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The management of burns is costly and complex. The problem is compounded in low and middle income countries (LMICs) where the incidence of burn injuries is high but infrastructure and funding for management and prevention is limited. Cost of illness studies allows for quantification of the costs associated with public health problems. Without cost quantification, focus and allocation of funding is challenging. The authors explored the availability of cost-focused burns research data in a target LMIC. The focus of their research was Nepal. A structured literature review including published papers, Ministry of Health (MOH) and World Health Organization (WHO) statistics was conducted to identify cost of illness studies or evidence relating to burn-related resource and costs. Gaps in the evidence base were highlighted. Research methodologies from other LMICs were reviewed. We found 32 papers related to burn injury in Nepal, one key MOH document and one relevant WHO data source. Most research focused on the epidemiology and etiology of burns in Nepal. Of the papers, only 14 reported any type of burn-related resource use and only 1 paper directly reported (limited) cost data. No studies attempted an overall quantification of the cost of burns. MOH statistics provided no additional insight into costs. Our study found an almost complete lack of cost-focused burns research in Nepal. Primary research is needed to quantify the cost of burns in Nepal. Initial focus could usefully be on the cost of care in tertiary hospitals. A full cost of burns for Nepal remains some way off. [ABSTRACT FROM AUTHOR]

Burns are potentially catastrophic injuries that disproportionately affect non-Western countries. We summarize results on the epidemiology of burn injuries in Saudi Arabia of all eligible papers through 2019, specifically evaluating the age and gender of patients, the location and mechanism of injury, burn size and severity, and outcomes. Between July 5 and July 10, 2019, a comprehensive literature review was performed on MEDLINE, EMBASE, Google Scholar, and the Cochrane Library. For this search, "Saudi Arabia," coupled with the search terms "burn," "thermal burn," "flame burn," "chemical burn," "electrical burn," and "contact burn" to identify all abstracts potentially relating to the topic of interest. Eleven studies, encompassing 3308 patients, met eligibility criteria. Younger children (variably defined as ≤10-12) accounted for 52% of all burns. Males outnumbered females by an overall ratio of 1.42:1. About 83% of burns occurred at homes. Scald injuries accounted for 62.4% of injuries, followed by flame-induced burns (28.7%), electrical burns (3.3%), and chemical burns (2.8%). Pertaining to burn extent and severity, 80% to 100% of the burns were limited to <40% total body surface area, while roughly 60% were second-degree burns. Most patients remain in the hospital for 1 to 4 weeks. The overall mortality across studies including patients of all ages was 6.9%, while just 0.76% in the two studies restricted to pediatric patients. Scald injuries involving young children comprise the lion's share of burn injuries in Saudi Arabia. Increased public awareness is necessary to reduce the incidence and severity of these potentially catastrophic injuries. [ABSTRACT FROM AUTHOR]

According to the World Health Organization, unintentional injuries were responsible for over 3.9 million deaths and over 138 million disability-adjusted life-years in 2004, with over 90% of those occurring in low- and middle-income countries (LMIC). This paper utilizes the year 2004 World Health Organization Global Burden of Disease Study estimates to illustrate the global and regional burden of unintentional injuries and injury rates, stratified by cause, region, age, and gender. The worldwide rate of unintentional injuries is 61 per 100,000 population per year. Overall, road traffic injuries make up the largest proportion of unintentional injury deaths (33%). When standardized per 100,000 population, the death rate is nearly double in LMIC versus high-income countries (65 vs. 35 per 100,000), and the rate of disability-adjusted life-years is more than triple in LMIC (2,398 vs. 774 per 100,000). This paper calls for more action around 5 core areas that need research investments and capacity development, particularly in LMIC: 1) improving injury data collection, 2) defining the epidemiology of unintentional injuries, 3) estimating the costs of injuries, 4) understanding public perceptions about injury causation, and 5) engaging with policy makers to improve injury prevention and control. [ABSTRACT FROM PUBLISHER]

Necrotic tissue generated by a thermal injury is typically removed via surgical debridement. However, this procedure is commonly associated with blood loss and the removal of viable healthy tissue. For some patients and contexts such as extended care on the battlefield, it would be preferable to remove devitalized tissue with a nonsurgical debridement agent. In this paper, a proprietary debridement gel (SN514) was evaluated for the ability to debride both deep-partial thickness (DPT) and full-thickness burn wounds using an established porcine thermal injury model. Burn wounds were treated daily for 4 days and visualized with both digital imaging and laser speckle imaging. Strip biopsies were taken at the end of the procedure. Histological analyses confirmed a greater debridement of the porcine burn wounds by SN514 than the vehicle-treated controls. Laser speckle imaging detected significant increases in the perfusion status after 4 days of SN514 treatment on DPT wounds. Importantly, histological analyses and clinical observations suggest that SN514 gel treatment did not damage uninjured tissue as no edema, erythema, or inflammation was observed on intact skin surrounding the treated wounds. A blinded evaluation of the digital images by a burn surgeon indicated that SN514 debrided more necrotic tissue than the control groups after 1, 2, and 3 days of treatment. Additionally, SN514 gel was evaluated using an in vitro burn model that used human discarded skin. Treatment of human burned tissue with SN514 gel resulted in greater than 80% weight reduction compared with untreated samples. Together, these data demonstrate that SN514 gel is capable of debriding necrotic tissue and suggest that SN514 gel could be a useful option for austere conditions, such as military multi-domain operations and prolonged field care scenarios. [ABSTRACT FROM AUTHOR]

Mafenide acetate is an effective but costly antimicrobial solution used for burn wounds. The package insert instructs the user to discard unused solution within 48 hours of opening. The purpose of this study is to evaluate the antimicrobial activity of mafenide acetate beyond 48 hours after reconstitution, to possibly reduce cost by eliminating product waste. Staphylococcus aureus and Pseudomonas aeruginosa isolates were used to seed Mueller-Hinton agar plates. Filter paper disks were then saturated with 5% mafenide acetate at 0, 2, 7, 14, 30, and 60 days after reconstitution. Disks were then placed on the seeded agar plates and incubated. After incubation, the zone of inhibition around each plate was measured. A zone of inhibition of 2 mm or greater was indicative of susceptibility. Mafenide acetate remained efficacious, with a zone of inhibition of >2 mm to both organisms at 0, 2, 7, 14, 30, and 60 days after mafenide acetate reconstitution. This in vitro study demonstrates that the antimicrobial activity of mafenide acetate remains present for at least 60 days after reconstitution. Unused mafenide may not need to be discarded at 48 hours after opening. Reducing wasted product has the potential to translate into cost savings. [ABSTRACT FROM AUTHOR]

Competence in healthcare is a recognized expectation by consumers. In 2018 following an extensive review and consensus-building process, burn nursing practice competencies were published. Clinical nurse leaders were called upon to use these published competencies in practice as a basis for the requisite knowledge and skills needed in the care of the burn-injured individual. In 2019 at the 51st Annual Meeting of the American Burn Association, nurses from four U.S. burn centers reported on their center's incorporation of the competencies within their educational nursing curriculums. This paper provides a forum for each of the lead authors from Rhode Island Hospital Burn Center, the University of Utah Health Burn Trauma Intensive Care Unit, Parkland Regional Burn Center, and the University of Chicago Medicine Burn Center to outline their current utilization of the new burn nurse competencies and plans for future use. [ABSTRACT FROM AUTHOR]

For patients with major burn injuries, an accurate burn size estimation is essential to plan appropriate treatment and minimize medical and surgical complications. However, current clinical methods for burn size estimation lack accuracy and reliability. To overcome these limitations, this paper proposes a 3D-based approach-with personalized 3D models from a limited set of anthropometric measurements-to accurately assess the percent TBSA affected by burns. First, a reliability and feasibility study of the anthropometric measuring process was performed to identify clinically relevant measurements. Second, a large representative stratified random sample was generated to output several anthropometric features required for predictive modeling. Machine-learning algorithms assessed the importance and the subsets of anthropometric measurements for predicting the BSA according to specific patient morphological features. Then, the accuracy of both the morphology and BSA of 3D models built from a limited set of measurements was evaluated using error metrics and maximum distances 3D color maps. Results highlighted the height and circumferences of the bust, neck, hips, and waist as the best predictors for BSA. 3D models built from three to four anthropometric measurements showed good accuracy and were geometrically close to gold standard 3D scans. Outcomes of this study aim to decrease medical and surgical complications by decreasing errors in percent TBSA assessments and, therefore, improving patient outcomes by personalizing care. [ABSTRACT FROM AUTHOR]

This paper describes the wound microbiology and outcome of using systemic antibiotic prophylaxis (SAP) in mass burn casualties (MBC). The charts of 31 patients (mean age: 21 years, mean burn area: 42% of the total body surface area) injured in a dust explosion were reviewed for 1 month after the burn. Polymicrobial and rare pathogen wound infections (Acinetobacter junii, Aeromonas sobri, et al) were common in MBC due to sterility breech. Following the use of SAP for 2 to 14 days after admission, there was a reduction in wound infection rate from 45% at week 1 postburn to 10% at week 4. In addition, no blood stream infection occurred in the first week after the burns. Multidrug-resistant Acinetobacter baumannii, Klebsiella pneumoniae, and Candida albicans were the top three wound pathogens cultured. Multidrug-resistant microorganism infections were found in 39% of the patients, and the odds ratios for the these infections in burn patients with more than ≥40% total body surface area and in patients receiving two or more classes of antibiotics were 41.7 (95% confidence interval [CI] = 2.1-810.7, P = .01) and 9.9 (95% CI= 1.0-92.7, P = .04), respectively. Although SAP did not prevent wound or blood stream infections, no mortality occurred in our patients. A randomized controlled study is needed to investigate the impact of SAP on burn mortality in MBC. [ABSTRACT FROM AUTHOR]

We present in this paper the application of deep convolutional neural networks (CNNs), which is a state-of-the-art artificial intelligence (AI) approach in machine learning, for automated time-independent prediction of burn depth. Color images of four types of burn depth injured in first few days, including normal skin and background, acquired by a TiVi camera were trained and tested with four pretrained deep CNNs: VGG-16, GoogleNet, ResNet-50, and ResNet-101. In the end, the best 10-fold cross-validation results obtained from ResNet-101 with an average, minimum, and maximum accuracy are 81.66, 72.06, and 88.06%, respectively; and the average accuracy, sensitivity, and specificity for the four different types of burn depth are 90.54, 74.35, and 94.25%, respectively. The accuracy was compared with the clinical diagnosis obtained after the wound had healed. Hence, application of AI is very promising for prediction of burn depth and, therefore, can be a useful tool to help in guiding clinical decision and initial treatment of burn wounds. [ABSTRACT FROM AUTHOR]

Patient-Reported Outcome Measures (PROMs) identify vital information about patient needs and therapeutic progress. This paper outlines the development and validation of the CARe Burn Scale-Adult Form: a PROM that assesses quality of life in adults living with a burn injury. Eleven patients, 10 family members and 4 health professional interviews, and a systematic review informed the development of a conceptual framework and a draft measure. Cognitive debriefing interviews conducted with three adult burn patients, one family member, and eight health professionals provided feedback to ascertain content validity of the measure. The measure was then field tested with 304 adult burn patients. Rasch psychometric analysis was conducted for scale reduction, and traditional psychometric analyses provided a comparison with other measures. Further psychometric testing with an additional 118 adult burn patients tested the shortened CARe Burn Scale in relation to other quality of life PROMs. The conceptual framework outlined 14 domains; 12 of which fulfilled Rasch and traditional psychometric analyses. Two individual scales did not fulfill the Rasch criteria and were retained as checklists. Individual CARe Burn Scales correlated moderately-to-highly with other quality of life scales measuring similar constructs, and had low-to-no correlations with dissimilar constructs and the majority of sociodemographic factors, indicating evidence of concurrent and divergent validity. The CARe Burn Scale-Adult Form can help identify patient needs and provides burns-specialist health professionals with a tool to assess quality of life and therapeutic progress after a burn event and related treatment. [ABSTRACT FROM AUTHOR]

Inhalation injury is an independent risk factor in burn mortality, imparting a 20% increased risk of death. Yet there is little information on the natural history, functional outcome, or pathophysiology of thermal injury to the laryngotracheal complex, limiting treatment progress. This paper demonstrates a case series (n = 3) of significant thermal airway injuries. In all cases, the initial injury was far exceeded by the subsequent immune response and aggressive fibroinflammatory healing. Serial examination demonstrated progressive epithelial injury, mucosal inflammation, airway remodeling, and luminal compromise. Histologic findings in the first case demonstrate an early IL-17A response in the human airway following thermal injury. This is the first report implicating IL-17A in the airway mucosal immune response to thermal injury. Their second and third patients received Azithromycin targeting IL-17A and showed clinical responses. The third patient also presented with exposed tracheal cartilage and underwent mucosal reconstitution via split-thickness skin graft over an endoluminal stent in conjunction with tracheostomy. This was associated with rapid abatement of mucosal inflammation, resolution of granulation tissue, and return of laryngeal function. Patients who present with thermal inhalation injury should receive a thorough multidisciplinary airway evaluation, including early otolaryngologic evaluation. New early endoscopic approaches (scar lysis and mucosal reconstitution with autologous grafting over an endoluminal stent), when combined with targeted medical therapy aimed at components of mucosal airway inflammation (local corticosteroids and systemic Azithromycin targeting IL-17A), may have potential to limit chronic cicatricial complications. [ABSTRACT FROM AUTHOR]

Introduction: Tobacco Heating System 2.2 (THS 2.2, marketed as iQOS) is a heat-not-burn (HNB) tobacco product that has been successfully introduced to global markets. Despite its expanding market, few independent and systematic researches into THS 2.2 have been carried out to date.Methods: We tested a comprehensive list of total particulate matter (TPM), water, tar, nicotine, propylene glycol, glycerin, carbon monoxide, volatile organic compounds, aromatic amines, hydrogen cyanide, ammonia, N-nitrosamines, phenol, and polycyclic aromatic hydrocarbon under both ISO and HCI regimes. We also simulated pyrolysis of THS 2.2 heating sticks and made comparisons with conventional cigarette tobacco fillers using comprehensive gas chromatography-mass spectrometry (GC × GC-MS) to determine whether the specially designed ingredients help reduce harmful constituents.Results: Other than some carbonyls, ammonia, and N-nitrosoanabasine (NAB), the delivered releases from THS 2.2 were at least 80% lower than those from 3R4F. Tar and nicotine remained almost the same as 3R4F. Interestingly, the normalized yield of THS 2.2 to 3R4F under the HCI regime was lower than that under the ISO regime.Conclusions: THS 2.2 delivered fewer harmful constituents than the conventional cigarette 3R4F. Simulated pyrolysis results showed that the lower temperature instead of specially designed ingredients contributed to the distinct shift. In particular, if smoking machines are involved to evaluate the HNB products, smoking regimes of heat-not-burn tobacco products should be carefully chosen.Implications: To our knowledge, few independent studies of HNB products have been published. In this paper, a comprehensive list of chemical releases was tested systematically and compared to those from 3R4F. Although THS 2.2 generates lower levels of harmful constituents, the nicotine and tar levels were almost identical to 3R4F.The results should be discussed carefully in the future when assessing the dual-use with other conventional cigarettes, nicotine dependence of HNB products, etc. This study also suggests that regulatory agencies should pay attention to the smoking regimes that are adopted to evaluate HNB tobacco products. [ABSTRACT FROM AUTHOR]

Pediatric burns in the urban environment present special problems. Communities in the inner-city may be unique with hardships due to various socioeconomic factors. Few, if any, papers have specifically sought to analyze pediatric burns in the inner-city, and there has been no report to date reviewing Harlem New York City, one of the most challenged areas in the nation. The aim of this study is to understand the prehospital circumstances and socioeconomic factors of affected patients, hospital care, and management of pediatric patients admitted with burns in Harlem. A retrospective review was performed of all the patients aged 0 to 18 years old admitted to the burn care unit from January 2006 to May 2017. Data collected included age, gender, ethnicity, burn mechanism, total burn surface area, first aid and management, socioeconomic factors including parental supervision, single or binary parenting, caregiver financial and employment status, New York City Administration for Children's Services (ACS) child protective services reporting for child abuse or neglect. Analysis was done using Microsoft Excel 2016 and SPSS statistics v23. A total of 177 pediatric burn patient admissions were included. The majority of the patients were toddlers (1-5 years of age). The most common type was scald burns. The average TBSA burnt was approximately 9%. Nearly all the injuries occurred at home with more being during winter months. Strikingly, the majority of patients, over 75%, did not receive appropriate first aid measures. Moreover, socioeconomic issues were significant with 60% of patients having single parents, approximately 35% with lack of supervision and neglect or abuse reported in 25% of these cases. Unemployment rate of the caregiver was high, with 50% unemployed or in between jobs. In 73% of the patients, their parents were receiving some form of social aid for childcare and sustenance of family needs. Pediatric burns are a major public health issue. An understanding of community variations with these injuries is essential taking into account socioeconomic challenges that these children face. Our inner-city hospital pediatric burn admissions have substantial caregiver and socioeconomic challenges in excess of traditionally reported in the literature. Most injuries occurred at home and the majority lacked proper prehospital first aid care. This analysis is informative, providing professionals and caregivers topics of consideration regarding safe practices at home, appropriate first aid measures, prevalent socioeconomic issues in our community in Harlem. There is a need to address socioeconomic factors which may potentially prevent pediatric burn admissions in these inner-city communities. [ABSTRACT FROM AUTHOR]

Recent introduction of rapid bromelain-based enzymatic debridement has been increasingly popular in its use in nonsurgical debridement in deep partial and full thickness burns. We designed this study to evaluate the evidence suggested by current studies on the perceived benefits of using Nexobrid® compared with traditional surgical standard of care in burns wound debridement. A comprehensive search on electronic databases Pubmed, Embase, and Web of Science was done to identify studies published between 1986 and 2017 involving the use of Nexobrid® in deep partial and full thickness burns. Studies were evaluated for proposed benefits and categorized under supporting evidence, contradicting evidence, and anecdotal opinions. Seven well-designed prospective studies met the inclusion comprising four randomized controlled trials. Six proposed benefits associated with the use of Nexobrid® were extracted including reduced time to complete debridement, need for surgery, area of burns excised, need for autograft, time to wound closure, and improved scar quality. Most proposed benefits have strong supporting evidences with minimal anecdotal opinions from controlled trials except the proposed improvement in scar quality and reduced time to wound healing that had at least three refuting evidence and one anecdotal evidence. Incidence of pain was also evaluated and was mainly anecdotal lacking formal objective assessment or cohort study. Despite the lack of literatures available, the benefits of Nexobrid® are evident in published randomized and single arm studies. Large number of studies is needed to aid further evaluating the proposed benefits of Nexobrid®. [ABSTRACT FROM AUTHOR]

Accurate determination of burn size significantly impacts both immediate management and long-term outcome. In the era of evidence-based medicine, the variability in TBSA% assessment shown by traditional methods may prove unacceptable and technology-aided systems become the "accepted standard." The objective of this study was to push this scenario to the limit by investigating the accuracy and consistency of TBSA% estimations using a computer-aided tool. Five Laymen (health care-burn management naïve people) were trained on the handling of the technology-aided assessment tool Burn Case 3D© and asked to calculate TBSA% for 18 clinical pictures of burns with different patterns and sizes. Forty-four burn Professionals (senior burn surgeons, plastic surgery residents, anesthesiologists, emergency physicians, senior registered nurses) were provided the same pictures and assessed TBSA% using traditional paper-based tools ("Rule of Palm"; "[Wallace] Rule of Nines"; "Lund and Browder chart). The Laymen's computer-aided calculations did not differ significantly (P > .05) from the senior burn surgeons' estimations in 17 of the 18 cases. However, when comparing the Laymen's TBSA% calculations with the whole group Professionals there were significant differences (P < .05) in (again) 17 of the 18 cases. Laymen's calculations were also more consistent (mean SD, 0.95%). The Professionals showed a generalized significant overestimation of TBSA% as compared with the Laymen's calculations (up to 198.5%). Innovative software provide a high potential to improve objectivity and quality of burn assessment in the future. [ABSTRACT FROM AUTHOR]

There is growing scholarly interest in what leads to global or national prioritization of specific health issues. By retrospectively analysing agenda setting for India's national burn programme, this study aimed to better understand how the agenda-setting process influenced its design, implementation and performance. We conducted document reviews and key informant interviews with stakeholders and used a combination of analytical frameworks on policy prioritization and issue framing for analysis. The READ (readying material, extracting data, analysing data and distilling findings) approach was used for document reviews, and qualitative thematic analysis was used for coding and analysis of documents and interviews. The findings suggest three critical features of burns care policy prioritization in India: challenges of issue characteristics, divergent portrayal of ideas and its framing as a social and/or health issue and over-centralization of agenda setting. First, lack of credible indicators on the magnitude of the problem and evidence on interventions limited issue framing, advocacy and agenda setting. Second, the policy response to burns has two dimensions in India: response to gender-based intentional injuries and the healthcare response. While intentional burns have received policy attention, the healthcare response was limited until the national programme was initiated in 2010 and scaled up in 2014. Third, over-centralization of agenda setting (dominated by a few homogenous actors, located in the national capital, with attention focused on the national ministry of health) contributed to limitations in programme design and implementation. We note following elements to consider when analysing issues of significant burden but limited priority: the need to analyse how actors influence issue framing, the particularities of issues, the inadequacy of any one dominant frame and the limited intersection of frames. Based on this analysis in India, we recommend a decentralized approach to agenda setting and for the design and implementation of national programmes from the outset. [ABSTRACT FROM AUTHOR]

The purpose of this paper was to analyze the characteristics of burns caused by moxibustion. A retrospective survey of the medical records of patients was performed on patients who visited our center from January 2009 to January 2017, treating for burns caused by moxibustion. Data were extracted and evaluated, including demographics, site and extent of burns, type and treatment duration of moxibustion, practitioners, and cost. A total of 82 consecutive patients treated for moxibustion-induced burns were included. The average patient age was 42.4 years, with the male to female ratio of 1.2:1. Burns caused by direct and indirect moxibustion were 7 and 75 cases, respectively. Averagely, moxibustion was performed 3.6 times a week for 3.7 weeks and lasts for 16.2 minutes each treatment. The average distance for indirect moxibustion was 3.4 cm (ranged from 2 to 5 cm) away from the acupoints. First-degree and superficial partial thickness burns, deep partial thickness burns, and full thickness burns were present in 16, 59, and 7 cases, respectively. Most of the burns were minor burns, with diameter less than 2 cm (69 cases). The most common sites were the lower extremities (46 cases), followed by abdomen (29 cases) and upper extremities (5 cases). The average cost for inpatients and outpatients was 5 164 and 2 192 RMB, respectively. Majority of moxibustion-induced burns are minor burns, and there is a high probability of the burn being deep if it occurs in the lower extremities. [ABSTRACT FROM AUTHOR]

The management of severe burns remains a complex challenge. Adenosine, lidocaine, and magnesium (ALM) resuscitation therapy has been shown to protect against hemorrhagic shock and traumatic injury. The aim of the present study was to investigate the early protective effects of small-volume ALM fluid resuscitation in a rat model of 30% total body surface area (TBSA) thermal injury. Male Sprague–Dawley rats (320–340 g; n = 25) were randomly assigned to: 1) Sham (surgical instrumentation and saline infusion, without burn, n = 5), 2) Saline resuscitation group (n = 10), or 3) ALM resuscitation group (n = 10). Treatments were initiated 15-min after burn trauma, including 0.7 mL/kg 3% NaCl ± ALM bolus and 0.25–0.5 mL/kg/h 0.9% NaCl ± ALM drip, with animals monitored to 8.25-hr post-burn. Hemodynamics, cardiac function, blood chemistry, hematology, endothelial injury markers and histopathology were assessed. Survival was 100% for Shams and 90% for both ALM and Saline groups. Shams underwent significant physiological, immune and hematological changes over time as a result of surgical traums. ALM significantly reduced malondialdehyde levels in the lungs compared to Saline (P =.023), and showed minimal alveolar destruction and inflammatory cell infiltration (P <.001). ALM also improved cardiac function and oxygen delivery (21%, P =.418 vs Saline), reduced gut injury (P <.001 vs Saline), and increased plasma adiponectin (P <.001 vs baseline). Circulating levels of the acute phase protein alpha 1-acid glycoprotein (AGP) increased 1.6-times (P <.001), which may have impacted ALM's therapeutic efficacy. We conclude that small-volume ALM therapy significantly reduced lung oxidative stress and preserved alveolar integrity following severe burn trauma. Further studies are required to assess higher ALM doses with longer monitoring periods. [ABSTRACT FROM AUTHOR]

The coronavirus disease and the subsequent pandemic that followed drastically changed human civilization with disruptive effects on health and overall wellbeing of mankind. This disruptive effect has been shown to include changes in epidemiology of burn injuries. This study therefore aimed to determine the impact of covid-19 on acute burn presentation at the University College Hospital (UCH), Ibadan. This was a retrospective study carried out between April 1, 2019 and March 31, 2021. The period was divided into two: April 1, 2019 to March 31, 2020 and April 1, 2020 to March 31, 2021. Data obtained from the burn unit registry were analyzed using the Scientific Package For Social Sciences version 25. The only statistically significant finding from this study was the marked reduction in burn ICU admission during the pandemic (P < 0.001). A total of 144 patients presented to the burn intensive care unit at UCH, Ibadan during the period under review with 92 patients in the prepandemic year, and 52 patients in the pandemic year. Patient group from 0- to 9-year-olds representing 42% in prepandemic, and 30.8% in the pandemic period was the most affected age group. Scald was predominantly among the pediatric age group in both groups. Males were more likely to suffer flame burn in both study periods with a near gender equilibration during the pandemic. Burn injury during the pandemic resulted in more total body surface area burned. The lockdown effect of the pandemic resulted in a significant reduction in acute burn admissions at the UCH, Ibadan. [ABSTRACT FROM AUTHOR]

To investigate the effectiveness of cough machine assistance combined with care bundle on mental resilience and self-efficacy on burned patients with moderate to severe inhalation injury. Totally 98 burned patients with moderate to severe inhalation injury from April 2021 to April 2022 were enrolled in this retrospective analysis. They were divided into the control group (n = 49, conventional therapy) and combined-therapy group (n = 49, cough machine assistance and care bundles). The mental resilience, posttraumatic growth, and self-efficacy were conducted. The arterial blood gas analysis indicators and incidence of pulmonary infection were also evaluated. The length of hospital stay in combined-therapy group was significantly less than that of control group. There was no difference of pulmonary infections between two groups before treatment. However, the incidence of pulmonary infection in the combined-therapy group was significantly lower. After the therapy, the combined-therapy group showed significantly higher partial pressure of oxygen, and lower levels of oxyhemoglobin saturation and partial pressure of carbon dioxide compared with the control group. The evaluation with the mental resilience, posttraumatic growth, and self-efficacy after the therapy, indicated that the patients in the combined-therapy group had significantly higher scores of optimism, strength, tenacity, relating to others, new possibilities, personal strength, appreciation of life and spiritual change, and self-efficacy. The combined therapy with cough machine assistance and care bundles can effectively improve the mental resilience and self-efficacy level of burned patients with moderate to severe inhalation injury, showing potential for possible clinical applications. [ABSTRACT FROM AUTHOR]

Hydrofluoric acid is a colourless or almost colourless, fuming liquid having a highly caustic and corrosive effect on organic tissue. Many kinds of hydrofluoric acid in concentrations are used in industrial processes and laboratory uses because of its useful chemical properties. Hydrofluoric acid causes severe and painful burns to the skin and eyes. In this paper, the immediate symptoms, the typical treatments in the literature, first aid and therapy of hydrofluoric acid burns are reviewed. [ABSTRACT FROM PUBLISHER]

Skin burn injury from light cables is a rare complication of laparoscopic surgery, but it can be severe and distressing for both the patient and the surgeon. A case report of skin burns due to laparoscopic light source is presented in this article, followed by an experimental trial to confirm the findings, and review of literature. The light source is usually connected to the camera to give adequate light inside the abdominal cavity for visualization of the internal organs, and hence, safe surgery. The light source should deliver cool light to prevent any burn from heat to skin or internal organs, but in fact, it is not usually cool and can reach high temperatures. Precautions and recommendations to avoid skin burns due to the light source are included. Surgeons should be aware of burns from light sources in laparoscopic surgery and take precautions to prevent them. [ABSTRACT FROM AUTHOR]

Facial burns are extremely common in the burn population, as is the need for endotracheal intubation. However, securing the endotracheal tube in these patients can be difficult. Our institution's historically preferred method of securing tubes with twill tape was effective but had a high rate of device-related pressure ulcers. The introduction of new silicone pressure-reducing strips for use in conjunction with twill tape was effective in reducing the incidence of pressure ulcers in this patient population from 21% to 5% (P = .032). [ABSTRACT FROM AUTHOR]

Corneal alkali burns cause extensive damage not only to the cornea but also to the intraocular tissues. As an anti-inflammatory therapy, subconjunctival administration of mesenchymal stem cells (MSCs) for corneal protection after corneal alkali burn has been explored. Little evidence demonstrates the potential of subconjunctival MSCs delivery in protecting the post-burn intraocular tissues. This study aimed to evaluate the therapeutic efficacy of subconjunctival injection of human placental (hP)-MSCs in protecting against ocular destruction after the burn. hP-MSCs were subconjunctivally administered to C57/BL mice after corneal alkali burn. Western blot of iNOS and CD206 was performed to determine the M1 and M2 macrophage infiltration in the cornea. Infiltration of inflammatory cells in the anterior uvea and retina was analyzed by flow cytometry. The TUNEL assay or Western blot of Bax and Bcl2 was used to evaluate the anti-apoptotic effects of MSCs. MSCs could effectively facilitate cornea repair by suppressing inflammatory cytokines IL-1β, MCP-1, and MMP9, and polarizing CD206 positive M2 macrophages. Anterior uveal and retinal inflammatory cytokines expression and inflammatory cell infiltration were inhibited in the MSC-treated group. Reduced TUNEL positive staining and Bax/Bcl2 ratio indicated the anti-apoptosis of MSCs. MSC-conditioned medium promoted human corneal epithelial cell proliferation and regulated LPS-stimulated inflammation in RAW 264.7 macrophages, confirming the trophic and immunoregulatory effects of MSCs. Our findings demonstrate that subconjunctival administration of MSCs exerted anti-inflammatory and anti-apoptotic effects in the cornea, anterior uvea, and retina after corneal alkali burn. This strategy may provide a new direction for preventing post-event complications after corneal alkali burn. [ABSTRACT FROM AUTHOR]

Individuals who experience burns are at higher risk of developing posttraumatic stress disorder and chronic pain. A synergistic relationship exists between posttraumatic stress disorder and chronic pain. We sought to evaluate the role of individual posttraumatic stress disorder symptom clusters as predictors of pain interference. We hypothesized that the hyperarousal and emotional numbing symptom clusters would be predictive of pain interference, even when accounting for the other two posttraumatic stress disorder symptom clusters, pain intensity, and other covariates. Multivariate linear regression analyses were completed using data from the Burn Model System National Database. A total of 439 adult participants had complete responses on self-report measures assessing posttraumatic stress disorder symptoms, pain intensity, and pain interference at 6-month after discharge and were included in analyses. Results indicate hyperarousal (B =.10, p =.03) and emotional numbing (B =.13, p =.01) posttraumatic stress disorder symptom clusters were each significantly associated with pain interference, even when accounting for pain intensity (B =.64, p <.001). Results highlight the importance of the emotional numbing and hyperarousal posttraumatic stress disorder symptom clusters in explaining pain interference. Findings suggest that when posttraumatic stress disorder symptoms or chronic pain are present, screening for and treating either condition may be warranted to reduce pain interference. Further, psychological interventions that target emotional numbing and hyperarousal posttraumatic stress disorder symptoms may be fruitful for promoting better coping with chronic pain and reducing pain interference. [ABSTRACT FROM AUTHOR]

Delayed tree mortality can contribute to variability in fire effects in forests, but its prevalence is not well understood in eastern North American oak forests where a management goal is using prescribed fire to shape forest density and composition. To assess potential delayed mortality after prescribed fires, we tracked the fates of 690 trees of four species in burned and 542 trees in unburned oak forests in northwestern Ohio, USA, and modeled survival using tree diameter and bole char. Delayed mortality, occurring 3–4 growing seasons after fire and in addition to initial mortality (1–2 growing seasons after fire), varied with species and tree diameter. Compared to initial mortality, delayed mortality resulted in eleven times more small-diameter (1–13 cm) red maple (Acer rubrum) dying after fire. White oak (Quercus alba), 1–25 cm in diameter, also incurred delayed mortality (five-times increase in dead trees). Neither sassafras (Sassafras albidum) nor black oak (Quercus velutina) displayed delayed mortality. Background tree mortality in unburned sites was minimal (0.4% per year across species). Logistic regression to model canopy survival selected only stem diameter for burned red maple trees, whereas both diameter and bole char related to survival in other species. Results suggest that (1) monitoring postfire tree mortality in oak forests should extend for at least four growing seasons to detect delayed mortality in some species, and that (2) single surface fires may eventually reduce encroaching red maple in oak forests more than initial postfire years indicate. [ABSTRACT FROM AUTHOR]

Burn-induced compartment syndrome represents a serious and acute condition in deep circumferential burns of the extremities which, if left untreated, can cause severe complications. The surgical escharotomy that releases the high subdermal pressure is the therapeutic treatment of choice for burn-induced compartment syndrome. Guidelines for escharotomy indications and timing include pressure greater than 30 mm Hg and 6 Ps (Pain, Pallor, Paresthesia, Paralysis, Pulseless, and Poikilothermia). Nevertheless, despite the need for an early as possible pressure release, escharotomy is often delayed when a capable surgeon is not available, or if the indication is not completely clear to justify potential risks associated with surgical escharotomy. Early treatment of circumferential burns of the extremities with a Bromelain-based enzymatic agent NexoBrid® may represent a less traumatic and invasive procedure to reduce intra-compartmental pressure, replacing surgical escharotomy. This case study of 23 patients describes the variation of compartmental pressure in patients with circumferential burns of the extremities treated with NexoBrid® enzymatic escharotomy-debridement. All the patients were treated with NexoBrid® within 2 to 22 hours post-injury in our Burn Intensive Care Center. The excessive pressure recorded before treatment returned to normal below 30 mm Hg and an approximately 60% reduction of the compartmental pressure was observed in most cases within 1 hour from NXB application. On NexoBrid® removal after 4 hours complete debridement-escharotomy of the burns was achieved. Enzymatic escharotomy-debridement appears to be a useful and safe method to reduce postburn compartmental pressure. Additional randomized, well-controlled powered studies are needed to further support these results. [ABSTRACT FROM AUTHOR]

Attaining adequate glycemic control in burn patients has been shown to reduce infection-related mortality. Previous internal evaluation of continuous insulin infusion (CII) use revealed a hypoglycemia rate of 0.6% and an average time within goal glycemic range (70-149 mg/dl) of 13.8 h/day. A new algorithm, designed to adjust dosage based on glycemic response, underwent six iterations over 2 years before the final version was implemented. The purpose of this retrospective study was to assess the post-implementation performance of the newly developed CII algorithm. The current study was powered to detect a 50% reduction in hypoglycemic events, as compared to a pre-implementation historical control. The cohort was 62% male with a mean age of 54.5 ± 17.4. Sixty-five percent had thermal injuries with a median 23.5 (11-45) %TBSA. There were no differences in demographics between groups. Among the 20 records reviewed, 5239 point-of-care glucose values were assessed. Post-implementation, hypoglycemia rates were significantly lower (0.6% vs 0.2%; P < .001). There was no difference in median blood glucose between groups (149.9 vs 146.5 mg/dl; P = .56). Time spent within goal glycemic range was not significantly different (13.8 vs 14.7 h/day; P = 0.23). There were no differences in infection, length of stay, or survival. The consolidation, education, and implementation of a single, dynamic CII algorithm reduced the incidence of hypoglycemia. The authors expect that education and diligence with follow-up glucose monitoring will further improve time within goal glycemic range by preventing rebound hyperglycemia. [ABSTRACT FROM AUTHOR]

Major burn injuries incite a hypermetabolic response, and the initiation of early enteral nutrition is the standard of care in patients with large burns and contributes to improved outcomes. Perioperative fasting is a common cause of caloric deficits in burn patients and can be obviated with intraoperative enteral nutrition. However, the risks and benefits of this practice are unknown, and there is a concern for aspiration. We conducted a systematic review and meta-analysis to evaluate the safety and efficacy of intraoperative enteral nutrition. We performed a systematic literature search using PubMed, Scopus, and OvidSP MEDLINE databases. We identified studies that evaluated the effects of intraoperative enteral nutrition in adult burn patients compared to those undergoing routine perioperative fasting. We performed a meta-analysis on the incidence of mortality, pneumonia, wound infections, and aspiration in burn patients receiving intraoperative enteral nutrition. We identified seven articles for qualitative review and four for quantitative review (N = 83 patients). There were no statistically significant increases in the risk of mortality (odds ratio [OR] = 1.28, 95% confidence interval [CI]: 0.49, 3.31), wound infections (OR = 0.71, 95% CI: 0.16, 3.24), pneumonia (OR = 2.1, 95% CI: 0.7, 6.1), and aspiration (OR = 1.14, 95% CI: 0.07, 18.75) in patients receiving intraoperative enteral nutrition. Within individual studies, intraoperative enteral nutrition patients received significantly more calories than standard fasting patients. Intraoperative enteral nutrition may increase nutritional intake in burn patients without an increase in complications; however, this is based on limited studies. Randomized controlled trials are needed before recommendations on intraoperative enteral nutrition practice can be made. [ABSTRACT FROM AUTHOR]

The breast and anterior chest are the most commonly burned part of the trunk. Burn injuries to the breast can be associated with pain, asymmetries, and significant social stigma. Burns to the breast bud in the young female may inhibit normal breast development and result in either significant asymmetries or amastia, making the treatment of breast burn injuries challenging. A retrospective chart review was conducted on all female patients under the age of 21 years admitted to our institution for breast burn injuries from January 1, 2008 to December 30, 2018. Patients were included if they had follow-up reconstructive procedures for breast burn injuries many days after their acute-phase treatment. Ninety-six patients aged 1 to 20 years have been admitted to our institution with burned breast injuries. The mean age of this cohort (n = 96) was 6.4 ± 4.8 years with a mean percent TBSA of 36.3 ± 21.4 and a mean time since injury from admission of 2279.1 ± 2284.1 days. Flame burns (66.8 percent) were the most common etiology for breast burn injuries, followed by scald burns (22.8 percent), in this cohort. The mean body mass index was 22.7 ± 6.3 kg/m2. Follow-up for reconstructive procedures was 7.2 ± 5.6 years after injury date. Our institution's 10-year experience of 96 female patients with severe burn injuries has enhanced our understanding of reconstructive techniques. The location, size, anatomic extent, type of deformity, and symmetry must all be assessed before any treatment plans, which may need to include a combination of modalities. [ABSTRACT FROM AUTHOR]

On August 27 and 28, 2018, the American Burn Association, in conjunction with Underwriters Laboratories, convened a group of experts on burn and inhalation injury in Washington, DC. The goal of the meeting was to identify and discuss the existing knowledge, data, and modeling gaps related to understanding cutaneous thermal injury and inhalation injury due to exposure from a fire environment, and in addition, address two more areas proposed by the American Burn Association Research Committee that are critical to burn care but may have current translational research gaps (inflammatory response and hypermetabolic response). Representatives from the Underwriters Laboratories Firefighter Safety Research Institute and the Bureau of Alcohol, Tobacco, Firearms and Explosives Fire Research Laboratory presented the state of the science in their fields, highlighting areas that required further investigation and guidance from the burn community. Four areas were discussed by the full 24 participant group and in smaller groups: Basic and Translational Understanding of Inhalation Injury, Thermal Contact and Resulting Injury, Systemic Inflammatory Response and Resuscitation, and Hypermetabolic Response and Healing. A primary finding was the need for validating historic models to develop a set of reliable data on contact time and temperature and resulting injury. The working groups identified common areas of focus across each subtopic, including gaining an understanding of individual response to injury that would allow for precision medicine approaches. Predisposed phenotype in response to insult, the effects of age and sex, and the role of microbiomes could all be studied by employing multi-omic (systems biology) approaches. [ABSTRACT FROM AUTHOR]

The objective of this review was to systematically evaluate the available literature addressing the use of orthoses (splints and casts) with adult and pediatric burn survivors and determine whether practice guidelines could be proposed. This review provides evidence-based recommendations specifically for rehabilitation professionals who are responsible for burn survivor rehabilitation. A summary recommendation was made after the literature was retrieved using a systematic review and critical appraisal by multiple authors. The level of evidence of the literature was determined in accordance with the Oxford Centre for Evidence-based Medicine criteria. Due to the low level of evidence in the available literature, only one practice guideline could be recommended: orthotic use should be considered as a treatment choice for improving range of motion or reducing contracture in adults who have sustained a burn injury. To address the rehabilitation-specific gaps found in the literature regarding orthotic use in burn rehabilitation and provide guidance to clinicians, a formal expert consensus exercise was conducted as a final step to the project. The resultant manuscript provides a summary of the literature regarding orthotic use with burn patients, one practice guideline, proposed orthotic terminology and additional practice recommendations based on expert opinion. The limitations in the current literature are also discussed, and suggestions are made for future studies in the area of orthotic use after burn injury. [ABSTRACT FROM AUTHOR]

There are few studies on the inflammatory processes and the role of cytokines involved in pediatric burn injuries. The present study aims to measure the serum levels of cytokines and their relationship with the degree of burn injury in children. Within the 48 hours of hospitalization, the serum samples were obtained to measure inflammatory cytokines (interleukin-6, interleukin-8, interleukin-10 [IL-6, IL-8, and IL-10] and tumor necrosis factor-alpha [TNF-α]). The level of all of these cytokine factors was assessed by enzyme-linked immunosorbent assay technique. The mean levels of IL-6, IL-8, IL-10, and TNF-α was 18.15 ± 4.77 pg/ml, 59.54 ± 4.59 pg/ml, 8.41 ± 2.09 pg/ml, and 1.48 ± 0.15 pg/ml, respectively, which were higher than the normal range designated for the healthy pediatrics age group. The levels of TNF-α were higher in patients with sepsis (P = .03) and deceased patients (P = .001). There was a statistically significant difference in the levels of IL-8 in patients with second- (.001) and third-degree (.001) burn injuries in comparison to the first-degree burn injuries, and the level of IL-8 was statistically significantly higher in patients with electrical burn injuries in comparison to scald burn injuries (.01). IL-10 was statistically significantly higher in patients with contact burn injuries in comparison to scald (.001) and flame (.03) burn injuries. Cytokine levels in pediatric burn patients increased after severe burn injuries. There was a significant correlation between the levels of IL-8 and the degree of burn injuries. [ABSTRACT FROM AUTHOR]

Narcolepsy is a rare brain disorder characterized by excessive daytime sleepiness (EDS), cataplexy, hypnagogic hallucinations, and sleep paralysis. Stimulants have been used to relieve the symptoms of EDS. Narcolepsy symptoms may pose a risk to burn injury. The study aimed to investigate the risk of burn injury in narcolepsy patients and to examine the relationship between the use of stimulants and the risk of burn injury. In all, 507 narcolepsy patients and 504 controls matched by gender, age, index year, and Charlson Comorbidity Index (CCI) score were enrolled between 1998 and 2012, then followed until the end of 2013 using Taiwan's National Health Insurance Research Database. During the follow-up period, participants who developed burn injury were identified. Cox regression analysis was used to calculate the hazard ratio (HR) with 95% confidence interval (CI) of the burn incidence rate between narcolepsy patients and unaffected controls. Narcolepsy patients had a significantly increased risk of burn injury compared to unaffected controls (5.37 versus 2.69 per 1,000 person-years, HR: 2.04, 95% CI: 1.13-3.67) after adjusting for gender, age, CCI score, urbanization degree, and duration of stimulants use. Also, the use of stimulants in narcolepsy patients was associated with a lower incidence rate of developing burn injury, but the risk estimate was not statistically significant after adjusting for the above-mentioned variables. This study shows narcolepsy patients have an increased risk of burn injury and the use of stimulants may reduce the burn incidence rate, providing a reference for developing prevention interventions. [ABSTRACT FROM AUTHOR]

The underrepresentation of racial and ethnic minority groups has been well-documented in general and plastic surgery but not in burn surgery. The aim of this study is to evaluate current minority group disparities among burn surgery leadership. A cross-sectional analysis was performed. Burn surgeons included directors of American Burn Association-verified burn centers in the United States, past and current presidents of the American Burn Association, and editorial board members of five major burn journals (Journal of Burn Care & Research, Burns, Burns & Trauma, Annals of Burns & Fire Disasters, and the International Journal of Burns and Trauma). Surgeons were compared based on factors including age, gender, training, academic rank, and Hirsch index (h-index). Among 71 burn center directors, 50 societal presidents, and 197 journal editors, minority groups represented 18.3, 2.0, and 34.5%, respectively. Among burn center directors, the group classified collectively as nonwhite was significantly younger (49 vs 56; P < .01), graduated more recently (2003 vs 1996; P < .01), and had a lower h-index (9.5 vs 17.4; P < .05). There were no significant differences in gender, type of residency training, advanced degrees obtained, fellowships, academic rank, and academic leadership positions between white and nonwhite groups. When compared with the 2018 U.S. National Census, burn unit directors had a 5.1% decrease in nonwhite representation. Disparities in representation of ethnic and racial minorities exist in burn surgery despite having similar qualifying factors. [ABSTRACT FROM AUTHOR]

Superstitious beliefs have been frequently encountered in our day-to-day practices among patients and caretakers. Though this is a common phenomenon, there is a paucity of data pertaining to these beliefs due to various reasons. Many of these beliefs are deep engraved into the culture and mindsets of the population. This is an observational study performed in Tertiary burn care center in India during period October 1, 2018 to January 31, 2019. Data from 100 patient units were collected through a set of questionnaires given to each of patient and their caregivers/family members and responses were collected and analyzed. In the food category of superstitions, there was a thought that white colored foods had to be avoided to avoid pus discharge and wound healing in 60% of the response; eating pomegranate or drinking the juice of pomegranate improves the hemoglobin in 80% of the response. Wearing various colored strings in various parts of the body seemed to be a dominant practice in 85% of the responses, wearing the hair with origin from human, donkeys, horses, and various animals was practiced in 45% of people and wearing peacock feathers was seen in 40% of patients. About 95% of the patients thought adversely to the idea of bathing or even contact of the water with the wounds. This study is an attempt to analyze the different parameters of superstition, misconception, and magical beliefs. [ABSTRACT FROM AUTHOR]

Managing multicenter clinical trials (MCTs) is demanding and complex. The Randomized controlled Evaluation of high-volume hemofiltration in adult burn patients with Septic shoCk and acUte kidnEy injury (RESCUE) trial was a prospective, MCT involving the impact of high-volume hemofiltration continuous renal replacement therapy on patients experiencing acute kidney injury and septic shock. Ten clinical burn centers from across the United States were recruited to enroll a target sample size of 120 subjects. This manuscripts reviews some of the obstacles and knowledge gained while coordinating the RESCUE trial. The first subject was enrolled in February 2012, 22 months after initial IRB approval and 29 months from the time the grant was awarded. The RESCUE team consisted of personnel at each site, including the lead site, a data coordination center, data safety monitoring board, steering committees, and the sponsor. Seven clinical sites had enrolled 37 subjects when enrollment stopped in February 2016. Obstacles included changes in institutional review boards, multiple layers of review, staffing changes, creation and amendment of study documents and procedures, and finalization of contracts. Successful completion of a MCT requires a highly functional research team with sufficient patient population, expertise, and research infrastructure. Additionally, realistic timelines must be established with strategies to overcome challenges. Inevitable obstacles should be discussed in the pretrial phase and continuous correspondence must be maintained with all relevant research parties throughout all phases of study. [ABSTRACT FROM AUTHOR]

Participant attrition in longitudinal studies can lead to substantial bias in study results, especially when attrition is nonrandom. A previous study of the Burn Model System (BMS) database prior to 2002 identified participant and study-related factors related to attrition. The purpose of the current study was to examine changes in attrition rates in the BMS longitudinal database since 2002 and to revisit factors associated with attrition. Individuals 18 years and older enrolled in the BMS database between 2002 and 2018 were included in this study. Stepwise logistic regression models identified factors significantly associated with attrition at 6, 12, and 24 months postburn injury. The percentage of individuals lost to follow-up was 26% at 6 months, 33% at 12 months, and 42% at 24 months. Factors associated with increased risk of loss to follow-up across two or more time points include male sex, lower TBSA burn size, being unemployed at the time of burn, shorter duration of acute hospital stay, younger age, not having private health insurance or workers' compensation, and a history of drug abuse. Retention levels in the BMS have improved by at least 10% at all time points since 2002. The BMS and other longitudinal burn research projects can use these results to identify individuals at high risk for attrition who may require additional retention efforts. Results also indicate potential sources of bias in research projects utilizing the BMS database. [ABSTRACT FROM AUTHOR]

While disparities in healthcare outcomes and services for vulnerable populations have been documented, the extent to which vulnerable burn populations demonstrate disparities in long-term care is relatively underexplored. This study's goal was to assess for differences in long-term occupational or physical therapy (OT/PT) and psychological service use after burn injury in vulnerable populations. Data from the Burn Model System National Database (2006-2015) were analyzed. The vulnerable group included participants in one or more of these categories: 65 years of age or older, nonwhite, no insurance or Medicaid insurance, preinjury receipt of psychological therapy or counseling, preinjury alcohol and/or drug misuse, or with a preexisting disability. Primary outcomes investigated were receipt of OT/PT and psychological services. Secondary outcomes included nine OT/PT subcategories. Outcomes were examined at 6, 12, and 24 months postinjury. One thousand one hundred thirty-six burn survivors (692 vulnerable; 444 nonvulnerable) were included. The vulnerable group was mostly female, unemployed at time of injury, and with smaller burns. Both groups received similar OT/PT and psychological services at all time points. Adjusted regression analyses found that while the groups received similar amounts services, some vulnerable subgroups received significantly more services. Participants 65 years of age or older, who received psychological therapy or counseling prior to injury, and with a preexisting disability received more OT/PT and psychological or peer support services at follow-up. Overall, vulnerable and nonvulnerable groups received comparable OT/PT and psychological services. The importance of long-term care among vulnerable subgroups of the burn population is highlighted by this study. Future work is needed to determine adequate levels of follow-up services. [ABSTRACT FROM AUTHOR]

We have encountered many burn cases with lower extremity burn with adverse outcome. The study was a retrospective cohort study in 2 years, mean (SD) of follow up was 12(7) months. All demographic data, cause burn, time, total burn surface area (TBSA), presence lower extremity burn and its burn surface area (BSA), foot burn, delay in treatment, smoking, infection, morbidity, co-morbid diseases, length of stay (LOS), amputation, mortality, and outcome were gathered from patients' files. Statistical analysis was done with SPSS 21software. We had 14,215 burn patients, of them 995 were admitted according to criteria of ABA. Six hundred and ten (61.3%) were male and 358 (37%) female. Male to female ratio was 1.58:1. The mean age ± SD was 33.64 ±23.45. Mean (SD) of lower extremity BSA was 12.09 ± 9.18%. The patients who had 10 to 19% burn, had 3 times more risk of mortality than patients with 0 to 9% burn (P < .018). And those with 20 to 29% burn had 35 times more risk of mortality comparing to patients with 0 to 9% burn. The difference was significant too. (P < .000). Delay in treatment, presence of co-morbid diseases and diabetes would not do any increase in mortality. The sex, weight, cause of burn, diabetes, and delay in treatment have not any influence on the death risk. But age and lower extremity BSA have influence on the risk of death. According to statistical study: with every 1-year increase in age, death rate increased by 4% (P < .0001). With every 1% increase in lower extremity BSA, death rate increase by 9% (P < .0005) and with every 1 day increase in LOS, the death rate increase by 4%. Statistical study shows lower extremity burn, TBSA, age, and LOS have great influence on the outcome of these patients. Sex, weight, cause of burn, and delay in treatment have not affected the risk of mortality. [ABSTRACT FROM AUTHOR]

Burn treatment and management is largely patient-dependent and self-care education helps reducing tangible and intangible costs as well as improving quality of care. Thus, this study aimed to develop a smartphone application for burn self-care. This research, conducted in 2018, consisted of two phases. Initially, the educational content required for the application was determined based on the literature review and clinicians' and patients' perspectives. The setting of the study was the largest burn and plastic surgery hospital in the country. Based on the results derived from the first phase of the study, the application prototype was designed in the Persian language to be used on smartphones. The usability of the application was evaluated by using a standard questionnaire and the data were analyzed by using descriptive statistics. The educational content of the application included eight different areas of self-care; namely, wound care, scar management, care and control of hypertrophic burn scars, nutrition, in-home pain management, mental health, follow-up, and rehabilitation. A specialist was consulted and related texts and images were selected to be included in the application. The application was used by burn patients for a week and users evaluated its usability at a good level. It seems that the application designed in the present study can help to increase patients' knowledge about burn conditions and improve their self-care skills. Further studies are needed to present the efficiency and effectiveness of the application in practice. [ABSTRACT FROM AUTHOR]

Burn scar contractures. Existing research on contractures is limited by incomplete analysis of potential contributing variables and differing protocols. This study expands the exploration of contributing variables to include surgery and rehabilitation treatment-related factors. Additionally, this study quantifies direct patient therapy time and patient exposure to rehabilitation prevention therapies. Data from subjects enrolled in the prospective Burn Patient Acuity Demographics, Scar Contractures and Rehabilitation Treatment Related to Patient Outcome Study (ACT) were analyzed to determine variables related to a limited range of motion (limROM) in seven joints and 18 motions (forearm supination) at discharge. Chi-squared and Student's t-test were used accordingly. Multivariate analysis was performed at the patient and joint motion level to control for confounders. Of the 300-member study group, 259 (86.3%) patients had limROM at discharge. Variables independently related to the development of moderate-to-severe limROM on the patient level were larger TBSA, having skin grafted and prolonged bed rest. Variables independently related to moderate-severe limROM on the joint motion level were the percentage of cutaneous functional unit (CFU) burned (P = .044), increase in the length of stay, weight gain, poor compliance with rehabilitation therapy and lower extremity joint burns. Rates of limROM are increased in patients who had larger burns, required surgery, had a greater percentage of the associated CFU burned, and had lower extremity burns. Attention to adequate pain control to ensure rehabilitation tolerance and early ambulation may also decrease limROM at discharge and quicker return to pre-burn activities and employment. [ABSTRACT FROM AUTHOR]

Pediatric burn injuries are vulnerable to severe complications, most often infection, making prompt and precise diagnosis of bacterial bioburden vital to preventing detrimental consequences and optimizing patients' outcomes. Currently, burn wounds are assessed for infection via examining the clinical signs and symptoms of infection, which can be confirmed by swab culture analysis. While the former approach is subjective and experience-dependant, the latter technique is susceptible to missing subsurface, biofilm-associated colonization, and any peripheral bacterial burden, and also delays confirmation by up to 5 days. The MolecuLight i:X is a handheld, noncontact fluorescence imaging device, which can reveal real-time information about clinically significant levels of bacteria and their biodistribution in surface and subsurface burn wound tissues. We conducted a single-center observational study to assess the device efficacy in identifying critical bacterial levels in pediatric burn wounds and to test the children's compliance and the overall feasibility of the device integration into the current diagnostic practice. Ten patients with 16 wounds were recruited and assessed for the presence or absence of clinical signs and symptoms of infection and the presence or absence of bacterial fluorescence on images, with swabs taken to confirm findings. Results demonstrate the device's ability to visualize clinically significant bacterial burden and to localize distribution of pathogens. All clinicians agreed on the high compliance with the device and high feasibility of incorporating the device into routine wound assessments. The results of this study may pave the way toward including bacterial fluorescence imaging into the standard diagnostic algorithm for pediatric burn population. [ABSTRACT FROM AUTHOR]

Early recognition of the need for escharotomy and other decompressive therapies is imperative for experienced burn providers, as to avoid reversible tissue ischemia and necrosis. With full-thickness burns, the eschar that develops is largely noncompliant. The predictable edema that develops during resuscitation of larger burns increases the likelihood ischemia-inducing pressure, as the underlying tissues swell within noncompliant skin, resulting in burn-induced compartment syndrome. Conventionally, this has been treated with decompressive therapies, such as escharotomy. The most recent surveys have identified that the United States and Canada both face a shortage of practicing burn surgeons. In the event of a burn disaster, many nonburn surgeons would need to provide burn care, including decompressive therapies. We reviewed the literature to provide accurate, accessible, and applicable recommendations regarding this practice following burn injury for both the practicing burn surgeon and those that would provide care in the burn disaster. [ABSTRACT FROM AUTHOR]

This study aims to evaluate the efficacy of Nile tilapia skin as a xenograft for the treatment of partial-thickness burn wounds in children. This is an open-label, monocentric, randomized phase II pilot study conducted in Fortaleza, Brazil. The study population consisted of 30 children between the ages of 2 and 12 years with superficial "partial-thickness" burns admitted less than 72 hours from the thermal injury. In the test group, the tilapia skin was applied. In the control group, a thin layer of silver sulfadiazine cream 1% was applied. Tilapia skin showed good adherence to the wound bed, reducing the number of dressing changes required, the amount of anesthetics used, and providing benefits for the patients and also for healthcare professionals, by reducing the overall work load. The number of days to complete burn wound healing, the total amount of analgesics required throughout the treatment, burn improvement on the day of dressing removal, and pain throughout the treatment were similar to the conventional treatment with silver sulfadiazine. Thus, tilapia skin can be considered an effective and low-cost extra resource in the therapeutic arsenal of pediatric superficial partial thickness burns. [ABSTRACT FROM AUTHOR]

Vital, genetically engineered, porcine xenografts represent a promising alternative to human cadaveric allografts (HCA) in the treatment of severe burns. However, their clinical value would be significantly enhanced if preservation and long-term storage-without the loss of cellular viability-were feasible. The objective of this study was to examine the direct impact of cryopreservation and the length of storage on critical in vivo and in vitro parameters, necessary for a successful, potentially equivalent substitute to HCA. In this study, vital, porcine skin grafts, continuously cryopreserved for more than 7 years were compared side-by-side to otherwise identically prepared skin grafts stored for only 15 minutes. Two major histocompatibility complex (MHC)-controlled donor-recipient pairs received surgically created deep-partial wounds and subsequent grafting with split-thickness porcine skin grafts, differentiated only by the duration of storage. Clinical and histological outcomes, as well as quantification of cellular viability via a series of 3-4,5-dimethylthiazol-2-yl]-2,5 diphenyltetrazolium bromide (MTT) assays, were assessed. No statistically significant differences were observed between skin grafts cryopreserved for 15 minutes vs 7 years. Parametric distinctions between xenografts stored for short- vs long-term durations could not be ascertained across independent clinical, histological, or in vitro evaluative methods. The results of this study validate the ability to reliably preserve, store, and retain the essential metabolic activity of porcine tissues after cryopreservation. Plentiful, safe, and readily accessible inventories of vital xenografts represent an advantageous solution to numerous limitations associated with HCA, in the treatment of severe burns. [ABSTRACT FROM AUTHOR]

Sulfur mustard burns are characterized by delayed symptoms, slow healing, and recurrence after closure. Incomplete debridement at the level of the basement membrane is the postulated cause. Graham pioneered laser debridement of mustard burns. For field or mass-casualty use, saline wet-to-wet or antibiotic-soak debridement is more practical. In this study, we compared laser, saline, and antibiotic debridement in a porcine model of deep partial-thickness injury. Deep-dermal sulfur mustard burns were produced in 18 anesthetized Gottingen minipigs using 10-μl saturated vapor cap exposure time of 90 minutes. Debridement was started 48 hours postinjury and consisted of a single laser treatment; 5 days of 5% aqueous mafenide acetate wet-to-wet dressings; or 7 to 12 days of saline wet-to-wet dressings. Wounds were treated with daily silver sulfadiazine for 30 days and, then, assessed by histopathology, silver-ion analysis, colorimetry, and evaporimetry. All wounds healed well with no sign of infection. Antibiotic debridement showed no advantage over saline debridement. There were no significant differences between groups for colorimetry or evaporimetry. Histopathology was graded on a mustard-specific scale of 1 to 15 where higher values indicate better healing. Mean histology scores were 13.6 for laser, 13.9 for mafenide, and 14.3 for saline. Saline debridement statistically outperformed laser (P < .05) but required the longest debridement time. Laser debridement had the benefit of requiring a single treatment rather than daily dressing changes, significantly decreasing need for wound care and personnel resources. Development of a ruggedized laser for field use is a countermeasures priority. [ABSTRACT FROM AUTHOR]

It is well-established that survival in burn injury is primarily dependent on three factors: age, percent total-body surface area burned (%TBSA), and inhalation injury. However, it is clear that in other (nonburn) conditions, nonmedical factors may influence mortality. Even in severe burns, patients undergoing resuscitation may survive for a period of time before succumbing to infection or other complications. In some cases, though, families in conjunction with caregivers may choose to withdraw care and not resuscitate patients with large burns. We wanted to investigate whether any nonmedical socioeconomic factors influenced the rate of early deaths in burn patients. The National Burn Repository (NBR) was used to identify patients that died in the first 72 hours after injury and those that survived more than 72 hours. Both univariate and multivariate regression analyses were used to examine factors including age, gender, race, comorbidities, burn size, inhalation injury, and insurance type, and determine their influence on deaths within 72 hours. A total of 133,889 burn patients were identified, 1362 of which died in the first 72 hours. As expected, the Baux score (age plus burn size), and inhalation injury predicted early deaths. Interestingly, on multivariate analysis, patients with Medicare (p = .002), self-pay patients (p < .001), and those covered by automobile policies (p = .045) were significantly more likely to die early than those with commercial insurance. Medicaid patients were more likely to die early, but not significantly (p = .188). Worker's compensation patients were more likely to survive the first 72 hours compared with patients with commercial insurance (p < .001). Men were more likely to survive the early period than women (p = .043). On analysis by race, only Hispanic patients significantly differed from white patients, and Hispanics were more likely to survive the first 72 hours (p = .028). Traditional medical factors are major factors in early burn deaths. However, these results show that nonmedical socioeconomic factors including race, gender, and especially insurance status influence early burn deaths as well. [ABSTRACT FROM AUTHOR]

With the ongoing implementation of a competency-based medical education (CMBE) model for residency programs in North America, emphasis on the duration of training has been refocused onto ability and competence. This study aims to determine the exposure of burn-related core procedural competencies (CPCs) in Canadian Plastic Surgery Residents in order to enhance curricular development and help define its goals. A retrospective review of burn-related resident case logs encompassing all 10 English-speaking plastic surgery residency programs from 2004 to 2014 was performed, including analysis of personal competence scores and resident role by Postgraduate Year (PGY)-year. Case logs of a total of 55 graduating plastic surgery residents were included in the study. Overall, 4033 procedures in burn and burn-related care were logged, accounting for 6.8% of all procedures logged. On average, each resident logged 73 burn procedures, 99% of which were CPCs. The most frequently performed procedure was harvest and application of autograft, allograft, or xenograft, while emergent procedures such as escharotomy and compartment release were performed on average less than one time per resident. Personal competence scores as well as role of the resident (surgical responsibility) increased as PGY-year progressed during residency. Canadian plastic surgery residency programs provide adequate exposure to the majority of the scope of burn care and surgery. However, infrequently encountered but critical procedures such as escharotomy and fasciotomy may require supplementation through dedicated educational opportunities. CMBE should identify these gaps in learning through facilitation of resident competency evaluation. With consideration for the amount of exposure to burn-related CPCs as identified, plastic surgery residency programs can work toward achieving competency in all aspects of burn care and surgery prior to the completion of residency. [ABSTRACT FROM AUTHOR]