On-line version ISSN 2078-5151
Print version ISSN 0038-2361
S. Afr. j. surg. vol.48 n.2 Cape Town May. 2010
H. J. KinguI; E. L. MazwaiII
IM.D., M.MED. (SURG.); Department of Surgery, Walter Sisulu University, Mthatha, Eastern Cape
IIM.B. CH.B., F.R.C.S. (ED.); Department of Surgery, Walter Sisulu University, Mthatha, Eastern Cape
BACKGROUND: The aim of the study was to investigate the demographics, aetiological factors, anatomical lesions, biological features, management protocol and outcomes of patients admitted with major burn injuries to the Nelson Mandela Academic Hospital (NMAH), which is one of only three tertiary hospitals in the Eastern Cape and is in the process of establishing a designated burns unit.
METHODS All burns patients admitted to the burns ward from January 2006 to July 2008 were included in the study. All were treated using multidisciplinary team care, a high index of suspicion for inhalation injuries, followed by prompt treatment, accurate burn extent and depth assessment, fluid therapy, patient-controlled analgesia, strict aseptic wound care, and early enteral feeding. Data collected included gender, age, residential address, cause and extent and depth of burns, serum albumin, whether any skin graft was done, hospital stay, complications and mortality.
RESULTS: The sample comprised 66 patients; 59 were children <14 years old, and 38 were <4 years. There were 34 males and 32 females; scalds and flame injuries accounted for 68% and 17% of cases respectively. The majority (85%) sustained burns ranging from 11% to 40% total body surface area (TBSA). The body areas injured were the left upper limb (60%), chest (58%), abdomen (49%) and right upper limb (48%). All sustained major burns, and skin grafts were performed on 39%. Complications included respiratory distress syndrome, fluid and electrolyte imbalances, protein energy malnutrition, infection and contracture deformities. The mean hospital stay was 3.7 days/% TBSA burn, and the overall mortality rate was 17%.
CONCLUSION: Mortality was unacceptably high. The strain of aggressive management to reduce mortality and morbidity would be alleviated by measures such as community health education, raised socio-economic status, and safety legislation. Establishing a well-staffed and well-equipped burns unit would greatly improve patient care.
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1. Karpelowsky JS, Rode H. Basic principles in the management of thermal injuries. SA Fam Pract 2008; 50(3): 24-31. [ Links ]
2. Duffy BJ, McLaughlin PM, Eichelberger MR. Assessment, triage, and early management of burns in children. Clin Ped Emerg Med 2006; 7: 82-93. [ Links ]
3. Mungadi IA. Childhood burn injuries in northwestern Nigeria. Niger J Med 2002; 11(1): 30-32. [ Links ]
4. Gali BM, Madziga AG, Naaya HU. Epidemiology of childhood burns in Maiduguri, north-eastern Nigeria. Niger J Med 2004; 13(2): 144-147. [ Links ]
5. Rode H. Burn research and clinical practice. S Afr J Surg 2007; 45: 4-10. [ Links ]
6. Sharma BR. Infection in patients with severe burns: Causes and prevention thereof. Infect Dis Clin NAm 2007; 21: 745-759. [ Links ]
7. Pham TN, Gibran NS. Thermal and electrical injuries. Surg Clin North Am 2007; 87(1): 185-206. [ Links ]
8. Shonubi AMO, Akiode O, Musa AA, Salami BA, Kingu HJ, Mohaleroe P. Thermal injuries in under-4-year-old children: the Lesotho experience. Afr J Med Sci 2005; 34: 77-80. [ Links ]
9. Komolofe OO, James J, Maloka M, Kalongeolera L. Epidemiology and mortality of burns at the Queen Elizabeth Central Hospital Blantyre, Malawi. Cent Afr J Med 2003; 49: 130-134. [ Links ]
10. Kalayi GD. Burn injuries in Zaria: A one-year prospective study. East Afr Med J 1994; 71(5): 317-322. [ Links ]
11. Holmes JH, Heimbach DM. Burns. In: Schwartz's Principles of Surgery. 8th ed. New York: McGraw-Hill, 2005: 187-221. [ Links ]
12. Prins A. Nutritional management of the burn patient. Continuing Medical Education 2008; 26(9): 432-435. [ Links ]
13. Heird WC. Food insecurity, hunger and undernutrition. In: Nelson Textbook of Pediatrics. 18th ed. Philadelphia, USA: Saunders-Elsevier, 2007: 225232. [ Links ]
14. Briassoulis G, Zavras N, Hatzis T. Malnutrition, nutritional indices, and early enteral feeding in critically ill children. Nutrition 2001; 17: 548-557. [ Links ]
15. Adesunkanmi K, Oyelami OA. The pattern and outcome of burn injuries at Wesley Guild Hospital, Ilesha, Nigeria: a review of 156 cases. J Trop Med Hyg 1994; 97(2): 108-112. [ Links ]
16. Van der Merwe E. Critical care of burn patients in developing countries: cost versus need. Continuing Medical Education 2008; 26(9): 428-430. [ Links ]
17. Pereira CT, Barrow RE, Sterns AM, et al. Age-dependent differences in survival after severe burns: a unicentric review of 1,674 patients and 179 autopsies over 15 years. J Am Coll Surg 2006; 202: 536-548. [ Links ]
18. Heimbach D. Early burn excision and grafting. Surg Clin North Am 1987; 67: 93. [ Links ]
19. Sheridan RL, Schnitzer JJ. Management of the high-risk pediatric burn patient. J Ped Surg 2001; 36(8): 1308-1312. [ Links ]
20. SteenkampWC, Albertyn R. Psychosocial factors that influence the outcome of burn treatment. Continuing Medical Education 2008; 26(9): 424-426. [ Links ]