Thermal Burn Injury Research Articles

The Effect of Aloe Vera Topical Gel Extraction on Tgf-Β1 Expression in Thermal Burn Eyelid Grade II Rats Model

Grade II eyelid burns are burns that reach the epidermis and part of the dermis of the palpebrae and can have impaired wound healing. TGF β1 has the broadest spectrum of action, affecting all cell types involved in all stages of wound healing. TGF β1 increases rapidly after injury and reaches peak levels three days after injury, which coincides with the peak of the inflammatory phase of wound healing. Decreased expression of TGF β1 is associated with impaired wound healing. Aloe Vera has long been known in Indonesia as a healing plant. Aloe Vera extract contains a variety of bioactive compounds that play a role in stimulating wound healing. The administration of Aloe Vera extract on thermal burns aims to reduce inflammation, increase collagen content, and increase the rate of re-epithelization. The administration of Aloe Vera gel extract allows faster healing of thermal burns and rebuilds the vascularity of the wound tissue. Objective of this study is to determine the difference between the expression of Transforming Growth Factor Beta 1 (TGF β1) in a rat model of thermal burn injury grade II of the eyelids treated with topical Aloe Vera gel extract with the concentrations of 20%, 40%, Balanced Salt Sodium (BSS) and a control group that was not given burn intervention. An experimental study with the post-test-only approach with a control group design. 24 Rats have induced grade II eyelid thermal burns, divided into four groups: Normal (without treatment), negative control (BSS), given Aloe vera 20%, 40%. Then TGF β1expression was quantified using the Image J application. The Topical application of Aloe vera gel can increase the expression of TGF along with the increase in dose. The highest rise in TGF expression was found in the group with 40% Aloe vera gel, followed by 20% Aloe vera gel compared to the negative control (BSS Balanced Salt Solution). Aloe Vera can increase TGF expression in a rat model of grade II palpebral burn injury and is dose-dependent.

Supraoptic nucleus morphological features of the hypothalamus in the skin burn injury dynamics

Relevance. The relevance of the study of the large cell nucleus of the anterior hypothalamus in case of skin damage is due to the important role of accompanying reactive changes in the neuroendocrine regulatory complex in stress. Since the hypothalamus is part of neuroendocrine cooperation, it shows pronounced signs of structural disorganization of neurons. The purpose of the study is to study structural changes in the supraoptic nucleus of the hypothalamus of rats in the dynamics of thermal burn injury of the skin. Materials and Methods. The study was conducted in laboratory mature male rats. To assess the morphological features of the supraoptic nucleus of the hypothalamus in the dynamics of skin burn injury, histological examination methods were carried out. The morphological analysis evaluated the neurotopographic organization of the nucleus and its structural organization. Structural transformations were judged by the shape and location of neurons, by the shape of neuronal pericarions, by the presence of focal gliosis, swelling, spongiosis. Results and Discussion. The results of morphological analysis showed that in the conditions of burn damage to the skin in the supraoptic nucleus of the hypothalamus, pronounced destructive changes in the form of focal gliosis, swelling, spongiosis, reversible and irreversible damage to nerve cells occurred in the initial post-traumatic period (on days 2-4). Weak structural tissue transformations on days 7-10 after burn exposure reflected the dynamics of repair of damaged nerve cells, testifying to of partial disorganization of nerve cells of a restorative nature. Conclusion. Thus, the revealed structural disorders in the supraoptic nucleus of the hypothalamus can be regarded as insignificant, which indicates the complex internal organization of the supraoptic nucleus of the hypothalamus and its high resistance to damaging exogenous influences. The morphological features of the supraoptic nucleus of the hypothalamus confirm the involvement of the neurosecretory apparatus in the process of adaptation to stress against the background of burn exposure, the selective participation of their neurohormones in the regulation of normal and pathological conditions, exerting a wide range of physiological influences in the development of protective and adaptive mechanisms.

The Effect of an Autologous Protein-Based Topical Serum on Cutaneous Burns.

Burns are skin lesions that can be life-threatening. Platelet-rich plasma (PRP) is growing as an effective alternative for the management of burns. The objective of this study was to assess the use of a storable topical serum based on plasma rich in growth factors (PRGF) in promoting burn wound healing, called Endoret-Serum (ES). 3D skin models were used to assess thermal burn injury. Extracellular matrix remodeling, tissue damage, and metabolic activity of explants were analyzed, and a histomorphometric examination was carried out. Silver sulfadiazine cream (SC) was used as control ointment for burn management. Three patients suffering from skin burns were also treated with ES and clinically assessed. Endoret-Serum was based on an enriched platelet fraction with neutral pH and containing a high load of growth factors. Both ES and SC reduced tissue damage after burn, with ES being more effective. ES treatment maintained the metabolic activity of explants at a healthy level, and increased collagen and elastin deposition. Both treatments preserved the cutaneous connective tissue and induced newly synthesized matrix, with ES being more effective. Both treatments induced an intense collagenization, but ES showed better results as it restored the basal layer network with reduced signs of fibrosis. ES decreased the apoptotic cell number. Patients suffering from skin burns showed complete healing after ES treatment. Endoret-Serum might promote cutaneous healing and may be useful for accelerating the regeneration of skin burns. J Drugs Dermatol. 2022;21(12):1330-1339. doi:10.36849/JDD.6763.

Accurate and early prediction of the wound healing outcome of burn injuries using the wavelet Shannon entropy of terahertz time-domain waveforms.

Severe burn injuries cause significant hypermetabolic alterations that are highly dynamic, hard to predict, and require acute and critical care. The clinical assessments of the severity of burn injuries are highly subjective and have consistently been reported to be inaccurate. Therefore, the utilization of other imaging modalities is crucial to reaching an objective and accurate burn assessment modality. We describe a non-invasive technique using terahertz time-domain spectroscopy (THz-TDS) and the wavelet packet Shannon entropy to automatically estimate the burn depth and predict the wound healing outcome of thermal burn injuries. We created 40 burn injuries of different severity grades in two porcine models using scald and contact methods of infliction. We used our THz portable handheld spectral reflection (PHASR) scanner to obtain the in vivo THz-TDS images. We used the energy to Shannon entropy ratio of the wavelet packet coefficients of the THz-TDS waveforms on day 0 to create supervised support vector machine (SVM) classification models. Histological assessments of the burn biopsies serve as the ground truth. We achieved an accuracy rate of 94.7% in predicting the wound healing outcome, as determined by histological measurement of the re-epithelialization rate on day 28 post-burn induction, using the THz-TDS measurements obtained on day 0. Furthermore, we report the accuracy rates of 89%, 87.1%, and 87.6% in automatic diagnosis of the superficial partial-thickness, deep partial-thickness, and full-thickness burns, respectively, using a multiclass SVM model. The THz PHASR scanner promises a robust, high-speed, and accurate diagnostic modality to improve the clinical triage of burns and their management.

Eyelid and scleral thermal injury following phacoemulsification in silicone oil: a case report

BackgroundPhacoemulsification has been the mainstay method for extracapsular cataract extraction surgery in the anterior segment; for cases of posterior drop of lens fragments into the vitreous, a posterior segment phacoemulsification instrument (fragmatome; Alcon, Inc., Fort Worth, TX) can be employed to remove the dislocated lens materials. Studies have reported on thermal injury to the cornea during phacmoemulsification of the anterior segment. However, few studies have investigated thermal burn in the simultaneous sclera and eyelid induced by the fragmatome. Currently, there is no reports and lack of optimal strategy for the management of nucleus drop in a vitreous cavity filled with silicon oil.Case PresentationWe present the case of a 53-year-old male patient with a thermal burn wound on the upper eyelid and sclera following phacoemulsification for a dropped lens in a silicone oil-filled vitreous. We further designed an experiment to verify our hypothesis that thermal injury could be induced by the high temperature of the metal tip during phacoemulsification in silicone oil. In our experiment, during 420 s of continuous ultrasonic wave, the temperature of the fragmatome tip in the balanced salt solution (BSS) increased from 22.0 to 24.0 ºC, while the temperature of the fragmatome tip in the silicone oil group increased from 22.0 to 43.0 ºC.ConclusionsThe temperature of the fragmatome tip increased significantly in silicone oil compared to BSS in the experiment. Thus, physicians should be aware of possible thermal complications when using fragmatome in eyes filled with silicone oil.

Understanding the approach to animals with thermal burns

Thermal burn injuries represent a spectrum of superficial to deep epidermal and dermal injury sustained after exposure to a liquid, solid or gaseous heat source. Severe thermal burns result in both local damage and systemic effects. In systemically compromised animals, managing major body system abnormalities takes priority over surgically managing the thermal burn. General principles of wound management are relevant to animals with thermal burns. The surgical approach will vary according to individual wound and patient factors. Adjunctive therapies, such as negative pressure wound therapy, are touched on. Further research into thermal burns in veterinary cases is warranted.

Platelet-activating factor and microvesicle particles as potential mediators for the toxicity associated with intoxicated thermal burn injury.

Thermal burn injuries (TBIs) in patients who are alcohol-intoxicated result in greater morbidity and mortality. The systemic toxicity found in human patients, which includes both immediate systemic cytokine generation with multiple organ failure and a delayed systemic immunosuppression, has previously been replicated in mouse models combining ethanol and localized TBI. Though considerable insights have been provided with these models, the exact mechanisms for these pathologic effects are unclear. In this review, we highlight the roles of the lipid mediator platelet-activating factor (PAF) and subcellular microvesicle particle (MVP) release in response to intoxicated thermal burn injury (ITBI) as effectors in the pathology. Particularly, MVP is released from keratinocytes in response to PAF receptor (PAFR) activation due to excess PAF produced by ITBI. These subcellular particles carry and thus protect the metabolically labile PAF which enable binding of this potent lipid mediator to several key sites. We hypothesize that PAF carried by MVP can bind to PAFR within the gut, activating myosin light chain kinase (MLCK). The subsequent gut barrier dysfunction in response to MLCK activation then allows bacteria to invade the lymphatic system and, eventually, the bloodstream, resulting in sepsis and resultant dysregulated inflammation in multiple organs. PAF in MVP also activate the skin mast cell PAFR resulting in migration of this key effector cell to the lymph nodes to induce immunosuppression. This review thus provides a mechanism and potential therapeutic approaches for the increased toxicity and immunosuppressive outcomes of TBI in the presence of acute ethanol exposure.

Radiofrequency in arthroscopic shoulder surgery: a systematic review.

Radiofrequency has seen an increase in use in orthopedics including cartilage lesion debridement in the hip and knee as well as many applications in arthroscopic shoulder surgery. The purpose of this systematic review is to evaluate the safety and usage of radiofrequency in the shoulder. This systematic review was registered with PROSPERO (international registry) and followed the preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) guidelines. Embase and PubMed were searched using: "shoulder," "rotator cuff," "biceps," "acromion" AND "monopolar," "bipolar," "ablation," "coblation," and "radiofrequency ablation." The title and abstract review were performed independently. Any discrepancies were addressed through open discussion. A total of 63 studies were included. Radiofrequency is currently utilized in impingement syndrome, fracture fixation, instability, nerve injury, adhesive capsulitis, postoperative stiffness, and rotator cuff disease. Adverse events, namely superficial burns, are limited to case reports and case series, with higher-level evidence demonstrating safe use when used below the temperature threshold. Bipolar radiofrequency may decrease operative time and decrease the cost per case. Shoulder radiofrequency has a wide scope of application in various shoulder pathologies. Shoulder radiofrequency is safe; however, requires practitioners to be cognizant of the potential for thermal burn injuries. Bipolar radiofrequency may represent a more efficacious and economic treatment modality. Safety precautions have been executed by institutions to cut down patient complications from shoulder radiofrequency. Future research is required to determine what measures can be taken to further minimize the risk of thermal burns.

The effects of aqueous extract of Labisia Pumila (Blume) Fern.-Vill. Var. Alata on wound contraction, hydroxyproline content and histological assessments in superficial partial thickness of second-degree burn model.

Background: Burns are considered a critical care problem in emergency medicine, resulting in physical, psychological, and chronic disabilities. Silver sulfadiazine is the gold standard in topical burn treatment but was associated with toxicity to keratinocytes and fibroblasts, which may delay wound healing. In discovering potential alternative treatments for burn wound healing, this study was performed to determine the effect of Labisia Pumila (Blume) Fern.-Vill. Var. Alata (LPVa) extract on thermal-burn wounds in rats. Methods: A total of 50 Sprague-Dawley male rats were categorized into five groups. There were three control groups; normal control (left untreated), negative control (given ointment base) and positive control (given silver sulfadiazine). Meanwhile, the two intervention groups were given with 2% LPVa leaf and root extracts, respectively. Burn wounds were inflicted on the loin region of the rat by applying a heated steel rod at 80°C for 10 s. On days 3, 7, 14, and 21, wounds were measured macroscopically using a digital calliper and one animals of each group were sacrificed, and the wounded skin were excised for histomorphological assessments. The wounds were excised for hydroxyproline content on Day 14 of treatment. Result: For wound contraction percentage, both the leaf and root extracts of LPVa showed a significant reduction in burn wound size on Day 7 onwards, when compared to other groups. For hydroxyproline content, only the leaf extract of LPVa produced significantly higher content compared to both negative and normal control groups. In terms of histological examination, the leaf extract group demonstrated a superior healing effect than the root extract group. Conclusion: Both leaf and root extracts of LPVa could promote wound healing in the thermal-burn wound rat model, with leaf extract being superior to root extract.

The Effect of Zinc Oxide Nanoparticles on Properties and Burn Wound Healing Activity of Thixotropic Xymedone Gels

Zinc oxide nanoparticles (ZnO NPs) modified by oxopyrymidine alcohol, also known as xymedone (Xym), were obtained and studied using FTIR, UV-vis, and fluorescent spectroscopy, and SEM, BET, powder XRD, and DLS analysis. A formulation of thixotropic hydrophilic gels containing Carbopol-based Xym and ZnO NPs was developed. A vertical Franz cell with a cellulose acetate membrane was used as a model to investigate the passive diffusion of the gel components by AAS. The gel components—Xym and ZnO NPs—were shown to penetrate through acetyl cellulose membrane within 5–7 h depending on an initial amount, and its values were in the range of 56–77%. The penetration of modified ZnO NPs by Xym was more effective in contrast to ZnO NPs without modification. The burn wound healing activity of ZnO NPs–Xym gel was demonstrated on a thermal burn wound model on rats. SOD and GR activity was increased by 30–35% during ZnO NPs–Xym gel treatment, the burn area on 10 postburn day decreased by 10% in contrast to a positive control, Methyluracyl®® ointment.

Erythrocyte aggregation in sudden flow arrest is linked to hyperthermia, hypoxemia, and band 3 availability

BackgroundErythrocyte aggregation is a phenomenon that is commonly found in several pathological disease states: stroke, myocardial infarction, thermal burn injury, and COVID‐19. Erythrocyte aggregation is characterized by rouleaux, closely packed stacks of cells, forming three‐dimensional structures. Healthy blood flow monodisperses the red blood cells (RBCs) throughout the vasculature; however, in select pathological conditions, involving hyperthermia and hypoxemia, rouleaux formation remains and results in occlusion of microvessels with decreased perfusion. ObjectivesOur objective is to address the kinetics of rouleaux formation with sudden cessation of flow in variable temperature and oxygen conditions. MethodsRBCs used in this in vitro system were obtained from healthy human donors. Using a vertical stop‐flow system aligned with a microscope, images were acquired and analyzed for increased variation in grayscale to indicate increased aggregation. The onset of aggregation after sudden cessation of flow was determined at proscribed temperatures (37–49°C) and oxygen (0%, 10%), and in the presence and absence of 4, 4′‐Diisothiocyano‐2,2′‐stilbenedisulfonic acid (DIDS). Both autologous and homologous plasma were tested. ResultsRBCs in autologous plasma aggregate faster and with a higher magnitude with both hyperthermia and hypoxemia. Preventing deoxyhemoglobin from binding to band 3 with DIDS (dissociates the cytoskeleton from the membrane) fully blocks aggregation. Further, RBC aggregation magnitude is greater in autologous plasma. ConclusionsWe show that the C‐terminal domain of band 3 plays a pivotal role in RBC aggregation. Further, aggregation is enhanced by hyperthermia and hypoxemia.

Adjunctive effect of pulsed electromagnetic field therapy on quadriceps muscle strength after burn injury

Purpose. This study was conducted to examine the effect of pulsed electromagnetic field therapy on quadriceps muscle strength after burn injury. Methods. From April 2021 to June 2022, sixty male patients who suffered from second degree lower limb thermal burn injury and Total body surface area (TBSA) from 25% to 35% participated in this study. Their ages ranged from (20-40) years. They were randomly assigned in two groups, a study group composed of 30 patients who received (PEMF) over thigh area before strengthening exercise for quadriceps muscle and a control group composed of 30 patients who received strengthening exercise for quadriceps muscle. Patients of both groups received traditional physical therapy program.. Evaluation tool was isokinetic dynamometer to measure the quadriceps muscle peak torque before the treatment and after 8 weeks of treatment for both groups. Results. There was no significant difference between both group (study and control) in mean values of quadriceps peak torque pre-treatment (P > 0.05). There was a significant increase in the mean values of quadriceps peak torque after 8 weeks of treatment in both groups (p < 0.05) while there was a significant difference in post treatment mean values of quadriceps peak torque in the study group when compared with control group (p < 0.05). Conclusion. Pulsed electromagnetic field therapy is an effective modality that can be used for improving muscle strength and performance in patients with lower limb burn when applied prior to strengthening exercise.

Thermal Burn Wounds Produce Greater Scars Compared to Similarly Sized Excisional Wounds And Topical Amiloride Applied to Burn-Induced Scars Shows Scar Reduction

Background: Victims of severe traumatic injuries such as large surface area lacerations and thermal burns require substantial medical care that primarily promotes healing. And although this care is essential, there is a lack of pharmacological treatments that reduce the resulting scars, consequently leaving many traumatic victims with profusely disfigured skin.
 Methods: A rabbit-ear injury model was used to compare scar progression in adjacently paired contact thermal burns (n=24) and excisional wounds (n=16). Once that model revealed significant differences in scar hypertrophy between these two types of injuries, a succeeding study involved solely inducing burns, with the resulting wounds undergoing scar elevation index (SEI) and gene expression analysis after unilateral topical treatment with either amiloride (n=12), celecoxib (n=11) or contralateral vehicle control (n=10 for each of the two control groups). 
 Results: In the initial burn and excisional wound comparison study, thermal burns showed significantly larger scars, both in scar height measured at four timepoints (P<0.0001, <0.01, <0.05, and <0.05) and histologically by analyzing the SEI (P<0.05). In the succeeding project, burn-induced scars treated with amiloride also demonstrated a significantly reduced histological SEI (P<0.05) compared to scars receiving vehicle control. However, relative PTGS2, ACTA2 and COL1A1 expression was not significantly different in scar tissues treated with amiloride compared to those receiving vehicle control. Also, no significant differences in SEI were determined in scars treated with celecoxib compared to vehicle control
 Conclusions: Contact thermal burn injuries create profusive hypertrophic scars compared to similarly sized excisional wounds. Topical application of amiloride to burn-induced scars reduce scar formation, yet this finding necessitates further studies to comprehend the mechanism behind its scar-reducing effect.

771 Novel approach for skin regeneration: mRNA-based telomerase enhancement of autologous skin cell suspension

The RECELL® Autologous Cell Harvesting Device enables point-of-care preparation of autologous skin cell suspension (ASCS). Currently, ASCS is approved for the treatment of acute thermal burn injuries, with additional indications under investigation. We hypothesize the therapeutic potential of ASCS may be enhanced for skin regeneration and primed for skin rejuvenation by improving the cells’ ability to divide and differentiate by reverse-aging through telomere extension. A method to safely extend telomeres in fibroblasts and myoblasts has been demonstrated using the delivery of modified mRNA encoding telomerase (TERT).

Effects of Drug-Free Pectin Hydrogel Films on Thermal Burn Wounds in Streptozotocin-Induced Diabetic Rats.

This study aims to examine the influence of drug-free pectin hydrogel films on partial-thickness burn wounds using streptozotocin-induced diabetic rats as the animal model. Thirty male Sprague Dawley rats were included in the wound healing study, and scalding water was used to produce wounds in the dorsum region of the rats. Two different formulations of pectin hydrogel films, PH 2.5% and PH 5%, were prepared using a solvent evaporation method. MEBO® (moist exposed burn ointment), a commercial herbal formulation was used as a positive control. The progress of the wound healing was observed and compared between untreated normal rats, untreated diabetic rats, diabetic rats treated with MEBO®, diabetic rats treated with PH 2.5%, and diabetic rats treated with PH 5%. The results showed that diabetic rats treated with PH 5% healed faster than the untreated diabetic rats and diabetic rats treated with PH 2.5%. Interestingly, the diabetic rats treated with PH 5% healed as well as diabetic rats treated with MEBO®, where wounds were healed entirely on day 20. Nevertheless, both PH 2.5% and PH 5% showed a greater zone of inhibition than MEBO® when tested against Staphylococcus aureus.

Platelet Priming and Activation in Naturally Occurring Thermal Burn Injuries and Wildfire Smoke Exposure Is Associated With Intracardiac Thrombosis and Spontaneous Echocardiographic Contrast in Feline Survivors.

Wildfires pose a major health risk for humans, wildlife, and domestic animals. We previously discovered pathophysiologic parallels between domestic cats with naturally occurring smoke inhalation and thermal burn injuries and human beings with similar injuries; these were characterized by transient myocardial thickening, cardiac troponin I elevation and formation of intracardiac thrombosis. While the underlying mechanisms remain unclear, results from murine models suggest that platelet priming and activation may contribute to a global hypercoagulable state and thrombosis. Herein, we evaluated and compared the degree of platelet activation, platelet response to physiologic agonists and levels of platelet-derived microvesicles (PDMV) in 29 cats with naturally occurring wildfire thermal injuries (WF), 21 clinically healthy cats with subclinical hypertrophic cardiomyopathy (HCM) and 11 healthy cats without HCM (CC). We also quantified and compared circulating PDMVs in WF cats to CC cats. In addition, we examined the association between thrombotic events, severity of burn injuries, myocardial changes, and the degree of platelet activation in cats exposed to wildfires. Flow cytometric detection of platelet surface P-selectin expression showed that WF cats had increased platelet response to adenosine diphosphate (ADP) and thrombin compared to the two control groups indicating the presence of primed platelets in circulation. In addition, cats in the WF group had increased circulating levels of PDMV, characterized by increased phosphatidylserine on the external leaflet. Cats in the WF group with documented intracardiac thrombosis had elevated platelet activation and platelet priming in the presence of ADP. While high dose arachidonic acid (AA) mostly resulted in platelet inhibition, persistent response to AA was noted among cats in the WF group with intracardiac thrombosis. Univariate and multiple logistic regression analyses demonstrated that increased platelet response to AA was independently associated with thrombotic events. This is the first study reporting the significant association between platelet priming and intracardiac thrombosis in domestic cats with naturally occurring wildfire-related injuries and smoke inhalation. Further studies are required to delineate additional mechanisms between inflammation and thrombosis, especially regarding platelet primers and the cyclooxygenase pathway.One Sentence SummaryPlatelet activation and shedding of platelet-derived microvesicles due to platelet priming is present following naturally occurring wildfire smoke exposure and thermal burn injuries in a population of domestic cats.

The effect of 20 minutes of cool running water first aid within three hours of thermal burn injury on patient outcomes: A systematic review and meta-analysis

Burn injuries are a leading cause of morbidity that can result in devastating disability and poor quality of life for survivors. This systematic review aimed to synthesise evidence regarding the effect of 20minutes of cool running water (CRW) within three hours of injury on outcomes of patients with thermal burn injuries. This systematic review was conducted in reference to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Multiple databases (PubMed, EMBASE, CENTRAL, CINAHL Complete via EBSCO, PROQUEST Dissertations and Theses), and the Australia New Zealand Clinical Trial Registry were searched for eligible studies published in English and Chinese, without date restriction. Meta-analyses were undertaken Methodological quality of studies was assessed by using Downs and Black Checklist. Of 323 records, seven studies were included. The majority (67%) of studies were conducted in Australia and New Zealand. The methodological quality was ranked between 'fair' and 'good'. Twenty minutes of CRW within the first three hours of burn injury significantly decreased the odds of patients requiring skin grafting and surgical intervention for wound management. There is considerable evidence suggesting the application of 20min of CRW within the first three hours of injury improves outcomes for patients with burn injury. Consensus between burn organisations and collaborative efforts to translate evidence into practice are needed to optimise burn first aid care which can improve patient outcomes globally.

ASSESSMENT OF MICROALBUMINURIA AND BLOOD PLATELET COUNT AND ITS ASSOCIATION WITH THE SEVERITY OF BURNS AND OUTCOMES

Background: Burn injury causes a systemic inflammatory response, leads to reduced platelet count, and leakage of a significant amount of albumin in the interstitium and urine. Prognostic indicators play a critical role in patient management. There are not set prognostic factors indicating the outcome of a patient post burn injury. Objective: Correlate microalbuminuria and platelet count with clinical variables in the post-burn injury patients. It is carried out in an attempt to find a simple, cost-effective and at the same time reliable prognostic factor in burn patients. Methodology: This is a Prospective Cohort study conducted from May 2017 to December 2018. Any patient presenting with thermal burn injury fulfilling the inclusion criteria was included. Patients with a history of renal dysfunction or co-morbidities precipitating were excluded. Inhalational injury, Systemic inflammatory response, renal failure were assessed along with microalbuminuria and platelet count to outcome variable of survivors and non-survivors. A total of 49Results: patients were included. The presence of microalbuminuria showed a strong association with outcome variables but quantitative analysis of the same was not indicative more over microalbuminuria was strongly positive in presence of Inhalational injury and renal failure. Platelet count reached minimum value at 3 - 5 days from injury showing a strong correlation with outcomes. : Microalbuminuria and Platelet count are promising prognostic factors and canConclusion be used to direct the management of the patient with burn injury.

50 Rise of the (Learning) Machines: Artificial Intelligence for the Assessment of Adult Thermal Burns

IntroductionBurn depth assessment (BDA) is an essential component of the physical exam used in the treatment and triage of burn injured patients. And while many specialties incorporate labs and imaging to determine diagnoses, burn professionals must rely on a physical exam that is accurate in only 70-80% of cases. Our goal was to assess the accuracy of a new imaging technology called Multispectral imaging (MSI) combined with a machine learning algorithm to aid in rapid BDA. We present the results of the first multi-center study using this technology in adult burn injuries.MethodsIn a multi-center IRB-approved study, an MSI device was used to image subjects >18 years of age with thermal burn injuries. The imaging device captured a set of images measuring the reflectance of visible and near-IR light. Subjects were enrolled and imaged within 72 hours of injury with serial imaging as permitted. The images were used to develop a type of machine learning algorithm called a convolutional neural network (CNN) that could identify the regions of non-healing burn within an image. Non-healing burn areas were determined by a panel of three burn surgeons using two standards: a) images confirming 21-day spontaneous healing; or b) pathology reports detailing histologic changes from multiple punch biopsies taken prior to burn excision. From this data, an ensemble of eight separate CNN algorithms was used to automatically identify non-healing burn tissue. Training and test accuracies of the ensemble CNN were calculated using cross-validation at the level of the subject.ResultsOne hundred (100) adults were enrolled and imaged. The population had a mean age 45.6 ± 16.7; mean TBSA 13.0 ± 9.3; and was 31% female. From these adults, 210 burn regions were serially imaged. The estimated performance result from the ensemble CNN for identification of non-healing burn regions was AUC of 0.96. Based on the ROC curve, an ideal threshold showed an accuracy of 92.0%, sensitivity 91.9%, and specificity 92.0%.ConclusionsOur study demonstrates a non-invasive technology that rapidly determines an accurate DBA relative to traditional bedside exam. More accurate burn wound assessment could lead to avoiding unnecessary surgeries or delays in treatment and dramatic cost savings. Use of such a device in a disaster has additional value to better align a patient’s burn care needs and available resources.

92 ASCS Treatment Impact on Length of Stay Data and Costs for Patients with Small Burns

IntroductionIntroduction: Small burns with a total body surface area (TBSA) of < 20% account for the large majority (92%) of burn injury hospital admissions. Autologous skin cell suspension (ASCS) is a novel treatment for acute thermal burn injuries – including small burns -- that is associated with significantly lower donor skin requirements than split-thickness skin grafts, the traditional standard of care (SOC). The ASCS treatment indication was recently expanded from adult patients to include pediatric patients. Previously modeled analyses suggested that ASCS use is associated with a lower hospital length of stay (LOS) and costs savings versus SOC. This study evaluated whether real-world data (RWD) corroborate these findings in small burns and in both adult and pediatric populations.MethodsMethods: Data were collected from January 2019 through August 2020 from 500 facilities in the United States. Adult patients (age ≥ 21) and pediatric patients (< age 21) receiving inpatient burn treatment with ASCS were identified and matched to patients receiving SOC based on sex, age, TBSA < 20%, and comorbidities. Based on typical BEACON model outcomes, LOS was assumed to account for 70% of total costs and was used as a proxy to assess the data. LOS was assumed to cost $7,554 per day. Mean LOS and costs were calculated for the ASCS and SOC adult and pediatric cohorts. The incremental revenue associated with changes in inpatient capacity was also analyzed.ResultsResults: A total of 151 ASCS and 2,243 SOC adult cases and 19 ASCS and 341 SOC pediatric cases were identified. In adults, the SOC cohort had a higher percentage of patients with TBSA < 20% than the ASCS cohort (82.9% vs. 55.0%). For small burns, sixty-three matches were made for each adult cohort, and seven matches were made for each pediatric cohort. For adults, LOS was 18.5 days with ASCS use and 20.6 days with SOC use (difference: 2.1 days [10.2%]). For pediatrics, the ASCS LOS was 18.6 days, and the SOC LOS was 21.4 days (difference: 2.9 days [15.4%]). This difference led to cost savings of $15,587.62 per adult ASCS patient. Total cost savings with ASCS adult patients were $22,268.03 per patient. The reduced LOS with ASCS adult patients resulted in an increased capacity of 2.0 inpatients per bed per year, which was estimated to increase hospital revenue by $83,894 per burn unit bed annually. Pediatric cost results and savings were similar.ConclusionsConclusion: This RWD analysis shows that small burn treatment with ASCS is associated with reduced LOS and substantial cost savings compared with SOC in both adult and pediatric populations, supporting the validity of previous model projections. ASCS use may also significantly increase hospital revenue related to increased inpatient capacity.