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Introduction Posttraumatic growth (PTG) is “the subjective experience of positive psychological change reported by an individual as a result of the struggle with trauma” (Zoellner and Maercker, 2006 [1]). PTG after burn is similar to PTG after other types of trauma (Martin et al., 2016 [2]). The aim was to assess the relationship between coping styles, via the BriefCOPE (Carver et al., 1989 [ 3 ]), and posttraumatic growth via the Posttraumatic Growth Inventory (Cann et al., 2010 [4]), in an adult burn population. Method 36 burn patients who required surgery for wound closure were recruited within 2 years of their burn. They completed the PTGI, DASS-D, and BriefCOPE, and again one month later. Regression analysis with backwards elimination assessed the relationships between coping styles, depression and posttraumatic growth. Results Of the 14 coping types identified in the BriefCOPE, three were associated with PTG after burn: positive reframing, religion and acceptance. Three coping strategies were associated with greater levels of depression: behavioural disengagement, venting and self-blame. Conclusion Behavioural disengagement, venting and self-blame behaviours can be used as ‘red flags’ to trigger early screening for depression and to enable timely treatment of depression. To maximise posttraumatic growth interventions that promote positive reframing, use of religion, and acceptance are necessary.

Background The objective of this study was to describe and quantify the long-term hospital service use (HSU) after burn injury and associated costs in a population-based cohort of patients with unintentional burns and compare with uninjured people. Methods This retrospective population-based cohort study analysed de-identified linked health administrative data of all unintentional burns patients (n = 10,460) between 2000 and 2012 in Western Australia and a matched uninjured comparison cohort (n = 42,856). HSU after burn injury (annual admission counts and cumulative length of stay) was examined. HSU costs were based on the Australian Refined Diagnosis Related Groups (AR-DRGs) code on each record. Generalised linear models were used to examine and quantify associations between burn injury and long-term HSU and associated costs. Results There were 48,728 hospitalisations after burn occurring within the study period in the burn cohort; in the uninjured comparison cohort, there were 53,244 post-study index hospitalisations. Of those in the burn cohort, 63.9% (n = 6828) had a further hospitalisation after burn injury; this compared with 40.4% (n = 17,297) in the uninjured cohort. After adjustment for socio-demographic and pre-existing health conditions the burn cohort had 2.48 times the hospitalisation rate compared to the uninjured cohort (95% CI: 2.33–2.65). The cost of post-index hospitalisations in the burn cohort totalled to $AUS248.3 million vs $AUS240.8 million in the uninjured cohort. After adjustment, the burn cohort had hospital costs 2.77 times higher than the uninjured controls (95% CI: 2.58–2.98). Conclusions After adjustment for covariates, burn patients experienced greater hospital use for a prolonged period after the initial injury compared with uninjured people. The mean cost per episode of care was generally higher for members of the burn cohort compared to the uninjured cohort indicating either more complicated admissions or admissions for more expensive conditions.

Long-term laryngotracheal complications (LTLC) after inhalation injury (II) are an under-recognized condition in patients with burns. The purpose of this study was to systematically review all available evidence on LTLC after II and identify gaps in knowledge to guide the direction of future research. A scoping review was performed to synthesize all available evidence on LTLC after II, as guided by the question, “What are the LTLC after II, in patients with or without a history of translaryngeal intubation and/or tracheostomy?”. MEDLINE, Web of Science, Ovid Embase, Cochrane Library, and Google Scholar were searched for publications on this topic. Of the 3567 citations screened, a total of 153 full-text articles were assessed for eligibility and 49 were included in the scoping review. The overall level of evidence was low, with case reports constituting 46.7% of all included human studies. The lesions were most frequently in the trachea (36.9%), followed by the glottis (34.7%) and subglottis (19.0%). LTLC occur in 4.8 to 6.5% of patients after II and these complications are under-recognized in burns patients. The risk factors for LTLC include high-grade II, elevated initial inflammatory responses, prolonged translaryngeal intubation, and a history of tracheostomy. The goal of management is to restore airway patency, preserve voice quality, and restore normal diet and swallow function. There is limited high-level evidence on LTLC, particularly with regards to long-term functional morbidity in voice and swallow. Large, prospective studies are required to address this gap in knowledge.

Burns are a common form of trauma in children. Common mechanisms of injury include scalds from hot beverages and contact burns from household items. The physical and psychological trauma may have long-lasting effects for both child and family. Children are not just small adults; there are important anatomical and physiological differences. Paediatric burn patients have specific treatment needs that must be accounted for. Estimation of burn size, threshold for commencement of intravenous fluid resuscitation and enteral feeding, in addition to wound assessment, wound care, and treatment are all different to a similar size injury in an adult. These paediatric-specific issues are discussed in more detail. The investigation and interpretation of suspected non-accidental burn presenting to a burns unit is also outlined.

Fungal kerion is a hypersensitivity reaction to a scalp dermatophyte which gains access to the hair shaft following physical trauma. However, precipitating injuries are rarely reported. We report the case of a 4-year-old girl who presented with non-healing scalp lesions following a deep dermal forehead scald caused by hot water. The third degree burn was epithelialized with two autologous split skin grafts from a donor thigh site. The grafts were complicated by early bacterial infection treated with intravenous antibiotics. The child returned to her remote community and was lost to follow up. Three months later, fungal kerion at the same site as the burn was clinically diagnosed and confirmed with culture of Trichophyton tonsurans from plucked hair samples. Her condition improved after treatment with oral terbinafine and co-trimoxazole (for suspected bacterial co-infection). Clinical recognition of fungal kerion following a deep burn injury as a trauma mechanism is presented to facilitate early recognition in other children with similar risk factors.

Burns cause acute damage to the peripheral nervous system with published reports identifying that neurological changes after injury remain for a prolonged period. To shed some light on potential mechanisms, we assessed injury etiology and patterns of nervous system morbidity after injury by comparing long-term hospital admissions data of burns patients and other non-burn trauma patients with uninjured people.Linked hospital and death data of a burn patient cohort (n=30,997) in Western Australia during the period 1980-2012 were analysed along with two age and gender frequency matched comparison cohorts: non-burn trauma patients (n=28,647) and; non-injured people (n=123,399). The number of annual NS disease admissions and length of stay (LOS) were used as outcome measures. Multivariable negative binomial regression modelling was used to derive adjusted incidence rate ratios and 95% confidence intervals (IRR, 95% CI) and adjusted Cox regression models and hazard ratios (HR) were used to examine time to first nervous system admission after burn and incident admission rates.The most common peripheral nervous system condition identified in each cohort (burn, non-burn trauma, uninjured) were episodic and paroxysmal disorders followed by nerve root and plexus disorders and polyneuropathies/peripheral NS conditions. Significantly elevated admission rates for NS conditions (IRR, 95% CI) were found for the burn (2.20, 1.86-2.61) and non-burn trauma (1.85, 1.51-2.27), compared to uninjured. Peripheral nervous system admission rates after injury (IRR, 95% CI) were significantly higher regardless of age at time of injury for the burn (15years: 1.97, 1.49-2.61; 15-45: 2.70, 2.016-3.55; ≥45year: 1.62, 1.33-1.97) and non-burn trauma cohorts (15years: 1.91, 1.55-2.35; 15-45: 1.94, 1.51-2.49; ≥45year: 1.42, 1.18-1.72), when compared to the uninjured. Significantly higher rates of incident NS hospitalisations were found for the burn cohort vs. uninjured cohort for a period of 15-years after discharge (0-5 years: HR, 95% CI: 1.97, 1.75-2.22; 5-15 years; HR, 95% CI: 1.44, 1.28-1.63). The non-burn trauma cohort had significantly higher incident nervous system admissions for 10 years after discharge (0-30 days: HR, 95% CI: 4.75, 2.44-9.23; 30days to 1-year HR, 95% CI: 2.95, 2.34-3.74; 1-5 years; HR, 95% CI: 1.47, 1.26-1.70; 5-10 years; HR, 95% CI: 1.34, 1.13-1.58).Results suggest that injury patients are at increased risk of peripheral nervous system morbidity after discharge for a prolonged period of time. The time patterns associated with incident nervous system conditions suggest possible differences in underlying pathology and long-term patient care needs. Further research is needed to elucidate the underlying neuropathology.

Summary Aim To investigate the effect of ablative fractional CO2 laser (AFCO2L) on burns scar appearance and dermal architecture at 6 weeks and up to 3-years post-treatment. Methods Twenty adult patients with a burn-related scar were recruited. Inclusion criteria were a minimum scar area of 10 × 10 cm and Vancouver scar scale (VSS) score of >5 and ≥6 months since the time of injury. The region of scar was randomised to treatment/control zones. Treatment zones received 3 standardised laser treatments at 4- to 6-week intervals. All areas of scar received standard scar care. Outcome measures were recorded at baseline, 6-weeks post final treatment and up to 3 years post-treatment. Measures included blinded assessor VSS, Patient Scar Assessment Scale and histological tissue analysis. Results Nineteen and nine patients completed the short- and long-term studies, respectively. Clinical results revealed improvement in all scar areas over time. There was a statistically significant improvement in pain and itch in the treatment zone compared to the control zone at 6 weeks. Histological data revealed a significant increase in medium-sized collagen fibres at 6 weeks relative to the control site. Sub-group analysis according to scar age revealed greater histological improvement following laser treatment in immature scars relative to more mature scar. Conclusions Results demonstrate that 3 treatments of AFCO2L significantly improve scar pain, itch and dermal architecture at 6 weeks post-treatment. Histological results suggest greater potential in treating immature scar. Further investigation into the timing of laser treatment could help assist treatment protocols.

ObjectiveTo quantify postinjury cardiovascular-related health service use experienced by mid to older aged adults hospitalised for injury, compared with uninjured adults. Additionally, to explore the effect of beta-blocker medications on postinjury cardiovascular hospitalisations among injury patients, given the potential cardioprotective effects of beta blockers.DesignA retrospective cohort study using linked administrative and survey data.ParticipantsRecords of 35 026 injured and 60 823 uninjured matched adults aged over 45 from New South Wales, Australia, who completed the 45 and up survey.Primary and secondary outcome measuresAdmission rates and cumulative lengths of stay for cardiovascular hospitalisations, and prescription rates for cardiovascular medications. Negative binomial and Cox proportional hazards regression modelling were used to generate incident rate ratios (IRRs) and HR.ResultsCompared with the uninjured, those with injury had a 19% higher adjusted rate of postinjury cardiovascular admissions (IRR 1.19, 95% CI 1.14 to 1.25), spent 40% longer in hospital for ardiovascular disease (IRR 1.40, 95% CI 1.26 to 1.57) and had slightly higher cardiovascular prescription rates (IRR 1.04, 95% CI 1.02 to 1.06), during study follow-up. Those in the injury cohort that used beta blockers both prior to and after injury (continuous) appeared to have reduced need for post-injury cardiovascular hospitalisation (IRR 1.09, 95% CI 1.17 to 1.42) compared with those commencing on beta blockers after injury (after 30 days: IRR 1.69, 95% CI 1.37 to 2.08).ConclusionsApparent increased postinjury hospitalisation rates and prolonged length of stay related to cardiovascular disease suggest that injury patients may require clinical support for an extended period after injury. Additionally, injury patients who were on continuous beta blocker treatment appeared to have lower need for post-injury cardiovascular hospitalisations. However, the data do not allow us to draw clear conclusions and further clinical research is required.

Background The objective of this study was to describe and quantify mental health (MH) admissions experienced by patients with unintentional burns subsequent to their injury. Methods A retrospective population-based cohort study that used de-identified linked hospital, death and mental health in-patient case registry data of all burn patients hospitalised for unintentional burns (n = 10,460) between 2000 and 2012 in Western Australia and an age and gender matched uninjured comparison cohort (n = 42,856). Cohorts had a median age at study index of 26 years with males comprising 66% of each cohort. MH admissions for 5 years before and after the injury were examined. Negative binomial and Cox proportional hazards regressions were adjusted for socio-demographic and pre-existing health conditions and used to quantify associations between burns and MH hospitalisations. Results In the burn cohort during the 5-year post-burn period, 4% had a MH admission, 2% were admitted for self-harm, and 3% were admitted for a behavioural disorder caused by drugs/alcohol. Significantly elevated adjusted admission rates for MH conditions were observed for the burn cohort compared with the uninjured cohort (IRR, 95% CI: 4.89, 3.52–6.79). Increased MH admission rates were found for all age groups but were most pronounced in those younger than 18 years of age at time of burn (IRR, 95% CI: 6.28, 3.00–13.14), followed by those aged 18–60 (5.14, 3.59–7.35) and those over 60 years (IRR, 95% CI: 2.97, 1.38–6.39) compared to the uninjured cohort. Gender-specific analyses showed significant differences for male (IRR, 95% CI: 4.48, 3.05–6.59) and female burn patients (IRR, 95% CI: 6.00, 3.62–9.92), compared to uninjured. The burn cohort had higher adjusted first time admissions for MH conditions (HR, 95% CI: 3.55, 2.72–4.64), mood and anxiety disorders (HR, 95% CI: 3.77, 2.81–5.08), psychotic disorders (HR, 95% CI: 3.55, 1.99–6.15) and behavioural disorders related to alcohol/drugs (HR, 95% CI: 4.75, 3.09–7.28) for five years after the initial burn. Conclusions Patients hospitalised for unintentional burns had significantly higher MH admission rates after discharge than that observed for an uninjured cohort. Ongoing mental health support is clearly indicated for many burns patients for a prolonged period after discharge.

Objective To compare hospitalisations for diabetes mellitus (DM) after injury experienced by burn patients, non-burn trauma patients and people with no record of injury admission, adjusting for socio-demographic, health and injury factors. Methods Linked hospital and death data for a burn patient cohort (n = 30,997) in Western Australia during the period 1980–2012 and two age and gender frequency matched comparison cohorts: non-burn trauma patients (n = 28,647); non-injured people (n = 123,399). The number of DM admissions and length of stay were used as outcome measures. Multivariate negative binomial regression was used to derive adjusted incidence rate ratios and 95% confidence intervals (IRR, 95%CI) for overall post-injury DM admission rates. Multivariate Cox regression models and hazard ratios (HR) were used to examine time to first DM admission and incident admission rates after injury discharge. Results The burn cohort (IRR, 95%: 2.21, 1.80–2.72) and other non-burn trauma cohort (IRR, 95%CI: 1.63, 1.24–2.14) experienced significantly higher post-discharge admission rates for DM than non-injured people. Compared with the non-burn trauma cohort, the burn cohort experienced a higher rate of post-discharge DM admissions (IRR, 95%CI: 1.40, 1.07–1.84). First-time DM admissions were significantly higher during first 5-years after-injury for the burn cohort compared with the non-burn trauma cohort (HR, 95%CI: 2.00, 1.31–3.05) and non-injured cohort (HR, 95%CI: 1.96, 1.46–2.64); no difference was found >5 years (burn vs. non-burn trauma: HR, 95%CI: 0.88, 0.70–1.12; burn vs non-injured: 95%CI: 1.08 0.82–1.41). No significant difference was found when comparing the non-burn trauma and non-injured cohorts (0–5 years: HR, 95%CI: 1.03, 0.71–1.48; >5years: HR. 95%CI: 1.11, 0.93–1.33). Conclusions Burn and non-burn trauma patients experienced elevated rates of DM admissions after injury compared to the non-injured cohort over the duration of the study. While burn patients were at increased risk of incident DM admissions during the first 5-years after the injury this was not the case for non-burn trauma patients. Sub-group analyses showed elevated risk in both adult and pediatric patients in the burn and non-burn trauma. Detailed clinical data are required to help understand the underlying pathogenic pathways triggered by burn and non-burn trauma. This study identified treatment needs for patients after burn and non-burn trauma for a prolonged period after discharge.

Posttraumatic growth is positive psychological change that occurs beyond pre-trauma levels. Understanding the relationship between growth, stress and quality of life after burn improves understanding about the nature of postburn psychological growth and associated quality of life factors. This study aimed to determine the nature of these relationships, and whether posttraumatic growth changed over time in individuals. Two hundred and seventeen surveys were collected from 73 adult burn patients. The Posttraumatic Growth Inventory, Depression, Anxiety and Stress Score, SF-36 quality of life and Burns Specific Health Score - Brief surveys, together with demographic and clinical information was collected over a six month period. Acute and non-acute burns were equally represented. Growth and stress were positively correlated (p=0.004), but depression and growth had a curved relationship (p=0.050). Growth scores reduced as affect (p=0.008) and mental health improved (p

Posttraumatic growth after burn is a relatively new area of study with only a small number of studies that have examined this phenomenon. It is important to understand the presentation of posttraumatic growth and coping in burn survivors, how it changes over time and the components which influence growth so that we can understand how to promote posttraumatic growth in burn survivors. The aim of this review was to assess these three parameters. Studies were identified through multiple databases with specific search terms to identify posttraumatic growth after burn. From the 813 articles found, 57 were identified as potentially useful, and 8 as eligible for review; three qualitative, one mixed methods, two quantitative, one discussion paper and part of a review which assessed all psychosocial outcomes. Growth presented as realising personal strength, reprioritising, spirituality, humanity, changed relationships, and compassion and altruism. Styles of coping included feelings of gratefulness and downward comparison, humour and planning. Suddenness of the event, and the severity and location of injury might affect the amount of growth experienced. Overall function, quality of life, social support and optimism, hope and new opportunities are influences on growth after burn, all of which have the potential for improvement through targeted intervention strategies. Further research is indicated in many areas related to growth, intervention and measurement.

Introduction Visible scarring after burn causes social challenges which impact on interpersonal connection. These have health impacts which may worsen outcomes for burn patients and reduce the potential for posttraumatic growth (PTG). Aim The aim of the study was to investigate adult burn survivors' experiences of interpersonal relationships as potential barriers to posttraumatic recovery following hand or face burns. Method This qualitative study explored patient experiences of interpersonal situations. A purposive sample ( n =16) who had visible burn scarring were interviewed more than two years after their burn. Results Emotional barriers included the fear of rejection, feelings of self-consciousness, embarrassment and humiliation. Situational barriers included inquisitive questions, comments and behaviours of others. Responses depended on the relationship with the person, how they were asked and the social situation. Active coping strategies included positive reframing, humour, changing the self, and pre-empting questions. Avoidant coping strategies included avoidance of eye contact, closed body language, hiding scars, and learning to shut down conversations. Conclusion Emotional and situational barriers reduced social connection and avoidant coping strategies reduced the interaction of people with burns with others. Active coping strategies need to be taught to assist with social reintegration. This highlights the need for peer support, family support and education, and social skills training.

Background Currently, limited long-term data on hyperglycaemia and insulin sensitivity in burn patients are available and the data that do exist are primarily related to paediatric severe burns. The aim of this study was to assess if burn is associated with increased post-burn admissions for diabetes mellitus. Methods A population-based longitudinal study using linked hospital morbidity and death data from Western Australia was undertaken of all persons hospitalized for a first burn (n = 30,997) in 1980–2012 and a frequency matched non-injury comparison cohort, randomly selected from Western Australia's birth registrations and electoral roll (n = 123,399). Crude admission rates and summed length of stay for diabetes mellitus were calculated. Negative binomial and Cox proportional hazards regression modelling were used to generate incidence rate ratios (IRR) and hazard ratios (HR), respectively. Results After adjustment for socio-demographic factors and pre-existing health status, the burn cohort had 2.21 times (95% Confidence Interval (CI): 1.36–1.56) as many admissions and almost three times the number of days in hospital with a diabetes mellitus diagnosis (IRR, 95% CI: 2.94, 2.12–4.09) than the uninjured cohort. Admission rates were significantly elevated for those burned during childhood (

We demonstrate the use of the near-infrared attenuation coefficient, measured using optical coherence tomography (OCT), in longitudinal assessment of hypertrophic burn scars undergoing fractional laser treatment. The measurement method incorporates blood vessel detection by speckle decorrelation and masking, and a robust regression estimator to produce 2D en face parametric images of the attenuation coefficient of the dermis. Through reliable co-location of the field of view across pre- and post-treatment imaging sessions, the study was able to quantify changes in the attenuation coefficient of the dermis over a period of ~20 weeks in seven patients. Minimal variation was observed in the mean attenuation coefficient of normal skin and control (untreated) mature scars, as expected. However, a significant decrease (13 ± 5%, mean ± standard deviation) was observed in the treated mature scars, resulting in a greater distinction from normal skin in response to localized damage from the laser treatment. By contrast, we observed an increase in the mean attenuation coefficient of treated (31 ± 27%) and control (27 ± 20%) immature scars, with numerical values incrementally approaching normal skin as the healing progressed. This pilot study supports conducting a more extensive investigation of OCT attenuation imaging for quantitative longitudinal monitoring of scars. (Figure presented.) En face 2D OCT attenuation coefficient map of a treated immature scar derived from the pre-treatment (top) and the post-treatment (bottom) scans. (Vasculature (black) is masked out.) The scale bars are 0.5 mm.

Posttraumatic growth (PTG) is "the subjective experience of positive psychological change reported as a result of the struggle with trauma". Very few studies have explored PTG after burn injury. The Posttraumatic Growth Inventory (PTGI) is a 21-item questionnaire which assesses five domains in which PTG has been found. First, the aim of this study was to assess how PTG presented after a severe burn, and second, whether it could be measured by the PTGI in Australian burn survivors.A mixed method approach was used. Seventeen patients who had a severe burn injury at least 2 years previously were interviewed and completed the PTGI. The interviews were analyzed, then compared to the PTGI responses.PTG in burn survivors had similarities to PTG arising from other trauma. Burn-specific context such as heat intolerance and functional problems influenced the type of changes made. Barriers to PTG in relationships were related to guilt burden and visible scarring.PTG presents similarly after burn to other trauma types, but has other features to consider when devising intervention strategies. The PTGI is a 5-min screening tool that adequately identifies the presence or absence of PTG in burn survivors in Western Australia, and can guide intervention.The Posttraumatic Growth Inventory is a 5-min screening tool that adequately identifies the degree of PTG in burn survivors in Western Australia. It is a quick and easy tool to use to identify the need for clinical intervention. It will also evaluate the effectiveness of strategies designed to target PTG. A mean score of 2.5 can be used as a threshold to guide intervention strategy.

Background Burns are a devastating injury that can cause physical and psychological issues. Limited data exist on long-term mental health (MH) after unintentional burns sustained during childhood. This study assessed long-term MH admissions after paediatric burns. Methods This retrospective cohort study included all children ( Results The burn cohort had a significantly higher adjusted rate of post-burn MH admissions compared to the uninjured cohort (IRR, 95% CI: 2.55, 2.07–3.15). Post-burn MH admission rates were twice as high for those younger than 5 years at index burn (IRR, 95% CI 2.06, 1.54–2.74), three times higher for those 5–9 years and 15–18 years (IRR, 95% CI: 3.21, 1.92–5.37 and 3.37, 2.13–5.33, respectively) and almost five times higher for those aged 10–14 (IRR, 95% CI: 4.90, 3.10–7.76), when compared with respective ages of uninjured children. The burn cohort had higher admission rates for mood and anxiety disorders (IRR, 95% CI: 2.79, 2.20–3.53), psychotic disorders (IRR, 95% CI: 2.82, 1.97–4.03) and mental and behavioural conditions relating to drug and alcohol abuse (IRR, 95% CI: 4.25, 3.39–5.32). Conclusions Ongoing MH support is indicated for paediatric burn patients for a prolonged period after discharge to potentially prevent psychiatric morbidity and associated academic, social and psychological issues.

BACKGROUND: Severe burn triggers systemic responses that result in reduced muscle mass and bone formation, with recent evidence also suggesting systemic effects on bone after minor burn. The aim of this study was to assess if children and adolescents who are hospitalised with a burn have increased long-term hospital service use for musculoskeletal conditions. METHODS: A population-based longitudinal study using linked hospital morbidity and death data from Western Australia was undertaken of those younger than 20 years when hospitalized for a first burn (n=13,244) during the period 1980-2012 and a frequency matched non-injury comparison cohort, randomly selected from Western Australia's birth registrations and electoral roll (n=51,021). Crude admission rates and cumulative length of stay for musculoskeletal diseases were calculated. Negative binomial and Cox proportional hazards regression modelling were used to generate incidence rate ratios (IRR) and hazard ratios (HR), respectively. RESULTS: After adjusting for demographic characteristics and pre-existing health status, those who were hospitalised for a burn had 1.87 times as many hospital admissions for a musculoskeletal disease (95%CI: 1.69-2.08) and spent 2.61 times as long in hospital with musculoskeletal disease (95%CI: 2.09-3.27), than the uninjured comparison cohort. The burn cohort had significantly higher rates of first time admissions over the study period for arthropathies (HR, 95%CI: 1.14, 1.00-1.29, p=0.047), dorsopathies (HR, 95%CL: 1.64, 1.29-2.08) and for soft tissue disorders (HR, 95%CI: 1.33, 1.11-1.60); results were not statistically significant for incident admissions for osteopathies and chrondropathies (HR, 95%CI: 1.07, 0.71-1.59) or connective tissue disorders (HR, 95%CI: 0.54, 0.24-2.09). CONCLUSIONS: These results identified elevated post-discharge hospital service use for diseases of the musculoskeletal system for a prolonged period after discharge for those with both severe and minor burns. Language: en

BACKGROUND: The systemic responses to burns (in particular, elevated levels of catecholamines and stress hormones) have been shown to have an impact on cardiac function for at least 3 years in children with burns. However, it is not clear if these changes lead to long-term effects on the heart. The aim of this study was to assess whether pediatric burn injury is associated with increased long-term hospital use for circulatory diseases. METHODS: A population-based longitudinal study was undertaken using linked hospital and death data from Western Australia for children younger than 15 years when hospitalized for a first burn injury (n = 10 436) in 1980–2012 and a frequency matched noninjury comparison cohort, randomly selected from Western Australia’s birth registrations (n = 40 819). Crude admission rates and cumulative length of stay for circulatory diseases were calculated. Negative binomial and Cox proportional hazards regression modeling were used to generate incidence rate ratios and hazard ratios, respectively. RESULTS: After adjustment for demographic factors and preexisting health status, the burn cohort had 1.33 (incidence rate ratio) times (95% confidence interval [CI]: 1.08–1.64) as many circulatory system hospitalizations, 2.26 times the number of days in hospital with a diagnosis of a circulatory disease (2.26, 95% CI: 1.06–4.81), and were at a higher risk of incident admissions (hazard ratio 1.22, 95% CI: 1.03–1.46), compared with the uninjured cohort. CONCLUSIONS: Children who sustain burn injury experience elevated hospital admission rates and increased length of hospital stay for diseases of the circulatory system for a prolonged period of time after burn discharge.

This study presents the first in vivo longitudinal assessment of scar vasculature in ablative fractional laser treatment using optical coherence tomography (OCT). A method based on OCT speckle decorrelation was developed to visualize and quantify the scar vasculature over the treatment period. Through reliable co-location of the imaging field of view across multiple imaging sessions, and compensation for motion artifact, the study was able to track the same scar tissue over a period of several months, and quantify changes in the vasculature area density. The results show incidences of occlusion of individual vessels 3 days after the first treatment. The subsequent responses ˜20 weeks after the initial treatment show differences between immature and mature scars. Image analysis showed a distinct decrease (25 ± 13%, mean ± standard deviation) and increase (19 ± 5%) of vasculature area density for the immature and mature scars, respectively. This study establishes the feasibility of OCT imaging for quantitative longitudinal monitoring of vasculature in scar treatment. En face optical coherence tomography vasculature images pre-treatment (top) and ˜20 weeks after the first laser treatment (bottom) of a mature burn scar. Arrows mark the same vessel pattern.

To assess if burn injury in older adults is associated with changes in long-term all-cause mortality and to estimate the increased risk of death attributable to burn injury.We conducted a population-based matched longitudinal study - based on administrative data from Western Australia's hospital morbidity data system and death register. A cohort of 6014 individuals who were aged at least 45 years when hospitalized for a first burn injury in 1980-2012 was identified. A non-injury comparison cohort, randomly selected from Western Australia's electoral roll (n = 25 759), was matched to the patients. We used Kaplan-Meier plots and Cox proportional hazards regression to analyse the data and generated mortality rate ratios and attributable risk percentages.For those hospitalized with burns, 180 (3%) died in hospital and 2498 (42%) died after discharge. Individuals with burn injury had a 1.4-fold greater mortality rate than those with no injury (95% confidence interval, CI: 1.3-1.5). In this cohort, the long-term mortality attributable to burn injury was 29%. Mortality risk was increased by both severe and minor burns, with adjusted mortality rate ratios of 1.3 (95% CI: 1.1-1.9) and 2.1 (95% CI: 1.9-2.3), respectively.Burn injury is associated with increased long-term mortality. In our study population, sole reliance on data on in-hospital deaths would lead to an underestimate of the true mortality burden associated with burn injury.Évaluer si les brûlures, chez les adultes âgés, sont associées à un changement de la mortalité à long terme toutes causes confondues et estimer la majoration du risque de décès attribuable aux brûlures.Nous avons réalisé une étude longitudinale appariée en population, à partir de données administratives extraites des registres de décès et du système de données sur la morbidité des hôpitaux d'Australie occidentale. Une cohorte de 6 014 individus, âgés d'au moins 45 ans au moment de leur première hospitalisation pour brûlures, sur la période de 1980 à 2012, a été identifiée. Une cohorte comparative d'individus n'ayant pas souffert de brûlures a été aléatoirement sélectionnée dans les listes électorales d'Australie occidentale (n = 25 759) pour appariement avec la cohorte des patients victimes de brûlures. Nous avons utilisé des courbes de Kaplan-Meier et une régression des risques proportionnels de Cox pour analyser les données et obtenir les ratios des taux de mortalité et les pourcentages de risque attribuable.Dans la cohorte des personnes hospitalisées pour brûlures, 180 personnes (3 %) sont décédées à l'hôpital et 2 498 personnes (42 %) sont décédées après leur sortie de l'hôpital. Nous avons trouvé un taux de mortalité 1,4 fois supérieur pour les victimes de brûlures comparativement aux individus non victimes de brûlures (intervalle de confiance de 95 % : 1,3-1,5). Dans cette cohorte, la mortalité à long terme attribuable aux brûlures a été de 29 %. Le risque de mortalité a été majoré à la fois en cas de brûlures graves et de brûlures mineures, avec des ratios de taux de mortalité ajustés de 1,3 (IC de 95 % : 1,1-1,9) et 2,1 (IC de 95 % : 1,9-2,3) respectivement.Les brûlures sont associées à une majoration de la mortalité à long terme. Dans la population étudiée, l'utilisation exclusive des données relatives aux décès survenus dans les hôpitaux aurait entraîné une sous-estimation de la vraie charge de mortalité associée aux brûlures.Evaluar si las quemaduras en adultos de edad avanzada están asociadas con los cambios en la mortalidad por todas las causas a largo plazo y estimar el aumento del riesgo de muerte atribuible a las quemaduras.Se llevó a cabo un estudio poblacional longitudinal emparejado sobre la base de datos administrativos proporcionados por el sistema de datos de morbilidad y el registro de defunciones de los hospitales de Australia Occidental. Se identificó una cohorte de 6014 individuos que tenían como mínimo 45 años cuando fueron hospitalizados por una primera quemadura entre 1980 y 2012. Se comparó una cohorte de personas que no habían sufrido quemaduras seleccionadas aleatoriamente del censo electoral de Australia Occidental (n=25 759) con los pacientes. Se utilizaron el método de Kaplan-Meier y la regresión de Cox de riesgos proporcionales para analizar los datos, las razones de tasas de mortalidad generados y los porcentajes de riesgo atribuible.De todos los hospitalizados con quemaduras, 180 (el 3%) murieron en el hospital y 2498 (el 42%) murieron después de haber sido dados de alta. Los individuos con quemaduras tenían una tasa de mortalidad 1,4 veces mayor a la de los individuos sin quemaduras (intervalo de confianza, IC, del 95%: 1,3–1,5). En esta cohorte, la mortalidad a largo plazo atribuible a las quemaduras resultó ser del 29%. El riesgo de mortalidad se incrementó tanto por quemaduras graves como por quemaduras leves, con unas razones de tasas de mortalidad ajustadas de 1,3 (IC del 95%: 1,1-1,9) y 2,1 (IC del 95%: 1,9-2,3), respectivamente.Las quemaduras están asociadas al aumento de la mortalidad a largo plazo. En nuestra población de estudio, confiar exclusivamente en los datos relativos a las muertes en hospitales llevaría a una subestimación de la verdadera carga de mortalidad asociada con las quemaduras.تقييم ما إذا كانت إصابات الحروق في البالغين الأكبر سنًا مرتبطة بتغيرات في معدَّل الوفيات لجميع الأسباب على المدى الطويل وتقدير الاختطار الزائد للموت الذي يعزى إلى الإصابات الناتجة عن الحروق.أجرينا دراسة طولانية مطابقة قائمة على السكان – تستند إلى البيانات الإدارية المأخوذة من نظام بيانات المراضة وسجل الوفيات الخاص بمستشفيات ولاية أستراليا الغربية. تم تحديد مجموعة منبالنسبة للأشخاص الذين تم إدخالهم إلى المستشفى للعلاج من الإصابة بالحروق، توفى 180 (بنسبة 3‏ %) شخصًا منهم في المستشفى وتوفى 2498 (بنسبة ‏‏42‏ %) شخصًا بعد خروجهم من المستشفى. وكان معدل وفيات الأفراد الذين يعانون من إصابات الحروق أكبر بـ1.4 مرة من هؤلاء الأفراد الذين لا يعانون من أي إصابة (بنسبة أرجحية مقدارها ‏95‏ %: 1.3–1.5). في هذه المجموعة، كانت نسبة الوفيات طويلة الأمد التي تعزى إلى إصابات الحروق قد بلغت 29‏ %. ولقد زاد اختطار الوفيات جراء الإصابة بكلاً من الحروق الوخيمة والخفيفة مع نسب معدلات الوفيات المصححة من 1.3 (بنسبة أرجحية مقدارها ‏95‏‏ %: 1.1–1.9) و2.1 (بنسبة أرجحية مقدارها 95‏‏ %: 1.9–2.3)، على التوالي.ترتبط إصابات الحروق بزيادة نسبة الوفيات طويلة الأمد. في دراسة السكان التي أجريناها، وجدنا أن الاكتفاء بالاتكال على البيانات الصادرة عن حالات الوفيات في داخل المستشفى قد يؤدي إلى التقليل من تقدير عبء معدلات الوفيات الحقيقية المرتبطة بإصابات الحروق.旨在评估老年人群的烧伤情况是否与各种原因造成的长期死亡率的变化有关，并估计因烧伤而增加的死亡风险。.我们开展了一项以人群为基础的配对式纵向研究——基于从西澳大利亚的医院发病率数据系统和死亡登记处采集的管理数据。现已确定有 6014 个人 1980 – 2012 年期间因首次烧伤而住院且年龄至少为 45 岁。从西澳大利亚的选民名册 (在那些因烧伤而住院的人群中，180 (3%) 名在医院死亡，2498 (42%) 名在出院后死亡。烧伤个人的死亡率比非受伤人群的死亡率高 1.4 倍（95% 置信区间，CI：1.3 - 1.5）。在该类人群中，因烧伤造成的长期死亡率为 29%。死亡风险因严重烧伤和轻微烧伤而增加，调整后的死亡比率分别为 1.3 (95% CI:1.1 - 1.9) 和 2.1 (95% CI:1.9 - 2.3)。.烧伤与长期死亡率的增加有关。在我们的研究人群中，单纯依靠院内死亡数据将会导致在因烧伤造成的死亡率方面低估真正的量。.Оценка вероятной связи ожоговых травм у пациентов преклонного возраста с изменениями показателей общей смертности в отдаленном периоде, а также оценка повышенного риска смертельного исхода в результате ожоговой травмы.Проведено популяционное сравнительное продольное исследование на основании административных данных о заболеваемости и книг регистрации актов смерти больницы Западной Австралии. Была определена группа из 6014 человек, в которую входили лица старше 45 лет, госпитализированные с первой ожоговой травмой за период с 1980 по 2012 год. Контрольная группа без травм, выбранная произвольно из списка избирателей Западной Австралии (Из пациентов, госпитализированных с ожогами, 180 человек (3%) умерли в больнице и 2498 человек (42%) умерли после выписки из больницы. Лица с ожоговыми травмами имели в 1,4 раза больший коэффициент смертности, чем их соотечественники, не имевшие травм (доверительный интервал 95%, CI: 1,3–1,5). В этой группе смертность в отдаленном периоде, приписываемая ожоговым травмам, составила 29%. Риск смертности возрастал как при тяжелых, так и при легких ожогах, коэффициент смертности равнялся 1,3 (95% CI: 1,1–1,9) и 2,1 (95% CI: 1,9–2,3) соответственно.Ожоговые травмы связаны с ростом показателей смертности в отдаленном периоде. Что касается популяции нашего исследования, то использование исключительно данных больничной смертности приводит к недооценке истинного коэффициента смертности, связанного с ожоговыми травмами.

Objective To compare post-injury cardiovascular disease (CVD) hospital admissions experienced by burn patients with non-burn trauma patients and people with no record of injury, adjusting for socio-demographic, health and injury factors. Methods Linked hospital and death data were analysed for a cohort of burn patients (n = 30,997) hospitalised in Western Australia during the period 1980–2012 and age and gender frequency matched comparison cohorts (non-burn trauma: n = 28,647; non-injured: n = 123,399). The number and length of hospital stay for CVD admissions were used as outcome measures. Multivariate negative binomial regression was used to derive adjusted incidence rate ratios (IRR) and 95% confidence intervals (95%CI). Multivariate Cox regression models and hazard ratios (HR) were used to examine first time post-injury CVD admissions. Results The burn cohort had a higher rate of CVD (combined) admissions (IRR, 95%CI: 1.16: 1.08–1.24) and spent longer in hospital (IRR, 95%CI: 1.37, 1.13–1.66) than the non-burn trauma cohort. Both the burn cohort (IRR, 95%CI: 1.50, 1.40–1.60) and the non-burn trauma cohort (IRR, 95%CI: 1.29, 1.21–1.37) had higher adjusted rates of post-injury CVD admissions compared with the non-injured cohort. The burn cohort (HR, 95%CI: 2.27, 1.70–3.02) and non-burn trauma cohort (HR, 95%CI: 2.19, 1.66–2.87) experienced significantly elevated first time CVD admissions during the first 6 months after injury, decreasing in magnitude from 6 months to 5 years after injury (HR, 95%CI: burn vs. non-injured; 1.31, 1.16–1.48; non-burn trauma vs. non-injured; 1.16, 1.03–1.31); no significant difference in incident admission rates was found beyond 5 years (HR, 95%CI: burn vs. non-injured; 0.99, 0.92–1.07; non-burn trauma vs. non-injured; 1.00, 0.93–1.07). Conclusions Burn and non-burn trauma patients experience elevated rates of post-injury CVD admissions for a prolonged period after the initial injury and are particularly at increased risk of incident CVD admissions during the first 5-years after the injury event. Detailed clinical data are required to help understand the underlying pathogenic pathways triggered by burn and non-burn trauma. This study identified treatment needs for injury patients, burn and non-burn, for a prolonged period after discharge.

We have been developing an automated method to image lymphatic vessels both ex vivo and in vivo with optical coherence tomography (OCT), using their optical transparency. Our method compensates for the OCT signal attenuation for each A-scan in combination with the correction of the confocal function and sensitivity fall-off, enabling reliable thresholding of lymphatic vessels from the OCT scans. Morphological image processing with a segment-joining algorithm is also incorporated into the method to mitigate partial-volume artifacts, which are particularly evident with small lymphatic vessels. Our method is demonstrated for two different clinical application goals: the monitoring of conjunctival lymphatics for surgical guidance and assessment of glaucoma treatment; and the longitudinal monitoring of human burn scars undergoing laser ablation treatment. We present examples of OCT lymphangiography ex vivo on porcine conjunctivas and in vivo on human burn scars, showing the visualization of the lymphatic vessel network and their longitudinal changes due to treatment.

The systemic responses triggered by burns have been shown to include effects on the gastrointestinal tract. However, it is not clear if these changes lead to long-term gastrointestinal morbidity in patients with burns. The aim of this study was to assess if pediatric burns are associated with increased hospital use for gastrointestinal diseases after discharge for the initial injury. A population-based longitudinal study was performed using linked hospital and death data from Western Australia for children younger than 15 years when hospitalized for a first burn injury (n = 10,436) between 1980 and 2012, along with a frequency-matched noninjury comparison cohort, randomly selected from Western Australia's birth registrations (n = 40,819). Crude admission rates and cumulative length of stay for digestive diseases were calculated. Negative binomial and Cox proportional hazards regression modeling were used to generate incidence rate ratios (IRRs) and hazard ratios, respectively. After discharge, the pediatric burn cohort experienced twice the rate of gastrointestinal disease admissions (IRR, 95% confidence interval [CI]: 2.03, 1.56-2.65), spent over twice as long in hospital (IRR, 95% CI: 2.23, 1.67-2.98), and had a higher rate of first-time or incident gastrointestinal disease admissions (hazard ratio, 95% CI: 1.18, 1.08-1.29) when compared with the uninjured cohort, after adjusting for demographic and preexisting health factors. Children who experience a burn injury hospitalization are at increased risk of postburn hospital service use for gastrointestinal diseases when compared with uninjured children.

a b s t r a c t Background: With an ageing population the prevalence of burns in the elderly is increasing. The influence of increasing age on post-burn quality of life (QoL) is unquantified. Aim: To examine the effect of ageing on QoL recovery after burn. Methods: The Burn Specific Health Scale-Brief (BSHS-B) and Short Form Health Outcomes (SF-36), collected up to 24 months post-injury, for patients treated by the Royal Perth Hospital Burn Service were analysed. Multivariable analysis was adjusted for demographic and injury factors. The impact of ageing on rate of recovery was examined using BSHS-B normative data. Results: The cohort (n = 1051) was 79.6% male with mean TBSA of 8% and age of 37.3 years. The SF-36 showed advancing age predicted poorer outcomes in physical function, role physical, vitality and role emotional domains but reduced bodily pain. The BSHS-B was affected by injury factors, not ageing. The standardised rate of recovery after burn improved with advancing age. The provision of surgery positively affected most outcomes assessed. Conclusion: This study quantified the impact of ageing on post-burn QoL recovery and confirmed that physical function suffered to the greatest degree. The results emphasise the importance of pro-active burn surgery and physical rehabilitation strategies with older patients.

This study investigated demographic factors, experience of burn/care and first aid course attendance as factors influencing burn first aid knowledge.A cross-sectional study was undertaken using convenience sampling of members of sporting and recreation clubs. The main outcome measure was the proportion of correct responses to multiple-choice questions relating to four burn scenarios: (1) scald, (2) contact burn, (3) ignited clothing, and (4) chemical burn.A total of 2602 responses were obtained. Large gaps (30-50% incorrect answers) were identified in burn first aid knowledge across all scenarios. 15% more individuals gave correct answers if they had attended a first aid course compared to those who had not (p0.0001); this proportion increased if the course was undertaken within the previous five years (p0.0001) or contained a burns-specific component (p0.0001). Males and younger (≤25 years) and older (≥65 years) age-groups had relatively lower levels of burn first aid knowledge. Gender and age were significant predictors of first aid course attendance, with males and younger (≤25 years) and older (≥65 years) age-groups less likely to have attended a first aid course.In this sample, first aid training undertaken within the last 5 years with a specific burns component was associated with enhanced burn first aid knowledge.

Background Burn injury initiates an acute inflammatory response that subsequently drives wound repair. However, acute disruption to the immune response is also common, leading to susceptibility to sepsis and increased morbidity and mortality. Despite increased understanding of the impact of burn injury on the immune system in the acute phase, little is known about long-term consequences of burn injury on immune function. This study was established to determine whether burn injury has long-term clinical impacts on patients’ immune responses. Methods Using a population-based retrospective longitudinal study and linked hospital morbidity and death data from Western Australia, comparative rates of hospitalisation for respiratory infections in burn patients and a non-injured comparator cohort were assessed. In addition, a mouse model of non-severe burn injury was also used in which viral respiratory infection was induced at 4 weeks post-injury using a mouse modified version of the Influenza A virus (H3NN; A/mem/71-a). Results and conclusions The burn injured cohort contained 14893 adult patients from 1980–2012 after removal of those patients with evidence of smoke inhalation or injury to the respiratory tract. During the study follow-up study a total of 2,884 and 2,625 respiratory infection hospital admissions for the burn and uninjured cohorts, respectively, were identified. After adjusting for covariates, the burn cohort experienced significantly elevated admission rates for influenza and viral pneumonia (IRR, 95%CI: 1.73, 1.27–2.36), bacterial pneumonia (IRR, 95%CI: 2.05, 1.85–2.27) and for other types of upper and lower respiratory infections (IRR, 95% CI: 2.38, 2.09–2.71). In the mouse study an increased viral titre was observed after burn injury, accompanied by a reduced CD8 response and increased NK and NKT cells in the draining lymph nodes. This data suggests burn patients are at long-term increased risk of infection due to sustained modulation of the immune response.

Science and technologies based on terahertz frequency electromagnetic radiation (100 GHz-30 THz) have developed rapidly over the last 30 years. For most of the 20th Century, terahertz radiation, then referred to as sub-millimeter wave or far-infrared radiation, was mainly utilized by astronomers and some spectroscopists. Following the development of laser based terahertz time-domain spectroscopy in the 1980s and 1990s the field of THz science and technology expanded rapidly, to the extent that it now touches many areas from fundamental science to 'real world' applications. For example THz radiation is being used to optimize materials for new solar cells, and may also be a key technology for the next generation of airport security scanners. While the field was emerging it was possible to keep track of all new developments, however now the field has grown so much that it is increasingly difficult to follow the diverse range of new discoveries and applications that are appearing. At this point in time, when the field of THz science and technology is moving from an emerging to a more established and interdisciplinary field, it is apt to present a roadmap to help identify the breadth and future directions of the field. The aim of this roadmap is to present a snapshot of the present state of THz science and technology in 2017, and provide an opinion on the challenges and opportunities that the future holds. To be able to achieve this aim, we have invited a group of international experts to write 18 sections that cover most of the key areas of THz science and technology. We hope that The 2017 Roadmap on THz science and technology will prove to be a useful resource by providing a wide ranging introduction to the capabilities of THz radiation for those outside or just entering the field as well as providing perspective and breadth for those who are well established. We also feel that this review should serve as a useful guide for government and funding agencies. OA hybrid

We propose a method to image cutaneous lymphatic vessels in vivo with optical coherence tomography (OCT). Our method segments the transparent lymphatic vessels by thresholding the OCT signal after calibration for systematic variations due to the confocal effect and the sensitivity drop-off, and subsequent compensation for light attenuation with depth. We describe the method and present a pilot demonstration on two human burn scar patients undergoing ablative laser fractionation treatment. The results show visualization of the lymphatic vessels (diameter: ∼30–150 μm) separate from the blood microvasculature network.

BACKGROUND AND OBJECTIVE: The systemic responses triggered by burns and resuscitative measures may cause pulmonary damage and edema in the acute phase. These effects may occur in the absence of inhalation injury. Currently, there is a paucity of data on the recovery of the respiratory system postburn. This study aimed to examine 10-year hospital service use for respiratory morbidity in children with cutaneous burns and no smoke inhalation injury. METHODS: A population-based longitudinal study with 10-year follow-up using linked hospital and death from Western Australia for children RESULTS: After adjustment for demographic factors and preexisting health status, the burn cohort had higher rates of admissions for influenza and viral pneumonia (IRR, 1.78; 95% confidence interval [CI], 1.10–2.87), bacterial pneumonia (IRR, 1.34; 95% CI, 1.06–1.70), and other respiratory infections (IRR, 1.65; 95% CI, 1.43–1.90. No significant difference was found for other upper respiratory tract conditions (IRR, 1.10; 95% CI, 0.98–1.23) or chronic lower respiratory diseases (IRR, 0.99; 95% CI, 0.80–1.23) compared with the uninjured cohort. CONCLUSIONS: These findings demonstrated increased respiratory infection admissions after burns. These outcomes suggest that immune changes triggered by a burn injury may persist in some children for at least 10 years after wound healing.

Age is well-known to be a significant factor in both disease pathology and response to treatment, yet the molecular changes that occur with age in humans remain ill-defined. Here, using transcriptome profiling of healthy human male skin, we demonstrate that there is a period of significantly elevated, transcriptome-wide expression changes occurring predominantly in middle age. Both pre and post this period, the transcriptome appears to undergo much smaller, linear changes with increasing age. Functional analysis of the transient changes in middle age suggest a period of heightened metabolic activity and cellular damage associated with NF-kappa-B and TNF signaling pathways. Through meta-analysis we also show the presence of global, tissue independent linear transcriptome changes with age which appear to be regulated by NF-kappa-B. These results suggest that aging in human skin is associated with a critical mid-life period with widespread transcriptome changes, both preceded and proceeded by a relatively steady rate of linear change in the transcriptome. The data provides insight into molecular changes associated with normal aging and will help to better understand the increasingly important pathological changes associated with aging.

A double-blind randomized controlled trial with a paired split-scar design compared verapamil, an L-type Ca2+ channel antagonist, and triamcinolone for prevention of keloid recurrence after excision. Ca2+ channel blocking activity of verapamil in keloid cells was explored. One keloid was excised per subject and each wound half randomized to receive intralesional injections of triamcinolone (10 mg/ml) or verapamil (2.5 mg/ml) at monthly intervals (4 doses). Interim analysis was performed after 14 subjects were completed. Survival analysis demonstrated significantly higher keloid recurrence with verapamil compared to triamcinolone 12 months post-surgery (log-rank test, p = 0.01) and higher overall risk of recurrence with verapamil (hazard ratio 8.44, 95% CI 1.62-44.05). The study was terminated early according to the stopping guideline (p

Background Scald is the most common cause of burn in children in Australia. The time taken by the burn wound to heal impacts on scar outcome. Commonly scald injuries are treated conservatively; in our unit the practice is that if healing does not occur within 10 days, surgery is used to aid healing with the aim of improving scar outcome. This randomised controlled pilot study compares early treatment regimens to facilitate tissue salvage and reduce the incidence of definitive surgery at 10 days following scald injury. Methods All paediatric patients with partial thickness scald injury were clinically assessed between July 1, 2009 and June 30, 2010. A burn of 2% TBSAB or more and deemed not to heal within 10 days, were considered for the trial. These patients were randomised to one of three treatment arms: the local standard treatment (Intrasite™, Acticoat™ and Duoderm ® dressings every 2–3 days) with surgery at 10 days, Biobrane ® only or Biobrane ® and autologous cell suspension using the ReCell ® kit. The primary outcome was surgery performed after 10 days; secondary outcomes were rates of healing, pain experienced, and scar outcomes. Results 15% of scald presentations in the 12 month period met the eligibility criteria. 13 patients were recruited into the pilot study; early intervention was associated with a decreased time to healing with fewer dressing changes, less pain and better scar outcomes. Conclusion Investment of surgical resources in the acute stages within 4 days of injury saved on nursing time, dressing, analgesic and scar management costs.

Four employees at a chemical plant sustained extensive chemical burns following the explosion of a pipeline containing 100% sulphuric acid. We describe the management of these patients from the initial ED triage through to discharge from hospital in life and limb threatening chemical burns.Four patients who sustained chemical burns to the torso and extremities are reviewed. Data was retrieved from patient case notes and operating theatre logbooks.Four patients sustained chemical burns during the blast and were immediately transferred to a local ED where a prompt referral was made to the burns service. All patients were male aged 25-59 years (mean 46.5). Burn size was 2-50% BSA (mean 22.5). Following RFDS transfer to the state burns service two patients required immediate excisional surgery. In these patients the chemical burn involved full thickness skin loss with extensive underlying muscle and neurovascular damage. One patient required immediate above knee amputation of one leg and fascial burn excision of the other. The other patient required fascial burn excision of both legs followed by Integra placement 24h later. Both patients had prolonged hospital stays due to the complex nature of their injuries requiring multiple trips to theatre and lengthy rehabilitation. The two patients with smaller burns had straightforward surgery and an unremarkable recovery.Early communication following this mass casualty incident allowed for organisation of tertiary services and early radical surgery which was life saving. Management lessons were learnt following this mass casualty chemical burn incident.

Background Major burn can lead to impairment of the immune system and individuals who experience chronic immunosuppression are at a greater risk of developing a malignancy. Examination of prospective long term follow-up data to clarify the risk of cancer in this patient group is important. Methods Linked hospital morbidity records of 23,450 persons admitted with an index burn in Western Australia from 1983 to 2008 were merged with cancer and death data. The cancer incidence of those hospitalised for burn was compared to the general population of Western Australia. Poisson regression was used to assess the impact of burn severity and skin graft on cancer risk. Results From 1983 to 2008, there were 759 notifications of cancer (standardised incidence ratio (SIR), 95% confidence interval (CI): 0.97, 0.90–1.04). For the cohort admitted 1983–2008, a significant decrease in cancer risk for males (SIR, 95%CI: 0.90, 0.83–0.99), and a non-significant increase in cancer risk for females (SIR, 95%CI: 1.12, 1.00–1.28) were estimated. For the sub-cohort admitted 1983–1987 with optimum follow-up, incidence of cancer was significantly less for males (SIR, 95%CI: 0.86, 0.75–0.99), while a significant increase in risk of cancer for females (SIR, 95%CI: 1.39, 1.15–1.69) was estimated. Conclusions There appears to be a gender effect in relation to incidence of cancer after burn. The risk of cancer for females hospitalised for burn during 1983–1987, with optimum follow-up time, was significant and increased in magnitude to 39% greater incidence of all-cause cancer than that for females in the general population of Western Australia. Burn and cancer risk A state-wide longitudinal analysis.

Burn injury can lead to abnormal sensory function at both the injury and at distant uninjured sites. Here, we used a mouse model to investigate return of nociceptive function and reinnervation of the skin at the wound and uninjured distant sites following a 3% total burn surface area full-thickness burn injury. We have previously shown that topical application of zinc-metallothionein-IIA (Zn 7 -MT-IIA) accelerates healing following burn injury, and here, we investigated the potential of Zn 7 -MT-IIA to enhance reinnervation and sensory recovery. In all burn-injured animals, there was a significant reduction in nociceptive responses (Semmes-Weinstein filaments) at locations near and distant to the wound up to 8 weeks following injury. Cutaneous nerve reinnervation (assessed using protein gene product 9.5 immunohistochemistry) of the wound center was slow in the epidermis but rapid in the dermis. In the dermis, nerves subsequently degenerated both at the wound center and in distant uninjured areas. In contrast, epidermal nerve densities in the distant uninjured areas returned to normal, uninjured levels. Zn 7 -MT-IIA did not influence return of nociceptive function nor reinnervation. We conclude that burn injury compromises nociceptive function and nerve regeneration both at the injury site and systemically; thus, therapies in addition to Zn 7 -MT-IIA should be explored to return normal sensory function.

BACKGROUND: This study presents a 26-year epidemiological assessment of burn injury hospitalisations for people 15-29years of age in Western Australia. METHODS: Linked hospital morbidity and death data for all persons hospitalised with an index burn injury in Western Australia for the period 1983-2008 were analyzed. Annual age-specific incidence rates were estimated. Poisson regression analyses were used to estimate temporal trends in hospital admissions. RESULTS: There were 6404 burn hospital admissions of which 76% were male. Males had hospitalisation rates 3.0 times that of females (95%CI: 2.8-3.2) and Aboriginal people had rates 2.3 times (95%CI: 2.1-2.5) that of non-Aboriginal persons. Hospitalisations for burn injury declined by 42% (95%CI: 35-47) for males and 21% (95%CI: 6-33) for females. Hospitalisations declined by 53% (95%CI: 35-63) for Aboriginal people, and by 35% (95%CI: 29-41) for non-Aboriginal people. Significant reductions were observed for flame and electrical burn hospitalisations. The major causes of burns in males were exposure to controlled fires and ignition of inflammable materials, with scalds the predominant cause of burn in females. CONCLUSIONS: Downward trends in burn injury hospitalisations for both males and females 15-29years of age were observed; however, males and Aboriginal persons have significantly elevated hospitalisation rates. Language: en

Patient involvement is an important component of burn care and is necessary to produce good outcomes. Patient education using multimedia resources is useful in facilitating self-management and recovery from burn injury. The study aims to provide and evaluate an instructional DVD to assist burn patients with their self-management. The project was divided into three phases: 1) research about the needs of patients, 2) production of the DVD based on those needs, and 3) evaluation of the effectiveness of the DVD. In phase III, 49 burn patients (73% male; median age 32 years, median TBSA 3%) completed a survey on confidence in their burn care before development of an educational DVD, the results of which were compared with those of 55 burn patients (58% male; median age 35 years, median TBSA 3%) who completed the same survey questions after viewing a burn care DVD. Patient confidence in all self-management activities showed a statistically significant improvement (P < .01). An instructional burns DVD improves confidence in self-management of patients who have not been admitted to hospital and is a useful adjunct to current burn practice.