Epidemiological retrospective analysis in major burn patients: single centre medical records from 2009 to 2019.

Burns cause a loss of skin barrier function, rendering it prone to infection. The prevention of infection comprises a focus on the treatment of patients with burns. Therefore, we analysed the results of microbiological tests of patients with severe and extremely severe burns to provide a basis for the prevention and treatment of infection in patients with burns. The results of microbiological tests of patients with severe and extremely severe burns admitted to our burn centre between 2009 and 2019 were retrospectively reviewed. The overall positive rate of microbial detection was 40.67% and did not significantly decline over the 10-year study period. The most common positive sites were wounds, sputum, and urine. The most common bacterial species causing the infections were Acinetobacter baumannii, Klebsiella pneumoniae, and Pseudomonas aeruginosa. Furthermore, the predictors of a positive detection, overall and at various sites, mainly included the burn area and depth, inhalation injury, and length of the hospital stay. Positive detection was an important predictor of the prognosis. In particular, a positive blood culture and Klebsiella pneumoniae had better predictive strength for mortality than other sites and strains. This study analysed the microbiological testing results at a single burn centre over a period of 10 years. The results provide information regarding the predictors of a positive detection and the influence of a positive detection on prognosis, and can be used as a basis for the development of clinical infection prevention and treatment strategies, as well as the selection of treatment measures.

Effects of depression on healing and inflammatory responses of acute wounds in rats.

This study aimed to elucidate the effect of depression on the healing of acute wounds in rats. We hypothesized that depression would have negative effects on inflammation and wound healing and that antidepressant therapy would reverse these effects. This study included 100 rats randomly allocated into five groups: control group (CG), depression group (DG), pre-depression group (PDG), antidepressant group (AG), and pre-antidepressant group (PAG). Acute wounds were created on the rats' backs. The groups were subjected to no interventions (CG), aversive stimuli before (PDG) and after (DG) wound creation, and antidepressant treatment before (PAG) and after (AG) wound creation. On the day of wound creation and on days 3, 6, 9, and 12 after wound creation, observations of the wound area and degree of depression (evaluated using the sucrose preference test, open-field test, and weight change) were recorded. On days 6 and 12 after wound creation, venous serum and wound tissues were collected. Tumor necrosis factor alpha (TNF-α), interleukin (IL)-1ß, IL-6, and IL-10 levels were measured using the enzyme-linked immunosorbent assay. Results showed an initial increase followed by a decrease in the degree of depression in all groups except DG (continuous decline). The wound-healing rate was significantly lower in PDG and DG than in CG; it was higher in AG and PAG than in CG. DG and PDG had higher concentrations of inflammatory cytokines than CG, and AG and PAG had lower concentrations than CG. This indicates that the onset of depression delays the healing of acute wounds and aggravates the inflammatory response in rats. Antidepressant treatment counteracts both of these negative effects.

Towards the heterogeneity of sepsis / 医学研究生学报

Sepsis is a heterogeneous syndrome which varies in etiology, pathogenesis, clinical manifestation, treatment and prognosis. According to the difference in these respects, sepsis can be divided into different phenotypes and endotypes, which may serve as valuable guidance in the individualized clinical treatment and precise prognostic judgment of the disease.

Focus on the diagnosis and treatment of severe burn induced coagulopathy / 医学研究生学报

The treatment of severe burn involves circulation, respiration, infection, surgical operation and so on. Coagulation disorder is also one of the main problems in severe burn patients, but there is no definite standard of diagnosis and treatment. The above clinic problems also weaken the diagnosis and treatment of the Severe Burn Induced Coagulopathy (SBIC). Therefore, for a long time, specialist medical staff have lost sensitivity to SBIC, missing diagnosis and misdiagnosis often occur, affecting prognosis. In this article, the pathogenesis, clinical manifestation, diagnosis and treatment of SBIC are described. The purpose is to make specialist medical staff pay attention to the diagnosis of SBIC and to start comprehensive intervention as soon as possible, in order to improve the prognosis.

A few considerations on trauma care in a modern naval warfare / 解放军医学杂志

Building a powerful navy is the key to safeguarding China’s maritime rights and interests and developing maritime strategy. Improving the level and capability of trauma care for naval battle is one of the important tasks for safeguarding naval combat capability and keeping up morale. This paper analyzes the characteristics of naval battle and both the key points and difficulties of medical support under the conditions of modern war, and draws lessons from the experiences of United States navy in the construction of medical support mode, force allocation and maritime health platform, and refers to its training mode and evaluation methods by relying on advanced medical equipment to carry out simulated trauma care efficiently. This paper considers and analyzes the mode of maritime health support, the allocation and utilization of mobile medical service force, the research work related to trauma for naval battle and the training of health professionals. The aim of this study was to provide some effective suggestions for improving capacity and efficiency of trauma care for naval battle.

Analgesic and sedative effects of inhaling a mixture of nitrous oxide and oxygen on burn patient during and after dressing change / 中华烧伤杂志

<p><b>OBJECTIVE</b>To investigate the analgesic and sedative effects of inhaling a mixture of nitrous oxide and oxygen on burn patient during and after dressing change.</p><p><b>METHODS</b>A total of 240 burn patients hospitalized in the Institute of Burn Research of Changhai Hospital Affiliated to the Second Military Medical University, Department of Burns of the First People's Hospital in Zhengzhou, and Department of Burns and Plastic Surgery of General Hospital of Ningxia Medical University from October 2011 to September 2012 were enrolled in our study, and they were all in accordance with the inclusion criteria. The 240 patients were divided into control group (n = 60, treated with inhalation of oxygen during dressing change) and treatment group (n = 180, treated with inhalation of a mixture of 65% nitrous oxide and oxygen during dressing change) according to the computer-generated list of random number. The other treatments in control group and treatment group were the same. Before, during, and after dressing change, heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), oxygen saturation (SO2), and adverse effects were observed. The degree of pain and anxiety felt by the patients were respectively evaluated with the visual analogue scale (VAS) and Chinese version of the burn specific pain anxiety scale (C-BSPAS) at the same time points as above. Data were processed with analysis of covariance, chi-square test, analysis of variance, and rank sum test.</p><p><b>RESULTS</b>There were no significant differences between control group and treatment group in the levels of HR, SBP, DBP, and SO2 before dressing change (with F values respectively 0.76, 0.06, 1.11, 0.70, P values all above 0.05). Compared with those of control group, the levels of HR, SBP, DBP, and SO2 in treatment group were significantly ameliorated during dressing change (with F values respectively 81.78, 146.36, 226.44, 205.62, P values all below 0.01). After dressing change, the levels of DBP in the two groups were close (F = 0.31, P > 0.05), but the levels of HR, SBP, and SO2 showed statistical differences (with F values respectively 7.02, 8.69, 12.23, P < 0.05 or P < 0.01). Before dressing change, the VAS scores were approximate between control group and treatment group (Z = 0.21, P > 0.05). Compared with those in control group (9.4 ± 0.7, 1.7 ± 2.5), the VAS scores were significantly lowered in treatment group during and after dressing change (1.6 ± 1.3, 0.7 ± 1.1, with Z values respectively 11.84, 3.35, P values all below 0.01). There was no significant difference in C-BSPAS score between control group and treatment group before dressing change (Z = 0.62, P > 0.05). Compared with those in control group (75 ± 13, 73 ± 12), the C-BSPAS scores in treatment group were decreased during and after dressing change (9 ± 15, 9 ± 14, with Z values respectively 11.91, 12.28, P values all below 0.01). There were no obvious adverse effects in two groups before, during, and after dressing change.</p><p><b>CONCLUSIONS</b>A mixture of nitrous oxide and oxygen seems to have obvious analgesic and sedative effects on burn patients during dressing change, and it can be widely used.</p>

Study and translation of systemic control technology for the burn and trauma related lung injuries / 中华烧伤杂志

Burns and traumas are common injuries during both peace time and wartime. Lung is the earliest organ subjected to dysfunction and the incidence is highest. The systemic protective technology for the burn and trauma related lung injuries is based on evidence-based medicine and translational medicine. It includes a series of effective measures, such as rescue and treatment scheme for massive burn casualties, prophylactic tracheostomy, protective ventilation strategy, sequential cell protection, and prevention and treatment of sequelae, which prevents aggravation of lung injuries caused by ischemia reperfusion, oxidative stress, and iatrogenic factors, as well as reduces the incidence of complications to ensure the recovery after burns and traumas.

Development of quality of life scale in Chinese burn patients: cross-cultural adaptation process of burn-specific health scale - brief.

PURPOSE: This study was designed to develop and test a Chinese burn patient-specific quality of life (QOL) scale based on the burn-specific health scale - brief (BSHS - B) to provide an effective assessment tool to measure quality of life in Chinese burn patients. METHOD: Delphi method was used after the translation, back translation and pre-commissioning tests of BSHS - B, to amend the description of the items for cultural adaptation. The adapted Chinese version (ACV) of the BSHS - B was tested for internal consistency and validity of construct on a group of 271 burn patients from three major burn units in China. RESULTS: Thirty-eight items within six domains of ACV BSHS-B were developed with scoring '0-4' in each item. The mean total score for our study group was 98.36 (standard deviation (S.D.)=37.86), ranging from 13 to 150. The total Cronbach's alpha value was 0.97 and total split-half reliability was 0.98, demonstrating that the internal consistency of the ACV was very high. Pearson correlations among the six domains of ACV BSHS - B were statistically significant. Exploratory factor analysis results showed that the six-factor function explained 78.30% of total variance; each entry in the corresponding domain had a factor-loading value higher than 0.4, indicating that the scale has a good validity. CONCLUSION: The ACV of the BSHS - B showed good reliability and validity, and can be used as a tool for assessing the QOL in Chinese burn patients.

Lay emphasis on the treatment of massive burn casualties in conflagration / 中华烧伤杂志

Burn surgery belongs to disaster medicine. Burn is a common trauma that occurs in social activities of human beings in all ages, either in the time of peace or war. During the development of human medicine in modern times, the summary of experience in treating massive burn casualties due to severe fire accidents has effectively promoted the renovation of treating technology and theory of burns and the development of burn surgery. The results of treatment of burn injury in casualties occurred in the fire of Cocoanut Grove night club in Boston in 1942, and the high-rise apartment house fire in Shanghai in 2010 were summarized and analyzed in this article, emphasizing the correlating issues of inhalation injury.

Advancement in the research of mechanism of endogenous cellular injury in visceral complications as complications after severe burn / 中华烧伤杂志

It is of great importance to know the endogenous mechanism in burn-induced organ injuries, not only for the understanding of pathophysiological processes after burn, but also for guiding the clinical treatment. Recent studies have widened and deepened our scope and understanding of secondary injuries to various organs. However, a unanimous understanding of molecular pathway involved in all burn-induced organ injuries has not been attained. Relatively, the mechanism of endogenous cellular injuries as a result of burn injury could be regarded as a common one to explain the causation of cellular injury, and to guide the prevention and treatment for the burn-induced complications using cytoprotection strategy. This review summarized four aspects of the mechanism of endogenous cellular injuries, including cellular injuries induced by ischemic/hypoxic-oxidative stress, excessive inflammatory factors released by inflammatory cells, immunosuppression caused by suppression of function of adaptive immune cells, and dysfunction of important supportive cells of various organs.

Fungal infection after a tragedy: a report of three cases of candidosis in a fire accident / 中华医学杂志(英文版)

Patients who suffer severe burns are at increased risk for local and systemic infections. The incidence of fungal infections has increased in recent years, and these infections represent a major issue in burn intensive care units. Herein, we report three cases of fungal infection due to Candida species occurring in patients undergoing supportive therapy and antibiotic treatment during their hospitalization. Two of these patients were infected with Candida parapsilosis, and one was infected with Candida albicans. The risk factors for these patients' Candida infections were multiple and prolonged courses of antimicrobial treatment, steroid treatment, tracheal intubation and smoke inhalation. Susceptibility testing of nine antifungal compounds was performed, and the minimum inhibitory concentration (MIC) values of all isolated strains were lower than the breakpoint MIC value for resistance of the relevant drug. All three patients were cured by treatment with antifungal agents. Candida infection may occur 1 - 3 weeks after thermal injury, and the prompt recognition and treatment of such infections with antifungal therapies may result in decreased morbidity and mortality associated with these infections in burn patients.

Pediatric burns due to hot water from water dispenser: a neglected issue that should be highly concerned / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>More and more Chinese drink hot water from water dispensers while many children were scalded due to this change. The present study aimed to propose a feasible strategy for prevention.</p><p><b>METHODS</b>A retrospective study was conducted for all water dispensers related pediatric burns admitted to Changhai Hospital from January 2005 to December 2009.</p><p><b>RESULTS</b>The number of new cases and incidences of pediatric burns due to hot water from water dispensers was significantly increasing year after year. In the total 238 involved cases, 175 cases happened on males and 78.9% were at the age of 1 - 4 years. The burn areas were mainly located in upper extremities. All water dispensers in the surveyed families had no isolate protection devices and 85.2% of their locations were easy for children to reach. Nearly half of the children were in the same room with their guardians when injured. Total 196 burned children were playing the taps of water dispensers before injured, unfortunately, 80.6% of them have not been stopped until burned.</p><p><b>CONCLUSION</b>As the kind of burns is quite serious and with bad outcome, some recommendations should be followed, such as buying water dispensers with protection devices, keeping children from touching them and so on.</p>

mTOR partly mediates insulin resistance by phosphorylation of insulin receptor substrate-1 on serine(307) residues after burn.

Mammalian target of rapamycin (mTOR) is an important mediator for cross talk between nutritional signals and metabolic signals of insulin by downregulating insulin receptor substrate proteins. Therefore, mTOR inhibition could become a therapeutic strategy in insulin-resistant states, including insulin resistance induced by burn. We tested this hypothesis in the rat model of 30% TBSA full thickness burn, using the mTOR inhibitor rapamycin. Rapamycin (0.4 mg/kg, i.p.) was injected 2 h before euglycemic-hyperinsulinemic glucose clamps at 4 days after burn. IRS-1, phospho-serine³°7, phospho-tyrosine of IRS-1 and phospho-mTOR in muscle tissue were determined by immunoprecipitation and Western blot analysis or immunohistochemistry. Plasma TNF-α, insulin and C-peptide were determined before and after euglycemic-hyperinsulinemic glucose clamps. Our data showed that TNF-α, insulin and C-peptide significantly increased in the early stage after burn (P < 0.01). The infused rates of total 10% glucose (GIR, mg/kg min) significantly decreased at 4 days after burn. The level of IRS-1 serine³°7 phosphorylation in muscle in vivo significantly increased after burn (P < 0.01), while insulin-induced tyrosine phosphorylation of IRS-1 significantly decreased (P < 0.01). Inhibition of mTOR by rapamycin inhibited the phosphorylation of mTOR, reduced serine³°7 phosphorylation, elevated tyrosine phosphorylation and partly prevented the decrease of GIR after burn. However, TNF-α, insulin and C-peptide were not decreased by rapamycin treatment postburn. Taken together, these results indicate that the mTOR pathway is an important modulator of the signals involved in the acute regulation of insulin-stimulated glucose metabolism, and at least, partly contributes to burn-induced insulin resistance. mTOR inhibition may become a therapeutic strategy in insulin-resistant states after burn.

Repair system engineering and the concept of sequential cytoprotection in treatment of burn / 中华烧伤杂志

It has been an essential trend to understand and solve the difficult problems arising in the treatment process of burn with views of holistic theory. Recent researches have indicated that the driven factors and the termination signals of repair system engineering in treatment of burn are the unity of two opposite rather than two independent bodies with chronological order. Repair driven factors are germinated at the cost of systemic inflammatory response and even multiple organ damage. Inflammatory response is both a necessary procedure of burn repair and the pathological basis of multiple system dysfunction after burn. A comprehensive burn therapy nominated sequential cytoprotection (SCP) strategy has emerged in which the knowledge derived from basic research is translated to clinical practice stepwise, and it might play an important role in treatment of severe burn. Further multi-center randomized controlled clinical trials should be conducted in order to raise the level of SCP strategy in guideline of evidence-based medicine.

Unplanned decannulation of tracheotomy tube in massive burn patients: a retrospective case series study / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Unplanned extubation is associated with adverse outcomes in intensive care unit. The massive burn patient differs from other critically ill patients in many ways. However, little is known about the unplanned decannulation (UD) in Burn Intensive Care Unit. This paper describes the special features of the circumstances and outcome of UD of tracheotomy tube in massive burn patients.</p><p><b>METHODS</b>A case series study was performed between January 1999 and December 2008 and UD of tracheotomy tube was analyzed retrospectively. A total of 21 patients with 29 UD events were identified. Demographic data, diagnosis, intervention, UD events and outcome of UD patients were collected. Differences in proportions were compared using the chi-square (χ(2)) or Fisher's exact test.</p><p><b>RESULTS</b>Patients with UD were often burned with head and neck (67%) and combined with inhalation injury (62%). The majority of them (76%) were transferred patients, occurred early (55%) and were accidental UD (79%). UD events tended to happen in day shift (90%) and to be associated with the medical procedure that was performing by caregivers at besides (79%). Loose of the stabilizing rope, medical procedure and tracheotomy malposition were the main causes of UD. Early UD and reintubation failure were associated with patients' death.</p><p><b>CONCLUSIONS</b>UD happened to massive burn patients can lead to patient death. Careful management of respiratory tract was essential for massive burn patients.</p>

Increased hsp70 of glucocorticoid receptor complex induced by scald and heat stress and its possible effect on the affinity of glucocorticoid receptor / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Glucocorticoid (GC) insensitivity/GC resistance is an important etiological and prognostic factor in multiple diseases and pathophysiological processes such as scald, shock and asthma. The function of GC was mediated by glucocorticoid receptor (GR). Scald not only decreased the expression of GR but also reduced the affinity of GR, which played an important role in GC resistance in scalded rats. Whereas the molecular mechanism responsible for the decrease of GR affinity resulted from scald remains unclear. Recent studies showed that the changes of heat shock proteins (hsp) especially hsp90 and hsp70 of GR heterocomplex were associated with GR low affinity in vitro.</p><p><b>METHODS</b>The affinity of GR in hepatic cytosols and in the cytosols of SMMC-7721 cells were determined by radioligand binding assay and scatchard plot. GR heterocomplex in cytosols were captured by coimmunoprecipation and the levels of hsp90 and hsp70 of GR complex were detected by quantitative Western blotting.</p><p><b>RESULTS</b>Similar with that of hepatic cytosol of scalded rats, a remarkable decrease of GR affinity was also found in the cytosol of heat stressed SMMC-7721 cells. The level of hsp70 of GR complex in hepatic cytosol of scalded rats (30% total body surface area immersion scald) and in cytosol of heat stressed human hepatocarcinoma cell line SMMC-7721 were both increased by 1.5 fold, whereas no change of hsp90 in GR heterocomplex was found. According to the correlation analysis, there may be a positive relationship between increased hsp70 of GR complex and decreased GR affinity in the cytosols.</p><p><b>CONCLUSIONS</b>The primary results indicated that the level of hsp70 of GR heterocomplex was increased in the hepatic cytosol of scalded rats and the cytosol of heat stressed SMMC-7721 cells. The increase of hsp70 of GR complex might be associated with the decrease of GR affinity.</p>

Effect of hydrogen-rich saline on blood pressure and antioxidant ability of lung tissue in scalded rats following delayed resuscitation / 中华烧伤杂志

<p><b>OBJECTIVE</b>To study the effect of hydrogen-rich saline on blood pressure and antioxidant ability of lung tissue in scalded rats following delayed resuscitation.</p><p><b>METHODS</b>The hydrogen-rich saline was prepared (hydrogen-saturated normal saline with hydrogen concentration of 0.6 mmol/L). Twenty SD rats were divided into hydrogen-rich saline group (HS) and normal saline group (NS) according to the random number table, with 10 rats in each group. All the rats were subjected to 30% total body surface area (TBSA) full-thickness scald. Rats in HS and NS groups were infused with hydrogen-rich saline or normal saline with one half of the total fluid replacement volume as calculated according to the Parkland formula (4 mL×kg(-1)×%TBSA(-1)) at post scald hour (PSH) 7 and one-quarter of the volume at PSH 9 and 17 respectively. The general condition of rats during the experiment was observed. The systolic pressure of rats was measured at PSH 6 and 24. All rats were sacrificed at PSH 24 to collect lung tissue for detecting superoxide dismutase (SOD) inhibition ratio and malondialdehyde (MDA) level. Data were processed with t test.</p><p><b>RESULTS</b>All rats survived through the experiment. The systolic pressure of rats in HS group and NS group was respectively (87 ± 4) mm Hg (1 mm Hg = 0.133 kPa) and (86 ± 5) mm Hg at PSH 6, and the values were close (t = 0.213, P = 0.834); however the systolic pressure at 24 h was higher in HS group than in NS group [(124 ± 7) mm Hg vs. (115 ± 6) mm Hg, t = 2.958, P = 0.008]. SOD inhibition ratio of lung tissue in HS group [(0.465 ± 0.014)%] was higher than that in NS group [(0.358 ± 0.021)%, t = 11.767, P = 0.000]. MDA level of lung tissue in HS group [(922 ± 196) pmol/mg] was lower than that in NS group [(1118 ± 212) pmol/mg, t = -2.142, P = 0.046].</p><p><b>CONCLUSIONS</b>Delayed resuscitation for scalded rats with hydrogen-rich saline is helpful in the recovery of systolic pressure, and it can ameliorate lung tissue injury caused by reperfusion through enhancing the effect of antioxidase.</p>

The direct hospitalisation costs of paediatric scalds: 2-year results of a prospective case series.

OBJECTIVE: To reveal the characteristic and distribution of length of hospital stay (LOS) and direct hospitalisation costs of paediatric scald. METHODS: A prospective case series observation was performed from January 2005 to December 2006 at the Burn Center, Changhai Hospital, Shanghai, China. The information, such as demographics, clinical diagnosis and treatments since admission, of the paediatric scald patients included in the series was recorded. The direct cost of a treatment event was recorded into the price system when it was incurred. All cost data were summarised on completion of the study. The distribution of LOS and the hospitalisation costs were recorded by gender, age, total burn area, depth of burn, blood transfusion and patterns of treatment. Mann-Whitney signed-rank test was used to assess the differences between continuous, non-normally distributed variables, and multiple linear regression was used to model LOS and direct hospitalisation costs. Statistical analyses were undertaken with SPSS 15.0 statistical software. RESULTS: Patients aged 3 years or less accounted for more than half of the total LOS and hospitalisation costs, patients with burn area less than 10%TBSA (total burn surface area) accounted for more than 70% of the total LOS and more than half of the hospitalisation costs and patients with second-degree burn accounted for more than 78% of the total LOS and hospitalisation costs. Depth of burn, area of burn, patterns of treatment and blood transfusion were independent predictors of LOS; whereas LOS, area of burn and blood transfusion were independent predictors of hospitalisation costs. CONCLUSION: Paediatric scalds have particular characteristics in terms of distribution of LOS and direct hospitalisation costs and the factors influencing them. The data presented in this study should assist burn care practitioners and hospital epidemiologists estimate and compare the economic burden of paediatric burns at other institutions; it may also be useful in resource allocation and cost-effectiveness analysis of treatment versus prevention strategies.

Repair of deep burn and traumatic wounds in lower extremities with combined transplantation of multiple pedicled skin flaps / 中华烧伤杂志

<p><b>OBJECTIVE</b>To summarize the clinical experience in repair of deep burn and traumatic wounds with combined transplantation of different types of pedicled skin flaps in lower extremities.</p><p><b>METHODS</b>Two hundred and thirty-six patients with 271 deep wounds in lower extremities after burn or trauma were repaired with muscular skin flaps, local fascial flaps and island flaps with vascular pedicle (more than 20 types) in our department from Jan. 1998 to Sept. 2008.</p><p><b>RESULTS</b>Complete necrosis of skin flaps occurred in 1 case, congestion and necrosis over the edge of skin flaps occurred in 3 cases, which were healed after grafting, and other skin flaps survived well with soft texture. Skin flaps were too bulky in 26 cases, among them 17 cases were thinned, and the appearance of other skin flaps were satisfactory. In 68 patients with functional region injury were recovered to certain extent without contracture.</p><p><b>CONCLUSIONS</b>Skin flaps with pedicles, multiple transplantations if necessary, can repair deep wounds satisfactorily in lower extremities after deep burn or trauma injury.</p>

Epidemiology of pediatric burns requiring hospitalization in China: a literature review of retrospective studies.

OBJECTIVE: This review was an effort to systematically examine the nationwide data available on pediatric burns requiring hospitalization to reveal burn epidemiology and guide future education and prevention. METHODS: The China Biomedical Disk Database, Chongqing VIP Database, and China Journal Full-Text Database were searched for articles reporting data on children and their burns from January 2000 through December 2005. Studies were included that systematically investigated the epidemiology of pediatric burns requiring hospitalization in China. Twenty-eight articles met the inclusion criteria, all of which were retrospective analyses. For each study included, 2 investigators independently abstracted the data related to the population description by using a standard form and included the percentage of patients with burn injury who were <15 years old; gender and distribution of age; type of residential area; place of injury; distribution of months and time; reasons for burn; anatomical sites of burn; severity of burn; and mortality and cause of death. These data were extracted, and a retrospective statistical description was performed with SPSS11.0 (SPSS Inc, Chicago, IL). RESULTS: Of the pediatric patients studied, the proportion of children with burn injury ranged from 22.50% to 54.66%, and the male/female ratio ranged from 1.25:1 to 4.42:1. The ratio of children aged 3 years was 0.19:1 to 4.18:1. The rural/urban ratio was 1.60:1 to 12.94:1. The ratio of those who were burned indoors versus outdoors was 1.62 to 17.00, and there were no effective hints on the distribution of seasons and anatomical sites of burn that could be found. The peak hours of pediatric burn were between 17:00 and 20:00. Most articles reported the sequence of reasons as hot liquid > flame > electricity > chemical, and scalding was, by far, the most predominant reason for burn. The majority of the studies reported the highest proportion involved in moderate burn, and the lowest proportion was for critical burn. The mortality rate ranged from 0.49% to 9.08%, and infection, shock, and multiple organ dysfunction syndrome were the most common causes of death. CONCLUSIONS: Considering the national proportion of children, a high proportion of hospitalized patients with burn injury were children; those who were male, aged