Burn Dressings Research Articles

Nile tilapia skin (Oreochromis niloticus) for burn treatment: ultrastructural analysis and quantitative assessment of collagen

Nile tilapia (Oreochromis niloticus) skin is a well-known biomaterial used as an occlusive dressing for burn treatment. It is also an inexpensive and important source of collagen. This study aims to describe the ultrastructural aspects of Nile tilapia skin, assess its collagen amount and organization, and compare quantitative methods of histochemical and immunohistochemical analysis (in all sterilization steps for use in burn dressings). One sample (0.5 × 0.5 cm) of ten different fish skins was divided in four groups: in natura skin (IN), chemical sterilization (CH), additional irradiation (30 kGy) (IR), and skins used in burn treatment (BT) to compare histochemical and immunohistochemical findings of collagen amount and describe ultrastructural aspects through scanning electron microscopy. The amount of type I collagen decreased during sterilization and clinical use owing to gradual reduction of immunostaining (anti-collagen-I) and decreasing fiber thickness of the collagen, when compared to type III (Picrosirius-red-polarized light). The collagen fibers were rearranged at each sterilization step, with a low collagen percentage and large structural disorganization in BT. The amount of type-I collagen was further reduced after BT (p < 0.05). Both the methods did not exhibit a quantified value difference (p = 0.247), and a positive correlation (r = 0.927; 95 % CI = 0.720–0.983) was observed between them, with concordance for collagen quantification in similar samples, presenting a low systematic error rate (Dalberg coefficient: 6.70). A significant amount of type-I collagen is still observed despite sterilization, although clinical application further reduces type I collagen. Its quantification can be performed both by immunohistochemistry and/or Picrosirius Red reliably.

Development of Hydrogel‐Based Sprayable Wound Dressings for Second‐ and Third‐Degree Burns

On‐site, prehospital care is vital for minimizing the severity of injuries caused by acute burns, especially those of the second and third degrees. Burn wounds typically have irregular shapes and depths and cover a large total body area. Due to the severity and complexity of burn wounds, traditional sheet‐like wound dressings are not always suitable. Alternatively, sprayable wound dressings can be used for convenient, quick, and large‐scale dressing changes. They can also prevent infection and secondary trauma depending on their reagent content. Sprayable wound dressings function as a therapeutic barrier that provides moisturization and pain relief, absorbs extrudates, protects against bacterial infections, and acts as a delivery system for small molecules and drugs. This review discusses the recent developments in sprayable hydrogel‐based wound dressings for high‐degree burns. An introduction to burn wound classifications, the ideal burn dressing designs and characteristics, and the current availability of commercial spray‐on burn dressings are presented. To achieve the optimal healing capacities using sprayable wound dressings, researchers are currently focusing on modifying the solution viscosities, propellant systems, and pump nozzle designs for spray formulations. Finally, the use of hydrogel‐based dressings to replace skin graft surgeries for tissue regeneration is discussed.

To compare the effect of sea buckthorn and silver sulfadiazine dressing on period of wound healing in patients with second-degree burns: A randomized triple-blind clinical trial.

Burn injuries can be associated with the incidence of disability and death, yet their management remains a costly difficult problem. We conducted this clinical trial to evaluate the period of wound healing with sea buckthorn dressings for the second-degree burns and compare the results with 1% silver sulfadiazine (SSD) dressings. This randomized triple-blind clinical trial was conducted in a hospital in Isfahan, Iran. Fifty-five patients suffering second-degree burns were recruited through convenient sampling and randomly divided into two groups and treated with either sea buckthorn cream or 1% SSD. Wound dressings were done until complete wound healing was attained. The process of healing burns was monitored using the Bates-Jensen Wound Assessment Tool; complete healing was determined by using the standard burn healing checklist. It was deduced that the period of healing second-degree burns in the group treated with sea buckthorn cream was shorter than the group treated with 1% SSD (p < 0.001). The results demonstrated the greater clinical efficacy of sea buckthorn cream over 1% SSD for healing second-degree burns. It was concluded that using sea buckthorn dressing by reducing the period of wound healing can shorten the course of treatment of second-degree burns as well as reduce the burden of care in health care services.

Silver Nanoparticle-Based Nanocomposites for Combating Infectious Pathogens: Recent Advances and Future Prospects.

Silver nanoparticles (Ag NPs) and their nanocomposites with polymers are potent agents for antibacterial and disinfectant applications. The structural parameters of Ag-NPs, such as size, shape, and surface area, are very critical for developing appropriate formulations for the targeted applications. The impact of these factors on the performance of Ag NPs is analyzed. Ag NPs with a broad spectrum of antibacterial activities have already found applications in wound and burn dressing, food preservation, agricultural ponds, treatment for infected areas, coatings, water treatment, and other biomedical applications. Ag NPs are quite useful against antibiotic-resistant bacteria, but their level of toxicity needs careful investigation as their toxicity could be very harmful to human health and the environment. This review discusses the challenges and prospects of various Ag NPs and their composites. The review will enrich the knowledge about the efficiency and mechanism of various Ag nanoparticle-based antibacterial agents.

Global burn care and the ideal burn dressing reloaded — A survey of global experts

PurposeBurn care is a highly relevant medical specialty in every part of the world. Different infrastructure, healthcare systems and access to medical supplies lead to different needs, treatment strategies and outcomes. A fundamental tool in a burn care provider’s armamentarium is the use of different dressings. Several studies have investigated the question of the ideal burn dressing, but none could achieve a proper global perspective. With advanced dressings being on the rise, we conducted this study to get a global understanding of the actual use and idea of the ideal burn dressing. ObjectiveThe objective of this study was to investigate the understanding of an ‘ideal burn dressing’ on a global scale. Materials and methodsA questionnaire about burn care and the ideal burn dressing has been created and translated to five of the most spoken languages world-wide (English, Spanish, French, Chinese, Indonesian). It has been uploaded to an online survey platform and sent out to burn experts worldwide. The voluntary participation was possible for a period of four weeks. ResultsIn total, 196 respondents from 49 countries participated in the study, yielding a response rate of 24.5%. The most important burn dressing characteristics in a cumulative ranking were (1) lack of adhesion (80.54%), (2) pain-free dressing change (79.87%), (3) requirement of fewer dressing changes, while in a linear ranking they were (1) anti-infective (35.14% 1st), pain-reduction (24.14% 2nd), and high absorbency (23.49% 3rd). Silver-based dressings are the most used dressings for superficial (45.21%) and deep (52.78%). 94.81% believe that the choice of burn dressing affects the outcome. ConclusionThis investigation has delivered valuable insights into the global perspective of the ideal burn dressing. Yet, the question of the ideal burn dressing is still inconclusive. Wound dressing research is of fundamental interest for patients, healthcare providers and healthcare systems.

A Comparison of the Effect of Visual and Auditory Distractions on Physiological Indicators and Pain of Burn Dressing Change Among 6–12-Year-Oldchildren: A Clinical Trial Study

PourposeThis study aimed to compare the effect of audiovisual distraction on physiological indicators and pain of burn dressing change among 6–12 year-old children. Design and methodsThe study was a single-blind clinical trial with a three-group that sample size was 120 children aged 6–12 years admitted to the burn ward of Hamadan Besat Hospital. Data collection tools were the Oucher pain scale, a Cheklist form of the physiological Indicators, and apulse oximetry device. The cartoons were shown for visual group and the melodic poems were played for the auditory group 2 min before the dressing until the end of the procedure (at 2-min intervals). Data were analyzed by SPSS-16 software one-way, variance analysis and post-hoc Bonferroni test. ResultsTherewere statistically significant differences between visual, auditory and control groups in the mean pain intensity scores at all measurement times, the mean arterial blood oxygen saturation percentage at all measurement times except for the10 min before the dressing and the start of the procedure and the mean heart rate at all measurement times except for 10 min before dressing (p < 0.001). Post-hoc tests showed that the difference in the mean heart rate was related to the difference between the visual and auditory distraction groups during and at the end of the dressing (p < 0.05), the visual and control groups at all measurement times (P < 0.001) and the auditory and control groups at all measurement times (p < 0.05). ConclusionAudiovisual distraction is effective in reducing the fluctuations of physiological indicators and the burn dressing pain intensity in children at all times of measurement, especially during changedressing. Practice implicationsThe findings of this study are relevant to clinical practice because they suggest preparing children before and during a burning procedure situation.

Timing of excision of full-thickness burns and the effect of delay on outcome

Context: The time of debridement of burn wounds is controversial. This study assessed the outcomes of various times of excision of full-thickness thermal burns involving a total body surface area (TBSA) of 15%–40% when immediate grafting is not possible.Aims: This study aimed to compare mortality rate and hospital days between very early excision, delayed early excision, and delayed excision.Setting and Design: This was a retrospective observational research study of 103 patients older than 18 years with full-thickness thermal burns involving a TBSA of 15%–40%, admitted to our Adult Burns Unit from January 2014 to December 2016.Subjects and Methods: Only “traditional” burn wound dressings such as Jelonet, Melladerm, Anticoat, or bandages were used without immediate skin grafting. Using the STATA Version 14.2 (College Hill, TX) statistical program, the Mann–Whitney U-test was used to compare any two groups, the Kruskal–Wallis test to determine differences between any three groups and the Chi-square test to measure associations between gender and patient outcome. Linear regression was used to determine the predictors of the number of hospital days postsurgery.Results: With a median patient age of 34 years, 66% were male. The majority had delayed excision (41.7%), 34% had delayed early excision and 24.3% had very early excision.Conclusions: Where immediate cover after excision is not possible due to cost or availability, and the wound is only covered with “traditional” burn dressings, early excisions had no advantage over delayed excisions with regard to mortality rate or duration of hospital stay.

In situ gelling and dissolvable hydrogels for use as on-demand wound dressings for burns.

Currently, no dressings utilized in burn clinics provide adhesion, hydration or mechanical strength on the same order as human skin as well as the ability to be atraumatically removed. We report the synthesis, characterization, and in vivo evaluation of in situ polymerized and subsequent dissolvable hydrogels as burn wound dressings. Hydrogel dressings, from a small library of synthesized materials form in situ, exhibit storage moduli between 100-40 000 Pa, dissolve on-demand within 10 minutes to 90 minutes, swell up to 350%, and adhere to both burned and healthy human skin at 0.2-0.3 N cm-2. Further, results from an in vivo porcine second degree burn model demonstrate functional performance with healing equivalent to conventional treatments with the added benefit of facile, in situ application and subsequent removal via dissolution.

Effectiveness of a hydrogel dressing as an analgesic adjunct to first aid for the treatment of acute paediatric burn injuries: a prospective randomised controlled trial

ObjectiveTo compare the effectiveness of two acute burn dressings, Burnaid hydrogel dressing and plasticised polyvinylchloride film, on reducing acute pain scores in paediatric burn patients following appropriate first aid.DesignSingle-centre, superiority,...

Sericin for Tissue Engineering

Sericin is a 10-to-400 kDa hydrophilic protein with high serine content and is a silk constituent together with fibroin. It is produced in the middle silk gland of the silkworm and encoded by four sericin genes. The molecular weight of sericin and its biological activity vary depending on the extraction method employed. Its chemical structure, in terms of random coil and β-sheet conformations, also differs with the extraction method, thereby extending its applications in various fields. Sericin, which was discarded in the textile industry in the past, is being applied and developed in the biomedical field, owing to its biological properties. In particular, many studies are underway in the field of tissue engineering, evaluating its applicability in burn dressing, drug delivery, bone regeneration, cartilage regeneration, and nerve regeneration.

Treatment of Partial Thickness Burns: A Prospective, Randomized Controlled Trial Comparing Four Routinely Used Burns Dressings in an Ambulatory Care Setting.

This prospective, randomized controlled trial study compared the effects of four dressings for adult partial thickness burns, focusing on re-epithelialization time and cost effectiveness. Adults with partial thickness burns meeting inclusion criteria were randomized to either Biobrane™, Acticoat™, Mepilex® Ag, or Aquacel® Ag. Primary endpoint for analysis was >95% re-epithelialization. Incremental cost-effectiveness ratios were calculated based on dressing costs. Dominance probabilities between treatment arms were calculated from bootstrap resampling trial data. One hunderd thirty-one partial thickness burn wounds in 119 patients were randomized. Adjusting for sex, age, smoking status, burn mechanism, TBSA, and first aid adequacy, Mepilex® Ag had a reduced time to re-epithelialization compared to Biobrane™ (IRR: 1.26; 95% CI: 1.07-1.48, P < .01). Economic analysis showed that there was a 99%, 71%, and 53% probability that Mepilex® Ag dominated (cheaper and more effective) Biobrane™, Acticoat™, and Aquacel® Ag, respectively. Mepilex® Ag achieved faster re-epithelialization and better cost effectiveness. Patient satisfaction and comfort seems better with Biobrane™ although not reflected within the end outcome of the healed wound. It is the patients' (after extensive education) and clinicians' choice, level of experience, and availability of products in praxis that will guide the decision as to which the product is used individually on which patient.

The Effect of Visual Aberration on Burn Dressing Replacement Pain in Children Aged 6-12 Years: A Clinical Trial Study

The Effect of Visual Aberration on Burn Dressing Replacement Pain in Children Aged 6-12 Years: A Clinical Trial Study

Application of Amniotic Stem Cells on an Acellular Dermal Matrix Scaffold in a Burned Patient: A Case Report

BackgroundAdvances in science have allowed newly created medicinal products based on gene therapy, somatic cell therapy, and tissue engineering to be used in the treatment of human diseases. December 2008 legislation aims to ensure they are both safe for patients and available throughout the European Union. Amniotic stem cells are designated by the European Medicines Agency Committee for Advanced Therapies as an advanced therapy medicinal product; therefore, production must be in accordance with Regulation (EC) No. 1394/2007 of the European Council of 13 November 2007 on advanced therapy medicinal products. ObjectivesThis article details preliminary results of innovative amniotic stem cell transplant (supported by an acellular dermal matrix [ADM] produced in-house with Suprathel wound and burn dressing) in a burn patient and compares them with results in a patient treated with allogeneic skin. Material and MethodsAmniotic stem cells were applied to a 40-year-old patient with IIb°/III° thermal burns of 36% of total body surface area and III°/IV° of 1%. Wound healing was assessed by histologic examination and the Bates-Jensen scale. Reduction in pain perception was verified by 10-point visual analog scale. Hospitalization time was compared to length of stay for patients treated with standard therapy. ResultsThe patient was discharged from hospital on the 12th day after surgery with complete wound healing (almost 2 times shorter than the control). ConclusionsThe use of amniotic stem cells and ADM may be the optimal method for burn treatment.

Development of dynamic cell and organotypic skin models, for the investigation of a novel visco-elastic burns treatment using molecular and cellular approaches

BackgroundBurn injuries are a major cause of morbidity and mortality worldwide. Despite advances in therapeutic strategies for the management of patients with severe burns, the sequelae are pathophysiologically profound, up to the systemic and metabolic levels. Management of patients with a severe burn injury is a long-term, complex process, with treatment dependent on the degree and location of the burn and total body surface area (TBSA) affected. In adverse conditions with limited resources, efficient triage, stabilisation, and rapid transfer to a specialised intensive care burn centre is necessary to provide optimal outcomes. This initial lag time and the form of primary treatment initiated, from injury to specialist care, is crucial for the burn patient. This study aims to investigate the efficacy of a novel visco-elastic burn dressing with a proprietary bio-stimulatory marine mineral complex (MXC) as a primary care treatment to initiate a healthy healing process prior to specialist care. MethodsA new versatile emergency burn dressing saturated in a >90% translucent water-based, sterile, oil-free gel and carrying a unique bio-stimulatory marine mineral complex (MXC) was developed. This dressing was tested using LabSkin as a burn model platform. LabSkin a novel cellular 3D-dermal organotypic full thickness human skin equivalent, incorporating fully-differentiated dermal and epidermal components that functionally models skin. Cell and molecular analysis was carried out by in vitro Real-Time Cellular Analysis (RTCA), thermal analysis, and focused transcriptomic array profiling for quantitative gene expression analysis, interrogating both wound healing and fibrosis/scarring molecular pathways. In vivo analysis was also performed to assess the bio-mechanical and physiological effects of this novel dressing on human skin. ResultsThis hybrid emergency burn dressing (EBD) with MXC was hypoallergenic, and improved the barrier function of skin resulting in increased hydration up to 24 h. It was demonstrated to effectively initiate cooling upon application, limiting the continuous burn effect and preventing local tissue from damage and necrosis. xCELLigence RTCA® on primary human dermal cells (keratinocyte, fibroblast and micro-vascular endothelial) demonstrated improved cellular function with respect to tensegrity, migration, proliferation and cell-cell contact (barrier formation) [1]. Quantitative gene profiling supported the physiological and cellular function finding. A beneficial quid pro quo regulation of genes involved in wound healing and fibrosis formation was observed at 24 and 48 h time points. ConclusionUtilisation of this EBD + MXC as a primary treatment is an effective and easily applicable treatment in cases of burn injury, proving both a cooling and hydrating environment for the wound. It regulates inflammation and promotes healing in preparation for specialised secondary burn wound management. Moreover, it promotes a healthy remodelling phenotype that may potentially mitigate scarring. Based on our findings, this EBD + MXC is ideal for use in all pre-hospital, pre-surgical and resource limited settings.

Comparison of the efficacy of silver-based antimicrobial burn dressings in a porcine model of burn wounds

PurposeA variety of silver-based antimicrobial dressings are available on the market and are commonly used to prevent infection. Such prophylaxis is particularly important in treating burns, yet there is a paucity of evidence confirming the efficacy of commercially available dressingsin vivo. We describe here an in vivo porcine model of burns, which we use to test the antimicrobial efficacy of three common wound dressings and a control. ProceduresDomestic Yorkshire-cross pigs were medicated for pain management before inflicting burns with a heated brass rod. The wounds were artificially challenged with a mixture of two pathogens commonly associated with burn wound infection:Staphylococcus aureus and Pseudomonas aeruginosa. The following dressing materials were sutured in place: gauze, nanocrystalline silver, silver-plated nylon, and polyethylene/polyester coated with high-oxidation silver salts. After 1 and 3 days, the wounds were assessed for erythema, swelling, and re-epithelialization, tissue was biopsied to determine the recovery of the challenge microorganisms, and histology was performed. We also examined the number of microorganisms present on the dressings themselves. ResultsHistology indicated that 30 s was sufficient to produce burns extending into the deep dermal layer. After 3 days, nanocrystalline silver and silver-plated nylon led to slightly reduced swelling relative to simple gauze, although none of the dressings significantly affected erythema or wound re-epithelialization. All the dressings led to decreased recovery of the challenge organisms from the burn tissue, relative to simple gauze. However, the magnitude of the reduction was greatest for nanocrystalline silver (log10 reduction = 4–5); additionally, only nanocrystalline silver gave a statistically significant decrease (P = 0.02). Notably, the antimicrobial effect for all dressings was reduced by Day 3 relative to Day 1. Similar trends were observed for microbial retention on the dressings themselves. ConclusionNanocrystalline silver-based wound dressings generally outperformed silver-plated nylon and high-oxidation silver salts in thisin vivo model of burn wounds. Relative to prophylactic use, it may be advisable to change the dressings more frequently when treating an infected wound.

Antimicrobial Activity of Silver-Treated Bacteria against other Multi-Drug Resistant Pathogens in Their Environment.

Silver is a potent antimicrobial agent against a variety of microorganisms and once the element has entered the bacterial cell, it accumulates as silver nanoparticles with large surface area causing cell death. At the same time, the bacterial cell becomes a reservoir for silver. This study aims to test the microcidal effect of silver-killed E. coli O104: H4 and its supernatant against fresh viable cells of the same bacterium and some other species, including E. coli O157: H7, Multidrug Resistant (MDR) Pseudomonas aeruginosa and Methicillin Resistant Staphylococcus aureus (MRSA). Silver-killed bacteria were examined by Transmission Electron Microscopy (TEM). Agar well diffusion assay was used to test the antimicrobial efficacy and durability of both pellet suspension and supernatant of silver-killed E. coli O104:H4 against other bacteria. Both silver-killed bacteria and supernatant showed prolonged antimicrobial activity against the tested strains that extended to 40 days. The presence of adsorbed silver nanoparticles on the bacterial cell and inside the cells was verified by TEM. Silver-killed bacteria serve as an efficient sustained release reservoir for exporting the lethal silver cations. This promotes its use as a powerful disinfectant for polluted water and as an effective antibacterial which can be included in wound and burn dressings to overcome the problem of wound contamination.

Optimization of human-like collagen composite polysaccharide hydrogel dressing preparation using response surface for burn repair

Collagen and polysaccharide materials have great advantages for burn wound healing and skin regeneration. The purpose of this study was to develop a promising burn dressing. Mixing hyaluronic acid (HA), carboxylated chitosan (CCS) and human-like collagen (HLC) to simulate extracellular matrix (ECM), and glutamine transaminase (TG) was used as a crosslinker. The mechanical properties and pore size of the hydrogel were optimized by response surface methodology. The results showed that the tensile elastic modulus of the hydrogel was 480.43 ± 15.82 kPa, the tensile strain was 55.23 ± 2.43 %, and the pore size was 90.43 ± 5.57 μm. This study constructed a skin burn model and demonstrated that the hydrogel dressing could effectively prevent bacteria infection and confirmed that the hydrogel dressing was more beneficial for promoting burn wound healing than a commercial film (DUO DERM). Therefore, the HLC/HA/CCS hydrogel can be considered a promising burn wound dressing.

The importance of silver nanoparticles in human life

One nanomaterial that is having an early impact in health care product is nano-silver. Silver has been used for the treatment of medical ailments for over 100 years due to its natural antibacterial and antifungal properties. The nano silver particles typically measure 25nm. They have extremely large relatively surface area, increasing their contact with bacteria or fungi, and vastly improving its bactericidal and fungicidal effectiveness. The nano silver when in contact with bacteria and fungus will adversely affect cellular metabolism and inhibit cell growth. The nano silver suppresses respiration, basal metabolism of electron transfer system, and transport of substrate in the microbial cell membrane. The nano silver inhibits multiplication and growth of those bacteria and fungi which cause infection, odor, itchiness and sores. Nano Silver can be applied to range of other healthcare products such as dressings for burns, scald, skin donor and recipient sites; acne and cavity wounds; and female hygiene products – panty liners, sanitary towels and pants.

Feasibility and impact of the implementation of a clinical scale-based sedation-analgesia protocol in severe burn patients undergoing mechanical ventilation. A before-after bi-center study.

Severe burn patients undergo prolonged administration of sedatives and analgesics for burn care. There are currently no guidelines for the dose adaptation of sedation-analgesia in severe burn patients. We performed a before-after 2-center study to demonstrate the feasibility and efficacy of a sedation-analgesia scale-based protocol in severely burned patients receiving ≥24h of invasive mechanical ventilation. Before the intervention, continuous infusion of hypnotic and morphine derivatives was continued. During the Intervention phase, general anesthesia was relayed from day 1 by RASS/BPS-titrated continuous infusion of hypnotic and morphine derivatives and with short half-life drugs adminstered for daily burn dressings. The primary outcome was the duration of invasive mechanical ventilation in the ICU. Eighty-seven (46.2%) patients were included in the Control phase and 101 (53.7%) in the Intervention phase. The median burned cutaneous surface was 20% [11%-38%] and median ABSI was 7 [5-9]. The durations of hypnotic and opioid infusions were not statistically different between the 2 phases (8 days [2-24] vs. 6 days [2-17] (P=0.3) and 17 days [4-32] vs. 8 days [3-23] (P=0.06), respectively). The duration of mechanical ventilation was 14 days [3-29] in the Control phase and 7 days [2-24] in the Intervention phase (P=0.7). When taking into account the competition between mortality and weaning from mechanical ventilation, we found no significant difference between the 2 phases (Gray test, P=0.4). The time-series analysis showed no difference for the duration of mechanical ventilation in the Intervention phase (P=0.6). Eighteen (20.7%) patients died in the Control phase, and 18 (18%) in the Intervention phase (P=0.6). Scale-based lightening of continuous sedation-analgesia with repeated short general anesthesia for dressing is feasible in severe burn patients but failed to demonstrate a decrease in the duration of invasive mechanical ventilation.

795 Factors Associated with Time to Initial Debridement in a Pediatric Burn Center

Abstract Introduction There is sparse literature addressing the time of initial burn debridement. The purpose of this study was to describe factors associated with time to initial debridement in one American Burn Association (ABA) verified pediatric burn center. Methods Quality improvement data was prospectively collected for pediatric burn patients admitted from July 2018 through June 2019. The data included sedation method, total body surface area (TBSA) burn, mechanism of injury, and time to burn wound debridement. Adverse outcomes were also recorded. Nonparametric methods were used to evaluate associations. Medians are presented with interquartile ranges (IQR). Results There were 137 patients included in this study. The median time to initial debridement was 261 minutes (IQR: 166–321). Most patients (80%) received conscious sedation for their first debridement. The median time to debridement was significantly lower for patients receiving sedation as opposed to those without sedation, 240 minutes (IQR: 163–308) vs 338 minutes (IQR: 257–442), p=0.0004. Patients with TBSA burn &amp;gt; 5% (n=46) also had a significant earlier time to debridement as compared with patients with smaller burns, 183 minutes (IQR: 150–277) vs 283 minutes (IQR: 197–360), p&amp;lt; 0.0001. There was a significant difference in time to initial debridement based on mechanism of injury, p=0.0213. The median time to debridement for flame burns was 173 minutes (IQR: 149–308) as compared with scald burns with a median of 247 (IQR: 157–298) and contact burns, median 286 (IQR: 197–389). There were no adverse outcomes observed during the study period. Conclusions In an ABA verified pediatric burn center, conscious sedation, larger TBSA burn, and flame burns appeared to contribute to earlier time to debridement, with no adverse outcomes. Further analysis are ongoing as to whether pain scores differed for these initial burn dressings and if conscious sedation had any effects on subsequent dressings. Applicability of Research to Practice This study adds to the sparse literature regarding time to initial debridement and identifies factors associated with an earlier time to debridement. This study also raises further opportunities for investigation regarding the relationship between initial sedated debridement procedures and pain scores during subsequent dressing changes.