Journal of Burn Care & Research最新文献

Burn injury can have a lasting impact on quality of life beyond the initial injury. The aim of this study was to examine the recovery process through analyzing the relationship between body image, physical function, and return to work. This study uses data from the Burn Model System National Longitudinal Database and includes 1001 participants injured between 2015 and 2023 who were measured using Patient-Reported Outcomes Measurement Information System-29 Physical Function, Employment Status, and the Body Image subscale. Associations were explored using multivariate linear and logistic regression analyses. Physical function was positively associated with body image and negatively associated with burn size, age, and amputation. Employment was positively correlated with body image and employment at injury, while negatively correlated with age. Other variables, including burn etiology, burn center site, race, and ethnicity, were significant at different time points. By understanding how these factors change and are associated with outcomes across recovery, the healthcare team can make more tailored efforts to improve the psychosocial and physical well-being of burn survivors.

Previous iterations of burn severity (mild, moderate, and severe) were not data-driven and were outdated. Clustering analyses have gained popularity for identifying homogenous subgroups from heterogeneous medical conditions, such as asthma, sepsis, and lung disease. There is no consensus in burn literature regarding what constitutes massive burns. The current classification includes a 20% total body surface area (TBSA) burn and a 95% TBSA burn as severe. Latent class and hierarchical clustering analyses were applied to the American Burn Association National Burn Research Dataset. Cluster variables included length of stay, length of stay, intensive care unit length of, number and type of procedures, and number and type of complications. Nonclustering variables were evaluated after clustering, including burned TBSA, inhalation injury, mortality, discharge disposition, age, sex, and race. Latent class analysis suggested 3 clusters. Hierarchical clustering analysis was applied to the most severe latent class, creating 4 total burn severity groups. In total, 112 297 patients were included in the final analysis. The mean TBSA burned for each class is 4.26 ± 4.91 for minor, 8.07 ± 8.39 for moderate, 22.76 ± 17.31 for severe and 36.72 ± 21.61 for massive. The age and sex proportions were similar among all clusters. The clustering variables steadily increased for each severity cluster. Mortality was the highest in the massive cluster (18.2%). Data-informed categories of burn severity were formed using clustering analyses, which will be helpful for triage, data benchmarking, and class-specific research.

Ibuprofen, a non-steroidal anti-inflammatory drug (NSAID), can increase the risk of bleeding, a significant concern in burn surgery, which often involves substantial blood loss. This study aims to evaluate the safety of ibuprofen use in burn patients undergoing skin grafting. A retrospective case-control chart review was conducted for patients admitted with acute burn injury from 01/01/2024 to 07/31/2024 who underwent skin grafting. The primary outcome variables included perioperative transfusion requirement, bleeding, skin graft failure, and other complications. A total of 53 patients met inclusion criteria, 24 (45.2%) of whom received scheduled ibuprofen therapy during their hospitalization. The total body surface area affected was 12.3±9.3% for the non-ibuprofen group and 14.3±12.1% for the ibuprofen group (p=0.62). A total of 79.3% of patients in the non-ibuprofen group received meshed grafts compared to 79.2% in the ibuprofen group (p=0.734). Perioperative transfusion requirements were similar between the two cohorts, averaging 4.6±3.1 for the non-ibuprofen group and 3.2±2.8 units of packed red blood cells for the ibuprofen group (p=0.207). Skin graft failure (defined as need for re-grafting) occurred in 6.9% (n=2) of the non-ibuprofen cohort versus none (n=0) in the ibuprofen group (p=0.112). Postoperative complications did not vary significantly between the two groups for seroma (p=0.259), hematoma (p=0.498), and infection (p=0.568). There were no cases of hypersensitivity or gastrointestinal bleeding. There is likely no increased risk of bleeding or skin graft failure in burn injury patients taking ibuprofen, suggesting that these medications may be safe in this context.

Negative pressure wound therapy (NPWT) is a form of wound coverage that involves negative pressure and a semi-occlusive membrane to manage wound closure. In burn care, NPWT are currently utilized as temporary dressings for large wounds, skin-grafted burn wounds, and as a dressing on dermal substitutes. Little is known regarding optimal roles and indications of NPWT in burn care. This systematic review better characterizes the role of NPWT in burn care and provides updated recommendations. A systematic review of PubMed and Cochrane databases was performed utilizing PRISMA guidelines. All peer-reviewed publications published any time through September 17, 2021 were included. Inclusion criteria consisted of studies containing a control group without NPWT, an intervention group with NPWT, and studies involving the use of NPTW in burn care. A total of 15 studies were analyzed, with a Risk of Bias (ROB) analysis performed to rate the quality of included studies. We find NPWT is superior to conventional dressings as a modality for skin grafting coverage, dressing on dermal substitutes, dressing on donor site wounds, and dressing on moderate to large burns. Outcomes such as length of hospitalization, length of wound healing, and rates of infections were improved in those treated with NPWT compared to conventional dressings. In conclusion, several clear benefits to utilizing NPWT have been defined for several modalities in burn care. However, further research with more robust controlled clinical trials is necessary to better quantify the role of NPWT in burn care and to better define parameters to optimize wound healing.

Treatment of a burn wound often depends on the vertical depth of injury, which is commonly determined by visual assessment. Burn progression is the concept that in the early post-burn period, a partial thickness burn may progress to a deeper burn requiring surgery. Therefore, the initial appearance of the wound may not be indicative of the eventual extent of injury. Several preclinical studies attribute burn wound progression to events such as vasoconstriction, inflammation, programmed cell death, free radical damage, and microvascular occlusion. Due to the concern for translatability of animal models for burn wounds, human studies are essential to understand burn progression in patients. Unfortunately, only a few small human studies exploring mechanisms including apoptosis, ischemia, and infection exist. Inherent to determining burn progression is burn depth determination and healing potential, an area of research that has many ongoing investigations without a clear standard method to replace visual evaluation. Treatments to prevent burn progression in humans, including use of negative pressure wound therapy and application of cooling dressings, have been studied with small sample sizes. Here, we aim to summarize the current data on human burn progression. Additionally, we discuss novel methods that could be used in future research to define early burn wound progression. Future work in human tissue should focus on the assessment and timeline of progression, explore the reversibility and prevention of injury progression and use animal models in parallel as complementary tools for hypothesis-driven research based on findings in humans.

Unplanned extubation rates in burn patients were previously reported at 27% (3 cases per 100 ventilator days). As facial burns pose a unique challenge to tube securement, patients in our unit have surgically placed bite blocks to secure the endotracheal tube at the provider's discretion. Herein, we assessed unplanned extubation rates at our burn center. We performed a retrospective cohort study including burn patients who required mechanical ventilation from 7/01/2015 to 6/30/2023. Demographics, comorbidities, injuries, and hospital course information were collected and compared between patients who had an unplanned extubation and those who did not. Binary logistic regression analyses were performed to identify factors associated with unplanned extubation and ventilator-associated pneumonia (VAP) complication. P < 0.05 was considered significant. Of 360 patients, 17 (4.7%) had unplanned extubations, representing 0.7 cases per 100 ventilator days. There were no significant differences in demographics, comorbidities, or burn injury characteristics between groups. Patients with unplanned extubation were more likely to have an inhalation injury (70.6% vs. 42.6%, p=0.001), paCO2 ≥50 (70.6% vs. 39.1%, p=0.031), more ventilator days (6 [2-15] vs. 2 [1-4] days, p<0.001), and more hospital days (14 [8.5-25.5] vs. 8 [2-20], p=0.020). VAP rate tended to be higher in the unplanned extubation group (17.6% vs. 5.5%, p=0.077. On multivariate analysis, inhalation injury was associated with increased risk of unplanned extubation (Odds ratio (OR) = 4.68 [1.59-13.81], p=0.005). No patients with bite blocks had an unplanned extubation. Further study on the utility of advanced securement devices is recommended.

Wildland firefighting is a niche specialization in the fire service - inherently dangerous with unique risks. Over the past decade, fatalities amongst all firefighters have decreased; however, wildland firefighter fatalities have increased. This subject has only been described in the grey literature, and a paucity of medical literature exists. The United States Fire Administration's online fatality database was queried for on duty mortality between 1990 and 2022. The year 2001 was excluded due to the 340 deaths that occurred on September 11th. Data collected included demographics, incident characteristics, and nature of fatality and was compared between the decades using a Fisher's exact test. From 1990-2000 to the decade of 2013-2022, there has been a significant increase in wildland fatalities, from 2% to 10% of total fatalities (p < 0.00001). Despite the recent wave of 2023 wildfires across North America, the average annual number of wildfires has decreased 23% (from 79,829 to 61,377) between 1990-2000 and 2013-2022. Burn related fatalities have increased over time, from 9% of fatalities to 27% (p < 0.01), while trauma related injuries decreased significantly between the second and third decade (p <0.01). MI accounted for 16% of total fatalities, with no significant change over time. Although wildfires have become less common over the past decade, there was a 5-fold increase in wildland firefighter fatalities with burn related fatalities also increasing. Further investigation, including analysis of 2023 data, is required to augment development of health and safety measures for these heroes.

The standard modality for diagnosis of smoke inhalational injury in burn patients is bronchoscopy with or without bronchoalveolar lavage (BAL). However, the risks associated with these procedures are poorly described in established literature. We sought to investigate the association between diagnostic BAL at admission and the development of pneumonia in burn patients. This retrospective analysis of intubated burn patients studied those who underwent bronchoscopy on admission, comparing patients who received BAL to those who did not. Demographics and baseline characteristics were analyzed using chi-squared or Student's t-test. Unadjusted and multivariable logistic regression studies assessed the effect of admission BAL on the development of pneumonia. Out of the 196 patients who underwent bronchoscopy, 98 met our criteria for analysis. The BAL group was more likely to be male and have a higher grade of abbreviated injury score. Patients who received BAL were more likely to develop pneumonia during the admission in both unadjusted and multivariable logistic regression models. These patients also had a longer hospital length of stay, greater number of ventilator days, and were more likely to undergo second bronchoscopy. These findings associate admission BAL with increased risk of pneumonia during the index hospitalization, suggesting a judicious use of BAL during admission bronchoscopy in burn patients.

Assessment and management of burns require nuanced, timely interventions in high-stake settings, creating challenges for trainees. Simulation-based education has become increasingly popular in surgical and nonsurgical subspecialties to supplement training without compromising patient safety. This study aimed to systematically review the literature on existing burn management-related simulations. A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Articles describing burn-specific surgical and nonsurgical simulation models were included. The model type, study description, simulated skills, assessment methods, fidelity, cost, and outcomes were collected. Of 3472 articles, 31 met the inclusion criteria. The majority of simulations were high-fidelity (n = 17, 54.8%). Most were immersive (n = 17, 54.8%) and used synthetic benchtop models (n = 13, 41.9%), whereas none were augmented reality (AR)/virtual reality (VR). Simulations of acute and early surgical intervention techniques (n = 16, 51.6%) and burn wound assessments (n = 15, 48.4%) were the most common, whereas burn reconstruction was the least common (n = 3, 9.7%). Technical skills were taught more often (n = 29, 93.5%) than nontechnical skills (n = 15, 48.4%). Subjective assessments (n = 18, 58.1%) were used more often than objective assessments (n = 23, 74.2%). Of the studies that reported costs, 91.7% (n = 11) reported low costs. This review identified the need to expand burn simulator options, especially for burn reconstruction, and highlighted the paucity of animal, cadavers, and AR/VR models. Developing validated, accessible burn simulations to supplement training may improve education, patient safety, and outcomes.