Pub Date : 2025-11-19DOI: 10.1016/j.burns.2025.107788
Peng Han, Jie Zhang, Yunpeng Ma
Background
The pathogenesis of keloids is still unclear and effective biomarkers are lacking. Therefore, it is urgent to find clinically effective biomarkers and study their regulatory mechanisms.
Methods
Candidate genes were screened by amplifying RNA methylation-related gene modules by weighted correlation network analysis and intersecting them with differentially expressed genes in the GSE145725 dataset. After Mendelian randomisation, machine learning and gene expression validation, keloid prediction models were constructed. Subsequently, genomic enrichment analysis, immune infiltration, GeneMANIA analysis, molecular network and drug prediction were performed, and biomarker function was explored using single-cell datasets. Finally, biomarker expression in clinical samples was validated by reverse transcription quantitative polymerase chain reaction (RT-qPCR).
Results
A total of two biomarkers (PEAR1 and MAPKAPK3) were identified and the disease prediction model performed well. They were mainly involved in the proteasomal and ribosomal pathways and were associated with myeloid dendritic cells and resting T CD4 + memory cells. In addition, fibroblasts were identified as key cells expressing PEAR1 and MAPKAPK3. RT-qPCR confirmed that the expression of both biomarkers was downregulated in the keloid group, consistent with the results of differential expression analysis.
Conclusion
This study suggests that PEAR1 and MAPKAPK3 may contribute to keloid formation and provides insights for subsequent functional studies.
{"title":"Uncovering and validating biomarkers associated with RNA methylation modifications in keloids: Insights from transcriptomic and Mendelian randomization analyses","authors":"Peng Han, Jie Zhang, Yunpeng Ma","doi":"10.1016/j.burns.2025.107788","DOIUrl":"10.1016/j.burns.2025.107788","url":null,"abstract":"<div><h3>Background</h3><div>The pathogenesis of keloids is still unclear and effective biomarkers are lacking. Therefore, it is urgent to find clinically effective biomarkers and study their regulatory mechanisms.</div></div><div><h3>Methods</h3><div>Candidate genes were screened by amplifying RNA methylation-related gene modules by weighted correlation network analysis and intersecting them with differentially expressed genes in the GSE145725 dataset. After Mendelian randomisation, machine learning and gene expression validation, keloid prediction models were constructed. Subsequently, genomic enrichment analysis, immune infiltration, GeneMANIA analysis, molecular network and drug prediction were performed, and biomarker function was explored using single-cell datasets. Finally, biomarker expression in clinical samples was validated by reverse transcription quantitative polymerase chain reaction (RT-qPCR).</div></div><div><h3>Results</h3><div>A total of two biomarkers (PEAR1 and MAPKAPK3) were identified and the disease prediction model performed well. They were mainly involved in the proteasomal and ribosomal pathways and were associated with myeloid dendritic cells and resting T CD4 + memory cells. In addition, fibroblasts were identified as key cells expressing PEAR1 and MAPKAPK3. RT-qPCR confirmed that the expression of both biomarkers was downregulated in the keloid group, consistent with the results of differential expression analysis.</div></div><div><h3>Conclusion</h3><div>This study suggests that PEAR1 and MAPKAPK3 may contribute to keloid formation and provides insights for subsequent functional studies.</div></div>","PeriodicalId":50717,"journal":{"name":"Burns","volume":"52 1","pages":"Article 107788"},"PeriodicalIF":2.9,"publicationDate":"2025-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145617724","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}
Burn survivors can experience overlapping symptoms; identifying clusters may improve care. This study examined chronic symptom clusters six months post-burn and their predictors and psychosocial impacts.
Methods
Data from the Burn Model System (2015–2022) were analyzed using factor analysis of post-burn symptoms. Linear regression assessed associations between factor scores and psychosocial outcomes.
Results
The sample included 405 patients (66 % male; mean age 45.4; median burn size 14 % TBSA; 60.2 % fire/flame). A three-factor solution was identified: (1) Psychological distress (28 % variance) with high loadings for anxiety and depression, moderate for sleep disturbance; (2) Pain-related symptoms (22 %) with high pain interference and intensity, moderate fatigue; (3) Itch-related symptoms (16 %) with high itch interference, moderate itch intensity. Rehabilitation days were associated with all factors; surgeries with Factors 1 and 2. Women scored higher on Factor 1, while %TBSA predicted Factor 3. Higher Factor 1 scores were linked to poorer mental health, greater PTSD burden, and lower life satisfaction and higher Factor 2 scores to worse physical and mental health.
Conclusion
At six months post-burn, symptoms clustered into psychological distress, pain, and itch factors. Pain and distress, but not itch, were associated with poorer physical, mental, and social functioning.
{"title":"Pain, itch, and psychological distress symptom clusters in burn survivors: A factor analysis","authors":"Lynn Nakad , Arushi Biswas , Jeannie-Marie Leoutsakos , Rachel Kornhaber , Michelle Cleary , Julie A. Caffrey , Sheera F. Lerman","doi":"10.1016/j.burns.2025.107787","DOIUrl":"10.1016/j.burns.2025.107787","url":null,"abstract":"<div><h3>Background</h3><div>Burn survivors can experience overlapping symptoms; identifying clusters may improve care. This study examined chronic symptom clusters six months post-burn and their predictors and psychosocial impacts.</div></div><div><h3>Methods</h3><div>Data from the Burn Model System (2015–2022) were analyzed using factor analysis of post-burn symptoms. Linear regression assessed associations between factor scores and psychosocial outcomes.</div></div><div><h3>Results</h3><div>The sample included 405 patients (66 % male; mean age 45.4; median burn size 14 % TBSA; 60.2 % fire/flame). A three-factor solution was identified: (1) Psychological distress (28 % variance) with high loadings for anxiety and depression, moderate for sleep disturbance; (2) Pain-related symptoms (22 %) with high pain interference and intensity, moderate fatigue; (3) Itch-related symptoms (16 %) with high itch interference, moderate itch intensity. Rehabilitation days were associated with all factors; surgeries with Factors 1 and 2. Women scored higher on Factor 1, while %TBSA predicted Factor 3. Higher Factor 1 scores were linked to poorer mental health, greater PTSD burden, and lower life satisfaction and higher Factor 2 scores to worse physical and mental health.</div></div><div><h3>Conclusion</h3><div>At six months post-burn, symptoms clustered into psychological distress, pain, and itch factors. Pain and distress, but not itch, were associated with poorer physical, mental, and social functioning.</div></div>","PeriodicalId":50717,"journal":{"name":"Burns","volume":"52 1","pages":"Article 107787"},"PeriodicalIF":2.9,"publicationDate":"2025-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145617720","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 : 2025-11-17DOI: 10.1016/j.burns.2025.107785
Tobias Niederegger , Thomas Schaschinger , Jule Brandt , Leonard Knoedler , Samuel Knoedler , Alen Palackic , Felix J. Klimitz , Dorothea Noll , Patrick Most , Julia Ritterhoff , Adriana C. Panayi , Gabriel Hundeshagen
Severe burns induce a hypermetabolic and inflammatory state, impairing wound healing and contributing to long-term morbidity. Fibroblast growth factor 21 (FGF-21), a metabolic hormone regulating lipid oxidation, glucose uptake, and mitochondrial homeostasis, has emerged as a potential biomarker and therapeutic modulator in critical illness.
This systematic review followed PRISMA 2020 guidelines and assessed seven studies (2015–2024) published until April 2025. Clinical, in vivo, and in vitro investigations were included. Methodological quality was evaluated using the Level of Evidence, Newcastle-Ottawa Scale, and the SYRCLE Risk of Bias tool.
In our study, FGF-21 was commonly upregulated following burn injury and was associated with hypermetabolism, adipose tissue browning, mitochondrial stress, and systemic inflammation. Nutritional interventions, including hydrolyzed collagen and omega-3 fatty acids, reduced FGF-21 levels, improved wound healing, and attenuated inflammatory responses. Preclinical models demonstrated that administration of exogenous FGF-21 enhanced re-epithelialization, angiogenesis, mitochondrial function, and anti-inflammatory signaling pathways. Conversely, chronically elevated endogenous FGF-21 levels were consistently linked to metabolic exhaustion, liver dysfunction, and impaired recovery.
Overall, FGF-21 may be a promising diagnostic and therapeutic target in burn care. Its clinical relevance and long-term effects require further investigation for successful integration into clinical practice.
{"title":"The burn repair molecule? Evaluating FGF-21 in thermal injury – A systematic review","authors":"Tobias Niederegger , Thomas Schaschinger , Jule Brandt , Leonard Knoedler , Samuel Knoedler , Alen Palackic , Felix J. Klimitz , Dorothea Noll , Patrick Most , Julia Ritterhoff , Adriana C. Panayi , Gabriel Hundeshagen","doi":"10.1016/j.burns.2025.107785","DOIUrl":"10.1016/j.burns.2025.107785","url":null,"abstract":"<div><div>Severe burns induce a hypermetabolic and inflammatory state, impairing wound healing and contributing to long-term morbidity. Fibroblast growth factor 21 (FGF-21), a metabolic hormone regulating lipid oxidation, glucose uptake, and mitochondrial homeostasis, has emerged as a potential biomarker and therapeutic modulator in critical illness.</div><div>This systematic review followed PRISMA 2020 guidelines and assessed seven studies (2015–2024) published until April 2025. Clinical, in vivo, and in vitro investigations were included. Methodological quality was evaluated using the Level of Evidence, Newcastle-Ottawa Scale, and the SYRCLE Risk of Bias tool.</div><div>In our study, FGF-21 was commonly upregulated following burn injury and was associated with hypermetabolism, adipose tissue browning, mitochondrial stress, and systemic inflammation. Nutritional interventions, including hydrolyzed collagen and omega-3 fatty acids, reduced FGF-21 levels, improved wound healing, and attenuated inflammatory responses. Preclinical models demonstrated that administration of exogenous FGF-21 enhanced re-epithelialization, angiogenesis, mitochondrial function, and anti-inflammatory signaling pathways. Conversely, chronically elevated endogenous FGF-21 levels were consistently linked to metabolic exhaustion, liver dysfunction, and impaired recovery.</div><div>Overall, FGF-21 may be a promising diagnostic and therapeutic target in burn care. Its clinical relevance and long-term effects require further investigation for successful integration into clinical practice.</div></div>","PeriodicalId":50717,"journal":{"name":"Burns","volume":"52 1","pages":"Article 107785"},"PeriodicalIF":2.9,"publicationDate":"2025-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145617718","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 : 2025-11-17DOI: 10.1016/j.burns.2025.107783
Yuanqi Li, Liqin Zhang, Jing Zhao, Pin Lu, Yaguang Cao
{"title":"Comment on: \"The effect of virtual reality and music on pain, anxiety, and pain-related anxiety in burn patient care\"","authors":"Yuanqi Li, Liqin Zhang, Jing Zhao, Pin Lu, Yaguang Cao","doi":"10.1016/j.burns.2025.107783","DOIUrl":"10.1016/j.burns.2025.107783","url":null,"abstract":"","PeriodicalId":50717,"journal":{"name":"Burns","volume":"52 1","pages":"Article 107783"},"PeriodicalIF":2.9,"publicationDate":"2025-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145614205","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 : 2025-11-17DOI: 10.1016/j.burns.2025.107786
Da Huang , Yan Zheng , Ming Xu , Wenying Huang
Objective
This study aimed to systematically evaluate the efficacy of robot-assisted training (RAT) in improving the physical rehabilitation outcomes of burn patients and to establish a clinical basis for its broader application.
Methods
Randomized controlled trials (RCTs) investigating the use of RAT in burns rehabilitation were searched from PubMed, Embase, Web of Science, Scopus, Cochrane Library, China National Knowledge Infrastructure (CNKI), Wan Fang Data (WanFang), and Chinese BioMedical Literature Database (CBM) databases (as of March 18, 2025). The quality of the study was assessed using the Cochrane risk of bias tool. Analyses were performed using RevMan 5.3, and data that could not be synthesized were presented in a descriptive manner.
Results
Nine RCTs, involving 531 patients, were included. RAT significantly improved hand grip strength (MD=1.2, 95 % CI: 0.21–2.19, p = 0.02) and lower limb 6-minute walking distance (6MWT: MD=73.06, 95 % CI: 1.18–144.93, p = 0.05). However, no significant differences were observed in Functional Ambulation Category (FAC) scores (MD=0.4, 95 % CI: −0.09–0.9, p = 0.11) or pain reduction (MD=0.29, 95 % CI: −0.22–0.8, p = 0.26). The certainty of all the evidence was shown to be very low. Multiple descriptive statistical analysis highlighted RAT’s superiority in enhancing finger mobility, hand dexterity, and select gait parameters.
Conclusions
Our systematic review suggests that incorporating RAT into conventional physiotherapy may offer some benefits for the functional rehabilitation of upper and lower limbs in burn patients; however, the certainty of the evidence supporting this recommendation is very low. Consequently, high-quality research is required to validate the efficacy of RAT in future studies.
目的系统评价机器人辅助训练（robot-assisted training， RAT）改善烧伤患者肢体康复效果的效果，为其广泛应用奠定临床基础。方法从PubMed、Embase、Web of Science、Scopus、Cochrane图书馆、中国知网（CNKI）、万方数据（WanFang Data）和中国生物医学文献数据库（CBM）检索截至2025年3月18日的研究RAT在烧伤康复中的应用的随机对照试验（RCTs）。使用Cochrane偏倚风险工具评估研究质量。使用RevMan 5.3进行分析，无法合成的数据以描述性方式呈现。结果纳入9项随机对照试验，共531例患者。大鼠显著改善了手部握力（MD=1.2, 95 % CI: 0.21-2.19, p = 0.02）和下肢6分钟步行距离（6MWT: MD=73.06, 95 % CI: 1.18-144.93, p = 0.05）。然而，在功能活动类别（FAC）评分（MD=0.4, 95 % CI: - 0.09-0.9, p = 0.11）或疼痛减轻（MD=0.29, 95 % CI: - 0.22-0.8, p = 0.26）方面没有观察到显著差异。所有证据的确定性都很低。多重描述性统计分析表明RAT在增强手指活动能力、手部灵巧性和选择步态参数方面具有优势。结论我们的系统评价表明，将大鼠纳入常规物理治疗对烧伤患者的上肢和下肢功能康复有一定的益处；然而，支持这一建议的证据的确定性非常低。因此，在未来的研究中，需要高质量的研究来验证RAT的有效性。
{"title":"The effect of robot-assisted training on burn rehabilitation: A systematic review and meta-analysis","authors":"Da Huang , Yan Zheng , Ming Xu , Wenying Huang","doi":"10.1016/j.burns.2025.107786","DOIUrl":"10.1016/j.burns.2025.107786","url":null,"abstract":"<div><h3>Objective</h3><div>This study aimed to systematically evaluate the efficacy of robot-assisted training (RAT) in improving the physical rehabilitation outcomes of burn patients and to establish a clinical basis for its broader application.</div></div><div><h3>Methods</h3><div>Randomized controlled trials (RCTs) investigating the use of RAT in burns rehabilitation were searched from PubMed, Embase, Web of Science, Scopus, Cochrane Library, China National Knowledge Infrastructure (CNKI), Wan Fang Data (WanFang), and Chinese BioMedical Literature Database (CBM) databases (as of March 18, 2025). The quality of the study was assessed using the Cochrane risk of bias tool. Analyses were performed using RevMan 5.3, and data that could not be synthesized were presented in a descriptive manner.</div></div><div><h3>Results</h3><div>Nine RCTs, involving 531 patients, were included. RAT significantly improved hand grip strength (MD=1.2, 95 % CI: 0.21–2.19, p = 0.02) and lower limb 6-minute walking distance (6MWT: MD=73.06, 95 % CI: 1.18–144.93, p = 0.05). However, no significant differences were observed in Functional Ambulation Category (FAC) scores (MD=0.4, 95 % CI: −0.09–0.9, p = 0.11) or pain reduction (MD=0.29, 95 % CI: −0.22–0.8, p = 0.26). The certainty of all the evidence was shown to be very low. Multiple descriptive statistical analysis highlighted RAT’s superiority in enhancing finger mobility, hand dexterity, and select gait parameters.</div></div><div><h3>Conclusions</h3><div>Our systematic review suggests that incorporating RAT into conventional physiotherapy may offer some benefits for the functional rehabilitation of upper and lower limbs in burn patients; however, the certainty of the evidence supporting this recommendation is very low. Consequently, high-quality research is required to validate the efficacy of RAT in future studies.</div></div>","PeriodicalId":50717,"journal":{"name":"Burns","volume":"52 1","pages":"Article 107786"},"PeriodicalIF":2.9,"publicationDate":"2025-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145617719","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 : 2025-11-16DOI: 10.1016/j.burns.2025.107784
Sarah Smailes , Catherine Wharfe
Introduction
Identifying valid and reliable instruments to measure physical function is key to standardising outcome reporting and improving patient care in adult burn survivors. The Functional Assessment for Burns (FAB) score is predictive of discharge outcome in adult burn inpatients and is used in routine clinical practice by therapists. The aim of this study was to assess the interrater reliability of the FAB score when used by different members of the inpatient rehabilitation team.
Objectives
This research aimed to evaluate the interrater reliability of the FAB score.
Methods
A prospective observational study assessed the interrater reliability of the FAB score when used by three different therapists simultaneously rating the same patient-scoring episode (n = 22).
Results
The Intraclass Correlation Coefficient (ICC) for the FAB score as a complete tool revealed excellent agreement (ICC 0.999, P < 0.001, 95 % confidence interval 0.999 – 0.999), with Cronbach’s alpha 0.999. Individual components of the FAB score revealed excellent agreement (ICC > 0.983, P < 0.001) with narrow 95 % confidence intervals.
Conclusion
The FAB score is the first physical functional outcome measure developed specifically for patients on the burns ward to have demonstrated both interrater reliability and, based on our previous work, predictive validity. The overall FAB assessment, as well as its individual domains, showed excellent interrater reliability, supporting its utility in this patient population.
确定有效和可靠的仪器来测量身体功能是标准化结果报告和改善成人烧伤幸存者患者护理的关键。烧伤功能评估（FAB）评分可预测成人烧伤住院患者的出院结果，并被治疗师用于常规临床实践。本研究的目的是评估不同住院康复团队成员使用FAB评分时的互译信度。目的评价FAB评分的被测者信度。方法一项前瞻性观察性研究评估了三名不同治疗师同时对同一患者评分事件进行评分时FAB评分的间信度（n = 22）。结果FAB评分的类内相关系数（ICC）作为一个完整的工具显示出极好的一致性（ICC 0.999, P <； 0.001,95 %置信区间0.999 - 0.999），Cronbach 's alpha 0.999。FAB评分的各个组成部分显示出极好的一致性（ICC > 0.983, P <； 0.001），置信区间窄至95 %。FAB评分是第一个专门为烧伤病房的患者开发的身体功能结果测量，它既证明了相互间的可靠性，也证明了基于我们之前的工作的预测有效性。总体FAB评估，以及它的个别领域，显示出出色的相互可靠性，支持其在该患者群体中的效用。
{"title":"Testing the interrater reliability of the Functional Assessment for Burns (FAB) score in adult burn inpatients","authors":"Sarah Smailes , Catherine Wharfe","doi":"10.1016/j.burns.2025.107784","DOIUrl":"10.1016/j.burns.2025.107784","url":null,"abstract":"<div><h3>Introduction</h3><div>Identifying valid and reliable instruments to measure physical function is key to standardising outcome reporting and improving patient care in adult burn survivors. The Functional Assessment for Burns (FAB) score is predictive of discharge outcome in adult burn inpatients and is used in routine clinical practice by therapists. The aim of this study was to assess the interrater reliability of the FAB score when used by different members of the inpatient rehabilitation team.</div></div><div><h3>Objectives</h3><div>This research aimed to evaluate the interrater reliability of the FAB score.</div></div><div><h3>Methods</h3><div>A prospective observational study assessed the interrater reliability of the FAB score when used by three different therapists simultaneously rating the same patient-scoring episode (<em>n</em> = 22).</div></div><div><h3>Results</h3><div>The Intraclass Correlation Coefficient (ICC) for the FAB score as a complete tool revealed excellent agreement (ICC 0.999, <em>P</em> < 0.001, 95 % confidence interval 0.999 – 0.999), with Cronbach’s alpha 0.999. Individual components of the FAB score revealed excellent agreement (ICC > 0.983, <em>P</em> < 0.001) with narrow 95 % confidence intervals.</div></div><div><h3>Conclusion</h3><div>The FAB score is the first physical functional outcome measure developed specifically for patients on the burns ward to have demonstrated both interrater reliability and, based on our previous work, predictive validity. The overall FAB assessment, as well as its individual domains, showed excellent interrater reliability, supporting its utility in this patient population.</div></div>","PeriodicalId":50717,"journal":{"name":"Burns","volume":"52 1","pages":"Article 107784"},"PeriodicalIF":2.9,"publicationDate":"2025-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145617814","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 : 2025-11-15DOI: 10.1016/j.burns.2025.107782
Amy Woods , Poh Tan, Tamara Mertz, Christopher J. Lewis
Background
Accurate and reproducible assessment of total body surface area (TBSA) in burns is vital for guiding fluid resuscitation, triage, referral decisions, and overall clinical management. Traditional methods are widely used but prone to significant inter-rater variability and diagnostic inaccuracies.
Objective
This systematic review evaluates emerging technologies developed to improve TBSA estimation, focusing on diagnostic accuracy and inter-rater reliability.
Methods
A comprehensive search of EMBASE, MEDLINE (OVID), Web of Science, Scopus, PubMed and Cochrane Library databases was conducted. Studies assessing technological tools for TBSA estimation in both human and artificial burns were included. Primary outcomes were accuracy and reliability, while secondary outcomes included speed and user feedback. Study quality was appraised using the QUADAS-2 tool.
Results
Thirty-six studies were included: 3D programs (n = 7), mobile applications (n = 11), 3D stereophotogrammetry (n = 8), and machine learning models (n = 10). 3D stereophotogrammetry showed the highest accuracy (mean ICC = 0.988) and excellent inter-rater reliability (ICC = 0.989). 3D programs demonstrated good diagnostic performance and reduced variability. Mobile applications improved accuracy and consistency, particularly among non-specialists, and offered practical benefits in prehospital settings. Machine learning, though largely in experimental phases, demonstrated promising accuracy, with some models outperforming clinician estimates.
Conclusion
3D stereophotogrammetry provided more consistent and reliable estimates of TBSA, while mobile applications offered practical and scalable solutions. Early machine learning approaches showed potential but remain largely experimental. Overall, most studies were of low quality and methodologically heterogeneous; therefore, definitive conclusions cannot yet be drawn. Further high-quality, real-world research is required to validate accuracy and establish clinical utility.
{"title":"Advancements in burn size assessment: A systematic review of emerging technologies","authors":"Amy Woods , Poh Tan, Tamara Mertz, Christopher J. Lewis","doi":"10.1016/j.burns.2025.107782","DOIUrl":"10.1016/j.burns.2025.107782","url":null,"abstract":"<div><h3>Background</h3><div>Accurate and reproducible assessment of total body surface area (TBSA) in burns is vital for guiding fluid resuscitation, triage, referral decisions, and overall clinical management. Traditional methods are widely used but prone to significant inter-rater variability and diagnostic inaccuracies.</div></div><div><h3>Objective</h3><div>This systematic review evaluates emerging technologies developed to improve TBSA estimation, focusing on diagnostic accuracy and inter-rater reliability.</div></div><div><h3>Methods</h3><div>A comprehensive search of EMBASE, MEDLINE (OVID), Web of Science, Scopus, PubMed and Cochrane Library databases was conducted. Studies assessing technological tools for TBSA estimation in both human and artificial burns were included. Primary outcomes were accuracy and reliability, while secondary outcomes included speed and user feedback. Study quality was appraised using the QUADAS-2 tool.</div></div><div><h3>Results</h3><div>Thirty-six studies were included: 3D programs (n = 7), mobile applications (n = 11), 3D stereophotogrammetry (n = 8), and machine learning models (n = 10). 3D stereophotogrammetry showed the highest accuracy (mean ICC = 0.988) and excellent inter-rater reliability (ICC = 0.989). 3D programs demonstrated good diagnostic performance and reduced variability. Mobile applications improved accuracy and consistency, particularly among non-specialists, and offered practical benefits in prehospital settings. Machine learning, though largely in experimental phases, demonstrated promising accuracy, with some models outperforming clinician estimates.</div></div><div><h3>Conclusion</h3><div>3D stereophotogrammetry provided more consistent and reliable estimates of TBSA, while mobile applications offered practical and scalable solutions. Early machine learning approaches showed potential but remain largely experimental. Overall, most studies were of low quality and methodologically heterogeneous; therefore, definitive conclusions cannot yet be drawn. Further high-quality, real-world research is required to validate accuracy and establish clinical utility.</div></div>","PeriodicalId":50717,"journal":{"name":"Burns","volume":"52 1","pages":"Article 107782"},"PeriodicalIF":2.9,"publicationDate":"2025-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145617817","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 : 2025-11-13DOI: 10.1016/j.burns.2025.107780
Hailiang Liu , Shujun Wang , Dongjie Li , Dawei Li, Yijie Zhang, Xin Li, Chuan’an Shen
Background
Mitochondrial DNA (mtDNA) plays a crucial role in inflammation regulation and can be passively or accidentally released in setting of cellular stress or traumatic injury. In this study, we try to evaluate the distribution and significance of mtDNA in blister fluid of paediatric small area intermediate depth burn wounds.
Methods
This trial was conducted as a follow-up analysis of a single-centre, prospective observational study that enrolled 62 children with small area partial-thickness thermal burns. The mtDNA in blister fluid was measured with a PCR-based assay. The levels of cytokines including interleukin-6 (IL-6), interleukin-8 (IL-8) and transforming growth factor β1 (TGF-β1) were evaluated by using ELISA. Association of mtDNA with inflammatory markers and wound healing outcome was analysed.
Results
The mtDNA copy number (mtDNA-CN) was determined as median (min, max) value of 76.30 (16.5, 219.1). Spearman rank correlation coefficient analysis showed that the levels of IL-6, IL-8, and TGF-β1 all exhibited significant correlations with mtDNA-CN in burn blister fluid samples (all P < 0.05). Moreover, a significant association between wound healing time and mtDNA-CN in blister fluid was observed (P < 0.05); Kaplan-Meier curves by log-rank test demonstrated that mtDNA-CN in blister fluid was significantly associated with for time to re-epithelialization (P < 0.05).
Conclusion
Blister fluid mtDNA may serve to evaluate burn wound severity in children with small area intermediate-depth burns.
{"title":"Characteristics and significance of blister fluid cell-free mitochondrial DNA in pediatric small area intermediate-depth burn wounds","authors":"Hailiang Liu , Shujun Wang , Dongjie Li , Dawei Li, Yijie Zhang, Xin Li, Chuan’an Shen","doi":"10.1016/j.burns.2025.107780","DOIUrl":"10.1016/j.burns.2025.107780","url":null,"abstract":"<div><h3>Background</h3><div>Mitochondrial DNA (mtDNA) plays a crucial role in inflammation regulation and can be passively or accidentally released in setting of cellular stress or traumatic injury. In this study, we try to evaluate the distribution and significance of mtDNA in blister fluid of paediatric small area intermediate depth burn wounds.</div></div><div><h3>Methods</h3><div>This trial was conducted as a follow-up analysis of a single-centre, prospective observational study that enrolled 62 children with small area partial-thickness thermal burns. The mtDNA in blister fluid was measured with a PCR-based assay. The levels of cytokines including interleukin-6 (IL-6), interleukin-8 (IL-8) and transforming growth factor β1 (TGF-β1) were evaluated by using ELISA. Association of mtDNA with inflammatory markers and wound healing outcome was analysed.</div></div><div><h3>Results</h3><div>The mtDNA copy number (mtDNA-CN) was determined as median (min, max) value of 76.30 (16.5, 219.1). Spearman rank correlation coefficient analysis showed that the levels of IL-6, IL-8, and TGF-β1 all exhibited significant correlations with mtDNA-CN in burn blister fluid samples (all P < 0.05). Moreover, a significant association between wound healing time and mtDNA-CN in blister fluid was observed (P < 0.05); Kaplan-Meier curves by log-rank test demonstrated that mtDNA-CN in blister fluid was significantly associated with for time to re-epithelialization (P < 0.05).</div></div><div><h3>Conclusion</h3><div>Blister fluid mtDNA may serve to evaluate burn wound severity in children with small area intermediate-depth burns.</div></div>","PeriodicalId":50717,"journal":{"name":"Burns","volume":"52 1","pages":"Article 107780"},"PeriodicalIF":2.9,"publicationDate":"2025-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145617815","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 : 2025-11-13DOI: 10.1016/j.burns.2025.107779
Olivia Antoinette Smith , Ascanio Tridente , Sankhya Kapil Sen
Background
Burn injuries may be complex, life-changing and life-threatening. Knowing the factors that contribute to unfavourable outcomes, particularly mortality, is crucial so that they can be assessed and addressed. Well-recognised contributors to adverse outcomes in burn patients include age, burn size, revised Baux score, and inhalation injury. Less well described, but increasingly reported, is frailty status. Here we aim to expand the current literature by adjusting for confounders not previously investigated. This is important particularly with an increasing emphasis on frailty assessment in acute care.
Methods
A retrospective analysis of adult burn patients who required admission was conducted at a single burns unit in the United Kingdom from 2019 to 2024. The Rockwood Clinical Frailty Scale (CFS) was used to assess an individual’s frailty on a scale of 1 (very fit) to 9 (terminally ill). Univariate and multi-variate linear and logistic regression analyses assessed associations between various predictors, including revised Baux score and frailty (as a potential prognostic factor), and hospital mortality, length of stay, and time taken to heal.
Results
Our study included 1451 adult patients. Adjusting for age, sex, burn size, inhalation injury, and revised Baux score, frailty was significantly associated with increased mortality (OR 3, CI 1.84 – 4.88, p < 0.001), length of hospital stay (LOS, b 2.03, 95 % CI 1.27 – 2.78, p < 0.001), and time taken to heal (b 4.5, 95 % CI 1.75 – 7.3, p = 0.001). Other significant predictors of mortality were %TBSA (OR per % increase 1.06, 95 % CI 1.03–1.1, p < 0.001) and revised Baux (OR per 1 point increase 1.06, 95 % CI 1.03 – 1.1, p = 0.001). Burn %TBSA was also predictive of LOS (β per 1 % increase 0.35, 95 % CI 0.24 – 0.47, p < 0.001).
Conclusions
Our findings suggest that 1) age, %TBSA, revised Baux score, and frailty are independently associated with mortality in burn injured patients; 2) frailty score and the % TBSA are independent predictors of increased length of hospital stay; and 3) frailty is an independent predictor of prolonged burn wound healing time. Further validation in more severe burn cohorts and multi-centre populations is needed before strong clinical recommendations can be made.
背景：烧伤可能是复杂的，改变生活和危及生命的。了解导致不利结果的因素，特别是死亡率，至关重要，这样才能对这些因素进行评估和处理。烧伤患者不良结局的公认影响因素包括年龄、烧伤面积、修订后的Baux评分和吸入性损伤。虽然描述得不太好，但越来越多的报道是虚弱的状态。在这里，我们的目标是通过调整以前没有研究过的混杂因素来扩展当前的文献。这是非常重要的，特别是在日益强调脆弱评估在急性护理。方法：回顾性分析2019年至2024年在英国一家烧伤科收治的成人烧伤患者。Rockwood临床虚弱量表（CFS）用于评估个体的虚弱程度，范围从1（非常健康）到9（身患绝症）。单变量和多变量线性和逻辑回归分析评估了各种预测因素之间的关联，包括修订Baux评分和虚弱（作为潜在的预后因素）、住院死亡率、住院时间和愈合时间。结果：本研究纳入1451例成人患者。调整年龄、性别、烧伤大小、吸入性损伤和修订后的Baux评分后，虚弱与死亡率增加显著相关（OR 3, CI 1.84 - 4.88, p ）结论：我们的研究结果表明：1)年龄、TBSA %、修订后的Baux评分和虚弱与烧伤患者的死亡率独立相关；2)虚弱评分和TBSA %是住院时间增加的独立预测因子；3)虚弱是延长烧伤创面愈合时间的独立预测因子。在提出强有力的临床建议之前，需要在更严重的烧伤队列和多中心人群中进行进一步的验证。
{"title":"Can we predict mortality, length of stay, and time taken to heal at the point of admission in burn patients?","authors":"Olivia Antoinette Smith , Ascanio Tridente , Sankhya Kapil Sen","doi":"10.1016/j.burns.2025.107779","DOIUrl":"10.1016/j.burns.2025.107779","url":null,"abstract":"<div><h3>Background</h3><div>Burn injuries may be complex, life-changing and life-threatening. Knowing the factors that contribute to unfavourable outcomes, particularly mortality, is crucial so that they can be assessed and addressed. Well-recognised contributors to adverse outcomes in burn patients include age, burn size, revised Baux score, and inhalation injury. Less well described, but increasingly reported, is frailty status. Here we aim to expand the current literature by adjusting for confounders not previously investigated. This is important particularly with an increasing emphasis on frailty assessment in acute care.</div></div><div><h3>Methods</h3><div>A retrospective analysis of adult burn patients who required admission was conducted at a single burns unit in the United Kingdom from 2019 to 2024. The Rockwood Clinical Frailty Scale (CFS) was used to assess an individual’s frailty on a scale of 1 (very fit) to 9 (terminally ill). Univariate and multi-variate linear and logistic regression analyses assessed associations between various predictors, including revised Baux score and frailty (as a potential prognostic factor), and hospital mortality, length of stay, and time taken to heal.</div></div><div><h3>Results</h3><div>Our study included 1451 adult patients. Adjusting for age, sex, burn size, inhalation injury, and revised Baux score, frailty was significantly associated with increased mortality (OR 3, CI 1.84 – 4.88, p < 0.001), length of hospital stay (LOS, <em>b</em> 2.03, 95 % CI 1.27 – 2.78, p < 0.001), and time taken to heal (<em>b</em> 4.5, 95 % CI 1.75 – 7.3, p = 0.001). Other significant predictors of mortality were %TBSA (OR per % increase 1.06, 95 % CI 1.03–1.1, p < 0.001) and revised Baux (OR per 1 point increase 1.06, 95 % CI 1.03 – 1.1, p = 0.001). Burn %TBSA was also predictive of LOS (β per 1 % increase 0.35, 95 % CI 0.24 – 0.47, p < 0.001).</div></div><div><h3>Conclusions</h3><div>Our findings suggest that 1) age, %TBSA, revised Baux score, and frailty are independently associated with mortality in burn injured patients; 2) frailty score and the % TBSA are independent predictors of increased length of hospital stay; and 3) frailty is an independent predictor of prolonged burn wound healing time. Further validation in more severe burn cohorts and multi-centre populations is needed before strong clinical recommendations can be made.</div></div>","PeriodicalId":50717,"journal":{"name":"Burns","volume":"52 1","pages":"Article 107779"},"PeriodicalIF":2.9,"publicationDate":"2025-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145670566","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 : 2025-11-12DOI: 10.1016/j.burns.2025.107778
Norberto Navarrete
{"title":"Diagnostic challenges of acute kidney injury in burn patients: Time to refine the criteria?","authors":"Norberto Navarrete","doi":"10.1016/j.burns.2025.107778","DOIUrl":"10.1016/j.burns.2025.107778","url":null,"abstract":"","PeriodicalId":50717,"journal":{"name":"Burns","volume":"52 1","pages":"Article 107778"},"PeriodicalIF":2.9,"publicationDate":"2025-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145617795","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}
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