Impact Of Burn Injury Research Articles

Bridging frailty and burns: Defining acute burn injury as a cause of long-term frailty

Although our understanding of frailty has evolved and multiple indices have been developed, the impact of burn injuries on long-term health has been overlooked. With over 11 million annual cases globally, burns affect all demographics, although socioeconomic disparities are evident. With survival rates improved, morbidity among survivors is becoming more evident, and shows similarity to predictors of frailty. Some of the chronic effects of burns, including mental health issues and increased risks of disease, mirror frailty markers. Studies show burn survivors have lower life expectancy, independent of burn severity. Integrating burn history into frailty assessments and establishing specialized long-term care can mitigate this frailty risk. Improved interdisciplinary follow-up and research are vital for enhancing burn survivors' quality of life and longevity.

3 Hand Burn Injuries and Occupational Impairment: Impact of Burn Injuries on Return-to-Work Outcomes

3 Hand Burn Injuries and Occupational Impairment: Impact of Burn Injuries on Return-to-Work Outcomes

SMOOTH protocol: A pilot randomised prospective intra-patient single-blinded observational study for examining the mechanistic basis of ablative fractional carbon dioxide laser therapy in treating hypertrophic scarring.

Burn injuries are the fourth most common type of trauma and are associated with substantial morbidity and mortality. The impact of burn injury is clinically significant as burn injuries often give rise to exuberant scarring. Hypertrophic scarring (HTS) is a particular concern as up to 70% of burns patients develop HTS. Laser therapy is used for treating HTS and has shown positive clinical outcomes, although the mechanisms remain unclear limiting approaches to improve its effectiveness. Emerging evidence has shown that fibroblasts and senescent cells are important modifiers of scarring. This study aims to investigate the cellular kinetics in HTS after laser therapy, with a focus on the association of scar reduction with the presence of senescent cells. We will conduct a multicentre, intra-patient, single-blinded, randomised controlled longitudinal pilot study with parallel assignments to achieve this objective. 60 participants will be recruited to receive 3 interventional ablative fractional CO2 laser treatments over a 12-month period. Each participant will have two scars randomly allocated to receive either laser treatment or standard care. Biopsies will be obtained from laser-treated, scarred-no treatment and non-scarred tissues for immune-histological staining to investigate the longitudinal kinetics of p16INK4A+-senescent cells and fibroblast subpopulations (CD90+/Thy1+ and αSMA+). Combined subjective scar assessments including Modified Vancouver Scar Scale, Patient and Observer Scar Assessment Scale and Brisbane Burn Scar Impact Profile; and objective assessment tools including 3D-Vectra-H1 photography, DermaScan® Cortex, Cutometer® and ColoriMeter®DSMIII will be used to evaluate clinical outcomes. These will then be used to investigate the association between senescent cells and scar reduction after laser therapy. This study will also collect blood samples to explore the systemic biomarkers associated with the response to laser therapy. This study will provide an improved understanding of mechanisms potentially mediating scar reduction with laser treatment, which will enable better designs of laser treatment regimens for those living with HTS. ClinicalTrials.gov: NCT04736251.

38 Burn Prevention and Education for Newcomers to North America

Abstract Introduction The experience of a city’s fire department suggested regions typically home to immigrant and multigenerational families show increased occurrence of fire calls. This study explored the incidence of fire calls in our city stratified by geographic ward and identified opportunities for fire and thermal injury prevention in immigrants. Methods This study was approved by our university’s research ethics board. Fire call data from 2016-2021 was used to characterize adjusted fire totals, civilian injuries, incident descriptions, sources of fire ignition, type of material, area of origin, and contribution to ignition of these fires by ward. ANOVAs were performed to reveal differences in fire characteristics between wards. High fire occurrence wards were classed as at greater risk and probable targets for prevention. To follow, an open ended interview was conducted with a newcomer organization in the city to elucidate factors that contribute to thermal injury risk in immigrants. Interview content was informed by a literature search around the factors and impact of burn injury in immigrants to North America, Europe, and Australia. Interview responses were thematically analyzed. Results The city is stratified into 14 wards, within which there are several communities described by income, education, immigration diversity and more. Between wards, total adjusted fire incidents were not significantly different (p = 0.119). Though, fire characteristics did differ regionally. Common fire incident descriptions included vehicle/structure, trash and cooking fires with less variability by ward in the number of cooking fires compared to the two former. Contributions to ignition were frequently human related. The supplementary interview highlighted individual burn risk as multifactorial. Cultural norms (notably cooking practices and equipment such as pressure cookers), inexperience (related to weather and frostbite risk), and participation in entry level jobs (including cooking) may impart increased burn risk to immigrants. Senior immigrants were noted to be specifically at risk for burns given their propensity to retain cultural cooking norms. Conclusions Newcomers may face increased fire and thermal injury risk that can be attributed to occupational hazards not specific to immigrants and adjustment to a new way of life. Given that many fires and injuries are connected to cooking, kitchen safety and environmental education becomes important to enable safer engagement in cultural practices. Follow up to this work includes matching high fire incidence wards to their resident immigrant groups for targeted prevention. Applicability of Research to Practice Inclusion of race and ethnicity in burn registries may assist in recognizing at risk groups for burn prevention and serve as a retrospective comparator to assess the impact of population specific burn prevention efforts.

Farnesysltransferase Inhibitor Prevents Burn Injury-Induced Metabolome Changes in Muscle.

Burn injury remains a significant public health issue worldwide. Metabolic derangements are a major complication of burn injury and negatively affect the clinical outcomes of severely burned patients. These metabolic aberrations include muscle wasting, hypermetabolism, hyperglycemia, hyperlactatemia, insulin resistance, and mitochondrial dysfunction. However, little is known about the impact of burn injury on the metabolome profile in skeletal muscle. We have previously shown that farnesyltransferase inhibitor (FTI) reverses burn injury-induced insulin resistance, mitochondrial dysfunction, and the Warburg effect in mouse skeletal muscle. To evaluate metabolome composition, targeted quantitative analysis was performed using capillary electrophoresis mass spectrometry in mouse skeletal muscle. Principal component analysis (PCA), partial least squares discriminant analysis (PLS-DA), and hierarchical cluster analysis demonstrated that burn injury induced a global change in metabolome composition. FTI treatment almost completely prevented burn injury-induced alterations in metabolite levels. Pathway analysis revealed that the pathways most affected by burn injury were purine, glutathione, β-alanine, glycine, serine, and threonine metabolism. Burn injury induced a suppressed oxidized to reduced nicotinamide adenine dinucleotide (NAD+/NADH) ratio as well as oxidative stress and adenosine triphosphate (ATP) depletion, all of which were reversed by FTI. Moreover, our data raise the possibility that burn injury may lead to increased glutaminolysis and reductive carboxylation in mouse skeletal muscle.

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.

Physical, Psychological, and Social Outcomes in Pediatric Burn Survivors Ages 5 to 18 Years: A Systematic Review.

Acute pediatric burn injuries often result in chronic sequelae that affect physical, psychological, and social outcomes. To date, no review has comprehensively reported on the impact of burn injuries across all three domains in school-aged children. The aim of this systematic review was to identify published literature that focuses on the impact of burn injuries on physical, psychological, or social functioning, and report upon the nature of study characteristics and their outcomes. We included literature published after 1980, focusing on burn outcomes in children aged 5 to 18 years. Each eligible study was systematically reviewed and primary outcomes were classified into outcome domains based on existing frameworks. Fifty-eight studies met inclusion criteria, and reported on physical (n = 24), psychological (n = 47), and social (n = 29) domains. The majority of the studies had sample sizes of <100 participants, burn size of <40%, and findings reported by parents and/or burn survivors. Only eight of 107 different measures were used in three or more studies. Parents and burn survivors generally reported better physical and social outcomes and worse psychological functioning compared to non-burn populations. Physical disabilities were associated with psychological and social functioning in several studies. Follow-up data reported improvements across domains. This review demonstrates the importance of physical, psychological, and social status as long-term outcomes in burn survivors. Mixed findings across three outcome domains warrant long-term research. Findings of this review will guide the foundation of comprehensive burn and age-specific instruments to assess burn recovery.

T3 Are Burns a Chronic Condition: Examining Physical and Mental Functioning up to 20 Years After Injury

Abstract Introduction Burn survivors often face many long-term physical and psychological symptoms associated with their injury. To date, however, few studies have examined the impact of burn injuries on quality of life beyond 2 years post-injury. The purpose of this study is to examine the physical and mental well-being of burn survivors up to 20 years after injury. Methods Data from the Burn Model System National Database (1997–2020) were analyzed. Patient-reported outcome measures were collected at discharge with a recall of preinjury status, and then at 5, 10, 15, and 20 years after injury. Outcomes examined were the Physical Component Summary (PCS) and Mental Component Summary (MCS) of the Short Form-12. Trajectories were developed using linear mixed methods model with repeated measures of PCS and MCS scores over time and controlling for demographic and clinical variables. The model fitted score trajectory was generated with 95% confidence intervals to demonstrate score changes over time and associations with covariates. Results The study population included 420 adult burn survivors with a mean age of 42.4 years. The population was mainly male (66%) and white (76.4%) with a mean burn size of 21.5% and length of hospital stay of 31.3 days. Higher PCS scores were associated with follow-up time points closer to injury, shorter hospital stay, and younger age. Similarly, higher MCS scores were associated with earlier follow-up time points, shorter hospital stay, female gender, and non-perineal burns. MCS trajectories are demonstrated in the Figure. Conclusions Burn survivors’ physical and mental health worsened over time. Such a trend is different from previous reported results for mental health in the general population. Demographic and clinical predictors of recovery over time are identified.

115 The Impact of Burn Injury on Upper Extremity Prosthesis Users

Abstract Introduction Burns with upper extremity (UE) amputation present a unique rehabilitation challenge. The purpose of this study of UE amputees who are active prosthesis users was to compare outcomes for those with and without burns. Methods This is part of a larger nationwide study of U.S. military members and veterans with UE amputations. In-person data were collected at 5 sites. An therapist measured passive and active range of motion (PROM, AROM); administered the Quick Disability of the Arm, Shoulder, and Hand; Community Reintegration of Injured Service Members-Computer Adaptive-Test; Trinity Amputation and Prosthetic Experience Scale; health-related quality of life (VR-12); Activities Measure for Upper Extremity Amputees; Southampton Assessment Procedure; 9-Hole Peg Test; and Jebsen-Taylor Hand Function Test (JTHF); and recorded residual and phantom pain; timing of prosthesis receipt; and current prosthesis use. The IRB approved this study. Results Data were collected on 126 individuals with UE amputation, of whom 105 had data on etiology and were included. Of these, 13 (12.4%) had burns (B) vs non-burn (NB). The majority were unilateral amputees (69% B, 90% NB). Most were transradial (TR) amputees (B 84.6%, NB 66.3%) as opposed to transhumeral (TH). A minority received their prosthetics within the first 3 months post-amputation (11.1% B, 28.8% NB) (p=0.15). Average age was 57.6 (SD 15.6) years for NB and 53.0 (20.6) years for B. Mean time since amputation was 22.5 (18.0) years for NB and 25.2 (17.3) years for B. The following non-significant differences in outcomes between B and NB were observed. Thirty-nine percent of B were employed full-time vs 18.9% of NB (p=0.15). The primary prosthesis was, for NB, a body-powered prosthesis (66.7%); for B, myoelectric (50%) or body-powered (50%). For unilateral UE amputees, there were no differences between B and NB on performance testing for dexterity and functional tasks or in self-reported disability, quality of life or prevalence or intensity of pain. B trended towards more moderate to severe PROM deficits with shoulder forward flexion (TH B 50%, TH NB 23.1% [p=0.444]; TR B 20%, TR NB 5.6% [p=0.197]) and shoulder abduction (TH B 50%, TH NB 26.9% [p=0.497]; TR B 30%, TR NB 16.4% [p=0.376]). Also, TR amputees with burns trended towards more PROM deficits with elbow flexion (B 20%, NB 6.9% [p=0.212]) and elbow extension (B 20%, NB 8.6% [p=0.272]). AROM deficits also trended greater in B. Conclusions We did not observe differences in physical function, pain levels, or quality of life between those with and without burns. Further studies with larger samples are needed, to include analysis of burn location, burn size, hospital length of stay, and rehabilitation care.

Adipose Tissue Metabolic Function and Dysfunction: Impact of Burn Injury.

For decades, adipose tissue had been considered as merely a storage depot and cushion to protect organs against trauma and injury. However, in recent years, a number of impactful studies have pinpointed the adipose tissue as an endocrine organ mediating systemic dysfunction in not only metabolic disorders such as obesity, but also in the stages following traumatic events such as severe burns. For instance, thermal injury induces a chronic β-adrenergic response associated with drastic increases in adipose lipolysis, macrophage infiltration and IL-6 mediated browning of white adipose tissue (WAT). The downstream consequences of these physiological changes to adipose, such as hepatomegaly and muscle wasting, are only now coming to light and suggest that WAT is both a culprit in and initiator of metabolic disorders after burn injury. To that effect, the aim of this review is to chronicle and critically analyze the scientific advances made in the study of adipose tissue with regards to its role in orchestrating the hypermetabolic response and detrimental effects of burn injury. The topics covered include the magnitude of the lipolytic response following thermal trauma and how WAT browning and inflammation perpetuate this cycle as well as how WAT physiology impacts insulin resistance and hyperglycemia post-burn. To conclude, we discuss how these findings can be translated from bench to bedside in the form of therapeutic interventions which target physiological changes to WAT to restore systemic homeostasis following a severe burn.

612 Assessing the Impact of Burns on Children Aged 5–18 Years: A Narrative Review of Health Outcomes Literature

Abstract Introduction Burn injuries can have major long-term effects on the health and quality of life for children and adolescents. This study narratively reviewed the health outcomes literature focusing on the impact of burn injury for children aged 5–18. Methods Literature targeting pediatric outcomes was reviewed to identify the effects of burns on children aged 5–18 (n=16). Inclusion criteria included studies that focused on the impact of burns on health and quality of life and were age-appropriate for this population. Articles were identified via PubMed, Web of Science, and manual reference checks. Data collected included the outcomes and health domains assessed in each article and the findings of the effects of the burn injury on those specific outcomes. The Preschool LIBRE Conceptual Model served as a ‘domains framework’ to guide the identification of outcomes and health domains. Results Long-term burn-specific outcomes and broad health domains identified were physical functioning (n=9), psychological functioning (n=12), social functioning (n=4), symptoms (n=8), and family (n=7). Some studies exclusively focused on one domain whereas others assessed two domains or more. Subdomains such as upper extremity functioning and functional independence were addressed in the physical functioning domain. Psychological functioning outcomes included subdomains such as emotional health and behavioral problems. Social functioning outcomes evaluated subdomains such as problems with peers and social participation. The symptoms domain addressed post-burn pain and itch. Family outcomes subdomains such as parental satisfaction with appearance and general family functioning were identified. Conclusions Burn-specific outcomes and health domains assessing the effects of burns on children aged 5–18 were identified among 16 studies. There is a need for a comprehensive assessment tool that more precisely measures the impact of burn injury across these domains. This work will inform the development of the School-Aged Life Impact Burn Recovery Evaluation (LIBRE) Computer Adaptive Test (CAT) Profile – a new outcome metric for children and adolescents with burns. Applicability of Research to Practice This review is relevant to researchers and clinicians assessing health outcomes and measuring burn recovery in children aged 5–18.

The Relationship of Level of Education to Social Reintegration after Burn Injury: A LIBRE Study.

Social and emotional recovery from burn injury is a complex process impacted by both clinical and social factors. Because level of education (LOE) has been correlated to overall health, health outcomes, and life expectancy, we questioned whether LOE might be associated with successful social recovery after burn injury. The Life Impact Burn Recovery Evaluation (LIBRE) data set served as a novel tool to explore this question. The LIBRE project is a collaborative effort designed to provide a clinical yardstick for social reintegration among burn survivors. After institutional review board approval, 601 burn survivor respondents, aged 18 or over with >5% TBSA burn were surveyed and a six-scale, 126-item LIBRE Profile was derived from their responses. LOE was collapsed into four categories ranging from less than high school equivalency certificate to graduate degree. Impact of burn injury on subsequent LOE was examined by splitting the sample into those burned at age 30 years or less and those burned at greater than 30 years of age. Regression models were run to estimate associations between education and scale scores with adjustment for age at injury, sex, marital status, work status, TBSA, and time since burn. Regression models were run on the entire cohort and then stratified by age at burn injury (≤30 vs >30). Among all subjects, we found an association between LOE and social recovery as measured by LIBRE scale scores. This association was contributed entirely from the cohort burned at age 30 or less: for those burned at greater than age 30, there was no association between LOE and social recovery. Of particular interest, the distribution of LOE among those burned at ≤ 30 was very similar to LOE distribution in both millennials and in the U.S. population at large. LOE appears to be associated with social recovery for those burned at younger ages but not for those burned at over age 30. More importantly, burn injury during schooling may have no impact on a survivor's educational trajectory since distribution of LOE in our ≤30 cohort mirrors that of the general population. LOE and age at burn injury may provide a quick screen for survivors at risk of difficult social reintegration, allowing providers to target those at risk with additional peer support and counseling.

In hot water: The impact of burn injuries from hot water bottles — Experience of a UK burns unit and review of the literature

IntroductionHot water bottles (HWBs) are a common domestic item in the UK. Their use is associated with burns injuries, either by contact for prolonged periods with the skin, or through the HWB leaking or bursting. MethodsWe used electronic health records to retrospectively review HWB related burns treated by the Burns Service at Chelsea and Westminster Hospital between January 2017–March 2018. We analysed the mechanism of injury, size and depth of burn, method of treatment and costs associated with HWB burns in our centre. Results80 patients sustained HWB burns during this period, with a similar incidence of contact burns (41/80, 51.3%) and scalds (38/80, 47.5%), with one steam burn. The commonest area burnt was the lower limb (40/80, 50%). Most burns had a TBSA of 1% or smaller (50/80, 62.5%). 30 patients had full thickness burns, with 37 in total received operative management. We estimate that the total cost for managing this cohort of patients was over £68,634. ConclusionsThere are a significant proportion of patients presenting with HWB burns that could be prevented, with significant impact on patient morbidity and resource burden on the NHS. Targeted public awareness campaigns are needed to ameliorate these injuries.

Rising mortality in patients with combined burn and trauma

Combined trauma in the burn patient has been previously shown to have higher mortality. With improved critical care and multidisciplinary approach, we hypothesized the risk of mortality in combined burn and trauma has decreased. A retrospective analysis of trauma, burn and combined burn-trauma patients in the National Trauma Data Bank was performed comparing years 2007–2015 to years 1994–2002. The impact of burn injuries on mortality in patients with minor trauma has decreased (OR 2.45, CI 2.26–2.66, p<0.001 compared to OR 4.04, CI 4.51–4.66, p<0.001) in years 2007–2015 while the impact of burn injuries on mortality in patients with severe trauma has increased (OR 1.37, CI 1.29–1.47, p<0.001 compared to OR 1.26, CI 1.05–1.51, p<0.001). When controlling for known risk factors of mortality in burn and trauma, the contribution of the severity of trauma on mortality in combined burn-trauma patients with total body surface area ≥20% is negligible. In contrast, an increase in percentage of total body surface area burned is associated with a step-wise increase in mortality for all combined burn-trauma patients. However, the largest impact is seen in patients with minor trauma. This population represents a unique overlap of patients where future collaborative research can help identify best practices and improve outcomes.

Association Between Burn Injury and Mental Illness among Burn Survivors: A Population-Based, Self-Matched, Longitudinal Cohort Study

Mental health disorders are prevalent before and after burn injury. However, the impact of burn injury on risk of subsequent mental health disorders is unknown. We conducted a population-based, self-matched longitudinal cohort study using administrative data in Ontario, Canada between 2003 and 2011. All adults who survived to discharge after major burn injury were included, and all mental health-related emergency department visits were identified. Rate ratios (RRs) for mental health visits in the 3 years after burn, compared with the 3 years before, were estimated using negative binomial generalized estimating equations. Among 1,530 patients with major burn injury, mental health visits were common both before (141 per 1,000 person years) and after (154 per 1,000 person years) injury. Mental health visits were most common in the 12 weeks immediately preceding injury. No significant difference in the overall visit rate was observed after burn (RR 0.97; 95% CI 0.78 to 1.20), although among patients with less than 1 pre-injury visit, mental health visits tripled (RR 3.72; 95% CI 2.70 to 5.14). Self-harm emergencies increased 2-fold (RR 1.95; 95% CI 1.15 to 3.33). Mental health emergencies are prevalent among burn-injured patients. Although the overall rate of mental health visits is not increased after burn, the rate increases significantly among patients with one or fewer visits pre-injury. Self-harm risk increases significantly after burn injury, underscoring the need for screening and targeted interventions after discharge. An increased rate immediately before burn suggests an opportunity for injury prevention through mental healthcare.

Fecal Microbiota Transplant Restores Mucosal Integrity in a Murine Model of Burn Injury.

The gut microbiome is a community of commensal organisms that are known to play a role in nutrient production as well as gut homeostasis. The composition of the gut flora can be affected by many factors; however, the impact of burn injury on the microbiome is not fully known. Here, we hypothesized that burn-induced changes to the microbiome would impact overall colon health. After scald-burn injury, cecal samples were analyzed for aerobic and anaerobic colony forming units, bacterial community, and butyrate levels. In addition, colon and total intestinal permeabilities were determined. These parameters were further determined in a germ-reduced murine model. Following both burn injury and germ reduction, we observed decreases in aerobic and anaerobic bacteria, increased colon permeability and no change to small intestinal permeability. After burn injury, we further observed a significant decrease in the butyrate producing bacteria R. Gnavus, C. Eutactus, and Roseburia species as well as decreases in colonic butyrate. Finally, in mice that underwent burn followed by fecal microbiota transplant, bacteria levels and mucosal integrity were restored. Altogether our data demonstrate that burn injury can alter the microbiome leading to decreased butyrate levels and increased colon permeability. Of interest, fecal microbiota transplant treatment was able to ameliorate the burn-induced changes in colon permeability. Thus, fecal transplantation may represent a novel therapy in restoring colon health after burn injury.

Morphological Changes in Subcutaneous White Adipose Tissue After Severe Burn Injury.

Severe burn injury produces a plethora of metabolic abnormalities which contribute to the prolonged morbidity of burn survivors. The authors have recently demonstrated trans-differentiation of white adipose tissue (WAT) after burn trauma, toward a more thermogenic phenotype. However, the impact of burn injury on subcutaneous WAT (sWAT) morphology in humans is unknown. Here, the authors studied the effect of severe burn injury on the architecture of sWAT. sWAT was collected from 11 severely burned children (11 ± 3 years; 55 ± 16% total BSA burned) and 12 nonburned healthy children (9 ± 3 years). Histology, electron microscopy, immunohistochemistry, and immunofluorescence were performed on fixed adipose tissue sections. sWAT cytokine and collagen concentrations were measured by multiplex assay and sirius/fast green staining method, respectively. sWAT histology demonstrated multiple fat droplets, significantly (P < .05) reduced mean cell size (104 ± 6 vs 68 ± 3 μm) and higher collagen content (7 ± 0.8 vs 4 ± 0.4) in burn patients. sWAT from burn victims stained positive for CD68 suggesting infiltration of macrophages. Furthermore, electron microscopic analysis showed multiple fat droplets and greater mitochondrial abundance in sWAT of burn survivors. In agreement with this, mitochondrial respiratory capacity in the leak and coupled state increased by 100% in sWAT of burned children from 1 to 3 weeks postinjury. The cytokines IL-6, IL-8, IL-13, IL-1a, IL-1b, MCP-1, and TNF-α were all significantly greater in the sWAT of burned children versus healthy children (P < .05). Furthermore, IL-6, IL-8, IL1-a, IL-1b, and TNF-α significantly increased after injury in sWAT of burned children (P < .05). This study provides detailed evidence of morphological and functional changes in sWAT of burn survivors which was associated with tissue inflammation. A better understanding of morphological and functional changes in sWAT will help discern the mechanisms underlying hypermetabolism in burned patients.

The Systemic Effect of Burn Injury and Trauma on Muscle and Bone Mass and Composition.

By understanding the global inflammatory effects on distant myopathies, surgeons can better guide the rehabilitative process for burn patients. The authors tested the systemic effect of burn injury on distant injured muscle and native bone using immunohistochemistry and validated a new morphometric analytic modality to reproducibly quantify muscle atrophy using computed tomographic imaging. In vivo studies were performed on C57/BL6 mice using an Achilles tenotomy with concurrent burn injury model. Total muscle and bone (tibia and fibula) volume/density were quantified near the site of Achilles tenotomy using micro-computed tomography at 5, 7, and 9 to 12 weeks after surgery. The impact of burn injury on the inflammatory cascade [nuclear factor (NF)-κB, p-NF-κB] and the interconnected protein catabolism signaling pathway (Atrogin-1) was assessed by immunohistochemistry. Muscle volume and density at the site of Achilles tenotomy in burned mice were significantly diminished compared with nonburned mice at 5 weeks and 9 to 12 weeks. Similar decreases in muscle volume and density were observed when comparing tenotomy to no tenotomy. Cortical bone health remained stable in burn/tenotomy mice compared with tenotomy. Muscle atrophy was associated with up-regulation of p-NF-κB, NF-κB, and Atrogin-1 assessed by immunohistochemistry. Burn injury significantly decreases muscle volume and density. Increased muscle atrophy using our computed tomographic morphometric analysis correlated with a significant increase in intramuscular inflammatory markers and proteolysis enzymes. This study demonstrates a unique characterization of how burn injuries may worsen local myopathy. Moreover, it provides a novel approach for quantifying muscle atrophy over an expanded period.

Systemic factors associated with adipose tissue remodeling after severe burn injury in children (1160.2)

The chronic adrenergic stress response to severe burn injury a causes plethora of metabolic abnormalities. However, the impact of burn injury on adipose tissue (AT) metabolism remains largely unknown. Here, we studied the effect of severe burn injury on systemic biomarkers thought to be involved in AT remodeling (i.e. White‐to‐brown transdifferentiation).Ten severely burned children (age 12±4 years; % total burn surface area 49±20) and ten healthy children (age 12±5 years) participated in this study. Hormones levels were measured by luminex multiplex magnetic assay kit and ELISA kit in plasma samples obtained in the fasted state (2‐4 weeks post injury in burned patients).Plasma fibroblast growth factor 21 (634 vs 40 pg/ml, (p=0.07), leptin (9 vs 1.2 ng/ml; p=0.055), interleukin ‐ 6 (68 vs 4.8 pg/ml; p=0.03) and amylin (65 vs 24 ng/ml, p=0.06) were all increased systemically in burn patients vs. healthy subjects. Irisin also showed a trend to be increased in burn patients (116 vs 83 ng/ml, p=0.24), however this was not statistically different. These findings suggest that severe chronic inflammatory stress alters the systemic hormonal profile of burn patients in a similar manner to that observed during adrenergic stimulation in rodents that has been shown to result in white‐to‐brown transdifferentiation.Grant Funding Source: NIH (P50‐GM60338, R01‐GM05668) and SHC (84090, 84080, 71008 and 71006) g

Review of Burn Injuries Secondary to Home Oxygen

The use of long-term home oxygen therapy (HOT) has become increasingly common for treatment of chronic pulmonary diseases. Although illegal to smoke while on HOT, there is an increasing incidence of burn injuries in those patients who smoke while on HOT. The importance of recognition of the prevalence of this injury, the obstacles faced when treating these patients, and understanding the proposed algorithmic approach to be taken with patients on HOT, including prescription, reassessment, and prevention of burn injury are outlined in this review. Retrospective epidemiological data including circumstances, admission, treatment, and disposition were collected and reviewed on the patients treated from 1999 to 2008 with burns secondary to smoking while on HOT. Seventeen patients sustained injuries secondary to smoking on HOT over the 9-year period; 9 patients were female and 8 were male. All the patients were on HOT for chronic obstructive pulmonary disease. Mean patient age was 69.1 ± 2.5 years and mean TBSA 2.8 ± 0.4%; 11.8% (2/17) sustained inhalation injury requiring intubation and 23.5% (4/17) required wound debridement and skin grafting. Mean hospital stay was 42.8 ± 12.5 days; 10.3 ± 5.4 days in the burn intensive care unit and 32.5 ± 11.0 days in the ward. Before the burn injury, 23.5% (4/17) lived in long-term care facilities. On discharge from hospital, 47.1% (8/17) were transferred to extended care facilities or other acute care hospitals, and 11.8% (2/17) died during their hospitalization. After recovery, there was a 35.3% reduction in patients able to return home and/or live independently. A significant number of burn injuries secondary to smoking while on HOT was observed. These patients differ from standard burn patients because they are older in age, have higher rates of inhalation injury, and have much longer lengths of hospitalization, despite smaller TBSA injuries. Prevention of this injury would improve the safety of the patient and those around them as well as healthcare resource allocation. A proactive multidisciplinary algorithmic approach is presented which can be used to manage patients on HOT at risk for continued smoking to decrease the incidence and the impact of burn injuries in this patient population.