Body Surface Area Burn Research Articles

Quality of Life Assessment Four Years after a More than Ninety Percent Total Body Surface Area in Two Survivors with Burns: Case Report.

There are few reports in the literature detailing the Quality of Life (QOL) of survivors with greater than 90% total body surface area (TBSA) burns. The objective was to assess two such individuals seen at our center with the Burn Specific Health Scale-Brief (BSHS-B) survey four years after discharge. Subject responses were categorized into their respective BSHS-B health domains (heat sensitivity, affect, hand function, treatment regimens, work, sexuality, interpersonal relationships, simple abilities, and body image) and a raw score was calculated for each domain. Lower scores indicated a greater perceived decrease in QOL. The nine domains of BSHS-B survey questions were further separated into three categories: physical (hand function, work, simple abilities), treatment (treatment regimens and heat sensitivity), and psychosocial (interpersonal relationships, affect, body image, sexuality). The psychosocial category had higher scores and better outcomes, while the physical and treatment ones had lower scores and worse outcomes compared to the other categories. For both individuals, interpersonal relationships and simple tasks domains were considered important in their QOL, while work, heat sensitivity and hand function received lower scores. Family support, intense physical rehabilitation, and psychosocial management were crucial during the postoperative and follow-up periods.

Clinico-demographic profile of burns in the Middle-East and North-Africa (MENA) region: a systematic review and meta-analysis

Burn injuries remain a public health issue with risk of mortality and multiple post-burn morbidities. This article aims to systematically review and meta-analyse data about burns in the Middle-East and North-Africa (MENA) region. Methods Pubmed, Web of Science, Scopus, Global Index Medicus, Cochrane Library and Google scholar data were searched from their dates of inception till April 2024. Results One hundred and one studies were included in this review, representing data from twelve countries in the region. Data was sub-grouped into two groups: pediatric group and emergency room (ER) group. The pooled random-effect estimates were male gender 58.6% [95% CI 56.9–60.2%], accidental injury 91.1% [95% CI 85.9–94.5%], scald burn 50% [95% CI 46.7–53.4%], at home injury 79.9% [95% CI 76.7–82.8%], upper limbs involvement 51.7% [95% CI 46.8–56.6%], mean body surface area burned (BSAB) 17.2% [95% CI 14.69–19.84%], second-degree burns 56.5% [95% CI 49–63.8%], length of stay 11.18 days [95% CI 9.68–12.68%] and mortality rate 9.1% [95% CI 7.5–11%]. All included studies were of good quality. Conclusion This review shows scarcity of studies from many countries in the MENA region. These data will inform policy makers and burn specialists about the extent of this public issue in the region.

Pediatric Burn Care for Burn Injury: Outcomes by Timing of Referral Using a U.S. Single-Center Retrospective Cohort, 2005-2019.

Burn centers offer specialized care to pediatric patients with burn injuries. However, data about outcome in relation to timing of transfer are limited. We examined these timings and outcomes among burn-injured pediatric patients. Single-center, retrospective cohort study of U.S. national and international practice. Shriners ESO Trauma Burn Registry, 2005-2019. Patients 0-17 years old admitted to a pediatric burn center with 10-80% total body surface area (TBSA) burn between 2005 and 2019. None. The cohort of 761 patients was subcategorized according to timing of referral: early presentation (EP) (0-7 d), delayed presentation (DP) (8-60 d), and very delayed presentation (VDP) (> 60 d). Primary outcomes included hospital length of stay (LOS), ICU LOS, percent TBSA (%TBSA)/LOS ratio, mortality, and disposition. Dichotomous outcomes were analyzed using logistic regression and continuous outcomes were compared using median regression, both utilizing multivariable analysis adjusting for a priori confounders and presented as adjusted coefficients (ACs) with 95% CI. Delayed referral (DP and VDP) was associated with higher %TBSA burn and with fewer referrals from high-income countries. Compared with EP, VDP was associated with higher LOS/%TBSA (AC, 0.2 [0.01-0.4]). On univariate analysis, in comparison with EP, DP and VDP were associated with higher ICU (DP 16 [6-29]; VDP 8 [0-18]) and hospital LOS (DP 34 [21-55]; VDP 32 [18-58]). Overall, ten of 761 patients died (1.3%), and we found no association between timing of referral and mortality. Also, in 751 survivors, 635 patients (84.6%) were discharged home without home health, and we found no association with timing of referral on multivariable analysis. In this report, we have reviewed our single-center, international burn-injured pediatric cohort, operating in the United States (2005-2019). We find that referral with VDP as opposed to EP was associated with increased LOS/%TBSA.

Central Venous Catheter Use in Burn Patients: Complications and Preventive Measures

Summary: The use of a central venous catheter (CVC) is essential in the management of burn patients, especially due to the difficulty of venous access, the length of hospitalization, and the need for routine fluid replenishment and medication administration, particularly antibiotics. Aim of the study: The aim of this study is to identify the rate of complications associated with central venous catheters in the context of burn patients to discuss its indications and the benefit/risk ratio. Methods: This descriptive retrospective study was conducted in the Plastic Surgery Department of CHU Mohamed VI in Marrakech, involving patients who received a central venous catheter during their admission to the burn unit from March 2023 to March 2024. Data collection included basic demographic data, comorbidities, burn mechanism, burn depth, percentage of burned body surface area (BSA), central catheter location (subclavian, femoral, jugular), the site (healthy/burned), the duration of catheter placement, complications (infection and venous thrombosis), detection of germs during culture, and the length of hospital stay. Results: Infection and venous thrombosis were identified as the most frequent complications of CVC use. Further research is needed to evaluate the role of regular CVC changes (every 10 to 15 days after insertion) in preventing infections and to establish a clear anticoagulation protocol for preventing deep vein thrombosis (DVT). Conclusion: While CVCs can be a valuable resource in the treatment of burn patients, they are associated with significant risks, some of which may be life-threatening. The duration of CVC placement should be minimized, and blood cultures (preferably from the CVC tip) should be systematically sent after 10 days or at the first suspicion of complications to reduce the incidence and severity of CVC-related infections.

Evaluation of a National Sample of 16,671 Pediatric Burn Admissions: Identifying Predictors of Non-accidental Pediatric Burns

BackgroundBurn injuries remain one of the leading causes of injury and death in children. Studies have demonstrated a higher mortality for pediatric burns associated with non-accidental injury. Using data from a burn registry, our study aimed to discern potential factors associated with non-accidental burn injuries. MethodsWe utilized the American Burn Association database from 2016 to 2018, which collects data from over one hundred burn centers across the United States, to evaluate a large pediatric burn population. Patients aged ≤14 years were analyzed. The population was then divided into suspected non-accidental versus accidental burn injuries. A multivariable logistic regression model was utilized to evaluate for predictors of burn injuries. Additional models were used to assess the relationship between suspected non-accidental burn injury and mortality, intensive care unit (ICU) stay, and hospital length of stay. Results16,671 pediatric patients were included. Of those, 1228 (7.4%) patients suffered non-accidental burn injury. A majority of children who sustained non-accidental burn injury were younger, non-white, and sustained scald burns. The regression model demonstrated predictors for non-accidental burn injuries included younger age, Black race, chemical/corrosion burns, government insurance, and increased total body surface area (TBSA) burn. Overall mortality for the population was 0.5%. ConclusionThis evaluation of a national burn registry reveals differences in pediatric patients sustaining non-accidental burns compared to accidental burns. The findings in this study identify pediatric populations at risk for suspected non-accidental burn injuries which may assist in preparing the families for expectations after admission for a burn injury. Level of EvidenceIII.

A multi-centre prospective cohort study investigating the roles of psychological flexibility and self-compassion in appearance concerns after burn injuries.

Appearance concerns following burn injuries are common. Psychological factors are important in maintaining such concerns. However, there is a lack of longitudinal or prospective research investigating their development. This study investigated whether psychological flexibility and self-compassion at hospital admission predicted subsequent appearance concerns. A multi-centre prospective cohort study across six burn services. Adults (n = 175; 67% male) in hospital following burn injuries were recruited. Questionnaires measuring appearance concerns, psychological flexibility, self-compassion, post-traumatic stress disorder symptoms and perceived noticeability were completed during hospital admission and two- and six-months later. Demographic and burn injury information was collected. Correlational analyses showed that increased psychological flexibility and self-compassion at admission were associated with decreased appearance concerns cross-sectionally and prospectively at two- and six-month follow-up. These associations remained significant when controlling for key covariates (i.e. gender, age, ethnicity, percentage total body surface area burnt, perceived noticeability, PTSD symptoms). Multiple linear regression analyses revealed that psychological flexibility and self-compassion predicted appearance concerns during hospital admission. Although psychological flexibility significantly predicted appearance concerns over time, it became non-significant when controlling for baseline appearance concerns. Psychological flexibility has a protective role against appearance concerns soon after burn injuries, although this protective role is reduced when accounting for baseline appearance concerns. Early interventions targeting psychological flexibility (i.e. acceptance and commitment therapy) may be beneficial after burns if adapted to address appearance-related concerns.

Burn Injury Severity in Adults: Proposed Definitions Based on the National Burn Research Dataset.

Previous iterations of burn severity (mild, moderate, and severe) were not data-driven and were outdated. Clustering analyses have gained popularity for identifying homogenous subgroups from heterogeneous medical conditions, such as asthma, sepsis, and lung disease. There is no consensus in burn literature regarding what constitutes massive burns. The current classification includes a 20% total body surface area (TBSA) burn and a 95% TBSA burn as severe. Latent class and hierarchical clustering analyses were applied to the American Burn Association National Burn Research Dataset. Cluster variables included length of stay, length of stay, intensive care unit length of, number and type of procedures, and number and type of complications. Non-clustering variables were evaluated after clustering, including burned TBSA, inhalation injury, mortality, discharge disposition, age, sex, and race. Latent class analysis suggested three clusters. Hierarchical clustering analysis was applied to the most severe latent class, creating four total burn severity groups. In total, 112,297 patients were included in the final analysis. The mean TBSA burned for each class is 4.26±4.91 for minor, 8.07±8.39 for moderate, 22.76±17.31 for severe and 36.72±21.61 for massive. The age and sex proportions were similar among all clusters. The clustering variables steadily increased for each severity cluster. Mortality was the highest in the massive cluster (18.2%). Data informed categories of burn severity were formed using clustering analyses, which will be helpful for triage, data-benchmarking, and class-specific research.

Exercise and Heat Stress in Well-Healed Burn Survivors: Effects of Cooling Modalities on Thermal and Perceptual Responses.

Burn injuries that require grafting impair thermoregulation, which may dissuade individuals with such injuries from being physically active. We tested the hypothesis that cooling modalities attenuate core temperature elevations and perceptions of heat stress during physical activity in the heat among adults with well-healed burn injuries. Adults with no burn injuries (non-burned), 20-40% body surface area burn injuries (moderate burn), and > 40% body surface area burn injuries (large burn) performed 1 hour of moderate intensity exercise (2.5 ± 0.2 mph and 2% grade) on four different occasions in two environmental conditions (30 °C & 39 °C, 40% relative humidity). Within each environmental condition, we applied one of the following cooling modalities, random assigned, for each visit: no cooling (control), fan at 4 m/s (fan), water spray every 5 min (water spray; scaled to burn area size), or a combination of water spray + fan. In 30 °C, perceptual strain index (PeSI) was reduced in the non-burned and moderate burn groups with water spray + fan, whereas PeSI was reduced with all cooling modalities in the large burn group. The cooling modalities did not affect core temperature responses. In the 39 °C environment, water spray and water spray + fan attenuated the elevation in core temperature (p ≤ 0.007) only in the large burn group. In the moderate burn group, PeSI was decreased with water spray + fan (p = 0.017). In the large burn group, both water spray alone and water spray + fan (p ≤ 0.041) lowered PeSI. For both environments across burn groups, the applied cooling modalities were generally more effective at reducing indices of perceptual strain relative to indices of thermal strain (e.g., core temperature).

Burn Injury in Obesity: Examination of the Burn Care Quality Platform’s (BCQP) Available Data on Obese Patients to Determine Burn Related Outcomes

IntroductionLiterature examining the impact of obesity in burn injury remains mixed. Previous examination of the National Burn Repository, now the BCQP, in obesity-related burn research is limited. The aim of this work was to provide an assessment of the BCQP dataset to examine the effect of obesity on burn-related outcomes. Materials and MethodsA retrospective review of the BCQP dataset from 2015-2018 was conducted. The primary outcome measure was mortality. Secondary outcomes included overall length of stay (LOS), ICU LOS, and total hospital costs. Patients were grouped as obese or non-obese and further stratified by total body surface area burn (TBSA) size for comparison purposes. Multiple logistic regression (MLG) was used to compare the effect of several independent variables on mortality, ICU LOS >7days, hospital LOS >10 days and total hospital costs >$200,000. ResultsOf 41,031 patients in the analysis, 3,845 (9.37%) were obese. Obese patients had a higher mean TBSA (p=0.01), longer overall LOS (p<0.001), ICU LOS (p<0.001) and total hospital costs (p<0.001). MLG found obesity to an independent predictor of ICU LOS >7 days, hospital LOS >10 days and total hospital costs >$200,000. Obesity was not an independent predictor of mortality in burn patients even stratified by burn size. ConclusionsThe presence of obesity in this dataset was not found to be a predictor of mortality for any burn size, but was a predictor of overall LOS, ICU LOS, and total hospital costs. Including obesity-related parameters in databases may improve analysis in obesity-related burn research.

Epidemiological characteristics and outcomes of special-cause burns: analysis of 33,619 burn patients in a major regional burn center in China from 2004 to 2021

Special-cause burn injuries are usually more severe and difficult to manage, and often contribute to a high mortality in severely injured patients. The aim of this study was to present the epidemiological characteristics of special-cause burn in a major regional burn center in China between 2004 and 2021 and determine the risk factors associated with the mortality of burn patients. A total of 33,619 burn patients were included the study, among which 4,452 (13.2%) were special-cause burn patients. Compared to the thermal burn group, the special-cause burn patients were usually male, elder, married and III-IV degree of burn with onset of upper extremity in summer and autumn. Moreover, a greater proportion of patients in the special-cause burn group underwent surgical treatment and amputation and had a higher median hospital stay and treatment costs. During the multivariate logistic regression, older age, male, unmarried, winter, III-IV degree of burn, ≥ 3 burn sites, and larger total body surface area (TBSA) of burn were significantly associated with higher burn mortality (all P < 0.05), however, patients with special-cause burn injuries have not increased odds for mortality (P > 0.05). These results suggested that special cause-burn patients suffer more severe injuries, resulting in longer hospital stays and higher health care expenditures, but it did not significantly increase the mortality risk. Therefore, burn clinicians should not only have the responsibility to cure burns, but also need to know and popularize burn epidemiological characteristic and precaution.

Clinical and Epidemiological Profile of Deep Second Degree Burn Patients Treated with Platelet Lysate

The wound healing process in burn victims is still a problem today despite the advances made in the management of these patients with the different resuscitation regimens, the advent of antibiotic therapy as well as the different local treatments used. The local application of a high concentration of growth factor through the use of halogenic platelet concentrates lyzed by freezing- thawing has been done in the past with the aim of accelerating the healing process of the various wounds. The aim of this work is to describe Clinical and epidemiological profile of deep second degree burn patients treated with platelet lysate. A longitudinal and prospective study was carried out in 30 adult patients with deep second-degree burns with boiling water with a burned body surface area ≤ 5%, treated locally with allogeneic platelet lysate in the Burn centre and Plastic Surgery Service of the General Hospital “Dr. Juan Bruno Zayas Alfonso” in Santiago de Cuba, during the period of February 2015 to February 2016.A total of 30 adult patients have been studied. The mean age was 33.93. Female sex predominated with a male/female ratio of 1/2. The most frequent location of burns was in the lower limbs accounting for 36.6% of patients, followed by the upper limbs and anterior trunk at 26.7% in both cases. For the study group, the epitelization time was less than 21 days and in the majority of cases (66.7%) this time was 7-13 days. Non-relevant side effects were observed in 80% of patients and included pruritus (50%), perilesional erythema (8.3%) and pain in 29.2% of patients. Apart from these side effects, no complications have been observed in our patients. The promising results reported in this study and in the literature warn that platelet lysate may become a potential therapeutic candidate for deep second- degree burns from boiling water.

Serum procalcitonin and C-reactive protein as indices of early sepsis and mortality in North Indian pediatric burn injuries: a prospective evaluation and literature review.

Delays in diagnosing sepsis in children afflicted with thermal injuries can result in high morbidity and mortality. Our study evaluated the role of the biomarkers Procalcitonin (PCT) and C-reactive protein (CRP) as predictors of early sepsis and mortality, respectively, in this group of patients. This was a prospective evaluation of 90 pediatric burn cases treated at a tertiary care burn center in Northern India. Patients, aged 1-16 years, presenting within 24 hours of being burned, with >10% body surface area of burn injury were included in the study. Levels of PCT and CRP were measured on days 1, 3, 5, and 7. Patients were followed until discharge, 30th post-burn day, or death, whichever occurred first. Sepsis was clinically present in 49 of 90 (54.4%) cases with a median 30% total body surface area (TBSA) of burns. Mortality was seen in 31 of 90 (34.4%) cases with a median of 35% TBSA burns. High PCT and CRP were seen in the sepsis group, particularly on days 3, 5, and 7. PCT was also significantly higher in the mortality group (days 1 and 3). While PCT was a good early predictor of sepsis and mortality in children with burns, CRP was reliable as a predictor of sepsis only. Both markers, however, can serve as adjuncts to culture sensitivity reports for diagnosing early onset sepsis and initiation of antibiotic therapy in appropriate patients.

Effectiveness of Autologous Skin Cell Suspension in Large Total Body Surface Area Burns: Analysis of Clinical Outcomes and Patient Charges

Abstract Autologous skin cell suspension (ASCS) is an adjunct to conventional split-thickness skin grafts (STSG) for acute burns, enhancing healing and reducing donor site requirements. This study validates ASCS’s predictive benefits in hospital stay reduction and cost savings by analyzing outcomes and real-world charges post-ASCS implementation at a single institution. A retrospective study (2018-2022) included burn patients with ≥10% TBSA. The study population comprised 2 groups: burns treated either with a combination of ASCS ± STSG or with STSG alone. Outcomes included LOS, surgeries, infection, complications, days on antibiotics, and adjusted charge per TBSA. The ASCS ± STSG group demonstrated significantly shorter LOS (Mdn: 16.0 days, IQR: 10-26) than the STSG group (Mdn: 20.0 days, IQR: 14-36; P = .017), and fewer surgeries (Mdn: 1.0, IQR: 1-2) versus the STSG group (Mdn: 1.0, IQR: 1-4; P = .020). Postoperative complications were significantly lower in ASCS ± STSG (11% vs. 36%; P &amp;lt; .001). The STSG group had a longer distribution of antibiotic days (IQR: 0-7.0, min–max: 0-76) than the ASCS ± STSG group (IQR: 0-0, min–max: 0-37; P = .014). Wound infection incidence did not differ (P = .843). ASCS ± STSG showed a lower distribution of adjusted charge per TBSA (IQR: $10 788.5-$28 332.6) compared to the STSG group (IQR: $12 336.8-$29 507.3; P = .602) with a lower mean adjusted charge per TBSA ($20 995.0 vs. $24 882.3), although this was not statistically significant. ASCS ± STSG utilization demonstrated significant reductions in LOS, surgeries, postoperative complications, antibiotics, and potential cost savings. These findings underscore the practicality of integrating ASCS in burn management, offering substantial benefits to patients and healthcare institutions.

AN AUTOPSY-BASED STUDY ON THE PATTERNS OF INJURIES OF BURN CASES IN JORHAT DISTRICT, ASSAM

Objective: This autopsy-based study aimed to determine the incidence of burn-related fatalities in Jorhat District, Assam, identify associated factors, investigate injury patterns and severity, explore contributing factors, examine the relationship between injuries and cause of death, differentiate between dermo-epidermal and deep burns, investigate circumstances surrounding burn injuries, and offer recommendations for prevention and forensic investigation improvements. Methods: Data were collected from medico-legal autopsies conducted at the Mortuary of the Department of Forensic Medicine, Jorhat Medical College and Hospital, Jorhat, between May 11, 2020, and May 10, 2021. Demographic information, burn characteristics, autopsy findings, and circumstances of injuries were analyzed. Results: Out of 628 medico-legal autopsies, burn-related deaths comprised 7.32% of cases. Victims with 51–60% total body surface area burns were most common (23.91%). Burns often occurred indoors, notably in kitchens (56.52%) and bedrooms (26.08%), with a majority in closed rooms (54.35%). Synthetic (47.82%) or cotton (41.30%) clothing was prevalent, and kerosene was common in alleged suicidal cases (23.92%). Most victims died within 24 h (43.46%), primarily due to shock (52.17%), and septicemia (45.65%). Dermo-epidermal burns were prevalent (93.47%), and deaths were mainly accidental (65.21%). Histopathological analysis revealed dermis and epidermis separation (82.60%), flattened and elongated epithelial cells (73.91%), congestion (76.09%), leukocyte infiltration (73.91%), capillary dilatation (67.39%), and edema (67.39%). Conclusion: This study provides comprehensive insights into burn injury characteristics, circumstances, and consequences. Recommendations include preventive measures and improvements in forensic investigation practices related to burn injuries, offering valuable implications for health care, forensic medicine, and public awareness initiatives.

Precision Medicine Approach Using Triple Combination Antifungal Therapy for Fusarium Brain Abscesses and Endocarditis in an Adult Burn Patient.

We report a management strategy for disseminated Fusarium solani fungal infection in an adult 35% total body surface area burn patient with brain abscesses and concomitant pulmonic valve endocarditis resulting in the longest survival reported in a burn patient. Early in his hospital course, the patient was diagnosed with a Fusarium burn wound infection with concomitant fungemia and was treated with a prolonged course of intravenous (IV) antifungal monotherapy. Shortly thereafter, he developed focal neurologic deficits and was found to have brain abscesses on MRI. He underwent emergent craniotomy with debridement, and triple antifungal therapy was initiated. Transesophageal echocardiography demonstrated pulmonic valve vegetations, which resolved with triple antifungal therapy. Disseminated Fusarium solani infection is quite rare with mortality approaching 100%. Given the rarity of this disease process, there are no established antifungal treatment guidelines. However, this patient survived for approximately 1 year after diagnosis with treatment including source control via craniotomy and debridement coupled with prolonged courses of combination antifungal therapy (given the near pan-resistance of his fungal infection). Pharmacogenomic testing was utilized to establish the patient's metabolism of voriconazole and dosing adjusted accordingly to improve the efficacy of the combination therapy. To our knowledge, an adult burn patient surviving this length of time after Fusarium brain abscesses with disseminated infection has not been previously described.

Diagnosis and Management of Orbital Compartment Syndrome in Burn Patients - a Systematic Review.

Orbital compartment syndrome is a poorly understood complication of acute burns. The purpose of this systematic review is to summarize the literature describing orbital compartment syndrome in burn patients to provide greater detail on risk factors and guide management of this morbid condition. A systematic review of the PubMed, Embase, and Cochrane Library databases was performed in June 2023 according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Study quality was assessed using two validated scoring systems. After removing duplicates, 303 unique articles were reviewed and 8 met inclusion criteria. All publications were retrospective. Most studies considered intraocular pressure >30-40mmHg as diagnostic for orbital compartment syndrome. Sixty unique cases of orbital compartment syndrome were reported. Orbital compartment syndrome occurred most frequently within 24 hours post-burn. The mean total body surface area of burn was 58.7%; the mean 24-hour resuscitation volume was 6.01 cc/kg/%total burn surface area; and 86.5% of cases had periorbital burns. Surgical decompression always started with lateral canthotomy. When pressures were not immediately reduced, cantholysis was performed. Study quality per Median Newcastle Ottawa Scores ranged from 38.9% to 94.4% (median 66.7%). A precise threshold for surgical decompression of OCS remains conflicted; however, IOP>30-40mmHg warrants intervention. Burn surgeons/intensivists should be aware of the risk factors for this vision-threatening complication and act appropriately.

Outpatient Follow Up and Reconstructive Surgery Rates in Massive Burn Survivors: Investigating the Social Determinants.

Burn care continues to improve and larger total body surface area (TBSA) burn survival is increasing. These survivors require more extensive care than smaller burns and are at higher risk for wound/scar related complications. Prior work has shown low rates of follow up for burn survivors linked to socioeconomic factors such as housing insecurity and substance use. There are limited studies that evaluate socioeconomic factors that contribute to follow up and reconstructive surgery rates in massively burned patients. Patients that survived to discharge with >50% TBSA burns and planned return to treating institution were included in the study. Univariate and multivariate analyses were performed on the data collected. Sixty-Five patients were included with an average TBSA of 63.1%. Fifty-three patients (81.5%) attended at least one follow up appointment with median of four follow-up appointments. Younger patients (33±9 vs 44±11; p=0.0006), patients with larger TBSA burns (65±13 vs 55±5%; p=0.02), those with private insurance and those without housing insecurity (1.8% vs 45.4%; p=0.003) were more likely to follow up. On multivariate regression analysis, patients with housing insecurity were independently associated with lack of follow up (OR: 0.009 CI: 0.00001-0.57). Thirty-five patients had at least one reconstructive surgery and 31 patients had reconstructive surgery after discharge. No patients with housing insecurity underwent reconstructive surgery. Follow up rates in massive burns were higher than reported for smaller TBSA burns and more than half received reconstructive surgery. Housing insecure patients should be targeted for improved follow up and access to reconstructive surgery.

Intraluminal release of citrullinated histone 3 from various cellular origins coincides with microvascular thrombosis in burn wounds.

Loss of perfusion in the burn wound might cause wound deepening and impaired healing. We previously showed persistent microvascular thrombosis coinciding with intraluminal neutrophils extracellular traps in human burned skin. This study investigates the presence of intraluminal citrullinated histone 3 (H3cit) from different cellular origins (neutrophils, monocytes, and lymphocytes) in relation to microvascular thrombosis of burn wounds. Eschar was obtained from burn patients (n = 18) 6-40 days postburn with a mean total burned body surface area of 23%. Microvascular presence of tissue factor (TF), factor XII (FXII) and thrombi was assessed by immunohistochemistry. Intramicrovascular cell death was analyzed via immunofluorescent microscopy, combining antibodies for neutrophils (MPO), monocytes (CD14), and lymphocytes (CD45) with endothelial cell markers CD31 and H3cit. Significantly increased microvascular expression of TF, FXII, and thrombi (CD31+) was found in all eschar samples compared with control uninjured skin. Release of H3cit from different cellular origins was observed in the lumen of the dermal microvasculature in the eschar tissue 7-40 days postburn, with release from neutrophilic origin being 2.7 times more abundant. Intraluminal presence of extracellular H3cit colocalizing with either MPO, CD14, or CD45 is correlated to increased microvascular thrombosis in eschar of burn patients.

13 Thromboelastographic Coagulation Assessment in Burn Patients Receiving Plasma Inclusive Resuscitation

Abstract Introduction As resuscitative strategies in burn patients are re-evaluated, a consensus has not been reached on the role for colloids, as lactated ringers remain the fluid of choice with variable use of colloids. Colloids, such as fresh frozen plasma (FFP), may be effective at maintaining oncotic pressure, resupplying coagulation factors, mitigating coagulopathy, and treating the endothelium. This work aims to characterize the coagulation profile of burn patients treated with plasma inclusive resuscitation (PIR) using rapid thromboelastography (rTEG) by comparing it to burn patients primarily resuscitated with crystalloids alone. Methods Patients admitted to a regional burn center who had greater than 20% total body surface area (TBSA) burns that received PIR were included in the study. Patients admitted with burn injuries and resuscitated primarily with lactated ringers were included in the comparison group. Demographic data and blood samples were collected at 4 time points: baseline, before FFP, immediately following the initial unit of FFP, and following the completion of consecutive units of FFP. Samples collected from patients that received LR only were approximated to the FFP group time points. Coagulation parameters were measured using rTEG in blood samples. Descriptive analysis was used to compare demographic and burn injury characteristics at admission. A mixed effects model was used to compare the two groups through the observation period overall and at each time point. Results There were 35 patients in the FFP group and 15 patients in the comparison group. The groups were primarily male (74.3% vs 73.3%), and there was no difference in demographics, TBSA (34.0% (27.0-48.5) vs 33.0% (26.5-46.5, p=0.82)), Baux score, inhalation injury, and mortality rate (28.6% vs 26.7%, p=0.99). Major coagulation markers of rTEG (k, α-angle, MA, and ly30) were not different between these groups and were within normal ranges. The R time in the crystalloid group was greater than the normal range at all 4 time points. There were significant differences in R time at pre-FFP (30.0(25.0-32.5) secs vs 48.0 (36.0-54.0) secs, p&amp;lt; 0.001) and after all units (27.5(20.9-33.8) secs vs 48.0(48.0-54.0) secs, p&amp;lt; 0.0001) when compared to the FFP group where R time was in the normal range. Conclusions Plasma inclusive burn resuscitation did not result in hypercoagulability or changes in lysis when compared to patients primarily resuscitated with crystalloids. The elevated R time in the crystalloid group, which was not seen in the FFP group, may be due to the lack of replenishment in coagulation factors that FFP would provide. Further understanding of PIR’s role in the inflammatory response is needed to evaluate its impact during resuscitation. Applicability of Research to Practice Plasma inclusive resuscitation may be another tool to treat the multifactorial nature of burn shock and burn induced coagulopathy.

Evaluating the Effects of Food Deserts and Food Swamps in an Urban Burn Patient Population.

Poverty is a known risk factor for burn injury and is associated with residency in food deserts and food swamps. Our aim was to determine the prevalence of residency in food deserts and food swamps and to investigate the relationship between food environment, comorbidities, and wound healing in patients with burns. We performed a retrospective chart review of all patients with burns aged ≥ 18 seen in the emergency department or admitted to the burn service at an American Burn Association-verified urban academic center between January 2016 and January 2022. Patient GeoIDs were used to classify residency in food deserts and food swamps, and comorbidities and demographics were recorded. A subset of patients with <20% total body surface area burns who underwent single-operation split-thickness skin grafting was identified for wound healing analysis. A total of 3063 patients were included, with 206 in the heal time analysis. In total, 2490 (81.3%) lived in food swamps and 96 (3.1%) lived in food deserts. Diabetes, hypertension, and tobacco smoking were more prevalent in food swamps than in food deserts or good access areas. While there was no significant effect of the food environment on wound healing, diabetes was associated with longer healing times. Most patients with burns reside in food swamps, which are associated with a higher prevalence of hypertension, diabetes, and smoking. The food environment was not significantly associated with wound healing. Not having diabetes was associated with a shorter time for wound healing.