Analysis of 12,661 pediatric burns in Wuhan institute of burns: A retrospective study of fifteen years

BackgroundBy analyzing the epidemic characteristics of pediatric burns in a burn center serving large areas of Hubei Provence and partly surrounding provinces around Wuhan City, the aim of this study is to provide better strategies for the prevention and care for pediatric burns.MethodsPediatric burn patients who were younger than 13 years old in Wuhan Third Hospital from 2004 to 2018 were included. Demographic and clinical data were collected, analyzed and compared among groups.Results12,661 pediatric burns, mean aged 2.37 ± 2.30 y, were admitted during the 15 years, with 7973 boys (62.97%) and 4688 girls (37.03%). By age groups, infant (<3y), preschool (>3−6y) and school children (>6−13y) accounted for 81.12% (10,270 cases), 12.08% (1530 cases) and 6.80% (861 cases) respectively. The most cause of injury was scalds (11,232, 88.71%), followed by flame burns (917, 7.24%), electric burns (201, 1.59%), contact burns (127, 1.00%), firework or firecracker (124, 0.98%), chemical burns (40, 0.32%) and hot crush injury (20, 0.16%). The mean age of firework or firecracker burns was 6.19 ± 2.83y, electric burns 5.18 ± 3.31y, flame burns 4.73 ± 3.53y, hot crush injury 3.85 ± 2.37 y, contact burns 3.66 ± 3.35y, chemical burns 3.03 ± 2.50y, and scald 2.06 ± 1.91y. Over half cases (57.34%) were small burns less than 10% total burn surface area (TBSA) and the larger TBSA, the fewer number of patients. The mortality rate was 0.11% and correlated with TBSA, age and etiology. The mean length of stay (LOS) was 12.63 ± 11.91 days and highly correlated with etiology and TBSA. The mean hospital cost was 11210.76 ± 21248.87 RMB (about 1600 USD) or 1626.91 ± 3957.59 RMB (about 230 USD) per % TBSA, which was correlated with depth of burn, TBSA, etiology, LOS and age.ConclusionPediatric burns in central China was still common and even increasing. Majority of the pediatric burn victims were boys under three years old, while the mean ages of different etiologies varied from about 2–6 years old. Education and prevention aiming the high risks are the key point to decrease pediatric burns.     

Differences in parent-perceived and patient-reported quality of life among young adult burn patients: A prospective longitudinal study

PurposeThis study examines the differences in parent-perceived and patient-reported quality of life (QoL) among young adult burn patients three years after injury and the factors affecting these differences.MethodThe sample comprised 35 burn patients from the Formosa Fun Coast Water Park dust explosion and their parents. The study was conducted from June 2016 to August 2018. We used self-report questionnaires to collect socio-demographic data, the adapted Chinese version of the Burn Specific Health Scale-Brief, and the Impact of Events Scale for Burn.ResultsThe analysis indicated that simple abilities recovered the fastest, while body image recovered the slowest. The variation trends of these factors were similar but parents’ scores were lower than patients’ scores. Parents’ post-traumatic stress disorder (PTSD) scores were higher than that of patients, but were not statistically significant. Parents’ gender and PTSD levels and patients’ burn area affected differences in parent-perceived QoL among patients. PTSD levels were significantly higher among mothers.ConclusionsFor parents, PTSD is a common response to their children experiencing burn injuries. Parents’ observations of warning signs enable early medical intervention. Establishing a family-centered care plan, providing psychological support for both parents and patients, and forming a continuous care system with efficient communication can support patients’ return to society.     

Burn patients with history of kidney transplant experience increased incidence of wound infection

ObjectiveTo determine if history of kidney transplant is an independent risk factor for increased incidence of wound infection and other morbidities in burn patients.BackgroundWhile the goal of immunosuppression post-organ transplantation is to prevent graft rejection, it is often associated with significant adverse effects such as increased susceptibility to infection, drug toxicity, and malignancy. Burn injuries lead to a dysregulated hypermetabolic state and a compromised cutaneous barrier, which predisposes to infection and delayed wound healing. We surmise that a history of kidney transplant increases the risk of wound infection in in-hospital burn victims.MethodsA retrospective analysis was performed on 57,948 adults diagnosed in-hospital with a burn injury between 2008–2014, obtained from the Nationwide Inpatient Sample (NIS) by Healthcare Cost and Utilization Project (HCUP).Results103 burn victims (0.2%) with a history of kidney transplant (KTX) were identified. Compared to burn patients without a history of transplant (No-KTX), they were older (54.3 ± 13.8 vs 49.8 ± 18.7; p = 0.001), more likely be insured under Medicare (69.9% vs 31.1%; p < 0.001), and less likely to have Medicaid (5.8% vs 17.2%; p = 0.002). Higher in-hospital mortality index scores were observed in KTX compared to no-KTX with p < 0.001. The incidence rates of complications such as wound infection (33.0 vs 16.3; p < 0.001) and acute renal failure (18.4 vs 7.7; p < 0.001) were significantly higher in the KTX group. After adjusting for confounding factors in multivariable analysis, the incidence of wound infection remained significantly higher. Burn patients with history of KTX were not more likely to be treated at a transplant (TX) center. TX centers were determined to have higher mortality rate, longer length of stay, and higher total hospital charges.ConclusionHistory of kidney transplant is an independent risk factor for increased incidence of wound infection in burn patients.     

Socio-economic cost and health-related quality of life of burn victims in Spain

ObjectivesThe aim of the study was to determine the economic burden (direct and indirect costs) of burn victims and the impact of burn on health-related quality of life in Spain.MethodsIn 2003, a cross-sectional study was carried out with 898 burned people. Data regarding demographic features, health resource use, informal care, indirect costs and quality of life were prospectively collected through hospital admission databases and questionnaires filled out by burn victims and caregivers.ResultsThe mean annual cost (direct and indirect) per burn patient was US$ 99,773. The most important categories of costs were those of in-patient care and temporary and permanent disability. Direct healthcare costs of burn patients represented 19.6% of the total. Total annual cost for burn patients in Spain was US$ 313 million. The mean health-related quality of life measured by European Quality of Life 5-Dimension score was 0.84 and the mean visual analogue score was 67.ConclusionsThe costs of burn are higher than those of many other conditions, and a cost-effectiveness assessment of the different interventions for burn should become a priority in health policy.     

Effects of candidaemia on outcome of burns

AimTo evaluate the diversity and antifungal susceptibilities of Candida isolates from wounds and blood of burn victims, and the associated mortality rates compared with those of controls without candidaemia.MethodsWe performed a nested case-control study within a database of clinical data for all patients admitted to our burn unit from January 2001 to December 2005. Each candidaemic patient was compared with two matched controls. Bloodstream cultures were performed if the core temperature was >39 °C, and three sites were cultured weekly for fungal identification (burn wound, pharynx, urinary tract).ResultsAt least one episode of candidaemia was diagnosed among 20 of 851 persons admitted during the study period. Isolates in bloodstream infection were Candida albicans (65%), C. parapsilosis (25%) and C. tropicalis (10%). The median time between admission and onset of candidaemia was greater with C. albicans infection (42.6 ± 31 days) than with infection by other yeasts (18 ± 12 days). Candidaemia was associated with more extensive burn and longer duration of hospital stay but with similar mortality, compared with controls.ConclusionCandidaemia in burn cases is mostly due to fluconazole-susceptible C. albicans and is not associated with increased mortality.     

Examining posttraumatic stress symptoms in a national sample of homicide survivors: prevalence and comparison to other violence victims

The present study examined posttraumatic stress disorder (PTSD) symptoms among friends and family members of homicide victims (homicide survivors). Out of a national sample of 1,753 young adults who completed follow-up interviews after participating in the National Survey of Adolescents, 268 homicide survivors and 653 victims of other interpersonal violence were selected for the study. Participants completed structured telephone interviews that covered the loss of a family member or close friend to homicide, violence exposure, and PTSD symptomatology. Findings indicated that 39% of homicide survivors met criteria for all 3 symptom clusters and 30% of homicide survivors met criteria for 2 PTSD clusters (functional impairment was not assessed). Multivariate logistic regression analyses demonstrated that homicide survivors were more likely than victims of other violence to meet criteria for all 3 PTSD symptom clusters (OR = 1.91, p < .05) and 2 symptom clusters (OR = 1.77, p < .05) when demographic characteristics and number of violent events were included in the model. These findings highlight the high prevalence of subthreshold PTSD symptoms among homicide survivors. Results suggest that homicide survivors are at elevated risk for PTSD symptoms in comparison to victims of other interpersonal violence.     

Quantification of changes in functional capacity and muscle strength in patients: a burn intensive care unit cohort study

BackgroundRegular functional status and muscle strength assessments should be performed with burn victims.ObjectiveTo evaluate the functionality and peripheral muscle strength of burn patients admitted to the hospital.MethodsA longitudinal and prospective study was conducted from March to November 2019, including adult burn victims who were admitted to the ICU and discharged from the hospital. Patients were assessed on admission, every 10 days, at discharge from the ICU and from the hospital. Functionality was assessed using the Chelsea Critical Care Physical Assessment (CPAx) and the Functional Independence Measure (FIM). Muscle strength was assessed using the Medical Research Council (MRC) scale and handgrip dynamometry.Results41 patients were included, 27 men and 14 women, with a median age of 41 (IQR [28–56]) years, mean TBSA of 19 (SD ± 12) percent, mean Abbreviated Burn Severity Index (ABSI) of 6 (SD ± 2) and the mean ICU time was 29 (SD ± 9) days. The CPAx, FIM and MRC evaluations improved (P < 0.0001) when compared to admission to the ICU and at hospital discharge, while the dynamometry showed no statistical difference. The ABSI only showed an association with the length of stay.ConclusionThe CPAX scale was sensitive to changes in functionality throughout the hospital stay in severely burned patients, in the present study. The assessment of global muscle strength was more sensitive than handgrip strength and the ABSI was associated with length of stay in this population.     

Issues and concerns of family members of burn patients: A scoping review

IntroductionThe issues and concerns that emerge in the families of burn patients have received minimal attention.ObjectiveTo map out what is known about the challenges facing the family members of burn patients.MethodsThe review followed the PRISMA Extension guidelines for scoping reviews and the review approach by Arksey and O’Malley to synthesize the available evidence. Twenty-six (26) papers from various database searches were identified and included in the review. The citation retrieval and retention methods are reported in a PRISMA statement.ResultsAlthough most of the studies included parents (n = 21), the evidence suggests that the shared concerns of family members include taking on new roles, and psychosocial and financial issues. Uniquely, parents had to endure blame, shame and guilt; partners/spouses were faced with difficulties in re-establishing an emotional connection with the patient; siblings simultaneously expressed jealousy and feelings of being outsiders; and children with a burn parent had to deal with feelings of exclusion from the care delivery process. Aside from these individuals, friends, neighbours and in-laws may also assume a caregiving role, with grandparents playing a supporting role. Family members are unprepared for their roles, as they are forced into them suddenly. Although distress may occur among family members, its determinants, severity, pattern and recovery process remain unclear.ConclusionA burn is a family injury that creates the need for family-centred care. Future studies need to explore the nature of psychological distress, family members’ recovery pathways, and how family members can prepare for their roles in the period after discharge.     

Telemedicine in burn patients: reliability and patient preference

IntroductionBurn care is demanding and time intensive. After initial evaluation and treatment, remote follow-up of suitable patients might reduce the on-site workload and efficiency. In this study, the reliability of telemedicine assessment of burn patients and preference of patients to use telemedicine was investigated.MethodsThe study was designed as cross-sectional, and included 100 acute burn patients admitted to our burn service between 1 December 2018 and 31 May 2019. Informed consent was obtained from the patients for imaging of the burn wound. Burn wounds were evaluated in the outpatient clinic by an experienced burn specialist, and lesion images that were sent using WhatsApp were evaluated by another. Patients were offered telemedicine follow-up using WhatsApp communication without being present. The data of assessments, demographic and epidemiological data, and reasons for preference of follow-up via telemedicine were examined.ResultsThe mean age of our patients was 21.21 ± 21.7 years. The percentage of burned total body surface area was 3.66 ± 3.4 on examination and 3.44 ± 3.2 on WhatsApp and the level of concordance was very high (ICC = 0.993). The inter-rater reliability values for the face-to-face examination and telemedicine groups in terms of “burn depth” and “decision of hospitalization” was congruent. Of the patients, 61% did not choose follow up with telemedicine. Demand of face-to-face assessment by burn expert was the most common reason (60.7%). In 26 patients who chose to be followed up with telemedicine, the most common reason was “living distance from the burn center” (92.3%). The remaining 13 patients indicated they did not have a preference.ConclusionsIn the assessment of burn wounds, telemedicine and face-to-face examination resulted in agreement in terms of burn depth, decision of hospitalization and percentage of total body surface area. Although WhatsApp is a reliable method, the majority of patients preferred a face-to-face follow-up. WhatsApp application can be used in remote follow up of eligible burn patients after giving brief information about the procedure.     

Incidence of self-inflicted burn injury in patients with Major Psychiatric Illness

IntroductionPsychiatric disorders are mental illnesses that impair judgment, thought process and mood that can result in physical and emotional disability. According to DSM-IV, mental disorders increases risk of traumatic injury, particularly burn [1] (American Psychiatric Association, 2013). However, there are few studies that look at patients with pre-existing major psychiatric disorders and burn outcomes. We aim to assess the incidence and intentionality of burn injury in patients with pre-existing psychiatric disorders.MethodsThis is a retrospective study of patients admitted to the UNC Jaycee Burn Center from 2002 to 2015 and entered in the burn registry. Variables analyzed include basic demographics, insurance status, total body surface area (TBSA) of burn, Charlson comorbidity index (CCI), burn etiology, presence of inhalation injury, burn circumstance, intensive care unit (ICU) and hospital length of stay (LOS) and mortality. Chi-square, Analysis of Variance (ANOVA), Kruskal–Wallis test and Multivariate logistic regression was used to analyze the data.Results11,650 adult and pediatric patients were entered in the burn registry from 2002 to 2015 and 494 (4.2%) adult and pediatric patients had preexisting major psychiatric illness (MPI). Within the large cohort of admitted burn patients, 90 (0.8%) patients presented with self-inflicted burn injuries. 41% of patients with SIB (n = 37/90) had MPI. The incidence of self-inflicted burn injury (SIB) within the MPI (n = 494) cohort was 7.5% (n = 37). Mean age of patients with and without self-inflicted burn injury was 35.3 (±11.6) vs. 41.8 (±17.3), respectively. Mean TBSA was significantly higher in patient with SIB at 18.6 (±16.5) vs. 8.5(±12.2) p < 0.001. Non-white race had significantly higher rate of SIB compared to white cohort. There was no significant difference in mortality rates between SIB and Non-SIB (5.4% vs. 3.7%, p = 0.609), respectively. Median Hospital LOS was significantly increased in patients with SIB compared to NSIB 31 (IQR = 55) vs. 9 (IQR = 20) days, p = 0.004. Multivariate logistic regression for predictors of self-inflicted burn injury showed that minorities were more likely to incur self-inflicted burn injury among patients with major psychiatric illnesses.ConclusionThe incidence of self-induced burn injury in patients with MPI is low and of all the self-inflicted burn patients, 60% did not have a major psychiatric illness identified. Our findings emphasize the importance of identifying patients with MPI with or without self-induced injury that may benefit from more extensive psychiatric screening after burn and counseling, particularly minority patients as they may benefit from additional mental health counseling following severe burn.     

Variations in insulin requirements can be an early indicator of sepsis in burn patients

IntroductionA >25% increase in daily insulin dosing is suggestive of possible sepsis in burn patients, however, no conclusive evidence is available regarding the time point at which insulin dosing begins to increase. The purpose of this study is to determine the exact time point at which the insulin requirement increases among non-diabetic burn patients with sepsis.MethodsA retrospective chart review in non-diabetic burn patients with ≥20% total body surface area burned (TBSA) during 2010–2018 who received a blood culture for suspected sepsis. Absolute insulin dosing at intervals (0, 24, 48, 72, and 96 h prior to blood culture) were Box–Cox transformed and compared vs.?96 h reference using mixed-effects models accounting for within-patient dependencies.ResultsFifty-eight patients (84% males, age 44 ± 17 years, TBSA% 49 ± 17.5) were included. When cube root of daily insulin dosing was regressed on each time point in a mixed-effects model, statistically significant increase in insulin dosing compared to baseline was observed for ?48 (p = 0.018), ?24 (p = 0.011), and 0 h (p = 0.008).ConclusionDaily insulin dosing increases 48 h prior to development of other clinical signs of sepsis and can be used as a sensitive early marker.     

The relationship between posttraumatic growth,self-efficacy,and social support in burn patients: A cross-sectional study

AimsTo explore the effects of self-efficacy and social support on posttraumatic growth among burn patients.MethodsThis study adopted a cross-sectional design and used convenience sampling method to recruit moderate and severe burn patients. The study was conducted from January to July, 2018 in a tertiary hospital in Linyi, China. Self-administered questionnaires were used to collect data on posttraumatic growth, social support, and self-efficacy. Path analysis conducted using SPSS AMOS 21.0 software was used to explore the relationship between the above three variables.ResultsThe mean scores for posttraumatic growth, social support, and self-efficacy were 58.11 ± 9.60, 43.48 ± 6.81, and 24.97 ± 5.71, respectively. Self-efficacy and social support were directly and positively related to posttraumatic growth among burn patients. Social support was also indirectly and positively associated with posttraumatic growth. Self-efficacy partially mediated the relationship between social support and posttraumatic growth.ConclusionsSelf-efficacy was an important mediator for burn patients’ social support and posttraumatic growth. Therefore, self-efficacy and social support should be considered when designing and implementing of interventions for posttraumatic growth among burn patients.     

Changes in serum phosphorus level in patients with severe burns: A prospective study

BackgroundThe second most abundant mineral in the body, phosphorus (P), is absorbed in the small intestine after ingestion enhanced by 1,25-dihydroxy vitamin D, and its excretion is exclusively regulated by the kidney. It is clinically significant, aside from its disturbance in burn ICU patient’s P mechanism. The increasing rate of morbidity and mortality among the patients can be associated with severe hypophosphatemia. The current study aimed at investigating the changes in serum P levels in the early period after burns, the relationship between serum P level and TBSA (total body surface area) of burn, and the impact of hypophosphatemia on patients’ clinical outcomes.Material and methodsThe current prospective, observational study was conducted on 137 patients hospitalized in the burn intensive unit (BICU) of Velayat Sub-specialty Burn and Plastic Surgery Center from December 2015 to May 2017. According to the TBSA percentage, the patients were divided into three groups. The level of serum P was determined in the 1st, 3rd, 5th, 7th, and 9th days of hospital stay and before discharge. To evaluate the trend of P changes in the sixtime-points, the average changes along with 95% confidence intervals (CI) were used for multivariate analysis of variance with repeated measures (repeated measures ANOVA). A P-value of 0.05 or less was considered statistically significant. The analyses were performed using SPSS software, version 19 (SPSS Inc.).ResultsTotally, 137 patients (70% male, mean age 32 ± 21years, and TBSA 32.6 ± 14%) were included in the study. The overall incidence of hypophosphatemia was 75.1%. Hypophosphatemia developed as early as 1.66 ± 0.136 (95%CI: 1.4–1.9) days after injury. The highest decrease in the serum P level was observed on the 3rd and 5th days after burn as 2.78 mg/dL and 2.85 mg/dL, respectively (P-value = 0.001). A correlation was observed between TBSA and serum P level. The mean serum P level decreased with increasing the percentage of burns. There was a correlation between serum P level and mortality; therefore, a decrease in serum P level increased the patient's mortality rate (P < 0.05).ConclusionThe current study highlighted that hypophosphatemia is often observed in patients with burn injuries during their hospitalization. It is potentially beneficial to identify patients at risk of hypophosphatemia. Therefore, it is suggested that P level be assessed regularly in patients with burn injuries for the timely initiation of P replacement therapy.     

Burn injury as a result of interpersonal violence in the Northern Territory Top End

AimTo describe the demographics, circumstances, burn wound characteristics and current tertiary centre management of interpersonal violence (IPV) burn victims in the Northern Territory Top End. It is anticipated that such knowledge gained will be of benefit to key stakeholders across the spectrum of injury prevention and management in this region.MethodsAll adult admissions to the Royal Darwin Hospital (RDH) during 2010–2015 were identified through the Burns Registry of Australia and New Zealand. Demographic and burn characteristics were compared between those classified as IPV and non-IPV. Case note review provided supplementary data for the IPV subset.ResultsFifty-three patients met IPV criteria, comprising 7.4% of admissions to the RDH Burn Service. IPV burn victims were 2.3 times more likely to be female than those with non-IPV burn (95% CI: 1.2–4.3), and 17 times more likely to be Indigenous (95% CI: 7.9–35). Approximately half (53%) of IPV burns were classified as family or domestic violence; scalding was the most common mechanism in this group. Ten patients (19%) had incomplete burn care through self-discharge, all identified as Indigenous. Twenty percent of patients had no documented inpatient psychosocial support.ConclusionsFemale and Indigenous persons are at increased risk of IPV burn. The challenges of providing care to the IPV burn population extend beyond burn wound closure.     

Prevalence of HIV infection among burn patients: is there a relationship with patients' outcomes?

The aim of the present study was to determine the prevalence of human immunodeficiency virus (HIV) infection among acute burn patients and its impacts on patient's outcomes in an Iranian burn care hospital. A cross‐sectional study was conducted in a tertiary burn care hospital in Iran, retrospectively reviewing the data records of all patients admitted between February 2011 and February 2012. The HIV status of all the patients was assessed in relation to clinical outcomes and the patient's prognosis. A total of 969 patients were included in this study. Five patients (0·5%) were HIV positive, and all of them were male. Mean burn area was significantly larger in HIV‐positive patients than the healthy group (P < 0·05). HIV‐positive patients had a longer period of hospitalisation than HIV‐negative patients (23·2 ± 16·3 versus 13·1 ± 14·6, P = 0·008). Nonetheless, the average number of procedures and the mortality rate did not significantly differ between the study groups (P > 0·05). Comparison of age, sex and burn extent between HIV‐positive patients and HIV‐negative cases also revealed similar results. Prevalence of HIV infection among our burn population was 0·5%; thus, HIV status may be related with more extensive injuries and longer hospital stays.     

Epidemiology and outcome analysis of 1359 intensive care burn patients: A 14-year retrospective study in a major burn center

AimsGlobally, burn-related morbidity and mortality still remain high. In order to identify regional high-risk populations and to suggest appropriate prevention measure allocation, we aimed at analyzing epidemiological characteristics, etiology and outcomes of our 14-year experience with an intensive care unit (ICU) burn patient population.MethodsA retrospective observational study was conducted including patients treated between March 2007 and December 2020 in our intensive care burn unit. Demographic, clinical and epidemiological data were collected and analyzed.ResultsA total of 1359 patients were included. 68% of the subjects were males and the largest age group affected entailed 45–64-year-old adults (34%). Regarding etiology, flame and contact burns were the most common in all age groups. Mean affected total body surface area (TBSA) was 13 ± 14.5% in all subjects. Most of the burns occurred domestically or during recreational activities. Mean hospital stay was 17.77 ± 19.7 days. The average mortality was 7.7%. The mortality rate showed an overall decreasing trend whilst burn severity remained consistent from 2007 to 2020.ConclusionsDespite consistent burn severity presentations of annual ICU admissions, burn injury mortality showed a decreasing trend, which was in part attributed to substantial progress in burn care and treatment and improved burn prevention awareness. Statistically significant age and gender differences could be detected with regard to burn etiology and seasonality, as well as outcomes, which highlight the importance of individualized primary prevention programs.     

Enzymatic debridement in scalds is not as effective as in flame burns regarding additional eschar excision: A retrospective matched-control study

ObjectiveEnzymatic debridement of burn eschar became an accepted and widely used technique for burn wound treatment over the last years. However, this practice is not exempt from failure and recent experimental studies indicate that it may not be as efficient in scalds as in flame burns.MethodsPatients that were admitted to the burn intensive care unit between June 2017 and February 2021 and received enzymatic debridement within the first 72 h after scald and flame burn were included. Patients with scald burns were matched regarding age, sex and per cent total body surface area (%TBSA) burned in a 1:2 ratio with patients presenting with flame burns.ResultsEighteen patients with scald burns were matched with 36 with flame burns. After matching, both groups were similar in terms of age (flame burns 44.5 ± 21.1 years vs. scald 41.8 ± 22.6 years, p = 0.666), and %TBSA burned (11.0 ± 8.2% vs. 10.6 ± 9.6%, p = 0.851). Patients with scald burns significantly more often underwent further surgical eschar excision compared to controls (scald 16 (88.9%) vs. flame 19 (52.8%), p = 0.016). Length of stay per %TBSA was significantly longer in scald burns (scald 7.8 ± 9.2 days vs. flame 3.7 ± 3.8, p = 0.013).ConclusionThis study indicates that enzymatic debridement may not be as effective in scalds as in flame burns. It was shown that patients with scalds and subsequent enzymatic debridement more frequently underwent additional surgical intervention and that the size of the transplanted area was larger compared to control. Moreover, those patients had a longer length of stay at the hospital per %TBSA burned.     

Addressing sexual function in adult burns victims: A multidisciplinary survey of current practice in UK burn units

BackgroundBurn injury was shown to affect a patient’s sexuality. Cultural and social inhibitions may mean this topic is often overlooked.AimsTo assess current opinion and management strategies amongst UK burns care teams in relation to addressing sexual function after burn injuries.MethodAn online questionnaire was circulated to all members of the British Burn Association.ResultsThe majority of UK burn care professionals reported that sexual function after burn injury was an important (79% of respondents) and unaddressed problem (85% of respondents) in current clinical practice. However, over 90% of professionals reported that they ‘never’ or ‘only occasionally’ ask patients about their sexual function concerns. Multiple different management strategies are employed by UK burns centers, with a number of respondents indicating no designated individual responsible for leading care in this area.ConclusionsCurrently no standardized method is in common use to address sexual function concerns of adult burns victims. The authors suggest this topic may be included in future information leaflets for patients and in burns awareness courses for medical professionals.     

Higher baseline copper levels are associated with worse outcome in burn patients with overweight and obesity

IntroductionWe examined the interactive effects of copper (Cu) and overweight (overweight) and obesity on outcomes of burn patients. We posited that higher baseline Cu among burn patients with overweight or obesity will be associated with poor clinical outcomes vs. patients with a normal weight.MethodsA retrospective review was conducted on patients with ≥20% total burn surface area (TBSA) with an initial measurement of Cu. Patients were grouped by body mass index (BMI). The interactions between baseline Cu and BMI groups on multiple burn patient outcomes were examined in a series of multiple regression models.ResultsOne-hundred-and-sixty patients met eligibility (age 43.9 ± 17.5, males 86.3%, normal weight:overweight:obesity = 53:38:69). BMI groups did not differ significantly on demographics, burn severity, or baseline biochemistry. Normal weight patients with higher baseline Cu had shorter ICU stay (ICUS), shorter length of stay (LOS), and had fewer operations (Ps < 0.05). In contrast, overweight and obese patients with higher baseline Cu had longer ICU stay (p = 0.001 and p = 0.034), LOS (p = 0.005 and p = 0.066), and increased operations (p = 0.001 and p = 0.067).ConclusionsHigher baseline Cu seems associated with adverse outcomes in overweight and obese burn patients. Further research is needed to confirm this association and explore the direction of causality.