Accurate burn depth estimation remains one of the foundations of optimal burn care. The method by which burn depth is determined has traditionally been clinical examination alone. This continues to hold true in the United States, despite a plethora of literature supporting the use of more accurate modalities such as laser Doppler imaging (LDI). LDI has widespread use in burn centers in the United Kingdom and around the world. Thus, the reason for a lack of use in U.S. burn centers remains elusive. A survey of U.S. burn center directors was conducted to assess their current practices and attitudes with regard to burn depth estimation at U.S. burn centers in an effort to answer this question. Surveys were returned from 68 burn center directors (49% response rate). All respondents reported using clinical examination in their current practice for the daily evaluation of acute burns, with a biopsy being the next most commonly used modality. The most preferred modality was also clinical examination (60%), followed by LDI (6%) and biopsy (4%). The top three modalities ranked as "most promising" for daily use were clinical examination, LDI, and noncontact/high-frequency ultrasound. Directors identified the top three limitations to the use of new technology as cost (72%), availability (63%), and lack of support by evidence to date (35%). Future studies may need to focus on overcoming these perceived limitations before the widespread use of LDI or other new modalities will be realized at burn centers in the United States.
Introduction. Agriculture is an industry where family members often live and work on the same premises. This study evaluated injury patterns and outcomes in children from farm-related accidents. Methods.A 10-year retrospective review of farm-accident related injuries was conducted of patients 17 years and younger. Data collected included demographics, injury mechanism, accident details, injury severity and patterns, treatments required, hospitalization details, and discharge disposition.Results. Sixty-five patients were included; 58.5% were male and the mean age was 9.7 years. Median Injury Severity Score and Glasgow Coma Scale were 5 and 15, respectively. Accident mechanisms included animal-related (43.1%), fall (21.5%), and motor vehicle (21.5%). Soft tissue injuries, concussions and upper extremity fractures were the most common injuries observed (58.5%, 29.2%, and 26.2%, respectively). Twenty-six patients (40%) required surgical intervention. Mean hospital length of stay was 3.4 ± 4.7 days. The majority of patients were discharged to home (n = 62, 95.4%) and two patients suffered permanent disability. Conclusion.Overall, outcomes for this population were favorable, but additional measures to increase safety, such as fall prevention, animal handling, and driver safety training should be advocated. Med 2017;10(4):92-95. KS J
Introduction. New recommendations for emergency medical services spinal precautions limit long spinal board use to extrication purposes only and are to be removed immediately. Outcomes for spinal motion restriction versus spinal immobilization were studied. Methods. A retrospective chart review of trauma patients was conducted over a 6-month period at a level I trauma center. Injury severity details and neurologic assessments were collected on 277 patients. Results. Upon arrival, 25 (9.0%) patients had a spine board in place. Patients placed on spine boards were more likely to be moderately or severely injured (ISS>15: 36.0% vs. 9.9%, p = 0.001) and more likely to have neurological deficits documented by EMS (30.4% vs. 8.8%, p = 0.01) and the trauma team (29.2% vs. 10.9%, p = 0.02). Conclusions. This study suggests that the long spine board is being properly used for more critically injured patients. Further research is needed to compare neurological outcomes using a larger sample size and more consistent documentation.
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