Burns Institute Research Articles

652 Burns and Incidence of Operative Treatment

Abstract Introduction Over the past three decades, it has been repeatedly demonstrated that early surgical intervention is associated with improved outcomes in burns, however, large-scale studies regarding the incidence of operative treatment in burn patients are lacking. We conducted a retrospective study using the TriNetX database, a global, real-time electronic medical record driven index of patient populations, analyzing the incidence of grafting procedures in burned patients related to age and % total body surface area (TBSA) burned. Methods The population of burn patients and operative treatments were indexed using ICD-10 codes T31.0-T31.9 and 1013913, respectively. Queries were structured as sequential events allowing analysis of burn diagnosis to be followed by a subsequent operation. The patient population was partitioned by TBSA burned, and the number of grafting procedures were assessed. All patients were included and stratified by ages of 0–17, 18–34, 35–64, and 65–89. The data includes information collected between 2000–2020 from over 35 healthcare organizations comprising the Research network in TriNetX. Extracted data were analyzed using chi-square statistical analysis with p< 0.05 considered significant. Results Of 116,325 burn patients identified, 11.14% underwent at least one grafting procedure. Of surgeries performed, the majority occurred in the 35–64 years age group (45.3% p = < 0.001). Additionally, the incidence of grafting procedures was directly proportional to patient age: age groups of 0–17, 18–34, 35–64, and 65–89 years received grafting procedures in 6.5% (p = < 0.001), 9.8% (p = < 0.001), 12.9% (p = < 0.001), and 15.9% (p = < 0.001) of cases, respectively. When stratified by TBSA burned, those with 40–49% TBSA burns had the highest incidence of operations (50.7% p = < 0.001). Large TBSA burns correlated with increasing incidence of grafting procedures until 50–59% TBSA burned, where incidence begins to decrease, likely related to referral patterns which did not capture grafting procedures performed at specialized burn treatment centers or institution of palliative care. Conclusions This study reveals that the incidence of operational treatment increases with both age and percent TBSA burned. The data corroborate a referral pattern for burns that demonstrates a decline in operative treatments beginning with 50–59% TBSA, inconsistent with referral guidelines to specialized burn care centers published by the ABA.

579 Benefits of Licensed Clinical Social Worker Utilization in an Adult Burn Clinic: More Than Just Checking the Box

Abstract Introduction Our burn institution cares for critically ill burn patients and provides post-acute care for a large referral base. The clinic is staffed by a wound certified physical therapist, an advanced practice registered nurse and a licensed clinical social worker (LCSW), with consult access to Trauma/Burn Surgeons. The incidence of acute stress symptoms after burn injury is noted in up to 35% to 40% of patients. Therefore, it is important to identify symptoms of anxiety and depression early and begin symptom management. Burn patients have access to a multi-disciplinary team, and a licensed therapist, that can identify symptoms of acute stress and make recommendations for appropriate treatment in concert with the medical staff. This project seeks to determine the prevalence of acute stress in post-acute burn patients seen in an adult burn clinic and the benefits of utilizing a Licensed Clinical Social Worker to perform screening. Methods For a one-year period all burn patients in the burn clinic were screened by the LCSW. The subjects underwent initial screenings for depression, anxiety, and suicide risk at their first clinic visit. The PHQ-2 and PHQ-9 were utilized to assess depression, the GAD-7 for anxiety and the Columbia Suicide scale to assess suicide risk. Patients were initiated into multi-modal therapies based on specific scoring. These intervention strategies were based on the Depression Screening Protocol which included education on depression, and/or anxiety, with or without participation in a Trauma/Burn Peer Support Group. Patients were prescribed medication per provider discretion, and/or connected to community resources such as, counseling, and psychiatric mental health services. Results During the one-year assessment period screening compliance was >90%. During this period, >50% of patient’s scores were clinically significant for acute stress. Over half of those that screened positive were connected to community resources of counseling services or psychiatric care. 100% of those that screened positive were given education and connection to peer support services. An incidental correlation was noted between increased total body surface area involvement and work-related accidents with increased symptomology. Conclusions The inclusion of an LCSW in the burn clinic has improved the overall care of the burn injured patient. The assessment of depression and anxiety related to the burn injury has led to an increase in peer support participation and an increase in referrals to counseling and/or psychiatric services.

Rapid and accurate detection of carbapenem-resistance gene by isothermal amplification in Acinetobacter baumannii.

Background Acinetobacter baumannii (A. baumannii) is one of the pivotal pathogens responsible for nosocomial infections, especially in patients with low immune response, and infection with carbapenem-resistant A. baumannii has been increasing in recent years. Rapid and accurate detection of carbapenem-resistance genes in A. baumannii could be of immense help to clinical staff.MethodsIn this study, a 15-μL reaction system for recombinase polymerase amplification (RPA) was developed and tested. We collected 30 clinical isolates of A. baumannii from the Burn Institute of Southwest Hospital of Third Military Medical University (Army Medical University) for 6 months and tested antibiotic susceptibility using the VITEK 2 system. A. baumannii was detected based on the blaOXA-51 gene by PCR, qPCR and 15 μL-RPA, respectively. Sensitivity and specificity were evaluated. In addition, PCR and 15 μL-RPA data for detecting the carbapenem-resistance gene blaOXA-23 were comparatively assessed.ResultsThe detection limit of the blaOXA-51 gene by 15 μL RPA was 2.86 CFU/ml, with sensitivity comparable to PCR and qPCR. No positive amplification signals were detected in non-Acinetobacter isolates, indicating high specificity. However, only 18 minutes were needed for the 15 μL RPA assay. Furthermore, an antibiotic susceptibility test showed that up to 90% of A. baumannii strains were resistant to meropenem and imipenem; 15 μL RPA data for detecting blaOXA-23 showed that only 10% (n = 3) of A. baumannii isolates did not show positive amplification signals, and the other 90% of (n = 27) isolates were positive, corroborating PCR results.ConclusionWe demonstrated that the new 15 μL RPA assay for detecting blaOXA-23 in A. baumannii is faster and simpler than qPCR and PCR. It is a promising alternative molecular diagnostic tool for rapid and effective detection of A. baumannii and drug-resistance genes in the field and point-of-care testing.

Editorial introductions

Editorial introductions

ABSI scoring system for burns: concerns and modifications in a developing country

Burns are a major health problem worldwide. In some countries, they are the fourth leading cause of death in trauma patients. Every year, more than 200,000 deaths occur because of diverse types of burns, and the majority of these deaths occur in low-income countries. The incidence of burn mortality depends on both patient factors (age, gender, and comorbidities) and burn factors (depth and total burn surface area (TBSA)). Mortality prediction for burn patients is important not only to determine the prognosis of individual patients but to assess the performance of the burn institute and the quality of the health care the patients receive. Many mortality or survival prediction models have been developed, modified, and validated. The abbreviated burn scoring index (ABSI) is one of the most commonly used scores for assessing patients’ mortality. It was reviewed, modified, and validated in this study. This is a retrospective analysis of cases admitted to Kasr Al-Ainy Burn Unit (KABU), Cairo University Hospitals, Egypt, over a period of 5 years (January 2012 to December 2016). The data were analyzed using the ABSI scaling system. The predicted survival using the ABSI was the same as the actual survival for all age groups except children less than 10 years and pregnant females, who had actual survival rates that differed from those predicted. ABSI is one of the best indicators of the mortality and well-being of burn patients. A modification of the ABSI score that added one point for children less than 10 years yielded closer predicted and actual survival rates and this change was statistically significant. A larger number of pregnant females is needed to validate the scoring system for pregnant patients. Close attention and care are always recommended for these two special high-risk groups. Level of Evidence: Level II, risk / prognostic study.

Burn Institute of Southwest Hospital and I

Dr. Wang has engaged in surgery and burn medicine for 61 years. He is one of the first generation of burn doctor in China, who treated burn patients more than ten thousands and went to dozens of cities and areas to rescue the wounded near hundred batches. He made contribution to the establishment of Chinese special scheme for treating burn patients. He established the institute lab of metabolism and nutrition in 1985, and treated burn patients and carried out research of burn metabolism and nutrition simultaneously. He developed new theory that other routes like internal organs especially intestine besides burn wound can induce hypermetabolism i. e." enterogenous hypermetabolism" . If gut works, early feeding (EF) and enteral nutrition (EN) are better than delayed feeding and parenteral nutrition, and EN or EF can promote gastrointestinal resuscitation, reduce intestine injury, modulate hypothalamus and pituitary function, and decrease hypermetabolism. At the end of the 1980s, by measuring the resting energy expenditure of 105 adult burn patients and normal adults, they worked out the first formula for calories supply in Chinese burn adults. He published 340 papers, while 50 papers were exchanged in international meeting, and published 53 monographs (as editor or associate editor in chief for 9 books). Metabolism and Nutrition in Burns is the 1st burn metabolism and nutrition book in China. We got 24 awards of nation, army, and provincial and ministerial level in science, technology, medicine, and education, and there were two awards of " National 2nd Science and Technology Award" (respectively the 1st and 2nd author). He was the chairman of Burn Institute of Southwest Hospital during 1988-1999, and the institute was appraised as " Model Unit of Grass-roots in General Logistics Department" and awarded the 1st and the 2nd collective merits during that time. He was the vice president of Chinese Burn Association and chief editor of Chinese Journal of Burns.

The most uncommon 60 years of Burn Institute of Southwest Hospital

The author has witnessed the past 60 years of Burn Institute of Southwest Hospital after her establishment. This article reviews the past, discusses the present, and expects the future.

Fifty Years of Burn Care at Shriners Hospitals for Children, Galveston.

More than 50 years ago, Shriners Hospitals for Children expanded their philanthropy to include care for burned children. In so doing, the effects of their work weightily expanded from rehabilitation and quality of life outcomes to include survival proper. As the first facility dedicated to the care of burned children, originally designated the Shriners Burn Institute, the Galveston hospital remains the cornerstone of this endeavor. Shriners maintains charitable pediatric hospitals, provide care irrespective of the patient's or the family's ability to pay, and promote research. The sole criterion for admission at Shriners Hospitals for Children is the determination by a surgeon at a Shriners hospital that "the child's trouble may be corrected or improved." This philanthropic effort to provide medical care for children is one expression of the human commonality recognized by Shriners. In this article, we provide some background information on how this hospital came into existence as well as a global summary of its interventions toward greater survival and more complete rehabilitation of burned children. Based on the findings presented herein, we assert that there is less suffering and less loss of life due to childhood burns today than in previous years. We attribute much of this improvement to the simple voluntary collective decision by Shriners to provide alms for burned children.

John Davidson Constable, M.D., 1928 to 2016

John Davidson Constable, M.D., 1928 to 2016

Epidemiological characterization of Acinetobacter baumannii bloodstream isolates from a Chinese Burn Institute: A three-year study

Acinetobacter baumannii infection is a serious threat to burn patients. Bacteremia due to A. baumannii is becoming the most common cause of mortality following burn. However, the epidemiology of A. baumannii causing burn-related bloodstream infections has rarely been reported. We retrospectively collected 81 A. baumannii isolates from the bloodstream of burn patients over a three-year period. Antibiotic susceptibility tests, the prevalence of antibiotic-resistant genes and sequence typing (ST) were conducted to characterize these strains. Most of the isolates showed an extensive drug-resistant phenotype. The resistance frequencies to imipenem and meropenem were 94% and 91%, respectively. The blaOXA-23-like gene, AmpC, IS-AmpC, PER and SIM are the five most prevalent resistant genes, and their prevalence rates are 93% (75/81), 86% (70/81), 73% (59/81), 73% (59/81) and 52% (42/81), respectively. The 81 isolates were grouped into 10 known and 18 unknown ST types, with ST368 (38%) being the most prevalent. Except for ST457 and four new types (STn2, STn6, STn11 and STn14), the remaining 23 ST types belonged to one clonal complex 92, which is most common among clinical isolate in China. The above results indicated that ST368 isolates possessing both the blaOXA-23-like gene and ampC gene were the main culprits of the increasing nosocomial A. baumannii infection in this study. More attention should be paid to monitoring the molecular epidemiology of A. baumannii isolates from burn patients to prevent further distribution. Such information may help clinicians with therapeutic decisions and infection control in the Burns Institute.

Healing the Burn: Advances in Burn Treatment Technology Aim to Save Lives, Lessen Pain and Scarring.

When brothers Jamie and Glen Selby, aged 5 and 7, arrived at the Shriners Burns Institute in Denver, Colorado, in July 1983, more than 97% of their skin had been destroyed by a fire they had accidentally started while playing in an abandoned house. The boys were so badly burned that their outlook was grim-a 6-year-old friend who was also in the fire died from his injuries?but Jamie and Glen were lucky. Not only did they survive, but they were also some of the first patients to benefit from a new burn treatment nicknamed test-tube skin.

Editorial introductions

Editorial introductions

Editorial introductions

Editorial introductions

Bacterial and fungal profile of burn wound infections in Tertiary Care Center

Background: Burn patients are at high risk for infection, and it has been estimated that 75% of all deaths following burns are related to infection. It is, therefore, essential for a burn institution to determine its specific pattern of burn wound microbial colonization, time-related changes in predominant flora and antimicrobial profiles. Aim: To find out the bacterial and fungal profile of burn wound and evaluate the antimicrobial susceptibility pattern of the organism isolated. Materials and Methods: The present study was conducted in the Department of Microbiology, Dr. V. M. Government Medical College, Solapur, Maharashtra from December 2012 to December 2014. The wound swabs were collected from 50 patients, having total body surface area of burn in between 20% and 40% on the 4 th , 10 th , and 16 th day. Total 202 wound swabs were collected aseptically and cultured for the growth of bacteria and the fungi. Bacterial growths were then subjected to various biochemical tests for identification and antibiotic sensitivity testing. Results: Single isolates were present in 71.28%, and multiple isolates were noted in 18.31% of wound swabs. The isolation rate of Gram-negative organisms was high. The most common isolate was Klebsiella pneumoniae (34.40%) followed by Pseudomonas aeruginosa (23.94%), Staphylococcus aureus (22.94%), Escherichia coli (7.34%), Acinetobacter spp. (2.75%), Proteus mirabilis (2.75%), and Citrobacter species (1.38%). Candida species (4.59%) was the only fungus isolated, of which Candida albicans (50%) was the most common. Gram-negative bacteria were the most sensitive to imipenem (93.67%) and amikacin (75.94%) while Gram-positive bacteria were the most sensitive to linezolid (100%) and vancomycin (100%). Conclusion: K. pneumoniae was found to be the most common bacterial agent involved. The results of the present study will be helpful in understanding the pattern of burn wound microbial infection, the dominant bacterial and fungal flora, and the antimicrobial resistance.

Toll-like receptor 2 modulates the expression of T cell transcription factors following alcohol and burn injury

s / Alcohol 47 (2013) 567–576 572 17. Toll-like receptor 2 modulates the expression of T cell transcription factors following alcohol and burn injury X. Li, J.L. Rendon, M.A. Choudhry, Alcohol Research Program, Burn & Shock Trauma Research Institute, Department of Surgery, Loyola University Chicago Health Sciences Division, Maywood, IL 60153, USA Previous studies from our laboratory have shown that acute alcohol (ethanol) intoxication combined with burn injury suppresses T cell proliferation, IL-2 and IFN-g production. We further found that T cell stimulation with Toll-like receptor 2 (TLR2) agonist (HKLM) prevents the decrease in T cell IFN-g release following ethanol and burn injury. This study examined the effect of ethanol and burn injury on T cell transcription factors (e.g., NFAT, Tbx21, Jun and Fos) and determined whether TLR2 agonist modulates the expression of these factors following ethanol and burn injury. To test this, male C57/BL6 mice (w25 g) were gavaged with ethanol (w2.9 mg/kg) to achieve a blood ethanol level of w100 mg/dl prior to receiving w12.5% total body surface area sham or burn injury. One day after injury, mice were sacrificed and splenic T cells were isolated. T cells were cultured with platebound anti-CD3 antibody in the presence or absence of TLR2 agonist (HKLM 108 cells/ml) for 48 h. Supernatants were collected for the measurement of IFN-g by ELISA and cells were lysed. The cells lysates were analyzed for NFAT, Tbx21, Jun and Fos mRNA expression by RT-PCR. As reported earlier, there was a significant decrease in IFN-g release following ethanol and burn injury compared to shams. T cells stimulated with anti-CD3 combined with TLR2 agonist did not show a decrease in IFN-g release following ethanol and burn injury. This was accompanied with a significant decrease in NFAT, Tbx21, Jun and Fos expression in T cells stimulated with anti-CD3 following ethanol and burn injury. However T cells stimulated with anti-CD3 combined with TLR2 agonist did not exhibit a decrease in expression of these transcription factors. Together, these findings suggest that TLR2 stimulation of T cells normalizes IFN-g by modulating NFAT, Tbx21, Jun and Fos expression following ethanol intoxication combined with burn injury (Supported by NIH R01 AA015731 [MAC], F30 AA020167 [JR] and the Dr. Ralph and Marian C. Falk Medical

198 PDX-1 mRNA Expression in Endoscopic Ultrasound-Guided Fine Needle Cytoaspirate As a New Marker for the Diagnosis of Pancreatic Cancer

198 PDX-1 mRNA Expression in Endoscopic Ultrasound-Guided Fine Needle Cytoaspirate As a New Marker for the Diagnosis of Pancreatic Cancer

'Professor Galveston' has departed. Obituary - Daniel Traber

'Professor Galveston' has departed. Obituary - Daniel Traber

University of Cincinnati College of Medicine

University of Cincinnati College of Medicine

Correction: A Computer Simulation of Progesterone and Cox2 Inhibitor Treatment for Preterm Labor

The affiliations of the fifth author, Charles F. Simmons, are incorrect. He is affiliated only with #1, Department of Pediatrics, Steven Spielberg Pediatric Research Center, Burns and Allen Research Institute, Cedars-Sinai Medical Center, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California, United States of America

Burn injuries caused by ship fire: A 12-year study in Shanghai

The 105 patients admitted to our Burn Institute from 1st January 1996 to 31st December 2007, with ship fire-related burns were studied retrospectively. The mean age was 30.2 ± 12.6 years with a range of 1–58. One hundred and three patients (98.1%) were men and 2 (1.9%) women. The mean total burn surface area (TBSA) was 46.5%, mostly deep burns. The most common areas of burn were the head, neck and upper limb. Summer months July, August, June and September were times of highest incidence. Fifty-seven (54.3%) patients had inhalation injury, 42 received tracheotomy, and 38 received mechanical ventilation. The treatment was complex, difficult, long, and costly. The interval between burn and start of resuscitation ranged from 2.1 to 67 h with a mean of (5.9 ± 4.4) h. Forty-two patients (40%) started intravenous fluid resuscitation 6 h after burn. Twenty-four patients (23%) received insufficient fluid resuscitation developed hypotension and severe shock at admission. Ninety-two (87.6%) patients required operations including tracheotomy, debridement and grafting, per patient was 5.2. The mean length of hospital stay was 44.2 days. Pulmonary edema was the most common complication during the early post-burn period (within 7 days), and sepsis during the later period (>7 days). Nine patients died of MODS or sepsis, giving a mortality rate of 8.57%. Conclusion: Caution and preventive measures are needed for persons in ships for fire-related burns.