Journal of Burn Care & Research最新文献

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.

ReCell, is a skin processing device that produces an autologous skin cell suspension (ASCS), which has shown promise in enhancing skin regeneration for patients with burn injuries. Despite its growing use in clinical practice, the current literature displays considerable variability in study design and quality, leading to ongoing uncertainty about its true clinical effectiveness. This systematic review and meta-analysis aims to comprehensively evaluate the clinical efficacy of ReCell's ASCS technology in the treatment of burns. A systematic review was conducted in accordance with PRISMA guidelines, using searches across PubMed, Web of Science, Embase, and Cochrane databases. The review protocol was prospectively registered on PROSPERO (CRD42024606554). The Cochrane Risk of Bias Tool and the ROBINS-I tool were applied to assess bias in randomized controlled trials and observational studies, respectively. The overall methodological quality of included studies was appraised using the GRADE framework. Fourteen studies (n = 3362) fulfilled the inclusion criteria. The pooled mean patient age was 38.35 years, with a male predominance (69.8%). The average %TBSA affected was 14.6% (95% CI: 8.76-20.44), with substantial heterogeneity (I2 = 95.1%). Meta-analysis demonstrated a statistically significant reduction in complication rates with ASCS combined with split-thickness skin grafting (STSG) compared to STSG alone (RR = 0.64, 95% CI: 0.41-1.00, P = .048). However, rates of wound infection and graft failure did not differ significantly between groups. ASCS demonstrates potential to reduce complications in burn care. Nevertheless, due to heterogeneous study designs, further high-quality, large-scale randomized trials are warranted to validate its long-term efficacy and broader clinical utility.

Burn injuries disproportionately impact children in low- and middle-income countries (LMICs), with Sub-Saharan Africa bearing the highest burden. While pediatric injury research in LMICs is growing, data on pediatric burn injuries and associated mortality in LMICs remain limited. The objective of this study was to describe a cohort of pediatric burn injury patients from a pediatric injury registry in Northern Tanzania, including the epidemiology, clinical presentation, pre-hospital factors, and clinical outcomes. We conducted a retrospective observational study of burn injury patients from a pediatric injury registry at a tertiary zonal referral hospital in Northern Tanzania. We evaluated patient demographics, emergency department presentation, and inpatient data. Study outcomes included ICU admission, in-hospital mortality, and morbidity at discharge. Differences in statistics were evaluated with analysis of variance (ANOVA)/t-test, chi-square tests, or Fisher's exact tests. We assessed associations with ICU stay, in-hospital mortality, and morbidity by reporting adjusted odds ratios and 95% confidence intervals from multivariable logistic regression models. 133 pediatric burn patients were enrolled between November 2020 and August 2024. Sixty-eight patients were female (51%), and most were aged 5 years or younger (81.9%). Scalds were the most common injury. The in-hospital mortality rate was 22.6%. Burn severity was independently associated with all 3 study outcomes. Pediatric burn mortality was high, with burn severity predicting poor outcomes. This study highlights the urgent need to address gaps in burn injury prevention, community education on timely burn care, and pre-hospital and referral systems for pediatric burn patients in Northern Tanzania.

Shock-induced endothelial dysfunction plays a critical role in burn pathophysiology, with endothelial glycocalyx layer degradation promoting systemic inflammation, vascular instability, and multi-organ failure. The angiopoietin-tunica interna endothelial cell kinase (TIE2) axis, particularly the angiopoietin-1 (Ang-1) and angiopoietin-2 (Ang-2) balance, regulates endothelial function; elevated Ang-2 and a high Ang-2/1 ratio are linked to worse outcomes in critical illness. While well-documented in sepsis and trauma, effects of burn-induced angiopoietin dysregulation remain unclear. This study evaluates Ang-1, Ang-2, and the Ang-2/1 ratio as biomarkers of endothelial dysfunction and predictors of 30-day mortality in patients with burn injuries. In this prospective study, 62 adult patients with burn injuries were enrolled (January 2021-November 2024), with serum Ang-1 and Ang-2 measured via enzyme-linked immunosorbent assay on postburn day 1. Of 62 patients, 52 were analyzed; 78.05% of survivors and 90.91% of non-survivors were male. Median age was 45 (survivors) vs 54 years (non-survivors, P = .139). Non-survivors trended toward burns > 20% TBSA (72.73% vs 41.46%, P = .093). Ang-1 was lower in non-survivors (3.96 vs 7.97 ng/mL, P < .001), predicting early mortality (area under the receiver operating characteristic [AUROC]: 0.82) with a cut-off of 4.825 ng/mL and decreased mortality risk (odds ratio [OR]: 0.63, 95% confidence interval [CI]: 0.40-0.87, P = .017). Ang-2 was higher (6.07 vs 1.99 ng/mL, P < .001; AUROC: 0.95), with a cut-off of 3.554 ng/mL. The Ang-2/1 ratio was elevated (1.59 vs 0.23, P < .001; AUROC: 0.93), with a cut-off of 0.504 and increased mortality risk (OR: 2.17, 95% CI: 1.10-5.12, P = .038). Early Ang-1, Ang-2, and Ang-2/1 ratio levels correlate with 30-day mortality and may guide early prognostication.

The American Burn Life Support course recommends fluid resuscitation of patients with TBSA ≥20% to prevent burn shock. Our center resuscitates patients with burns greater than 15% TBSA. Herein, we characterize that population. Patients with burns 15% to 19.9% TBSA admitted from January 1, 2019 to March 31, 2023 who received protocolized fluid resuscitation were included. Demographics, hospital course, and fluids received were reviewed. Fluid resuscitation was categorized as "below range" (Parkland formula [PF] < 3 mL/kg/%TBSA), "within range" (PF = 3-5 mL/kg/%TBSA or "above range" (PF > 5 mL/kg/%TBSA). Similarly, urine output (UOP) was expressed as "below range" (<30 mL/h), "within range" (31-50 mL/h) or "above range" (>50 mL/h). The resuscitation groups were compared. P < .05 was considered significant. Thirty-three patients received resuscitation via Brooke (9.1%), PF (63.6%), or other formula (27.3%). Most were male (81.8%) with a median TBSA of 17%; median age was 57 years. Almost 20% of patients required vasopressors during resuscitation. Fifteen patients were within the predicated range of PF, 15 were under, and 3 were over. There was no difference between the groups with respect to demographics, burn injury variables, or complications. Notably, the average creatinine and lactate 24 h postadmission were 0.9 mg/dL and 2 mg/dL, respectively. Half of the study patients received greater than maintenance; all were in either the within burn resuscitation range or above range groups. This retrospective study suggests that patients with smaller burns may benefit from resuscitation as 50% received more than maintenance. Resuscitation of smaller burns requires more study.

Hand burns pose complex clinical challenges due to the intricate anatomy of the hand and its indispensable role in daily activities. In this retrospective cohort study, we evaluated 88 adult patients admitted to a specialized burn center with burns involving one or both hands. We collected demographics, burn characteristics, and clinical variables from medical records, and assessed functional outcomes 1 year after injury using the Disabilities of the Arm, Shoulder, and Hand (DASH) score. Nonparametric tests compared patient subgroups, a 6-factor multivariable regression (age, %TBSA, depth, digital involvement, bilateral involvement, and amniotic-membrane use) identified predictors of more severe functional impairment. Although larger burns required longer hospital stays, neither burn size nor depth emerged as independent predictors of hand function in the multivariable model. In contrast, anatomical burn site, particularly digital and bilateral hand involvement, was strongly associated with higher DASH scores, highlighting the importance of the precise location of the burn in long-term recovery. Age also played a critical role, with older patients showing worse outcomes regardless of other clinical factors. Surgical management varied across the cohort, with the use of amniotic membrane grafts standing out as a potentially favorable approach. Patients receiving these grafts showed lower DASH scores, suggesting better preservation of hand function compared to other methods. While these findings reinforce the need to focus on specific anatomical areas and patient age in treatment planning, they also point to innovative biologic materials as a promising avenue for functional recovery. Multicenter studies may help refine these observations and guide burn care in the future.

Steam inhalation therapy is common practice for coryzal symptoms, especially in children. However, it can cause major scald injuries due to accidental contact with the hot water. The authors used an electronic database to retrospectively identify all children admitted with burn injuries secondary to steam inhalation therapy during a 5-year period from September 2019 to August 2024 at Trousseau Hospital pediatric burn unit. Data collected included patient demographics, mechanism of burn, burn areas and extent, need of surgical treatment, type of hospitalization, length of stay, infections, and other complications. The authors also conducted a brief literature review. A total of 33 children were identified during a 5-year period at our center, with median age of 6 years old, and male predominance (60.6%). A total of 81.8% of children were burned to perineum and/or thigh areas, with 63.6% over perinea more precisely. In total, 51.5% were admitted in intensive care unit, before being transferred to surgical ward, for a mean hospital stay of 18 days. Surgery was needed for 51.5% of children. Moreover, the literature review found only rare controversial benefits to this practice, and many warnings about its dangers. Burn injuries secondary to steam inhalation therapy in children are common cause of severe morbidity with long-term sequelae. They also contribute to a significant number of surgeries and extended hospital stays, therefore increasing costs for national health systems. Authors highlighted a worrying outbreak of cases linked to extensive media coverage of this practice. Better public awareness through simple public advice and prevention policies could help to reduce these injuries.

Genital burn injuries raise concerns about potential abuse. Understanding the demographics of this patient population is critical for planning patient care. This study determines the demographic predictors of suspected abuse in genital burn injuries using a national database. A retrospective review was conducted using the Burn Care Quality Platform data from 2013 to 2022. Genital burn patients suspected of abuse were identified, and demographics, burn characteristics, and clinical data were analyzed. Multiple logistic regression was used to evaluate factors associated with suspected abuse. Of the 3833 genital burn patients with available data on suspected abuse, 258 (6.7%) were identified as suspected abuse victims. Younger age (OR = 0.927 per year, 95% CI, 0.894-0.961, P < .001) was protective, and Black patients had higher odds of suspected abuse compared to White patients (OR = 2.10, 95% CI, 1.35-3.27, P = .001). Living in skilled nursing facilities (OR = 285.91, 95% CI, 11.36-7198.82, P = .001), homelessness (OR = 62.48, 95% CI, 15.11-258.43, P < .001), and adult group homes (OR = 51.29, 95% CI, 6.25-421.07, P < .001) were strongly associated with abuse. Mental/personality disorders (OR = 11.03, 95% CI, 2.97-40.94, P < .001) and dementia (OR = 7.18, 95% CI, 1.19-43.18, P = .031) increased odds. Contact burns had higher odds compared to scalds (OR = 3.27, 95% CI, 1.04-10.26, P = .042), but the impact of TBSA varied by burn type, with larger flame burns less likely associated with abuse than scalds (OR = 0.963, 95% CI, 0.939-0.989, P = .005). This study provides valuable insight into demographic characteristics associated with suspected abuse in genital burns. The identification of these patients early on will allow proper treatment and discharge planning.