Burn Dressings Research Articles

The impact of an open-label design on human amniotic membranes vs. silver sulfadiazine dressings for second-degree burns: a randomized controlled clinical trial

BackgroundBurn wounds require optimal medical management due to associated psycho-emotional and socioeconomic impacts and severe pain. The use of synthetic and biological dressings improves healing and reduces burn wound complications. The present study aimed to compare the outcomes of using human amniotic membrane (hAM) dressings and conventional silver sulfadiazine (SSDZ) ointment dressings in the management of second-degree burn wounds.MethodsFifty patients who participated in this clinical trial were divided into two groups via simple randomization. All the enrolled patients, who had burnt in the last 24 h, had thermal damage mechanisms and were suffering from less than 20% second-degree heat-burn wounds on the skin surface. The target group (n = 25) was treated with hAM, and the control group (n = 25) was treated with SSDZ ointment. The researcher-designed checklist was used to determine the clinical performance in the follow-up assessments on days 7, 14, and 30.ResultsNo significant differences were detected in terms of sex, age, or percentage of burn wounds (p > 0.05). Wound epithelialization at days 7, 14, and 30, scar formation, wound pigmentation, pain severity, analgesia requirements, and hospital stay length (on day 30) were significantly lower in the target group (treated with hAM) than in the control group (treated with SSDZ ointment) (p < 0.05). However, treatment costs in the target group ($170) were significantly higher than those in the control group ($71) (p < 0.001).ConclusionDespite its higher cost, hAM, as a technology-based therapy dressing, demonstrates superiority over SSDZ ointment in terms of wound healing and pain management.

Analgesic Use of Virtual Reality for Burn Dressing Changes in Low- and Middle-income Countries: A Feasibility Study.

The paucity of pain management options in resource-limited settings is a significant and systemically unaddressed problem. To improve global health equity, it is important to bridge this gap in care without introducing the peril of opioid dependence. We present a proof-of-concept case series wherein virtual reality (VR) was successfully used to manage discomfort in patients undergoing burn dressing changes in sub-Saharan Africa. Nine patients presenting with burn injuries of variable severity underwent routine stabilization and dressing as part of standard-of-care treatment. During dressing changes, a VR intervention consisting of the Dream Flight interactive game displayed on an Oculus Quest 2 headset was offered to patients. Patient mood scores were collected before VR initiation and at the conclusion of the dressing change by a translator using the Youth Feelings Scale. There were no adverse events associated with use of the VR headset and no patients elected to terminate the VR during their procedure. Patients and physicians subjectively reported satisfaction with the device's utility in the procedure. Before VR initiation, the 95% confidence interval for patient mood score was 4.89 ± 1.725. After VR initiation, the 95% confidence interval for patient mood score was 8.78 ± 1.40. Our results of this proof-of-concept case series to suggest both feasibility of use and positive influence on patient discomfort and periprocedural satisfaction. We propose that VR should be explored as an analgesic alternative and/or adjunct to narcotics in resource-limited countries, particularly for high-pain, low-duration procedures.

Comparative Study of Single and Coaxial Electrospun Antimicrobial Cross-Linked Scaffolds Enriched with Aloe Vera: Characterization, Antimicrobial Activity, Drug Delivery, Cytotoxicity, and Cell Proliferation on Adipose Stem Cells and Human Skin Fibroblast.

The preparation of materials with application in the biomedical field needs to attend some characteristics such as biocompatibility, nontoxicity, adequate mechanical properties, and the ability to mimic the extracellular matrix. Scaffolds for use in cell culture were prepared based on gelatin, polylactic acid (PLA), aloe vera mucilage, and tetracycline. Fibers were prepared in single and coaxial configuration and then cross-linked with glutaraldehyde saturated vapor. The fibers were obtained with cylindric morphology and changed to ribbon morphology and porous membranes, similarly to the extracellular matrix, when cross-linked. Membranes prepared by coaxial electrospinning showed core-shell structures when observed by transversal images, which is beneficial for controlled drug release. Characterization techniques such as scanning electron microscopy, thermogravimetric analysis, and Fourier transform infrared spectroscopy demonstrated the cross-linking due to the increase in diameter, formation of imine groups, and improvement of thermal stability. Antibiotic release tests showed that the prevalent release mechanism is diffusion and can be controlled considering the encapsulation effect, when fibers are prepared with a coaxial configuration, increasing the drug release time, making it a suitable material for controlled release. The biological evaluation of the scaffolds was carried out in two cell lines: mammalian adipose stem cells (ASCs), used as a primary cell culture, and Detroit 548 human skin fibroblasts as a dermal cell model. Aloe vera enriched scaffolds showed better activity in contact with both cell lines, exhibiting cell viability values greater than 90% and favorable results in live-dead assays when no damaged cells were observed. Cell proliferation was evaluated using Detroit 548 human skin fibroblast on gelatin-based scaffolds by the staining of the adhered cells; the images showed good confluence and morphology of the cells on the aloe vera and antibiotic loaded membranes for both of the studied configurations. Antibiotic loaded membranes presented antimicrobial activity against S. aureus, and this behavior increased when aloe vera is included. According to the results, the scaffolds prepared on single configuration enriched with aloe vera and tetracycline could be used in dermal tissue engineering as burn dressings, diabetic foot apposite, and skin substitutes, and the scaffolds prepared with a coaxial configuration are recommended for controlled release systems of antibiotics as treatments for chronic wounds such as diabetic foot and burn healing.

Effect of Virtual Reality Glasses on Pain During Burn Dressing

Objective: The study was conducted as a randomized controlled experimental study in order to determine the effect of virtual reality glasses on pain during burn dressing in inpatients and outpatients in the burn unit. Methods: The research was carried out in the Burn Unit of Izmir Bozyaka Training and Research Hospital between July and August 2021. The sample size was 60 patients who were selected by random sampling and consented to take part in the study. The cohort was divided into 30 in the experimental group and 30 controls. The patients in the experimental group wore virtual reality glasses with vision and sound before the dressing started. The patients in the control group underwent routine burn dressing. Sociodemographic Data Questionnaire and Numerical Pain Scale were used to collect data. Results: The pain scale mean score of the experimental group (4.17±1.60) was significantly lower than the mean score of the control group (6.17±1.58) (p=0.000). Conclusion: The use of virtual reality glasses during burn dressing, which is usually a very painful procedure, reduced patient perception of pain. It is recommended that the application be started to be used on a regular basis in the burn unit.

Spreadable thermosensitive nanocomposite hydrogel dressing with ultrasound-responsive bactericidal/repair-promoting regulation and cascade antioxidantion for infected burn wound repair

Treating severe burn wounds poses significant challenges, including considerable cell loss, excessive inflammation, and a high susceptibility to bacterial infections. Ideal burn dressings should exhibit excellent antibacterial properties, anti-inflammatory effects, and promote cell proliferation. Additionally, they need facilitate painless dressing changes and be user-friendly. Herein, we synthesized a thermosensitive hydrogel by crosslinking poly (N-isopropylacrylamide-co-allyloxybenzaldehyde) (PNA) and amino-terminated Pluronic F127 (APF) through a Schiff base reaction. It exhibited reversible gel-sol transition and spreadability. By incorporating piezoelectric gold nanoparticle-modified barium titanate (Au@BaTiO3) and cascade antioxidant MOF-818, a nanocomposite hydrogel dressing with diverse bioactive functionalities was developed. Results demonstrated that the nanocomposite hydrogel possessed gel-sol transition properties, maintained a stable gel state within a broad temperature range, and desirable self-healing property. Au@BaTiO3 exhibited good piezoelectric properties and ROS generation upon ultrasound stimulation, while MOF-818 displayed highly efficient cascade nanozyme activity. The combination of Au@BaTiO3 and MOF-818 promoted fibroblast proliferation and migration, reduced intracellular ROS levels, and induced anti-inflammatory polarization of macrophages under ultrasound stimulation. In vitro and in vivo antibacterial results disclosed that the nanocomposite hydrogel had excellent antibacterial activity under high-intensity ultrasound stimulation. When applied to infected burn wounds, the nanocomposite hydrogel can rapidly sterilize the wound upon initial high-intensity ultrasound, and then reduce inflammation and promote M2 macrophage polarization by the following low-intensity ultrasound stimulation, and thus accelerating the healing by improving granulation tissue formation, angiogenesis, and collagen deposition.

Effect of Applying Virtual Reality Glasses as A supportive Intervention to Reduce Pain, Anxiety and Fear of Children during Burn Dressing.

Effect of Applying Virtual Reality Glasses as A supportive Intervention to Reduce Pain, Anxiety and Fear of Children during Burn Dressing.

725 Satisfaction of Patient, Burn Nurse/Tech and Anesthesia Provider for Monitored Anesthesia Care Burn Dressing Change

725 Satisfaction of Patient, Burn Nurse/Tech and Anesthesia Provider for Monitored Anesthesia Care Burn Dressing Change

A novel, reverse-phase-shifting, thermoreversible foaming hydrogel containing antibiotics for the treatment of thermal burns in a swine model – A pilot study

BackgroundThis study compared a novel topical hydrogel burn dressing (CI-PRJ012) to standard of care (silver sulfadiazine) and to untreated control in a swine thermal burn model, to assess for wound healing properties both in the presence and absence of concomitant bacterial inoculation. MethodsEight equal burn wounds were created on six Yorkshire swine. Half the wounds were randomized to post-burn bacterial inoculation. Wounds were subsequently randomized to three treatments groups: no intervention, CI-PRJ012, or silver sulfadiazine cream. At study end, a blinded pathologist evaluated wounds for necrosis and bacterial colonization. ResultsWhen comparing CI-PRJ012 and silver sulfadiazine cream to no treatment, both agents significantly reduced the amount of necrosis and bacteria at 7 days after wound creation (p < 0.01, independently for both). Further, CI-PRJ012 was found to be significantly better than silver sulfadiazine (p < 0.02) in reducing bacterial colonization. For wound necrosis, no significant difference was found between silver sulfadiazine cream and CI-PRJ012 (p = 0.33). ConclusionsCI-PRJ012 decreases necrosis and bacterial colonization compared to no treatment in a swine model. CI-PRJ012 appeared to perform comparably to silver sulfadiazine. CI-PRJ012, which is easily removed with the application of room-temperature water, may provide clinical advantages over silver sulfadiazine.

Recent progress of electrospun nanofibers as burning dressings.

Burns are a global public health problem, which brings great challenges to public health and the economy. Severe burns often lead to systemic infection, shock, multiple organ failure, and even death. With the increasing demand for the therapeutic effect of burn wounds, traditional dressings have been unable to meet people's needs due to their single function and many side effects. In this context, electrospinning shows a great prospect on the way to open up advanced wound dressings that promote wound repairing and prevent infection. With its large specific surface area, high porosity, and similar to natural extracellular matrix (ECM), electrospun nanofibers can load drugs and accelerate wound healing. It provides a promising solution for the treatment and management of burn wounds. This review article introduces the concept of burn and the types of electrospun nanofibers, then summarizes the polymers used in electrospun nanofiber dressings. Finally, the drugs (plant extracts, small molecule drugs and nanoparticles) loaded with electrospun burn dressings are summarized. Some promising aspects for developing commercial electrospun burn dressings are proposed.

Evaluation of pain associated with the application of burn dressings.

Topical wound care after burn injury has revolutionized burn care. Dressings and topical solutions provide broad-spectrum antimicrobial coverage to prevent wound infection, be easy to apply and remove, and promote wound healing. A wide variety of dressings are available for providers to choose from based on wound characteristics. An additional factor to consider when making that decision is any pain associated with applying the dressing and frequency of dressing changes. This retrospective study aimed to examine the daily and maximum pain reported by patients and daily opioid consumption to determine if there are any differences among commonly used dressings including 5% sulfamylon solution (SMS), manuka honey, negative-pressure wound therapy (NPWT), silver sulfadiazine, and silver nylon. This study demonstrated that silver sulfadiazine had lower mean daily pain scores compared only to manuka honey as well as lower maximum scores when compared to all other dressings except silver nylon. Furthermore, the choice of dressing did not have an overwhelming effect on the amount of opioids consumed by patients during their hospital stay with manuka honey having less opioid consumption when compared to only 5% SMS and NPWT only. Further studies are needed with additional validated pain assessment tools and clinically relevant endpoints to fully elucidate the impact of burn dressings and other topical wound care options on pain.

Study of the Mechanical Properties of Gelatin Films with Natural Compounds of Tamarix hispida

In this work, an extract of the Tamarix hispida (TH-10) was prepared in 10 vol.% water-ethanol solution. Based on the properties of antioxidant, and anti-inflammatory activity, various gelatin films containing (10–15 wt.%) gelatin were obtained. The fabricated gelatin films containing TH-10 extract were used as wound dressings for burns. Their deformation properties, physical and mechanical properties, and SEM micrographs were defined. An additional film structure was determined by using a Fourier transform infrared spectrometer (FT-IR). The strength of polymer films containing TH-10 depends on gelatin content. This indicates that the gelatin film binds the TH-10 with the help of hydrophobic interactions. It was found that the higher amount of gelatin leads to lower tear resistance of films. This is due to the formation of micro-cracks on the surface of films leading to their easy rupture. During the study of tensile strength, it was proven that the optimal amount of glycerin in the film is 5 vol.%. The polymer film containing 12 wt.% gelatin and 1 wt.% TH-10 was recognized as the most effective composition in terms of strength and elasticity properties for application as wound dressing materials.

Cellulose-Based Metallogels-Part 3: Multifunctional Materials.

The incorporation of the metal phase into cellulose hydrogels, resulting in the formation of metallogels, greatly expands their application potential by introducing new functionalities and improving their performance in various fields. The unique antiviral, antibacterial, antifungal, and anticancer properties of metal and metal oxide nanoparticles (Ag, Au, Cu, CuxOy, ZnO, Al2O3, TiO2, etc.), coupled with the biocompatibility of cellulose, allow the development of composite hydrogels with multifunctional therapeutic potential. These materials can serve as efficient carriers for controlled drug delivery, targeting specific cells or pathogens, as well as for the design of artificial tissues or wound and burn dressings. Cellulose-based metallogels can be used in the food packaging industry to provide biodegradable and biocidal materials to extend the shelf life of the goods. Metal and bimetallic nanoparticles (Au, Cu, Ni, AuAg, and AuPt) can catalyze chemical reactions, enabling composite cellulose hydrogels to be used as efficient catalysts in organic synthesis. In addition, metal-loaded hydrogels (with ZnO, TiO2, Ag, and Fe3O4 nanoparticles) can exhibit enhanced adsorption capacities for pollutants, such as dyes, heavy metal ions, and pharmaceuticals, making them valuable materials for water purification and environmental remediation. Magnetic properties imparted to metallogels by iron oxides (Fe2O3 and Fe3O4) simplify the wastewater treatment process, making it more cost-effective and environmentally friendly. The conductivity of metallogels due to Ag, TiO2, ZnO, and Al2O3 is useful for the design of various sensors. The integration of metal nanoparticles also allows the development of responsive materials, where changes in metal properties can be exploited for stimuli-responsive applications, such as controlled release systems. Overall, the introduction of metal phases augments the functionality of cellulose hydrogels, expanding their versatility for diverse applications across a broad spectrum of industries not envisaged during the initial research stages.

Principles for the use of modern wound dressings&#x0D; for local treatment of limited borderline burns

Aim of the review to analyze the principles of the use of wound dressings for limited borderline burns.&#x0D; We have made an attempt to systematize the use of wound dressings depending on the state of the wound surface, the stage of the wound process. The proposed system simplifies the selection of the dressing and increases the chance for optimal treatment leading to positive clinical results.

Larval therapy vs conventional silver dressings for full-thickness burns: a randomized controlled trial

BackgroundThis is the first clinical trial to investigate the effectiveness of maggot debridement therapy (MDT) for full-thickness burn injuries in comparison to conventional silver dressings.MethodsThirty-one cases with full-thickness (grade III based on ICD-10 classifications version 2019) burns were assigned into larval therapy (15 cases) and conventional treatment (16 cases) groups. Participants in the MDT group have received loose larvae on days 0, 2, 4, and 6, while controls received a conventional regimen comprised of sharp debridement, silver sulfadiazine, antibiotic therapy, and offloading every day. The primary and secondary outcomes were defined as the time to debridement (from admission to skin autograft) and time to healing (from admission to complete healing post-skin autograft). Patients in two groups were also compared in terms of necrosis resolution, granulation, and granulation/necrosis (g/n) ratio during study time periods.ResultsParticipants who received larvae had significantly decreased necrosis on days 2 (p = 0.028) and 4 (p = 0.023) compared to those who received control treatment. Significant differences (p < 0.001) were also observed for granulation between the two groups in favor of MDT and the fold changes of g/n in the larvae group were 5, 15, and 13 times higher than that for the conventional regimen on days 2, 4, and 6 of treatment, respectively. Strikingly, a subgroup analysis of high necrotic burns (necrosis > 50%) revealed a significant improvement (p < 0.001) for MDT compared to the control treatment. There were also significant differences (p < 0.001) for the time to debridement and time to healing between the two groups. However, bacterial contamination did not show significant changes between the two treatment regimens.ConclusionsOur findings revealed that MDT has a favorable superiority over conventional regimen for the treatment of grade-III burns, and thus further clinical trials with larger sample size are warranted to confirm these results.

Versatile Hydrogel Dressings That Dynamically Regulate the Healing of Infected Deep Burn Wounds.

Severe burns threaten patient lives due to pain, inflammation, bacterial infection, and scarring. Most burn dressings that are commonly used perform a single function and are not well suited for the management of deep burns. Therefore, a multifunctional antimicrobial peptide- and stem cell-loaded macroporous hydrogel that can fight bacterial infection and regulate wound healing progression by temporally regulating cytokine production by internal stem cells is developed. The macroporous skeletal hydrogel is manufactured via the cryogenic gelation of hyaluronic acid (cryogel). Based on the oxidative polymerization reaction of dopamine, the antimicrobial peptide DP7 is immobilized on the surface of the cryogel (DA7CG). Placental mesenchymal stem cells (PMSCs) are then packaged inside the macroporous hydrogel (DA7CG@C). According to the results of in vitro and in vivo experiments, during the inflammatory phase, DP7 inhibits infection and modulates inflammation; during the proliferative phase, DA7CG@C accelerates the regeneration of skin, blood vessels, and hair follicles via internal stem cells; and during the remodeling phase, DA7CG@C contributes to extracellular matrix remodeling due to the ability of DP7 to regulate the paracrine secretion of PMSCs, synergistically promoting scar-free healing. DA7CG@C can participate in all phases of wound healing; therefore, it is a promising dressing for burn treatment.

Biopolymer conjugation with phytochemicals and applications

Abstract Sustainable and intelligent solutions are required to address the issues brought about by anthropogenic activity and the restricted availability of resources. Every nation is attempting to use each product from a natural resource in a necessary way in light of the current rise in environmental awareness. The bio-based biopolymers can be made from bacteria, animals, or plants. Biopolymers are a diverse class of compounds that are either produced by biological systems or synthesized from biological resources. Biopolymers are categorized as biodegradable and nonbiodegradable. Based on origin, they are further classified as being either bio based or fossil fuel based. Recently, biopolymers have gained immense recognition in different areas of biomedical field such as wound healing, burn dressing, tissue engineering, and fungal infection. These biodegradable polymer composites are effective at containing and releasing bioactive medications, such as probiotics, enzymes, pharmaceuticals, and nutraceuticals. Moreover, medicinal plants, a rich source of phytochemicals have been extensively used for their various therapeutic activities since ancient times and are being steadily providing the basis in modern drug delivery systems. There has been a lot of interest in the detection, separation, and use of dietary phytochemicals that may enhance human health and act as natural pigments, antioxidants, or antimicrobials well-being by preventing chronic illnesses like cancer, diabetes, obesity, and cardiovascular disorders. However, the delivery of these compounds for enhanced efficacy requires a rational approach. Therefore, the present chapter discuss about various sources of biopolymer, challenges, their construction mechanism, and their conjugation with phytochemicals as well as their applications.

Supramolecular hybrid hydrogels as rapidly on-demand dissoluble, self-healing, and biocompatible burn dressings.

Despite decades of efforts, state-of-the-art synthetic burn dressings to treat partial-thickness burns are still far from ideal. Current dressings adhere to the wound and necessitate debridement. This work describes the first "supramolecular hybrid hydrogel (SHH)" burn dressing that is biocompatible, self-healable, and on-demand dissoluble for easy and trauma-free removal, prepared by a simple, fast, and scalable method. These SHHs leverage the interactions of a custom-designed cationic copolymer via host-guest chemistry with cucurbit[7]uril and electrostatic interactions with clay nanosheets coated with an anionic polymer to achieve enhanced mechanical properties and fast on-demand dissolution. The SHHs show high mechanical strength (>50kPa), self-heal rapidly in ∼1min, and dissolve quickly (4-6min) using an amantadine hydrochloride (AH) solution that breaks the supramolecular interactions in the SHHs. Neither the SHHs nor the AH solution has any adverse effects on human dermal fibroblasts or epidermal keratinocytes in vitro. The SHHs also do not elicit any significant cytokine response in vitro. Furthermore, in vivo murine experiments show no immune or inflammatory cell infiltration in the subcutaneous tissue and no change in circulatory cytokines compared to sham controls. Thus, these SHHs present excellent burn dressing candidates to reduce the time of pain and time associated with dressing changes.

ARAG, an Antioxidant-Rich Gel, Shows Superiority to Mepilex Ag in the Treatment of Deep Partial Thickness Burns without Sacrificing Antimicrobial Efficiency.

Current treatments for deep tissue burns are limited, and most serve only to enhance hydration or prevent bacterial growth. This leaves burn healing dependent on slow natural processes to debride the wound and reestablish the epidermal and dermal layers of the skin. Infections are well known to destabilize this process through a variety of mechanisms, most notably through increased inflammation and the resulting oxidative stress. In this study, we show that ARAG (an antioxidant-rich antimicrobial gel) can suppress the growth of multiple bacteria commonly found to infect burns (Klebsiella pneumoniae, Proteus vulgaris, Pseudomonas aeruginosa, and Staphylococcus aureus). This inhibition is comparable to that conferred by silver ion release from burn dressings such as Mepilex-Ag. We further show, using a porcine model for deep partial-thickness burns, that ARAG allows for enhanced wound healing over Mepilex-Ag, the current standard of care. Histological findings indicate this is likely due to increased wound debridement and dampening of late inflammatory processes, leading to more balanced physiologic healing. Taken together, these findings show promise for ARAG as a superior alternative to the current standard of care.

Transforming Wound Management: Nanomaterials and Their Clinical Impact.

Wound healing is a complex process that can be further complicated in chronic wounds, leading to prolonged healing times, high healthcare costs, and potential patient morbidity. Nanotechnology has shown great promise in developing advanced wound dressings that promote wound healing and prevent infection. The review article presents a comprehensive search strategy that was applied to four databases, namely Scopus, Web of Science, PubMed, and Google Scholar, using specific keywords and inclusion/exclusion criteria to select a representative sample of 164 research articles published between 2001 and 2023. This review article provides an updated overview of the different types of nanomaterials used in wound dressings, including nanofibers, nanocomposites, silver-based nanoparticles, lipid nanoparticles, and polymeric nanoparticles. Several recent studies have shown the potential benefits of using nanomaterials in wound care, including the use of hydrogel/nano silver-based dressings in treating diabetic foot wounds, the use of copper oxide-infused dressings in difficult-to-treat wounds, and the use of chitosan nanofiber mats in burn dressings. Overall, developing nanomaterials in wound care has complemented nanotechnology in drug delivery systems, providing biocompatible and biodegradable nanomaterials that enhance wound healing and provide sustained drug release. Wound dressings are an effective and convenient method of wound care that can prevent wound contamination, support the injured area, control hemorrhaging, and reduce pain and inflammation. This review article provides valuable insights into the potential role of individual nanoformulations used in wound dressings in promoting wound healing and preventing infections, and serves as an excellent resource for clinicians, researchers, and patients seeking improved healing outcomes.

66 Key Features of Virtual Reality Impact Effectiveness of Pain Reduction in Pediatric Burn Patients

Abstract Introduction Virtual reality (VR) is a safe and effective pain management during burn dressing. However, key features of VR that impact the effectiveness of pain reduction remains unknown. Methods Our randomized clinical trial included 90 children aged 6 to 17 years who were treated in the outpatient clinic of an American Burn Association–verified pediatric burn center. Active VR participants (n=31) played a VR game while passive VR participants (n=30) were immersed in the same VR environment without interactions. VR groups were also compared with a standard care group (n=29). The primary outcome was self-reported overall pain and worst pain during burn dressing using a visual analog scale (VAS; range, 0-100). Participants in the active and passive VR groups reported 3 key features of the VR game (engaging, fun, realistic) and all participants (VR and standard care group) reported how much time he/she thought about pain during the burn dressing. Key features of the VR game and time thinking about pain were reported using a scale ranging from 0 (not at all) to 100 (very much). A composite score was created by ranking scores of the 3 key features of the VR game and then summarizing them into one final composite score. Our study hypothesis was that the key features of the VR game significantly impact the effectiveness of VR in reducing pain during burn dressing care. Results Nonparametric Spearman correlation analysis indicated the active VR group reported statistically significant higher average scores for all 3 key features of VR (engaging: 78.9, 95% confidence interval (CI)=68.5-89.3; fun: 85.7, 95%CI=76.6-94.7; realistic: 73.1, 95% CI=62.3-83.8) in comparison with the passive VR group (engaging: 72.7, 95% CI=59.9-85.5; fun: 77.3, 95%CI=65.6-89.0; realistic: 59.1, 95% CI=44.7-73.5) (all p-value &amp;lt; 0.01). The composite VR score was also significantly correlated with how much time the participant thought about pain during the burn dressing (coefficient= -0.344, p=0.007). The final multivariate logistic regression model of reporting moderate-to-severe pain found that key features of the VR game were statistically significant factors for overall pain and worst pain after adjusting for age, race/ethnicity, healing degree, pain medication use within 6 hours, and anxiety score (p&amp;lt; 0.01). Conclusions This study provides evidence that key features of VR significantly impact its effectiveness in pain management among pediatric burn patients. Applicability of Research to Practice Active VR game is more effective and should be used for pediatric pain management.