European burn journal最新文献

National Burns Care Standards (NBCS) within the UK recommend psychological care throughout the burn pathway and psychosocial screening of inpatients admitted for over 24 h, at a time when this is clinically appropriate and prior to discharge. This brief report presents preliminary data from an audit of psychosocial screening in adult burns inpatients within a Scottish Burns Unit over a three-year period. Results are reported on the frequency and type of psychosocial screening completed. Differences between the groups of inpatients who were screened and those not screened are presented and discussed with a focus on plans for increasing the number of inpatients screened and improvements in how psychosocial screening data is collected.

Ethnic inequalities exist across healthcare, including access to and experiences and outcomes of mental health services. Access to and engagement with burns clinical psychology services is essential for all patients. This study aimed to explore the ethnic diversity of adults referred to a burns clinical psychology service compared to those admitted to the burns service. It also aimed to investigate associations between ethnicity and indicators of access and engagement (receiving, declining or not attending psychological assessments, receiving psychological therapy and the number of therapy sessions completed). Routinely collected data over eight years were analysed. Analysis revealed an association between ethnicity and referral to the burns clinical psychology service. Patients from White British and Other ethnic backgrounds were less likely to be referred, whereas patients from Black and Asian ethnic groups were more likely to be referred. There were no statistically significant associations between ethnicity and receiving, declining or not attending psychological assessments or receiving psychological therapy. Furthermore, there was no statistically significant difference in the number of psychological therapy sessions received between the ethnic groups. Therefore, patients from ethnic minority groups did not appear to have significant difficulties engaging with the service but further research is recommended.

While thermal injuries to the external genitalia occur less often than burns to the trunk and extremities, such injuries can potentially leave patients with devastating lifelong sequelae. Though much is known about treating burns in commonly exposed areas of the body, there is a lack of agreement concerning the management of genital thermal injuries. In this review, we seek to synthesize the past and existing literature into a clear analysis while reviewing current recommendations and new developments in the management of genital thermal injuries of the penis and scrotum. Specifically, recommendations for managing genital burns are discussed, including the role of urinary and fecal diversion, debridement, use of skin grafts, and flap coverage choice. Finally, less common thermal injuries, such as frostbite of the genitalia, are discussed.

Inhalation injury is a major contributor to mortality following burn injury. Despite recognised clinical criteria to guide the intubation of burn patients, concerns remain regarding overutilisation of intubation. Complications can arise as a result of intubation, including ventilator-associated pneumonia (VAP). This study reviews the indications for intubation against the internationally accepted criteria (American Burns Association (ABA) and Denver criteria) for burn patients treated at the Royal Adelaide Hospital (RAH) burns unit between 2017 and 2020. Burn patients who were intubated on arrival to the RAH or in a pre-hospital setting were identified using the BRANZ database. Indications for intubation were compared to the ABA and Denver criteria. A total of 61 patients were identified with a mean total body surface area of 17.8%. A total of 95% of patients met one of the ABA and Denver criteria. The most common ABA and Denver criteria for intubation was deep facial burns or singed facial hair, respectively. Most adult patients with burns admitted to the RAH are intubated per published criteria. Early nasoendoscopy/bronchoscopy may be useful in determining patients who can be safely extubated within 48 h.

Burns and scarring are considered some of the greatest problems in public health because of their frequent occurrence. Today, photo-electric technology shows promising results in the treatment of burn scars. Over the years, more clinical trials and more technologies for scarring have emerged. The aim of this study was to determine better timing and methods of photo-electric therapy for burn scars. This study was registered in PROSPERO (CRD42023397244), following the PRISMA statement, and was carried out in concordance with the PRISMA checklist. In October 2022, we searched PubMed.gov, Embase, and the Cochrane library (1980-present) for published studies related to the photo-electric treatment of burn scars. Two review authors independently selected the studies, extracted the data, assessed the risk of bias among the studies included, and carried out NIH assessments to assess the certainty of the evidence. A third review author arbitrated any disagreements. Our research included 39 studies. We found evidence suggesting that photo-electric therapy between six months and one year offers significantly better outcomes than treatment of scarring after one year. The evidence also suggests the use of IPL for the treatment of early burn scarring. However, it is important to emphasize that the scientific evidence remains insufficient. We need more clinical trials of higher quality and with less heterogeneity to confirm our results.

Background: There is little evidence regarding the efficacy of Regenerative Epidermal Suspension (RES™) management for paediatric partial-thickness burns. The Biobrane^® RECELL^® Autologous skin Cell suspension and Silver dressings (BRACS) Trial evaluated three dressings for the re-epithelialisation of partial-thickness burns in children.

Methods: Eligible children (age ≤ 16 years; ≥5% TBSA; ≤48 h of injury) were randomised to silver dressings, RES™/Biobrane^® or Biobrane^®. The measured outcomes were the time to re-epithelialisation (primary outcome), pain, itch, intervention fidelity, treatment satisfaction, health-related quality of life, health resource utilisation and adverse effects.

Results: The median time to re-epithelialisation in days was no different for RES™/Biobrane^® at 12 (IQR: 5.6-18.4; n = 7) and slower by two days for Biobrane^® at 14 (IQR: 6.3-21.7; n = 7) when compared to silver dressings 12 (IQR: 3.7-20.3; n = 8). Reduced pain, fewer infections, no sepsis, no skin graft, and the lowest impact on health-related quality of life were reported in the RES™/Biobrane^® group compared to other groups. Due to the COVID-19 pandemic, recruitment suspension resulted in a smaller cohort than expected and an underpowered study.

Conclusions: The pilot trial findings should be interpreted cautiously; however, they indicate that a fully powered randomised controlled trial is warranted to substantiate the role of RES™ for medium to large paediatric partial-thickness burn management.

Burn injuries are commonly treated with split-thickness skin grafting. However, low expansions offered by spilt-thickness skin grafting inhibit the treatment of large and severe burn injuries when limited donor skin is available. To overcome this gap, in this work, it was attempted to study the expansion potential of skin grafts with novel auxetic incisions with rotating rectangle (RR), honeycomb (HC), alternating slit (AS), H-shaped (HS), Y-shaped (YS), and I-shaped (IS) unit cells, through development of skin graft simulants. Clinically relevant biaxial load testing was conducted to estimate the stress-strain response, void area, and meshing ratio. Moreover, hyperelastic constitutive models were employed to characterize the non-linear biomechanical behavior of the skin graft simulants. The maximum void area increase was observed in the HS skin graft simulant, indicating low skin cover. Overall, the IS auxetic skin graft design exhibited meshing ratio higher than traditional grafts (>3:1), low void area and stresses, which can be beneficial for large skin cover and burn wound healing. With further optimization and clinical tests, the auxetic skin graft designs may find a place with the graft manufacturers for fabrication of grafts with better surgical outcomes for severe burn injuries.

The British National Burn Care Standards highlight the importance of routine psychosocial screening to optimise psychological well-being following burn injury. Routine screening enables clinicians to identify those who may benefit from further psychological intervention. In this case, we outline how active follow-up from routine psychosocial screening and early intervention supports psychological recovery from a burn injury and how multidisciplinary care can be incorporated into cognitive therapy for post-traumatic stress disorder. This case also illustrates how psychologists are well positioned within physical healthcare to notice themes arising in patient care and use this to inform service development, for example, through staff training.

Background: Frailty can have a negative influence on outcomes in elderly patients after burn injuries. The Dutch hospitals have used a four-domain frailty screening instrument from the Dutch Safety Management System (DSMS) since 2012. However, its feasibility and validity have hardly been studied. We aim to assess the feasibility and validity of frailty screening in specialized burn care. Methods: A multicentre retrospective cohort study was conducted in all Dutch burn centres. Patients aged ≥ 70, with a primary admission between 2012-2018, were included. Data were derived from electronic patient files. Results: In total, 515 patients were included. Frailty screening was complete in 39.6% and partially complete in 23.9%. Determinants for a complete screening were admission after 2015 (OR = 2.15, 95% CI 1.42-3.25) and lower percentage TBSA burned (OR = 0.12, 95% CI 0.05-029). In all completely screened patients, 49.9% were at risk of frailty. At risk patients were older, had more comorbidities (known group validity), a longer length of stay, and more frequently a non-home discharge (predictive validity). Conclusion: Frailty screening in specialized burn care is feasible and was conducted in 63.5% of admitted patients. In total, 44% of screened patients were at risk of frailty. Validity of frailty screening was confirmed. Frailty screening can contribute to optimal specialized burn care.

Background: Use of intravascular warming catheters following major burns has been shown to be effective to maintain normothermia, but their use may be associated with complications. The aim of this study was to determine what proportion of patients with an intravascular warming catheter developed a potentially catheter-related venous thromboembolism (VTE) and to identify contributing risk factors. Methods: This was a retrospective cohort study of patients admitted to the Victorian Adult Burns Service January 2013 to July 2018 with major burns (TBSA > 20%) who had an ICY^TM intravascular warming catheter. Warming catheter insertion and other details were identified with a manual search of the patients' medical records by a single author while incidence of VTE was determined by the coding department from a central database. Results: Forty patients had an intravascular warming catheter inserted during the study period. The number of patients in the catheter group that sustained a VTE was eight (20%), of which four (10%) could have been catheter-related due to the anatomical location. In the cases of the four potentially catheter-related VTE, other preventable VTE risk factors including suboptimal prophylactic anticoagulation (n = 2), prolonged catheter duration (n = 1) and prolonged haemoconcentration (n = 2) were identified. Conclusions: We found 20% of major burns patients with an intravascular warming device had significant VTE; however, only half of these may have been related to the catheter. A careful assessment for each patient that balances risks and benefits should be undertaken prior to using intravascular warming devices.