Characteristics Of Burn Injuries Research Articles

Analysis of anatomic location of burns inpatients in China from 2009 to 2018

BackgroundBurns cause serious physical and psychological harm to patients, placing a heavy burden on the global healthcare system. Our previous study detailed the epidemiological characteristics of burn injuries in Chinese inpatients from 2009 to 2018. Interestingly, the anatomic locations of burn injuries vary by gender, age, provinces, and outcomes among different causes. Therefore, this current study aims to analyze the characteristics of burn injuries in inpatients with various burn sites by collecting data in China from 2009 to 2018. This analysis will inform future healthcare system decisions and provide effective strategies.MethodsBurns inpatients from 196 hospitals across 31 provinces in China were included in the study, covering the period from 2009 to 2018. The data collected encompassed information on gender, age, etiology, regions, clinical outcomes, and anatomical locations of the injuries. Data analysis was conducted using Microsoft Excel 2007.ResultsFrom 2009 to 2018, a total of 333,995 burns inpatients were recorded. The most vulnerable parts to burns were multiple burn sites (230,090, 68.89%). Women were more susceptible to lower limb burns (15,608, 14%), while men were more prone to eye injuries (8,387, 3.37%) and hand burns (6,119, 2.75%). The age group of 0–10 years was the most vulnerable to burns across all body areas, including internal organs. In China, individuals aged 20–50 years were at a higher risk of head and neck burns compared to other age groups. The Han population showed increased vulnerability to eye injuries (2.12 times higher than minorities), respiratory tract issues (2.09 times higher than minorities), and trunk burns (1.83 times higher than minorities), while being less susceptible to internal organ injuries (0.23 times fewer than minorities) and lower limb burns (0.78 times fewer than minorities). The southwest region had the highest proportion of burns inpatients with burns affecting single body parts, whereas the eastern area had the highest rates of respiratory tract burns (0.85%) and multiple burn sites (80.64%). Scalding was identified as the most common cause of burns, while flame burns (769, 55.81%) and chemical burns (438, 47.35%) were the main causes of respiratory tract and internal organ injuries, respectively.ConclusionsThis study provides an initial description of characteristics of burns inpatients with various anatomic locations of burns in China over the past decade. Our findings will contribute to the most up-to-date clinical evidence database for healthcare planning and prevention initiatives in both China and other countries.

13 Thromboelastographic Coagulation Assessment in Burn Patients Receiving Plasma Inclusive Resuscitation

Abstract Introduction As resuscitative strategies in burn patients are re-evaluated, a consensus has not been reached on the role for colloids, as lactated ringers remain the fluid of choice with variable use of colloids. Colloids, such as fresh frozen plasma (FFP), may be effective at maintaining oncotic pressure, resupplying coagulation factors, mitigating coagulopathy, and treating the endothelium. This work aims to characterize the coagulation profile of burn patients treated with plasma inclusive resuscitation (PIR) using rapid thromboelastography (rTEG) by comparing it to burn patients primarily resuscitated with crystalloids alone. Methods Patients admitted to a regional burn center who had greater than 20% total body surface area (TBSA) burns that received PIR were included in the study. Patients admitted with burn injuries and resuscitated primarily with lactated ringers were included in the comparison group. Demographic data and blood samples were collected at 4 time points: baseline, before FFP, immediately following the initial unit of FFP, and following the completion of consecutive units of FFP. Samples collected from patients that received LR only were approximated to the FFP group time points. Coagulation parameters were measured using rTEG in blood samples. Descriptive analysis was used to compare demographic and burn injury characteristics at admission. A mixed effects model was used to compare the two groups through the observation period overall and at each time point. Results There were 35 patients in the FFP group and 15 patients in the comparison group. The groups were primarily male (74.3% vs 73.3%), and there was no difference in demographics, TBSA (34.0% (27.0-48.5) vs 33.0% (26.5-46.5, p=0.82)), Baux score, inhalation injury, and mortality rate (28.6% vs 26.7%, p=0.99). Major coagulation markers of rTEG (k, α-angle, MA, and ly30) were not different between these groups and were within normal ranges. The R time in the crystalloid group was greater than the normal range at all 4 time points. There were significant differences in R time at pre-FFP (30.0(25.0-32.5) secs vs 48.0 (36.0-54.0) secs, p< 0.001) and after all units (27.5(20.9-33.8) secs vs 48.0(48.0-54.0) secs, p< 0.0001) when compared to the FFP group where R time was in the normal range. Conclusions Plasma inclusive burn resuscitation did not result in hypercoagulability or changes in lysis when compared to patients primarily resuscitated with crystalloids. The elevated R time in the crystalloid group, which was not seen in the FFP group, may be due to the lack of replenishment in coagulation factors that FFP would provide. Further understanding of PIR’s role in the inflammatory response is needed to evaluate its impact during resuscitation. Applicability of Research to Practice Plasma inclusive resuscitation may be another tool to treat the multifactorial nature of burn shock and burn induced coagulopathy.

Long-term vitamin D insufficiency and associated risk factors for paediatric burns patients

The most recognised role of vitamin D in the body is for calcium absorption, and sufficiency is defined as a vitamin D blood serum level greater than 20 ng/mL (50 nmol/L). In growing children, hypovitaminosis D is associated with bone and muscle weakness, fractures, and osteoporosis. Burns patients are at a greater risk of low vitamin D levels due to lack of ultraviolet rays reaching the skin during prolonged hospital admission and sun avoidance post-burn injury. This study aimed to identify any individual, seasonal or burn injury characteristics in paediatric patients that were associated with low total vitamin D levels. Three different vitamin D metabolites were analysed to identify if, and where, in the synthesis pathway any insufficiencies may be occurring. Liquid Chromatography Mass Spectrometry (LCMS) was used to concurrently assess vitamin D3 (25OHD3 or Calcifediol), its epimer (3epi-25(OH)D3), and its precursor Pre Vitamin D3 (Cholecalciferol), in the plasma from 193 Australian paediatric burn patients, compared to 46 healthy controls. The results indicated that 61 % of healthy controls and up to 76 % of all burn patients had below normal clinical ranges of Total 25OHD3 (25(OH)D3 + 3epi-25(OH)D3). However, there were no significant differences between patient groups (control, acute, scarring, and reconstructive). The season of sample collection contributed significantly to total vitamin D levels but patients who were undergoing reconstructive surgery 1–17 years post-burn had consistently low vitamin D levels across all seasons. Routine screening, dietary monitoring, and potential supplementation of vitamin D in the burns population is recommended as it may impact recovery, growth and development of the child post-burn.

Venous Thromboembolism in Burn Patients: A 5-Year Retrospective Study.

Background and Objectives: Burn patients manifest all components of Virchow's triad, amplifying the concern for venous thromboembolism (VTE). Routine prophylaxis for VTE remains a subject of debate, with the central concern being the occurrence of associated adverse events. Materials and Methods: We conducted a five-year retrospective study on burn patients admitted to our burn center. Demographic data, comorbidities, burn lesions characteristics, surgical interventions, anticoagulant medication, the need for transfusions, the presence of a central venous catheter, length of stay, complications, and mortality were recorded. Results: Of the overall number of patients (494), 2.63% (13 patients) developed venous thromboembolic complications documented through paraclinical investigations. In 70% of cases, thrombosis occurred in a limb with central venous catether (CVC). Every patient with VTE had a Caprini score above 8, with a mean score of 12 points in our study group. Conclusions: Considering each patient's particularities and burn injury characteristics, individualized approaches may be necessary to optimize thromboprophylaxis effectiveness. We suggest routinely using the Caprini Risk Assessment Model in burn patients. We recommend the administration of pharmacologic thromboprophylaxis in all patients and careful monitoring of patients with Caprini scores above 8, due to the increased risk of VTE. Additionally, ongoing research in this field may provide insights into new strategies for managing thrombotic risk in burn patients.

Grill-Related Burn Injuries: A Matched Cohort Study.

Barbequing can result in devastating burn injuries with unsafe practices. This study aims to characterize the demographics, injury characteristics, and outcomes of grill-related burns and identify ways of burn prevention. A retrospective review of patients admitted to a single-institution, metropolitan burn center from January 1, 2017, to July 1, 2023. Data included demographics, burn injury characteristics, and outcomes. Each Grill Cohort patient was matched to 3 nongrill controls by mBaux score and burn location. Of 2355 patients, 69 (2.9%) met Grill Cohort inclusion criteria. The Grill Cohort had 55 (79.7%) males and an average age of 41.7 ± 17.5 years old. In the Grill Cohort, 25 (36.2%) patients had positive blood alcohol, 8 (11.6%) tested positive for amphetamines, and 5 (7.2%) for cocaine at the time of admission. A total of 61 (88.4%) Grill Cohort burns involved the upper extremity, 43 (62.3%) the head/neck, 34 (49.3%) the lower extremity, and 30 (43.5%) the trunk. Compared with the Control Cohort, the Grill Cohort had smaller proportions of patients who were undomiciled (P < .01) or had a history of mental illness (P < .001). Grill-related burns had a greater proportion of flash/flame burns (P < .001). This study suggests that middle-aged, domiciled males without psychiatric comorbidities are more likely to make preventable grilling errors resulting in burn injuries. Prevention strategies targeting this demographic group should emphasize the risks of grilling while intoxicated, proper handling of propane tanks and lighter fluid, and the use of flash/flame-resistant gear protecting the upper extremities and head/neck.

Demographics and Clinical Characteristics of Burn Injuries in Nigeria: A Tertiary Hospital Cohort.

Burn injuries account for 4.8% of trauma deaths in Nigeria and annually for 20,000 deaths. This study was to catalogue the demographics of patient who presented at a referral center in Nigeria. In a retrospective study, we reviewed the records of all burn patients who presented over a 36-month period (January 2018 to December 2020). The clinical and demographic data was extracted using a self-designed questionnaire. Information obtained included biodata, etiology, time of presentation, first aid used, TBSA, length of hospital stay (LOHS), and outcome which was analyzed with SPSS version 28. A total of 112 burn patients presented at our facility, 87 male and 25 female (m: f = 3.5:1). Forty-four percent were children 10 years old and below. Though scalding with hot liquids was the commonest cause of injury in children, flame burn was the commonest etiology (57.1%). Inhalational injuries occurred in 14.2%. Raw eggs and pap were used as first aid by 23%. Most patients were discharged home, and 19.6% died. The prevalence of burn injuries remains high in developing countries. Most causes of burns are preventable. Dangerous traditional practices add to patient morbidity. Education on effective prevention strategies is important in reducing morbidity and mortality.

Burn injury characteristics and outcomes among pediatric and adult patients admitted to Ministry of National Guard Health Affairs (MNGHA) hospitals in Saudi Arabia

ObjectiveThis study aims to describe the characteristics and outcomes of burn injuries in pediatric and adult patients admitted to Ministry of National Guard Health Affairs (MNGHA) hospitals in Saudi Arabia. MethodsA multicenter retrospective cohort study was conducted between 2015 and 2021 in five hospitals run by the MNGHA inSaudi Arabia. The study included 555 patients who were admitted to the hospital with burns, and data were collected from an institutional trauma registry on various aspects such as sociodemographic variables, burn clinical characteristics and burn outcomes. The differences in epidemiological data, general characteristics, and outcomes of burn patients with ≤18 and >18 years of age among Saudi hospitalized patients. The associations between patient characteristics and burn outcomes were assessed using multivariable logistic regression. ResultsMost of the participants representing 66.1% males and females 33.9%. Flame and contact were the most common causes of burn injuries, accounting for 43.6% and 43.2% of cases, respectively; followed by chemical (6.7%), then electrical (5.4%), and friction (1.1%). The study revealed that pediatric were the most frequently admitted age group for burn injuries with most cases occurring at home (57%). Pediatric patients had a higher percentage of hot fluid injuries, accounting for 77.5 % of cases (P = 0.00). Flame injuries were more prevalent in adults, accounting for 65.3% of cases (P < 0.05). The study reported that there were significant associations between age, gender, % TBSA, body region affected, and inhalation injury with admission to the ICU in patients with burn injuries. Relative to patients with third degree burns, first and second-degree burns were associated with a lower likelihood of mortality (OR 0.13, 95% CI: 0.03,0.51, p = 0.00). ConclusionThe study’s findings can be utilized to aid in the implementation of different prevention programs and allocate appropriate resources for treatment to reduce the incidence and morbidity of burn injuries. It is essential to continue educating the public on fire safety in the home environment. This can help raise awareness, promote household safety precautions, and encourage early medical care seeking.

Blood glucose control in the burn intensive care unit: A narrative review of literature

Burn survivors undergoing complex glycemic derangements in the acute period after burn are at significantly increased risk of worse outcomes. Although most critical care investigations recommend intensive glycemic control to prevent morbidity and mortality, conflicting recommendations exist. To date, no literature review has studied outcomes associated with intensive glucose control in the burn intensive care unit (ICU) population. This review addresses this gap to improve practice guidelines and support further research regarding glycemic control. This is a narrative review of literature utilizing PubMed for articles published at any time. Inclusion criteria were English studies describing glucose management in ICU adult burn patients. Studies involving pediatric patients, non-human subjects, care non-ICU care, case reports, editorials, and position pieces were excluded. Our literature search identified 2154 articles. Full text review of 61 articles identified eight meeting inclusion criteria. Two studies reported mortality benefit of intensive glucose control ( mg/dL) compared to controls ( mg/dL), while two studies showed no mortality differences. Three studies reported reduced infectious complications such as pneumonia, urinary tract infection, sepsis, and bacteremia. A majority of the studies (6/8) reported higher risk for hypoglycemia with tight glucose control, but few reported instances of adverse sequela associated with hypoglycemia. Intensive glucose control may provide benefit to burn patients, but complications associated with hypoglycemia must be considered. This review recommends an individualized patient-centered approach factoring comorbidities, burn injury characteristics, and risk factors when determining whether to employ intensive glucose control.

Documented nutritional therapy in relation to nutritional guidelines post burn injury – a retrospective observational study

Intensive nutritional therapy is an essential component of burn care. Regarding post-minor burn injuries, the literature is lacking. The aim of this study was to evaluate documented nutritional therapy in relation to international guidelines after both minor and major burn injuries. The secondary aim of this study was to evaluate the adequacy of energy and protein intake compared to individual nutritional goals post-burn injury. A retrospective observational single-centre study including patients admitted between 2017 and 2019at a burn centre in Sweden was performed. The patients included in the study were ≥18 years old and in need of hospital care for ≥72h post-burn injury. Information about patients' demographics, nutritional therapy, and clinical characteristics of burn injury was collected. The patients were divided according to total body surface area burnt (TBSA %) into minor burn injuries (TBSA <20%) and major burn injuries (TBSA ≥20%). Descriptive statistics were used to analyse data. Adherence to guidelines was established by comparing 24 nutritional therapy recommendations to documented treatment. If documented nutritional treatment were in accordance with guidelines, adherence was considered high (≥80%), moderate (60-79.9%) or low (<59.9%). One hundred thirty-four patients were included, 90 patients with minor burn injuries and 44 patients with major burn injuries. Documented adherence to the nutritional guideline was overall low. After minor burn injury, 8% (2/24) of nutritional therapy recommendations had a high adherence (fat intake <35% of total energy intake and enteral nutrition as prioritized feeding route), 17% (4/24) a moderate adherence, and 75% (18/24) a low adherence. In patients treated after a major burn injury, there were two recommendations with documented high adherence (Vitamin C and Zinc); 25% (6/24) had moderate adherence, and 67% (16/24) had low adherence. In addition, quite a large amount of missing data was found. Adequacy of documented nutritional intake, compared to the individual documented goal, was 78% (±23%) for energy and 66% (±22%) for protein after minor burn injury. After major burn injury, the adequacy was 89% (±21%) for energy and 78% (±19%) for protein, respectively. This study revealed low adherence to nutritional guidelines in patients treated for minor and major burn injuries. Compared to major burn injuries, lower documented adequacy for both energy and proteins was found in minor burn injuries. Given the disparity between guidelines and documented nutritional therapy, and the lack of specific guidelines for minor burn injuries, there could be a considerable risk of inadequate nutritional therapy post-burn injury.

70 Burn Injury is Not a Risk Factor for Long-term Opioid Use

Abstract Introduction The United States continues to suffer from a serious epidemic of opioid use. Exposure to opioids is a known risk factor for long-term use and dependence. This is of particular importance to burn care, as opioids are frequently essential to manage the pain associated with burn injuries. The purpose of this study was to characterize opioid use among burn patients after hospitalization and to identify any risk factors for long-term dependence. Methods All patients admitted to a burn center during a single year period (2/1/2020-2/1/21) were examined. Patients who died were excluded. A controlled substance reporting system was utilized to determine opioid use over a time period from 6 months prior to injury and up to 12 months post-hospital discharge. Reporting to this database is mandated by law and therefore includes all prescriptions regardless of prescriber, insurance, location, etc. Duration of opioid use was recorded for all patients in the study. Long-term use was defined as having an active opioid prescription at 12 months post-hospital discharge. Patient demographic information, burn injury characteristics, operative interventions, and hospital course were examined to determine risk factors for long-term opioid use following burn injury. Results A total of 185 patients were included in the study. Patients were predominantly male (76.2%) and had an average age of 47.5 years old. Patients had an average TBSA burn of 9.5% and a length of stay of 6.7 days. A total of 54.7% of patients received an opioid prescription at discharge. Only 17 patients (9.7%) had persistent opioid use at 1 year. The only independent risk factor identified for long term opioid use was pre-injury use (p&amp;lt; 0.001). Among the 17 patients still on opioids at 1 year, 16 had filled 3 or more opioid prescriptions in the 6 months prior to injury. The solitary patient without a pre-existing opioid history had multiple readmissions and delayed operative interventions after their initial hospital course. Conclusions A majority of burn patients received opioids for pain control following hospital discharge. However, the duration of therapy was generally short among opioid naïve patients. Burn injury was not associated with long term opioid use among patients in the study. Applicability of Research to Practice When used judiciously and with caution, opioids can be safely prescribed to burn patients without fear of long-term opioid dependence.

115 The Association between Burn Characteristics and Body Image in School-Aged Children years 5 to 12

Abstract Introduction Children ages 5 to 12 are in pivotal stages of psychological development as they become more self-aware. Body image can be a formation of both internal experiences and influences from the surrounding environment. This perceived image adapts during this age group and can be negatively impacted by the changes in physical appearance due to the burn injury. Previous research indicates older age and the presence of larger, visible burns can impact body image and self-esteem in the present and long-term. This study assessed the association between burn characteristics and the child’s ability to maintain positive body image in this age group using a new parent-reported instrument for assessment of child outcomes after burn injury. Methods Preliminary data was obtained from the School-Aged Life Impact Burn Recovery Evaluation (LIBRE)5-12 study, which is currently in stages of field-testing. Classic test theory methods were used to assess body image items (n = 13) from the Psychological domain. Each item was scored on a 5-point Likert scale ranging from 0 (never) to 4 (always). Data was recoded for selected items such that higher scores denote better functioning. Multivariate linear regression analyses measured the association between burn injury characteristics and body image (controlling for sex, race and ethnicity, burn injury to critical areas, total body surface area burned (TBSA), and age at survey completion). Mean body image score was calculated. Results Data was obtained from 356 surveys with completed body image items from parents of children with burns. The mean age at survey completion was 8.6 + 2.4 years and mean total body surface area burned (TBSA) was 9.2 + 13.9 with 55% male and 66% white. Items from body image subdomain were identified as a unidimensional scale (α = 0.91, item-total correlations &amp;gt;0.4, ratio of the 1st and 2nd eigenvalues = 4.98). The mean body image score was 3.5 + 0.6. The presence of a foot burn (p = 0.0099), genitalia burn (p = 0.0449) and TBSA &amp;gt;1% (p = 0.0013) resulted in a lower body image score (3.3 + 0.6, 3.1 + 0.8, and 3.4 + 0.7, respectively). In the regression model, age at survey completion was also associated with decreased body image score (β = 0.074, p &amp;lt; 0.0001). Conclusions Parents reported older school-aged burn survivors often had difficulty with body image. Presence of larger burn size and injury to critical areas also worsened body image. Applicability of Research to Practice Burn-care providers and family members can utilize body image score to understand the burn survivor’s current body image satisfaction and assist in fostering positive body image after burn injury through assessment and early intervention.

Patient, or Prisoner? - Acute Burn Injuries in Prisoners: The Birmingham Burns Centre Experience.

Increased risk of violence and self-harm means prisoners are a vulnerable population with complex health needs. They account for a small proportion of patients with burn injuries, however present a unique set of challenges. This study investigates the incidence, pattern and outcomes of burn injuries in prison population. Prisoners referred from 2010-2021 were identified using the International‎‎‎‏‏‎ Burn Injury Database(iBID). Patient demographics, burn injury characteristics and outcomes were collected. Patients were then stratified based on mechanism of injury, treatment modality (surgery/conservative), hospital admission (inpatient/outpatient) and compliance with outpatient follow-up, for subgroup analyses. Sixty-eight prisoners sustained burns during the study period, with a median age of 28.5 years and TBSA of 3%. The majority were male (98.5%) and required hospital admission (75%). Scalds were the most common injury type (77.9%) and assault the most frequent cause of burns (63.2%). Eighteen patients (26.5%) underwent a surgical procedure and there were two mortalities. Of patients for whom follow-up was planned, 22% attended no appointments, with a further 49% of prisoners missing at least one appointment. Relative to patients managed non-operatively, prisoners undergoing surgery had a longer stay and all attended outpatient follow-up appointments. Prisoners represent a unique population with exceptional challenges. Attention should be given to protecting vulnerable patients at risk of assault, education of prison staff around burn prevention and first aid, and ensuring that prisoners are able to access burns follow-up to minimise long term sequelae. Opportunities exist to aid this such as the adoption of telemedicine.

Burn injury characteristics, referral pattern, treatment (costs), and outcome in burn patients admitted to a hospital with or without a specialized Burn Centre (BURN-Pro)

PurposeData on the epidemiology, treatment, and outcome of burn patients treated at non-burn centre hospitals are not available. The primary aim was to compare the burn characteristics of patients admitted to a hospital with or without a specialized burn centre.MethodsThis multicentre, prospective, cohort study enrolled patients with burns admitted to a hospital without a burn centre and patients with < 10% total body surface area (TBSA) burned admitted to the burn centre. Primary outcome measure was the burn-related injury characteristics. Secondary outcome measures were adherence to the Emergency Management of Severe Burns (EMSB) referral criteria, treatment (costs), quality of life, and scar quality.ResultsDuring the 2-year study period, 48 patients were admitted to a non-burn centre and 148 patients to the burn centre. In the non-burn centre group, age [44 (P25–P75 26–61) versus 30 (P25–P75 8–52) years; P = 0.007] and Injury Severity Score [2 (P25–P75 1–4) versus 1 (P25–P75 1–1); P < 0.001] were higher. In the burn centre group, the TBSA burned was significantly higher [4% (P25–P75 2–6) versus 2% (P25–P75 1–4); P = 0.001], and more surgical procedures were performed (in 54 versus 7 patients; P = 0.004). At 12 months, > 85% of the non-burn centre group and > 75% of the burn centre group reported no problems in quality of life. Scar quality score was < 1.5 in both groups, with significantly poorer scores in the burn centre group (P ≤ 0.007).ConclusionBoth groups differed in patient, burn, and treatment characteristics. At 12 months, quality of life and scar quality were good in both groups. Significantly poorer scar quality scores were found in the burn centre group. This might be related to their larger burns and more frequent surgery. The organization of burn care in the Netherlands seems to work adequately. Patients are treated locally when possible and are transferred when necessary.

Evaluating effects of burn injury characteristics on quality of life in pediatric burn patients and caregivers

ObjectivesThe purpose of this study was to evaluate pediatric burn patients’ and caregivers’ quality of life (QoL), while identifying clinical characteristics correlated with psychological stress. MethodsPediatric burn patients at an ABA-verified institution from November 2019-January 2021 were included. Caregivers of patients 0–4 years completed the Infant’s Dermatology QoL Index (IDQOL). Patients> 4–16 years completed the Children’s Dermatology Life Quality Index (CDLQI). The Short Post-Traumatic Stress Disorder Rating Interview (SPRINT) measured caregivers’ stress. Generalized linear mixed models evaluated associations between assessment scores and burn characteristics. ResultsOverall, 27.3% (39/143) of IDQOL and 53.1.% (41/96) of CDLQI scores indicated that patients’ burns caused moderate to extremely large effects on QoL. In caregivers, 4.5% (7/159) scored> 14 on the SPRINT, warranting further PTSD evaluation. For the IDQOL, each additional 1% TBSA burn was associated with a 2.75-point increase (p = 0.05), and patients sustaining 2nd degree deep partial thickness burns scored an average of 3.3 points higher compared to 2nd degree superficial partial thickness burns (P < 0.01). CLDQI and SPRINT scores demonstrated a similar pattern. ConclusionsQoL is impacted in a substantial proportion of pediatric burn patients. Larger TBSA and increased burn depths cause significantly more psychological stress in children, and caregivers may require more extensive psychological evaluation.

Investigation of glucose, serum insulin levels, and insulin resistance in patients with major burn: a retrospective cross-sectional study.

Many studies have reported that insulin resistance (IR) is present and persistent in patients with major burns; however, the evidence remains insufficient. This study was planned to investigate insulin levels and IR in the early post-traumatic period in patients with major burns and to determine the prevalence of IR after burn injury. This study included 68 patients. These patients were followed up once a week for 4 weeks after hospitalization. In the follow-up examinations, demographic and burn injury characteristics; HbA1c, procalcitonin serum glucose, and insulin levels; and IR were evaluated. IR was seen in some weeks only in 25 of the 68 patients included in the study. Among all patients, IR was determined in only 11 (16.17%) patients from the 1st day of hospitalization until discharge. Patients with and without IR were evaluated as 2 groups, and their biochemical parameters were compared, and no significant difference was found between glucose and procalcitonin levels (P>0.05). Glucose levels were >100 mg/dL in the first few weeks in all patients who were followed up; however, they returned to the normal range in the following weeks. In patients with IR, there was insufficient evidence to conclude that the condition persists. We believe that the HOMA-IR value is not directly related to burn injuries and that other additional pathologies may cause it during treatment.

Grip strength in children after non-severe burn injury

PurposeTo characterise grip strength in children with non-severe burn injury, and further understanding of how demographic and clinical variables impact musculoskeletal recovery. MethodsA retrospective, cross-sectional audit of routinely collected clinical data was performed. Standardised protocols were used to measure height, weight and grip strength. Demographic and clinical information was collected from patient medical records. Grip strength comparisons were made against normative data using paired t-tests. General linear regressions with backwards elimination were performed to assess impact of clinical, demographic and physical variables on grip strength. ResultsChildren who were right hand (RH) dominant had reduced RH (18.9 ± 9.9 kg, p = 0.001) and left hand (LH)(17.6 ± 9.3 kg, p = 0.027) grip strength compared to age, sex and hand-dominance matched norms (RH, 20.0 ± 10.0 kg; LH, 18.4 ± 9.5 kg). Children who were assessed closer to the time of their injury, and those who were burnt at a young age were more likely to score grip strength values below the norm (p < 0.001 for all analyses). In particular, females appeared to be at a higher risk of low grip strength scores if burnt at a young age (p < 0.001). ConclusionsChildren with non-severe burn injury struggle to recover musculoskeletal strength, with those who were assessed closer to the time of injury or burnt at a young age especially at risk of impaired grip strength performance. Grip strength does not appear to be influenced by any other clinical variables or burn injury characteristics.

75 Patient Reported Outcome Measures Associated with Burn Severity

IntroductionBurns continue to be a leading cause of unintentional injury sustained by children. The lasting effects of burn treatment on pediatric patients’ quality of life are still poorly understood. Patient-Reported Outcomes Measurement Information System (PROMIS) is a reliable tool that evaluates a patient’s physical, mental, and social health. To measure the impact of burn injuries on quality of life, we integrated the use of PROMIS into our outpatient clinic. Our aim for this study is to determine the effects of patient demographics, burn treatment, and burn characteristics on PROMIS scores.MethodsA retrospective review of patient and PROMIS data collected at our institution from June 2016 to August 2019 was conducted. Patient demographics, burn injury characteristics, PROMIS Pediatric Mobility, Upper Extremity, Pain Interference, and Peer Relationships scores were collected. Statistical analysis was conducted using Wilcoxon Two-Sample Test, Chi-Square, and Pearson’s Correlation Coefficient.Results163 pediatric burn patients completed PROMIS questionnaires. The median injury age was 5.94 years (interquartile range (IQR)= 6.9) and had a median total body surface area of 15% (IQR = 25.5). Individual burn characteristics did not impact Peer Relationships scores; however, they did have a significant effect on Upper Extremity, Mobility, and to a lesser extent, Pain Interference scores. Older injury age (-0.24, p = 0.02), longer length of stay (-0.25, p = 0.02), larger total body surface area (-0.27, p = 0.009), and more operating room visits (-0.28, p = 0.006), were associated with worse Upper Extremity scores. Similarly, older injury age (-0.2, p = 0.04), longer length of stay (-0.25, p = 0.01), more days in the intensive care unit (-0.24, p = 0.01), and more operating room visits (-0.26, p = 0.01) impacted Mobility scores. Worse Pain Interference scores were correlated with longer length of stay (0.24, p=0.01), and larger total body surface area (0.19, p=0.05). Upper Extremity scores correlated with Mobility scores (0.60, p < 0.0001); Pain Interference (-0.23, p < 0.02) and Upper Extremity (0.3, p < 0.003) scores correlated with Peer Relationships scores; and Upper Extremity (-0.48, p < 0.0001) and Mobility (-0.42, p < 0.0001) scores correlated with Pain Interference scores.ConclusionsPeer Relationships scores are not influenced by patient demographics or burn characteristics. This is in contrast with Upper Extremity, Mobility, and Pain Interference scores which are all directly affected by burn characteristics. The patients’ impression of their upper extremity function has the greatest impact on their perceived pain, peer relationships, and mobility.

515 Deficiencies of Rule-based Technology generated Antibiograms and Application in Patients with Prolonged Lengths of Stay

IntroductionAntibiograms are unit specific annual reports of cumulative pathogen incidence and antibiotic susceptibilities, used to guide selection of empiric antibiotic therapies. Rule-based technology (RBT) expedites data compilation, but follows “first pathogen, per patient” and limits applicability, especially for prescribing antibiotics in units with higher lengths of stay. The objective was to compare the pathogens and susceptibilities of the current automated RBT antibiogram with one manually collected through chart review with additional rules applied.MethodsThis is a single-center, retrospective cohort study utilizing chart review to assess patients admitted to the Burn Center between January 2018 and December 2019 from whom significant bacterial cultures were obtained. Demographics and burn injury characteristics were collected. Treatment data related to the infection and antibiotic usage was also collected. Specific to the culture, timing, site, pathogen, and sensitivity were collected. All cultures within the first 30 days of admission were included. The current RBT antibiogram served as the control. And new antibiogram versions were created using additional rules and compared to the RBT antibiogram.ResultsDuring the 2 years, 657 patients were admitted. Two-hundred four patients remained after applicable exclusions. Sixty-one percent were excluded due to lack of cultures. Mean age was 50.6 ± 16.5 years and 66% were male. Forty-nine percent were Caucasian. Seventy-two percent were admitted for an acute burn injury with flame as the primary mechanism and a median percent total body surface area of 10 (3, 21). Fifty-nine percent had at least one hospital acquired risk factor with over one-third having recent illicit drug use and one-third having a recent hospitalization. Of the 410 cultures included, 57% were Gram-negative and half were from wound infections. Sensitivities were significantly different when comparing the RBT to those created from significant cultures within 7 days of admission, cultures within 7 days of admission and without hospital-acquired infection risk factors (Figure 1), and those being treated with an initial or subsequent course of antibiotics. Recommended empiric antibiotic changed from double coverage to a single β-lactam with > 90% susceptibility. The susceptibilities between first and subsequent courses were dramatically different (Figure 2)ConclusionsThe antibiogram was significantly different from the RBT version after including factors, such as days since admission, presence of hospital acquired risk factors, or previous antibiotic courses. Before developing an antibiogram or interpreting the output, it is important to consider which automated criteria are utilized, especially for units with extended lengths of stay.

20-летний опыт работы комбустиологической службы в системе экстренной медицины Республики Узбекистан

Republic of Uzbekistan.Material and methods. The results of the work of the combustiological service of the Republic of Uzbekistanhave been studied in the period since 2001 to 2020 based on a retrospective analysis. The dynamics of burninjuries over the years, including those of childhood victims, is presented. The data on thermal damage in theregions of our country are given. The characteristics of burn injuries are shown in terms of etiological structure,as well as in terms of hospitalization of victims from the moment of injury.Results. In the period from 2001 to 2020, there was a steady increase in burn injuries up per year, which duringthe last decade has tended to somewhat decrease and stabilize at an annual level of 5000-6000 cases. Amongthe regions of Uzbekistan, the leading positions in terms of thermal damage are occupied by the Tashkentregion, Republic of Karakalpakstan and Bukhara region. In 61,8% of cases, there were burn injuries in thevictims of childhood. In the majority of cases, hospitalization of victims takes place within the first 6 hours fromthe moment of injury. Among the etiological causes of thermal damage, the most common factor is a hot liquidburn (67,2%).Conclusions. The Combustiology Service of the System of Emergency Medicine of the Republic of Uzbekistanis an organized structure that provides effective specialized and qualified assistance to victims with thermalinjuries. The increase in cases of burn injuries dictates the need for further improvement of research andorganizational and methodological work on the problem of burns in the Republic of Uzbekistan, which willcontribute to improving the quality of specialized medical care to victims with burns and their complications.

Epidemiological and clinical characteristics of burn injuries among hospitalized patients in Babylon Province

Background: Burns form the fourth most common cause of injury after road traffic injuries, falls, and interpersonal conflicts and are usually correlated with devastating physical, mental, social, and financial harms, particularly in low and middle-income countries like Iraq. Objectives: To investigate the epidemiological and clinical characteristics of burn injury patients, to measure the mortality rate (case fatality rate) for burns, and to explain the main determinants of deaths among hospitalized burn injury patients. Patients and Methods: This was an observational descriptive cross-sectional study conducted on all acute burn injury cases who were admitted to the biggest teaching hospital in Babylon Province, Iraq. Data were collected from patients themselves or their companions and from patients’ hospital records using a pretested questionnaire designed for collecting the requested information that included demographic data, burn characteristics, burn determinants, and burn outcomes. Results: A sample of 120 patients with burn injuries were investigated. The mean age ± standard deviation was 18.9 ± 17.9 years. The mean age of burn death victims was 24.5 ± 17.66 years. The young age group (15–24 years) represented the highest proportion. Male to female ratio was 1:1.4. Most of the patients had low educational and income levels. The case fatality rate was 26.6% (32/120). The majority of cases were from rural areas; 67% of suicidal burn deaths had more than 50% of total body surface area. Intentional burn death victims had significantly severe burns (third-degree burn and high body surface area) as compared to accidental burn death victims. There was a statistically significant difference as regards the mode of burns between the intentional and accidental burn deaths; all intentional death victims were burnt with flame. Conclusions: The case fatality rate of burn injuries was high, females outnumbered males, the majority of the victims had low educational and income levels, and suicidal burn deaths were significantly associated with severe burn as compared to the accidental ones.