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  • 1.
    Shyaka, Ian
    et al.
    Rwanda Mil Hosp, Rwanda; Rwanda Mil Hosp, Rwanda.
    Miranda, Elizabeth
    Harvard Med Sch, MA USA; Univ Southern Calif, CA USA.
    Eilers-Velin, Lotta
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Regionledningskontoret, Center for Disaster Medicine and Traumatology. Harvard Med Sch, MA USA.
    Mukagaju, Francoise
    Rwanda Mil Hosp, Rwanda.
    Nezerwa, Yves
    Rwanda Mil Hosp, Rwanda.
    Ntirenganya, Faustin
    Univ Teaching Hosp Kigali CHUK, Rwanda.
    Furaha, Charles
    Rwanda Mil Hosp, Rwanda.
    Riviello, Robert
    Harvard Med Sch, MA USA; Brigham & Womens Hosp, MA USA.
    Pompermaier, Laura
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery. Region Östergötland, Regionledningskontoret, Center for Disaster Medicine and Traumatology.
    Estimating mortality risk in burn patients admitted at Rwanda's largest referral hospital2024In: International Journal of Burns and Trauma, ISSN 2160-2026, Vol. 14, no 1, p. 25-31Article in journal (Refereed)
    Abstract [en]

    Background: Burns is a disease of poverty, disproportionately affecting populations in low- and middle-income countries, where most of the injuries and the deaths caused by burns occurs. In Sub-Saharan Africa, it is estimated that one fifth of burn victims die from their injuries. Mortality prediction indexes are used to estimate outcomes after provided burn care, which has been used in burn services of high-income countries over the last 60 years. It remains to be seen whether these are reliable in low-income settings. This study aimed to analyze inhospital mortality and to apply mortality estimation indexes in burn patients admitted to the only specialized burn unit in Rwanda. Methods: This retrospective study included all patients with burns admitted at the burn unit (BU) of the University Teaching Hospital in Kigali (CHUK) between 2005 and 2019. Patient data were collected from the BU logbook. Descriptive statistics were calculated with frequency (%) and median (interquartile range, IQR). Association between burns characteristics and in-hospital mortality was calculated with Fisher's exact test, and Wilcoxon rank, as appropriate. Mortality estimation analysis, including Baux score, Lethal Area 50 (LA50), and point of futility, was calculated in those patients with complete data on age and TBSA. LA50 and point-of-futility were calculated using logistic regression. Results: Among the 1093 burn patients admitted at the CHUK burn unit during the study period, 49% (n=532) had complete data on age and TBSA. Their median age, TBSA, and Baux score were 3.4 years (IQR 1.9-17.1), 15% (IQR 11-25), and 24 (IQR 16-38), respectively. Overall, reported in-hospital mortality was 13% (n=121/931), LA50 for Baux score was 89.9 (95% CI 76.2-103.7), and the point-of-futility was at a Baux score of 104. Conclusion: Mortality estimation indexes based on age and TBSA are feasible to use in low-income settings. However, implementation of systematic data collection would contribute to a more accurate calculation of the mortality risk.

  • 2.
    Pompermaier, Laura
    et al.
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Steinvall, Ingrid
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Elmasry, Moustafa
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Eladany, Mostafa M.
    Suez Canal Univ, Egypt.
    Abdelrahman, Islam Mohamedy
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Fredrikson, Mats
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Inflammation and Infection. Linköping University, Faculty of Medicine and Health Sciences.
    Sjöberg, Folke
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, ANOPIVA US.
    Long-term mortality after self-inflicted burns2024In: Burns, ISSN 0305-4179, E-ISSN 1879-1409, Vol. 50, no 1, p. 252-261Article in journal (Refereed)
    Abstract [en]

    Background: Those with self-inflicted burns are a small but consistent group among burn patients, with large injuries and conflicting findings regarding their in-hospital mortality. Overall, burn survivors have a shorter life expectancy, as compared with national controls, but long-term mortality after self-inflicted burns is understudied. The aim of this retrospective study was to investigate possible differences in long-term mortality among survivors after self-inflicted and accidental burns.Methods: All adult patients with burns admitted at the Linkoping Burn Centre and discharged alive between 2000 and 2017 were included, and end of follow up was April 26, 2021. Those with unknown survival status at that time were excluded. A Cox proportional hazards regression model, adjusted for age and sex, was used to analyse long term mortality.Results: Among the 930 patients included in this study, 37 had self-inflicted burns. Overall, median follow up period was 8.8 years and crude mortality was 24.7%. After adjustment for age and sex, self-inflicted burns were independently associated with long-term mortality, Hazard Ratio= 2.08 (95% CI 1.13-3.83). Post hoc analysis showed that the effect was most pronounced during the first years after discharge although it was noticeable over the whole study period.Conclusion: Long-term risk of mortality after discharge from a burn centre was higher in patients with self-inflicted burns than in patients with accidental burns. The effect was noticeable over the whole study period although it was most pronounced during the first years after discharge.

    The full text will be freely available from 2024-09-28 00:00
  • 3.
    Depetris, Nadia
    et al.
    CTO Hosp, Italy; Via Zuretti 29 CTO Citta Salute & Sci, Italy.
    Lavrentieva, Athina
    Papanikolaou Hosp, Greece.
    Dash, Suvashis
    All India Inst Med Sci, India.
    Rogers, Alan David
    Sunnybrook Hlth Sci Ctr, Canada.
    Pompermaier, Laura
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Response to Letter to Editor regarding the manuscript "Quality indicators in burn care: An international burn care professionals survey to define them"2024In: Burns, ISSN 0305-4179, E-ISSN 1879-1409, Vol. 50, no 2, p. 530-531Article in journal (Other academic)
  • 4.
    Faria, Isabella
    et al.
    Harvard Med Sch, MA USA.
    Campos, Leticia
    Univ Pernambuco, Brazil.
    Jean-Pierre, Tayana
    Harvard Med Sch, MA USA.
    Naus, Abbie
    Harvard Med Sch, MA USA.
    Gerk, Ayla
    Univ Catolica Argentina, Argentina.
    Cazumba, Maria Luiza
    Univ Fed Minas Gerais, Brazil.
    Buda, Alexandra M.
    Harvard Med Sch, MA USA; Univ Rochester, NY USA.
    Graner, Mariana
    Univ Sao Paulo, Brazil.
    Moura, Carolina B.
    Fac Saude & Ecol Humana, Brazil.
    Pendleton, Alaska
    Harvard Med Sch, MA USA; Massachusetts Gen Hosp, MA USA.
    Pompermaier, Laura
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery. Harvard Med Sch, MA USA.
    Truche, Paul
    Harvard Med Sch, MA USA.
    Ferreira, Julia Loyola
    McGill Univ, Canada; McGill Univ, Canada.
    Bowder, Alexis N.
    Harvard Med Sch, MA USA; Med Coll Wisconsin, WI USA.
    Correction: Gender-Based Discrimination Among Medical Students: A Cross-Sectional Study in Brazil (vol 15, pg 283, 2022)2023In: Journal of Surgical Research, ISSN 0022-4804, E-ISSN 1095-8673, Vol. 284, p. 251-251Article in journal (Other academic)
  • 5.
    Faria, Isabella
    et al.
    Harvard Med Sch, MA USA; Harvard Med Sch, MA 02115 USA.
    Campos, Leticia
    Univ Pernambuco, Brazil.
    Jean-Pierre, Tayana
    Harvard Med Sch, MA USA.
    Naus, Abbie
    Harvard Med Sch, MA USA.
    Gerk, Ayla
    Univ Catol Argentina, Argentina.
    Cazumba, Maria Luiza
    Univ Fed Minas Gerais, Brazil.
    Buda, Alexandra M.
    Harvard Med Sch, MA USA; Univ Rochester Med Ctr, NY USA.
    Graner, Mariana
    Univ Sao Paulo, Brazil.
    Moura, Carolina B.
    Fac Saude & Ecol Humana, Brazil.
    Pendleton, Alaska
    Harvard Med Sch, MA USA; Massachusetts Gen Hosp, MA USA.
    Pompermaier, Laura
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery. Harvard Med Sch, MA USA.
    Truche, Paul
    Harvard Med Sch, MA USA.
    Ferreira, Julia Loyola
    McGill Univ, Canada; McGill Univ Hlth Ctr, Canada.
    Boulder, Alexis N.
    Harvard Med Sch, MA USA; Med Coll Wisconsin, WI USA.
    Gender-Based Discrimination Among Medical Students: A Cross-Sectional Study in Brazil2023In: Journal of Surgical Research, ISSN 0022-4804, E-ISSN 1095-8673, Vol. 283, p. 102-109Article in journal (Refereed)
    Abstract [en]

    Introduction: Gender-based discrimination (GBD) creates a hostile environment during medical school, affecting students personal life and academic performance. Little is known about how GBD affects the over 204,000 medical students in Brazil. This study aims to explore the patterns of GBD experienced by medical students in Brazil. Methods: This is a cross-sectional study using an anonymous, Portuguese survey dissemi-nated in June 2021 among Brazilian medical students. The survey was composed of 24 questions to collect data on GBD during medical school, formal methods for reporting GBD, and possible solutions for GBD. Results: Of 953 responses, 748 (78%) were cisgender women, 194 (20%) were cisgender men, and 11 (1%) were from gender minorities. 65% (616/942) of respondents reported experiencing GBD during medical school. Women students experienced GBD more than men (77% versus 22%; P < 0.001). On comparing GBD perpetrator roles, both women (82%, 470/574) and men (64%, 27/42) reported the highest rate of GBD by faculty members. The occurrence of GBD by location differed between women and men. Only 12% (115/953) of respondents reported knowing their institution had a reporting mechanism for GBD. Conclusions: Most respondents experienced GBD during medical school. Cisgender women experienced GBD more than cisgender men. Perpetrators and location of GBD differed for men and women. Finally, an alarming majority of students did not know how to formally report GBD in their schools. It is imperative to adopt broad policy changes to diminish the rate of GBD and its a consequential burden on medical students. 2022 Elsevier Inc. All rights reserved.

  • 6.
    Dash, Suvashis
    et al.
    All India Inst Med Sci, India.
    Pompermaier, Laura
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Lavrentieva, Athina
    Papanikolaou Hosp, Greece.
    Rogers, Alan David
    Sunnybrook Hlth Sci Ctr, Canada.
    Depetris, Nadia
    CTO Hosp, Italy; Via Zuretti 29 CTO Citta Salute & Sci, Italy.
    Quality indicators in burn care: An international burn care professionals survey to define them2023In: Burns, ISSN 0305-4179, E-ISSN 1879-1409, Vol. 49, no 6, p. 1260-1266Article in journal (Refereed)
    Abstract [en]

    Introduction: Quality indicators (QIs) are tools for improving and maintaining the standard of care. Although burn injuries are a major global health threat, requiring standardized management, there is a lack of worldwide accepted quality indicators for burn care. This study aims to identify the best burn care-specific QIs as perceived by worldwide burn practitioners.Methods: The ISBI Burn Care Committee developed a survey to analyze which burn care specific QIs were relevant to international burn care professionals. The questionnaire was based on the three dimensions of the Donabedian model (i.e., Structure, Process, and Outcome) to evaluate the quality of care. The study was conducted from April to September 2021 and analyzed and reported following the Checklist for Reporting Results of Internet E-Surveys (CHERRIES). Results: According to the 124 worldwide respondents, the most relevant QIs were: access to intensive care, burn surgeons, and dedicated burn care nurses (Structure category), 24 hours access to burn services, local protocols based on documented guidelines (Process category), and in-hospital mortality and incidence of severe infections (Outcome category).Conclusions: Specific QIs related to structures, clinical processes, and outcomes are needed to monitor the treatment of burn patients globally, assess the efficiency of the provided treatment, and harmonize the worldwide standard of burn care.

  • 7.
    Moura, Carolina
    et al.
    Univ Fed Fluminense, Brazil.
    Bittencourt, Marcela
    Univ Jose Rosario Vellano, Brazil.
    Cazumba, Maria Luiza
    Fac Med Univ Fed Minas Gerais, Brazil.
    Buda, Alexandra
    Program Global Surg & Social Change PGSSC, MA 02115 USA.
    Bowder, Alexis
    Program Global Surg & Social Change PGSSC, MA 02115 USA.
    Corlew, Daniel Scott
    Program Global Surg & Social Change PGSSC, MA 02115 USA.
    Botelho Filho, Fabio Mendes Botelho
    Fac Med Univ Fed Minas Gerais, Brazil.
    Barboza, Lucas
    Fac Med Univ Fed Minas Gerais, Brazil.
    Pompermaier, Laura
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    The Impact of COVID-19 on Burns: A Brazilian Study2023In: EUROPEAN BURN JOURNAL, ISSN 2673-1991, Vol. 4, no 1Article in journal (Refereed)
    Abstract [en]

    During the COVID-19 pandemic, some of the strategies chosen to contain the spread, such as social isolation and use of alcohol-based hand sanitizer, were suspected to increase the risk of domestic accidents, especially burns. The aim of this study was, therefore, to investigate possible differences in epidemiological trends among burned patients admitted to the main referral hospital of the State of Minas Gerais, Brazil, before and during the pandemic. Methods: All categories of new burns admitted at the Burn Unit of the Joao XXIII Hospital in Belo Horizonte, Minas Gerais. The study group consisted of burn patients admitted between 1 March and 31 December 2020, and the control group consisted of those admitted between 1 March and 31 December 2019. The population was analyzed descriptively, and differences between patients admitted before and during the pandemic were tested using t-test, Wilcoxon Mann-Whitney Rank Sum test, the Chi-Squared test or Fisher's exact test, as appropriate. Results: During the study period, 914 patients were admitted at the burns unit, 535 before the pandemic (control group) and 379 during the pandemic (study group). During the pandemic, referral from other hospitals decreased, while time between injury and admission remained unchanged. TBSA% and LOS diminished, while the depth of burns, presence of inhalation injuries, and in-hospital mortality did not. In adults, the place and mechanism of injury changed during the pandemic, while in children they did not. Conclusion: Fewer patients with burns were referred for specialized burn care during the pandemic, although patients admitted for specialized burn care had smaller TBSA% and shorter LOS.

  • 8.
    Graner, Mariana
    et al.
    Univ Sao Paulo, Brazil.
    Gutierre, Marcela
    Univ Sao Paulo, Brazil.
    Salgado, Lucas S.
    Uniao Educ Vale do Aco, Brazil.
    Mishaly, Asher
    Univ Nove Julho, Brazil.
    Baptista, Joao
    Univ Sao Paulo, Brazil.
    Calheiros, Gregory
    Univ Sao Paulo, Brazil.
    Buda, Alexandra M.
    Harvard Med Sch, MA USA.
    Bowder, Alexis N.
    Harvard Med Sch, MA USA.
    Corlew, D. Scott
    Harvard Med Sch, MA USA.
    Botelho, Fabio
    McGill Univ, Canada.
    de Souza Gomez, David
    Univ Sao Paulo, Brazil.
    Alonso, Nivaldo
    Univ Sao Paulo, Brazil.
    Pompermaier, Laura
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Who Gets Burned in Brazil?2023In: Journal of Burn Care & Research, ISSN 1559-047X, E-ISSN 1559-0488Article in journal (Refereed)
    Abstract [en]

    Burns are preventable injuries that still represent a relevant public health issue. The identification of risk factors might contribute to the development of specific preventive strategies. Data of patients admitted at the Hospital due to acute burn injuries from May 2017 to December 2019, was extracted manually from medical records. The population was analyzed descriptively, and differences between groups were tested using the appropriate statistical test. The study population consisted of 370 patients with burns admitted to the Hospital burn unit during the study period. The majority of the patients were males (257/370, 70%), median age was 33 (IQR:18-43), median TBSA% was 13 (IQR 6.35-21.5 and range 0-87.5%), and 54% of patients had full-thickness burns (n = 179). Children younger than 13 years old represented 17% of the study population (n = 63), 60% of them were boys (n = 38), and scalds was the predominant mechanism of burn injury (n = 45). No children died, however 10% of adults did (n = 31). Self-inflicted burns were observed in 16 adults (5%), of whom 6 (38%) died during admission, however self-inflicted burns were not observed in children. Psychiatric disorders and substance misuse were frequent in this subgroup. White adults male from urban areas who had not completed primary school degree were the major risk group for burns. Smoking and alcohol misuse were the most frequent comorbidities. Accidental domestic flame burns were the predominant injuries in the adult population and scalds in the pediatric.

  • 9.
    Wall, S. L.
    et al.
    School of Clinical Medicine, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Pietermaritzburg, South Africa; Pietermaritzburg Burn Service, Pietermaritzburg Metropolitan Department of Surgery, South Africa, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Pietermaritzburg, South Africa; Developing Research, Innovation, Localization and Leadership (DRILL), College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.
    Velin, Lotta
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Regionledningskontoret, Center for Disaster Medicine and Traumatology.
    Abbas, A.
    The Aga Khan University, Pakistan.
    Allorto, N. L.
    School of Clinical Medicine, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Pietermaritzburg, South Africa; Pietermaritzburg Burn Service, Pietermaritzburg Metropolitan Department of Surgery, South Africa, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Pietermaritzburg, South Africa.
    Graner, M.
    School of Medicine, University of Sāo Paulo, Sāo Paulo, Brazil.
    Moeller, E.
    Department of Surgery, Oregon Health and Science University, United States.
    Ryan-Coker, M. F. D.
    Department of Surgery, Faculty of Health Sciences, University of Nairobi, Kenya.
    Pompermaier, Laura
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Who tells the story of burns in low-and-middle income countries? - A bibliometric study.2023In: Burns, ISSN 0305-4179, E-ISSN 1879-1409, Vol. 49, no 4, p. 854-860Article in journal (Refereed)
    Abstract [en]

    Low- and middle-income countries (LMICs) remain drastically underrepresented in health research, with African countries producing less than 1% of the global output. This work investigates authorship patterns of publications on burns in LMICs. Original research studies addressing burn injuries in LMICs and published between 1st January 2015 and 31st December 2020 were included in the review. Descriptive statistics were performed for country affiliations of authors, World Bank Country Income Groups, WHO group, study-focus and country studied. Of the 458 results, 426 studies met the inclusion criteria. Nearly a quarter of papers on burns in LMICs had both first and senior authors from high-income countries (HICs, n = 95, 24.4%), more than half of the papers had both first and senior authors from upper middle- income countries (upper MICs, n = 222, 57.2%), while less than 1% (n = 3) had first and senior authors exclusively from lower-income countries (LICs). Eleven percent (n = 41/388) of all papers were written without either first nor senior author being from the country studied, and 17 of them (41%) had both first and senior authors from the USA. Twenty-five (6%) of the papers had the first author and not the senior author from the country of focus, while six (2%) had the senior and not the first author from the country of interest. To overcome global health challenges such as burns, locally led research is imperative. The maximum benefit of HIC-LMIC collaborations is achieved when LMICs play an active role in leading the research. When LMICs direct the research being conducted in their country, the harm of inherently inequitable relationships is minimized.

  • 10.
    Velin, Lotta
    et al.
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Regionledningskontoret, Center for Disaster Medicine and Traumatology.
    Chew, Michelle
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Clinical Chemistry and Pharmacology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, ANOPIVA US.
    Pompermaier, Laura
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Discrimination in an "equal country" - a survey amongst Swedish final-year medical students2022In: BMC Medical Education, E-ISSN 1472-6920, Vol. 22, no 1, article id 503Article in journal (Refereed)
    Abstract [en]

    Background Discrimination due to gender and ethnicity has been found to be widespread in medicine and healthcare. Swedish and European legislation list seven discrimination grounds (age, sex, ethnicity, religion, sexuality, non-binary gender identity, and disability) which may intersect with each other; yet these have only been sparsely researched. The aim of this study was to assess the extent of discrimination, based on these seven discrimination grounds, amongst final-year medical students in Sweden. Methods A web-based survey, based on the CHERRIES-checklist, was disseminated to course coordinators and program directors in charge of final year medical students at all seven medical schools in Sweden. Quantitative data were analyzed using descriptive statistics, Fishers exact test, and logistic regression. Free-text answers were analyzed thematically using the "Master Suppression techniques" conceptual framework. Results Of the 1298 medical students contacted, 247 (19%) took part in the survey. Almost half (n = 103, 42%) had experienced some form of discrimination, and this difference was statistically significant by gender (p = 0.012), self-perceived ethnicity (p < 0.001), country of birth other than Scandinavia (p < 0.001) and visible religious signs (p = 0.037). The most common type of discrimination was gender-based (in 83% of students who had experienced discrimination), followed by age (48%), and ethnicity (42%). In the logistic regression, women/non-binary gender (p = 0.001, OR 2.44 [95% CI 1.41-4.22]), country of birth not in Scandinavia (p < 0.001, OR 8.05 [2.69-24.03]), non-Caucasian ethnicity (p = 0.04, OR 2.70 [1.39-5.27]), and disability (p = 0.02, OR 13.8 [1.58-12040]) were independently associated with discrimination. Half of those who had experienced religion-based discrimination and nearly one-third of victims of ethnicity-based discrimination reported "large" or "extreme" impact of this. Clinical staff or supervisors were the most common offenders (34%), closely followed by patients and their relatives (30%), with non-Caucasian respondents significantly more likely to experience discrimination by patients (p < 0.001). Conclusions Discrimination appears to be frequent in medical school, even in one of the worlds "most equal countries". Discrimination is most commonly gender- or ethnicity-based, with ethnicity- and religion-based discrimination appearing to have the largest impact. Future research should continue to evaluate discrimination from an intersectional perspective, adapted for local contexts and legislations.

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  • 11.
    Ferreira, Julia
    et al.
    McGill University, Montreal, Quebec, Canada; Harvey E. Beardmore Division of Pediatric Surgery, Montreal Children's Hospital, Montreal, Canada.
    Bowder, Alexis N
    Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts.
    Faria, Isabella
    Federal University of Minas Gerais, Belo Horizonte, Brazil.
    Graner, Mariana
    School of Medicine, University of São Paulo, São Paulo, Brazil.
    Buda, Alexandra M.
    Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts.
    Zimmerman, Kathrin
    Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts.
    Truché, Paul
    Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts.
    Pompermaier, Laura
    Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts.
    Botelho, Fábio
    Harvey E. Beardmore Division of Pediatric Surgery, Montreal Children's Hospital, Montreal, Canada.
    Alonso, Nivaldo
    School of Medicine, University of São Paulo, São Paulo, Braz.
    Scheffer, Mário César
    School of Medicine, University of São Paulo, São Paulo, Brazil.
    Alves Guilloux, Aline Gil
    School of Medicine, University of São Paulo, São Paulo, Brazil.
    Evolution of Gender Disparities Among Brazilian Surgical, Anesthesia, and Obstetric Providers.2022In: Journal of Surgical Research, ISSN 0022-4804, E-ISSN 1095-8673, Vol. 275, p. 1-9Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: Since 2010, most graduating physicians in Brazil have been female, nevertheless gender disparities among surgical specialties still exist. This study aims to explore whether the increase in female physicians has translated to increased female representation among surgical specialties in Brazil.

    METHODS: Data on gender, years of practice, and specialty was extracted from Demografia Médica do Brasil, from 2015 to 2020. The percentage of women across 18 surgical, anesthesia, and obstetric (SAO) specialties and the relative increases in female representation during the study period were calculated.

    RESULTS: Of the 18 SAO specialties studied, 16 (88%) were predominantly male (>50%). Only obstetrics/gynecology and breast surgery showed a female predominance, with 58% and 52%, respectively. Urology, neurosurgery, and orthopedic surgery and traumatology were the three specialties with the largest presence of men - and the lowest absolute growth in the female workforce from 2015 to 2020.

    CONCLUSIONS: In Brazil, where significant gender disparities persist, women are still underrepresented in surgical specialties. Female presence is predominant in surgical specialties dedicated to the care of female patients, while it remains poor in those with male patient dominance. Over the last 5 y, the proportion of women working in SAO specialties has grown, but not as much as in nonsurgical specialties. Future studies should focus on investigating the causes of gender disparities in Brazil to understand and tackle the barriers to pursuing surgical specialties.

  • 12.
    Murhula, Gauthier Bahizire, Sr
    et al.
    University of Bukavu, Bukavu, Democratic Republic of Congo.
    Musole, Patrick Bugeme, Sr
    University of Bukavu, Bukavu, Democratic Republic of Congo.
    Kafupi Nama, Bienfait
    University of Bukavu, Bukavu, Democratic Republic of Congo.
    Tshibwid, Florent A Zeng
    University of Lubumbashi, Lubumbashi, Democratic Republic of Congo.
    Mayeri Garhalangwamuntu, Daniel
    Hôpital Provincial Général de Référence de Bukavu, Bukavu, Democratic Republic of Congo.
    Cikomola, Fabrice Gulimwentuga
    University of Bukavu, Bukavu, Democratic Republic of Congo; Hôpital Provincial Général de Référence de Bukavu, Bukavu, Democratic Republic of Congo .
    Pompermaier, Laura
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Factors Associated With Outcomes After Burn Care: A Retrospective Study in Eastern Democratic Republic of Congo2022In: Journal of Burn Care & Research, ISSN 1559-047X, E-ISSN 1559-0488, Vol. 43, no 1, p. 85-92Article in journal (Refereed)
    Abstract [en]

    In low-income countries, the incidence of burns is high and severe burns are frequently managed at peripheral facilities. Outcome after burn care is poorly studied although it might help identify risk-group and improve treatment strategies. This study aimed to study factors associated with in-hospital outcomes in a burn cohort in the Democratic Republic of Congo. In this retrospective study, we included burn patients admitted to the surgical department at the Hôpital Provincial Général de Référence de Bukavu between January 2013 and December 2018. Differences between groups were tested using χ 2 test or Fisher's exact tests or Wilcoxon rank sum test, as appropriate. Multivariate logistic regression was used to analyze the effect of patients and of burn characteristics on in-hospital mortality, prolongated length of stay (=LOS ≥ 25 days), and occurrence of complications. The study population consisted of 100 patients, mainly young males with the rural origin, moderate-sized but deep burns. Of them, 46 developed complications, 12 died. Median LOS was 25 days (IQR: 15–42). In-hospital death was independently associated with Total Burn Surface Area percentage “TBSA%” (OR = 3.96; 95% CI = 1.67–9.40) and Full-thickness Burns (FTB) (10.68; 1.34–84.74); prolongated LOS with FTB (3.35; 1.07–10.49), and complication with rural origin (5.84; 1.51–22.53), TBSA% (3.96; 1.67–9.40), FTB (4.08; 1.19–14.00), and burns on multiple sites (4.38; 1.38–13.86). In-hospital death was associated with TBSA% and FTB, prolongated LOS with FTB, and complications with burns characteristics and rural origin of the patients. Additional studies are necessary to investigate the effect of provided burn care on outcomes.

  • 13.
    Gerk, Ayla
    et al.
    Faculty of Medical Sciences, Universidad Católica Argentina, Buenos Aires, Argentina.
    Campos, Letícia
    Faculty of Medical Sciences, Universidade de Pernambuco, Recife, Pernambuco, Brazil.
    Naus, Abbie
    Harvard Medical School - Program in Global Surgery and Social Change, Boston, Massachusetts.
    Faria, Isabella
    Harvard Medical School - Program in Global Surgery and Social Change, Boston, Massachusetts.
    Buda, Alexandra M.
    Harvard Medical School - Program in Global Surgery and Social Change, Boston, Massachusetts.
    Moura, Carolina B.
    Faculdade da Saúde e Ecologia Humana, Vespasiano, Minas Gerais, Brazil.
    Graner, Mariana
    chool of Medicine, University of São Paulo, São Paulo, São Paulo, Brazil.
    Cazumbá, Maria Luiza
    Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
    Jean Pierre, Tayana Assomptia
    Harvard Medical School - Program in Global Surgery and Social Change, Boston, Massachusetts.
    Pompermaier, Laura
    Harvard Medical School - Program in Global Surgery and Social Change, Boston, Massachusetts.
    Truche, Paul
    Harvard Medical School - Program in Global Surgery and Social Change, Boston, Massachusetts.
    Pendleton, Alaska
    Harvard Medical School - Program in Global Surgery and Social Change, Boston, Massachusetts.
    Bowder, Alexis N
    Harvard Medical School - Program in Global Surgery and Social Change, Boston, Massachusetts.
    Ferreira, Júlia Loyola
    McGill University, Montreal, Quebec, Canada.
    Gender Discrimination, Career Aspirations, and Access to Mentorship Among Medical Students in Brazil.2022In: Journal of Surgical Research, ISSN 0022-4804, E-ISSN 1095-8673, Vol. 279, p. 702-711, article id S0022-4804(22)00428-0Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: Gender-based discrimination (GBD) creates a hostile environment that can affect medical students. Mentorship has been recognized as a mitigating factor for GBD. We aimed to investigate the impacts of GBD on career selection and well-being of medical students in Brazil and to explore access to mentorship among these students.

    METHODS: A cross-sectional study was performed using an anonymous survey in Portuguese. The survey was distributed in June 2021 to students enrolled in Brazilian medical schools. It contained 24 questions, including demographics, episodes of GBD experienced by responders and their impact on professional and personal life, and mentorship access.

    RESULTS: Of 953 respondents, 748 (78%) were cisgender women, 194 (20%) cisgender men, and 11 nonbinary (1%). Sixty-six percent (625/953) of students reported experiencing GBD, with cisgender women and nonbinary being more likely to experience it than cisgender men (P < 0.001). Responders who experiences GBD report moderate to severe impact on career satisfaction (40%, 250/624), safety (68%, 427/624), self-confidence (68%, 426/624), well-being (57%, 357/625), and burnout (62%, 389/625). Cisgender women were more likely to report these effects than men counterparts (P < 0.01). Only 21% of respondents (201/953) had mentors in their medical schools.

    CONCLUSIONS: Our findings demonstrate that GBD is widespread among Brazilian medical students affecting their personal and professional lives, and most of them do not have access to a mentor. There is an urgent need to increase access to mentors who could mitigate the adverse effects of GBD and help develop a diverse and inclusive medical workforce.

  • 14.
    Pompermaier, Laura
    et al.
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery. Harvard Med Sch, MA 02115 USA.
    Jose, Adorno
    Reg Hosp, Brazil.
    Nikki, Allorto
    Univ KwaZulu Natal, South Africa; Univ KwaZulu Natal, South Africa.
    Khaled, Altarrah
    Alsabah Hlth Reg, Kuwait.
    Barret, Juan
    Univ Autonoma Barcelona, Spain.
    Jeffery, Carter
    Louisiana State Univ, LA USA.
    Shobha, Chamania
    Choithram Hosp & Res Ctr, India.
    Jack, Chong Si
    Singapore Gen Hosp, Singapore.
    Scott, Corlew
    Harvard Med Sch, MA 02115 USA.
    Nadia, Depetris
    Citta Salute & Sci Torino, Italy.
    Elmasry, Moustafa
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Liao, Junlin
    Univ Iowa, IA 52242 USA.
    Josef, Haik
    Tel Aviv Univ, Israel; Sheba Med Ctr, Israel.
    Briana, Horwath
    Univ Iowa, IA 52242 USA.
    Sunil, Keswani
    Natl Burns Ctr Airoli, India.
    Tetsuro, Kiyozumi
    Natl Def Med Coll, Japan.
    Jorge, Leon-Villapalos
    Chelsea & Westminster Hosp, England.
    Gaoxing, Luo
    Army Third Mil Med Univ, Peoples R China.
    Hajime, Matsumura
    Tokyo Med Univ, Japan.
    Ariel, Miranda-Altamirano
    Hosp Civil Guadalajara, Mexico.
    Naiem, Moiemen
    Birmingham Womens & Childrens Hosp, England; Univ Birmingham, England.
    Kiran, Nakarmi
    Kirtipur Hosp, Nepal.
    Nawar, Ahmed
    Cairo Univ, Egypt.
    Faustin, Ntirenganya
    Univ Rwanda, Rwanda.
    Anthony, Olekwu
    Fed Med Ctr Owo, Nigeria.
    Tom, Potokar
    Swansea Univ, Wales; Swansea Univ, Wales.
    Liang, Qiao
    Shanghai Jiao Tong Univ, Peoples R China.
    Man, Rai Shankar
    Kirtipur Hosp, Nepal; Natl Acad Med Sci, Nepal.
    Steinvall, Ingrid
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Ahmed, Tanveer
    Sheikh Hasina Natl Inst Burn & Plast Surg, Bangladesh.
    Molina, Philipe Luiz Vana
    Univ Sao Paulo, Brazil.
    Shelley, Wall
    Univ KwaZulu Natal, South Africa; Univ KwaZulu Natal, South Africa; Univ KwaZulu Natal, South Africa.
    Mark, Fisher
    Univ Iowa, IA 52242 USA.
    Impact of COVID-19 on global burn care2022In: Burns, ISSN 0305-4179, E-ISSN 1879-1409, Vol. 48, no 6, p. 1301-1310Article in journal (Refereed)
    Abstract [en]

    Background: Worldwide, different strategies have been chosen to face the COVID-19-patient surge, often affecting access to health care for other patients. This observational study aimed to investigate whether the standard of burn care changed globally during the pan-demic, and whether country acute accent s income, geographical location, COVID-19-transmission pat-tern, and levels of specialization of the burn units affected reallocation of resources and access to burn care.Methods: The Burn Care Survey is a questionnaire developed to collect information on the capacity to provide burn care by burn units around the world, before and during the pandemic. The survey was distributed between September and October 2020. McNemar`s test analyzed differences between services provided before and during the pandemic, chi 2 or Fishers exact test differences between groups. Multivariable logistic regression analyzed the independent effect of different factors on keeping the burn units open during the pandemic.Results: The survey was completed by 234 burn units in 43 countries. During the pandemic, presence of burn surgeons did not change (p = 0.06), while that of anesthetists and dedi-cated nursing staff was reduced (&lt; 0.01), and so did the capacity to manage patients in all age groups (p = 0.04). Use of telemedicine was implemented (p &lt; 0.01), collaboration be-tween burn centers was not. Burn units in LMICs and LICs were more likely to be closed, after adjustment for other factors.Conclusions: During the pandemic, most burn units were open, although availability of standard resources diminished worldwide. The use of telemedicine increased, suggesting the implementation of new strategies to manage burns. Low income was independently associated with reduced access to burn care.(c) 2021 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

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  • 15.
    Pompermaier, Laura
    et al.
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Drake Af Hagelsrum, Emma
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Ydenius, Viktor
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Sjöberg, Folke
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, ANOPIVA US.
    Steinvall, Ingrid
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Elmasry, Moustafa
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Patient Reported Experiences at a Swedish National Burn Centre2022In: Journal of Burn Care & Research, ISSN 1559-047X, E-ISSN 1559-0488, Vol. 43, no 1, p. 249-254Article in journal (Refereed)
    Abstract [en]

    Previous studies have shown that burn patients were satisfied with the received care. Satisfaction was not strongly associated to burns or to psycho-social characteristics, suggesting that other factors, related to burn care specific aspects, may be important. The aim of this study was to analyze the independent effect of provided workload on the general satisfaction in adult patients at a Swedish national Burn Centre. The study population (n = 122) included patients ≥18 years, treated at the Linköping Burn Centre between 2016 and 2017. Experienced burn care was evaluated with the PS-RESKA survey (score range: 0-4), and provided workload was scored with the Burn Scoring System (BSC). Groups were compared with χ 2 test, MW test, or Fisher´s exact test. Multivariable logistic regression analyzed the independent effect of BSC on the outcome High Satisfaction (= score ≥3 to the survey-question: "How would you score your global experience at the Burn Centre?"). In-patients (n = 60) had more often larger burns and required more workload than out-patients (median[IQR]: TBSA% = 6.3 [3-12.3] % vs. 0.7 [0.3-2] %, p < .001; BSC = 65 [25.5-135.5] vs. 6 [4-9], p < .001). Both groups were highly satisfied with the experienced care (mean score [SD] = 3.68 [0.57] vs. 3.41 [0.77], p = .03). Neither characteristics of the patients (age, sex), nor TBSA% nor provided workload (BSC) were independently associated with High Satisfaction. Regardless of burn severity, demographics and provided workload, adult patients with burns were highly satisfied with the experienced burn care. This finding suggested that the reason of the satisfaction was multifactorial.

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  • 16.
    Nezerwa, Yves
    et al.
    Rwanda Mil Hosp, Rwanda; Univ Teaching Hosp Kigali CHUK, Rwanda.
    Miranda, Elizabeth
    Harvard Med Sch, MA 02115 USA; Univ Southern Calif, CA 90007 USA.
    Velin, Lotta
    Harvard Med Sch, MA 02115 USA; Lund Univ, Sweden.
    Shyaka, Ian
    Rwanda Mil Hosp, Rwanda; Univ Teaching Hosp Kigali CHUK, Rwanda.
    Mukagaju, Francoise
    Rwanda Mil Hosp, Rwanda; Univ Teaching Hosp Kigali CHUK, Rwanda.
    Busomoke, Fabrice
    Univ Teaching Hosp Kigali CHUK, Rwanda; Univ Rwanda UR, Rwanda.
    Nsanzimana, Jean de Dieu
    Univ Teaching Hosp Kigali CHUK, Rwanda; Univ Rwanda UR, Rwanda.
    Mukeshimana, Marthe
    Univ Teaching Hosp Kigali CHUK, Rwanda.
    Mushimiyimana, Didace
    Univ Teaching Hosp Kigali CHUK, Rwanda.
    Mukambasabire, Belise
    Univ Teaching Hosp Kigali CHUK, Rwanda.
    Uwimana, Leoncie
    Univ Teaching Hosp Kigali CHUK, Rwanda.
    Ntirenganya, Faustin
    Univ Teaching Hosp Kigali CHUK, Rwanda; Univ Rwanda UR, Rwanda.
    Furaha, Charles
    Rwanda Mil Hosp, Rwanda.
    Riviello, Robert
    Harvard Med Sch, MA 02115 USA; Brigham & Womens Hosp, MA 02115 USA.
    Pompermaier, Laura
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery. Harvard Med Sch, MA 02115 USA.
    Referral of Burn Patients in the Absence of Guidelines: A Rwandan Study2022In: Journal of Surgical Research, ISSN 0022-4804, E-ISSN 1095-8673, Vol. 278, p. 216-222Article in journal (Refereed)
    Abstract [en]

    Introduction: The management of severe burns and pediatric burns requires an organized system of care delivery, which includes referral guidelines. In Rwanda, the burn unit at the University Teaching Hospital of Kigali (CHUK) is the only dedicated burn unit in the country and admits patients of all ages referred from the other provinces. However, since there are no official referral guidelines, it is unknown whether patients with burns are appropriately referred. This study aims to analyze referral patterns among burn patients admitted at the CHUK burn unit and their adherence to the referral criteria listed by the American Burn Association (ABA), comparing patients transferred to the burn unit from facilities within Kigali and those referred from facilities outside Kigali. Methods: This retrospective study included all patients with acute burns admitted to the CHUK burn unit with data available on the province of origin from 2005 to 2019. Patients with burns younger than 16 y were defined as pediatric burns, as per the CHUK routines. Characteristics of all burns referred from a facility within Kigali (Pat-K) and facilities outside Kigali (Pat-O) were compared using Fishers exact test for categorical variables or Wilcoxon rank-sum test for continuous variables. The adherence to ABA referral criteria was assessed for variables with available data, which were total burnt surface area %, burn thickness, cause of burn, and age. Results: The study population consisted of 1093 patients, of which 1064 had data regarding if they were referred from other facilities to CHUK. Overall, the median age was 3 y (2-16 y), with Pat-O being older than Pat-K (P &lt; 0.001). Scalds were the dominant cause of injury in both groups; flame was more common among Pat-O than among Pat-K (in 25.5% versus 10.6%, P &lt; 0.01). Burns of larger size and depth were more common among Pat-O, as compared to the Pat-K group [median total burnt surface area % = 19% versus 15.5%, respectively ( P &lt; 0.001); presence of full-thickness burns = 55.6% versus 29.7 %, respectively (P &lt; 0.001)]. Hospitalization was longer and in-hospital mortality higher in Pat-O than in Pat-K [LOS = 42 d (interquartile range 11-164) versus 28 d (interquartile range 9-132), P &lt; 0.05; in-hospital mortality = 18.9% versus 10.1%, P &lt; 0.001]. Among Pat-O, 85% had characteristics that mirrored one or more of the analyzed ABA criteria. Conclusions: Although there are no clear guidelines, referral patterns indicate that patients are being appropriately referred for specialized burn care in Rwanda. Compared to patients from Kigali, rural patients had larger and more severe injuries, needed more surgical interventions, and had worse outcomes. Most of referred patients matched criteria listed among international referral guidelines. However, the statement of national referral criteria is essential to improve timely access to adequate care. (C) 2022 Elsevier Inc. All rights reserved.

  • 17.
    Holm, Sebastian
    et al.
    Uppsala Univ Hosp, Sweden.
    Tell, Katinka
    Uppsala Univ Hosp, Sweden.
    Karlsson, Matilda
    Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery. Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology.
    Huss, Fredrik
    Uppsala Univ Hosp, Sweden; Uppsala Univ, Sweden.
    Pompermaier, Laura
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Elmasry, Moustafa
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Löfgren, Jenny
    Karolinska Inst, Sweden; Karolinska Univ Hosp, Sweden.
    Sociodemographic Patterns of Pediatric Patients in Specialized Burn Care in Sweden2022In: Plastic and Reconstructive Surgery - Global Open, E-ISSN 2169-7574, Vol. 10, no 4, article id e4246Article in journal (Refereed)
    Abstract [en]

    Background: Trauma is a leading cause of mortality in children. Burns affect children disproportionally. Although burn incidence and mortality are decreasing, differences in the risk depend on socioeconomic status. The present study aimed to investigate the sociodemographic patterns of pediatric patients (0-17 years) managed at the two burn centers in Sweden. Uppsala, and Linkoping, between 2010 and 2020. Method: This retrospective register-based study used hospital records from the two burn centers combined with information front Statistics Sweden plus data regarding number of asylum seekers from the Swedish Migrations Agency. Choropleth maps representing the patients geographical distribution were created. Information about income levels per geographic area was added. A Wilcoxon signed-rank test was performed to investigate differences in median income levels between the areas where the patients lived, related to Swedens median income. Results: The study included 2455 patients. Most of the children aged below 5 years (76%) and were boys (60%). The mean percentage of total skin area was 4.2%. There was no significant increment or decrease in the incidence of pediatric burns during the study. Most patients with recorded zip codes lived in areas with an income level below the national median (n = 1974, 83%). Children with asylum status were over-represented compared with residents and/or Swedish citizens. Conclusions: In Sweden, most pediatric burns occur in families that live in areas with low-income levels. Pediatric burns affect children with asylum status disproportionally compared with those who are residents in and/or citizens of Sweden. Prevention strategies should be designed and implemented to alleviate this health inequity.

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  • 18.
    Barreto Cazumba, Maria Luiza
    et al.
    Univ Fed Minas Gerais, Brazil.
    Buda, Alexandra M.
    Harvard Med Sch, MA, USA.
    Bittencourt, Marcela M.
    Univ Jose Rosario Vellano, Brazil.
    Moura, Carolina
    Fac Saude & Ecol Humana, Brazil.
    Braga, Paula
    Fac Saude & Ecol Humana, Brazil.
    Bowder, Alexis N.
    Harvard Med Sch, MA, USA.
    Corlew, Daniel Scott
    Harvard Med Sch, MA, USA.
    Botelho, Fabio
    McGill Univ, Canada.
    Magalhaes, Lucas
    Joao XXIII Hosp, Brazil.
    Pompermaier, Laura
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery. Harvard Med Sch, MA, USA.
    The Use of Alcohol as a Disinfectant During the Pandemic and Flame Burns: A Brazilian Study2022In: Journal of Burn Care & Research, ISSN 1559-047X, E-ISSN 1559-0488, Vol. 43, no 3, p. 753-754Article in journal (Other academic)
  • 19.
    Truche, Paul
    et al.
    Harvard Medical School, USA.
    Campos, Letícia Nunes
    Universidade de Pernambuco, Recife, PE, Brazil .
    Marrazzo, Enzzo Barrozo
    Pontifícia Universidade Católica de Minas Gerais Poços de Caldas, Brazil.
    Rangel, Ayla Gerk
    Universidad Católica Argentina, Argentina.
    Bernardino, Ramon
    Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
    Bowder, Alexis N
    Harvard Medical School, USA.
    Buda, Alexandra M
    Harvard Medical School, USA.
    Faria, Isabella
    Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
    Pompermaier, Laura
    Harvard Medical School, USA.
    Rice, Henry E.
    Duke University Medical Center and Duke Global Health Institute, Durham, USA .
    Watters, David
    Deakin University and Barwon Health, Melbourne, Australia.
    Dantas, Fernanda Lage Lima
    Federal University of Acre, Public Health System State of Acre, Brazil.
    Mooney, David P.
    Boston Children’s Hospital, Boston, MA, USA.
    Botelho, Fabio
    Montreal Children’s Hospital, Montreal, Canada .
    Ferreira, Rodrigo Vaz
    Disciplina de Cirurgia, Universidade do Estado do Amazonas, Brazil.
    Alonso, Nivaldo
    Department of Plastic Surgery, University of São Paulo, São Paulo, Brazil .
    Association between government policy and delays in emergent and elective surgical care during the COVID-19 pandemic in Brazil: a modeling study2021In: The Lancet Regional Health - Americas, E-ISSN 2667-193X, article id 100056Article in journal (Refereed)
    Abstract [en]

    Background:The impact of public health policy to reduce the spread of COVID-19 on access to surgical care is poorly defined. We aim to quantify the surgical backlog during the COVID-19 pandemic in the Brazilian public health system and determine the relationship between state-level policy response and the degree of state-level delays in public surgical care.

    Methods:Monthly estimates of surgical procedures performed per state from January 2016 to December 2020 were obtained from Brazil's Unified Health System Informatics Department. Forecasting models using historical surgical volume data before March 2020 (first reported COVID-19 case) were constructed to predict expected monthly operations from March through December 2020. Total, emergency, and elective surgical monthly backlogs were calculated by comparing reported volume to forecasted volume. Linear mixed effects models were used to model the relationship between public surgical delivery and two measures of health policy response: the COVID-19 Stringency Index (SI) and the Containment & Health Index (CHI) by state.Findings:Between March and December 2020, the total surgical backlog included 1,119,433 (95% Confidence Interval 762,663–1,523,995) total operations, 161,321 (95%CI 37,468–395,478) emergent operations, and 928,758 (95%CI 675,202–1,208,769) elective operations. Increased SI and CHI scores were associated with reductions in emergent surgical delays but increases in elective surgical backlogs. The maximum government stringency (score = 100) reduced emergency delays to nearly zero but tripled the elective surgical backlog.

    Interpretation:Strong health policy efforts to contain COVID-19 ensure minimal reductions in delivery of emergent surgery, but dramatically increase elective backlogs. Additional coordinated government efforts will be necessary to specifically address the increased elective backlogs that accompany stringent responses.

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  • 20.
    Allorto, Nikki
    et al.
    Univ KwaZulu Natal, South Africa.
    Rencken, Camerin A.
    Brown Univ, RI USA.
    Wall, Shelley
    Univ KwaZulu Natal, South Africa; Univ KwaZulu Natal, South Africa.
    Pompermaier, Laura
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Factors impacting time to surgery and the effect on in-hospital mortality2021In: Burns, ISSN 0305-4179, E-ISSN 1879-1409, Vol. 47, no 4, p. 922-929Article in journal (Refereed)
    Abstract [en]

    Objectives: Early surgery improves outcomes after burn injuries but is often not available in limited resource settings (LRS), where a more conservative approach is widespread. This study aimed to analyze factors associated with delay in surgical treatment, and the impact on in-hospital mortality. Methods: All patients with burns treated with surgery between 2016 and 2019 at the Pietermaritzburg Burn Service, in South Africa, were included in this retrospective study. Early surgery was defined as patients who underwent surgery within 7 days from injury. The population was analyzed descriptively and differences between groups were tested using t-test, and chi(2) test or Fishers exact test, as appropriate. Multivariable logistic regression was used to analyze the effect of delay in surgical treatment on in-hospital mortality, after adjustment for confounders. Results: During the study period, 620 patients with burns underwent surgery. Of them, 16% had early surgery. The early surgery group had a median age and TBSA of 11 years (3-35) and 12.0% (5-22) compared to 7 years (2-32) and 6.0% (3-13) in the late surgery group (p=0.45, p&lt;0.001). In logistic regression, female sex [aOR: 3.30 (95% CI: 1.47-7.41)], TBSA% [aOR: 1.09 (95% CI: 1.05-1.12)], and FTB [aOR: 3.21 (95% CI: 1.43-7.18)] were associated with in-hospital mortality, whereas having early surgery was not [aOR: 1.74 (95% CI: 0.76-3.98)]. Conclusion: This study found that early surgery was not associated with in-hospital mortality. Independent predictors of in-hospital mortality were female sex, presence of full thickness burn, and larger burn size. Future studies should investigate if burn care capacity in LRS may influence the association between early excision and outcome. (C) 2020 Elsevier Ltd and ISBI. All rights reserved.

  • 21.
    Moeller, Ellie
    et al.
    Univ Miami, FL 33136 USA.
    Riesel, Johanna
    Boms, Okechi
    Pompermaier, Laura
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Pusic, Andrea
    Corlew, Scott
    Female Leadership in Academic Plastic Surgery: A Comprehensive Analysis2021In: Plastic and reconstructive surgery (1963), ISSN 0032-1052, E-ISSN 1529-4242, Vol. 148, no 6, p. 1408-1413Article in journal (Refereed)
    Abstract [en]

    Background: Gender equity remains to be realized in academic plastic and reconstructive surgery. The purpose of this study was to measure the proportion of women in leadership roles in academic plastic and reconstructive surgery to verify where gender gaps may persist. Methods: Six markers of leadership were analyzed: academic faculty rank, manuscript authorship, program directorship, journal editor-in-chief positions, society board of directors membership, and professional society membership. Descriptive statistics were performed, and chi-square tests were used to compare categorical variables. Results: About 16 percent to 19 percent of practicing plastic surgeons are female, as measured by the percentage of female faculty and American Society of Plastic Surgeons members. Female plastic surgeons comprised 18.9 percent (n = 178) of the faculty from 88 academic plastic surgery institutions, and represented 9.9 percent of full professors and 10.8 percent of chiefs. Nineteen institutions had no female faculty. Women were first authors in 23.4 percent of publications and senior author in 14.7 percent of publications. No journal studied had a female editor-in-chief. Of the examined plastic and reconstructive societies, the proportion of women on the board of directors ranged from 16.7 percent to 23.5 percent. Conclusions: The proportion of female program directors, first manuscript authors, and board members of certain societies is commensurate with the number of women in the field, suggesting an evolving landscape within the specialty. However, women remain underrepresented in many other leadership roles, heralding the work that remains to ensure gender parity exists for those pursuing leadership roles in the field of plastic and reconstructive surgery.

  • 22.
    Westlund Firchal, Emmelie Westlund
    et al.
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Sjöberg, Folke
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, ANOPIVA US.
    Fredrikson, Mats
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Inflammation and Infection. Linköping University, Faculty of Medicine and Health Sciences.
    Pompermaier, Laura
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Elmasry, Moustafa
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Steinvall, Ingrid
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Long-term survival among elderly after burns compared with national mean remaining life expectancy2021In: Burns, ISSN 0305-4179, E-ISSN 1879-1409, Vol. 47, no 6, p. 1252-1258Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: As compared to younger adults, older people have a greater risk of domestic accidents, such as burns, and their prognosis is worsened by a diminished physiological ability to face a thermal trauma. The in-hospital mortality is adversely affected by old age and burn size, whereas less is known about the long-term-survival in elderly patients who survive a burn injury. The aim of this study was to investigate if elderly burn patients after discharge from a Swedish National Burn Centre have a shorter remaining life compared to the national population, by using calculated remaining Life Expectancy (rLE).

    METHODS: In this retrospective study we included all patients who were admitted for burns to the Linköping Burn Centre during 1993-2016 and who were 60 years or older and alive, at the time of discharge. The control group was extracted from Statistics Sweden, the national statistics database, and consisted of all individuals from the Swedish population matched for each patient in the study group, by sex and age at the year of discharge. The proportion who died before reaching the rLE was compared between the study population and the control group by calculating risk ratio.

    RESULTS: The study group consisted of 111 former patients and 77 of them (69%) died before reaching the rLE, with mean 4.7 years of life lost (YLL), which was 33% more than that (52%) of the control group (RR 1.33, 95% CI 1.18-1.51). Burn related factors, such as TBSA % or FTB % were not found to account for this effect.

    CONCLUSION: We found that the long-time survival of elderly patients after burns is shorter than that of a national control, the magnitude of which is quantitatively important. The current study does not support that burn related factors account for this effect and the reason should therefore be sought in other factors, such as e.g., co-morbidity or psychosocial issues.

  • 23.
    Miranda, Elizabeth
    et al.
    Harvard Med Sch, MA 02115 USA; Univ Southern Calif, CA 90007 USA.
    Velin, Lotta
    Harvard Med Sch, MA 02115 USA; Lund Univ, Sweden.
    Ntirenganya, Faustin
    Univ Teaching Hosp Kigali CHUK, Rwanda.
    Riviello, Robert
    Harvard Med Sch, MA 02115 USA; Brigham & Womens Hosp, MA 02115 USA.
    Mukagaju, Francoise
    Rwanda Mil Hosp, Rwanda.
    Shyaka, Ian
    Rwanda Mil Hosp, Rwanda.
    Nezerwa, Yves
    Rwanda Mil Hosp, Rwanda.
    Pompermaier, Laura
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery. Harvard Med Sch, MA 02115 USA.
    Recording Patient Data in Burn Unit Logbooks in Rwanda: Who and What Are We Missing?2021In: Journal of Burn Care & Research, ISSN 1559-047X, E-ISSN 1559-0488, Vol. 42, no 3, p. 526-532Article in journal (Refereed)
    Abstract [en]

    Systematic data collection in high-income countries has demonstrated a decreasing burn morbidity and mortality, whereas lack of data from low- and middle-income countries hinders a global overview of burn epidemiology. In low- and middle-income countries, dedicated burn registries are few. Instead, burn data are often recorded in logbooks or as one variable in trauma registries, where incomplete or inconsistently recorded information is a known challenge. The University Teaching Hospital of Kigali hosts the only dedicated burn unit in Rwanda and has collected data on patients admitted for acute burn care in logbooks since 2005. This study aimed to assess the data registered between January 2005 and December 2019, to evaluate the extent of missing data, and to identify possible factors associated with "missingness." All data were analyzed using descriptive statistics, Fishers exact test, and Wilcoxon Rank Sum test. In this study, 1093 acute burn patients were included and 64.2% of them had incomplete data. Data completeness improved significantly over time. The most commonly missing variables were whether the patient was referred from another facility and information regarding whether any surgical intervention was performed. Missing data on burn mechanism, burn degree, and surgical treatment were associated with in-hospital mortality. In conclusion, missing data is frequent for acute burn patients in Rwanda, although improvements have been seen over time. As Rwanda and other low- and middle-income countries strive to improve burn care, ensuring data completeness will be essential for the ability to accurately assess the quality of care, and hence improve it.

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  • 24.
    Velin, Lotta
    et al.
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Regionledningskontoret, Center for Disaster Medicine and Traumatology.
    Donatien, Mbonyintwari
    College of Medicine and Health Sciences, University of Rwanda, Rwanda.
    Wladis, Andreas
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Regionledningskontoret, Center for Disaster Medicine and Traumatology.
    Nkeshimana, Menelas
    University Teaching Hospital in Kigali, Kigali, Rwanda.
    Riviello, Robert
    Brigham and Women’s Hospital, Boston, MA, United States of America; Department of Global Health and Social Medicine, Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, United States of America.
    Uwitonze, Jean-Marie
    Emergency Medical Services (SAMU), Kigali, Rwanda.
    Byiringiro, Jean-Claude
    College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda.
    Ntirenganya, Faustin
    College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda; University Teaching Hospital in Kigali, Kigali, Rwanda.
    Pompermaier, Laura
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Regionledningskontoret, Center for Disaster Medicine and Traumatology. Department of Global Health and Social Medicine, Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, United States of America.
    Systematic media review: A novel method to assess mass-trauma epidemiology in absence of databases—A pilot-study in Rwanda2021In: PLOS ONE, E-ISSN 1932-6203, Vol. 16, no 10, article id e0258446Article, review/survey (Refereed)
    Abstract [en]

    Objective Surge capacity refers to preparedness of health systems to face sudden patient inflows, such as mass-casualty incidents (MCI). To strengthen surge capacity, it is essential to understand MCI epidemiology, which is poorly studied in low- and middle-income countries lacking trauma databases. We propose a novel approach, the "systematic media review", to analyze mass-trauma epidemiology; here piloted in Rwanda. Methods A systematic media review of non-academic publications of MCIs in Rwanda between January 1(st), 2010, and September 1(st), 2020 was conducted using NexisUni, an academic database for news, business, and legal sources previously used in sociolegal research. All articles identified by the search strategy were screened using eligibility criteria. Data were extracted in a RedCap form and analyzed using descriptive statistics. Findings Of 3187 articles identified, 247 met inclusion criteria. In total, 117 MCIs were described, of which 73 (62.4%) were road-traffic accidents, 23 (19.7%) natural hazards, 20 (17.1%) acts of violence/terrorism, and 1 (0.09%) boat collision. Of Rwandas 30 Districts, 29 were affected by mass-trauma, with the rural Western province most frequently affected. Road-traffic accidents was the leading MCI until 2017 when natural hazards became most common. The median number of injured persons per event was 11 (IQR 5-18), and median on-site deaths was 2 (IQR 1-6); with natural hazards having the highest median deaths (6 [IQR 2-18]). Conclusion In Rwanda, MCIs have decreased, although landslides/floods are increasing, preventing a decrease in trauma-related mortality. By training journalists in "mass-casualty reporting", the potential of the "systematic media review" could be further enhanced, as a way to collect MCI data in settings without databases.

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  • 25.
    Truche, Paul
    et al.
    Harvard Medical School, USA.
    Moeller, Ellie
    Harvard Medical School, USA.
    Wurdeman, Taylor
    Harvard Medical School, USA.
    Zimmerman, Kathrin
    Harvard Medical School, USA.
    Cruz, Norma
    International Confederation of Plastic Surgery Societies, Utrecht, the Netherlands; University of Puerto Rico, San Juan, Puerto Rico.
    Nakarmi, Kiran
    Kirtipur Hospital, Kathmandu, Nepal.
    Rai, Shankar M.
    Kirtipur Hospital, Kathmandu, Nepal.
    Eado, Yegeremu
    ALERT Hospital and AAU, Addis Ababa, Ethiopia.
    Pompermaier, Laura
    Harvard Medical School, USA.
    Meara, John G.
    Harvard Medical School, USA.
    Corlew, D. Scott
    Harvard Medical School, USA ; International Confederation of Plastic Surgery Societies, Utrecht, the Netherlands.
    The Plastic Surgery Workforce and Its Role in Low-income Countries2021In: Plastic and Reconstructive Surgery - Global Open, E-ISSN 2169-7574, Vol. 9, no 4, p. e3428-e3428Article in journal (Refereed)
    Abstract [en]

    Background: Plastic surgery varies in scope, especially in different settings. This study aimed to quantify the plastic surgery workforce in low-income countries (LICs), understand commonly treated conditions by plastic surgeons working in these settings, and assess the impact on reducing global disease burden.

    Methods: We queried national and international surgery societies, plastic surgery societies, and non-governmental organizations to identify surgeons living and working in LICs who provide plastic surgical care using a cross-sectional survey. Respondents reported practice setting, training experience, income sources, and perceived barriers to care. Surgeons ranked commonly treated conditions and reported which of the Disease Control Priorities-3 essential surgery procedures they perform.

    Results: An estimated 63 surgeons who consider themselves plastic surgeons were identified from 15 LICs, with no surgeons identified in the remaining 16 LICs. Responses were obtained from 43 surgeons (70.5%). The 3 most commonly reported conditions treated were burns, trauma, and cleft deformities. Of the 44 "Essential Surgical Package'' procedures, 37 were performed by respondents, with the most common being skin graft (73% of surgeons performing), cleft lip/palate repair (66%), and amputations/escharotomy (61%). The most commonly cited barrier to care was insufficient equipment. Only 9% and 5% of surgeons believed that there are enough plastic surgeons to handle the burden in their local region and country, respectively.

    Conclusions: Plastic surgery plays a significant role in the coverage of essential surgical conditions in LICs. Continued expansion of the plastic surgical workforce and accompanying infrastructure is critical to meet unmet surgical burden in low- and middle-income countries.

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  • 26.
    Mukagaju, Francoise
    et al.
    Rwanda Mil Hosp, Rwanda.
    Velin, Lotta
    Harvard Med Sch, MA 02115 USA; Lund Univ, Sweden.
    Miranda, Elizabeth
    Harvard Med Sch, MA 02115 USA; Univ Southern Calif, CA 90007 USA.
    Shyaka, Ian
    Rwanda Mil Hosp, Rwanda.
    Nezerwa, Yves
    Rwanda Mil Hosp, Rwanda.
    Furaha, Charles
    Rwanda Mil Hosp, Rwanda.
    Ntirenganya, Faustin
    Univ Teaching Hosp Kigali CHUK, Rwanda; Univ Rwanda, Rwanda.
    Riviello, Robert
    Harvard Med Sch, MA 02115 USA; Brigham & Womens Hosp, MA 02115 USA.
    Pompermaier, Laura
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery. Harvard Med Sch, MA 02115 USA.
    What is Known About Burns in East Africa? A Scoping Review2021In: Journal of Surgical Research, ISSN 0022-4804, E-ISSN 1095-8673, Vol. 266, p. 113-124Article, review/survey (Refereed)
    Abstract [en]

    Background: Bums are a global public health concern, with the majority of the disease burden affecting low-and middle-income countries. Yet, as suggested by previous publications, there is a widespread belief that literature about burns in low-and middle-income countries is lacking. Therefore, we aimed to assess with a scoping review, the extent of the literature output on bums in East Africa, and to investigate patient demographics, injury characteristics, treatment and outcomes, as reported from the existing publications. Methods: Studies discussing bums in East Africa were identified by searching PubMed / Medline (National Library of Medicine), EMBASE (Elsevier), Global Health Database (EBSCO), and Global Index Medicus on December 12, 2019. Controlled vocabulary terms (i.e., MeSH, EMTREE, Global Health thesaurus terms) were included when available and appropriate. No year restrictions were applied. Results: A total of 1,044 records were retrieved from the database searches, from which 40 articles from 6 countries published between 1993 and 2019 were included in the final review. No studies were found from five East African countries with the lowest GDP. Most papers focused on pediatric trauma patients or tertiary hospital settings. The total number of burn patients recorded was 44,369, of which the mean proportion of males was 56%. The most common cause of injury was scalds (61%), followed by open flame (17%). Mortality rate ranged from 0-67%. The mean length of stay in hospital was between 9-60 d. Conclusions: Burn data is limited in the East African region, with socio-economically weak countries being particularly underrepresented. This scoping review has identified the largest set of literature on burns in East Africa to date, indicating the importance of reviewing data at a regional or local level, as "global" studies tend to be dominated by high-income country data. Data collection in specific registries is needed to better characterize the exact burden of burn injuries in East Africa. (c) 2021 Elsevier Inc. All rights reserved.

  • 27.
    Pompermaier, Laura
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Elmasry, Moustafa
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Steinvall, Ingrid
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Self-inflicted burns in a National Swedish Burn Centre [BRÛLURES VOLONTAIRES DANS UN CTB SUÉDOIS]: an overview [REVUE D’UNE SÉRIE]2019In: Annals of burns and fire disasters, ISSN 1592-9558, Vol. 32, no 4, p. 272-277Article in journal (Refereed)
    Abstract [en]

    In the Western world, self-inflicted burns are often associated with mental health disorders, and the management, particularly the pain treatment, can often be complicated by the psycho-social background of the patients. The aim was to describe a group of patients with self-inflicted burns by analysing their in-hospital mortality and the use of sedation during procedures. All patients with self-inflicted burns admitted to the Linköping Burn Centre during 2000-2017 were included. The control group consisted of adults (≥17 years) with accidental burns, admitted during the same period. Multivariable logistic and linear regression was used for analysis. Three percent of all patients (47/1601) had self-inflicted burns: most of them were men (60%, 28/47), none was younger than 17 years, and flame was the major cause of injury. Self-inflicted burn patients were younger and had larger burns: mean age (SD) was 42 (16) and 49 (20) years, respectively; mean TBSA (SD) was 29% (26) and 14% (17), respectively. The crude rate of procedures done under sedation was higher (mean (SD) 0.37 (0.23) compared with 0.24 (0.25)) as was crude in-hospital mortality (8/47, 17% compared with 72/1018, 7%). Multivariable analyses showed no difference in the use of sedation for procedures or in-hospital mortality after adjustment for TBSA%, full thickness burns, age and sex. Age and TBSA% were associated with in-hospital mortality, whereas the intentionality of the burn was not. TBSA% and female sex were associated with increased use of sedation for wound care procedures, whereas self-inflicted burns were not.

  • 28.
    Pompermaier, Laura
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Elmasry, Moustafa
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Abdelrahman, Islam
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery. Department of Surgery, Plastic Surgery Unit, Suez Canal University, Ismailia, Egypt.
    Fredrikson, Mats
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences.
    Sjöberg, Folke
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping.
    Steinvall, Ingrid
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Are there any differences in the provided burn care between men and women? A retrospective study2018In: Burns & Trauma, E-ISSN 2321-3876, Vol. 6, article id 22Article in journal (Refereed)
    Abstract [en]

    Background

    Disparity between medical treatment for men and women has been recorded worldwide. However, it is difficult to find out if the disparities in both the use of resources and outcome depend entirely on sex-related discrimination. Our aim was to investigate if there are differences in burn treatments between the sexes.

    Methods

    All patients admitted with burns to Linköping University Hospital during the 16-year period 2000–2015 were included. Interventions were prospectively recorded using the validated Burn SCoring system (BSC). Data were analysed using a multivariable panel regression model adjusted for age, percentage total body surface area (%TBSA), and in-hospital mortality.

    Results

    A total of 1363 patients were included, who generated a total of 22,301 daily recordings while they were inpatients. Males were 70% (930/1363). Sex was not an independent factor for daily scores after adjustment for age, %TBSA, and mortality in hospital (model R2=0.60, p < 0.001).

    Conclusion

    We found no evidence of inequity between the sexes in treatments given in our burn centre when we had adjusted for size of burn, age, and mortality. BSC seems to be an appropriate model in which to evaluate sex-related differences in the delivery of treatments.

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  • 29.
    Pompermaier, Laura
    et al.
    Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery. Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology.
    Steinvall, Ingrid
    Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery. Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology.
    Elmasry, Moustafa
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery. The Plastic Surgery Unit, Surgery Department, Suez Canal University, Ismailia, Egypt.
    Thorfinn, Johan
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Sjöberg, Folke
    Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery. Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping.
    Burned patients who die from causes other than the burn affect the model used to predict mortality: a national exploratory study2018In: Burns, ISSN 0305-4179, E-ISSN 1879-1409, Vol. 44, no 2, p. 280-287Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: The Baux score - the sum of age and total body surface area burned (TBSA %) - is a good predictor of mortality has a high specificity but low sensitivity. Our aim was to examine the causes of death in patients who die with Baux scores of <100, which may explain the lower sensitivity and possibly affect the prediction of mortality.

    METHODS: All patients admitted to our centre for burn care from 1993 to 2015 (n=1946) were included in this retrospective, descriptive, exploratory study. The study group comprised those patients who died with Baux scores of <100 (n=23), and their medical charts were examined for the cause of death and for coexisting diseases.

    RESULTS: Crude mortality was 5% (93/1946) for the overall cohort, and a quarter of the patients who died (23/93) had Baux scores of less than 100 (range 64-99). In this latter group, flame burns were the most common (18/23), the median (10th-90th centile) age was 70 (46-86) years and for TBSA 21 (5.0-40.5) %, of which 7 (0-27.0) % of the area was full thickness. The main causes of death in 17 of the 23 were classified as "other than burn", being cerebral disease (n=9), cardiovascular disease (n=6), and respiratory failure (n=2). Among the remaining six (burn-related) deaths, multiple organ failure (predominantly renal failure) was responsible. When we excluded the cases in which the cause of death was not related to the burn, the Baux mortality prediction value improved (receiver operating characteristics area under the curve, AUC) from 0.9733 (95% CI 0.9633-0.9834) to 0.9888 (95% CI 0.9839-0.9936) and the sensitivity estimate increased from 45.2% to 53.9%.

    CONCLUSION: Patients with burns who died with a Baux score <100 were a quarter of all the patients who died. An important finding is that most of these deaths were caused by reasons other than the burn, usually cerebrovascular disease. This may be the explanation why the sensitivity of the Baux score is low, as factors other than age and TBSA % explain the fatal outcome.

  • 30.
    Pompermaier, Laura
    et al.
    Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery. Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences.
    Steinvall, Ingrid
    Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery. Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences.
    Fredrikson, Mats
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences.
    Thorfinn, Johan
    Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery. Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology.
    Sjöberg, Folke
    Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery. Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology.
    Long-term survival after burns in a Swedish population2017In: Burns, ISSN 0305-4179, E-ISSN 1879-1409, Vol. 43, no 1, p. 157-161Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: As widely reported, the progress in burn care during recent decades has reduced the hospital mortality. The effect of the burns on long-term outcome has not received so much attention, and more study is indicated. The aim of this retrospective study was to investigate the long-time survival among patients who had been treated for burns.

    METHODS: We studied 1487 patients who were discharged alive from the Linköping University Hospital Burn Centre during the period 1993 until the end of December 2012. We used Cox's regression analysis to study the effect of burns on long-term survival after adjustment for different factors.

    RESULTS: Age and a full-thickness burn were significantly associated with mortality after discharge (p<0.001), whereas percentage of total body surface area burned (TBSA %), need for mechanical ventilation, and gender were not. Less than 1% of the patients with burns (13/1487) died within 30 days of discharge and a total of 176/1487 (12%) died during follow-up.

    CONCLUSION: Age and full-thickness burns reduce the long-time survival after discharge from the Burn Centre, whereas the effect of TBSA% and need for artificial ventilation ends with discharge.

  • 31. Order onlineBuy this publication >>
    Pompermaier, Laura
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Outcome of burn care: the mortality perspective2017Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background: Despite the improvements in burn care during the last decades, burns remain catastrophic for the patients and a challenge for the care-givers.  The early outcome of burn care is to assess its quality and to improve it, but the crucial outcome is mortality, which is the main focus of this thesis. In particular, I address questions about mortality that have arisen from working with burned patients and that can have clinical consequences: the impact of pre- existing medical conditions; long-term survival; the causes of unexpected deaths; and the possible differences between sexes in the provision of resources.

    Patients with burns share the fact that the time of their injury is known, its severity can be quantified from the size of the burn, and the care is relatively standardised. The analysis of outcome among burned patients treated at a single burn centre may therefore be of general value to others who treat burns.

    Methods: We retrospectively analysed data that had been collected prospectively (the burn    unit database) from patients with burns admitted consecutively to a national burn centre in Sweden during the last 25 years.

    Results: Age and percentage of total body surface area burned (TBSA %) affected the in- hospital mortality, whereas pre-existing medical conditions did not influence the prediction of outcome (Paper I). After discharge, both age and the presence of full thickness burns reduced the long-term survival, whereas the extent of the burn (TBSA %) did not (Paper II). Most patients with moderate burns who die in hospital despite a good prognosis, die for reasons   other than the burn (Paper III). Previously, it has been shown that sex is not an independent factor for mortality during burn care; in this thesis we show that the sex of the patients did not affect the number of medical interventions given either (Paper IV).

    Conclusion: The addition of “coexisting condition” to a mortality model based on age and   size of burn does not improve its predictive value; rather, the factor “age” is sufficient to adjust for comorbidity in the assessment of a burn and its outcome (Paper I).

    If patients with burns survive, the long-term prognosis is good. The effect of age is the one that governs survival, whereas the effect of the extent of the burn ends when the patient is discharged (Paper II).

    The in-hospital mortality during burn care is low, but some patients die for reasons other than the actual burn (Paper III).

    In a centre where the mortality is independent of the sex of the patient, the provision of medical interventions is also equal between men and women (Paper IV).

    List of papers
    1. Inclusion of coexisting morbidity in a TBSA% and age based model for the prediction of mortality after burns does not increase its predictive power
    Open this publication in new window or tab >>Inclusion of coexisting morbidity in a TBSA% and age based model for the prediction of mortality after burns does not increase its predictive power
    2015 (English)In: Burns, ISSN 0305-4179, E-ISSN 1879-1409, Vol. 41, no 8, p. 1868-1876Article in journal (Refereed) Published
    Abstract [en]

    Introduction: Several models for predicting mortality have been developed for patients with burns, and the most commonly used are based on age and total body surface area (TBSA%). They often show good predictive precision as depicted by high values for area under the receiver operating characteristic curves (AUC). However the effect of coexisting morbidity on such prediction models has not to our knowledge been thoroughly examined. We hypothesised that adding it to a previously published model (based on age, TBSA%, full thickness burns, gender, and need for mechanical ventilation) would further improve its predictive power. Methods: We studied 772 patients admitted during the period 1997-2008 to the Linkoping University Hospital, National Burn Centre with any type of burns. We defined coexisting morbidity as any of the medical conditions listed in the Charlson list, as well as psychiatric disorders or drug or alcohol misuse. We added coexisting medical conditions to the model for predicting mortality (age, TBSA%, and need for mechanical ventilation) to determine whether it improved the model as assessed by changes in deviances between the models. Results: Mean (SD) age and TBSA% was 35 (26) years and 13 (17) %, respectively. Among 725 patients who survived, 105 (14%) had one or more coexisting condition, compared with 28 (60%) among those 47 who died. The presence of coexisting conditions increased with age (p &lt; 0.001) among patients with burns. The AUC of the mortality prediction model in this study, based on the variables age, TBSA%, and need for mechanical ventilation was 0.980 (n = 772); after inclusion of coexisting morbidity in the model, the AUC improved only marginally, to 0.986. The model was not significantly better either. Conclusion: Adding coexisting morbidity to a model for prediction of mortality after a burn based on age, TBSA%, and the need for mechanical ventilation did not significantly improve its predictive value. This is probably because coexisting morbidity is automatically adjusted for by age in the original model. (C) 2015 Elsevier Ltd and ISBI. All rights reserved.

    Place, publisher, year, edition, pages
    ELSEVIER SCI LTD, 2015
    Keywords
    Burns; Comorbidity; Mortality; Prediction model
    National Category
    Clinical Medicine
    Identifiers
    urn:nbn:se:liu:diva-124131 (URN)10.1016/j.burns.2015.09.017 (DOI)000367127700031 ()26507519 (PubMedID)
    Available from: 2016-01-22 Created: 2016-01-19 Last updated: 2021-12-28
    2. Long-term survival after burns in a Swedish population
    Open this publication in new window or tab >>Long-term survival after burns in a Swedish population
    Show others...
    2017 (English)In: Burns, ISSN 0305-4179, E-ISSN 1879-1409, Vol. 43, no 1, p. 157-161Article in journal (Refereed) Published
    Abstract [en]

    INTRODUCTION: As widely reported, the progress in burn care during recent decades has reduced the hospital mortality. The effect of the burns on long-term outcome has not received so much attention, and more study is indicated. The aim of this retrospective study was to investigate the long-time survival among patients who had been treated for burns.

    METHODS: We studied 1487 patients who were discharged alive from the Linköping University Hospital Burn Centre during the period 1993 until the end of December 2012. We used Cox's regression analysis to study the effect of burns on long-term survival after adjustment for different factors.

    RESULTS: Age and a full-thickness burn were significantly associated with mortality after discharge (p<0.001), whereas percentage of total body surface area burned (TBSA %), need for mechanical ventilation, and gender were not. Less than 1% of the patients with burns (13/1487) died within 30 days of discharge and a total of 176/1487 (12%) died during follow-up.

    CONCLUSION: Age and full-thickness burns reduce the long-time survival after discharge from the Burn Centre, whereas the effect of TBSA% and need for artificial ventilation ends with discharge.

    Place, publisher, year, edition, pages
    Elsevier, 2017
    Keywords
    Burns, Outcome, Long-term survival, Mortality
    National Category
    Anesthesiology and Intensive Care
    Identifiers
    urn:nbn:se:liu:diva-131478 (URN)10.1016/j.burns.2016.07.018 (DOI)000392476000022 ()27613474 (PubMedID)
    Note

    Funding agencies: Department of Hand and Plastic Surgery Linkoping University Hospital; Region of Ostergotland; Linkoping University, Linkoping, Sweden

    Available from: 2016-09-22 Created: 2016-09-22 Last updated: 2021-12-28Bibliographically approved
    3. Burned patients who die from causes other than the burn affect the model used to predict mortality: a national exploratory study
    Open this publication in new window or tab >>Burned patients who die from causes other than the burn affect the model used to predict mortality: a national exploratory study
    Show others...
    2018 (English)In: Burns, ISSN 0305-4179, E-ISSN 1879-1409, Vol. 44, no 2, p. 280-287Article in journal (Refereed) Published
    Abstract [en]

    INTRODUCTION: The Baux score - the sum of age and total body surface area burned (TBSA %) - is a good predictor of mortality has a high specificity but low sensitivity. Our aim was to examine the causes of death in patients who die with Baux scores of <100, which may explain the lower sensitivity and possibly affect the prediction of mortality.

    METHODS: All patients admitted to our centre for burn care from 1993 to 2015 (n=1946) were included in this retrospective, descriptive, exploratory study. The study group comprised those patients who died with Baux scores of <100 (n=23), and their medical charts were examined for the cause of death and for coexisting diseases.

    RESULTS: Crude mortality was 5% (93/1946) for the overall cohort, and a quarter of the patients who died (23/93) had Baux scores of less than 100 (range 64-99). In this latter group, flame burns were the most common (18/23), the median (10th-90th centile) age was 70 (46-86) years and for TBSA 21 (5.0-40.5) %, of which 7 (0-27.0) % of the area was full thickness. The main causes of death in 17 of the 23 were classified as "other than burn", being cerebral disease (n=9), cardiovascular disease (n=6), and respiratory failure (n=2). Among the remaining six (burn-related) deaths, multiple organ failure (predominantly renal failure) was responsible. When we excluded the cases in which the cause of death was not related to the burn, the Baux mortality prediction value improved (receiver operating characteristics area under the curve, AUC) from 0.9733 (95% CI 0.9633-0.9834) to 0.9888 (95% CI 0.9839-0.9936) and the sensitivity estimate increased from 45.2% to 53.9%.

    CONCLUSION: Patients with burns who died with a Baux score <100 were a quarter of all the patients who died. An important finding is that most of these deaths were caused by reasons other than the burn, usually cerebrovascular disease. This may be the explanation why the sensitivity of the Baux score is low, as factors other than age and TBSA % explain the fatal outcome.

    Place, publisher, year, edition, pages
    Elsevier, 2018
    Keywords
    Baux score, Burns, Cause of death, Mortality
    National Category
    Cardiac and Cardiovascular Systems
    Identifiers
    urn:nbn:se:liu:diva-142898 (URN)10.1016/j.burns.2017.07.014 (DOI)000427535000006 ()28830698 (PubMedID)2-s2.0-85027674409 (Scopus ID)
    Note

    Funding agencies: Burn Centre, Department of Plastic Surgery, Hand Surgery, and Burns, Region Ostergotland; Linkoping University, Linkoping, Sweden

    Available from: 2017-11-09 Created: 2017-11-09 Last updated: 2021-12-28Bibliographically approved
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  • 32.
    Pompermaier, Laura
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences.
    Steinvall, Ingrid
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Fredrikson, Mats
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences.
    Elmasry, Moustafa
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery. Suez Canal University, Egypt.
    Sjöberg, Folke
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping.
    Response to comments on: Burned patients who die from causes other than the burn affect the model used to predict mortality: A national exploratory study2017In: Burns, ISSN 0305-4179, E-ISSN 1879-1409, Vol. 43, no 8, p. 1827-1827Article in journal (Other academic)
    Abstract [en]

    n/a

  • 33.
    Pompermaier, Laura
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Steinvall, Ingrid
    Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery. Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences.
    Fredrikson, Mats
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences.
    Sjöberg, Folke
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Inclusion of coexisting morbidity in a TBSA% and age based model for the prediction of mortality after burns does not increase its predictive power2015In: Burns, ISSN 0305-4179, E-ISSN 1879-1409, Vol. 41, no 8, p. 1868-1876Article in journal (Refereed)
    Abstract [en]

    Introduction: Several models for predicting mortality have been developed for patients with burns, and the most commonly used are based on age and total body surface area (TBSA%). They often show good predictive precision as depicted by high values for area under the receiver operating characteristic curves (AUC). However the effect of coexisting morbidity on such prediction models has not to our knowledge been thoroughly examined. We hypothesised that adding it to a previously published model (based on age, TBSA%, full thickness burns, gender, and need for mechanical ventilation) would further improve its predictive power. Methods: We studied 772 patients admitted during the period 1997-2008 to the Linkoping University Hospital, National Burn Centre with any type of burns. We defined coexisting morbidity as any of the medical conditions listed in the Charlson list, as well as psychiatric disorders or drug or alcohol misuse. We added coexisting medical conditions to the model for predicting mortality (age, TBSA%, and need for mechanical ventilation) to determine whether it improved the model as assessed by changes in deviances between the models. Results: Mean (SD) age and TBSA% was 35 (26) years and 13 (17) %, respectively. Among 725 patients who survived, 105 (14%) had one or more coexisting condition, compared with 28 (60%) among those 47 who died. The presence of coexisting conditions increased with age (p &lt; 0.001) among patients with burns. The AUC of the mortality prediction model in this study, based on the variables age, TBSA%, and need for mechanical ventilation was 0.980 (n = 772); after inclusion of coexisting morbidity in the model, the AUC improved only marginally, to 0.986. The model was not significantly better either. Conclusion: Adding coexisting morbidity to a model for prediction of mortality after a burn based on age, TBSA%, and the need for mechanical ventilation did not significantly improve its predictive value. This is probably because coexisting morbidity is automatically adjusted for by age in the original model. (C) 2015 Elsevier Ltd and ISBI. All rights reserved.

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