| Objective1.Burns are tissue injuries caused by high temperature,chemicals,or electricity.Severe burns can involve all the organs and tissues of the human body,leading to a series of pathophysiological processes and even death.2.This article reviews clinical data from burn patients and cases resulting in death from burns to provide evidence for burn severity analyses.Methods1.Cases selection and investigationBased on the Electronic Medical Record System(EMRS),we collected data for burn patients who were admitted to Southwest Hospital from January 1,2009,to December 31,2016.Patients without acute burn injuries(i.e.,those with scarring or cosmetic problem s),chronic wounds and others,were excluded.We recorded the medical records of hospitalized patients,including demographic information,causes of and factors related to the injury,the condition of the burn,prehospital and hospital treatment,major com plications and the treatment results.2.Statistical MethodsAfter the data were collected and listed using Excel 2007(Microsoft Corp.,Redmond,WA,USA),the statistical software SPSS 20.0(IBM Corp.,Armonk,NY,USA)was used to perform analysis of variance,post hoc tests and theχ～2 test between different groups.The mean±standard deviation or the median[interquartile range(IQR)]was used to describe the dispersion of variables among the statistical data.The Mann-Whitney U-test was performed to compare two or more medians of categorical variables(age,gender,type of burn,outcome).Multivariate logistic regression analysis was used to screen for risk factors for burn patients.Theχ～2 test was used for pairwise and multi-group comparisons.P<0.05was considered to indicate statistical significance.Results1.During the period from 2009 to 2016,13,205 burn patients were admitted to the Burn Research Institute of Southwest Hospital of the Army Medical University(Chongqing,China).After excluding 3,426 inpatients who were not mainly treated for burns,9,779patients were retained.Among them,6,560(67.1%)were male and 3,219(32.9%)were female.The burn patients covered each age group,with those aged 25-49 years accounting for the largest proportion at 36.1%.The patients were mainly from Chongqing,followed by Sichuan and Guizhou.The median and IQR of the length of stay was 17(9-33)days.The group aged 0-1 years included almost the same number of patients as that of the group aged2-14 years.According to a statistical analysis,the mortality rate was only 0.7%.The medians and IQRs of the TBSA and full-thickness burn area for all patients are presented in Table I.When formulating a burn prevention strategy,it is required to consider not onl y the characteristics of the burn itself but also the distribution,season,climate and human factors of the local population.Male inpatients were more common than female inpatients.The proportions of burn patients admitted in the Spring,Summer,Autumn and Winter were 25.8,28.3,22.2 and 23.7%,respectively,with the proportion being slightly higher in the Summer.2.The 0-10-year-old group had the largest number of burns and included more males than females.In the 0-1-year-old age group,no significant difference was observed among the patients in terms of gender and causes of injury.In the group of patients aged≥2 years,significant differences in the cause of the burn between different genders were identified.With the increase in age,the number of patients with burn injuries decreased.Of note,2,637 male patients and 898 female patients were included in the 25-49-year-old group.As presented in Table II,the number of male burn patients was higher than that of females.After dividing the patients into 5 different age groups,a significant difference in the cause of injury by gender in the 0-1-year-old age group was identified,while significant differences were present in the other age groups(P<0.01).Analysis of the TBSA by gender revealed no significant differences(P>0.05).3.Among all of the hospitalized patients,the minimum TBSA was 0.1%and the maximum TBSA was 100%The groups with a TBSA of 0-5%and 6-15%included more burn victims but fewer deaths compared with those in the groups with a higher TBSA..With the increase in the TBSA,the number of deaths increases gradually.The number of deaths increased significantly when the TBSA was>50%,although the number of cases in that group was lower than that in the groups with a lower TBSA.4.Scalding,flame and electricity were the major causes of burn injury,followed by solid materials and hot steam.A significant difference was identified in the TBSA between different burn types and in-hospital mortality.Other causes of burns mainly included infrared,ultraviolet and high-temperature dust.Among all causes of burn injury,the death rate of patients with chemical burns was highest,as the burn degree was deeper and the complications were more serious.Recently,with the renewal of treatment concepts and the refinement of the management of burn patients,the importance of the LOS of burn patients has gradually been emphasized These new treatment concepts and patient management contribute to the shorter LOS and lower mortality in 2015 and 2016.5.Clinicians face numerous difficulties when treating burns.The factors that may affect the survival of burn patients include widespread complications,patient age,burn area and tolerance to injury.As determining the sole cause of death for a patient is difficult,the present study focused on the patients who succumbed to mortality and aimed to identify what factors might increase their risk of death.Among all of the cases that resulted in death,sepsis and organ complications(internal organ failure and bleeding)were the most common and major causes,although in certain cases,death occurred due to mild inhalation injury and shock..Statistical analysis indicated that the patients with more complications also had higher mortality rates.For instance,29.41%of the burn patients with two types of complication died,while the mortality rate was 60.29%for the burn patients with three types of complication.However,with the improvement in medical treatment and the high quality of nursing technology,a decline in the number of deaths induced by sepsis and organ complications has been observed.6.The three major complications in burn patients are inhalation injury,shock and infection.In the present study,shock was selected as an index for multivariate analysis.Infection is mainly a matter that requires the attention of medical staff.In addition,certain studies have expressed doubt regarding inhalation injury as a prognostic factor in burn patients;prior to the popularization of the fibrotic bronchoscope at our institution,the diagnosis of inhalation injury mainly relied on the clinician’s experience,this subjective assessment can sometimes be controversial.Therefore,inhalation injuries as an index affecting the risk of mortality of burn patients were not included.First,single-factor analysis was used to screen and reassign multiple variables associated with death.Subsequently,the variables were subjected to analysis with multivariate logistic regression models.Next,the fitting method was used to screen six risk factors associated with burn-associated death.After sorting the factors according to their odds ratio,it was revealed that explosion,shock,age,TBSA and full-thickness burn area were risk factors for burn injury-associated death.As presented in the results,patients injured by an explosion had the highest OR..Therefore,the mortality rate of these patients is higher;indeed,the mortality rate of burn patients injured by explosions was reported to be 38.46%.With the increased LOS,the patient mortality decreased(regression coefficient,-0.020;P<0.001).ConclusionsWith improvements in burn treatment technology in recent years,burn patient mortality was significantly reduced.Complications,including multiple organ failure and severe systemic infection,may reduce the survival rate of patients.The major risk factors for death included burns resulting from explosions,as well as shock,age(aged 0-1 or≥50years),greater TBSA and full-thickness burn area.With increasing length of stay at the hospital,patient mortality decreased.The renewal of treatment concepts and refined patient management contributed to the shorter LOS and lower mortality in 2015 and 2016. |
PDF Full Text Request