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. 2016 Jun 30;29(2):139-143.

Scald management protocols - outcome differences in two different time periods using different treatment strategies

M Elmasry  1 , I Steinvall  2 , J Thorfinn  2 , A H Abbas  3 , O A Adly  3 , I Abdelrahman  1 , M A Nagi  3 , F Sjoberg  4
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Scald management protocols - outcome differences in two different time periods using different treatment strategies

M Elmasry et al. Ann Burns Fire Disasters. .

Abstract
in English, French

Over the years the treatment of scalds in our centre has changed, moving more towards the use of biological dressings (xenografts). Management of scalds with mid dermal or deep dermal injuries differs among centers using different types of dressings, and recently biological membrane dressings were recommended for this type of injury. Here we describe differences in treatment outcome in different periods of time. All patients with scalds who presented to the Linkoping Burn Centre during two periods, early (1997-98) and later (2010-12) were included. Data were collected in the unit database and analyzed retrospectively. A lower proportion of autograft operations was found in the later period, falling from 32% to 19%. Hospital stay was shorter in the later period (3.5 days shorter, p=0.01) and adjusted duration of hospital stay/TBSA% was shorter (1.2 to 0.7, p=0.07). The two study groups were similar in most of the studied variables: we could not report any significant differences regarding outcome except for unadjusted duration of hospital stay. Further studies are required to investigate functional and aesthetic outcome differences between the treatment modalities.

Le traitement des brûlures par liquides chauds a changé avec le temps, évoluant de plus en plus vers l’usage des pansements biologiques (xénogreffes). La prise en charge de ce type de brûlures (de profondeur moyenne ou profonde) diffère suivant les centres qui utilisent différents types de pansements et plus récemment, les membranes biologiques ont été recommandées pour ce type de traumatisme. Dans cette étude, nous décrivons les résultats thérapeutiques obtenus au cours de différentes périodes. Tous les patients avec des brûlures par liquides chauds admis au Centre de brûlés Linkoping pendant deux périodes d’abord de 1997-1998 et plus tard de 2010 à 2012 ont été inclus. Les résultats de notre banque de données ont été recueillis et analysés de façon rétrospective. Une proportion basse de greffes cutanées a été retrouvée dans la dernière période passant de 32% à 19%. Le séjour à l’hôpital a été également raccourci dans cette période (3,5 jours en moins, p= 0,01) et la durée d’hospitalisation en rapport avec l’étendue a diminué (1,2 à 0,7, p=0,07). Les résultats dans les deux groupes étaient semblables dans la plupart des variables étudiées: nous ne trouvons pas de différence significative sur le plan des résultats, excepté pour la durée d’hospitalisation. De nouvelles études sont nécessaires pour évaluer les divers résultats fonctionnels et esthétiques en fonction des modalités thérapeutiques.

Keywords: burns,; duration of stay; outcome,; scalds,.

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Figures

Table I
Table I. The different patient groups based on the treatment plan
Table II
Table II. Details of the study group
Fig. 1
Fig. 1. The association between duration of hospital stay and TBSA% during the two periods A and B. Solid circles and solid line = period A, open boxes and dotted lines = period B. The fitted lines are exponential. LOS A = 4.2252*exp(0.0568*x), LOS B = 2.5058*exp(0.0689*x) TBSA% - LOS A: y = 2.6901 + 0.8066*x; r = 0.79; p < 0.001; r2 = 0.63 TBSA% - LOS B: y = 3.0889 + 0.4936*x; r = 0.53; p <0.001; r2 = 0.28
Fig. 2
Fig. 2. The association between duration of hospital stay and TBSA. Solid circles and solid line = children, open boxes and dotted lines = adults. The fitted lines are exponential. LOS Children = 2.2202*exp(0.0836*x), LOS Adults = 4.8619*exp(0.0393*x) TBSA% - LOS Children: y = 0.5349 + 0.8135*x; r = 0.73; p < 0.001; r2 = 0.53 TBSA% - LOS Adults: y = 6.7765 + 0.3571*x; r = 0.49; p = 0.003; r2 = 0.24<
Table III
Table III. Duration of hospital stay, multivariable regression
Fig. 3
Fig. 3. The association between duration of hospital stay and TBSA%. Solid circles and solid line = surgically managed group, open boxes and dotted lines = conservatively managed group. The fitted lines are exponential. TBSA% - LOS Surgical: y = 4.4541 + 0.8005*x; r = 0.78; p = 0.0000 TBSA% - LOS conservative: y = 3.4873 + 0.2836*x; r = 0.41; p = 0.00009
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