الفهرس 
Introduction
Epidemiology of burnOnly 14 pages are availabe for public view
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Abstract
Burn trauma is one of the real problems of modern medicine, because of its heavy clinical course, the difficulties of treating the victims, the high mortality rate, and sometimes unacceptable results of treatment, the risk of injury and mortality considerably greater in low- to middle-income countries in Africa and Asia.
Burn sepsis is one of the most common fatal burn injury complications. Despite medical advancements, burn sepsis accounts for 50-to-60 percent of burn injury deaths. Burn sepsis occurs after a burn injury patient develops an infection as a result of the burn wound itself or other types of infection that occur during the treatment process such as pneumonia or urinary tract infection.
The study aimed to evaluate how much the adopted protocols of management of post burn sepsis are applied in pediatric intermediate care unit in Assiut university children hospital within one year from August 2015 to July 2016. The adopted protocols used according to American guidelines and Australian and New Zealand Burns Association 2010 which is locally approved by pediatric intermediate care unit in Assiut university children hospital
The study included 50 cases who were admitted in pediatric intermediate care unit within this year. The results showed that 30 cases (60%) were male, and 20 (40%) cases were female. Their ages ranged from one year to 11 years. The majority of cases were belonged to age group 1-3 years which included 32 cases (64%).
Data of the study showed that scald burn was the most common cause of burn (76%) followed by flame (12%). Scald was predominant among the 1 ~ 6 years age group and in both males and females in pediatric intermediate care unit in Assiut University Children Hospital partially followed the reference standard of the study.
Regarding the history, history of previous medications & past medical disease were done and recorded by resident physician for all cases (100%), history of allergy was done and recorded in 49 cases (98%). However, history of possibility of being medicolegal case, timing of last meal & history of tetanus prophylaxis after burn were neither done nor recorded in all cases.
In this study, events of burn, date of burn and date of hospital admission after burn were done and recorded in all cases (100%).
The depth of burn was recorded in 47 cases (94%) and revealed that most cases 2nd degree (42%), 40% of cases were 2nd degree with 3rd degree (mixed degrees) and 12% of cases were 1st degree with 2nd degree while 6% of cases showed no external manifestation of burn (inhalational burn).
The percentage of burn was recorded in 47 cases (94%) that was ranged from 7-60% of total body surface area (mean =29.9%). Our study confirmed previous findings that burns of less than 29% TBSA represent the large majority of burns (56%).
The site of burn was recorded in 47 cases (94%) showed that limbs were the most common burn sites, accounting for 78% of all admissions (lower limbs more than upper limbs). The second most common site was the head, face and neck region (24%), followed by the trunk (17%). These lesions mainly being associated with burns of the upper thorax.
Regarding the examination, All data of general examination and vital signs (heart rate, respiratory rate, blood pressure & temperature) and conscious level were fully recorded in all cases (100%) and revealed tachycardia was detected in 22 cases (44%) & bradycardia in one case (2%), hypotension was detected among of patient in 22 cases (44%), temperature was normal in 23 cases (46%), hyperthermia in 19 cases (38%) & hypothermia in 8 cases (16%). Tachypnea was detected in 35 cases (70%) and bradypnea in one cases (2%).
Patients in age group 1-3 years exhibited the highest frequency of each of tachycardia, tachypnea and hypotension in comparison to their patient in other age groups.
Pulse oximetry was done for all cases (100%) but recorded in 23 cases (46%).
Analysis of the previous data showing that asking about full examination was done according to guidelines.
Regarding the investigation, guidelines was followed partially done and recorded in this study as CBC was recorded in 47 cases (94%) but not done in 3 cases (6%) as one of them was fire burn (60% of total body surface area), bradycardia, shocked & hypoxic. This case was died within one hour after admission. The other two cases were scald burn (30-4o% of TBSA), shocked & were died within first 24 hours after admission
Blood gases and electrolytes were done in 47 cases (94%) but recorded in 43 cases (86%). Randam blood glucose was done in 49 cases (98%) but recorded in 45 cases (90%), grouping ABO and RH were done and recorded in 49 cases (98%) and coagulation profile was done & recorded 45 cases (90%).
Renal function was recorded 44 cases (88%) and liver function was recorded in 28 cases (66%). Chest X ray was done in 39 (88%) but recorded only in 15 cases (30%).
Urine analysis was recorded in 40 cases (80%), urine culture was recorded in 15 cases (30%) and blood culture was recorded in 37 cases (74%) but not done in 13 cases due to 12 cases were died within first 48 after hospital admission.
Calculation of urine out put was done for 35 cases (70%) but recorded in 20 cases (40%).
CVP was not done in all cases (0%).
Wound swap was done & recorded in 36 cases (72%), wound biopsy was recorded one case (2%) and sputum culture & lavage was not done in all cases.
Follow up investigations of the patient showed some defects as CBC follow up was done & recorded 23 cases (46%) within 5 to 10 days after hospital admission, electrolytes follow up was recorded in 27 (54%), urine culture follow up was recorded in 6 cases (12%) and blood culture follow up was done & recorded in 10 cases (20%) within 3 to 4 weeks after hospital admission
Airway was used in 5 cases (10%) (3 cases were fire burn & 2 cases inhalational burn). O2 inhalation was used in 40 cases (80%) (already 23 cases were hypoxic by pulse oximetry). Fluid resuscitation was used in 33 cases (66%). Fluids used were Ringer lactate or normal saline and used correctly and observed by direct observation of cases and recorded by resident doctors in patient sheet. Monitoring of vital signs were done & recorded in all cases (100%)
Drugs used for treatment of the studied cases showed that opioid was not used in all cases while paracetamol used in 40 cases (80%) as analgesic followed by NSAID then midazolam.
Antibiotics used according to guidelines in 28 cases (56%) while antibiotics changed according to blood culture among 15 cases (30%).
IV immunoglobulin was needed in 8 cases (16%).
H2 receptor antagonist used in 46 cases (92%).
Vasopressor used in 33 cases (66%) according to condition of patient.
Fresh frozen plasma used in 34 cases (68%).
Wound care was followed partially to guidelines as wond cleaning with saline or Ringer lactate & topical antimicrobial was done for 45 cases (90%)
Early depridement occurred in 43 cases (86%).
The topical antimicrobial agents used were Betadine ointment (povidone iodine) in 45 cases (90%), MEBO (sesame oil & bees wax) in 37cases (74%), Amikacin or Garamycin in 20 cases (40%), mycostatin ointment in one case (2%).
The other topical antimicrobial as silver sulfadiazine, mafenide acetate, silver nitrate, bactitracin & Bactroban were not used in all cases as it is not recommended by the plastic surgery team in Assiut University Hospital but recommended by other guidelines.
Regarding the infection control measures for the studied cases as swap from nose, swap from groin, limited number of staff & visitors entering the room and isolated patients with major burn were not done in all cases which recommended in guidelines while the other infection control measures was followed partially as hand rub was done in 40 cases (80 %), wear gloves in 45 cases (90 %), wear gown in 40 cases (80%) and wear masks in 5 cases (10%).
Regarding the outcome of the studied cases, it was noticed that 44% of cases died and 56% of cases improved. Out of the non-survivors, 54.5% died within 1st 48 hours from hospital admission, 45.5% died within 3-20 days.
The age group 1-3 yr showed a death rate of 63.6%, the age group 3-6 yr had 7 deaths (32%), and among children aged 6-11 yr the death rate was (4.5%)
Mortality was directly proportional to the percentage of TBSA burned and depth of burn.
The non survivors showed low values of length of hospital stay {mean (SD)=9.4(6.6)} in comparison to the survivors. The overall median Length of hospital stay for survivors was 29 days (range 5-120 days), nearly 20% of all patients stayed in hospital for more than 60 days in this study.
Accordingly, the LOS in this study may be longer than the actual wound treatment time. Furthermore, burns caused by flame, electricity and explosion were also perceived as risk factors for a long LOS, indicating the need for etiology-based individualized burn treatment strategies.
Cases prepared for surgical intervention were 8 cases (16%),3 cases died post surgery (2 cases were scald burn & one case was fire burn). Survivors seemed to undergo more operations than non survivors. First, 82% of survivors did not receive operations, whereas 86% of non-survivors did not undergo operations.
Regarding the Complications in the studied cases. It was noticed that metabolic acidosis was the commonest complication detected among these cases (66%) followed by wound infection (60%), UTI (30%), renal impairment (20%) and burn shock (16%).