High-Risk Factors causing Mortality in Pediatric Burn Patients, admitted in Burns Centre of Karachi
Background: Different risk variables that lead to mortality of a burn victim. The most important categories for assessment of severity in burns among pediatric age group is, total body surface area (TBSA) involved, age and type of burn which can lead to increased deaths. The current study was performed to analyze the various factors of causing risk of burns and leading to mortality.
Methods: It is a cross-sectional non-probability descriptive study, performed of Pediatric Burns unit Ruth Pfau Civil hospital, Karachi. Clinical recordof 227 Patients of both sexes135 males and 92 females was analyzed after receiving approval from Burn Center, Ruth Pfau Civil Hospital Karachi. Statistical analyzes was carried out using version 20.00 of SPSS.
Results: Largest percentage of mortality was in age between 1 and 5 years. In 139 patients, Scalding due to hot water was the most common form of burn. Major cause of mortality was due to multiple burns with > 50% involvement of TBSA was the most common category constituting 68.7% among the patients in the current study. Significant association was analyzed between the nutritional status of patients as assessed by albumin levels and mortality (p=0.004). However, total mortality among the reported cases in between 2016 until 2018 was 28.2% being in 1-5years of age with above-mentioned associations.
Conclusion: Current research indicates that an increasing mortality in pediatric burn patients is linked with the proportion of total body surface area (TBSA) exposed to burns, duration of the exposure, decrease total protein content due to damage of tissues and muscles. This leads to prolonged protein and intravenous fluid replacement. One of the most common complication is progression to respiratory failure.
Keywords: Burns, burns etiology, burns mortality rate.
1. Kraft R, Herndon DN, Al-Mousawi MA, Williams FN et.al. Burn Size And Survival Probability In Peadiatric Patients In Modern Burn Care. Lancet. March 2012; 379(9820): 1013–1021.
2. Phillipo L Chalya, Joseph B Mabula, Ramesh M Dass, GeofreyGiiti, Alphonce B Chandika, Emmanuel S Kanumba.Pattern of childhood burn injuries and their management outcome at Bugando Medical Centre in Northwestern Tanzania. BMC Research Notes[internet]. 2012 Nov [cited 2015 March 20]; 4:485. Available from:http://www.biomedcentral.com doi:10.1186/1756-0500-4-485
3. Agbenorku P, Agbenorku M. Pediatric burns mortality risk factors in a developing country’s tertiary burns intensive care unit. Int J Burn Trauma. 2015; 3(3):151-158. Available from: www.IJBT.org /ISSN: 2160-2026/IJBT1304003
4. Karimi H, Motevalian SA, Rabbani AH et.al. Prediction of Mortality in Pediatric Burn Injuries: R-Baux Score to Be Applied in Children (Pediatrics-Baux Score). Iran J Pediatr. Apr 2013; 23(2): 165-170
5. Akansel N, Yılmaz S, Aydin N, et.al.Etiology of Burn Injuries Among 0-6 Aged Children in One University Hospital Burn Unit, Bursa, Turkey. International Journal of Caring Sciences. May-August 2018; 6(2):208-16
6. Okoro PE, Igwe PO, Ukachukwu AK. Childhood burns in south eastern Nigeria. African Journal of Paediatric Surgery. January-June 2009; 6(1):24-7
7. Yavuz A, Ayse A, Abdullah A, Belkiz B. Clinical and demographic features of pediatric burns in the eastern provinces of Turkey. Scand J Trauma ResuscEmerg Med 2017; 19:6 .http://www.sjtrem.com/content/19/1/6 doi: 10.1186/1757-7241-19-6
8. Toon MH, Maybauer DM , Arceneaux LL, et.al. Children with burn injuries-assessment of trauma, neglect, violence and abuse. J Inj Violence. 2015 Jul; 3(2): 98-110.
9. Tirmizi SZA, Mirza FH, Mangi P, et.al. Pattern of Burn Injuries and Outcome in Children. Journal of the Dow University of Health Sciences Karachi 2013; 7 (1): 41-45.
10. Chatterjee BF, Barancik JI, Fratianne RB, et al. Northeastern Ohio trauma study. V. Burn injury. J trauma 1986;26:844
11. Alaghehbandan R, RossingnolAM, Rastegar LA. Pediatric burn injury in Tehran, Iran. Burns 2001;27:115–8
12. Tompkins RG, Remensnyder JP, Burke JF, et al. significant reductions in mortality for children with burn injuries through the use of prompt eschar excision. Ann Surg 1988;208:577–85.
13. Mcloughlin E, McGuire A. The causes, cost, and prevention of childhood burn injuries. Am J Dis Child 1990;144:677–83.
14. Maghsoudi H, Samnia N. Etiology and outcome of pediatric burns in Tabriz, Iran. Burns(2005); 31(6): 721-725.
15. Bücker R, Schumann M, Amasheh S, Schulzke JD. Claudins in intestinal function and disease. Curr Top Membr. 2010;65:195–227.
16. Lu Z, Ding L, Lu Q, Chen YH. Claudins in intestines: distribution and functional significance in health and diseases. Tissue Barriers. 2018;1(3):e24978.
17. Smalley KS, Brafford P, Haass NK, Brander JM, Brown E, Herlyn M. Up-regulated expression of zonulaoccludens protein-1 in human melanoma associates with N-cadherin and contributes to invasion and adhesion. Am J Pathol. 2005;166(5):1541–54.
18. Umeda K, Ikenouchi J, Katahira-Tayama S, Furuse K, Sasaki H, Nakayama M, et al. ZO-1 and ZO-2 independently determine where claudins are polymerized in tight-junction strand formation. Cell. 2006;126(4):741–54.
19. Fasano A. Physiological, pathological, and therapeutic implications of zonulin-mediated intestinal barrier modulation: living life on the edge of the wall. Am J Pathol. 2008;173(5):1243–52.
20. Van Itallie CM, Fanning AS, Bridges A, Anderson JM. ZO-1 stabilizes the tight junction solute barrier through coupling to the perijunctional cytoskeleton. MolBiol Cell. 2009;20(17):3930–40.
21. Luissint AC, Nusrat A, Parkos CA. JAM-related proteins in mucosal homeostasis and inflammation. SeminImmunopathol. 2014;36(2):211–26.
22. 22.Chen CL, Liu YL, Wang P, Sun W, Wang FJ. Role of MLC phosphorylation in intestinal epithelial barrier dysfunction induced by severe burn injury. ActaAcadem Med MilitTert. 2008;30(15):1434–7.
23. Liu YL, Wang FJ, Chen CL, Wng P. Increased intestinal permeability in severely burnt rats: regulatory mechanism of Rho kinase. ActaAcadem Med MilitTert. 2008;30(9):817–9..
24. Peterson CY, Costantini TW, Loomis WH, Putnam JG, Wolf P, Bansal V, et al. Toll-like receptor-4 mediates intestinal barrier breakdown after thermal injury. Surg Infect. 2010;11(2):137–44.
25. Yang XK, Chen J, Bai H, Tao K, Zhou Q, Hou HY, et al. Inhibition of Na+/H+ exchanger 1 by cariporide reduces burn-induced intestinal barrier breakdown. Burns. 2013;39(8):1557–64.
Copyright (c) 2021 Lubna Riaz, Riaz Ahmed Shahid, Muhammad Noman Rashid, Roomana Batool, Saleem Ullah Abro, Qurratulain Saleem
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
All research articles published in the Journal of Rawalpindi Medical College (JRMC) are fully open access: immediately freely available to read, download, and share. Copyrights of all articles published in JRMC are retained by the authors. First publication rights are granted to JRMC. The journal/publisher is not responsible for subsequent uses of the work.
All articles are published under the Creative Commons Attribution (CC BY-SA 4.0) license.