Pub Date : 2024-10-10DOI: 10.1016/j.burns.2024.10.001
M. De Henau , S. Schins , C. Colla , E. van den Kerckhove , R. van der Hulst , S. Tuinder
Background
Hypertrophic scars and keloids are forms of pathologic scarring that can give rise to pain and pruritus. The link between nerve function and nerve density and the symptoms in pathologic scars (PS) remains unclear.
Objective
We aim to assess current knowledge on nerve function and nerve density in PS, and to explore a possible association between alterations in sensibility/nerve density and pathologic scar symptoms.
Methods
A scoping review was conducted. After performing a systematic search using PubMed, Embase and Web-of-Science, relevant papers were selected and analyzed by 2 reviewers. Data was charted in tables in combination with a narrative summary of main findings.
Results
Nineteen studies were included. Overall, functional sensibility in PS seems disturbed, with a higher frequency of allodynia and altered thermosensory thresholds, suggesting involvement of small fiber neuropathy. Nerve fiber density varied with the investigated skin layer and the used staining techniques, which implied limitations to compare findings from different studies. However, evidence suggests involvement of neuropeptides in the pathologic scar formation and symptomatology.
Conclusions
Wide heterogeneity between studies exists. Therefore, no firm conclusions can be formulated. However, evidence suggests involvement of the cutaneous nervous system by neurogenic inflammation in the pathophysiology of pathologic scars and their symptoms.
{"title":"Are symptoms in pathologic scars related to nerve function or density? A scoping review","authors":"M. De Henau , S. Schins , C. Colla , E. van den Kerckhove , R. van der Hulst , S. Tuinder","doi":"10.1016/j.burns.2024.10.001","DOIUrl":"10.1016/j.burns.2024.10.001","url":null,"abstract":"<div><h3>Background</h3><div>Hypertrophic scars and keloids are forms of pathologic scarring that can give rise to pain and pruritus. The link between nerve function and nerve density and the symptoms in pathologic scars (PS) remains unclear.</div></div><div><h3>Objective</h3><div>We aim to assess current knowledge on nerve function and nerve density in PS, and to explore a possible association between alterations in sensibility/nerve density and pathologic scar symptoms.</div></div><div><h3>Methods</h3><div>A scoping review was conducted. After performing a systematic search using PubMed, Embase and Web-of-Science, relevant papers were selected and analyzed by 2 reviewers. Data was charted in tables in combination with a narrative summary of main findings.</div></div><div><h3>Results</h3><div>Nineteen studies were included. Overall, functional sensibility in PS seems disturbed, with a higher frequency of allodynia and altered thermosensory thresholds, suggesting involvement of small fiber neuropathy. Nerve fiber density varied with the investigated skin layer and the used staining techniques, which implied limitations to compare findings from different studies. However, evidence suggests involvement of neuropeptides in the pathologic scar formation and symptomatology.</div></div><div><h3>Conclusions</h3><div>Wide heterogeneity between studies exists. Therefore, no firm conclusions can be formulated. However, evidence suggests involvement of the cutaneous nervous system by neurogenic inflammation in the pathophysiology of pathologic scars and their symptoms.</div></div>","PeriodicalId":50717,"journal":{"name":"Burns","volume":"51 1","pages":"Article 107280"},"PeriodicalIF":3.2,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142631984","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-10DOI: 10.1016/j.burns.2024.107288
Artur Manasyan , Nicolas Malkoff , Brigette Cannata , Eloise W. Stanton , Maxwell B. Johnson , Haig A. Yenikomshian , T. Justin Gillenwater
Background
Timely admission to the burn unit is crucial. Ideal burn care requires prompt interventions such as wound and body temperature management, infection control, and fluid resuscitation to prevent complications like burn progression and infection. In this study, we identify specific factors and outcomes associated with delayed admission to a regional burn center.
Methods
Patients admitted to a large urban burn center from January 2015 to December 2023 were retrospectively queried, with subsequent collection of demographic and outcome variables from chart review. Descriptive statistics, Welch’s t-tests of unequal variances, and Chi-square analysis were performed. Multiple logistic regression was performed to explore the association between delayed admission and ICU stay, ventilator requirements, and mortality.
Results
A total of 3137 patients were included in the study. Approximately 63.4 % of patients were admitted within 24 h, while 36.6 % had a significant delay in care of over 24 h after injury. Male patients were likely to experience delayed admission (39.0 vs. 31.8 %, p < 0.001). There was no significant difference in age between the two cohorts (38.6 vs. 39.7 years, p = 0.199). There was no significant difference in time to admission by racial background (p = 0.061). Total body surface area burned (TBSA) varied between the delayed and control cohorts (15.518.7 % vs. 8.212.9 %, p < 0.001). Patients who were single (p < 0.001) and lived alone (p = 0.011) were more likely to experience a delay in burn unit admission. Homelessness (p < 0.001), substance abuse disorder (p < 0.001), and uninsured status (p < 0.001) were also associated with delayed admission. In regression analysis when controlling for TBSA, delay in care was significantly associated with a greater requirement for ICU stay (p < 0.001) and mechanical ventilation (p = 0.021) but was not associated with increased mortality (p = 0.232).
Conclusion
Sociodemographic variables such as homelessness, lack of social support, and substance abuse are associated with delayed burn unit admission. Knowledge of these factors can inform future interventions to improve outcomes for vulnerable patients, promoting better recovery and long-term outcomes after burn injury.
{"title":"Factors associated with delayed admission to the burn unit: A major burn center’s experience","authors":"Artur Manasyan , Nicolas Malkoff , Brigette Cannata , Eloise W. Stanton , Maxwell B. Johnson , Haig A. Yenikomshian , T. Justin Gillenwater","doi":"10.1016/j.burns.2024.107288","DOIUrl":"10.1016/j.burns.2024.107288","url":null,"abstract":"<div><h3>Background</h3><div>Timely admission to the burn unit is crucial. Ideal burn care requires prompt interventions such as wound and body temperature management, infection control, and fluid resuscitation to prevent complications like burn progression and infection. In this study, we identify specific factors and outcomes associated with delayed admission to a regional burn center.</div></div><div><h3>Methods</h3><div>Patients admitted to a large urban burn center from January 2015 to December 2023 were retrospectively queried, with subsequent collection of demographic and outcome variables from chart review. Descriptive statistics, Welch’s t-tests of unequal variances, and Chi-square analysis were performed. Multiple logistic regression was performed to explore the association between delayed admission and ICU stay, ventilator requirements, and mortality.</div></div><div><h3>Results</h3><div>A total of 3137 patients were included in the study. Approximately 63.4 % of patients were admitted within 24 h, while 36.6 % had a significant delay in care of over 24 h after injury. Male patients were likely to experience delayed admission (39.0 vs. 31.8 %, p < 0.001). There was no significant difference in age between the two cohorts (38.6 vs. 39.7 years, p = 0.199). There was no significant difference in time to admission by racial background (p = 0.061). Total body surface area burned (TBSA) varied between the delayed and control cohorts (15.5<span><math><mo>±</mo></math></span>18.7 % vs. 8.2<span><math><mo>±</mo></math></span>12.9 %, p < 0.001). Patients who were single (p < 0.001) and lived alone (p = 0.011) were more likely to experience a delay in burn unit admission. Homelessness (p < 0.001), substance abuse disorder (p < 0.001), and uninsured status (p < 0.001) were also associated with delayed admission. In regression analysis when controlling for TBSA, delay in care was significantly associated with a greater requirement for ICU stay (p < 0.001) and mechanical ventilation (p = 0.021) but was not associated with increased mortality (p = 0.232).</div></div><div><h3>Conclusion</h3><div>Sociodemographic variables such as homelessness, lack of social support, and substance abuse are associated with delayed burn unit admission. Knowledge of these factors can inform future interventions to improve outcomes for vulnerable patients, promoting better recovery and long-term outcomes after burn injury.</div></div>","PeriodicalId":50717,"journal":{"name":"Burns","volume":"50 9","pages":"Article 107288"},"PeriodicalIF":3.2,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142512284","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-10DOI: 10.1016/j.burns.2024.107287
John Warner-Levy, Karl Walsh
{"title":"Burn risks associated with at-home sugaring (Persian waxing) – The hidden dangers of social media beauty trends","authors":"John Warner-Levy, Karl Walsh","doi":"10.1016/j.burns.2024.107287","DOIUrl":"10.1016/j.burns.2024.107287","url":null,"abstract":"","PeriodicalId":50717,"journal":{"name":"Burns","volume":"50 9","pages":"Article 107287"},"PeriodicalIF":3.2,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142479881","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-04DOI: 10.1016/j.burns.2024.09.018
Hilarión Castañeda-Rodríguez , Elizabeth López-Segura , Rocío Muñoz-Sandoval , Oscar Fabian Gutiérrez-Tenorio , Juan Manuel Marquez-Romero
Background
Pediatric burn injuries are a significant public health issue in low- and middle-income countries, leading to substantial morbidity and mortality. This study aimed to evaluate the efficacy of the No+Quema2 educational program, implemented in Aguascalientes, Mexico, in preventing burn injuries among children under nine years old.
Methods
The No+Quema2 program, initiated in 2014, included educational courses for children, training for health workers, and specialized care for children with burn sequelae. Epidemiological data on burn injuries from 2014 to 2022 were retrieved from the National System of Epidemiological Surveillance of the Health Ministry of Mexico. Monthly incidence rates per 100,000 inhabitants were analyzed using the Mann-Kendall trend test and segmentation analysis to detect trends and changes.
Results
The program trained over 25,000 scholars from 1750 elementary schools and distributed medical kits for immediate burn care. Additionally, 200 children with burn sequelae received scheduled treatment. The analysis showed a significant decrease in the state incidence rate of burn injuries compared to the national mean post-implementation. The estimated number of burn injuries prevented during the study period was approximately 3839, or 604 per year.
Conclusion
The No+Quema2 program has made a significant impact on burn prevention among children in Aguascalientes, Mexico. Despite the limitations of relying on government-reported data, the correlation between the program's activities and the observed decrease in burn injuries is promising. These findings underscore the critical importance of the No+Quema2 program's activities in achieving sustained, targeted educational interventions and long-term reductions in burn injury incidence. They also highlight the need for more robust study designs to validate these outcomes, emphasizing the importance of evidence-based strategies in future burn prevention efforts.
{"title":"Efficacy of a burn prevention educational program to diminish the incidence of burn injuries in the pediatric population","authors":"Hilarión Castañeda-Rodríguez , Elizabeth López-Segura , Rocío Muñoz-Sandoval , Oscar Fabian Gutiérrez-Tenorio , Juan Manuel Marquez-Romero","doi":"10.1016/j.burns.2024.09.018","DOIUrl":"10.1016/j.burns.2024.09.018","url":null,"abstract":"<div><h3>Background</h3><div>Pediatric burn injuries are a significant public health issue in low- and middle-income countries, leading to substantial morbidity and mortality. This study aimed to evaluate the efficacy of the No+Quema2 educational program, implemented in Aguascalientes, Mexico, in preventing burn injuries among children under nine years old.</div></div><div><h3>Methods</h3><div>The No+Quema2 program, initiated in 2014, included educational courses for children, training for health workers, and specialized care for children with burn sequelae. Epidemiological data on burn injuries from 2014 to 2022 were retrieved from the National System of Epidemiological Surveillance of the Health Ministry of Mexico. Monthly incidence rates per 100,000 inhabitants were analyzed using the Mann-Kendall trend test and segmentation analysis to detect trends and changes.</div></div><div><h3>Results</h3><div>The program trained over 25,000 scholars from 1750 elementary schools and distributed medical kits for immediate burn care. Additionally, 200 children with burn sequelae received scheduled treatment. The analysis showed a significant decrease in the state incidence rate of burn injuries compared to the national mean post-implementation. The estimated number of burn injuries prevented during the study period was approximately 3839, or 604 per year.</div></div><div><h3>Conclusion</h3><div>The No+Quema2 program has made a significant impact on burn prevention among children in Aguascalientes, Mexico. Despite the limitations of relying on government-reported data, the correlation between the program's activities and the observed decrease in burn injuries is promising. These findings underscore the critical importance of the No+Quema2 program's activities in achieving sustained, targeted educational interventions and long-term reductions in burn injury incidence. They also highlight the need for more robust study designs to validate these outcomes, emphasizing the importance of evidence-based strategies in future burn prevention efforts.</div></div>","PeriodicalId":50717,"journal":{"name":"Burns","volume":"50 9","pages":"Article 107279"},"PeriodicalIF":3.2,"publicationDate":"2024-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142512367","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-03DOI: 10.1016/j.burns.2024.10.002
Christos Vosinakis , Simona Ippoliti , Efthimios Samoladas , Anna-Bettina Haidich , Irene E. Gamatsi , Lee Smith , Chryssa Pourzitaki
Introduction
Despite the multitude of preventative methods, postburn hand contractures are poorly controlled and often require surgery. However, there is no consensus on which hand reconstruction technique is most efficacious. This systematic review aims to compare the efficacy of available postburn hand contracture reconstruction techniques over the long term and to evaluate the quality of current literature. Effectiveness is assessed with functional improvement, increase of skin surface area, and scar quality/enhanced cosmesis.
Material and methods
Four medical databases/registries were searched (PubMed/MEDLINE, Scopus, Cochrane, EMBASE) alongside grey literature sources from December 2012 to November 2022 for randomized controlled trials and observational studies with ≥ 15 participants and ≥ 3-month follow-up. Exclusion criteria were acute burn management, non-burn/non-hand contractures, non-surgical management, other burn sequelae, non-English studies, and outcomes reports, reviews, communications, editorials, letters, case reports, and non-human studies. Quality was assessed with the Joanna Briggs Institute checklist and GRADE.
Results
Seven observational studies (1310 patients) were eligible; three with a pre-/post-operative design and four comparative cohorts. Functional and aesthetic/scar quality outcomes for skin grafting and random or defined-vascularization flaps, complication rates and rehabilitation modalities were reported. No studies on dermal substitutes or utilising skin surface area measurements were identified. Significant risk of bias, indirectness and imprecision were noted in all studies, deriving from absence of randomization, blinding, or independent control groups; confounding; missing data; and subpar reporting. Owing to heterogeneity in outcome measures, meta-analysis was not possible.
Conclusions
No consensus remains on the superiority of a single reconstruction technique. Meticulous preoperative planning and intensive rehabilitation are vital. A stepwise approach, considering individual patient and contracture characteristics and the limitations of each technique, should be followed. Well-designed and conducted future studies, utilizing reliable and validated contracture description methods and outcome assessment, are now imperative.
{"title":"Effectiveness of hand reconstruction techniques for the treatment of postburn contractures of the hand: A systematic review","authors":"Christos Vosinakis , Simona Ippoliti , Efthimios Samoladas , Anna-Bettina Haidich , Irene E. Gamatsi , Lee Smith , Chryssa Pourzitaki","doi":"10.1016/j.burns.2024.10.002","DOIUrl":"10.1016/j.burns.2024.10.002","url":null,"abstract":"<div><h3>Introduction</h3><div>Despite the multitude of preventative methods, postburn hand contractures are poorly controlled and often require surgery. However, there is no consensus on which hand reconstruction technique is most efficacious. This systematic review aims to compare the efficacy of available postburn hand contracture reconstruction techniques over the long term and to evaluate the quality of current literature. Effectiveness is assessed with functional improvement, increase of skin surface area, and scar quality/enhanced cosmesis.</div></div><div><h3>Material and methods</h3><div>Four medical databases/registries were searched (PubMed/MEDLINE, Scopus, Cochrane, EMBASE) alongside grey literature sources from December 2012 to November 2022 for randomized controlled trials and observational studies with ≥ 15 participants and ≥ 3-month follow-up. Exclusion criteria were acute burn management, non-burn/non-hand contractures, non-surgical management, other burn sequelae, non-English studies, and outcomes reports, reviews, communications, editorials, letters, case reports, and non-human studies. Quality was assessed with the Joanna Briggs Institute checklist and GRADE.</div></div><div><h3>Results</h3><div>Seven observational studies (1310 patients) were eligible; three with a pre-/post-operative design and four comparative cohorts. Functional and aesthetic/scar quality outcomes for skin grafting and random or defined-vascularization flaps, complication rates and rehabilitation modalities were reported. No studies on dermal substitutes or utilising skin surface area measurements were identified. Significant risk of bias, indirectness and imprecision were noted in all studies, deriving from absence of randomization, blinding, or independent control groups; confounding; missing data; and subpar reporting. Owing to heterogeneity in outcome measures, meta-analysis was not possible.</div></div><div><h3>Conclusions</h3><div>No consensus remains on the superiority of a single reconstruction technique. Meticulous preoperative planning and intensive rehabilitation are vital. A stepwise approach, considering individual patient and contracture characteristics and the limitations of each technique, should be followed. Well-designed and conducted future studies, utilizing reliable and validated contracture description methods and outcome assessment, are now imperative.</div></div>","PeriodicalId":50717,"journal":{"name":"Burns","volume":"50 9","pages":"Article 107281"},"PeriodicalIF":3.2,"publicationDate":"2024-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142479883","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-30DOI: 10.1016/j.burns.2024.09.016
Hinpetch Daungsupawong , Viroj Wiwanitkit
{"title":"Comparison of outcome of early tangential excision with autografting versus interactive antimicrobial dressing in deep-partial thickness burn patients: Correspondence","authors":"Hinpetch Daungsupawong , Viroj Wiwanitkit","doi":"10.1016/j.burns.2024.09.016","DOIUrl":"10.1016/j.burns.2024.09.016","url":null,"abstract":"","PeriodicalId":50717,"journal":{"name":"Burns","volume":"50 9","pages":"Article 107277"},"PeriodicalIF":3.2,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142512366","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-30DOI: 10.1016/j.burns.2024.09.017
Mehdi Molavi Vardanjani , Seyed Reza Borzou , Farshid Shamsaei , Ali Reza Soltanian , Amir Sadeghi
Introduction
One of the most important duties of the members of the treatment team is to pay attention to the mental, psychological, and social aspects of burn patients. One of the concerns of these patients during their stay in the hospital is the fear of rejection. The objective of this research is to examine the concept of 'fear of rejection' among patients hospitalized with burn injuries.
Method
This study was conducted between January 2023 and March 2024 in Hamadan, Iran, employing a qualitative content-analysis approach. The study enrolled sixteen patients, and data were collected through deep and semi-structured interviews. The data were then analyzed using the conventional content-analysis approach developed by Graneheim and Lundman.
Results
A group of 16 patients, comprising an equal number of men and women, were interviewed for this study. Based on the data obtained from these interviews, negative brainstorming, frustration, fear of permanent physical disabilities, occupational and financial challenges were identified as categories; visualization of a foggy future and inability in performance of roles emerged as the two themes.
Conclusion
Based on the results of this study, it can be said that the fear of social rejection, characterized by an inability to perform roles and the visualization of a foggy future, significantly affects the psychological and physical health of burn patients, potentially delaying their recovery. Assisting these patients in reaching their fullest potential to contribute to society post-discharge, and fostering optimism for a promising future, constitute a paramount aspect of daily care and ongoing support.
{"title":"Burn injury and fear of rejection: A qualitative study","authors":"Mehdi Molavi Vardanjani , Seyed Reza Borzou , Farshid Shamsaei , Ali Reza Soltanian , Amir Sadeghi","doi":"10.1016/j.burns.2024.09.017","DOIUrl":"10.1016/j.burns.2024.09.017","url":null,"abstract":"<div><h3>Introduction</h3><div>One of the most important duties of the members of the treatment team is to pay attention to the mental, psychological, and social aspects of burn patients. One of the concerns of these patients during their stay in the hospital is the fear of rejection. The objective of this research is to examine the concept of 'fear of rejection' among patients hospitalized with burn injuries.</div></div><div><h3>Method</h3><div>This study was conducted between January 2023 and March 2024 in Hamadan, Iran, employing a qualitative content-analysis approach. The study enrolled sixteen patients, and data were collected through deep and semi-structured interviews. The data were then analyzed using the conventional content-analysis approach developed by Graneheim and Lundman.</div></div><div><h3>Results</h3><div>A group of 16 patients, comprising an equal number of men and women, were interviewed for this study. Based on the data obtained from these interviews, negative brainstorming, frustration, fear of permanent physical disabilities, occupational and financial challenges were identified as categories; visualization of a foggy future and inability in performance of roles emerged as the two themes.</div></div><div><h3>Conclusion</h3><div>Based on the results of this study, it can be said that the fear of social rejection, characterized by an inability to perform roles and the visualization of a foggy future, significantly affects the psychological and physical health of burn patients, potentially delaying their recovery. Assisting these patients in reaching their fullest potential to contribute to society post-discharge, and fostering optimism for a promising future, constitute a paramount aspect of daily care and ongoing support.</div></div>","PeriodicalId":50717,"journal":{"name":"Burns","volume":"50 9","pages":"Article 107278"},"PeriodicalIF":3.2,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142479880","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-24DOI: 10.1016/j.burns.2024.09.012
Ganesh Rajaratnam, Alexander J Baldwin
Aim: To evaluate variations in diagnostic criteria and management recommendations for smoke inhalation injury (SII) amongst the burn networks of England, Scotland, and Wales.
Methods: A descriptive cross-sectional study examining SII guidelines provided by adult burn units and centres in England, Scotland and Wales.
Results: All 16 adult burn units and centres responded. Fourteen (87.5 %) had guidelines. Due to sharing of guidelines, ten unique guidelines were assessed. Diagnostic criteria showed variability with no universal criterion shared amongst guidelines. Bronchoscopy was recommended by 90 % of guidelines, but the timing varied. The use of bronchoscopic scoring systems was recommended by four guidelines. Bronchoalveolar lavage (BAL) was recommended by four, with considerable variation in frequency and choice of lavage fluid. All guidelines advised at least one nebulised agent: heparin (n = 8); N-acetyl cysteine (NAC) (n = 8); or salbutamol (n = 8). All guidelines included advice on carbon monoxide poisoning; however, carboxyhaemoglobin (COHb) cut-off levels for treatment varied (5 % [n-4], 10 % [n = 3], 15 % [n = 1]). All recommended high-flow oxygen. Seven (70 %) guidelines offered guidance on cyanide poisoning. Reduced/altered consciousness was the only consistent diagnostic criterion. Five (50 %) guidelines provided intubation guidance, emphasising the role of a 'senior clinician' as the intubator. Ventilatory guidance appeared in eight guidelines, focusing on lung protective ventilation (n = 8); oxygenation goals (n = 3); and permissive hypercapnia (n = 3). Within lung-protective ventilation, advice on tidal volume (6, or 6-8 ml/kg) and plateau pressures (>30 cmH2O) were presented most commonly (n = 7).
Conclusion: This study has outlined the substantial variations in guidance for the management of SII. The results underscore the need for a national guideline outlining a standardised approach to the diagnosis and management of SII, within the limitations of the current evidence.
{"title":"\"To BAL or not to BAL, that is the question\": Variations in smoke inhalation injury guidelines from burn units and centres in England, Scotland and Wales.","authors":"Ganesh Rajaratnam, Alexander J Baldwin","doi":"10.1016/j.burns.2024.09.012","DOIUrl":"https://doi.org/10.1016/j.burns.2024.09.012","url":null,"abstract":"<p><strong>Aim: </strong>To evaluate variations in diagnostic criteria and management recommendations for smoke inhalation injury (SII) amongst the burn networks of England, Scotland, and Wales.</p><p><strong>Methods: </strong>A descriptive cross-sectional study examining SII guidelines provided by adult burn units and centres in England, Scotland and Wales.</p><p><strong>Results: </strong>All 16 adult burn units and centres responded. Fourteen (87.5 %) had guidelines. Due to sharing of guidelines, ten unique guidelines were assessed. Diagnostic criteria showed variability with no universal criterion shared amongst guidelines. Bronchoscopy was recommended by 90 % of guidelines, but the timing varied. The use of bronchoscopic scoring systems was recommended by four guidelines. Bronchoalveolar lavage (BAL) was recommended by four, with considerable variation in frequency and choice of lavage fluid. All guidelines advised at least one nebulised agent: heparin (n = 8); N-acetyl cysteine (NAC) (n = 8); or salbutamol (n = 8). All guidelines included advice on carbon monoxide poisoning; however, carboxyhaemoglobin (COHb) cut-off levels for treatment varied (5 % [n-4], 10 % [n = 3], 15 % [n = 1]). All recommended high-flow oxygen. Seven (70 %) guidelines offered guidance on cyanide poisoning. Reduced/altered consciousness was the only consistent diagnostic criterion. Five (50 %) guidelines provided intubation guidance, emphasising the role of a 'senior clinician' as the intubator. Ventilatory guidance appeared in eight guidelines, focusing on lung protective ventilation (n = 8); oxygenation goals (n = 3); and permissive hypercapnia (n = 3). Within lung-protective ventilation, advice on tidal volume (6, or 6-8 ml/kg) and plateau pressures (>30 cmH2O) were presented most commonly (n = 7).</p><p><strong>Conclusion: </strong>This study has outlined the substantial variations in guidance for the management of SII. The results underscore the need for a national guideline outlining a standardised approach to the diagnosis and management of SII, within the limitations of the current evidence.</p>","PeriodicalId":50717,"journal":{"name":"Burns","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2024-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142367315","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-24DOI: 10.1016/j.burns.2024.09.013
John Warner-Levy, James D Bedford, Karl Walsh
{"title":"Tourniquet burns: Best practices for alcohol skin preparation.","authors":"John Warner-Levy, James D Bedford, Karl Walsh","doi":"10.1016/j.burns.2024.09.013","DOIUrl":"https://doi.org/10.1016/j.burns.2024.09.013","url":null,"abstract":"","PeriodicalId":50717,"journal":{"name":"Burns","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2024-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142367316","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-24DOI: 10.1016/j.burns.2024.09.014
Mr Howard Chu, Laveena Yarlagadda, Mr Christopher Wearn
Introduction: There are an estimated 10 million hot water bottles (HWB) currently in use within the United Kingdom (UK), and HWB related burn injuries represent a significant resource burden to UK Burns Services. These injuries can be caused through a variety of mechanisms including scalds sustained when filling the bottle or scalds from leaking or rupture. The fuel poverty crisis started in February 2022 leading to an estimated six-fold increase in alternative sources of heating, in particular hot water bottles. In this study, we wish to understand the impact that this may have had upon burn injuries sustained by these products.
Methods: All hot water bottle (HWB)-related injuries sustained January 2014 - February 2023 were retrieved from the UK International Burn Injury Database (IBID). Data were collected on patient demographics, injury mechanism, anatomical location, and clinical outcomes. The data were collated and analysed; statistical analysis was performed using R StudioTM. Patient levelling costs were also incorporated to enable translation of these data into healthcare costs.
Results: A total of 5944 HWB-related burn injuries were recorded in the IBID database in England and Wales, from 2014 to 2023, with a mean of 594 (SD 146.2) burn injuries annually, costing an estimated £ 12.7 million. There were 423 burn injuries sustained from HWB in winter 2022 compared to 295 in winter 2021, representing a 43.4 % increase over one year, with a corresponding increase of 43.1 % in the number of patients managed in an outpatient setting. The largest increase in burn incidence between winter 2021 and winter 2022 was seen in children (0-16 years old) and older adults (greater than 65 years old) with a rise of 60.3 % (n = 41) and 68.5 % (n = 37) respectively.
Conclusion: Our epidemiological study on hot water bottle (HWB)-related burn injuries within the United Kingdom has shown that the dramatic rise in fuel prices, which sparked the fuel poverty crises, has coincided with a 43.4 % increase in HWB burns incidence on the health service in that year alone. This alarming rise in HWB-related injuries highlights the continued need for targeted public awareness campaigns to ensure a safe and proper use of these devices.
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