Laryngeal morphologic changes and epidemiology in patients with inhalation injury: a retrospective study.

BACKGROUND AND OBJECTIVES: Laryngeal morphologic changes are important in risk assessment of upper airway obstruction (UAO) after inhalation injury. This retrospective study evaluates the clinical application of laryngeal burn classification system. MATERIALS AND METHODS: Clinical data from January 1999 to June 2013 were analyzed retrospectively. The following data collected: age, gender, total burned surface area (TBSA), third-degree burn surface area, co-morbid injuries and complications, proportion of patients with tracheotomy, interval between tracheotomy and injury, incidence and mortality of UAO, and reasons for death. RESULTS: Four hundred and forty-three patients were included; 405 patients underwent multiple fibro-laryngoscopic observation, of which I, II and III types of laryngeal burns were present in 49.9, 38.0, and 12.1% patients, respectively. Laryngeal burn severity was related to TBSA and third-degree burn surface area. Overall tracheotomy rate (n=443) was 37.02%. The mean interval between tracheotomy and injury was 10.0±12.17h. Over 75% patients underwent tracheotomy within 12h. Compared with moderate inhalation burn group, the severe inhalation burn group showed a significantly higher tracheotomy rate within 12h and a significantly shorter interval between tracheotomy and injury. Patient mortality was significantly related to the severity of inhalation injury. CONCLUSION: The classification system of the morphologic laryngeal changes in laryngeal burn patients could effectively evaluate the UAO risk, enable earlier prophylactic tracheotomy after UAO onset, reduce surgical difficulties and risks, decrease clinical pressure of doctors, and prevent UAO. Laryngeal burn severity was related to TBSA and mortality and may be an important severity and prognosis indicator of inhalation injury.

Analysis of 59 cases of frostbite in plain region / 中华烧伤杂志

<p><b>OBJECTIVE</b>To retrospectively survey frostbite in patients living in plain regions, and to analyze the features of frostbite and the results after hospitalization.</p><p><b>METHODS</b>Fifty-nine patients with frostbite, aged from 15 to 85 years admitted in Beijing Jishuitan Hospital from 1992 to 2007, were enrolled in this study. Occupation, cause of the injury, initial visit time, position and degree of depth (assessed according to the standard of burn injury) of frostbite, and amputation rate of patients were recorded and analyzed.</p><p><b>RESULTS</b>Most patients of the 59 cases were workers or unemployed, the main reasons of injury were prolonged contact with material in a low temperature, with impaired consciousness, and having an out-door activity. The average first visit time was 11 days after the exposure. Frostbite was superficial 2(nd) to deep 2(nd) degree in 12 patients, while 47 patients were found to have 3(rd) to 4(th) degree injury. Limbs, or fingers and toes were amputated from 40 patients. The differences between patients visited within 3 days after frostbite and patients visited later than 3 days in respect of degree of depth of frostbite and amputation rate were statistically significant (P < 0.05). There was no significant difference in amputation rates in different body parts of frostbite (P > 0.05).</p><p><b>CONCLUSIONS</b>Patients in plain regions mainly suffer frostbite at the distal portions of the extremities. They should visit hospital early after injury so that the degree of frostbite can be alleviated and rate of amputation can be lowered.</p>