Olga Quintana

Biodebridement: a case report of maggot therapy for limb salvage after fourth-degree burns.

The wound healing and antimicrobial properties of maggots are well known. Maggot debridement therapy has been used for the treatment of various conditions. For maggot debridement therapy, the larvae of the blowfly are applied over necrotic or nonhealing wounds. We used maggot debridement therapy with the larvae of Phaenicia sericata for limb salvage after bilateral lower extremity fourth-degree burns.

A Prospective, Randomized Trial of Acticoat Versus Silver Sulfadiazine in the Treatment of Partial-Thickness Burns: Which Method Is Less Painful?

Despite recent improvements in analgesia, pain control during dressing changes continues to be a major challenge in patients with burns. We investigated two different dressing modalities to compare how much pain the patient experienced during and after the dressing change. Patients with partial-thickness burns that required only topical wound care were assigned randomly to treatment with Acticoat (Smith and Nephew USA, Largo, FL) or silver sulfadiazine (AgSD). The outcome variable was pain during wound care, which was measured using visual analog pain scores. The mean visual analog pain scores for the wounds treated with Acticoat or AgSD wounds were 3.2 and 7.9, respectively (P < .0001; paired Students t-test). In 41 of the 47 paired pain score observations, the pain in the wound treated with AgSD was perceived as greater than in the wound treated with Acticoat. Burn wound care with Acticoat is less painful than burn wound care with AgSD in patients with selected partial-thickness burns.

Use of a warming catheter to achieve normothermia in large burns

Maintaining burn patients’ body temperature during surgery is a significant challenge. Although increasing the ambient operating room (OR) temperature and other passive rewarming methods help, such measures have limited effectiveness and prove taxing on OR personnel. Initial studies indicate that an intravascular warming catheter may improve and sustain burn patient body temperatures. The authors hypothesize that the warming catheter is similarly effective at maintaining normothermia despite a lower OR temperature than in a cohort of matched control burn patients. This is a retrospective case-control study involving patients with major burns treated between January 2006 and June 2011. Cases received an intravascular warming catheter, whereas controls receive traditional temperature conserving interventions. As the catheters maintained body temperature, the room temperature was gradually lowered to normal. Twenty-three patients were involved in 31 cases using the catheter, compared with 39 controls in 62 surgeries. The mean temperature deviation for each catheter group was −0.76 ± 1°C and −0.80 ± 0.9°C for the control group. Given 20-minute intervals throughout the operations, the mean patient temperature for cases and controls never deviated by more than 1°C. OR staff satisfaction has improved with decreased room temperatures. An intravenous warming catheter reliably maintained patient core body temperature during surgery. To date, this is the largest cohort study of such a catheter among burn patients. This system may be more effective than current warming techniques, with the potential to decrease the total number of procedures and the time to complete wound closure.

Tracking non-burn center care: what you don't know may surprise you.

The American Burn Association publishes a list of defined criteria for patients who require admission or transfer to a burn center. This study examines the extent to which those criteria are observed within a regional burn network. Hospital discharge data for 2008 were obtained for all hospitals within the South Florida regional burn network. Patients with International Classification of Diseases, 9th revision discharge diagnoses for burns were reviewed, and their triage destination was compared with the burn triage referral criteria to determine whether patients were inappropriately triaged. Descriptive statistics were used to analyze the data. Four hundred ninety-eight burn admissions were documented to non–burn center center hospitals, 269 (54%) of which were deemed inappropriate by burn triage referral criteria. Burn center patients had greater length of stay when compared with non–burn center patients (14 vs 7 days), but a greater percentage were discharged home for self-care (88 vs 57%). Thirty-three percent of the inappropriate admissions were in a neighboring county, whereas 27% were in the same county where the burn center is located. Inappropriate burn patient triage may be occurring to more than half of the burn patients within our regional burn network despite better functional outcomes at the burn center. This may be because of a lack of knowledge regarding triage criteria, patient insurance status, or other factors. Further studies are necessary to fully characterize the problem and implement education or incentives to encourage appropriate burn patient triage.

A new algorithm to allow early prediction of mortality in elderly burn patients

INTRODUCTION The elderly are the fastest growing population segment, and particularly susceptible to burns. Predicting outcomes for these patients remains difficult. Our objective was to identify early predictors of mortality in elderly burn patients. METHODS Our Burn Centers prospective database was reviewed for burn patients 60+ treated in the past 10 years. Predictor variables were identified by correlative analysis and subsequently entered into a multivariate logistic regression analysis examining survival to discharge. RESULTS 203 patients of 1343 (15%) were eligible for analysis. The average age was 72 ± 10 (range 60-102) and the average total body surface area (TBSA) burned was 23 ± 18% (range 1-95). Age, TBSA, base deficit, pO(2), respiratory rate, Glasgow Coma Score (GCS), and Revised Trauma Score (RTS, based on systolic blood pressure, respiratory rate, and GCS) all correlated with mortality (p ≤0 .05). Using multiple logistic regression analysis, a model with age, TBSA and RTS was calculated, demonstrating: In this model, β(0) is a constant that equals -8.32. CONCLUSIONS Predicting outcomes in elderly burn patients is difficult. A model using age, TBSA, and RTS can, immediately upon patient arrival, help identify patients with decreased chances of survival, further guiding end-of-life decisions.

The impact of caregiver support on mortality following burn injury in the elderly

Advances in burn care have decreased mortality in the past 20 years, but affecting elderly mortality rates (>65 years) remain challenging. This study evaluates the impact of home caregiver support on elderly burn patients’ mortality. The authors retrospectively reviewed patients aged 65 and older admitted to their burn center from July 1995 to October 2004. Patient demographics, Injury Severity Score, TBSA, and patients’ primary caregiver were collected. The outcomes were mortality, disposition, and length of stay and these were evaluated using univariate and subsequently multivariate regression. Significance was calculated at P ⩽ .05. A total of 112 patients were included in the analysis. The mean age was 76±8. Male patients constituted 47%, whereas 53% were female patients, and mean TBSA was 21±16%. Thirty patients’ primary caregiver was a spouse, for 38 it was a child, and 44 had no caregiver. Fifty-eight patients survived (51.7%), and 54 patients died (48.3%). Only 21% of the survivors had a child as their primary caregiver; however, 48% of the nonsurvivors had a child as the primary caregiver (P ⩽ 0.05). On multivariate analysis, age, TBSA, and child as primary caregiver were all independent predictors of mortality. Having a child as a caregiver provided the largest impact, with an odds ratio of 4.4 (95% confidence interval, 1.2–15.62; P = .02).

Co-production: A viable consideration for developing nations

This paper presents the concept of co-production. Its potential and possible problems in dealing with international markets are explored. Models are used to illustrate the relationship of co-production with the life-cycle of products. The need for management awareness in the processes involved is also discussed.

Early Predictors of Mortality in Elderly Burn Patients: 218.

Introduction: The elderly are the fastest growing segment of the population and are comprising an increasing proportion of burn patients. Predicting outcome for these patients remains difficult. Our objective was to identify early predictors of mortality in elderly burn patients. Methods: The prospectively collected database from our Level 1 Trauma Center was reviewed for the past 10 years. All burn patients 60 years old were included. Predictor variables were identified by a correlative analysis and subsequently entered into a multivariate logistic regression analysis with survival to hospital discharge as the dependent variable. Significance was set at an alpha of 0.05. Results: There were 203 patients eligible for analysis. The average age was 72 (range 60–102). The average total body surface area (TBSA) burned was 23% (range 1–95). Age, TBSA, base deficit, p02, respiratory rate, Glasgow Coma Score, and Revised Trauma Score (based on systolic blood pressure, respiratory rate, and Glasgow Coma Score) were all correlated with mortality (p 0.05, Pearson’s Correlation Coefficient). In multiple logistic regression analysis, the Revised Trauma Score was the most significant predictor of mortality (p 0.01). A single point reduction in the Revised Trauma Score led to a greater than 50% increase in the odds of mortality. A model with age, TBSA and Revised Trauma Score was highly predictive of mortality (Hosmer and Lemeshow Test).Conclusions: Predicting outcomes in elderly burn patients is difficult. Early predictors of mortality may help to guide end-of-life decisions. A model using age, TBSA and Revised Trauma Score may be used to help identify patients with decreased odds of survival.