A review of burn care at an emerging centralised burns unit

Abstract

Background. The aim of the study was to investigate the demographics, aetiological factors, anatomical lesions, biological features, management protocol and outcomes of patients admitted with major burn injuries to the Nelson Mandela Academic Hospital (NMAH), which is one of only three tertiary hospitals in the Eastern Cape and is in the process of establishing a designated burns unit. Methods. All burns patients admitted to the burns ward from January 2006 to July 2008 were included in the study. All were treated using multidisciplinary team care, a high index of suspicion for inhalation injuries, followed by prompt treatment, accurate burn extent and depth assessment, fluid therapy, patient-controlled analgesia, strict aseptic wound care, and early enteral feeding. Data collected included gender, age, residential address, cause and extent and depth of burns, serum albumin, whether any skin graft was done, hospital stay, complications and mortality. Results. The sample comprised 66 patients; 59 were children <14 years old, and 38 were <4 years. There were 34 males and 32 females; scalds and flame injuries accounted for 68% and 17% of cases respectively. The majority (85%) sustained burns ranging from 11% to 40% total body surface area (TBSA). The body areas injured were the left upper limb (60%), chest (58%), abdomen (49%) and right upper limb (48%). All sustained major burns, and skin grafts were performed on 39%. Complications included respiratory distress syndrome, fluid and electrolyte imbalances, protein energy malnutrition, infection and contracture deformities. The mean hospital stay was 3.7 days/% TBSA burn, and the overall mortality rate was 17%. Conclusion. Mortality was unacceptably high. The strain of aggressive management to reduce mortality and morbidity would be alleviated by measures such as community health education, raised socio-economic status, and safety legislation. Establishing a well-staffed and well-equipped burns unit would greatly improve patient care.