Journal of Burn Care & Research最新文献

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.

Burns to the perianal region pose specific challenges in management due to the complex structure of the surrounding tissue, bacterial contamination, and repetitive stress. Fecal diversion via diverting ostomy may be elected in these injuries because of its potential to enhance wound healing and skin graft adherence; however, its use introduces alternative risks such as prolonged ileus, fistula, leakage, and failure of reversal. This study aimed to determine the perspectives of burn surgeons regarding the use of diverting ostomy for perianal burn injuries. We conducted a survey of 12 physicians who are burn center directors in the Northeast Region of the American Burn Association regarding their practices for patients with full-thickness perianal burn injuries requiring a skin graft. Response rate was 11/12 (92%). Six individuals (54.5%) reported "Never (0%)" to performing a diverting ostomy in this context; the remaining 5 individuals responded "Rarely (<10%)." Reasons stated for performing a diverting ostomy in the "Rarely" group included cases where the patient suffered an intra-anal or anorectal injury. These results were summarized with a relevant review of the literature and experience in our clinical practice. Our findings indicate that diverting ostomy is a relatively uncommon practice for burn surgeons treating full-thickness buttocks injuries. With appropriate wound care and critical care management, good outcomes can be obtained without the need for diverting ostomy. Non-surgical alternatives to fecal diversion are commonly used by burn specialists and should be considered in perianal burn injuries.

High-voltage electrocution injuries can result in extensive, multisystem tissue damage, including vascular injuries. The decision between revascularization and early amputation remains challenging, especially given the risks of hemorrhage, infection, and repair failure. A comprehensive literature review was performed using PubMed, Scopus, and Cochrane databases with predefined MeSH terms and keywords related to electrocution and arterial injury. Nineteen relevant human studies were selected after screening. In addition, we present a case of high-voltage upper limb injury in which an arterial interposition graft using the deep inferior epigastric artery (DIEA) was performed in an attempt to maintain hand perfusion. Most published reports describe venous grafts-the most commonly used option-or flow-through flaps as reconstructive options. To date, no previous cases have reported the use of arterial grafts in this context. Arterial injuries may present acutely or subacutely, and a variety of repair techniques have been described, without clear evidence favoring one approach over another. In our case, despite technically successful placement of a DIEA arterial graft following radial artery rupture, early thrombosis and distal ischemia occurred, ultimately resulting in limb loss. Vascular injury from electrocution is often more extensive than macroscopically evident. Reconstructive attempts should be considered only in stable patients, especially when preserving the dominant limb in young individuals. Although arterial grafts offer structural advantages, they may not overcome the systemic and local damage induced by electrocution. Further research is needed to define clearer guidelines for vascular repair versus amputation in these complex scenarios.

Gel sheets have been used to treat hypertrophic scars (HSc) since the 1980s, though evidence for their efficacy-especially for burn-related HSc-is limited. This study conducted a randomized, evaluator-blinded trial to assess gel sheets on established burn HSc compared to intra-individual patient-matched control scars receiving usual care. Thirty-six adult burn survivors with 2 similar scars (based on ultrasound thickness > 2.034 mm and erythema index > 300) were enrolled. One scar per person was randomly assigned to receive gel sheets plus usual care, while the other received usual care only, over a 3-month period. Objective measures (thickness, elasticity, erythema, transepidermal water loss [TEWL], and melanin) were taken at baseline, monthly, and 1-month posttreatment. Itch and pain were self-reported, and adherence tracked monthly. An analysis of covariance (ANCOVA) after 3 months of treatment, and at 1-month posttreatment follow-up, controlling for pretreatment values, showed no significant difference between groups for thickness, elasticity, erythema, TEWL, melanin or itch intensity. However, ANCOVA revealed a significant increase in elasticity in the treated scars when only participants who wore the gel sheet over 16 h a day were analyzed. Comparisons of pretreatment to 3 months of all participants, using paired t-tests, showed a significant decrease in thickness and TEWL, and an increase in elasticity in both groups, but no significant change in erythema or melanin of either site. In conclusion, scar thickness, elasticity, and TEWL improved over time in both groups, but there was no significant between-group difference. However, gel sheets may enhance elasticity if worn over 16 h daily.

Patients recovering from burn injuries experience long-term psychological, physiological, and biomechanical challenges due to scarring. While interventions to address these challenges exist, insurance coverage is often limited. This study examines the insurance policies of major health insurers regarding cosmetic reconstruction (CR) following burn injuries. A comprehensive review of coverage policies was conducted for 5 major health insurance providers: UnitedHealth Group, Elevance Health (formerly Anthem), Humana, CVS (Aetna), and Centene Corporation. The review focused on invasive and noninvasive CR interventions for burn injuries. Data were collected from state-specific insurance documents using Microsoft Excel. As of 2024, UnitedHealth Group holds a 28% share of the Medicare Advantage market and 14% of the commercial market, serving all 50 states. Humana controls 18% of the Medicare Advantage market, while CVS (Aetna) holds 11% in both markets, with nationwide coverage. However, none provides coverage for CR unless there is documented significant functional impairment (FI). Elevance Health has limited coverage in 19 states, contingent on FI documentation, while Centene Corporation covers CR on a case-by-case basis, leading to fragmented access across the United States. Standardized, equitable coverage for burn-related CR is needed to remove bureaucratic barriers hindering survivors' recovery. Inconsistent insurance policies prevent access to essential aftercare, exacerbating physical and emotional burdens. Policy reform is crucial to ensure all burn survivors receive the care needed for recovery and a restored quality of life.

Cannabis use has increased with expanding legalization and societal acceptance, raising questions about its impact on burn care. Given its known effects on pain perception, metabolism, and immune modulation, cannabis may influence various aspects of burn treatment, including pain management, wound healing, and rates of infection. This study explores trends in cannabis use among burn patients and evaluates its association with clinical outcomes using the National Trauma Data Bank (NTDB). The NTDB was used to identify burn patients from 2017 to 2021, isolating burn injuries through e-code variables. Cannabis use was documented at admission, and patients without screening data were excluded. The primary exposure variable was cannabis use, with outcomes including mortality, stroke, myocardial infarction, organ failure, timing of surgery, and postsurgical complications. Secondary outcomes included ED vital signs, length of stay, and intensive care needs. Multivariable regression models were applied to analyze the association between cannabis use and outcomes. Of 319 941 burn patients, 52 803 (16.5%) tested positive for cannabis. Cannabis-positive patients were more likely to be male (18% vs 11%, P < .001) and younger (28.9 vs 32.6 years, P < .001). They had higher rates of venothromboembolic events, required longer ICU stays, and were more likely to develop ventilator-associated pneumonia. Additionally, cannabis-positive patients had a higher incidence of organ failure (2.1% vs 1.3%, P = .012) and reoperations (5.2% vs 4.1%, P = .019). Cannabis use in burn patients is associated with more complex recoveries, including higher risks of complications. Integrating cannabis screening into burn care protocols and further research is essential to optimize treatment strategies.

Patients from low-socioeconomic status (SES) backgrounds face barriers to quality burn care, such as limited healthcare access and follow-up. Many turn to online resources like Google, which may provide overwhelming or irrelevant information. This study compares the accuracy, readability, and SES-relevance of burn care information from ChatGPT and Google to address these disparities. A standardized set of questions on immediate burn care, medical treatments, and long-term care was developed based on clinical guidelines. Responses from ChatGPT (v4.0) and the first Google search result were analyzed. Two medical students and 2 burn surgeons assessed accuracy using the Global Quality Score (GQS) on a scale of 1 (poor) to 5 (excellent). Readability was measured using the Flesch-Kincaid grade level, and SES relevance was determined by counting responses that included themes related to affordability and access to care. Accuracy, readability, and SES relevance were then compared using a Wilcoxon signed-rank test. ChatGPT provided higher-quality responses (GQS 4.35 ± 0.60) than Google (GQS 2.25 ± 1.10, P < .01). ChatGPT was unanimously preferred for half of the questions. Both platforms had reading grade levels of 8 and 9, but ChatGPT addressed SES issues in 74% of responses, compared to Google's 33%. ChatGPT outperformed Google in providing accurate, SES-relevant burn care information. Artificial intelligence tools like ChatGPT may help reduce health information disparities for low-SES patients by offering tailored and user-friendly guidance. Future studies should validate these findings across other clinical topics and patient populations.

Accurate burn depth assessment remains a challenge, especially in emergency settings. This study aimed to develop a low-cost artificial intelligence (AI)-based system for burn wound classification using deep learning and large language models (LLMs). A total of 397 burn wound images from public databases were augmented to 7156 images and categorized by depth. A classification model was trained using PaddlePaddle, and a burn-specific LLM was developed based on clinical guidelines. Model performance was evaluated using accuracy, recall, and F1 score and compared against 10 medical students and 6 general LLMs on 80 out-of-sample images. Our model achieved an overall accuracy of 96.82% and F1 score of 96.70%, outperforming medical students (F1: 76.63%) and general LLMs (F1: 68.75%-73.75%). In a separate test using 10 guideline-based true/false questions, all AI models answered correctly, whereas students had only 64% accuracy. This integrated model offers accurate burn depth recognition and guideline-based treatment suggestions, addressing the shortage of burn care specialists, and supporting medical education.

Frostbite injury in prepubescent children is rare and, as such, has limited research and guidelines specific to managing this population. Here, we present a 5-patient case series of all prepubescent pediatric patients with severe frostbite injury who were treated with thrombolytics at our ABA-verified burn center. All patients were documented to have excellent preservation of tissue with no adverse effects related to thrombolytic administration. This case series underscores the potential of thrombolytic therapy in pediatric frostbite cases, paving the way for improved clinical outcomes and highlighting the necessity of further research to establish standardized treatment guidelines.