Journal of Burn Care & Research最新文献

Patients with major burn injuries are at high risk of venous thromboembolism. In 2022, a new prophylaxis guideline was introduced for adults with burns ≥ 20% total body surface area: enoxaparin 40 mg twice daily, renally, and weight adjusted. This quality improvement study assessed compliance and outcomes by comparing patients admitted postguideline (January 2022-December 2023) to a preguideline cohort (July 2019-June 2021) who received enoxaparin 40 mg daily. Among 138 actively treated patients (77% male, median age 43 years, and median % total body surface area 35), 57 were treated preguideline and 45 post, with no major differences between groups. Preguideline, 5 patients developed venous thromboembolic complications (2 pulmonary emboli, 3 deep vein thromboses) versus 3 incidental thromboembolisms (1 pulmonary embolus, 2 deep vein thromboses) postguideline. Transfusion for bleeding was similar across groups, but major bleeding affecting dermal substitute application increased from 1 case (2%) preguideline to 7 cases (15%) postguideline, this difference was not statistically significant. To mitigate this, intravenous tranexamic acid and increased transfusion rates were implemented after 12 months, eliminating major bleeding events in the subsequent period. Overall, 88% of patients received venous thromboembolic prophylaxis in line with the guideline. Despite an initial increase in bleeding complications, intraoperative adjustments resolved these issues, demonstrating a learning curve. The guideline was successfully implemented and appears effective in reducing venous thromboembolic risk with acceptable complications.

Traumatic tattoos, resulting from the accidental impregnation of foreign particles, are common consequences of road traffic accidents and explosions. Unlike conventional tattoos, these occur when high-impact events embed foreign materials into the skin, causing persistent discoloration and cosmetic disfigurement. Preventing the permanent inclusion of these particles through immediate removal is widely considered as the best strategy. Nowadays, the preventing procedures by means of scrubbing remain insufficient and the need for delayed additional methods is one of the main causes of concern. Consequently, we aim to propose a new therapeutic protocol with enzymatic debridement to prevent and treat traumatic tattoos. In this prospective study, we included patients diagnosed with traumatic tattoos referred to our National Burn Center during 9 months (from June 2024 to March 2025). All were treated with enzymatic debridement (Nexobrid) to remove necrotic tissues after initial cleaning of the wound. Pigmented surface was evaluated before and after enzymatic debridement. A total of 15 consecutive patients were successfully treated with enzymatic debridement (Nexobrid) under sedation within the first 24 hours after the initial incident. In total, 92.5% of the surface of pigmented dermis was cleared from pigments after treatment, thus preventing the occurrence of traumatic tattoos. No adverse events were reported during the treatment. Enzymatic debridement presents a comprehensive approach to wound care in cases of traumatic tattoos, offering precision, tissue preservation, and user-friendly application, and to optimize functional and cosmetic outcomes. These advantages position it as an effective alternative to more traditional methods, particularly in settings that require minimal invasiveness and maximal tissue conservation.

Cell suspension autograft (CSA) is a non-cultured, autologous cellular suspension used in partial-thickness burns or as an adjunct to widely meshed split-thickness skin grafts (STSGs). While CSA has been shown to improve patient outcomes in burn care, literature is limited in highlighting its impact on mortality when used in combination with STSG. This retrospective, matched, case-control study investigates the clinical efficacy of CSA in adult patients with burn injuries admitted to a regional burn center from 2015 to 2023. Patients treated with CSA and STSG (n = 63, "CSA-treated") were compared against patients treated with STSG alone (n = 126, "non-CSA-treated"). Non-CSA-treated patients were matched in a 2:1 fashion to CSA-treated patients based on third-degree burned TBSA and age. Outcomes included mortality, length of stay (LOS), intensive care unit LOS (ICU LOS), and number of procedures. Multivariate analyses revealed that CSA-treated patients had a significant reduction in mortality (P = .0445) and a 78.9% reduction in odds of death (OR: 0.211) compared to non-CSA-treated patients. Cell suspension autograft-treated patients displayed nonsignificant increases in LOS (P = .0670), ICU LOS (P = .0851), and number of procedures (P = .9084). Selection and chronology bias may partially account for the improved mortality in the CSA-treated group. The nonsignificant increases in LOS, ICU LOS, and number of procedures may be reflective of increased survivorship. These findings demonstrate that CSA enhances survival in patients with burn injuries when used with STSG, warranting further research to confirm these results.

Introduction: This study aims to evaluate the accuracy and quality of responses generated by ChatGPT-4o to frequently asked questions (FAQs) posed by practicing physicians regarding the initial assessment of pediatric burn injuries, as assessed by pediatric burn specialists.

Material and methods: Thirty-four FAQs about pediatric burn care were posed to ChatGPT-4o twice, 2 weeks apart, in a blinded manner by 4 experienced pediatric surgeons who work at a national tertiary referral burn center. Questions were divided into 5 subgroups; initial assessment and triage, fluid resuscitation and hemodynamic management, wound care and infection prevention, pain management and sedation, special situations and follow-up. The reliability of ChatGPT-4o's answers was evaluated utilizing the modified 5-point DISCERN tool (mDISCERN). The comprehensive quality of the answers was assessed using the Global Quality Score (GQS). Inter-rater reliability was measured using intraclass correlation coefficients (ICCs).

Results: ChatGPT-4o demonstrated high-quality and reliable responses to questions. The median GQS was 4.75 (range: 3.50-5.00). The mDISCERN median score was 9.25 (range: 7.00-10.00), reflecting strong informational reliability. There was a very strong correlation between GQS and mDISCERN scores (r = 0.858, P < .001), indicating consistent alignment between content quality and reliability. Inter-rater reliability analysis showed excellent consistency for average scores (ICC = 0.87, P < .001), supporting the robustness of the reviewers' assessments.

Conclusions: ChatGPT-4o demonstrated itself to be a high-quality and reliable source of information for the initial evaluation of pediatric patients with burn injuries, providing substantial support for healthcare professionals in clinical decision-making.

Severe burns involve the full thickness of the skin and subcutaneous structures. These burns require skin grafting, and the primary type of skin graft used is a split-thickness skin graft (STSG) coupled with dermal substitutes. However, due to certain complications with this type of graft, artificial skin substitutes have gained traction as an alternative to autologous skin grafting. Biodegradable temporizing matrix (BTM) is an example of a dermal regenerative matrix. Biodegradable temporizing matrix grafting is secured with surgical staples. The study aim is to assess the association between the number of staples per square centimeter used to secure this graft on patient outcomes. This single-center, retrospective study analyzed 39 patients who received BTM grafting between 2017 and 2024. Primary outcomes included graft take, hospital stay, and time to grafting. Statistical analyses included linear, logistic, and Poisson regression, adjusting for confounders like diabetes and wound infection. Increased staple density significantly reduced hospital stay and trended toward shorter time to STSG, improved graft take, and fewer grafting surgeries. Results indicate a potential role for staple density in optimizing outcomes. Limitations include small sample size, single-institution design, and possible measurement errors in staple counting. Future research should focus on larger, multicenter studies and standardized staple counting methods to validate these findings.

Burn injuries are a major cause of morbidity and mortality in low- and middle-income countries, with infections and antimicrobial resistance posing significant challenges. Carbapenem-resistant Gram-negative bacteria are particularly concerning in burn intensive care units. The aim of the study was to evaluate bacteriological profile, and antimicrobial susceptibility patterns of burn ICU patients, and identify risk factors associated with carbapenem resistance, invasive infections, and in-hospital mortality. This retrospective, single-center study included all patients admitted to a 30-bed burns ICU in north India between January and December 2024, whose clinical sample was received for microbiological investigations. Data on demographics, clinical parameters, and microbiological findings were extracted from hospital records and analyzed using chi-square, Fisher's exact, Mann-Whitney U tests, and multivariable logistic regression. Out of 246 patients included, the mean age was 29.1 ± 20.4 years and mean total body surface area (TBSA)% was 39.0% ± 19.9%. Overall mortality was 42.3%. A total of 1586 samples yielded 1057 pathogens, predominantly Gram-negative bacteria (Pseudomonas aeruginosa 36.1%, Acinetobacter baumannii 22.3%, and Klebsiella pneumoniae 18.8%). Carbapenem resistance was observed in 85.3% of patients and was significantly associated with higher TBSA% (P < .001), longer hospital stays (P = .022), and mortality (P < .001). Invasion was present in 27.6% and was significantly associated with both carbapenem resistance and mortality. Multivariable logistic regression identified TBSA% (odds ratio [OR]: 1.07, P < .001) and invasion (OR: 4.14, P = .001) as independent predictors of mortality. Carbapenem resistance and invasive infections are highly prevalent in burn ICU patients, underscoring the urgent need for robust infection control, regular antibiogram surveillance, and targeted antimicrobial stewardship in burn care settings.

Pyogenic granuloma (PG) is a benign vascular proliferation that commonly arises following trauma. Its occurrence in healing burn wounds, particularly in infants, is rare and poses diagnostic challenges. We present the case of an 11-month-old male who developed multiple rapidly growing, angiomatous nodules on the right cheek and scalp 2 weeks after sustaining a second-degree scald burn from boiling milk. The lesions exhibited typical bleeding and friability, prompting surgical excision and coverage with split-thickness skin grafts. Histopathological examination confirmed the diagnosis of PG. Postoperative recovery was uneventful, and follow-up at 2.5 years showed complete resolution without recurrence and minimal scarring. This case illustrates a rare but distinct manifestation of postburn PG, emphasizing the importance of recognizing this reactive vascular phenomenon. A comprehensive review of the 38 cases reported in the literature so far underscores the variable clinical presentations and management strategies, reinforcing surgical excision as a reliable and curative intervention.

Facial burns can cause profound psychological distress, often treated with selective serotonin reuptake inhibitors or serotonin-norepinephrine reuptake inhibitors. While their psychiatric benefits are established, their impact on wound healing and long-term outcomes is less defined. This study examines associations between early serotonergic antidepressant exposure and physiological complications following facial burn injury. Adult patients with second- or third-degree facial burns (2010-2025) were identified in the TriNetX US Collaborative Network. Those prescribed antidepressants within one month of injury were compared to controls without antidepressant use. Propensity score-matching was performed based on demographics, burn characteristics, and psychiatric as well as medical comorbidities. Outcomes assessed at 90 days, 180 days, and 1 year included skin infection, hypertrophic scarring, lactic acidosis, hyperglycemia, hypoglycemia, and mortality. Univariate regression analyses were used to compare each outcome, with significance defined as P < .05. Of 46 971 facial burn patients identified, 3392 remained in each group after matching. Patients in the matched antidepressant group had significantly higher rates of hypertrophic scarring and skin infection at all time points compared to those in the matched control group (P < .01). Additionally, lactic acidosis and hyperglycemia became elevated beginning at 180 days (P < .05) among patients who were prescribed antidepressants. Mortality, however, was consistently lower in the matched antidepressant group at all time intervals (P < .05). Early serotonergic antidepressant use after facial burn injury is linked to increased risk of hypertrophic scar formation, infection, and metabolic disturbances, yet decreased rates of mortality.

Pediatric burn injuries can lead to both acute procedural distress and longer-term psychological challenges, including anxiety, depression, and post-traumatic stress symptoms. While physical rehabilitation is well integrated into burn care, mental health interventions remain underutilized and inconsistently applied. This systematic review and meta-analysis evaluate procedural and psychological strategies used to improve mental health and pain-related outcomes in pediatric burn survivors. A comprehensive search of PubMed, Embase, and Scopus was conducted for studies published from January 2000 to December 2023. Eligible studies included pediatric burn patients (≤18 years) and evaluated interventions targeting either acute pain/anxiety during wound care or longer-term psychological recovery. Random-effects meta-analyses were performed for studies reporting extractable continuous outcomes. Heterogeneity was assessed using I2 and τ2 statistics. Twenty-four studies involving 1705 pediatric burn patients were included. Interventions addressed either procedural distress (eg, virtual reality [VR], music therapy) or psychological sequelae (eg, cognitive-behavioral therapy, pharmacologic treatments, school-based support).VR demonstrated a significant and consistent effect in reducing procedural pain, with a pooled standardized mean difference (SMD) of -0.95 (95% CI, -1.31 to -0.59, P < .0001, I2 = 0%). Music therapy showed a nonsignificant pooled effect (SMD = -0.47, 95% CI, -6.62 to 5.69, P = .51, I2 = 80.8%), though individual studies suggested benefits in older children or when paired with physical therapy. Cognitive-behavioral, creative, and psychosocial interventions showed promise but varied in effectiveness. Virtual reality is a robust, nonpharmacological intervention for procedural pain management in pediatric burn care. However, robust evidence supporting interventions for long-term psychological outcomes remains limited.