Diagnosis Of Burns Research Articles

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.

Associations of urban versus rural patient residence on outcomes after burn: A national inpatient sample database study

IntroductionBurn patients in rural areas may encounter poorer outcomes associated with barriers to care; however, residence has not been studied in a large sample. The association between rural-versus-urban residence and outcomes after burn was examined using the National Inpatient Sample (NIS) database. MethodsUsing the 2019 NIS database, patients over 18 years with a primary diagnosis of burn or corrosive injury were included. Level of urbanization was categorized into six groups. Outcomes after burn such as in-hospital mortality, multifactorial shock, prolonged mechanical ventilation, length of stay, and total costs were analyzed after adjusting for demographic factors and hospital characteristics. ResultsWe included 4671 records, which represented a weighted population of 23,085 patients. Rural residence was associated with higher percentage of prior transfer but not in-hospital mortality. Compared to the most urbanized counties, encounters from the most rural counties were associated with higher odds of shock (aOR:2.62, 99% CI: 1.04–6.56, p = 0.007). ConclusionBurn encounters from less urbanized counties did not experience differences in mortality, rates of skin grafting, prolonged mechanical ventilation, length of stay, or overall costs. However, odds of shock were higher among the least urbanized counties. Despite improved triage and transportation systems across the US, disparities and challenges exist for burn patients from rural residence.

One disaster two traumas: Being under rubble and burn injuries in the 2023 Maraş, Turkey earthquakes

IntroductionOn February 6, 2023, two separate destructive earthquakes with magnitudes of 7.7 and 7.5 occurred in Kahramanmaraş, Türkiye. More than 50,000 people lost their lives, and over 100,000 were reported injured. In this study, patients referred to hospitals with burn diagnosis and management of burn wounds following the disaster were evaluated. Material and methodsInformation on burn injury admissions related to the earthquake was collected from all burn facilities in the country within 15 days after the earthquake. The patients' demographics, being under rubble, rescue times, burn causes, grafting procedures, and deaths were recorded. ResultsFollowing the earthquake, burn victims were transferred to the 13 Burn Treatment Centers located in 10 provinces. A total of 191 patients were burned. Among the burn patients, 101 (52.9%) were rescued from the rubble 2–60 h after the earthquake. Eight patients who were hospitalized at the burn centers died. Scalding and flame burns were the most common etiologies. Burned total body surface area, concomitant crush injury, hospitalization, and mortality was higher among the patients trapped under rubble (p < 0.001, p < 0.001, p < 0.001, and p < 0.001, respectively). Victims who stayed longer time under the rubble required significantly more grafting procedures (p < 0.001). ConclusionIn a literature review, it was observed that there are a limited number of publications reporting earthquake-related burns. In the February, 6 Türkiye earthquake, flame burns were seen due to small fires that occurred in collapsed buildings during the earthquake. And also contact burns and hot liquid burns were seen in earthquake victims trapped under rubble. Bursting hot water pipes, overturned stoves, contact with hot central heating radiators, and heated construction irons caused scalding and contact burns. It is believed that prolonged entrapment may cause delays in burn treatment or lead to deeper burns due to prolonged contact with the burning agent, increasing hospitalization rates. This earthquake once again drew attention to burn injuries that could occur during and after earthquakes, including those that may occur under rubble.

A Swine Burn Model for Investigating the Healing Process in Multiple Depth Burn Wounds.

Burn wound healing is a complex and long process. Despite extensive experience, plastic surgeons and specialized teams in burn centers still face significant challenges. Among these challenges, the extent of the burned soft tissue can evolve in the early phase, creating a delicate balance between conservative treatments and necrosing tissue removal. Thermal burns are the most common type, and burn depth varies depending on multiple parameters, such as temperature and exposure time. Burn depth also varies in time, and the secondary aggravation of the "shadow zone" remains a poorly understood phenomenon. In response to these challenges, several innovative treatments have been studied, and more are in the early development phase. Nanoparticles in modern wound dressings and artificial skin are examples of these modern therapies still under evaluation. Taken together, both burn diagnosis and burn treatments need substantial advancements, and research teams need a reliable and relevant model to test new tools and therapies. Among animal models, swine are the most relevant because of their strong similarities in skin structure with humans. More specifically, Yucatan minipigs show interesting features such as melanin pigmentation and slow growth, allowing for studying high phototypes and long-term healing. This article aims to describe a reliable and reproducible protocol to study multi-depth burn wounds in Yucatan minipigs, enabling long-term follow-up and providing a relevant model for diagnosis and therapeutic studies.

Factors Predicting 90-Day Readmissions for US Older Adult Burn Patients From the 2016-2018 Nationwide Readmissions Database.

Older adults with burn injuries have a high risk of readmission after the initial burn admission. Frailty is associated with poor outcomes from the initial burn injury, however, it remains unknown if frailty impacts readmission in older adults after the initial index burn admission. Our study aims to examine patient, frailty, burn, surgical, and hospital factors that contribute to 90-day readmissions in older adults with an acute burn. Patients ≥ 50 years of age with an acute burn diagnosis in the Nationwide Readmissions Database (2016-2018) were included. Patients who died during index admissions were excluded from the readmission analysis. Patient, burn, hospital stay, and hospital characteristics were analyzed. Using variables significant from univariate logistic regression analysis, we performed a multivariable logistic regression analysis to identify factors associated with 90-day readmissions. A total of 41,500 weighted index burn admissions were included. The 90-day readmission rate was 25.6% (10,641/41,500). Almost all the readmissions were unplanned (96.5%). The most common primary readmission diagnoses based on Clinical Classifications Software Refined were burn injury and septicemia. Multivariable logistic regression analysis demonstrated an increased hospital frailty risk and lower-body-only burns were associated with an increased risk of readmission. Notably, surgical treatment of the burn injury during the index admission was associated with a decreased risk of readmission. This highlights the importance and challenges of surgical decision-making for older adults with high comorbidity burden. Future studies are needed to develop decision guides to help clinicians identify patients who would benefit from surgical treatment versus more conservative strategies in older adult patients with burns.

Epidemiological and cost analysis of burned patients in Iran

IntroductionConsidering the financial support provided by insurance and the government for burn patients in Iran, and recognizing the substantial economic impact associated with their treatment, there is a pressing need to delve into the epidemiology of these patients and analyze the related costs. This study aims to explore the epidemiological aspects and hospitalization costs of burn patients specifically within the burn ward of Imam Reza 68-bed Hospital in Mashhad, a regional center of referral in the eastern part of the country. MethodsData had extracted from the electronic data collection system, which is used on a daily basis in the hospital. We included patients with a primary or secondary diagnosis of burns, code T20.0-T32.9 and T95 according to the International Classification of Diseases ICD-10. Ultimately, 1151 patients were included in the study. We analyzed 1151 burn cases in terms of patients’ age at the time of the event, gender, type of burn (Chemical, scalds, flame, electrical and contact burns), anatomical location of the burn (head and neck, upper limb, lower limb, multiple regions and part unspecified), burn etiology, burn degree (I, II, III), total burn surface area (%TBSA), Inpatient ward, expenditure ($), burn mortality rate and length of hospitalization. The age group was divided into seven groups by the 10 years intervals. Statistical analysis of the data was performed using SPSS-16 and Excel software. Results1151 patients were included in the study. High-risk groups are pediatric up to nine (0–9) years. According to age, we found that most cases were children, respectively, 25% (291) cases. Men accounted for 743 cases (65%), women for 408 (35%). Major causes of severe burn injury were flame burns (49%) and scalds (43%). Unspecified was the most common burn location (40%), followed by the multiple regions (23%) and upper limb (11%). In cases of head and neck burns, the financial burden on the patient is elevated compared to other types of burns due to increased expenses for medications, disposable medical instruments, and hoteling. The main items for the burned patients are hoteling (38% of total costs), surgeon (24%), medicine (16%), and medical consumables (6%). The per capita expenditure was $9,365 ± $8,100 in pediatrics and $11,179 ± $10,180 in adults Conclusions: Most cases of death were related to burn in multiple areas of the body and then trunk burn (30% and 19%, respectively) and no death was observed in patients with hand and wrist burn. Burns can be incredibly severe and life-threatening, especially when they affect multiple areas of the body, such as the trunk and any burn injury is still a serious matter. It's important to prioritize fire safety and take precautions to prevent such accidents from happening.

Мануальная диагностика термических ожогов кожи. Сообщение второе

The novelty of this study lies in the application of manual (osteopathic) approach to the diagnosis of thermal skin burns in patients in the acute period (1-3 days) of burn injury in order to study the depth and area of high-temperature skin lesions in burns. Materials and methods: 24 patients with II-III degree thermal burns with a lesion area up to 10% were examined by clinical, osteopathic, and instrumental methods. Clinical (palpation diagnostics), instrumental (laser Doppler fluorometry), analytical, and statistical methods of research were used. The study result is the substantiation of the palpation diagnostics method for determining the true depth and area of the burn wound, the condition of the underlying tissues, the involvement of which in the burn process in the projection of the burn wound affects the course and prognosis of II-III degree thermal burns in patients and their quality of life in the future. The novelty, informativeness, and efficiency of the manual method of diagnosis are shown (Russian Patent for the invention No. 2339300 “A method for diagnosing the depth of a burn wound”)

A simple machine learning approach for preoperative diagnosis of esophageal burns after caustic substance ingestion in children

A simple machine learning approach for preoperative diagnosis of esophageal burns after caustic substance ingestion in children

Incidence and Risk Factors Associated with Microbial Colonization of Burn Wounds: An Observational Study

Background: Microbial colonization of burn wounds leads to infection, which is a major cause of morbidity/mortality, prolonged admission, and cost. This study aims to investigate the incidence of positive burn wound colonization and its associated risk factors in a provincial referral center within a single-payer system. Methods: We performed a retrospective review of all adult (≥18 years) patients admitted to a single, tertiary burn center, with a primary burn diagnosis between January 2011 and 2021. Microbiology records were screened to identify patients with culture-positive burn wounds. Univariable and multivariable logistic regression analyses were used to evaluate risk factors associated with burn site colonization. Results: The sample included N = 634 participants. Most were male (72.1%), with a flame injury (62%), and had a mean age of 47.6 (±18.0) years and a TBSA of 13.5% (±14.8). The incidence of positive burn wound colonization was 27.3%. Increasing participant age, diabetic status, larger burn TBSA, presence of full-thickness burns, inhalation injury, and lower limb and trunk involvement were associated with statistically significant ( P ≤ .05) increased odds of a positive burn wound culture. Conclusion: This study provides an estimate of the incidence of primary burn wound colonization at a single, tertiary care, burn center as well as identifies potential risk factors associated with this outcome. Clinicians should consider closely monitoring patients with these risk factors for possible progression to clinical burn site infection. Future research should address strategies to mitigate colonization in patients with identified risk factors.

Adult Burn Inpatients Have Increased Burn Severity and Mortality Compared to Children in Retrospective Analysis of National Inpatient Sample 2017.

Socioeconomic status and comorbidities are associated with increased mortality in patients with external surface burn patients, however differences between pediatric and adult burn populations have not been adequately studied. Our objectives were to explore the presentation, management, and outcomes of external surface burns across age groups. The 2017 National Inpatient Sample (NIS) was queried for patients with any diagnosis of external body surface burns. Demographics, comorbidities, complications, total charges, length of stay (LOS), number of procedures undergone (NPU), and time from admission to first procedure (TFP) were identified. Univariate and multivariable analyses were used to identify statistical associations with age. 52,335 inpatients were identified with burns, with the majority male (63.6%) and adults (81.8%). Mean age was 50.5 (standard error [SE] 0.1) and 5.5 (SE 0.1) years for adults and children, respectively. Adults had higher prevalence of hypertensive disease (43.5% versus. 1.4%), diabetes mellitus (24.1% versus 0.3%), and obesity (11.7% versus 1.6%) than children (P < 0.001). Adults versus children had higher odds for mortality (odds ratio [OR] 4.26, 95% confidence interval [CI] 3.08-5.89), sepsis (OR 5.16, 95% CI 4.10-6.48), and pneumonia (OR 4.26, 95% CI 3.30-5.50). In this national cohort of inpatients with external surface burns, comorbidities, and odds for mortality and complications varied by age. Pediatric patients more often had lower household incomes; however, adults had significantly higher odds for mortality suggesting that age and comorbidity status are more impactful on burn outcomes than socioeconomic status.

Fragmentation of Care After Admissions for Burn: An Analysis of the National Readmissions Database

IntroductionBurn patients require complex longitudinal care guided by a team with specific clinical expertise. Burn patients are at increased need for readmission, which may result in Fragmentation of care (readmission to hospitals other than the index hospital), that can lead to increases in mortality, length of stay, and financial burden. In the already-complex burn patient, negative effects of care fragmentation may be magnified. We hypothesized that specific patient and demographic factors would be associated with burn readmissions and fragmentation of care. MethodsUtilizing the Nationwide Readmissions database, we identified patients admitted between January and September 2017 with a principal diagnosis of burn readmitted to any hospital within 90 d of index discharge. Demographics, total burn surface area, Elixhauser comorbidities, and index discharge disposition were collected. Primary outcome was readmission to the same hospital as the index admission. Penalized multivariable logistic regression assessed factors associated with index hospital readmission. ResultsOf 9987 burn patients who survived an index burn admission, 1082 (10.8%) were readmitted. Approximately half (51.6%, n = 558) of readmissions occurred at the index hospital. Factors associated with readmission to the same hospital were disposition to home with home health care (odds ratio: 1.42 [1.02-1.96], P = 0.037), private insurance (odds ratio: 1.63 [1.07-2.49], P = 0.022), and ZIP code income quartile >$74,000 (OR 1.87 [1.26-2.78], P = 0.002). ConclusionsDisposition home with home health care, private insurance, and a ZIP code income quartile greater than $74,000 were associated with a lower odds of having fragmentated care. Our data suggest that fragmentation of care may be potentiating a disparity for lower-income burn patients.

Photographic Evaluation of Burn Depth via Telemedicine: Insights from Iranian Surgeons.

The accurate assessment of burn depth is crucial for determining appropriate treatment. Telemedicine has emerged as a promising tool for supporting burn diagnosis and decision-making, as it allows for remote consultation with burn specialists and access to high-quality imaging. The aim of this study was to evaluate the diagnostic capabilities of telemedicine in diagnosing burn depth. A total of 15 Iranian surgeons participated in this study; they were presented with 13 images of partial thickness burn ulcers located on the extremities and trunk of patients. The participating surgeons were required to provide their diagnoses of burn type and depth, as well as the necessity of surgical intervention, and their responses were recorded. Data from 11 participants and 143 responses were analyzed. The average diagnostic accuracy for superficial burns was 79.3%, while for deep burns, it was 13.72%. The mean total diagnostic accuracy was 75.2%. The results of this study suggest that photographs can be a reliable diagnostic tool for evaluating superficial burns. However, photographs are neither valid nor reliable for assessing burn depth. These findings have important implications for the use of telemedicine in burn diagnosis and indicate that additional diagnostic tools may be necessary for accurate assessment of deep burns.

Epidemiology and mortality in patients hospitalized for burns in Catalonia, Spain

Burn injuries are one of the leading causes of morbidity worldwide. Although the overall incidence of burns and burn-related mortality is declining, these factors have not been analysed in our population for 25 years. The aim of this study has been to determine whether the epidemiological profile of patients hospitalized for burns has changed over the past 25 years. We performed a retrospective cohort study of patients hospitalised between 1 January 2011 and 31 December 2018 with a primary diagnosis of burns. The incidence of burns in our setting was 3.68/105 population. Most patients admitted for burns were men (61%), aged between 35 and 45 years (16.8%), followed by children aged between 0 and 4 years (12.4%). Scalding was the most prevalent mechanism of injury, and the region most frequently affected was the hands. The mean burned total body surface (TBSA) area was 8.3%, and the proportion of severely burned patients was 9.7%. Obesity was the most prevalent comorbidity (39.5%). The median length of stay was 1.8 days. The most frequent in-hospital complications were sepsis (16.6%), acute kidney injury (7.9%), and cardiovascular complications (5.9%). Risk factors for mortality were advanced age, high abbreviated burn severity index score, smoke inhalation, existing cardiovascular disease full-thickness burn, and high percentage of burned TBSA. Overall mortality was 4.3%. Multi-organ failure was the most frequent cause of death, with an incidence of 49.5%. The population has aged over the 25 years since the previous study, and the number of comorbidities has increased. The incidence and severity of burns, and the percentage of burned TBSA have all decreased, with scalding being the most prevalent mechanism of injury. The clinical presentation and evolution of burns differs between children and adults. Risk factors for mortality were advanced age, smoke inhalation, existing cardiovascular disease, full-thickness burn, and high percentage of burned TBSA.

Spatial attention-based residual network for human burn identification and classification

Diagnosing burns in humans has become critical, as early identification can save lives. The manual process of burn diagnosis is time-consuming and complex, even for experienced doctors. Machine learning (ML) and deep convolutional neural network (CNN) models have emerged as the standard for medical image diagnosis. The ML-based approach typically requires handcrafted features for training, which may result in suboptimal performance. Conversely, DL-based methods automatically extract features, but designing a robust model is challenging. Additionally, shallow DL methods lack long-range feature dependency, decreasing efficiency in various applications. We implemented several deep CNN models, ResNeXt, VGG16, and AlexNet, for human burn diagnosis. The results obtained from these models were found to be less reliable since shallow deep CNN models need improved attention modules to preserve the feature dependencies. Therefore, in the proposed study, the feature map is divided into several categories, and the channel dependencies between any two channel mappings within a given class are highlighted. A spatial attention map is built by considering the links between features and their locations. Our attention-based model BuRnGANeXt50 kernel and convolutional layers are also optimized for human burn diagnosis. The earlier study classified the burn based on depth of graft and non-graft. We first classified the burn based on the degree. Subsequently, it is classified into graft and non-graft. Furthermore, the proposed model performance is evaluated on Burns_BIP_US_database. The sensitivity of the BuRnGANeXt50 is 97.22% and 99.14%, respectively, for classifying burns based on degree and depth. This model may be used for quick screening of burn patients and can be executed in the cloud or on a local machine. The code of the proposed method can be accessed at https://github.com/dhirujis02/Journal.git for the sake of reproducibility.

779 Utilization of Palliative Care in Patients Succumbing to Primary Burn Injury

Abstract Introduction Burn injury is associated with significant morbidity and mortality. Access to palliative care (PC) is variable, and many patients who die after burns do not receive specialized PC consultation. We conducted a retrospective nation-wide study of patients admitted with a primary diagnosis of burn injury who died prior to hospital discharge to identify factors associated with receiving palliative care. Methods Data from the HCUP National Inpatient Sample (2016-2019) were queried to identify inpatient deaths among adults ≥18 admitted with a primary ICD-10 burn diagnosis. Differences in demographic and clinical characteristics were assessed between patients who did and did not receive PC using chi-square tests and multivariable Poisson regression on data weighted to represent the national population. Baux scores were calculated by adding age and percentage of body burnt based upon ICD-10 code categorizations; a revised Baux score was calculated for inhalation injury. Results Of 98,845 patients admitted to inpatient care from 2016 to 2019 with a primary burn diagnosis, 3250 (3.3%) died prior to discharge. 1390 (42.8%) of patients who died had a PC encounter. Patients who did not receive PC were younger (mean 58.7 vs. 63.9, p=0.0002), had lower Baux scores (mean 104.6 vs. 112.4, p=0.002) and a longer length of stay (LOS) (mean 19.3 vs. 13.3, p=0.008). Controlling for age, sex, Baux score and LOS, White patients had a 35% greater likelihood of receiving PC than Black patients (incidence rate ratio, IRR 1.35, 0.95 CI (1.02,1.79)). All else held constant, patients aged 70-79 had the greatest likelihood (68%, IRR 1.68, 0.95 CI (1.31,2.15)) of receiving PC versus patients &amp;lt; 60 years old. Urban teaching hospitals had the highest percentage of burn patients (92.7% vs. 5.2% non-teaching vs. 2.1% rural) and the highest rate of providing PC (43% vs. 30% non-teaching vs. 20% rural, p=0.446) to patients that died. Insurance type (Medicare, Medicaid, Private, and other) did not correlate with receiving PC (p=0.054). The number of diagnoses, procedures and gender did not differ between deceased patients who did and did not receive PC. Conclusions More than half of burn patients who died prior to discharge did not receive a palliative care consultation. Unsurprisingly, older patients were more likely to receive PC. Patients who did not receive PC were more likely to have been younger, Black, have had lower Baux scores or to have been treated in non-urban non-teaching hospitals. The high Baux score of the younger patients (104.6) is associated with significant risk of death; this population might benefit from PC consultation. The discrepancy between White and Black patients in the delivery of PC services is striking. Further study is necessary to identify not only those burn patients most likely to benefit from PC but also the barriers to receiving palliative care in burn injury. Applicability of Research to Practice Demonstrates the inconsistency of palliative care use in the burn population

Developing a Statewide System for Prehospital Routing of Burn Injuries

Introduction:In the USA, traumatic injuries are the leading cause of death before age 45 and have significantly lower mortality if treated in a verified trauma center. Burn injuries are included in trauma statistics and represent 1.1 million injured people annually seeking medical assistance. Routing of burn injuries to ABA-recognized burn centers has yet to be assessed as it has in trauma injury. Our goal was to examine the impact of prehospital routing of burn injuries on hospital length of stay, mortality, and potential costs-of-care through a statewide care coordination center.Method:Our study is a retrospective statewide analysis of burn injuries from 01/01/2017 thru 12/31/2019 using the Louisiana Hospital Inpatient Discharge Database. Routing of burn patients was implemented in 2018 using the ABA burn referral criteria. Data included: total admissions with primary burn diagnosis, region, discharge status, length of stay, and raw mortality by region and state. Descriptive and comparative statistics were performed to assess the impact of routing burn-injured patients. Cost analysis was performed using Louisiana Medicaid per diem rates from 2021 at $1,907.92/day.Results:1,288 patients were treated in Louisiana during the study period, with 855 post-routing and 433 pre-routing. The mean length of stay was reduced from 11.84 days in 2017 to 8.82 days in 2018 (p value=0.0988), with a potential savings of 761 inpatient care days or $2.17 million. Overall mortality across the state was unchanged except in the highest volume region, where it dropped from 7.9% in 2017 to 3.6% in 2019 (54%).Conclusion:Burn injuries are a time-sensitive trauma. This study marks the first analysis pre and post-implementation of routing for burn injuries by a statewide care coordination center. Our study demonstrates improvement in length of stay and mortality but a continued need to examine other contributing factors, such as injury severity and concomitant trauma.

Clinical Investigation of a Rapid Non-invasive Multispectral Imaging Device Utilizing an Artificial Intelligence Algorithm for Improved Burn Assessment.

Currently, the incorrect judgment of burn depth remains common even among experienced surgeons. Contributing to this problem are change in burn appearance throughout the first week requiring periodic evaluation until a confident diagnosis can be made. To overcome these issues, we investigated the feasibility of an artificial intelligence algorithm trained with multispectral images of burn injuries to predict burn depth rapidly and accurately, including burns of indeterminate depth. In a feasibility study, 406 multispectral images of burns were collected within 72 hours of injury and then serially for up to 7 days. Simultaneously, the subject's clinician indicated whether the burn was of indeterminate depth. The final depth of burned regions within images were agreed upon by a panel of burn practitioners using biopsies and 21-day healing assessments as reference standards. We compared three convolutional neural network architectures and an ensemble in their capability to automatically highlight areas of nonhealing burn regions within images. The top algorithm was the ensemble with 81% sensitivity, 100% specificity, and 97% positive predictive value (PPV). Its sensitivity and PPV were found to increase in a sigmoid shape during the first week postburn, with the inflection point at day 2.5. Additionally, when burns were labeled as indeterminate, the algorithm's sensitivity, specificity, PPV, and negative predictive value were: 70%, 100%, 97%, and 100%. These results suggest multispectral imaging combined with artificial intelligence is feasible for detecting nonhealing burn tissue and could play an important role in aiding the earlier diagnosis of indeterminate burns.

Clinical application of functional near-infrared spectroscopy for burn assessment.

Significance: Early assessment of local tissue oxygen saturation is essential for clinicians to determine the burn wound severity. Background: We assessed the burn extent and depth in the skin of the extremities using a custom-built 36-channel functional near-infrared spectroscopy system in patients with burns. Methods: A total of nine patients with burns were analyzed in this study. All second-degree burns were categorized as superficial, intermediate, and deep burns; non-burned skin on the burned side; and healthy skin on the contralateral non-burned side. Hemodynamic tissue signals from functional near-infrared spectroscopy attached to the burn site were measured during fNIRS using a blood pressure cuff. A nerve conduction study was conducted to check for nerve damage. Results: All second-degree burns were categorized into superficial, intermediate, and deep burns; non-burned skin on the burned side and healthy skin on the contralateral non-burned side showed a significant difference distinguishable using functional near-infrared spectroscopy. Hemodynamic measurements using functional near-infrared spectroscopy were more consistent with the diagnosis of burns 1 week later than that of the degree of burns diagnosed visually at the time of admission. Conclusion: Functional near-infrared spectroscopy may help with the early judgment of burn extent and depth by reflecting differences in the oxygen saturation levels in the skin.

Child physical abuse screening in a pediatric ED; Does TRAIN(ing) Help?

BackgroundChild maltreatment is distressingly prevalent yet remains under-recognized by healthcare providers. In 2015 the Ohio Children's Hospital Association developed the Timely Recognition of Abusive INjuries (TRAIN) collaborative in an effort to promote child physical abuse (CPA) screening. Our institution implemented the TRAIN initiative in 2019. The objective of this study was to examine the effects of the TRAIN initiative at this institution.MethodsIn this retrospective chart review we recorded the incidence of sentinel injuries (SIS) in children presenting to the Emergency Department (ED) of an independent level 2 pediatric trauma center. SIS were defined and identified by a diagnosis of ecchymosis, contusion, fracture, head injury, intracranial hemorrhage, abdominal trauma, open wound, laceration, abrasion, oropharyngeal injury, genital injury, intoxication, or burn in a child < 6.01 months of age. Patients were stratified into pre-TRAIN (PRE), 1/2017–9/2018, or post-TRAIN (POST), 10/2019–7/2020, periods. Repeat injury was defined as a subsequent visit for any of the previously mentioned diagnoses within 12 months of the initial visit. Demographics/visit characteristics were analyzed using Chi square analysis, Fischer’s exact test, and student’s paired t-test.ResultsIn the PRE period, 12,812 ED visits were made by children < 6.01 months old; 2.8% of these visits were made by patients with SIS. In the POST period there were 5,372 ED visits, 2.6% involved SIS (p = .4). The rate of skeletal surveys performed on patients with SIS increased from 17.1% in the PRE period to 27.2% in the POST period (p = .01). The positivity rate of skeletal surveys in the PRE versus POST period was 18.9% and 26.3% respectively (p = .45). Repeat injury rates did not differ significantly in patients with SIS pre- versus post-TRAIN (p = .44).ConclusionImplementation of TRAIN at this institution appears to be associated with increased skeletal survey rates.

Children's post-burn scars in Mongolia.

This study aimed to identify some risk factors for post-burn scarring in children aged 0-18 years. One hundred and eighty two participants were involved in this cohort study. Under the age of 18 who were admitted to the Department of Burn Reconstructive Surgery with a diagnosis of upper and lower extremity burns were followed for 6months. A total of 182 participants (62.1% male, and 37.9% female participants) enrolled in this study. Age ranged from 1 to 17 and the average age was 3.95 ± 3.35. The degree of burn and the anatomical location of the burn had a statistically significant effect on the development of hypertrophic scars. The length of the patient's hospitalisation days and the area of ​​the burn were statistically correlated with wound healing (P= 000, P= .074). For example, the average length of hospitalisation days was 8± 5 days in the hypertrophic scars group of patients, and in the group with normal scars, average bed days were 6± 3 days (P= .000). Grade IIIb burns increased the risk of hypertrophic scar development by 4.9 times and grade IV burns increased it by 2.5 times. In addition, when the area of burns was 11% or more, the risk of hypertrophic scar development was increased by 58.8%. In the case of wound swab infection, the risk of hypertrophic scar development was 12.4% higher (B= 1.124, 95 EI=0.55; 2.28, P= .748). Participants' age, burn area and degree of burn are statistically significant risk factors for post-burn scarring in children aged 0-18 years.