Although survival after major burn injury is increasingly common, persistent psychosocial morbidity often remains prevalent, and the relationship between burn severity and long-term psychosocial recovery is less understood. We aimed to evaluate longitudinal trajectories of mental health and social recovery across large burn-size strata to examine whether injury severity differentially influences internal psychological outcomes versus external social participation. We conducted a retrospective, multicenter longitudinal analysis of adults with ≥20% total body surface area burns enrolled in the Burn Model System National Longitudinal Database, using outcome measures available across their respective collection periods. Participants were stratified by total body surface area groups of large (20-49.9%), very large (50-69.9%), or massive (≥70%). Outcomes included Patient-Reported Outcomes Measurement Information System domains of Depression, Anxiety, and Ability to Participate in Social Roles; Community Integration Questionnaire-Social Integration; and employment status assessed at 6-, 12-, and 24-months post-injury. Mixed-effects linear regression models adjusted for demographic and clinical covariables. Among 815 participants, depression and anxiety remained elevated relative to population norms, while social participation improved across all burn sizes longitudinally. Survivors with massive burns demonstrated the greatest improvement in mental health over 24-months, with changes reaching clinically meaningful magnitude, and their community integration at 24-months was comparatively preserved, coming closest to pre-injury burn levels despite lower perceived social role ability and employment. These findings demonstrate that psychosocial recovery over the first 24-months does not worsen in proportion to injury severity, indicating that injury severity alone should not define prognosis. Rather, survival and rehabilitation after massive burn injury can translate into meaningful psychological adaptation and social integration that benefits from sustained, multidisciplinary follow-up across all burn severities.

Due to complex local and systemic pathophysiological responses, severely burned patients present amajor anesthesiological challenge. This review article summarizes the current state of knowledge and key recommendations for the anesthesiological management of adult patients with major burn injuries. The recommendations presented in this article are based on the updated S2k guidelines "Management of thermal injuries in adults" from September 2025 as well as on expert consensus of the Working Group on Intensive Care Medicine of the German Society for Burn Injuries ("Arbeitskreis Intensivmedizin der Deutschen Gesellschaft für Verbrennungsmedizin, DGV)". Anesthesiological management of patients with major burn injuries requires substantial clinical expertise and clear interdisciplinary communication. Core priorities include fluid resuscitation, thermoregulation, airway management and transfusion management, with close and proactive interdisciplinary collaboration being an essential factor in the perioperative management process.

Hyperpyrexia in major burn injury: describing the epidemiology and evaluating the effectiveness of an intravascular temperature management device.

Inhalation injury remains a major contributor to morbidity and mortality in critically ill burn patients, although its hemodynamic impact during early resuscitation is incompletely understood. Patients with inhalation injury could exhibit distinct hemodynamic alterations compared with those without inhalation injury, potentially contributing to worse outcomes. We conducted a prospective, single-center observational study over four years including adult patients with major burns. Hemodynamic variables, fluid administration, and analytical biomarkers during initial resuscitation were analyzed according to inhalation injury. A total of 180 patients were included: 96 with ≥20% total body surface area (TBSA) burned without inhalation injury and 84 with inhalation injury irrespective of TBSA, with similar severity scores. Patients with inhalation injury were older and had lower %TBSA burned. They exhibited reduced initial cardiac index, higher lactate, increased stroke volume variation, greater late extravascular lung water index, and elevated NT-proBNP. Mechanical ventilation was more frequent (88% vs. 59%), with a non-significant trend toward higher mortality (28% vs. 18%, p=0.10). Fluid requirements were comparable between groups. In a predefined 25-75% TBSA subgroup, hemodynamic patterns were consistent with the overall cohort. Among patients with inhalation injury, non-survivors showed lower initial cardiac index and higher lactate, troponin, extravascular lung water, and NT-proBNP, despite similar intrathoracic blood volume. These findings demonstrated that inhalation injury was associated with early reductions in cardiac index, lower preload, and a delayed increase in extravascular lung water without higher fluid requirements; mortality correlated with greater cardiac dysfunction and elevated myocardial injury biomarkers during resuscitation.

While the early metabolic hallmarks of major burns are well established, less clear are the potential long-term metabolic consequences, including any future risk of dysregulated glucose metabolism. To address this, a real-world database of ∼125 million patients (TriNetX) was examined. Adult patients treated for large burns (≥30% total body surface area) or routine immunization (control comparator), with no prior diagnosis of diabetes mellitus, were identified. The two groups were propensity-score matched, resulting in a final pool of 5139 patients per group, balanced for age (40.6 ± 18.3 years), sex (69.7% male), race, and ethnicity (all P = 1.00). Using Kaplan-Meier survival analysis, the incidence of diabetes diagnosis in the 15-year period following the index event (burn or routine immunization) was determined. The estimated 15-year cumulative incidence of a diabetes diagnosis was 16.5% and 12.2% in the burn and comparator groups, respectively (log rank test: P = 0.0003), indicating that burn injury is significantly associated with an increased risk of diabetes within the 15-year post-burn period. Notably, both groups displayed equivalent degrees of adiposity, with the burn and comparator groups having an average BMI of 28.5 ± 6.6 and 28.4 ± 6.8 kg.m-2, respectively (P = 0.77). In summary, our data suggest that following major burns, patients remain at a heightened risk for the development of diabetes for several years.

Dietitian perspectives of nutrition support practices in major burn injuries.

Burn sequelae of the popliteal fossa cause significant functional impairment, with aesthetic and psychological consequences. Flexion contractures are the most frequent, and several therapeutic classifications exist; however, the clinical heterogeneity of these sequelae makes it difficult to establish a consensus. A retrospective study (January 2014 to January 2022) included 20 patients who underwent surgical treatment for major burn sequelae of the popliteal fossa. Functional outcomes were assessed using the Ogawa and Pribaz, and Baux and Mimoun classifications. The median age was 15.5 years, with a male predominance (sex ratio=1.5). Sixty percent of patients were from rural areas, and 55% received initial non-specialized management. Skin contractures were present in 90% of cases, with a severe knee extension deficit in 89%. Reconstruction involved local techniques such as Z-plasties (40%) and locoregional flaps (pedicled transposition or perforator flaps; 45%). These two categories were analyzed separately due to their distinct anatomical and technical considerations. Final functional outcomes were considered good to excellent in 80% of cases after a median follow-up of 1.15 years. Children are particularly susceptible to popliteal fossa burn sequelae, with a risk of recurrence. The quality of initial management influences the severity of sequelae. Surgical intervention is indicated in the presence of ulceration or significant functional impairment. Local flaps demonstrated good results with fewer recurrences. The main limitations of this study include the small sample size, its retrospective nature, and limited follow-up. A management algorithm for retractile sequelae has been proposed and requires prospective validation.

Primary care utilization and attachment among burn survivors: A population-based matched cohort study.

Impact of hypothermia on the care outcome of burns patients transferred to a tertiary burn unit in NSW, Australia.

Defining rehabilitation goals after burn injury using the International Classification of Functioning, Disability and Health (ICF) framework.

Comparative prognostic performance of early renal biomarkers for major adverse kidney events in severe burn patients.

ABRUPT2 was a prospective, randomized, multicenter trial to determine whether lactated Ringer's + 5% albumin (Alb) reduces resuscitation requirements compared to lactated Ringer's (LR) alone in major burns. The prospective, observational, multicenter ABRUPT study(1) found that initiation of albumin rapidly lowered fluid input and improved urine output in patients with burns ≥ 20% TBSA. Based on the ABRUPT trial, inclusion was increased to ≥ 25% TBSA and ≥ 20% full-thickness. Patients ≥ 18 years were randomized to receive LR or Alb (2/3 LR + 1/3 5% albumin) for initial resuscitation. The initial rate was 2-4ml/kg/% TBSA and adjusted to urine output (0.5-1mL/kg/hour). For safety or excessive fluid volumes (> 250mL/kg in 24 hours), investigators could crossover between assigned study arms. The study was stopped at 99 subjects (Alb-48, LR-51) due to declining enrollment in 19/27 centers. Mean % TBSA burn was 46%. Twenty-six (51%) LR patients crossed over to Alb, but there were no crossovers from Alb to LR. Despite crossovers, following intention-to-treat, there were statistically significant (p 0.001) increased fluids at 24 and 48 hours for the LR group compared to Alb. The LR group averaged 1.5 (95% CI: 0.59,2.3) ml/kg/%TBSA and 2.1 (95% CI: 1.0,3.1) ml/kg/%TBSA times higher fluids compared to Alb at 24 and 48 hours, respectively. There were no differences in mortality, time to healing or acute kidney injury. The use of 5% albumin significantly reduced fluid requirements compared to LR alone in the first 48 hours after injury.

Background and Objectives: Major burn injury causes profound hypermetabolism and altered thermoregulation. While perioperative hypothermia is linked to adverse outcomes, the prognostic significance of preoperative core temperature in major burn patients remains poorly defined. Therefore, we investigated the association between preoperative core temperature and postoperative mortality in patients with major burns. Materials and Methods: This retrospective study included 635 adult patients with major burns who underwent surgery. Preoperative core temperature was measured in the intensive care unit before surgery. The primary outcome was 90-day postoperative mortality. Secondary outcomes were 30-day postoperative complications, including major adverse cardiovascular events (MACE), bloodstream infection, and continuous renal replacement therapy (CRRT) requirement. Cox proportional hazards regression, receiver operating characteristic (ROC) curve, Kaplan–Meier survival, and restricted cubic spline analyses were performed. Results: The 90-day postoperative mortality rate was 35.6%. Mortality increased in a graded manner as preoperative core temperature decreased. In multivariable Cox regression analysis, preoperative core temperature remained independently associated with 90-day mortality. Restricted cubic spline analysis showed an inverse linear association between preoperative core temperature and mortality risk. ROC curve analysis identified 37.0 °C as an exploratory and hypothesis-generating cohort-specific threshold for risk stratification. Regarding secondary outcomes, the core temperature ≤37.0 °C group had higher rates of MACE, bloodstream infections, and CRRT requirement (all p < 0.05). Conclusions: Lower preoperative core temperature was associated with increased 90-day postoperative mortality in adults with major burns undergoing surgery. Preoperative temperature may serve as a clinically relevant marker of physiologic vulnerability and postoperative risk.

HighlightsWhat are the main findings?Burn injuries disproportionately affect children and young adults, with scalds as the leading cause.In-hospital mortality was 8.5%, strongly predicted by inhalation injury, TBSA ≥ 15%, and ICU admission.What are the implications of the main findings?Strengthening critical care and burn management capacity is urgently needed.Prevention and treatment strategies should prioritize children and young adults at highest risk.Background: Burn injuries are a major cause of morbidity and mortality in low- and middle-income countries, yet remain underreported due to limited data systems. This study describes the epidemiology of burn patients admitted to two major burn centers in Addis Ababa, Ethiopia, and identifies predictors of in-hospital mortality. Methods: A cross-sectional study was conducted among patients with new burn injuries admitted between 1 September 2021, and 1 November 2023, at the Addis Ababa Burn, Emergency, and Trauma Center (AaBET) and Yekatit 12 Medical College (Y12MC) hospitals. Data were extracted from medical records. Descriptive statistics summarized patient characteristics, and binary logistic regression with multivariable analysis identified factors associated with in-hospital mortality using adjusted odds ratios (AORs) and 95% confidence intervals (CIs). Results: Chart completeness was 96.2%. Among 800 patients, 57% were female, with a median age of 18 years (range: 0–89); approximately 80% were under 30 years. Scalds were the leading cause (49.1%). In-hospital mortality was 8.5% (95% CI: 6.5–10.4). Significant predictors included inhalation injury (AOR 6.53), TBSA ≥ 15% (AOR 3.33), deep burns (AOR 1.96), and ICU admission (AOR 14.42). Conclusions: In-hospital mortality was moderate, disproportionately affecting children and young adults, underscoring the need to strengthen critical care and management of severe burns.

Advances in burn care have markedly improved survival after major injuries. However, survivors often experience significant physical and psychosocial sequelae. We aimed to characterize long-term health-related quality of life (HRQoL) among burn survivors to inform expected trajectories, rehabilitation needs, and common impairments. Adult burn survivors from a multicenter, longitudinal cohort study were stratified into 20-49.9%, 50-69.9%, and ≥70% total body surface area burn size groups. Patient-reported physical and mental HRQoL and life satisfaction were assessed using validated outcome measures at discharge (pre-injury recall), 6, 12, 24 months, and 5 years post-injury. Standardized summary scores were derived using validated bridges. Mixed-effects linear regression models evaluated longitudinal changes and between-group differences. A total of 1,113 participants were analyzed. All outcomes declined early after injury but improved progressively thereafter. Notably, by 24 months, mental health and life satisfaction approached pre-injury levels across all burn size groups. Physical health deficits were greater with increasing burn size, with significant net differences relative to the 20-49.9% reference group (p<.0001). Mental health and life satisfaction outcomes showed minimal between-group differences overall, though individuals with the largest burns exhibited significantly better relative mental health at 24 months (p<.05). Although outcomes improve over time following major burn injury, persistent physical deficits support the classification of major burns as a chronic condition. These findings characterize burn size-specific recovery trajectories and demonstrate that, despite persistent physical deficits, mental health and life satisfaction can return to near pre-injury levels even after the most extensive injuries.

This study aimed to investigate long-term prevalence of nutrition impact symptoms, such as appetite and eating-related issues that may impede food intake, in patients with minorand majorburn injuries. In this prospective longitudinal cohort study, 60 adults participated. Two questionnaires, the Disease-Related Appetite Questionnaire (DRAQ-burn) and the Eating Symptom Questionnaire (ESQ-burn), were completed during follow-up visits at 6 and 12 months post trauma. Median burn extent was 4.5% in the minor burn group and 24.0% in the major burn group. At six months, the median number of symptoms reported in DRAQ-burn was 2.0 for all patients; at 12 months, it was 1.0 for minor burns and 1.5 for major burns. Reported symptoms in the ESQ-burn remained stable at a median of 1.0 across both time points and burn severities. Most frequently reported symptoms included fluctuation in appetite/eating, never/rarely feeling hungry, tiredness affecting appetite/eating, and nausea. No statistically significant differences were found between burn severity groups or over time. Overall, although the nutrition impact symptoms were reported to be more mild than severe in nature, they persisted for up to a year post burn, highlighting the need for ongoing nutritional follow-up to mitigate the risk of malnutrition.

Severe thermal burn injuries trigger intense inflammation, hypermetabolism and protein catabolism, and muscle wasting. High protein intakes and pharmacological modulation of hypermetabolism belong to routine therapy in burn centers. The urea-to-creatinine ratio (UCR) has emerged as a potential biomarker of protein catabolism in critical illness. The study aims at assessing the relevance of the UCR in major burns while observing its response to pharmacomodulation with propranolol. Retrospective study including burn patients admitted to the intensive care unit (ICU) for burns involving ≥20% of TBSA (total body surface area), surviving >10 days between January 2006 and December 2023. Burn severity was categorized into three groups: 1) 20-40%, 2) 41-60% and 3) >60% TBSA. Standard variables and nutritional management were recorded. Serum C-reactive protein (CRP), urea, creatinine and UCR were compared across the burn groups during the first 30 days, as was use of propranolol. Results as median with interquartile range. Altogether 150 patients were included, aged 46 [29.5, 61.0] years, burned 31.5 [25.0, 54.5]% TBSA. ICU mortality was 12% (18/150). Protein intakes were progressed to 1.4 g/kg/day in Groups 1 and 2, and (1.6 g/kg/day in Group 3). The UCR increased until day 10 reaching a value of 150, initially parallelling CRP, but remained persistently elevated while CRP declined after day 10, with non-significant differences between groups. The urea and UCR values were higher with higher protein intakes (p = 0.001). In the cohort, 85 (56.6%) received propranolol started on day 8. The UCR trajectories were modestly lower with propranolol versus without. The urea-to-creatinine ratio is an available and clinically applicable biomarker of catabolism and protein metabolism in major burn patients with persistent high values. Its modest response to propranolol therapy, and association with protein dose suggests it could serve as a potential marker in future interventional studies. Prospective studies are needed to validate its clinical applicability.

Lightning strikes present a risk, resulting in deaths and injuries annually. Lightning injuries, like electrical injuries, can have brain injury and chronic pain, but unlike electrical injuries, lightning injuries do not have major burns or amputations. This study is divided into two stages. The first stage presents the mechanisms of lightning injuries, including 1) direct strike, 2) touch voltage, 3) side flash, 4) step voltage, 5) upward unconnected leader (UUL), and 6) trauma associated with the air expansion near the lightning channel. The second stage of the study is dedicated to presenting the main results of lightning safety advocacy programs, which combine engineering components, such as the protection of structures against lightning (LPS) and thunderstorm warning systems, with behavioral actions, such as training, alerts, the creation of councils, and governmental policies. The 2011 Runyanya Primary School tragedy in Uganda, where a lightning strike killed 18 students and injured 38, led to the establishment of International Lightning Safety Day (ILSD, 28 June), highlighting the need for global awareness. This study also proposes ways for government involvement, especially in developing countries, to improve lightning prevention and protection, emphasizing the importance of integrated and multidisciplinary approaches.

Major burn injury triggers systemic inflammation and metabolic responses beyond the skin. Early intestinal barrier failure can amplify post-burn inflammation and organ dysfunction, yet the dynamic epithelial lesions that generate focal leakage in vivo remain unclear. We characterized villus-tip epithelial shedding, epithelial gap formation, and tracer leak sites early after burn using intravital multiphoton fluorescence microscopy. Male C57BL/6 mice were assigned to Control or Burn groups (30-35% total body surface area full-thickness burn; n=6/group). Intestinal permeability was assessed at 2, 4, and 6 hours post-injury using luminal fluorescein isothiocyanate-dextran (4 kilodaltons) with portal venous sampling. Distal-ileum intravital imaging was performed 330-420 minutes post-injury (1-minute intervals). Ten villi per mouse were quantified for shedding duration and prevalence, condensation-first versus extrusion-first sequence, epithelial gap density, goblet-cell proportion, and focal luminal tracer leak sites. Major burn shortened shedding duration and increased shedding prevalence during the 90-minute observation (p<0.05), with a shift toward a condensation-first pattern and fewer extrusion-first events (p<0.05). Burn increased epithelial gap density and goblet-cell proportion (p<0.05). Portal serum fluorescein isothiocyanate-dextran concentrations were elevated at 6 hours (p<0.05), and imaging localized tracer penetration to discrete post-shedding epithelial defects, consistent with incomplete sealing. Major burn rapidly disrupts intestinal barrier integrity through accelerated stress-associated shedding, increased gap formation, and focal leak sites. These time-resolved structural lesions provide an in vivo substrate for early hyperpermeability and suggest a time-critical window for gut-directed interventions to mitigate downstream post-burn complications.

Over the past years, burn care has evolved from a discipline focused on survival to one centered on restoring long-term health, function, and quality of life. Significant advances in critical care, early excision and grafting, infection control, and metabolic support have transformed survival outcomes for even the most severe injuries. As a result, the field now faces a new frontier: understanding and managing the long-term physical, psychological, and systemic sequelae of survival. This review traces the evolution of burn care over the last century and outlines the challenges and priorities for the next 25 years. The first era of progress, defined by innovations in resuscitation, surgery, and critical care, has given rise to a growing cohort of long-term survivors. Research over the past decade has revealed that major burns induce chronic multisystem alterations, including metabolic, cardiovascular, neurocognitive, and immunological dysfunctions. Emerging concepts such as burn-associated heart failure exemplify this shift from acute to chronic disease understanding. Looking ahead, the future of burn medicine lies in personalized and lifelong care, supported by translational research, digital health, regenerative therapies, and interdisciplinary collaboration. Overall, burn care stands at a pivotal crossroads. By integrating precision medicine, rehabilitation science, and psychosocial care, we aim to move the field from survival toward sustained, holistic recovery over the next 25 years.