Racial and ethnic disparities are endemic to the United States and are only beginning to attract the attention of researchers. With an increasingly diverse population, focused and tailored medicine to provide more equitable care is needed. For surgical trauma populations, this topic is a small but expanding field and still rarely mentioned in burn medicine. Disparities in prevention, treatment, and recovery outcomes between different racial and ethnic minorities who are burned are rarely discussed. The purpose of this study is to determine the current status of identified disparities of care in the burn population literature and areas of future research. A systematic review was conducted of literature utilizing PubMed for articles published between 2000-2020. Searches were used to identify articles that crossed the burn term (burn patient OR burn recovery OR burn survivor OR burn care) and a race/ethnicity and insurance status-related term (race/ethnicity OR African-American OR Black OR Asian OR Hispanic OR Latino OR Native American OR Indigenous OR Mixed race OR 2 or more races OR socioeconomic status OR insurance status). Inclusion criteria were English studies in the US that discussed disparities in burn injury outcomes or risk factors associated with race/ethnicity. 1,169 papers were populated, 55 were reviewed, and 36 articles met inclusion criteria. Most studies showed minorities had poorer inpatient and outpatient outcomes. While this is a concerning trend, there is a paucity of literature in this field and more research is needed to create culturally-tailored medical care and address the needs of disadvantaged burn survivors.
Introduction A significant portion of intensive care unit (ICU) patients require a Foley catheter during their admission. Foley use has become more criticized as nationwide quality improvement processes attempt to reduce catheter associated urinary tract infections (CAUTI). Burn patients in the ICU have a higher rate of catheter utilization due to difficult fluid management, need for accurate volume measurements, and significant wound care. Males may have a condom catheter exchanged once they are stabilized. Historically, a noninvasive alternative to the Foley has not been available for females. While the female external catheter has existed for quite some time and hospital systems are increasingly encouraging their use, there is no standard of practice for when they are best utilized. Specific to the burn population, potential barriers include body habitus, perineal burns, and pain on frequent changing of the device. Our study aims to evaluate the current female external catheter use in our burn ICU in order to develop a standard protocol to increase utilization while thoughtfully delineating the contraindications. Methods A quality improvement project for guidelines on the use of a female external urinary collection device was conducted. All female patients admitted to the burn ICU during 2019 were included. Data was collected on burn TBSA, anatomic location, ICU days, ventilator days, and foley catheter days. Foley catheter days, external urinary catheter days, urinary tract infection (UTI) rates, and incidence of failure of external device were collected. Results Of the 46 total female burn patients, 31 required a foley catheter at some point during their stays. 11 patients used an external urinary collection device. Of the 11 users, one urinary device had to be removed due to skin breakdown. One other patient required replacement with a Foley catheter as a result of oliguria and the need for closer fluid management. 5 of the successful users of the external catheter were clinically obese. No patients contracted a UTI while using the external catheter. 3 UTI’s developed in women while using a Foley catheter. Patients who had altered mental status and perineal wounds were not eligible to use the external catheter. Conclusions In our practice, we found contraindications to external female catheter use to include altered mental status and perineal wounds. Obesity was not a contraindication and device usage may be most beneficial in incontinent patients. Further investigation is needed to better optimize female external urinary collection device usage within the burn ICU setting. This may help minimize CAUTI’s among female burn patients.
Eine 24-jährige Patientin stellt sich mit seit einem Tag bestehenden diffusen krampfartigen abdominalen Schmerzen, Appetitverlust, Nausea und Emesis sowie Diarrhö auf der Notfallstation vor. In der kör-perlichen Untersuchung können epigastrische Druckschmerzen ohne peritoneale Reizung erhoben werden. In der laborchemischen Untersuchung finden sich normwertige Leukozyten bei erhöhtem C-reaktives-Protein(CRP)-Wert (94,4 mg/l). Es war 28 Monate zuvor bei morbider Adipositas [initialer Body-Mass-Index (BMI) 41,5 kg/m 2 ] die Durchführung eines laparoskopischen antekolischen, antegastrischen Roux-en-Y-Magenbypass (RYGBP) mit anisoperistaltischer Seit-zu-Seit-Jejunojejunostomie erfolgt. Bisher war der Verlauf komplikationslos, und die Patientin hatte ihr Übergewicht um 95,1% reduziert (aktueller BMI 25,8 kg/m 2 ). ComputertomographieIn der kontrastmittelgestützten Computertomographie des Abdomens (Abdomen-CT) kann ein "target sign" im Bereich der nutritiven Schlinge nachgewiesen werden (. Abb. 1). Die Bezeichnung beruht darauf, dass bei der Einstülpung eines Dünndarmabschnitts in einen anderen, beim axialen Schnittbild beide konzentrischen Dünndarmwände in Form einer "Zielscheibe" dargestellt werden.
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