Ethical decision making in severe paediatric burn victims

Rode, H.; Millar, A. J. W.; Castle, Bryan W.; Lyle, Jill

doi:10.7196/samj.4250

Cited by 13 publications

(2 citation statements)

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“…Some of the consequences of burns are well known and include pain, infections, scarring, wound contractures, amputations, and death, as well as psychological trauma. 3,4 Children under 5 and the elderly have the highest burn mortality worldwide. The fire-related mortality rate in Africa for children under 5 is 32.9 per 100,000.…”

Section: Introductionmentioning

confidence: 99%

Morbidity and mortality of paediatric burns patients at Maputo Central Hospital, Mozambique

Amado¹,

Rocha²,

Khosa³

et al. 2018

East. Cent. Afr. J. Surg.

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Background: The incidence of paediatric burn injuries is increasing in Africa. Paediatric burn injuries are among the leading causes of preventable morbidity and mortality in sub-Saharan Africa. Research on the morbidity and mortality in this setting is much needed. Methods: We conducted a prospective questionnaire-based analysis of paediatric burn patients presenting to the Maputo Central Hospital during a five-month period. Interviews were conducted with the children's caretakers by 2 paediatric surgery residents and 1 paediatrician at the Eduardo Mondlane Medical School in Maputo, with the aid of nursing staff. Results: Questionnaires were completed for 66 patients. Most burns occurred from scald injuries (n = 46), particularly from cooking (n = 27) and bathwater (n = 19), followed by fire injuries (n = 16). Burns occurred more frequently in the afternoon (n = 26) and morning (n = 23). Many patients reported no adult caretaker present at the time of the burn injury (n = 24). Most burns were grade II (n = 49). Nearly h alf of th e patients received a blood transfusion (n = 30). One-third of the patients underwent operative surgical debridement (n = 21). Skin grafting was performed on a subset of these patients (n = 13). A large number of patients developed a wound infection (n = 39). All deaths occurred in patients who were admitted to the paediatric intensive care unit and had sepsis (n = 9). The mean total body surface area (TBSA) of burn deaths was 37% (range 20% to 50%), and many deaths were secondary to fire burns (6 of 9; 66.7%). Conclusions: Most paediatric burn injuries occur in association with domestic activities, such as cooking and bathing. Adult caretakers are frequently not present at the time of the burn injury. Mortality rates are high, especially for large body surface area burns caused by fire. Educational programmes may help reduce the incidence of burns and the associated morbidity and mortality. The improvement and expansion of emergency and intensive burn care services may help to improve survival.

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Section: Introductionmentioning

confidence: 99%

Morbidity and mortality of paediatric burns patients at Maputo Central Hospital, Mozambique

Amado¹,

Rocha²,

Khosa³

et al. 2018

East. Cent. Afr. J. Surg.

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“…The ultimate aim should be to provide the best care as possible for all patients. Until the available capacity and resources are limiting factors, triage decisions must be taken while aiming for the survival of the maximum number of patients in an objective manner, even if that results in denying treatment for the patients with very poor prognosis [ 5 , 17 , 20 , 47 ]. This does not only apply to resource-scarce settings, but also to higher income settings in times of disasters or crises [ 18 , 19 ].…”

Section: Discussionmentioning

confidence: 99%

Clinical decision-support for acute burn referral and triage at specialized centres – Contribution from routine and digital health tools

Boissin

2022

Global Health Action

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Background Specialized care is crucial for severe burn injuries whereas minor burns should be handled at point-of-care. Misdiagnosis is common which leads to overburdening the system and to a lack of treatment for others due to resources shortage. Objectives The overarching aim was to evaluate four decision-support tools for diagnosis, referral, and triage of acute burns injuries in South Africa and Sweden: referral criteria, mortality prediction scores, image-based remote consultation and automated diagnosis. Methods Study I retrospectively assessed adherence to referral criteria of 1165 patients admitted to the paediatric burns centre of the Western Cape of South Africa. Study II assessed mortality prediction of 372 patients admitted to the adults burns centre by evaluating an existing score (ABSI), and by using logistic regression. In study III, an online survey was used to assess the diagnostic accuracy of burn experts’ image-based estimations using their smartphone or tablet. In study IV, two deep-learning algorithms were developed using 1105 acute burn images in order to identify the burn, and to classify burn depth. Results Adherence to referral criteria was of 93.4%, and the age and severity criteria were associated with patient care. In adults, the ABSI score was a good predictor of mortality which affected a fifth of the patients and which was associated with gender, burn size and referral status. Experts were able to diagnose burn size, and burn depth using handheld devices. Finally, both a wound identifier and a depth classifier algorithm could be developed with relatively high accuracy. Conclusions Altogether the findings inform on the use of four tools along the care trajectory of patients with acute burns by assisting with the diagnosis, referral and triage from point-of-care to burns centres. This will assist with reducing inequities by improving access to the most appropriate care for patients.

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Pediatric Burn Surgery

Rode

Martinez

2020

Pediatric Surgery

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Ethical decision making in severe paediatric burn victims

Cited by 13 publications

References 10 publications

Morbidity and mortality of paediatric burns patients at Maputo Central Hospital, Mozambique

Morbidity and mortality of paediatric burns patients at Maputo Central Hospital, Mozambique

Clinical decision-support for acute burn referral and triage at specialized centres – Contribution from routine and digital health tools

Pediatric Burn Surgery

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