The Journal of burn care & rehabilitation
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J Burn Care Rehabil · Nov 1991
Randomized Controlled Trial Comparative Study Clinical TrialBurn size estimate reliability: a study.
A study was undertaken to assess any differences between physicians' and nurses' estimates of burn size from drawings of 10 hypothetical patients with burns. Patient drawings were sent to the 199 burn facilities that are listed in the American Burn Association's Burn Care Resources in North America 1989-1990. The mailings were randomized between physicians and nurses. ⋯ Estimates of burn sizes with the use of standardized burn forms were consistently the same whether estimates were made by physicians or nurses. Sixty-eight percent of the respondents used the Rule of Nines or the Lund & Browder chart to estimate burn size, but 21% of the respondents failed to answer the question about which method is used in their units. In conclusion, there appears to be little variance in estimation of burn size as made by experienced burn nurses and physicians, and use of these estimates in a centralized data bank should be reliable.
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J Burn Care Rehabil · Nov 1991
Comparative StudyA prospective safety study of femoral vein versus nonfemoral vein catheterization in patients with burns.
A prospective study was undertaken to determine the safety of femoral vein catheterization in patients with burns. Forty-two patients had a total of 275 catheterizations and were divided into two groups: group 1, femoral vein catheterization = 80 catheters and group 2, nonfemoral vein catheterization = 195 catheters (180 subclavian, 8 internal jugular, and 7 supraclavicular). All catheters were changed to new sites every 48 hours, and dressings were changed every 24 hours. ⋯ There were no noninfectious complications from femoral vein catheterization. Two subclavian catheters had to be repositioned. This study suggests that central venous access in patients with burns can be safely employed with the use of the femoral vein.
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J Burn Care Rehabil · Nov 1991
Comparative StudyCultured epithelial autografts: three years of clinical experience with eighteen patients.
Eighteen patients with major burns (mean total body surface area burned was 49% and mean total body surface area with full-thickness burns was 38%) had cultured epithelial autografts applied to 2% to 35% of the body surface area. In six patients successful "take" of greater than 65% occurred, and in 12 patients less than 40% "take" occurred. Most wounds underwent early excision to subcutaneous fat or fascia, and the wounds of 16 patients had been treated previously with homograft. ⋯ The anterior trunk and thighs are the best recipient sites. The number of autograft harvests that were required to close wounds and the length of hospital stay were not significantly decreased by the use of cultured epithelial allografts as compared with comparable full-thickness burns that were treated previously without cultured epithelial allografts. Presently, grafting with cultured epithelial allografts is an adjunct but not an alternative to conventional burn-wound coverage with split-thickness autograft, because engraftment is inconsistent.
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J Burn Care Rehabil · Nov 1991
Do trauma scores accurately predict outcomes for patients with burns?
A highly refined quality assurance program relies on accurate outcome evaluations and the identification of patients who are truly worthy of peer review. In our hospital, the Glasgow Coma Score, the Trauma Score, and the Injury Severity Score are used to monitor patients with burns. ⋯ Linear regression techniques demonstrated that only the Baux Score, the Edlich Burn Score, and the Zawacki Score were correlated with length of stay (p less than 0.01). On the basis of this retrospective review, the Baux Score, the Edlich Burn Score, and the Zawacki Score more accurately predicted outcomes for patients with burns than did the Trauma Score, the Injury Severity Score, and the Glasgow Coma Score; these scores can thus provide the most valuable information for quality assurance activities.
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J Burn Care Rehabil · Nov 1991
Reduced fluid volume requirement for resuscitation of third-degree burns with high-dose vitamin C.
The effects of high-dose vitamin C therapy (170 mg, 340 mg, and 680 mg/kg/day) were evaluated in 70% body surface area third-degree burns in guinea pigs that were resuscitated with 1 ml/kg/%burn Ringer's lactate solution. The water content measurements of the burned skin at 24 hours after burn injury in the vitamin C-treated groups were significantly lower than those of the control group (1 ml/kg/%burn) and those of the standard resuscitation group (4 ml/kg/%burn). ⋯ In comparison with the regimen of 340 mg vitamin C, the regimen of 680 mg vitamin C was no more beneficial, and the regimen of 170 mg was less effective. With administration of adjuvant high-dose vitamin C, we were able to reduce the total 24-hour resuscitation volume from 4 ml/kg/%burn to 1 ml/kg/%burn, while a comparable cardiac output was maintained.