Journal of Burn Care & Research最新文献

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.

Autologous skin cell suspension (ASCS) technology has emerged as a promising advancement in pediatric burn care, offering potential benefits in wound healing, aesthetic outcomes, and resource utilization. This systematic review and meta-analysis evaluated 8 studies encompassing 135 pediatric patients with burns ranging from 0.3% to 90% total body surface area (TBSA). Autologous skin cell suspension demonstrated significant efficacy in promoting rapid reepithelialization, with mean times to > 90% reepithelialization ranging from 7 to 81 days. A sensitivity analysis excluding high-TBSA outliers confirmed improved precision in pooled healing time (13.2 days, 95% CI: 0.2-26.2), suggesting ASCS may be particularly effective in moderate burns. Aesthetic outcomes were favorable, particularly in facial burns, where ASCS minimized visible scarring and reduced complications. Resource utilization findings highlighted reduced hospital length of stay (LOS) by 2.9 days for small burns and a 60% reduction in autograft needs in full-thickness burns. However, substantial heterogeneity was noted in healing and LOS outcomes, as evidenced by high I2 values in meta-analyses, indicating variability in study populations and protocols. Limitations included small sample sizes, single-center designs, and variability in follow-up durations. Despite these challenges, ASCS shows promise in pediatric burn care, emphasizing the need for standardized protocols and further research to optimize its application. These findings suggest that ASCS could enhance both clinical outcomes and patient quality of life, making it a valuable addition to pediatric burn management strategies.

Burns are associated with significant inflammation and pain. Topical agents like heparin can modulate these processes and improve outcomes. Our study aims to evaluate the effectiveness of using topical heparin (TH) in patients with burns. On August 7, 2024, we conducted a literature search on PubMed, Scopus, and Web of Science. Only randomized controlled studies were included. Data were extracted on analgesic drug usage, bleeding events, sepsis, visual analog scale pain scores, length of hospital stay, and mortality. Statistical analysis was performed using R software (version 4.4.1), heterogeneous data. Seven randomized controlled trials (503 patients; topical heparin: 249, control: 254) were included. Analgesic use (1-2 times/day: RR = 3.04, P = .68; 3-4 times/day: RR = 0.06, P = .18), bleeding (RR = 5.06, P = .37), sepsis (RR = 0.77, P = .40), hospital stay, and mortality (RR = 0.13, P = .90) showed no significant differences. Topical heparin reduced local wound infections by 60% (RR = 0.40, P < .01) and lowered Visual Analog Scale pain scores (MD = -3.34, P < .01). However, sensitivity analysis excluding an outlier nullified the pain reduction (MD = -4.17, P = .57). All studies had a high risk of bias, especially in outcome measurement and randomization. Topical heparin reduces pain and local wound infections in burn patients without having an impact on other outcomes. Evidence is limited by a high risk of bias. Well-designed randomized trials are needed to determine its broader clinical value.

Infection is the primary cause of death among burn-injured patients, with soft tissue infection trailing only pneumonia as the most common source of sepsis. Methicillin-resistant Staphylococcus aureus (MRSA) has become endemic in burn units, resulting in the frequent initiation of empiric vancomycin therapy. Methicillin-resistant S aureus nasal swab screening rapidly identifies patients who are MRSA-colonized, informing contact precaution and decontamination protocols. We hypothesized that MRSA nasal swab results could also be used to reliably predict results of wound cultures obtained from infected burns. We performed a retrospective review of all 250 patients who underwent weekly nasal swab screening and developed a burn infection in our unit over a 36-month period. By comparing nasal screening results with bacterial cultures, we determined test performance metrics for MRSA nasal swabs: sensitivity 64.1%, specificity 96.2%, positive predictive value 75.8%, and negative predictive value 93.5%. Nasal swabs were slightly more sensitive for predicting community-acquired MRSA infections compared with hospital-acquired infections. In total, 30 patients (76.9%) presented with community-acquired MRSA infections; of those, 20 (66.7%) had tested positive for MRSA colonization on nasal screen. A total of 9 patients (23.1%) developed hospital-acquired MRSA infections; 5 (55.6%) had tested positive for MRSA on a preceding nasal swab. The NPV calculated here indicates that patients who test negative for MRSA colonization by recent nasal swab are highly unlikely to have a burn infection caused by MRSA. Burn centers should employ universal MRSA nasal screening and de-escalate MRSA antibiotic coverage when treating burn infections in patients with a negative nasal swab result.

Patients with massive burn injuries represent a unique patient cohort because they are associated with high morbidity and mortality while requiring high care intensity. This study aimed to compare the characteristics and outcomes of patients with massive burns (total body surface area ≥ 40%) versus those without, by utilizing the WHO Global Burn Registry. Descriptive statistics summarized demographic and burn characteristics. Multivariable logistic regression quantified the impact of massive burns on mortality, likelihood of surgical intervention, and functional impairment among survivors. Among 9274 patients in the database, 1828 (19.7%) had massive burns, with a median total body surface area of 55% (interquartile range: 45%-75%). These patients were predominantly managed in low-resource settings (60%) and sustained higher rates of inhalation injury (48% vs. 7%, P < .001) and flame-based burns (83% vs. 40%, P < .001) compared with the non-massive burns cohort. Logistic regression showed that massive burns increased the odds of mortality (OR 7.25, 95% CI 6.08-8.65) and functional impairment (OR 1.36, 95% CI 1.004-1.81), while decreased the odds of undergoing surgical intervention (OR 0.55, 95% CI 0.48-0.62). Massive burns significantly predict higher mortality and long-term functional challenges while reducing the likelihood of surgical intervention. These findings underscore the need for tailored management strategies and comprehensive rehabilitation for this high-risk population, particularly in resource-limited settings.

The primary aim of this study was to determine whether a significant correlation exists between the relative decline in serum concentrations of interleukin-6 (IL-6) and interleukin-8 (IL-8) between the third and eighth days after injury and the duration of epithelialization in dermal burns among pediatric patients. Additional objectives included analyzing the correlation between total body surface area (TBSA) affected and serum IL-6 and IL-8 levels on the third day after injury, evaluating differences in cytokine dynamics between surgically and conservatively treated patients, and assessing the influence of invasive bacterial presence on IL-6 and IL-8 concentrations. This prospective study included 36 pediatric patients with second-degree dermal burns affecting up to 20% TBSA. Serum concentrations of IL-6 and IL-8 were measured on the third, fifth, and eighth days after injury. There was no significant correlation between the relative decline in IL-6 or IL-8 and the duration of epithelialization (P = .713). However, IL-6 and IL-8 levels correlated significantly with TBSA on the third day after injury (P = .037 for IL-6 and P = .001 for IL-8). No significant differences were observed in cytokine dynamics between surgical and conservative treatment groups. The presence of invasive bacteria did not significantly affect IL-6 or IL-8 concentrations.

Severe burn injuries inflict significant physical and psychological morbidity, though advances in acute care have dramatically improved survival rates. Patients with severe burn injuries require specialized rehabilitation to address burn-specific complications, including hypertrophic scarring, contractures, chronic pain, mental health challenges and psychosocial issues. A retrospective audit was conducted on patients admitted from 2013 to 2023 to a specialized adult burn rehabilitation unit providing care for severe burn injuries. Data was collected on demographics, injury characteristics, treatment and surgical history, rehabilitation progress, and recorded complications. The Functional Independence Measure (FIM) was routinely collected at admission and discharge. In total, there were 59 patients with an average age of 47. The average TBSA was 46%. High rates of deep venous thrombosis (DVT) (29%), heterotopic ossification (17%), and contractures (49%) were noted. Mental health issues were recorded in 49% of patients. The average inpatient rehabilitation stay was 54 days. Disability measured by FIM score showed improvement from 91 to 110 (P < .001). Severe disability rates decreased from 20% on admission to 5% on discharge. There was a high prevalence of complications among severe burn patients, including heterotopic ossification and unexpectedly elevated rates of DVT. Burn-specific rehabilitation is effective at reducing disability and improving functional outcomes. Prospective studies on specific burn injury complications in the rehabilitation setting are recommended.