Edwards Dianna, Heard Jason, Latenser Barbara A, Quinn Keely Y, van Bruggen Jaap, Jovic Goran
Carver School of Medicine, University of Iowa, Iowa City, USA.
J Burn Care Res. 2011 Jan-Feb;32(1):31-8. doi: 10.1097/BCR.0b013e318204b36a.
The American Burn Association/Children's Burn Foundation (ABA/CBF) sponsors teams who offer burn education to healthcare providers in Zambia, a sub-Saharan country. The goals of this study are 1) to acquire burn-patient demographics for the Eastern Province, Zambia and 2) to assess the early impact of the ABA/CBF-sponsored burn teams. This is a retrospective chart review of burn patients admitted in one mission hospital in Katete, Zambia, July 2002 to June 2009. July 2002 to December 2006 = data before ABA/CBF burn teams and January 2007 to June 2009 = burn care data during/after burn outreach. There were 510 burn patients hospitalized, male:female ratio 1.2:1. Average age = 15.6 years, with 44% younger than 5 years. Average TBSA burned = 11% and mean fatal TBSA = 25%. Average hospital length of stay = 16.9 days survivors and 11.6 days nonsurvivors. Most common mechanisms of burn injuries: flame (52%) and scald (41%). Ninety-two patients (18%) died and 23 (4.5%) left against medical advice. There were 191 (37.4%) patients who underwent 410 surgical procedures (range 1-13/patient). There were 138 (33.7%) sloughectomies, 118 (28.7%) skin grafts, 39 (9.5%) amputations, and 115 (28.1%) other procedures. Changes noted in the 2007 to 2009 time period: more patients had burn diagrams (48.6 vs 27.6%, P < .001), received analgesics (91 vs 84%, P = .05), resuscitation fluid (56 vs 49%, P = not significant [NS]), topical antimicrobials (40 vs 37%, P = NS), underwent skin grafting (35.5 vs 25.1%, P = NS), and underwent any operative intervention (40.6 vs 35.2%, P = NS), compared with patients treated between 2002 and 2006. This study represents the largest, most comprehensive burn data set for a sub-Saharan region in Africa. There has been a statistically significant improvement in documentation of burn size as well as administration of analgesics, validating the efficacy of the ABA/CBF-sponsored burn teams. Continued contact with burn teams may lead to increased use of resuscitation fluids, topical antimicrobials, and more patients undergoing operative intervention, translating into improved burn patient outcomes.
美国烧伤协会/儿童烧伤基金会（ABA/CBF）资助了一些团队，这些团队为撒哈拉以南国家赞比亚的医疗服务提供者提供烧伤教育。本研究的目标是：1）获取赞比亚东部省烧伤患者的人口统计学数据；2）评估ABA/CBF资助的烧伤团队的早期影响。这是一项对2002年7月至2009年6月在赞比亚卡特特一家教会医院收治的烧伤患者进行的回顾性病历审查。2002年7月至2006年12月 = ABA/CBF烧伤团队成立之前的数据，2007年1月至2009年6月 = 烧伤外展期间/之后的烧伤护理数据。共有510名烧伤患者住院，男女比例为1.2:1。平均年龄 = 15.6岁，44%的患者年龄小于5岁。平均烧伤总面积 = 11%，平均致命烧伤总面积 = 25%。存活患者的平均住院时间 = 16.9天，非存活患者为11.6天。烧伤最常见的原因：火焰伤（52%）和烫伤（41%）。92名患者（18%）死亡，23名患者（4.5%）自动出院。191名患者（37.4%）接受了410次外科手术（每位患者1 - 13次不等）。其中有138次（33.7%）削痂手术、118次（28.7%）植皮手术、39次（9.5%）截肢手术以及115次（28.1%）其他手术。在2007年至2009年期间观察到的变化：与2002年至2006年期间接受治疗的患者相比，更多患者有烧伤示意图（48.6%对27.6%，P < 0.001）、接受了镇痛药治疗（91%对84%，P = 0.05）、接受了复苏液治疗（56%对49%，P = 无显著差异[NS]）、接受了局部抗菌药物治疗（40%对37%，P = NS）、接受了植皮手术（35.5%对25.1%，P = NS）以及接受了任何手术干预（40.6%对35.2%，P = NS）。本研究代表了非洲撒哈拉以南地区最大、最全面的烧伤数据集。在烧伤面积记录以及镇痛药使用方面有统计学上的显著改善，证实了ABA/CBF资助的烧伤团队的有效性。与烧伤团队的持续接触可能会导致复苏液、局部抗菌药物的使用增加，以及更多患者接受手术干预，从而改善烧伤患者的治疗结果。
