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PubMed1987

Burn mortality. Experience at a regional burn unit. Literature review.

The burn patient population at a regional burn unit in Central New York State, from 1974 through 1980, (N = 507) is described completely in terms of age, total burn size, full thickness burn size, sex, race, etiology of burn, inhalation injury, referral pattern, distance from burn unit, interval to admission, length of hospitalization and causes of death. The interrelationship of these factors is examined to define their contribution to injury severity and identify variables useful in predicting death. Demographic profiles are compared to the population base, and the case-mix of patients is contrasted with that of other burn units. A logistic model to predict death is developed using the variables of full-thickness burn size, age, age 2, and the presence of inhalation injury. The power of statistical methods to predict death is discussed in relation to the 37 patients who died with emphasis on the outliers present in unscreened patient populations. The point is made that any clinically useful index of burn severity must include a factor reflecting the physiologic stress imposed on the individual patient. Clinical issues pertaining to the treatment of nonsurvivors are discussed in relation to the physician's responsibility, euthanasia, and resource consumption. Results of treatment are difficult to evaluate because of the variables of patient selection, injury severity, time, and the absence of a satisfactory measure of morbidity. Effective prevention is the only way to eliminate the deaths of victims who do not survive to enter the health care system and the morbidity that inevitably results from tissue loss. From the standpoint of public health, burn morbidity may have an economic impact far different from that of burn mortality. Supraregional burn units with access limited to seriously but not hopelessly burned individuals are proposed. Supraregional burn units would make the delivery of burn care more efficient and allow the selection of a patient sample homogeneous in terms of severity, thus increasing the reliability of treatment evaluations.

Adolescent↗
PubMed1994

Occupational burns in the Burns Centre at the Singapore General Hospital.

This study reviewed all work-related burn injuries within the period 1 April 1992 to 31 March 1993 for the purpose of establishing data on occupational burns in Singapore to identify the specific at-risk population and formulate prevention strategies. All 163 patients who were admitted to the Burns Centre, Singapore General Hospital, as a result of burns suffered in the workplace were reviewed using the World Health Organisation Burns Data Protocol. Burns data recorded included demography, industrial sector involved, aetiology, extent of injury and eventual outcome in terms of mortality and morbidity. Occupational burns accounted for 45% of all admissions to the Burns Centre. Male workers in the 20 to 40-year age group predominated with 90% of admissions. The most common aetiology was flame burns and explosions (52.8%) followed by scalds (24.5%) and electrical (10.4%), chemical (6.1%) and contact (6.1%) burns. The average body surface area (BSA) involved was 8% (range 0.25% to 90%). Twenty-seven patients suffered full-thickness burns and the average area of involvement was 2% (range 0.25% to 90%). The most common anatomical regions involved were the upper limbs (46.3%) followed by lower limbs (31.9%). Eighteen patients (11.0%) sustained major burns requiring fluid resuscitation and 39 patients (23.9%) sustained respiratory burns. Seven patients died, giving a mortality rate of 4.3%. The average BSA for these patients was 46.4% and all had respiratory burns. In all, occupational burns accounted for 2011 patient-days of hospitalization, 630,637 lost days at work and inpatient treatment costs amounting to S $1.32 million.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

The media glorifying burns: a hindrance to burn prevention.

The media have a profound influence on the actions of children and adults. Burns and burn prevention tend to be ignored or even mocked. The purpose of this presentation is to reveal the callousness of the media in its dealings with burns and burn prevention. Printed materials with a relationship to burns, risk of burning, or disrespect for the consequences of burns were collected. The materials were tabulated into four categories: comics, advertisements (ads), articles that made light of burns, and television shows that portrayed behavior that would risk burn injury. Most burn-related materials were found in comics or advertisements. Several comics made light of high-risk behavior with flames, scald injury, contact injury, or burns. In addition, several advertisements showed people on fire or actions that could easily lead to burns. Several articles and televisions shows portrayed high-risk behavior that, in some instances, led to copycat injuries. Flames are frequently used to sell items that target adolescent boys or young men. The high incidence injuries that frequent this population parallel the high-risk behaviors portrayed by the media. The media portrays flames and high-risk behavior for burn injury as being cool, funny, and without consequence. The use of flames on clothing and recreational equipment (skateboards, hot rods) particularly targets the high-risk adolescent male. The burn community should make the media aware of the harm it causes with its callous depiction and glorification of burns.

Accident Prevention↗
PubMedDate not supplied

Impact of burn size and initial serum albumin level on acute renal failure occurring in major burn.

BACKGROUND: Acute renal failure (ARF) is not a rare occurrence in severe burns and is an important complication leading to an increase in mortality. The severity of the burn is largely determined by the burn size, and severe burns are likely to cause enough loss of extracellular fluid and albumin from plasma volume to produce shock and hypoalbuminemia. HYPOTHESIS: We hypothesized that initial serum albumin level may be useful as an indicator of prognosis and severity of injury in burned patients. METHODS: The clinical characteristics of 147 adult patients with second- and third-degree burns covering 30% or more of their body surface area were analyzed retrospectively. Logistic regression was used to estimate the relative risks of ARF and mortality associated with the larger burn size and the lower serum albumin level at admission. RESULTS: Mean burned body surface was 60.0 +/- 21.8% (range 30-100%). Twenty-eight (19.0%) out of 147 patients experienced ARF, defined as a serum creatinine > or = 2 mg/dl, during the admission. The patients with ARF had larger burn size (79.5 +/- 15.4 vs. 55.3 +/- 20.5%, p < 0.0001) and lower serum albumin concentration at admission (1.92 +/- 0.66 vs. 2.48 +/- 0.82 g/dl, p < 0.0005) compared with those without ARF. All patients with ARF expired, whereas 29.4% (35/119) of the patients without ARF died. The burn size > or = 65% was associated with a risk of ARF that was 9.9 times and with a risk of death that was 14.2 times as high as that for the burn size <65%. The initial serum albumin level <2.5 g/dl was associated with a risk of death that was 2.7 times as high as that for the initial serum albumin level > or = 2.5 g/dl. CONCLUSIONS: When major burns are complicated by ARF, the mortality rate increases significantly. Burn size is an independent predictor of ARF occurring in major burns. Initially depressed serum albumin level is associated with an increase in mortality in the major burn patients.

Acute Kidney Injury↗
PubMed2001

[The preparation of collagen burn pellicle of compound sulfadiazine silver and assessment of its efficacy in an animal experiment on deep partial thickness burn wound].

OBJECTIVE: To prepare the collagen burn pellicle of compound sulfadiazine sliver and observe its therapeutic effect on deep partial thickness burn wound. METHODS: The initator method was adopted for preparing the collagen burn pellicle of compound sulfadiazine sliver. A model of deep partial thickness burn wound was established in 84 SD rats for the observation of the effect of collagen burn pellicle of compound sulfadiazine sliver on burn wound healing. RESULTS: The collagen burn pellicle of compound sulfadiazine sliver enhanced the coming off of necrotic tissues and the healing of burn wound. The hydroxyproline content of burn wound was higher in the experiment group than that in the comparison groups, (P < 0.05). The percentage of G0/G1-phase in full skin cells of burn wound at 5, 7, 10 and 14 days after burn was lower than that in the comparison groups (P < 0.05). The percentage of S-phase at 5, 7 and 14 days was higher in the experiment group than that in the comparison groups (P < 0.05). The water content in full skin cells of burn wound at 24, 36 and 48 hours after burn was significantly lower in the experiment group than that the comparison groups (P < 0.05). CONCLUSION: The collagen burn pellicle of compound sulfadiazine sliver can enhance wound healing in the management of deep partial thickness burn wound.

Animals↗
PubMed2004

[The changes of characteristics of burn injuries and treatment data of burned adults in Kaunas University of Medicine Hospital in 1981-2001].

About 8000 people get burned in Lithuania every year; over 2000 of them have to be hospitalized. About 500 adults and children, who have heavy burn accidents, are treated in the specialized burn centers in Kaunas and Vilnius. With the flow of time, causes of burn accidents change; new treatment methods appear and are applied, the duration of treatment in the hospital as well as other burn accident data change. Consequently we can conclude that in Lithuania as well as all over the world burns are considered to be a serious medical, psychological, economic and social problem. A retrospective 723 in-patient case study was carried out in order to analyze accident and treatment data. The article deals with accident and in-patient treatment data analysis of the adults hospitalized in 1981, 1985, 1991, 1995 and 2001 at the Department of Plastic Surgery and Burns of Kaunas University of Medicine. In 1981, 1985, 1991, 1995 and 2001, respectively 156, 116, 174, 173 and 106 burn accident adult patients were treated. In all years number of burned male patients was twice higher than of female patients. It was noticed that in most cases people of the employable age got burned; the average age of patients 41.3 years. The main source of burns was flame (47.2%); town inhabitants got burned two times more frequently than villagers. It was found that the number of burns with hot liquids increased. The number of unemployed patients increased as well. The absolute majority of patients were treated due to deep burns (87.55%), the total average of burned area decreased from 12.66% in 1981 to 10.99% in 2001. The number of patients undergoing an operation has grown. Active surgery tactics and early operations gave the possibility to decrease almost twice the duration of in-patient treatment in 2001 in comparison to 1981. The time till the first operation decreased from 19.1 days in 1981 to 7 days in 2001.

Accidents, Occupational↗
PubMed2006

Characteristics of burn patients at a major burn center in Shanghai.

In China, burns are becoming a major cause of morbidity and mortality with large societal and economic implications. To date, there is little epidemiological data on burns in China to direct prevention efforts. This study describes the characteristics of burn patients admitted to a major burn center in Shanghai using a burn registry developed in Toronto, Canada. A retrospective review of burn patients discharged from the Shanghai's Rui Jin Hospital Burn Unit, between March 1st 2002 and April 30th 2003, was conducted. Of 527 patients discharged, 307 were acute burn patients and 302 (98.4%) had complete data to be included in the study. There were 214 (71%) males and 88 (29%) females with a male to female ratio of 2.4:1. The median age was 30 years, and the median total body surface area burned was 10%. The majority of burns occurred at work (58%), and the most frequent etiology was flames (39%) followed by scalds (31%) and contact with hot objects (15%). Sixteen (5%) patients had inhalation injury and six (2%) patients died. There were 70 (23%) children (0-14 years), 221 (73%) adults (15-59 years) and 11 (4%) seniors (60 years and above). Children had more scald burns (83%) and the majority (83%) occurred at home. Adults had more flame burns (46%) and the majority (79%) were work-related injuries. Seniors had more flame burns (73%) and the majority (55%) occurred in domestic incidents. Seniors had deeper burns (13%, p=0.005), required more escharotomies (55%, p=0.002), required more operations (2, p=0.051) and had higher mortality (36%, p<0.001) than other age groups. These results provide compelling evidence for performing population-based studies to identify risk factors that are susceptible to modification in each age group.

Adult↗
PubMedDate not supplied

Combat burn life support: a military burn-education program.

The Advanced Burn Life Support Course has been used to train military physicians and nurses for more than 16 years. Although it useful for teaching the fundamentals of burn care, the course is designed for a civilian audience, covers only the first 24 hours of burn care, and presumes the availability of a burn center for patient transfer. In preparation for hostilities in Iraq, we developed several add-on modules to the standard Advanced Burn Life Support course to meet specific needs of military audiences. These modules cover the treatment of white phosphorus burns; the treatment of mustard gas exposure; the long-range aeromedical transfer of burn patients; the management of burn patients beyond the first 24 hours; and the delivery of burn care in austere environments. These add-on modules are termed Combat Burn Life Support. Between January 22, 2003, and May 12, 2003, Advanced Burn Life Support and/or Combat Burn Life Support courses were provided to a total of 1035 military health care providers in the United States, Germany, and the Middle East. Student feedback was largely positive and is being used for further course refinement. The Combat Burn Life Support Course is designed to augment, rather than replace, the Advanced Burn Life Support Course. Although intended for a military audience, the course material is equally applicable to civilian terrorist or mass casualty situations.

Burn Units↗
PubMed1987

Occupation-related burns: five-year experience of an urban burn center.

Mortality from burns in the United States has not improved appreciably since 1955 among men, and the rate of decline among women appears to be slowing. Although one-quarter of all serious burns result from occupational accidents, few systematic epidemiologic studies of occupational burns have been conducted. We reviewed 232 cases of occupational burns among the 1,076 civilians seen as outpatients or admitted to the Regional Burn Treatment Center of the University of California Medical Center in San Diego from 1977 to 1982. Scalds were the most common type of burn overall and in women, but flame-related burns resulted in the highest average percent body surface area burned and were more common in men; tar-related, flame-related, chemical, and electrical burns affected men almost exclusively. Electrical burns were disproportionately severe, as measured by time lost from work, fatalities, and permanent disability, in relation to their frequency and amount of body surface area involved. Contact burns were more frequent in younger persons. Hispanics were overrepresented compared with their representation in the general population. Occupational associations included scalds due to hot grease among restaurant workers, tar burns among roofing workers, electrical burns among farm workers, and injuries reflecting hazards to firefighters and electricians. The number of days off work after hospitalization correlated closely with the number of days hospitalized, which in turn correlated significantly with percentage of body surface area burned.(ABSTRACT TRUNCATED AT 250 WORDS)

Accidents, Occupational↗
PubMed1997

Mortality determinants in massive pediatric burns. An analysis of 103 children with > or = 80% TBSA burns (> or = 70% full-thickness).

OBJECTIVE: Survivors and nonsurvivors among 103 consecutive pediatric patients with massive burns were compared in an effort to define the predictors of mortality in massively burned children. SUMMARY BACKGROUND DATA: Predictors of mortality in burns that are used commonly are age, burn size, and inhalation injury. In the past, burns over 80% of the body surface area that are mostly full-thickness often were considered fatal, especially in children and in the elderly. In the past 15 years, advances in burn treatment have increased rates of survival in those patients treated at specialized burn centers. The purpose of this study was to document the extent of improvement and to define the current predictors of mortality to further focus burn care. METHODS: Beginning in 1982, 103 children ages 6 months to 17 years with burns covering at least 80% of the body surface (70% full-thickness), were treated in the authors' institution by early excision and grafting and have been observed to determine outcome. The authors divided collected independent variables from the time of injury into temporally related groups and analyzed the data sequentially and cumulatively through univariate statistics and through pooled, cross-sectional multivariate logistic regression to determine which variables predict the probability of mortality. RESULTS: The mortality rate for this series of massively burned children was 33%. Lower age, larger burn size, presence of inhalation injury, delayed intravenous access, lower admission hematocrit, lower base deficit on admission, higher serum osmolarity at arrival to the authors' hospital, sepsis, inotropic support requirement, platelet count < 20,000, and ventilator dependency during the hospital course significantly predict increased mortality. CONCLUSIONS: The authors conclude that mortality has decreased in massively burned children to the extent that nearly all patients should be considered as candidates for survival, regardless of age, burn size, presence of inhalation injury, delay in resuscitation, or laboratory values on initial presentation. During the course of hospitalization, the development of sepsis and multiorgan failure is a harbinger of poor outcome, but the authors have encountered futile cases only rarely. The authors found that those patients who are most apt to die are the very young, those with limited donor sites, those who have inhalation injury, those with delays in resuscitation, and those with burn-associated sepsis or multiorgan failure.

Adolescent↗
PubMed2003

Modulation of inflammatory and catabolic responses in severely burned children by early burn wound excision in the first 24 hours.

HYPOTHESIS: Early burn wound excision modulates the hypermetabolic response in severe pediatric burn injuries. DESIGN: Before-after trial. SETTING: A 30-bed burn referral center in a private, university-affiliated hospital. METHODS: We studied 35 severely burned children who were divided into 2 groups. One group (n = 20) was treated with early burn wound excision within 24 hours after the injury. The second group (n = 15) was treated conservatively with silver sulfadiazine in other burn facilities for 5 days, and burn wounds were surgically excised when patients were admitted to our burn center on day 6 after the injury. Data compiled included oxygen consumption and acute-phase protein, interleukin 1beta; interleukin 6, interleukin 10, tumor necrosis factor alpha, and anabolic hormone (growth hormone, insulinlike growth factor type 1) levels preoperatively and 24 hours and 5 days postoperatively. MAIN OUTCOME MEASURES: Acute-phase and hypermetabolic responses. RESULTS: Early burn wound excision abrogated the hypermetabolic response in pediatric burn patients. Patients who underwent conservative treatment had a significantly more severe inflammatory and hypermetabolic response at the same time interval and significantly lower levels of anabolic hormones. CONCLUSIONS: Early burn wound excision is a safe therapeutic approach that modulates the hypermetabolic response after burn injury. It was superior to the conservative treatment of silver sulfadiazine and delayed excision, and it should be considered when treating all severe full-thickness burns.

Acute-Phase Reaction↗
PubMedDate not supplied

An analysis of the long-distance transport of burn patients to a regional burn center.

The concentration of specialized burn care to relatively few centers within relatively large geographic regions requires an organized system of patient triage, referral, and transport. The purpose of this study was to identify systematic errors in either the initial evaluation or care of burn patients requiring transport more than 90 miles to a single regional burn center. Therefore, we undertook a descriptive analysis of patients transported more than 90 miles to a single regional burn center from 2000 to 2003. The outcomes of interest were duration of transport, errors in burn size estimation, errors in fluid management, appropriateness of intubation, and complications during transport. During the years 2000 to 2003, there were 1877 admissions to the burn center; 949 (51%) were transferred from an outside facility. Of these 949, 424 (45%) were transferred more than 90 miles from a referring facility to our burn center. The average transport time from injury to our burn center was 7.2 hours (range, 1.6-48). There were no patient deaths during transport, and the most common complications were loss of or inability to secure intravenous access and inability to secure an airway. Burn size estimates differed significantly (P < .001) between referring providers and burn center physicians. This study confirms that patients can be transported safely and efficiently over long distances to a regional burn center. Given the current geographic distribution of burn centers and concerns about declining numbers of burn surgeons, organized systems of patient triage and transport may become increasingly important.

Adult↗
PubMed2002

[The burned hand. A computer-assisted study of late function of 67 burned and operated hands].

A good functional outcome of the hand is important in the rehabilitation of severely burned patients. The aim of the study was to evaluate the late functional outcome of deeply burned hands using a computer aided system and to correlate the function with the distribution of the hand burns. Over a 12-year-period 378 patients whose acutely burned hands had been operated on at the burn center of the university hospital Aachen were invited to a follow-up examination. 67 burned and operated hands were evaluated 57 (3-364) months after the burn by the computerized evaluation system EVAL. Active flexion and extension, grip strength, pinch (key, 3-tip and 2-tip), moving 2-point sensitivity and the pattern of skin grafts and scars were assessed. The use of the hand in daily activities was evaluated by a questionnaire. The hands were classified in 4 groups according to the burn pattern: I: patchy burns (total < 12 cm2), II: confluent dorsal burns, III: confluent palmar burns, IV: mutilating burns. Good results were found in group I (n = 25), comparable to normal hand function. In group II (n = 25) there was a significant loss of total active flexion with preserved strength. Increased extension lag and impaired grip strength characterized group III (n = 8). Late functional results in group IV (n = 9) depended on the reconstructive procedure. Between the 4 groups there were significant differences in function. The results were well correlated to the burn pattern and its extent according the classification.

Activities of Daily Living↗
PubMed2005

A seven-year epidemiology study of 12,381 admitted burn patients in Taiwan--using the Internet registration system of the Childhood Burn Foundation.

This study described the epidemiological characteristics of the 12,381 admitted burn patients in Taiwan. The data was from 43 contracted hospitals of the Childhood Burn Foundation, in the years from 1997 to 2003. This descriptive study included 8172 males and 4206 females, with a male to female ratio of 1.94 and an average age of 29.3 years. There were 3993 (33.4%) patients under 18 years old; and 26.4% of the patients were children under 7 years old. First and second years of life were the peak of incidence. The mean extent of burn was 14.0% total body surface area with 950 patients (7.7%) suffering from a burn extent >/=40% TBSA. Scalds resulted in 5085 admissions (43.2%) and flame burns accounted for 3825 admissions (32.5%). In patient group under 18 years old, 76.8% were scald burn and 14.1% were flame burn. The majority of the burn injuries (53.3%) occurred in the dwelling place; 1122 patients had inhalation injuries and required admission to the burn center for pulmonary support. In addition, suicide attempts were recorded in 2.4% (300 cases) of all burn patients with a mean burn size of 40.7% total body surface and mortality rate of 29.3%. The overall mortality rate is 381 out of 12,381 patients (3.1%). The LA(50) was around 80% TBSA. The significant effects of risk factors, such as old age, large burn extent, combined inhalation injury and suicide were demonstrated. Adequate first aid by water cooling affected the outcome of the patient group with burn extent less than 30% TBSA, which was shown by the decrease of length of stay. These results showed some unique distributions that reflected certain socio-economic and cultural background of Taiwan.

Accidents, Home↗
PubMed2001

Pentadecapeptide BPC 157 cream improves burn-wound healing and attenuates burn-gastric lesions in mice.

The effects of the gastric pentadecapeptide BPC 157 were investigated when administered topically or systemically in burned mice. This agent is known to have a beneficial effect in a variety of models of gastrointestinal lesions, as well as on wound or fracture healing. Deep partial skin thickness burns (1.5x1.5 cm) covering 20% of total body area, were induced under anesthesia on the back of mice by controlled burning and gastric lesions were assessed 1, 2, 3, 7, 14 and 21 days following injury. The first application of BPC 157 was immediately following burning, and thereafter, once daily, until 24 h before sacrifice. In the initial experiments, exposure to direct flame for 5 s, the BPC 157 was applied at 10 microg or 10 ng/kg b.w. intraperitoneally (i.p.) by injection or alternatively, topically, at the burn, as a thin layer of cream (50 microg of BPC 157 dissolved in 2 ml of distilled water was mixed with 50 g of commercial neutral cream (also used as local vehicle-control)), while silver sulfadiazine 1% cream was a standard agent acting locally. Others received no local medication: they were treated i.p. by injection of distilled water (distilled water-control) or left without any medication (control). In subsequent experiments involving deeper burns (direct flame for 7 s), BPC 157 creams (50 microg, 5 microg, 500 ng, 50 ng or 5 ng of BPC 157 dissolved in 2 ml of distilled water was mixed with 50 g of commercial neutral cream), or vehicle as a thin layer of cream, were applied topically, at the burn. Compared with untreated controls, in both experiments, in the BPC 157 cream-treated mice all parameters of burn healing were improved throughout the experiment: less edema was observed and inflammatory cell numbers decreased. Less necrosis was seen with an increased number of capillaries along with an advanced formation of dermal reticulin and collagen fibers. An increased number of preserved follicles were observed. Two weeks after injury, BPC 157 cream-treated mice completely reversed the otherwise poor re-epithelization ratio noted in the untreated control or mice treated with vehicle only. Tensiometry investigation showed an increased breaking strength and relative elongation of burned skin, while water content in burned skin decreased. This was, however, not the case with the vehicle or silver sulfadiazine. Relative to the control values, in silver sulfadiazine cream-treated mice, only collagen fiber formation was increased, in addition to a decreased inflammatory cell number. Relative to control values, BPC 157 given i.p. decreased the number of inflammatory cells, lowered water content in burned skin, and raised breaking strength and relative elongation of burned skin during tensiometry. Through the experimental period, gastric lesions were continuously noted in all thermally injured mice left without local medication and they were consistently attenuated only by BPC 157 treatments: either given i.p. (at either dose), or given locally (at either concentration). Other treatments (i.e. local treatment with silver sulfadiazine cream or neutral cream in mice subjected for 5 s to direct flame), led to only poor, if any attenuation. This stable gastric pentadecapeptide appears to be active and gives a stimulation to burn healing at the defect site. The agent may act by causing an upregulation of the growth factors, as well as influencing other local factors.

Administration, Topical↗
PubMedDate not supplied

Degree of burn, location of burn, and length of hospital stay as predictors of psychosocial status and physical functioning.

The purpose of this study was to identify predictors of psychologic and physical functioning of the victim with burn injuries from initial hospitalization to discharge. Thirty-one patients admitted to a burn center participated in the study and completed the Burn-Specific Health Scale. Most patients were men between 17 and 45 years of age. Length of stay in the hospital was bimodal, i.e., although about half stayed in the hospital for less than 15 days, about one fifth were hospitalized for more than 28 days. The study hypothesized that degree of burn, location of burn, and length of hospital stay would be associated with psychologic and physical functioning at the first-alert stage (stage of first orientation after burn injury) and the predischarge stage (immediately before discharge from the hospital). At the predischarge stage, the degree of the burn strongly predicted the patient's functioning. Patients with first-degree burns reported lower physical and psychologic functioning on every area of the Burn-Specific Health Scale. Conversely, at the first-alert stage, patients with third-degree burns reported higher psychologic functioning in certain areas (mental and social domains). Having a second-degree burn was not associated with reported psychologic or physical functioning. If the burn involved either the patient's hand or head, the location of the burn predicted certain areas of physical functioning at the first-alert and predischarge stage. Length of hospital stay predicted physical functioning; patients who stayed longer in the hospital reported lower mobility and hand function.

Activities of Daily Living↗
PubMed2006

Dielectric measurement in experimental burns: a new tool for burn depth determination?

BACKGROUND: There has been a lack of methods to provide quantitative information of local tissue edema after burn injury. Noninvasive dielectric measurements provide this information. The measured value, the dielectric constant, is directly related to the amount of water in tissue. Using probes of different sizes, the measurements give information from different tissue depths. The aim of this study was to characterize edema formation at different tissue depths and to examine whether the dielectric measurements could be used to distinguish partial- and full-thickness burns in pigs. METHODS: An experimental animal study with pigs (n = 6) was performed in which dielectric measurements were taken of superficial, partial-thickness, and full-thickness burns for 72 hours. RESULTS: There was an increase in tissue water content in the superficial dermis in the partial-thickness burns at 48 hours. In whole dermis, the superficial burns resulted in increased tissue water content at 8 hours, and the partial-thickness burns resulted in increased tissue water content at 8, 24, and 72 hours. In deep burns, the water content was significantly decreased in the superficial dermis at 24 hours. All burns resulted in a considerable increase in fat water content. The dielectric probes could be used to differentiate partial- and full-thickness burns as early as 8 hours after burn. Receiver operating curve analysis of the measurements indicated 70 to 90 percent sensitivity and 80 to 100 percent specificity after 8 hours. CONCLUSIONS: The dielectric measurements provide a sensitive and noninvasive method for examining tissue edema and differentiate partial- and full-thickness burns in experimental burns. Thus, they are of clinical interest for early burn depth determination.

Animals↗
PubMed2016

Early leukocyte gene expression associated with age, burn size, and inhalation injury in severely burned adults.

BACKGROUND: In the patient with burn injury, older age, larger percentage of total body surface area (TBS) burned, and inhalation injury are established risk factors for death, which typically results from multisystem organ failure and sepsis, implicating burn-induced immune dysregulation as a contributory mechanism. We sought to identify early transcriptomic changes in circulating leukocytes underlying increased mortality associated with these three risk factors. METHODS: We performed a retrospective analysis of the Glue Grant database. From 2003 to 2010, 324 adults with 20% or greater TBS burned were prospectively enrolled at five US burn centers, and 112 provided blood samples within 1 week after burn. RNA was extracted from pooled leukocytes for hybridization onto Affymetrix HU133 Plus 2.0 GeneChips. A multivariate regression model was constructed to determine risk factors for mortality. Testing for differential gene association associated with age, burn size, and inhalation injury was based on linear models using a fold change threshold of 1.5 and false discovery rate of 0.05. RESULTS: After adjusting for potential confounders, age greater than 60 years (relative risk [RR], 4.53; 95% confidence interval [CI], 2.93-6.99), burn size greater than 40% TBS (RR, 4.24; 95% CI, 2.61-6.91), and inhalation injury (RR, 2.08; 95% CI, 1.35-3.21) were independently associated with mortality. No genes were differentially expressed in association with age greater than 60 years or inhalation injury. Fifty-one probe sets representing 39 unique genes were differentially expressed in leukocytes from patients with burn size greater than 40% TBS; these genes were associated with platelet activation and degranulation/exocytosis, and gene-set enrichment analysis suggested increased cellular proliferation and down-regulation of proinflammatory cytokines. CONCLUSION: Among adults with large burns, older age, increasing burn size, and inhalation injury have a modest effect on the leukocyte transcriptome in the context of the "genomic storm" induced by a 20% or greater than TBS burned. The 39-gene signature we identified may provide novel targets for the development of therapies to reduce morbidity and mortality associated with burns greater than 40% TBS. LEVEL OF EVIDENCE: Epidemiologic study, level III.

Adult↗