The Journal of burn care & rehabilitation
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J Burn Care Rehabil · Jan 1996
Comparative StudyComparison of length of hospital stay to mortality rate in a regional burn center.
Data were collected prospectively from 196 patients admitted to our regional burn center during a 10-month period. Fifteen patients died during hospitalization, for a mortality rate of 7.7%. The mean hospital stay of the 181 patients who survived was 13.9 days (+/- 13.7 SD), ranging from 2 to 89 days. ⋯ One hundred ten patients received at least 1 day of antibiotic treatment, and 22 patients required ventilatory support during hospitalization. Hospital stay was longer for those requiring antibiotics (18.6 days vs 7 days) or ventilatory support (34.4 days vs 11.2 days). When these and other variables were entered into a linear regression model, the most powerful predictors of hospital stay were burn size and duration of antibiotic use (p = 0.0001), followed next by the presence of other traumatic injuries (p = 0.047).
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J Burn Care Rehabil · Jan 1996
Randomized Controlled Trial Clinical TrialA randomized single-blind evaluation of a discharge teaching book for pediatric patients with burns.
To evaluate the influence of a modular, multidisciplinary, pediatric burn discharge book on burn-care-related knowledge and satisfaction of caregivers, we studied children less than 17 years of age admitted with an acute thermal injury to the pediatric burn unit of a large, tertiary care hospital in Winnipeg, Canada over a 32 month period. Demographic characteristics of the population are similar to published profiles of other pediatric burn units with the exception that North American Indian (NAI) families were disproportionately admitted, with 59 out of the 123 (48%) admissions from a geographic area that has less than 15% NAIs. We randomly assigned the families to receive discharge instructions with the book (intervention group) or routine discharge teaching without the book (comparison group). ⋯ A positive correlation (p < 0.05) was found with having English as the first language, having a child with more extensive burns, having a younger age of the child with burns, and having fewer children in the home. In conclusion, we found that the discharge book improved the burn-care-related knowledge of caregivers. However, other factors, particularly ethnic and language background, were of greater influence.
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J Burn Care Rehabil · Jan 1996
Case ReportsAssessment of cosmetic and functional results of conservative versus surgical management of facial burns.
This study was undertaken to determine whether tangential excision and thick split-thickness skin grafting (STSG) of deep facial burns give a better cosmetic and functional result than conservative management. Forty patients (28 adults, 12 children) treated for facial burns between July 1989 and July 1991 were evaluated in follow-up (mean 18.3 +/- 8.3 months). The patients were categorized into the following groups according to depth and management of their facial burns: (A) healed without surgery in less than 21 days (n = 13), (B) healed without surgery in 21 days or more (n = 11), (C) early debridement and thick STSG in 18 days or less after the burn (n = 6), and (D) delayed debridement and thick STSG in more than 18 days after the burn (n = 10). ⋯ The most common functional problems for these patients were microstomia (17/27) and eyelid ectropion (17/27). Patients with superficial facial burns that heal in less than 21 days appear to heal with generally very acceptable cosmetic and functional results. However, in those patients with deep facial burns that require prolonged periods for spontaneous wound healing, tangential excision of the wound and resurfacing with thick STSG appear to give better cosmetic results than conservative management, with no greater incidence of functional complications.
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Toxic epidermal necrolysis syndrome is one of several clinically similar, severe acute, exfoliative skin disorders that have become of increasing interest to burn surgeons in recent years. Recognition of a clinical course similar to extensive second-degree burns has resulted in the development of treatment protocols that are best carried out in a burn unit by personnel experienced in critical care techniques, the management of extensive cutaneous injuries, fluid and electrolyte derangements, and intensive nutritional support of critically ill patients. ⋯ The target organs of the immune reaction are skin and mucous membranes. Appropriate management of the extensive skin wounds and the nutritional and critical care support afforded by treatment in burn units appears to have contributed significantly to the increasing survival of patients with this devastating and potentially lethal illness.
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J Burn Care Rehabil · Jan 1996
The use of haloperidol in the agitated, critically ill pediatric patient with burns.
Haloperidol has become the drug of choice for sedation of the acutely agitated, delirious adult patient in the critical care setting because of its well-documented efficacy and lack of major side effects. Its use in the critically ill pediatric patient with burns has not been described. ⋯ Our findings support the safe and effective use of haloperidol to treat severe agitation and delirium in the critically ill pediatric patient. The intravenous route appears to be more effective than the enteral route and should be considered when rapid, acute control of agitation is required.