Burn Center Research Articles

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 the 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 to 2023. Age, burn date, and etiology of burn were used to assess temporal and mechanistic patterns of injury for preschool-age and school-age children. Home zip code was used to determine each child's home Childhood Opportunity Index (COI) score, which is composed of subdomains for Education, Health and Environment, and Social and Economic. We calculated the odds ratio for odds of pediatric burn admission for each COI subdomain 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 < .001). There was a dose-response relationship between COI 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.

Art therapy as a bridge to expand burn care beyond surgery: Providers’ perspectives in an inpatient burn center

Burn injuries necessitate resource-intensive multidisciplinary care and psychosocial support. Incorporating art therapy in burn centers could enhance patient and provider care. However, research on the impact and reception of art therapy within the context of burn care is scarce. A doctoral dissertation study introduced art therapy intervention for burn patients. As part of this research, we conducted a qualitative study to explore health-care providers’ experiences, with a focus on their perspectives on burn-care and art therapy to inform research and clinical practice. Using thematic analysis in qualitative research, we conducted semi-structured interviews with 10 health-care providers from varied disciplines and identified the following three themes: a) Burn care is a “multifaceted problem” as well as an impact-driven, rewarding experience for providers; b) The visuality of art therapy coupled with physical activity is perceived as a necessary “emotional outlet” for burn patients; and c) Future art therapy research/practice goals are linked to complex patient presentations, specific multidisciplinary team challenges, and the critical care environment. Positive perceptions reinforced that art therapy could contribute to inpatient care as part of multidisciplinary burn teams. More research is needed to address the identified psychosocial, functional, and interprofessional needs of patients and providers.

Elimination of an outbreak of carbapenem-resistant Acinetobacter baumannii in a burn unit

Carbapenem-resistant Acinetobacter baumannii (CRAB) is an opportunistic pathogen which has caused numerous healthcare-associated outbreaks particularly in intensive care and burn units. We describe an outbreak in a burn unit where 3 patients were identified as being colonized or infected with CRAB. A multi-faceted approach and rapid implementation of infection prevention measures were effective in identification and removal of potential environmental reservoirs resulting in the prevention of further transmission.

Achieving The Nutritional Goal Of Burn Patients In A Referral Hospital In The Northern Region Of Brazil

Background: Burns represent a significant health challenge, not only due to the pain and suffering they cause, but also due to metabolic complications. Oral nutritional therapy is a powerful tool in the recovery of these patients, as the burn requires double the energy demands. Therefore, achieving the nutritional goal in burn patients should be considered a priority in clinical management. Materials and Methods: Patients admitted to the Burn Treatment Center at a reference hospital in the North region were evaluated. For nutritional diagnosis, the gold standard tools for nutritional risk analysis were applied, Nutritional Risk Screening (NRS-2002) for adults and Screening Tool for Risk on Nutritional Status and Growth (Strongkids, 2012) for children. These are validated low-cost and non-invasive methods. Monitoring the achievement of VET and protein was carried out through food records and the percentages achieved in accordance with the prescribed calories and proteins were calculated. Results: 22 adult patients were evaluated. Of these, 15 men and 7 women, with an average age of 35.8 years. The assessment revealed 7% malnourished, 67% eutrophic, 33% obese and 13% obese. Adults averaged 2026 cal/day with 112% VET attainment and 90g protein with 125% intake. It is worth highlighting the joint action of nutrition professionals with the prescription of hypercaloric and hyperprotein preparations to adapt to the needs recommended for burn patients, in addition to Oral Nutritional Therapy (ONT), with an increase of 600cal/day and 40g of proteins. The use of hypercaloric and hyperprotein supplementation in burn patients is a strong ally in diet therapy, given the catabolic state and high risk of depletion. Among the children's audience, 7 children were served: 4 boys and 3 girls, an average age of 4.4 years. The nutritional diagnosis showed 85% in eutrophy, and 15% in nutritional risk. The VET of this group was on average 1215 cal and 39g of protein. Children achieved an average of 142% of daily VET and 175% of protein needs. To this end, 85% used TNO, accounting for 300 cal and 7.6 g of additional protein to the oral diet. Conclusion: Achieving the nutritional goals prescribed for burn patients has a significant impact on the meffectiveness of treatment

Posttraumatic growth among burn patient family caregivers in China

BackgroundBurns carries a high risk of severe physical damage, prolonged recovery, and mental health implications for both patients and their caregivers. While distress among caregivers of burn patients has been studied, less attention has been given to potential positive psychological changes. This study focuses on the prevalence, temporal dynamics, and predictors of posttraumatic growth (PTG) among caregivers. MethodsA cross-sectional survey was conducted with 161 family caregivers from two Chinese burn units in 2016–2017. Participants completed a general information questionnaire and four measures: Posttraumatic Growth Inventory, Posttraumatic Stress Disorder Checklist, Depression, Anxiety, and Stress Scale-21, and Multidimensional Scale of Perceived Social Support. ResultsThe PTG scores for caregivers, with an average of 59.8 (± 13.9), exhibited a curvilinear pattern over a period of 36 months, initially decreasing and then increasing. Multiple linear and quadratic regression analyses affirmed that heightened anxiety (p < 0.001), male gender (p < 0.05), college education (p < 0.05), and increased social support (p < 0.05) positively predicted family caregiver PTG. ConclusionsThis is the first study of burn injury caregiver PTG. The study indicates caregivers of burn patients may undergo positive psychological transformation. Variations in predictive factors necessitate validation through longitudinal research. The dynamic interplay of psychological outcomes between patients and caregivers requires further exploration.

Comparative analysis on pulverized coal combustion preheated by self-sustained purifying burner with coaxial and centrosymmetric air nozzle structures: Purification, combustion and NOx emission characteristics

To optimize secondary air nozzle structure in purifying burner, this study focused on the comparison of purification, combustion and NOx emission characteristics of pulverized coal preheated by a 30 kW purifying burner with coaxial and centrosymmetric structures. Centrosymmetric structure shifted the position of main burning region down in high-temperature reduction unit (HTRU), and the number of branches differently influenced the temperature in different regions with this structure. For reductive gas components, CO concentration with centrosymmetric structure was higher compared to coaxial structure, while the differences in H2 and CH4 concentrations were smaller. Centrosymmetric structure was more disadvantageous to improve physicochemical properties of pulverized coal compared to coaxial structure, and this structure with four branches further deteriorated its properties compared to two branches. In mild combustion unit (MCU), the temperature at top was lower with centrosymmetric structure, while was higher in the rest. Centrosymmetric structure more effectively reduced NOx emission compared to coaxial structure, but with slight sacrifice of combustion efficiency (η). Moreover, both two-branch and four-branch centrosymmetric structures realized ultra-low NOx emission (<50 mg·m−3) with high η of over 98.50%, and the former was more advantageous. With this optimal structure, η and NOx emission were 99.25% and 40.42 mg·m−3.

Effect of X-ray radiation on Multi-drug Resistant (MDR) Enterobacteriaceae &amp; P.aeruginosa isolated from burn unit patient. The phenotypic and molecular study, Biofilm formation

Background: Multi-drug-resistant (MDR) bacteria are a significant global health concern due to their elevated rates of morbidity and mortality in burn patients. In This study investigated the presence of multidrug-resistant pathogenic bacteria in individuals with burn injuries, the formation of biofilms, and the impact of X-ray radiation. Method: For this study Clinical swabs about120 burn patients were obtained between December 2023 and June 2024 from burn units at Ramadi and Falluja Teaching Hospitals. Both conventional and Vitek2(bioMérieux) methods were used to identify the bacterial isolates. The isolates were then divided into three multi-drug resistance groups. The Colorimetric method (MTP) detected biofilms. To detect blaOXA-23,blaOXA-48, Omp, and blaTEM resistance genes, multiplex PCR was used. This research used two lumbosacral spine X-ray levels. Two levels of radiation were used 40 (80KV) mAs and 51.2 (85KV). Result: Results of burn isolation revealed 30(27%) P.aeruginosa, 18(16%) k.pneumoniae, 7(6%) E.coli, 7(6%) P.mirabilis. Of the all isolates, 100% produced biofilm. The Multiplex-PCR analysis revealed that the blaTEM genes were the predominant ones, constituting 30% of the samples. Subsequently, blaOXA-23 constituted 24.5% of the cases, whereas Omp accounted for 22.7% and blaOXA-48 for 13.6%. The radiation impact of X-rays produced by two dosages, 40(80KV)mAs for 125msec and 51,2(85KV) mAs for 160msec, demonstrates that there is no effect or alteration in the resistance capacity of all the bacterial isolates tested. Conclusion: This study showed that burn unit isolates produce ESBLs, which is a major concern in the intensive care unit due to its high morbidity and potential mortality. These data match antibiotic phenotypic test results showing substantial cefepime resistance. All isolates forming biofilms, this may association with high pathogenicity. This demands quick intervention to manage nosocomial outbreaks. No X-ray effect was seen on susceptibility a burn unit bacterial isolate.

Detection of OXA-23, OXA-48, OmpA and bla-TEM genes in carbapenem-resistance Acinetobacter baumannii and biofilm formation in burn patients at Al-Anbar Government

Background. Antibiotic-resistant bacteria represent a highly global health issue by causing high rates of morbidity and mortality in burn units, whereas biofilms significantly contribute to complications in burn patients. Objectives. The study investigates the prevalence of (OXA-23, OXA-48, OmpA and bla-TEM) and biofilm formation of Acinetobacter baumannii in the Burn Unit of the Al-Anbar government. Methods. A total of 120 clinical swab samples from burn patient were collected from December 2023 to April 2024 from the burn units of Ramadi Teaching Hospital and Falluja Teaching Hospital for the study. The colonies were identified using conventional and Vitek methods. Colorimetric technique (MTP) and multiplex PCR were used to detect biofilms and resistance genes. Results. Among 120 samples, 40 (33.3%) were Acinetobacter baumannii, 34 (80%) were MDR- resistant, and 6 (15%) were XDR. 90% of the isolates were resistant to Cefotaxime, and Colistin was more sensitive in all forty isolates. All 40 isolates formed significant biofilms. The percentage of positive results for OXA-23, OmpA and bla-TEM genes were 80%, 65%, and 55% of respectively. Carbapenem testing is essential to identify carbapenem-producing strains from non-producing strains due to the high prevalence of multidrug-resistant A. baumannii with the OXA-23 and OmpA genes. Conclusion. These findings highlight the urgent need for effective infection control measures and the development of new therapeutic strategies to manage these infections in burn patients.

Geospatial Analysis of Pediatric Burns Reveals Opportunities for Injury Prevention

BackgroundGeospatial analysis is useful for identifying hot spots for preventable injuries and for informing prevention efforts. We hypothesize that specific populations of children in South Florida are at increased risk of burn injury. MethodsWe used a regional burn center registry to geocode burn cases treated from July 2013 to December 2022 for patients <18 years. Spatial analysis was utilized to identify high-density areas and potential spatial clusters of patients living in Palm Beach, Broward, and Miami-Dade Counties. Sociodemographic factors, burn etiology, and physiologic characteristics were analyzed using geospatial and statistical analyses. Results689 patients (58% male, median age 2 [1–8] years) were identified. The annual incidence of burns was 5.5 per 100,000 children. There was no seasonal variation in injury patterns. Most patients were Black (51%) and non-Hispanic (73%). Scald burns (72%) represented the most common etiology, followed by flame (10%) and contact with hot objects (9%). Most patients (58%) required inpatient admission. Scald and contact burns occurred in younger patients compared to other mechanisms (median [IQR] age: 2 [1–6] vs. 8 [4–12] years, p < 0.001). Race, ethnicity, and insurance status were not associated with inpatient admission (all p > 0.05). Overall, there was a higher rate of pediatric burn injuries affecting Black residents, with a paucity of injuries in predominately high-income areas. ConclusionsA disproportionate amount of pediatric burn injuries occur in low-income and predominantly Black neighborhoods. Additionally, scald and contact burns are a target for injury prevention in South Florida. These data may inform public health implementation to reduce morbidity in vulnerable populations. Level of EvidenceLevel III. Type of StudyRetrospective comparative study.

Successful control of an outbreak of Panton–Valentine leucocidin positive meticillin resistant Staphylococcus aureus in a National Burns Unit through early detection by whole genome sequencing

We report an outbreak of PVL-producing MRSA in the Irish National Burns Unit in 2022 involving seven patients, two staff members and two positive environmental samples. This outbreak was successfully controlled using a range of measures including staff screening, environmental screening and enhanced cleaning. The use of real time whole genome sequencing (WGS) allowed for rapid identification of relatedness and for a rapid outbreak response. We share our successful approach to control this outbreak.

The ‘AfterBurn’ Longitudinal Exploratory (ABLE) study: Cohort profile

With advanced medical treatments more burns patients survive their injuries, requiring a better understanding of the quality-of-life outcomes experienced after the burn. The aims of the ABLE study cohort profile are to describe the baseline characteristics. The study included participants aged 18 years or over, admitted to a single state-wide burns centre in Queensland, Australia with a ‘major burn injury’. Baseline survey data were collected either in person or by telephone within 28 days of the injury and participants were followed up with in-person, or telephone interviews at 3-, 6- and 12-months post-burn. Injury and burns treatment information were collected from medical records or the hospital database and surveys collected demographic and psychosocial data. Health-Related Quality of Life (HRQoL) data were collected using the 12-item Short Form Survey – version 1 (SF-12v1) and the Burn Specific Health Scale – Brief version (BSHS-B). Of the 274 participants recruited, 71.5 % (N = 196) remained enrolled in the study at 12 months post-burn. The median age for the cohort was 41.5 years (range 18 to 87 years) and the majority were male (72 %) as well as non-Indigenous Australians (76 %). The median Total Body Surface Area (TBSA) burned was 4.75 % (IQR=1.5–10.13) with a range of 0.1 % to 79.75 %. The largest percentage of participants sustained a flame burn (N = 129, 47.1 %) followed by scald (N = 56, 20.4 %) then contact burn (N = 54, 19.7 %). Fewer participants were injured by chemical (N = 14, 5.1 %), friction (N = 11, 4 %), and electrical burns (N = 6, 2.2 %). There were 37.9 % participants who reported having been diagnosed with a psychological condition prior to their burn injury. These findings provide an overview of baseline characteristics with a greater understanding of personal, environmental, burn injury and burn treatment factors in a state-wide burn centre.

A Study of Cadaveric Skin Graft Harvest and Usage: An Observational Prospective Pilot Study.

Background Burn injuries pose a significant global public health challenge, causing substantial morbidity and mortality, particularly in low- and middle-income countries. Timely and effective wound coverage is critical in treating severe burns to prevent infection, reduce pain, and promote healing. Cadaveric skin grafts (allografts) have become essential in treating extensive burn wounds, serving as temporary biological dressings to prepare the wound bed for autografting. This study aims to comprehensively analyze the process of cadaveric skin graft harvest and usage in a tertiary care setting. It seeks to evaluate the procedures, challenges, and outcomes associated with cadaveric skin grafts, contributing to optimizing burn care practices and improving patient outcomes. Methods This observational study was conducted at a tertiary care hospital and burns center with a skin bank, involving 44 cadaveric skin graft harvests and 27 applications between July 1, 2011, and June 30, 2013. The study focused on prospective donors and recipients needing cadaveric skin grafts. Inclusion criteria for donors included consent from the next of kin and the absence of infections or septicemia, while exclusion criteria included prolonged post-mortem intervals and medico-legal cases. The procedures adhered to the Euro Skin Bank protocols, encompassing retrieval, processing, storage, and usage. Data were analyzed using Epi-Info version 7.2.1 software, employing descriptive statistics for categorical variables. Ethical clearance was obtained from the university ethical committee, with mandatory written informed consent for skin donation. Results Out of 519 deaths in the tertiary care hospital, significant barriers to skin donation included septicemia, skin changes, late reporting, young age, medico-legal issues, and positive viral markers. Notably, 114 (21.97%) of next of kin refused consent. Cadaveric skin was harvested in five (11.36%) cases, with potential donors identified in 78 (15.02%) of deaths. Donors were predominantly older males, with efficient procurement processes ensuring timely harvests. The tertiary burns center facilitated 39 (88.63%) cases of cadaveric skin harvests with a skin bank, either at the donor's home or other hospitals notified to the burns center. Cadaveric skin grafts were applied in 27 cases, primarily for burns, with high graft uptake observed over 10 days. Non-healing ulcers showed 100% graft uptake. The survival rate among burn patients was 20 (74%), with deaths mainly due to sepsis and multi-organ failure. Significant barriers to obtaining consent included a lack of awareness, superstitions, social stigmas, and religious objections. Conclusion The study highlights the critical role of cadaveric skin in managing extensive wounds, particularly burns. Despite challenges in obtaining consent and limited donor availability, cadaveric skin grafts effectively prepared wound beds for autografting, contributing to improved patient outcomes. Increasing community awareness and addressing superstitions and social stigmas are essential for improving donation rates.