Burns : journal of the International Society for Burn Injuries
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Case Reports Clinical Trial
Initial experience of using GRAFTAC absorbable staples to attach split skin grafts.
The GRAFTAC skin stapler with absorbable tacs has been used to attach split-skin grafts in 28 patients, under a variety of clinical situations, and the outcomes studied. This knowledge has been reviewed in the light of our existing experience with the more familiar metal staple. ⋯ The relative costs were analysed and an attempt made to compare the cost-effectiveness of tacs and staples. A rationale for use of the more expensive GRAFTAC stapler is presented.
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This retrospective study involved analysis of the data of the inpatients discharged with a diagnosis of burns, from various hospitals in Scotland, during the period 1970-92. There were 51,350 such inpatients all over Scotland, with an average annual rate of 2233 cases. Overall burn incidence in actual numbers was 43.7 per cent in < 15 year olds, 41.2 per cent in 15-64 year olds and 15.1 per cent in > or = 65 year olds. ⋯ The total number of deaths due to burns and/or smoke inhalation has declined in all age groups and the decline has been statistically significant (chi-squared = 19.62, 1 d.f., P < 0.001). Maximum number of deaths occurred in > or = 65 year olds (44 per cent), followed closely by 16-64 year olds (43.5 per cent), and 12.5 per cent of deaths in adolescents and children. The decline was due to improved management of burns and a decrease in the number of patients having large body surface area burns.
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Electrical injuries are unique with respect to low mortality rates, but very high rates of short- and long-term morbidity, and overall outcome. Controversy still exists regarding the advantages of one-stage debridement versus early serial debridement of necrotic tissue. The purpose of this study was a retrospective evaluation of treatment, morbidity and outcome in a group of patients with electrical injuries. ⋯ The average length of stay was 22 days, and the cost of hospitalization ranged from $900 to $120 000 (mean !4,901). Significant long-term neurological deficits persisted in 73 per cent of patients at long-term follow-up (mean 4.5 years). Only 5.3 per cent of patients after high-voltage electrical injury were able to return to their premorbid job.
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This review assess the influence of burn variables on patients' survival using epidemiological analysis of 144 patients admitted over a 2-year period, the overall mortality rate was 9.7 per cent. The risk of mortality in patients with 30-50 and 50-80 per cent total body surface area (TBSA) burns was 16 and 86 times that in patients with less than 30 per cent TBSA burns respectively. ⋯ When burn surface area (BSA) exceeded 30 per cent TBSA, the effect of the other two variables on survival were reinforced. When the patients' age was under 6 years and BSA was above 85 per cent TBSA, the risk of mortality was increased five times but insignificantly raised its rate.
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This study attempts to measure and quantify changes in workload and outcome in clinically ill burn patients admitted to the intensive care unit at this institution over the 11-year period 1982-92. The case notes were studied for all patients admitted to the intensive care unit, 163 cases in total, but information was incomplete in 14. Mortality over the period is compared, using Chi squared analysis with Yates correction, with mortality probability from Bull's chart relating age and body surface area of burn (1971). ⋯ The duration of stay for admitted patients also shows an increase, the combination of these factors suggesting an increasing workload. There has been no change in outcome over the period. The figures provide a baseline for comparison of outcome in critically ill burn patients and are an important means by which to measure future change.