Hilary Y Liu, Mario Alessandri-Bonetti, Siddhi Shockey, Alain C Corcos, Jenny A Ziembicki, Guy M Stofman, Francesco M Egro
Hand burns have a significant impact on the long-term function of burn patients. Recently, new protocols and technologies, such as dermal substitutes, have been introduced for the treatment of hand burns. This cross-sectional study investigates the preferred current management of acute hand burns and the role of dermal substitutes in treatment. A 10-question survey related to acute hand burns management was sent to 64 directors of American Burn Association (ABA)-verified burn centers. A total of 51.6% (n=33) directors of ABA-verified burn centers responded to the survey. For the treatment of superficial partial-thickness hand burns, 90.9% preferred a non-operative approach. Conversely, most respondents chose a single-stage excision and skin graft for deep partial-thickness hand burns (75.8%) and full-thickness hand burns (51.5%). However, for full-thickness hand burns, some surgeons prefer a two-stage reconstruction involving excision and placement of a skin substitute (27.3%) or allograft (9.1%), followed by a skin graft. Only 6.1% would utilize a three-stage reconstruction involving excision and allograft, excision and skin substitute, followed by skin grafting. Among surgeons who used skin substitutes (n=26), Integra (42.3%) and Novosorb Biodegradable Temporising Matrix (BTM) (23.1%) were preferred. The top reasons for choosing one specific dermal substitute were surgeon's preference (n=20; 76.9%) and cost (n=9; 34.6%). While a conservative non-operative approach is preferred for superficial partial-thickness hand burns, excision and skin grafting as a one-stage procedure remains the most common strategy for deep partial-thickness and full-thickness hand burns.
{"title":"Management of Acute Hand Burns: A Survey of American Burn Association-Verified Burn Centers","authors":"Hilary Y Liu, Mario Alessandri-Bonetti, Siddhi Shockey, Alain C Corcos, Jenny A Ziembicki, Guy M Stofman, Francesco M Egro","doi":"10.1093/jbcr/irae184","DOIUrl":"https://doi.org/10.1093/jbcr/irae184","url":null,"abstract":"Hand burns have a significant impact on the long-term function of burn patients. Recently, new protocols and technologies, such as dermal substitutes, have been introduced for the treatment of hand burns. This cross-sectional study investigates the preferred current management of acute hand burns and the role of dermal substitutes in treatment. A 10-question survey related to acute hand burns management was sent to 64 directors of American Burn Association (ABA)-verified burn centers. A total of 51.6% (n=33) directors of ABA-verified burn centers responded to the survey. For the treatment of superficial partial-thickness hand burns, 90.9% preferred a non-operative approach. Conversely, most respondents chose a single-stage excision and skin graft for deep partial-thickness hand burns (75.8%) and full-thickness hand burns (51.5%). However, for full-thickness hand burns, some surgeons prefer a two-stage reconstruction involving excision and placement of a skin substitute (27.3%) or allograft (9.1%), followed by a skin graft. Only 6.1% would utilize a three-stage reconstruction involving excision and allograft, excision and skin substitute, followed by skin grafting. Among surgeons who used skin substitutes (n=26), Integra (42.3%) and Novosorb Biodegradable Temporising Matrix (BTM) (23.1%) were preferred. The top reasons for choosing one specific dermal substitute were surgeon's preference (n=20; 76.9%) and cost (n=9; 34.6%). While a conservative non-operative approach is preferred for superficial partial-thickness hand burns, excision and skin grafting as a one-stage procedure remains the most common strategy for deep partial-thickness and full-thickness hand burns.","PeriodicalId":15205,"journal":{"name":"Journal of Burn Care & Research","volume":"26 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142260959","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Erin E Ross, Alexis Coulourides Kogan, Maxwell Johnson, Haig A Yenikomshian
People experiencing homelessness are at increased risk for serious burn injuries and face additional barriers to care such as inability to perform wound care and difficulty with follow-up. Although not burn-specific, street medicine programs provide direct medical care to people experiencing unsheltered homelessness in their own environment and may be well positioned to bridge this gap in burn care for this population. We conducted a cross-sectional survey to characterize the burn care experience of street medicine teams with providing burn care for people experiencing homelessness. The 60 respondents included 18 (30%) physicians, 15 (25%) nurse practitioners or physician assistants, 15 (25%) registered nurses, and 6 (10%) medical students, and 6 (10%) other team members. The most common reported barriers to care were prior negative experiences with emergency departments, and transportation to burn centers. There was regional variability in frequency of providing burn care, which was reflected in respondent comfort with assessing and treating burns. Burns were most often dressed with daily dressings such as a non-adherent dressing over silver sulfadiazine or bacitracin. Silver-based contact dressings were rarely used. Street medicine teams in the United States are treating burn injuries among people experiencing homelessness, though management practices and experience treating burns was variable. As street medicine programs continue to grow, burn-related education, training, and connections to local burn centers for team members is important. Through strengthened partnerships between burn centers and street medicine teams, these programs may be well positioned to bridge the gap in burn care for people experiencing homelessness.
{"title":"Burn Care in the Street: A Survey of the Current Landscape of Burn Care Provided by Street Medicine Teams","authors":"Erin E Ross, Alexis Coulourides Kogan, Maxwell Johnson, Haig A Yenikomshian","doi":"10.1093/jbcr/irae183","DOIUrl":"https://doi.org/10.1093/jbcr/irae183","url":null,"abstract":"People experiencing homelessness are at increased risk for serious burn injuries and face additional barriers to care such as inability to perform wound care and difficulty with follow-up. Although not burn-specific, street medicine programs provide direct medical care to people experiencing unsheltered homelessness in their own environment and may be well positioned to bridge this gap in burn care for this population. We conducted a cross-sectional survey to characterize the burn care experience of street medicine teams with providing burn care for people experiencing homelessness. The 60 respondents included 18 (30%) physicians, 15 (25%) nurse practitioners or physician assistants, 15 (25%) registered nurses, and 6 (10%) medical students, and 6 (10%) other team members. The most common reported barriers to care were prior negative experiences with emergency departments, and transportation to burn centers. There was regional variability in frequency of providing burn care, which was reflected in respondent comfort with assessing and treating burns. Burns were most often dressed with daily dressings such as a non-adherent dressing over silver sulfadiazine or bacitracin. Silver-based contact dressings were rarely used. Street medicine teams in the United States are treating burn injuries among people experiencing homelessness, though management practices and experience treating burns was variable. As street medicine programs continue to grow, burn-related education, training, and connections to local burn centers for team members is important. Through strengthened partnerships between burn centers and street medicine teams, these programs may be well positioned to bridge the gap in burn care for people experiencing homelessness.","PeriodicalId":15205,"journal":{"name":"Journal of Burn Care & Research","volume":"210 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142260963","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Louis A Perkins, Sadie Munter, William Johnston, Jeanne G Lee, Laura N Haines, Jay J Doucet, Alan Smith, Jarrett E Santorelli
There is a paucity of literature on friction burn epidemiology, injury characteristics, and management after trauma. This study aims to characterize friction burns resulting from motorcycle accidents, evaluate the role of specialized burn surgery teams, and assess the need for operative intervention. The trauma registry of a Level 1 Trauma Center was queried for all admissions after motorcycle accidents between January 2018 and December 2022. Patients were included if there was an external cause of injury code for an abrasion. Chart review was conducted to confirm a road rash injury, identify burn consultation, wound care recommendations, need for operating room (OR) procedure and skin grafting, and outcomes. Among the 810 patients meeting inclusion criteria, the cohort was 92% male, 46% Hispanic, with median age of 33 (IQR 26-44), and median ISS 8 (IQR 5-14). The extremities were most affected by friction burn followed by the abdomen, thorax, and face. Burn surgery was consulted in 7% (n=57) of cases which had a median TBSA of 4% (IQR 2-6%); 23% (n=13) of these patients underwent excision in the OR, 16% (n=9) required autografting, and 61% (n=35) were referred for burn follow-up on discharge. On multivariable regression, consults to burn were more likely in female patients (OR 3.40, p=0.002) and those with involvement of the upper extremity, abdomen, or thorax. Friction burns are common after motorcycle-related trauma. Local wound care is sufficient for a vast majority of these injuries and the need for specialized burn care and operative intervention is rare.
{"title":"Friction Burns: Defining the Rub of Road Rash After Motorcycle Trauma","authors":"Louis A Perkins, Sadie Munter, William Johnston, Jeanne G Lee, Laura N Haines, Jay J Doucet, Alan Smith, Jarrett E Santorelli","doi":"10.1093/jbcr/irae181","DOIUrl":"https://doi.org/10.1093/jbcr/irae181","url":null,"abstract":"There is a paucity of literature on friction burn epidemiology, injury characteristics, and management after trauma. This study aims to characterize friction burns resulting from motorcycle accidents, evaluate the role of specialized burn surgery teams, and assess the need for operative intervention. The trauma registry of a Level 1 Trauma Center was queried for all admissions after motorcycle accidents between January 2018 and December 2022. Patients were included if there was an external cause of injury code for an abrasion. Chart review was conducted to confirm a road rash injury, identify burn consultation, wound care recommendations, need for operating room (OR) procedure and skin grafting, and outcomes. Among the 810 patients meeting inclusion criteria, the cohort was 92% male, 46% Hispanic, with median age of 33 (IQR 26-44), and median ISS 8 (IQR 5-14). The extremities were most affected by friction burn followed by the abdomen, thorax, and face. Burn surgery was consulted in 7% (n=57) of cases which had a median TBSA of 4% (IQR 2-6%); 23% (n=13) of these patients underwent excision in the OR, 16% (n=9) required autografting, and 61% (n=35) were referred for burn follow-up on discharge. On multivariable regression, consults to burn were more likely in female patients (OR 3.40, p=0.002) and those with involvement of the upper extremity, abdomen, or thorax. Friction burns are common after motorcycle-related trauma. Local wound care is sufficient for a vast majority of these injuries and the need for specialized burn care and operative intervention is rare.","PeriodicalId":15205,"journal":{"name":"Journal of Burn Care & Research","volume":"18 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142260961","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
We aimed to compare the effectiveness of thymoquinone (TQ), most important bioactive component of black cumin, St. John wort (SJW) oil, a traditional medicinal plant used in burns, and silver sulfadiazine (AgSD), well-known anti-inflammatory agent used in modern medicine, in an experimental burn rat-model. 63 Wistar-Albino rats were randomly divided into 9 groups (n=7). TQ, SJW were administered topically and systemically but AgSD was applied topically. Epithelialization, inflammatory cell response, granulation tissue, vascularization, and fibrosis were evaluated. Malondialdehyde (MDA), total antioxidant status (TAS), total oxidant status (TOS), vitamin E, 8-hydroxy-deoxyguanosine (8-OHdG), coenzyme Q10 (CoQ10) were analyzed in serum. Topical TQ accelerated theepithelialization, enabled granulation, vascularization and fibrosis in wounds (P=0.001). Topical and systemic TQ increased Vitamin-E levels (P=0.003) but reduced TOS and 8-OHdG levels (P=0.001). Topical SJW reduced granulation and vascularization. Topical and systemic SJW decreased TOS, MDA and 8-OHdG levels (P=0.001), but increased TAS (P=0.001), and Vitamin-E levels (P=0.003). Topical AgSD reduced TOS, 8-OHdG, MDA levels (P=0.001). Topical and systemic TQ demonstrated significant advantages in accelerating wound healing process, while also enhancing antioxidant defenses and reducing oxidative damage. SJW oil, particularly in topical application, improved epithelialization and antioxidant status but showed less efficacy in systemic use. AgSD, while effective in reducing oxidative stress, was less successful in promoting wound healing and appeared to delay granulation and fibrosis. TQ offers superior protective and healing benefits, SJW is effective locally but less so systemically, and AgSD should be used cautiously, potentially combined with antioxidants to mitigate its negative impact on wound healing.
{"title":"Comparison of The Effectiveness of Thymoquinone, St. John Wort Oil and Silver Sulfadiazine in Experimental Burn Wounds","authors":"Yasin Canbaz, Percin Karakol, Remzi Erten, Tolga Mercantepe, Hamit Hakan Alp, Esra Turan Canbaz, Idris Turel, Murat Cetin Ragbetli, Serdar Yüce","doi":"10.1093/jbcr/irae174","DOIUrl":"https://doi.org/10.1093/jbcr/irae174","url":null,"abstract":"We aimed to compare the effectiveness of thymoquinone (TQ), most important bioactive component of black cumin, St. John wort (SJW) oil, a traditional medicinal plant used in burns, and silver sulfadiazine (AgSD), well-known anti-inflammatory agent used in modern medicine, in an experimental burn rat-model. 63 Wistar-Albino rats were randomly divided into 9 groups (n=7). TQ, SJW were administered topically and systemically but AgSD was applied topically. Epithelialization, inflammatory cell response, granulation tissue, vascularization, and fibrosis were evaluated. Malondialdehyde (MDA), total antioxidant status (TAS), total oxidant status (TOS), vitamin E, 8-hydroxy-deoxyguanosine (8-OHdG), coenzyme Q10 (CoQ10) were analyzed in serum. Topical TQ accelerated theepithelialization, enabled granulation, vascularization and fibrosis in wounds (P=0.001). Topical and systemic TQ increased Vitamin-E levels (P=0.003) but reduced TOS and 8-OHdG levels (P=0.001). Topical SJW reduced granulation and vascularization. Topical and systemic SJW decreased TOS, MDA and 8-OHdG levels (P=0.001), but increased TAS (P=0.001), and Vitamin-E levels (P=0.003). Topical AgSD reduced TOS, 8-OHdG, MDA levels (P=0.001). Topical and systemic TQ demonstrated significant advantages in accelerating wound healing process, while also enhancing antioxidant defenses and reducing oxidative damage. SJW oil, particularly in topical application, improved epithelialization and antioxidant status but showed less efficacy in systemic use. AgSD, while effective in reducing oxidative stress, was less successful in promoting wound healing and appeared to delay granulation and fibrosis. TQ offers superior protective and healing benefits, SJW is effective locally but less so systemically, and AgSD should be used cautiously, potentially combined with antioxidants to mitigate its negative impact on wound healing.","PeriodicalId":15205,"journal":{"name":"Journal of Burn Care & Research","volume":"30 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2024-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142260964","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Rishub K Das, Puja M Jagasia, Amanda E Baily, Ronnie Mubang, Brian C Drolet
This study evaluated the prevalence characteristics of advanced practice providers, including nurse practitioners and physician assistants, who provide care related to burns in the United States from 2013 to 2022 using national claims data. Our analysis was a retrospective, large cohort study evaluating debridement, wound care, and office-based services provided by advanced practice providers from 2013 to 2022 using the Medicare Provider Utilization and Payment Data Public Use Files from the CMS. The reported provider type and billing codes were used to identify healthcare professionals providing burn care. Trends over the study period and available data about care provided were analyzed. From 2013 to 2022, burn care providers included 6,918 (43.3%) surgeons, 4,264 (26.7%) other physicians, and 4,783 (30.0%) advanced practice providers. Overall, the number of advanced practice providers who billed for burn care increased by 250.4% from 714 in 2013 to 2,502 in 2022. Compared with physicians, advanced practice providers were more likely to be female and provide care in micropolitan areas with less than 50,000 people. Based on these trends, we project that the number of APPs providing services related to burns will increase by 56.7% from 2,502 in 2022 to 3,921 (95% CI, 3,541-4,303; R2=0.97) in 2030. With a growing need for burn care and predicted shortages in the surgeon workforce, the scope of practice and integration of advanced practice providers merits further discussion and evaluation.
{"title":"Advanced Practice Providers in Burn Care, 2013-2022","authors":"Rishub K Das, Puja M Jagasia, Amanda E Baily, Ronnie Mubang, Brian C Drolet","doi":"10.1093/jbcr/irae179","DOIUrl":"https://doi.org/10.1093/jbcr/irae179","url":null,"abstract":"This study evaluated the prevalence characteristics of advanced practice providers, including nurse practitioners and physician assistants, who provide care related to burns in the United States from 2013 to 2022 using national claims data. Our analysis was a retrospective, large cohort study evaluating debridement, wound care, and office-based services provided by advanced practice providers from 2013 to 2022 using the Medicare Provider Utilization and Payment Data Public Use Files from the CMS. The reported provider type and billing codes were used to identify healthcare professionals providing burn care. Trends over the study period and available data about care provided were analyzed. From 2013 to 2022, burn care providers included 6,918 (43.3%) surgeons, 4,264 (26.7%) other physicians, and 4,783 (30.0%) advanced practice providers. Overall, the number of advanced practice providers who billed for burn care increased by 250.4% from 714 in 2013 to 2,502 in 2022. Compared with physicians, advanced practice providers were more likely to be female and provide care in micropolitan areas with less than 50,000 people. Based on these trends, we project that the number of APPs providing services related to burns will increase by 56.7% from 2,502 in 2022 to 3,921 (95% CI, 3,541-4,303; R2=0.97) in 2030. With a growing need for burn care and predicted shortages in the surgeon workforce, the scope of practice and integration of advanced practice providers merits further discussion and evaluation.","PeriodicalId":15205,"journal":{"name":"Journal of Burn Care & Research","volume":"44 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142260965","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Erin E Ross, Elizabeth Flores, Paige K D Zachary, Haig A Yenikomshian
Burn injury can have profound detrimental effects on quality of life and mental health of children. We collected demographics, burn etiology, burn date, and home zip code for pediatric patients admitted to our burn unit from 2016-2023. Age, burn date, and etiology of burn were used to assess temporal and mechanistic patterns of injury for pre-school-age and school-age children. Home zip code was used to determine each child’s home Childhood Opportunity Index score, which is composed of sub-domains for Education, Health & Environment, and Social & Economic. We calculated the odds-ratio for odds of pediatric burn admission for each COI sub-domain quintile, using very high opportunity neighborhoods as the reference. Scald was the prevailing burn etiology (64%). In school-age children, July was the month with the most burn injuries (19%), attributable to firework injuries. School-age children were also more likely to be injured in a week without classroom instruction (p<0.001). There was a dose-response relationship between Childhood Opportunity Index and odds of burn admission, with the greatest odds of burn admission observed for children from very low educational opportunity areas (OR 5.21, 95% CI 3.67-7.39). These findings support interventions for burn prevention such as increased education about the dangers of fireworks, addressing inequities in access to childcare and extracurricular activities, and reducing the default water heater temperatures in multi-unit dwellings
烧伤会对儿童的生活质量和心理健康产生深远的不利影响。我们收集了 2016-2023 年期间烧伤科收治的儿科患者的人口统计数据、烧伤病因、烧伤日期和家庭邮政编码。年龄、烧伤日期和烧伤病因用于评估学龄前儿童和学龄儿童受伤的时间和机理模式。家庭邮政编码用于确定每个儿童的家庭 "儿童机会指数 "得分，该指数由教育、健康及环境、社会及经济等子领域组成。我们以机会指数非常高的社区为参照，计算了每个机会指数子域五分位数的小儿烧伤入院几率比例。烫伤是最常见的烧伤病因（64%）。在学龄儿童中，7 月是烧伤最多的月份（19%），原因是烟花伤害。在没有课堂教学的一周内，学龄儿童也更容易受伤（p<0.001）。童年机会指数与烧伤入院几率之间存在剂量反应关系，来自教育机会极少地区的儿童烧伤入院几率最大（OR 5.21，95% CI 3.67-7.39）。这些发现支持采取预防烧伤的干预措施，如加强有关烟花危险的教育、解决儿童保育和课外活动机会不平等的问题，以及降低多单元住宅中热水器的默认温度。
{"title":"Pediatric Burn Unit Admission is Associated with School Holidays and Lower Home Childhood Opportunity Level","authors":"Erin E Ross, Elizabeth Flores, Paige K D Zachary, Haig A Yenikomshian","doi":"10.1093/jbcr/irae180","DOIUrl":"https://doi.org/10.1093/jbcr/irae180","url":null,"abstract":"Burn injury can have profound detrimental effects on quality of life and mental health of children. We collected demographics, burn etiology, burn date, and home zip code for pediatric patients admitted to our burn unit from 2016-2023. Age, burn date, and etiology of burn were used to assess temporal and mechanistic patterns of injury for pre-school-age and school-age children. Home zip code was used to determine each child’s home Childhood Opportunity Index score, which is composed of sub-domains for Education, Health & Environment, and Social & Economic. We calculated the odds-ratio for odds of pediatric burn admission for each COI sub-domain quintile, using very high opportunity neighborhoods as the reference. Scald was the prevailing burn etiology (64%). In school-age children, July was the month with the most burn injuries (19%), attributable to firework injuries. School-age children were also more likely to be injured in a week without classroom instruction (p&lt;0.001). There was a dose-response relationship between Childhood Opportunity Index and odds of burn admission, with the greatest odds of burn admission observed for children from very low educational opportunity areas (OR 5.21, 95% CI 3.67-7.39). These findings support interventions for burn prevention such as increased education about the dangers of fireworks, addressing inequities in access to childcare and extracurricular activities, and reducing the default water heater temperatures in multi-unit dwellings","PeriodicalId":15205,"journal":{"name":"Journal of Burn Care & Research","volume":"29 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142260983","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Alexander Kurjatko, Colette Galet, Isaac Weigel, Justin Suarez, Lucy Wibbenmeyer
Trace element deficiency is an adverse nutritional outcome that can occur with burn injuries, and can interfere with a patient’s recovery. The aim of this study was to review the efficacy of our predominately enteral trace element supplementation strategy and determine the burn size at which patients are at risk for trace element deficiency. We reviewed 53 burn patients admitted to our burn center from August 1, 2019 to May 31, 2022 who had their trace element levels and C-reactive protein monitored in two-week increments. Receiver operating characteristic analysis indicated a 22.1% BSAB cutoff for zinc supplementation to prevent deficiency with 91.7% sensitivity and 92.6% specificity, and a 27.5% BSAB cutoff with 88.9% sensitivity and 81% specificity for copper. No patient in our cohort developed selenium deficiency, regardless of burn size. Patients with greater than 30% body surface area burned developed deficiencies in both zinc and copper within the first two weeks of hospitalization. Our results provide guidance for trace element replacement based on burn size.
{"title":"Trace Element Supplementation in Burn Patients: Exploring the Relationship Between Burn Size and Mineral Needs","authors":"Alexander Kurjatko, Colette Galet, Isaac Weigel, Justin Suarez, Lucy Wibbenmeyer","doi":"10.1093/jbcr/irae175","DOIUrl":"https://doi.org/10.1093/jbcr/irae175","url":null,"abstract":"Trace element deficiency is an adverse nutritional outcome that can occur with burn injuries, and can interfere with a patient’s recovery. The aim of this study was to review the efficacy of our predominately enteral trace element supplementation strategy and determine the burn size at which patients are at risk for trace element deficiency. We reviewed 53 burn patients admitted to our burn center from August 1, 2019 to May 31, 2022 who had their trace element levels and C-reactive protein monitored in two-week increments. Receiver operating characteristic analysis indicated a 22.1% BSAB cutoff for zinc supplementation to prevent deficiency with 91.7% sensitivity and 92.6% specificity, and a 27.5% BSAB cutoff with 88.9% sensitivity and 81% specificity for copper. No patient in our cohort developed selenium deficiency, regardless of burn size. Patients with greater than 30% body surface area burned developed deficiencies in both zinc and copper within the first two weeks of hospitalization. Our results provide guidance for trace element replacement based on burn size.","PeriodicalId":15205,"journal":{"name":"Journal of Burn Care & Research","volume":"43 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142260984","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Eloise W Stanton, Artur Manasyan, Callie M Thompson, Gourang P Patel, Alexandra M Lacey, Taryn E Travis, Sebastian Q Vrouwe, Clifford C Sheckter, Justin Gillenwater
Comprehensive studies on the incidence, risk factors, and prophylactic measures related to venous thromboembolism (VTE) are lacking in burn care. This study characterizes VTE risk and existing prevention measures to improve and inform overall patient care in the field of burn care on a national scale. The US National Trauma Data Bank (NTDB) was queried from 2007 to 2021 to identify burn-injured patients. Descriptive statistics and multivariate regression analyses were used to explore the association between demographic/clinical characteristics and VTE risk as well as compare various VTE chemoprophylaxis types. There were 326,614 burn-injured patients included for analysis; 5,642 (1.7%) experienced a VTE event during their hospitalization. Patients with VTE were significantly older, had greater BMIs and %TBSA, and were more likely to be male (p<0.001). History of smoking, hypertension or myocardial infarction, and/or substance use disorder were significant predictors of VTE (p<0.001). Patients who received low molecular weight heparin (LMWH) were less likely to have VTE compared to patients treated with heparin when controlling for other VTE risk factors (OR: .564 95% CI .523-.607, p<0.001). Longer time to VTE chemoprophylaxis (>6 hours) initiation was significantly associated with VTE (OR=1.04 95% CI 1.03=1.07, p<0.001). This study sheds light on risk factors and chemoprophylaxis in VTE to help guide clinical practice when implementing prevention strategies in burn patients. This knowledge can be leveraged to refine risk stratification models, inform evidence-based prevention strategies, and ultimately enhance the quality of care for burn patients at risk of VTE.
{"title":"Venous Thromboembolism Incidence, Risk Factors, and Prophylaxis in Burn Patients: a National Trauma Database Study","authors":"Eloise W Stanton, Artur Manasyan, Callie M Thompson, Gourang P Patel, Alexandra M Lacey, Taryn E Travis, Sebastian Q Vrouwe, Clifford C Sheckter, Justin Gillenwater","doi":"10.1093/jbcr/irae171","DOIUrl":"https://doi.org/10.1093/jbcr/irae171","url":null,"abstract":"Comprehensive studies on the incidence, risk factors, and prophylactic measures related to venous thromboembolism (VTE) are lacking in burn care. This study characterizes VTE risk and existing prevention measures to improve and inform overall patient care in the field of burn care on a national scale. The US National Trauma Data Bank (NTDB) was queried from 2007 to 2021 to identify burn-injured patients. Descriptive statistics and multivariate regression analyses were used to explore the association between demographic/clinical characteristics and VTE risk as well as compare various VTE chemoprophylaxis types. There were 326,614 burn-injured patients included for analysis; 5,642 (1.7%) experienced a VTE event during their hospitalization. Patients with VTE were significantly older, had greater BMIs and %TBSA, and were more likely to be male (p&lt;0.001). History of smoking, hypertension or myocardial infarction, and/or substance use disorder were significant predictors of VTE (p&lt;0.001). Patients who received low molecular weight heparin (LMWH) were less likely to have VTE compared to patients treated with heparin when controlling for other VTE risk factors (OR: .564 95% CI .523-.607, p&lt;0.001). Longer time to VTE chemoprophylaxis (&gt;6 hours) initiation was significantly associated with VTE (OR=1.04 95% CI 1.03=1.07, p&lt;0.001). This study sheds light on risk factors and chemoprophylaxis in VTE to help guide clinical practice when implementing prevention strategies in burn patients. This knowledge can be leveraged to refine risk stratification models, inform evidence-based prevention strategies, and ultimately enhance the quality of care for burn patients at risk of VTE.","PeriodicalId":15205,"journal":{"name":"Journal of Burn Care & Research","volume":"26 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142199639","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Matthew J Heron, Tyler R Reinoso, Julia M Dane, Siam K Rezwan, Sylvia Mack, Kristen P Broderick, Carisa M Cooney, Julie A Caffrey
Fractional laser therapy improves skin texture, range of motion, and quality of life for patients with traumatic scars. Nevertheless, anecdotal evidence suggests declining insurance coverage for laser therapy. We aimed to characterize the landscape of insurance coverage for fractional laser therapy present our six-year reimbursement trends. We cross-sectionally analyzed the 60 largest American health insurers by enrollee size and market share. For each, we identified their laser therapy policy for scar revision and extracted their documentation, prior, and continuing authorization requirements and treatment guidelines. We also collected retrospective institutional claims data from 2017 to 2022 to investigate trends in reimbursement. Of the 60 largest health insurers, we identified 11 (18.3%) policies on scar revision and 40 policies (66.7%) on reconstructive surgery, including scar revision. Nineteen policies considered laser therapy medically necessary with evidence of functional impairment refractory to prior treatment. Three insurers denied laser coverage under any circumstance. Of the 1,531 claims submitted by our institution for burn scar laser therapy, 13.8% were denied. Patients with Medicare (ORadj, 3.78) or Medicaid (ORadj, 2.80) had significantly greater odds of coverage than privately insured patients (p<0.01). There was a 14.5% annual reduction in the odds of reimbursement during the study period (ORadj, 0.86, p < 0.01). Laser therapy is a powerful treatment that is not widely available to patients with traumatic scars. Our institutional data suggest this access may be further eclipsed by decreasing trends in coverage since 2017. Strategies are needed to protect patient access to this life-changing treatment.
{"title":"The Fractured Insurance Landscape of Laser Therapy for Scar Revision","authors":"Matthew J Heron, Tyler R Reinoso, Julia M Dane, Siam K Rezwan, Sylvia Mack, Kristen P Broderick, Carisa M Cooney, Julie A Caffrey","doi":"10.1093/jbcr/irae173","DOIUrl":"https://doi.org/10.1093/jbcr/irae173","url":null,"abstract":"Fractional laser therapy improves skin texture, range of motion, and quality of life for patients with traumatic scars. Nevertheless, anecdotal evidence suggests declining insurance coverage for laser therapy. We aimed to characterize the landscape of insurance coverage for fractional laser therapy present our six-year reimbursement trends. We cross-sectionally analyzed the 60 largest American health insurers by enrollee size and market share. For each, we identified their laser therapy policy for scar revision and extracted their documentation, prior, and continuing authorization requirements and treatment guidelines. We also collected retrospective institutional claims data from 2017 to 2022 to investigate trends in reimbursement. Of the 60 largest health insurers, we identified 11 (18.3%) policies on scar revision and 40 policies (66.7%) on reconstructive surgery, including scar revision. Nineteen policies considered laser therapy medically necessary with evidence of functional impairment refractory to prior treatment. Three insurers denied laser coverage under any circumstance. Of the 1,531 claims submitted by our institution for burn scar laser therapy, 13.8% were denied. Patients with Medicare (ORadj, 3.78) or Medicaid (ORadj, 2.80) had significantly greater odds of coverage than privately insured patients (p&lt;0.01). There was a 14.5% annual reduction in the odds of reimbursement during the study period (ORadj, 0.86, p &lt; 0.01). Laser therapy is a powerful treatment that is not widely available to patients with traumatic scars. Our institutional data suggest this access may be further eclipsed by decreasing trends in coverage since 2017. Strategies are needed to protect patient access to this life-changing treatment.","PeriodicalId":15205,"journal":{"name":"Journal of Burn Care & Research","volume":"87 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142260985","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Lucas Rezende de Freitas, Ofonime Chantal Udoma-Udofa, Pedro Henrique Reginato, Henrique Costa Mitsui, Henrique Provinciatto, Fabricio Carvalho Torres
Deep burn injuries necessitate effective debridement to promote healing and reduce complications. Traditional surgical debridement is the standard of care; however, it can lead to significant tissue loss, excessive bleeding and delayed healing. Bromelain-based enzymatic debridement offers a potential less invasive alternative that aims to selectively remove necrotic tissue while preserving viable ones. Therefore, this systematic review and meta-analysis comprehensively compares bromelain debridement versus standard care in the management of partial and full-thickness burns. Cochrane Library, Embase, and Medline were searched until May 30th, 2024 for studies comparing bromelain debridement versus standard care. R version 4.4.0 was used to pooled risk ratio and mean difference in a random-effects model. We included seven studies, comprising 484 participants, of whom 238 (49%) were treated with enzymatic debridement. Bromelain significantly reduced time to eschar removal (MD - 7.60 days 95% CI [-9.76, -5.44]; I² = 70%) in comparison with standard care. Additionally, bromelain group presented a significant reduction in the risk of surgical excision (RR 0.17; 95% CI [0.06, 0.47]; I² = 79%) and need for autografts (RR 0.40; 95% CI [0.18, 0.93]; I² = 76%) in comparison with standard group. No differences were found in behalf of time to wound closure (MD -7.64; 95% CI [-18.46]-[3.18]; I2 = 86%), nor in Modified Vancouver Scar Scale (MD -0.36; 95% CI [-0.96]-[0.23]; I2 = 0%). Bromelain-based enzymatic debridement may accelerate eschar removal and reduce the need for surgical excision and autografts, without adversely affecting wound closure time or long-term scar quality.
深度烧伤需要进行有效的清创，以促进愈合并减少并发症。传统的手术清创是治疗的标准，但会导致大量组织损失、出血过多和延迟愈合。基于菠萝蛋白酶的酶解清创法提供了一种潜在的微创替代方法，旨在选择性地清除坏死组织，同时保留有活力的组织。因此，本系统综述和荟萃分析全面比较了菠萝蛋白酶清创与标准护理在治疗部分和全厚烧伤中的效果。截至 2024 年 5 月 30 日，我们在 Cochrane Library、Embase 和 Medline 上检索了比较溴甲烷清创与标准护理的研究。使用 R 4.4.0 版本在随机效应模型中汇总风险比和平均差。我们纳入了七项研究，共有484名参与者，其中238人（49%）接受了酶解清创治疗。与标准治疗相比，菠萝蛋白酶明显缩短了清除焦痂的时间（MD - 7.60 天 95% CI [-9.76, -5.44]；I² = 70%）。此外，与标准组相比，溴甘肽组显著降低了手术切除风险（RR 0.17；95% CI [0.06，0.47]；I² = 79%）和自体移植需求（RR 0.40；95% CI [0.18，0.93]；I² = 76%）。在伤口闭合时间（MD -7.64；95% CI [-18.46]-[3.18]；I2 = 86%）和改良温哥华疤痕量表（MD -0.36；95% CI [-0.96]-[0.23]；I2 = 0%）方面未发现差异。以菠萝蛋白酶为基础的酶解清创疗法可加快焦痂的清除，减少手术切除和自体移植的需要，同时不会对伤口愈合时间或长期疤痕质量产生不利影响。
{"title":"Bromelain-Based Enzymatic Debridement Versus Standard of Care in Deep Burn Injuries: A Systematic Review and Meta-Analysis","authors":"Lucas Rezende de Freitas, Ofonime Chantal Udoma-Udofa, Pedro Henrique Reginato, Henrique Costa Mitsui, Henrique Provinciatto, Fabricio Carvalho Torres","doi":"10.1093/jbcr/irae172","DOIUrl":"https://doi.org/10.1093/jbcr/irae172","url":null,"abstract":"Deep burn injuries necessitate effective debridement to promote healing and reduce complications. Traditional surgical debridement is the standard of care; however, it can lead to significant tissue loss, excessive bleeding and delayed healing. Bromelain-based enzymatic debridement offers a potential less invasive alternative that aims to selectively remove necrotic tissue while preserving viable ones. Therefore, this systematic review and meta-analysis comprehensively compares bromelain debridement versus standard care in the management of partial and full-thickness burns. Cochrane Library, Embase, and Medline were searched until May 30th, 2024 for studies comparing bromelain debridement versus standard care. R version 4.4.0 was used to pooled risk ratio and mean difference in a random-effects model. We included seven studies, comprising 484 participants, of whom 238 (49%) were treated with enzymatic debridement. Bromelain significantly reduced time to eschar removal (MD - 7.60 days 95% CI [-9.76, -5.44]; I² = 70%) in comparison with standard care. Additionally, bromelain group presented a significant reduction in the risk of surgical excision (RR 0.17; 95% CI [0.06, 0.47]; I² = 79%) and need for autografts (RR 0.40; 95% CI [0.18, 0.93]; I² = 76%) in comparison with standard group. No differences were found in behalf of time to wound closure (MD -7.64; 95% CI [-18.46]-[3.18]; I2 = 86%), nor in Modified Vancouver Scar Scale (MD -0.36; 95% CI [-0.96]-[0.23]; I2 = 0%). Bromelain-based enzymatic debridement may accelerate eschar removal and reduce the need for surgical excision and autografts, without adversely affecting wound closure time or long-term scar quality.","PeriodicalId":15205,"journal":{"name":"Journal of Burn Care & Research","volume":"10 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142199638","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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