Epidemiology of injuries, treatment (costs) and outcome in burn patients admitted to a hospital with or without dedicated burn centre (Burn-Pro): protocol for a multicentre prospective observational study.

INTRODUCTION: The Emergency Management of Severe Burns (EMSB) referral criteria have been implemented for optimal triaging of burn patients. Admission to a burn centre is indicated for patients with severe burns or with specific characteristics like older age or comorbidities. Patients not meeting these criteria can also be treated in a hospital without burn centre. Limited information is available about the organisation of care and referral of these patients. The aims of this study are to determine the burn injury characteristics, treatment (costs), quality of life and scar quality of burn patients admitted to a hospital without dedicated burn centre. These data will subsequently be compared with data from patients with<10% total bodysurface area (TBSA) burned who are admitted (or secondarily referred) to a burn centre. If admissions were in agreement with the EMSB, referral criteria will also be determined. METHODS AND ANALYSIS: In this multicentre, prospective, observational study (cohort study), the following two groups of patients will be followed: 1) all patients (no age limit) admitted with burn-related injuries to a hospital without a dedicated burn centre in the Southwest Netherlands or Brabant Trauma Region and 2) all patients (no age limit) with<10% TBSA burned who are primarily admitted (or secondarily referred) to the burn centre of Maasstad Hospital. Data on the burn injury characteristics (primary outcome), EMSB compliance, treatment, treatment costs and outcome will be collected from the patients' medical files. At 3 weeks and at 3, 6 and 12 months after trauma, patients will be asked to complete the quality of life questionnaire (EuroQoL-5D), and the patient-reported part of the Patient and Observer Scar Assessment Scale (POSAS). At those time visits, the coordinating investigator or research assistant will complete the observer-reported part of the POSAS. ETHICS AND DISSEMINATION: This study has been exempted by the medical research ethics committee Erasmus MC (Rotterdam, The Netherlands). Each participant will provide written consent to participate and remain encoded during the study. The results of the study are planned to be published in an international, peer-reviewed journal. TRIAL REGISTRATION NUMBER: NTR6565.

Normative data for the Patient-Rated Wrist Evaluation questionnaire.

STUDY DESIGN: Cross-sectional study. INTRODUCTION: The Patient-Rated Wrist Evaluation (PRWE) questionnaire is used to evaluate functional outcomes after treatment of wrist and hand injuries and nontraumatic conditions. Since patients commonly present with an injury, it is impossible to assess preinjury physical functioning. Therefore, it is important to be aware of the population-based normative data. PURPOSE OF THE STUDY: The aim of this study was to determine the normative data for the PRWE questionnaire. Secondary, we aimed to determine if there were factors influencing these normative data. METHODS: Visitors and employees of 4 hospitals were requested to participate. Excluded were all participants who were scheduled for surgery or were in treatment or after treatment for an injury of the wrist or hand within 1 year after trauma. All participants were asked to complete the PRWE questionnaire and were asked for their age, sex, history of wrist or hand fracture or surgery, daily activities, and the type of employment. The socioeconomic status was determined based on the zip code. RESULTS: The median PRWE score was 0 (interquartile range: 0-8.5) and the mean score 7.7 (standard deviation: 15.0). Women had significantly higher scores compared to men, and younger individuals had significantly lower scores. Participants with a history of wrist or hand fracture or surgery, and participants who were unfit for work had significantly higher scores. Socioeconomic status was not correlated with the PRWE score. DISCUSSION: The purpose was to provide an representative overview of the normative data for the normal population. We did not want to present the data of an unnatural healthy population, which is not representative of the normal population. Deleting patients with chronic wrist or hand complaints, would have resulted in normative values which are not representable for the normal, average population. CONCLUSION: Low scores are observed for the PRWE in the general population. These scores are age and sex dependent and are higher in individuals with a history of wrist or hand fracture or surgery or who are unfit for work.

Long-term success rates after an anterior neurectomy in patients with an abdominal cutaneous nerve entrapment syndrome.

BACKGROUND: Surgery occasionally is proposed in patients with chronic abdominal wall pain caused by an anterior cutaneous nerve entrapment syndrome (ACNES) who are refractory to injection therapy. An anterior neurectomy may seem successful, but follow-up is usually short and populations are small. The primary aim of this study was to determine the long-term success rate of surgery in a large ACNES population. METHODS: In this retrospective observational study, patients with ACNES ≥18 years who underwent a primary anterior neurectomy between January 2004 and February 2012 in one single center were studied. Pain scores were obtained before surgery, after surgery, and at the moment of questioning using a pain intensity numeric rating scale (PI-NRS 0-10) and a 6-point verbal category rating scale. Success was defined as a ≥50% PI-NRS reduction or ≥2 point verbal rating scale reduction. RESULTS: Data of 181 neurectomies in 154 individuals were available for analysis (female, n = 127, 82.5%; age 47 ± 17 years, range, 20-83). Pain before operation was severe (mean PI-NRS 8.08, SD 1.43). Short-term (1-3 months postoperative) success was 70% (127/181 procedures). Three subjects showed spontaneous remission of complaints after ≥3 months. After a mean 32 months (range, 3-93) follow-up, a success rate of 61% (109/180) on the long-term was found. CONCLUSION: A 70% short-term success rate and a 61% long-term success rate after a primary anterior neurectomy in patients with chronic abdominal pain due to ACNES were attained. Surgery is the method of choice in ACNES patients who are refractory to a conservative regimen.

[Treatment of injuries of the Chopart joint]. / Behandeling van letsels van het Chopart-gewricht.

BACKGROUND: Injuries to the Chopart joint of the tarsal foot are relatively rare, difficult to recognize and are associated with significant long term morbidity. CASE DESCRIPTION: A 16-year-old boy attended the emergency department after a forklift truck ran over his left foot. Physical examination and X-ray evaluation revealed a fracture of the Chopart joint with a navicular bone fracture and dislocation of the calcaneo-cuboidal joint. Operative open reduction and internal fixation was performed. One year after operative treatment, the patient was able to play sport without functional impairment. CONCLUSION: Adequate evaluation on initial presentation of the injury and additional investigations are imperative for the treatment of patients with Chopart joint injuries. Adequate operative reduction and fixation at an early stage will result in good functional recovery.