Journal of Burn Care & Research最新文献

Total body surface area (TBSA) burned is critical for assessing burn extent and guiding acute treatment, but its role in predicting long-term outcomes remains underexplored. This study leverages the Burn Model Systems (BMS) database to evaluate how TBSA is characterized and its predictive value for survivors' outcomes, aiming to propose standardized approaches for its use. Publications from the BMS database (1994-2024) were analyzed for TBSA characterization and its relationship to both patient-reported outcomes (eg, quality of life, psychological well-being) and objective outcomes (eg, physical recovery, complications). Descriptive statistics were used to summarize TBSA usage across studies and its influence on outcomes. Of 107 publications, 91 (85%) included TBSA data. Among these, 91% used TBSA as a continuous variable, 23% employed categorical methods, and 16% utilized both. Categorical TBSA stratification varied, with deciles (n = 6) and quintiles (n = 3) being most common, while others used inconsistent approaches. Approximately 32% of studies assessed TBSA's direct impact on outcomes such as physical and psychosocial recovery, return to work, and pain/itch. A quarter of studies included TBSA as a covariate without directly examining its predictive value. Of 32 papers reporting TBSA outcomes, 74.4% demonstrated significant impact on outcomes. TBSA is widely utilized but inconsistently characterized, and few studies directly assess its role in long-term outcomes. Standardizing TBSA reporting could improve predictive accuracy, facilitate cross-study comparisons, and guide evidence-based care for burn survivors.

With the aging population, burn injuries in elderly patients are increasing. Early surgical excision is a key component of burn management, yet its benefits in geriatric patients remain unclear. This study evaluates the impact of excision timing on survival in patients aged 75 years and older. This retrospective, single-center study included patients ≥75 years hospitalized in a burn center between 2018 and 2022. Two groups were defined: early excision (within 14 days postburn) and conservative treatment (excision after 14 days or wound care only). Primary outcomes were 1- and 6-month mortality. Secondary outcomes included hospital length of stay (LOS), healing time, and the LOS/TBSA ratio. Among 170 patients (mean age 82.9 ± 5.4 years, TBSA 5.7% ± 4.2), early excision was performed in 37.6% (n = 64). One-month mortality was 3.12% in the early excision group vs 7.55% in the conservative group (OR = 0.4; 95% CI, 0.081-1.92; P = .32). Six-month mortality was significantly lower in the early excision group (3.12% vs 16.04%; OR = 0.17; 95% CI, 0.0038-0.76; P = .01). Length of stay was significantly shorter in the early excision group (P < .001). No significant differences were observed for LOS/TBSA ratio (P = .06) or healing time (P = .91). Early surgical excision (<14 days) may reduce 6-month mortality in elderly burn patients. These results support earlier intervention; however, larger prospective studies are needed to confirm these findings and reduce retrospective bias.

Burn injuries present significant physiological challenges. Emerging evidence has found that circadian rhythms-the body's intrinsic 24-hour cycles-play a key role in regulating immune responses, hormonal secretion, and tissue repair, all essential for recovery. However, their specific impact on burn healing remains underexplored. This scoping review aimed to evaluate how circadian rhythms affect recovery outcomes in burn patients and animal models. PubMed, Embase, and Scopus were searched using terms, including "circadian rhythms" and "burn trauma." Nine studies met inclusion criteria, comprising 516 human patients (unweighted mean age and total body surface area (TBSA) across studies was 42.88 years and 19.7%) and several animal models. Burn-related circadian disruptions were consistently observed. Studies reported elevated daytime cortisol in burn patients, reduced nighttime melatonin, and a reduction in PER3 expression. Burn timing impacted outcomes: nighttime burns were associated with slower healing and increased complications. Reduced light exposure was linked to delayed sleep phase syndrome. Due to heterogeneity and small sample sizes, a meta-analysis was not feasible. These findings underscore circadian biology's relevance in burn recovery. Further clinical studies are needed to explore how timing-based strategies can be effectively integrated into burn care.

Skin grafts are essential in reconstructive surgery, although complications such as hematomas, seromas, infections, and shear forces can compromise their success. This study evaluated the effectiveness of a hemostatic net fixation technique to improve graft integration and reduce complications. Fifteen patients treated with non-meshed split-thickness grafts fixed using continuous sutures forming a hemostatic net were compared to meshed grafts fixed with staples or sutures along the edges (traditional technique). Both treatments were applied to split wound areas in the same patient. Six months of follow-up, assessing graft integration, aesthetic appearance, and complications, were reported. No patients experienced hematomas, seromas, or infections, and all grafts integrated successfully. Additionally, a blinded panel of plastic surgeons rated the aesthetic appearance of the two techniques. The aesthetic appearance was evaluated with higher scores in the grafts fixed with a hemostatic net. In conclusion, the fixation of skin grafts using a hemostatic net improves integration and aesthetic outcomes while minimizing complications such as hematoma or seroma. Further studies with more surgical areas are needed to confirm these benefits. The technique could represent a significant advancement in reconstructive and aesthetic surgery, optimizing clinical and cosmetic outcomes.

After major burn injury, patients experience a hypermetabolic response leading to catabolic effects. Anabolic steroids have been investigated to combat these effects. Oxandrolone, the primary anabolic steroid used to combat burn hypermetabolism, was removed from the US market in June 2023, and our institution implemented testosterone as an alternative. A known side effect of anabolic steroid use is transaminitis. This study aims to compare the incidence of transaminitis between oxandrolone and testosterone in patients with major burn injury. A single-center, retrospective cohort study was conducted to evaluate adult patients with at least 20% BSA burn injury who received either testosterone or oxandrolone. The primary outcome evaluated was incidence of transaminitis. Secondary outcomes included the need for dose reduction or discontinuation of the steroid, length of stay (LOS), and mortality. Preliminary data were analyzed for significance. Seventy patients received either oxandrolone (n = 52) or testosterone (n = 18). Demographics were similar. The incidence of transaminitis was not statistically significant between oxandrolone and testosterone, 38% vs 28% (P = .596). The rate of dose decrease between the 2 groups was not significant, 17% vs 0% (P = .071). There was a statistically significant difference in early discontinuation of the drug between the groups, 33% oxandrolone vs 0% testosterone (P = .014). The median LOS was 28 and 36 days, respectively, with a mortality rate of 21% and 6% in each group. Preliminary data from this study demonstrate a trend to higher incidence of oxandrolone transaminitis in comparison to testosterone, without statistical significance.

Disasters often lead to increased generator use, resulting in carbon monoxide poisonings (COP) and burn injuries that can overwhelm regional burn centers. Following Hurricane Ida, emergency medical services (EMS) providers in southeastern Louisiana were empowered to treat minor COP and burn injuries on the scene without hospital transport. This study evaluated the impact of that policy. Using EMS and Louisiana Emergency Response Network (LERN) data, we analyzed EMS calls from 3 periods surrounding Hurricane Ida's landfall on August 29, 2021: pre-Ida (07/08-08/25), mid-Ida (08/26-09/08), and post-Ida (09/09-10/31). We tracked call volumes, transport rates, and EMS turnaround times. Weekly calls were compared using Kruskal-Wallis tests and negative binomial regression; transport rates were assessed using chi-squared tests. Emergency medical services received 1607 COP or burn-related calls during the study period. Pre-Ida, EMS averaged 15.3 calls/day (89% COP), with transport rates of 98% for COP and 61% for burns; turnaround time averaged 63 ± 36 min. Mid-Ida saw a rise to 20.9 calls/day (84% COP), with transport rates of 78% for COP and 73% for burns; turnaround was 64 ± 31 min. Post-Ida, calls declined to 10.6/day, with 97% of COP and 61% of burns transported; turnaround was 69 ± 49 min. No repeat EMS calls were made by patients treated on the scene. The study observed a significant increase in CO-related EMS dispatches during mid-Ida, with a concurrent decrease in hospital transports, indicating successful on-scene care. Emergency medical services turnaround times remained stable across all periods. These findings highlight effective collaboration between EMS and burn centers during disaster response.

Patients with severe burns are more vulnerable to infection, sepsis, and death. With heavy use of antimicrobials, changes in burn wound microbial and antibiotic resistance patterns have been reported; however, the literature remains scarce. This study assessed wound colonization trends in first positive cultures in our burn unit over the last decade. This is a retrospective cohort study including all patients admitted to our burn unit from July 2013 to June 2023. Demographics, TBSA, injury mechanism and admission information were obtained. Wound culture information including date of positive cultures, type of organisms, and antibiotic susceptibility data was also collected. Patients were stratified based on TBSA as small (<10%), moderate (10%-19.9%), and severe burns (≥20%). Descriptive statistics were obtained. Generalized linear models were fit to assess the trends of positive cultures over time for the 3 TBSA strata. A total of 2755 patients were included; median age was 38 years, 72.2% were male; 74.1%, 15.9%, and 10.1% presented with small, moderate, and severe burns, respectively. Wound cultures on initial presentation were performed in 40.3% of our population with 600 cases having positive first cultures; 84.7% grew Gram-positive, 35.7% Gram-negative, and 9.7% fungal organisms. Data showed an increase in Gram-positive and fungal species over the study period in first positive cultures of severe burn patients. We also found increasing rates of resistance for several antibiotics, including erythromycin, oxacillin, and vancomycin. Future studies are warranted to evaluate changes in microorganism growth throughout the hospital course of severe burn patients.

Psychosocialsequelae from burn injuries may be significant for both patients and caregivers, affecting functional recovery. Narrative medicine, one aspect of medical humanities, uses guided reading, discussion, and writing to allow persons to feel seen and heard, and to reflect and express themselves. This low-cost, non-pharmacological intervention may benefit persons recovering from a burn injury, as well as caregivers. A prospective, uncontrolled, feasibility and acceptability trial was carried out in a 12-bed regional burn center with 6 patients and 6 caregivers (not dyadic pairs). Feasibility was defined as a minimum threshold of 85% completed intervention sessions; acceptability was defined as a minimum enrollment rate of 35%. Anticipating a subsequent quasi-experimental design, candidate outcome variables (anxiety and emotional regulation) were measured for potential use. Participants' written texts were collected and analyzed using thematic analysis. The study was acceptable (35%) and feasible to deliver to patients with burns (100%). Caregiver acceptability was low (under 35%), although it was feasible to deliver to caregivers (86%). Two candidate outcome variables (anxiety and emotional regulation) showed measurable change in the expected direction in both patients and caregivers. Thematic analysis yielded 4 themes: out-of-hospital stressors, hope and compassion, medical updates, and emotions. Meaningful contributions may be made by narrative medicine interventions, offering a low-cost, non-pharmacological option to reduce anxiety and regulate emotions. Results warrant revising the study design and proceeding with further development of this behavioral intervention.

Pediatric thermal injury induces immune dysfunction, which is associated with adverse clinical outcomes (eg, nosocomial infections [NIs]). As such, it is crucial to identify those most at risk for developing NI and determine immunomodulating therapeutics to augment the immune response. Our hypothesis was that immune suppression after pediatric thermal injury is reversible ex-vivo using the immunomodulators recombinant human granulocyte macrophage-colony stimulating factor (GM-CSF) and varlilumab (CD27-agonist). We enrolled 141 pediatric patients with acute thermal injuries from a single burn center. Blood samples were taken within the first week after injury to analyze immune function and ex-vivo reversibility. Pediatric patients with burn injuries who went on to develop an NI displayed a decrease in innate (ex-vivo lipopolysaccharide [LPS]-induced tumor necrosis factor alpha [TNFα] production capacity) and adaptive immune function (ex-vivo phytohemagglutinin [PHA]-induced interleukin [IL]-10 production capacity) compared to patients with burn injuries who recovered without infection. After correcting immune function measurements by the total number of cells, the ratio of LPS-induced TNFα/CD14+ monocytes decreased within the first 72 h for patients with burn injuries who developed an NI, whereas PHA-induced IL-10/CD4+ lymphocytes was significantly decreased at days 4-7. Samples co-incubated with GM-CSF significantly increased ex-vivo LPS-induced TNFα, while samples containing CD27 increased PHA-induced IL-10 production capacity, in the first 72 h, compared to samples that did not receive immunomodulators. The results of our study identified key markers to discover who is most at risk for developing NI, and provided early evidence of immunomodulators that may enhance immune function early after pediatric burn injury.