Objective: This study aimed to assess the accuracy of the revised BAUX score for predicting mortality among the major burn patients with acute kidney injury (AKI) compared with non-AKI group. The epidemiologic information and risk factors of AKI in major burn patients were also the point of interest. Methods: This study was a retrospective cohort study. The medical records of 144 major burn patients admitted at the burns unit of Siriraj Hospital from 2010-2016 were reviewed and important data were retrieved. Results: Age, hypertension, diabetes mellitus, severity of the burn injuries, and inhalation injuries were the factors related to AKI in major burn patients. The mortality rate due to AKI in burn patients was high (44.4%). The accuracy of the revised BAUX score in predicting the mortality among the major burn patients from our series was only fair (66.7%). Conclusion: AKI affected on mortality of the major burn patients. Until the better predictor comes up, the revised BAUX score should be considered as a predictor of mortality in these patients.
Abstract To investigate factors predicting hospital mortality and hospital length of stay (LOS) in traumatized adults and older adults, we conducted a three-year retrospective study at an academic hospital, Bangkok, Thailand. We reviewed medical records of 627 trauma patients admitted to the ED. Subjects were classified into 2 groups: adults (□55y), and older adults (□55y). Data were collected for demographic and clinical characteristics, physiologic deterioration using the Modified Early Warning Score (MEWS), severity of injury using the Circulation Respiration Abdomen Motor and Speech Score (CRAMS), and outcomes of hospital mortality and LOS. Multivariable logistic and linear regression models were performed. For hospital mortality, an elevated MEWS (Older adults [n= 267]: MEWS≥3, OR=4.80, 95%CI, 1.02-22.56 vs Adults [n = 360]: MEWS≥4, OR=11.63, 95%CI, 1.94-69.82) and CRAMS (Older adults: CRAMS≤9, OR=19.21, 95%CI, 2.78-132.98 vs Adults: CRAMS≤6, OR=18.58, 95%CI, 3.40-101.65) were strongly predictive, adjusted for demographic and clinical data. For LOS, road traffic accident (RTA) (Older adults: β=0.80, 95%CI, 0.31-1.29, p < .01 vs Adults: β=0.44, 95%CI, 0.21-0.67, p < .001) and falls (Older adults: β=0.88, 95%CI, 0.44-1.32, p < .001 vs Adults: β=0.33, 95%CI, 0.02-0.65, p < .05) were associated with LOS, adjusted for demographic and clinical data. MEWS and CRAMS predicted hospital mortality, and RTA and falls predicted LOS in both age groups. Results support the need for interventions for close monitoring and medical management for older traumatized patients based on CRAMS and MEWS assessment to decrease the risk of death, and targeting those sustaining falls and RTA to reduce prolonged LOS.
Review question / Objective: To perform a meta-analysis of hypocalcemia in trauma patients relative to mortality as the primary outcome. Condition being studied: This meta-analysis was performed to evaluate the correlation between hypocalcemia and mortality in trauma patients. Eligibility criteria: randomized-controlled trials or cohort studies (either prospective or retrospective) that reported our primary outcome of interest, which is the correlation between hypocalcemia and mortality in trauma patients.
Background: The objective of post-burn hypertrophic scar prevention is to improve patient quality of life. Many treatments have been employed to obviate hypertrophic scarring, but the optimal treatment has not yet been identified. Several studies have demonstrated the potential of silicone gel in scar prevention. Objective: To investigate the efficacy of silicone gel combined with pressure garment for prevention of post-burn hypertrophic scar. Materials and Methods: This randomized controlled trial included patients with completely epithelialized post-burn wound injury that were recruited from the Burn Unit of the Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand. Study patients were allocated to the pressure garment alone group (control) or the pressure garment with silicone gel group (study). Gel was applied to scar tissue twice daily after bathing, and the pressure garment was worn for 23 hours each day for 24 weeks. Scars were evaluated using the Vancouver Scar Scale (VSS) at 2, 4, 12, and 24 weeks of treatment. Results: Fifty patients (25 per group) were included. The average age of patients and size of wound was 39.74+10.75 years and 95.95+29.30 cm2, respectively. Most patients (72%) were male. There was no significant difference between groups for age, gender, size of burn wound, or infection. The study group demonstrated significantly lower pigmentation (at week 24, p<0.05), increased pliability (at weeks 12 and 24, p<0.05), and decreased height (at week 24, p<0.05) than the control group; however, no significant difference was observed between groups for vascularity, pain, or itching. Total modified VSS score was significantly lower in the study group than in the control group at 12 and 24 weeks (p<0.05). Conclusion: The present study demonstrated the statistically significant benefit of combining silicone gel with pressure garment for post-burn hypertrophic scar prevention compared to pressure garment alone. Keywords: Effectiveness, Silicone gel, Pressure garment, Burn wound, Hypertrophic scar
Objective: To study the predictive power of systemic inflammatory response syndrome (SIRS) scores, platelet count, and blood glucose level for multiple organ dysfunction syndrome (MODS) in patients with major trauma. Methods: The sample was 87 patients with major trauma, hospitalized within 24 hours after injury. SIRS score, platelet count and maximum blood glucose level were measured within the first 24 hours after injury, while MODS was measured by the Denver post-injury multiple organ failure (MOF) score at the 3rd day after injury. Multiple regression analysis, using the enter method, was employed to analyze the data with a significance level of .05. Results: The majority of the samples were male (85.1%) with an average age of 40.39 years. Most of them sustained multiple organ injuries and received surgical treatment within the first 24 hours. It was found that 25.3% of these patients developed organ dysfunction on the 3rd day after injury while 9.2% experienced MODS. SIRS score, platelet count and blood glucose level could predict MODS in patients with major trauma, with 41.7% of the variance explained (R2 = .417, p < .001). Conclusion: Patients with major trauma should receive close monitoring on their SIRS score, platelet count and blood glucose level within 24 hours after injury. Moreover, Denver post-injury MOF score should be routinely used for detection of organ dysfunction so that preventative measures can be appropriately implemented.
Foreign body (FB) in the upper gastrointestinal tract (UGIT) is a common clinical problem in endoscopic practice. At present, many physicians recommend endoscopy for both diagnosis and treatment. To date, few have report endoscopic findings and management of FB in UGIT.To report the authors' experience and outcome of the endoscopic management of foreign body ingestion at Siriraj Hospital.Medical records of patients with FB ingestion in the UGIT, who underwent endoscopic management between January 2004 and January 2008 at Siriraj Hospital, were reviewed.The analysis included 34 patients of which 58.82% were men. The mean age of the group was 18.26 years (range 10 months - 86 years). 58.82% of patients were younger than 5 years. Esophagogastroduodenoscopy (EGD) was performed in 100% of cases, under general anesthesia (GA) in 85.29%, and under transintravenous anesthesia (TIVA) in 14.71%. Endoscopic management was successful in all cases. The extractions were done with rat-tooth forceps, polypectomy snare, dormia basket, or tripods. There were no procedure related complications.The ingested FB varied widely according to the underlying medical condition and age. In a tertiary care center endoscopic removal of FB in UGIT could be safely performed with a very good result.
Background: Post-burn hypertrophic scars are prevalent and they can cause significant functional and cosmetic impairment. Previous literatures has shown the beneficial effect of silicone gel sheet in treatment of hypertrophic scars but the literatures reported benefits in the original product which is more expensive and have the effects on financial burden of the patients that results in high cost of treatment. Objective: To compare efficacy of silicone gel sheet between commercial brands of silicone gel sheet, Cicacare® and Actewound®, on post-burn hypertrophic scar. Material and Method: Prospective randomized controlled trial was conducted in 30 patients with second to third degree burns with post-burn hypertrophic scar. Vancouver scar scale (VSS) was evaluated at 0, 2, 4, 8, 12, 16, 20, 24 weeks after treatment. Results: No difference in pigmentation, pliability, pain, itching, vascularity, height, Vancouver scar scale (VSS) and satisfaction (physical appearance, adhesive properties, ease of application, patient comfort, uniform with skin, durability) between commercial brands of silicone gel sheet, Cicacare® and Actewound® groups (p>0.05). Both commercial brands of silicone gel sheets demonstrated comparable results; however the cost of treatment is less expensive with Actewound®. Conclusion: Actewound® can be used as alternative, more affordable choice for management of post-burn hypertrophic scar. Keywords: Silicone gel sheets, Hypertrophic scar, Post-burn scar, Scar treatment, Burns
Damage control strategies play an important role in trauma patient management. One such strategy, hypotensive resuscitation, is being increasingly employed. Although several randomized controlled trials have reported its benefits, the mortality benefit of hypotensive resuscitation has not yet been systematically reviewed.To conduct a meta-analysis of the efficacy of hypotensive resuscitation in traumatic hemorrhagic shock patients relative to mortality as the primary outcome, with acute respiratory distress syndrome (ARDS), acute kidney injury (AKI), and multiple organ dysfunction as the secondary outcomes.PubMed, Medline-Ovid, Scopus, Science Direct, EMBASE, and CNKI database searches were conducted. An additional search of relevant primary literature and review articles was also performed. Randomized controlled trials and cohort studies reporting the mortality rate associated with hypotensive resuscitation or limited fluid resuscitation were selected. The random-effects model was used to estimate mortality and onset of other complications.Of 2114 studies, 30 were selected for this meta-analysis. A statistically significant decrease in mortality was observed in the hypotensive resuscitation group (risk ratio [RR]: 0.50; 95% confidence interval [CI]: 0.40-0.61). Heterogeneity was observed in the included literature (I2: 27%; degrees of freedom: 23; p = 0.11). Less usage of packed red cell transfusions and fluid resuscitations was also demonstrated. No significant difference between groups was observed for AKI; however, a protective effect was observed relative to both multiple organ dysfunction and ARDS.This meta-analysis revealed significant benefits of hypotensive resuscitation relative to mortality in traumatic hemorrhagic shock patients. It not only reduced the need for blood transfusions and the incidences of ARDS and multiple organ dysfunction, but it caused a non-significant AKI incidence.
Background: 40% of needle thoracostomy were failed in emergency situation. The Advanced Trauma Life Support was recommended to apply 5-cm of needle into the 2nd intercostal space (ICS) about the midclavicular line (MCL) for immediate treatment of tension pneumothorax. 9.9-35% of normal chest wall thickness (CWT) from the previous studies were more than 5 cm. Objective: To analyze the average of Thai patient CWT at the 2nd ICS in MCL. Material and Method: Prospective data collection of the patients who underwent a chest computed tomography scans during the period between April and September 2009. CTW was measured at the 2nd ICS in the MCL in distant for standard procedure, shortest distant and injured distant. Results: The mean CWT patients were 35.2+11.9 mm for the right side and 34.7+11.7 mm for the left side. The mean of shortest distant was 30.9 mm. The mean CWT was significantly higher in patients with high body-mass index (BMI). Conclusion: The standard 5-cm needle may be not passed into the thoracic cavity in 11.3 % of studied population. CWT was showed significant correlation with BMI. 44.5% of patients with BMI more than 30 kg/m2 had CWT more than 5 cm. Keywords: Needle thoracostomy, Chest wall thickness, Pneumothorax
