Burns : journal of the International Society for Burn Injuries
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Data pertaining to 562 consecutive admissions for burn treatment were analysed to identify factors related to survival. Besides socioeconomic, demographic and burn-related variables, three indices to measure burn severity, were proposed and evaluated with the help of multiple regression and discriminant analyses. The results of multiple regression analysis showed that one of the proposed indices, total burned surface (TBS), based on presence or absence of burn injury on 11 different body sites, turned out to be the best single predictor of survival. ⋯ Using this cut-off point (20 per cent) the TBS index provided the correct prediction of the eventual survival status in about 93 per cent of 562 patients. This cut-off point score of 20 was cross-validated on an independent sample of 924 cases. The prediction in 79 per cent of patients could be made correctly.
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A review of 113 patients with massive burns treated in our centre from 1970 to 1989 is presented. There were 57 adults patients with massive burns (> or = 50 per cent TBSA) in 1980-89 who were compared with 56 patients with similar massive burns in the period between 1970 and 1979. The results show a significant improvement (P < 0.01) in survival rate of the more recent patients. The increased survival rate is attributed to improvements in the early treatment of inhalation injury, sepsis and multiorgan failure.
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Comparative Study
The progress of hypertrophic scars monitored by ultrasound measurements of thickness.
Ultrasound scanning was used to measure the thickness of hypertrophic scars following burn injury. Scarred areas on patients receiving pressure therapy were monitored at regular intervals from the initial healing, through the hypertrophic stage, to maturation of the scars. The data, collected over a period of 30 months, allowed a comparison of scar development in children and adults and a comparison of the response at different anatomical sites. Measurements made on individual patients could be related to factors affecting the progress of their hypertrophic areas and provided a useful backup to visual assessment during pressure garment therapy.
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Sixteen patients at various stages of pregnancy suffered burns covering between 10 and 80 per cent of the body surface area. This review highlights the management problems of these patients during the first, second and third trimesters. Only two mothers (both with 80 per cent TBSA burns) died. There were five fetal deaths, three of them intrauterine.
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Five hundred and eighty-three children (0-18 years old), consisting of 33.4 per cent of all burn inpatients, were admitted to the University of Alberta Hospitals over an 11-year period (January 1978 to December 1988). Demographic and outcome variables, in addition to aetiological factors, were examined. 48.4 per cent of burns occurred in children less than 4 years of age, with males predominating in every age group (P less than 0.001). Children had smaller burns, a higher incidence of scalds, less inhalation injuries and a lower mortality compared to adult burn patients admitted over the same time period (P less than 0.05). ⋯ High-risk environments identified were the home (74.6 per cent of burns) and recreational settings (12.4 per cent of burns), mainly occurring around campfires. Native children were overrepresented in the burn population compared to the general population by a factor of approximately 10:1. Scald prevention, high-risk environments (home and recreational), high-risk populations (male and natives) and unsafe practices with flammable liquids (petrol in particular) should be emphasized in paediatric burn prevention programmes.