Journal of burn care & research : official publication of the American Burn Association
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Comparative Study
Do burn patients cost more? The intensive care unit costs of burn patients compared with controls matched for length of stay and acuity.
Modern intensive care management of burn patients is resource intensive with important ramifications for funding of regional burn services. The aim of this retrospective cohort study was to determine the intensive care unit costs for burn patients compared with nonburn patients matched for length of stay and severity of illness. The patient record was reviewed to compare costs associated with expendables (medications and fluids), investigations (laboratory and radiological tests), and physiotherapy sessions in 13 burn patients and 13 nonburn controls. ⋯ The authors found no significant difference in the mean daily intensive care unit cost of burn patients compared with controls matched for length of stay and acuity. However, physiotherapy and dressing costs were higher in burn patients, and there was a trend to increase costs associated with analgesic/anxiolytic/sedative medications. Antimicrobials accounted for a significant proportion of pharmacy costs in both groups.
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High-voltage electrical burns of the upper extremity are often limb threatening. Typically, emergency fasciotomies are followed by serial debridements until only viable tissue remains. After debridement, flap coverage is required to preserve viable but exposed tendons, nerves, vessels, bones, and joints and to salvage these seriously injured upper extremities. ⋯ Limb salvage in severe upper extremity electrical injuries is difficult even in the best circumstances. Dependable flap coverage is mandatory to prevent infection and avoid the need for early or late amputation. The pedicled TFL flap in our series of patients has served to be a dependable flap in these severe upper extremity injuries and should be added to the surgical armamentarium of those caring for these difficult surgical problems.
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Bloodstream infections (BSIs) are a major cause of morbidity and mortality in thermally injured patients. However, these infections have not been well defined in this patient population. Therefore, the authors performed a retrospective case-control study to characterize the epidemiology, microbiology, and outcomes of burn-associated BSIs. ⋯ On evaluation of case-matched controls, mortality was higher for patients with BSI only <50% TBSA strata. Conclusions were unaffected by adjustment for TBSA and other possible confounders and was not influenced by possible failure of some sites to consistently capture BSI information. Development of BSI in hospitalized burn patients is associated with significant increases in morbidity, mortality, and resource utilization.
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Comparative Study
Psychological effects observed in child burn patients during the acute phase of hospitalization and comparison with pediatric patients awaiting surgery.
The main aim of this article is to examine, first, the emotional and behavioral reactions in children who have suffered burns, during their first days of hospitalization (N = 103) (ages, 1-17 years and average TBSA%, 12.84). In addition, in relationship to this question, the article compares a group of 33 of these children hospitalized for burns, with children awaiting surgery (N = 36), taking into account that all were awaiting surgery and all were from the same age group (6-14 years). The authors used the State-Trait Anxiety Inventory for Children (STAIC) and the Child Behavior Checklist (CBCL). ⋯ The results of the comparison group show that the group awaiting minor surgery registered higher state anxiety (STAIC) levels and somatic complaints (CBCL). Where behavior is concerned, the children suffering from burns showed problems of attention and behavior (CBCL). The authors may conclude that the differences with respect to anxiety among child patients suffering from burns and those awaiting minor surgery are linked to the reason for hospital admission.
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Burn injury survival means coping with more than just the physical changes and disabilities often encountered after burn injury. Overall quality of life is important, and issues such as sexuality and intimacy are significant facets of quality of life. A literature review revealed limited research regarding current burn center practices related to sexuality and intimacy concerns of burn survivors and their partners. ⋯ Designated staff to provide education is lacking, and there is limited comfort on the part of health care providers in initiating such conversations. These factors seem to often prevent burn care professionals from adequately addressing burn survivor's sexuality and intimacy needs and establish the need for further development of training and educational materials specific to sexuality, intimacy, and burn injury survival. The limited number and lack of diversity among participants create potential for bias and limit generalizability of results.