The impact of patient demographics and comorbidities upon burns admitted to Tygerberg Hospital Burns Unit, Western Cape, South Africa

Cloake, Thomas; Haigh, T.; Cheshire, James; Walker, David Ian

doi:10.1016/j.burns.2016.08.031

Cited by 12 publications

(5 citation statements)

References 12 publications

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“…Among research conducted in other countries, a study that evaluated 221 patients hospitalized in burn centers in South Africa between 2011 and 2013 found that the rate of male patients was 68.8%. [34] In the study by Cohen-Manheim et al [35] that evaluated patients in five burn centers in Israel, the rate of male patients was 67.3% between 1997 and 2003, and in the same study, it was 68.0% between 2004 and 2010. In northern Iran, 69.6% of all burn patients and 64.2% of burn patients who died were male.…”

Section: Discussionmentioning

confidence: 91%

Evaluation of clinical outcomes and comparison of prediction models in the burn population hospitalized from the emergency department: Can burn mortality scores be used in a post-conflict area such as northwest Syria?

Karaca

Çelik

Emem

2023

Ulus Travma Acil Cerrahi Derg

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Section: Discussionmentioning

confidence: 91%

Evaluation of clinical outcomes and comparison of prediction models in the burn population hospitalized from the emergency department: Can burn mortality scores be used in a post-conflict area such as northwest Syria?

Karaca

Çelik

Emem

2023

Ulus Travma Acil Cerrahi Derg

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“…Mortuary data from Mpumalanga Province reported the fatal burn rate to be 3.8 per 100 000 inhabitants, [16] with data from Western Cape Province showing more than doubling of the death rate over a 20-year period. [17] In Cape Town, burn mortality in children was reported as 3.6% and that in adults 7.9%. [18] As an international comparison, an audit of mortality from the Global Burn Registry, a World Health Organization initiative, showed overall mortality to be 17% in LMICs v. 9% in HICs.…”

Section: Discussionmentioning

confidence: 99%

Burn injuries in KwaZulu-Natal Province, South Africa: Quantifying the healthcare burden

Allorto,

Rencken,

Bishop

2023

S Afr Med J

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Background. Most burn injuries occur in low- and middle-income countries (LMICs) and affect those of lower socioeconomic status disproportionally. A multifaceted approach is needed to improve burn outcomes. Healthcare strategies and reform should be data driven, but South Africa (SA) currently lacks sufficient baseline data related to burn injuries. The absence of local data is compounded by a global lack of published data from LMIC settings. The Pietermaritzburg Burn Service Registry (PBSR) is the only established registry for burn injuries in SA. Objectives. To use the high-quality, detailed data from the PBSR to estimate the KwaZulu-Natal (KZN) provincial burden of burns in terms of length of stay, need for surgery and mortality. Our broader aim is to quantify the magnitude of the problem to highlight the need for specific burn care strategies in SA. Methods. We conducted an observational, retrospective review of burns data from two databases, the District Health Information System (DHIS) between 2013 and 2018, and the more detailed PBSR between 2016 and 2019. We compared the distribution of mild, moderate and severe injuries as well as the distribution of adult and paediatric admissions between the DHIS and PBSR data sets. We then assumed that outcomes for the province would follow similar patterns to the Pietermaritzburg Burn Service and applied the proportions to the DHIS data set to estimate the annual provincial burden. Results. In the DHIS, there was an annual mean (standard deviation (SD)) of 4 807 (760) children (age ≤12 years) and 3 622 (588) adults (age >12 years) admitted to hospitals in KZN with burn injuries. Annual average injury severity was 76.0% mild (mean (SD) n=5 539 (1 112.4)), 19.8% moderate (n=1 441 (148.8)) and 4.2% severe (n=312 (24.5)). These proportions were similar in the PBSR. Projections estimate that 2 967 patients would need surgery, with 212 500 hospital days required annually in the province. Additionally, provincial mortality would be 586 patients, including 84% with burns of mild and moderate severity. These deaths are potentially preventable. Conclusion. There is a significant, unquantified burden of burn injury in KZN, highlighting the urgent need for development of specialised surgical services for burns. Collection of more robust national data to verify our projections is required to confirm the need and guide required healthcare reform.

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“…Thermal injury patients who are human immunodeficiency virus (HIV) positive are known to have a high mortality rate secondary to concomitant infection. 1,3,6 There are several tests available for the diagnosis of PTB. Sputum sent for a PTB culture is generally considered the gold standard diagnostic test for PTB, however, it typically takes six weeks before the result is obtained.…”

Section: Introductionmentioning

confidence: 99%

“…Thermal injury patients who are human immunodeficiency virus (HIV) positive are known to have a high mortality rate secondary to concomitant infection. 1 , 3 , 6 …”

Section: Introductionmentioning

confidence: 99%

Protocol for clinical diagnosis and empiric treatment of pulmonary tuberculosis in severely burned patients: observations and literature review

Kulenkampff

Kleintjes

Kotzee

et al. 2023

Scars, Burns & Healing

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Introduction Reactivation of pulmonary tuberculosis is a prevalent concomitant infection and cause for mortality in burns patients in Sub-Saharan Africa. First line laboratory diagnostic studies for pulmonary tuberculosis are often negative in these patients and if relied on, result in high mortality. The purpose of this report is to share our experience with a novel protocol of empiric treatment of clinically suspected pulmonary tuberculosis in severely burned patients with negative GeneXpert tests in a tertiary burns centre and to present a brief literature review on the topic. Methods A retrospective chart review of all patients, who sustained thermal injury with an inhalation component, with negative GeneXpert tests who were treated empirically for pulmonary tuberculosis over a five-year period (2015–2020) was performed. Additionally, a literature search was performed on Medline (PubMed), Cochrane and Google Scholar databases. Results Over the five-year period, 20 patients with suspected pulmonary tuberculosis and severe burns requiring ventilation were managed according to the protocol and all survived to discharge. The literature search identified six factors that explain the consequence of pulmonary tuberculosis in severely burned patients and provide a hypothesis for the negative laboratory studies encountered. Conclusion There was an improved outcome for patients with the clinical diagnosis of reactivation of pulmonary tuberculosis when they were started on empirical pulmonary tuberculosis treatment. There are several potential mechanisms that can contribute to reactivation of pulmonary tuberculosis in susceptible severely burned patients. The GeneXpert test should not be relied upon in these patients for a diagnosis, but rather all other clinical evidence should inform management. Lay Summary From the current literature evidence most patients who have severe burns complicated by a secondary infection known as pulmonary (lung) tuberculosis, die as a result. The purpose of this report is to share our experience with treatment of pulmonary tuberculosis during a five-year period, from 2015 to 2020, in a specialized adult tertiary burn center. Severely burned patients who were suspected of having pulmonary tuberculosis and received treatment despite having negative laboratory tests for pulmonary tuberculosis, had a better survival rate than expected. A brief literature review on the topic of pulmonary tuberculosis and severe burns was done to investigate causes for reactivation of pulmonary tuberculosis and negative laboratory studies in these patients. The literature search identified the following factors that can potentially affect the reactivation of pulmonary tuberculosis in severely burned patients: decreased immune system; secondary infections; low blood albumin(protein) levels; decreased clearance of bacteria from the airways, the development of pulmonary tuberculosis biofilms (capsules that protect the bacteria from chemicals and antibiotics) and the role of a fat molecule called phosphatidylinositol mannoside in pulmonary tuberculosis. In conclusion, the pulmonary tuberculosis test should not be relied upon in these patients, but rather all the clinical evidence such X-ray changes in association with difficulty to wean the patient off the ventilator should be used to inform treatment choice.

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The impact of patient demographics and comorbidities upon burns admitted to Tygerberg Hospital Burns Unit, Western Cape, South Africa

Cited by 12 publications

References 12 publications

Evaluation of clinical outcomes and comparison of prediction models in the burn population hospitalized from the emergency department: Can burn mortality scores be used in a post-conflict area such as northwest Syria?

Evaluation of clinical outcomes and comparison of prediction models in the burn population hospitalized from the emergency department: Can burn mortality scores be used in a post-conflict area such as northwest Syria?

Burn injuries in KwaZulu-Natal Province, South Africa: Quantifying the healthcare burden

Protocol for clinical diagnosis and empiric treatment of pulmonary tuberculosis in severely burned patients: observations and literature review

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