Burns : journal of the International Society for Burn Injuries
-
Stevens Johnson Syndrome/toxic epidermal necrolysis (SJS/TEN) are rare, potentially fatal desquamative disorders characterised by large areas of partial thickness skin and mucosal loss. The degree of epidermal detachment that occurs has led to SJS/TEN being described as a burn-like condition. These patients benefit from judicious critical care, early debridement and meticulous wound care. This is best undertaken within a multidisciplinary setting led by clinicians experienced in the management of massive skin loss and its sequelae. In this study, we examined the clinical outcomes of SJS/TEN overlap & TEN patients managed by our regional burns service over a 12-year period. We present our treatment model for other burn centres treating SJS/TEN patients. ⋯ Management in our burns service with an aggressive wound care protocol involving debridement of blistered epidermis and wound closure with synthetic and biological dressings seems to have produced benefits in mortality when compared to predicted outcomes.
-
Observational Study
Measuring serum albumin levels at 0 and 24h: Effect on the accuracy of clinical evaluations in the prediction of burn-related mortality.
To evaluate whether measuring serum albumin levels in clinical assessments affects the accuracy of mortality predictions in large burns and to compare patients' serum albumin levels at hour 0(Alb0h) and hour 24(Alb24h) following their admission. ⋯ Measuring serum albumin levels in clinical assessments slightly increases the accuracy of mortality predictions; however, different cut-off points for Alb0h and Alb24h needs to be considered to avoid interpretation errors.
-
Observational Study
Characterization of variables for potential impact on vancomycin pharmacokinetics in thermal or inhalation injury.
To characterize the pharmacokinetics of vancomycin dosing in thermal or inhalation injury as they relate to percent total body surface area burn (TBSA) and days since injury (DSI). ⋯ DSI, percent TBSA, and CrCl can be used to predict faster vancomycin CL and need for higher total daily doses. Augmented pharmacokinetics can occur as early as two days after injury and decrease with time. Acceptable target trough attainment is still lacking and this data should assist in performance improvements for initial vancomycin dosing.
-
Journal clubs allow discussion of the quality and findings of recent publications. However, journal clubs have not historically been multidisciplinary. Burn care is recognized as a true collaborative care model, including regular multidisciplinary rounds. Since 2011 we have offered a multidisciplinary burn journal club at our institution. We present an evaluation of the factors that have made the sessions successful to facilitate others to commence their own club. ⋯ The success of the journal club has been possible through the engagement of the entire burn team. Champions within each discipline, facilitated discussion and evaluation tools have helped nurture a nonthreatening team based learning environment.
-
To compare hospitalisations for diabetes mellitus (DM) after injury experienced by burn patients, non-burn trauma patients and people with no record of injury admission, adjusting for socio-demographic, health and injury factors. ⋯ Burn and non-burn trauma patients experienced elevated rates of DM admissions after injury compared to the non-injured cohort over the duration of the study. While burn patients were at increased risk of incident DM admissions during the first 5-years after the injury this was not the case for non-burn trauma patients. Sub-group analyses showed elevated risk in both adult and pediatric patients in the burn and non-burn trauma. Detailed clinical data are required to help understand the underlying pathogenic pathways triggered by burn and non-burn trauma. This study identified treatment needs for patients after burn and non-burn trauma for a prolonged period after discharge.