Comparison of six outcome prediction models in an adult burn population in a developing country.

There are two types of prognostic model - burn-specific and general - to predict mortality risk in burn patients. Most prediction models were devised in developed countries. The aim of this study was to compare the performance of six outcome models in a developing country. In a retrospective cohort study, data of all thermal burned adult patients (age ≥ 18 years) admitted to the Burn Intensive Care Unit (BICU) were collected and then the following six prediction models were used to assess each patient: Acute Physiology and Chronic Health Evaluation (APACHE II), Abbreviated Burn Severity Index (ABSI), Belgian Outcome in Burn Injury (BOBI), the Ryan model, revised Baux and FLAMES model. Discriminative ability and goodness-of-fit of the prediction models were determined by receiver operating characteristic curve analysis and Hosmer-Lemeshow tests. We included 238 patients (mean age: 38.3 ± 18.39 years, average TBSA: 58.27% ± 24.55) in our study; 172 (72.3%) of them were diagnosed with inhalation injury and 178 (72.4%) were intubated. Mortality rate was 69.7%. Deceased patients had significantly higher mean age, %TBSA and number of inhalation injury. The area under the curve of the models was between 64.5 (APACHE II) and 85.9 (ABSI). The best estimation of predicted mortality was obtained with the ABSI model (67.2%).

Des scores de gravité spécifiques ou généraux peuvent être utilisés pour évaluer le pronostic d'un brûlé, la plupart d'entre eux ayant été construits dans des pays développés. Le but de cette étude était de comparer 6 d'entre eux dans un pays en développement. Les données de tous les patients admis en réanimation spécialisée ont été collectées pour calculer 6 scores de gravité qui étaient : APACHE II, ABSI, BOBI, Ryan, Baux révisé et FLAMES. La sensibilité et la spécificité de ces modèles ont été analysées par courbe ROC et test de Hosmer-Lemeshow. Deux cent trente huit patients de 38,3 +/- 18,39 ans, brûlés sur 58,27 +/- 24,55% de SCT ont été inclus. Cent soixante douze (72,3%) avaient inhalé des fumées et 178 (72,4%) avaient été intubés. La mortalité était de 69,7%. Les patients décédés étaient plus âgés, brûlés sur une plus grande surface et avaient plus fréquemment inhalé des fumées. Les aires sous la courbe ROC allaient de 64,5 (APACHE II) à 85,9 (ABSI). Cette étude confirme que l'ABSI reste le meilleur score de gravité pour les patients brûlés.

Cervical meningocele associated with subependymal nodular heterotopia.

Heterotopia is a subgroup of migration abnormalities, recognized by arrest of radial migration of neuroblasts. Being a well-known cause for developmental delay, mental retardation, and epilepsy, association of heterotopia with some other conditions has also been proposed. There are several case reports regarding the concurrence of heterotopia and encephalocele; however, no such association has been reported with cervical meningocele. Herein, we present the first case of periventricular nodular heterotopia associated with cervical meningocele. Our case further emphasizes the role of brain MRI in the evaluation of those with neural tube defects. Recognition of possible associated heterotopia is important for planning proper treatment and genetic counseling.

Comparison of the outcome of burn patients using acute-phase plasma base deficit.

Background. In recent years, plasma base deficit has been used as a marker to determine the status of tissue perfusion in trauma patients and also to predict the outcome of these patients. This study was performed to investigate the effect of plasma base deficit in predicting burn patient outcome. Methods. This prospective cohort study was performed from October 2009 to October 2010 in the acute phase of burn patients who were admitted within 6 h post-injury to Motahari Burn Hospital in Iran. The patients were divided into two groups based on the plasma base deficit in the first 24 h post-injury: group A, in which the mean plasma base deficit was less than or equal to -6 (more negative), and group B, in which the mean plasma base deficit greater than -6. Statistical analysis was performed using SPSS v.16 software. Results. Thirty-eight patients were enrolled in each group. The mean plasma base deficit in group A (-7.76 ± 2.18 mmol) was significantly less than that in group B (-1.19 ± 2.82) mmol (p < 0.05). Although there was no significant difference between the mean of fluid resuscitation and urine output in the first 24 h after injury between the two groups (p > 0.05) and despite removal of interfering factors, there were significant differences between the systemic inflammatory response syndrome and the multiple organ dysfunction syndrome score and the percentage of sepsis between the two groups (p < 0.05). The mortality rate in group A (63.2%) was significantly higher than that in group B (36.8%) (p > 0.05). Conclusion. The plasma base deficit can be used as a valuable marker in the resuscitation of burn patients, along with clinical criteria. Physiological indicators (burn percentage, age, and mucosal burns) are not sufficient to predict mortality and morbidity in burn patients, and it is necessary to investigate the role of biochemical markers such as base deficit in determining the final outcome of burn patients.

Foley catheter entrapment resulting from the formation of a true knot in a female infant: sonographic findings.

One of the rarest complications of bladder Foley catheter insertion is knotting of the catheter. We present a case of Foley entrapment secondary to formation of a true knot at the proximal end of the catheter in a 6-month-old female infant who was referred to our center for voiding cystourethrograthy. Sonography of the bladder revealed the knotted catheter in the urinary bladder.