A Study of Sepsis in Severe Burn Patients for 5 Years

PURPOSE: The aim of this study was epidemiologic research on morbidity rate changes and causes of sepsis in severe burn patients, as they are highly vulnerable to sepsis which is closely related to mortality rate. METHODS: A retrospective review was conducted on 1,026 patients admitted to Burn Intensive Care Unit (BICU) of Hangang Sacred Heart Hospital from September 2011 to December 2015. Age, sex, burn size, whether the patient has inhalation injury, LOS (length of stay), LOSICU (Length of Stay in the Intensive Care Unit), and route of infection were taken into account. RESULTS: The average age, total body surface area (TBSA), the degree of inhalation injury, abbreviated burn severity index (ABSI), acute physiology and chronic health valuation score (APACHE) II, and LOS were higher in the dead than the survivors, and the differences were statistically significant. Incidence rate of sepsis was also meaningfully higher in the dead group, 64.8%. Patients with sepsis had higher average age, degree of inhalation injury, TBSA, and LOS, showing statistically significant differences as well compared to patients without sepsis. For five years from 2011 to 2015, rates of severe burn patients diagnosed with sepsis were 43.3%, 54.3%, 46.4%, 51.9%, and 43.9% respectively. CONCLUSION: Severe burn patients with higher age, larger burn size, and inhalation injury require more careful monitor as they are likely to be infected with sepsis. In addition, more laboratory parameters for early detection of sepsis need to be developed, so that follow-up studies can be conducted on prognostic factors correlated to sepsis.

A Study on the Communication Gap and Different Understandings between Doctor and Patient about Burn Treatment in the Burn Center of a University Hospital

PURPOSE: Burn is an unusual medical situation with limited information open to common people. This study was designed to evaluate the communication gap and different understandings between doctor and patient about burn treatment and to improve quality of the treatment. METHODS: Cross-sectional studies were done with interview and questionnaire. 25 doctors and nurses of burn ward and 50 burn patients in Han-gang Sacred Heart Hospital Burn Center were participated. To understand the communication gap and different perception between doctors' and patients' on 1) burn sequela and recovery, 2) disease course and prognosis, 3) healing environment, cost, hospitalization, 4) nurse-physician collaboration, 5) psychiatric consultation, 6) extra incentive were analyzed. RESULTS: Patients tend to expectation positive answer about their prognosis from their physician but they have recognized chronic and negative prognosis of burn treatment. Patients want to know clear and detailed explanation about their test result or treatment methods. Physicians thought that it is important to consider patients' economic status and provide different treatment principle. Short duration of hospitalization is not related to the anxiety of rehabilitation. Patients thought that nurses could manage superficial or repeated treatment. It is more likely that physicians warn the disadvantages of psychiatric consultation than patients. Both groups thought that extra incentive or gratitude money is not helpful for the doctor patient relationship. CONCLUSION: Given the discrepant views of physicians and patients on the burn treatment, physician should be aware of the discrepancies and attempts to resolve any differences.

Pathways Analysis for Depression in Hospitalized Acute Burn Patients

PURPOSE: The goal of this study was to develop a model of risk factors for depression in hospitalized burned patients. METHODS: Seventy-seven patients over 20 tears of age who were admitted to the Hangang Sacred Heart Hospital for burn injury, completed Structured Interview Post-traumatic stress disorder (PTSD), Beck Depression Inventory (BDI), Visual Analogue Scale (VAS) for pain and itching after 1 month from burn. A path analytic strategy was used to develop a model of risk factors for depression in burned patients. RESULTS: Two pathways to depression were developed. 1) From sleep disturbance and then to depression 2) from burn pain to PTSD and then to depression. It was revealed that sleep disturbance and PTSD had a direct effect on depression, pain had both direct and indirect effect on depression. CONCLUSION: Sleep disturbance and PTSD are associated with depression in burned patients. The identification of two developmental pathways suggests the importance of establishing preventive interventions for depression.

Dynamic Elbow Flexion Orthosis for Elbow Flexion Limit in Upper Extremity Burn

PURPOSE: Patients who have a elbow flexion limitation from burn often contend with a severe functional problem in activity of daily living. Positional splint or serial casting have been invented to prevent from elbow contracture, which splint could not improved the range of motion more than 90 flexion. The purpose of this article is to present a dynamic forced elbow flexion orthosis with limited motion joint to overcome the problem of less effective function of correctability of conventional splints. METHODS: The cases were 3rd degree burned patients of upper extremities who had a elbow joint flexion limitation from the post burn skin or joint contracture. This dynamic elbow flexion brace device was fabricated with the dynamic force of the elbow joint, which was induced by a rubber band or spring device into the orthotic joint. The orthosis kept a lower grade constant corrective force with coustom made design and strong strap fixation with comfortable material. RESULTS: This dynamic elbow flexion brace device was fabricated for two burn patients who had 24% and 37% TBSA in a flame burn with extensive involvement of the upper extremities. They developed hypertrophic scar and skin contracture around both elbow joint. Both patients had moderate to severe elbow joint limitation of motion. Patients with elbow limitation had improved the range of motion more than 90 flexion by this dynamic elbow flexion brace. CONCLUSION: The dynamic forced elbow flexion orthosis with limited motion joint had improved the range of motion more than 90 flexion, however those has some problems which ought to be improved to more effective and comfortable function.

Burn Injury in Stroke Patients

PURPOSE: To provide epidemiologic data of the burn injuries in stroke patients and to determine the most effective prevention and education methods. METHODS: We retrospectively reviewed the medical records of patients who had been admitted to the burn center at the Hangang Sacred Heart Hospital between January 2002 and June 2008. Burn cause, size, depth, duration of hospital stay, rate of operation performed, outcomes and time from stroke onset to burn were reviewed and compared. RESULTS: We reviewed the charts of total 87 patients (57 men and 30 women with a mean age of 61.95+/-14.48 years). Places of burn were divided into two groups (at home: n=52, outside: n=25) and patients injured at home were more than twice than who were outside. According to etiology of infarction, patients group was divided into ischemic (n=49) and hemorrhagic (n=38) group. Most of the patients were injured from flame burn. The rate of operation for ischemic group was significantly higher than hemorrhagic group. The etiology of infarction and cause of burn were not significant to prognosis. Chronic group (defined as burn occurred 6 months after the onset of stroke) had the higher incidence of burn injuries. But, there was no significant relationship between the time from stroke onset to burn and burn cause, prognosis, rate of operation, total body surface area burned. Non-survivor group had a higher operation rate than survivor group, although there was no difference in total burn surface area. CONCLUSION: Functional recovery of stroke was not associated with burn injury in our study. Flame burn took the highest percentage of burn causes. We believe that studies pooling different center's results are need to improve significance of conclusion drawn from these data.

Clinical Significance of the Ki-67 Index for Colorectal Cancer

PURPOSE: Monoclonal antibody Ki-67 has been employed to evaluate the growth fraction of various tumors. The purpose of this study is to determin the prognostic value of the Ki-67 index for colorectal cancer. METHODS: The Ki-67 index was investigated by counting the immunohistochemically stained cells. We described this as the permillage. We reviewed the test results of 36 colorectal cancer patients and we compared the Ki-67 index with other clinical factors. RESULTS: There was no correlation between the Ki-67 index and the other established risk factors, and only the number of invaded lymph nodes and their degree of differentiation were related with the Ki-67 index. CONCLUSION: The Ki-67 index is an important marker of the growth fraction of tumor. The pattern of tumor growth is determined not only by the growth fraction, so the discovery of other parameters that can reflect tumor growth and the Ki-67 index can help the patients with respect to their prognosis & treatment.

Clinical Features and Adequate Indication of CRRT in Severely Burned Patients

PURPOSE: Acute renal failure is not a rare event in severe burns and the prognosis of a burn patient becomes remarkably unfavorable with the onset of renal insufficiency. Several studies have reported that the incidence of ARF in severe burns is 0.5 ~ 30% and the mortality rate is 73 ~ 90%. This study analyzed the clinical features of severe burns requiring continuous renal replacement therapy (CRRT) to determine the adequate indication for CRRT. METHODS: Thirty-nine patients requiring CRRT out of 492 burned patients who were admitted to the burn intensive care unit in the Burn center, Hangang Sacred Heart Hospital from January 2003 to December 2004, were reviewed. CRRT was indicated when azotemia, fluid overload, acidosis, or hyperkalemia were observed. The APACHE II score, BUN, creatinine, creatine kinase, bicarbonate and base excess were analyzed at admission and at the initiation of CRRT for the survival group and non-survival group. RESULTS: The incidence of ARF requiring CRRT in severely burned patients was 7.9%. The average of burn area was 51.1%. The mean delay in initiating CRRT was 16.6 days and the mean duration of CRRT was 7.0 days. There was no difference between the survival group and the non- survival group in the data obtained upon admission, but there was a significant difference in the BUN level at the initiation CRRT. Therefore, the BUN level at the initiation CRRT has corelation with the mortality. CONCLUSION: CRRT is helpful for treating severely burned patients who have ARF, particularly those with accompanying with hemodynamic instability. This study showed that the BUN level at the initiation of CRRT associated with mortality. Therefore, the BUN level is an important criterion for initiating CRRT in these patients. However, a prospective randomized control study will be needed to accurately define BUN level.

Clinical Practice Using Allograft Skin in the Treatment of Massive Burns

PURPOSE: The most common cause of death in massive burn patients is burn wound sepsis. Therefore we have been using allograft skin for preventing burn wound sepsis. METHODS: Included in this study were 71 subjects who had sustained extensive burns from December 2003 through February 2006. 1. Early selective Escharectomy was performed for full thickness burn areas. 2. Allograft skins were grafted on excision area. 3. An autograft was performed for areas with a formation of granulation tissue after the allograft skin had come away. 4. A modified sandwich grafting technique (1 : 4 ~ 6 meshed autograft with Cultured Epithelial Autografts) was performed in large sized burns. 5. Acellular dermal substitute was concurrently used to prevent burn scar contraction on joint areas. RESULTS: Seventy one subjects were included (Fresh allograft: 9 cases, Cryo-preserved allograft: 42 cases, Glycerol preserved allograft: 20 cases). The average burn area was 41.8 (20 ~ 92) %TBSA (Total Body Surface Area). The mean area of the allograft skin used was 26.9 (8 ~ 70) %TBSA. The grafted allograft skins usually came away 3 weeks later. Four cases of initial take failure were occurred. All of these cases were pediatric patients using cadaver skin. Nine patients were dead from heart failure, severe inhalation, respiratory failure, pneumonia in old age, renal failure etc. There was no definite wound sepsis. Cultured Epithelial Autografts (CEAs) were used in fourteen cases. In twenty- five cases, acellular dermal substitute was simultaneously used. CONCLUSION: Early selective escharectomy, allograft skin coverage, acellular dermal substitutes and wide meshed autograft with CEA application would be immensely helpful techniques in patients with extensive burns.