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Severe burn injury: some determinants of epidemiological and surgical outcomes

NELE BRUSSELAERS UGent (2010)
abstract
Introduction: Severe burn injuries require hospitalisation in a specialised burn unit and are associated with a considerable morbidity and mortality, but also have a major health-economic and psychological impact, requiring a prolonged hospitalisation and revalidation. Objectives: To analyse the occurrence rate, aetiology and outcome of severe burn injuries, including risk factors for death, and major complications (bloodstream infections [BSI] and acute kidney injury [AKI]). We also developed a mortality prediction model, and studied the surgical treatment of burns in Belgium and the spectrum of current skin replacements and scar assessment techniques. Methods: Cohort studies were used to investigate the epidemiology of severe burn injuries, and to develop (Belgian data) and validate (Hungarian data) a mortality prediction model. The impact of a BSI was assessed by matched-cohort study (Ghent burn unit), and of AKI by systematic review and meta-analysis. The surgical treatment was assessed by a survey performed in the Belgian burn units. A literature review was performed to analyse the epidemiology within Europe, skin replacement and burn scar assessment. Results: Burn mortality is relatively low and continuously decreasing. The mortality rate is strongly dependent on the presence of particular risk factors in the population studied. The major risk factors for mortality (age, total burned surface area [TBSA], and inhalation injury) as used in our Belgian Outcome in Burn Injuries [BOBI] prediction model, showed a high discriminative value. BSI did not adversely affect survival, but contributed to a substantial economic burden. Despite of the wide heterogeneity of the studied populations, AKI clearly remains one of the most prevalent and fatal complications. Several approaches can be followed to obtain final wound closure, with as ultimate goal an optimal functional and aesthetic outcome. A total multi-disciplinary approach is however essential for success, including scar assessment which can be performed by several tools and scales. Conclusion: Severe burn injuries still cause considerable morbidity and mortality, with especially a high impact of AKI on the outcome. A total multidisciplinary approach, including the surgical treatment, remains essential to reduce the infection risk (and complication rate) and obtain full skin restoration, consequently reducing functional and aesthetical sequellae.
Please use this url to cite or link to this publication:
author
promoter
UGent and UGent
organization
year
type
dissertation (monograph)
subject
keyword
Burn Injury, Burns, Epidemiology, Surgery, Infection, Intensive care
pages
279 pages
publisher
Ghent University. Faculty of Medicine and Health Sciences
place of publication
Ghent, Belgium
defense location
Gent : UZ (auditorium C)
defense date
2010-06-28 17:30
ISBN
9789078322207
language
English
UGent publication?
yes
classification
D1
additional info
dissertation consists of copyrighted materials
copyright statement
I have transferred the copyright for this publication to the publisher
id
1073200
handle
http://hdl.handle.net/1854/LU-1073200
date created
2010-11-12 10:11:20
date last changed
2010-11-16 14:24:25
@phdthesis{1073200,
  abstract     = {Introduction: Severe burn injuries require hospitalisation in a specialised burn unit and are associated with a considerable morbidity and mortality, but also have a major health-economic and psychological impact, requiring a prolonged hospitalisation and revalidation. 
Objectives: To analyse the occurrence rate, aetiology and outcome of severe burn injuries, including risk factors for death, and major complications (bloodstream infections [BSI] and acute kidney injury [AKI]). We also developed a mortality prediction model, and studied the surgical treatment of burns in Belgium and the spectrum of current skin replacements and scar assessment techniques.
Methods: Cohort studies were used to investigate the epidemiology of severe burn injuries, and to develop (Belgian data) and validate (Hungarian data) a mortality prediction model. The impact of a BSI was assessed by matched-cohort study (Ghent burn unit), and of AKI by systematic review and meta-analysis. The surgical treatment was assessed by a survey performed in the Belgian burn units. A literature review was performed to analyse the epidemiology within Europe, skin replacement and burn scar assessment.
Results: Burn mortality is relatively low and continuously decreasing. The mortality rate is strongly dependent on the presence of particular risk factors in the population studied. The major risk factors for mortality (age, total burned surface area [TBSA], and inhalation injury) as used in our Belgian Outcome in Burn Injuries [BOBI] prediction model, showed a high discriminative value. BSI did not adversely affect survival, but contributed to a substantial economic burden. Despite of the wide heterogeneity of the studied populations, AKI clearly remains one of the most prevalent and fatal complications. Several approaches can be followed to obtain final wound closure, with as ultimate goal an optimal functional and aesthetic outcome. A total multi-disciplinary approach is however essential for success, including scar assessment which can be performed by several tools and scales.
Conclusion: Severe burn injuries still cause considerable morbidity and mortality, with especially a high impact of AKI on the outcome. A total multidisciplinary approach, including the surgical treatment, remains essential to reduce the infection risk (and complication rate) and obtain full skin restoration, consequently reducing functional and aesthetical sequellae.},
  author       = {BRUSSELAERS, NELE},
  isbn         = {9789078322207},
  keyword      = {Burn Injury,Burns,Epidemiology,Surgery,Infection,Intensive care},
  language     = {eng},
  pages        = {279},
  publisher    = {Ghent University. Faculty of Medicine and Health Sciences},
  school       = {Ghent University},
  title        = {Severe burn injury: some determinants of epidemiological and surgical outcomes},
  year         = {2010},
}

Chicago
Brusselaers, Nele. 2010. “Severe Burn Injury: Some Determinants of Epidemiological and Surgical Outcomes”. Ghent, Belgium: Ghent University. Faculty of Medicine and Health Sciences.
APA
Brusselaers, N. (2010). Severe burn injury: some determinants of epidemiological and surgical outcomes. Ghent University. Faculty of Medicine and Health Sciences, Ghent, Belgium.
Vancouver
1.
Brusselaers N. Severe burn injury: some determinants of epidemiological and surgical outcomes. [Ghent, Belgium]: Ghent University. Faculty of Medicine and Health Sciences; 2010.
MLA
Brusselaers, Nele. “Severe Burn Injury: Some Determinants of Epidemiological and Surgical Outcomes.” 2010 : n. pag. Print.