| Objective1. This study aims to identify the current status of epidemiological study and certain epidemiological characteristics of hospitalized burn patients in China through a systematic review of previous literature.2. A multicenter prospective observational study was performed to investigate the epidemiological characteristics of massively burned patients in China and to evaluate the correlation between burn index (BI) and mortality and explore risk factors associated with the prognosis of massively burned patients so as to provide theoretical support for future burn prevention.Methods1. The Current Status of Epidemiological Study on Hospitalized Burn Patients.A systemic Pubmed, Embase, China Biology Medicine disc Database (CBM) and Chinese Journal Full-text Database (CJFD) search was conducted on retrospective papers published Between 1978 and 2015 that focused on epidemiology of burns in China. The selection and assessment of each study retrieved was conducted by two investigators independently for inclusion. Data on demographic characteristics, seasonal variation,agents causing burns, severity, case fatality rate (CFR) and main causes of death were extracted using a standard form for analysis by IBM SPSS version 20 (IBM Corp., Armonk,NY, USA).2. A Multicenter Study on the Epidemiology and Prognosis of Patients with Massive burns in China.2.1 The Epidemiology of Patients with Massive BumsAll patients with massive burns of 30% and above of their total body surface area(TBSA) admitted to the burn departments of the participating 106 hospitals in thirty provinces across the mainland of China between January 1, 2014, and December 31, 2014,were included in this study. The information of age, gender, time of the injury, admission time, prehospital emergency care of burn wound, etiology of burns, burn area (including second-degree burns and full thickness burns), inhalation injury, the outcome and length of hospital stay were collected by the standardized structured questionnaire for analysis.Patients were classified into three age groups: children (0-14 years), adults (15-59 years)and seniors (60 years and above), the epidemiological information mentioned above were described and analyzed among the three age groups.2.2 The Correlation between Burn Index and Mortality in Massively Burned Patients.On the basis of BI, we stratified patients into seven groups and compared the background characteristics to evaluate the correlation between burn index (BI) and mortality. For the cutoff for BI that was best associated with mortality was explored by receiver operating characteristic (ROC) analysis and estimated by the Youden index.Furthermore, a ROC curve was drawn and area under the ROC curve (AUC) was calculated for BI.2.3 Risk Factors Associated with the Prognosis of Massively Burned Patients.Following the univariate analyses on age, gender, admission time, prehospital emergency care of burn wound, etiology of burns, burn index, inhalation injury between the survival and the dead groups, a forward stepwise logistic regression was performed,using variables at a significance level of p less than 0.1 to identify the independent predictors for prognosis.All statistical analyses were performed using IBM SPSS version 20. Continuous variables were compared using Student's t test or Rank sun test, whereas categorical variables were compared using the Chi-square test where appropriate. p < 0.05 was considered statistically significant.Results1. The Current Status of Epidemiological Study on Hospitalized Burn Patients.Thirty-one retrospective articles were included in this study. The result indicates that,male to female ratio of burn patients varies from 1.65 to 5.23. Pediatric burn patients under 14-year-old account for 23.17% to 48.97%, in which young children under 5-year-old are reported to account for 21.90% to 36.20% of all the burn cases. Young workers aged between 20 and 30 making up at least 20.06% and at most 36.40% of all burn patients, in addition, patients aged 60 and above make up less than 5% of the all the admissions. The proportion of admissions in summer ranges from 27.6% to 53.8% of the whole hospitalized burn patients. Thermal injury is reported to make up 70.00% to 94.61% of all the burn injuries, among which scalds constitute 42.97% to 82.47%. Minor burn patients with less than 10% TBSA burned account for 34.16% to 75.02%. The CFR ranges widely from 0.34%to 7.52% in different areas and periods. Sepsis. MODS and inhalation injury are considered to be the most common causes of burn deaths.2. A Multicenter Study on the Epidemiology and Prognosis of Patients with Massive burns in China.2.1 The Epidemiology of Patients with Massive BurnsA total of 2,483 massively burned patients were enrolled in this study. The subjects were 69.59% male,with a male-to-female ratio of 2.29:1. The mean age was 49.23 ± 16.67 years. children, adults and seniors represented 19.57%, 67.34% and 13.09% of the cases,respectively. Massive burns were more prevalent in May, June, July and August (49.62%),with a peak in July (13.69%). Most patients (78.82%) were admitted within 6 hours after the burn injury.The percentages of patients admitted within 6 hours post-injury in children, adults and seniors were 91.19%, 80.22% and 74.20%, respectively, and there were significant differences in the admission time among the different age groups (?2 = 42.769,p<0.001).However, regarding the prehospital emergency management of burn wounds, only 417 patients (16.79%) received proper disinfection and dressing. Conversely, 32.62% of the patients did not receive any drug or wound dressings. The wound areas of 46.48% patients were covered improperly with folk remedies such as toothpaste, soy sauce, eggs or other substances. There were significant differences in the prehospital emergency management of burn wound patients among the age groups (?2 = 255.044,p < 0.001)Flames caused the highest proportion of massive buns (57.63%). followed by scalds(31.25%). Scald injuries were most prevalent in children (81.07%), whereas flame injuries accounted for 66.89% and 75.84% of the injuries in adults and seniors, respectively. The etiology of burns differed significantly among age groups (?2 = 727.78, p < 0.01).The mean TBSA burn was 55.53±21.39%. In total, 42.93% of the patients sustained burns ranging from 30 to 39% of their TBSA. and 19.81% of patients had burns that covered 40 to 49% of their TBSA. Additionally, 37.25% of the patients had burns covering> 50% of their TBSA, among which 152 patients (6.12%) suffered a burn area of 90% or more of their TBSA. The mean BI was 39.75 ± 21.59, and the BI was significantly higher in adults (43.98±22.69) and seniors (40.81 ± 18.45) than in children (27.69 ± 15.18) (?2=224.747, p < 0.01). Most of the patients (68.55%) suffered full-thickness burns, and the incidence of full-thickness burns increased from 50.82% in children to 70.79% in adults. In seniors, this percentage was even higher (83.48%) (?2 = 108.517,p< 0.001). A total of 804(32.38%) patients were complicated with inhalation injuries. The incidence of inhalation injuries was 8.85% in children; this was increased to 36.76% in adults, and the percentage was even higher in seniors (44.95%),(?2 = 161.205,p < 0.01).Among the admitted patients, 243 died, corresponding to a CFR of 9.79%. Seniors faced the highest risk of death (19.57%), followed by adults (9.52%) and children (4.12%).There was a statistically significant difference in the outcomes of the different age groups(?2 = 296.867, p< 0.01). The mean LOS was (79.14± 54.89), the LOS in children,adults and seniors were (52.27 ± 40.19) days, (86.12 ± 56.11) days and (56.52 ± 33.88) days,respectively, and there were significant differences (?2 = 42.769,p<0.001).2.2 The Correlation between Burn Index and Mortality in Massively Burned Patients.Kaplan-Meier survival curves showed significant differences in the survival of different BI groups (log rank test?2 = 1097.430, p < 0.01). The cutoff was identified as 41:at this point, the Youden's index peaked at 0.76. The AUC of BI for survival prediction was 0.94 (95% CI, 0.929-0.954)2.3 Risk Factors Associated with the Prognosis of Massively Burned Patients.Multivariate logistic regression analyses showed that a BI greater than 41 was a strong predictor of mortality, with an odds ratio (OR) of death that was 10.93 times (p <0.001) of patients below the threshold. Inhalation injury was associated with an OR of death that was 7.969 times (p < 0.001) of the patients without inhalation injury. Compared to children, mortality was higher in seniors (OR, 3.609 [95% CI, 1.860-7.002]; p < 0.001).The mortality was also higher in those who used "folk remedies" to treat the wound than those who received proper cleaning and dressing (OR, 2.028 [95% Cl, 1.272-3.233]; p <0.001). Patients who were admitted over 6 hours after injury also faced a higher risk of mortality than did patients who arrived within 6 hours after injury (OR, 1.663 [95% CI,1.094-2.526]; p< 0.001). Etiology and gender was not associated with mortality in this patient population.Conclusions1. The Current Status of Epidemiological Study on Hospitalized Burn Patients. Males are more vulnerable to burns in most areas of China. The age distribution of burn patients shows peaks at the age groups of 0-5 and 20-30 yr. Burn injuries are particularly prevalent in summer. Thermal burns, especially scalds are the most common type of burn injuries.Minor burn patients with or less than10% TBSA make up the majority of hospital admissions. Future research should focus on the early diagnosis and treatment of sepsis,MODS and inhalation injury so as to decrease the CFR of burn injuries. In addition, it is necessary to improve education on the prevention of burns and relevant prehospital emergency care of burns, so as to reduce the morbidity and mortality of burn injury.2. A Multicenter Study on the Epidemiology and Prognosis of Patients with Massive burns in China.Our research demonstrated that adult aged 15-59 predominate in massively burned patients, the percentage of children decreases while the percentage of seniors increases by contrast with general burns. Males are high-risk population regarding massive burn injuries,however, among the groups aging 70 years or above, females outnumber males. Massive burn injuries are more prevalent in May, June, July and August. Most patients are likely to receive clinical treatment in time; however, the current level of prehospital emergency burn care is relatively low in China. Scalds are the main cause of pediatric burns, whereas flames predominate in adult and senior burns. The severity of burn injury in Children is relatively low than adults and seniors. The incidence of full-thickness burns and inhalation injury is relatively high in seniors.When BI excess 41, the CFR increases significantly, BI of 41 is a crucial threshold for CFR in massively burned patients.Risk factors for poor prognosis of massive burns included BI exceeding 41,complicating with inhalation injury, older than 60, a history of covering the burn using a folk remedy, a hospital admission more than 6 hours post-burn. |
PDF Full Text Request