Journal of Burn Care & Research最新文献

Burn injuries have a significant impact on various aspects of survivors' lives. This study evaluates, assesses, and interprets the health-related quality of life in post-burn adult survivors. Of 135 patients admitted from 2019 to 2023 in the burns intensive care unit, 70 responded to a questionnaire. Primary socio-demographic data and details about the cause and extent of burns were collected. A brief (EuroQol-5 Dimension-5 Levels) EQ-5D-5L questionnaire was completed by interviewing burn survivors, and data were then analysed. The mean age of participants was 52.12 years, and the prevalent gender was males (61.4%). Thermal burns were the most common cause of burn-related injury (91.4%)-most subjects (57.1%) suffered from partial-thickness burns, followed by full-thickness burns affecting 40.0%. The most presented percentage of Total Body Surface Area (%TBSA) burned was 1-10%, accounting for 60% of cases. The most required hospitalization timeframe was 1-5 days. Regarding participants' Quality of Life (QoL), most reported no problem in the five health dimensions. The health dimensions that were mainly affected were depression/anxiety followed by pain/discomfort. All participants' mean EQ-Visual Analogue Scale (EQ-VAS) score was 80.98. Our findings disclose a compromised health-related quality of life for post-burn individuals, particularly in dimensions of depression/anxiety followed by pain/discomfort. There is a pressing need to establish long-term support for burn survivors by relevant organisations.

Burn Center (BC) verification is a rigorous process designed to ensure optimal care for burn injury patients. The American Burn Association (ABA) lists 135 verification criteria, yet only 50-60% of BCs are verified. This study assesses the operational, financial, and clinical disparities between verified burn centers (VBCs) and non-verified burn centers (nVBCs) in the U.S. the U.S. The study was conducted using The Databases for Optimal Resources for Injury Care (DORIC), a centralized database developed from the American Hospital Association (AHA), American College of Surgeons Committee on Trauma, ABA, all fifty United States' (U.S.) Departments of Health, the National Injury Resource Database (NIRD), and claims databases, through collaboration with BData, Louisiana State University Health Sciences Center (LSUHSC), and University of New Orleans (UNO). Data were analyzed for quality and statistical rigor by a data analyst and a biostatistician. The study demonstrated no significant differences in hospital size, location (urban/rural), hospital bed number, or burn intensive care unit bed number between VBCs and nVBCs. However, significant differences were identified in total hospital discharges and revenue. VBCs had more patient discharges (median 22,212 vs. 15,639; p=0.019) and generated significantly more total revenue (median $994,945,750 vs. $652,390,948; p=0.014), Medicare revenue (median $171,016,940 vs. $83,739,527; p=0.0023), and inpatient revenue (median $2,070,789,977 vs. $1,347,440,093; p=0.0125) compared to nVBCs. These disparities in discharges and revenue underline the financial and operational benefits of BC verification. Our findings provide valuable insights to guide policy and decision-making in burn care, aiming to improve care quality, accessibility, and equity.

Burn patients often require frequent moderate sedation for burn wound care procedures. The American Society of Anesthesiology recommends patients be made nil per os prior to moderate sedation. Here, we aimed to assess the risk of moderate sedation in burn patients with uninterrupted nutrition. A 12-month single-center retrospective analysis on non-intubated/non-tracheostomy burn patients receiving moderate sedation for wound care was performed. A total of 97 moderate sedations were completed on 24 patients. A median of three oral premedications and three intravenous analgesic/anxiolysis medications per patient were administered during each periprocedural period and achieved a median Richmond Agitation-Sedation Score of -2 (-3, -1). The median of any kind of nutrition was consumed 38 minutes prior to sedations, with a median of 113 minutes from consumption of a full meal. In 32 sedations (33%), patients had tube feeds continued throughout wound care. No complications related to aspiration were noted in any sedation event (97.5% upper Confidence Interval 3.7%), including no episodes of vomiting, evidence of aspiration, pneumonia, hypoxemia, complete airway obstruction, laryngospasm, or death. Hypertension was noted in 17 sedations. Hypotension was noted in six sedations. In conclusion, no harmful adverse events were associated with maintained nutrition throughout the peri- and intra-sedative wound care periods, including ongoing gastric tube feeds in this small sample of burn patients. These data suggest that uninterrupted nutrition during burn wound care moderate sedation procedures is a safe practice and warrants further study.

Burn injuries in children are a significant source of distress for both the child and their parents. Beyond the acute distress of the injury itself and its subsequent treatment course, families can develop larger psychological symptoms such as anxiety, depression, and posttraumatic stress symptoms (PTSS). Parental distress can influence the child's response to pain, and in turn, their injury recovery. Identifying temporal patterns of distress during the treatment course is crucial to providing early and effectively timed psychological interventions. This study explores the relationship between parental distress at three key time points- before, during, and at the end of the child's initial burn clinic visit- with psychosocial outcomes. Findings support a dynamic relationship between parental distress, child acute stress symptoms, and child observed pain during the initial burn clinic visit, underlining the importance of parental distress in the child's recovery. Future work should focus on developing resilience-based, family-centered interventions to improve quality of care and long-term psychosocial outcomes.

This retrospective study aims to valuate the efforts of implementing a validated pediatric psychosocial risk screening tool with pediatric patients admitted to the burn unit. Outcome interventions included providing targeted psychosocial interventions of a child life specialist during inpatient stay with the objective of assessing emotional outcomes during the transition to outpatient care. This study analyzes the adaptive and maladaptive behaviors recorded in certified child life specialist (CCLS) documentation to calculate a weighted score for interpretation of pediatric patients' behavior at outpatient follow-up. Results before and after the implementation of the Psychosocial Risk Assessment in Pediatrics (PRAP) tool to identify and subsequently provide a multidisciplinary support plan to the moderate-high risk patients were compared. Utilization of the PRAP tool at a large burn center identified inpatient burn patients ages 3-17 years who were at moderate risk or high risk for increased psychosocial distress. Subsequent CCLS psychosocial interventions did not yield significant results, however, use of the PRAP screening tool for pediatric patients in the inpatient setting predicted weighted scores measured at the outpatient appointment. he benefits of PRAP screening and CCLS intervention warrant further investigation on long term benefits of such interventions on reducing adverse psychological outcomes in pediatric burn patients.

Despite advancements in burn care, pain persists despite multidisciplinary management efforts. This review aimed to synthesise the qualitative research that explored the impact of pain on burn survivors' rehabilitation and recovery. In September 2023, PubMed, CINAHL, and Scopus were searched for peer-reviewed published research in English. Nineteen articles from 17 studies met the inclusion criteria. The review used Thomas and Harden's thematic synthesis framework for qualitative research evidence. Two descriptors of pain were described, physical and psychological pain. Pain in burn survivors, both physical and psychological, was complex, intertwined, and dynamic across three stages: before, during, and after interventions. This was found to closely align with Cleary et al.'s trauma-informed model of care in burn settings, which emphasises a three-stage process, underlining that pain is not static but evolves and fluctuates, necessitating adaptive and patient-centred burn care and post-treatment mental health support. Adopting a Trauma-Informed Care (TIC) approach in burn injury settings is crucial. Individuals post-burn encounter varying degrees of physical and psychological pain, which for some remains persistent. Using patient-reported measures throughout recovery deepens the understanding of burn survivors' pain, respecting their personal experiences and insights. It is essential to conduct future longitudinal research and push for a burn-specific qualitative pain assessment to address these complex needs effectively.

Burns are a leading cause of non-fatal injury worldwide and leave survivors with significant complications, including prolonged hypermetabolism. Rodent models are commonly used to better understand the molecular underpinnings of burn injury. However, there is a lack of congruency in methodological reporting standards, particularly with regard to the reporting of burn size. We undertook a scoping review to identify gaps in the methodological reporting in mouse burn model literature. Full-text English peer-reviewed articles were included if they utilized a scald or contact burn to the dorsal and/or ventral sides of mice. Of the 7,073 queried articles, 1,057 met our inclusion criteria. Basic animal characteristics such as mouse sex, strain, age, and body mass were excluded in several papers, where only ~34% of included papers reported all four details. Roughly half of the papers reviewed did not report absolute burn size (~53%) or the measured/calculated total body surface area (TBSA) of mice, typically reporting relative burn size as a percentage of TBSA only. Further, the use of different k-constants in TBSA calculations created significant variation, thereby leading to ~20% differences in relative burn sizes in similarly sized/aged mice. Regardless of whether mice were randomized to experimental groups, the method of randomization and key husbandry variables were infrequently reported. In order to promote rigor, reproducibility, and translatability, preclinical models of burn injury studies should adhere to the essential 10 of the ARRIVE (Animal Research: Reporting of In Vivo Experiments) guidelines, and also report absolute burn sizes and the TBSA of mice.

This report highlights the experiences of two individuals who suffered chemical burns leading to chronic dermatitis. Both patients were exposed to concentrated chemical cleaning agents that resulted in the development of persistent cutaneous conditions that worsened over time despite initial treatment and recovery. These cases evidence the long-lasting effects of chemical burns and highlight the importance of workplace safety measures and effective treatment strategies to prevent long term complications. The report emphasises the role of early medical attention, proper protective gear and awareness of potential chemical sensitivities, in preventing and managing such injuries.