Contributors to the length-of-stay trajectory in burn-injured patients

Dölp, R.; Rehou, Sarah; McCann, Matthew R.; Jeschke, Marc G.

doi:10.1016/j.burns.2018.07.004

Cited by 33 publications

(29 citation statements)

References 33 publications

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“…The most significant prognostic factor providing the highest discharge ratios in all children was %TBSA, similar to previous research (Dolp et al 2018;Möller et al 2017;Hussain and Dunn 2013;AbdelWahab et al 2018;Taylor et al 2017;Gravante et al 2007;Matin et al 2015;Elrod et al 2019;Wang et al 2018;Hyland et al 2015;Meshulam-Derazon et al 2006). In Aboriginal and Torres Strait Islander children, greater %TBSA levels have been reported to increase LOS, however our ratios were greater than previous reports (Möller et al 2017).…”

Section: Discussionsupporting

confidence: 88%

“…Internationally there is a sound body of knowledge surrounding prognostic factors for hospital LOS in burn injuries (Dolp et al 2018;Moore et al 2015;Hussain and Dunn 2013;AbdelWahab et al 2018;Taylor et al 2017;Gravante et al 2007;Sierra Zúñiga et al 2016;Matin et al 2015;Elrod et al 2019;Wang et al 2018). In adults, percentage total body surface area (%TBSA), full thickness burns, socioeconomic status (SES), age, inhalation injury, comorbidities, surgical interventions, and injury complications have been shown to be associated with a longer LOS (Dolp et al 2018;Moore et al 2015;Hussain and Dunn 2013;AbdelWahab et al 2018;Taylor et al 2017;Gravante et al 2007;Sierra Zúñiga et al 2016). In children with a burn injury, large %TBSA (> 16%), burn cause (scald or flame compared to other types), full and partial thickness burns increase LOS, whereas younger age and early skin grafting decrease LOS (Matin et al 2015;Elrod et al 2019;Wang et al 2018).…”

Section: Introductionmentioning

confidence: 99%

“…They also represent one of the most common injuries requiring medical attention for Aboriginal and Torres Strait Islander children < 6 years of age (Department of Social Services 2009 ; Department of Social Services 2011 ). As an injury burns are complex, resource intensive and costly, creating significant occupation and social limitations (Kornhaber et al 2017 ; Dolp et al 2018 ; Weedon and Potterton 2011 ; McGarry et al 2014 ). Depending on severity, children and their families can have extensive hospital lengths of stay (LOS) for initial treatment, as well as ongoing rehospitalisation for treatment and scar management.…”

Section: Introductionmentioning

confidence: 99%

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Factors contributing to longer length of stay in Aboriginal and Torres Strait Islander children hospitalised for burn injury

et al. 2020

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Background Aboriginal and Torres Strait Islander children have higher incidence, severity and hospital length of stay for their acute burn injuries than other Australian children. We examined factors contributing to longer length of stay for Aboriginal and Torres Strait Islander children with an acute burn injury. Methods Burns Registry of Australia and New Zealand admissions of children < 16 years of age between October 2009 and July 2018 were analysed. Descriptive statistics explored patient and injury characteristics; Cox-regression models estimated characteristics associated with longer length of stay. Knowledge Interface methodology and Indigenous research methods were used throughout. Results A total of 723 children were identified as Aboriginal and Torres Strait Islander and 6257 as other Australian. The median hospital length of stay for Aboriginal and Torres Strait Islander children (5 days [CI 5–6]) was 4 days longer than other Australian children (1 day [CI 1–2]). Remoteness, flame burns, high percentage total body surface area (%TBSA) and full thickness burns were factors associated with longer length of stay for Aboriginal and Torres Strait Islander children. Similar prognostic factors were identified for other Australian children along with Streptococcus sp. and Staphylococcus sp. infection. Conclusion Remoteness, flame burns, %TBSA, and full thickness burns are prognostic factors contributing to extended hospital length of stay for all Australian children. These factors are more prevalent in Aboriginal and Torres Strait Islander children, impacting length of stay. Treatment programs, clinical guidelines, and burns policies should engage with the unique circumstances of Aboriginal and Torres Strait Islander children to mitigate inequities in health.

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Section: Discussionsupporting

confidence: 88%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Factors contributing to longer length of stay in Aboriginal and Torres Strait Islander children hospitalised for burn injury

et al. 2020

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“…Burns patients are generally more susceptible to infection due to impaired immune function. Risk factors for sepsis in burns include >20% of total body surface area (TBSA), inhalation injury, delayed burn wound excision, increased length of hospital stay, use of artificial medical devices and ICU admission [24][25][26][27][28]. Patients in burn ICUs are more vulnerable to septicaemia than general ICU patients [29].…”

Section: Discussionmentioning

confidence: 99%

Molecular and epidemiological analysis of a Burkholderia cepacia sepsis outbreak from a tertiary care hospital in Bangladesh

et al. 2020

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Background Burkholderia cepacia complex (Bcc) is a group of serious pathogens in cystic fibrosis patients and causes life threatening infections in immunocompromised patients. Species within the Bcc are widely distributed within the environment, can survive in the presence of disinfectants and antiseptics, and are inherently multidrug resistant (MDR). Methods Dhaka Medical College Hospital (DMCH) patients with a B. cepacia positive blood culture between 20 October 2016 to 23 rd September 2017 were considered as outbreak cases. Blood stream infections (BSIs) were detected using BacT/ALERT 3D at DMCH. B. cepacia was isolated on chromogenic UTI media followed by MALDI-TOF. Minimum inhibitory concentration (MIC) of clinically relevant antibiotics was determined by agar dilution. Whole genome sequencing was performed on an Illumina MiSeq platform. Patients' demographic and clinical data were collected. Patients' clinical history and genomic data of the outbreak strains were merged to investigate possible outbreaks. Ninety-one B. cepacia genomes were downloaded from 'Burkholderia Genome Database' and the genomic background of the global strains were compared with our outbreak strains. Results Among 236 BSIs, 6.35% (15/236) were B. cepacia. Outbreak cases were confined to the burn critical care unit and, to a lesser extent, the paediatrics department. There was a continuum of overlapping cases at DMCH between 23 October 2016 to 30 August 2017. Core genome SNPs showed that the outbreak strains were confined to a single clade, corresponded to a common clone (ST1578). The strains were shown to be MDR and associated with a mortality of 31% excluding discharge against medical advice. MIC profiles of the PLOS NEGLECTED TROPICAL DISEASES

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“…In response to the problems found during initial management, it has been decided to use a stay of less than 24 h as the threshold for determining an unjustified, unnecessary transfer of a burn patient. However, we are aware that the length of stay of a burn patient is often estimated based on a percentage of the total area affected [37,38]. Measuring length of stay according to burn surface area percentage may not only be relevant in the context of per-operative follow-up, but also during the rehabilitation phase.…”

Section: Discussionmentioning

confidence: 99%

Early clinical management of severe burn patients using telemedicine: a pilot study protocol

Moreau

Paré

2020

Pilot Feasibility Stud

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Background: Emergency physicians are responsible for assessing the severity of a patient's burns, which determines whether the patient needs to be transferred to a burn center. Such a proper assessment represents a daunting task because severe burn injuries are rare. Inaccurate estimates often result in unjustified and costly transfers and unneeded fluid resuscitation and assisted ventilation procedures. Telemedicine offers a solution to these challenges. The present pilot study aims to investigate the feasibility, acceptability, and potential value of a large telemedicine initiative at the University of Montreal Health Center's burn center and its network of referring hospitals. Methods: A three-stage study protocol is proposed to achieve this objective. First, a proof of concept phase will assess the technical feasibility of telemedicine at one referring hospital with a high volume of patient transfers. Second, the organizational and human feasibility of the project will be evaluated in four referring medical centers. All teleconsultation sessions will be analyzed using the WHO's telemedicine implementation model. The third phase will consist of evaluating the potential impacts of telemedicine in a subset of 10 referring hospitals. The quality of communications between referring physicians and specialists will be assessed using semi-structured interviews. A pre-test/post-test with a comparison group design will be used to assess the effects of telemedicine on patient transfers, ventilation procedures, patient complications, mortality, length of ICU stay, and additional surgical procedures. The economic viability of telemedicine will be assessed using a cost-minimization approach. Discussion: The telemedicine initiative is expected to yield positive and significant outcomes that are relevant to a wide range of medical centers that already use or are considering using a similar technology. The contribution of this pilot study lies in its ability to reveal technological, organizational, and human barriers and provide a preliminary assessment of the clinical and economic value of a large-scale telemedicine initiative in the context of burn medicine.

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Contributors to the length-of-stay trajectory in burn-injured patients

Abstract: Progress has been made to update the conventional one day/%TBSA to better aid health care providers in giving appropriate outcomes for patients and their families and to supply intensive care units with valuable data to assess quality of care and to improve patient prognosis.

Cited by 33 publications

References 33 publications

Factors contributing to longer length of stay in Aboriginal and Torres Strait Islander children hospitalised for burn injury

Factors contributing to longer length of stay in Aboriginal and Torres Strait Islander children hospitalised for burn injury

Molecular and epidemiological analysis of a Burkholderia cepacia sepsis outbreak from a tertiary care hospital in Bangladesh

Early clinical management of severe burn patients using telemedicine: a pilot study protocol

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