Journal of Burn Care & Research最新文献

The predictive value of Lactate dehydrogenase (LDH)/ Albumin (ALB) ratio (LAR) in patients with severe burns has not been explored. The aim of the study was to investigate the correlation between LAR at admission and short-term mortality in severe burned patients. Patients with a primary diagnosis of severe burns, defined as 30% Total Body Surface Area (TBSA) or more, admitted to the burn center of Changhai Hospital were screened, and 324 patients were ultimately enrolled in this study. Binary logistic regression, univariate and multivariate analyses, Least Absolute Shrinkage and Selection Operator (LASSO) regression, Receiver Operating Characteristic (ROC) analysis, Kaplan-Meier curve and nomogram were used to analyze and present the relationship between admission LAR and short-term mortality. Patients with high admission LAR were more likely to die than low LAR. Age, LAR, TBSA, tracheostomy and heart disease were used to establish the nomogram with LAR having the highest area under the curve (AUC) value. We utilized nomograms to visually express data analysis results. This nomogram incorporates the lymphocyte-to-albumin ratio (LAR), a robust and readily accessible prognostic marker, to aid in the identification of patients with severe burns who are at high risk for short-term mortality. Therefore, it is well-suited for early risk stratification, from initial patient assessment after admission to the early inpatient phase, particularly in mass-casualty incidents like forest fires and explosions.

In general, literature on treatment refusals in burn care has largely centered on decisional capacity in the acute phases of burn treatment and an individual's "right to die" rather than endure treatment or its consequences. However, burn providers frequently encounter in the moment refusals in which patients who very much want to survive attempt to delay or otherwise avoid treatment for various reasons, including trauma response, anticipatory anxiety, pain, desire for control, and ambivalence. In this paper, we consider a case inspired by our shared experience as clinical ethicists in which a burn patient readily expressed a desire to live and agreed to necessary treatment yet would often demonstrate significant distress in anticipation of and during even the most basic of care. We explore the utility and shortcomings of existing frameworks of decisional capacity in this context and detail a multidisciplinary team, patient-centered approach to care.

Hidradenitis suppurativa (HS) is a chronic skin disease with a significant psychosocial burden. Skin of color (SOC) populations remain underrepresented in HS literature. Surgical excision is often pursued after failed medical management, but predictors of post-surgical disease recurrence are not well characterized. This study aimed to identify non-surgical risk factors associated with persistent, refractory HS despite medical and surgical intervention in a predominantly SOC patient population. A retrospective chart review was conducted on 31 adult HS patients with prior excision surgery. Patients were categorized into remission (n=15) or refractory (n=16) cohorts. Demographic, clinical, and surgical data were extracted from the electronic medical record. There was no association between surgical closure technique and refractory disease (p=0.5936). Patients with refractory disease were more likely to be active smokers at the time of surgery (68.8% vs. 33.3%, p=0.0486), have groin or perineal involvement (p=0.0059; p=0.0185), and have psychiatric comorbidities (75% vs. 33.3%, p=0.0198). Female patients with gynecological comorbidities or evidence of female hormone dysregulation were significantly more likely to achieve remission after excision surgery (p=0.0024). Active cigarette smoking and groin/perineal involvement are significant predictors of refractory disease despite surgical intervention. While all HS patients should be screened for psychosocial burden of disease, patients with refractory disease may be at higher risk of comorbid psychiatric illness. Further research is needed to illicit the role of female hormone level dysregulation in HS pathophysiology and post-operative outcomes. Limitations include a small sample size and single-institution, retrospective nature of the study.

Deep dermal burns pose a high risk for long-term functional and aesthetic impairments. The choice of wound dressing following enzymatic debridement plays a critical role in modulating the healing response and scar formation. While both Kerecis® and Suprathel® have demonstrated clinical safety and efficacy, comparative long-term data remain limited. Kerecis®, being associated with accelerated wound healing in previous studies, was compared to Suprathel® in this study to evaluate functional and aesthetic scar outcomes using an intraindividual study design. This prospective, intraindividual study included 21 patients with deep dermal burns of the hands and feet, who underwent enzymatic debridement using Nexobrid®. Each patient received treatment with both Kerecis® and Suprathel® on comparable burn areas, ensuring consistency in the comparison. Scar outcomes were evaluated at 3-, 6-, and 12-months post-treatment. Objective parameters such as skin pigmentation, elasticity, transepidermal water loss, and oxygen saturation were measured. Additionally, subjective aesthetic, clinical, and functional parameters were assessed using the Patient and Observer Scar Assessment Scale (POSAS) and the Vancouver Scar Scale (VSS). At the 12-months follow-up, objective measurements demonstrated significant differences in erythema and gross elasticity, with Kerecis® exhibiting comparatively favorable outcomes. Subjective analyses indicated a significantly improved scar height and pliability for the Kerecis® group in the VSS and the POSAS Observer Scale. However, no significant differences were found in the POSAS Patient Scale. Both dressings provide satisfactory long-term scar outcomes in enzymatically debrided deep dermal burns, with Kerecis® showing trends toward more physiological scar characteristics in selected parameters, warranting further patient-centered research.

Clinical competency guidelines promote optimal, safe standard-of-care. While nationally established clinical competencies exist for burn occupational therapists and physiotherapists, no equivalent frameworks exist for burn speech-language-pathologists (SLPs). To address this gap, we developed a burn-specific SLP competency tool. Led by the American Burn Association (ABA) Rehabilitation Committee, an expert panel of burn SLPs, Burn Therapists-Certified (BT-C) clinicians, and a physiatrist implemented a staged process. Current national and international practice guidelines were synthesized through modified Delphi methodology, with expert consensus meetings to create and refine a burn SLP competency tool. The ABA Burn Rehabilitation Therapists Competency Tool served as the model framework. Eighteen multidisciplinary burn clinicians representing 14 burn centers, across three countries, refined the burn SLP competency tool. A steering group (five SLPs, one burn physiatrist) identified 103 competency statements spanning 15 core clinical domains. These were presented across two rounds of Delphi survey and consensus meetings. The tool was refined with each survey resulting in a final tool comprising 81 knowledge and application competency statements covering 17 domains, tailored to the burn SLP across the continuum-of-care for adult and pediatric populations. The tool is structured into two tiered levels of expertise; Level-1: minimum level of specialist skill required to manage a burn patient, Level-2: expert level of specialist skill and recognized resource to other SLPs. This initiative has produced the first internationally developed and consensus-based competency tool for burn SLPs. It establishes a standardized reference for SLPs to deliver specialized burn care throughout the acute and rehabilitative continuum.

Toxic epidermal necrolysis (TEN) is a rare and life-threatening cutaneous adverse reaction characterized by >30% total body surface area desquamation and mucosal involvement. Although ocular, oral, and urogenital mucosal involvement are well described, pulmonary mucosal injury is uncommon and associated with high mortality. We report a case of a 33-year-old woman with rapidly progressive TEN complicated by respiratory failure. Despite early multidisciplinary management including local wound care, immunomodulatory therapy, systemic corticosteroids, and lung-protective mechanical ventilation, she developed worsening hypoxemia and hypercarbia with radiographic findings consistent with acute respiratory distress syndrome. As respiratory failure progressed despite maximal conventional therapy, she was cannulated for venovenous extracorporeal membrane oxygenation (ECMO). Following ECMO therapy, her pulmonary infiltrates gradually resolved in parallel with cutaneous re-epithelialization. She underwent tracheostomy for prolonged ventilatory support, was successfully decannulated after nine days of ECMO support, and survived to discharge. This case adds to the limited data supporting the feasibility of ECMO as a rescue therapy for TEN-associated severe respiratory failure. In carefully selected TEN patients with refractory respiratory failure, ECMO may serve as an effective bridge to pulmonary recovery. Further studies are needed to better define patient selection, timing, and outcomes in this population.

The burden of alcohol and substance use disorder is disproportionately high among burn patients and portends worse clinical outcomes. The CAGE questionnaire is a validated four-question screen for alcohol and drug use. This study aimed to identify demographic and clinical variables that predict positive CAGE screens or negative-to-positive screen conversion in burn survivors and to examine psychosocial and functional outcomes. The Burn Model System database was used to assess characteristics of burn patients who completed a CAGE screen at discharge (1994-2023). The relationship between CAGE scores and Satisfaction with Life Scale (SWLS), PROMIS (Patient Reported Outcomes Measurement Information System)-Anxiety, -Depression, -Pain Interference, and -Physical Function, were analyzed. Mean length of hospital stay was longer in patients with positive CAGE screens (34.0 vs 25.1 days, p<.001). Mean number of surgeries demonstrated a similar association (2.8 vs 2.2, p<.001). Significant differences were also observed by ethnicity, race, employment status, burn mechanism, marital status, and insurance type. Drug misuse at the time of injury was significantly higher in CAGE-positive patients (34.9 vs 6.6%, p<.001). Younger age (p=.004) and unemployment (p=.001) were significantly associated with transition to a positive CAGE screen within 24 months. At 12 months, a positive CAGE screen was associated with lower SWLS (p<.001) and higher (detrimental) PROMIS-Anxiety (p=.006) and -Depression (p=.019) scores. These data suggest significant associations between positive CAGE screens, as a surrogate for drug and alcohol misuse, and measures of burn severity (length of stay and number of surgeries), psychological stress (anxiety and depression), and social dysfunction (unemployment).

Enzymatic debridement with NexoBrid® has become a cornerstone of modern burn care due to its selective tissue-sparing properties. However, the optimal timing and strategy for surgical intervention following enzymatic treatment remain debated. We aimed to evaluate the clinical outcomes of the ENGAGE protocol (ENzymatic debridement with NexoBrid®, followed by Grafting After Graded early Excision), a structured algorithm integrating enzymatic debridement with scheduled wound reassessment and selective early excision. This before and after observational study included adult burn patients treated with NexoBrid® between January 2020 and October 2025 (2020-2022 received standard NexoBrid® management; 2023-2025 received the ENGAGE protocol, featuring day-7 reassessment and selective excision). Endpoints included autologous grafting rate, length of hospital stay (LOS), mortality, and number of surgical procedures. Eighty-eight patients were analyzed (27 standard NexoBrid® management, 61 ENGAGE). Baseline characteristics and burn etiologies were comparable. The ENGAGE group showed a significantly shorter LOS (mean±SD: 24±13.8 vs 32±19.2 days, median: 23 vs 27 days, p=0.03) with no increase in grafting rate (60.7% vs 59.3%, p=0.54) or mortality (9.8% vs 7.4%, p>0.5). The number of surgical procedures per patient was higher in the ENGAGE group (4.36±3.82 vs 2.74±3.82, p=0.029), reflecting planned early reassessment and targeted intervention rather than increased morbidity. The ENGAGE protocol reduces hospital stay without compromising grafting or survival outcomes. By incorporating early, biologically guided excision after enzymatic debridement, it offers a structured and effective refinement of modern burn wound management.