Survival analysis and mortality predictors of hospitalized severe burn victims in a Malaysian burns intensive care unit

Background:Prognostic measures to determine burn mortality are essential in evaluating the severity of individual burn victims.This is an important process of triaging patients with high risk of mortality that may be nursed in the acute care setting.Malaysian burn research is lacking with only one publication identified which describes the epidemiology of burn victims.Therefore,the objective of this study was to go one step further and identify the predictors of burn mortality from a Malaysian burns intensive care unit(BICU)which may be used to triage patients at higher risk of death.Methods:This is a retrospective cohort study of all admissions to Hospital Sultan Ismail’s BICU from January 2010 till October 2015.Admission criteria were in accordance with the American Burn Association guidelines,and risk factors of interest were recorded.Data was analyzed using simple logistic regression to determine significant predictors of mortality.Survival analysis with time to death event was performed using the Kaplan-Meier survival curve with log-rank test.Results:Through the 6-year period,393 patients were admitted with a male preponderance of 73.8%.The mean age and length of stay were 35.6(±15.72)years and 15.3(±18.91)days.There were 48 mortalities with an overall mortality rate of 12.2%.Significant risk factors identified on simple logistic regression were total body surface area(TBSA)>20%(p<0.001),inhalation injury(p<0.001)and presence of early systemic inflammatory response syndrome(SIRS)(p<0.001).Survival analysis using Kaplan-Meier survival curve showed similar results with TBSA>20%,presence of SIRS,mechanical ventilation and inhalation injury which were associated with poorer survival(p<0.001).Conclusion:The predictors of mortality identified in a Malaysian BICU were TBSA>20%,early SIRS,mechanical ventilation and inhalation injury which were associated with poorer survival outcome.The immunological response differs from individual patients and influenced by the severity of burn injury.Early SIRS on admission is an important predictor of death and may represent the severity of burn injury.Patients who required mechanical ventilation were associated with mortality and it is likely related to the severity of pulmonary insults sustained by individual patients.This data is important for outcome prognostication and mortality risk counselling in severely burned patients.

Clinical characteristics of 1653 injured motorcyclists and factors that predict mortality from motorcycle crashes in Malaysia

Purpose: Amongst the ASEAN countries, Malaysia has the highest road fatality risk (>15 fatalities per 100 000 population) with 50% of these fatalities involving motorcyclist. This contributes greatly to ward admissions and poses a significant burden to the general surgery services. From mild rib fractures to severe intra-abdominal exsa nguinations, the spectrum of cases man aged by surgeons resulting from motorcycle accidents is extensive. The objective of this study is to report the clinical characteristics and identify predictors of death in motorcycle traumatic injuries from a Malaysian trauma surgery centre. Methods: This is a prospective cross-sectional study of all injured motorcyclists and pillion riders that were admitted to Hospital Sultanah Aminah and treated by the trauma surgery team from May 2011 to February 2015. Only injured motorcyclists and pillion riders were included in this study. Patient demography and predictors leading to mortality were identified. Significant predictors on univariate analysis were further analysed with multivariate analysis. Results: We included 1653 patients with a mean age of (35 ± 16.17) years that were treated for traumatic injuries due to motorcycle accidents. The mortality rate was 8.6%(142) with equal amount of motorcycle riders (788) and pillion riders (865) that were injured. Amongst the injured were male predominant (1 537) and majority of ethnic groups were the Malays (897) and Chinese (350). Severity of injury was reflected with a mean Revised Trauma Score (RTS) of 7.31 ± 1.29, New Injury Severity Score (NISS) of 19.84 ± 13.84 and Trauma and Injury Severity Score (TRISS) of 0.91 ± 0.15. Univariate and multivariate analysis revealed that age>35, lower GCS, head injuries, chest injuries, liver injuries, and small bowel injuries were significant predictors of motorcycle trauma related deaths with p < 0.05. Higher trauma severity represented by NISS, RTS and TRISS scores was also significant for death with p < 0.05. Conclusion: Age, lower GCS, presence of head, chest, liver, small bowel injuries and higher severity on NISS, RTS and TRISS scores are predictive of death in patients involved w让h motorcycle accidents. This information is important for prognostic mortality risk prevention and counselling.

Critical adjustments and trauma surgery trends in adaptation to COVID-19 pandemic in Malaysia

Malaysia has one of the highest total numbers of COVID-19 infections amongst the Southeast Asian nations,which led to the enforcements of the Malaysian"Movement Control Order"to prohibit disease transmission.The overwhelming increasing amount of infections has led to a major strain on major healthcare services.This leads to shortages in hospital beds,ventilators and critical personnel protective equipment.This article focuses on the critical adaptations from a general surgery department in Malaysia which is part of a Malaysian tertiary hospital that treats COVID-19 cases.The core highlights of these strategies enforced during this pandemic are:(1)surgery ward and clinic decongestions;(2)deferment of elective surgeries;(3)restructuring of medical personnel work force;(4)utilization of online appli cations for tele-communication;(5)operating room(OR)adjustments and patient screening;and(6)continuing medical education and updating practices in context to COVID-19.These adaptations were important for the continuation of emergency surgery services,preventing transmission of COVID-19 amongst healthcare workers and optimization of medical personnel work force in times of a global pandemic.In addition,an early analysis on the impact of COVID-19 pandemic and lockdown measures in Malaysia towards the reduction in total number of elective/emergent/trauma surgeries performed is described in this article.