Journal of Burn Care & Research最新文献

Burn injuries are among the most common life-threatening injuries for which medical attention is sought, and are accompanied by intense, severe pain, particularly during treatment. Burn therapy pain management with opioid and nonopioid analgesics is often insufficient when administered alone. Virtual reality (VR) interfaces provide an immersive experience that has demonstrable therapeutic benefits, including distraction from, and reduction of, pain. In this interventional pilot study, we assessed the correlation between VR and passive distraction and pain tolerance during burn wound treatment. This pilot study assessed patients undergoing burn wound dressing changes while receiving both pharmacological and VR intervention. Questionnaires and evaluation forms were subjectively completed by both patients and medical staff before and after treatment, and clinical metrics were recorded throughout the treatment. Forty-one patients ≥18 years old and 76.9% male that had primarily undergone ≥4 dressing changes before the study were included. Correlations were found between VR engagement during treatment and a decrease in subjective levels of nausea, anxiety, and pain sensation. Furthermore, high levels of VR engagement were correlated with high levels of VR enjoyment. These results suggest that highly engaging and enjoyable VR interfaces may reduce sensations of anxiety and pain in burn patients during dressing changes. Furthermore, these data suggest that VR technology may be applied as an adjunct therapy to pharmacological treatment in the standardization of burn wound care management. Further studies with control groups and larger sample populations are needed for better quantification of these benefits.

Some severe burn injuries may warrant amputation; however, the physical and functional adjustments resulting from postburn amputation can have long-term consequences. This study investigates longitudinal functional and psychosocial outcomes among pediatric burn amputees. Pediatric participants enrolled in the Burn Model System national longitudinal, multicenter database between 2015 and 2023 with postburn amputations were included. Participants with amputations were matched using nearest-neighbor matching to those without amputations based on burn location, age, and % total burn surface area burn size. Primary outcomes were the Patient-Reported Outcomes Measurement Information System Pediatric-25 Profile v2.0 Physical Function and the Children Burn Outcomes Questionnaire: appearance subscore, both measured at 6-, 12-, and 24 months postburn. In this study, 17 participants had amputations, and 17 did not (matched participants). Pairwise analyses at each timepoint found those with amputations reported significantly lower physical function scores at 24 months postburn (54.9 ± 11.6 vs 66 ± 5, P = .013). No significant differences were found in appearance scores. This study suggests that pediatric burn amputees may potentially face greater physical impairment long-term, highlighting an important area of research that deserves further attention.

Nutrition is paramount for wound healing after burn injury. With rising food prices and time off work due to burn injuries, access to adequate nutrition may be a significant financial stressor. We asked patients at an outpatient burn clinic to complete the Household Food Security Module, which queries about food security over the preceding 12 months. Demographics and burn characteristics were abstracted from the medical record. We assessed the overall prevalence of food insecurity, risk factors for food insecurity, and potential effects of food insecurity on nutritional status and wound healing time. Wound healing time was assessed via Cox regression while adjusting for burn depth, total body surface area burned, and diabetes. Over 40% of participants reported experiencing food insecurity; it was more common in patients who preferred Spanish language (P = 0014) or were unemployed (P = .049). Just over half of participants experiencing food insecurity were using any food assistance resources. Among patients more than 30 days from burn injury, patients who were food insecure had larger burns (P = .01). Experience of food insecurity was not associated presence of malnutrition on nutrition-focused physical exam (P = .47). Wound healing time for burns managed in the outpatient setting was associated with burn depth (P < .001), but not food insecurity (P = .95), burn size (P = .17), or diabetes (P = .14). Although food insecurity did not result in malnutrition or negatively impact wound healing time, it is important for providers to routinely screen for food insecurity due to increased nutritional requirements and loss of wages after burn injury.

Lithium-ion batteries are used in many commercial products such as electronics, cell phones, and e-cigarettes. The use of these batteries has become widespread over recent years due to their chargeability and long-lasting performance. Though a rare occurrence, lithium-ion batteries can fail due to myriad battery defects, which can cause fires and burns. One particular concern is that of thermal runaway, a critical failure marked by a sudden exothermic reaction that occurs as a result of damage to the lithium battery. Thermal runaway can produce heat in excess of 1800 °F, causing severe burns to individuals in close proximity. A 39-year-old man presented to an emergency department (ED) with full-thickness burns to his right foot after an episode of lithium-ion battery thermal runaway in his footwarmer. The patient's boot suddenly and unexpectedly caught fire for several seconds prior to being successfully removed. The patient subsequently underwent several weeks of debridements, auto- and homografting, and wound care before eventually making a full recovery. This case highlights the rare, but serious, risk posed by lithium-ion batteries as a result of thermal runaway. This phenomenon can cause devastating full-thickness burns in a matter of seconds. As lithium-ion-powered appliances grow in popularity, stringent safety measures should be implemented to prevent catastrophic injuries. Furthermore, healthcare providers should be made aware of injuries caused by thermal runaway to appropriately treat patients.

Thermal injury-associated toxic shock syndrome (TSS) is a life-threatening condition that can occur in children following burn injuries. The objective of this study was to describe the clinical manifestations, treatment, and outcomes of children who experienced TSS following a thermal injury. Additionally, the existing literature was systematically examined and published cases of pediatric TSS occurring after burns were compiled. In June 2023, without regard for time constraints, articles that met the criteria were searched across several electronic databases. The inclusion criteria were English-language publications, pediatric patients, and reported outcomes of interest for clinical questions. Due to the heterogeneity of the included publications and the lack of data in an appropriate format, a meta-analysis was not feasible. Our research identified 23 studies published between 1980 and 2023, including 72 cases (from multiple countries) that met the inclusion criteria. Of the 72 patients with thermal injuries complicated by TSS, 53 (73.6%) children survived, 6 (8.3%) died, and for 13 (18%) cases, the outcome was not documented. Our systematic review highlights the rarity, severity, and complexity of pediatric thermal injury-associated TSS. Key findings from the review indicate that pediatric thermal injury-associated TSS carries a high mortality rate and significant morbidity. By increasing awareness, improving diagnostic accuracy, and optimizing treatment strategies, healthcare professionals can improve patient outcomes in this challenging condition.

Reducing scar size after severe burn injuries is an important and challenging medical, technological, and social problem. We have developed a battery-powered pulsed electric field (PEF) device and surface needle electrode applicator to deliver PEFs to the healing dorsal burn wound in rats. The pulsed electric field was used to treat residual burn wounds caused by metal contact in rats starting 10 days after the injury for 4 months every 11 or 22 days for 4 months using varying time applied voltages at 250-350 V range, 400 mA current, 40 pulses, 70 μs duration each, delivered at pulse repetition frequency 10 Hz at 5 locations inside the wound. We found 40%-45% reduction in the scar size in comparison with untreated controls in both upper and lower dorsal locations on rats' backs 2 months after the last PEF application. We have not detected significant histopathological differences in the center of the scars besides the thickness of the newly generated epidermis, which was thicker in the PEF-treated group. We showed that minimally invasively applied PEFs through needle electrodes are effective method and device for treating residual burn wounds in the rat model, reducing the size of the resulting scars, without any adverse reaction.

There are few reports in the literature detailing the Quality of Life (QOL) of survivors with greater than 90% total body surface area (TBSA) burns. The objective was to assess two such individuals seen at our center with the Burn Specific Health Scale-Brief (BSHS-B) survey four years after discharge. Subject responses were categorized into their respective BSHS-B health domains (heat sensitivity, affect, hand function, treatment regimens, work, sexuality, interpersonal relationships, simple abilities, and body image) and a raw score was calculated for each domain. Lower scores indicated a greater perceived decrease in QOL. The nine domains of BSHS-B survey questions were further separated into three categories: physical (hand function, work, simple abilities), treatment (treatment regimens and heat sensitivity), and psychosocial (interpersonal relationships, affect, body image, sexuality). The psychosocial category had higher scores and better outcomes, while the physical and treatment ones had lower scores and worse outcomes compared to the other categories. For both individuals, interpersonal relationships and simple tasks domains were considered important in their QOL, while work, heat sensitivity and hand function received lower scores. Family support, intense physical rehabilitation, and psychosocial management were crucial during the postoperative and follow-up periods.

Preserving denatured dermis has been shown to promote wound healing and improve skin appearance and function. Angiogenesis is crucial for the healing of burn wounds. However, the metabolic mechanisms underlying angiogenesis during burn recovery remain unclear. In this study, ultra-high performance liquid chromatography-mass spectrometry analysis revealed six distinct metabolites in a heat-denatured cell model. A bioinformatics approach was used to predict the differentially expressed metabolites, and four metabolic pathways closely related to trauma repair were identified. These pathways might play a significant role in the regression of thermally injured endothelial cells. We also found that increasing D-mannose level promoted the angiogenic activity of human umbilical vein endothelial cells in the heat-denatured cell model, enhancing cell proliferation, migration, and tube formation. In summary, these findings revealed changes in metabolites and metabolic pathways in thermally injured endothelial cells, and demonstrated that D-mannose could promote angiogenesis during the recovery of thermally injured endothelial cells.

Acute Respiratory Distress Syndrome (ARDS) is a common complication among mechanically ventilated adult burn patients; however, the risk factors associated with its development are not well understood. Conflicting evidence also exists regarding ARDS as an independent predictor of poor hospital outcomes. The purpose of this study is to identify risk factors for ARDS in mechanically ventilated adult burn patients and characterize the impact of ARDS on hospital course. The National Trauma Data Bank (NTDB) was queried for patients >=18 years with International Classification of Diseases (ICD) codes corresponding to burn injury from 2007-2016. Hospitalized patients with at least 48 hours of mechanical ventilation were included. Multivariate logistic regression were used to identify risk factors for ARDS. Propensity score-matched analysis at a 1:3 ratio was used to determine the impact of ARDS on hospital course. This sample included 13928 patients, of which 1437 (10.3%) developed ARDS. Hypotension in the Emergency Department, alcohol use disorder, total body surface area (TBSA), Injury Severity Score (ISS), and inhalation injury were independently associated with ARDS. In the propensity score-matched cohort, ARDS patients had a significantly longer median (interquartile range) length of stay (31 [15-54] vs. 22 [9-43], p<0.001). In-hospital mortality was also significantly higher in the ARDS cohort (203 [35%] vs. 325 [24%], p<0.001). These findings highlight the impact of patient and injury characteristics on developing ARDS and support the consideration of ARDS when estimating mortality risk in burn patients.