Journal of Burn Care & Research最新文献

Residential fires remain a leading cause of severe burn-related injuries and fatalities, particularly in socioeconomically disadvantaged regions. Despite existing fire safety standards, limited resources in low-income communities hinder effective prevention. This study evaluates the impact of community-based fire risk-mitigation strategies on fire-related burn admissions in a high-poverty urban area. A retrospective review of all fire-related burn admissions to a regional burn center in Memphis, Tennessee, was conducted over a 5-year period (July 1, 2019 to June 30, 2024). Only incidents occurring within city limits were included to ensure consistent exposure to the same interventions. Patient demographics, burn characteristics, and clinical outcomes were analyzed annually. Interventions implemented included free smoke alarm installations ("Get Alarmed, TN!"), fire safety education ("Close the Door!"), and urban blight reduction efforts. Of 481 burn injuries admitted to a regional burn center in Memphis, 204 (42.4%) were fire-related. A significant reduction in fire-related admissions was observed after mid-2021 (from 58% in 2020 to 32.9% in 2023, P = .0003), without concurrent changes in demographics or injury severity. ZIP codes with poverty rates >30% saw the most substantial decline in injury rates, while less impoverished areas showed an opposite trend. Fire prevention initiatives were associated with a significant and sustained reduction in fire-related injuries in high-poverty areas. These findings underscore the effectiveness of targeted, low-cost interventions and highlight the importance of ongoing investment in fire safety education and infrastructure in socioeconomically vulnerable communities.

Increased length of stay (LOS) in patients with burn injuries is associated with increased adverse and poorer outcomes. Despite the awareness of the profound risks associated with increased LOS, large studies examining associated variables are lacking. This study aimed to identify pre-existing conditions, injury characteristics, and intrahospital events that influence whether patients meet or exceed the expected LOS based on the LOS:TBSA ratio, 1.5 days for adults aged 18-59 years and 2.0 days for older adults aged ≥ 60 years. A retrospective review of an adult cohort study admitted to a tertiary burn center was conducted. We included all surviving patients with burn injuries admitted from January 2006 to June 2021. Primary outcome was whether patients met or exceeded the expected LOS:TBSA ratio. Median (IQR) age was 45 (31-58) years, 1635 (70%) were male, and median (IQR) %TBSA was 7 (3-14). Median (IQR) LOS was 13 (6-20) days, and LOS:TBSA median (IQR) was 1.65 (0.98-2.95). We found inhalation injury to be a predictor of prolonged LOS in both adults and older adults, while female sex and greater age only contributed to increased LOS in the adult group. In-hospital complications are modifiable factors of prolonged LOS in both adults and older adult patients. We identified that greater age, female sex, inhalation injury along with in-hospital complications affected LOS in adults. Greater age and sex did not affect LOS in older adult patients. Identified risk factors should be adjusted for in future prospective studies.

Burn centers are vital for managing burn injuries, with timely referral being crucial for optimal care. The American Burn Association (ABA) provides referral criteria to help healthcare providers identify patients needing specialized treatment. However, adherence to these guidelines varies, leading to inefficiencies in resource use. This study assesses consultation patterns and hospital size on referral practices and outcomes at a state burn center. A retrospective review of 588 telephone inquiries between January 1 and December 31, 2024, was conducted. Data on hospital size, adherence to ABA guidelines, and patient disposition (admission, referral to ED, or outpatient follow-up) were analyzed using chi-square tests (P < .05). Of the 588 inquiries, 29% came from larger hospitals (≥300 beds), with 34% resulting in-patient admissions. In contrast, 36% of calls were from smaller hospitals (<100 beds), with only 20% leading to admissions. Larger hospitals adhered to ABA guidelines more often (72%) compared to smaller hospitals (25%), with a P-value of .02. Larger hospitals were 1.21 times more likely to have referrals admitted than medium-sized hospitals and 1.7 times more likely than smaller hospitals (P < .005). Overall, 35% of referrals led to admissions. Hospital size significantly influences adherence of guidelines and referral outcomes. Larger hospitals are more likely to follow guidelines and admit patients. Combining structured telehealth programs with enhanced educational initiatives and outreach for referring hospitals may improve efficiency, optimize resource use, and strengthen burn care delivery.

Burn injuries often require advanced treatments to optimize healing, yet the comparative effectiveness of autologous skin cell suspension (ASCS) across wound types remains unclear. While ASCS shows promise in enhancing wound healing, its relative efficacy in burn versus non-burn wounds is not well understood. This study evaluates ASCS outcomes in burn and non-burn patients, hypothesizing that ASCS is equally effective in promoting healing across both wound types. This retrospective cohort study analyzed 100 patients with full-thickness injuries treated with ASCS, comparing burn (n = 28) and non-burn (n = 72) groups. Outcomes included wound closure at 4 and 8 weeks, complication rates, age, length of stay, time from ASCS application to discharge, American Society of Anesthesiologists score, Mangled Extremity Severity Score, wound size, estimated blood loss, case time, operating room time, and follow-up duration. Statistical significance was set at P < .05, using T tests and Chi-square analysis. At 4 weeks, wound closure was comparable at 78.6% (22/28) for burns and 75% (54/72) for non-burns. By 8 weeks, closure reached 100% (28/28) for burns and 93% (67/72) for non-burns. Complication rates were 25% in both groups. Follow-up averaged 64.24 days for burns and 89.54 days for non-burns. No significant differences were found in wound closure or complications, supporting the hypothesis. These findings suggest that ASCS is a versatile and valuable addition to burn treatment protocols, offering promising results irrespective of injury etiology. The results can inform clinical guidelines and protocols, enabling confident application of ASCS beyond burns to optimize patient outcomes.

Severe burns trigger hyperinflammatory and hypermetabolic responses, leading to systemic organ damage. High mobility group box 1 (HMGB1) is an inflammatory peptide released from injured sites. This study investigated wound progression in scald burn rats treated with anti-HMGB1 antibody (Ab). Male Sprague-Dawley rats were divided into sham burn (n = 5), burn with vehicle treatment (n = 8), and burn with anti-HMGB1 Ab treatment (n = 8). After 30% total body surface area burns, rats were treated with chicken IgY (burn/vehicle group) or anti-HMGB1 Ab (burn/treatment group). Skin samples were collected at 3 and 14 days after burn for histological analysis of wound composition and healing. ANOVA and post hoc Tukey tests were used for statistical analysis. Anti-HMGB1 Ab improved healing, increasing epithelial thickness on day 14 compared to sham (58 μm ± 22 μm vs 21 μm ± 3 μm; P < .01) and dermal thickness over vehicle (1.7 mm ± 0.23 mm vs 1.4 mm ± 0.25 mm; P < .05). Panniculus carnosus muscle loss was lower in the anti-HMGB1 Ab-treated group than vehicle group (-6.4% ± 1.5% vs -70.9% ± 25%; P = .01). High mobility group box 1 expression decreased in epithelium on day 14 (17.15% ± 11.94% vs 60.83% ± 5.28%; P = .02) and dermal inflammation decreased significantly on day 3 (0.45% ± 0.10% vs 4.05% ± 0.49%; P < .0001). Reducing circulating HMGB1 levels decreases burn wound conversion with improved wound healing.

Chronic pain is a common and debilitating outcome for many burn patients, necessitating effective and equitable pain management. Although opioids are routinely prescribed for severe and chronic pain, prior studies have shown that Black patients are less likely to receive opioid prescriptions than White patients, raising concerns about racial disparities in pain treatment. This study aimed to investigate whether such disparities in opioid prescribing extend to other racial and ethnic groups following burn injury. Using the TriNetX database, we identified adult patients (≥18 years) diagnosed with both burn injuries and chronic pain between January 1, 2016, and January 1, 2023. To reduce confounding, cohorts were propensity score matched for age, burn severity, and comorbidities. We then examined differences in opioid prescription rates at six- and twelve-months post-injury using univariate regression models, calculating odds ratios (ORs) with statistical significance set at P<.05. Among 32 167 burn patients with chronic pain, 63.66% (n = 20 478) were White, 17.80% (n = 5726) Black or African American, 2.57% (n = 827) Asian, 1.09% (n = 351) Native Hawaiian, and 0.60% (n = 193) American Indian. Compared to White patients, the odds of receiving an opioid prescription were significantly lower for Black (OR: 0.693, P<.0001), Asian (OR: 0.576, P=.0135), Native Hawaiian (OR: 0.313, P=.0074), and Other Race patients (OR: 0.641, P=.0081). No significant difference was observed for American Indian patients (OR: 0.809, P=.6689). While racial differences in the prevalence of chronic pain were observed, our analysis specifically focused on treatment disparities within those already diagnosed with chronic pain. These findings reveal inequities in opioid prescribing practices for chronic pain management after burn injuries and underscore the need for policy-level changes to promote equitable care across all racial and ethnic groups.

We present a case of a severe thermal injury leading to vasogenic edema that appears indistinguishable on CT scan from infectious cerebritis. Despite extensive damage seen on imaging, the patient did not exhibit neurological deficits expected for the injured brain region throughout the entire hospital stay. Long-term antibiotic therapy ultimately ruled out infection as the cause of extensive vasogenic edema on imaging, making thermal injury the etiology of exclusion. This case emphasizes the impact that severe burns can have on the central nervous system.

Burn pain is among the most distressing and complex aspects of burn injuries, significantly impeding the treatment process and overall patient care. Despite advancements in pain management, many patients with burn injuries continue to experience inadequate relief. Investigating the experiences of both patients and healthcare providers offers valuable insights into the challenges of pain management. This qualitative study was conducted in Iran between 2024 and 2025. Eighteen hospitalized patients with burn injuries and 21 healthcare providers-including physicians, nurses, psychologists, and physiotherapists-were selected through purposive sampling. Data were gathered via semi-structured individual interviews until saturation and analyzed using Graneheim and Lundman's content analysis method, supported by MAXQDA 2020 software. Four main categories and 13 subcategories emerged: "Endless suffering accompanied by a sense of collapse," "The cycle of suffering and restlessness," "Barriers to pain relief," and "A holistic approach to pain management." Findings showed that patients endured severe physical pain along with psychological distress such as anxiety, despair, and sleep disturbances, while healthcare providers emphasized systemic barriers, resource limitations, and the restricted effectiveness of current approaches. These results highlight the multifaceted and enduring nature of burn pain and underscore the importance of addressing both patient experiences and provider challenges. In conclusion (shortened), burn pain represents one of the most intense and debilitating forms of suffering, with consequences extending beyond the physical dimension. Targeted strategies informed by these insights may improve the quality of care and patient outcomes.

Postoperative pain management is a significant challenge in patients undergoing burn excision. Pharmacologic pain management strategies include both opioid and non-opioid medications. Given the national overuse of opioids and the associated negative effects, it is prudent and essential to find ways to manage pain with fewer or no opioids. We hypothesize that intraoperative administration of intravenous methadone reduces total morphine milligram equivalents per weight used in the 36 h following surgery. This is a retrospective, single-center cohort study of adult burn patients who underwent a first excision of full thickness burn between January 2019 and January 2021. One group received intraoperative intravenous methadone while the non-exposure group did not. The primary outcome was total morphine milligram equivalents per weight utilized in the 36 h following surgery. Secondary outcomes included average pain scores in the post-anesthesia care unit and for 36 h postoperatively, as well as discharge opioid prescriptions. The methadone group contained 104 subjects, and the non-exposure group contained 119 subjects. Poisson regression, with adjustment for covariates, showed that the methadone group required fewer 36-h postoperative opioids (IRR = 0.89, P = .447) and were discharged with fewer opioid prescriptions (IRR = 0.86, P = .363) independent of the age and %TBSA differences. Post-anesthesia care unit pain scores were lower in the methadone group (IRR = 0.91, P = .350), as were 36-h postoperative pain scores (IRR = 0.92, P = .310). These trends toward improved pain control and reduced opioid requirements in patients receiving intraoperative, intravenous methadone did not reach statistical significance. Prospective, adequately powered randomized studies are needed to advance these findings.

Acute burn care is heavily resource-dependent and thus was significantly impacted by the COVID-19 pandemic. This study sought to examine the relationship between COVID-19 and the length of stay (LOS) in hospital following burn injury, as prolonged admissions have implications on both individuals and healthcare systems. Additionally, this study explored how COVID-19 affected the homeless burn population, as homelessness has been associated with longer hospital admissions due to limited post-discharge resources. Single-center, retrospective cohort study using data from the Burn Registry and medical chart review with inclusion of all adult burn patients admitted to a quaternary provincial burn unit from April 1, 2016, to March 31, 2023. Patients admitted prior to April 1, 2020, were considered the pre-COVID cohort. Key variables included demographic characteristics and LOS, with homelessness defined as a lack of a fixed address. Of 498 included patients, 301 and 197 were in the pre-COVID and COVID cohorts, respectively. While both cohorts had similar age and gender distributions, a significant difference was noted in LOS between cohorts, with COVID cohort patients staying in hospital for 22 (24) days compared to 20 (29) days in the pre-COVID cohort. More notably, a 58% increase in homeless patients was seen during COVID, with 17% (50/301) of admitted patients being homeless pre-COVID compared to 26% (52/197) during COVID (P < .05). The COVID-19 pandemic resulted in a slightly increased LOS in burn patients, with homeless patients disproportionately affected. This has important implications for both patient outcomes and healthcare resource allocation.