Journal of Burn Care & Research最新文献

Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) Syndrome are potentially fatal skin conditions frequently cared for in burn units. In a national database study, we studied the demographics and outcomes of this patient population. This retrospective cohort study included patient admissions for SJS/TEN. Patient demographics and outcomes were compared and adjusted for age, sex, inhalation injury, and percent total body surface area (TBSA). Logistical regression was used for binary outcomes, and linear regression was used for continuous outcomes. All outcomes were described in reference to the entire disease continuum (SJS/TEN) and each specific disease subcohort (SJS, SJS-TEN Overlap, and TEN). Of 271,971 patients queried within the Noncommercial Burn Research Dataset, 2,416 patients had a diagnosis of SJS/TEN. These patients were statistically more likely to be older (48±22 years vs. 36±22 years), housed (1% vs. 2%), females (57% vs. 34%), and have a higher mean TBSA (8±13% vs. 7±12%). In multivariable analysis, SJS/TEN was associated with increased risk of unplanned intubations (Odds Ratio [OR] 1.69) and pneumonia (OR 1.26), but not respiratory failure (OR 0.36). There was also an increased risk for sepsis (OR 1.43). Patients were significantly more likely to have a shorter hospital LOS (OR -3.7). There was no significant difference in mortality. In subcohort analysis, a stepwise increase in morbidity and mortality was observed when comparing SJS, SJS-TEN Overlap, and TEN. SJS/TEN is a rare but extremely morbid disease continuum that frequently involves female patients and results in increased respiratory and alternative complications.

Friction injury occurs when a patient slides across a surface at high velocity, resulting in mechanical abrasion, laceration, and thermal burn. Mechanical abrasion removes tissue to a variable depth depending on surface texture in contact, and thermal burn devitalizes tissue to a variable depth based on contact pressure and transfer of kinetic energy. In these heterogenous wounds, tangential excision can excise healthy tissue alongside devitalized tissue, and other debridement techniques like hydrosurgery or dermabrasion may not reach deeper crevasses created by abrasion and laceration. Additionally, traditional skin grafts create significant donor site morbidity. This case series presents an early experience with a novel approach using bromelain-based enzymatic debridement combined with autologous skin cell suspension. Bromelain-based enzymatic debridement acts uniformly on a wound surface despite its topography, optimizing removal of devitalized tissue while preserving healthy tissue. Autologous skin cell suspension reduces donor site morbidity. This combined strategy minimizes dressing changes, optimizing pain control and enabling outpatient management. We observe rapid healing and outstanding cosmetic outcomes, and no patients experienced wound infection or other complications or required secondary procedures for nonhealing.

Unhoused persons are particularly vulnerable to frostbite injury due to prolonged exposure to extreme temperatures. This study hypothesized that unhoused frostbite injured patients have a higher mortality risk compared to housed individuals. Data from two high volume frostbite centers were analyzed and linked to state health department records. A longitudinal cohort of 933 frostbite patients who survived their initial hospital stay (n = 925) was examined with Cox proportional hazards regression to adjust for confounders (age, sex, race, alcohol use, and drug use). Nearly one third of patients were unhoused at the time of injury. Most patients discharged home (56.7%), but alternative discharge locations included: [alternative housing (6.1%), inpatient psychiatric care (7.0%), acute rehabilitation (5.7%), nursing care (11.2%), shelter/street (6.4%) and AMA discharge (3.5%)]. During follow-up, 185 (19.8%) of patients died. Time from frostbite injury to death ranged from 5 days to 17 years. Mortality between unhoused and housed frostbite patients was similar (19.7% vs 20.2%), but unhoused individuals died at significantly younger ages. Age was a significant predictor of mortality, while sex, race, and alcohol abuse were not. Living situation and drug use showed a trend toward increased mortality risk, but did not reach significance. The model (LR chi 2 = 150.43, p<.001) indicated that the combined set of predictors significantly explained the variability in mortality risk. Findings highlight the need for targeted healthcare strategies to address socioeconomic disparities and improve outcomes for unhoused persons.

Post-burn pruritus (PBP) significantly affects patients, causing discomfort and hindering recovery. Antihistamines, which block H1 receptors, are commonly prescribed for PBP, yet large-scale studies on their usage patterns are limited. This study evaluates antihistamine prescription trends and provider practices for PBP across varying burn severities from moderate to severe burns (≥20% TBSA). A treatment pathways analysis was performed using TriNetX, a global, federated, deidentified database. Patients with burns ≥20% TBSA from the past 20 years (2004-2024) who developed pruritus were identified and stratified into four cohorts: 20-40%, 40-60%, 60-80%, and ≥80% TBSA. The analysis evaluated trends in antihistamine prescriptions, including the number of patients treated with antihistamines, types prescribed, and median times to treatment initiation, duration, and therapy switching. The total sample included 2,754 patients (20-40% TBSA, n=1,712; 40-60%, n=613; 60-80%, n=253; ≥80%, n=176). Over 70% received antihistamines, with hydroxyzine as the most common first-line therapy, followed by diphenhydramine. Across all cohorts, the average of the median times for initiation, therapy duration, and time before switching was 16.75 days, 90.25 days, and 27.75 days, respectively. Significant variations in the timing of therapy initiation suggest a gap in consistent symptom management during critical recovery periods, potentially affecting patient comfort and overall outcomes. These findings underscore the importance of vigilant post-burn assessment, stepwise escalation based on response, and complementary strategies to optimize PBP management. Frequent switching and prolonged durations suggest a need for more effective and tailored therapeutic approaches to improve recovery outcomes for burn patients.

Burn injuries represent a worldwide public health concern. Nigella sativa (NS), a herbal medicinal plant, widely used in Ayurveda, Unani, and Siddha holds potential to address this issue. This review evaluated the potential of NS extract and its key component, Thymoquinone (TQ), in accelerating burn wound healing, focusing on their mechanisms, safety, and efficacy. Studies were retrieved from PubMed, Google Scholar, and ScienceDirect using keywords "Nigella sativa," "Thymoquinone," "burns," and "wound healing." Reports were screened for suitability, and the scientific name was verified on www.worldfloraonline.org. NS extract and TQ accelerate burn wound healing in vitro and in vivo through various mechanisms involving anti-inflammatory, anti-oxidative, anti-microbial, and tissue regenerative effects. TQ achieved 91.35% wound closure in NIH/3T3 cells (mouse fibroblasts) and wound closure rate of 2.35 ± 0.05% in 3T3-CCL92 cells (fibroblasts from mouse embryos). It also reduced oxidative stress and inflammation in murine burn models. Nanoformulations of TQ showed higher safety (LD₅₀: 300-2000 mg/kg) than pure TQ (LD₅₀: 50-300 mg/kg). A Phase I trial confirmed the safety of black cumin oil (5% TQ) at 200 mg/day for 90 days in healthy adults. Therefore, formulations based on NS extract and TQ can manage burn injuries and be extrapolated into clinical settings.

Burns are a leading cause of childhood injury. Analysis of pediatric burn epidemiology is essential for targeting educational and public health strategies but there is limited available UK data, particularly traversing the COVID-19 pandemic. We hypothesize that the last 20 years have seen significant changes in injury patterns and service provision, with a marked effect from national lockdown measures. This study aims to describe the epidemiology of pediatric burns referrals and admissions within a pediatric burns unit in the UK over 20 years (2005-2024). A retrospective analysis was performed for pediatric patients referred to our center between 2005 and 2024. The International Burn Injury Database (iBID) was used to extract demographic and injury information. Data before, during and after COVID-19 lockdown periods was compared. 6919 patients met the inclusion criteria. 1872 (27.1%) of patients required admission. There was a significant reduction in admission rate following covid despite an increase in average TBSA (p<0.01). Most cases were scalds (n=3100, 44.8%) or contact burns (n=2650, 38.3%). The majority of patients were aged under 5 years (n=4529, 65.5%), with a rise in referrals for older children across the study period. There was a noticeable rise in aerosol-related flash burns, cold burns and treadmill- related friction burns during and after the pandemic. This study provides epidemiological data for the development of public health initiatives and adaptation of pediatric burns services. Emerging mechanistic trends and service re-design following the COVID pandemic requires further multi-center evaluation to inform future care.

Burn wounds pose significant challenges due to their susceptibility to microbial invasion and limited effective dressing options. This study aimed to evaluate the wound healing potential of a sericin-based self-healing and stretchable hydrogel loaded with Psidium guajava L. extract against full-thickness burn wounds in mice. The hydrogel was characterized by physicochemical analyses including SEM, FTIR, XRD, viscosity, pH, swelling degree, weight loss, and mechanical strength. In vivo experiments used a Swiss albino mice burn model, where 6 mm full-thickness wounds were induced with a hot metal rod. Hydrogels were applied topically at regular intervals, and wound healing was assessed through wound contraction measurements, healing time, and histological analysis. Hematological parameters and serum biomarkers i.e. pro- and anti-inflammatory cytokines, matrix metalloproteinases (MMPs), tissue inhibitors of metalloproteinases (TIMPs), antioxidants (GSH, GPx, CAT, SOD), angiogenic factors (VEGF), and oxidative stress markers (MDA) were also evaluated. Results demonstrated that the hydrogels exhibited high swelling capacity and notable weight loss, suggesting effective absorption of wound exudates and reduced infection risk. Notably, Hydrogel 4 (3% sericin + 3% P. guajava L.) achieved significantly improved wound healing (89.66%) compared to controls (37.16%) by day 15. Histological examination confirmed collagen deposition and hair follicle regeneration, indicative of complete healing. Hematological findings showed increased red blood cell counts and reduced white blood cells, reflecting resolution of inflammation. Serum analyses revealed elevated anti-inflammatory markers (IL-10), TIMPs, and antioxidants (GSH, GPx, CAT, SOD), alongside decreased pro-inflammatory cytokines (IL-6, IL-8, IL-1β, TNF-α), MMPs, angiogenic factor VEGF, and oxidative stress marker MDA. Hydrogel 4 showed a 3.47-fold increase in SOD and a 68% reduction in MDA, underscoring its efficacy in mitigating oxidative stress. In conclusion, the sericin-based hydrogel infused with P. guajava L. exhibited excellent physicochemical and biological properties, promoting effective burn wound healing. Hydrogel 4 demonstrated the most pronounced therapeutic benefits, making it a promising candidate for advanced wound dressing applications.

Severe burns unleash a hyper-catabolic and immunosuppressive state that erodes lean tissue and delays repair. Alpha-ketoglutarate (α-KG), usually delivered enterally as the dipeptide ornithine α-ketoglutarate, feeds the tricarboxylic-acid cycle, donates nitrogen for amino-acid synthesis, and modulates collagen formation and immunity. We systematically appraised the biological mechanisms, delivery strategies, and clinical outcomes associated with α-KG/OKG in burn care to clarify its therapeutic value and translational readiness. A PRISMA-2020-compliant search of PubMed, EMBASE, Web of Science, Cochrane, and Google Scholar up to May 2025 identified clinical, in-vivo, and relevant in-vitro studies linking α-KG or OKG with thermal injury. Study quality was assessed using the Newcastle-Ottawa Scale, SYRCLE Risk-of-Bias tool, and Oxford Levels of Evidence. Fifteen studies published between 1984 and 2024 met inclusion criteria, including clinical, animal, and mechanistic work, most conducted in France. Across studies, OKG supplementation replenished glutamine and arginine pools, improved nitrogen balance, preserved muscle mass, and promoted wound healing through enhanced collagen synthesis and immune modulation. Clinical data confirmed improved nitrogen retention, reduced muscle breakdown, and faster wound closure. Preclinical studies further showed that α-KG preconditioning enhances stem cell-driven regeneration and vascularization. Additional effects, such as improved glucose tolerance and hepatic enzyme preservation, suggest some benefits occur independently of glutamine pathways. This review highlights α-KG and OKG as promising adjuncts to enhance metabolic recovery, wound repair, and immune competence after burns. Evidence supports improved nitrogen balance and healing, but findings remain limited by heterogeneity and small cohorts, warranting renewed and well-powered studies.

Methicillin-resistant Staphylococcus aureus (MRSA) is a common pathogen in burn-injured patients. Many studies have evaluated the overall utility of MRSA nares polymerase chain reaction (PCR) swabs for antimicrobial stewardship; however, there is a paucity of data in burns. This study evaluated the clinical utility of MRSA PCR in burn-injured patients at an academic medical center. This retrospective, single-center chart review included admitted adult burn-injured patients from July 2020 to June 2024. The primary objective was to determine the overall negative predictive value (NPV) of MRSA PCR in patients with burn injuries for suspected MRSA infections. Secondary objectives included determining the sensitivity, specificity, NPV, and positive predictive value (PPV) of MRSA PCR for specific culture types. There were 89 patients, and 289 cultures were included. The overall prevalence of MRSA positive cultures was 13.4% for the study period. For the primary outcome, the NPV of MRSA PCR was 98.3% (95% confidence interval, 95.5%-99.5%). For the whole cohort the PPV was 22.5%, sensitivity was 73.4%, and specificity was 86.1%. The total cost of vancomycin therapy (doses and levels) was US $37 935.75, which was estimated using average wholesale price. A cost avoidance of US $378.15 per patient was estimated for patients not meeting criteria for vancomycin therapy. Overall, this study found a high NPV for MRSA PCR in burn-injured patients with suspected infections. In addition, MRSA PCR may be used along with other clinical markers to decrease the use of antimicrobials targeting MRSA, which may help decrease the cost of therapy.