European burn journal最新文献

Background: Burns cause about 180,000 deaths annually and lead to substantial morbidity, especially in low- and middle-income countries. Clinical assessment of burn depth and TBSA relies on visual and bedside examination and remains subjective. Convolutional neural networks (CNNs) have been proposed to improve objectivity in image-based burn assessment, but clinical generalizability and acceptance remain uncertain. Aims: To map current evidence on CNN performance for burn TBSA, burn depth and treatment-related tasks and to explore whether a large language model (LLM) can organize extracted findings into a transparent, literature-derived orientation decision tree. Methods: We performed a scoping review following PRISMA-ScR. PubMed, Web of Science and Cochrane were searched on 5 April 2025. Eligible studies reported CNN analysis of 2D burn images and quantitative performance metrics. We summarized reported values descriptively. We then provided a structured summary of extracted findings to ChatGPT to draft a one-page orientation decision tree. Two consultant burn surgeons reviewed the figure for clarity and plausibility. Results: Of 659 records, 24 studies were included. Across studies, reported performance for TBSA and depth assessment was often high, but study designs, datasets, labels, imaging modalities and validation strategies varied substantially. High reported performance does not necessarily imply clinical robustness or real-world accuracy. A single study reported high test-set accuracy for graft versus non-graft using heavily expanded data. This value should not be generalized. Conclusions: CNNs show promise for image-based burn TBSA and depth assessment, but heterogeneity, dataset limitations and limited external validation restrict interpretation and clinical transfer. The LLM-derived decision tree is a literature-synthesis orientation figure, not a clinical decision-support tool.

Background: Burns result in approximately 180,000 deaths annually, with the majority occurring in rural regions of Africa and Southeast Asia. This study aimed to assess the available resources, key challenges, and potential solutions in burn care from the perspective of healthcare providers in India.

Methods: An online survey was conducted among burn care professionals across India. The survey was disseminated via social media platforms, burn care networks, and hospital representatives.

Results: A total of 105 respondents, primarily from tertiary care centers, participated in the survey. Of these, 64.2% were affiliated with government hospitals, and 40.1% served catchment areas extending beyond 300 km. Dedicated burn units were present in 88.0% of government hospitals, compared to 66.9% in non-government facilities. Treatment costs were significantly lower in government hospitals, with 88.8% offering care either free of charge or at minimal cost (p ≤ 0.00001).

Conclusions: The findings reveal significant gaps in staff training, intensive care monitoring, and infection prevention. Many patients initially seek help from traditional healers, often delaying appropriate treatment and worsening outcomes. Enhancing education, implementing standard monitoring practices, and ensuring adherence to clinical protocols are critical steps toward improving burn care outcomes in India.

(1) Background: Inhalation injury significantly worsens burn outcomes but lacks a standardized definition and diagnostic consensus, complicating prognosis. Existing diagnostic tools often show limited sensitivity and specificity, reducing clinical utility. This study aimed to identify potential clinical markers, recorded at or shortly after admission, for inhalation injury prognostication. (2) Methods: A retrospective cohort study of 59 burn patients admitted to Tygerberg Hospital's Burn Centre (South Africa) between 23 April 2016 and 15 August 2017 was conducted. Descriptive statistics were reported based on data type and distribution. Fisher's exact test, Spearman's rank correlation (rho), and partial least squares regression (VIP scores) assessed associations, correlations, and predictive value. p < 0.05 (two-tailed) denoted significance. (3) Results: Severe inhalation injury accounted for 61% of admissions (mean 11.2; CI = 9.5-12.9), with a 38.9% mortality rate. Significant associations (p ≤ 0.008) and positive correlations (p ≤ 0.06) were noted for total body surface area (rho = 0.357), complications (rho = 0.690), and burns intensive care unit length of stay (BICU LOS, rho = 0.908). Complications and BICU LOS showed the strongest predictive contributions (VIP = 1.229 and 1.372). Lactate (rho = 0.331, p < 0.011) and hoarseness (rho = -0.314, p < 0.015) correlated significantly but lacked association. (4) Conclusions: Findings suggest elevated lactate may serve as a prognostic marker, while BICU LOS and complications may reflect disease progression. A multi-marker approach is recommended.

Background: Pneumonia contributes to post-burn morbidity and mortality. Understanding the mechanisms that predispose burn patients to pneumonia is crucial to both stratifying patients at increased risk and developing targeted interventions.

Methods: A prospective observational study was conducted with 47 human patients who sustained large burn injuries with serum collected on days 2 and 3 post-burn and assessed for Angiopoietin-1 (Ang-1) and -2 (Ang-2). C57BL/6 mice were subjected to either sham injury or a 12.5% total body surface area (TBSA) scald burn injury, and plasma and lungs were assessed.

Results: Patients who developed pneumonia within 30 days of injury had higher serum Ang-2 and Ang-2/1 ratio on post-injury days 2 and 3. Similar to patient findings, we observed an increase in Ang-2 in burn mice compared to sham. Within the lungs of burn mice, we found significant increases in Tyrosine kinase with immunoglobulin and epidermal growth factor homology domains 2 (TIE2) receptor transcript Tek, downstream mediators TNFAIP3 Interacting Protein 2 (Tnip2) and phosphoinositide-3-kinase regulatory subunit 1 (Pik3r1), in addition to endothelial adhesion molecules intracellular adhesion molecule-1 (ICAM-1) and vascular cell adhesion molecule-1 (VCAM-1), along with neutrophil infiltration and markers compared to sham.

Conclusions: These findings suggest that burn injury increases Angiopoetin-2 and downstream signaling in the lungs, which may contribute to post-burn pulmonary dysfunction. Further studies are necessary to understand if modulating the Ang-TIE2 axis can protect against pneumonia post-burn.

Background: Burn patients can suffer prolonged hospital stays, infections, and wound breakdown. Given the complexity of burns, it is often difficult to determine which underlying factors contribute to complications. The Burn Care Quality Platform (BCQP) is the largest database of burn patients globally available, and it accounts for underlying or coinciding disease conditions present in burn patients. Muscle wasting conditions, such as sarcopenia, cachexia, and protein malnutrition, are suspected of causing worse outcomes. Prior analysis of BCQP data (2000-2017) demonstrated that patients with muscle wasting had prolonged hospitalization and adverse outcomes.

Methods: Building on our previous work, we extended logistic regression analysis to BCPQ data through 2022 to assess whether reporting and outcomes had changed.

Results: Updated BCQP data demonstrated a statistically significant increase in mortality in cachexia vs. non-muscle wasting patients (Odds Ratio [OR]: 2.2 [95% Confidence Interval (CI): 1.3-3.7], p = 0.004), but no increase in mortality was seen with protein malnutrition (OR: 1.1 [95% CI: 0.93-1.35], p = 0.239). However, the diagnosis rate of muscle wasting conditions decreased by 53% since the previous analysis, suggesting a potential under-reporting of these diagnoses in BCQP patients.

Conclusions: Burn care could be augmented by better diagnosis of underlying conditions that predispose to muscle wasting.

The rehabilitation of burn patients is essential and is intrinsically linked to conventional rehabilitation; the motivational challenges faced by burn patients in maintaining engagement with these rehabilitation programs are well known. It is understood that the use of other resources, particularly technological ones, associated with conventional rehabilitation could overcome these constraints and thereby optimize the rehabilitation program and health outcomes. The objective of this study is to synthesize the available evidence on the use of exergames in rehabilitation programs for burn patients. This systematic review was developed following the guidelines of the Joanna Briggs Institute (JBI). The search was conducted in the following databases: Medline^®, CINAHL^®, Sports Discus^®, Cochrane^®, and Scopus^® during May 2025. The PRISMA Checklist Model was used to organize the information from the selected studies. Seven RCTs were included, involving a total of 236 participants. Outcomes related to the use of exergames in the rehabilitation of burn patients were identified, including increased range of motion, functionality, strength, speed of movement, improved balance, reduced fear and pain, and satisfaction with the technological resource used. It is believed that the results of this review, which confirmed the advantage of using exergames, such as Nintendo Wii, PlayStation, Xbox Kinect, or Wii Fit, to optimize the functionality of burn patients, can support clinical decision-making and encourage the integration of exergames to improve rehabilitation programs for burn patients.

Background: The last decade has seen transformative changes in burn care, driven by advances in pharmacology, regenerative medicine, surgical techniques, and digital technologies. As management strategies evolve beyond survival to encompass functional and esthetic recovery, this review consolidates current evidence to inform best practice. Methods: A comprehensive narrative review was conducted using PubMed to identify peer-reviewed English-language articles from the past 10 years relevant to acute and long-term burn management. Selection focused on high-level evidence, including randomized controlled trials, systematic reviews, and meta-analyses, emphasizing novel and evolving clinical interventions. Results: Key advances include the integration of propranolol and oxandrolone for metabolic modulation; enzymatic debridement agents such as NexoBrid^®; regenerative approaches like epidermal cell sprays (e.g., RECELL^®) and dermal substitutes (e.g., Integra^®, MatriDerm^®, NovoSorb^® BTM); and innovations in scar modulation, notably fractional CO₂ laser therapy. The emergence of 3D bioprinting, and artificial intelligence further supports a shift toward precision burn medicine. Conclusions: Burn management is evolving from protocol-driven to patient-centred care, underpinned by high-quality evidence and technological innovation. The integration of systemic, local, and rehabilitative strategies is improving outcomes in survival, function, and quality of life. Ongoing challenges include cost, access, and translation of novel therapies into widespread clinical practice.

Background: Enzymatic debridement with Nexobrid (NXB) is established for burn care, but specific outcomes in the elderly remain poorly characterized. This study evaluates the safety, efficacy, and clinical outcomes of NXB in patients aged ≥65 years.

Methods: A retrospective case-series of 43 consecutive elderly patients (mean age 74.5 years) with deep partial- to full-thickness burns treated with NXB at a single burn center. Data on demographics, burn characteristics, treatment chronology, and complications were analyzed.

Results: The median total burn surface area (TBSA) was 11%. NXB was applied selectively, with a mean debrided area of 7.41% TBSA, primarily on limbs and hands. While 76.7% of patients ultimately required surgical autografting, no patient required an escharotomy in NXB-treated areas. The mortality rate was 25.6%, which was lower than expected for a median revised Baux score of 90, which is expected to be more than 50%. Hypertrophic scarring occurred in 28.1% of survivors, associated with a prolonged median healing time of 63 days.

Conclusions: In elderly burn patients, NXB facilitates precise eschar removal and reliably prevents compartment syndrome, demonstrating a strong safety profile even in high-risk individuals. Its primary benefit shifts from reducing surgical incidence to optimizing the wound bed for grafting. These findings support the use of NXB in the elderly, with the understanding that subsequent grafting is often still required due to age-related delayed healing.

Background: Critical care for patients with severe burn injuries is challenging, particularly in the first 24-48 h. Multiple guidelines exist but their recommendations vary in content and in the level of detail.

Methods: This narrative review analyzed recent (last 10 years) adult burn guidelines in English, Dutch and German, sourced from PubMed, Medline and official burn society publications. The review focused on airway management, mechanical ventilation, fluid resuscitation, pain management and procedural sedation.

Results: All guidelines emphasize early airway assessment and timely intubation in patients at risk for loss of airway patency; however, a strategy for analyzing patients at risk is lacking. Lung-protective ventilation strategy is generally recommended. Fluid resuscitation is the cornerstone during the first phase, though recommendations for thresholds, volume and adjuncts differ. (Chronic) pain management should be multimodal, combining pharmacologic and non-pharmacologic approaches, but specifics on choice of modality are limited, also, there is no uniform strategy for procedural sedation management.

Conclusion: Current guidelines offer broadly consistent recommendations for initial burn care but differ in specifics, reflecting evidence gaps. Future guidelines should address advances in airway management, fluid resuscitation endpoints, volume and adjuncts, and give a more detailed (chronic) pain strategy to improve standardization and outcomes.

Introduction: Massive burns, particularly those exceeding 90% total body surface area (TBSA), represent one of the most demanding challenges in critical care and reconstructive surgery. Advances in resuscitation, early excision, and wound coverage techniques have improved survival rates, but despite these advances, mortality remains high, and standardized treatment protocols are lacking. Case Report: We report a case which demonstrates survival and meaningful recovery in an extreme case of massive burns. A 57-year-old woman sustained 92% TBSA burns following a gas explosion at her home. She developed burn shock requiring aggressive fluid resuscitation and vasopressor support. Due to extensive burns and limited donor sites, staged debridement with temporary allograft coverage was performed, followed by Meek micrografting for definitive wound closure. After 197 days in the Burn Unit and an additional three months of rehabilitation, she regained functional independence. Conclusions: While historically considered non-survivable, burns exceeding 90% TBSA are increasingly being successfully treated with multimodal strategies. This case highlights the importance of multidisciplinary care in redefining survival expectations for massive burn patients. As burn care continues to evolve, further research is needed to refine treatment strategies, enhance long-term functional outcomes and standardize protocols for these complex cases.