PURPOSE: To find progression and prognosis of pancreatitis developed in massive burn patients through retrospective analysis. METHODS: A retrospective study was conducted on 32 patients with abnormal increase of serum lipase level among 2523 acute burn patients admitted to our burn center from January 1, 2017 to June 30, 2018. Pancreatitis in this study was defined as a serum lipase concentration level that is higher than 180 IU/L which is three times more than the normal level (less than 60 IU/L). In this study, a retrospective analysis was performed on patients with serum lipase level higher than 300 IU/L to better understand causality of burns and pancreatitis. RESULTS: 32 patients (1.27%) had serum lipase level higher than 180 IU/L among 2523 acute burn subjects. And 13 patients (0.52%) of these 32 patients had serum lipase level elevated more than 300 IU/L. The study indicated serum lipase level was increased around 7 days after the injury. It returned to normal level early as after 1 to 2 weeks and late as after 4 to 6 weeks of injury. The serum amylase level was increased as similar modality as to the serum lipase level increase. The serum bilirubin, AST, ALT, LD, and GGT were also observed to be elevated when serum lipase was more than 1000 IU/L. CONCLUSION: The pancreatitis developed in burn patients are mostly as mild symptom. It could due to the ischemic injury and can easily be treated by a temporary fasting, TPN, and Gabexate intravenous injection.
Amylases ; Bilirubin ; Burn Units ; Burns ; Fasting ; Gabexate ; Humans ; Injections, Intravenous ; Lipase ; Pancreatitis ; Prognosis ; Retrospective Studies

PURPOSE: The aim of this study was to investigate the characteristics of Acute Kidney Injury Network (AKIN)-defined nephrotoxicity in patients undergoing intravenous colistimethate sodium (CMS) therapy for major burns. METHODS: This retrospective study included burn patients who received more than 48 h of intravenous CMS between September 2009 and December 2015. Data collection was performed using the institution's electronic medical record system. Patients assigned to the developed nephrotoxic group experienced aggravation of current AKIN stage during CMS treatment; those assigned to the non-nephrotoxic group experienced no change in current or exhibited improved AKIN stage during CMS therapy. RESULTS: A total of 306 patients were included in this study. All patients were grouped according to AKIN stage: AKIN 0 (n=152); AKIN 1 (n=6); AKIN 2 (n=9); AKIN 3 (n=139). The baseline creatinine (Cr) level was 0.73 mg/dL. The incidence of nephrotoxicity was 50.3% according to AKIN stage; overall mortality was 45.8%. The non-nephrotoxic group consisted of 127 (74.7%) patients and 43 (25.3%) were in the developed nephrotoxic group. In patients requiring continuous renal replacement therapy (CRRT), baseline Cr level was 0.83 mg/dL, pre-CMS Cr level was 1.17 mg/dL, and post-CMS Cr level was 1.34 mg/dL. CONCLUSION: CMS can be administered without signs of nephrotoxicity for a certain period (approximately 1 week), it can be used relatively safely for 2 weeks. Application of CMS is a reasonable option for treating infections caused by multi-drug resistant gram-negative bacteria in patients with major burns. The caution should be exercised nevertheless.
Acute Kidney Injury ; Burns ; Colistin ; Creatinine ; Data Collection ; Electronic Health Records ; Gram-Negative Bacteria ; Gram-Negative Bacterial Infections ; Humans ; Incidence ; Mortality ; Renal Replacement Therapy ; Retrospective Studies ; Sodium

BACKGROUND: Malnutrition is associated with many adverse clinical outcomes. The present study aimed to identify the prevalence of malnutrition in hospitalized patients in Korea, evaluate the association between malnutrition and clinical outcomes, and ascertain the risk factors of malnutrition. METHODS: A multicenter cross-sectional study was performed with 300 patients recruited from among the patients admitted in 25 hospitals on January 6, 2014. Nutritional status was assessed by using the Subjective Global Assessment (SGA). Demographic characteristics and underlying diseases were compared according to nutritional status. Logistic regression analysis was performed to identify the risk factors of malnutrition. Clinical outcomes such as rate of admission in intensive care units, length of hospital stay, and survival rate were evaluated. RESULTS: The prevalence of malnutrition in the hospitalized patients was 22.0%. Old age (≥ 70 years), admission for medical treatment or diagnostic work-up, and underlying pulmonary or oncological disease were associated with malnutrition. Old age and admission for medical treatment or diagnostic work-up were identified to be risk factors of malnutrition in the multivariate analysis. Patients with malnutrition had longer hospital stay (SGA A = 7.63 ± 6.03 days, B = 9.02 ± 9.96 days, and C = 12.18 ± 7.24 days, P = 0.018) and lower 90-day survival rate (SGA A = 97.9%, B = 90.7%, and C = 58.3%, P < 0.001). CONCLUSION: Malnutrition was common in hospitalized patients, and resulted in longer hospitalization and associated lower survival rate. The rate of malnutrition tended to be higher when the patient was older than 70 years old or hospitalized for medical treatment or diagnostic work-up compared to elective surgery.
Cross-Sectional Studies ; Hospitalization ; Humans ; Intensive Care Units ; Korea ; Length of Stay ; Logistic Models ; Malnutrition ; Multivariate Analysis ; Nutrition Assessment ; Nutritional Status ; Prevalence ; Risk Factors ; Survival Rate

PURPOSE: Fire suits are very important protective equipment for firefighters. In fire scene, radiant heat and warmed water invade into conventional protective clothing gap. The safety of firefighters has long been a hot topic in Korea. Nevertheless, there are still lack of researches and investigations for safety of firefighters. We revealed the characteristics of the burn site and the hospitalization of injured firefighters according to the wearing of the conventional and special protective clothing. METHODS: This study analyzed the data obtained from the online survey (ko.surveymonkey.com) from September 19, 2016 to October 21, 2016 for nationwide firefighters who are cooperating with the National Security Agency. 4,891 firefighters responded to the questionnaire and 424 burn victims were reported. The analysis was conducted with 322 except 102 incomplete responders. The obtained data was analyzed with Chi-square test (P<0.05). RESULTS: The most common site of burn injury during firefighting was hand 166 (51.6%) followed by face 79 (24.5%), neck 55 (17.1%) and wrist 49 (15.2%). The number of people wearing conventional protective clothing was 81 (25.2%) and the number of people wearing special protective clothing was 20 (6.2%). The number of people wearing protective gloves was 247 (76.7%). In terms of protective clothing in injured firefighters, special protective clothing showed lower hospitalization rate comparing with conventional protective clothing (24.7% vs. 5.0%, P<0.05). CONCLUSION: The most common site of burn injury in Firefighters is hand. The special protective clothing showed lower hospitalization rate comparing with conventional protective clothing.
Burns* ; Firefighters* ; Fires ; Gloves, Protective ; Hand ; Hospitalization* ; Hot Temperature ; Human Body* ; Humans ; Korea ; Neck ; Protective Clothing* ; Security Measures ; Water ; Wrist

PURPOSE: Firefighters are vulnerable to burn injury during firefighting. In extensive fires, conducted heat and radiant heat can cause burn injury even though firefighters are not directly exposed to fire. There has been increasing interest in the health problems of firefighters considerably since Hongje-dong fire of 2001, which claimed the lives of six fireman. However, there have been no studies done on the characteristics of firefighter burn injuries in South Korea. Therefore, we investigated the characteristics of firefighter burn injuries in a burn center. METHODS: A retrospective, single-center research was performed between Jan 2006 to Dec 2015. 24 firefighters came to the burn center. The electronic medical records of patients were reviewed. RESULTS: Flame burns (87.5%) were the major cause of burn in firefighter. All the patients suffered second-degree or third-degree burns. Mean burn size was 6.1±6.7%. 22 of 24 patients were hospitalized and 2 of 22 hospitalized patients admitted to intensive care unit. Mean length of hospitalization was 29.1±23.7 days and mean length of intensive care unit hospitalization was 6.0±1.4 days. The face was the site most commonly burned, representing 25.8% of injuries. The hand/wrist, upper extremity, and neck were the next largest groups, with 19.4, 12.9, 11.3% of the injuries, respectively. CONCLUSION: Firefighter burn injuries occur to predictable anatomic sites with common injury patterns. The burn size was small but, admitted patients need about 30 days of hospitalization.
Burn Units* ; Burns* ; Electronic Health Records ; Epidemiologic Studies* ; Firefighters* ; Fires ; Hospitalization ; Hot Temperature ; Humans ; Intensive Care Units ; Korea ; Neck ; Retrospective Studies* ; Upper Extremity

PURPOSE: Acute kidney injury (AKI) in major burn patients is a common complication with high morbidity and mortality. The mainstream treatment is early diagnosis and rapid termination and prevention of the underlying insult. Therefore, it's essential to identify early biomarkers predicting AKI. METHODS: A total of 85 patients who were admitted to the burn intensive care unit from June 2012 to July 2013 were included in this prospective cohort study. Ten biomarkers (blood urea nitrogen, serum creatinine, urine creatinine, cystatin C, cystatin C glomerular filtration rate, AST, lacate dehydrogenase [LD], creatine kinase, lactic acid, and myoglobin) were obtained at time of admission and evaluated as diagnostic biomarkers to predicting AKI and early AKI. RESULTS: Out of 85 patients, 35 patients were dead and overall mortality was 41.2%. The mean age was 49.4 years and mean percentage of total body surface area was 53.2%. Area under the curve (AUC) of receiver operating characteristic curve of biomarkers on predicting AKI were 0.746, 0.718, and 0.717 in LD, lactic acid, and serum creatinine, respectively. AUC of cystatin C predicting AKI was much lower at 0.555. AUC of biomarkers on predicting early AKI were 0.833, 0.816, 0.790, and 0.759 in LD, serum creatinine, AST, and serum myoglobin. CONCLUSION: LD, lactic acid and serum creatinine were acceptable as diagnostic biomarkers of AKI and LD, serum creatinine, AST, and serum myoglobin were reasonable as diagnostic biomarkers of early AKI. However, cystatin C was an unfavorable biomarker in major burn patients.
Acute Kidney Injury* ; Area Under Curve ; Biomarkers* ; Body Surface Area ; Burns* ; Cohort Studies ; Creatine Kinase ; Creatinine ; Cystatin C ; Early Diagnosis ; Glomerular Filtration Rate ; Humans ; Intensive Care Units ; L-Lactate Dehydrogenase ; Lactic Acid ; Mortality ; Myoglobin ; Nitrogen ; Oxidoreductases ; Prospective Studies ; ROC Curve ; Urea

PURPOSE: This study was planned to evaluate the effect of plant extracts contained dressing material which is rich in procyanidins for treatment of deep second degree burn. METHODS: This study conducted from September 1, 2013 to February 28, 2014. Patients with the deep dermal burn wound which is larger than 200 cm2 were enrolled in this study. The test material was applied total 3 times every 2 days when the wounds were relatively clean, with thin eschar and scab removed and the dermal layer exposed. The test and control sites were treated with hydro-foam equally. The effectiveness was evaluated by comparing the re-epithelialization rates between the test and control sites. Two burn surgeons blindly evaluated for re-epithelialization. Evaluation of adverse reaction was also performed during study period. RESULTS: Total of 40 patients were enrolled. Mean total body surface area burned% was 12.3+/-5.5% and the test material was first applied at mean post burn day # 7.2+/-2.0.The re-epithelialization period was 9.0+/-1.7 days in the test site and 11.1+/-2.0 days in the control site. In the test site, re-epithelialization was 2.1+/-1.0 days faster than in the control site (P<0.0001). There was no significant adverse reaction during study period. CONCLUSION: The plant extracts contained dressing material which is rich in procyanidins accelerates wound healing time and shows the safety.
Bandages* ; Body Surface Area ; Burns* ; Humans ; Plant Extracts* ; Proanthocyanidins* ; Re-Epithelialization ; Wound Healing ; Wounds and Injuries

BACKGROUND: Major burn injury induces an inflammatory response that is accompanied by the release of various cytokines. We investigated the gradual changes in the levels of pro-inflammatory and anti-inflammatory cytokines following burn injury and determined the relationship between these levels and burn size in adult Korean patients with burn injury. METHODS: Blood samples from 9 healthy controls and 60 Korean burn patients were collected on days 1, 3, 7, 14, and 21 after burn injury, and concentrations of interleukin (IL)-6, IL-8, IL-10, tumor necrosis factor (TNF)-alpha, and granulocyte-colony stimulating factor (G-CSF) were measured. Burn patients were divided into 3 groups according to burn size (15-30%, 31-50%, >50% total body surface area), and the concentrations of the cytokines were compared between these groups and the control group over 3 weeks. RESULTS: Compared to their levels in controls, IL-6, IL-8, IL-10, TNF-alpha, and G-CSF levels in burn patients were significantly higher during the observation period. Median concentrations of IL-8, IL-10, and G-CSF at each time point increased with burn size, although peak levels and time to peak levels of these cytokines differed from patient to patient. CONCLUSIONS: These findings indicate that IL-6, IL-8, IL-10, TNF-alpha, and G-CSF are important mediators in inflammatory changes after burn injury; however, various factors, including burn size, may influence the concentrations of these cytokines.
Adolescent ; Adult ; Aged ; Asian Continental Ancestry Group ; Burns/blood/*pathology ; Granulocyte Colony-Stimulating Factor/*blood ; Humans ; Interleukin-10/*blood ; Interleukin-6/*blood ; Interleukin-8/*blood ; Male ; Middle Aged ; Republic of Korea ; Time Factors ; Tumor Necrosis Factor-alpha/*blood ; Young Adult

BACKGROUND: Major burn injury induces an inflammatory response that is accompanied by the release of various cytokines. We investigated the gradual changes in the levels of pro-inflammatory and anti-inflammatory cytokines following burn injury and determined the relationship between these levels and burn size in adult Korean patients with burn injury. METHODS: Blood samples from 9 healthy controls and 60 Korean burn patients were collected on days 1, 3, 7, 14, and 21 after burn injury, and concentrations of interleukin (IL)-6, IL-8, IL-10, tumor necrosis factor (TNF)-alpha, and granulocyte-colony stimulating factor (G-CSF) were measured. Burn patients were divided into 3 groups according to burn size (15-30%, 31-50%, >50% total body surface area), and the concentrations of the cytokines were compared between these groups and the control group over 3 weeks. RESULTS: Compared to their levels in controls, IL-6, IL-8, IL-10, TNF-alpha, and G-CSF levels in burn patients were significantly higher during the observation period. Median concentrations of IL-8, IL-10, and G-CSF at each time point increased with burn size, although peak levels and time to peak levels of these cytokines differed from patient to patient. CONCLUSIONS: These findings indicate that IL-6, IL-8, IL-10, TNF-alpha, and G-CSF are important mediators in inflammatory changes after burn injury; however, various factors, including burn size, may influence the concentrations of these cytokines.
Adolescent ; Adult ; Aged ; Asian Continental Ancestry Group ; Burns/blood/*pathology ; Granulocyte Colony-Stimulating Factor/*blood ; Humans ; Interleukin-10/*blood ; Interleukin-6/*blood ; Interleukin-8/*blood ; Male ; Middle Aged ; Republic of Korea ; Time Factors ; Tumor Necrosis Factor-alpha/*blood ; Young Adult

PURPOSE: We designed our study to find optimal timing for tracheostomy, and to determine the effects of early tracheostomy on clinical courses in flame burned patients with inhalation injury. METHODS: A retrospective chart review was completed for adult patients admitted to Hangang Sacred Heart Hospital Burn Center, Hallym University Medical Center, Seoul, Korea, between March 1, 2004 and February 28, 2009, who were diagnosed with flame burn with inhalation injury and who underwent tracheostomy during their hospitalization. One hundred eighteen patients were enrolled in this study. Patients were assigned to one of three groups based on the timing of tracheostomy: postburn days (PBD) 0 to 7 [Early tracheostomy (ET) group], 8 to 12 [Intermediate tracheostomy (IT) group], and greater than 13 [Late tracheostomy (LT) group]. We compared incidence of pneumonia, duration on mechanical ventilation, length of stay in intensive care unit (ICU LOS), and survival between groups. To assess the effect of tracheostomy on pulmonary function, we analyzed changes of PaO2/Fio2 (P/F) ratio. RESULTS: There were 46 patients in the ET group, 47 in the IT group and 25 in the LT group. Tracheostomy day (PBD) was 5.2+/-1.7 in ET group, 10.0+/-1.5 in IT group, and 14.8+/-1.9 in LT group (P<0.01). Statistics did not show the correlation between the timing of the tracheostomy and the incidence of pneumonia. Also mortality rate in each group showed no significant differences. There were significant differences between groups for duration on mechanical ventilation and ICU LOS (P<0.01). P/F ratio correlated with time flow showed no significant differences (P=0.10). Also there were no differences between groups in changes of P/F ratio (P=0.08). CONCLUSION: In flame burned patients with inhalation injury who require prolonged mechanical ventilation, performing tracheostomy within PBD 7 may shorten the duration on mechanical ventilation and length of stay in intensive care unit.
Academic Medical Centers ; Adult ; Burn Units ; Burns ; Heart ; Hospitalization ; Humans ; Incidence ; Inhalation ; Intensive Care Units ; Korea ; Length of Stay ; Pneumonia ; Respiration, Artificial ; Retrospective Studies ; Tracheostomy