Journal of Burn Care & Research最新文献

Scars are common and debilitating outcomes of burn injury, with no current consensus regarding the gold standard in scar management. Noninvasive interventions such as silicone gels are popular adjuvant treatments due to ease of application. Onion extract (OE) has been proposed as a potential scar treatment modality due to its antimicrobial and anti-inflammatory properties. A systematic search of the literature was conducted using PubMed, Scopus, and Cochrane for articles published between January 2000 and December 2021. Inclusion criteria were studies (1) involved OE gel or OE treatment and (2) those assessing scar prevention or treatment outcomes. Patient and physician reported scar outcomes after treatment and adverse effects were recorded. A total of 21 articles were included in the final review. Five studies found statistically significant improvements in overall scores and individual Vancouver Scar Scale components in the OE treatment group compared to the silicone groups. Several studies found that combined treatment of OE with other topical treatment modalities such as triamcinolone or silicone gel produced significant improvements in scar symptoms. In this review, reported adverse effects were minimal, often consisting of self-resolving pruritus, irritation, and erythema. This review supports OE's potential utility in scar prevention and treatment. Most studies reported minimal adverse events with OE application and significant benefits in specific scar characteristics. Further research is needed to investigate scar outcomes after treatment with OE with larger sample sizes and a follow-up period greater than a year.

Septic arthritis (SA) are rare in patients with burns, but delayed treatment can result in irreversible joint destruction. Early diagnosis and immediate treatment are necessary to prevent joint destruction. Robot training in patients with musculoskeletal diseases and burns, can improve joint range of motion (ROM), muscle strength, and lower extremity function. The aim of this report is to present robot training utility in patient with lower extremity electrical burns and associated SA. Rebless® (H-ROBOTICS, KOREA) for ROM and strength training, can operate in passive or active modes in knee or ankle flexion and extension. Rebless® works by providing visual feedback on angles during flexion and extension training. Two participants, diagnosed with SA after burns, and unable to walk before training because of joint pain, limited ROM, and muscle weakness, underwent 30 min of robot training using Rebless® with 30 min conventional therapy, 5 days a week for 8 weeks. After training, the gait function, muscle strength, and pain scores of the participants improved without adverse effects on joint ROM. This report is the first to demonstrate that robot training has a positive effect on gait function, pain, muscle strength with no soft tissue contractures or other complications in a patient with burn injury and SA.

Fellowship program websites pertaining to various subspecialties have been evaluated according to the amount and type of content they communicate to prospective applicants. This study aimed to evaluate what information specifically burn fellowship programs communicate through their websites and to what extent, if at all. In total, 10 of the 30 unique burn fellowship programs, American Burn Association (ABA)-verified or otherwise, identified through the ABA website did not have official websites which could be readily located at the time of data collection. Thus, 20 burn fellowship program websites were included in the analysis. Burn fellowship program websites were assessed according to 23 criteria relating to recruitment, education, and social life. On average, each website contained an average of 8.5 ± 2.6 criteria (range, 2-13), with all of them listing a program contact email/phone, and 95% containing a program description. Only 35% of programs listed the faculty, and a single program advertised alumni job placement. Neither the total number of fellows, the total number of clinical faculty, nor the Accreditation Council for Graduate Medical Education accreditation status were significantly associated with the amount or type of content. Geographic region was associated with a significant difference in the amount of education-related content. Fellowship program websites are important to prospective applicants when comparing programs and deciding where to apply. These results show where burn fellowship programs can increase the amount of publicly available information that applicants tend to find helpful in order to hopefully both diversify and tailor their applicant pool to those whose goals align with the programs'.

The Burn Therapist Certification (BT-C) was introduced in 2018 to acknowledge occupational therapists (OT) and physical therapists (PT) with specialized knowledge, skill, and experience in the promotion of quality burn rehabilitation. Currently, BT-Cs make up 11.7% of therapists working in burn rehabilitation (n = 39/333). The purpose of this review is to report on the contributions of BT-Cs to organizational leadership of the American Burn Association (ABA) and in the generation of new knowledge through peer-reviewed publications. Despite the small percentage of burn therapists who are certified, they have a disproportionately large involvement in leadership within the ABA and burn research in the Journal of Burn Care and Rehabilitation (JBCR). From 2018 to 2023, BT-Cs have contributed to nearly one-half (n = 26/56) of therapy authored publications in the JBCR and almost one-third (n = 65/202) of accepted abstracts at the ABA annual meeting. Certified burn therapists demonstrate substantial involvement throughout the ABA, including maintaining an 85% membership rate and, on average, serve in 53% (n = 31/59) of the therapy allotted committee positions. Therapist pursuit of certification can have a profound impact on the burn community through publication, leadership, and development of care standards. Although therapists have indicated a desire to pursue certification, barriers related to a lack of association and center support have been identified. The burn community has endorsed certification as a mark of excellence for nurses and physicians. Maximizing the value of a transdisciplinary approach to burn care is also dependent on the excellence of therapies. If the burn community desires improved engagement and contribution from therapies, it should support therapist certification.

Self-inflicted burns (SIBs) represent a distinct entity in burn care often associated with an underlying psychiatric etiology. In this review, we summarize the existing evidence on SIBs in North America to inform targeted prevention and interventions for patients afflicted with SIBs. The following databases were queried to identify relevant articles used for literature review: PubMed, Embase, and Scopus. The main outcome measures were burn characteristics and risk factors of SIBs in the American population. A total of 14,189 patients were included across 13 included studies. The percent of total body surface area burned ranged from less than 1% to 100%, with a mean of 29.6% ± 20.7%. Depressive disorders were the most reported overall; however, among mood disorders, bipolar disorder was also reported frequently, while anxiety was reported least. Motives for self-inflicting burn injury included premeditated self-injury as a coping mechanism, escape or response to delusions, impulsive self-injury, and most commonly, suicidal intention. The majority of the studies reported that preadmission drug and alcohol abuse were associated with the occurrence of SIBs. Other identified risk factors for SIB injury included female sex, younger age, unemployment, and unmarried status. From this, it is imperative that targeted interventions are developed to address the complex interplay of psychiatric disorders, drug use, and other demographic risk factors among the American population. It is crucial for initiatives to emphasize early identification of individuals at risk of self-harm, better access to mental health services, and stronger drug abuse programs to target SIB occurrence in the United States.

Daily rehabilitation after burn injury is vital for the prevention of function-limiting contractures. However, adherence to prescribed therapy following acute burn hospitalization has historically been low and not well-studied. Studies involving virtual reality technology have demonstrated an association with improved functional outcomes in burn therapy. We conducted a 5-year randomized controlled trial comparing 12 weeks of a home-based virtual rehabilitation (HBVR) system with standard burn therapy. Our primary outcome was adherence to prescribed home therapy, measured by e-diary self-report. Secondary outcomes included steps walked daily and patient-reported outcomes regarding stiffness, upper extremity function, and mobility. We enrolled 50 subjects, of which 48 provided data for analysis (23 HBVR, 25 control). Overall adherence to prescribed home therapy was low, 37.2% in the HBVR group and 60.0% in the control group. Reasons for nonadherence in the HBVR group included lack of time, engagement, and replacement of therapy with other physical activity. However, some subjects enjoyed HBVR and believed it aided their recovery. There was no difference in daily steps walked between the 2 groups. Daily walking gradually improved from 3500 steps per day in the first week after baseline and plateaued at 6000 steps per day at week 5. There were no differences in stiffness, upper extremity function, and mobility between the 2 groups at baseline and 3-, 6-, and 12-month follow-up. Subjects demonstrated improved upper extremity function and mobility in the first year after discharge, which coincided with increasing stiffness.

The hypermetabolism that occurs after large burns leads to muscle wasting that can result in weakness, difficulty fighting infections, and other challenges to healing. Overall, rates of muscle wasting are not well established across burn centers. The Burn Care Quality Platform (BCQP), the largest available dataset on burn patients globally, was used to explore the rate of Muscle Wasting using data collected from more than 100 burn centers. "Muscle Wasting" was defined from relevant ICD codes (sarcopenia, muscle cachexia, protein malnutrition). Binomial and logistic regression were used to analyze the role of Muscle Wasting in burn mortality and other outcomes after controlling for demographic and comorbid characteristics. In total, the BCQP provided data from 84 438 adult and pediatric burn patients injured between 2000 and 2018. Only 2.6% (N = 2159) of the patients in the BCQP were diagnosed with having Muscle Wasting at some point during their admission. While Muscle Wasting was not associated with a statistically significant impact on mortality, it remained an independent predictor of inability to discharge to independent living, longer inpatient days, as well as an average of 10 additional surgical procedures (P < .001 for all) as compared to patients who did not have Muscle Wasting. Muscle Wasting is an independent risk factor for several adverse outcomes in burn patients, but not mortality in the BCQP. Confidence in these findings would be improved with more accurate data collection, as the diagnosis of Muscle Wasting is likely under-reported, under-diagnosed, or both.

In modern burn care, the focus extends beyond mere patient survival to encompass long-term functional and cosmetic outcomes. Research suggests that the technique and manner of suturing during skin grafting play a significant role in scar formation. This study aimed to explore the effectiveness of wound edge approximation with skin grafting compared to the conventional approach, where the graft edge exclusively interacts with the wound edge, in reducing hypertrophic scar development. Seventy-four burn unit patients eligible for grafting were randomly allocated into 2 groups: those receiving grafts with overlapping edges (Group A) and those receiving grafts with edges tailored to the burn wound (Group B). Evaluation of graft sites occurred immediately post-surgery and at 1 and 6 months post-operatively using the standardized Vancouver Scar Scale (VSS) administered by trained surgeons. The findings of this study revealed that there was no statistically significant difference between the 2 examined groups regarding the average duration of hospitalization and the mean thickness of wounds (P > 0.05). Similarly, the mean scores for pain, vascular index, and pigmentation index immediately post-surgery, at 1 month, and 6 months later, as well as the scar height index and flexibility immediately and at 1-month post-surgery, and the VSS index at the study's conclusion, showed no significant variation between the 2 groups (P > 0.05). However, at the 6-month follow-up, the mean scar height score (P = 0.004) in the overlapping group and the mean flexibility score (P = 0.017) in the non-overlapping group were significantly lower compared to the respective alternative group. This indicates a notable improvement in scar height and wound flexibility in the overlapping group over the non-overlapping group after 6 months.

Burn injury contributes to significant morbidity and mortality in the United States. Despite an increased focus on racial and ethnic disparities in healthcare, there remains a critical knowledge gap in our understanding of the effect of these disparities on complications experienced by burn patients. The American Burn Association's National Burn Repository data were reviewed from 2010 to 2018. Information regarding demographics, burn mechanism and severity, complications, and clinical outcomes were recorded. Data analysis was performed using 1:1 propensity score matching and logistic regression modeling. A separate analysis of Hispanic and non-Hispanic patients was performed using Chi-squared tests. Among 215,071 patients, racial distribution was 65.16% White, 19.13% Black, 2.18% Asian, 0.74% American Indian/Alaskan Native, and 12.78% other. Flame injuries were the most common cause (35.2%), followed by scald burns (23.3%). All comparisons were made in reference to the White population. Black patients were more likely to die (OR: 1.28; 95% CI, 1.17-1.40), experience all (OR: 1.08; 95% CI, 1.03-1.14), cardiovascular (OR: 1.24; 95% CI, 1.08-1.43), or infectious (OR: 1.64; 95% CI, 1.40-1.91) complications, and less likely to experience airway complications (OR: 0.83; 95% CI, 0.74-0.94). American Indian/Alaskan Native patients were more likely to experience any complication (OR: 1.33; 95% CI, 1.05-1.70). All minority groups had increased length of hospital stay. Black, Asian, and other patients had longer length of ICU stay. Black patients had longer ventilator duration. Among 82 775 patients, 24 075 patients were identified as Hispanic and 58 700 as non-Hispanic. Statistically significant differences were noted between groups in age, total body surface area, proportion of 2nd-degree burn, and proportion of 3rd-degree burn (P < .01). These findings highlight the need for further work to determine the etiology of these disparities to improve burn care for all patients.