Journal of Burn Care & Research最新文献

Despite the growing incidence of burn injuries globally and the advancements in physical recovery, the psychological aspect of burn trauma recovery remains inadequately addressed. This review aims to consolidate existing literature on posttraumatic stress disorder (PTSD) and depression in adult burn survivors, recognizing the need for a holistic approach to burn recovery that encompasses both physical and mental health. The comprehensive analysis of 156 studies revealed significant variations in methodological approaches, leading to challenges in creating standardized protocols for mental health assessment in burn care. Key findings include the identification of a wide range of psychological assessment tools and a substantial research gap in low- and middle-income countries, where the majority of burn injuries occur. Only 7.0% of the studies assessed interventions for PTSD or depression, indicating a lack of focus on treatment modalities. The studies identified demographic factors, patient history, psychosocial factors, burn injury characteristics, and treatment course as risk factors for PTSD and depression postburn injury. The review highlights the need for early screening, intervention, and attention to subjective experiences related to burn injury, as these are strong predictors of long-term psychological distress. It also emphasizes the complexity of addressing psychological distress in burn survivors and the need for more standardized practices in assessing PTSD and depression specific to this population.

Violence against women is a global public health problem. Centers for Disease Control and Precention (CDC) data show 41% of US women have experienced intimate partner violence. Burn-related violence against women is an extremely confronting form of physical violence. The aim of this study was to describe the frequency, demographics, injury characteristics, and outcomes of women admitted to US burn centers who have experienced burn violence compared to those with accidental burn injuries. 2008-2018 data were comparative statistics were used to describe/compare groups. 54 523 women met study inclusion criteria. 956 (2%) experienced burn violence. Women who experienced burn violence had a younger median [IQR] age (36 [27,48] vs 47 [32,61], P < .0001), were Black/African American (44.5% vs 22.4%, P < .0001), were covered by Medicaid (38.8% vs 21.6%, P < .0001), had a higher median [IQR] %TBSA extent (6.0% [3,15.2] vs 3.0% [1,7.3], P < .0001), a higher proportion with third-degree burns (35.4% vs 28.9%, P < .0001), and a higher proportion with TBSA > 20% (18.2% vs 6.7%, P < .0001). Scald/flame injuries were the most frequent mechanism of injury. Women who experienced violence had a higher median [IQR] length of hospital stay (7.0 [2,18] vs 4.0 [1,11] days, P <.0001), Intensive Care Unit (ICU) stay (8.5 [2,27] vs 4 [2,13] days, P < .0001), and mortality rate (5.7% vs 4.3%, P < .04). The frequency of women who sustained burn violence appears small yet experience worse outcomes. Clinicians should be aware of these demographic/clinical characteristics to provide optimal care to this vulnerable population.

Mental health is a component of care that should be addressed for patients with burns while they are hospitalized. Unfortunately, dedicated burn psychotherapists are rare in burn centers in the United States (US), and it can take months for patients to be seen by a mental health professional after referral. Our burn center has a dedicated licensed clinical social worker who sees patients within 2 business days of referral. She uses cognitive behavioral therapy (CBT), which is designed to alleviate symptoms of anxiety, depression, and acute stress by modifying the individual's maladaptive thoughts. To evaluate the timely use of CBT as a treatment for depression in patients with burns, we measured depressive symptoms before and after psychotherapy. Burn clinic nurses administered the Patient Health Questionnaire (PHQ-9) depression screener as part of standard care. We computed difference scores to determine the change in PHQ-9 scores at both group and individual levels. At a group level, psychotherapy significantly improved symptoms of depression, indicated by a decreased mean PHQ-9 score. On an individual level, half of the patients (50.7%) experienced a meaningful improvement in their symptoms, indicated by a change in their PHQ-9 depression category, while 35.6% showed no change. Although it was not an effective solution for all patients in this study, timely use of CBT could be an important component of burn care for many and should be considered as part of standard care in burn centers across the US.

Etherified Carboxymethylcellulose Matrix (eCMC) is a revolutionary application of carboxymethylcellulose (CMC) in wound care, known for its potential in hemostasis and tissue regeneration. This study aims to investigate the mechanism of eCMC in tissue healing by establishing a rat burn model and administering eCMC as a treatment. The objective is to analyze cytokines and inflammatory mediators using a Cytokine Array and histochemical staining to understand the effects of eCMC on tissue regeneration. A rat burn model was created, and eCMC was applied as a treatment. Tissue samples were collected at multiple time points to assess the expression of cytokines and inflammatory mediators using a Cytokine Array. In addition, histochemical staining was performed to evaluate tissue regeneration factors. eCMC induced the expression of endogenous cytokines, particularly vascular epithelial growth factor and platelet-derived growth factor, while inhibiting inflammatory cytokines such as CINC-1, CINC-2, and MMP-8. This dual action facilitated wound healing and mitigated the risk of infection. eCMC demonstrates promising potential for enhancing skin regeneration. Further research is warranted to delve into the precise mechanism of eCMC's cytokine regulation. In vitro and in vivo studies should be conducted to comprehensively investigate the therapeutic capabilities of eCMC in wound healing.

This quality improvement project at a single institution aimed to increase the proportion of prescribed tube feeds delivered to adult patients in the burn population with greater than 20% affected TBSA. A retrospective chart review was performed on all adult patients with burns from January 2018 to July 2022 with greater than 20% TBSA burns to compare quantitative measures such as length of stay, change in weight, and mean tube feeds delivered over hospitalization. Prospective data collection began in August 2022, when the first intervention was implemented, and continued until July 2023 in the same patient population to serve as a postintervention cohort. Using a multidisciplinary approach, the team implemented 8 interventions, which increased the mean proportion of tube feeds delivered to patients from 43% to 78%, marking a significant increase in nutrition delivered to patients, which is critical for wound healing following burn injuries.

The prevalence of psychological symptoms in burn survivors has been well documented; however, the role of biological sex requires further investigation. This study explored sex differences among burn survivors and examined the impact of sex, age, and total body surface area (TBSA) of the burn injury on the risk of developing posttraumatic stress disorder (PTSD) and depression and, subsequently, the influence of initial risk on symptom outcomes 30 days postinjury. Participants included 374 adult patients enrolled in the Burn Behavioral Health program at a regional Burn Center. T-tests and chi-square tests were conducted to determine differences between sexes on outcome measures. A path analysis was conducted to evaluate relationships between variables of interest. Findings revealed significant sex discrepancies in risk and symptom outcomes. Compared to men, women reported greater total risk scores of developing PTSD and depression (P = .005) early after their burn injury. A subscale analysis showed that women reported greater risk scores for depression (P < .001), but not on PTSD. Women did not report higher depression scores 30 days postinjury compared to men but did report higher PTSD scores than men (P = .020). When sex, age, and TBSA were included in a path analysis, female sex (P = .001), younger age (P < .001), and larger TBSA of the burn injury (P = .024) were associated with greater risk. In addition, risk scores significantly predicted PTSD (P < .001) and depression (P < .001) symptoms 30 days postinjury. Our research shows how sex, age, and TBSA affect the risk of PTSD and depression among burn survivors. It underscores the importance of accounting for sex and age differences in mental health risk, especially in women and younger patients. This emphasizes the urgency of early screening and intervention.

Burn care continues to improve and larger total body surface area (TBSA) burn survival is increasing. These survivors require more extensive care than smaller burns and are at higher risk for wound/scar-related complications. Prior work has shown low rates of follow-up for burn survivors linked to socioeconomic factors such as housing insecurity and substance use. There are limited studies that evaluate socioeconomic factors that contribute to follow-up and reconstructive surgery rates in massively burned patients. Patients who survived to discharge with >50% TBSA burns and planned return to the treating institution were included in the study. Univariate and multivariate analyses were performed on the data collected. Sixty-five patients were included with an average TBSA of 63.1%. Fifty-three patients (81.5%) attended at least one follow-up appointment with median of 4 follow-up appointments. Younger patients (33 ± 9 vs 44 ± 11; P = .0006), patients with larger TBSA burns (65 ± 13 vs 55 ± 5%; P = .02), those with private insurance, and those without housing insecurity (1.8% vs 45.4%; P = .003) were more likely to follow up. On multivariate regression analysis, patients with housing insecurity were independently associated with lack of follow-up (OR: 0.009; CI: 0.00001-0.57). Thirty-five patients had at least one reconstructive surgery and 31 patients had reconstructive surgery after discharge. No patients with housing insecurity underwent reconstructive surgery. Follow-up rates in massive burns were higher than reported for smaller TBSA burns and more than half received reconstructive surgery. Housing-insecure patients should be targeted for improved follow-up and access to reconstructive surgery.

Adequate and effective pain management and prevention of depression are essential in patients with burns. This study aims to explore the effects of ketamine sedation in patients with burns in terms of mood disorders, depression, anxiety, and suicidality during postoperative follow-up in the intensive care unit. This study targeted subjects aged 18-65 years, in the ASA I-II class, with basic communication skills, no history of diagnosed mental illness, and no history of neuropsychiatric or cognitive disorders or related treatment. The study was conducted on 67 patients. After preoxygenation, anesthesia induction was practiced with 2 mg/kg intravenous (IV) propofol and 1 mcg/kg IV fentanyl in the general anesthesia group. Anesthesia was continued with a mixture of 0.3-0.5 mcg/kg/min remifentanil, 2% sevoflurane, 50% air, and 50% oxygen. In the sedation group, 1 mcg/kg IV fentanyl and 1 mg/kg IV ketamine were administered at induction; anesthesia was maintained by adding 30-50 mg IV propofol if necessary. The Montgomery-Asberg Depression Rating Scale (MADRS), Hamilton Anxiety Rating Scale (HAM-A), and Beck Scale for Suicidal Ideation (BSSI) have been administered via way of means of a psychiatrist preoperatively and on the primary postoperative day. In intragroup evaluations, MADRS values for the sedation anesthesia group decreased statistically significantly after the anesthesia (11.63 ± 5.49) compared to the preanesthesia period (14.44 ± 7.22) (P < .001). HAM-A scores of both anesthesia groups decreased statistically significantly after anesthesia. No patient was found to have suicidal ideation in all evaluations in which BSSI was used. Patients with burns may have a high potential for depression, anxiety disorders, and suicidal tendencies due to the trauma they have experienced. In these patients, sedation anesthesia with ketamine may reduce negative mood, depression, anxiety, and suicidal tendencies in the postoperative period.

This study utilized CiteSpace software to conduct a bibliometric analysis of the literature related to the use of growth hormones in treating burns. The results showed that the research on this topic has attracted increasing attention from scholars worldwide, with the number of publications increasing annually. The research teams and institutions involved in this field are mainly concentrated in China, followed by the United States, Russia, and other countries. The analysis also revealed the prominent co-cited literature and the most influential authors in the field, such as D. N. Herndon and Y. Li. The main research themes identified in the literature included the effects of growth hormones on wound healing, tissue repair and regeneration, inflammatory responses, and cell proliferation. In addition, the research on the clinical applications of growth hormone in burn treatment has been expanded to include areas such as metabolic regulation, immune function, and the prevention of infections. The findings of this study provide useful insights into the current status and future directions of research in the field of growth hormone treatment of burns.