Dedicated Burn Centre Research Articles

Skin Bank Establishment in Treatment of Severe Burn Injuries: Overview and Experience with Skin Allografts at the Vienna Burn Center.

Depending on their extent, burn injuries require different treatment strategies. In cases of severe large-area trauma, the availability of vital skin for autografting is limited. Donor skin allografts are a well-established but rarely standardized option for temporary wound coverage. Ten patients were eligible for inclusion in this retrospective study. Overall, 202 donor skin grafts obtained from the in-house skin bank were applied in the Department of Plastic and Reconstructive and Aesthetic Surgery, Medical University of Vienna. Between 2017 and 2022, we analysed the results in patient treatment, the selection of skin donors, tissue procurement, tissue processing and storage of allografts, as well as the condition and morphology of the allografts before application. The average Abbreviated Burn Severity Index (ABSI) was 8.5 (range, 5-12), and the mean affected total body surface area (TBSA) was 46.1% (range, 20-80%). In total, allograft application was performed 14 times. In two cases, a total of eight allografts were removed due to local infection, accounting for 3.96% of skin grafts. Six patients survived the acute phase of treatment. Scanning electron microscope images and histology showed no signs of scaffold decomposition and intact tissue layers of the allografts. The skin banking program and the application of skin allografts at the Vienna Burn Center can be considered successful. In severe burn injuries, skin allografts provide time by serving as sufficient wound coverage after early necrosectomy. Having an in-house skin banking program at a dedicated burn centre is particularly advantageous since issues of availability and distribution can be minimized. Skin allografts provide a reliable treatment option in patients with extensive burn injuries.

The Effects of Rapid Rewarming on Tissue Salvage in Severe Frostbite Injury.

Frostbite is a high morbidity injury caused by soft tissue freezing, which can lead to digit necrosis requiring amputation. Rapid rewarming is a first-line treatment method that involves placing affected digits into a warm water bath. This study aims to assess the clinical practices for frostbite at facilities outside of dedicated burn centers, and any impact these practices have on tissue salvage. Retrospective chart review at a single burn center identified frostbite patients admitted directly or as transfers over a 7-year period. Records were reviewed to identify initial treatment strategies. If given, time to thrombolytics from admit was noted. Tissue salvage rates were calculated from radiologically derived tissue at-risk scores and final amputation scores. One-hundred patients were transferred from outside facilities, and 108 were direct admissions (N = 208). There was no significant difference in group demographics. Rapid rewarming was the initial treatment modality more commonly in direct admit patients (P = .016). The use of rapid rewarming did not correlate with tissue salvage (P = .112). Early use of thrombolytics had a positive impact on tissue salvage (P = .003). Thrombolytics were given 1.2 hours earlier in direct admit patients (P = .029), however there was no difference in tissue salvage rates between the groups (P = .127). Efforts should focus on larger scale study to further assess the effectiveness of rapid rewarming. Although rapid rewarming did not significantly impact tissue salvage in this study, we continue to recommend its use over less studied treatment methods, and continue to view it as an important bridge to burn center transfer and administration of thrombolytic therapy.

Epidemiology and outcome of acute burn patients at a new dedicated burn centre in Nepal

Introduction: Burn injury remains one of the biggest health concerns in the developing world. It has been regarded as a formidable public health issue in terms of mortality, morbidity and permanent disability. We aim to provide an overview of the basic epidemiological characteristics of burn patients admitted at a dedicated burn center in Chitwan, Nepal.
 Methods: This was a retrospective, hospital-based observational study conducted at Chitwan Medical College Teaching Hospital (CMCTH) burn ward from September 2017 to August 2019. Patients’ records from admission/discharge book, admission/discharge summaries as well as patient’s individual files were reviewed to obtain the necessary data. Demographic data, clinical characteristics, treatments and outcomes were statistically analyzed.
 Results: Among the 202 patients, the number of males slightly predominated that of females with a ratio of 1.02:1. The median age was 24 years, and the median total body surface area (TBSA) burned was 15%. Children less than 10 years comprised one third of all patients while more than one fifth were elderly. The commonest etiological factor was flame burn, closely followed by scald. The mortality rate was 12.38% for the period under review. Majority of the patients spent less than 10 days on admission and around one fifth needed surgical intervention aimed at earlier coverage. Binary logistic regression analysis showed that age, Body Mass Index (BMI) and total body surface area (TBSA) burnt were the major predictors of burn mortality.
 Conclusions: The outcome of burn injuries is poor. Appropriate preventive & therapeutic measures need to be taken in terms of social education & provision of quality healthcare to reduce the incidence & improve the survival outcome of burn patients which should focus on children and elderly especially during the winter season.

4 The Effects of Rapid Rewarming on Tissue Salvage in Severe Frostbite Injury

Abstract Introduction Frostbite is a high morbidity, high cost injury caused by soft tissue freezing, which can lead to digit or limb necrosis requiring amputation. Many severe frostbite injuries are initially assessed at healthcare facilities outside of dedicated burn centers. Rapid rewarming is the widely accepted first line treatment and is typically performed by placing the affected body parts in a 40–42 C water bath for 15–30 minutes. The aim of this study is to ascertain the clinical practices at the referring facilities before transferring patients with severe frostbite to regional burn centers, as well as any impact on clinical outcomes. Methods Upon IRB approval, retrospective chart review identified severe frostbite patients admitted to our ABA verified burn center between 2014 and 2019. Records were reviewed to identify initial rewarming strategy from referring facilities. Time to thrombolytics after initial admission was also noted. Amputation and salvage rates were calculated. Results Seventy-four severe frostbite patients presented to outside facilities and 96 were direct admissions (N=170). There was no significant difference in age, gender, social and comorbid characteristics between transfer and direct admit groups. We found that a significantly greater number of transfer patients received tPA versus direct admit patients (82.4% v 66.7%, P=0.023). On average, tPA was given 1.5 hours earlier in the direct admit patients (5.8 vs 7.3 hours, P=0.004). There was no significant difference in tissue at risk scores (10.2 v 9.1, P=0.465), percentage of patients requiring amputation (35.1% v 24.0%, P=0.126), or tissue salvage rates (76.8 v 84.2, P=0.207) between the two groups. In the cohort of patients presenting to outside hospitals, 66% received rapid rewarming. Other warming modalities at referring centers included warm intravenous fluids, heated blankets, heated oxygen, catheter-based warming, bladder irrigation, and heat packs. On regression analysis, the use of rapid rewarming was not a significant predictor for poor outcomes for limb salvage (P=0.578). The early use of thrombolytics had a positive outcome on limb salvage (P=0.013). Conclusions Initial rewarming practices for frostbite vary dramatically at outside centers. While rapid rewarming was not statistically associated with improved outcomes, variations in specific treatment modalities and limited sample size decrease the likelihood of identifying differences in a retrospective study. Outreach efforts are needed to educate outside centers about the importance of rapid rewarming and early transfer of severe frostbite patients to burn centers for thrombolytic therapy. Applicability of Research to Practice This study shows the need for outreach and education of frostbite management for non-burn centers.

Epidemiology of injuries, treatment (costs) and outcome in burn patients admitted to a hospital with or without dedicated burn centre (Burn-Pro): protocol for a multicentre prospective observational study

IntroductionThe Emergency Management of Severe Burns (EMSB) referral criteria have been implemented for optimal triaging of burn patients. Admission to a burn centre is indicated for patients with severe burns...

Firefighter Injury Data Are Wrought With Discrepancy: Pearls From the National Burn Repository.

In 2015, 68,085 firefighters suffered work-related injury, according to estimates from the U.S. Fire Administration. Despite these figures, only 473 firefighter injuries were captured in the National Burn Repository (NBR) over a 9-year period. Of the 96 burn centers that contribute data, 50 did not report a single firefighter burn injury. Two thirds of the injuries were reported by two individual centers. The NBR does not capture the full scope of firefighter injuries, likely due to issues with reporting, data extraction, and firefighters seeking burn care at facilities without dedicated burn centers. Firefighters have unique considerations when it comes to planning return to work in a high-heat environment after thermal injury. Firefighters should have access to burn centers when seeking treatment for burn injury.

Validation of the burn intervention score in a National Burn Centre

The Linköping burn score has been used for two decades to calculate the cost to the hospital of each burned patient. Our aim was to validate the Burn Score in a dedicated Burn Centre by analysing the associations with burn-specific factors: percentage of total body surface area burned (TBSA%), cause of injury, patients referred from other (non-specialist) centres, and survival, to find out which of these factors resulted in higher scores. Our second aim was to analyse the variation in scores of each category of care (surveillance, respiration, circulation, wound care, mobilisation, laboratory tests, infusions, and operation).We made a retrospective analysis of all burned patients admitted during the period 2000–15. Multivariable regression models were used to analyse predictive factors for an increased daily burn score, the cumulative burn score (the sum of the daily burn scores for each patient) and the total burn score (total sum of burn scores for the whole group throughout the study period) in addition to sub-analysis of the different categories of care that make up the burn score.We retrieved 22301 daily recordings for inpatients. Mobilisation and care of the wound accounted for more than half of the total burn score during the study. Increased TBSA% and age over 45 years were associated with increased cumulative (model R2 0.43, p<0.001) and daily (model R2 0.61, p<0.001) burn scores. Patients who died had higher daily burn scores, while the cumulative burn score decreased with shorter duration of hospital stay (p<0.001).To our knowledge this is the first long term analysis and validation of a system for scoring burn interventions in patients with burns that explores its association with the factors important for outcome. Calculations of costs are based on the score, and it provides an indicator of the nurses’ workload. It also gives important information about the different dimensions of the care provided from thorough investigation of the scores for each category.

Effect of primary admission to burn centers on the outcomes of severely burned patients

ObjectiveBurns represent a special form of severe trauma. Due to long hospitalization, rehabilitation, and extensive scar treatment, severe burn injuries rank among the most expensive traumatic injuries regarding associated health care costs. The presented single-burn-center experiences evaluated the effects of primary versus secondary burn intensive care unit (BICU) admissions on outcomes in severely burned patients. MethodsWithin 30 months, 186 patients were admitted to the BICU. The cases were divided into two groups depending on their admission type: “primary” vs. “secondary”. All patients were analyzed retrospectively regarding the need for surgery, encountered complications, time of hospitalization and overall survival. ResultsThe incidence of primary BICU-admissions was 65.1%. Both patient groups were comparable regarding demographics, comorbidities, % TBSA burn, associated inhalation injuries, ABSI scores and intubation rates (p>0.05). Both groups received similar numbers of operations and had overall comparable mortality rates (p>0.05). However, duration until first burn excision, length of ventilation, as well as BICU- and overall hospital length of stay were significantly shorter in the “primary”- compared to the “secondary” group (p<0.05). ConclusionSeveral burn societies have published precise criteria of when a patient needs to be referred to a burn center. In the presented series, patients that were primarily treated at a BICU showed significantly better outcomes regarding several parameters. In order to further optimize treatment of burn patients it therefore appears that precise initial assessment and if appropriate respective primary transport to dedicated burn centers needs to be re-emphasized, especially among first- and emergency care providers.

Prevention of Staphylococcus aureus burn wound colonization by nasal mupirocin

Background There are two important routes for the transmission of Staphylococcus aureus to the burn wound. In the endogenous route, patients naturally carrying S. aureus colonize their own wounds, whereas in the exogenous route burn wounds are cross-infected from other sources. In this study we evaluated the effect of blocking the endogenous route on S. aureus burn wound colonization by mupirocin application in the nose of patients at the time of admission. Methods From September 2000 to January 2002 all patients with burns admitted to a single dedicated Burn Centre received nasal mupirocin upon admission. This period was compared to two control periods (C1: July 1999 to July 2000 and C2: January 2002 to January 2003) for S. aureus burn wound colonization. The colonization risk was analysed, adjusting for confounding, with Cox proportional hazard regression. Results A total of 98 patients did not have S. aureus burn wound colonization at the time of admission and were, thus, considered at risk for S. aureus acquisition during their stay. As compared to C1, the relative risk of acquiring S. aureus in their wound was 0.48 (95% CI: 0.24–0.97) in the mupirocin period and 0.55 (95% CI: 0.28–1.1) during the C2 period. S. aureus nasal/pharyngeal colonization was a significant independent risk factor for wound colonization (RR: 2.3; 95% CI: 1.2–4.2). Conclusion Nasal mupirocin may contribute to risk reduction of S. aureus wound colonization in patients with burns.