Burning Research Articles

A systematic study of emergency strategies for skin healing after pediatric burns: a comprehensive review and a multidisciplinary perspective.

Burn injuries are a significant cause of morbidity and mortality in pediatric populations. Our study aims to provide an in-depth overview of the current emergency treatment strategies for dermal injuries in children. While advances in burn care have led to improved outcomes for patients with dermal injuries, there remains considerable variability in treatment approaches, and numerous opportunities exist to enhance patient care through the adoption of novel therapies and more effective management of healthcare resources. Children with severe burns often experience profound physiological changes that can result in a range of complications, including infections, fluid and metabolism imbalance due to increased catabolism and protein requirements. Our systematic review focuses on emergency treatment approaches that have demonstrated direct application in pediatric burn care. To this aim, we consulted the scientific databases PubMed, Embase, Web of Science, and Cochrane Library, selecting n = 6 studies that outline the emergency therapeutic approach used in the pediatric setting after a burn, highlighting the most widely adopted techniques and their clinical applications. Study selection was guided by defined eligibility criteria; only original articles published in English that investigated emergency interventions in pediatric populations (0 to 17 years) were considered. Studies were excluded if they involved subjects over 17 years of age, focused on conditions unrelated to burns, employed in vitro or in vivo models, or were review articles. Through a comprehensive examination of these approaches, our study aims to identify areas for improvement and potential advancements in pediatric burn management, suggesting possible future approaches based on Advanced therapy medicinal products (ATMPs) storage approaches.

Molecular and genomic insights into multidrug-resistant (MDR) and extensively drug-resistant (XDR) Pseudomonas aeruginosa causing burn wound infections in Bangladesh.

The emergence of multidrug-resistant (MDR) and extensively drug-resistant (XDR) Pseudomonas aeruginosa represents a significant challenge in managing nosocomial infections, particularly in vulnerable populations such as burn patients. This study provides genomic and molecular characterization of MDR and XDR P. aeruginosa strains isolated from burn patients at Sheikh Hasina National Institute of Burn and Plastic Surgery (SHNIBPS) in Dhaka, Bangladesh. Over an 8-month period, 110 wound swabs were collected, with 91 isolates identified as P. aeruginosa. Antimicrobial susceptibility testing demonstrated a multidrug-resistant pattern in 30 isolates and an extensive drug-resistant pattern in the remaining 61 isolates analyzed in this study. PCR assays detected beta-lactamase genes from all four Ambler classes, revealing a notable prevalence of blaNDM-1 (16.48%) and blaVIM-2 (31.87%), with both genes co-occurring in 3.30% of the isolates. Additionally, blaPER-1 (15.38%), blaCTX-M (4.40%), blaOXA-1 (84.62%), and blaOXA-48 (51.65%) genes were detected. Class I integrons were detected in 84 isolates. A total of 21% of the isolates exhibited strong biofilm-forming capabilities. Key biofilm-associated genes (pelB, pilT, rhlB) were detected in most of the isolates. Whole genome sequence analysis of two selected XDR isolates identified different beta-lactamase genes such as blaPDC-98, blaPDC-374, blaOXA-50, blaOXA-677 and blaOXA-847. Virulence factor genes, metal resistance genes, and prophage sequences were also identified in the analysis. The genomic epidemiology analysis of 9,055 P. aeruginosa strains, based on MLST data, revealed the dominance of ST235. The blaPDC and blaOXA genes were found to be notably prominent worldwide. The comparative genomic analysis of P. aeruginosa strains from Bangladesh demonstrated an expanding pangenome as well as high degree of genetic variability. The study emphasized the dynamic nature of the P. aeruginosa pangenome and underscored the necessity for stringent infection control measures in burn units to manage and mitigate the spread of these highly resistant strains.

Diverting Ostomy Practices in Burn Surgeons Treating Full-Thickness Perianal Injuries.

Burns to the perianal region pose specific challenges in management due to the complex structure of the surrounding tissue, bacterial contamination, and repetitive stress. Fecal diversion via diverting ostomy may be elected in these injuries because of its potential to enhance wound healing and skin graft adherence; however, its use introduces alternative risks such as prolonged ileus, fistula, leakage, and failure of reversal. This study aimed to determine the perspectives of burn surgeons regarding the use of diverting ostomy for perianal burn injuries. We conducted a survey of 12 physicians who are burn center directors in the Northeast Region of the American Burn Association (ABA) regarding their practices for patients with full-thickness perianal burn injuries requiring a skin graft. Response rate was 11/12 (92%). 6 individuals (54.5%) reported "Never (0%)" to performing a diverting ostomy in this context; the remaining 5 individuals responded "Rarely (<10%)." Reasons stated for performing a diverting ostomy in the "Rarely" group included cases where the patient suffered an intra-anal or anorectal injury. These results were summarized with a relevant review of the literature and experience in our clinical practice. Our findings indicate that diverting ostomy is a relatively uncommon practice for burn surgeons treating full-thickness buttocks injuries. With appropriate wound care and critical care management, good outcomes can be obtained without the need for diverting ostomy. Non-surgical alternatives to fecal diversion are commonly used by burn specialists and should be considered in perianal burn injuries.

Circadian Rhythms and Burn Recovery: A Scoping Review of Biological Disruptions and Clinical Implications.

Burn injuries present significant physiological challenges. Emerging evidence has found that circadian rhythms-the body's intrinsic 24-hourcycles-play a key role in regulating immune responses, hormonal secretion, and tissue repair, all essential for recovery. However, their specific impact on burn healing remains underexplored. This scoping review aimed to evaluate how circadian rhythms affect recovery outcomes in burn patients and animal models. PubMed, Embase, and Scopus were searched using terms including "circadian rhythms" and "burn trauma". Nine studies met inclusion criteria, comprising 516 human patients (unweighted mean age and TBSA across studies was 42.88years and 19.7%) and several animal models. Burn-related circadian disruptions were consistently observed. Studies reported elevated daytime cortisol in burn patients, reduced nighttime melatonin, and a a reduction in PER3 expression.Burn timing impacted outcomes: nighttime burns were associated with slower healing and increased complications. Reduced light exposure was linked to delayed sleep phase syndrome. Due to heterogeneity and small sample sizes, a meta-analysis was not feasible. These findings underscore circadian biology's relevance in burn recovery. Further clinical studies are needed to explore how timing-based strategies can be effectively integrated into burn care.

A multifunctional hydrogel with hemostatic and photothermal properties for burn repair†

Effective management of burn wounds requires multifunctional dressings with integrated hemostatic, antibacterial, antioxidant, and regenerative properties. Herein, we developed an injectable hydrogel by grafting dopamine onto γ-polyglutamic acid (γ-PGA), followed by crosslinking with carboxymethyl chitosan (CMCS) via EDC/NHS chemistry. The resulting PGDA/CMCS hydrogel exhibited excellent injectability, bioadhesion, and mechanical stability (compressive modulus: 1.15 kPa), along with high swelling capacity (up to 1179%) and controlled degradation. The hydrogel showed potent ROS-scavenging activity (78.2% for DPPH˙), efficient photothermal conversion (31.05%), and enhanced antibacterial effects under NIR irradiation. In vitro assays confirmed good cytocompatibility (>90% viability) and hemocompatibility (hemolysis <5%). In vivo, the hydrogel rapidly stopped bleeding in tail and liver injury models and significantly promoted burn wound healing, especially when combined with photothermal stimulation. This multifunctional hydrogel holds strong potential for clinical use in hemorrhagic and infected wound management.

Trends in first positive culture results in major burn center over a ten-year period.

Patients with severe burns are more vulnerable to infection, sepsis, and death. With heavy use of antimicrobials, changes in burn wound microbial and antibiotic resistance patterns have been reported; however, the literature remains scarce. This study assessed wound colonization trends in first positive cultures in our burn unit over the last decade. This is a retrospective cohort study including all patients admitted to our burn unit from July 2013 to June 2023. Demographics, total burn surface area (TBSA), injury mechanism and admission information were obtained. Wound culture information including date of positive cultures, type of organisms, and antibiotic susceptibility data was also collected. Patients were stratified based on TBSA as small (<10%), moderate (10-19.9%), and severe burns (≥20%). Descriptive statistics were obtained. Generalized linear models were fit to assess the trends of positive cultures over time for the three TBSA strata. A total of 2755 patients were included; median age was 38years, 72.2% were male; 74.1%, 15.9%, and 10.1% presented with small, moderate, and severe burns, respectively. Wound cultures on initial presentation were performed in 40.3% of our population with 600 cases having positive first cultures; 84.7% grew Gram positive, 35.7% Gram negative, and 9.7% fungal organisms. Data showed an increase in Gram positive and fungal species over the study period in first positive cultures of severe burn patients. We also found increasing rates of resistance for several antibiotics, including erythromycin, oxacillin, and vancomycin. Future studies are warranted to evaluate changes in microorganism growth throughout the hospital course of severe burn patients.

Hydroxyurea Therapy and Burn Wound Healing in Sickle Cell Disease: A TriNetX Database Study.

Sickle cell disease (SCD) is an autosomal recessive disorder characterized by abnormal hemoglobin (Hb), vaso-occlusive crises, and hemolytic anemia. Hydroxyurea has been proven effective in managing SCD but is associated with non-healing skin ulcers. Additionally, its effects on wound healing in burn patients remain unclear. This study investigates the role of hydroxyurea in mortality, wound infection, wound disruption, and sepsis among SCD patients with burn injuries. Using the TriNetX database, cohorts were identified based on ICD-10 codes for adult patients aged 18years or older diagnosed with SCD, previous burn injury, and hydroxyurea use. Propensity score matching was performed for demographics (age, sex, race, ethnicity), comorbidities that affect wound healing, and clinical variables (burn severity and SCD severity). Mortality, wound infection, wound disruption, and sepsis were assessed at 30days, three months, and six months post-burn injury. Statistical methods such as chi-square analysis and risk ratio were used, with a statistical significance at p<.05. Hydroxyurea cohort had significantly higher risk for wound healing outcomes such as wound disruption, wound infection, and recurrent sepsis at each time outcome. However, hydroxyurea cohort had significantly lower risk of mortality compared to control group at each time outcome. This study highlights the need of considering hydroxyurea's impact on wound healing when developing treatments for SCD patients with burn injury. Further research is needed to investigate its mechanism in wound healing processes and develop safer treatment alternatives.

Modern strategies for the prevention and treatment of post-burn scars (a systematic review)

Despite advancements in modern reconstructive surgery, preventing the formation of thick scar tissue that impairs limb function or causes cosmetic defects remains a critical challenge. Equally important is the effective correction of existing scars to optimize both functional and aesthetic outcomes. Severe functional impairment of the upper limbs can result in disability. A combination of surgical and nonsurgical interventions is essential to enhance functionality while minimizing the risk of scar recurrence. Platelet-rich plasma injections, stem cell therapy, adipose tissue transplantation, and a combination of negative pressure wound therapy (NPWT) with traditional flap reconstruction and other transplantation methods are gaining popularity in modern reconstructive surgery. NPWT plays a crucial role in preparing the wound bed for subsequent tissue reconstruction and serves as an effective alternative to traditional dressings. The vacuum created over the wound after closure with a skin autograft helps prevent inflammation at the graft base, reduces excessive granulation tissue formation, and minimizes the risk of rough scar development in the long term. The mechanisms of formation of hypertrophic scar and keloids have not yet been completely understood. However, research indicates that bone marrow-derived cells, including fibrocytes and keratinocyte-like cells, contribute to the inflammatory cell infiltrate during wound healing, and can play a role in cutaneous fibrosis, especially in cases of impaired healing. Several pathophysiological and biochemical processes involved in the repair of extensive and deep wounds have been established. Additionally, the role of keratinocytes within hair follicle bulbs in promoting epithelialization of post-burn wound surfaces, particularly in areas with preserved skin appendages, has been recognized. Studies indicate that stromal-vascular fraction of adipose tissue plays a positive role in various stages of wound healing, including keloid and hypertrophic scar formation. Adipose-derived stem cells can be used in combination with hydrogel. The hydrogel base of dressings maintains a moist environment in both burn wounds and wound surfaces following tangential or radical excision of burn scab. This promotes faster wound healing, reduces the risk of scar hyperplasia, and enhances the sustained release and effectiveness of medications applied to the hydrogel base. Prompt surgical intervention, including early excision and grafting, along with modern treatment methods in the early postoperative period for deep burns, can significantly reduce the risk of hypertrophic and keloid scar formation.

Beyond the Burn: Evaluating Insurance Support for Cosmetic Reconstruction After Burn Injury.

Patients recovering from burn injuries face long-term psychological, physiological, and biomechanical challenges due to scarring. While interventions to address these challenges exist, insurance coverage is often limited. This study examines the insurance policies of major health insurers regarding cosmetic reconstruction (CR) following burn injuries. A comprehensive review of coverage policies was conducted for five major health insurance providers: UnitedHealth Group, Elevance Health (formerly Anthem), Humana, CVS (Aetna), and Centene Corporation. The review focused on invasive and noninvasive CR interventions for burn injuries. Data was collected from state-specific insurance documents using Microsoft Excel. As of 2024, UnitedHealth Group holds a 28% share of the Medicare Advantage market and 14% of the commercial market, serving all 50 states. Humana controls 18% of the Medicare Advantage market, while CVS (Aetna) holds 11% in both markets, with nationwide coverage. However, none provide coverage for CR unless there is documented significant functional impairment (FI). Elevance Health has limited coverage in 19 states, contingent on FI documentation, while Centene Corporation. covers CR on a case-by-case basis, leading to fragmented access across the United States. Standardized, equitable coverage for burn-related CR is needed to remove bureaucratic barriers hindering survivors' recovery. Inconsistent insurance policies prevent access to essential aftercare, exacerbating physical and emotional burdens. Policy reform is crucial to ensure all burn survivors receive the care needed for recovery and a restored quality of life.

Association of early in-hospital endotracheal intubation with clinical outcomes in patients with traumatic coma: a multicenter observational study

BackgroundGuidelines recommend immediate endotracheal intubation for patients with a GCS score ≤ 8. However, the impact of immediate airway intubation on patient outcomes remains uncertain. This study aimed to investigate the association between endotracheal intubation in the resuscitation area and outcomes in patients with trauma and a Glasgow coma scale (GCS) score < 8.MethodsThis study used data from the Japan Trauma Data Bank from January 2019 and December 2023. Adult patients with trauma (≥ 18 years) and a GCS score < 8 upon hospital arrival were included. Data of patients who transferred from another hospital, had prehospital intubation, had burn injuries, had early transfer to another hospital, or were admitted to centers registering < 50 patients were excluded. Endotracheal intubation included orotracheal, nasotracheal, and surgical airway placements performed in the resuscitation area. Hierarchical regression estimated hospital-level odds ratios for intubation and outcomes, adjusting for patient characteristics, comorbidities, and injury severity. Pearson correlations assessed the relationship between hospital-level intubation rates and favorable neurological outcomes.ResultsOverall, 11,927 patients from 96 hospitals were analyzed, of whom 67.9% underwent endotracheal intubation in the resuscitation area. Hospital-level intubation rates varied from 0% to 93.5%. Higher hospital-level intubation rates were significantly correlated with favorable neurological outcomes (r = 0.247, p = 0.015) but not with overall survival.ConclusionsOne-third of hospitals did not adhere to standard intubation protocols. Hospital-level analysis found that endotracheal intubation in the resuscitation area in patients with a GCS score < 8 following trauma was associated with better neurological outcomes after adjusting for patient characteristics and injury severity. These findings suggest that monitoring immediate intubation rates serves as a quality indicator of institutional trauma care capability; however, further research is warranted to more fully understand the direct effects of early intubation on patient outcomes.

Rapidly Gelling Sprayable Hydrogels Integrating Carbon Quantum Dots and Plant Extracellular Vesicles Enable Multifunctional Wound Care via Photothermal Management, Immunomodulation, and Ferroptosis.

Research around wound healing is proliferating, but there is a lack of all-in-one care products, including wound healing, that need to be developed to meet contemporary demands for minimalism and outdoor sports. Herein, an in-situ forming sprayable hydrogel is designed by integrating multifunctional therapeutic properties. The hydrogel is capable of in situ gelation by rapid cross-linking of tannic acid, Fe3+ions, and acrylamide, thus forming a stable supramolecular double-network with superior adhesion, self-healing ability, and on-demand removability. Further incorporating Flos Sophorae-derived carbon quantum dots and cactus-derived extracellular vesicles, this hydrogel accelerates wound closure, promotes angiogenesis and hair follicle regeneration in murine acute and burn wound mice, and is associated with macrophage polarization from M1 to M2, reducing inflammation and fibrosis. Moreover, the tannic acid-Fe3+-polyacrylamide supramolecular network has ferroptosis-inhibitory properties, highlighting its potential in preventing oxidative damage in chronic wound healing applications. In addition, photothermal conversion capability and inherent antibacterial properties of hydrogel suggest potential for broader applications such as dry heat sterilization, water disinfection, and thermal management. With its rapid gelation, adaptable mechanical properties, and comprehensive therapeutic effects, this hydrogel offers a promising strategy for advanced wound management and holds potential for broader biomedical applications.

Smart multilayer chitosan-based nanofibers for burn wounds: pH-responsive dual release of diclofenac sodium &Hamamelis virginiana extract: From design to in vitro &in vivo evaluation.

Smart multilayer chitosan-based nanofibers for burn wounds: pH-responsive dual release of diclofenac sodium &Hamamelis virginiana extract: From design to in vitro &in vivo evaluation.

Importance of Trauma Informed Framework for Social Workers in Burn Care Centers and the Community - A Conceptual Paper

Burn injuries disrupt the dynamics of families and social networks, requiring interventions that strengthen these support systems. In the United States, the integration of trauma-informed social work into burn care is not only essential for individual well-being, it is also crucial for the optimization of healthcare outcomes and the reduction of public health costs associated with untreated trauma-related emotional and psychological challenges. Trauma-informed social work recognizes that burn survivors have experienced trauma not only during the incident itself but also throughout their treatment and recovery. Social workers trained in trauma-informed care are equipped to recognize these challenges and offer culturally responsive, empathetic and therapeutic support. They help burn survivors regain a sense of control over their lives, make informed decisions about their care, and navigate the complex healthcare and community-based rehabilitation systems post-discharge. This conceptual paper highlights the imperative need for a comprehensive approach to psychosocial burn care that acknowledges the importance of trauma-informed social work in addressing the complex physical and emotional needs of patients and survivors in both inpatient and community-based therapeutic settings while impact of burn trauma on family/caregivers is beyond the scope of the paper. Such an approach aims to restore the physical, emotional and psychological well-being of this population, promoting their path to recovery and reintegration into society.

Exploring the role of two polypeptide nanofiber gels derived from RADA16-I self-assembly in accelerating burn wound healing

This study systematically evaluates the therapeutic effects and molecular mechanisms of peptide nanofiber gels RG and RJ in deep second-degree burn wound healing. The gels are composed of the self-assembling peptide RADA16-I (R) conjugated with either a GLP-1 analog (G) or Jagged-1 protein (J), both of which exhibit good physicochemical properties, including well-defined three-dimensional nanofiber architectures, transparent gel consistency, and significantly enhanced mechanical strengths (storage modulus increased by ~ 4.3-fold for RG and ~ 7.09-fold for RJ) with high composite viscosities (5.36 Pa·s for RG; 7.08 Pa·s for RJ). In vitro experiments demonstrated that RG and RJ significantly promoted cell proliferation and migration. In vivo studies revealed that RG and RJ accelerated the healing of deep second-degree burn wounds through significant angiogenesis, reduction of systemic inflammation, and enhanced tissue regeneration. Notably, after 14 days, the wound closure rates in the RG and RJ groups reached 89.5% and 76.8%, respectively, compared to 70.1% in the R group and 67% in the control group. This difference can be attributed to their advantages in reducing systemic inflammation, promoting vascular formation during the healing process, and increasing collagen deposition. Our findings suggest that RG and RJ nanofiber gels hold great potential as innovative solutions for the care of deep second-degree burn wounds.

Utilizing Indirect Intrapleural Pressure to Guide Mechanical Ventilation in Burn Patients with ARDS

Abstract Patients with severe burn injuries are at risk of developing acute respiratory distress syndrome (ARDS). Modern ARDS management does not typically factor in how burn injury influences lung dynamics during ventilator management. Obtaining indirect intrapleural pressures via esophageal pressure monitoring (Pes) may provide unique guidance on optimal positive end expiratory pressure (PEEP) titration to prevent alveolar collapse while ensuring safe plateau pressures but is not well described in burn injured patients. This work examined the use of Pes in burn injured patients with ARDS to determine its effect on ventilator changes. Burn injured patients admitted to an ABA verified burn center who developed ARDS by the Berlin definition and received Pes were retrospectively reviewed to determine ventilator settings and oxygenation trends. Severity of ARDS and oxygenation were determined by PaO2 to FiO2 (P/F) ratios and oxygenation indices (OI) prior to Pes use, and at 1-, 3- and 5-day intervals following initiation. Of the 23 patients included, the median revised Baux score was 91.6 (73.9-114.6), and the mortality rate was 82.6%. Increases in PEEP were required [12 (4) vs 17 (4); p&amp;lt;.0001] following Pes initiation. P/F ratios increased by day 5 post-Pes monitoring [300 (35.1)] compared to pre- [141 (26.5); p=.0020], 1 day post- [169 (26.5); p=.0134] and 3 days post- [179 (29.4); p=.0325] monitoring. OI between pre-Pes monitoring and day 5 post Pes monitoring, were not significant [17.3 (1.92) vs 13.4 (2.57)]. A strategy incorporating Pes to guide ventilator management in burn injured patients with ARDS may be used.

Mental Health Outcomes and Psychosocial Impacts of Facial Burns: A Scoping Review.

Burn injuries have been proven to carry long-term psychological and social consequences. To identify the mental and psychosocial impacts of facial burns on patients' quality-of-life outcomes. The methods were developed in agreement with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extensions for Scoping Review guidelines. A literature search utilizing the PubMed and Scopus databases was performed. Peer-reviewed, English-language studies examining psychological, social, or quality-of-life outcomes associated with facial burns were included. Anxiety and depression were significantly worse in facial burn patients [Hospital Anxiety and Depression Scale (HADS) score: 2.5 ± 2.8, P < .002, HADS Score: 2.1 ± 2.7, P < .001, respectively]. Body image dissatisfaction was significantly higher in adolescent facial burn patients compared to those without facial burns, 1 year after the injury (P < .001). After undergoing augmented reality coupled rehabilitation, quality of life scores were improved compared to baseline (P < .001). This scoping review highlights the negative impacts of facial burns on mental health and psychosocial outcomes. Additional research is needed to further substantiate interventions, such as cognitive behavioral strategies and virtual reality-based rehabilitation, in the long-term management of individuals with facial burns.

Detection of biofilm formation and antibiotic sensitive among Pseudomonas aeruginosa isolated from burn patients

Burns are the most destructive condition, in which the outer covering layer of the skin disappears and a scab forms, which is colonized by various opportunistic microorganisms, Pseudomonas aeruginosa is a common isolate from burn infections,leading to various pathological conditions Burn swabs were collected from patients Iraqi hospitalized at Burns Specialist Hospital in the Medical City , Baghdad, Iraq by Levene technique or syringe technique, respectively. Standard laboratory protocols for identifying P.aeruginosa were followed. The Kirby-Bauer disk diffusion method was used to test the sensitivity of the isolates to antibiotics according to CLSI 2022 guidelines. Biofilm production was accessed by microtiter plate assay.Twenty five isolates of P.aeruginosa were isolated from Iraqi burn patients. Identified by Biochemical test and Vitek 2E System.Antibiotic susceptibility test was conducted to the isolates of P. aeruginosaby using disc diffusion method to 15 antibiotics from different classes.The antibiotics resistance rate was determined as follows: Trimethoprin/sulphamethhoxazole (100%) Ceftazidime and Tobtamycin (88%), Piperacllintazobactam and Cefotaxime (72%), Cefazolin and Meropenem (60%), Cefoperazone (52%) Gatifloxacin (%) and Aztreonam(20%). Pseudomonas aeruginosa isolates have the ability to form biofilms on microtiter plates .The results showed that only 56% of P. aeruginosa isolates were strong biofilm producers. Meanwhile, 36% and 8% of the isolates were intermediate and low productive, respectively. .The production of exopolysaccharides during biofilm formation makes the condition more severe. Furthermore, continuous monitoring of this type of burn wound infection using the antimicrobial profile of the isolates is essential not only for infection control but also for empiric treatment.

Virtual reality as a strategy for intra-operatory anxiolysis and pharmacological sparing in patients undergoing breast surgeries: The V-RAPS randomized controlled trial protocol.

Virtual reality (VR) has increasingly found applications beyond leisure and video games, extending into the field of medicine. Recent studies indicate that VR can effectively reduce anxiety and pain in pediatric patients undergoing uncomfortable medical procedures, such as burn wound care. Yet, VR use in the operating room is still rare, despite a growing trend toward regional anesthesia without general anesthesia; physicians still frequently rely on pharmacological sedation to manage procedural anxiety. By leveraging VR's anxiolytic properties, it may be possible to decrease the need for intravenous (IV) sedation which is associated with risk of adverse events like apnea and hypoxemia and delayed recovery. This study's main objective is to determine the impact of VR on IV sedation requirements in adult patients undergoing breast surgery under paravertebral (PV) block without general anesthesia. We will be using Paperplane Therapeutics' VR headset and software which offer three distinct VR scenario choices. We hypothesize that VR immersion will reduce the need for intraoperative pharmacological sedation. Secondary objectives include assessing the tolerance of patients to the VR headset, examining the impact of the chosen VR scenario on the primary outcome, evaluating the incidence of adverse effects, measuring patient satisfaction, and analyzing the output of the Nociception Level (NOL) Index among awake surgical patients. This single center randomized controlled trial will enroll 100 patients aged 18 or above undergoing breast surgery under PV block. Participants will be randomly allocated to the VR group or the control group; both will have access to pharmacological sedation through patient-controlled sedation (PCS). Participants in the VR group will choose between three different VR scenarios and will be allowed to switch between these scenarios during surgery. The primary outcome will be the time-adjusted and weight adjusted dose of self-administered intraoperative propofol. Secondary outcomes will include patient satisfaction, adverse events, and post-anesthesia care unit length of stay (PACU LOS). This trial has been approved by the regional ethics committee (Comité d'Éthique de la Recherche du CIUSSS de l'Est de l'Île de Montréal) on September 9th, 2024. ClinicalTrials.gov (July 25th, 2024). Unique protocol ID: 2025-3802. Trial identification number: NCT06522711.

Epidemiology and prognosis of burn injuries in China: a meta-analysis

BackgroundBurns are a significant cause of disability and death. Nonfatal burns have drastic impacts on survivors’ lives. This study examines the epidemiological characteristics and prognostic factors of burn injuries of hospitalized patients in China.MethodsLiterature search was conducted in online databases and study selection was based on precise eligibility criteria. Meta-analyses of proportions were performed to estimate the relative incidence rates of burn injuries between 1980 and 2022 by age, total body surface area (TBSA), cause, and season. Odds ratios (ORs) were pooled and metaregression analyses were performed to seek prognostic factors for mortality.Results23 studies (465,433 patients; 33% females [95%CI 30, 35]) were included. Incidence rates were higher for age groups 0–4 and 30–45 years. Incidence was higher in summer (29% [95%CI 27, 30]) and lower in autumn (21% [95%CI 20, 22]). The incidences of mild (TBSA 0–10%), moderate (TBSA 10–30%), severe (TBSA 30–50%), and very severe (TBSA > 50%) burns were 52% [95%CI 45, 59] 27% [95% CI 23, 32], 9% [95%CI 6, 13], and 8% [95%CI 6, 10], respectively. Scald (50% [95%CI 43, 57]) and flame (27% [95%CI 19, 37]) were the main sources of burns. The mortality rate was 3% [95%CI 2, 3]. Age (OR 2.283 [95% CI 1.441, 3.125]), TBSA (2.266 [95% CI 1.708, 2.824), burn severity (OR 1.064 [95% CI 1.025, 1.103]), and inhalation injury (OR 6.670 [95% CI 3.032, 11.308]), and flame burns (metaregression coefficient: 0.128 [95% CI 0.029, 0.227]; p = 0.015) were associated with higher mortality.ConclusionsIn China, burn injuries remain a serious health concern. Young children (0–4 years of age) constitute a special risk group for safety measures. Burns due to flame are found to be more fatal than other causes.

Psychometric evaluation and development of a 3-item short form of the Posttraumatic Growth Inventory (PTGI-3): A National Institute on Disability, Independent Living, and Rehabilitation Research Burn Model System Study.

The Posttraumatic Growth Inventory (PTGI) was developed to measure positive psychological changes individuals can experience after trauma. While the 10-item form (PTGI-10) is relatively brief, an even shorter version would be valuable in situations where participant response burden is of particular concern. The PTGI-10 was administered to 1,076 adults recovering from moderate to severe burn injury between 6-months and 20-years after injury as part of an ongoing longitudinal study. Analyses completed to inform item selection included classical test theory analyses of reliability (i.e. Cronbach's alpha) and item performance, item response theory analyses, and qualitative item review. A focus group selected items for a new short form while considering results of the analyses as well as item content and acceptability. Score agreement between the PTGI-10 and the newly created short form was examined. A confirmatory factor analysis supported unidimensionality though reliability (α=0.94) and results of local dependency indicated items were highly redundant. A new three item short form (PTGI-3) was created and includes one item from each of the three categories of perceived benefits identified in posttraumatic growth theory. Reliability of the new short form is moderate (>0.8) for scores ±1 SD around the mean. Scores on the PTGI-3 correlate highly (r=0.94) with scores on the PTGI-10. The PTGI-3 has sufficient reliability for group comparisons, balances item content, and includes items that are acceptable to people with burn injury.