Journal of burn care & research : official publication of the American Burn Association
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We sought to present the epidemiology of intentional burns, both deliberate self-inflicted burns and assault burns. Patient records from the University of Alabama at Birmingham Burn Center were reviewed retrospectively. Information pertaining to demographic and injury characteristics were obtained. ⋯ Patients sustaining intentional burn injury had larger mean TBSA burned (26.1% vs 13.8%), longer mean hospital length of stay (19.9 days vs 13.2 days), higher incidence of inhalational injury (20.8% vs 8.7%), higher rate of mortality (20.0% vs 9.8%), and were more likely to have an elevated blood alcohol content (14.6% vs 7%) when compared with all other burn patients. Patients with deliberate self-burns were more likely to be men (85.7% vs 55.7%) and more likely to have a positive drug screen test than assault burn patients (11.4% vs 0%). Patients who suffer intentional burns tend to have more severe burns and experience worse outcomes.
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Randomized Controlled Trial Multicenter Study
Randomized clinical study of Hydrofiber dressing with silver or silver sulfadiazine in the management of partial-thickness burns.
This prospective, randomized study compared protocols of care using either AQUACEL Ag Hydrofiber (ConvaTec, a Bristol-Myers Squibb company, Skillman, NJ) dressing with silver (n = 42) or silver sulfadiazine (n = 42) for up to 21 days in the management of partial-thickness burns covering 5% to 40% body surface area (BSA). AQUACEL Ag dressing was associated with less pain and anxiety during dressing changes, less burning and stinging during wear, fewer dressing changes, less nursing time, and fewer procedural medications. Silver sulfadiazine was associated with greater flexibility and ease of movement. ⋯ The AQUACEL Ag dressing protocol tended to have lower total treatment costs (Dollars 1040 vs. Dollars 1180) and a greater rate of re-epithelialization (73.8% vs 60.0%), resulting in cost-effectiveness per burn healed of Dollars 1,409.06 for AQUACEL Ag dressing and Dollars 1,967.95 for silver sulfadiazine. A protocol of care with AQUACEL(R) Ag provided clinical and economic benefits compared with silver sulfadiazine in patients with partial-thickness burns.
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Randomized Controlled Trial Comparative Study
Comparing the Vancouver Scar Scale with the cutometer in the assessment of donor site wounds treated with various dressings in a randomized trial.
Cutaneous scarring observed in wounds is, to a significant degree, dependent upon the time it takes for the wounds to heal. Various topical dressings are proposed to influence healing time in donor sites. In this prospective randomized study, we examined the effect of Vaseline gauze (VD; Branolind, Paul Hartmann AG, Germany), Biobrane (BD; Bertek Pharmaceuticals, Inc., Morgantown, WV), an occlusive film dressing Barrier Flex (OD; Moelnlycke Health Care GmbH, Germany), and an equine collagen foil, Tissu Foil E (CD; Baxter, Heidelberg, Germany), on re-epithelialization and scarring in standardized donor site wounds. ⋯ Viscolelastic differences did not significantly correlate with healing time. Various wound dressings had minimal yet significant influence on healing time and scarring. In contrast to the VSS, viscoelastic measurements of skin pliability can objectify scarring when few differences are anticipated.
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Fluid therapy for burn shock is adjusted to establish a target level of urinary output. However, the means for adjusting infusion rate are not defined. Our objective was to compare the performance of automated computer-controlled resuscitation with manual control for burn resuscitation. ⋯ Hourly urinary output in the technician group was undertarget by 25% as opposed to 16% with the closed-loop group (P = .02). Automated closed-loop control of infusion rates after burn injury produced urinary outputs in target ranges with less variation and less under target values than manual hourly adjustments. Closed-loop resuscitation may provide an improvement over current resuscitation regimens.
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Scald burns by domestic tap water constitute a painful, potentially debilitating, and sometimes-fatal form of thermal injury. In this setting, the very young and older members of the population are particularly susceptible, owing in part to having thinner skin, which renders them more susceptible to thermal insult. Various codes have set forth a safety standard for maximum delivery temperature of domestic tap water at 120 degrees F (48.9 degrees C), based on adult susceptibility to burns. ⋯ The mathematical model shows that the equivalent surface temperature for a threshold scald injury in children is dependent on the depth into the skin at which the injury is identified. For example, the injury produced by a 120 degrees F, 10-second exposure at a depth of 600 microm in an adult is matched in a child at 72% of the depth (432 microm) by an insult of 115.9 degrees F for the same duration. The recommendation is that existing hot water standards be reduced by 3 to 4 degrees F to provide an equivalent level of scald protection to children.