Pub Date : 2024-11-17DOI: 10.1016/j.burnso.2024.100382
Deepak K. Ozhathil , Teresa R. Kontos , Kim M. Priban , Evan P. Bailey , Elizabeth A. Halicki , Steven A. Kahn MD
Over the past four decades, obesity rates in the United States have consistently increased, with current estimates indicating that over 42% of adults are affected [1]. In contrast, burn injuries have decreased significantly during the same period, largely due to effective public awareness campaigns and improvements of safety regulations [2]. Despite these opposing trends, the percentage of burn patients at the author’s hospital with a concurrent diagnosis of obesity has risen, posing unique challenges for clinical providers. Patients with elevated body weight and extensive burns require special considerations for proper positioning, wound exposure, and minimizing ergonomic risks to healthcare workers [3]. Currently, there is a notable lack of comprehensive guidelines on operative strategies specifically tailored for this patient population. In response to this knowledge gap, the authors’ institution implemented novel surgical techniques designed to manage circumferential burn wounds in patients with higher body weight.
{"title":"Innovative surgical management of large burn wounds in patients with elevated body weight to enhance team safety","authors":"Deepak K. Ozhathil , Teresa R. Kontos , Kim M. Priban , Evan P. Bailey , Elizabeth A. Halicki , Steven A. Kahn MD","doi":"10.1016/j.burnso.2024.100382","DOIUrl":"10.1016/j.burnso.2024.100382","url":null,"abstract":"<div><div>Over the past four decades, obesity rates in the United States have consistently increased, with current estimates indicating that over 42% of adults are affected <span><span>[1]</span></span>. In contrast, burn injuries have decreased significantly during the same period, largely due to effective public awareness campaigns and improvements of safety regulations <span><span>[2]</span></span>. Despite these opposing trends, the percentage of burn patients at the author’s hospital with a concurrent diagnosis of obesity has risen, posing unique challenges for clinical providers. Patients with elevated body weight and extensive burns require special considerations for proper positioning, wound exposure, and minimizing ergonomic risks to healthcare workers <span><span>[3]</span></span>. Currently, there is a notable lack of comprehensive guidelines on operative strategies specifically tailored for this patient population. In response to this knowledge gap, the authors’ institution implemented novel surgical techniques designed to manage circumferential burn wounds in patients with higher body weight.</div></div>","PeriodicalId":72486,"journal":{"name":"Burns open : an international open access journal for burn injuries","volume":"9 ","pages":"Article 100382"},"PeriodicalIF":0.0,"publicationDate":"2024-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142704036","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-07DOI: 10.1016/j.burnso.2024.100378
Olivia Fruergaard, Mathias Ørholt, Christian Lyngsaa Lang, Jennifer Berg Drejøe, Mikkel Herly, Peter Vester-Glowinski, David Hebbelstrup Jensen
Background
Restoring a functional dermis following extensive, deep wounds, such as those caused by severe burns, presents a significant reconstructive challenge. Although split thickness skin graft (STSG) and full thickness skin graft (FTSG) can provide adequate coverage, dermal templates are becoming increasingly important in restoring function. The purpose of this systematic review is to assess the efficacy, advantages and limitations of employing NovoSorb® Biodegradable Temporizing Matrix (BTM) in the treatment of complex wounds.
Methods
The systematic review was carried out in accordance with PRISMA and MOOSE guidelines when appropriate. All studies until April 2024 involving patients treated with NovoSorb® BTM were considered. Infection, adverse events, and BTM loss were among the outcomes evaluated.
Results
We identified 725 studies, and 69 were included after screening. The included studies involved 880 participants and were mostly concerned with the management of burns, but other difficult wounds were also addressed. The infection rate was 10%, yet only few reported losing their BTM as a result of this consequence. The incidence of adverse events was low, with the majority of trials reporting no adverse events related to BTM.
Conclusion
Our systematic review focused primarily on case series and case reports that demonstrated the efficacy of Novosorp BTM and the rarity of side effects. However, there were very few comparison research. More research is needed to fully analyze the efficacy, limitations, and downsides of using Novosorb (BTM).
{"title":"A systematic review of the Novosorb® Biodegradable Temporizing Matrix in the treatment of complex wounds","authors":"Olivia Fruergaard, Mathias Ørholt, Christian Lyngsaa Lang, Jennifer Berg Drejøe, Mikkel Herly, Peter Vester-Glowinski, David Hebbelstrup Jensen","doi":"10.1016/j.burnso.2024.100378","DOIUrl":"10.1016/j.burnso.2024.100378","url":null,"abstract":"<div><h3>Background</h3><div>Restoring<!--> <!-->a<!--> <!-->functional<!--> <!-->dermis<!--> <!-->following<!--> <!-->extensive,<!--> <!-->deep<!--> <!-->wounds,<!--> <!-->such<!--> <!-->as<!--> <!-->those<!--> <!-->caused<!--> <!-->by<!--> <!-->severe<!--> <!-->burns,<!--> <!-->presents<!--> <!-->a<!--> <!-->significant<!--> <!-->reconstructive<!--> <!-->challenge. Although split thickness skin graft (STSG) and full thickness skin graft (FTSG) can provide adequate coverage, dermal templates are becoming increasingly important in restoring function. The purpose of this systematic review is to assess the efficacy, advantages and limitations of employing NovoSorb® Biodegradable Temporizing Matrix (BTM) in the treatment of complex wounds.</div></div><div><h3>Methods</h3><div>The systematic review was carried out in accordance with PRISMA and MOOSE guidelines when appropriate. All studies until April 2024 involving patients treated with NovoSorb® BTM were considered. Infection,<!--> <!-->adverse<!--> <!-->events,<!--> <!-->and<!--> <!-->BTM<!--> <!-->loss<!--> <!-->were<!--> <!-->among<!--> <!-->the<!--> <!-->outcomes<!--> <!-->evaluated.</div></div><div><h3>Results</h3><div>We identified 725 studies, and 69 were included after screening. The included studies involved 880 participants and were mostly concerned with the management of burns, but other difficult wounds were also addressed. The infection rate was 10%, yet only few reported losing their BTM as a result of this consequence. The incidence of adverse events was low, with the majority of trials reporting no adverse events related to BTM.</div></div><div><h3>Conclusion</h3><div>Our systematic review focused primarily on case series and case reports that demonstrated the efficacy of Novosorp BTM and the rarity of side effects. However, there were very few comparison research. More research is needed to fully analyze the efficacy, limitations, and downsides of using Novosorb (BTM).</div></div>","PeriodicalId":72486,"journal":{"name":"Burns open : an international open access journal for burn injuries","volume":"9 ","pages":"Article 100378"},"PeriodicalIF":0.0,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142655861","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-07DOI: 10.1016/j.burnso.2024.100381
Sinan Dogan , Arina Mahmoud , Ingrid Steinvall , Elin Albertsson , Elina Bergman , Jamila Halimi , Moustafa Elmasry
Background
It has been known for decades that early excision of burns reduces morbidity and mortality. Early surgical excision and skin grafting has become the most important part of successful healing in burn management, especially in major burns. However, it is not entirely clear whether early excision and skin transplantation has the same advantages in smaller burns and there is no consensus on the timing of skin grafting in this group. The aim was to investigate the effect of timing and other factors for skin graft take rate among minor burns.
Methods
This retrospective study included patients with thermal injury, a burn size smaller than 11 % total body surface area (TBSA), and who were treated with a skin graft operation. Take rate at the second dressing change after operation was used as main outcome, a cut-off of 95% take rate was for the multivariable logistic regression.
Results
A total of 195 patients were included, median (IQR) age was 42 (9–68) years, 65 % were male, and median (IQR) area of deep burns was 2 (1–4) % of the body surface area (BSA). Multivariable regression showed that smaller area of deep burns and scalds (compared with flame and contact burns) were associated with a take rate of ≥ 95 %. Age, timing of the skin graft transplantation, and plasma C-reactive protein showed no independent effect on take rate. The regression model was significant but weak (ROC AUC 0.71, 95 % CI 0.62–0.79).
Conclusion
Our results suggest that the extent and depth of the burn are the most important factors for skin graft take rate among minor burns, while timing of the transplantation is not associated with take rate for the skin graft. The advantageous effect of scalds may be interpreted to mean that scalds in general are more superficial than flame and contact burns, a difference that may not be detected by the use of a Lund and Browder chart. The conclusion is, however, tempered by the retrospective study design and the relatively low discriminatory power in our study.
背景数十年来，人们一直知道烧伤的早期切除可以降低发病率和死亡率。早期手术切除和皮肤移植已成为烧伤治疗中成功愈合的最重要部分，尤其是在大面积烧伤中。然而，对于较小面积的烧伤，早期切除和皮肤移植是否具有同样的优势尚不完全清楚，而且对于这类烧伤的植皮时机也没有达成共识。这项回顾性研究纳入了热损伤、烧伤面积小于总体表面积（TBSA）11%、接受植皮手术治疗的患者。结果 共纳入 195 名患者，中位（IQR）年龄为 42（9-68）岁，65% 为男性，中位（IQR）深度烧伤面积为体表面积（BSA）的 2（1-4）%。多变量回归显示，深度烧伤和烫伤（与火焰烧伤和接触性烧伤相比）面积越小，治愈率就越高（≥ 95%）。年龄、植皮时间和血浆 C 反应蛋白对取出率没有独立影响。我们的结果表明，烧伤的范围和深度是影响轻度烧伤植皮率的最重要因素，而移植时间与植皮率无关。烫伤的有利影响可解释为烫伤一般比火焰烧伤和接触性烧伤更浅，使用伦德和布劳德图表可能无法发现这种差异。不过，由于我们的研究采用的是回顾性研究设计，且鉴别力相对较低，因此这一结论并不成立。
{"title":"Skin graft take rate among minor burns – A cohort study to investigate the effect of factors such as burn depth, burn size, and timing of the operation","authors":"Sinan Dogan , Arina Mahmoud , Ingrid Steinvall , Elin Albertsson , Elina Bergman , Jamila Halimi , Moustafa Elmasry","doi":"10.1016/j.burnso.2024.100381","DOIUrl":"10.1016/j.burnso.2024.100381","url":null,"abstract":"<div><h3>Background</h3><div>It has been known for decades that early excision of burns reduces morbidity and mortality. Early surgical excision and skin grafting has become the most important part of successful healing in burn management, especially in major burns. However, it is not entirely clear whether early excision and skin transplantation has the same advantages in smaller burns and there is no consensus on the timing of skin grafting in this group. The aim was to investigate the effect of timing and other factors for skin graft take rate among minor burns.</div></div><div><h3>Methods</h3><div>This retrospective study included patients with thermal injury, a burn size smaller than 11 % total body surface area (TBSA), and who were treated with a skin graft operation. Take rate at the second dressing change after operation was used as main outcome, a cut-off of 95% take rate was for the multivariable logistic regression.</div></div><div><h3>Results</h3><div>A total of 195 patients were included, median (IQR) age was 42 (9–68) years, 65 % were male, and median (IQR) area of deep burns was 2 (1–4) % of the body surface area (BSA). Multivariable regression showed that smaller area of deep burns and scalds (compared with flame and contact burns) were associated with a take rate of ≥ 95 %. Age, timing of the skin graft transplantation, and plasma C-reactive protein showed no independent effect on take rate. The regression model was significant but weak (ROC AUC 0.71, 95 % CI 0.62–0.79).</div></div><div><h3>Conclusion</h3><div>Our results suggest that the extent and depth of the burn are the most important factors for skin graft take rate among minor burns, while timing of the transplantation is not associated with take rate for the skin graft. The advantageous effect of scalds may be interpreted to mean that scalds in general are more superficial than flame and contact burns, a difference that may not be detected by the use of a Lund and Browder chart. The conclusion is, however, tempered by the retrospective study design and the relatively low discriminatory power in our study.</div></div>","PeriodicalId":72486,"journal":{"name":"Burns open : an international open access journal for burn injuries","volume":"9 ","pages":"Article 100381"},"PeriodicalIF":0.0,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142655860","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-06DOI: 10.1016/j.burnso.2024.100380
David M. Hill
Introduction
Dermal substitutes have significantly changed the practice of caring for acute and chronic wounds, earning a place on the reconstructive ladder. MatriDerm is a single-layer acellular dermal matrix composed of bovine collagen types I, III, and V with added bovine elastin (CEM). It was developed in the 1990′s, has been commercially available outside of the US since 2005, and received FDA clearance for use in the US in 2021. The objective of this study was to review the published literature to identify an exhaustive list of references describing the clinical use of CEM and summarize the findings.
Methods
An extensive search of PubMed and Google Scholar was performed to identify manuscripts describing the clinical use of CEM. Manuscripts were excluded if they were primarily animal models, in vitro studies, reviews, expert opinion articles, or lacked sufficient detail. Google Translate was utilized when necessary.
Results
Five hundred and thirty-five manuscripts containing potential details of CEM usage were identified. After exclusions, 128 remained (13 randomized control trials, 30 cohort studies, and 85 case series/reports) originating from 38 countries, including nearly 2,600 clinical cases dating back to 1995. Cases varied considerably and included: burns, acute traumatic injuries, chronic wounds, and soft tissue reconstruction in patients ranging from pediatric to the elderly. A single-stage procedure (CEM placement and covered with an autograft in the same procedure) was the most reported technique, but autograft application in a later procedure was also reported. Negative pressure wound therapy was utilized in many of the studies. Study endpoints varied widely and included graft take, several objective scar scales, cutometer/durometer measures, range of motion, patient satisfaction scores, and histology.
Conclusions
There is an extensive body of global literature dating back to the 1990’s documenting CEM successfully utilized as a dermal matrix for a vast number of patients and indications.
导言：真皮替代品极大地改变了急慢性伤口的护理方法，在重建阶梯上占据了一席之地。MatriDerm 是一种单层无细胞真皮基质，由 I、III 和 V 型牛胶原组成，并添加了牛弹性蛋白 (CEM)。它于 20 世纪 90 年代研发成功，自 2005 年起在美国以外的国家上市，并于 2021 年获得美国食品及药物管理局批准在美国使用。本研究的目的是对已发表的文献进行回顾，找出描述 CEM 临床应用的详尽参考文献列表，并对研究结果进行总结。如果手稿主要是动物模型、体外研究、综述、专家意见文章或缺乏足够的细节，则将其排除在外。必要时使用谷歌翻译。结果共找到 535 篇包含 CEM 用途潜在细节的手稿。经排除后，剩下的 128 篇文章（13 篇随机对照试验、30 篇队列研究和 85 篇病例系列/报告）来自 38 个国家，包括近 2,600 个临床病例，最早可追溯到 1995 年。病例差异很大，包括烧伤、急性外伤、慢性伤口和软组织重建，患者从儿童到老人不等。报告最多的技术是单阶段手术（在同一手术中放置 CEM 并用自体移植物覆盖），但也有在后期手术中应用自体移植物的报道。许多研究都采用了负压伤口疗法。研究终点差异很大，包括移植物取材、几种客观疤痕量表、切口计/硬度计测量、活动范围、患者满意度评分和组织学。结论早在 20 世纪 90 年代，全球就有大量文献记录了 CEM 作为真皮基质成功应用于大量患者和适应症的情况。
{"title":"A systematic review of the clinical use of a single-layer bovine collagen-elastin acellular dermal matrix","authors":"David M. Hill","doi":"10.1016/j.burnso.2024.100380","DOIUrl":"10.1016/j.burnso.2024.100380","url":null,"abstract":"<div><h3>Introduction</h3><div>Dermal substitutes have significantly changed the practice of caring for acute and chronic wounds, earning a place on the reconstructive ladder. MatriDerm is a single-layer acellular dermal matrix composed of bovine collagen types I, III, and V with added bovine elastin (CEM). It was developed in the 1990′s, has been commercially available outside of the US since 2005, and received FDA clearance for use in the US in 2021. The objective of this study was to review the published literature to identify an exhaustive list of references describing the clinical use of CEM and summarize the findings.</div></div><div><h3>Methods</h3><div>An extensive search of PubMed and Google Scholar was performed to identify manuscripts describing the clinical use of CEM. Manuscripts were excluded if they were primarily animal models, in vitro studies, reviews, expert opinion articles, or lacked sufficient detail. Google Translate was utilized when necessary.</div></div><div><h3>Results</h3><div>Five hundred and thirty-five manuscripts containing potential details of CEM usage were identified. After exclusions, 128 remained (13 randomized control trials, 30 cohort studies, and 85 case series/reports) originating from 38 countries, including nearly 2,600 clinical cases dating back to 1995. Cases varied considerably and included: burns, acute traumatic injuries, chronic wounds, and soft tissue reconstruction in patients ranging from pediatric to the elderly. A single-stage procedure (CEM placement and covered with an autograft in the same procedure) was the most reported technique, but autograft application in a later procedure was also reported. Negative pressure wound therapy was utilized in many of the studies. Study endpoints varied widely and included graft take, several objective scar scales, cutometer/durometer measures, range of motion, patient satisfaction scores, and histology.</div></div><div><h3>Conclusions</h3><div>There is an extensive body of global literature dating back to the 1990’s documenting CEM successfully utilized as a dermal matrix for a vast number of patients and indications.</div></div>","PeriodicalId":72486,"journal":{"name":"Burns open : an international open access journal for burn injuries","volume":"9 ","pages":"Article 100380"},"PeriodicalIF":0.0,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142655859","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-03DOI: 10.1016/j.burnso.2024.100376
William Rice , Hemasree Yeluru , Miles Reese , Ricardo Rendel , Alexa Soult , Jessica Burgess
Introduction
Scald burns are challenging to manage due to their evolutionary nature and nuanced injury pattern. Different mediums, such as hot water, steam, or grease, each have unique physical properties that may inflict more damage and incite a different inflammatory response. While pediatric patients are often the focus of scald burn research, a significant number of adults still suffer from scald burns, especially while cooking with hot grease. Our study aimed to analyze differences in injury pattern and management between grease versus non-grease scald burns.
Materials and Methods
A retrospective chart review was done on all scald burn patients at a tertiary burn care center from January 2020 to December 2022. The primary outcomes were admission and length of stay with the primary exposure being grease versus non-grease scald burns. Secondary outcomes included rates of surgical excision and changes in surgical management plans. Multivariate regressions were employed to control for sex, age, total body surface area (TBSA), and burn thickness.
Results
Of 165 patients with scald burns, 41 out of 91 (45.1 %) with grease burns and 43 out of 74 (58.1 %) with non-grease burns were admitted. No statistically significant difference in length of hospital stay existed between admitted grease and non-grease burns (p = 0.45). Additionally, no differences were observed for surgical excision (p = 0.63) and changes in surgical management plans (p = 0.47)
Conclusion
The mechanism of scald burn caused by either a grease or non-grease source is not associated with any differences in admission, length of hospital stay, or surgical management. Scald burn management should still focus on patient age, TBSA, and burn thickness regardless of the causative agent.
{"title":"Management considerations in grease versus non-grease scald burns in adults: A retrospective cohort study at a tertiary burn care facility","authors":"William Rice , Hemasree Yeluru , Miles Reese , Ricardo Rendel , Alexa Soult , Jessica Burgess","doi":"10.1016/j.burnso.2024.100376","DOIUrl":"10.1016/j.burnso.2024.100376","url":null,"abstract":"<div><h3>Introduction</h3><div>Scald burns are challenging to manage due to their evolutionary nature and nuanced injury pattern. Different mediums, such as hot water, steam, or grease, each have unique physical properties that may inflict more damage and incite a different inflammatory response. While pediatric patients are often the focus of scald burn research, a significant number of adults still suffer from scald burns, especially while cooking with hot grease. Our study aimed to analyze differences in injury pattern and management between grease versus non-grease scald burns.</div></div><div><h3>Materials and Methods</h3><div>A retrospective chart review was done on all scald burn patients at a tertiary burn care center from January 2020 to December 2022. The primary outcomes were admission and length of stay with the primary exposure being grease versus non-grease scald burns. Secondary outcomes included rates of surgical excision and changes in surgical management plans. Multivariate regressions were employed to control for sex, age, total body surface area (TBSA), and burn thickness.</div></div><div><h3>Results</h3><div>Of 165 patients with scald burns, 41 out of 91 (45.1 %) with grease burns and 43 out of 74 (58.1 %) with non-grease burns were admitted. No statistically significant difference in length of hospital stay existed between admitted grease and non-grease burns (p = 0.45). Additionally, no differences were observed for surgical excision (p = 0.63) and changes in surgical management plans (p = 0.47)</div></div><div><h3>Conclusion</h3><div>The mechanism of scald burn caused by either a grease or non-grease source is not associated with any differences in admission, length of hospital stay, or surgical management. Scald burn management should still focus on patient age, TBSA, and burn thickness regardless of the causative agent.</div></div>","PeriodicalId":72486,"journal":{"name":"Burns open : an international open access journal for burn injuries","volume":"9 ","pages":"Article 100376"},"PeriodicalIF":0.0,"publicationDate":"2024-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142655862","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-03DOI: 10.1016/j.burnso.2024.100379
Sameh Natsha , Hester Lacey , Souad Belkebir , Ann Attili , Aya Atatra , Rawand Daragmeh , Anas Abu-Safa , Baljit Dheansa , Rasha Khayyat
Background
Determining frequently colonizing microorganisms and typical demographics affected by burns in the West Bank is essential to aid timely and effective injury management.
Methods
This study included n = 435 patients with burn injuries between January 2018-December 2021 at a tertiary center in Nablus. Eligible medical records were reviewed, and relevant data extracted.
Results
n = 244 males and n = 191 females, average age 14.5 years were included. n = 227 had wound swab cultures, n = 80 which were positive. Scald injuries were the most common mechanism of injury (n = 314, n = 162 in males (p < 0.001), average age of 10.5 years). The most common organisms isolated were Pseudomonas aeruginosa (n = 17) and Staphylococcus aureus (n = 18). n = 17 multidrug resistant (MDR) organisms were cultured, MRSA most commonly (n = 9), followed by K. pneumoniae (ESBL) (n = 5). Overall length of stay (LOS) was 17.27 days in all patients and 28.2 days in those with MDR, with increasing LOS significantly associated with positive culture and MDR development of MDR (p < 0.001).
Conclusions
Younger male demographics and longer hospital admission increase the risk of burn wound colonization and MDR development in the Northern West Bank. Pseudomonas aeruginosa and Staphylococcus aureus were prevalent organisms isolated. MDR development represents a significant challenge in the effective management of injuries in an immunologically vulnerable cohort.
{"title":"Microbial profile of burn wound injuries in the Northern West Bank − A retrospective cohort study","authors":"Sameh Natsha , Hester Lacey , Souad Belkebir , Ann Attili , Aya Atatra , Rawand Daragmeh , Anas Abu-Safa , Baljit Dheansa , Rasha Khayyat","doi":"10.1016/j.burnso.2024.100379","DOIUrl":"10.1016/j.burnso.2024.100379","url":null,"abstract":"<div><h3>Background</h3><div>Determining frequently colonizing microorganisms and typical demographics affected by burns in the West Bank is essential to aid timely and effective injury management.</div></div><div><h3>Methods</h3><div>This study included n = 435 patients with burn injuries between January 2018-December 2021 at a tertiary center in Nablus. Eligible medical records were reviewed, and relevant data extracted.</div></div><div><h3>Results</h3><div>n = 244 males and n = 191 females, average age 14.5 years were included. n = 227 had wound swab cultures, n = 80 which were positive. Scald injuries were the most common mechanism of injury (n = 314, n = 162 in males (p < 0.001), average age of 10.5 years). The most common organisms isolated were <em>Pseudomonas aeruginosa</em> (n = 17) and <em>Staphylococcus aureus</em> (n = 18). n = 17 multidrug resistant (MDR) organisms were cultured, MRSA most commonly (n = 9), followed by <em>K. pneumoniae</em> (ESBL) (n = 5). Overall length of stay (LOS) was 17.27 days in all patients and 28.2 days in those with MDR, with increasing LOS significantly associated with positive culture and MDR development of MDR (p < 0.001).</div></div><div><h3>Conclusions</h3><div>Younger male demographics and longer hospital admission increase the risk of burn wound colonization and MDR development in the Northern West Bank. <em>Pseudomonas aeruginosa</em> and <em>Staphylococcus aureus</em> were prevalent organisms isolated. MDR development represents a significant challenge in the effective management of injuries in an immunologically vulnerable cohort.</div></div>","PeriodicalId":72486,"journal":{"name":"Burns open : an international open access journal for burn injuries","volume":"9 ","pages":"Article 100379"},"PeriodicalIF":0.0,"publicationDate":"2024-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142655858","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01DOI: 10.1016/j.burnso.2024.100377
C.M. Burns , K.D. Boffard , M.S. Moeng
<div><h3>Introduction</h3><div>Burns is one of the important presentations in trauma surgery in both first and third-world countries. Hypotension is often seen in the clinical presentation of a burn injury. Hypotension is the strongest independent predictor of an adverse outcome, according to a study done on emergency departments’ hospital outcomes; the lower the systolic, the worse the outcome. No direct study shows that presenting with or developing hypotension within 48hrs of admission and burn injury will have a worse outcome in our low-middle income setting.</div></div><div><h3>Objectives</h3><div>To determine the outcomes of burn patients who developed hypotension within 48hrs of arrival at a Burn Centre in Johannesburg. In a singled time event.</div></div><div><h3>Methods</h3><div>A retrospective descriptive study was conducted at a Level 1 Trauma Centre Burn unit in Johannesburg from 01 Jan 2019 to 31 Dec 2020. Patients who had a hypotensive episode at any point during the 48 h period were recruited. Hypotension was defined as a systolic blood pressure of less than 90mmhg. The patients were then divided into two groups: those who presented with or developed hypotension within 48hrs and those who did not. After that, the in-hospital mortality of both groups was to be determined. The study included all the patients who presented to the Burn Centre. Those younger than 18, or requiring readmission in the same study or delayed admissions of more than 24 h were excluded. Demographics, burn information, resuscitation data, outcomes and disposition status were evaluated. The STATA Statistics/Data Analysis version 16.0 was used to analyse the data. The level of significance was set at a p-value < 0.05. Ethical approval was obtained from the Human Research Ethics Committee (HREC) (medical) of the University of the Witwatersrand with the clearance number: M220132.</div></div><div><h3>Results</h3><div>Of the 132 patients seen, only 105 met the study inclusion criteria. Most patients were male: 91/105 (86.6 %). Flame burns accounted for the majority of the burns, 64/105 (60.95 %), followed by electrical burns, 26/105 (24.76 %). Hot water and chemical burns only accounted for 11/105 (10.48 %) and 4 (3.81 %) cases. Hypotension within 48hrs was noted in 37/105(35 %) of the cases. Hypotensive patients had an increased burn depth (p = 0.03), higher inhalation rate component (p = <0.001), greater lactate levels(p = 0.00001), higher baux score(p = 0.00001) and more likelihood of being placed on the ventilator (p = <0.00001) or dialysis (p = 0.008). Mortality was noted in 16 (43 %) of the patients who developed hypotension compared to 5 (7.4 %) patients of non-hypotensive patients (p < 0.001). The mortality of patients who presented with or developed hypotension was 9.59 times (95 % CI 3.1–29.4; p = 0.00001) higher than those who did not develop hypotension. Age and TBSA affected by burn, were found to have significant predictive value for mortali
{"title":"Outcomes of burn patients presenting with hypotension within 48 hrs of admission to a level 1 Burn Centre","authors":"C.M. Burns , K.D. Boffard , M.S. Moeng","doi":"10.1016/j.burnso.2024.100377","DOIUrl":"10.1016/j.burnso.2024.100377","url":null,"abstract":"<div><h3>Introduction</h3><div>Burns is one of the important presentations in trauma surgery in both first and third-world countries. Hypotension is often seen in the clinical presentation of a burn injury. Hypotension is the strongest independent predictor of an adverse outcome, according to a study done on emergency departments’ hospital outcomes; the lower the systolic, the worse the outcome. No direct study shows that presenting with or developing hypotension within 48hrs of admission and burn injury will have a worse outcome in our low-middle income setting.</div></div><div><h3>Objectives</h3><div>To determine the outcomes of burn patients who developed hypotension within 48hrs of arrival at a Burn Centre in Johannesburg. In a singled time event.</div></div><div><h3>Methods</h3><div>A retrospective descriptive study was conducted at a Level 1 Trauma Centre Burn unit in Johannesburg from 01 Jan 2019 to 31 Dec 2020. Patients who had a hypotensive episode at any point during the 48 h period were recruited. Hypotension was defined as a systolic blood pressure of less than 90mmhg. The patients were then divided into two groups: those who presented with or developed hypotension within 48hrs and those who did not. After that, the in-hospital mortality of both groups was to be determined. The study included all the patients who presented to the Burn Centre. Those younger than 18, or requiring readmission in the same study or delayed admissions of more than 24 h were excluded. Demographics, burn information, resuscitation data, outcomes and disposition status were evaluated. The STATA Statistics/Data Analysis version 16.0 was used to analyse the data. The level of significance was set at a p-value < 0.05. Ethical approval was obtained from the Human Research Ethics Committee (HREC) (medical) of the University of the Witwatersrand with the clearance number: M220132.</div></div><div><h3>Results</h3><div>Of the 132 patients seen, only 105 met the study inclusion criteria. Most patients were male: 91/105 (86.6 %). Flame burns accounted for the majority of the burns, 64/105 (60.95 %), followed by electrical burns, 26/105 (24.76 %). Hot water and chemical burns only accounted for 11/105 (10.48 %) and 4 (3.81 %) cases. Hypotension within 48hrs was noted in 37/105(35 %) of the cases. Hypotensive patients had an increased burn depth (p = 0.03), higher inhalation rate component (p = <0.001), greater lactate levels(p = 0.00001), higher baux score(p = 0.00001) and more likelihood of being placed on the ventilator (p = <0.00001) or dialysis (p = 0.008). Mortality was noted in 16 (43 %) of the patients who developed hypotension compared to 5 (7.4 %) patients of non-hypotensive patients (p < 0.001). The mortality of patients who presented with or developed hypotension was 9.59 times (95 % CI 3.1–29.4; p = 0.00001) higher than those who did not develop hypotension. Age and TBSA affected by burn, were found to have significant predictive value for mortali","PeriodicalId":72486,"journal":{"name":"Burns open : an international open access journal for burn injuries","volume":"8 4","pages":"Article 100377"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142560583","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01DOI: 10.1016/S2468-9122(24)00055-5
{"title":"Editorial Board Page","authors":"","doi":"10.1016/S2468-9122(24)00055-5","DOIUrl":"10.1016/S2468-9122(24)00055-5","url":null,"abstract":"","PeriodicalId":72486,"journal":{"name":"Burns open : an international open access journal for burn injuries","volume":"8 4","pages":"Article 100367"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142658963","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-18DOI: 10.1016/j.burnso.2024.100375
Deni Alia Yadi , Chandra Isabella Hostanida Purba , Tuti Pahria , Bejo Ropii , Maulidwina Bethasari , Arif Tri Prasetyo
Burns are identified as damage to the skin and organs, commonly resulting from contact with fire, electrical currents, radiation, heated liquids or surfaces, or chemical agents. It is considered as a challenging medical condition both physically and psychologically with significant morbidity and fatality rates. Optimal wound healing required not only extensive medical care such as fluid resuscitation, wound care, infection prevention, pain control, surgical interventions, but also strong emotional and social support from family member. This article presented and discussed the burden, the role of family, the challenges and strategy in improving the healing process and enhancing treatment outcomes through family engagement. Family involvement could minimize complication rates, enhance therapy adherence, and speed up patient rehabilitation. This review provide an overview of the value of family support in burn therapy while also adding fresh insights to the existing research on the role of family in improving burn patient outcomes.
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Pub Date : 2024-10-11DOI: 10.1016/j.burnso.2024.100374
T. Netshiongolwe , S. Znamerovskyi , A. Muganza
The number of patients presenting with burn injuries in Africa is increasing [1,2], and these injuries can have devastating outcomes [3,4]. One contributing factor to these outcomes is the lack of adequately trained staff in providing expert burn wound care. There is little emphasis on training staff in caring for burn patients in Africa. Our goal was to assess the services offered at a specialized burn unit in South Africa and compare them to the recommendations of the American Burn Association for providing fellowship training in burn care. Establishing such a fellowship program will help train experts who can improve burn care services across Africa.
{"title":"Assessing a tertiary surgical units readiness to offer a fellowship in burn care in Africa","authors":"T. Netshiongolwe , S. Znamerovskyi , A. Muganza","doi":"10.1016/j.burnso.2024.100374","DOIUrl":"10.1016/j.burnso.2024.100374","url":null,"abstract":"<div><div>The number of patients presenting with burn injuries in Africa is increasing [1,2], and these injuries can have devastating outcomes [3,4]. One contributing factor to these outcomes is the lack of adequately trained staff in providing expert burn wound care. There is little emphasis on training staff in caring for burn patients in Africa. Our goal was to assess the services offered at a specialized burn unit in South Africa and compare them to the recommendations of the American Burn Association for providing fellowship training in burn care. Establishing such a fellowship program will help train experts who can improve burn care services across Africa.</div></div>","PeriodicalId":72486,"journal":{"name":"Burns open : an international open access journal for burn injuries","volume":"8 4","pages":"Article 100374"},"PeriodicalIF":0.0,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142444565","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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