Background: Only a few papers are published on the safety and effectiveness of acute burn care in low-income countries. A cohort study was therefore carried out to determine such outcomes.Methods: The study was conducted in a rural Tanzanian hospital in 2017-2018. All patients admitted with burns were eligible. Complications were scored during admission as an indication for safety. Survivors of severe burn injuries were evaluated for time of reepithelialization, graft take, disability (WHODAS2.0) and quality of life (EQ5D-3L) up to 3 months post-injury, as an indication of effectiveness.Results: Patients presented on average at 5 days after injury (SD 11, median 1, IQR 0-4). Three patients died at admission. The remaining 79 were included in the cohort. Their median age was 3 years (IQR 2-9, range 0.5-49), mean TBSA burned 12% (SD10%) and mortality rate 11.4%. No surgery-related mortality or life-threatening complications were observed. Skin grafting was performed on 29 patients at a delayed stage (median 23 days, IQR 15-47). Complications of skin grafts included partial (25% of procedures) and complete graft necrosis (8% of procedures). The mean time to reepithelialization was 52 (SD 42) days after admission. Disability and quality of life improved from admission to 3 months after injury (p<0.001, p<0.001, respectively).Conclusion: In this resource-limited setting patients presented after a delay and with multiple complications. The mortality during the first two weeks after admission was high. Surgery was found to be safe and effective. A significant improvement in disability and quality of life was observed.
BackgroundHyperbaric oxygen therapy (HBOT) is used to treat various wound types. However, the possible beneficial and harmful effects of HBOT for acute wounds are unclear.MethodsWe undertook a systematic review to evaluate the effectiveness of HBOT compared to other interventions on wound healing and adverse effects in patients with acute wounds. To detect all available randomized controlled trials (RCTs) we searched five relevant databases up to March 2010. Trial selection, quality assessment, data extraction, and data synthesis were conducted by two of the authors independently.ResultsWe included five trials, totaling 360 patients. These trials, with some methodologic flaws, included different kinds of wound and focused on different outcome parameters, which prohibited meta-analysis. A French trial (n = 36 patients) reported that significantly more crush wounds healed with HBOT than with sham HBOT [relative risk (RR) 1.70, 95% confidence interval (CI) 1.11–2.61]. Moreover, there were significantly fewer additional surgical procedures required with HBOT (RR 1.60, 95% CI 1.03–2.50), and there was significantly less tissue necrosis (RR 1.70, 95% CI 1.11–2.61). In one of two American trials (n = 141) burn wounds healed significantly quicker with HBOT (P < 0.005) than with routine burn care. A British trial (n = 48) compared HBOT with usual care. HBOT resulted in a significantly higher percentage of healthy graft area in split skin grafts (RR 3.50, 95% CI 1.35–9.11). In a Chinese trial (n = 145) HBOT did not significantly improve flap survival in patients with limb skin defects.ConclusionsHBOT, if readily available, appears effective for the management of acute, difficult to heal wounds.
OBJECTIVE: This study aimed to examine the prevalence and predictors of reconstructive surgery among pediatric burn patients in the Netherlands.METHODS: Pediatric burn patients were identified through the Dutch Burn Repository R3. Eligibility criteria included a burn requiring hospital admission or surgical treatment at one of the Dutch burn centers in 2009-2019. First, patient, burn, and treatment characteristics were summarized using descriptive statistics. Second, time to the first reconstructive surgery was modelled using Kaplan Meier curves. Third, a prediction model was developed using univariate and multivariate logistic regression. The model's performance was assessed using calibration, discrimination, and explained variance. Fourth, internal validation was performed using bootstrapping.RESULTS: Approximately three percent (n = 84) of pediatric patients (n = 3072) required reconstructive surgery between the initial burn-related hospital admission and September 2021. Median time to the first reconstructive surgery was 1.2 (0.7-1.6) years. Most surgeries were performed on the face, arm, neck, hand, or anterior trunk, owing to contractures or hypertrophic scarring. Predictors of reconstruction included the etiology, anatomical site, extent of full-thickness burn, surgical treatment in the acute phase, and length of hospital stay.CONCLUSION: Our study provided an overview of the prevalence and independent predictors of reconstructive surgery in the pediatric burn population.
Achtergrond: In acute intensieve werksettings, waar de werkdruk al hoog was en er altijd impact is van indrukwekkende gebeurtenissen, zorgt COVID-19 voor toename van druk. Zorgprofessionals worden geconfronteerd met een nieuw en onbekend ziektebeeld, lopen risico op besmetting of om een besmettingsbron voor patiënten te zijn, communicatie met de patiënt is minder goed mogelijk, en zij krijgen te maken met een hogere werkdruk. Dit leidt tot een ongezonde werksituatie. De potentiële gevolgen hiervan zijn (post-traumatische) stress, burn-out en uitval. Er is daarom noodzaak om curatieve ondersteuning tijdens de crisis/indrukwekkende gebeurtenissen en preventieve ondersteuning ter voorbereiding op crisis/indrukwekkende gebeurtenissen en ter nazorg aan te bieden. Professionals uit het netwerk van Lectoraat Acute Intensieve Zorg werkzaam in de frontlinie vanuit ambulance, Spoedeisende Hulp (SEH), Acute Opname Afdelingen en Intensive Care geven aan moeite te hebben met het omgaan met de indrukwekkende situaties bij de COVID-19 crisis. Ze hebben gevraagd om een toolkit van werkzame interventies die kunnen worden ingezet om beter met deze situatie om te kunnen gaan om hiermee duurzame inzetbaarheid in, tijdens en na crisissituaties te vergroten. Het gaat hierbij om interventies gericht op curatieve en preventieve ondersteuning. Plan van aanpak: In dit project wordt ontwerpgericht onderzoek middels mixed methods design toegepast. In co-creatie met de praktijk ontwikkelen we een toolkit met bruikbare, zo mogelijk evidence based, interventies om zorgprofessionals te ondersteunen om om te gaan met indrukwekkende gebeurtenissen, gebaseerd op lessen uit de COVID-19 crisis. Deze toolkit dient ervoor om duurzame inzetbaarheid te ondersteunen en te vergroten. Vanuit de HAN werken de lectoraten Acute Intensieve Zorg en Human Resource Management nauw samen met beroepsverenigingen en publieke instellingen uit de acuut intensieve keten. Alle partners verspreiden ontwikkelde kennis en producten via hun netwerk.
