The impact of socio-economic deprivation on burn injury: A nine-year retrospective study of 6441 patients.

INTRODUCTION: Low socio-economic status is thought to be associated with increased burn risk, however the significance and generalisability across different populations and cultures has been questioned. METHODS: A nine-year retrospective study of burn presentations to a large teaching hospital (2005-2014) was performed to investigate the association between socio-economic status and burns. Demographic and injury data was collected via the trust 'Information portal'. The Welsh Index of Multiple: Deprivation 2011 was used to score for socio-economic status. Chi-squared test and Odds Ratios were calculated and statistical significance defined as p<0.05 throughout. RESULTS: 6441 burns were identified, with 755 (11.7%) admitted. Overall incidence rates were the highest published in the UK (0.35/1000/year) with sub group analysis showing the highest rates in under fives and males. Significant relationships between both age and burn mechanism and gender and burn mechanism (p=0.0005) were identified. Scald (67.1%) was the most common mechanism with the upper limb (48%) most commonly burned. Chi square analysis demonstrated a significant relationship between socio-economic deprivation, age and burn incidence (p≤0.0005), with a disproportionately high number of burns in patients under the age of 16 in the most deprived quintile (OR 1.23; 95% CI 1.06-1.44). CONCLUSION: This study specifically highlights patients under the age of 16 living in poorer socio-economic areas as the most at risk of suffering burns receiving hospital attention. This study demonstrates burns as a significant public health issue, and the results should aid in designing specific burn prevention strategies to target high-risk groups.

Following up the follow up--long-term complications in paediatric burns.

Paediatric burn follow-up optimally follows a balance between complication detection and avoiding unnecessary hospital visits. In a long-term review, we assessed complication patterns in children with burns requiring surgery. Using the Welsh Burns Centre database, a retrospective note review of paediatric burns over 3 years from 1995 was performed, identifying all children undergoing surgery for their burns. 94 patients were identified with a median follow-up since injury of 13.6 years. Mean age was 5.27 (SD=4.9) years. TBSA ranged from <1 to 70%. 94% underwent split-skin grafting. 18% (n=17) developed contractures and 33% (n=31) developed hypertrophic scarring. Those developing contractures were younger, and suffered significantly greater TBSA burns (p<0.05) than those developing hypertrophic scarring or those without complications. All contractures developed within 1-13 months, and hypertrophic scarring within 1-17 months. All patients sustaining axillary burns developed contractures, whilst 75% of contractures developed around the upper limb. In conclusion, younger patients with larger TBSA burns in the upper limb were at higher risk for contractures and hypertrophic scarring, which all presented within 18 months. Therefore any patients that are complication-free 18 months after-injury can be safely discharged, allowing streamlining of follow-up for the benefit of patients, parents and hospital resources.

Haemothorax: A potentially fatal complication of subclavian cannulation--A case report.

Central venous cannulation forms one of the mainstays of management of trauma and haemodynamically unstable patients. Frequently this procedure has to be done as an emergency in the emergency department. Ultrasound guidance has been recommended, especially for use by trainee members of the emergency department. We report a case of 44% full thickness burns with subclavian artery puncture due to a misplaced central venous catheter. This led to massive haemothorax, which eventually caused the patient to succumb. We re-emphasise the need for ultrasound guidance for insertion of central venous lines, especially in the emergency setting.

Wet cement remains a poorly recognised cause of full-thickness skin burns.

In 1993 we published a paper stating that wet construction cement is a poorly recognised cause of full-thickness burns [Injury 24 (1993) 615]. Ten years since publication we re-evaluated cement burns to ascertain if there had been any changes in awareness and incidence. All cement related burns assessed at this unit were reviewed over a three and a half year period. Postal questionnaires were sent to all those affected. Cement burns accounted for 2.2% of referrals to the Burns Unit during this studied period as compared to 1% during the original study. Fifty-one percent of patients stated they were unaware of the risk of cement burns and took no precautions. Eighty-six percent of the burns involved the lower limb. Fifty-three percent of burns affected professional users. Fifty percent had full-thickness involvement with 21% requiring operation. Eighty-eight percent of patients did not notice any warnings on the cement bag or delivery docket and 95% felt warnings should be larger and more obvious. This study has shown that cement burns may have resulted from shortcomings in the information and warnings provided to customers by cement manufacturers.

Paediatric friction hand injuries caused by domestic vacuum cleaners-a review from one unit.

The management of seven children with vacuum cleaner friction burns is described. Six of the children sustained full thickness burns. Four were treated operatively. Indications for surgery are outlined and important accident prevention strategies are highlighted.

Prophylactic treatment of deep dermal burn scar to prevent hypertrophic scarring using the pulsed dye laser: a preliminary study.

The pulsed dye laser, by selectively targeting blood vessels, has been used to treat established hypertrophic scars with good effect. This prospective clinical study aims to assess the feasibility of treating deep dermal burn wounds prophylactically before the formation of hypertrophic scars. Patients with burn wounds that took longer than 2 weeks to heal were primarily recruited. Each patient's burn area was divided into a treated area and a negative control. The area was laser treated with the pulsed dye laser (Chromos 585; SLS, Wales) twice at 6 weekly intervals. The appearance of the wound at both sites was inspected visually and scored at 6 weeks, and at 3, 6, and 9 months. Five patients with six burn sites (forearm, arm, and back) were treated. Treated areas achieved better scarring at 6 weeks ( = 0.04, paired -test) and at 3 months ( = 0.003, paired -test). The difference, however, became insignificant at 6 and 9 months. No notable side effects were seen in all patients. Prophylactic treatment of burn wounds with the pulsed dye laser is effective in hastening the resolution of scarring. In the authors' opinion, this treatment may revolutionize the traditional method of hypertrophic burn scar prevention, and should be considered early, especially for patients who are prone to hypertrophic scarring, and in areas where hypertrophic scarring are common.

An audit of the tetanus immunisation status of plastic surgery trauma and burns patients.

This study audits the tetanus immunisation management of plastic surgery trauma patients by their referring Accident and Emergency departments, and compares this to nationally published guidelines. We assessed 269 burns and trauma patients, referred from across South Wales, using a questionnaire together with their Accident and Emergency notes or letter. The precise question(s) that had been asked regarding the tetanus immunisation status of the patient, and the immunisation management based on the results of those questions, were recorded. The accurate tetanus immunisation status of the patient was established, the wound was assessed and further management was given as indicated. Only 16 patients had been asked whether they had received a course of tetanus, and 41 patients were not questioned about their tetanus immunisation status by the referring Accident and Emergency department. As a consequence of more accurate questioning, 73 patients (27%) required further action after their arrival in the Plastic Surgery unit. This audit has demonstrated that the management of tetanus immunoprophylaxis in plastic surgery trauma patients cannot be confidently left to the referring Accident and Emergency department but should form an integral part of the treatment at the admitting unit.

Burn wound management in patients with epilepsy: adopting a multidisciplinary approach.

Many burns that occur following an epileptic seizure are deep due to prolonged contact with the thermal source. Primary care staff need to be aware of this and ready to refer patients to a burns unit.

Isolated buttock burns: epidemiology and management.

This is a retrospective study of the epidemiology and management of isolated buttock burns presenting to the Welsh Regional Burns Centre from January 1996 to December 1999. A total of 36 cases have been treated of which 31 are included in this study. Approximately, 50% are in the paediatric age group and the sex distribution is equal for both adults and children. Contact burns form the largest group, and in children resulted in superficial burns requiring dressings only. The adult population is more likely to sustain deeper burns that require skin grafting, and approximately 50% will have a contributing premorbid condition. Despite difficulties in dressing and positioning of the patients, grafting of full thickness burns is appropriate without recourse to faecal diversion.

The use of a bilaminate artificial skin substitute (Integra) in acute resurfacing of burns: an early experience.

Integra artificial skin provides immediate full-thickness reconstruction for cutaneous burns. The clinical outcome appears to be superior in terms of final function and cosmesis. Consequently the use of such a skin substitute is being heralded as the future treatment of choice, particularly for massive burns where autologous donor skin is limited. The three cases reported here describe the senior author's early experience with Integra and highlight some of the difficulties and successes encountered. A high rate of dermal graft loss and slow epidermal engraftment have tempered the original enthusiasm, but with growing experience the final outcome justifies the continued use of Integra in our unit.

Lime burns in a professional football goalkeeper - an unusual hazard.

Burns due to lime, although well reported as a result of occupational exposure, are uncommon in the sports arena. A case of such a chemical burn, which required surgery in a football goalkeeper is presented. There are safe alternatives to line marking on football pitches the use of which will prevent such injuries and avoid litigation.

Work-related burns in South Wales 1995-96.

The aim of this work was to evaluate the epidemiology of occupational burns referred to the Welsh Regional Burns Unit from 1st January 1995 to 31st December 1996. Three hundred and twenty-four patients were identified as having sustained occupational burns and the case notes of 319 were available for review. Data on age, sex, occupation, aetiology, percentage and site of burn, treatment, complications and length of hospital stay were recorded. Twenty percent of all burns referred to our unit occurred in the workplace, the majority of whom were male (male:female 11:1), with a mean age of 34 years. Patients presented late to our unit in 35% of cases, with an average delay of 5 days. Chemical burns predominated (23%), followed by flame (14%) and scald (14%). Small burns (< or =1% TBSA) were seen in 70% of all patients. Five patients had burns involving >15% TBSA. One hundred and seventy-five patients were admitted, of whom 79 required surgery. The length of stay ranged from 1-110 days (mean 8.5), with an average follow-up for all patients of 3.5 months. One patient died as a result of his burn injury. In conclusion, occupational burn injuries continue to account for a significant proportion of all burn injuries, affecting mainly young males in physical occupations. Despite Health and Safety guidance, chemical burns are the predominant cause and more needs to be done to educate those working with chemicals to prevent injury.

Burns in patients with epilepsy: changes in epidemiology and implications for burn treatment and prevention.

PURPOSE: To determine the epidemiology of burns in patients with epilepsy and to identify changes in epidemiology compared with previous studies; to identify further strategies that can be used in the primary and secondary prevention of such injuries in this group of patients. METHODS: A retrospective case note review of 111 patient episodes to a regional burns unit where the admission criterion was a burn secondary to an epileptic seizure. RESULTS: The majority (60 of 111) of burns were due to scald injury and were sustained in a domestic setting. This group of patients (mean age, 42.7 years) accounted for 1.6% of admissions during the study period. The data demonstrate a change in the epidemiology when compared with previous studies. Most burns were small (mean area burnt, 2.2%) but deep, and 72 of 111 patient episodes required surgery, and 12% of patients had reburn injuries requiring readmission. CONCLUSIONS: Scald injuries are now the major cause of burns in those with epilepsy, and the proportion of such patients admitted to a regional burns unit has reduced. Patients and health professionals need to be aware of such injuries and of appropriate prevention strategies.