Gilbert Abou Dagher, Rajha Eva, El Khuri Christopher, Bou Chebl Ralph, Mailhac Aurelie, Makki Maha, El Sayed Mazen
Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
Clinical Research Institute, American University of Beirut Medical Center, Beirut, Lebanon.
Burns. 2018 Feb;44(1):218-225. doi: 10.1016/j.burns.2017.06.015. Epub 2017 Aug 7.
The epidemiology of burns is well described in the United States, Europe and Asia. However, few studies address this topic in the Levant region. This study aims to describe characteristics of burn victims treated at the emergency department of a tertiary care center in Beirut, Lebanon and to report on factors that affect ED disposition.
A retrospective cohort study was conducted in the ED of a tertiary care hospital, in Beirut, Lebanon, between 2009 and 2013. Patients were recruited if their final ED diagnosis was burn. A descriptive analysis of patients' characteristics including burns was done, followed by a bivariate analysis to compare two groups (admitted vs discharged). Statistical analysis included the use of Student t-test and Pearson chi-square where appropriate. A multivariate analysis was then conducted to determine the predictors of hospital admission.
A total of 366 patients had their charts queried. Age category distributions of the patients were 73 (19.9%) <5 years, 39 (10.7%) 5-14 years, 236 (64.5%) 15-65 years and 18 (4.9%) >65 years of age. Around half of the patients (47.3%) were males, with scalding being the most common mechanism of burn (53.9%), followed by contact with hot object (16.8%) and flame (11.9%). In terms of disposition from the ED, 58 (15.8%) patients were admitted to the hospital with 42 (72.4%) going to GPU, 12 (20.6%) to ICU and 4(6.9%) transferred to either another hospital or to an acute burn facility. Admitted patients tended to be at the extremes of ages (<5 years or ≥65 years), male dominant, more likely to be brought in by family, with higher proportions of more severe mechanisms of injury (flame, electric, chemical). Admitted patients also sustained higher degrees of burns with more TBSA injured. Predictors of hospital admission included the aforementioned factors with the strongest predictors of admission being full-thickness degree burn (OR 18.56 (4.67-73.72 CI95% p≤0.001)) and mechanism of injury such as electrical (OR 23.01 (3.23-163.89 CI95% p=0.002)) and chemical (OR 17.43 (2.33-130.14 CI95% p=0.003)).
Characteristics of burn patients treated in an urban ED in Lebanon mirror those of burn victims in other international studies. Future larger epidemiologic studies are needed to better quantify the impact of burns in Lebanon.
烧伤的流行病学在美国、欧洲和亚洲已有详尽描述。然而，在黎凡特地区针对该主题的研究较少。本研究旨在描述在黎巴嫩贝鲁特一家三级护理中心急诊科接受治疗的烧伤患者的特征，并报告影响急诊处置的因素。
2009年至2013年期间，在黎巴嫩贝鲁特一家三级护理医院的急诊科进行了一项回顾性队列研究。若患者最终在急诊科的诊断为烧伤，则纳入研究。对包括烧伤在内的患者特征进行了描述性分析，随后进行双变量分析以比较两组（入院与出院）。统计分析在适当情况下包括使用学生t检验和Pearson卡方检验。然后进行多变量分析以确定医院入院的预测因素。
共查询了366例患者的病历。患者的年龄类别分布为：73例（19.9%）年龄小于5岁，39例（10.7%）年龄在5 - 14岁，236例（64.5%）年龄在15 - 65岁，18例（4.9%）年龄大于65岁。约一半患者（47.3%）为男性，烫伤是最常见的烧伤机制（53.9%），其次是接触热物体（16.8%）和火焰（11.9%）。就从急诊科的处置情况而言，58例（15.8%）患者入院，其中42例（72.4%）进入综合诊疗单元，12例（20.6%）进入重症监护病房，4例（6.9%）转至另一家医院或急性烧伤机构。入院患者往往处于年龄极端情况（小于5岁或≥65岁），以男性为主，更有可能由家人送来，具有更高比例的更严重损伤机制（火焰、电击、化学）。入院患者烧伤程度也更高，烧伤总面积更大。医院入院的预测因素包括上述因素，入院的最强预测因素是全层烧伤程度（比值比18.56（4.67 - 73.72，95%置信区间，p≤0.001））以及损伤机制，如电击（比值比23.01（3.23 - 163.89，95%置信区间，p = 0.002））和化学（比值比17.43（2.33 - 130.14，95%置信区间，p = 0.003））。
黎巴嫩一家城市急诊科治疗的烧伤患者特征与其他国际研究中的烧伤受害者特征相似。未来需要开展更大规模的流行病学研究，以更好地量化烧伤在黎巴嫩的影响。
