs for pediatric burn prevention and treatment. Methods We performed descriptive analyses of children age ≤ 18 years in the WHO GBR. We also described facility-level capacity. Data were extracted in September of 2021. Results There were 8,640 pediatric and adult entries from 20 countries. Of these, 3,649 (42%) were children (0–18 years old) from predominantly middle-income countries. The mean age was 5.3 years and 60% were boys. Children aged 1–5 years comprised 62% ( n = 2,279) of the cohort and mainly presented with scald burns (80%), followed by flame burns (14%). Children >5 years ( n = 1,219) more frequently sustained flame burns (52%) followed by scald burns (29%). More than half of pediatric patients (52%) sustained a major burn (≥15% total body surface area) and 48% received surgery for wound closure during the index hospitalization. Older children had more severe injuries and required more surgery. Despite the frequency of severe injuries, critical care capacity was reported as “limited” for 23% of pediatric patients. Conclusions Children represent a large proportion of people with burn injuries globally and often sustain major injuries that require critical and surgical intervention. However, critical care capacity is limited at contributing centers and should be a priority for healthcare system development to avert preventable death and disability. This analysis demonstrates that the GBR has the potential to highlight key epidemiological characteristics and hospital capacity for pediatric burn patients. To improve global burn care, addressing barriers to GBR participation in low- and low-middle-income countries would allow for greater representation from a diversity of countries, regions, and burn care facilities.
... 19,20,21,22,23 Segundo alguns pesquisadores, no ano de 2004, ocorreram aproximadamente em todo o mundo, o universo de 11 milhões de queimaduras registradas e que, receberam indicação para a realização de tratamento médico especializado, sendo que destes, cerca de 300.000 resultaram no óbito do paciente vitimado por esse tipo de fenômeno. 25 Conforme encontrado em alguns estudos e pesquisas especializadas, o fenômeno das queimaduras são classificadas enquanto a quarta (4ª) maior causa de lesões registradas em todos os países, estando atrás apenas dos acidentes automobilísticos junto as rodovias, as quedas e quedas da própria altura, e também, dos vários tipos e modalidades de violência. 25 Por isso, a importância e a necessidade de serem desenvolvidos estudos e pesquisas sistematizadas, objetivando melhor compreender esse complexo fenômeno e os seus vários desdobramentos, na busca de melhores formas de tratamento e de terapias especializadas para esse paciente. ...
... 25 Conforme encontrado em alguns estudos e pesquisas especializadas, o fenômeno das queimaduras são classificadas enquanto a quarta (4ª) maior causa de lesões registradas em todos os países, estando atrás apenas dos acidentes automobilísticos junto as rodovias, as quedas e quedas da própria altura, e também, dos vários tipos e modalidades de violência. 25 Por isso, a importância e a necessidade de serem desenvolvidos estudos e pesquisas sistematizadas, objetivando melhor compreender esse complexo fenômeno e os seus vários desdobramentos, na busca de melhores formas de tratamento e de terapias especializadas para esse paciente. 24,25 Nesse contexto, pode ser defendido que o artigo científico em questão, se constitui enquanto uma importante publicação identificada na revista "Annaes de Enfermagem", o primeiro periódico científico brasileiro desta categoria e que, viria a se tornar a "Revista Brasileira de Enfermagem -REBEN", dissertando sobre importantes técnicas e procedimentos, utilizados para o cuidado de pacientes vitimados de várias questões relacionadas as queimaduras e, as suas formas de tratamento". ...
... 25 Por isso, a importância e a necessidade de serem desenvolvidos estudos e pesquisas sistematizadas, objetivando melhor compreender esse complexo fenômeno e os seus vários desdobramentos, na busca de melhores formas de tratamento e de terapias especializadas para esse paciente. 24,25 Nesse contexto, pode ser defendido que o artigo científico em questão, se constitui enquanto uma importante publicação identificada na revista "Annaes de Enfermagem", o primeiro periódico científico brasileiro desta categoria e que, viria a se tornar a "Revista Brasileira de Enfermagem -REBEN", dissertando sobre importantes técnicas e procedimentos, utilizados para o cuidado de pacientes vitimados de várias questões relacionadas as queimaduras e, as suas formas de tratamento". 24 Em suas próprias palavras e, introduzindo o artigo desenvolvido em relação aos conhecimentos relacionados aos primeiros socorros para as pessoas vitimadas de queimaduras que, eles eram indispensáveis, no que se refere "[...] ao conhecimento de todos, visto ser muito comum se darem pequenos acidentes em que somos forçados a agir". ...
Article
Objetivo: Analisar as contribuições da Dra. Aurora de Afonso Costa, para o cuidado do enfermeiro a pacientes vitimados de queimaduras. Método: Trata-se de um estudo classificado enquanto documental e de abordagem qualitativa. As fontes primárias se constituíram de artigos de periódicos científicos, produções acadêmicas, livros, sites e portais eletrônicos, leis, decretos, decretos-leis, dentre outros. Resultados: Foi identificado num artigo idealizado pela eminente docente e pesquisadora, questões relacionadas a anatomia, a fisiologia, os graus de complexidade, os tipos, o processo cicatrizacional, a extensão, a área de prioridade, o tratamento medicamentoso e a utilização de “ambrina”. Conclusão: A presente pesquisa apontou as contribuições da Dra. Aurora no tratamento de pessoas vitimadas de queimaduras, os primeiros cuidados a serem implementados com a pessoa vitimada, e a implementação de curativos e coberturas para o seu reestabelecimento e reabilitação.
... In 2017, burn injuries accounted for >8.4 million disability-adjusted life years [2] highlighting the significant medical, social, economic, and personal burden associated with these injuries [3][4][5]. For example, physical disfigurement from burn scar contractures can impact psychological health, cause social stigma, and lead to social isolation and abandonment [6]. The burden of burn injuries is not distributed evenly across the globe, with higher rates of morbidity and mortality observed across lowand middle-income countries when compared with high-income countries [7]. ...
... The burden of burn injuries is not distributed evenly across the globe, with higher rates of morbidity and mortality observed across lowand middle-income countries when compared with high-income countries [7]. However, this should not mean that prevention initiatives should wholly focus on low-and middleincome countries, as the vast majority of burn injuries can be prevented through effectively designed systems and initiatives [6]. ...
... Two crucial parts of any injury prevention approach are surveillance and analysis. Effective prevention interventions cannot be designed without a concise description of the problem at hand [6]. International research has demonstrated certain times of day where burn injury figures appear to rise and fall considerably. ...
Article
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Burns are a leading cause of morbidity and mortality worldwide. Understanding when and how burns occur, as well as the differences between countries, would aid prevention efforts. A review of burn injuries occurring between July 2009 and June 2021 was undertaken using data from the Burns Registry of Australia and New Zealand. Peak injury times were identified on a country-by-country basis. Variations in demographic and injury event profiles between countries were compared using descriptive statistics. There were 26,925 admissions recorded across the two countries (23,323 for Australia; 3602 for New Zealand). The greatest number of injuries occurred between 6 PM to 7 PM in Australia (1871, 8.0%) and between 5 PM to 6 PM in New Zealand (280, 7.8%). In both countries, scalds accounted for the greatest proportion of injuries during peak times (988, 45.8%), but a greater proportion of young children (under three years) sustained burns during New Zealand’s peak times. The number of burn injuries associated with the preparation and/or consumption of food offers an opportunity for a targeted prevention program that may yield benefits across the two countries. Age- and mechanism-related differences in the profile of burn-injured patients need to be considered when developing and implementing such a program.
... 1 The World Health Organisation (WHO) estimates that 11 million burn injuries occur each year, of which 180,000 lead to death. 2 In high-income countries, there has been a large reduction in burn injuries. Burn injuries remain a massive issue in Low-and Middle-Income Countries (LMICs) and more than 90% of burns are thought to occur in these countries. ...
... Burn injuries remain a massive issue in Low-and Middle-Income Countries (LMICs) and more than 90% of burns are thought to occur in these countries. 2 The majority of burns are small and do not require hospital admissions. Information on burn epidemiology is inconsistent, with high-income countries having more available data compared to LMICs. ...
Article
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Burn injuries have decreased markedly in high-income counties while the incidence of burns remains high in Low- and Middle- Income Countries (LMICs) where over 90% of burns are thought to occur. However, the cause of burns in LMIC is poorly documented. The aim was to document the causes of severe burns and the changes over time. A cross-sectional survey was completed for 2014 and 2019 in eight burn centres across Africa, Asia and Latin America: Cairo, Nairobi, Ibadan, Johannesburg, Dhaka, Kathmandu, Sao Paulo and Guadalajara. The information summarised included demographics of burn patients, location, cause and outcomes of burns. In total, 15,344 patients were admitted across all centres, 37% of burns were women and 36% of burns were children. Burns occurred mostly in household settings (43% to 79%). In Dhaka and Kathmandu, occupational burns were also common (32% and 43%, respectively). Hot liquid and flame burns were most common while electric burns were also common in Dhaka and Sao Paulo. The type of flame burns varies by centre and year, in Dhaka, 77% resulted from solid fuel in 2014 while 74% of burns resulted from Liquefied Petroleum Gas in 2019. In Nairobi, a large proportion (32%) of burns were intentional self-harm or assault. The average length of stay in hospitals decreased from 2014 to 2019. The percentage of deaths ranged from 5% to 24%. Our data provides important information on the causes of severe burns which can provide guidance in how to approach the development of burn injury prevention programs in LMIC.
... Severe burn injuries, encompassing more than one-fifth of total body surface area (TBSA) remain a substantial source of worldwide morbidity and mortality, with up to 300,000 deaths per 11 million incidences per year by WHO estimates [1][2][3]. Although incidences of burn trauma have declined gradually, burn injury remains the fourth most common type of trauma worldwide [2]. ...
... Severe burn injuries, encompassing more than one-fifth of total body surface area (TBSA) remain a substantial source of worldwide morbidity and mortality, with up to 300,000 deaths per 11 million incidences per year by WHO estimates [1][2][3]. Although incidences of burn trauma have declined gradually, burn injury remains the fourth most common type of trauma worldwide [2]. It affects younger patients in a bimodal distribution, with the majority of cases in children (1-15.9 ...
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Background: In this systematic review, we summarize the aetiology as well as the current knowledge regarding thermo(dys)regulation and hypothermia after severe burn trauma and aim to present key concepts of pathophysiology and treatment options. Severe burn injuries with >20% total body surface area (TBSA) affected commonly leave the patient requiring several surgical procedures, prolonged hospital stays and cause substantial changes to body composition and metabolism in the acute and long-term phase. Particularly in severely burned patients, the loss of intact skin and the dysregulation of peripheral and central thermoregulatory processes may lead to substantial complications. Methods: A systematic and protocol-based search for suitable publications was conducted following the PRISMA guidelines. Articles were screened and included if deemed eligible. This encompasses animal-based in vivo studies as well as clinical studies examining the control-loops of thermoregulation and metabolic stability within burn patients. Results: Both experimental animal studies and clinical studies examining thermoregulation and metabolic functions within burn patients have produced a general understanding of core concepts which are, nonetheless, lacking in detail. We describe the wide range of pathophysiological alterations observed after severe burn trauma and highlight the association between thermoregulation and hypermetabolism as well as the interactions between nearly all organ systems. Lastly, the current clinical standards of mitigating the negative effects of thermodysregulation and hypothermia are summarized, as a comprehensive understanding and implementation of the key concepts is critical for patient survival and long-term well-being. Conclusions: The available in vivo animal models have provided many insights into the interwoven pathophysiology of severe burn injury, especially concerning thermoregulation. We offer an outlook on concepts of altered central thermoregulation from non-burn research as potential areas of future research interest and aim to provide an overview of the clinical implications of temperature management in burn patients.
... Some burns are severe enough to require medical attention [9]. Most burns were not fatal, but they had a significant impact on the patient's quality of life and the financial stability of their family due to extended hospital stays and functional loss, which resulted in social isolation and disgrace [10,11]. Depending on the degree and proportion of burns, it is determined whether hospitalization is necessary or whether outpatient care is appropriate. ...
Article
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Background The skin is the largest organ of the body. Burns are important health issues that significantly affect a variety of population groups. Skin grafting is still regarded as the gold standard in surgical burn treatment. The availability of skin for grafting is one of the main challenges in burn surgical therapies. Thus, this study aimed to assess the public perception and attitude regarding skin donation in Saudi Arabia. Method The study was a cross-sectional study that included the general population in Saudi Arabia (≥ 18 years old). A self-administered survey was distributed online. Statistical analysis was carried out using RStudio (R version 4.1.1). Categorical data were presented as frequencies and percentages, while continuous data were expressed as the median and interquartile range (IQR). Results A total of 8515 were included in the study. Most participants (71.5%) were females. Among the respondents, 64.9% were between the ages of 18 and 30. Females had a higher knowledge level of skin graft donation compared to males. Participants aged >30 years had lower knowledge levels compared to younger participants. Lower knowledge scores were also observed among married, widows, as well as uneducated participants. Five thousand two hundred and seven (61.1%) participants support skin donation. The most reported barrier to skin donation was religious reasons (52.4%), while the main motives for supporting skin donation were humane-related factors (73.2%). The influence of close relatives on participants' decisions to donate was evident in 52.6% of the instances. Conclusion It was found that most participants support skin donation in Saudi Arabia. Religious reasons were the most common hindering factors against skin donation. Females and young-aged groups were found to have a higher knowledge level. Further studies are recommended to shed light on this subject allowing for appropriate solutions implantation.
... Patients with burns have heterogeneous demographic characteristics in that they include both sexes in every age range, with diverse social and medical backgrounds, but they are homogeneous as to the cause of injury, the burn. 32,33 The time of injury is known, the estimate of the damage (expressed as TBSA%) is measurable, and it is a strong indicator of the severity of the illness. 5 The medical care is relatively standardised and allows daily monitoring of medical interventions and the nursing care given. ...
... Burns injuries affect 11 million people globally and 140 000 people in England every year. 1 Injuries can result in long-lasting functional and psychosocial disability. 2 Healthcare costs are substantial and are related to long hospital admissions, multiple surgeries and the need for rehabilitation. 3 Despite the importance to healthcare expenditure, quality of patient life and outcomes, there is a discrepancy between treatment burden and the volume of high-quality evidence in burn care. ...
Article
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Introduction Burns affect 11 million people globally and can result in long-term disability with substantial associated healthcare costs. There is limited research funding to support trials to provide evidence for clinical decision-making. Research prioritisation ensures that research focuses on the topics most important to stakeholders, addressing issues of research waste and evidence gaps. The aim of this project is to agree the global top 10 research priorities important to international patients, carers and clinicians from all income status countries. Methods and analysis The Global Burns Research Priority Setting Partnership will use James Lind Alliance methods to establish the top 10 research priorities in global burns care. An initial international online multilingual survey will collect candidate research priorities from stakeholders. To increase equity in participation, the survey will also be available via the social media app WhatsApp. Additionally, interviews will be conducted. Data will be analysed to identify and collate research questions and to verify that the priorities are true clinical uncertainties. This list will then be ranked by stakeholders in order of importance via a second online survey. Finally, a consensus meeting will identify the top 10 research priorities. Ethics and dissemination The University of Bristol Medical School Faculty Ethical Committee has approved this project. Research into burn care should be prioritised to ensure that funding is focused where most needed. This should be undertaken internationally, to ensure inclusion of the views of professionals and patients from lower income countries, where the incidence of thermal burns is highest. The involvement of the James Lind Alliance will ensure that the methodology is robust and that the patient voice is heard. The final top 10 priorities will be disseminated to funders, governments and researchers internationally to inform future global burns research.
... The higher mortality was seen in low-middleincome countries compared with the high-income countries, probably due to limited resources available, insufficient preventive measures, and inadequate treatment [1]. Globally, there are 300,000 people dying from burn in approximately 11 million people with burn injuries seeking medical care annually [2]. Therefore, many of burn patients end up experiencing disability (morbidity) which often leads to rejection stigma from their community, which will ultimately reduce the quality of life of sufferers [3]. ...
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BACKGROUND: Burn injury is one of the serious public health problems. Many of burn patients end up with experiencing disability (morbidity). Meanwhile, the epidemiology of burn patients in eastern part of Indonesia is rarely reported. AIM: We aimed to investigate the sociodemographic characteristic of burn patients in Sanglah General Hospital as the center referral hospital for eastern part of Indonesia. MATERIALS AND METHODS: Viable data were collected from burn patients admitted to Burn Center of Sanglah Hospital between January 2014 and December 2018. A cross-sectional study design was used with statistical analysis which was performed using IBM Statistics 23 for Windows. RESULTS: A total of 725 subjects were involved in this study. Subjects were divided into two groups of emergency (n = 607, 83.72%) and non-emergency (n = 118, 17.28%). There were 525 (72.4%) burn subjects who were ≥17 years old with combustion caused by flame as the most common case (n = 264, 56.9%), whereas 200 (27.6%) subjects were <17 years old, while the group of age 0–5 years old (n = 115, 57.5%) gave largest proportion admission in pediatric group of scalding as the main cause (n = 100, 69.4%). CONCLUSION: We found that adults and elders had the highest risk of acquiring combustion caused by flame. Scalding was the most burns case found in the pediatric population.
... Critical illness resulting from thermal injury leads to systemic inflammatory response syndrome (SIRS) involving a massive systemic cytokines' release that characterized by two at minimum of the listed four criteria: tachypnea, tachycardia , fever and leukopenia or leukocytosis [3]. This is coupled with an anti-inflammatory response as the body seeks homeostasis restoration, a condition known by the compensatory antiinflammatory response syndrome (CARS) that results in a significant functional and numerical decrease of multiple immune cell types such as monocytes, neutrophils, lymphocytes, macrophages, and natural killer cells [4][5][6]. The usual post-traumatic cellular response is decrease in lymphocytic count and an increase in the neutrophils and white blood cells (WBC)count [3]. ...
Article
Background: The utility of laboratory values to predict complications in pediatric burn patients is poorly understood. This study assessed the laboratory investigations’ role in morbidities and mortalities prediction after moderate and severe thermal burn in pediatrics. Methods: This prospective cohort study was carried out on 40 children with moderate and major thermal burn. All patients were subjected to clinical evaluation and laboratory investigations such as CBC, c-reactive protein (CRP), serum albumin, serum creatinine and urea. Results: Patients were subdivided into two groups: uncomplicated group (n=25) and complicated group (n=15). CRP, serum albumin, platelet count, serum creatinine and urea can significantly predict sepsis incidence with AUC of 0.922, 0.912, 0.911, 0.807, 0.810, at cut off >12, ≤2, ≤194, >0.7, >23, with sensitivity of 100%, 90.91%, 100 %,100 %, 85.71%, specificity of 86.21 %, 86.21%, 79.31%, 24.24%, 39.39%, PPV of 73.3 %, 71.4%, 64.7%, 21.9% , 23.1% and NPV of 100 %, 96.2 %, 100 %, 100 % , 92.9% respectively. Serum creatinine and urea can significantly predict incidence of acute kidney injury (AKI) with AUC of 0.807, 0.810 At cut off >0.7, >23, with sensitivity of 100.00 %, 85.71%, specificity of 24.24%, 39.39%, PPV of 21.9%, 23.1% and NPV of 100.0%, 92.9% respectively. Percent of burn, total ABSI, CRP, platelet, inhalation injury, albumin, creatinine and urea were dependent predictors for mortality. Sex, inhalation injury, percent of burn, total ABSI, hemoglobin, CRP, platelet, albumin, and creatinine were dependent predictors for sepsis. Sex, inhalation injury, percent of burn, total ABSI, CRP, hemoglobin, platelet, albumin and creatinine were dependent predictors for complication of acute kidney disease. Conclusions: CRP, serum albumin, platelet count, serum creatinine and urea are good predictors of sepsis, AKI and mortalities after moderate to severe burn in pediatrics.
... According to a scoping review by Mukagaju and colleagues, between 1993 and 2019, 44,369 patients with burns were reported in East Africa [3]. Mortality of burns has declined in the past decades but people living in the middle-and lowincome countries still face a challenge [4]. Despite the high incidence of burns in sub-Saharan Africa, health care providers skilled in burns care are rare, and there is a need to scale up proper training to manage such patients [5]. ...
Article
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Background There is a high mortality of burns especially in low- and middle-income countries which already have less developed healthcare systems. Besides, little is known about nursing students’ knowledge and practices towards the need to monitor fluid requirements in admitted burns patients. Objective To assess the knowledge and practices of nursing students regarding monitoring fluid requirements for hospitalised paediatrics and adult burn patients on the surgical ward at Mbarara regional referral hospital. Methods We conducted an online descriptive cross-sectional study among clinical nursing students at Mbarara University of Science and Technology (MUST) during September and November 2021. We assessed knowledge and practices using an adapted questionnaire. Summary statistics were then used to describe the data. Results Thirty-seven nursing students (64.9% response rate) participated in our survey. Twenty one (56.8%) were female and had a modal age range of 20-24 years. Nineteen (51.4%) of the students were BNC (Bachelor of Nursing Completion) students, with the rest being BNS (Bachelor of Nursing). More than 75% of students correctly answered each of two out of the ten questions. More than three quarters of the students reported having done each of six out of the eleven practices surveyed. Conclusion Nursing students had poor knowledge and fair satisfactory practices regarding monitoring of the fluid requirements in burns patients. More similar studies are needed to survey more nursing students on this topic and to henceforth evaluate the need for periodic re-trainings and reassessment of clinical skills of nursing students.
... In fact, the increase in the scale and number of burn injuries has already become a global trend [17]. e increase in the incidence rate of burn injuries may be closely related to social and economic development [18]. With a large population, China is in the stage of development; so, many patients are affected by burn injuries [19]. ...
Article
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Objective: This study was designed to understand the local changes of burn injuries in recent 10 years, so as to provide reliable reference data and viewpoints for prevention and vigilance of local burn injuries. Methods: In this study, 184 patients with a burn injury admitted to our hospital from 2012 to 2021 were enrolled and analyzed retrospectively. According to their information in the electronic database, the number of patients with burn injuries and the location of each disaster each year were analyzed, and the age, sex, hospital stay and hospitalization expense of each patient were collected. With 5 years as the boundary, the patients were divided into a 2012-2016 group and a 2017-2021 group and the differences of the two groups in the abovementioned aspects were compared. Results: During 2012-2021, the incidence rate of burn injuries in men was higher than that in women and workplaces had a higher burn injury rate than residents' homes. Compared with the period of 2012-2016, the number of fires or explosions and the number of patients with a burn injury during 2017-2028 both increased, but there was no significant change in disaster location, male-female ratio, age, average hospital stay, and average hospitalization expense. Conclusion: In the face of the increasing prevalence of burn injuries, we should strengthen fire-fighting knowledge-related education and fire prevention management and actively explore post-burn injury treatment strategies and potential treatment targets to promote the development of burn injury management and treatment strategies.
... Thermal injuries caused by hot liquids, solids, or fire account for a large proportion of burns injuries (Lee, 1997). According to a 2018 report by the World Health Organization, there are about 11 million burns patients worldwide each year, and although the mortality rate has dropped from the 300,000 recorded in 2011 [(Peck, 2011)], the death toll is still as high as 180,000 [ (Pereira et al., 2013)]. The improvement of the survival rate of burns patients is mainly attributed to the improvement of intensive care level, the improvement of wound care, and the effective control of infection (Cioffi et al., 1993;Finnerty et al., 2007). ...
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Background: Severe burns and blunt trauma can lead to multiple organ dysfunction syndrome, the leading cause of death in intensive care units. In addition to infection, the degree of immune inflammatory response also affects prognosis. However, the characteristics and clinical relevance of the common mechanisms of these major diseases are still underexplored. Methods: In the present study, we performed microarray data analysis to identify immune-related differentially expressed genes (DEGs) involved in both disease progression in burns and blunt trauma. Six analyses were subsequently performed, including gene enrichment analysis, protein‐protein interaction (PPI) network construction, immune cell infiltration analysis, core gene identification, co-expression network analysis, and clinical correlation analysis. Results: A total of 117 common immune-related DEGs was selected for subsequent analyses. Functional analysis emphasizes the important role of Th17 cell differentiation, Th1 and Th2 cell differentiation, Cytokine-cytokine receptor interaction and T cell receptor signaling pathway in these two diseases. Finally, eight core DEGs were identified using cytoHubba, including CD8A, IL10, CCL5, CD28, LCK, CCL4, IL2RB, and STAT1. The correlation analysis showed that the identified core DEGs were more or less significantly associated with simultaneous dysregulation of immune cells in blunt trauma and sepsis patients. Of these, the downregulation of CD8A and CD28 had a worse prognosis. Conclusion: Our analysis lays the groundwork for future studies to elucidate molecular mechanisms shared in burns and blunt trauma. The functional roles of identified core immune-related DEGs and dysregulated immune cell subsets warrant further in-depth study.
... The proposed advantage of a biologic mesh is that the patient's immune cells can infiltrate the material to defend against the bacterial load and eventually replace the biologic mesh with the host tissue [6]. Unfortunately, the long-term durability of biologic grafts used for complex abdominal wall reconstruction has been disappointing [7,8]. Contaminated or infected 2 of 14 hernia repair sites, reinforced with biologic scaffolds, are associated with recurrence rates as high as 50% [9]. ...
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Background: Tissue regeneration is a complex process that allows wounds to heal. Many options are currently available to help human skin repair and to reduce the recurrence of hernias. The aim of this study is to analyze the best decellularization protocol for allogenic human dermal tissues. Methods: Dermal flaps from donors were used and compared with a control group. Each flap was subjected to seven different decellularization protocols and washed with a sequence of five solutions. The samples were then subjected to four control tests (such as Nile Red), and long-term contacts were analyzed to assess whether the decellularized dermis samples could support the growth of human fibroblasts. Results: All the samples had an average residual viability of 60%. Except for one sample, the decellularization treatments were able to reduce cell viability significantly. The Nile Red test showed a significant reduction in phospholipid content (mean 90%, p-value < 0.05) in all treatments. The cell growth increased in a linear manner. As described in the literature, sodium-dodecyl-sulfate (SDS) caused an interference between the test and the detergent. Conclusions: This paper shows the first step to finding the best decellularization protocol for allografting human dermal tissues. Further biocompatibility tests and DNA quantification are necessary.
... In order to thrive in the life it needs to be in temperate climate that means being around the fire on one hand and is always at risk for its exposure to burns on the other hand. 1 Treating wounds due to burns have been drastically changed with passage of the time and advancement in technology of medical care. The impact of such a treatment has been noticed with profound implications in course of healing of such wounds. ...
Article
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Background: Fires and burns incidence are on constant rise. Efforts had been made since very ancient times to curb such debilitating injuries resulting from domestic violence, vitriol incidences, accidents and mishaps. Treating the burns always had been an intricate matter of concern. Since primitive times the treatment modalities had been changed over and over in the search of best available options. Aim: To compare the efficacy of empirical treatment with that of advanced medical care among the victims of burns. Methods: The study comprised of 300 cases of burns presented from January to December 2020 in Accidents and Emergency Department of the Jannah Hospital Lahore for empirical treatment and those managed in the Burn Center of Jannah Hospital Lahore for advanced medical care of burns. Those who have been referred from periphery and could not get advanced medical care or had their wound healed when brought to above setup were considered as treated as empirically managed burn victims. Results: The comparative analysis of empirical therapy and advanced medical care revealed significant difference when observed among the literacy level and medium of burns with 0.000 value of p. While no significance difference was observed when analysis was carried out for age and gender with a p value of 0.187 and 0.496 respectively.
... Burns are a leading cause of trauma worldwide and are responsible for an estimated 300,000 deaths worldwide each year. 1 Among these patients, sepsis and acute respiratory distress syndrome (ARDS) are the two most common causes of death. 2 In the pediatric population, sepsis and ARDS make up 47% and 29% of the mortality associated with burns, respectively. 3 In adults, a small study found that sepsis and ARDS each make up 24% of the mortality associated with burn injury. ...
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Burns are among the leading causes of trauma worldwide, and acute respiratory distress syndrome (ARDS) is a common cause of death in burn patients. Some patients develop hypoxemia refractory to conventional therapies and may be initiated on extracorporeal membrane oxygenation (ECMO) as rescue therapy. We conducted a meta-analysis for studies reporting on survival rates of patients receiving ECMO for burns or inhalation injuries, which was the primary outcome. Secondary outcomes included the hospital and intensive care unit length of stay and duration of ECMO. Random-effects (DerSimonian and Laird) were conducted. The pooled survival from 10 studies was 53.6% (95% confidence interval [CI]: 37.6-69.2%, high certainty). Survival was significantly associated with age (regression coefficient [B]: -0.0088, 95% CI: -0.0155 to -0.0021, p = 0.011) and the proportion of male patients (B: -1.0137 95% CI: -1.9695 to -0.0580, p = 0.038). Patients were cannulated on ECMO for a mean of 8.4 days (95% CI: 6.1-10.7) and remained in the ICU for a mean of 40.4 days (95% CI: 11.4-69.3). Mean hospital length of stay was 45.4 days (95% CI: 31.7-59.0). In conclusion, patients with burn and inhalation injuries who develop ARDS refractory to conservative management have a survival rate of 54% when placed on ECMO.
... 7 8 Burn care systematic reviewers have reported difficulty combining evidence owing to outcome reporting heterogeneity. [9][10][11] The limitation is important in burn care-despite high numbers of patients globally (annual incidence 11 million), 12 clinical uncertainty regarding optimal management persists. ...
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Objective To develop a core outcome set for international burn research. Design Development and international consensus, from April 2017 to November 2019. Methods Candidate outcomes were identified from systematic reviews and stakeholder interviews. Through a Delphi survey, international clinicians, researchers, and UK patients prioritised outcomes. Anonymised feedback aimed to achieve consensus. Pre-defined criteria for retaining outcomes were agreed. A consensus meeting with voting was held to finalise the core outcome set. Results Data source examination identified 1021 unique outcomes grouped into 88 candidate outcomes. Stakeholders in round 1 of the survey, included 668 health professionals from 77 countries (18% from low or low middle income countries) and 126 UK patients or carers. After round 1, one outcome was discarded, and 13 new outcomes added. After round 2, 69 items were discarded, leaving 31 outcomes for the consensus meeting. Outcome merging and voting, in two rounds, with prespecified thresholds agreed seven core outcomes: death, specified complications, ability to do daily tasks, wound healing, neuropathic pain and itch, psychological wellbeing, and return to school or work. Conclusions This core outcome set caters for global burn research, and future trials are recommended to include measures of these outcomes.
... There have been many advances in the care of burn-injured patients leading to improved survival and outcomes. While overall morbidity and mortality is decreasing around the world [1][2][3][4][5] , care for the massively burned patient remains a particular challenge. Massively burn injured patients require multiple operations, lack sufficient donor skin for early autologous grafting and thus have prolonged lengths of stay. ...
Article
Massive burn injuries are a unique patient population with unique treatment paradigms. Data from 155 adult patients, admitted from 2009-2019, with >50% total body surface area burns (TBSA) were collected and analyzed. Average burn size was 70% TBSA and 63% had a concomitant inhalation injury. Approximately 30% of patients (46/155) transitioned to comfort care only measures within 24 hours of admission. Standard treatment patients were younger (37±13 vs 60±19 years; p<0.00001), male (94% vs 28%; p=0.001) and had smaller TBSA (66±13 vs 80±16; p<0.00001). Of the standard treatment group, 72 (66%) survived to discharge. Survivors had smaller TBSA (64±13 vs 71±13; p=0.003), less third degree TBSA (48±25 vs 71±13; p=0.003) and lower incidence of renal failure requiring dialysis (22% vs 73%, p<0.00001). Multivariate regression analysis showed that age (OR 1.05; p=0.025), total TBSA (OR 1.07; p=0.005) and renal failure (OR 10.2; p=0.00005) were independently associated with mortality. Inhalation injury was not significantly associated with mortality. About 23% (35/155) of patients had a psychiatric condition on admission and 19% (30/155) of patients were burned attempting suicide. Patients with psychiatric conditions spent more time in the hospital (62 vs 30 days; p=0.004), more time on ventilator (31 vs 12 days; p=0.046), underwent more surgery (4 vs 2 operations, p=0.03), and were less likely to die (34% vs 59%; p=0.02). In summary, age, burn size and renal failure were independently associated with mortality, with renal failure being the strongest factor. Psychiatric conditions are prevalent pre-injury and tend to require more inpatient care.
... Burn injuries contribute considerably to the global healthcare burden, with an estimated 11 million people annually affected worldwide. 1 The impact of burn trauma can be destructive, lifelong, and indiscriminate. People of all ages, ethnic origins, and backgrounds are at risk. ...
... Burns are created using two standard etiologies, including a metallic brass bar and a hot water scald, which represent the causes of many real-world clinical burn injuries. 70,71 The burn induction procedure is described in detail elsewhere. 72 Importantly, the diameter of each burn is ∼1 in:, and all adjacent burns are 4-cm apart in the horizontal and vertical directions. ...
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SignificanceSevere burn injuries cause significant hypermetabolic alterations that are highly dynamic, hard to predict, and require acute and critical care. The clinical assessments of the severity of burn injuries are highly subjective and have consistently been reported to be inaccurate. Therefore, the utilization of other imaging modalities is crucial to reaching an objective and accurate burn assessment modality.AimWe describe a non-invasive technique using terahertz time-domain spectroscopy (THz-TDS) and the wavelet packet Shannon entropy to automatically estimate the burn depth and predict the wound healing outcome of thermal burn injuries.ApproachWe created 40 burn injuries of different severity grades in two porcine models using scald and contact methods of infliction. We used our THz portable handheld spectral reflection (PHASR) scanner to obtain the in vivo THz-TDS images. We used the energy to Shannon entropy ratio of the wavelet packet coefficients of the THz-TDS waveforms on day 0 to create supervised support vector machine (SVM) classification models. Histological assessments of the burn biopsies serve as the ground truth.ResultsWe achieved an accuracy rate of 94.7% in predicting the wound healing outcome, as determined by histological measurement of the re-epithelialization rate on day 28 post-burn induction, using the THz-TDS measurements obtained on day 0. Furthermore, we report the accuracy rates of 89%, 87.1%, and 87.6% in automatic diagnosis of the superficial partial-thickness, deep partial-thickness, and full-thickness burns, respectively, using a multiclass SVM model.Conclusions The THz PHASR scanner promises a robust, high-speed, and accurate diagnostic modality to improve the clinical triage of burns and their management.
... Pediatric burns constitute a great challenge to patients, their families, and healthcare providers because of their high incidence rate (1-7 million/year) and frequent complications (49% of all cases) [1,2]. The facial region is assumed to be injured in 39% of all burns and the most common etiology is scalding [3]. ...
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Zinc-hyaluronan-containing burn dressings have been associated with enhanced reepithelialization and low infection rates, although their effectiveness has not yet been investigated in pediatric facial thermal injuries. This single-arm, retrospective cohort study assessed the characteristics of 23 children (≤17-year-old) with facial superficial partial-thickness burns and the wound closure capabilities of the applied zinc-hyaluronan gel. Patients were admitted consecutively to the Pediatric Surgery Division in Pécs, Hungary, between 1 January 2016 and 15 October 2021. The mean age of the children was 6.2 years; 30.4% of them were younger than 1 year. An average of 3% total body surface was injured in the facial region and 47.8% of the patients had other areas damaged as well, most frequently the left upper limb (30.4%). The mean time until complete reepithelialization was 7.9 days and the children spent 2 days in the hospital. Wound cultures revealed normal bacterial growth in all cases and follow-up examinations found no hypertrophic scarring. In conclusion, pediatric facial superficial partial-thickness burns are prevalent during infancy and coincide with left upper limb injuries. Rapid wound closure and low complication rates are accountable for the moderate amount of hospitalization. These benefits, along with the gel's ease of applicability and spontaneous separation, are linked to child-friendly burn care.
... Peck et al. reported varying sex differences in the incidence of people getting burns according to age, region and national income category; they stated that studied women suffered from more burns than men in Ethiopia. 39 Delay in leprosy diagnosis is not uncommon in leprosy endemic areas and is associated with many factors that may vary between communities. 20 Health system delay as a result of lack of leprosy knowledge among health workers could be one of the contributing factors. ...
... Burn injury refers to damage caused by heat (including flame, hot liquid, and high-temperature solid), electricity, corrosive chemicals, and radiation (Chen, 2018). It is reported that approximately 11 million people experience severe burn injuries globally each year with over 300 000 deaths (Peck, 2011). The ...
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This cross‐sectional study aimed to test the influences of social support and emotion regulation strategies (cognitive reappraisal and expression suppression) on burn survivors’ posttraumatic growth. Convenience sampling method was adopted to recruit 130 burn survivors from the department of burns and plastic surgery of a public hospital in Linyi, China. Data were collected using self‐reported questionnaires on social support, emotion regulation strategies, and posttraumatic growth. Structural equation modeling was performed using IBM AMOS 21.0. to explore the associations among social support, emotion regulation strategies, and posttraumatic growth in burn survivors. The results showed that social support positively affected cognitive reappraisal and negatively affected expression suppression in burn survivors. Furthermore, it positively affected posttraumatic growth. Moreover, social support indirectly influenced posttraumatic growth through cognitive reappraisal, which implies that cognitive reappraisal played a partial mediating effect in the relationship between social support and posttraumatic growth. These findings provided new insights into the predictors of posttraumatic growth. Cognitive reappraisal and social support should be taken into account to improve burn survivors’ posttraumatic growth. This article is protected by copyright. All rights reserved.
... Worldwide, burn injuries are the fourth most common type of injury, although incidences are decreasing [1][2][3]. As an example, the incidence in Germany for minor burns is 600/100,000 inhabitants per year, and the incidence for severe burns is 1/60,000 inhabitants per year [4]. ...
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Background and Objectives: Scar formation after burn trauma has a significant impact on the quality of life of burn patients. Hypertrophic scars or keloids can be very distressing to patients due to potential pain, functional limitations, or hyper- or hypopigmentation. In a previous study comparing Suprathel® and the new and cheaper dressing epicitehydro®, we were able to show that pain reduction, exudation, and time until wound-healing of partial-thickness burn wounds were similar, without any documented infections. No study exists that objectively measures and compares skin and scar quality after treatment with Suprathel® and epicitehydro® at present. Materials and Methods: In this study, the scar quality of 20 patients who had been treated with Suprathel® and epicitehydro® was objectively assessed using the Cutometer®, Mexameter®, and Tewameter®, as well as subjectively with the Patient and Observer Scar Assessment Scale, 3, 6, and 12 months after burn injury. Results: In all performed measurements, no significant differences were detected in scar formation after treatment of partial-thickness burn wounds with the two dressings. Conclusions: Both the newer and less expensive wound-dressing epicitehydro® and the well-known wound-dressing Suprathel® resulted in stable wound closure and showed good cosmetic results in the follow-up examinations.
Article
Burns not only damage the skin barrier, but also cause a series of inflammatory reactions and oxidative stress states. Among them, elderly patients are prone to suffer severe burns due to degenerative changes of their skin caused by aging factors, such as atrophy and thinning, etc. After burns, the body will continuously release inflammatory factors, resulting in systemic inflammatory response syndrome (SIRS) and oxidative stress, which are related to the poor treatment effect and the poor prognosis of elderly burn patients. It seems to be difficult for conventional treatments to control the disease development of elderly burn patients effectively. Considering the rapidly increasing elderly population, it is priority to understand the pathological process and the mechanisms to formulate more appropriate treatment strategies for elderly burn patients. In recent years, owing to considerable advances in nanotechnology, a variety of nanomaterials have been developed for wound healing and inflammation regulation. Its good biocompatibility, cell proliferation stimulation and antibacterial properties make the clinical treatment strategy more optimized. Concurrently, mesenchymal stem cells (MSCs) have also been used in the burns field and have been proven effective in not only controlling the level of inflammation and regulating the systemic immune balance, but also promoting wound healing and vascularization. Here, this review covers burns classification, the pathological process of elderly burn patients, and the research progress of nanotechnology and MSCs in burns. Eventually, we summarize the advantages and challenges of emerging strategies such as nanotechnology and MSCs in the treatment of elderly burn patients, expecting to promote the clinical transformation.
Article
Background Pediatric burns significantly impact the short-term health-related quality of life (HRQL) of children. Knowledge regarding the long-term impact is scarce. We therefore evaluated the parent-reported HRQL in pediatric burn patients 5 to 7 years after burns. Methods We invited parents of eligible children admitted to a Dutch Burn Center between August 2011 and September 2012. This sample was enriched with children with severe burns (> 10% of total body surface area [TBSA] burned) admitted between January 2010 and March 2013. The EQ-5D was completed by parents 5 to 7 years postburn. Outcomes and predictive factors were studied and compared between children with minor/moderate and severe burns. Results We included 130 children (mean TBSA burned 7%): 102 children with mild/intermediate burns and 28 with severe burns. Mean EQ-5D summary was 0.96 and EQ visual analogue scale (VAS) 93.1. These outcomes were significantly better in children with minor/moderate burns (0.97; 94.4) compared with children with severe burns (0.93; 88.3) (p < 0.05). Nineteen percent of the children with minor/moderate burns and 43% of those with severe burns reported any problems. The most frequently reported problem was anxiety/depression for both groups. Pain/discomfort (p = 0.012) and cognition (p = 0.035) were statistically significantly worse in children with severe burns compared with those with minor/moderate burns. Full thickness burns and number of surgeries were found to predict long-term HRQL impairment. Conclusion Five to seven years postburn, the majority of children in our study (76%) did not experience long-term problems with HRQL. In a minority of the children, burns showed to have a prolonged negative impact, especially in those being severely burned and who had to undergo surgery for their burns. Most experienced problems were related to anxiety/depression. These important insights could be used to inform children and their parents about the expected long-term HRQL after pediatric burns.
Article
Based on the Israeli National Trauma Registry (INTR) data, this study reports etiological, demographic, and clinical trends and includes all admissions to burn and trauma centers across Israel from 2011 to 2019 and compares these with 2004 to 2010 rates. From 2011 to 2019, 5,710 patients were admitted to burn centers across Israel. Children aged 0 to 1 years (25.9%), non-Jews (40.7%), and males (67.2%) remain the main groups of the burn casualties. Most of the casualties sustained 1 to 9% total body surface area (TBSA) burns with various depths. Scalds were less fatal than fire/flame-related casualties (<1 vs. 11.5%). Fewer surgical procedures were conducted for burns under 9% TBSA compared with greater TBSA. The percentage of TBSA and burn depth were found to be the most significant predictor of mortality among all age groups (>200 times increased risk with full-thickness burns >30% TBSA burn) and correlated with prolonged length of stay (>7 days).
Chapter
The injury pyramid is a commonly used model in order to illustrate the relationship between non-injurious events and fatal events, as well as the various injury-levels in-between. From a residential fire perspective, there is also the added aspect of whether fires are attended to or not. In practice, this means that the understanding of the residential fire problem is often understood merely from the perspective of fatal fires that are attended to by rescue services. However, as will be seen in this chapter, merely focusing on these incidents and the risk factors associated with these fires or victims produces a distinctly skew view of the residential fire problem. As such, it is important to attempt to assess and understand the entire residential fire injury pyramid.KeywordsInjury pyramidMorbidityMortalityNon-fatal firesFatal firesAt-risk groups
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The advances in additive manufacturing over the past decade have led to the development of innovative strategies in several healthcare sectors. The treatment and healing of chronic wounds remains a major clinical challenge due to insufficient healing, increasing number of patients and the financial burden in healthcare systems. The use of novel natural or synthetic biomaterials and the design of cell-laden bioinks combined with drug substances has paved the way for effective wound treatment and management including the engineering of skin substitutes and skin regeneration. The major advantages of printing technologies encompass the combination of unlimited bioactive molecules and cells with polymers, the fabrication of complex scaffold designs, accelerated healing times and personalised wound dressings. This review highlights the principles of additive manufacturing processes used for wound healing including technological advantages and processing limitations. We also provide the current trends and clinical improvements focusing on the use of materials with antimicrobial, antioxidant properties or the incorporation of drug substances and peptides for the treatment of chronic wounds. Finally, we present approaches for skin tissue engineering and regeneration based on 3D printing.
Article
Deep burns often do not heal easily, because the dermis of the skin is severely damaged, leading to severe inflammation and bacterial infection. Therefore, it is of great clinical significance to develop a dressing that promotes the healing process of deep burn wound. In this study, we used N-isopropyl acrylamide, sodium alginate and calcium chloride as the main materials, a series of calcium alginate/ poly (N-isopropyl acrylamide)(NIPAAm) hydrogel (CAPH) with different component ratios were synthesized. Its swelling properties, temperature response properties, rheological properties, biocompatibility properties, and in vitro drug release properties were investigated. Based on the above conditions, the CAPH(sodium alginate:NIPAAm = 2:15) with the best comprehensive performance was selected, which has a good biocompatibility. In addition, 0.02 % (w/v) mupirocin was loaded in CAPH. The temperature-responsive property of PNIPAAm in CAPH at 34 °C not only allowed the CAPH to rapidly release the drug under to prevent infection, but also to assist in wound contraction. Application of CAPH to localized wounds of deep second-degree burns in mice showed a faster healing rate and tissue regeneration. At the same time, collagen recovery was enhanced, collagen bundles were arranged in an orderly manner, and the scarring was not obvious after 16 days. Therefore, this research prepared a new safe and effective biomaterial.
Article
Background Burn scars are a major clinical sequelae of severe burn wound healing. To effectively establish a successful treatment plan and achieve durable results, understanding the pathophysiology of scar development is of utmost importance. Methods A narrative review of the principles of the kinematic chain of movement and the hypothesised effect on burn scar development based on properties of burn scars was performed. An examination of the literature supporting these concepts is presented in conjunction with illustrative cases, with a particular focus on the effect of combination treatments that include ablative fractional resurfacing with surgical contracture releases. Discussion Ablative fractional resurfacing combined with the surgical release of contractures are an effective treatment modality for burn scar reconstruction. This treatment approach seems particularly effective because it is one of the only approaches where the principles of functional kinematics can be addressed when tailoring a reconstructive approach to an individual burn patient. The presented cases illustrate the importance of recognising and including the principles of functional kinematic chains in any reconstructive treatment approach for burn scars. Further, epifascial contracture bands are cord like structures which can be found underneath the subcutaneous fat of scar contractures which follow the principles of functional kinematics. Contractures can be more efficiently released if these structures are divided as well. Conclusion Ablative fractional resurfacing combined with local tissue re-arrangements is a promising approach to address the underlying forces leading to hypertrophic burn scarring. To achieve an optimal outcome, it is essential to recognise and address the origin of the pathology when treating burn scars. Ablative fractional laser resurfacing allows a different scar approach as it is not limited to one surgical site and thus enables for effective treatment at the cause of the pathology.
Article
Burn wounds are one of the most severe complex forms of trauma. Hence, new treatment strategies that facilitate the healing process; reduce the severity and the healing time is the main concern of the health care systems. In this work, pentoxifylline-valsartan, (PTX- VAL), loaded liposomes integrated into gel were designed for the first time as a novel co-delivery carrier for the treatment of burn wounds. The objective of this work was to investigate the ability of the nano-based liposomal system to co-entrap two repurposed drugs; hydrophilic pentoxifylline and lipophilic valsartan for topical treatment of burn wounds. The impact of increasing the phospholipid amount to enhance the co-entrapment of PTX and VAL was investigated and in-vitro evaluation of the prepared formulations was conducted to choose the optimum composition with the highest entrapment of both drugs adopting a simple, reliable derivative spectrophotometric method. Structure elucidation was also performed using a transmission electron microscope. In addition, A simple selected derivative spectrophotometric method was developed for the assay of PTX-VAL novel combination. The proven selectivity, precision and accuracy assured the reliability of this analytical method. Being economic and fast makes routine application of the developed analytical method is recommended in pharmaceutical industry. The selected liposomal formulation integrated into gel matrix (PTX-VAL-LG) showed; nanometric size, acceptable entrapment efficiency of both PTX and VAL as well as sustained release profiles and thus, enhanced action.
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Acid attacks (vitriolage) are a form of violence that occurs in most countries of the world. Cases of acid attacks are no longer peculiar to developing countries; they also occur in western counties. This article analyses the legislative measures adopted by India, Bangladesh, Pakistan, Colombia, and Cambodia to combat acid attacks. It highlights the comparative strengths and weaknesses of these measures. It also examines the most important trends about the motivations of perpetrators reported in the literature in these countries, highlighting the sex-based nature of the phenomenon.
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Burn injuries are a leading cause of unintentional injury, associated with a dysfunctional immune response and an increased risk of infections. Despite this, little is known about the role of T cells in human burn injury. In this study, we compared the activation and function of conventional T cells and unconventional T cell subsets in skin tissue from acute burn (within 7 days from initial injury) burn, late phase burn (beyond 7 days from initial injury), and non-burn patients. We compared T cell functionality by a combination of flow cytometry and a multi-omic single-cell approach with targeted transcriptomics and protein expression. We found a significantly lower proportion of CD8+ T cells in burn skin compared to non-burn skin, with CD4+ T cells making up the bulk of the T cell population. Both conventional and unconventional burn tissue T cells show significantly higher IFN-g and TNF-a levels after stimulation than non-burn skin T cells. In sorted T cells, clustering showed that burn tissue had significantly higher expression of homing receptors CCR7, S1PR1, and SELL compared to non-burn skin. In unconventional T cells, including mucosal-associated invariant T (MAIT) and gd T cells, we see significantly higher expression of cytotoxic molecules GZMB, PRF1, and GZMK. Multiomics analysis of conventional T cells suggests a shift from tissue-resident T cells in non-burn tissue to a circulating T cell phenotype in burn tissue. In conclusion, by examining skin tissue from burn patients, our results suggest that T cells in burn tissue have a pro-inflammatory rather than a homeostatic tissue-resident phenotype, and that unconventional T cells have a higher cytotoxic capacity. Our findings have the potential to inform the development of novel treatment strategies for burns.
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Background and objectives Little is known of the potential sex and age differences in the MS prodrome. We investigated sex and age differences in healthcare utilization during the MS prodrome. Methods This was a population-based matched cohort study linking administrative and clinical data from British Columbia, Canada (population = 5 million). MS cases in the 5 years preceding a first demyelinating event (“administrative cohort;” n = 6,863) or MS symptom onset (“clinical cohort;” n = 966) were compared to age-, sex- and geographically-matched controls ( n = 31,865/4,534). Negative binomial and modified Poisson models were used to compare the rates of physician visits and hospitalizations per international classification of diseases chapter, and prescriptions filled per drug class, between MS cases and controls across sex and age-groups (< 30, 30–49, ≥50 years). Results In the administrative cohort, males with MS had a higher relative rate for genitourinary-related visits (males: adjusted Rate Ratio (aRR) = 1.65, females: aRR = 1.19, likelihood ratio test P = 0.02) and antivertigo prescriptions (males: aRR = 4.72, females: aRR = 3.01 P < 0.01). Injury and infection-related hospitalizations were relatively more frequent for ≥50-year-olds (injuries < 30/30–49/≥50: aRR = 1.16/1.39/2.12, P < 0.01; infections 30–49/≥50: aRR = 1.43/2.72, P = 0.03), while sensory-related visits and cardiovascular prescriptions were relatively more common in younger persons (sensory 30–49/≥50: aRR = 1.67/1.45, P = 0.03; cardiovascular < 30/30–49/≥50: aRR = 1.56/1.39/1.18, P < 0.01). General practitioner visits were relatively more frequent in males (males: aRR = 1.63, females: aRR = 1.40, P < 0.01) and ≥50-year-olds (< 30/≥50: aRR = 1.32/1.55, P = 0.02), while differences in ophthalmologist visits were disproportionally larger among younger persons, < 50-years-old (< 30/30–49/≥50: aRR = 2.25/2.20/1.55, P < 0.01). None of the sex and age-related differences in the smaller clinical cohort reached significance ( P ≥ 0.05). Discussion Sex and age-specific differences in healthcare use were observed in the 5 years before MS onset. Findings demonstrate fundamental heterogeneity in the MS prodromal presentation.
Article
Background Syria has been facing a dreadful crisis for the past 11 years, which has had a significant toll on the healthcare system of the country, and its ability to adequately manage acute injuries. In this research, we study the epidemiology and outcomes of burn patients admitted to the burn center of Al-Mouwasat Hospital in Damascus, Syria. Methods A retrospective cohort research was conducted from January 2017 to December 2021. All accessible paper-based medical records of burn injury patients admitted to the hospital were evaluated. ABSI score was used to classify injury degrees. Chi-square test and logistic regression model were used to study the association between demographic variables and outcomes. Results Of the 641 patients, 367 (57.3%) were males and 274 (42.7%) were females. Children represented more than half of our sample 377 (58.8%). The most common cause of burns was flame 393 (61.3%), followed by scalding 199 (31.0%). Most of the patients had a more than 10% TBSA of burns 511 (79.7%). 209 (32.6%) patients had a moderate ABSI score, followed by moderately severe in 149 (23.2%) patients. Children, patients who had high ABSI scores, and those who needed respiratory support were more likely to die than others 2.545 (1.079-6.004), 9.208 (4.061-20.879), respectively. Conclusion Death was the outcome of third of the hospitalized patients. Furthermore, Children made up more than half of the sample, and had the highest rates of leaving the hospital against medical advice. These results underline the importance of an updated nationally uniformed protocol for the management of burn patients.
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Background With the increase of geriatric burns, it’s urgent to summarize its characteristics. The aim of this study was to analyze the epidemiological and clinical characteristics of burn in the elderly in a large center, and to provide suggestions for the prevention and treatment of geriatric burns. Methods This retrospective study was conducted at Wuhan Institute of Burns which is the largest burn center in central China between 2004 to 2018. Demographic and clinical data of the 60 years or above older burn inpatients were collected from medical records, analyzed and compared among groups. Results This study analyzed 2554 elderly burns, which included 50.9% in young geriatric group (60–69 years old), 32.9% in middle geriatric group (70–79 years old) and 16.2% in the oldest geriatric group (80 years old or above). The most common causes of elderly burns were flames (1081, 42.3%) and scalding (1041, 40.8%). Elderly burns with total body surface area (TBSA) of 0–9% accounted for 60.6% and the larger TBSA, the fewer number of patients. The majority of patients (70.5%) injured at home.The median of time interval from injury to admission was 7 hours and the oldest geriatric group (24 hours) was highest. One hundred and twenty-one cases (8.5%) were treated by cooling treatment, and 72.7% of these patients were treated less than 10 minutes. The median number of pre-injury diseases was one. Ninety patients (6.3%) had inhalation injury.The median length of stay (LOS) was 14 days.The median hospital cost was 10410 CNY or 2137 CNY per % TBSA, which was correlated with TBSA, LOS, surgery, inhalation injury, number of pre-injury diseases and etiology. The mortality rate was 3.0% and correlated with TBSA, inhalation injury, pulmonary disease and Alzheimer’s disease. Conclusion Geriatric burns was still common and even increasing in central China, with flame burns and scalds the most common causes, majority of whom injured at home and often had problems such as few cooling treatment, improper emergency management and delayed admission. TBSA, etiology, pre-injury diseases and inhalation injury were the risk factors of length of stay, hospital cost and treatment outcomes.
Article
Introduction Global burn injury burden disproportionately impacts low- and middle-income countries. Surgery is a mainstay of burn treatment, yet access to surgical care appears to be inequitably distributed for women. This study sought to identify gender disparities in mortality and access to surgery for burn patients in the World Health Organization Global Burn Registry (GBR). Methods We queried the World Health Organization GBR for a retrospective cohort (2016-2021). Patients were stratified by sex. Outcomes of interest were in-hospital mortality and surgical treatment. Patient demographics, injury characteristics, outcomes, and health facility resources were compared between sexes with Wilcoxon rank sum test for nonparametric medians, and chi-squared or Fisher’s exact test for nonparametric proportions. Multivariable logistic regressions were performed to assess the relationships between sex and mortality, and sex and surgery. Results Of 8445 patients in the GBR from 20 countries (10 low resource), 40% of patients were female, with 51% of all patients receiving surgical treatment during their hospitalization. Female patients had a higher incidence of mortality (24% versus 15%, P < 0.001) and a higher median total body surface area (20% versus 15%, P < 0.001), yet a lower incidence of surgery (47% versus 53%, P < 0.001) following burn injury when compared to males. In multivariable analysis, female sex was independently associated with mortality after controlling for age, time to presentation, smoke injury, percent total body surface area, surgery, and country income status. Female sex was independently associated with surgical care (odds ratio 0.86, P = 0.001). Conclusions Female burn patients suffer higher mortality compared to males and are less likely to receive surgery. Further study into this gender disparity in burns is warranted.
Article
Attempted suicide by self-immolation or burning constitutes an uncommon form of attempted suicide in high income countries, presenting substantial challenges to burn units. The aim of this study was to analyze the epidemiologic characteristics and outcomes in intensive care burn patients treated for attempted suicide by burning. For this purpose, we examined intensive care burn patients admitted to a single major burn unit between March 2007 and December 2020. Demographic, clinical, epidemiological and mortality data were collected and analyzed. Major psychiatric comorbidities were evaluated according to ICD-9 and ICD-10 classifications. A total of 1325 intensive care unit burn patients were included. Suicide by burning was attempted in 45 cases (3.4%). Attempted suicide victims presented with significantly higher burn severity, reflected by higher abbreviated burn severity index scores and larger total body surface area affected. Burned total body surface area ≥30% and inhalation injuries were observed more frequently in suicidal patients. These patients also experienced prolonged hospital and intensive care unit length of stay, required more frequent surgical interventions and mechanical ventilation more frequently and had significantly longer periods on ventilation, causing an overall higher mortality rate (24.4%). Psychiatric comorbidities were present in 75.6% of patients who attempted suicide. Despite the low prevalence, burn severity and mortality are considerably high in patients who attempted suicide by burning, presenting a significant challenge for healthcare providers. The majority of patients had a history of psychiatric disorder, highlighting the importance of identifying patients at high-risk who may profit from increased psychiatric intervention.
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Çocuk psikoloji ve sosyolojisi
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patients entered the Al Sadder hospital in Al Najaf province, Iraq. The patients were divided into two groups: 40 with pseudomonas aeruginosa and 20 uninfected. The purpose of this study was to identify the function of the anti-inflammatory cytokine interleukin 10 (IL-10) in the pathophysiology of burn injuries. The patients were divided into two groups based on gender (34 males and 26 females) and age (1-61) years. To eliminate patients who had received antibiotic medication during the sample collection. There was a significant difference between males and females in this study, with the highest frequency of patient age being 16-30 (36.6 %), followed by 31-45 (30 %), 1-15 (23.4 %), and 46-61 (10%).All patients divided according to total degree of burn. However, P. aerogenosa antibiotic sensitivity test, in contrast most bacterial isolates exhibited high resistance to Ceftazidime (90%) Tobramycin (80%) and Gentamicin (80%), whereas resistance to Ciprofloxacin (50%) Amikacin (40%) and Pipracillin (70%) was variable finally less resist to TC (20%) and no resistance toward IMP (0 %). The study found that patients with P.aerogenosa infection had a substantially higher mean blood concentration of IL-10 (61.4 ± 11.8) than healthy controls (4.58 ± 0.77), whereas non-infected patients had a concentration of (18.21 ± 3.5)pg/ml and non-infected patients had a concentration of (4.5 ± 0.06) pg/ml.
Article
Burns carries a high risk of mortality and morbidity. This with increased chances of drug-resistant infections makes the management complicated. Hence this study was conducted to find out the prevalence of multi-drug resistant organisms (MDRO) in burns patients admitted to the intensive care unit at a tertiary care hospital. A 2-year retrospective study was conducted where burn patients reporting MDRO were included. Statistical analysis was performed using SPSS version 26 where a p-value <0.05 was considered statistically significant. Out of 97 patients, tissue cultures of 65 patients revealed the presence of MDRO in 27 (27.8%) patients. A male predominance (17, 63.0%) was noted with a mean age of 29.0-year-old. Fire burn (15, 55.6%) was reported to be the most common cause of burn with an average of 29.9% of Total Body Surface Area (TBSA) involved. MDR Pseudomonas aeruginosa was the commonest organism reported in 12 (44%) patients. The average length of stay (LOS) was noted to be 11.3 days with a mortality rate of 48.1% (Overall, in all MDRO’S infections). Patients who reported MDRO showed a tendency for longer hospitalization with a higher risk of mortality as the TBSA increased. However, in presence of other factors in burns like higher TBSA, inhalation injury and lack of advanced skin substitute these mortality figures, and their association can be debated. Lastly, the implementation of control measures, as basic as hand hygiene, should be partaken to reduce the burden of MDR infections.
Article
Aims Globally, burn-related morbidity and mortality still remain high. In order to identify regional high-risk populations and to suggest appropriate prevention measure allocation, we aimed at analyzing epidemiological characteristics, etiology and outcomes of our 13-year experience with an intensive care unit (ICU) burn patient population. Methods A retrospective observational study was conducted including patients treated between March 2007 and December 2020 in our intensive care burn unit. Demographic, clinical and epidemiological data were collected and analyzed. Results A total of 1359 patients were included. 68% of the subjects were males and the largest age group affected entailed 45 - 64-year-old adults (34%). Regarding etiology, flame and contact burns were the most common in all age groups. Mean affected total body surface area (TBSA) was 13 ± 14.5% in all subjects. Most of the burns occurred domestically or during recreational activities. Mean hospital stay was 17.77±19.7 days. The average mortality was 7.7%. The mortality rate showed an overall decreasing trend whilst burn severity remained consistent from 2007 to 2020. Conclusions Despite consistent burn severity presentations of annual ICU admissions, burn injury mortality showed a decreasing trend, which was in part attributed to substantial progress in burn care and treatment and improved burn prevention awareness. Statistically significant age and gender differences could be detected with regard to burn etiology and seasonality, as well as outcomes, which highlight the importance of individualized primary prevention programs.
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Significance: Severe burn injuries cause significant hypermetabolic alterations that are highly dynamic, hard to predict, and require acute and critical care. The clinical assessments of the severity of burn injuries are highly subjective and have been reported to be inaccurate consistently. Therefore, the utilization of other imaging modalities is crucial to reach an objective and accurate burn assessment modality. Aim: We describe a non-invasive technique using terahertz time-domain spectroscopy (THz-TDS) and the wavelet packet Shannon entropy to automatically estimate the burn depth and predict the wound healing outcome of the thermal burn injuries. Approach: We created forty burn injuries of different severity grades in two porcine models using scald and contact methods of infliction. We used our THz Portable Handheld Spectral Reflection (PHASR) Scanner to obtain the in vivo THz-TDS images. We used the energy to Shannon entropy ratio of the wavelet packet coefficients of the THz-TDS waveforms on Day 0 to create supervised support vector machine (SVM) classification models. Histological20 assessments of the burn biopsies serve as the ground truth. Results: We achieved an accuracy rate of 94.7% in predicting the wound healing outcome, as determined by histological measurement of the re-epithelialization rate on Day 28 post-burn induction, using the THz-TDS measurements obtained on Day 0. Furthermore, we report the accuracy rates of 89%, 87.1%, and 87.6% in automatic diagnosis of the superficial partial-thickness, deep partial-thickness, and full-thickness burns, respectively, using a multiclass SVM model. Conclusions: The THz PHASR Scanner promises a robust, high-speed, and accurate diagnostic modality to improve the clinical triage of burns and their management.
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Background: Severe burns are a leading cause of injuries worldwide and are usually accompanied by considerable morbidity and mortality. The purpose of this study was to investigate the changes of gene expression in blood and skin at different times after severe burn. Methods: Firstly, the gene expression profiles of different burn time samples in GSE19743 and GSE8056 were analyzed. Secondly, the maladjusted gene network was identified by protein-protein interaction (PPI) network, and the genes in the network were enriched and analyzed. In addition, the key dysfunctional genes were identified by betweenness algorithm, and evaluated by survival analysis, Cox analysis, receiver operating characteristic (ROC) analysis. Finally, crosstalk analysis and enrichment analysis were carried out between the blood- and skin-specific differentially expressed genes (DEGs) at different burn times. Results: The results showed that there were common DEGs in the blood and skin at different burn times. Importantly, we screened out the key dysfunctional genes BIRC5, NCAM1, PCNA, TOP2A, and VEGFA, which were related to the course of burns. Enrichment analysis showed that these maladjusted genes were mainly involved in the immune inflammation-related signal pathway. Additionally, significant crosstalk was identified between blood- and skin-specific genes at different burn times, especially in the blood. The signal pathways involved in specific genes represent their own pathological characteristics. Conclusions: Both blood and skin tissues express common pathological changes and unique molecular mechanisms at different times after burn injury. The results of this study provide guidance for clinical personalized treatment.
Article
Despite decades of efforts, state-of-the-art synthetic burn dressings to treat partial-thickness burns are still far from ideal. Current dressings adhere to the wound and necessitate debridement. This work describes the first “supramolecular hybrid hydrogel (SHH)” burn dressing that is biocompatible, self-healable, and on-demand dissoluble for easy and trauma-free removal, prepared by a simple, fast, and scalable method. These SHHs leverage the interactions of a custom-designed cationic copolymer via host-guest chemistry with cucurbit[7]uril and electrostatic interactions with clay nanosheets coated with an anionic polymer to achieve enhanced mechanical properties and fast on-demand dissolution. The SHHs show high mechanical strength (>50 kPa), self-heal rapidly in ∼1 min, and dissolve quickly (4–6 min) using an amantadine hydrochloride (AH) solution that breaks the supramolecular interactions in the SHHs. Neither the SHHs nor the AH solution has any adverse effects on human dermal fibroblasts or epidermal keratinocytes in vitro. The SHHs also do not elicit any significant cytokine response in vitro. Furthermore, in vivo murine experiments show no immune or inflammatory cell infiltration in the subcutaneous tissue and no change in circulatory cytokines compared to sham controls. Thus, these SHHs present excellent burn dressing candidates to reduce the time of pain and time associated with dressing changes.
Article
Background Barzilai medical center, in Ashkelon Israel, serves intermittently as a frontline hospital in times of war. During conflicts evacuation to adjacent burn centers is impossible. This study aims to describe characteristics of burn victims treated to assess the hospital's capabilities in burn handling. Methods A cross sectional study was conducted, between 2010 and 2021. All patients with icd9 codes describing a burn were recruited. Patients’ and burns' characteristics were analyzed. Results a total of 3085 patients were included, a yearly average of 257 patients. The high season was summer. The mean age was 28 years old, and 24% were in the ages 0-10 years. Patients were predominantly male (61%). The limbs were the most affected area (60%). Scald was the most prevalent etiology (45.61%). Second-degree burns were most common (60%). TBSA was often less than 5% (66%). The majority (92%) were treated as outpatients. An increase of 30% in burn injury victims' admission was noted during the last conflict. Conclusion Our results are in accordance with past studies in terms of the characteristics. We aim to build a reserve force of surgeons to be prepared for war and continued caring for all burn patients when transfer is not possible.
Cooking-related child burn injury causes a greater health burden in low-and-middle-income countries. Therefore, a community-based cross-sectional study was conducted among 5830 under-five-years old children in a resource-limited community in Northwest Ethiopia to determine the prevalence and risk factors of this child health problem. Data were collected by trained nurses using a questionnaire and the logistic regression analysis method was applied to identify factors linked with burn injury. Injury prevalence was 6.2% (95% CI:5.5-6.8); and this burden was linked with several risk factors such as lower literacy status of caretakers [AOR = 2.21 (95% CI:1.05-4.67)], overcrowding [AOR = 2.35(95% CI:1.25-4.43], lack of separate kitchen [AOR =2.19 (95% CI:1.56-3.07)], using traditional cookstove [AOR = 2.04 (95% CI:1.23-3.36)], and lack of child supervision [AOR = 2.27 (95% CI:1.63-3.17)]. In conclusion, children experience a high burden of burn injury. Thus, stakeholders should work to reduce child burn injury by modifying the aforementioned risk factors.
Article
Patients with a major burn injury differ considerably from the typical critical ill and trauma population. Very often, burn patients suffer from anemia throughout their hospital stay. This is caused both by combination of persistent blood loss with decreased erythropoiesis. Therefore, burn patients do have major transfusion requirements. However, transfusion is not devoid of risks or costs. We hereby review the best surgical techniques and medical approaches, aiming to reduce blood loss in a burn patient and optimize red cell production, so that we can reduce the need of RBC transfusion. The implementation of a combination of surgical techniques aiming to reduce blood loss and medical care approaches to prevent anemia, rather than single attitudes, should be adopted in burn care. There is an urgent need for clear guidelines that can easily be accepted, applied, and spread across different burn units to methodically implement measures to reduce blood loss and transfusion needs, and ultimately improve burn patients’ outcome and the health care financial status.
Chapter
Management of skin wounds is of great clinical importance. Inducing the formation of new blood vessels (angiogenesis) can accelerate the healing process in patients suffering from acute and chronic wounds (e.g., burns and diabetic ulcers). It is currently accepted that angiogenesis plays a substantial role in all four overlapping phases of normal wound healing, that is, hemostasis, inflammation, proliferation, and remodeling. Many experimental studies have focused on the design and development of skin replacements capable of stimulating neovascularization within the skin defect regions. The use of stem/progenitor cells and bioactive molecules (e.g., growth factors and cytokines) in combination with three-dimensional (3D) scaffolds are among the most promising applied strategies for promoting angiogenesis, and subsequently accelerating wound healing. Each approach has its own pros and cons for managing skin wounds. In the present chapter, we first describe the physiology of skin tissue, and the diseases and disorders which affect wound healing. We then summarize current therapies with a focus on tissue-engineering (TE) approaches. The critical role of proangiogenic strategies are discussed to highlight their importance for future studies
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Introduction: Epidemiological study on burn injuries and exploration of the risk factors in different settings is important for effective intervention. Very little is known about burn injuries in Ethiopia. Objectives: The aims of this study were to assess the annual incidence of burn injuries and to describe the local knowledge about burns in Mekele town in Tigray, Ethiopia. Methodology: We did a cross sectional survey of burn injuries on 7309 individuals in 1390 households. Results: The annual incidence in burns was 1.2%. Burn had the highest incidence among children less than 5 years old (4.8%). Scald (59%) was the leading cause of burn followed by flame (34%). Most burns occurred at home (81%). Eighty nine point four percent of the burns healed with minor or no sequelae, 9.4% developed sequelae and the mortality was 1%. Crowding and employment were significant risk factors for burn injury. Domestic burn injuries were common among women of reproductive age and work related burns were more common among men. Many people (36%) used harmful substances with deleterious consequences as first aid measure for burn. Discussion: This is the first study from northern Ethiopia and underlines that burn represents a major public health problem. However as we have used a long recall period people may have forgotten minor injuries and we may have underestimated the true incidence. Many people either do not know or have harmful misconceptions about first aid measures for burn injuries. Thus we recommend health education about burn prevention and first aid measures be given to the public. [Ethiop. J. Health Dev. 2002;16(1):1-7]
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To determine the frequency and nature of childhood injuries and to explore the risk factors for such injuries in low-income countries by using emergency department (ED) surveillance data. This pilot study represents the initial phase of a multi-country global childhood unintentional injury surveillance (GCUIS) project and was based on a sequential sample of children < 11 years of age of either gender who presented to selected EDs in Bangladesh, Colombia, Egypt and Pakistan over a 3-4 month period, which varied for each site, in 2007. Of 1559 injured children across all sites, 1010 (65%) were male; 941 (60%) were aged >or= 5 years, 32 (2%) were < 1 year old. Injuries were especially frequent (34%) during the morning hours. They occurred in and around the home in 56% of the cases, outside while children played in 63% and during trips in 11%. Of all the injuries observed, 913 (56%) involved falls; 350 (22%), road traffic injuries; 210 (13%), burns; 66 (4%), poisoning; and 20 (1%), near drowning or drowning. Falls occurred most often from stairs or ladders; road traffic injuries most often involved pedestrians; the majority of burns were from hot liquids; poisonings typically involved medicines, and most drowning occurred in the home. The mean injury severity score was highest for near drowning or drowning (11), followed closely by road traffic injuries (10). There were 6 deaths, of which 2 resulted from drowning, 2 from falls and 2 from road traffic injuries. Hospitals in low-income countries bear a substantial burden of childhood injuries, and systematic surveillance is required to identify the epidemiological distribution of such injuries and understand their risk factors. Methodological standardization for surveillance across countries makes it possible to draw international comparisons and identify common issues.
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Residential fires are the most important cause of fire-related mortality in the United States. Previous research has concentrated on fatal fires in urban areas; considerably less is known about fatal fires in rural areas. We studied fatal and nonfatal residential fires in predominantly rural areas. Using a case-control design, we compared all 151 fatal fires (cases) in single-family dwellings in North Carolina during a 13-month period with a sample of nonfatal fires (controls). Case fires were identified through the medical-examiner system, and control fires that occurred within a few weeks of the case fires were chosen from the records of randomly selected fire departments statewide. For each fire, fire officials were interviewed about the dwelling, the fire, the people involved, and the fire-response system. Although heating incidents were the leading cause of fires, fatal fires were more likely to have been caused by smoking (31 percent of fatal fires vs. 6 percent of nonfatal fires). Mobile homes posed a higher risk of death if a fire occurred (odds ratio, 1.7; 95 percent confidence interval, 1.1 to 2.6), as did the absence of a smoke detector (odds ratio, 3.4; 95 percent confidence interval, 2.1 to 5.6). Smoke detectors were more protective against death in fires involving young children and when no one present was impaired by alcohol or drugs or had a physical or mental disability. The presence of an alcohol-impaired person was the strongest independent risk factor for death in the case of a fire (odds ratio, 7.5; 95 percent confidence interval, 4.4 to 12.7). Residential fires are most likely to be caused by heating equipment or smoking materials. The risk of death is greatest in fires in mobile homes, in those involving alcohol-impaired persons, and in those in houses without smoke detectors.
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The aims were (1) to review inpatient burn records of Attat Hospital (Ethiopia) for the years 1983-1989, and (2) to determine the prevalence of burns and knowledge of first aid for burns in 16 communities served by Attat Hospital in rural Ethiopia. A retrospective review of all records was used to describe characteristics of the inpatient with burns and cost of the service. Adult members of a systematic random sample (20%) of households from 16 communities (total population = 10,183) were interviewed. Questions focused on what to do to put out the fire, what to do for first aid for a burn, the major cause of adult and childhood burns, and a history of burn in any household member. The study was conducted at Attat Hospital and in the surrounding Gurage-Chaha Region of West Shoa Province of Ethiopia. There were 271 burn inpatients during the 7 year period from 1983-1989; 163 households were selected for interview; there were no refusals. During the 7 year period the cost of tertiary inpatient burn treatment at Attat Hospital has been estimated to be US$86,366.72, of which the hospital absorbed 66%. From community based information the cumulative incidence of burns in this population was found to be 5-11%. The absence of a cumulative increase in burns over time in men suggests that female respondents may not fully recall burn histories in adult male household members. The study population possess inadequate knowledge regarding burn prevention and burn first aid. Deleterious traditional compounds were used on 32% of burn patients in the villages. Since most burns are related to household fires, generally in the domain of women in rural Ethiopia, women's groups may be the most appropriate setting for education on burn prevention and first aid. Burn prevention and first aid education should also be recognised as a priority in schools and in the training of community health workers.
Article
The purpose of this study was to present the epidemiology of thermal burn fatalities in the workplace in the United States between 1992 and 1999. Data on fatal thermal burn injuries in the United States between 1992 through 1999 were obtained from the Bureau of Labor Statistics Census of Fatal Occupational Injuries. Between 1992 and 1999, 1,189 fatal thermal burns occurred in the workplace (0.11 deaths/100,000 workers per year). Mortality increased with age, with those over 65 years of age having the greatest rate of death (0.20/100,000). Workers in the mining industry and transportation and public utilities had the highest rates of fatal thermal burns. Occupational categories with the highest rates included “extractive occupations” (eg, miners, explosives workers) and “transportation and material movers” (eg, truck drivers). The specific occupations with the highest rates were airplane pilots and navigators, furnace, kiln, and oven operators, and firefighters. Most decedents were operating vehicles or involved in “other transportation operations” at the time of the incident. The majority of injurious incidents occurred on “industrial premises” or the “street and highway.” Efforts to prevent fatal occupational thermal burn injuries should focus on older workers and those in occupations with frequent exposure to potential sources of thermal injury. Further study of nonfatal thermal burns in the workplace is needed because patterns of fatal burn injury may not reflect patterns of occupational burn injury overall.
Article
Background Physicians will be increasingly responsible for an aging society whose members demonstrate a notable striving for independence.Hypothesis With standard treatment of burns, older patients will have a survival rate of more than 70%, with at least 60% of patients becoming fully functional 6 months after hospital discharge.Methods A 7-year retrospective medical record review of burn unit patients was performed, and 221 (11%) of 1957 patients who were at least 59 years old were identified.Results Of 97 women (44%) and 124 men (56%), 64 (29%) had an associated smoke inhalation injury; 146 (66%), flame injury; and 44 (20%), scald injury. The bedroom and/or living room were the most common areas of injury (90 [41%]), followed by outdoors and the workplace (62 [28%]), the kitchen (40 [18%]), the bathroom (18 [8%]), and the garage or basement (11 [5%]) (P<.005). One hundred twenty-six injuries (57%) were associated with impaired judgment, mobility, or both. On hospital admission, 74 patients (36%) were intubated, 60 (30%) required intubation postoperatively, and 34 (18%) required both. The survival rate was 159 patients (72%) overall. Findings from an ethanol screening and a drug toxicology screening were positive in 22 and 32 patients (10% and 29%) on admission, respectively. Of the survivors, most were discharged to home with (87 [64%]) or without visiting nurse supervision, and at 6 months after discharge, 16 patients (50%) in transitional care facilities were able to return to an independent level of functioning. Of the 59- to 69-year-old age group, 83 (86%) survived compared with 59 (69%) in the 70- to 79-year-old age group and 18 (47%) in the 80 years and older age group.Conclusions In contrast to the usual male preponderance in patients with thermal injury, older women, many of whom are widowed, constituted almost half of the older patients admitted to the hospital. Modalities for injury prevention are necessary to provide optimal and safe household environments for a growing population of older persons.
Article
Context.— The United States has one of the highest fire fatality rates in the developed world, and three quarters of these deaths are in residential fires. Objective.— To compare characteristics of those who die and those who survive in the same residential fire. Design.— Data on fatal residential fires were collected from the medical examiner and interviews with local fire officials. Setting.— North Carolina. Subjects.— Persons in residential fires with at least 1 fatality in a 1-year period. Main Outcome Measure.— Dying vs surviving a fatal residential fire that occurred with more than 1 person at home. Results.— Of the 190 decedents, 124 (65%) were male, 78 (41%) were home alone, and 69 (53%) of 130 adults who had blood alcohol measured were intoxicated (blood alcohol content >22 mmol/L [100 mg/dL]). Of the 254 persons present during fires in which more than 1 person was at home, 112 died. Individuals more likely to die (high-vulnerability group) were younger than 5 years or 64 years or older, had a physical or cognitive disability, or were impaired by alcohol or other drugs (risk of death for group, odds ratio [OR], 4.01; 95% confidence interval [CI], 2.29-7.03). The presence of an adult with no physical or cognitive disabilities who was unimpaired by alcohol or other drugs (a potential rescuer) reduced the risk of death in the high-vulnerability group (OR, 0.49; 95% CI, 0.24-0.99) but not the low-vulnerability group. Overall, a functioning smoke detector lowered the risk of death (OR, 0.39; 95% CI, 0.18-0.83). Conclusions.— Smoke detectors were equally effective in both low- and high-vulnerability populations. The high-vulnerability group was more likely to survive if, in addition to a smoke detector, a potential rescuer was present. Further research should seek to identify prompts that facilitate speedy egress from a burning structure and that can be incorporated into residential fire alarm systems.
Article
In order to prevent injury in a large population one must first understand the distribution geographically, across social and age groups and analyse the differing forms of causation and severity. Not simply as a snapshot but the variation of these variables over time. Continuing analysis is imperative to assess the impact of any prevention methodologies employed. For the first time, these variables can be described for at least one form of injury in England and Wales. By considering a variety of data sources concerning burn injury, the epidemiology can for the first time be accurately be described for the entire population of England and Wales. By analysing and extrapolating representative information from regionally held Emergency Department data sets, adding these to National Health Service Hospital Episode Statistics (NHS.HES) data (1990 to 2009 225K cases), and most crucially data (2003–2009 25K cases) from the International Burn Injury Database (www.iBIDb.org) a full picture has emerged. Analysis has allowed cross validation of capture rates between NHS and iBID data sets and has allowed estimates of the injury load down to small geographical areas (lower super output areas). For rare severe injuries, particularly in children, larger catchment groupings are more appropriate (postcode district) and reveal wide variations in injury incidence rates, particularly in paediatric age groups. Similarly the modes of injury differ both geographically and over time. This complex interrelation will be the subject of the presentation.
Article
Toddler children and their parents were observed in their homes using an observation checklist of 46 child behaviors and 19 reactions by parents. The parent behaviors were categorized as positive, negative, or neutral, and parental reactions to specific child behaviors were examined to determine if the sex of the child or the actual behavior influenced the type of parental reaction. It was found that parents reacted significantly more favorably to the child when the child was engaged in a same-sex-preferred behavior and were more likely to give negative responses to cross-sex-preferred behaviors. Parents gave girls more negative responses when engaged in active, large motor activities. They gave girls more positive responses when they engaged in adult-oriented, dependent behavior. No difference in parental reaction toward boys and girls was present for aggressive behavior. Parents' self-report data and the observation of parents reactions did not correlate highly.
Article
Residential fires are the most important cause of fire-related mortality in the United States. Previous research has concentrated on fatal fires in urban areas; considerably less is known about fatal fires in rural areas. We studied fatal and nonfatal residential fires in predominantly rural areas. Using a casecontrol design, we compared all 151 fatal fires (cases) in single-family dwellings in North Carolina during a 13-month period with a sample of nonfatal fires (controls). Case fires were identified through the medical-examiner system, and control fires that occurred within a few weeks of the case fires were chosen from the records of randomly selected fire departments statewide. For each fire, fire officials were interviewed about the dwelling, the fire, the people involved, and the fire-response system. Although heating incidents were the leading cause of fires, fatal fires were more likely to have been caused by smoking (31% of fatal fires vs. 6% of nonfatal fires). Mobile homes posed a higher risk of death if a fire occurred (odds ratio, 1.7; 95% confidence interval, 1.1 to 2.6), as did the absence of a smoke detector (odds ratio, 3.4; 95% confidence interval, 2.1 to 5.6). Smoke detectors were more protective against death in fires involving young children and when no one present was impaired by alcohol or drugs or had a physical or mental disability. The presence of an alcohol-impaired person was the strongest independent risk factor for death in the case of a fire (odds ratio, 7.5; 95% confidence interval, 4.4 to 12.7). In conclusion, residential fires are most likely to be caused by heating equipment or smoking materials. The risk of death is greatest in fires in mobile homes, in those involving alcoholimpaired persons, and in those in houses without smoke detectors.
Article
Injuries are the leading cause of death for children. This review integrates the epidemiological literature on children's injury rates and the behavioral correlates of children's injuries with the psychological literature on gender based behavioral differences in children and parenting differences based on child gender. Boys are more likely to experience most kinds of injuries and are more likely to be involved in behaviors that are highly correlated with injury. Common parenting strategies may also be associated with an increase in boys' injury risk. Understanding the mechanism of boys' increased risk is a vital task that may ultimately prevent injuries in both boys and girls.
Article
Say not ‘I have found the path of the soul’.Say rather 'I have met the soul walking upon my path'. For the soul walks upon all paths.The soul walks not upon a line, neither does it grow like a reed.The soul unfolds itself, like a lotus of countless petals.Kahlil Gibran, The Prophet
Article
Russian life expectancy has fallen sharply in the 1990s, but the impact of the major causes of death on that decline has not been measured. To assess the contribution of selected causes of death to the dramatic decline in life expectancy in Russia in the years following the breakup of the Soviet Union. Mortality and natality data from the vital statistics systems of Russia and the United States. Russia, 1990-1994. Entire population of Russia. Mortality rates, life expectancy, and contribution to change in life expectancy. Application of standard life-table methods to calculate life expectancy by year, and a partitioning method to assess the contribution of specific causes of death and age groups to the overall decline in life expectancy. United States data presented for comparative purposes. Age-adjusted mortality in Russia rose by almost 33% between 1990 and 1994. During that period, life expectancy for Russian men and women declined dramatically from 63.8 and 74.4 years to 57.7 and 71.2 years, respectively, while in the United States, life expectancy increased for both men and women from 71.8 and 78.8 years to 72.4 and 79.0 years, respectively. More than 75% of the decline in life expectancy was due to increased mortality rates for ages 25 to 64 years. Overall, cardiovascular diseases (heart disease and stroke) and injuries accounted for 65% of the decline in life expectancy while infectious diseases, including pneumonia and influenza, accounted for 5.8%, chronic liver diseases and cirrhosis for 2.4%, other alcohol-related causes for 9.6%, and cancer for 0.7%. Increases in cardiovascular mortality accounted for 41.6% of the decline in life expectancy for women and 33.4% for men, while increases in mortality from injuries (eg, falls, occupational injuries, motor vehicle crashes, suicides, and homicides) accounted for 32.8% of the decline in life expectancy for men and 21.8% for women. The striking rise in Russian mortality is beyond the peacetime experience of industrialized countries, with a 5-year decline in life expectancy in 4 years' time. Many factors appear to be operating simultaneously, including economic and social instability, high rates of tobacco and alcohol consumption, poor nutrition, depression, and deterioration of the health care system. Problems in data quality and reporting appear unable to account for these findings. These results clearly demonstrate that major declines in health and life expectancy can take place rapidly.
Article
The aim of the study was to use state-wide health administrative data to assess the incidence, temporal trends, and external cause of burn injury-related hospital admissions and mortality in Western Australia from 1983 to 2008. Linked hospital morbidity and death data for all persons hospitalized with an index burn injury in Western Australia for the period 1983-2008 were identified. Annual age-specific incidence and age standardized rates were estimated. Poisson regression analyses were used to estimate temporal trends in hospital admissions and mortality. Zero-truncated negative binomial regression analysis was used to identify factors associated with hospital length of stay. From 1983 to 2008, there were 23,450 hospitalizations for an index burn injury. Hospital admission rates declined by an average annual rate of 2% (incidence rate ratio [IRR], 95% confidence interval [CI] = 0.983, 0.981-0.984), and burn-related mortality declined by an average annual rate of 2% (IRR, 95% CI = 0.98, 0.96-1.01). Aboriginal people while having significantly higher hospitalization rates than non-Aboriginal people experienced a greater 26-year decline in hospitalizations of 58% (IRR, 95% CI = 0.42, 0.37-0.48) compared with 32% (IRR, 95% CI = 0.68, 0.65-0.71) for non-Aboriginal people. Children younger than 5 years, 20- to 24-year-old men, and adults older than 65 years remain at high risk for burn injury, and males continue to be hospitalized twice as frequently as females. The results demonstrate declines in burn injury hospitalizations and mortality in both Aboriginal and non-Aboriginal populations. Continued research is required of the impacts of medical interventions and the burn pathway of identified high-risk populations.
Article
Provides a comprehensive assessment of the health status of Australians; measures mortality, disability, illness and injury arising from over 170 diseases and injuries. The burden of disease analysis gives a unique perspective on health.
Article
The objective of this study was to describe the epidemiology and financial burden of burn-associated hospitalizations for children younger than 18 years in the United States. Retrospective data analysis of pediatric burn-associated hospitalizations was done using the Healthcare Cost and Utilization Project Kids' Inpatient Database for 2000. An estimated 10,000 children younger than 18 years were hospitalized for burn-associated injuries in the United States in 2000. These children spent an estimated 66,200 days in the hospital with associated hospital charges equal to USD 211,772,700. Total charges and length of stay for pediatric burn-associated hospitalizations in the United States during 2000 were associated with degree of burn, percentage of total body surface area burned, child's age, region of the United States, hospital location, and hospital type. Children 2 years old or younger were more likely to be nonwhite, be hospitalized for burns, and burn their hands/wrists, compared with children 3 to 17 years of age. Male children in both age groups were more likely to be hospitalized for burns than female children. Children 2 years old or younger were more likely to be burned by hot liquids/vapors and contact with hot substances/objects, while children 3 to 17 years were more likely to be burned by fire/flames. This study is the first national study on healthcare resource utilization for pediatric burn-associated hospitalizations to utilize the KID database. Burns are a major source of pediatric morbidity and are associated with significant national healthcare resource utilization annually. Future burn prevention efforts should emphasize implementing passive injury prevention strategies, especially for young children who are nonwhite and live in low-income communities.
Article
Epidemiology of minor burns is not well defined worldwide. The aim of this study was to examine epidemiological features of minor and moderate burn events that could be beneficial for prevention purposes. The study was conducted in Ardabil province in north-west Iran in 2005-2006. A total of 1700 minor and moderate burns were studied using a pretested questionnaire. Using the SAS 9.1 statistical program analyses were made. Females comprised the majority of cases (n=1000, 58.8%) and children, aged six and younger, made up 36.4% of burn victims. The majority of burns were caused by hot water and tea with the primary containers being kettles in 37.8%, cups or glasses in 24.2%, pots in 13.6% and samovars in 7.9%. Samovars, gas stoves, valors and picnic gas stoves were the primary heating devices involved in burns. In 56% of the cases, overturning of liquid containers was the primary injury mechanism of scalds. 43% had a second-degree burn with a mean total body surface area of 1.3%. This study provides possible beneficial information for burn prevention in the Ardabil area and other similar settings.
Article
To examine the incidence and characteristics of non-fatal burn injury in Bangladesh. A population-based cross-sectional survey was conducted between January and December 2003 in Bangladesh. Nationally representative data were collected from 171 366 rural and urban households, with a total sample size of 819,429. The incidence of non-fatal burns was 166.3 per 100,000 per year. The rate was higher in females than in males (RR 1.15; 95% CI 1.03 to 1.27). Children less than 5 years of age were at much higher risk of burn injury than those older than 5 years (RR 7.05; 95% CI 6.35 to 7.8). Rural people were at more than three times higher risk of burn. The average number of days absent from school due to burn injury was 21.64 (SD 19.64); the average number of workdays lost was 22.96 (SD 35.94). The average duration of assistance required in daily living activities was 17.26 (SD 20.34) days. The hospitalisation rate was 12.6 per 100,000 population per year. The mean duration of hospital stay was 15.88 (SD 20.47) days. The rate of permanent disability was 2.6 per 100,000 population-years. Burn is a major cause of morbidity, disability, school absence, and workday loss. Young children, females, and rural dwellers are at highest risk. Home is the most risky place for children and females in terms of burn injury risk. To halt this devastating health issue, a national strategy and programme for burn prevention must be developed.
Article
Epidemiological studies report confidence or uncertainty intervals around their estimates. Estimates of the burden of diseases and risk factors are subject to a broader range of uncertainty because of the combination of multiple data sources and value choices. Sensitivity analysis can be used to examine the effects of social values that have been incorporated into the design of the disability–adjusted life year (DALY). Age weight, where a year of healthy life lived at one age is valued differently from at another age, is the most controversial value built into the DALY. The discount rate, which addresses the difference in value of current versus future health benefits, also has been criticized. The distribution of the global disease burden and rankings of various conditions are largely insensitive to alternate assumptions about the discount rate and age weighting. The major effects of discounting and age weighting are to enhance the importance of neuropsychiatric conditions and sexually transmitted infections. The Global Burden of Disease study also has been criticized for estimating mortality and disease burden for regions using incomplete and uncertain data. Including uncertain results, with uncertainty quantified to the extent possible, is preferable, however, to leaving blank cells in tables intended to provide policy makers with an overall assessment of burden of disease. No estimate is generally interpreted as no problem. Greater investment in getting the descriptive epidemiology of diseases and injuries correct in poor countries will do vastly more to reduce uncertainty in disease burden assessments than a philosophical debate about the appropriateness of social value
Article
This study was conducted to gain an in-depth understanding of people's perceptions of childhood burns and their prevention in rural areas of Bangladesh. Qualitative study. Five focus group discussions were conducted in this study. Eight to twelve members were present in each group. Groups were composed of mothers of children under 5 years of age, adolescent male and female students in Grades IX and X, fathers and local leaders such as school teachers and religious leaders. The study was conducted in a rural community of Bangladesh in 2003. Focus group participants were aware of the devastating consequences of childhood burn injuries. They reported that younger boys and older girls are at higher risk of burn injuries. They identified home as the most common place for childhood burn injuries, and stated that occurrence was more common in winter. They held the household members or caregivers responsible because of their lack of supervision and carelessness. The focus group participants suggested that people should supervise their children more carefully, and should take initiatives to modify their homes and premises as necessary so that children would not have access to fires and heat sources. Regarding first aid, the focus group participants reported prevailing harmful practices which are likely to make injuries worse. A safety education programme could be an effective intervention to improve knowledge and practices of rural people in Bangladesh with regard to prevention of burns injuries in children.
Article
Unlabelled: Approximately 600,000 burns present to Emergency Departments each year in the United States, yet there is little systematic or evidence-based training of Emergency Physicians in acute burn management. We retrospectively accessed the North Carolina Disease Event Tracking and Epidemiologic Collection Tool (NC DETECT) database to identify all thermal burns and electrical injuries with associated thermal burns presenting to 92% of North Carolina Emergency Departments over a 1-year period. Results: 10,501 patients met inclusion criteria, 0.3% of all state-wide reported ED visits. Ninety-two percent of burn visits were managed exclusively by Emergency Physicians without acute intervention by burn specialists, including 87% of first degree, 82% of second degree, and 53% of third degree injuries. Only 4.3% were admitted; 4.3% were transferred to another institution. Fifty-five percent were male; 33% were aged 25-44 and 33% presented on weekends. Conclusion: This is the first state-wide study of burn injury and identifies Emergency Physicians as the major providers of acute burn care. Ninety-two percent of 10,501 burn visits, including the majority of severe injuries, were managed exclusively by Emergency Physicians. This supports a need for improved, evidence-based training of Emergency Physicians in the acute management of burns of all types.
Article
The incidence of severe burn is extremely high in the Low and Middle Income Countries with an estimated 90% of the world incidence of which 50% is in South East Asia. Through an earlier analysis of 11,196 burn admission over 8 years (1993-2000--Phase I) to our burn unit we established the endemic nature of the injury [Ahuja RB, Bhattacharya S. An analysis of 11,196 burn admissions and evaluation of conservative management techniques. Burns 2002;28:555-61]. A continued analysis of 5566 burn admissions over the next 7 years (2001-2007--Phase II) and its comparison with the Phase I reveals a significant change in the epidemiological profile. The average yearly admissions have fallen by 43.14%, from 1399.5 patients in Phase I to 795.14 patients in Phase II. This fall in average yearly admissions is predominant in the age group 16-35 years (52.61% decline) and 36-55 years (46.51% decline). The overall female to male ratio has also changed from 1.26:1 to 0.91:1. However, the overall mean %TBSA burn has reduced only mildly from 49.12% TBSA in Phase I to 44.39% in Phase II. During Phase II there was also a significant decline of 46.93% and 56.25% in the yearly admission of flame and scald burn respectively. Non-intentional incidents still remain the main mode of injury accounting for 87.12% in Phase I and 89.89% in Phase II. But, the yearly admissions of non-intentional burns fell from 1219.25 in Phase I to 714.71 in Phase II, which is a significant drop of 41.38%. Kitchen continues to dominate as the main location for flame incidents, but the yearly admission rate from kitchen accidents dropped from 897.5 patients in Phase I to 368.43 patients in Phase II. At the same time, liquefied petroleum gas (LPG) leaks which accounted for only 0.72% of all kitchen accidents in Phase I rose to 10.74% in Phase II. Another redeeming feature is the reduction in overall mortality from 51.8% in Phase I to 40.20% in Phase II. Interestingly, a very significant negative correlation exists (being significant at 0.01 level--2 tailed) between burn admissions and the yearly per-capita income of Delhi, from 1993 to 2005, to prove that the incidence and profile of burns directly reflects the economic development of the society. We see this as the first long term study from a burn unit of a developing country to directly reflect this association of burn incidence and its changing profile with economic prosperity.
Article
This paper reviews burns that occur because of specific social habits and traditions; religious beliefs and activities; social events and festivals; and traditional medical practices. A literature review did not reveal any article that specifically reviews such burns. These injuries are not only interesting (being nation-specific) but are also important with regards to implementation of preventive measures in various countries around the world.
Article
Hospital-based studies have suggested that fire-related deaths might be a neglected public-health issue in India. However, no national estimates of these deaths exist and the only numbers reported in published literature come from the Indian police. We combined multiple health datasets to assess the extent of the problem. We computed age-sex-specific fire-related mortality fractions nationally using a death registration system based on medically certified causes of death in urban areas and a verbal autopsy based sample survey for rural populations. We combined these data with all-cause mortality estimates based on the sample registration system and the population census. We adjusted for ill-defined injury categories that might contain misclassified fire-related deaths, and estimated the proportion of suicides due to self-immolation when deaths were reported by external causes. We estimated over 163 000 fire-related deaths in 2001 in India, which is about 2% of all deaths. This number was six times that reported by police. About 106 000 of these deaths occurred in women, mostly between 15 and 34 years of age. This age-sex pattern was consistent across multiple local studies, and the average ratio of fire-related deaths of young women to young men was 3:1. The high frequency of fire-related deaths in young women suggests that these deaths share common causes, including kitchen accidents, self-immolation, and different forms of domestic violence. Identification of populations at risk and description of structural determinants from existing data sources are urgently needed so that interventions can be rapidly implemented.
Article
It has been previously established that the incidence of burn is higher in lower socioeconomic (SES) groups. What is not clear, however, is whether or not the severity of burn is also higher in lower SES groups. The purpose of this study is to establish a relationship between household-level socioeconomic status (SES) and severity-based incidence of burn. A burn injury database was generated from the National Injury Database (2001-2003) with a 1-year follow-up period containing information about the date and time of burn injury, the International Classification of Disease 10th Edition-based (ICD-10) diagnostic codes, gender, age, residence, and type of insurance. In addition, we calculated the severity of each burn using the Excess Mortality Ratio-adjusted Injury Severity Score (EMR-ISS), which is similar to the New Injury Severity Score. Socioeconomic status was measured on the basis of quintiles of premiums for National Health Insurance, which was decided on a household-level either by monthly salary (Employee Insurance, EI) or by owned property (Self-Employed Insurance, SEI). Medical Aid (MA) population was regarded as a reference. After calculation of 5 year-gender specific standardized incidence rates (SIRs) of burn by SES groups, the association of SES and severity of burn was evaluated using a multivariate logistic regression model and the Cox-proportional hazard regression analysis. A total of 870,411 burn cases were examined. The standardized incident rates (SIRs) of mild(1<or=EMR-ISS<or=8), moderate(9<or=EMR-ISS<or=24), severe(25<or=EMR-ISS<or=74), critical(EMR-ISS=75 or death), and total burn injury were 4951, 951, 124, 20, and 6046 per 1,000,000 person-years, respectively. Meaningful changes of relative risk by severity were found: it was greater in higher SES groups (0.67 in the highest SEI, 0.58 in the highest EI) compared to the Medical Aid (MA) population. For injuries classified to be greater than severe (25<or=EMR-ISS), odds ratios according to increase of SES level were significantly decreased to 0.77 in SEI and 0.63 in EI. For critical injuries, hazard ratios were also significantly decreased to 0.51 in the highest SEI and 0.32 in the highest EI. Severity-based incidence of burn was significantly affected by household-level SES in a nationwide cohort study, with more severe injuries noted in the lower socioeconomic groups.
Article
In terms of morbidity and disability, burn is a major public health problem throughout the world, especially in low-income countries. It causes long-term disability and remains as a health, social and economic burden. A population-based survey was conducted in Bangladesh between January and December 2003. Nationally representative data were collected from 171,366 rural and urban households comprising of a total 819,429 population, which included 351,651 children under 18 years of age. Mothers/head of households were interviewed with a structured instrument. The objective of this paper is to determine the consequences of childhood burn at social and economic levels in Bangladesh. In the survey, 1013 children were found with different degrees of burn in the preceding 1 year. Among them 20 children were permanently disabled. The rate of permanent disability was found to be 5.7 per 100,000. The average loss of school days was found to be about 21 days. More than two-thirds of the burn victims required assistance in their daily activities for different durations of time. More than 7% of the children required hospitalisation for their burns. The rate of hospitalisation was 21.9 per 100,000; the average duration of hospital stay was 13.4 days. The highest duration (40 days) of hospital stay was found among girls 10-14 years old. The highest expenditure for the treatment was also found in this age group. The average direct expenditure incurred by a family for treatment of severe burn was determined to be $462. In this study it was found that more than 61% of the families earn less than $50 a month. Burn is a devastating injury among all childhood injuries with significant additional economic consequences beyond the medical, pain, and suffering issues. Developing a national prevention program should be an immediate public health priority.
Article
Accidents are one of the main killers in Greenland, responsible for 16% of deaths but 34% of potential years of life lost (PYLL). During 1968-89, 1310 deaths from accidents were recorded, equivalent to a mortality rate of 118 per 100,000 person-years-more than six times higher than in Denmark. There was a decreasing secular trend but only for certain types of accidents. Mortality rates were considerably higher in indigenous Greenlanders than in Danes, higher in males than in females and higher in settlements than in towns. Most accidents were related to the Greenlandic life style with drowning and boat accidents responsible for 45% of all fatal accidents, and injuries due to fire, cold, firearms or bites of dogs responsible for 23%. In certain age groups and in particular in females, at least 60% of the fatal accidents were alcohol related.
Article
This retrospective review contains 127 paediatric burns up to 14 years of age admitted to the Burn Unit of the Department of Burns and Plastic Surgery, SMS. Medical College, Jaipur over a period of 1 year from January 1990. Epidemiological data include age, sex, seasonal variation, place of burn, family size, economic status, period of time between the accident and admission to hospital. The cause and mode of burn, the relationships between mortality and age, cause of burn and extent of burn are discussed. Most of the burn injuries occurred in the winter months between December and March. Males were affected predominantly. The majority of the burns occurred at home. Most of the patients belonged to the low socioeconomic strata and were members of medium or large size families. The commonest causes of injury were scalds in children under 5 years of age and flames in the older children. The overall mortality was 19.68 per cent.
Article
By virtue of being farther along a developmental path for motor activity level, girls may appear to be the less active sex when compared to less physically mature but same-aged boys. If so, observed sex differences in activity level may be an epiphenomenon of sex differences in maturity related declines in AL. To test this hypothesis and the associated premise that females would be more mature and less active than males, the customary activity levels and relative physical maturities of 83 5-8-year-olds were assessed. Relative maturity (percentage of estimated adult height attained) was negatively related to activity level, and girls were both less motorically active and more mature than boys. Though reduced in magnitude, the sex effect remained significant after maturity was added as a predictor of AL. Thus, sex differences are not due only to maturity differences but may be partially mediated by them.
Article
Information about injuries and violence as causes of death of women is scarce and often incomplete, and particularly so regarding women in the rural areas of South Asia. This report provides detailed specific information collected in Matlab, a sub-district of rural Bangladesh. Of 1139 women (aged 15-44 yr) who died there during the 11-yr period from 1976 to 1986, 207 (18%) were victims of unintentional injuries or violence. In this study, unintentional injuries include domestic and traffic accidents, drowning and snake-bites, while violent deaths are defined as due to intentional injury and include homicide, suicide and lethal complications of induced abortion. Injuries and violence accounted for 31% of all deaths among women aged 15-19 yr. This proportion dropped significantly with age to 10% among women aged 35-44 yr. Unmarried women suffered a higher proportion of such deaths (36%) than married women (15%). Violent deaths during pregnancy and complications of induced abortion among young unmarried women deserve special attention. In the male-dominated society under study, suicide and homicide are observed to be two frequent consequences of illegitimate pregnancy. Although this study suffers from the absence of data on non-fatal injuries and attempted violence, it may serve as a basis for recommending preventive measures.
Article
Deaths from fires are the fifth leading cause of injury death among people aged 65 years or older. To describe the epidemiology of deaths from residential fires among older people, we analyzed mortality data for 1984 collected by the National Center for Health Statistics. Although older people represented only 12% of the U.S. population in 1984, they accounted for 29% (1,278) of that year's 4,466 residential fire deaths. Conflagrations accounted for 78% of older people's deaths from residential fires; clothing ignitions and other fires accounted for 11% each. Residential fire death rates increased with advancing age. Older black people had death rates 4.6 times the death rates of older white people. Older males had higher death rates than older females. Host, environmental, and behavioral risk factors for residential fire deaths among older people and potential strategies for intervention are discussed. Unless intervention strategies are focused on older people, the residential fire death toll in the U.S. may actually grow as the population of older people increases from 12% of the population in 1984 to about 21% of the population in 2030.
Article
Epidemiological and medicolegal, including forensic pathological, aspects of 180 cases of fatal burns were studied in Kanpur (India) during the period of one year (October 1985 to September 1986). These constituted 10.79% of the total medicolegal deaths autopsied. Majority of the victims were young Hindu housewives burnt within 5 years of their marriage. The most common source of fire was cooking apparatus like chulha, coalfire, stove or cooking gas. In a substantial number of cases, kerosene oil was poured over the victims and fired with a match stick. About half of the burn cases were accidental, in which cooking on open unguarded flames and loose highly inflammable synthetic sarees of the victims can be blamed. Among the others who died in suspicious circumstances, i.e., burnt alive or forced to commit suicide by fire, dowry and family quarrels and marital disharmony were the two important predisposing factors. Illiteracy, arranged and child marriages, joint family structure, oedipal dominance of mother-in-laws, unemployment and economic dependence of the husband on the parents, near complete dependence of women on their husbands and inlaws, and lack of social security amongst Hindu females were other contributory factors affecting the incidence in some way. Male burn deaths were few and usually accidental.
Article
Forty-eight children who sustained accidental burns and scalds over a 5-year period (January 1972–December 1976) at the University College Hospital, Ibadan have been discussed. Thirty-three (69 per cent) of them suffered from scalds while 14 (29 per cent) had naked flame injuries. Ninety-two per cent of the accidents occurred in their own homes and most of the children were under the age of 5 years. The injuries were severe in 37 (77 per cent) and were complicated by sepsis (localized or generalized) as well as anaemia. Like in mot other studies, the offending organisms were Psuedomonas and Klebsiella spp., but unfortunately, the appropriate antibiotics were not often available. The mortality in the series was 6 per cent.