Burn Care Research Articles

Needs assessment for a new military burn care educational curriculum focused on prolonged field care: The Burns for Providers Program (BP2).

We performed a needs assessment to determine the essential elements for a curriculum teaching burn care during Large Scale Combat Operations against peer/near-peer adversaries within multi-domain contested combat environments. Virtual and face-to-face site visit meetings were conducted with 20 stakeholders at 3 levels: 1) Subject Matter Experts (SMEs) in military burn casualty care at the U.S. Army Institute of Surgical Research (USAISR), the Joint Trauma System (JTS), and the U.S. Army Medical Center of Excellence (US Army MedCOE) in Joint Base San Antonio (JBSA) - Fort Sam Houston, TX; 2) Course Directors, Instructors, Curriculum Innovators and Writers for the Combat Paramedic Branch and the Critical Care Flight Paramedic Program (CCFPP) at JBSA; and 3) regulatory administrators providing education, research and IRB administration for USAISR and US Army MEDCOE. The identified terminal learning objectives consisted of training in: burn casualty monitoring and principles of burn wound care according to available resources; best practices during PCC for pain, nutrition, and infection control; specific management of inhalation, chemical, radiation, electrical, pediatric, and mass casualty burn injuries; and procedural skill training for patient decontamination, debridement, dressings, and escharotomy. Additionally, needs were identified for novel technology that provides asynchronous individual learning opportunities using interactive role play simulations, immersive simulation, or virtual reality simulation as well as hands-on procedure simulators. Stakeholder engagement resulted in identification of sixteen terminal learning objectives that were subsequently used as the basis for a military curriculum we are calling the "Burns for Providers Program" (BP2).

The effect of interhospital transfer on pediatric burn injury mortality in a resource-limited setting.

The World Health Organization's burn mortality estimate is 180,000 annually. Ninety-five percent of all mortality caused by fire-related burns worldwide occurs in low- and middle-income countries (LMICs). Prior studies have shown that transfer status (direct transfer from an injury scene to a trauma center vs. indirect transfer from another health facility) affects patient outcomes. We evaluated the effect of interhospital transfer on burn mortality. We analyzed a burn database of pediatric patients admitted to the Kamuzu Central Hospital (KCH) burn unit in Lilongwe, Malawi. We performed a bivariate analysis based on their transfer status and mortality and a logistic regression analysis to determine the effect of transfer status on mortality after burn injury. A total of 2301 patients were analyzed, with 1095 (47.6%) being in the transfer cohort from referring hospitals. The median age was 3years (IQR 1-4). The transfer cohort had more patients presenting to the hospital more than 48h after injury. Upon multivariate logistic regression, controlling for pertinent variables, including time to presentation, burn-injured patients in the transfer cohort had increased odds of mortality (OR 2.26, 95% CI 1.22-4.19, and p=0.01) compared to patients who were not transferred. The predictive probabilities of burn mortality by TBSA showed significant differences in mortality based on transfer status at TBSA between 20% and 80%. Ensuring district hospitals and other primary health care centers in resource-limited settings are sufficiently equipped to provide initial burn resuscitation and care may decrease mortality rates associated with transferred patients.

The Plastic Surgeon Intensivist—an Opportunity to Lead US Burn Care

The Plastic Surgeon Intensivist—an Opportunity to Lead US Burn Care

Transformative Biomaterials in Burn Care: Utilizing Scaffolds, Hydrogels, and Chitosan for Optimized Healing and Scar Reduction

With over a million patients per year in the USA alone, burns are among the most common injuries in the world. In addition to preventing difficulties during burn injuries, the growing impact of scaffolds, hydrogels, cell scaffolds, and cell sheets with healing boosting elements expedite triggers and strengthens re-epithelialization and wound healing, which limits the creation of scars. While superficial partial-thickness and superficial burns typically heal without surgery, severe burns require special care, including topical antimicrobial surgery or bandages. Usually composed of polymeric biomaterials, scaffolds offer the structural support needed for cell adhesion and the subsequent formation of tissue. The term "tissue engineering triad" often refers to cells, scaffolds, and growth-stimulating signals. This may be accomplished in several ways by combining different polymers. Simple (planar) 3D structures may be produced using conventional and rapid prototyping techniques, but complicated structures have been successfully produced by carefully controlling the Molds and processing parameters. For biomedical and tissue engineering applications, chitosan has been widely employed (skin, bone, cartilage, and vascular grafts to substrates for mammalian cell culture). Additionally, it is renewable, biocompatible, biodegradable, nonantigenic, bioactive, and nontoxic.

Survey about target temperature and thermal management in intensive care for severe thermal trauma in burn centres of Germany, Austria and Switzerland

Burn trauma induces hypermetabolism and alters thermoregulation resulting in elevated body temperature. Because patients with burns are prone to heat loss and hypothermia, maintaining physiologic body temperature is important. However, optimal target temperature is widely unknown because thermoregulation of burn trauma has mainly been studied in the last century when treatment concepts differed from current one. The aim of this study was to investigate current thermal management of burn treatment and to investigate the discrepancies between classical concepts of thermoregulation in burn trauma and current practice of temperature management.A paper-based survey was conducted in burn centres in Germany, Austria and German-speaking Switzerland. Participants were asked for expected temperatures, temperature goals and thermal management of severely burned patients. Results were evaluated for adults and children.37 of 38 approached burn centres participated in this survey. 59% expected that adults with burn trauma would develop hyperthermia (>37.5°C) but only 27% expected hyperthermia in children (>38°C). The average target body temperature was 37.1°C for adults and 36.9°C for children. Adults below 35.7°C and children below 36.0°C were supposed to be hypothermic. Temperatures above 38.8°C in adults and 38.7°C in children raised suspicion for sepsis. Antipyretic treatment was assumed to be justified at temperatures above 39.1°C in adults and 38.5°C in children. Although the most common warmth protective method was to increase ambient temperature, 89% of all participants felt their wellbeing was affected by an increased ambient temperature and 68% were concerned about temperature related negative effects. Although 57% of the responding centres had established a standard operating procedure for thermal management, only 41% considered the available literature to be very relevant in daily practice and 89% criticized the lack of guidelines.Limit- and target-temperatures in European burn centres are heterogeneous. Classic concepts of thermal management in burn care are not generally adopted. A majority of the centers expresses the need for specific guidelines. The basis for this should be multicentre clinical trials on temperature management in burn trauma.

Concordance of ChatGPT With American Burn Association Guidelines on Acute Burns.

Burn injuries often require immediate assistance and specialized care for optimal management and outcomes. The emergence of accessible artificial intelligence technology has just recently started being applied to healthcare decision making and patient education. However, its role in clinical recommendations is still under scrutiny. This study aims to evaluate ChatGPT's outputs and the appropriateness of its responses to commonly asked questions regarding acute burn care when compared to the American Burn Association Guidelines. Twelve commonly asked questions were formulated by a fellowship-trained burn surgeon to address the American Burn Association's recommendations on burn injuries, management, and patient referral. These questions were prompted into ChatGPT, and each response was compared with the aforementioned guidelines, the gold standard for accurate and evidence-based burn care recommendations. Three burn surgeons independently evaluated the appropriateness and comprehensiveness of each ChatGPT response based on the guidelines according to the modified Global Quality Score scale. The average score for ChatGPT-generated responses was 4.56 ± 0.65, indicating the responses were exceptional quality with the most important topics covered and in high concordance with the guidelines. This initial comparison of ChatGPT-generated responses and the American Burn Association guidelines demonstrates that ChatGPT can accurately and comprehensibly describe appropriate treatment and management plans for acute burn injuries. We foresee that ChatGPT may play a role as a complementary tool in medical decision making and patient education, having a profound impact on clinical practice, research, and education.

Identification and quantification of physical activity in critically ill burn patients: a feasibility study

BackgroundPhysical activity is essential in burn care to counteract the effects of severe burns and inactivity during hospitalization. However, detailed knowledge of performed physical activities is lacking. This study evaluated the feasibility of a dual accelerometer-based method to assess type, frequency, and duration of physical activity in critically ill burn patients during hospitalization. MethodsA prospective observational study was conducted at the burn center of the Martini Hospital, Groningen, The Netherlands. Eligible were patients with a total body surface area (TBSA) burned of ≥15% or an indication for intensive care. Patients wore two accelerometers, one on the chest and one on the diagonally opposite thigh. An algorithm converted accelerometer data into type, frequency, and duration of activities common for intensive care patients. An activity diary was used to assess non-wear time and its content, e.g., surgery. ResultsFive patients (20-60 years, 13-31% TBSA burned, LOS 30-65 days) were included. Per patient, 14-49 days (17380-61796min) could be analyzed of which 7%-14% was non-wear time. During wear-time, 86-95% of activities could be identified and quantified. However, processing the data was a labor-intensive process. ConclusionThe dual accelerometer-based method proved feasible for research purposes. For clinical application, further refinement of data-processing is required.

Management considerations in grease versus non-grease scald burns in adults: A retrospective cohort study at a tertiary burn care facility

IntroductionScald 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 MethodsA 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. ResultsOf 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) ConclusionThe 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.

Wound Pain Management: The Present and the Future

Wound pain is a common issue during wound care procedures such as dressing changes and debridement, significantly affecting patient comfort and recovery. Effective pain management is essential, not only for enhancing quality of life but also for promoting healing and minimizing complications. Factors like resting pain intensity, expected pain, and type of dressing have been identified as key predictors of severe wound pain during these procedures, helping clinicians manage pain more effectively by enabling early intervention. The Wound Pain Management Model was developed to guide healthcare professionals in managing chronic wound pain through steps like wound assessment, local treatment, and systemic management when necessary. While opioids are a common treatment, concerns over dependence and side effects have led to the exploration of alternatives. Virtual reality (VR) has emerged as a promising non-pharmacological approach, reducing pain through distraction, particularly in burn and chronic wound care. However, variability in study designs limits the current understanding of VR’s overall effectiveness. This review examines both pharmacological and non-pharmacological approaches to wound pain management, with a focus on VR. Further research with larger, more consistent studies is needed to better assess VR’s long-term benefits across different patient groups and wound types.

Topical steroid use for suppression of hypergranulation in burns: Trends across the Atlantic.

Hypergranulated wounds from thermal injury remain a complex and debilitating problem for burn patients. Currently, there is no standard therapy to prevent or treat hypergranulation following burn injury. Many centers use topical corticosteroids; however, their use seems to be geographically dependent and controversial. The primary aim of this study was to quantify the current use of topical corticosteroids for post-burn hypergranulation in North America (NA) and Europe, while secondarily assessing for perceptions of safety and efficacy. We designed a survey that was distributed to the members of the European and American Burn Associations. Data was extracted and analyzed using SPSS software. A total of 165 respondents completed the survey (90 and 75 for the European and NA members, respectively). Seventy-one of the 90 (78.9%) European respondents reported they routinely use topical steroids for suppression of hypergranulation tissue in burns, versus 25 of the 75 (33.3%) NA respondents (p<0.001). European respondents, compared to NA respondents, were significantly more likely to consider topical steroid use safe (100% vs. 74.4%, p <0.001) and effective (98.6% vs. 66.7%, p < 0.001) for treatment of hypergranulated burn wounds. There was no significant difference in reported systemic effects seen after topical steroid use when comparing NA respondents and European respondents (6.5% vs. 6.9%, p > 0.10). The results of this study suggest that the use of steroids for hypergranulation tissue in burn care is more prevalent in Europe than NA, which may be due to discordant views on safety and efficacy despite minimal reported adverse effects.

Effects of two non-drug interventions on pain and anxiety in the nursing process of burn patients: a literature review with meta-analysis.

Burns are a global health issue causing significant mortality and high medical costs. Non-pharmacological interventions such as music therapy and virtual reality (VR) therapy have shown potential in alleviating pain and anxiety in burn patients. This study systematically evaluates the impact of these interventions using a network meta-analysis. A systematic review and network meta-analysis were conducted according to PRISMA 2020 guidelines and registered in PROSPERO (CRD42024566536). Searches in PubMed, Cochrane Library, Web of Science, and Embase up to November 22, 2023, identified randomized controlled trials (RCTs) involving music therapy or VR therapy in burn patients. The Cochrane Risk of Bias Tool (2.0) assessed study quality. Data were analyzed using StataMP-64 software. Seventeen RCTs with 1,119 burn patients were included. Both music therapy and VR therapy significantly reduced pain and anxiety compared to control groups. Music therapy was more effective for pain reduction (SUCRA: 85.4%), while VR therapy was superior for anxiety relief (SUCRA: 79.5%). Music therapy and VR therapy effectively reduce pain and anxiety in burn patients. Integrating these interventions into burn care can enhance patient outcomes. Further research is needed to confirm these findings and optimize individualized treatment plans. https://www.crd.york.ac.uk/prospero/, PROSPERO (CRD42024566536).

Bromelain based enzymatic debridement in burn patients, its outcome, advantages and disadvantages

The aim of this study is to evaluate the outcomes, advantages, and disadvantages of bromelain-based enzymatic debridement in the management of burn wounds. Ours is a study in which we have selected 10 patients with deep dermal and full thickness burns admitted in SMS hospital, Jaipur. These patients underwent bromelain based enzymatic debridement applied as per the manufactures protocol. The patients were then observed for bromelain’s efficacy in debridement, wound healing, pain, duration of hospital stay, superadded bacteraemia and cosmetic outcome. Complete removal of burn eschar was observed in 9 out of 10 patients. Bromelain-based enzymatic debridement effectively removed necrotic tissue within a shorter timeframe compared to traditional methods. Patients treated with bromelain-based enzymatic debridement showed significantly faster wound healing, reduced infection rates, and lower pain levels during debridement. Improved cosmetic outcomes, such as reduced scarring and better skin texture, were also observed. Bromelain-based enzymatic debridement offers notable advantages in burn care, including expedited healing and enhanced patient comfort. Despite these benefits, the treatment's higher cost and the risk of allergic reactions are important considerations. The limited availability of bromelain-based products also poses a challenge. These factors suggest that while bromelain is a promising alternative, its use should be carefully evaluated based on individual patient needs and resource availability.

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.

Fire at Sea: A 70-year Review of Fire-Related Mass Casualty Events on U.S. Aircraft Carriers.

A major fire at sea is among the most devastating events that can occur while a U.S. Navy combatant vessel is underway. Since World War II, no attack on a large U.S. Navy capital ship has occurred during combat operations. However, increasing global tensions raise the threat of future peer adversary naval combat, and shipboard medical caregivers must be prepared for mass casualty events in the deployed maritime environment. To better prepare modern naval caregivers for this possibility, we reviewed mass casualty events from major fires aboard large U.S. Navy aircraft carriers from 1950 through 2020 to summarize available objective data and identify lessons learned. Underway fires from any cause aboard U.S. Navy aircraft carriers and large amphibious assault ships causing more than 10 casualties (injuries + deaths) were reviewed from 1950 through 2020 using available open access sources including literature review, the Naval Safety Command mishap database, and U.S. Navy Judge Advocate Manual reports. Of 246 fires identified, 27 met inclusion criteria resulting in 1,634 casualties with a combined crew mortality of 23% of those injured. In the 16 events with at least 1 death, 2.0% of the total crew was injured with a combined mortality of 28%. All mishaps occurred while underway during routine training or combat operations; none were caused by an enemy combatant attack. Those events affecting more than 5% of the crew were particularly devastating resulting in a mortality rate of 29% of 1,056 total casualties. Given that main medical spaces may be damaged or destroyed during major fires from any cause, identified lessons learned included the need for (1) distributed medical supplies, (2) flexible medical treatment locations throughout the ship, (3) specific training to prepare non-physician caregivers and non-medical first responders to provide burn and hemorrhagic shock resuscitation, airway management, and prolonged care at or near the point of injury, and (4) the prolonged holding capability of critically ill burned and injured patients if evacuation off the ships is unavailable. Shipboard fires underway pose a significant threat to crew safety with a mortality of nearly a quarter of those injured. These fire mass casualty events immediately overwhelm shipboard medical capabilities requiring a complex response from all hands beginning with non-medical first responders. Notably, all events occurred outside of direct enemy combat, potentially underestimating the impact and number of casualties of a shipboard fire during naval combat. Advances in peer weaponry and the threat of future conflict emphasize the need for pre-deployment burn care training for all shipboard medical caregivers as well as advanced airway and resuscitation training for non-physician caregivers. This review underscores the profound impact of shipboard fires on crew safety, highlighting the critical need for enhanced preparedness and response strategies to prepare for fire-related mishaps during routine operations and naval combat.

The 2023 American Burn Association Research and Advocacy Summit: Our Roadmap.

Research is one of the American Burn Association's (ABA) strategic priorities. Advocacy is required not only to promote burn research, but also, the ABA's other strategic priorities (Prevention, Quality, and Education). The ABA convened a two-day Research and Advocacy (R&A) Summit in September 2023, to develop a roadmap for the organization's research and advocacy efforts. The in-person summit identified fourteen key R&A initiatives. A multidisciplinary workgroup then developed strategies to achieve each initiative. The initiatives and strategies were then approved by the ABA's Board of Trustees as our organization's roadmap for research and advocacy. The next task will be to implement the initiatives. This will require not only oversight from the ABA's Board of Trustees, but also, effort from and collaboration between several of the ABA's committees and panels, including the Burn Science Advisory panel (BSAP), the Research Committee, the Prevention Committee, The Governmental Affairs Committee, The Organization and Delivery of Burn care Committee, the Quality and Burn Registry Committee, the ad hoc Coding Committee, and the ABA's Central Office.

Rare but Relevant: Characterizing Self-Inflicted Burn Injuries in the United States.

Self-inflicted burns (SIBs) represent a distinct entity in burn care often associated with an underlying psychiatric etiology. In this review, we summarize the existing evidence on SIBs in North America to inform targeted prevention and interventions for patients afflicted with SIBs. The following databases were queried to identify relevant articles used for literature review: PubMed, Embase, and Scopus. The main outcome measures were burn characteristics and risk factors of SIBs in the American population. A total of 14,189 patients were included across 13 included studies. The percent of total body surface area burned ranged from less than one to 100%, with a mean of 29.6 +/- 20.7%. Depressive disorders were the most reported overall; however, among mood disorders, bipolar disorder was also reported frequently, while anxiety was reported least. Motives for self-inflicting burn injury included premeditated self-injury as a coping mechanism, escape or response to delusions, impulsive self-injury, and most commonly, suicidal intention. The majority of the studies reported that pre-admission drug and alcohol abuse were associated with the occurrence of SIBs. Other identified risk factors for SIB injury included female sex, younger age, unemployment, and unmarried status. From this, it is imperative that targeted interventions are developed to address the complex interplay of psychiatric disorders, drug use, and other demographic risk factors among the American population. It is crucial for initiatives to emphasize early identification of individuals at-risk of self-harm, better access to mental health services, and stronger drug abuse programs to target SIB occurrence in the U.S..

The influence of Muscle Wasting on Patient Outcomes among Burn Patients: A Burn Care Quality Platform Study.

The hypermetabolism that occurs after large burns leads to muscle wasting that can result in weakness, difficulty fighting infections, and other challenges to healing. Overall, rates of muscle wasting are not well established across burn centers. The Burn Care Quality Platform (BCQP), the largest available dataset on burn patients globally, was used to explore the rate of Muscle Wasting using data collected from more than 100 burn centers. "Muscle Wasting" was defined from relevant ICD codes (sarcopenia, muscle cachexia, protein malnutrition). Binomial and logistic regression were used to analyze the role of Muscle Wasting in burn mortality and other outcomes after controlling for demographic and comorbid characteristics. In total, the BCQP provided data from 84,438 adult and pediatric burn patients injured between 2000-2018. Only 2.6% (N=2,159) of the patients in the BCQP were diagnosed with having Muscle Wasting at some point during their admission. While Muscle Wasting was not associated with a statistically significant impact on mortality, it remained an independent predictor of inability to discharge to independent living, longer inpatient days, as well as an average of 10 additional surgical procedures (P<0.001 for all) as compared to patients who did not have Muscle Wasting. Muscle Wasting is an independent risk factor for several adverse outcomes in burn patients, but not mortality in the BCQP. Confidence in these findings would be improved with more accurate data collection, as the diagnosis of Muscle Wasting is likely under-reported, under-diagnosed, or both.

The role of machine learning in the improvement of physician-nurse relationships when the management of burn patients: A narrative review

In recent years, machine learning (ML) has emerged as a transformative technology in healthcare, providing significant advancements in patient care and management. Burn care, which necessitates comprehensive and coordinated efforts due to the severe and multifaceted nature of burn injuries, particularly benefits from ML's capabilities. This literature review investigates how ML enhances the collaboration between physicians and nurses in managing burn patients. In the present study, significant findings show that ML's predictive analytics can predict patient outcomes and complications, helping with proactive care strategies. ML-driven decision support systems offer real-time, evidence-based recommendations, ensuring consistent care approaches. In addition, ML-powered virtual simulations improve training and comprehension of roles, while advanced electronic health records (EHR) systems streamline documentation and information sharing. Continuous quality improvement is supported by ML's data-driven insights, leading to improved patient monitoring and management. Ultimately, integrating ML in burn care significantly improves physician-nurse collaboration, resulting in better patient outcomes. This includes reduced infection rates and shorter hospital stays. This highlights the vital role of ML in transforming healthcare delivery and professional collaboration in managing complex conditions like burn injuries.

What Outcomes Matter Most to Paediatric Burn Patients and Their Caregivers: A Comparison of Short-Term and Long-Term Priorities

Identifying outcomes that matter most is key in driving specialized paediatric burn care. The aim of this study was to discover the most important outcomes for paediatric burns. Parents of children (0–3 year and 4–11 years old) and adolescents (12–17 yearss old) completed surveys to identify outcomes that matter most in the short-term (&lt;6 months postburn) and long-term (6–24 months postburn). The percentage of patients scoring an outcome as ‘very important’ was used to rank the outcomes. Fifty-four parents/adolescents participated (response rate: 27%). Children had a median TBSA burned of 5.0% (IQR: 2.0–7.0%). In the short-term, ‘good wound healing’ and ‘no wound infection’ (both at 71.4–100%) were very important for all children. ‘Not having pain’ (90.3–93.8%) was ranked highest for children ≤11 years old, whereas ‘walking or moving around’ (85.7%) was most important for older children. In the long-term, more variation was seen in outcome priorities; however, both ‘not having pain’ (53.6–85.7%) and ‘flexibility of scar(s)’ (60.7–71.4%) were considered very important by all three groups. Patient- and parent-derived priorities are important for developing consumer-centric, highest-value care pathways. The priority of the outcomes identified is a starting point to discuss treatment options and recovery priorities in a family-centric approach to guide high-value, individualized care.

Outcomes of dermal substitutes in burns and burn scar reconstruction: A systematic review and meta-analysis.

Dermal substitutes have been introduced in burn care to improve wound healing outcomes; however, their use remains limited in standard treatments. This systematic review and meta-analysis aimed to evaluate the outcomes of dermal substitutes in patients with burns and patients requiring burn scar reconstruction and subsequently contribute to optimising the integration of dermal substitutes into clinical practice and reducing the knowledge gap. A comprehensive search across various databases included human studies from peer-reviewed journals on dermal substitutes for deep dermal and full-thickness burns, and scar reconstruction across all ages. Data from comparative trials were extracted, focusing on patient and wound characteristics, treatment specifics, and outcomes related to wound healing and scar quality. Meta-analysis was performed on trials reporting similar post-burn measures, with statistical heterogeneity assessed. Outcomes were presented using mean differences or odds ratios with 95% confidence intervals. A total of 31 comparative trials were included. The overall quality of the studies was considered moderate. The meta-analysis indicated delayed re-epithelialization 4-7 days after treatment with a collagen-elastin matrix compared to split-thickness skin graft in acute burns (-7.30%, p = 0.02). Significant improvement in subjective scar quality was observed with acellular dermal matrix compared to split-thickness skin graft in acute burn wounds 6 months post-operative (-1.95, p <0.01). While acknowledging the initially delayed wound healing, incorporating dermal substitutes into the surgical treatment of burn patients holds promise for enhancing scar quality. However, future research must prioritise outcome measure uniformity, address variations in dermal substitute application, and standardise indications for consistent and effective practices.