Burn Center Research Articles

Aminoglycoside Susceptibility among Extensive Drug Resistant Pseudomonas aeruginosa from Hospitalized Patients in Al-Diwaniyah, Iraq

Abstract Background: Pseudomonas aeruginosa is one of the most prevalent Gram-negative microbes associated with serious and fatal nosocomial infections. It is routine to use aminoglycosides as a treatment for P. aeruginosa infections. Objectives: The dissemination of aminoglycoside resistance offers a major challenge to the treatment of life-threatening infections caused by these bacteria. Aim of Study: Determination of aminoglycoside-modifying enzymes and 16S ribosomal RNA methylases in extensive-drug resistant (XDR) P. aeruginosa isolates. Materials and Methods: From November 2021 to August 2022, a total of 200 samples were collected in this cross-sectional study including burns (n = 80, 40%), wounds (n = 66, 33%), and diabetic foot ulcers (n = 54, 27%) from admitted patients to Al-Diwaniyah Burn Center and Al-Diwaniyah Teaching Hospital. The identification and antibiotic susceptibility profile of P. aeruginosa were done by vitek2 compact system. The isolates were subjected to polymerase chain reaction assays with specific primers for ant(4’)-IIa, ant(4’)-IIb, acc(6’)-Ia, aph(3’)-IIb, rmtA, and rmtD. Results: The recovery rate of P. aeruginosa isolates was (n = 50, 25.0%) from the clinical samples. Antibiotic-susceptibility patterns demonstrated that 18% of the isolates were multi-drug resistant and 22 (44%) were XDR. The XDR isolates were resistant to all 14 antibiotics related to the seven antibiotic classes tested in this study. The prevalence of aminoglycoside resistance genes among XDR isolates is ant(4’)-IIa (22.7%), (4’)-IIb (27.3%), acc(6’)-Ia (18.18%), aph(3’)-IIb (100%), rmtA (36.36%), rmtD (36.36%), mexZ and parR (100%). Conclusion: Increased resistance to aminoglycosides in Al-Diwaniyah Hospitals serves to highlight how critical this issue is when treating multidrug-resistant P. aeruginosa infections that are life-threatening. All the resistance isolates harbored aph(3’)-IIb gene.

Microcirculatory depth of focus measurement shows reduction of tissue edema by albumin resuscitation in burn patients

BackgroundSevere burns induce volume shifts via capillary leaks, eventually requiring massive fluid resuscitation and promoting tissue edema. Albumin may help to mitigate the edema, thereby improving perfusion. This study shows that sublingual microcirculation measurements can quantify both tissue perfusion and edema. MethodsThis prospective observational study was conducted between November 2018 and December 2019 in the intensive care unit of Maasstad Hospital Burn Center, Rotterdam, The Netherlands. Patients with severe burns affecting >15% of the total body surface area were included. Fluid management was conducted in accordance with the Parkland formula. Albumin (20%) was administered at a rate of 0.5 mL/(kg·h), starting 12 h after the burn incident. Alterations in the sublingual microcirculation, including capillary perfusion and density, were measured at admission (T0) and at 4 h (T4) and 12 h (T12) after admission. Sublingual depth of focus (DOF) of the microcirculation was used to quantify the tissue edema. ResultsNine patients were recruited with a mean total body surface area of 36% ± 23%. By T12, a median of 4085 mL (interquartile range [IQR]: 3714–6756 mL) of crystalloids and 446 mL (IQR: 176–700 mL) of 20% albumin were administered. The DOF increased significantly after crystalloid administration (T4 vs. T0, mean difference [MD]=27.4 µm, 95% confidence interval [CI]: 3.4 to 50.9, P=0.040). Following albumin administration, DOF significantly decreased (T12 vs. T4, MD=-76.4 µm, 95% CI: -116.6 to -36.1, P=0.002). Total vessel density decreased significantly with crystalloid administration (T4 vs. T0, MD=-3.5 mm/mm2, 95% CI: -5.7 to -1.4, P=0.004) but increased after albumin administration (T12 vs. T4, MD=6.2 mm/mm2, 95% CI: 3.2 to 9.3, P=0.001). ConclusionSublingual microcirculation measurement of DOF and other parameters provide a valuable tool for the assessment of tissue perfusion and edema in patients with severe burns. Further investigation is required to evaluate the role of albumin in increasing microcirculatory convection and reducing tissue edema.

The prevalence and predictors of reconstructive surgery in pediatric burn care

ObjectiveThis study aimed to examine the prevalence and predictors of reconstructive surgery among pediatric burn patients in the Netherlands. MethodsPediatric burn patients were identified through the Dutch Burn Repository R3. Eligibility criteria included a burn requiring hospital admission or surgical treatment at one of the Dutch burn centers in 2009–2019. First, patient, burn, and treatment characteristics were summarized using descriptive statistics. Second, time to the first reconstructive surgery was modelled using Kaplan Meier curves. Third, a prediction model was developed using univariate and multivariate logistic regression. The model’s performance was assessed using calibration, discrimination, and explained variance. Fourth, internal validation was performed using bootstrapping. ResultsApproximately three percent (n = 84) of pediatric patients (n = 3072) required reconstructive surgery between the initial burn-related hospital admission and September 2021. Median time to the first reconstructive surgery was 1.2 (0.7–1.6) years. Most surgeries were performed on the face, arm, neck, hand, or anterior trunk, owing to contractures or hypertrophic scarring. Predictors of reconstruction included the etiology, anatomical site, extent of full-thickness burn, surgical treatment in the acute phase, and length of hospital stay. ConclusionOur study provided an overview of the prevalence and independent predictors of reconstructive surgery in the pediatric burn population.

The predictive role of Interleukin 6 and Procalcitonin associated with bacterial infection causing sepsis in patients with severe burn

Background. Sepsis is a major contributor to both death and illness on a worldwide scale. Bacteremia characterized by the presence of gram-negative, gram-positive, or mixed growth bacteria has been shown to be associated with a significantly increased risk of septic shock and a bad prognosis. Biomarkers are used to aid in the diagnosis of sepsis and to differentiate between bacterial causes, namely Gram-negative, Gram-positive, and mix growth bacteria. Objectives. This study aimed to evaluate the role of PCT and IL-6 in predicting bacterial infection in burn patients with sepsis due to gram-negative, gram positive and mixed growth bacteria. Methods. Forty-four patients with age (1.5–75 years), and nineteen healthy controls with the same age range, were involved in this study during their attendance to Specialized Burns Hospital in the Medical City, Al-Kindi Teaching Hospital in Baghdad, and Al-Nasiriyah General Hospital in Thi-Qar province. The study was conducted from 1st December 2023 to 1st April 2024 and approved by ethical committees of Institute of Genetic Engineering and Biotechnology for Postgraduate Studies/ Baghdad University. Blood samples and data were collected to evaluate the level of PCT and IL-6 associated with bacterial infection for burn patients by enzyme linked immunosorbent assay (ELISA). Results. 25 (50%) showed growth for Gram-negative, 13 (26%) for Gram-positive and 12 (24%) for mix growth bacteria. Results appeared a significant increase at (P≤0.01) in each of PCT and IL-6 in burn patients to control group according to gender. Patients exhibiting a combination of bacterial growth have notably elevated levels of procalcitonin (PCT). Levels of PCT were significantly elevated in burn patients with mixed growth sepsis compared to patients with Gram-negative and Gram-positive sepsis. However, there were no significant differences in IL-6 levels between burn patients with mix growth sepsis and patients with gram-negative and gram-positive sepsis (P> 0.05). Measuring PCT levels may assist in selecting the appropriate empirical antibiotic treatment. Conclusions. The PCT biomarker demonstrated superior performance in distinguishing between microbial sepsis caused by various kinds of pathogens. This finding has great promise for its use in clinical practice, particularly in burn units.

Prognostic Scores for Mortality in Invasive Mechanically Ventilated Burn Patients.

Managing burn patients is a challenge requiring a multidisciplinary team with the ability to predict complications and act early to avoid them. There are few studies characterizing the population of critically ill burn patients in need of ventilatory support. This study aimed to describe the population of burn patients in need of invasive mechanical ventilation supportand assess in-hospital mortality and the factors associated with it. A longitudinal retrospective study was conducted, including burn patients admitted to a tertiary hospital burn unit over five consecutive years, who required invasive mechanical ventilation support during their hospitalization. Demographic data, comorbidities, characteristics of the injury scene, etiology, and characteristics of the burn were collected.Length of mechanical ventilation and hospitalization as well as mortality rate were evaluated.The determination of mortality predictors and the prognostic performance of mortality prediction scores were analyzed. A one-year follow-up was performed to evaluate the survival of discharged patients. A total of 141 patients were included in this study; 68.1% patients were malewith a median age of 58 years. The mean percentage of total body surface area (TBSA) burned was 24.5%. Home incidents were the most frequent, and fire was the most common cause of burns (80.9% of patients). The mean Abbreviated Burn Severity Index Score (ABSI) was 7.83, with an area under the curve in receiver operating characteristic curve (ROC) analysis (AUC_ROC) of 0.725; the mean Belgium Outcome of Burn Injury (BOBI) score was 3.45, with AUC_ROC of 0.740 and mean R-Baux of 89.1 and AUC_ROC of 0.834. The mean duration of invasive mechanical ventilation was 16.9±19.3 days. Age (p<0.001), length of mechanical ventilation (p<0.001), length of hospitalization (p<0.001), higher degree of burn (p=0.001), TBSA (p=0.040), and the presence of buttock burn (0.006) were associated with mortality in this sample. In-hospital mortality was 29.8%. The survival group had a 12% death rate at one-year follow-up, mostly in the first three months after discharge. Age, duration of mechanical ventilation, length of hospitalization, higher degree of burn, TBSA, and the presence of buttock burn were associated with mortality in this sample. R-Baux score was the most accurate test score to predict mortality in this challenging group of patients.

Gel Fuel Burns and the Napalm Effect.

Gel fuels, composed of flammable substances like ethanol and methanol, are commonly used for heating in various settings. Despite their convenience, improper handling can lead to severe burn injuries. This study examines the characteristics of gel fuels, particularly focusing on the "napalm effect" where the fuel continues to burn on surfaces it adheres to. A review of gel fuel burn literature was conducted, along with an analysis of two recent cases admitted to a burn unit. Gel fuel burns, though rare, can result in deep and extensive injuries, especially affecting the hands, face, and upper body. The cases presented highlight the severity of such burns and the challenges in their management, including respiratory complications and the need for early excision and grafting. Gel fuel burns, while infrequent in medical literature, pose significant risks and require specialized care. Further research and possibly regulatory measures may be warranted to mitigate these risks and prevent severe injuries.

Epidemiological and clinical characteristics of burns in adults: a 6-year retrospective study in a major burn center in Suzhou, China.

Burns are a prevalent form of unintentional injury and a significant public health concern in developing countries. We aimed to investigate the epidemiological and clinical characteristics of adult burn patients at a major center in Eastern China. This 6-year retrospective study analyzed patients with varying degrees of burns between January 2017 and December 2022 at the Suzhou Burns and Trauma Center. The study extracted demographic, clinical, and epidemiological data from electronic medical records for analysis. The study included 3,258 adult patients, of which 64.3% were male. The largest age group affected 30-59-year-old adults (63.04%). Scalds were the leading cause of burns (1,346, 41.31%), followed by flames (1,271, 39.01%). The majority of burn hospitalizations were those with moderate burns (1791, 54.97%). The morbidity rate was low at 0.68%, while mortality was strongly associated with age, etiology, and total body surface area. Patients with certain types of burns, such as explosions, hot crush injuries, and electric burns had more operations, longer lengths of hospital stay, and higher costs compared to those with scalds and flame injuries. Different prevention strategies should be formulated according to different etiologies, ages, and genders.

Evaluation of White Blood Cell Count, Lymphocyte Percentage, Neutrophil Percentage, and Elevated Temperature as Predictors of Wound Infection in Burn Patients.

Infection remains a chief cause of morbidity and mortality among burn patients. The burn wound surface is initially sterile after a thermal injury but eventually gets colonized by microorganisms. A burn wound is considered infected upon the presence of high concentrations of microorganismsin the wound and scab. Burn wound infections can lead to a delay in epidermal maturation, higher scar formation, and sepsis. However, burn patients are commonly misclassified as septic due to the manifestation of systemic inflammatory response syndrome (SIRS) after their injury, despite the presence or absence of an infection. This is a retrospective review of medical records of patients admitted to the burn unit in Salmaniya Medical Complex in Manama, Bahrain, between the years 2018 and 2020. Demographic data, total body surface area (TBSA), initial temperature, white blood cell count, lymphocyte percentage, neutrophil percentage, and wound cultures were obtained for all subjects. Logistic regression analysis was performed to compare the presence or absence of wound infection by the aforementioned parameters. Of 412 cases, 68.2%were male patients, with a mean age for the studied population of 25.1 years (standard deviation (SD)=20.7). Staphylococcus aureus was the most prevalent organism across all of the study population (n=31)(34.4%). Staphylococcus aureus was the most prevalent organism in patients under the age of five, while Pseudomonas aeruginosa was the most common organism among adults older than 65 years of age. TBSAwas not found to be a good predictor of wound infection. There was no statistically significant relation between initial temperature and wound culture (p-value=0.056). However, logisticregression revealed that the initial temperature increases the likelihood of positive wound culture by almost three times. White blood cell count, lymphocyte percentage, and neutrophil percentagewere not clinically reliable in predicting burn wound infection. However, initial temperature might be a helpful predictor. Further research is needed to identify reliable clinical parameters of burn wound infections.

Initiation of adaptive feeding within 24 h after burn injury improves nutritional therapy for severely burned patients.

Nutritional therapy is a crucial component of treatment for severely burned patients. Although overly aggressive enteral nutrition immediately after burn injury has potential risks, nutritional disruption after a severe burn can also increase infection risk and delay wound healing. For approximately six decades, the Ruijin Hospital Burn Center has used two distinct approaches for patients during the early period after burn injury: complete fasting or adaptive feeding. Notably, adaptive feeding more closely resembles enteral nutrition. In this retrospective study, we analyzed factors influencing the selection of either modality, as well as the benefits of adaptive feeding. We sought to promote adaptive feeding as a precursor to initiating enteral nutrition. This retrospective study analyzed medical data from adult patients with extensive burns between January 2009 and December 2020. All patients had been admitted to the burn department within 24 h after injury and had a burned area comprising >30% of total body surface area. Patients were divided into two groups: adaptive feeding and fasting. We examined the total burned area, full-thickness burned area, burn type, inhalation injury, start time of adaptive feeding, and start time of enteral nutrition. Outcome measures were 28-day mortality and hospital mortality. Univariate analysis revealed significant differences in burn type, percent of total body surface area (TBSA), full-thickness burned area, and inhalation injury between the adaptive feeding and fasting groups (all p < 0.05). Linear regression analysis showed that full-thickness burned area and inhalation injury were the main factors influencing the start time of adaptive feeding in patients with severe burns (p < 0.05). After propensity score matching analysis, the results showed that the start time of enteral nutrition was significantly earlier in the adaptive feeding group (p < 0.01). However, overall mortality, 28-day mortality, and length of hospital stay did not significantly improve in the adaptive feeding group. The incidence of intolerance after enteral nutrition therapy did not significantly differ between groups. The results of the study showed that larger full-thickness burned areas and concomitant inhalation injury were the primary factors considered by physicians when selecting complete fasting for severely burned patients. Moreover, the results indicate that adaptive feeding improves nutritional therapy for severely burned patients by shortening the time between injury and initiation of enteral nutrition. Complete fasting due to concerns about extensive burned area and inhalation injuries does not reduce the incidence of enteral nutrition intolerance; instead, it delays the initiation of enteral nutrition.

EVALUATION OF NURSE-PATIENT COMMUNICATION AND ITS IMPACT ON PATIENT SATISFACTION

Effective nurse-patient communication is critical to patient satisfaction, particularly in specialized care units like burn units. Poor communication can lead to adverse patient outcomes and dissatisfaction, highlighting the need for focused studies to evaluate and improve communication practices in healthcare settings. Objective: To assess nurse-patient communication and its impact on patient satisfaction in the burn unit of Nishtar Medical Hospital, Multan. Methods: A descriptive, cross-sectional study was conducted in the Burn Unit of Nishtar Medical Hospital, Multan, from May 2023 to May 2024. Three hundred patients admitted to the burn unit were selected using convenience sampling at discharge. Data were collected using two modified questionnaires: the La Monica Oberst Patient Satisfaction Scale (LOPSS) and the Nurse Quality of Communication with Patient Questionnaire (NQCPQ), both translated into English and Urdu. Patients were presented with the questionnaires before discharge and were given adequate time to complete them. Statistical analysis was performed to evaluate the results. Results: The mean score of LOPSS was 150.47 ± 9.09, indicating patient dissatisfaction in several areas, including the nurses' reluctance to consider patients' choices, inadequate assessments, and insufficient explanation of treatment plans, leading to patients feeling like mere cases. The mean score of NQCPQ was 89.29 ± 6.10, with the highest communication scores noted in the patient's active involvement in maintaining personal hygiene and the nurses' assistance with mobility, diet, and hygiene. Gender showed a direct statistical association with satisfaction scores and communication quality. Conclusion: Weak nurse-patient communication led to poor patient satisfaction scores. Enhancing professional communication among healthcare staff is imperative to improving the quality of care and patient satisfaction in burn units.

Application of cultured epidermal autograft, JACE®, improves survival rate in extensive burns: A propensity score matching study using Tokyo registry data.

Cultured epidermal autograft, JACE®, was introduced into the Japanese national health insurance system in 2009 and has been used in more than 1000 cases of extensive burns. The aim of this study was to investigate whether the use of JACE® contributes to survival rate in extensive burns. In this study, 119 cases were selected from 3990 cases in Tokyo Burn Unit Association registry data from 2009 to 2023, excluding cases with less than 40% total body surface area, cases of deaths within 4 weeks and cases with unknown length of hospital stay. In total, 25 patients treated with JACE® were selected and matched with another 25 patients who did not receive JACE® using propensity score matching. The results showed that patients treated with JACE® had a significantly higher survival rate than did those who were not treated with JACE® at all time points between 6 and 9 weeks post-injury. In addition, there was no significant difference in length of hospital stay between the groups. These results suggest that the use of JACE® in patients with extensive burns contributes to patient survival and does not prolong hospital stay.

Optimising Scar Management Intervention in the Case of a Head-and-Neck Burn for a Patient with a Learning Disability

Scars following burns can often prove complex to manage, particularly when crossing joints or special areas such as the head and neck, due to contractures. This case report discusses the individualised care and rehabilitation provided to a burn patient with a learning disability. The patient suffered both full and partial thickness burns equating to a total body surface area (%TBSA) of 7% of the face, neck, and anterior chest via the self-ignition of clothing. Acute treatment was provided at a regional burn unit followed by further in-patient care and rehabilitation at our burn facility. A motion rehabilitation instrument was employed to manage potential orofacial contracture; however, due to the patient’s impaired social functioning, this device was found to be unsuitable. Subsequently, a bespoke mouth-opening device replicating an ice lolly was fabricated utilising computer-aided design (CAD), enhancing the patient’s understanding along with encouraging independence. Microstomia was a risk in this case; however, this was prevented via the discussed regime, and successful patient rehabilitation was achieved.

A Multicenter, Retrospective Outcome Analysis of Vancomycin Area Under the Curve versus Trough-Based Dosing Strategies in Patients with Burn OR Inhalational Injuries (MONITOR).

Vancomycin is a glycopeptide antibiotic that requires close therapeutic monitoring. Prolonged exposure to elevated concentrations increases risk for serious adverse effects such as nephrotoxicity. However, sub-therapeutic concentrations may lead to bacterial resistance and clinical failure or death. The most recent Infectious Diseases Society of America (IDSA) publication regarding therapeutic monitoring of vancomycin recommends utilizing area under the curve (AUC)-based monitoring to maximize clinical success. Despite the guideline recommendation for AUC-guided dosing, many institutions still use trough-only monitoring in their practices, including those caring for patients with acute burn injuries. Following burn injury, patients are at a higher risk for infections, multi-organ failure, and pharmacokinetic alterations. The primary objective of this multi-center retrospective study is to determine optimal therapeutic monitoring of vancomycin by comparing clinical success between AUC vs. trough-based monitoring in burn patients. MONITOR was a multicenter, retrospective study of patients with thermal or inhalation injury admitted to one of 13 burn centers from 1/1/17 to 8/31/22 who received vancomycin. Demographic and clinical course data, including acute kidney injury (AKI) incidence and clinical success were obtained. Patients were evaluated for clinical success and grouped according to method of monitoring and adjusting doses: AUC vs. trough-based monitoring. Clinical success was a composite definition and lack of meeting any 1 of 5 criteria: 1) persistent infection, 2) relapse, 3) antibiotic failure (clinical worsening), 4) AKI, 5) death. Five-hundred seventeen vancomycin courses were assessed from 485 patients. There was no difference in the rate of clinical success between AUC monitored and the trough-only monitored groups. Incidence of AKI was higher in the trough-only group; however, was not statistically significant after controlling for renal function on admission, past medical history of chronic kidney disease (CKD), and concomitant nephrotoxins.

Sensitive Detection and Quantification of Oxygenated Compounds in Complex Samples Using GC-Combustion-MS.

This work introduces a new element-selective gas chromatography detector for the accurate quantification of traces of volatile oxygen-containing compounds in complex samples without the need for specific standards. The key to this approach is the use of oxygen highly enriched in 18O as the oxidizing gas in a combustion unit (800 °C) that allows us to directly and unambiguously detect the natural oxygen present in the GC-separated compounds through its incorporation into the volatile species formed after their combustion and their subsequent degradation to 16O in the ion source. The unspecific signal due to the low 16O abundance in the oxidizing gas could be compensated by measuring the m/z 12 that comes as well from the CO2 degradation. Equimolarity was proved with several O-containing compounds with different sizes and functionalities. A detection limit of 28 pg of injected O was achieved, which is the lowest ever reported for any GC detector, which barely worsened to 55 and 214 pg of O when the oxygenate partially or completely coeluted with a very abundant matrix compound. Validation was attained by the analysis of a SRM to obtain accurate (99-103%) and precise (1-4% RSD) results. Robustness was tested after spiking a hydrotreated diesel with 10 O-compounds at the ppm level, which could be discriminated from the matrix crowd and quantified (mean recovery of 102 ± 9%) with a single generic standard. Finally, it was also successfully applied to easily spot and quantify the 33 oxygenates naturally present in a complex wood bio-oil sample.

"Seasonal Dynamics in Burn Profiles: A Comprehensive Analysis at the Burn Care Centre, Islamabad."

Seasons have a major impact on the frequency and characteristics of burn injuries; in warmer months, thermal burns from outdoor activities are more common, while in cooler months, incidents involving heating sources and fires are more common. It is essential to comprehend these trends in order to customise safety precautions and awareness initiatives. Studies on the impact of seasonal variations help burn centres allocate resources more effectively in order to prepare for variations in patient volume and severity. Data from January 2016 to December 2022, with an emphasis on burn types excluding non-burn cases, were analysed retrospectively over a seven-year period at the Burn Care Centre in PIMS, Islamabad. The research examined hospital stays, demographics, burn causes, admissions, total burned surface area, and death rates while dividing the years into winter and summer seasons for analysis. With 4,014 admitted patients, the study found that winter admissions increased by 11.007%, with winter admissions accounting for 55.503% of all admissions and summer admissions for 44.496%. The gender distribution stayed the same, with 54.59% of the population being male and 45.99% being female. Hospital stays were longer for summer admissions (16.428) than for winter admissions (11.285). Summertime saw a rise in electric burn cases (307 cases), with a 43 case fatality rate. With 1699 cases, flame burns predominated in the epidemiology of burns, followed by scald burns with 1384 cases. In conclusion, seasonal differences have a substantial impact on burn profiles, with winter seeing a marked rise in occurrences. Men are also more likely to sustain electric burns, particularly in the summer. Effective management and prevention techniques depend on an understanding of these patterns.

The association between body mass index and physical function in adult burn survivors: A Burn Model System National Database study

IntroductionAn area of rehabilitation research in burns is the impact of co-morbidities on disease trajectory. Obesity is a comorbidity of increasing public health concern, but its role remains controversial regarding burn injury and physical recovery. Our aim was to evaluate the association between body mass index (BMI) categories as a measure of obesity at discharge and self-reported physical function (PF) during recovery of adult burn survivors. MethodsThis is a retrospective study on data collected by four major US burn centers, which contribute to the Burn Model System National Database. The data included BMI obtained at hospital discharge and self-reported PF-mobility, using the PROMIS measures assessed at 6, 12, and 24 months after burn. Subjects were classified into weight status categories based on BMI: underweight (BMI <18.5), normal weight (18.5 ≤ BMI <25), overweight (25 ≤ BMI <30), obesity class 1 (30 ≤ BMI <35), obesity class 2 (35 ≤ BMI <40), and obesity class 3 (BMI ≥40). Mixed-effects linear regression models were used to assess the association between BMI categories and PF scores over time, adjusted for patient and injury characteristics. ResultsA total of 496 adult burn patients aged 47 ± 16 years were included, with mean total body surface area (TBSA) burned of 18 ± 19 % and mean BMI at discharge of 28 ± 7 kg/m2. PROMIS PF scores significantly improved over time in the recovery phase after burn (time effect, p < 0.001). Compared to overweight burn patients, normal-underweights exhibited lower PF score by an average of 4.06 units (p = 0.001) but scores increased linearly by an estimated 0.17 units per month (p = 0.01) over the 24 months after discharge. Similarly, compared to overweight burn patients, class 1 obese reported lower PF score by a mean 2.67 units (p = 0.07) but PF increased linearly by 0.15 units per month (p = 0.07) over the 24 months after discharge. These findings were independent of the effects of age at discharge, sex, TBSA burned, and hand and leg burn. ConclusionBeing overweight was associated with improved and faster recovery of PF scores compared to normal, underweight, and obese burn patients during long-term recovery. Hence, our data suggests that long-term recovery and restoration of PF in adult burn survivors is not compromised by a small excess in body weight.

Effectiveness of Autodermoplasty in Combination with Injection of Autological Stromal-Vascular Cell Fraction in Treatment of Deep Burns

Introduction. The use of autologous stromal-vascular cell fraction of adipose tissue seems to be one of the promising technologies to increase the effectiveness of skin grafting and other skin restoration options in burnt patients. The main regenerative component of the stromal-vascular fraction are mesenchymal stem cells, which have a high reparative potential and low immunogenicity.The aim of the study was to increase the effectiveness of surgical treatment of patients with skin burns through the injection of autological stromal-vascular cell fraction of the adipose tissue.Materials and methods. The study was conducted as part of a prospective, open, randomized study involving 61 patients with extensive skin burns treated in burn centers Dzhanelidze Saint-Petersburg Research Institute of Emergency Medicine and Vishnevsky National Medical Research Center of Surgery, Ministry of Health of Russia, in 2021-2023. Cells of the stromal-vascular fraction of the adipose tissue were obtained mechanically and enzymatically. The prepared cell suspension was introduced into the granulation tissue during skin grafting with split autodermal grafts having a high perforation coefficient. During the study, planimetric parameters, as well as the results of histological and immunohistochemical tests, were assessed. The obtained findings were processed using generally accepted algorithms of variation and descriptive statistics. The alternative hypothesis was accepted at p0.05.Results. The proposed technique of autologous stromal-vascular cell fraction of the adipose tissue with simultaneous autodermoplasty with a split perforated graft allowed reducing the time of perforating cell epithelization by 28% (p0.05), the time of final engraftment by 11% (p0.05), the frequency of infectious complications in the postoperative period by 20% (p0.05), as well as the frequency of lysis and rejection reactions by 15% (p0.05). As stated, the introduction of an autologous stromal-vascular fraction during skin grafting resulted in early relief of the inflammatory reaction in the area of a deep burn wound, the fact being supported by clinical, cytological, histological and immunohistochemical tests.Conclusion. The use of cells from the stromal-vascular fraction of the adipose tissue can significantly increase the effectiveness of surgical treatment of patients with extensive skin burns. The proposed technique to obtain and apply the stromal-vascular fraction of the adipose tissue at the stage of autodermoplasty can be introduced into clinical practice in both burn centers and surgical/trauma departments, since it does not require special equipment.

Burn Center Verification and Safety-net Status: Are There Differences in Discharge to Inpatient Rehabilitation?

Discharge to acute rehabilitation following major burn injury is crucial for patient recovery and quality of life. However, barriers to acute rehabilitation, including race and payor type impede access. The effect of burn center organizational structure on discharge disparities remains unknown. This study aims to investigate associations between patient demographics, burn center factors, and discharge to acute rehabilitation on a population level. Using the California Healthcare Access and Information Database, 2009-2019, all inpatient encounters at verified and non-verified burn centers were extracted. The primary outcome was the proportion of patients discharged to acute rehabilitation. Key covariates included age, race, burn center safety net status, diagnosis related group, American Burn Association (ABA) verification status, and American College of Surgeons (ACS) Level 1 trauma center designation. Logistic regression and mixed-effects modeling were performed, with Bonferroni adjustment for multiple testing. Among 27,496 encounters, 0.8% (228) were discharged to inpatient rehabilitation. By race/ethnicity, the proportion admitted to inpatient rehabilitation was 0.9% for White, 0.6% for Black, 0.7% for Hispanic, and 1% for Asian. After adjusting for burn severity and age, notable predictors for discharge to inpatient rehabilitation included Medicare as payor (OR 0.30-0.88, p=0.015) compared to commercial insurance, trauma center status (OR 1.45-3.43, p<.001), ABA verification status (OR 1.16-2.74, p=0.008), and safety-net facility status (OR 1.09-1.97, p=0.013). Discharge to inpatient rehabilitation varies by race, payor status, and individual burn center. Verified and safety-net burn centers had more patients discharge to inpatient rehabilitation adjusted for burn severity and demographics.

Pediatric Burns - Who Requires Follow-up? A Study of Urban Pediatric Emergency Department Patients.

Hundreds of children suffer burn injuries each day, yet care guidelines regarding the need for acute inpatient treatment vs outpatient follow-up vs no required follow-up remain nebulous. This gap in the literature is particularly salient for the emergency clinician, who must be able to rapidly determine appropriate disposition. This was a retrospective review of patients presenting to a Level II pediatric trauma center, January 1, 2017-December 31, 2019, and discharged with an International Classification of Diseases, Rev 10, burn diagnosis. We obtained and analyzed demographics, burn characteristics, and follow-up data using univariate and bivariate analysis as well as logistic regression modeling. Patients were stratified into three outcome groups: group 1-patients who underwent emergent evaluation at a burn center or were admitted at their first follow-up appointment; group 2-patients who followed up at a burn center (as an outpatient) or at the emergency department (and were discharged home); and group 3-patients with no known follow-up. A total of 572 patients were included in this study; 58.9% of patients were 1-5years of age. Sixty-five patients met group 1 criteria, 189 patients met group 2 criteria, and 318 patients met group 3 criteria. Sixty-five percent of patients met at least one American Burn Association criteria, and 79% of all burns were second-degree burns. Flame and scald burns were associated with increased odds (odds ratio [OR] 1.21, OR 1.12) of group 1 vs group 2 + group 3 (P = 0.02, P < 0.001). Second/third-degree burns and concern for non-accidental trauma were also associated with increased odds of group 1 vs 2 or 3 (OR = 1.11, 1.35, P ≤ 0.001, 0.001, respectively). Scald burns were associated with increased odds of group 2 compared to group 3 (OR 1.11, P = 0.04). Second/third degree burns were also associated with increased odds of group 2 vs 3 (OR 1.19, P ≤ 0.001). There were few statistically significant variables strongly associated with group 1 (emergent treatment/admission) vs group 2 (follow-up/outpatient treatment) vs group 3 (no follow- up). However, one notable finding in this study was the association of scald burns with treatment (admission or follow-up) suggesting that the presence of a scald burn in a child may signify to clinicians that a burn center consult is warranted.

Challenges Faced by Parents of Pediatric Burn Survivors: A Thematic Analysis

Background: Burn injuries compromise the integrity of skin, its appendages, and underlying tissues due to exposure to various agents including dry and moist heat, corrosive substances, and high voltage electric currents. Particularly in the pediatric population, these injuries not only affect the children but also significantly impact the lives and health of their parents. Objective: This study aimed to explore the multifaceted challenges faced by parents of pediatric burn survivors at the Burn and Plastic Surgery Center in Hayatabad KPK Peshawar. Methods: Employing a qualitative case study design, this research involved 10 participants selected via purposive sampling. Data collection was conducted through face-to-face in-depth interviews using a semi-structured interview guide. All interviews were audio-recorded, with non-verbal cues and expressions meticulously documented. Thematic analysis was utilized to derive codes, categories, and subsequently, themes from the data. Results: Analysis revealed five major themes reflecting the challenges encountered by parents: socio-economic difficulties, psychological distress, physiological and physical health issues, spiritual anxiety with altered religious activities, and domestic violence and abuse. Specifically, 70% of participants experienced significant disruptions in their daily lives and interactions, while 100% reported financial hardships directly affecting their ability to manage the health care needs of their children. Conclusion: The study underscores the extensive challenges that parents of pediatric burn survivors face, highlighting the necessity for healthcare professionals to adopt a holistic approach in treating burnt children while concurrently addressing parental difficulties. Effective identification and management of these challenges are crucial to improving health outcomes for both the children and their parents.