Department of Emergency Medicine, Stanford University School of Medicine, Stanford, California, USA.
Emergency Medicine, University of California San Francisco School of Medicine, San Francisco, California, USA.
Emerg Med J. 2019 Mar;36(3):176-182. doi: 10.1136/emermed-2018-207900. Epub 2019 Jan 11.
Low/middle-income countries carry a disproportionate burden of the morbidity and mortality from thermal burns. Nearly 70% of burn deaths worldwide are from thermal burns in India. Delays to medical care are commonplace and an important predictor of outcomes. We sought to understand the role of emergency medical services (EMS) as part of the healthcare infrastructure for thermal burns in India.
We conducted a prospective observational study of patients using EMS for thermal burns across five Indian states from May to August 2015. Our primary outcome was mortality at 2, 7 and 30 days. We compared observed mortality with expected mortality using the revised Baux score. We used Χ analysis for categorical variables and Wilcoxon two-sample test for continuous variables. ORs and 95% CIs are reported for all modelled predictor variables.
We enrolled 439 patients. The 30-day follow-up rate was 85.9% (n=377). The median age was 30 years; 56.7% (n=249) lived in poverty; and 65.6% (n=288) were women. EMS transported 94.3% of patients (n=399) to the hospital within 2 hours of their call. Median total body surface area (TBSA) burned was 60% overall, and 80% in non-accidental burns. Sixty-eight per cent of patients had revised Baux scores greater than 80. Overall 30-day mortality was 64.5%, and highest (90.2%) in women with non-accidental burns. Predictors of mortality by multivariate regression were TBSA (OR 7.9), inhalation injury (OR 5.5), intentionality (OR 4.7) and gender (OR 2.2).
Although EMS rapidly connects critically burned patients to care in India, mortality remains high, with women disproportionally suffering self-inflicted burns. To combat the burn epidemic in India, efforts must focus on rapid medical care and critical care services, and on a burn prevention strategy that includes mental health and gender-based violence support services.
低收入和中等收入国家在热烧伤导致的发病率和死亡率方面负担过重。全世界近 70%的烧伤死亡病例来自印度的热烧伤。医疗延误很常见，是结果的一个重要预测因素。我们试图了解紧急医疗服务（EMS）作为印度热烧伤医疗保健基础设施的一部分的作用。
我们对 2015 年 5 月至 8 月期间印度五个邦使用 EMS 治疗热烧伤的患者进行了前瞻性观察研究。我们的主要结局是 2、7 和 30 天时的死亡率。我们使用修订后的 Baux 评分比较了观察到的死亡率与预期死亡率。我们使用卡方检验进行分类变量比较，使用 Wilcoxon 两样本检验进行连续变量比较。所有模型预测变量的比值比（OR）和 95%置信区间（CI）均有报道。
我们共纳入了 439 名患者。30 天随访率为 85.9%（n=377）。患者的中位年龄为 30 岁；56.7%（n=249）生活贫困；65.6%（n=288）为女性。EMS 在接到电话后 2 小时内将 94.3%（n=399）的患者送往医院。总体而言，烧伤总面积（TBSA）中位数为 60%，非意外伤害烧伤为 80%。68%的患者修订 Baux 评分大于 80。整体 30 天死亡率为 64.5%，女性非意外伤害烧伤患者死亡率最高（90.2%）。多变量回归分析的死亡预测因素是 TBSA（OR 7.9）、吸入性损伤（OR 5.5）、故意性（OR 4.7）和性别（OR 2.2）。
尽管 EMS 迅速将严重烧伤患者与印度的医疗联系起来，但死亡率仍然很高，女性不成比例地遭受自残性烧伤。为了应对印度的烧伤流行，必须努力将重点放在快速医疗护理和重症监护服务上，并制定一项烧伤预防战略，包括心理健康和基于性别的暴力支持服务。
