Aspects épidémiologiques et cliniques des brûlures cutanées graves en milieu hospitalier en Côte d'Ivoire / Epidemiological and Clinical Aspects of severe Cutaneous Burns in Hospital in Cote d'Ivoire

Contexte et Objectif. Les brûlures cutanées graves constituent un véritable problème de santé publique à l'échelle mondiale. L'objectif de cette étude était de décrire le profi l épidémiologique et clinique des brûlures cutanées graves dans le but de mettre en place de mesures préventives effi cientes. Méthodes. Ils'agissait d'une étude transversale rétrospective à visée descriptive et analytique déroulée sur une période de 3 ans au sein du service de Dermatologie du CHU de Bouaké. Tous les malades quelque soit l'âge et le sexe reçus au service dermatologie pour brûlure cutanée grave ont été inclus. Les tests statistiques utilisés étaient les tests de Kruskal Wallis (KW) et de Mann whitney-Wilcoxon(MWW) Résultats. Sur la période d'étude, nous avons inclus 46 patients sur 6074 admissions soit une prévalence hospitalière de 0,75%. L'âge moyen était de 20,79 ans. Le sex-ratio était de3,18. 10,9% de nos patients avaient une condition socio-économique défavorable. Les antécédents les plus retrouvés étaient l'épilepsie (6,5%) et les troubles psychiatriques (4,3%). Les brûlures thermiques étaient majoritaires(95,7%), etles brûlures par fl amme (56,8%) et l'ébouillantement (43,2%)en constituaient les principales causes.Les membres étaient plus atteints (93,5%).Les brûlures étaient du premier degré (10,9%) et du deuxième degré (89,1%). L'étendue moyenne de la brûlure était de 23,91%. Les sujets d'âge plus jeunes étaient surtout brûlés par les liquides chauds. Il n'y'avait pas de lien entre l'âge et l'étendue des lésions ni entre l'agent causal et l'étendue des lésions. Conclusion. Les brûlures cutanées graves représentent un fl éau en Côte d'ivoire.Il est indispensable d'instaurer des mesures de prévention en vue de limiter les conséquences de celles-ci.

The causes of burn wounds among adult patients treated at Pelonomi Tertiary Hospital, Bloemfontein

Background: Burn injuries account for approximately 180 000 deaths per annum, mostly in low- and middle-income countries. Aim: This study sought to determine the causes of burn wounds among adults admitted to the Burn Wound Unit at Pelonomi Tertiary Hospital in Bloemfontein for treatment.Methods: This was a prospective, cross-sectional study. The target population consisted of adult patients, hospitalised for burn wounds at Pelonomi Tertiary Hospital in Bloemfontein, between July 2016 and early January 2017. Relevant data was collected by means of a structured interview using a questionnaire. Results: A total of 49 patients were interviewed during the study period. Almost two-thirds of the patients were male (65.3%, n=32). The median age was 33 years (range 18 to 64 years). In most cases, the injury occurred at home (77.6%, n=38). Three quarters of the reported incidents (77.6%, n=38) were considered accidental of which 68.4% (n=26) were related to domestic activities. At the time of the accidental incident, 39.5% (n=15) patients had consumed alcohol. Eleven (22.4%) of the incidents were intentional with 63.6% (n=7) attributed to assault. The two main causes of burn injuries were flames including flaming liquids (59.2%, n=29) and hot liquids (22.5%, n=11). The most frequent area of injury was the left front thigh.Conclusion: The predominant cause of burn wounds was flames including flaming liquids, and injuries were mostly accidental in nature. Alcohol consumption and domestic activities were common in accidental burns

Burns in children admitted at the University Teaching Hospital of Kigali (CHUK), Rwanda: a descriptive study

Background: Burn injuries are responsible for high rates of mortality and morbidity in the pediatric population particularly in developing countries. However, there is a lack of published data on pediatric burn injuries in Rwanda.Objectives: This study aimed to describe burns in children admitted at the University Teaching Hospital of Kigali.Methods: This was a retrospective review over a 1-year period from June 2014 to June 2015 with data retrieved from the case-files of the patients.Results: The total number of children with burn injury admitted was 72. Males predominate with 63.9% of all cases. Three-quarters (77.8%) were aged 3 years and younger. Scalds were by far the commonest type of burn occurring in 93% of the patients. Partial thickness burns accounted for 91.7% of cases. The average length of hospital stay was 20.9 days and the mortality rate 16.7%. Total Body Surface Area (TBSA) burned greater than 25% and full thickness burns were associated with mortality.Conclusion: Scalds were the most common type of burns in this population. Mortality was higher than reported in studies from other developing countries. Improvement in household safety, promotion of early consultation and raising the awareness of the community through public health campaigns could positively reverse the trends

'Getting Under our Skin': Introducing Banked Allograft Skin to Burn Surgery in South Africa

Deceased donor skin possesses many of the properties of the ideal biological dressing; and a well-stocked skin bank has become a critically important asset for the modern burn surgeon. Without it; managing patients with extensive burns and wounds becomes far more challenging; and outcomes are significantly worse. With the recent establishment of such a bank in South Africa; the challenge facing the medical fraternity is to facilitate tissue donation so that allograft skin supply can match the enormous demand

A Review of the Peri-Operative Management of Paediatric Burns: Identifying Adverse Events

Background. Burn injuries are common in poverty-stricken countries. The majority of patients with large and complex burns are referred to burn centres. Of the children who qualify for admission; according to burn admission criteria; about half require some kind of surgical procedure to obtain skin cover. These range from massive full-thickness fire burns to skin grafts for small; residual unhealed wounds. Burn anaesthetic procedures are of the most difficult to perform and are known for high complication rates. Reasons include peri-operative sepsis; bleeding; issues around thermoregulation; the hypermetabolic state; nutritional and electrolyte issues; inhalation injuries and the amount of movement during procedures to wash patients; change drapes and access different anatomical sites. The appropriate execution of surgery is therefore of the utmost importance for both minor and major procedures.Objective. To review the peri-operative management and standard of surgical care of burnt children.Methods. This was a retrospective review and analysis of standard peri-operative care of burnt children at Red Cross War Memorial Children's Hospital; Cape Town; South Africa. A total of 558 children were operated on and supervised by the first author. Factors that could adversely affect surgical and anaesthetic outcomes were identified.Results. There were 257 males and 301 females in this study; with an average age of 50.1 months and average weight of 19.5 kg. The total body surface area involved was 1 - 80%; with an average of 23.5%. Inhalational injury was present in 11.3%; pneumonia in 13.1%; wound sepsis in 20.8%; and septicaemia in 9.7%; and organ dysfunction in more than one organ was seen in 6.1%. The average theatre temperature during surgery was 30.0oC. Core temperatures recorded at the start; halfway through and at completion of surgery were 36.9oC; 36.8oC and 36.5oC; respectively. The average preoperative and postoperative haemoglobin levels were 11.28 g/dL and 9.64 g/dL; respectively. Blood loss was reduced by the use of clysis from 1.5 mL/kg/% burn to 1.4 mL/kg/% burn. Adverse intraoperative events were seen in 17.6% of children.Conclusion. Burn surgery is a high-risk procedure and comorbidities are common. Anaesthesia and surgery must be well planned and executed with special reference to temperature control; rapid blood loss; preceding respiratory illnesses and measures to reduce blood loss

The Hospital Costs Associated with Acute Paediatric Burn Injuries

Background. Ongoing rationing of healthcare threatens services that are well established; and cripples others that desperately require investment. Burn; for one; remains a neglected epidemic in South Africa (SA); despite the magnitude of the problem.Objective. To identify the prominent components contributing to the cost of hospital admission with paediatric burn injury. Determining the true costs of specialist services is important; so that resources can be allocated appropriately to achieve the greatest possible impact.Methods. A retrospective study was undertaken over 1 year to determine patient demographics and injury details of 987 patients admitted with burn injuries to Red Cross War Memorial Children's Hospital; Cape Town; SA. The in-hospital financial records of 80 randomly selected patients were examined. This was followed by a prospective study to determine the financial implications of four cost drivers; i.e. bed cost per day; costs of medications received; costs of dressings for wound care; and costs of surgical intervention. A random selection of 37 dressing changes (in 31 paediatric patients) and 19 surgical interventions was observed; during which all costs were recorded.Results. As expected; severe flame burns are responsible for more prolonged hospital stays and usually require surgical intervention. Scald burns comprise the greatest proportion of burn injuries; and therefore account for a considerable part of the hospital's expenditure towards burn care.Conclusion. While community programmes aiming to prevent burn injuries are important; this study motivates for the implementation of accessible ambulatory services in low-income areas. This strategy would enable the burn unit to reduce its costs by limiting unnecessary admissions; and prioritising its resources for those with more severe burn injuries

Households' preparedness for first-aid of burns and falls in Khartoum

Background :Reports of natural disasters and injuries have increased in recent years in both low and high-income regions. Household emergency preparedness can limit the effects of not only natural disasters but also simple injuries. Little is known regarding the level of emergency preparedness in Sudan households. Method:A cross sectional community based survey was conducted in the Alemtidad region of Sudan between September 2012 and December 2012. A random selection of 89 households was done from 3200 in the region as per power calculation. Data were collected using a structured designed questionnaire and analysed using the statistical package for social science (SPSS) program version 20 and demographics were presented accordingly.Result:Less than half of households surveyed had any first aid supplies and most of these supplies were incomplete. Only 66 of housewives demonstrated knowledge about first aid for burns and falls; 88 took preventive measures against burns and falls and 51 had an action plan in case serious injury occurred. Knowledge levels of housewives reflect unacceptable levels of preparedness. Education is a significant predictor of preparedness. Conclusion :Household emergency preparedness is poor. It can be encouraged by community based outreach and education programmes focused on prevention and treatment of common injuries

Facteurs d'allongement du delai d'admission des brules graves a l'Hopital Central de Yaounde

Objectifs : Le but de cette etude etait de determiner les facteurs d'allongement du delai d'admission des brules graves en reanimation a Hopital Central de Yaounde. Patients et methodes : Il s'agi d'une etude prospective; descriptive et analytique; qui a couvert la periode allant du 1er janvier 2012 au 31 decembre 2013. Nous avons inclus 57 patients admis en reanimation pour une brulure grave et chez ces patients; nous avons analyse les donnees sociodemographiques; les caracteristiques de la brulure; les donnees sur la prise en charge prehospitaliere et l'admission en reanimation (date; heure). Resultats : Les accidents domestiques etaient en tete des circonstances de survenue (77;2) et la brulure thermique par ebouillantement etait la plus frequentes (61;4 ). La prise en charge medicale etait inexistante sur les lieux de l'accident; les patients n'avaient recu que des traitements traditionnels. Les patients etaient transportes par des vehicules non medicalises vers des centres de soins peripheriques en premiere reference (79); ou ils ont ete retenus pendant au moins 24 heures avant leur transfert secondaire a l'Hopital Central de Yaounde. Le delai d'admission en reanimation etait superieur a 12 heures (79); cet allongement etant du a la retention des victimes dans les centres de soins peripheriques; a l'automedication et aux pratiques traditionnelles; aux difficultes de transfert des patients liees aux moyens financiers limites et a l'ignorance. Conclusion : Le brule grave necessite une prise en charge precoce et adequate. Une chaine de secours devrait etre mise en place pour ameliorer la qualite la prise en charge initiale

Epidemiology and treatment of paediatric burns in a large children's hospital in Morocco: analysis of 394 cases

Introduction:Injury from burns represents 2 of emergency admissions in university hospitals in Morocco. Burn injuries can lead to substantial morbidity in the paediatric population including an impact on later life. Methods:A retrospective study of 394 paediatric burn patients was performed. Subjects were identified by review of the emergency centre logs and data were extracted from patient records. Data included demographic information; mechanism of burn; treatment prior to arrival at the hospital; hospital management and follow up conditions : ResultsThe majority (65.7; n=259) of patients were between 1 and 4years old with an average age of 4.26years and male predominance (male:female=2:1). Scalding was the main mechanism of injury (83.5; N=329). The trunk and upper limbs were the most commonly affected areas of the body (59 and 50; respectively) with the face affected in 9.6 of cases. The total body surface area burned ranged from 1 to 10 in 86 of patients. Seventy-five patients (19) required hospitalisation; 57 patients (14) required skin grafting and 27 (6.9) had major sequelae. Discussion: This large case series highlights the current epidemiology; management and outcome of paediatric burn victims in Morocco. Current burn management in low resources settings can be challenging and several additional measures should be taken to reduce morbidity among paediatric burn victims

Bacteriological Profile and Antibiogram of Aerobic Burn Wound Isolates in Mthatha; Eastern Cape; South Africa

Burn wound colonisation and infection is not only associated with delayed wound healing and scar formation; but may also lead to sepsisrelated mortality. A wide variety of microorganisms; like staphylococcus aureus; Pseudomonas aeruginosa; and Enterobacteriaceae-like Klebsiella pneumoniae and Escherichia coli; are involved. Resistance is generally increasing; with reports of multidrug-and pan-resistant isolates. This study was conducted to determine the common aerobic bacterial isolates in our setting and describe their antimicrobial susceptibility. This retrospective; descriptive study was carried out on 243 patients; from whom 312 burn wound specimens were received by the Nelson Mandela Academic Hospital microbiology laboratory of the National Health Laboratory Service; Mthatha. All samples were processed according to standard laboratory protocols; isolates were tabulated according to age and gender of the patients; and their percentage susceptibilities to relevant antibacterials were computed. A total of 229 patient specimens showed growth on culture. The total number of isolates was 629; out of which 269 were Gram-positive cocci and 360 were Gram-negative bacilli. The commonest organism was S. aureus (27.7); followed by K. pneumoniae (13.4); Proteus mirabilis (12.4); Group D streptococcus (9.4); P. aeruginosa (8.9) and E. coli (6.2). A generally high level of resistance was observed in many organisms. Methicillinresistant S. aureus accounted for 57.5of the S. aureus. Resistance among the Gram-negative bacilli was; in general; least to imipenem; amikacin and ciprofloxacin. The common organisms causing burn wound infections in our setting include staphylococci; Klebsiella; Proteus and Pseudomonas and there is a high level of resistance against commonly used antimicrobials. Regular surveillance of burn wound organisms and their antimicrobial resistance patterns will help in determining empirical antibiotic therapy for subsequent related septic events

Bacteriological Profile and Antibiogram of Aerobic Burn Wound Isolates in Mthatha; Eastern Cape; South Africa

Burn wound colonisation and infection is not only associated with delayed wound healing and scar formation; but may also lead to sepsisrelated mortality. A wide variety of microorganisms; like staphylococcus aureus; Pseudomonas aeruginosa; and Enterobacteriaceae-like Klebsiella pneumoniae and Escherichia coli; are involved. Resistance is generally increasing; with reports of multidrug-and pan-resistant isolates. This study was conducted to determine the common aerobic bacterial isolates in our setting and describe their antimicrobial susceptibility. This retrospective; descriptive study was carried out on 243 patients; from whom 312 burn wound specimens were received by the Nelson Mandela Academic Hospital microbiology laboratory of the National Health Laboratory Service; Mthatha. All samples were processed according to standard laboratory protocols; isolates were tabulated according to age and gender of the patients; and their percentage susceptibilities to relevant antibacterials were computed. A total of 229 patient specimens showed growth on culture. The total number of isolates was 629; out of which 269 were Gram-positive cocci and 360 were Gram-negative bacilli. The commonest organism was S. aureus (27.7); followed by K. pneumoniae (13.4); Proteus mirabilis (12.4); Group D streptococcus (9.4); P. aeruginosa (8.9) and E. coli (6.2). A generally high level of resistance was observed in many organisms. Methicillinresistant S. aureus accounted for 57.5 of the S. aureus. Resistance among the Gram-negative bacilli was; in general; least to imipenem; amikacin and ciprofloxacin. The common organisms causing burn wound infections in our setting include staphylococci; Klebsiella; Proteus and Pseudomonas and there is a high level of resistance against commonly used antimicrobials. Regular surveillance of burn wound organisms and their antimicrobial resistance patterns will help in determining empirical antibiotic therapy for subsequent related septic events

Childhood burns in South Eastern Nigeria

Background: Burns injuries are recognized as a major health problem worldwide. In children and; particularly; in our environment where poverty; ignorance and disease are still high; they constitute significant morbidity and mortality. Previous studies on this topic in parts of Nigeria either lumped adults and children together or were retrospective. We; therefore; prospectively studied the current trends in burns in children. Patients and Methods: This prospective study of burns spanned over a period of 18 months (June 2006-December 2007) at the Paediatric Surgery Units of the Imo State University Teaching Hospital; Orlu; and the Federal Medical Centre; Owerri; Imo State. Data were collected and analysed for age; sex; cause/type of burn; place of burn; presence or absence of adult/s; initial prehospital intervention; interval between injury and presentation; surface area and depth of burn and treatment and outcome. Results: Fifty-three patients were studied; 31 (58.4) were male and 22 (41.6) were female (M:F = 1.4:1). Patients mostly affected were aged 2 years and below. The most common cause of burns was hot water in 31 (58.5) patients. The vast majority of these injuries happened in a domestic environment (92.5) and in the presence of competent adult/s (88.7). Outcome of treatment was good: there were two (3.8) deaths and 46 (86) patients had complete recovery. Conclusion: Burns is still a major health problem among children in south eastern Nigeria. Fortunately; outcome of appropriate treatment is good. However; we think that poor safety consciousness among parents is a major predisposing factor. Public enlightenment on measures to ensure safe home environment may be necessary to avoid or limit childhood burns

Nutritional Management of the Burn Patient

The incidence of burn injuries is on the increase in Africa due to migration to urban areas and the development of slum areas; but there is a paucity of such data on the African continent. The South African Medical Research Council has indicated that 3.2of the South African population is burned annually; with 50of individuals who suffer burns being younger than 20 years. The Red Cross Children's Hospital admits 650 to 900 children with burn injuries annually.1 Burn injury; the most severe type of injury from a metabolic point of view; is characterised by the most profound alterations in basal metabolic rate and urinary nitrogen excretion. In addition; requirements for and/or metabolism of macro- and micronutrients are altered or increased. The major improvement in burn survival can be attributed to many factors; one being the development and implementation of improved methods of nutritional support that optimise host defences; enhance wound healing and support the metabolic response to stress.2 The greatest threats to survival from burns are still infection/sepsis; with burn wound sepsis and nosocomial pneumonia; including ventilatorassociated pneumonia (VAP); being the leading causes of death.2;3 Effective medical nutrition therapy in patients with burn injuries requires an understanding of the physiologic and metabolic alterations that accompany the burn injury; alterations in the immune system and the role of reactive oxygen species (ROS)

Predictors of mortality in paediatric burns at Ibadan, Nigeria

Burn injury constitutes a major cause of trauma related morbidity and mortality. Improvements in care have resulted in reduced mortality in the burn patient significantly. The aim of this study was to determine the outcome and management of burns in children. This was a prospective study of children aged 0-13 years, managed in the burns unit of University College Hospital, Ibadan, Nigeria, between January 2001 and September 2003. There were 62 patients, 42 (67.7%) were females and 20 (32.3%) were males (Male: Female= 1:2. Their ages ranged between 1month and 13 years (mean = 4.8 ± 3.8 years). Majority of the patients (56.5%) were below 4 years of age. Burn was caused predominantly by flame (57%), followed by inhalation injury in 43.5% of the patients. The percentage total burn surface area (%TBSA) ranged between 1%and 95%(mean 29.7%± 22.8%), and 41.4% of the patients sustained amajor burn (TBSA= 30%). Infective complications were present in 37% of patients. The overall mortality was 33.9%, and occurred in those patients with %TBSA of 14 95% (mean = 48.8%). Mortality rate was 62.9% among those that had inhalation injury compared with 11.4% in those without inhalation injury. There was no mortality in those patients whose %TBSAranged between 1 and 32%(mean = 17.5%). Percentage of the total body surface area burnt and the presence of inhalation injury were important predictors ofmortality in childhood burns injury

Epidemiology and Bacterial Colonization of Burn Injuries in Blantyre

Forty-nine patients from the Burns Unit at the QECH had swabs taken from various sites in order to determine the bacterial profile and antibiotic susceptibilities in burn wounds colonized by bacteria. The mean age was 16 years (range 1-70 years); 27 (55 ) of the study population were female and 22 (45) were male. Twenty-four (49) patients were epileptic. Open fire (41) was the most common cause of burn injuries among epileptics while hot water burns (29) were commonest among non-epileptics. Burn injury and percentage total burn surface area (TBSA) injuries decreased with age; and the upper and lower limbs; trunk; head and neck were the most commonly affected sites. Staphylococcus aureus was the commonest isolate (23); followed by Proteus mirabilis (22.7); Streptococci spp (15.9); Pseudomonas aeruginosa (4.5) and 3.4 for Escherichia coli; Salmonella and Klebsiella spp. There was a significant trend of bacterial growth with increasing CI 1.58-10.99]). Broad-spectrum antibiotics are required as first-line therapy for burns-related sepsis but there is need for surveillance of antibiotic susceptibility to help determine appropriate therapy

Iatrogenic burns injury complication neonatal resuscitation

A case of iatrogenic thermal injury in a newborn infant during resuscitation for perinatal asphyxia at a secondary health facility is described. The injury; with surface area coverage of about 4; involved the lower limbs. This report highlights the poor newborn resuscitation skills of traditional medical practice

Severe Burns as a Consequence of Epilepsy in a Rural Community of North Eastern Nigeria

Objective: Epilepsy; a common clinical disorder usually presents with generalized tonic clonic seizures resulting in a fall and loss of consciousness. Seizures occurring near a burning agent may lead to a fall onto the burning agent and result in severe burns. A prospective study of all patients who sustained burns during an epilepsy seizure presenting to Federal Medical Center Azare; Bauchi State; Nigeria between January 2003 and June 2005 was conducted. Methods: The age; sex; place of incidence; site and extent of injury; cause of burns and treatment outcome were analyzed. Results: A total of 79 patients presented with burns during the study period; nine (11) were as a result of an epileptic seizure. The nine patients comprised of 6 adults and 3 children. Majority were mothers and their children. The place of accident was the home in 7 patients while 2 occurred on the farm. Seven were flame burns and two scalds. Conclusion: This study highlights that epilepsy is an important cause of severe burns in our environment. Women at home and children dependent on them are more at risk hence the need for public enlightenment