Burn Center Research Articles

Extracellular matrix-based biomaterials in burn wound repair: A promising therapeutic strategy.

Burns are common traumatic injuries affecting many people worldwide. Development of specialized burn units, advances in acute care modalities, and burn prevention programs have successfully reduced the mortality rate of severe burns. Autologous skin grafting has been considered as the gold standard for wound coverage after the removal of burned skin. For full-thickness burns of a larger scale, however, the autograft donor site may be quickly exhausted, so that alternative skin coverage is necessary. Although rapid progress has been made in the development of skin substitutes for burn wounds during the last decade, no skin substitute has fulfilled the criteria as a perfect replacement for the damaged skin. Extracellular matrix (ECM) derived components have emerged as a source for the engineering of biomaterials capable of inducing desirable cell-specific responses and one of the most promising biomaterials for burn wound healing. Among these, acellular dermal matrix, small intestinal submucosa, and amniotic membrane have been applied to treat burn wounds with acceptable outcomes. This review has explored the use of biomaterials derived from naturally occurring ECM and their derivatives for approaches aiming to promote burn wound healing, and summarized the ECM-based wound dressings products applicable in burn wound and postburn scar contracture to date.

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

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

Electrical burns in train climbers treated in the Helsinki Burn Centre during the last 30years.

Patients who climb onto the roof of a stationary train carriage and sustain a high voltage electrical injury from the overhead cables represent a rare type of electrical injury. The aim of this study was to review all the electrical burns and their outcomes in train climbers treated in the Helsinki Burn Centre during the last three decades. 18 patients who had climbed onto the roof of a stationary electric train between November 1993 and December 2022 were included. Trauma- and outcome-related variables were collected. The primary outcome endpoints were in-hospital mortality and major amputations. 16 (88.9%) patients were male. The median age was 15.5years (range: 13-29years). All the burns were high-voltage electrical burns. The mean burn size was 45% of the total body surface area. Three (16.7%) patients died in hospital. The mean length of the Burn Centre stay was 50days. On average, the patients underwent 5 operations (range: 0-32) during their inpatient stay. Three patients required major amputation. Eight of the patients underwent late operations. Seven (38.9%) patients exhibited late neurological dysfunction or neuropsychological symptoms at long term follow-up. In conclusion, train climbers represent a rare group of young patients with electrical burns. Precautionary strategies should be implemented to prevent these injuries that are associated with high morbidity and mortality.

Anti-Cancer Drug-Induced Lyell’s Syndrome: A Series of Two Patients

Lyell’s syndrome or Toxic Epidermal Necrolysis (TEN) is a rare and life-threatening dermatological disease. Most commonly, this syndrome is drug-induced, and is a result of an immune-allergic reaction to medications. Anti-cancer drugs were not the most frequent groups of therapeutic agents related to Lyell’s syndrome, but the emergence of new therapeutic classes, particularly targeted therapy and immunotherapy, is changing current data. We present two cases of Lyell’s syndrome induced by anticancer drugs. (1) TEN in a man treated for metastatic urothelial carcinoma with Enfortumab Vedotin. (2) TEN in a man with metastatic melanoma treated with Nivolumab and Ipilimumab. Despite quick medical treatment and transfer to a severe burn unit, both patients died of TEN.

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

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

Pediatric burn injury at home in 30 years: A road to future prevention

IntroductionInjury prevention is valuable for pediatric burns at home. To develop future target of prevention, we aimed to elucidate characteristics and chronological changes of pediatric burn injuries at home in urban areas. Patients and MethodsWe conducted a retrospective observational study using the database of the Tokyo Burn Unit Association, which comprises 14 tertiary burn centers, the Tokyo Fire Department, Tokyo Medical Association, and the Tokyo city government. We included pediatric patients aged ≤15 years who had a burn injury at home in the last 30 years and divided them into five groups at 6-year intervals. We compared the mechanism, severity, and outcome of burn injuries between the groups. ResultsWe included 1092 pediatric patients, with no significant chronological changes in the incidence of burn injuries at home (approximately 200 patients in each 6-year period). The median age was 1 year in all the groups. Flame burns decreased from 7.7% to 1.6%, whereas scald burns remained at >80%. The burn area decreased from 10 (5–16) %total body surface area (%TBSA) to 7 (3–11) %TBSA. The length of hospital stay was reduced from 6 to 2 days, and in-hospital mortality was 0.4%–0.5% in the last decade. ConclusionsThe incidence of flame burns and burn area decreased over time with improving clinical outcomes in pediatric burns. The number of scald burns remained the same over time; thus, further social intervention is needed to prevent scald burns.

Selenoprotein P as a prognostic biomarker of burn sepsis: A prospective cohort study

IntroductionSeverely burned patients exhibit increased nutritional requirements and are at high risk of developing sepsis. Selenium is an essential trace element supporting antioxidant and anti-inflammatory pathways, mediated by incorporation into selenoproteins. The selenium status may affect sepsis risk in burn injury. MethodsThis prospective cohort study included 90 adult patients admitted to Zurich Burn Center, Switzerland. All patients received a continuous intravenous infusion of 1000μg sodium selenite per day during the first week as part of local standard of care. Three complementary biomarkers of serum selenium status were determined at nine time-points up to six months postburn, namely total selenium, selenoprotein P, and glutathione peroxidase 3. The resulting data were correlated to clinical parameters and outcomes, with sepsis as primary end point. ResultsA high fraction of the patients displayed selenium deficiency already at admission, and developed sepsis during hospitalization (n = 55; 61%). Selenium status at admission was inversely related to burn severity. Low baseline selenoprotein P was associated with sepsis incidence, irrespective of trauma severity (adjusted HR, 1.94; 95% CI, 1.05–3.63; p = 0.035). Burn severity and baseline concentrations of selenoprotein P and white blood cells corporately predicted sepsis with an area under the curve of 0.84 (95% CI, 0.75–0.93; p < 0.0001). Supplemental selenium was associated with a transient normalization of selenium status. ConclusionConsidering its rapid decline following severe burn injury, the assessment of serum selenoprotein P upon admission may contribute to an early prediction of sepsis risk.

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

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

Continuous peripheral nerve blocks for burn management: a retrospective study of outcomes and complications in 281 burn patients.

There is scarce literature regarding the use of continuous peripheral nerve blocks in acute burn patients, who may be at higher risk for catheter-related complications, including infection. We sought to describe our center's experience and infection rate with continuous perineural catheters in the setting of pain management for patients suffering from burns. A retrospective observational study was performed including all patients admitted to an American Burn Association-verified regional burn center between January 2018 and July 2023 who received a continuous peripheral nerve block for an acute burn injury. There were 281 patients in the study cohort who received 484 perineural catheters. The cohort was 52% men with a median age of 39 years (IQR 30-55). A catheter-associated infection, defined as a clinical diagnosis by the treating physicians requiring the need for treatment with antibiotics or surgical debridement, was identified in six perineural catheters (1.2%, 95% CI 0% to 2.2%) involving six different patients (2.1%, 95% CI 0% to 3.8%). The median total body surface area burned was 5% (IQR 2-9%) and 20% of patients had full-thickness burns. The most commonly used catheters were infraclavicular (49%), popliteal sciatic (29%), femoral (19%), and adductor canal (17%). One-third (33%) of patients did not require operating room debridement as the block provided sufficient analgesia for bedside debridement. The median duration of catheter use was 6 days (IQR 4-8). There were no documented cases of nerve injury or toxicity, vascular injury, or local anesthetic systemic toxicity. In our practice, continuous perineural catheters in the setting of acute burns are associated with an infection rate comparable to other surgical populations.

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

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

Comparative Analysis of Burn Injuries in Toddler and Preschool Children: Implications for Triage and Outcome Assessment.

This study aims to compare the demographic, clinical characteristics, and outcomes of burn injuries in toddler and preschool children, and to validate the American Burn Association (ABA) Burn Triage Decision Matrix in the Turkish pediatric population. A retrospective analysis was conducted on 684 pediatric burn patients (494 toddlers, 190 preschoolers) admitted to our burn center over a 5-year period. Variables including gender, burn etiology, burn area, depth, treatment modalities, complications, length of hospital stay, and mortality were analyzed. The performance of the ABA Burn Triage Decision Matrix was evaluated in both groups. Scalding was the predominant cause of burns in both groups, with a significant difference in the involvement of anterior trunk (p = 0.027). The mean Total Body Surface Area (TBSA) was comparable between the groups (p = 0.286). There was no significant difference in mortality rates (p = 0.385), treatment modalities, and complications. The ABA Burn Triage Decision Matrix demonstrated consistency in triaging the severity of burn injuries, with a notable discrepancy observed in the moderate risk category of toddler group. This study highlights the distinct characteristics and outcomes of burn injuries in different pediatric age groups. The ABA Burn Triage Decision Matrix's validation suggests its utility in enhancing triage accuracy and resource allocation in pediatric populations, especially in disaster-prone regions.

Comparative Phenotypic and Genotypic Properties of Serratia marcescens Isolates from Clinical Cases from human in AL-Diwaniyah Province, Iraq

Serratia marcescens is a Gram-negative, rod-shaped bacterium. It is an opportunistic and facultative anaerobe. This study aims to determine the occurrence rates of Serratia marcescens in human clinical samples, investigate the pigM gene, sequence the isolates, and compare them with global isolates documented in the NCBI database. Fifty burn samples were collected from the specialized center for burns in AL-Diwaniyah province, along with 35 urine samples from individuals suffering from UTIs from Al-Diwaniyah Teaching Hospital and various private laboratories. These samples were transferred in a cooled container to the microbiology lab at the Veterinary Medicine College, University of Al-Qadisiyah, for bacteriological assay. The samples were then cultured using selective and differential media. Following the purification of the cultured bacteria, biochemical tests were conducted to confirm the isolates. Results showed that 10 out of 85 samples (11.76%) were positive for Serratia marcescens. Culture positivity was most frequent in urine samples (17.1%), followed by burn samples (8%). Molecular methods revealed that human isolates gave 100% positive results for 16S rRNA. The study found that ten isolates of Serratia marcescens possess the pigM gene, with the 16S rRNA gene sequenced using the BLASTN algorithm of NCBI. All isolates were recorded under accession numbers (OR835629, OR835630, OR835631, OR835632, OR835633, OR835634, OR835635, OR835636, OR835637 and OR835638, showing 97-99% identity with isolates detected in China, India, and Nigeria. It can be concluded that the isolation rates of Serratia marcescens from urine samples are higher than those from burn samples. The sequencing results showed a 97-99% similarity with global isolates from China, India, and Nigeria.

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

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

Risk factors for Beta-lactam and carbapenem-resistant bacteria causing post-burn infections

Background: Burn patients are predisposed to infection because of the loss of skin barrier protection and low immunity. This study aims to evaluate the risk factors of post-burn infections due to beta-lactam and carbapenem-resistant bacteria (CR) isolated from a major burn unit.Methods: The descriptive study was conducted at Jinnah Hospital Lahore’s Burn and Reconstructive Surgery Centre (JB &amp; RSC) and the Institute of Microbiology and Molecular Genetics (MMG), University of the Punjab, Lahore. The clinical specimens of wound swabs, including the age, gender, socio-economic status, residence, occupation, hospital stay, wards, burn degree, total burnt surface area (TBSA%), etiology of burn, and other factors were recorded. Antimicrobial susceptibility testing (AST), ESBL and CR screening (Beta- lactam and carbapenem resistant bacteria) were performed using CLSI guidelines 2017.Results: The most dominant strain was Pseudomonas spp. 26.5% (n=106), followed by 15% (n=60) Klebsiella spp., and 7.5% (n=30) Acinetobacter spp. with ESBL-producing strains. Compared to nosocomial infections, community-acquired infections were observed in 314 (78.5%) patients with more ESBL production. There was a significant relation between burnt people having an age of ≤ 29 years with ESBL (p=0.985) and carbapenemases (p=0.694) infections. None of the other factors, like low socioeconomic status and more hospital stays had a significant correlation (p &gt; 0.05).Concluded: It has been concluded that MDR gram-negative strains play a serious role in burn infections and demand suitable methods to decrease their number. Pseudomonas spp. was the most common post-burn infection causing bacteria. Unfortunately, a high frequency of burn infections was observed in the patients at a young age.Keywords: Post burn infections; Gram negative; MDR; Beta- lactam; Carbapenem resistant

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

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

A feasible clinical pathway of severe pyoderma gangrenosum in burn centers based on three clinical cases

ObjectiveTo establish a standardized clinical pathway for the management of severe pyoderma gangrenosum (PG) in burn centers by analyzing and integrating insights from three detailed case studies. Methods and materialsFirst, we sum up experiences about identification and recovery methods for acute and chronic PG-induced wounds by analyzing the characteristics of emergent cases. Second, we analyzed the similarities and differences in the diagnosis and treatment of the clinical cases. Then, a clinical pathway was established by integrating the diagnosis and treatment characteristics of the three cases. ResultsA clinical pathway for severe PG management was developed for use in burn centers, which comprised: (1) Initial Assessment and Potential PG Identification Criteria, (2) Steps for Confirming a PG Diagnosis, (3) Treatment Protocol, and (4) Follow-up and Monitoring. ConclusionPG, as a rapidly progressing rare inflammatory skin disorder, is often misdiagnosed and treated inappropriately. The unpredictable course and the lack of standardized treatment protocols for PG makes its management challenging. The clinical pathway established in this study comprises a timely diagnostic process and optimizes treatment strategies, ultimately enhancing the quality of care for patients with PG. Future studies are needed to validate this pathway and explore its applicability in different clinical settings.

Assessing a tertiary surgical units readiness to offer a fellowship in burn care in Africa

The number of patients presenting with burn injuries in Africa is increasing [1,2], and these injuries can have devastating outcomes [3,4]. One contributing factor to these outcomes is the lack of adequately trained staff in providing expert burn wound care. There is little emphasis on training staff in caring for burn patients in Africa. Our goal was to assess the services offered at a specialized burn unit in South Africa and compare them to the recommendations of the American Burn Association for providing fellowship training in burn care. Establishing such a fellowship program will help train experts who can improve burn care services across Africa.

Factors associated with delayed admission to the burn unit: A major burn center’s experience

BackgroundTimely admission to the burn unit is crucial. Ideal burn care requires prompt interventions such as wound and body temperature management, infection control, and fluid resuscitation to prevent complications like burn progression and infection. In this study, we identify specific factors and outcomes associated with delayed admission to a regional burn center. MethodsPatients admitted to a large urban burn center from January 2015 to December 2023 were retrospectively queried, with subsequent collection of demographic and outcome variables from chart review. Descriptive statistics, Welch’s t-tests of unequal variances, and Chi-square analysis were performed. Multiple logistic regression was performed to explore the association between delayed admission and ICU stay, ventilator requirements, and mortality. ResultsA total of 3137 patients were included in the study. Approximately 63.4 % of patients were admitted within 24 h, while 36.6 % had a significant delay in care of over 24 h after injury. Male patients were likely to experience delayed admission (39.0 vs. 31.8 %, p < 0.001). There was no significant difference in age between the two cohorts (38.6 vs. 39.7 years, p = 0.199). There was no significant difference in time to admission by racial background (p = 0.061). Total body surface area burned (TBSA) varied between the delayed and control cohorts (15.5±18.7 % vs. 8.2±12.9 %, p < 0.001). Patients who were single (p < 0.001) and lived alone (p = 0.011) were more likely to experience a delay in burn unit admission. Homelessness (p < 0.001), substance abuse disorder (p < 0.001), and uninsured status (p < 0.001) were also associated with delayed admission. In regression analysis when controlling for TBSA, delay in care was significantly associated with a greater requirement for ICU stay (p < 0.001) and mechanical ventilation (p = 0.021) but was not associated with increased mortality (p = 0.232). ConclusionSociodemographic variables such as homelessness, lack of social support, and substance abuse are associated with delayed burn unit admission. Knowledge of these factors can inform future interventions to improve outcomes for vulnerable patients, promoting better recovery and long-term outcomes after burn injury.

Pediatric Burn Unit Admission is Associated with School Holidays and Lower Home Childhood Opportunity Level.

Burn injury can have profound detrimental effects on quality of life and mental health of children. We collected demographics, burn etiology, burn date, and home zip code for pediatric patients admitted to our burn unit from 2016-2023. Age, burn date, and etiology of burn were used to assess temporal and mechanistic patterns of injury for pre-school-age and school-age children. Home zip code was used to determine each child's home Childhood Opportunity Index score, which is composed of sub-domains for Education, Health & Environment, and Social & Economic. We calculated the odds-ratio for odds of pediatric burn admission for each COI sub-domain quintile, using very high opportunity neighborhoods as the reference. Scald was the prevailing burn etiology (64%). In school-age children, July was the month with the most burn injuries (19%), attributable to firework injuries. School-age children were also more likely to be injured in a week without classroom instruction (p<0.001). There was a dose-response relationship between Childhood Opportunity Index and odds of burn admission, with the greatest odds of burn admission observed for children from very low educational opportunity areas (OR 5.21, 95% CI 3.67-7.39). These findings support interventions for burn prevention such as increased education about the dangers of fireworks, addressing inequities in access to childcare and extracurricular activities, and reducing the default water heater temperatures in multi-unit dwellings.

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

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