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A prospective analysis of risk factors for pediatric burn mortality at a tertiary burn center in North India

Burns & Trauma 2017年第3期5卷 199-208页

作者： amol dhopte Rahul Bamal Vinay Kumar Tiwari Department of Plastic Reconstructive and Maxillofacial surgery Government Medical College and Hospital Nagpur 440003 India Department of Burns Plastic and Maxillofacial Surgery VMMC&Safdarjung Hospital New Delhi India Department of Burns and Plastic Surgery PGIMER&RML Hospital New Delhi India

Background:None of the available mortality predicting models in pediatric burns precisely predicts outcomes in every population. Mortality rates as well as their risk factors vary with regions and among different centers within the regions. The aim of this study was to identify socio-demographic and clinical risk factors for mortality in pediatric burns in an effort to decrease the mortality in these patients. Methods:A prospective analytical study was conducted in patients up to the age of 18 years admitted for burn injuries in a tertiary care burn center in India from January to December 2014. Clinical and demographic data was col ected through questionnaire-interview and patient fol ow-up during their stay in the hospital. Univariate and multivariate firth logistic regression was used to identify various risk factors for mortality in pediatric burns. Results:A total of 475 patients were admitted during the study period. Overal mortality was 31.3%(n=149) in this study. Mean age of the patients who died was 8.68 years. Of the 149 deaths, 74 were males and 75 were females (male to female ratio=0.98). Mean total body surface area (TBSA) involved of the patients who expired was 62%. Inhalational injury was seen in 15.5%(n=74) of pediatric burn admissions. Mortality was significantly higher (74.3%) in patients with inhalation injury. Mortality was highest in patients with isolates of Acinetobacter + Klebsiella (58.3%), followed by Pseudomonas + Klebsiella (53.3%), Acinetobacter (31.5%), and Pseudomonas (26.3%) (p < 0.0005). Factors found to be significant on univariate firth analysis were older age, female gender, suicidal burns, higher TBSA, presence of inhalation injury, increased depth of burn, and positive microbial cultures. On multivariate analysis, higher TBSA was identified as an independent risk factor for mortality. The adjusted odds ratios for TBSA involvement was 21.706 (25.1-50%), 136.195 (50.1-75%), and 1019.436 (75.1-100%), respectively. Conclusion: TBSA

关键词： Pediatric burns Mortality Risk factors Microbiological cultures India

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Epidemiology of pediatric burns and future prevention strategies—a study of 475 patients from a high-volume burn center in North India

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Burns & Trauma 2017年第1期5卷 50-57页

作者： amol dhopte V.K.Tiwari Pankaj Patel Rahul Bamal Department of Burns Plastic&Maxillofacial SurgeryVMMC&Safdarjung HospitalNew DelhiIndia Present Address:Department of Burns&Plastic Surgery PGIMER&RML HospitalNew DelhiIndia

Background: Pediatric burns have a long-term social impact. This is more apparent in a developing country such as India, where their incidence and morbidity are high. The aim of this study was to provide recent prospective epidemiological data on pediatric burns in India and to suggest future preventive strategies. Methods: Children up to 18 years old admitted to the Department of Burns, Plastic&Maxillofacial Surgery, VMMC&Safdarjung Hospital, New Delhi, between January and December 2014 were included in the study. Data regarding age, sex, etiology, total body surface area (TBSA), circumstances of injury, and clinical assessment were collected. The Mann-Whitney test or Kruskal-Wallis test or ANOVA was used to compare involved TBSA among various cohort groups accordingly. Univariate and multivariate linear regression analyses were used to determine the predictors of TBSA. Results: There were a total of 475 patients involved in the study, including seven suicidal burns, all of whom were females with a mean age greater than the cohort average. Age, type of burns, mode of injury, presence or absence of inhalation injury, gender, and time of year (quarter) for admission were found to independently affect the TBSA involved. Electrical burns also formed an important number of presenting burn patients, mainly involving teenagers. Several societal issues have come forth, e.g., child marriage, child labor, and likely psychological problems among female children as suggested by a high incidence of suicidal burns. Conclusions: This study also highlights several issues such as overcrowding, lack of awareness, dangerous cooking practices, and improper use of kerosene oil. There is an emergent need to recognize the problems, formulate strategies, spread awareness, and ban or replace hazardous substances responsible for most burn accidents.

关键词： Epidemiology Pediatric burns India Suicidal burns Burn prevention

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