来自英格兰和威尔士的85348名囚犯,2016年,监狱内报告了超过26,000起袭击事件和40,000起自残事件。这项研究主要集中在监狱中的烧伤,确定这些损伤的主要病因和临床结果。
回顾性检索数据,并进行病例系列研究,包括2007年至2017年从地区监狱转介给我们中心的所有烧伤,包括患者人口统计数据,损伤机制,受影响的总身体表面积,管理,和结果。使用先前发布的框架进行了护理成本分析。
记录了来自三个地区监狱的18起案件,67%来自一个监狱。随着时间的推移,推荐人数呈指数增长,44%发生在2017年。94%是烫伤,56%是继发于攻击的,主要是通过使用水壶,主要是针对面部和躯干。烧伤的TBSA平均值为2.89%(<1-8%),80%的人接受了急救。72.2%的患者住院平均4天。所有烧伤均采用敷料进行非手术治疗,平均接受2次门诊检查(1-8)。
转介在监狱中的不成比例的分布部分与各自的人口有关,但也可能代表相反的医疗规定。反复出现的攻击方法反映了相对容易获得热水作为有害物质,主要表现为影响更关键区域的烫伤,在近一半的病例中,伴随着身体创伤,这给管理带来了挑战。
建议进行有针对性的教育,以减少监狱中烧伤的发生率并确保适当管理,转介人数明显上升。因此,伯恩斯外联小组可以向内部监狱卫生工作人员提供培训,并审查向伯恩斯专科服务的转诊情况,旨在确保公平的护理,同时减轻与医院转移和管理相关的成本。
From 85348 inmates in England and Wales, over 26,000 incidents of
assault and 40,000 of self-harm were reported from within prisons in 2016. This study focuses primarily on burn injuries in prison, determining the predominant aetiology as well as clinical outcomes of these injuries.
Data was retrieved retrospectively and a case series performed, including all burns referred from regional prisons to our centre from 2007 to 2017 and comprising patient demographics, mechanism of injury, total body surface area affected, management, and outcome. Cost analysis of care was conducted using a previously published framework.
18 cases from three regional prisons were recorded, with 67% from a single prison. Referrals rose exponentially over time, with 44% occurring in 2017. 94% were scald burns, and 56% secondary to
assault, primarily through the use of kettles and mostly targeting the face and trunk. The mean TBSA of burn was 2.89% (<1-8%), and 80% received first aid. 72.2% were admitted to hospital for an average of 4 days. All burns were managed nonoperatively with dressings and underwent on average 2 outpatient reviews (1-8).
The disproportionate spread of referrals across the prisons correlates partly with the respective populations, but may also represent contrasting medical provisions. The recurring method of
assault reflects the relative ease of access to hot water as a harmful agent, predominantly presenting with scalds affecting more critical areas, and with concurrent physical trauma in nearly half of cases which presents management challenges.
Targeted education is recommended to reduce the incidence and ensure adequate management of burns in prison, referrals for which are demonstrably rising. Accordingly, the Burns Outreach team can provide training to in-house prison health staff and
review referrals to specialist Burns services, aiming to ensure equitable care while alleviating costs associated with transfer to and management in hospital.