BACKGROUND: The Burn Centre at Haukeland University Hospital has had a national burn function since 1984. PATIENTS AND METHODS: The following data were reviewed: area injured, age, sex, length of stay, mortality and county of residence for all admissions in the period 1984-2004. RESULTS: 1294 acute admissions for burns, chemical injuries or high-voltage injuries were identified. 71% of the patients were male. The mean age was 29.6 years; 24% were below 3 years of age. The mean (SD) area of injury was 19.5 +/- 18.3 % of the body surface area. 458 patients (35%) had burns involving less than 10% of the body surface area. The mean length of hospitalisation was 19.5 +/- 19.8 days. 140 patients (10.8%) died before discharge; these had a significantly higher age and injured area than the 1154 survivors. Every year there were 2-3 patients who had such extensive burns or substantial comorbidity that they only received palliative treatment. The probability of survival after a burn affecting 60% of the body surface, was around 50 % for all ages combined. On average 1.17 patients per 100.000 inhabitants were transferred annually from other parts of Norway for specialized treatment at this burn centre. INTERPRETATION: Despite societal focus on burn prevention measures there has been no reduction in the number of patients transferred to the burn centre during the 20-year period.
The examination of 1962 perspectives on healthcare provided by Ross Graham and Shannon Sibbald in their article "Looking Back 50 Years in Hospital Administration" provides an opportunity to see not only what happened 50 years ago, but how modern attitudes and concerns both match and differ from those of the past. Focusing on infection prevention and hospital design, this commentary explores the changes in procedure, policy and attitudes since 1962, and how they are affecting healthcare today.
[From surgeon assistant to independent specialist. The role of anesthesiologists and intensive care physicians in emergency medicine of the 20th century].
In 1952, Copenhagen was confronted with a poliomyelitis epidemic that involved the respiratory musculature in large numbers of patients. The anaesthetist B. Ibsen, who established carbon dioxide intoxication due to severe hypoventilation as the cause of death, proposed that the patients be treated by tracheostomy and positive pressure respiration in order to achieve better ventilation than with an iron lung. In the Netherlands, it was decided to organise the control ofthe epidemics on a nationwide basis. Various hospitals were asked to set up artificial respiration centres. In addition, the Beatrix Fund was set up in order to collect money for combating poliomyelitis. The epidemic reached the Netherlands in 1956. In Groningen University Medical Centre, 74 patients were admitted, of whom 36 had to be ventilated. In two cases, the mechanical ventilation could not be stopped and one of these was ultimately discharged home with chronic ventilation in 1960, thus becoming the first patient in the Netherlands to be given mechanical ventilation at home. The mechanical ventilation centres developed into the intensive care units as we know them today. Most of the forms of treatment now in use are based on the techniques thought up and elaborated by the pioneers working in the mechanical ventilation centres. The latest development in this series is the development of centres for home mechanical ventilation.
Berthelsen and Cronqvist recently published an article in Acta Anaesthesiologica Scandinavica including aspects which could lead on to further discussion about the Danish 1952-53 poliomyelitis epidemic. This paper considers how Bjørn Ibsen's initial approach to treatment during the epidemic was successful, as well as how it could have failed; the roles played by ventilatory failure vs. gross neurologic destruction in causing deaths; and compilations from publications of statistics concerning mortality of the epidemic. The Blegdam Hospital concept of 'life-threatening poliomyelitis' is revisited, along with its division into six anatomico-clinical categories for the 345 patients so classified. Attention is drawn to the severity of assorted cerebral lesions demonstrated in 114 of the 115 autopsies conducted from the 144 fatal cases. Despite an overall mortality rate of 41.6% among the entire epidemic's sickest patients, a lowest mortality rate of 11% in the last 18 of such patients is identified. Note is made of the difficulty in reconciling various sources for certain features -- for which the 1956 book on the epidemic, edited by H.C.A. Lassen, has been freely used. Some folklore about aspects of management is mentioned. In the light of other recent research by Dr Berthelsen an essential correction is needed in dating 'Bjørn Ibsen's Day', amending 26 August 1952 to the 27th.
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Comment On: Acta Anaesthesiol Scand. 2003 Nov;47(10):1190-514616314
The first multidisciplinary intensive care unit in the world was established at the Copenhagen Municipal Hospital in December 1953. The man behind the concept was the Danish anesthesiologist Bjørn Ibsen (born: 1915). The paper outlines the conditions that made it possible for Ibsen to establish a unit where all categories of severely-ill patients were monitored and treated around the clock along the lines used in the operating theatres. The history of the technological and scientific evolution of intensive care therapy is briefly summarised. It is concluded that despite the increased sophistication of intensive care therapy, it often meets with failure because it is started too late. The development of an early warning system is urgently needed.
