Journal of Burn Care & Research最新文献

Pediatric patients with burn injuries in the intensive care unit require the care of a multidisciplinary team. Occupational and physical therapists play a vital role in edema management, positioning, orthoses fabrication, and advancement of functional and developmental activities. Early mobilization in the intensive care unit is increasingly recognized as the standard of care for pediatric patients. However, outcomes and barriers specific to the pediatric burn population have not been evaluated. This study aimed to describe early mobilization practices in pediatric patients with burn injuries, identify the barriers to their participation, evaluate changes in mobility levels throughout intensive care unit admission, and examine the impact of total body surface area burn on mobility progression. We retrospectively reviewed 108 children with burns who were admitted to the intensive care unit at a pediatric burn center. Patient demographics and therapy visit-level data within the first 14 days of intensive care unit admission, which included level of activity performed and barriers to participation, were analyzed. Children with higher total body surface area burns had significantly lower levels of activity (P = .002). Barriers to therapy participation were common with 66% of children missing at least 1 physical therapy session and 55% missing at least 1 occupational therapy session within the first 14 days of intensive care unit admission. The most common barriers included patient involvement in testing or procedures (54%) and nursing concern about medical status (12%). Future research and quality improvement initiatives should prioritize interventions that address and mitigate barriers to implementation of early mobilization in this patient population.

Pediatric patients with larger TBSA burns have a high surface area to volume ratio and are at risk of over-resuscitation. In 2015, our burn center revised our resuscitation algorithm for "difficult to resuscitate" patients with >15% TBSA burn to substitute albumin for a portion of crystalloid volume, hoping to reduce negative effects of volume overload while preserving resuscitation goals. We retrospectively reviewed patients <18 years of age treated between 2008 and 2024 who required burn resuscitation. Patients who had ≥15% TBSA burn and required >40% of baseline fluids in the first 24 h were defined as "difficult to resuscitate." Patients who died in <48 h were excluded. Patient demographics, burn characteristics, treatment details, and patient outcomes were collected. Patients were compared using Fisher's exact and Wilcoxon rank sum tests. Thirty-four patients were "difficult to resuscitate," with 8 patients admitted prior to substitution of albumin and 26 patients treated after. Demographic characteristics did not vary between groups. Patients in the albumin group received less total intravenous fluid volume within 48 h (12.4 [IQR: 8.6-13.8] vs 7.8 [IQR 6.3-9.3] mL/kg/TBSA P = .037) and had lower serum lactate at 48 h (1.7 [IQR 1.7-2.2] vs 1.0 [IQR 0.8-1.3] mmol/L P = .018). Length-of-hospital-stay normalized to TBSA burn was shorter among those who received albumin (1.2 [IQR: 0.8-1.6] vs 1.9 [IQR:1.3-2.4] days P = .027). The substitution of albumin for pediatric burn patients who are difficult to resuscitate reduced total intravenous volume and length-of-stay per TBSA, while preserving chemical markers of adequate resuscitation.

Axillary burn contractures impair upper limb function and can recur after initial reconstruction. The risk factors for recurrence remain unclear. This study aims to evaluate the recurrence rate of axillary burn contractures and identify associated risk factors. A retrospective chart review was conducted on patients who underwent reconstructive surgery for axillary burn contracture at a single institution between 2009 and 2022. Data collected included demographic information, injury details, reconstruction type, follow-up, reoperations, and complications. There were 30 axillary burn scar contractures in 27 patients (74.1% male, 25.9% female; mean age of 36.8 ± 15.2 years). Almost all burns were thermal (n = 24; 88.9%) and partial thickness (n = 22; 81.5%). The mean time between injury and reconstructive surgery was 10.3 ± 8.5 months, and the mean follow-up period was 18.1 ± 26.4 months. Z-plasty was the most frequently employed reconstructive procedure (n = 12; 40%), followed by split-thickness skin graft (STSG) only (n = 5; 16.7%), and a 2-stage procedure with the application of a dermal substitute followed by STSG in 2 weeks (n = 4; 13.3%). The overall recurrence rate was 30.0% (n = 9). The Z-plasty group (n = 2; 16.7%) demonstrated relatively low rates of contracture recurrence. In contrast, the STSG only (n = 3; 60%) and latissimus dorsi flap with STSG (n = 2; 66.7%) groups had the highest rates of recurrence. Reoperation was performed in 77.8% of recurrent contractures (n = 7). The recurrence rate following axillary burn reconstruction is high, often requiring multiple reoperations. Given how procedure type affects contracture recurrence rate, reconstructive surgeons should consider using local flaps over skin grafts to release axillary burn contractures.

Childhood burn injuries can lead to physical and psychosocial challenges that linger well beyond the initial phases of the trauma. This study explores the interrelated roles of pain, body image, and physical function in children living with burn injuries using data from the Burn Model System National Longitudinal Database. A cohort of 110 children aged 8-17 was assessed 6 months postinjury. Descriptive and regression analyses revealed that, on average, pediatric burn survivors reported significantly lower pain interference compared with the general pediatric population. However, higher pain interference and number of surgical operations were negatively associated with physical function. Body image was not significantly associated with clinical variables, thus suggesting a more multifaceted nature of psychosocial recovery. These findings underscore the importance of comprehensive pain management and family-centered rehabilitation to foster resilience and enhance functional and emotional outcomes in pediatric burn survivors.

Burns have profound impacts on long-term psychiatric health. This retrospective cohort study aims to explore the relationship between biological sex and psychiatric morbidities among burned patients. Adult patients with burn injuries (≥18 years) from 2004 to 2024 were stratified by the biological sex using the TriNetX United States Collaborative Network database. Patients were propensity matched based on age, race, ethnicity, socioeconomic factors, total body surface area, and region of burn injury. Outcomes examined included posttraumatic stress disorder (PTSD), anxiety, depression, suicidal ideation and attempts, adjustment disorders, and substance use disorders at both 3 months and 1 year after burn. Risk ratios (RRs) were calculated with 95% confidence intervals. From the 1:1 matched analysis between 248 258 females and 271 987 males, females exhibited significantly higher risks of anxiety (RR = 1.60), depression (RR = 1.47), PTSD (RR = 1.23), and adjustment disorder (RR = 1.15) but presented significantly lower risks of suicide (RR = 0.85) and substance use disorders (RR = 0.62) compared to males at 3 months after burn injury. After 1 year, females remained with significantly increased risks of anxiety (RR = 1.78), depression (RR = 1.60), PTSD (RR = 1.39), and adjustment disorders (RR = 1.40) and continued with lower risk of suicide (RR = 0.91) and substance abuse disorders (RR = 0.73) compared to males. All results were significant with P < .05. Following burn injury, significant differences in psychiatric outcomes were found between males and females at 3 months and 1 year. Hence, these findings emphasize the consideration for sex-specific mental health interventions in burn care.

Fractional ablative laser (FAL) is a minimally invasive method of hypertrophic scar management first introduced in 2004. Laser technologies and techniques have continued to evolve since that time and have included the addition of laser-assisted drug delivery (LADD) to augment the effects of the laser on scars. Laser-assisted drug delivery is increasingly reported in the literature and standard treatment protocols, underscoring the popularity of this technique among clinicians. Given this popularity, it is important to scrutinize evidence relating to the clinical outcomes LADD may achieve for patients. This scoping review examined literature relating to LADD for the treatment of hypertrophic scars in humans, aiming to clarify what clinical outcomes are achieved with its use and examining how these outcomes were studied and measured. PubMed, EMBASE, Cochrane, the WHO International Clinical Trials Registry and ClinicalTrials.gov were systematically searched, and data about study methodology, outcome measurement tools and results were extracted. Fifty-five publications that discussed LADD for the treatment of hypertrophic scars in humans were identified. Sixteen different substances, most frequently corticosteroids, were used for LADD treatment of hypertrophic scars, most often in conjunction with a carbon dioxide FAL. Study designs, outcome measurement strategies and follow-up time-frames were highly variable, as were the patient outcomes achieved. The clinical outcomes achieved with LADD are unclear, largely due to the variability of study methodology and outcome measurement. The efficacy of this technique requires further investigation with robustly designed, large trials which have comparison groups and use validated scar outcome measurement tools.

Burns are complex injuries with devastating long-term impacts. Despite advancements in burn care, infections remain the leading cause of morbidity and mortality. Early and accurate detection of bacterial burden is critical for effective intervention, yet traditional diagnostic methods have limitations. Fluorescence imaging has emerged as an effective tool to enhance bacterial detection and guide infection management in burn wound management. This scoping review summarizes current evidence on fluorescence imaging-guided detection of bacterial loads in burn wounds and explores its potential role across different stages of burn care. A comprehensive literature search was conducted in PubMed using the inclusion and exclusion terms ("fluorescence" OR "autofluorescence") AND ("burn" OR "burns") AND "imaging" AND "bacteria" NOT "microscopy." This search yielded 30 publications, which were further filtered to exclude preclinical studies, review articles, or articles that were not specific to burns. A total of 6 articles investigating the diagnostic accuracy of fluorescence imaging (MolecuLight) in patients with burn injuries were identified. This evidence suggests that fluorescence imaging improves the accuracy of bacterial detection in burns compared to clinical assessment alone, facilitating targeted wound sampling and debridement, enhancing antimicrobial stewardship, and guiding timely interventions. In addition, burn wound surgical planning may be optimized by fluorescence imaging-guided identification of areas requiring excision and grafting. Fluorescence imaging shows promise in enhancing bacterial detection in burn wounds, aiding clinical decision-making and infection management. However, further statistically powered studies are needed to evaluate its impact on patient with burn injury outcomes.

Lower extremity compartment syndrome (LECS) following burn injury in the absence of circumferential burns is rare. Capillary leak syndrome (CLS) is a condition characterized by systemic capillary hyperpermeability and can be triggered by the multisystem inflammatory response seen in extensive burns. The resulting intravascular fluid loss into the interstitial space can elevate compartment pressures and contribute to the development of compartment syndrome. In the case presented here, the patient developed LECS in the setting of severe burn injury with clinical and laboratory evidence consistent with CLS, suggesting increased capillary permeability as a key pathogenic factor. This case was managed in accordance with the Declaration of Helsinki (2013). Institutional Review Board approval was not required per institutional policy. Written informed consent for treatment and publication was obtained from the patient's legal guardian, and all identifying details were removed. A 20-year-old male with a one-pack-per-day smoking history and no other medical history was admitted to the burn ICU following a house fire. He sustained 60% total body surface area (TBSA) superficial partial-thickness, deep partial-thickness, and full-thickness burns involving both upper and lower extremities, back, neck, and face, along with inhalation injury. Shortly after admission, he developed hemodynamic instability, managed with intravenous fluids, blood products, and vasopressors, resulting in initial stabilization. On hospital day 3, the patient developed LECS that was successfully treated by emergent bilateral 4-compartment fasciotomies. We describe a patient who developed LECS secondary to burn injuries, CLS, and aggressive fluid resuscitation. Patients with large TBSA burns and inhalation injury are at elevated risk for burn shock and multiorgan dysfunction, leading to significant morbidity and mortality. We explore the underlying pathophysiological mechanisms linking severe burns, CLS, and the development of compartment syndrome.

For pediatric burn patients, outpatient follow-up is essential to optimize outcomes. Social determinants of health (SDH) influence families' ability to attend clinic follow-up appointments. We hypothesize that SDH differences are associated with missing outpatient burn follow-up and therefore inferior burn-related outcomes. We performed a retrospective cohort study of patients <18 years of age who were admitted to our pediatric burn center during 2021-2022. Patient demographics, injury and management details, social work SDH assessment, and post-injury complications were collected. Multivariate regression was conducted to identify independent predictors of missed follow-up. Among 322 patients, median age at injury was 2.5 years (IQR: 1.4-7.8). Most patients were male (60.2%) and most were White (56.0%). About 46% of patients missed one or more appointment. Patients who missed appointments less often had a primary care provider (PCP) (91.3% vs 98.1%; P = .007) and were more commonly exposed to tobacco/illicit substances (31.8% vs 21.3%; P = .03). Patients who attended all appointments more often had their burns managed non-surgically (81.6% vs 62.8%, P < .0001). Controlling for relevant clinical factors, independent predictors of missing appointments included not having a PCP (aOR 6.10; 95% CI, 1.25-29.81) and requiring surgical burn management (aOR 3.13; 95% CI, 1.65-5.95). Next steps include collaborating with social work to improve support and resources for patients who are at increased risk for letting their outpatient burn care lapse. This may include establishing a PCP prior to discharge, particularly among patients requiring more extensive burn management.

Itching following a burn injury is a frequent complication that significantly affects patients' well-being. Despite its prevalence, the acute effects of itching during hospitalization and its correlation with specific burn characteristics remain under-researched, particularly in non-Western populations. In 2021, we carried out a cross-sectional study involving 268 adult patients who were admitted for a minimum of 48 hours after burn injury. We collected data through interviews and medical records, focusing on demographics, burn severity-categorized by total body surface area, tissue damage depth, and specific anatomical locations-and itch parameters, which were evaluated using a patient-reported intensity scale (0-10), duration, and areas affected. We utilized the ItchyQoL questionnaire to measure long-term well-being and the impact of itching on physical, emotional, and functional quality of life. Analyses included parametric and nonparametric tests as well as multivariable regression to evaluate how characteristics of itch and burn severity influenced recovery and quality of life. Itchy patients exhibited more extensive skin damage, deeper injuries, and prolonged hospitalizations compared with those without itching. Increased itch intensity and duration were linked to lower ItchyQoL scores, signifying a greater detrimental effect on quality of life. In multivariable analysis, itch intensity was identified as the most significant predictor of diminished well-being. The severity and duration of itching during hospitalization notably impact recovery and long-term quality of life. Addressing severe itching early can reduce hospital stays and promote healing.