RESUMO
Numerous burn mortality indicators and prognostic scores are necessary to classify with priorities severely burned patients in order to predict outcome. The purpose of this paper is to evaluate mortality predictors on admission, in order to determine Lethal Area 50 and to validate burn prognostic scores. The study is retrospective, clinical and analytical. The data utilized were accessed by investigating the medical charts of 5033 patients hospitalized with severe burns within the Intensive Care Unit of the Service of Burns in Tirana, Albania over the period 1992-2019. Descriptive and inferential statistics were performed using PSS 23 software. Statistical significance is defined as p<0.05. The incidence rate of hospitalization of patients with severe burns initially increased from 4.1 to 7.9 persons per 100,000 population/year in the period 1992 to 1999, followed by a decrease from 7.9 to 4.8 in 2019. Mortality was 12.2% and the average burn crude death rate was 0.7 patients per 100,000 population/year. Lethal Area 50 for the second decade (2010-2019) was 82.2%. All tested burn prognostic scores had good predictive values. In addition to the commonly used outcome predictors such as age, burn size and inhalation burn, we concluded that additional determinants like depth of burn and etiology of burns determined an unfavorable outcome. Fatality risk was 4 times higher in patients with full-thickness burns, 2.6 times higher in patients with flame burns, and 4 times higher in patients with inhalation injury.
De nombreux scores de gravité se proposent d'évaluer le devenir des patients brûlés. Cette étude rétrospective, clinique et analytique, a pour but d'évaluer et valider ces différents scores ainsi que de déterminer la « surface létale 50- SL50 ¼. Elle a utilisé les dossiers de 5 033 patients hospitalisés dans le secteur de réanimation du CTB de Tirana entre 1992 et 2019. L'incidence annuelle a augmenté de 4,1 à 7,9/100 000/an entre 1992 et 1999 puis est redescendue pour atteindre 4,8 en 2019. Avec une mortalité hospitalière de 12,2%, la mortalité par brûlure à l'échelle de la population albanaise était de 0,7/100 000/an, la SL50, évaluée entre 2010 et 2019, étant à 82,2% SCT. Si tous les scores existant avaient un bon rendement prédictif, nous proposons d'adjoindre à l'âge, la surface brûlée et l'inhalation de fumées, la profondeur et l'étiologie de la brûlure comme facteurs de mauvais pronostic. Le décès était 4 fois plus fréquent chez des patients ayant une brûlure profonde (même risque en cas d'inhalation de fumée) et 2,6 fois plus fréquent après brûlure par flamme.
RESUMO
Our aim was to assess the prevalence of gastro protection in the Albanian population using non-steroidal anti-inflammatory drugs (NSAIDs). A cross-sectional study, conducted in November-December 2011 in Albania, included 610 NSAIDs users (236 men and 374 women) who visited pharmacies to receive their NSAID medication. A structured questionnaire was administered to all participants including information on age, sex, educational status, pathology being treated with NSAID, presence of gastrointestinal ulcer or related complications, duration of NSAIDs therapy, type of drug used, and gastro protection therapy. Almost all participants (N=599) received NSAIDs to treat rheumatic and/or musculoskeletal disorders. Of these, 475 individuals were on chronic therapy with high daily doses of NSAIDs. Concomitant gastro protective therapy was found in 184 individuals (30 percent of the overall sample). Women and the more educated individuals received more gastro protection than men and the low educated counterparts, respectively (33.4 percent in women vs 25 percent in men; 47 percent in highly educated vs 18 percent in low educated). Appropriate use of gastro protective therapy for NSAID users needs to be promptly implemented in Albania, as its inappropriate use raises ethical and economic concerns. Prescriptions should follow clear guidelines for prevention of gastrointestinal damage following NSAIDs therapy among persons at high risk.