Significant Burn Injury Research Articles

Physical Outcomes of Patients With Burn Injuries—A 12 Month Follow-Up

There is only limited research documenting functional ability, physical fitness, and health related quality of life after burn injury. The objective of this study was to measure a comprehensive range of physiotherapy-related outcomes over a 12-month period for patients with significant burn injuries. A prospective study was performed on consecutive patients admitted to the Royal Adelaide Hospital over a 12-month period. Outcomes were measured at admission and discharge from hospital and at 1, 3, 6, and 12 months, and comprised the: Medical Outcomes Study 36-Item Short Form Health Survey, Quick Disabilities of the Arm, Shoulder and Hand questionnaire, Lower Extremity Functional Scale questionnaire, shuttle walk test, grip strength and scar appearance using the Matching Assessment with Photographs of Scars. A total of 86 patients (74 male, mean age 38 years) participated. There was a significant deterioration in all outcomes in the first few months after burn injury, with most outcomes improving towards baseline levels by 6 months. However, lower limb function (Lower Extremity Functional Scale) remained significantly reduced at 12 months and functional exercise capacity (shuttle walk test) was still markedly reduced at 6 months compared with predicted normal values. The total burn surface area significantly affected many of the outcomes. In conclusion, for this sample of patients after burn injury, there was an acceptable rate of recovery for physiotherapy-related outcomes, in that most measures had returned to near baseline levels by 6 months postinjury, with the exception of lower limb function and functional exercise capacity.

Prevalence of Major Psychiatric Illness in Young Adults Who Were Burned as Children

To determine the prevalence of major psychiatric illness in a group of young adults who suffered significant burn injury as children. A total of 101 persons (58 males, 43 females), aged 21 +/- 2.6 years, 14.0 +/- 5.4 years postburn of 54% +/- 20% total body surface area, were assessed for serious past and present mental illness by using a Structured Clinical Interview (SCID) for Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) Axis I diagnoses. The SCID findings demonstrated that the prevalence of any Axis I major mental illness was 45.5% for the past month (current) and 59.4% for lifetime. These rates of overall disorder and the rates for most specific disorders were significantly higher than those found in the US population of comparable age. Logistic regression was used to examine demographic and burn characteristics as predictors of current and lifetime psychiatric disorder within the burn survivor sample. The female gender was significantly associated with higher rates of any current disorder. Other demographic and burn characteristics were not significantly related to the overall prevalence of current or lifetime disorder. Only a small number of those with disorders reported any current mental health treatment. Significant burn injury as a child leads to an increased risk of developing a major mental illness. Young adults who suffered major burn injury as children should be screened for these illnesses to initiate appropriate treatment.

Effects of heparin on bacterial translocation and gut epithelial apoptosis after burn injury in the rat: Dose-dependent inhibition of the complement cascade

This study investigated levels of complement inhibition, apoptosis of gut epithelium, and bacterial translocation (BT) associated with different doses of heparin in rats with severe burns. After burn injury, the animals in Groups 1, 2, 3, and 4 received intravenous tail-vein bolus heparin doses of 150, 300, 600, and 1200 U/kg, respectively. Group 5 received no heparin after burn injury. Group 6 served as control group. According to the results, Group 2 had the highest rate of positive staining for C3, and Group 4 had the lowest rate. There were significant differences between these two groups with respect to distribution of immunoflouresein scores for C3 ( p = 0.01). Group 5 had the highest mean TUNEL index of all the groups (258/10) ( p = 0.01). On electron microscopy, the connective tissue cells in the ileal submucosa from Groups 4 and 5 showed more significant apoptotic changes than the corresponding cells in the other groups. The total BT values in Group 4 (129 × 10 4 CFU) and Group 5 (100 × 10 4 CFU) were both significantly higher than those in the other groups ( p = 0.01). Group 1 had the lowest total BT value (6.1 × 10 2 CFU) ( p = 0.001). In summary, our results confirm that heparin administration after significant burn injury in rats can reduce BT, and that the effect is related to dose. The findings also indicate that levels of BT after burn injury increase in parallel with the extent of gut epithelial cell apoptosis.

Enteral feeding in patients with major burn injury: the use of nasojejunal feeding after the failure of nasogastric feeding

Patients with major burn injury have increased protein and energy requirements and early feeding is an established part of their management. The optimal method of feeding is unknown. Nasogastric feeding is often unsuccessful and total parenteral nutrition has a number of potential disadvantages. Post pyloric feeding is an alternative means of providing enteral nutrition. We report our experience of enteral feeding of patients with significant burn injury. Nasogastric feeding was successful in only 7 of 17 patients (41%). The commonest reason that nasogastric feeding failed was gastric stasis. All patients who failed nasogastric feeding were commenced on nasojejunal feeding and a further two patients were fed by this route initially. Ten of these 12 patients (83%) were successfully fed nasojejunally. No major adverse events attributable to nasojejunal feeding were identified, a nasojejunal tube was successfully placed in all but 1 patient and the tubes were well tolerated. We conclude that nasojejunal tube feeding should be considered in all patients with significant burn injury who cannot tolerate nasogastric tube feeding.

Pediatric burn care

One third of patients with significant burn injuries are children who are injured in what are nearly always preventable incidents. These extremely painful and often scarring bunts are enormous stressors to patients and their families. Children are easily devastated by the burst injury and are often less able to respond to it than au adult. Pediatric burn injury provides multiple problems in early diagnosis and management. Although the entire cutaneous injury is easily visualized severity is frequently underestimated by caregivers and by the patient's family. Management pitfalls in children will be discussed including correct estimation of horn size and depth, fluid resuscitation and fluid maintenance vascular access, airway management, and thermal homeostasis.

Immediate Enteral Feeding in Burn Patients Is Safe and Effective W.S. MCDONALD, C.W. SHARP, E.A. DEITCH Annals of Surgery 213:177–183, 1991

Traditionally, it has been taught that a period of ileus occurs after significant burn injury, thus clinicians avoided use of the gut as the primary mode of administering nutrients in patients with major burns. Several studies have suggested early aggressive enteral support may be beneficial. One hundred six patients with burns involving 40 ± 21% of the total body surface area were entered into a study where gastric feeding was begun within 6 hours from the onset of injury. Feedings were administered as boluses and consisted of an intact protein diet. Eighty‐two percent of the patients absorbed at least part of their tube‐fed diet on the day of injury and this reached 95% by hospital day 4. Vomiting was the most frequent complication, occurring in 16 of 106 patients. No patient developed stress gastritis/ulcers and H‐2 blockers were not used. Among those patients who were unable to tolerate early enteral feeding, the mortality rate was significantly higher (38.5% us 9.3%, p < 0.004); these patients also had significantly larger burn size, (60 ± 26% us 35% ± 14%, p < 0.007). Early enteral support via the gastric route is safe and effective in most patients with major burns. More severely injured burn patients may require nasoduodenal tube placement.

Gasoline-Induced Contact Burns

Gasoline contact may cause significant full-thickness burn injuries. Systemic complications may result from the absorption of hydrocarbons through the skin. Regional neuromuscular absorption may produce transient or even permanent impairment. It is vital that the physician be aware of the possible full-thickness injuries and complications that may result from cutaneous exposure to gasoline.

Burns from buried electric cables

Twenty-six patients who sustained significant burn injuries as a result of striking underground electric cables are reviewed. This study sets out to highlight why such injuries occur and to recommend preventive measures to those digging in the London area. There were three deaths in this series.

Fluid Shifts After Burn Injury

Following significant burn injury, severe translocations occur in the distribution of water and solute. These result in major deficits in functional extracellular fluid and circulating water volume which may result in shock. The weight of evidence suggests that resuscitational regimens must contain large quantities of water which should be at least isotonic with respect at sodium; and some evidence suggests that current resuscitational regimens may not provide sufficient potassium to maintain the normal relationship between intracellular and extracellular solute and to prevent sodium sequestration. It is clear, however, that most of the currently used resuscitational "formulas" are effective in restoring and maintaining water balance, renal function, cardiac output, and in preventing or correcting shock.