Elsevier

Burns

Volume 42, Issue 3, May 2016, Pages 655-662
Burns

Epidemiology and outcome analysis of burn patients admitted to an Intensive Care Unit in a University Hospital

https://doi.org/10.1016/j.burns.2015.08.002Get rights and content

Highlights

  • Liquid alcohol was the most common causative agent of burns in our patients.

  • Home incidents were the most common place of injury.

  • Abbreviated Burn Severity Index was the score with the best performance.

  • Mortality was high for patients who received intensive care treatment.

Abstract

Objectives

To describe the epidemiologic aspects of burn victims who were hospitalized in the Intensive Care Unit (ICU) at the Burn Center in the University Hospital of the State University of Londrina (UEL).

Methods

A longitudinal retrospective study was conducted, involving patients admitted to the Intensive Care Unit of the Burn Center from January 2010 to December 2012. Demographic and diagnostic data including the diagnosis of the extent and causes of the burns, complications resulting from the burns and the need for specific surgical interventions were collected, together with data for the calculation of the Acute Physiology and Chronic Health Evaluation (APACHE II), Sequential Organ Failure Assessment (SOFA), Therapeutic Intervention Scoring System (TISS-28) and Abbreviated Burn Severity Index (ABSI). Data were collected at admission and daily until discharge from the burn Intensive Care Unit. Risk factors for death and the prognostic performance of scores to predict mortality were analyzed. The level of significance was set at 5%.

Results

Two hundred ninety-three patients were analyzed in the study; 68.30% were men, with a median age of 38 years (interquartile range: 28–52). The mean total body surface area burned was 26.60 ± 18.05%. Home incidents were the most frequent cause, occurring in 53.90% of the cases. Fire was the most common cause, found in 77.10% of patients. Liquid alcohol was the most common agent and was associated with 51.50% of the cases. The ABSI presented a median of 7, and the area under the ROC curve was 0.890. In multivariate analysis, age (p < 0.001), female gender (p = 0.02), total body surface area burned (p < 0.001), mechanical ventilation (p < 0.001) and acute renal failure (p < 0.001) were all associated with mortality. ICU mortality was 32.80%, and hospital mortality was 34.10%.

Conclusion

Burns most often occurred in young adult men in our study. The most common cause was a direct flame. Liquid alcohol was the most frequent accelerating agent. Patients were considered to be severely burned. Most of the samples had a high mean total body surface area burned. The ABSI score showed the best performance in discriminating non-survivors. Hospital mortality rate was high.

Introduction

Loss of skin integrity by injury or disease can result in important physiological imbalance, serious dysfunction or death. The most common causes of skin loss are burns, trauma and chronic wounds. A severely burned patient poses a challenge for a multidisciplinary therapeutic approach and has a great social impact because it affects a wide age range, including young adult patients of working age, and often leaves permanent sequelae [1]. The severity of a burn is mainly related to the total body surface area (TBSA), lesion depth and extreme ages. Inhalation injury is also described as one of the main factors that are associated with increased mortality [2].

According to the World Health Organization (WHO), approximately 11 million victims of burn per year need specialized care worldwide, becoming the fourth leading cause of direct trauma. It is estimated that a direct flame is responsible for 300,000 deaths each year. Although mortality from burns has been reduced in recent decades, 90% of the deaths occur in low and middle income countries. Risk factors for the occurrence of burns include socioeconomic status, race, ethnicity, age, gender, environment, comorbidities, regional factors and intent of injury, e.g., in homicide or suicide cases [3].

In Brazil, according to the Brazilian Society of Burns, about one million incidents involving burns occur each year, resulting in approximately 100,000 hospitalizations. The mortality rate from burns by flames in Brazil is 0.8/100,000 population/year, resulting in 1600 deaths per year [4]. Specialized units for burn treatment are scarce and unevenly distributed in Brazil. Of the 46 existing units in the country, 25 are concentrated in the southeast region [5].

Epidemiological studies with Latin American and especially Brazilian data are scarce, justifying an epidemiologic study with regional data. The present study was designed to answer questions about the most frequent causes of burns, clinical characteristics of patients and risk factors for death.

Section snippets

Methods

A longitudinal and retrospective study involving patients admitted to the Intensive Care Unit of the Burn Center of a University Hospital was conducted from January 2010 to December 2012. The Burn Center is composed of sixteen beds distributed in six Intensive Care Unit (ICU) beds and 10 ward beds, one emergency room and one operating room. All patients who were consecutively admitted in the six-bed ICU were included in the study period. Exclusion criteria were length of ICU stay less than 24 h,

Results

From January 2010 to December 2012, 414 patients were admitted in the six-bed ICU of the Burn Center. Reasons for patient exclusions were 80 patients who were less than 18 years old, one patient who was admitted for burn sequelae, four patients who had Stevens–Johnson syndrome, 18 patients who stayed less than 24 h in the ICU and 18 patients with other diagnoses. Therefore, 293 patients were analyzed in the study (Fig. 1). Patients had a median age of 38 years (interquartile range [ITQ] 28–52);

Discussion

This study evaluated the epidemiological data of burn patients who were admitted to an Intensive Care Unit that specialized in burns at a University Hospital. Because this is a study that examines severe burns, our patients had greater TBSA and a higher mortality than those described in other studies [14], [15], [16], [17]. In Lacerda et al., 65.35% of patients were considered to have a low severity of burns, with an average of 11.3% TBSA, resulting in an overall mortality rate of 5.94% [17]. A

Contributors

Queiroz, LFT: conception of the study, acquisition of data, drafting the article, final approval of the version to be submitted.

Grion, CMC: design of the study, analysis and interpretation of data, revising the article, final approval of the version to be submitted.

Anami, EHT: conception of the study, acquisition of data, revising the article, final approval of the version to be submitted.

Zampar, EF: conception of the study, acquisition of data, revising the article, final approval of the

Conflict of interest

None declared.

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