Journal of burn care & research : official publication of the American Burn Association
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Comparative Study
Effects of a restrictive blood transfusion policy on outcomes in children with burn injury.
A restrictive blood transfusion policy decreases blood utilization and improves outcomes in critically ill adults, but the impact of a restrictive blood transfusion policy in critically ill children is unclear. The study purpose was to compare the effects of a restrictive with a traditional blood transfusion policy in children with major burn injury. A retrospective review of all blood transfusions administered in a pediatric burn center during a 5-year period was conducted. ⋯ Patients in the traditional group received more blood than the restrictive group (12.3 +/- 1.8 vs 7.2 +/- 1.2 units/patient, P < .001). The mean cost of blood per patient was $2781 for the traditional group and $1489 for the restrictive group. A restrictive transfusion policy in children with burn injury decreases the amount of blood transfused, does not adversely impact patient outcome, and results in significant cost savings to the institution.
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Suicide by burning is a rare condition in the developed countries (0.06-1% of all suicides) but is more frequent in the developing countries (accounting for as many as 40.3% of all suicides). In different parts of Iran, between 1.39% and 9.50% of patients that attempted suicide and 25.0% and 40.3% of patients who committed suicide were via deliberate self-burning. Self-burning (immolation) comprises between 0.37% and 40% of total burn center admissions around the world and, in Iran, it comprises between 4.1% and 36.6% of admissions in Iranian burn centers. ⋯ Overall, this study demonstrates that self-immolation should be considered as a mental health problem in our society, and it is necessary to implement programs and strategies to prevent it. The public health approach provides a framework for a National Prevention Strategy to address this serious national problem. Local data on victims and victim stories from self-immolation provided the stimulus for community action.
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The bilayered dermal substitute Integra (Integra Life Sciences Corp., Plainsboro, NJ) was developed and has been widely used as primary coverage for excised acute burns. Our take has been slightly different, finding it most useful in the management of complex soft-tissue loss and threatened extremities as the result of tendon, joint, or bone exposure. Often tasked to fill significant volume loss, we have become adept at stacked multiple-layer applications. ⋯ The specific reconstructive use of Integra permitted unexpected salvage of several threatened extremities by protecting exposed tendons, bones and joints. Long-term histologic examination revealed unexpected persistence of Integra collagen. Large volume loss wounds benefited from the ability to fill voids with multilayered applications.
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Multicenter Study Comparative Study
Burns as a result of assault: associated risk factors, injury characteristics, and outcomes.
The purpose of this study was to identify specific premorbid factors and injury characteristics associated with intentional burn injuries and to compare outcomes for individuals injured by assault and those with unintentional injuries. Participants sustaining major burns from May 1994 to August 2005 and consenting to a multisite, prospective, longitudinal outcome study were included. Etiology of the injury was classified as intentional (i.e., assault) or unintentional. ⋯ They also demonstrated significantly greater levels of psychological distress during the acute hospitalization but not at follow-up. Understanding the unique characteristics and needs of patients with intentional burn injuries is important because these individuals are less likely to have a steady income and more likely to rely on community social services. Affordable and accessible community-based health services are necessary in order to improve their outcomes.
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Multicenter Study
The National Institute on Disability and Rehabilitation Research burn model system database: a tool for the multicenter study of the outcome of burn injury.
Advances in critical care and surgical management have significantly improved survival after burn injury over the past several decades. However, today, survival alone is an insufficient outcome. In 1994, the National Institute on Disability and Rehabilitation Research (NIDRR) created a burn model system program to evaluate the long-term sequelae of burn injuries. ⋯ A total of 4600 patients have been entered into the NIDRR database. To date, 3449 (75%) patients were alive at discharged and consented to follow-up data collection. The NIDRR database provides an expansive repository of patient, injury, and outcome data that can be used to analyze the impact of burn injury on physical and psychosocial function and for the design of interventions to enhance the quality of life of burn survivors.