Journal of Burn Care & Research最新文献

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.

Accidental ignition of home oxygen does not mandate emergent intubation, but due to the thermal component of the injury, patients are initially directed toward burn units. To identify potential benefit associated with admission to an American Burn Association (ABA)-verified burn center, the local registry was queried from January 2016 to May 2022. Charts were inspected for additional data related to the pattern of the patient's injuries, comorbidities, and hospital course. We compared patients admitted to the burn service with those primarily cared for by non-burn services. A total of 48 adult patients were admitted with burn injuries associated with home oxygen use. Of the 28 patients intubated on admission, 19 were managed by the burn service, and 9 by non-burn services. There were no differences in ventilator days, ICU days, total length of stay, or mortality. Of the 20 patients admitted without intubation, the burn service managed 7, and non-burn services managed 13. These 2 groups had no identified differences in ICU days, total length of stay, or mortality. This single-center review found no outcome differences between patients cared for in an ABA-verified burn center and those managed by non-burn services following home oxygen-related burn injury versus non-burn services for home oxygen ignition injury. In addition, most intubated patients required only short-term ventilation, suggesting intubation may often be avoidable in this population.

Acute respiratory distress syndrome (ARDS) is a major cause of mortality in patients with severe burns. High-flow nasal cannula (HFNC) and mechanical ventilation (MV) are the primary respiratory support modalities used in these cases. Nevertheless, comparative evidence on their effectiveness in adults with burn-related ARDS remains scarce. This retrospective cohort study included 124 burn patients diagnosed with ARDS between January 2016 and December 2023. Participants were classified into either an MV (n = 81) or an HFNC (n = 43) group according to the initial respiratory support they received. We analyzed demographic information, burn characteristics, physiological parameters, and clinical outcomes. The MV group exhibited significantly more severe burns, as indicated by a larger total burn surface area (69% vs. 45%, P = .043), a greater full-thickness burn area (33.5% vs. 25%, P = .012), and higher Abbreviated Burn Severity Index and Prognostic Burn Index scores (all P < .001). However, the worst pre-treatment P/F ratio did not differ significantly between groups (MV 170.00 vs. HFNC 183, P = .235). A numerical difference in mortality was observed, with higher rates in the MV group (13.58%) than in the HFNC group (6.98%), though this difference was not statistically significant (P = .269). No significant differences were found in length of hospital stay or total medical costs. These results indicate that HFNC may represent a feasible alternative to MV for providing initial respiratory support in burn patients with ARDS.

Burn injuries significantly impact morbidity and mortality, with early surgical intervention crucial for improving outcomes. However, concomitant traumatic brain injury (TBI) frequently complicates burn management, potentially delaying timely surgical treatment due to neurological concerns. Optimal timing of burn surgery in patients with concurrent TBI remains uncertain, necessitating clearer insights into their clinical outcomes. This retrospective study reviewed burned adults admitted to a Swiss Burn Center between 2014 and 2023. Patients were grouped as burns with TBI, burns alone, burns with other trauma, or electrical burns. Demographics, injury characteristics, timing of surgery, complications, and outcomes were analyzed. Generalized linear models and logistic regression were applied. Among 602 patients, 27 (4.5%) had a TBI. Mortality was highest in this group (22.2%) compared to isolated burns (3.7%), burns with other trauma (7.4%), and electrical burns (4.8%). Surgical delays (>72 h) occurred only in burn patients with TBI (22.2%), mainly due to hemodynamic instability, intracranial pressure monitoring, or additional trauma. Delayed surgery correlated with more surgical interventions (P = .018) and longer operative times (P = .048). Complications were more frequent: wound infections (48.1%) and graft loss (22.2%) were significantly higher in the TBI group. In conclusion, burns with concomitant TBI define a distinct, high-risk subgroup with increased surgical delays, complications, and mortality. Management requires an interdisciplinary approach, balancing early surgical intervention with neuroprotective strategies to optimize patient outcomes.

Burn injuries affect over half a million people in the United States annually, with 40 000 requiring hospitalization. Burn patients often experience significant psychological distress, with high rates of posttraumatic stress disorder (PTSD) and depression. Undetected or untreated psychiatric symptoms can complicate recovery, prolong hospital stays, and increase risk of long-term problems and readmissions. Although burn centers are well positioned to provide mental health services on both an inpatient and outpatient basis, few US burn centers have robust programs to meet these needs-despite psychological screening and intervention being a requirement for American Burn Association verification. This study describes the development of and early data from the Burn Behavioral Health (BBH) program, a burn center-based, technology-enhanced stepped-care model of delivering mental health services across the inpatient to outpatient continuum. BBH includes four steps: (1) initial screening, education, and early intervention; (2) symptom self-monitoring and self-help resources; (3) 30-day follow-up screening; and (4) provision of best-practice treatment via in-person or telehealth care, including individual and group therapy. Between February 2021 and October 2024, 1203 eligible patients were identified (Mage = 46.08, SDage = 18.04; 67% male; 53% White; 38% Black); 919 (84%) completed the initial screening. Nearly half (44%) screened positive for PTSD/depression risk and 95% of them received early intervention. The program reached 62% of patients for the 30-day follow-up, with 21% screening positive for PTSD/depression and 23% being interested in mental health services. These findings provide preliminary support for the BBH program, demonstrating its sustainability and capacity to engage a high proportion of burn patients across care settings, ultimately improving both access to and the quality of mental health care.

Burn injury is increasingly recognized as a chronic condition associated with long-term cardiovascular risk; however, few studies have explored underlying mechanisms. This study aimed to evaluate cardiovascular autonomic function in individuals with chronic burn injuries. Ten adults, 3-11 years post burn injury of 10%-70% TBSA (mean: 34% ± 5%) underwent standard autonomic function tests: Valsalva's maneuver, paced breathing, and isometric handgrip. Heart rate and blood pressure responses were compared to either established normative values or to matched controls for each respective test. Burn survivors had significantly lower Valsalva ratios (1.32 ± 0.19) compared to age/sex normative values (1.47 ± 0.07, P < .05) and reduced heart rate variability (root mean square of successive differences, RMSSD) compared to matched controls (31 ± 21 vs 57 ± 19 ms, P < .05), indicating impaired cardiac vagal modulation. Valsalva ratio and RMSSD were related in the burn survivors (r = 0.58, P = .079), and RMSSD but not Valsalva ratio, tended to relate to burn size (r = -0.57, P = .082). No group differences were observed in responses to isometric exercise. Chronic burn injury appears to be associated with diminished cardiac vagal control which may underlie elevated cardiovascular risk observed in this population.

Despite known regional variation in access to specialized burn centers, the differences in burn injury patterns across the United States have not been well described. We investigated the geographic variation in burn injury etiology across the United States. A retrospective cohort study of burn injury was conducted with Healthcare Cost and Utilization Project-National Inpatient Sample (HCUP-NIS) data from 2017 to 2020. ICD-10-CM codes were used to identify patients with burn injuries and etiology of injury. Demographics, including median household income quartile across regions, were also identified. The proportion of patients who sustained chemical burns (29.9 people per million population) and electrical burns (29.8 people per million population) was significantly higher in the South compared to other regions in the United States (at 4.7% and 4.8% of all inpatient burn admissions, respectively), despite the region's relative scarcity of burn centers. The South also had the highest proportion of self-pay patients, at 15.8%, compared to other regions, while also having the highest proportion of lower-income patients. These differences have implications for policy decisions concerning resource allocation.

The September 11th attacks were a unique disaster with numerous patients and extensive injury burden. The aim of this study was to provide an update on the long-term functional and psychological recovery of victims treated at a burn center following the September 11th attacks. A mixed methods approach using a quantitative survey and a qualitative interview was completed for each patient. All patients were treated at the burn center for injuries sustained during the September 11th attacks. Interviews were reviewed for trends in recovery and psychological impacts. The survey focused on psychological well-being, functional well-being, and comfort in trauma-related environments. Our study included 4 patients: 3 males and 1 female. The average age was 63 years (range: 57-73) and average total body surface area burned was 33.1% (range: 3%-80%). Two patients were burned in the North Tower following impact. Two patients were burned outside by debris. Following initial recovery, 3 patients required additional surgeries. All patients returned to work and hobbies after their injuries. Patients experienced psychological outcomes such as general anxiety, flashbacks, and survivor's guilt. All patients scored high on psychological well-being, while 3 patients with higher injury burden scored lower on functional well-being and comfort in trauma-related environments. Patients with burn injuries from the September 11th attacks with higher injury burden recovered psychologically but continued to struggle with functional well-being and comfort in trauma-related environments. Despite functional and psychological challenges, patients were able to return to work and continue their previous hobbies.

Timely closure of acute, full-thickness wounds is critical in minimizing complications such as infection, fluid loss, and impaired healing, all of which can adversely affect long-term patient outcomes. Although meshed autografting is the current standard of care, its effectiveness is limited by the need for donor skin and the re-epithelialization of expanded interstices. Prior research has shown that combining meshed autografts with skin cell suspension autograft (SCSA) enhances epidermal regeneration. In this study, we further investigate the mechanisms by which SCSA promotes re-epithelialization when applied with a widely expanded (3:1) meshed autograft in a full-thickness porcine wound model. Histological analyses demonstrate complete closure of graft interstices as early as 3 days post-surgery. A dual mechanism of re-epithelialization was observed, with keratinocytes migrating both from the edge of the interstices and from within the center of the interstices to form a continuous epithelial layer. The presence of a high number of proliferating cells in the wound bed further supports the regenerative activity of SCSA. These findings offer valuable mechanistic insight into the role of SCSA in accelerating wound closure and provide additional evidence for its use in improving outcomes for patients with acute full-thickness wounds.