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- Allorto, Nikki, et al.
(författare)
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Factors impacting time to surgery and the effect on in-hospital mortality
- 2021
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Ingår i: Burns. - : ELSEVIER SCI LTD. - 0305-4179 .- 1879-1409. ; 47:4, s. 922-929
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: Early surgery improves outcomes after burn injuries but is often not available in limited resource settings (LRS), where a more conservative approach is widespread. This study aimed to analyze factors associated with delay in surgical treatment, and the impact on in-hospital mortality. Methods: All patients with burns treated with surgery between 2016 and 2019 at the Pietermaritzburg Burn Service, in South Africa, were included in this retrospective study. Early surgery was defined as patients who underwent surgery within 7 days from injury. The population was analyzed descriptively and differences between groups were tested using t-test, and chi(2) test or Fishers exact test, as appropriate. Multivariable logistic regression was used to analyze the effect of delay in surgical treatment on in-hospital mortality, after adjustment for confounders. Results: During the study period, 620 patients with burns underwent surgery. Of them, 16% had early surgery. The early surgery group had a median age and TBSA of 11 years (3-35) and 12.0% (5-22) compared to 7 years (2-32) and 6.0% (3-13) in the late surgery group (p=0.45, p<0.001). In logistic regression, female sex [aOR: 3.30 (95% CI: 1.47-7.41)], TBSA% [aOR: 1.09 (95% CI: 1.05-1.12)], and FTB [aOR: 3.21 (95% CI: 1.43-7.18)] were associated with in-hospital mortality, whereas having early surgery was not [aOR: 1.74 (95% CI: 0.76-3.98)]. Conclusion: This study found that early surgery was not associated with in-hospital mortality. Independent predictors of in-hospital mortality were female sex, presence of full thickness burn, and larger burn size. Future studies should investigate if burn care capacity in LRS may influence the association between early excision and outcome. (C) 2020 Elsevier Ltd and ISBI. All rights reserved.
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| 2. |
- Boissin, Constance, et al.
(författare)
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Development and evaluation of deep learning algorithms for assessment of acute burns and the need for surgery
- 2023
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Ingår i: Scientific Reports. - : Springer Nature. - 2045-2322. ; 13:1
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Tidskriftsartikel (refereegranskat)abstract
- Assessment of burn extent and depth are critical and require very specialized diagnosis. Automated image-based algorithms could assist in performing wound detection and classification. We aimed to develop two deep-learning algorithms that respectively identify burns, and classify whether they require surgery. An additional aim assessed the performances in different Fitzpatrick skin types. Annotated burn (n = 1105) and background (n = 536) images were collected. Using a commercially available platform for deep learning algorithms, two models were trained and validated on 70% of the images and tested on the remaining 30%. Accuracy was measured for each image using the percentage of wound area correctly identified and F1 scores for the wound identifier; and area under the receiver operating characteristic (AUC) curve, sensitivity, and specificity for the wound classifier. The wound identifier algorithm detected an average of 87.2% of the wound areas accurately in the test set. For the wound classifier algorithm, the AUC was 0.885. The wound identifier algorithm was more accurate in patients with darker skin types; the wound classifier was more accurate in patients with lighter skin types. To conclude, image-based algorithms can support the assessment of acute burns with relatively good accuracy although larger and different datasets are needed.
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| 3. |
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| 4. |
- Greenhalgh, David G., et al.
(författare)
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Surviving Sepsis After Burn Campaign
- 2023
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Ingår i: Burns. - : Elsevier. - 0305-4179 .- 1879-1409. ; 49:7, s. 1487-1524
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: The Surviving Sepsis Campaign was developed to improve outcomes for all patients with sepsis. Despite sepsis being the primary cause of death after thermal injury, burns have always been excluded from the Surviving Sepsis efforts. To improve sepsis outcomes in burn patients, an international group of burn experts developed the Surviving Sepsis After Burn Campaign (SSABC) as a testable guideline to improve burn sepsis outcomes. Methods: The International Society for Burn Injuries (ISBI) reached out to regional or na-tional burn organizations to recommend members to participate in the program. Two members of the ISBI developed specific "patient/population, intervention, comparison and out-come" (PICO) questions that paralleled the 2021 Surviving Sepsis Campaign [1]. SSABC parti-cipants were asked to search the current literature and rate its quality for each topic. At the Congress of the ISBI, in Guadalajara, Mexico, August 28, 2022, a majority of the participants met to create "statements" based on the literature. The "summary statements" were then sent to all members for comment with the hope of developing an 80% consensus. After four reviews, a consensus statement for each topic was created or "no consensus" was reported. Results: The committee developed sixty statements within fourteen topics that provide guidance for the early treatment of sepsis in burn patients. These statements should be used to improve the care of sepsis in burn patients. The statements should not be considered as "static" comments but should rather be used as guidelines for future testing of the best treatments for in burn should be on a basis. Conclusion: Members of the burn community from the around the world have developed the Surviving Sepsis After Burn Campaign guidelines with the goal of improving the outcome of sepsis in burn patients. (c) 2023 Elsevier Ltd and ISBI. All rights reserved.
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| 5. |
- Holm, Sebastian, 1993-, et al.
(författare)
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Is the pre-operative wound culture necessary before skin grafting minor burns? A pilot study in a low resource setting burn service
- 2024
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Ingår i: Journal of Burn Care & Research. - : Oxford University Press. - 1559-047X .- 1559-0488.
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Tidskriftsartikel (refereegranskat)abstract
- The most common cited cause of split-thickness skin graft failure is infection and due to the association between bacterial findings in wound beds an attempt to decrease the bacterial burden before skin-grafting evolved. Thus, pre-operative microbiology swabs of the wound bed became routine at some institutions prior to grafting. This is not standard practice in the Pietermaritzburg burn service. Emphasis is instead placed on a strict protocol of intra-operative wound bed preparation to promote adequate graft take. This pilot study aims to evaluate whether pre-operative wound swabs are appropriate. We performed a prospective observational study to determine if positive wound cultures were associated with graft failure. All patients with a burn surface area of less than 10 %, where delayed grafting (later than 28 days from time of burn injury) was performed, from March to December 2021 were analyzed. Patient demographics, days from burn to graft, %TBSA burn, %TBSA grafted, whether sharp debridement prior to grafting in the same procedure was performed or not, use of topical gentamicin intra-operatively, graft outcome (% graft loss), need for regraft, and organism grown were recorded into an excel spread sheet for analysis. The sample included 52 patients. Of these, 17 (31.5%) were female. The median %TBSA grafted was 8% (IQR 4-13%) and similar in both groups. The median days from burn to grafting was 35 days. Thirty-nine patients (75%) had graft Take and 13 (25%) had graft Failure. In the failed group, median % graft failure was 50% (30 - 70%). Of the group with successful graft take, 90% were noted to have had a positive wound culture prior to grafting. A positive wound culture was not found to be a risk factor for graft failure (p=0.993). Despite the positive wound cultures graft take was more than 90 % in 75% of grafts performed and only 2/52 patients required supplementary grafting. We believe that this demonstrates that our local protocol is reasonable in this setting and that waiting for negative wound swabs prior to grafting should not be a reason to delay grafting.
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| 6. |
- Pompermaier, Laura, et al.
(författare)
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Impact of COVID-19 on global burn care
- 2022
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Ingår i: Burns. - : Elsevier Science Ltd. - 0305-4179 .- 1879-1409. ; 48:6, s. 1301-1310
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Tidskriftsartikel (refereegranskat)abstract
- Background: Worldwide, different strategies have been chosen to face the COVID-19-patient surge, often affecting access to health care for other patients. This observational study aimed to investigate whether the standard of burn care changed globally during the pan-demic, and whether country acute accent s income, geographical location, COVID-19-transmission pat-tern, and levels of specialization of the burn units affected reallocation of resources and access to burn care.Methods: The Burn Care Survey is a questionnaire developed to collect information on the capacity to provide burn care by burn units around the world, before and during the pandemic. The survey was distributed between September and October 2020. McNemar`s test analyzed differences between services provided before and during the pandemic, chi 2 or Fishers exact test differences between groups. Multivariable logistic regression analyzed the independent effect of different factors on keeping the burn units open during the pandemic.Results: The survey was completed by 234 burn units in 43 countries. During the pandemic, presence of burn surgeons did not change (p = 0.06), while that of anesthetists and dedi-cated nursing staff was reduced (< 0.01), and so did the capacity to manage patients in all age groups (p = 0.04). Use of telemedicine was implemented (p < 0.01), collaboration be-tween burn centers was not. Burn units in LMICs and LICs were more likely to be closed, after adjustment for other factors.Conclusions: During the pandemic, most burn units were open, although availability of standard resources diminished worldwide. The use of telemedicine increased, suggesting the implementation of new strategies to manage burns. Low income was independently associated with reduced access to burn care.(c) 2021 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
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