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Background: Patients with major burn injuries are prone to massive blood loss owing to tangential excision of burn wounds and donor skin harvesting. In general, topical application of the antifibrinolytic drug tranexamic acid (TXA) to surgical wounds reduces bleeding; however, its effect on bleeding and re-epithelialization in superficial wounds of burns has not been explored., Methods: This study aimed to investigate the therapeutic potential of topical TXA in reducing blood loss and its effect on wound re-epithelialization in burn surgery. Split-thickness skin graft donor wounds in burn patients were paired and randomized to topical application of either TXA (25 mg/mL) or placebo. Endpoints were postoperative bleeding as measured by dressing weight gain per cm 2 wound area, blood stain area per wound area, and visual evaluation of bleeding in the dressings. Healing time was recorded to analyze the effect on wound re-epithelialization., Results: There was no significant difference in bleeding or time to re-epithelialization between the TXA and placebo wounds. A post hoc subanalysis of wounds with dressing weight gain above the median, showed a significant difference in favor of TXA. However, use of tumescence may have influenced end points. No significant adverse events related to the study drugs were observed., Conclusions: This study demonstrates that topical application of TXA (25 mg/mL) to split-thickness skin graft donor wounds does not delay re-epithelialization. Although a reduction in bleeding is suggested, further studies are needed to determine the role of topical TXA in reducing bleeding in burn surgery., Competing Interests: The authors have no financial interest to declare in relation to the content of this article. K.A. received a grant from The Liaison Committee between the Central Norway Regional Health Authority and the Norwegian University of Science and Technology-NTNU, Trondheim, Norway (Grant ID no. 2016/29014). This study was also partially funded by an unrestricted research grant from Pfizer (Grant ID no. 6377247). The authors declare that otherwise they have no financial interest in any of the products, devices or drugs mentioned in this article., (Copyright © 2024 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons.)

Introduction: Pooling and comparing data from the existing global network of burn registers represents a powerful, yet untapped, opportunity to improve burn prevention and care. There have been no studies investigating whether registers are sufficiently similar to allow data comparisons. It is also not known what differences exist that could bias analyses. Understanding this information is essential prior to any future data sharing. The aim of this project was to compare the variables collected in countrywide and intercountry burn registers to understand their similarities and differences., Methods: Register custodians were invited to participate and share their data dictionaries. Inclusion and exclusion criteria were compared to understand each register population. Descriptive statistics were calculated for the number of unique variables. Variables were classified into themes. Definition, method, timing of measurement, and response options were compared for a sample of register concepts., Results: 13 burn registries participated in the study. Inclusion criteria varied between registers. Median number of variables per register was 94 (range 28 - 890), of which 24% (range 4.8 - 100%) were required to be collected. Six themes (patient information, admission details, injury, inpatient, outpatient, other) and 41 subthemes were identified. Register concepts of age and timing of injury show similarities in data collection. Intent, mechanism, inhalational injury, infection, and patient death show greater variation in measurement., Conclusions: We found some commonalities between registers and some differences. Commonalities would assist in any future efforts to pool and compare data between registers. Differences between registers could introduce selection and measurement bias, which needs to be addressed in any strategy aiming to facilitate burn register data sharing. We recommend the development of common data elements used in an international minimum data set for burn injuries, including standard definitions and methods of measurement, as the next step in achieving burn register data sharing., Competing Interests: Declaration of Competing Interest All authors, with the exception of AY, have completed an International Committee of Medical Journal Editors disclosure of interest form at www.icmje.org/disclosure-of-interest/. EB, JM, MB, RLB, LD, ME, YI, LP, NZ, and YS do not have any interests to declare. NB declares financial payments from Central Ohio Trauma Services as an ATLS instructor, Mallinckrodt Pharmaceuticals as a speaker, Vericel Corporation as an instructor, and Carpenter Lipps and Leland for expert testimony. NB receives a stipend from The Ohio State University for travel and meetings. NB is a board member of the Trauma Intervention Program and Epic Trauma steering board, both of which are unpaid positions. KM declares that the contents of this manuscript relating to the Burn Model System were developed under a grant from the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR grant number 90DPGE0004). NIDILRR is a Center within the Administration for Community Living (ACL), Department of Health and Human Services (HHS). The contents of this manuscript do not necessarily represent the policy of NIDILRR, ACL, HHS, and you should not assume endorsement by the Federal Government. OCT is the lead of the German Burn Registry and member of the steering committee of the German Society for Burn Treatment. LMT is a Representative on the Burns Registry of Australia and New Zealand steering committee, and representative on the Australian and New Zealand Burn Association board. KD is the medical director of the International Burn Injury Database. As part of this role, he is the co-chair of the Burn Care Informatics Group. This is a part time role funded by the NHS., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: The quality of burn care is highly dependent on the initial assessment and care. The aim of this systematic review was to investigate the agreement of clinical assessment of burn depth and %TBSA between the referring units and the receiving burn centres., Methods: Included articles had to meet criteria defined in a PICO (patients, interventions, comparisons, outcomes). Relevant databases were searched using a predetermined search string (November 6th 2021). Data were extracted in a standardised fashion. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach for test accuracy was used to assess the certainty of evidence. The QUADAS-2 tool was used to assess the risk of bias of individual studies as 'high', 'low' or 'unclear'., Results: A total of 412 abstracts were retrieved and of these 28 studies with a total of 6461 patients were included, all reporting %TBSA and one burn depth. All studies were cross-sectional and most of them comprising retrospectively enrolled consecutive cohort. All studies showed a low agreement between %TBSA calculations made at referring units and at burn centres. Most studies directly comparing estimations of %TBSA at referring institutions and burn centers showed a proportion of overestimations of 50% or higher. The study of burn depth showed that 55% were equal to the estimates from the burn centre. Most studies had severe study limitations and the risk of imprecision was high. The overall certainty of evidence for accuracy of clinical estimations in referring centres is low (GRADE ⊕⊕ОО) for %TBSA and very low (GRADE ⊕ООО) for burn depth and resuscitation., Conclusion: Overestimation of %TBSA at referring hospitals occurs very frequently. The overall certainty of evidence for accuracy of clinical estimations in referring centres is low for burn size and very low for burn depth. The findings suggest that the burn community has a significant challenge in educating and communicating better with our colleagues at referring institutions and that high-quality studies are needed., (Copyright © 2022 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Background: The number of burn patients over the age of 75 receiving advanced treatment, including extensive surgery and intensive care, is increasing. We aimed to describe the treatment and outcomes for burn patients over the age of 75 admitted to the National Burn Centre at Haukeland University Hospital. We also wanted to investigate whether frailty scores can be a predictor of the treatment outcome., Material and Method: All patients ≥ 75 years admitted to the National Burn Centre at Haukeland University Hospital in the period 2000-19 were included in the study. Frailty scores were calculated retrospectively based on patients' medical records., Results: Our study included 101 patients (50 women and 51 men). The number of admissions of older burn patients increased from an average of 3.3 per year in 2000-14 to 10.2 in the period 2015-19. The median total body surface area with burns was 11 % (range 0.9-80 %). Seventeen patients received palliative care, and 12 patients receiving active treatment died in hospital. In 68 of 84 (81 %) actively treated patients, tangential excision and split-thickness skin grafting were performed. The remainder received conservative treatment (non-surgical) with wound care and application of a silver dressing. Patients who died in hospital had a significantly higher total body surface area with burns (p < 0.0001) and higher frailty scores (p = 0.003) than patients who survived., Interpretation: The yearly number of patients over the age of 75 treated at the National Burn Centre tripled during the period. More than two-thirds of the patients were discharged alive. Extent of burn injury and frailty score are associated with mortality and may be useful for adjusting therapy.

Cellular therapies for burn wound healing, including the administration of mesenchymal stem or stromal cells (MSCs), have shown promising results. This review aims to provide an overview of the current administration methods in preclinical and clinical studies of bone-marrow-, adipose-tissue-, and umbilical-cord-derived MSCs for treating burn wounds. Relevant studies were identified through a literature search in PubMed and Embase and subjected to inclusion and exclusion criteria for eligibility. Additional relevant studies were identified through a manual search of reference lists. A total of sixty-nine studies were included in this review. Of the included studies, only five had clinical data from patients, one was a prospective case-control, three were case reports, and one was a case series. Administration methods used were local injection (41% in preclinical and 40% in clinical studies), cell-seeded scaffolds (35% and 20%), topical application (17% and 60%), and systemic injection (1% and 0%). There was great heterogeneity between the studies regarding experimental models, administration methods, and cell dosages. Local injection was the most common administration method in animal studies, while topical application was used in most clinical reports. The best delivery method of MSCs in burn wounds is yet to be identified. Although the potential of MSC treatment for burn wounds is promising, future research should focus on examining the effect and scalability of such therapy in clinical trials., Competing Interests: The authors declare no conflicts of interest.

Background: The objective of this article is to elucidate the scope of burn injuries in Norway, on the basis of those patients who had sustained a burn injury that caused hospitalisation through a calendar year., Material and Method: The article is based on data retrieved from the Norwegian Patient Registry on patients discharged from Norwegian hospitals in 2012 with a burn injury as their main diagnosis, supplemented with activity data for children admitted to the Burn Unit, Haukeland University Hospital, Bergen, during the period 2013 – 15., Results: In 2012, altogether 620 people (12.4/100 000 inhabitants) were hospitalised with burn injuries. Of these patients, 393 (63.4 %) were men. A total of 375 patients (60 %) were hospitalised more than once, and 124 (20 %) were admitted to more than one hospital. Altogether 367 patients (59 %) were hospitalised for less than eight days. Average hospitalisation time for the group as a whole was 11.3 days (SD 18.8 days). Many of the burn-injured patients were young: the average age was 27.4 years (SD 26.0 years). As many as 183 patients (30 %) were less than three years old. Children in this age group were admitted for burn injuries 12 times more frequently than children ≥ 5 years and adults., Interpretation: We found no definite reduction in burn injuries as a cause for admission to Norwegian hospitals in 2012 when compared to results from previous studies for the period 1992 – 2007. There ought to be a major potential for more effective prevention of burn injuries in the age group < 3 years, in which scalding (78 %) and contact with hot surfaces (most often stoves) (17 %) are the main mechanisms of injury.