Journal of burn care & research : official publication of the American Burn Association
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The aim of this study was to examine 2-year postdischarge outcomes-including hospital readmissions, complications, and mortality-for a cohort of older adults with burn injury. In a statewide hospital discharge database, we identified all patients ≥ 45 years of age admitted for acute burn injury from 1996 to 2005 and followed each patient for any hospital admissions 2 years following discharge. We then linked the state database to the National Death Index to identify patients who died within the 2-year period. ⋯ Survival progressively decreased by age category throughout the follow-up period. Compared with patients aged 45 to 54 years, the older age groups had increased mortality risk at 2 years: odds ratio (OR) 1.53 (95% confidence interval, 1.22-1.88) for the 55 to 64 years group, OR 2.51 (95% confidence interval, 2.03-3.09) for the 65 to 74 years group, and OR 2.90 (95% confidence interval, 2.36-3.55) for the ≥ 75 years group. This population-based study indicates that older patients have a high likelihood of rehospitalization and increased long-term mortality.
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Comparative Study
Novel predictors of sepsis outperform the American Burn Association sepsis criteria in the burn intensive care unit patient.
The purpose of this study was to determine whether systemic inflammatory response syndrome (SIRS) and American Burn Association (ABA) criteria predict sepsis in the burn patient and develop a model representing the best combination of novel clinical sepsis predictors. A retrospective, case-controlled, within-patient comparison of burn patients admitted to a single intensive care unit from January 2005 to September 2010 was made. Blood culture results were paired with documented sepsis: positive-sick, negative-sick (collectively defined as sick), and negative-not sick. ⋯ The model was significant in predicting positive-sick and sick, with an AUC of 0.775 (P < .001) and 0.714 (P < .001), respectively; comparatively, the ABA criteria AUC was 0.619 (P = .028) and 0.597 (P = .035), respectively. Usefulness of the ABA criteria to predict sepsis is limited to the day before blood culture is obtained. A significant contribution of this research is the identification of six novel sepsis predictors for the burn patient.
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Comparative Study
Albumin supplementation for hypoalbuminemia following burns: unnecessary and costly!
Following fluid resuscitation, patients with major burns frequently develop prolonged hypoalbuminemia. It is not known whether this should be corrected by albumin supplementation. The purpose of this study was to determine whether there are any benefits associated with albumin supplementation to correct hypoalbuminemia in burned adults. ⋯ There were no significant differences between the groups in daily SOFA score/first 30 days, peak SOFA score, ΔSOFA, hospital length of stay, time to wound healing, duration of mechanical ventilation, or 30-day and in-hospital mortality. The cost of routinely supplementing 5% albumin between PB day 2 to 30 in the albumin group was more than four times that for the controls where we did not routinely provide albumin (Can $65.50 vs Can $16.57 per patient per day). We conclude that routine supplementation of 5% human albumin to maintain a serum albumin level ≥ 20 g/L in burn patients is expensive and provides no benefit.
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Burn pain is one of the most excruciating types of pain and can be difficult to manage. Benzodiazepines may be effective in reducing pain by minimizing anxiety associated with dressing changes. This study aimed to evaluate the safety and efficacy of adjunctive midazolam during dressing changes in patients with uncontrolled pain using opioid monotherapy or significant anxiety associated with dressing changes. ⋯ One midazolam patient experienced oxygen desaturation with midazolam, but did not require flumazenil for reversal. The use of midazolam during burn dressing changes in patients with poorly controlled pain and/or anxiety was not associated with reduced requirements for oral morphine equivalents or lower pain scores during admission. Further research into the role of benzodiazepines in burn pain management is warranted.
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The study first assessed comfort levels of physical and occupational therapists who provide burn care prior to a hands-on intervention, then assessed therapists' confidence levels following an educational intervention. Physical and occupational therapists who previously treated burn survivors were invited to complete a preworkshop confidence level survey. From this information, four burn rehabilitation interventional categories were identified: positioning and exercise, compression, wound healing, and burn resources. ⋯ Baseline therapists' confidence levels in treating burn survivors were low, but improved following a one-day educational workshop. Providing hands-on burn education improved the confidence of therapists who treat burn survivors. Future efforts to improve therapist confidence and patient outcomes need to be explored.