Journal of Burn Care & Research最新文献

The hypermetabolism that occurs after large burns leads to muscle wasting that can result in weakness, difficulty fighting infections, and other challenges to healing. Overall, rates of muscle wasting are not well established across burn centers. The Burn Care Quality Platform (BCQP), the largest available dataset on burn patients globally, was used to explore the rate of Muscle Wasting using data collected from more than 100 burn centers. "Muscle Wasting" was defined from relevant ICD codes (sarcopenia, muscle cachexia, protein malnutrition). Binomial and logistic regression were used to analyze the role of Muscle Wasting in burn mortality and other outcomes after controlling for demographic and comorbid characteristics. In total, the BCQP provided data from 84,438 adult and pediatric burn patients injured between 2000-2018. Only 2.6% (N=2,159) of the patients in the BCQP were diagnosed with having Muscle Wasting at some point during their admission. While Muscle Wasting was not associated with a statistically significant impact on mortality, it remained an independent predictor of inability to discharge to independent living, longer inpatient days, as well as an average of 10 additional surgical procedures (P<0.001 for all) as compared to patients who did not have Muscle Wasting. Muscle Wasting is an independent risk factor for several adverse outcomes in burn patients, but not mortality in the BCQP. Confidence in these findings would be improved with more accurate data collection, as the diagnosis of Muscle Wasting is likely under-reported, under-diagnosed, or both.

In pediatric patients, frostbite is a well-documented cause of epiphyseal cartilage destruction and subsequent growth deformity of the affected phalanges. Cases of full acroosteolysis, also referred to as phalangeal osteolysis, of distal phalanges as soon as three months after cold exposure have yet to be reported. We describe a complicated case of frostbite-associated phalangeal osteolysis in the dominant hand of a nine-year-old patient, in the context of post-traumatic insensate hand after sustaining prior electrical burn injuries. This case demonstrates the unique sequela of pediatric frostbite injury involving early loss of the distal phalanx through resorption of the bone and parallel soft tissue retraction, rendering early plastic surgery reconstruction impractical. Reconstructive strategies for frostbite injury in pediatric patients will need to account for the individualized dynamic tissue changes that develop in the months after cold exposure.

Glucagon-like peptide-1 (GLP-1) agonists mimic the action of GLP-1, a hormone that regulates blood glucose levels via stimulation of insulin release and inhibition of glucagon secretion. After burn, the current literature suggests that the use of GLP-1 agonists results in less insulin dependence with similar glucose control and hypoglycemic events to patients receiving a basal-bolus insulin regimen. GLP-1 agonists may also promote wound healing through various mechanisms including angiogenesis and improved keratinocyte migration. Despite the potential benefits, GLP-1 agonists reduce gastrointestinal motility which impacts their widespread adoption in burn care. This dysmotility can result in inadequate nutrition delivery, unintentional weight loss, and is a potential aspiration risk. The net impact of these medications on burn patients is unclear. Given their potential to demonstrate the safety, efficacy, and optimal dosing of various GLP-1 agonists in acute burn management.

Older adults are at a higher risk of complications after burn injuries since many physical and mental changes are compounded by increasing age. Few studies have targeted the long-term effects of burns on older adults. Therefore, this study will investigate the long-term physical and mental health outcomes in older adults. 3129 participants from the Burn Model System Database were divided into 3 cohorts based on their age at injury (18-54, 55-64, and 65+). Physical Component Summary (PCS) and Mental Component Summary (MCS) scores were derived from the 12-item Short Form (SF-12) and the Veterans RAND 12-item (VR-12) health surveys and analyzed to measure recovery at preinjury, discharge, 2-year follow-up, and 5-year follow-up. ANOVA, T-score analysis, and linear mixed-effects models were utilized to assess for significant differences in outcome scores. PCS scores were significantly different between the 18-54 cohort and 65+ cohorts at the preinjury and 2-year time intervals (p<0.001 and p<0.001, respectively), but not at the 5-year follow up (P=0.28). MCS scores were significantly different between the 18-54 cohort and 65+ cohorts at all time intervals measured (p=0.001, p<0.001, P<0.001, and p=0.005 respectively), though the change in MCS scores over time were not significantly different between age cohorts across time (p=0.088). This supports that patients 65 years and older have a different physical function recovery trajectory when compared to patients under 64 years. These findings underscore the belief that for physical recovery after a burn injury, individualized physical rehabilitation plans will provide the most benefit for patients across all ages.

Small burn injuries are extremely prevalent in the pediatric population and continue to pose a challenge for clinicians. Despite their high incidence, a standardized algorithm for treating small burns does not currently exist, and care is often influenced by clinical judgement and resource availability. The aim of this study was to explore the utility of a two-stage grafting technique, involving allograft and autograft, for treating small burns (≤ 10% total body surface area) in pediatric patients. A retrospective review of patients aged 0-18 years who had a small burn and underwent a two-stage grafting procedure between 09-01-2018 and 09-01-2022 was conducted. One hundred and seventy-five patients with 220 wounds met the inclusion criteria for this study. The mean time from presentation to allograft surgery was 11.4 days (SD 5.2) followed by autograft surgery approximately one week later. Most patients were discharged within 24 hours following allograft surgery (87.4%) and autograft surgery (81.1%). Mean autograft take was 97.7% (SD 11.8) with only four patients experiencing significant graft loss requiring subsequent re-grafting. These positive outcomes demonstrate that the two-stage technique can be successfully utilized for treating smaller pediatric burns. Moreover, these findings help to address the significant knowledge gap regarding the optimal approach to treating small burn wounds. Further research is warranted to learn more about cosmetic outcomes following two-stage grafting and determine how it compares to other techniques for treating small burns.

Previous iterations of burn severity (mild, moderate, and severe) were not data-driven and were outdated. Clustering analyses have gained popularity for identifying homogenous subgroups from heterogeneous medical conditions, such as asthma, sepsis, and lung disease. There is no consensus in burn literature regarding what constitutes massive burns. The current classification includes a 20% total body surface area (TBSA) burn and a 95% TBSA burn as severe. Latent class and hierarchical clustering analyses were applied to the American Burn Association National Burn Research Dataset. Cluster variables included length of stay, length of stay, intensive care unit length of, number and type of procedures, and number and type of complications. Non-clustering variables were evaluated after clustering, including burned TBSA, inhalation injury, mortality, discharge disposition, age, sex, and race. Latent class analysis suggested three clusters. Hierarchical clustering analysis was applied to the most severe latent class, creating four total burn severity groups. In total, 112,297 patients were included in the final analysis. The mean TBSA burned for each class is 4.26±4.91 for minor, 8.07±8.39 for moderate, 22.76±17.31 for severe and 36.72±21.61 for massive. The age and sex proportions were similar among all clusters. The clustering variables steadily increased for each severity cluster. Mortality was the highest in the massive cluster (18.2%). Data informed categories of burn severity were formed using clustering analyses, which will be helpful for triage, data-benchmarking, and class-specific research.

Burn injury can have a lasting impact on quality of life beyond the initial injury. The aim of this study was to examine the recovery process through analyzing the relationship between body image, physical function, and return to work. This study uses data from the Burn Model System (BMS) National Longitudinal Database and includes 1,001 participants injured between 2015 and 2023 who were measured using Patient-Reported Outcomes Measurement Information System (PROMIS-29) Physical Function, Employment Status, and the Body Image subscale. Associations were explored using multivariate linear and logistic regression analyses. Physical function was positively associated with body image and negatively associated with burn size, age, and amputation. Employment was positively correlated with body image and employment at injury, while negatively correlated with age. Other variables including burn etiology, burn center site, race, and ethnicity were significant at different time points. By understanding how these factors change and are associated with outcomes across recovery, the healthcare team can make more tailored efforts to improve the psychosocial and physical well-being of burn survivors.