Journal articles on the topic 'Adult burn service'
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Sreedharan, Sadhishaan, Hana Menezes, Heathe Cleland, and Stephen Goldie. "Petrol-related burn injuries presenting to the Victorian Adult Burns Service." Australasian Journal of Plastic Surgery 2, no. 2 (September 28, 2019): 28–32. http://dx.doi.org/10.34239/ajops.v2n2.153.
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Introduction: Burns fuelled by petrol are a major cause of injury in Australia and New Zealand. The same quality of explosive ignition that makes petrol so valuable as a fuel can cause injuries when handled carelessly or used for a purpose for which it was not intended.
Methods: This was a retrospective cohort study that examined the epidemiology of patients admitted to the Victorian Adult Burns Service (VABS) based at the Alfred Hospital, Melbourne. Data were extracted from the VABS Database on patients presenting over a seven-year period, between 1st July 2009 to 30th June 2016.
Results: During the study period, 378 out of 1927 burns (19.6%) admissions were related to petrol use. Males aged 20 – 29 years were most at risk, contributing to 25.4% of petrol related burn injuries. A large portion of burns, 31.0%, occurred during a leisure activity. The mean total body surface area burnt in this cohort was 19.3% and surgery was required in 70.4% of cases. Petrol related burns injuries is estimated to cost AU$ 5,484,834 annually and had a mortality rate of 7.4%.
Conclusion: Misuse of petrol contributed to a substantial injury burden to Victorians. Raising community awareness through preventive strategies targeted at high-risk groups of at-risk behaviours is warranted to reduce the incidence of petrol related burn injuries.
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Potter, Melissa, David Aaron, Rachel Mumford, and Lucy Ward. "An evaluation of clinical psychology input into burns multidisciplinary follow-up clinics." Scars, Burns & Healing 9 (January 2023): 205951312211410. http://dx.doi.org/10.1177/20595131221141083.
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Introduction Research highlights the complex psychological needs that patients and their families can face following a burn injury, regardless of the objective severity of the injury and often beyond the timeframe of physical healing. Identification of psychological needs at different stages post-burn recovery is therefore a key role of clinical psychologists working in burn care services. Method This paper presents audit data collected across a two-year period in routine paediatric and adult multidisciplinary team follow-up clinics in a UK burns service. 808 clinical contacts (331 adults, 477 paediatrics) were recorded. Data gathered related to the identification of patient and/or family psychological need and the level of psychology input within clinic. Results For 43% of adult patients and 46% of paediatric patients seen in clinic, some degree of psychological need for the patient and/or family was identified during the consultation. A large majority of concerns related directly to the burn injury. This is consistent with previous research into the psychological impact of burns. Even for patients with no identified psychological needs, psychology presence enabled the opportunity for brief screening, preventative advice or signposting to take place during clinic. Discussion A substantial number of individuals and families presented with some level of psychological concern in relation to a burn injury when attending burns multidisciplinary team follow-up clinics. Conclusion A substantial number of patients and families presented with psychological needs in relation to a burn injury when attending burns MDT follow-up clinics. The presence of Clinical Psychologists at burns MDT follow-up clinics is beneficial for the identification of burns and non-burns related psychological concerns and is a valuable use of psychological resources within a burns service. Lay Summary The Regional Burns Centre holds regular outpatient scar clinics to monitor recovery and healing. As well as the medical professionals, the clinics are joined by Clinical Psychologists who can assess, refer, and support individuals struggling with their burn or scarring on a mental level. Over 15 months, data was collected about patients attending the clinics and the involvement of the psychologists. 43% of adult patients and 46% of paediatric patients were identified as having some psychological need, either related to their burn or to other aspects of their life. This demonstrates the benefits of having psychology presence within scar clinics, as nearly half of the patients seen in clinic received an assessment and further support (such as signposting and referrals to psychological support). Burns staff also felt that psychology presence enhanced conversations and increased collaboration with decision making around treatment.
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Campbell, Stephanie, and Trina Andres. "98 A 10-year Retrospective Review of Older Adult Admissions at a Regional Burn Center." Journal of Burn Care & Research 41, Supplement_1 (March 2020): S64—S65. http://dx.doi.org/10.1093/jbcr/iraa024.101.
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Abstract Introduction A verified regional burn center conducted a 10-year retrospective review of older adult patients admitted to the burn service. The primary goal of the review was to examine trends in mechanisms of injury, demographics, and outcomes to inform burn prevention programming. Methods Admission data from 2009–2018 was retrieved from burn center databases and combined into a Microsoft Excel spreadsheet. Older adults were defined as age 65 years and older. Patients admitted to the burn service for skin disorders or soft tissue infections were excluded. Patients with cutaneous burn injuries or inhalation only injuries were included. Results The total number of patients included was 697. Nearly a third of the patients were 65 to 69 years old, with incidence declining with each subsequent 5-year age group. Males accounted for 61.3% of admissions. Two thirds of the patients were White (67.6%). The other third consisted of Black (18.4%) and Hispanic (9.8%), Asian (1.9%) and Native American (0.14%) patients. Overall mortality was 14%. Mortality generally increased per 5-year age group: 65–69 (7.8%), 70–74 (10.6%), 75–79 (13.7%), 80–84 (20.6%), 85–89 (29.8%), 90–94 (24.2%), and 95–99 (42.9%). Baux scores ranged from 65 to 180. The highest Baux score that lived to discharge was 119. The average Baux score of the mortality group was 114 and the average of the lived group was 82. No patients with a Total Body Surface Area (TBSA) above 43% lived. Fire/flame burns accounted for 72.7%. Scald burns made up 19.9%, contact burns 3%, chemical burns 2.3% and electrical burns < 1%. Nearly a quarter (24.6%) of fire/flame burns were related to smoking on home oxygen therapy (HOT), which was also the overall most common mechanism at 17.8%. Other fire/flame mechanisms included housefires (21.2%), clothing catching on fire (16.9%), and gasoline-related injuries (11.7%). More than 70% of scald burns came from the three mechanisms: hot tap water, boiling water, and hot grease. For the mortality group, a third of patients had been injured in housefires (32.7%), followed by clothing catching on fire (17.4%) and HOT burns (12.2%). Conclusions Incidence rates decline with increasing age but mortality rates climb. Burn injuries with a TBSA greater than 40% are generally fatal in the older adult. Flame burns account for the majority of injuries with HOT and house fire injuries as the leading mechanisms. Scald burns were most often caused by hot tap water or boiling water. White older adults accounted for more than double the number of patients identified in all other races combined. Applicability of Research to Practice The demographics and mechanism of injury insight gained from this review can be utilized to inform prevention programming design in this region. Trends in mortality can help emphasize the seriousness of preventing older adult burn injuries and anticipate the mortality risk for older adults admitted to the burn center.
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Tracy, Lincoln M., Cheng Hean Lo, Heather J. Cleland, Warwick J. Teague, and Belinda J. Gabbe. "Early Impact of COVID-19 Pandemic on Burn Injuries, Admissions, and Care in a Statewide Burn Service." European Burn Journal 3, no. 3 (September 12, 2022): 447–56. http://dx.doi.org/10.3390/ebj3030039.
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Anecdotal evidence from specialist burn clinicians suggested patient numbers and workloads increased during lockdown periods. This study aimed to describe the impact of the early COVID-19-related public health control measures (i.e., lockdowns) on burn injuries, hospital admissions, and care in a statewide burn service. We examined admissions data from The Victorian Adult Burns Service (located at the Alfred Hospital) and the Royal Children’s Hospital Burns Service—both of which contribute to the Burns Registry of Australia and New Zealand—during lockdown periods between March and October 2020, compared to the same periods in previous years. There were 714 patients admitted during the control period and 186 during the COVID-19 period. Burns sustained during COVID-19 lockdowns were larger in size. During COVID-19 lockdowns a greater proportion of patients were admitted to intensive care. Although the number of burn-related admissions did not increase during lockdowns, burn injuries that did occur were more severe (i.e., affected a greater percentage of body surface area). These more severe injuries placed an additional and significant burden on an already strained healthcare system. Future public health messaging should include prevention information to minimize the number of injuries occurring during lockdowns and other responses.
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Heffernan, Jamie, and James Gallagher. "43 COVID Crisis: A Burn Approach." Journal of Burn Care & Research 42, Supplement_1 (April 1, 2021): S32. http://dx.doi.org/10.1093/jbcr/irab032.047.
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Abstract Introduction The net effect of the COVID-19 pandemic on this northeastern, urban healthcare system during March, April and May 2020 was the redirection of virtually all resources to the care of the affected population. Conversion of the majority of the hospital’s assets, including staff and infrastructure, to COVID care created a large reduction in resources for other clinical problems. The burn service was among those few essential disciplines that continued to receive acutely affected individuals during the crisis. The preservation of the burn center’s ability to continue its mission within the walls of a COVID hospital is the subject of this review. Methods All of the hospital’s ICU rooms, including all those on the burn unit, post anesthesia care units, some step-down units, and over 90% of the operating rooms (ORs) converted to COVID care ICUs. These vital actions by hospital administration enabled an increase in ICU beds from 114 to 270. Staff were redeployed to cover the massive influx of critical COVID patients. Burn inpatients during the transition were categorized by severity and age for disposition consideration. Of the 17 inpatients, 4 pediatric patients discharged home and 1 transferred to our associated children’s hospital; 7 adults discharged home, 2 transferred to our associated inpatient psychiatric hospital, 1 to inpatient rehab, and 2 transferred to a neighboring orthopedic hospital converted into an adult acute care hospital. The commitment to keep the burn center operational for both children and adults was facilitated by protecting the burn ICU hydrotherapy room, a large patient care space in the center of the burn ICU. Children, initially admitted and cared for in the hydrotherapy room until stable, transferred to our network Children’s hospital for continued care. Critical adult burns were admitted to the inpatient ICU with the COVID patients, acute burns were housed on the few remaining medical surgical units. Burn care was performed in the patients’ rooms to keep the hydrotherapy room “clean”. Results During the 3-month period described the burn service admitted and cared for 92 adult and 25 pediatric patients while maintaining a full ICU census. Although 3 admitted burn patients were COVID +, no burn patients housed in the ICU became COVID + during their stay. Conclusions The commitment to protect the burn hydrotherapy space for burn triage and care from the top level of administration was critical and notable given the widespread conversion of the subspecialty ICUs and most other patient care areas to COVID care units. Strict adherence to infection prevention guidelines and protection of the hydrotherapy room allowed burn patients to receive timely and appropriate care during a pandemic.
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Tichil, Ioana, Samara Rosenblum, Eldho Paul, and Heather Cleland. "Treatment of Anaemia in Patients with Acute Burn Injury: A Study of Blood Transfusion Practices." Journal of Clinical Medicine 10, no. 3 (January 27, 2021): 476. http://dx.doi.org/10.3390/jcm10030476.
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Objective: To determine blood transfusion practices, risk factors, and outcomes associated with the use of blood products in the setting of the acute management of burn patients at the Victorian Adult Burn Service. Background: Patients with burn injuries have variable transfusion requirements, based on a multitude of factors. We reviewed all acute admissions to the Victorian Adult Burns Service (VABS) between 2011 and 2017: 1636 patients in total, of whom 948 had surgery and were the focus of our analysis. Method and results: Patient demographics, surgical management, transfusion details, and outcome parameters were collected and analyzed. A total of 175 patients out of the 948 who had surgery also had a blood transfusion, while 52% of transfusions occurred in the perioperative period. The median trigger haemoglobin in perioperative was 80mg/dL (IQR = 76–84.9 mg/dL), and in the non-perioperative setting was 77 mg/dL (IQR = 71.61–80.84 mg/dL). Age, gender, % total body surface area (TBSA) burn, number of surgeries, and intensive care unit and hospital length of stay were associated with transfusion. Conclusions: The use of blood transfusions is an essential component of the surgical management of major burns. As observed in our study, half of these transfusions are related to surgical procedures and may be influenced by the employment of blood conserving strategies. Furthermore, transfusion trigger levels in stable patients may be amenable to review and reduction. Risk adjusted analysis can support the implementation of blood transfusion as a useful quality indicator in burn care.
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Kiely, John, Ibrahim Natalwala, Joseph Stallard, Orla Austin, Umair Anwar, and Preetha Muthayya. "The potential benefits of enzymatic debridement in multi-casualty burns incidents." Trauma 23, no. 3 (March 27, 2021): 252–57. http://dx.doi.org/10.1177/14604086211002583.
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Bromelain-based enzymatic debridement (ED) is a topical treatment that is growing in popularity for the non-surgical management of burn wounds. Although initially used for small injuries, experience has grown in using it for burns >15% Total Burns Surface Area (TBSA). A household explosion resulted in burns to multiple patients, with four requiring burn wound debridement. This case report demonstrates their management using ED. Four adult male patients were treated with ED, mean age 38.4 years. Their injuries ranged from 5–24% TBSA (mean 14.9%), with a high proportion of intermediate-deep dermal injury to their faces and limbs. Our centre has performed enzymatic debridement since 2016 and all senior burns surgeons and burns intensive care specialists in the team are experienced in its use. We perform enzymatic debridement using Nexobrid™ (Mediwound Ltd., Israel). Three patients were managed on a single theatre list, using ED for their burns at 19, 16 and 23 hours post-injury. One patient had ED of his injuries on intensive care at 18 hours. Patients with >15% TBSA were treated in a critical care setting with goal directed fluid therapy. Through the use of enzymatic debridement we were able to achieve burn debridement for four patients in under 24 hours. While not a true mass casualty incident, our experience suggests that for an appropriately resourced service it is likely to have advantages in this scenario. We suggest that burns services regularly using this technique consider inclusion into mass casualty protocols, with training to staff to enable provision in such an incident.
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Coffman, Beretta C., Joan Wilson, Kade Hardy, Farrah Parker, and Shana Addison. "765 Treatment of burns due to application of hair extensions and braiding in younger female patients." Journal of Burn Care & Research 43, Supplement_1 (March 23, 2022): S189—S190. http://dx.doi.org/10.1093/jbcr/irac012.318.
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Abstract Introduction Burn injury due to hair styling processes have been reported in the literature, but most of those have been reported to involve flat irons or chemical processing during hair coloring. Moreover, these injuries have predominantly involved adult patients. In the past, our center has seen similar injuries intermittently, with the addition of hot comb burns to the scalp as well. More recently, a number of younger female patients have been treated for a more uncommon injury related to application of hair extensions. The hair extensions are curled with hot boiling water which is usually taken from the microwave. The ends of the extensions are dipped in the hot water and when they are applied to the hair, the hot water burns the back, shoulders, and scalp. The purpose of this project is to describe the mechanism of injury from this type of hair styling process and to identify the population at risk. This will serve to raise awareness in the community so that preventive measures might be considered. Methods This is a case series describing an unusual mechanism of burn injury reviewing admissions from January 2016 through June 30, 2021. Results A total of 35 patients were admitted for this type of burn during this time. 32 were children and 3 were adults. Though this type of injury occurs more commonly in children, it can occur in adults as well. For purposes of this study, the focus will be injuries occurring in children. Conclusions This case series serves as a public service announcement to alert parents of young girls obtaining hair extensions and parents braiding the hair of young children of the potential danger of burn injury from the process. Burn clinicians are obligated to provide education that serves to help prevent such injuries. This presentation serves that purpose as well.
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Filippelli, Orazio Stefano Giovanni, Anna Maria Giglio, Simona Paola Tiburzi, Maria Teresa Archinà, Ercole Barozzi, Pietro Maglio, Stefano Candido, et al. "Management of Airways through Rapid Tracheostomy in a Severely Burnt Patient Attended to via Helicopter." Case Reports in Emergency Medicine 2021 (July 1, 2021): 1–3. http://dx.doi.org/10.1155/2021/5590275.
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In Catanzaro, Italy, an adult male with severe burns all over his body and in a state of coma was promptly rescued by the medical team at the air ambulance service (HEMS), who provided airway safety through laryngeal mask placement (LMA). The patient was subsequently transferred to the nearest Hub center, where an emergency tracheostomy was performed to ensure better airway management during the flight to the nearest available major burn center. This is the first documented case at regional level of a patient undergoing rapid tracheostomy through an imminent transfer with air ambulance.
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Garside, T. L., R. P. Lee, A. Delaney, and D. Milliss. "Clinical Practice Variation in Acute Severe Burn Injury." Anaesthesia and Intensive Care 46, no. 3 (May 2018): 321–25. http://dx.doi.org/10.1177/0310057x1804600310.
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The New South Wales (NSW) Statewide Burn Injury Service Database was reviewed to identify variations in clinical practice with respect to care of severely burn-injured patients in intensive care. We compared differences in practice relating to duration of endotracheal intubation and surgical grafting. In this retrospective observational study, we reviewed all intensive care unit (ICU) admissions to the two NSW adult burns centres, ICU A and ICU B, between January 2008 and December 2015. Data were analysed for association between duration of intubation and outcome. There were 855 admissions to adult ICU, with a significant difference in the percentage total body surface area (% TBSA) of burn and inhalation injury between patients in the two units. There was a significant difference in duration of intubation and ICU length of stay (LOS) between the units, which persisted when adjusted for age, % TBSA and inhalational injury. When analysing patients with more severe burns (>20% TBSA or intubated), the difference in duration of intubation remained significant (median of three days [interquartile range, IQR, 1–11 days] in A and 2 days [IQR 1–6 days] in B, P=0.003) as did ICU LOS (median 3 days [IQR 2–11 days] for A and 2 days [IQR 1–6 days] for B, P <0.0005). There was no significant difference in mortality between the two units for the severe or the more severe subgroup of burns when adjusted for age, % TBSA and inhalational injury (adjusted odds ratio, OR, for mortality 1.17 [95% confidence intervals 0.6 to 2.3, P=0.65]). There were significant differences in clinical practice, including duration of intubation, between the two ICUs. Longer intubation was associated with a longer ICU LOS, but was not associated with a difference in mortality. Large collaborative, prospective multicentre studies in severe burns are needed to identify best practice and variations in practice to determine if they are associated with increased mortality and/or cost.
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Voss, Jordan K., Jeanette Lozenski, Jennifer K. Hansen, Shannon Salerno, Aaron Lackamp, Jennifer Parks, Dhaval Bhavsar, and Anthony L. Kovac. "Sedation and Analgesia for Adult Outpatient Burn Dressing Change: A Survey of American Burn Association Centers." Journal of Burn Care & Research 41, no. 2 (September 21, 2019): 322–27. http://dx.doi.org/10.1093/jbcr/irz164.
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Abstract The management of pain and sedation during burn dressing change is challenging. Previous reviews and studies have identified wide variability in such practices in hospitalized burn patients. This survey-based study aimed to determine the most commonly utilized sedation and analgesia practices in adult burn patients treated in the outpatient setting. The goal was to identify opportunities for improvement and to assist burn centers in optimizing sedation procedures. A 23-question survey was sent to members of the American Burn Association. Nonpharmacological interventions including music, television, games, and virtual reality were used by 68% of survey respondents. Eighty-one percent reported premedicating with oral opioids, 32% with intravenous opioids, and 45% with anxiolytics. Fifty-nine percentage of respondents indicated that the initial medication regimen for outpatient dressing changes consisted of the patient's existing oral pain medications. Forty-three percent indicated that there were no additional options if this regimen provided inadequate analgesia. Fifty-six percentage of respondents felt that pain during dressing change was adequately controlled 75% to 100% of the time, and 32% felt it was adequately controlled 50% to 75% of the time. Nitrous oxide was used by 8%. Anesthesia providers and an acute pain service are available in a minority of cases (13.7% and 28%, respectively) and are rarely consulted. Procedural burn pain remains significantly undertreated in the outpatient setting and the approach to treatment is variable among burn centers in the United States. Such variation likely represents an opportunity for identifying and implementing optimal practices and developing guidelines for burn pain management in the outpatient setting.
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Milwood Hargrave, John, Phillip Pearce, Emily Rose Mayhew, Anthony Bull, and Sebastian Taylor. "Blast injuries in children: a mixed-methods narrative review." BMJ Paediatrics Open 3, no. 1 (September 2019): e000452. http://dx.doi.org/10.1136/bmjpo-2019-000452.
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Background and significanceBlast injuries arising from high explosive weaponry is common in conflict areas. While blast injury characteristics are well recognised in the adults, there is a lack of consensus as to whether these characteristics translate to the paediatric population. Understanding blast injury patterns in this cohort is essential for providing appropriate provision of services and care for this vulnerable cohort.MethodsIn this mixed-methods review, original papers were screened for data pertaining to paediatric injuries following blasts. Information on demographics, morbidity and mortality, and service requirements were evaluated. The papers were written and published in English from a range of international specialists in the field.ResultsChildren affected by blast injuries are predominantly male and their injuries arise from explosive remnants of war, particularly unexploded ordinance. Blasts show increased morbidity and mortality in younger children, while older children have injury patterns similar to adults. Head and burn injuries represent a significant cause of mortality in young children, while lower limb morbidity is reduced compared with adults. Children have a disproportionate requirement for both operative and non-operative service resources, and provisions for this burden are essential.ConclusionsCertain characteristics of paediatric injuries arising from blasts are distinct from that of the adult cohort, while the intensive demands on services highlight the importance of understanding the diverse injury patterns in order to optimise future service provisions in caring for this child blast survivor.
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Faskaj, Besnik, and Monika Belba. "Impact of Fluid Resuscitation Regimes in Relative Risk of Mortality in Burned Patients." Albanian Journal of Trauma and Emergency Surgery 5, no. 2 (July 20, 2021): 849–53. http://dx.doi.org/10.32391/ajtes.v5i2.231.
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Background; Some studies have supported the opinion that patients who get greater volumes of resuscitation fluids are at a higher chance of edema, complications, and probably bad outcomes. In the results of the International Society of Burn Injuries approximately half (49.5%) added colloid before 24h.
This study aims to analyze the relative risk for mortality comparing resuscitation in the first 24 hours with Parkland and resuscitation with the use of Colloids.
Material and Methods; This was an observational prospective cohort study conducted in the Service of Burns of the University Hospital Centre "Mother Teresa" in Tirana (UHCT), Albania. The study includes adult patients with critical burns > 40% TBSA, hospitalized in the Intensive Care Unit of the service during the period 2014 to 2019. Resuscitation in the first 24 hours is done with Ringer Lactate according to Parkland and with Ringer Lactate with the addition of colloids after 12 hours.
Results; The data for organ dysfunction and organ insufficiency were the same in the two groups without statistical significance. Mortality in the RL group was 48% (24 deaths of 50 patients) while in the RL + Colloid rehydrated group was 46% (23 deaths of 50 patients). Patients which have 40-60% burns and are rehydrated with RL + Colloids have a risk of death 0.4 times less than those rehydrated with RL.
Conclusions; Resuscitation with Ringer lactate and Colloids in the first 24 hours of thermal damage is a rehydration alternative for the treatment of burn shock. This therapy especially helps patients with major burns > 40% TBSA who during rehydration require large amounts of fluids and are associated with severe plasma hypoalbuminemia. Number Need to Treat (NNT benefit) is 10 so 1 in 10 patients can benefit in lowering the risk of death with RL + Colloid rehydration.
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Kassay, Andrea Danielle, Alexander Adibfar, and Robert Cartotto. "16 Sustained Low Efficiency Dialysis (SLED) in Burn Patients with Acute Kidney Injury." Journal of Burn Care & Research 42, Supplement_1 (April 1, 2021): S16—S17. http://dx.doi.org/10.1093/jbcr/irab032.021.
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Abstract Introduction Acute Kidney Injury (AKI) is common among patients with major burns and may require treatment with renal replacement therapy (RRT). Although continuous renal replacement therapy (CRRT) modalities are widely used and offer many advantages over traditional intermittent hemodialysis (IHD), CRRT is expensive, labour-intensive, and may not be available in some burn centers. Sustained Low Efficiency Dialysis (SLED) is a moderately efficient alternative to IHD, but its use in burn patients with AKI has not been described. The purpose of this study was to review our experience with SLED. Methods Retrospective review of adult burn patients with AKI treated by SLED between 07/2013 and 03/2020 at an adult regional ABA-verified burn center. Data was obtained from the electronic medical record including daily dialysis forms completed by the nephrology service. Values are shown as mean +/- SD or median (IQR) as appropriate. Results We evaluated 367 distinct SLED sessions provided to 33 patients [age 55.8 +/- 14 yrs., %TBSA burn 33 +/-19, % TBSA full thickness burn 10.5 (0, 35.8), and 54.5% with inhalation injury]. The serum creatinine (sCr) prior to the start of SLED was 2.96 (2.3, 4.17) mg/dL. SLED was initiated 5 (3, 10.8) days (range 0–24 d) post burn, and 7 (3.3, 12.8) sessions (range 1–44) with a duration of 4 (4,6) hours each were given per patient. Heparinization was required in 22 sessions (6%), and 46 sessions (12.5%) were aborted, most commonly due to clotting of the lines or circuit, and rarely (4%) due to hypotension. The net ultrafiltrate removal was 1.2 (0.7–2) L, with a dialysate flow rate of 350 (350, 500) mL/min. Among 208 sessions where patients were not on vasopressors (VPs) Pre-SLED, one or more VPs were required in 19 sessions (9%) during or at the termination of SLED. Among 116 sessions where patients were receiving norepinephrine (NEpi) infusions pre-SLED, the NEpi dose dropped from 7.3 +/- 4.2 µgm/min to 6 +/- 4.5 µgm/min (p=0.03). Pre and Post SLED values for blood pressure, creatinine, and potassium are shown in the table. The mortality rate was 36.4%, hospital length of stay was 42 (20.5, 61.5) days, and among surviving patients, 2 (9.5%) required dialysis post discharge. Conclusions SLED was effective and well tolerated. Hemodynamic instability was infrequently encountered.
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Adanichkin, Natalia, John Edward Greenwood, and Alexa McArthur. "Face care amongst patients admitted to the Adult Burn Service: a best practice implementation project." JBI Database of Systematic Reviews and Implementation Reports 13, no. 9 (September 2015): 369–85. http://dx.doi.org/10.11124/01938924-201513090-00022.
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Adanichkin, Natalia, John Edward Greenwood, and Alexa McArthur. "Face care amongst patients admitted to the Adult Burn Service: a best practice implementation project." JBI Database of Systematic Reviews and Implementation Reports 13, no. 9 (September 2015): 369–85. http://dx.doi.org/10.11124/jbisrir-2015-2207.
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Wright, Michael, and Jin A. Lee. "Multimodal Analgesia and Discharge Opioid Requirements in Burn Patients." Journal of Burn Care & Research 41, no. 5 (June 7, 2020): 963–66. http://dx.doi.org/10.1093/jbcr/iraa088.
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Abstract Analgesia in burn patients is challenging given the complexity of burn pain and prolonged need beyond hospital admission. Given the risks of opioids, the impact of multimodal analgesia postdischarge needs to be further elucidated in this population. This retrospective, single-center cohort study evaluated adult burn patients who were consecutively admitted to the burn service with at least 10% total body surface area burned and subsequently followed in the burn clinic between February 2015 and September 2018. Subjects were separated into two cohorts based on discharge pain regimens: multimodal and nonmultimodal. The primary outcome was the change in opioid requirements (measured in oral morphine equivalents) between discharge and first follow-up interval. Secondary outcomes included the classes of multimodal agents utilized and a comparison of opioid requirements between the last 24 hours of admission and discharge. A total of 152 patients were included for analysis, 76 in the multimodal cohort and 76 in the nonmultimodal cohort. The multimodal cohort was noted to have increased total body surface area burned and prolonged number of days spent in the intensive care unit at baseline; however, the multimodal cohort exhibited a more significant decrease in opioid requirements from discharge to first follow-up interval when compared with the nonmultimodal cohort (106.6 vs 75.4 mg, P = .039).
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Lu, Patrick, Dane Holden, Alex Padiglione, and Heather Cleland. "Perioperative antibiotic prophylaxis in Australian burns patients." Australasian Journal of Plastic Surgery 5, no. 1 (March 31, 2022): 48–55. http://dx.doi.org/10.34239/ajops.v5n1.286.
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Background: Perioperative antibiotic prophylaxis is perceived to reduce intraoperative bacteraemia and prevent surgical site infections, however, the evidence for its use in burns surgery is limited. Excessive use of perioperative antibiotics has become a growing concern. The authors aimed to audit the prescribing practices of perioperative antibiotic prophylaxis at the Victorian Adult Burns Service and determine whether the duration of antibiotic prophylaxis influenced the risk of postoperative wound infection, bacte-raemia and antibiotic resistance. Methods: This retrospective chart review included all acute adult burns patients who had an operation between November 2018 and November 2019. Basic demographic data, burn specific data and data on perioperative antibiotic use were collected. The outcome measures were wound infection, bacteraemia, other infections and presence of resistant organisms. Results: Results demonstrated that almost all patients (98.6%) received perioperative antibiotic prophylax-is. In comparison, there was no significant difference between the rate of postoperative wound infection, bacteraemia or antibiotic resistance between patients receiving a short or long course of antibiotics. Conclusion: The results of our study demonstrate variable use of perioperative antibiotic prophylaxis with-in one burns unit. There were many cases of unsubstantiated use of long courses of antibiotics without apparent benefit for clinical outcomes of wound infection or bacteraemia. With the growing concern over antibiotic overuse and development of resistance, there is an increasing need for development of clear guidelines for antibiotic use in burns surgery.
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Wisely, J. A., and N. Tarrier. "A survey of the need for psychological input in a follow-up service for adult burn-injured patients." Burns 27, no. 8 (December 2001): 801–7. http://dx.doi.org/10.1016/s0305-4179(01)00058-4.
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Lee, Jin A., and Michael Wright. "126 Multimodal Analgesia and Discharge Opioid Requirements in Burn Patients." Journal of Burn Care & Research 41, Supplement_1 (March 2020): S85. http://dx.doi.org/10.1093/jbcr/iraa024.129.
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Abstract Introduction Analgesia in burn patients is significantly challenging given the complexity of burn pain. Opioids are a mainstay of therapy, but studies demonstrate varying outcomes with respect to the efficacy of adjunctive non-opioid agents in the treatment of burn pain. The need for analgesia extends beyond hospital admission—given the known risks of opioids, the impact of multimodal analgesia on opioid requirements post-discharge needs to be further elucidated in this population. Methods In this retrospective, single-center cohort study, adult burn patients who were consecutively admitted to the burn ICU service and subsequently followed in the burn clinic between 2/2015 and 9/2018 were evaluated up to 6 months post-discharge. The subjects were divided into two cohorts based on discharge pain regimens: multimodal vs non-multimodal. Individuals taking long-acting opioids prior to admission were excluded. The primary outcome was the change in oral morphine equivalents (OME) between discharge and follow up occurring between 2 - 6 weeks post-discharge. Secondary outcomes included the number of multimodal agents utilized and a comparison of OME between the last 24 hours of admission and discharge. Results A total of 152 patients were included for analysis (n= 76 per cohort). The multimodal cohort demonstrated increased total body surface area burned (23.9% ± 15.4 vs 16.6% ± 7.1; p < 0.001) and prolonged number of days spent in the ICU (22.7 ± 23.1 vs 10.7 ± 8.9; p < 0.001). The change in OME from discharge to first follow up was -106.6 mg in the multimodal vs -75.4 mg in the non-multimodal cohort (p = 0.039; figure 1). In each cohort, discharge OME did not statistically differ from last 24 hour OME (multimodal: p = 0.067; non-multimodal: p = 0.537). The most common non-opioid agents utilized were acetaminophen and gabapentin. Conclusions Despite extended ICU length of stay and larger TBSA, burn patients discharged with multimodal pain regimens demonstrated a statistically significant reduction in oral morphine equivalents from discharge to first follow up compared to those discharged on opioid-only regimens. Applicability of Research to Practice This study demonstrates promising results with respect to lowering discharge opioid requirements by utilizing a multimodal analgesic approach in the management of burn pain.
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Griffiths, Catrin, Philippa Tollow, Danielle Cox, Paul White, Timothy Pickles, and Diana Harcourt. "The CARe Burn Scale—Adult Form: Identifying the Responsiveness and Minimal Important Difference (MID) Values of a Patient Reported Outcome Measure (PROM) to Assess Quality of Life for Adults with a Burn Injury." European Burn Journal 3, no. 1 (March 10, 2022): 211–33. http://dx.doi.org/10.3390/ebj3010019.
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The CARe Burn Scales are a suite of burn-specific PROMs for adults, children, young people, and parents affected by burns. This study aimed to determine the responsiveness and minimal important difference (MID) values of the Adult Form for use in adult burn care and research. Participants were recruited by 11 UK Burn Services. They completed online or paper versions of the CARe Burn Scale –Adult Form and a set of appropriate comparison validated measures and anchor questions at baseline (T1, up to 4 weeks post-burn), 3 months (T2), and 6 months post-burn (T3). A total of 269 participants took part at baseline and 226 (84%) were retained at the 6-month follow-up. Spearman’s correlation analysis and effect sizes based on Cohen’s d thresholds were reported and MID values calculated. MID values were created for all subscales and ranged from 4–15. The CARe Burn Scale–Adult Form is responsive to change over time and can therefore be used to reliably inform the management of adults’ burn injury treatment and recovery. It is freely available for clinical and research use.
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Lewis, Christopher J., Fiona Wood, and Anna Goodwin-Walters. "Iatrogenic Thermal Burns Secondary to Marine Sting Treatment." Journal of Burn Care & Research 41, no. 4 (March 6, 2020): 878–81. http://dx.doi.org/10.1093/jbcr/iraa042.
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Abstract Hot water immersion (HWI) therapy is an effective and validated treatment for a variety of marine stings. Unsupervised, however, it poses a significant risk of thermal injury. Herein, we describe our experience of iatrogenic thermal injury secondary to marine sting treatment. A 5-year retrospective review of all iatrogenic thermal burns secondary to marine stings referred to the State Adult Burn Service was conducted. Nine patients were identified, all sustaining stings to the feet from estuarine cobblerfish, stonefish, and stingrays. All patients continued unsupervised HWI at home and sustained thermal injury to their feet. The majority were treated conservatively with dressings and elevation. One patient required surgical debridement. While heat application is an effective treatment for marine stings, further patient education is required following discharge from point of care. We recommend that first-aid treatment guidelines be updated to reflect that patients are not recommended to continue scalding water immersion at home. However, if patients wish to continue HWI, water temperature should be checked manually with a thermometer or with a nonstung limb and limited to 30 minutes immersion, with 30-minute skin recovery time between.
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Dingle, Lewis, Poh Tan, Parisha Malik, and Samantha McNally. "A 10-Year Review of Sunburn Injuries Presenting to the Manchester Adult and Paediatric Specialist Burn Services." European Burn Journal 3, no. 4 (September 29, 2022): 472–85. http://dx.doi.org/10.3390/ebj3040041.
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Background: The incidence of sunburn injuries continues to rise despite increased awareness of the risks of sun exposure and availability of sun protection. Whilst not a significant burden on burns care services, patients remain exposed to associated risks for future development of skin malignancies. The aims of this study were to determine the burden and severity of sunburn injury presentations to the Manchester adult and children’s burns services. Methods: A 10-year retrospective review was performed of patients with sunburn injuries, presenting to the Manchester burn services between 2010 and 2019 (inclusive). Data were collected from the International Burn Injury Database (iBID), electronic patient record (EPR) and local data collection systems. The data extracted included patient demographics, sunburn characteristics and management of the burn injury including need for admission and any documented surgical interventions. Temporal correlation was determined by linear regression analysis. Results: In total, 131 paediatric and 228 adult patients with sunburn injuries were managed by the Manchester burns services over the 10-year period. Mean % total body surface area burned was low (2.00% and 2.12% in adult and paediatric patients, respectively), with the majority of injuries either superficial or superficial partial thickness. Thirty percent (30.2%) of adult and 40.5% of paediatric patients were admitted with a mean length of stay of 3.51 and 1.11 days, respectively. The presentation of sunburn injuries progressively increased over the study period with a peak in 2017 (n = 58). Similar trends in patient demographics, burn size and depth and temporal trends were observed in national data from the same period for both adult and paediatric patients. Conclusion: This 10-year retrospective cohort study demonstrates an increasing trend of sunburn injury presentations to the Manchester specialist burns services; a pattern replicated in national data from England and Wales. The majority of sunburn injuries do not present to specialist burn services; therefore, these reported injuries reflect only a fraction of the true burden of sunburn nationwide. Despite increased awareness, an obvious need for enhanced public awareness campaigns regarding sun protection is therefore needed to address this trend. The educational and preventative role of burns care services is a key component in tackling both consequences of burn injuries themselves and associated risks such as future skin cancer development.
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Jeevan, R., A. Rashid, N. S. Lymperopoulos, D. Wilkinson, and M. I. James. "Mortality and treatment cost estimates for 1075 consecutive patients treated by a regional adult burn service over a five year period: The Liverpool experience." Burns 40, no. 2 (March 2014): 214–22. http://dx.doi.org/10.1016/j.burns.2013.11.020.
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Doan, Tan N., Daniel Wilson, Stephen Rashford, Louise Sims, and Emma Bosley. "Epidemiology, management and survival outcomes of adult out-of-hospital traumatic cardiac arrest due to blunt, penetrating or burn injury." Emergency Medicine Journal 39, no. 2 (October 27, 2021): 111–17. http://dx.doi.org/10.1136/emermed-2021-211723.
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BackgroundSurvival from out-of-hospital traumatic cardiac arrest (TCA) is poor. Regional variation exists regarding epidemiology, management and outcomes. Data on prognostic factors are scant. A better understanding of injury patterns and outcome determinants is key to identifying opportunities for survival improvement.MethodsIncluded were adult (≥18 years) out-of-hospital TCA due to blunt, penetrating or burn injury, who were attended by Queensland Ambulance Service paramedics between 1 January 2007 and 31 December 2019. We compared the characteristics of patients who were pronounced dead on paramedic arrival and those receiving resuscitation from paramedics. Intra-arrest procedures were described for attempted-resuscitation patients. Survival up to 6 months postarrest was reported, and factors associated with survival were investigated.Results3891 patients were included; 2394 (61.5%) were pronounced dead on paramedic arrival and 1497 (38.5%) received resuscitation from paramedics. Most arrests (79.8%) resulted from blunt trauma. Motor vehicle collision (42.4%) and gunshot wound (17.7%) were the most common injury mechanisms in patients pronounced dead on paramedic arrival, whereas the most prevalent mechanisms in attempted-resuscitation patients were motor vehicle (31.3%) and motorcycle (20.6%) collisions. Among attempted-resuscitation patients, rates of transport and survival to hospital handover, to hospital discharge and to 6 months were 31.9%, 15.3%, 9.8% and 9.8%, respectively. Multivariable model showed that advanced airway management (adjusted OR 1.84; 95% CI 1.06 to 3.17), intravenous access (OR 5.04; 95% CI 2.43 to 10.45) and attendance of high acuity response unit (highly trained prehospital care clinicians) (OR 2.54; 95% CI 1.25 to 5.18) were associated with improved odds of survival to hospital handover.ConclusionsBy including all paramedic-attended patients, this study provides a more complete understanding of the epidemiology of out-of-hospital TCA. Contemporary survival rates from adult out-of-hospital TCA who receive resuscitation from paramedics may be higher than historically thought. Factors identified in this study as associated with survival may be useful to guide prognostication and treatment.
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Green, Elizabeth, Julia Cadogan, and Diana Harcourt. "A qualitative study of health professionals’ views on using iPads to facilitate distraction during paediatric burn dressing changes." Scars, Burns & Healing 4 (January 1, 2018): 205951311876487. http://dx.doi.org/10.1177/2059513118764878.
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Introduction: Distraction is a non-pharmacologic pain management technique commonly used to avert a person’s attention from procedural pain and distress during stressful procedures such as treatment after a burn injury. In recent years, computer tablets (such as iPads) have been used within paediatric burns services to facilitate distraction by way of apps, games, cartoons and videos during dressing changes. However, we know very little about health professionals’ experiences of using them in this context. Methods: The current study explored health professionals’ experiences of using iPads to facilitate distraction during paediatric burn dressing changes. Fifteen health professionals from a single paediatric burns unit were interviewed. Thematic analysis revealed two key themes: (1) the iPad is a universal panacea for distraction; and (2) trials and tribulations. Discussion: Participants considered iPads to be potentially useful and effective distraction tools, suitable for use with a wide range of patients with burn injuries including young children, adolescents and young adults. However, issues including health professionals’ understandings of one another’s roles, the challenge of working in a busy burns service, and lack of experience and confidence were identified as possible barriers to their use within routine burn care. Training for staff on the use of iPads as a means of facilitating distraction, development of guidelines and a review of how they are incorporated into routine burn care are recommended.
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Greenwood, John E., and Andrew P. Pearce. "Burns Assessment Team as Part of Burn Disaster Response." Prehospital and Disaster Medicine 21, no. 01 (February 2006): 45–52. http://dx.doi.org/10.1017/s1049023x00003319.
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AbstractWith a huge, climactically hostile catchment area, limited retrieval options and finite resources at the only adult burns unit in South Australia, this paper discusses the case for the establishment and maintenance of a Burns Assessment Team in South Australia. The composition and role of the team and its relationship with other retrieval services, the primary care unit, and the proposed National Burn Coordinator also are discussed.
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Henry, Nader, Ishan Radotra, and Sheirin Khalil. "Community management of burn injuries." InnovAiT: Education and inspiration for general practice 12, no. 8 (May 28, 2019): 459–65. http://dx.doi.org/10.1177/1755738019851536.
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Burn injuries are extremely common injuries for both adults and children, and yet knowledge of their management is often lacking in society and the subject is not routinely taught to clinicians. In this article, we aim to provide an overview of the pertinent points of the history, classification of burns, and rapid assessment methods for determining body surface area within primary care. This is followed by key aspects of management, referral criteria for transfer to a burns service, and important safeguarding issues surrounding burns.
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Abdullahu, Bajram, and Monika Belba. "Analyzing Mortality in Burned Patients with Lethal Area 50." Albanian Journal of Trauma and Emergency Surgery 6, no. 2 (July 20, 2022): 1013–17. http://dx.doi.org/10.32391/ajtes.v6i2.272.
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Background; Clinical outcome is the most measurable of the critical care activity. Although every burn center has its own particular limitations, it is clear that exists a minimum standard of survival after burn injury which is LA50 (Lethal Area 50).
The aim of this study is to present demographic and epidemiologic features of severe burns in Albania in the period 2009-2019 and to analyze burn mortality as an important outcome measure analyzing LA 50.
Material and Methods; The study is retrospective clinical and analytical. Since our burn center is the only one in the country it encompasses all the cases with moderate burns from the capital and severe burns. The data used are obtained by the analysis of the medical records of 1684 patients hospitalized in Burns Service ICU near University Hospital Center in Tirana, Albania during 2009-2019.
Results; While comparing the decade (2009-2019) with the previous one (1998-2008) there is a progressive decrease of mortality (6.89% versus 10.5%) of our burn patient population although mean BSA (%) burned increased to 25.6±19.1 % (versus 22.8±14.7%). LA 50 for all patients was 80.04%, for children was 77.7%, for adults was 87% and for elderly was 52.28%. The mortality rate of all ICU burns as an average for 2009-2019 was 0.35 cases per 100000 population/year.
Conclusions; The long-term studies and the comparison of our results with the ones of other burn centers have allowed us to determine the actual level of care and as well as to build up contemporary protocols in order to improve the treatment with the objection decreasing the mortality. Improvements in overall mortality expressed by LA 50 noticed it as an important outcome measure.
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Gibson, John Alexander Gerald, Jeremy Yarrow, Liz Brown, Janine Evans, Simon N. Rogers, Sally Spencer, and Kayvan Shokrollahi. "Identifying patient concerns during consultations in tertiary burns services: development of the Adult Burns Patient Concerns Inventory." BMJ Open 9, no. 12 (December 2019): e032785. http://dx.doi.org/10.1136/bmjopen-2019-032785.
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ObjectivesIdentifying the issues and concerns that matter most to burns survivors can be challenging. For a number of reasons, but mainly relating to patient empowerment, some of the most pressing concerns patients may have during a clinical encounter may not naturally be the focal point of that encounter. The Patient Concerns Inventory (PCI) is a tried and tested concept initially developed in the field of head and neck cancer that empowers patients during a clinical encounter through provision of a list of prompts that allows patients to self-report concerns prior to consultation. The aim of this study was to develop a PCI for adult burns patients.DesignContent for the PCI was generated from three sources: burns health-related quality of life tools, thematic analysis of one-to-one interviews with 12 adult burns patients and 17 multidisciplinary team (MDT) members. Content was refined using a Delphi consensus technique, with patients and staff members, using SurveyMonkey.SettingWithin outpatient secondary care.ParticipantsTwelve adult burns patients and MDT members from two regional burns centres.ResultsA total of 111 individual items were generated from the three sources. The Delphi process refined the total number of items to 58. The main emergent domains were physical and functional well-being (18 items), psychological, emotional and spiritual well-being (22 items), social care and social well-being (7 items) and treatment-related concerns (11 items).ConclusionsThe Adult Burns Patient Concerns Inventory is a 58-item, holistic prompt list, designed to be used in the outpatient clinic. It offers a new tool in burn care to improve communication between healthcare professionals and patients, empowering them to identify their most pressing concerns and hence deliver a more focused and targeted patient-centred clinical encounter.
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Farid, Mohammed, Yasser Al Omran, Darren Lewis, and Alan Kay. "Management of minor burns during the COVID-19 pandemic: A patient-centred approach." Scars, Burns & Healing 7 (January 2021): 205951312110205. http://dx.doi.org/10.1177/20595131211020566.
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Introduction: The UK government introduced lockdown measures on 23 March 2020 due to the first wave of the COVID-19 pandemic. A restructuring of clinical services was necessary to accommodate mandatory changes while also maintaining the best possible standards for patient care. The present study explored the initial management, follow-up and patient-reported outcomes of burn injuries <15% total body surface area (TBSA) during the height of the COVID-19 lockdown at a tertiary burns centre. Methods: A retrospective review of all adult patients with burns <15% TBSA during the national lockdown (23 March 2020 to 10 May 2020) was undertaken at The Queen Elizabeth Hospital Birmingham (QEHB), UK. All referrals from non-QEHB telemedicine (external) or QEHB emergency (internal) departments were reviewed for management, length of hospital stay and pattern of follow-up (ward attender, self-care, community or outreach nurses). A telephone survey based on a structured questionnaire was conducted to establish patients’ satisfaction. Results: A total of 84 burn patients were included in the study. The mean age was 39 years (age range = 19–91 years) and the male:female ratio was 4:1. Patients were managed non-operatively (n = 69, 82%) or operatively (n = 15, 18%). Patients attended the ward attender acute burns clinic only once (n = 36, 61%). The telephone survey captured 70% (n = 59) of the study population and 57 patients (97% of respondents) were pleased with the ongoing care and burn healing. Conclusion: The integration of patient led self-care, reduction in admissions, minimal clinics attendance and a telemedicine follow-up is an effective model for small burns management during the COVID-19 pandemic. A high degree of patient satisfaction was achieved with continuous and approachable communication channels with the burn multidisciplinary team. We continue to implement this effective model of burns management throughout the COVID-19 pandemic and the subsequent period. Lay Summary The lockdown measures due to the first wave of COVID-19 pandemic affected the way we manage all medical emergencies including burns. The initial management, follow-up and patient satisfaction for small burn injuries during lockdown has not been reported previously. The aim of this study is to examine the outcome in terms of small burn management, hospital stay, number of clinic reviews, healing and patient satisfaction during the lockdown period in a burn centre in the UK. This would look at the need for operations and whether patients stayed longer if they required an intervention. We reviewed adult patients with small burns during the national lockdown (23 March 2020 to 10 May 2020) at The Queen Elizabeth Hospital Birmingham (QEHB). All referrals from telemedicine, referral system (external) or QEHB (internal) were reviewed for management, length of hospital stay and pattern of follow-up. Patients were reviewed in the acute burns clinic and given advice for burn management and dressing for self-care. Follow-up was mostly via email (telemedicine) A telephone survey based on a structured questionnaire was conducted to find out patients’ satisfaction. Four times more men than women had small burns during the lockdown period. The average age was 39 years. The majority were managed conservatively with dressings (82%) and a small proportion required an operation (18%). Most patients attended the acute burns clinic only once (61%) for initial assessment and management. The telephone survey captured 70% of patient and 97% of respondents were pleased with the care and burn healing. The integration of patient-led self-care, reduction in admissions, minimal clinics attendance and a telemedicine follow-up is an effective model for burns management during the COVID-19 pandemic. A high degree of patient satisfaction was achieved with continuous and approachable communication channels with burn multidisciplinary team. We continue to implement this effective model of burns management throughout the COVID-19 pandemic and the subsequent period.
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Griffiths, Catrin, Philippa Tollow, Danielle Cox, Paul White, Timothy Pickles, and Diana Harcourt. "Testing the Responsiveness of and Defining Minimal Important Difference (MID) Values for the CARe Burn Scales: Patient-Reported Outcome Measures to Assess Quality of Life for Children and Young People Affected by Burn Injuries, and Their Parents/Caregivers." European Burn Journal 2, no. 4 (November 11, 2021): 249–80. http://dx.doi.org/10.3390/ebj2040019.
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The CARe Burn Scales are a portfolio of burn-specific PROMs for people affected by burns, including a Child Form (for children < 8 years (parent-proxy)), a Young Person Form (for young people aged 8–17 years), an Adult Form, and a Parent Form (for parents/carers of children aged 0–17 years). This study aimed to determine the responsiveness and minimal important difference (MID) values of the three scales developed for use in paediatric burn services and research. Participants were recruited by 15 UK Burn Services. Participants completed the appropriate CARe Burn Scale and a set of appropriate comparison validated measures, at three time points: 4 weeks (T1), 3 months (T2) and 6 months (T3) post-burn injury. Spearman’s correlation analysis and effect sizes based on Cohen’s d thresholds were reported and MID values were calculated. At baseline, 250 participants completed the Child Form, 69 completed the Young Person Form, and 320 completed the Parent Form. A total of 85–92% of participants were retained at follow up. The tested CARe Burn Scales were all responsive to change over time. MID values were created for all subscales and ranged from 2 to 11 for the Child Form, 3 to 14 for the Young Person Form and 3 to 10 for the Parent Form. The CARe Burn Scales for children, young people and parents are responsive to change over time. The scales are freely available for clinical and research use.
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Wu, Jun-Zuo, Wei-Che Chiu, Wei-Ting Wu, I.-Min Chiu, Kuo-Chen Huang, Chih-Wei Hung, and Fu-Jen Cheng. "Clinical Validation of Cardiac Arrest Hospital Prognosis (CAHP) Score and MIRACLE2 Score to Predict Neurologic Outcomes after Out-of-Hospital Cardiac Arrest." Healthcare 10, no. 3 (March 20, 2022): 578. http://dx.doi.org/10.3390/healthcare10030578.
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Background. Out-of-hospital cardiac arrest (OHCA) remains a challenge for emergency physicians, given the poor prognosis. In 2020, MIRACLE2, a new and easier to apply score, was established to predict the neurological outcome of OHCA. Objective. The aim of this study is to compare the discrimination of MIRACLE2 score with cardiac arrest hospital prognosis (CAHP) score for OHCA neurologic outcomes. Methods. This retrospective cohort study was conducted between January 2015 and December 2019. Adult patients (>17 years) with cardiac arrest who were brought to the hospital by an emergency medical service crew were included. Deaths due to trauma, burn, drowning, resuscitation not initiated due to pre-ordered “do not resuscitate” orders, and patients who did not achieve return of spontaneous circulation were excluded. Receiver operating characteristic curve analysis with Youden Index was performed to calculate optimal cut-off values for both scores. Results. Overall, 200 adult OHCA cases were analyzed. The threshold of the MIRACLE2 score for favorable neurologic outcomes was 5.5, with an area under the curve (AUC) value of 0.70 (0.61–0.80, p < 0.001); the threshold of the CAHP score was 223.4, with an AUC of 0.77 (0.68–0.86, p < 0.001). On setting the MIRACLE2 score cut-off value, we documented 64.7% sensitivity (95% confidence interval [CI], 56.9–71.9%), 66.7.0% specificity (95% CI, 48.2–82.0%), 90.8% positive predictive value (PPV; 95% CI, 85.6–94.2%), and 27.2% negative predictive value (NPV; 95% CI, 21.4–33.9%). On establishing a CAHP cut-off value, we observed 68.2% sensitivity (95% CI, 60.2–75.5%), 80.6% specificity (95% CI, 62.5–92.6%), 94.6% PPV (95% CI, 88.6%–98.0%), and 33.8% NPV (95% CI, 23.2–45.7%) for unfavorable neurologic outcomes. Conclusions. The CAHP score demonstrated better discrimination than the MIRACLE2 score, affording superior sensitivity, specificity, PPV, and NPV; however, the CAHP score remains relatively difficult to apply. Further studies are warranted to establish scores with better discrimination and ease of application.
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Moiemen, Naiem, Jonathan Mathers, Laura Jones, Jonathan Bishop, Philip Kinghorn, Mark Monahan, Melanie Calvert, et al. "Pressure garment to prevent abnormal scarring after burn injury in adults and children: the PEGASUS feasibility RCT and mixed-methods study." Health Technology Assessment 22, no. 36 (June 2018): 1–162. http://dx.doi.org/10.3310/hta22360.
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Background Eleven million people suffer a fire-related injury worldwide every year, and 71% have significant scarring. Pressure garment therapy (PGT) is a standard part of burn scar management, but there is little evidence of its clinical effectiveness or cost-effectiveness. Objective To identify the barriers to, and the facilitators of, conducting a randomised controlled trial (RCT) of burn scar management with and without PGT and test whether or not such a trial is feasible. Design Web-based surveys, semistructured individual interviews, a pilot RCT including a health economic evaluation and embedded process evaluation. Setting UK NHS burns services. Interviews and the pilot trial were run in seven burns services. Participants Thirty NHS burns services and 245 staff provided survey responses and 15 staff participated in individual interviews. Face-to-face interviews were held with 24 adult patients and 16 parents of paediatric patients who had undergone PGT. The pilot trial recruited 88 participants (57 adults and 31 children) who were at risk of hypertrophic scarring and were considered suitable for scar management therapy. Interviews were held with 34 participants soon after recruitment, with 23 participants at 12 months and with eight staff from six sites at the end of the trial. Interventions The intervention was standard care with pressure garments. The control was standard care comprising scar management techniques involving demonstration and recommendations to undertake massage three or four times per day with moisturiser, silicone treatment, stretching and other exercises. Main outcome measures Feasibility was assessed by eligibility rates, consent rates, retention in allocated arms, adherence with treatment and follow-up and completion of outcome assessments. The outcomes from interview-based studies were core outcome domains and barriers to, and facilitators of, trial participation and delivery. Results NHS burns services treat 2845 patients per annum (1476 paediatric and 1369 adult) and use pressure garments for 6–18 months, costing £2,171,184. The majority of staff perceived a need for a RCT of PGT, but often lacked equipoise around the research question and PGT as a treatment. Strong views about the use of PGT have the potential to influence the conduct of a full-scale RCT. A range of outcome domains was identified as important via the qualitative research: perceptions of appearance, specific scar characteristics, function, pain and itch, broader psychosocial outcomes and treatment burden. The outcome tools evaluated in the pilot trial did not cover all of these domains. The planned 88 participants were recruited: the eligibility rate was 88% [95% confidence interval (CI) 83% to 92%], the consent rate was 47% (95% CI 40% to 55%). Five (6%) participants withdrew, 14 (16%) were lost to follow-up and 8 (9%) crossed over. Adherence was as in clinical practice. Completion of outcomes was high for adult patients but poorer from parents of paediatric patients, particularly for quality of life. Sections on range of movement and willingness to pay were found to be challenging and poorly completed. Limitations The Brisbane Burn Scar Impact Profile appears more suitable in terms of conceptual coverage than the outcome scales that were used in the trial but was not available at the time of the study. Conclusions A definitive RCT of PGT in burn scar management appears feasible. However, staff attitudes to the use of pressure garments may lead to biases, and the provision of training and support to sites and an ongoing assessment of trial processes are required. Future work We recommend that any future trial include an in-depth mixed-methods recruitment investigation and a process evaluation to account for this. Trial registration Current Controlled Trials ISRCTN34483199. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 22, No. 36. See the NIHR Journals Library website for further project information
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Yaacobi, Dafna (Shilo), Yehiel Hayun, Lior Har-Shai, Arik Litwin, and Dean D. Ad-El. "Epidemiology of Burn Wounds Arriving to a Level 1 Trauma Center in Israel." Journal of Burn Care & Research 41, no. 2 (August 29, 2019): 317–21. http://dx.doi.org/10.1093/jbcr/irz160.
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Abstract Burn injuries have grave consequences for patients and impose a heavy economic burden on healthcare services. Studies on the epidemiology of burn injury in Israel are sparse and outdated, and improved understanding of current trends can help experts plan prevention campaigns and design effective treatment paradigms. This study sought to assess the background, clinical, and treatment characteristics of adult patients admitted with burn injury to a level 1 trauma center in Israel in 2005 to 2017. Data were retrospectively retrieved from the hard copy and electronic files as follows: patient sex and age; burn type, degree, and etiology; percentage total BSA (%TBSA) affected; and type of treatment and length of hospital stay (LOS). The cohort included 734 patients of mean age 41.79 years and a male-to-female ratio of 1.8:1. Thermal factors, particularly hot liquids, were the most common cause; second-degree burns were the most common. Mean %TBSA was 5.39%; mean LOS was 11.81 days; and mean LOS/%TBSA was 4.65. Advanced dressings alone yielded satisfactory outcome in 74.2% of patients. The relatively younger patient age and male predominance of our cohort were in line with published findings. The LOS was similar to previous studies in Israel but lower than in Europe. The LOS/%TBSA was higher than in the literature, with a decrease over time suggesting an increased effectiveness of treatment. There appears to be a decline in the rate of surgery for burn injury and increased expertise in the use of advanced dressings. National prevention campaigns should focus on scalds rather than flame-induced burns.
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Rose, Amanda, Alan D. Gilbertson, Heather Belacic, and John Crow. "611 Screening Adults for Depression and Suicidality in an Outpatient Burn Center." Journal of Burn Care & Research 41, Supplement_1 (March 2020): S149—S150. http://dx.doi.org/10.1093/jbcr/iraa024.237.
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Abstract Introduction In response to NIH recommendations and ABA verification standards, a protocol was initiated to screen adult burn patients in an outpatient verified burn center for depression and suicidality. It utilized the Patient Health Questionnaire (PHQ-9), a widely recognized depression screening tool. The protocol dictated patients scoring 10 or greater, or endorsing the suicide risk question would require further assessment. This project was part of a quality improvement initiative to assess initiating the protocol, identifying at-risk patients, and making appropriate referrals. Methods The initial visit of adults (ages 19 and over) seen over a one year period were retrospectively reviewed. For adults screening positive in the EMR, a Data Collection Form was completed gathering information on PHQ-9 scores, mental health treatment and diagnosis, and burn injuries. Results There were 748 adults seen for an initial visit at the burn center, ages 19–85, 61% men and 39% women. Of those patients, 572 had a PHQ-9 score documented in the EMR, demonstrating a 76% compliance rate with administration. Of those screened, 52 met criteria for inclusion by scoring 10 or greater or endorsing the suicide risk question on the PHQ-9. Scoring ranges on the PHQ-9 were as follows (N=52): 15.4% mild; 50% moderate; 19.2% moderate-severe; and 15.4% severe. Sixty percent of patients endorsed some suicidal ideation. Fifty two percent of patients were documented clearly as being on psychotropic medication or in specialized mental health services. Results were reviewed or discussed with patients in 81% of the initial visit notes. Nineteen of the 52 patients were offered a referral for mental health services. Conclusions Initiating this protocol creates an opportunity to begin conversations about mental health and offer additional support to patients. Approximately 9% of the outpatients screened at the burn center endorsed significant symptoms of depression and or suicidal ideation. Nearly half of these patients were not actively receiving treatment for these symptoms and could potentially benefit from mental health services. This project highlighted that compliance with administering and documenting the PHQ-9 and referral for follow-up services could be improved at this institution. Applicability of Research to Practice This protocol supports the need for continued evaluation and screening for depression and suicide risk in adult burn patients. Consideration should be given for monitoring other mental health conditions that could create barriers to care or compliance with treatment, such as anxiety, PTSD, psychosis, etc.
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Guest, Julian F., Graham W. Fuller, and Jacky Edwards. "Cohort study evaluating management of burns in the community in clinical practice in the UK: costs and outcomes." BMJ Open 10, no. 4 (April 2020): e035345. http://dx.doi.org/10.1136/bmjopen-2019-035345.
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ObjectiveTo evaluate health outcomes, resource use and corresponding costs attributable to managing burns in clinical practice, from initial presentation, among a cohort of adults in the UK.DesignRetrospective cohort analysis of the records of a randomly selected cohort of 260 patients from The Health Improvement Network (THIN) database who had 294 evaluable burns.SettingPrimary and secondary care sectors in the UK.Primary and secondary outcome measuresPatients’ characteristics, wound-related health outcomes, healthcare resource use and total National Health Service (NHS) cost of patient management.ResultsDiagnosis was incomplete in 63% of patients’ records as the location, depth and size of the burns were missing. Overall, 70% of all the burns healed within 24 months and the time to healing was a mean of 7.8 months per burn. Sixty-six per cent of burns were initially managed in the community and the other 34% were managed at accident and emergency departments. Patients’ wounds were subsequently managed predominantly by practice nurses and hospital outpatient clinics. Forty-five per cent of burns had no documented dressings in the patients’ records. The mean NHS cost of wound care in clinical practice over 24 months from initial presentation was an estimated £16 924 per burn, ranging from £12 002 to £40 577 for a healed and unhealed wound, respectively.ConclusionsDue to incomplete documentation in the patients’ records, it is difficult to say whether the time to healing was excessive or what other confounding factors may have contributed to the delayed healing. This study indicates the need for education of general practice clinicians on the management and care of burn wounds. Furthermore, it is beholden on the burns community to determine how the poor healing rates can be improved. Strategies are required to improve documentation in patients’ records, integration of care between different providers, wound healing rates and reducing infection.
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Chandramouli, Mathangi A., Jamie Heffernan, Angela Rabbitts, and Philip Chang. "756 Homeless and Burned – A Retrospective Analysis of an Especially Challenged Patient Population." Journal of Burn Care & Research 41, Supplement_1 (March 2020): S212. http://dx.doi.org/10.1093/jbcr/iraa024.337.
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Abstract Introduction The undomiciled burned patient presents more challenges to the burn team with regards to safe disposition. Discharge planning is complicated by the lack of a safe, clean environment to perform requisite wound care, thus prolonging hospital stays. The purpose of our study was to analyze the homeless patients admitted to a major urban burn center. This data would then better help identify trends and characteristics that could inform development of support services for this unfortunate population. Methods Demographic and clinical data from inpatients was collected from a single urban ABA verified burn center over a 3 year period between 1/2016 and 12/2018. Simple descriptive statistical analysis was performed. Results 1985 patients were admitted over the 3 year period. 48 homeless patients were identified (2.4%). The average age of this population was 39.8±16.8 years (range 3 months to 63 years old). There were 5 children (10.4% of the homeless cohort) in this population (ranging from 3 months to 4 years of age). Only 2 homeless burn inpatients were greater than 60 years of age (2% of the homeless cohort). There were 15 females (31%) and 33 males (69%). The mean TBSA was 5.8±9.9%. The average length of hospital stay was 21.9±29 days. 27 of the 48 patients (56%) required operative treatment. The 3 most common etiologies of skin injury were flame burns (29%), scald burns (25%), and cold injury (19%). The vast number of patients (39 out of 48, 81%) were discharged back to “their previous condition” (i.e. homeless shelter or the streets). There was 1 mortality in this group. Conclusions Contrary to widespread assumptions about the homeless being overwhelmingly male and adult, a significant percentage of the homeless burn patients were female with a percentage of patients being pediatric as well. The length of stay was significantly longer for most patients given the relatively small average size of burn injury. Cold injury was more significant etiology in this population compared to the overall burn population. Applicability of Research to Practice This analysis of the undomiciled burn inpatient at a single urban burn center will help better describe this especially challenging population and help focus social support and discharge planning resources for this group.
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Moser, William J., Kristen R. Bilka, Sebastian Q. Vrouwe, Jill Glick, and Veena Ramaiah. "60 Running Water While Bathing Is a Risk Factor for Pediatric Scald Burns." Journal of Burn Care & Research 43, Supplement_1 (March 23, 2022): S42. http://dx.doi.org/10.1093/jbcr/irac012.063.
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Abstract Introduction Scalds are the most common mechanism of burn in children, and a significant proportion of these injuries are associated with bathing. Burns sustained while bathing present a unique opportunity for injury prevention; previous studies have examined lowering water heater temperatures, however reputable infant bathing educational resources do not explicitly recommend avoiding running water and the risks that it could pose. In an effort to inform prevention programs, this study seeks to determine the incidence and circumstances of running water in bathing scald burns at our institution. Methods A retrospective review was performed of records from an American Burn Association verified center over a ten year period (1/1/2010 to 12/31/2019). This center treats both children and adults and is affiliated with an academic hospital in a major urban center. The burn database was queried for scald injuries in children less than three years involving bathing. The Child Advocacy and Protective Services team provides inpatient consultation for all children less than three years old with burn injuries allowing us to analyze the specific events surrounding the bathing scald burns in this cohort. Results A total of 123 patients met inclusion criteria. Three bathing safety risk factors were specifically noted in the chart review: (1) running water, (2) lack of caregiver presence for duration of bathing, and (3) failure of caregiver to check water temperature before bathing. Of the cases identified, 107 (87%) had clear documentation of running water as part of the history of injury, 66 (54%) cases involved failure of caregiver to check the water temperature before bathing and 53 (43%) cases did not have a caretaker present for the duration of the bath. In cases with only one risk factor, running water was identified in 34 (94%) out of 36 cases, and in cases with one or two risk factors, running water remained the primary risk factor with 38 (90%) out of 42 cases. When looking at the combination of risk factors, only three (2%) cases had no risk factors while 77 (63%) involved two or more risk factors. Conclusions The vast majority of bathing burn injuries in this series involved running water. In addition, a significant number of scald burns occurred from running water alone, even without the other identified risk factors. Conversely, only 2% of scald burns associated with bathing featured none of these three risk factors, suggesting that these injuries could be greatly impacted by safe bathing education.
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Duchin, Emma R., Megan Moore, Gretchen J. Carrougher, Emily K. Min, Debra B. Gordon, Barclay T. Stewart, Jody Sabel, Anne Jo-Nes, and Tam N. Pham. "123 Burn Patients’ Pain Experiences and Perceptions at a Regional Burn Center." Journal of Burn Care & Research 41, Supplement_1 (March 2020): S82—S83. http://dx.doi.org/10.1093/jbcr/iraa024.126.
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Abstract Introduction Burns are often painful injuries, associated with a long recovery. Little is known about patients’ pain experience or understanding of burn pain. Patients may also not be receiving sufficient pain education to optimize their pain experience. The aim of this project was to obtain patients’ perspectives to inform future burn pain education efforts at a regional burn center. Methods We conducted mixed-methods interviews in inpatient and outpatient units. Participants were >=14 years with acute burn injury, who received at least two wound care episodes, and were able to cognitively participate. Provider stakeholders designed the interview using a modified Delphi technique. Survey questions focused on patients’ pain experiences, understanding and desire to gain knowledge of burn pain and management. Descriptive quantitative analysis was performed on categorical data. Recorded interview segments were transcribed for content analysis using an online, HIPAA-compliant software. Results We interviewed 21 adult burn patients. Participants reported variable pain and pain management effectiveness, with inpatients reporting more severe pain than outpatients. Only 11% of inpatients reported having received enough pain information, compared to 50% of outpatients. Participants expressed, in decreasing order of importance, a need for more information on burn-related pain, medications and alternative treatments, analgesic weaning, and addiction risk. In-person education ranked as the most desirable education method, followed by pamphlets and video education. Qualitative content analysis yielded 3 major themes: patient’s pain experience, range of expectations, and clinical information/services desired. Mental and physical effects were key parts of participants’ pain experiences, with many participants reporting mental anguish in addition to pain. Most participants’ pain expectations were matched by their experience, while some individuals described higher pain levels than they anticipated. Positive experiences with the burn care team primarily revolved around provided education and information on pain, whereas negative experiences concentrated on wound care events. Participants desired more information on sleep and pain medications, realistic expectations of recovery timelines, and available mental health services. Conclusions Burn patients report variable pain experiences and a strong desire to receive additional pain education. This project informs key strategies to educate burn patients on pain. A high-level of interest in pain, pharmacologic and alternative therapies, weaning and addiction risks indicates a need for newer targeted education materials. Applicability of Research to Practice Burn patients’ perspectives help inform strategies and content creation for education materials that burn centers can provide.
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Broers, Michelle, Jodi Wojcik, and Lindsey k. Journey. "579 Benefits of Licensed Clinical Social Worker Utilization in an Adult Burn Clinic: More Than Just Checking the Box." Journal of Burn Care & Research 42, Supplement_1 (April 1, 2021): S141. http://dx.doi.org/10.1093/jbcr/irab032.229.
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Abstract Introduction Our burn institution cares for critically ill burn patients and provides post-acute care for a large referral base. The clinic is staffed by a wound certified physical therapist, an advanced practice registered nurse and a licensed clinical social worker (LCSW), with consult access to Trauma/Burn Surgeons. The incidence of acute stress symptoms after burn injury is noted in up to 35% to 40% of patients. Therefore, it is important to identify symptoms of anxiety and depression early and begin symptom management. Burn patients have access to a multi-disciplinary team, and a licensed therapist, that can identify symptoms of acute stress and make recommendations for appropriate treatment in concert with the medical staff. This project seeks to determine the prevalence of acute stress in post-acute burn patients seen in an adult burn clinic and the benefits of utilizing a Licensed Clinical Social Worker to perform screening. Methods For a one-year period all burn patients in the burn clinic were screened by the LCSW. The subjects underwent initial screenings for depression, anxiety, and suicide risk at their first clinic visit. The PHQ-2 and PHQ-9 were utilized to assess depression, the GAD-7 for anxiety and the Columbia Suicide scale to assess suicide risk. Patients were initiated into multi-modal therapies based on specific scoring. These intervention strategies were based on the Depression Screening Protocol which included education on depression, and/or anxiety, with or without participation in a Trauma/Burn Peer Support Group. Patients were prescribed medication per provider discretion, and/or connected to community resources such as, counseling, and psychiatric mental health services. Results During the one-year assessment period screening compliance was >90%. During this period, >50% of patient’s scores were clinically significant for acute stress. Over half of those that screened positive were connected to community resources of counseling services or psychiatric care. 100% of those that screened positive were given education and connection to peer support services. An incidental correlation was noted between increased total body surface area involvement and work-related accidents with increased symptomology. Conclusions The inclusion of an LCSW in the burn clinic has improved the overall care of the burn injured patient. The assessment of depression and anxiety related to the burn injury has led to an increase in peer support participation and an increase in referrals to counseling and/or psychiatric services.
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Gayed, Rita, Kristen Robinson, Annalise Labatut, and Rohit Mittal. "518 Prescribing practices of atypical antipsychotics in the burn ICU." Journal of Burn Care & Research 43, Supplement_1 (March 23, 2022): S94—S95. http://dx.doi.org/10.1093/jbcr/irac012.149.
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Abstract Introduction Atypical antipsychotics are commonly used in the management of agitation and delirium in the intensive care unit (ICU). Patients admitted to the burn intensive care unit (BICU) with burns with large total body surface involvement ( >20%) require prolonged mechanical ventilation and prolonged ICU stay, putting them at risk of ICU delirium. Furthermore, patients with burn injuries often have underlying psychiatric conditions, and some can develop new psychiatric disorders secondary to the trauma associated with their burn. Due to these factors many burn patients receive scheduled oral atypical antipsychotics during their ICU stay. The purpose of this study was to retrospectively characterize the prescribing practices of atypical antipsychotics in the BICU. Methods This was a single-center, retrospective chart review of adults admitted to the BICU with a burn injury who received scheduled oral atypical antipsychotics. Prescribing patterns in the ICU and on all transitions of care were analyzed. Additionally, the appropriateness of AAP prescribing at discharge was evaluated. AAPs were considered to be appropriately prescribed at discharge if a patient was continuing a home medication, or if psychiatric consult services recommended continuing at discharge. Results During the five year study period, 440 adults were admitted to the BICU with a burn injury, 18.2% of which were prescribed an AAP during their ICU course. Of those prescribed an AAP, 28.8% had a documented underlying psychiatric condition. Most patients were male (70%) with an average age of 41 years, and a mean total body surface area burn of 32%. The average ICU length of stay was 32 days. AAPs were primarily used to treat agitation/delirium (72.5% of patients). Quetiapine was the most commonly prescribed AAP. On transfer to stepdown, AAPs were continued in 78.4% of patients. Additionally, 67.7% were discharged on an AAP. Of these patients, continuation was considered appropriate in 54% of patients. Conclusions Despite overall lower AAP prescribing in the burn ICU compared to other ICUs, over two thirds of patients initiated on AAPs in the BICU were prescribed AAPs at discharge. AAPs should be evaluated for appropriateness at each transition of care.
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Yelvington, Miranda L., and Gretta E. Wilkinson. "507 Burn Survivor Perspectives On a “Virtual” Survivor Retreat." Journal of Burn Care & Research 42, Supplement_1 (April 1, 2021): S100—S101. http://dx.doi.org/10.1093/jbcr/irab032.158.
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Abstract Introduction The social distancing restrictions mandated by the COVID-19 pandemic have directly impacted burn survivor support groups. Around the country, Pediatric Camps and Adult Support groups have been canceled or moved to an alternate format. While these alternative methods provide much-needed support and interaction for burn survivor groups, it is unknown how they compare to traditional, in-person support programs. In November 2020, our facility will replace our traditional Adult Burn Survivor Retreat with an entirely virtual, synchronous retreat. The retreat will feature many of the sessions and experiences from the in-person retreat but will be lacking the face-to-face contact that is so valued by our Adult Survivor Group. Educational sessions will be provided by adult psychologists and social workers, burn therapists and nurses. An adult burn survivor will provide the keynote address. Adult burn survivors, who have participated in prior year’s retreats, will be invited to participate in a comparison feedback survey. Methods Participants in the Virtual Adult Survivor Retreat will complete a post-retreat survey, comparing the virtual retreat experience to the traditional in-person retreat format. Likert scale questions will address participation level, benefit of retreat, specific feedback for sessions and ease of ability for survivors to interact with peers. In addition, the survey will seek to identify barriers of the virtual format as a means of providing needed survivor support. Results Survey results will be analyzed, and trends will be reported. Statistically significant results can be further explored to guide future virtual events. Conclusions Virtual events utilizing video platforms have become commonplace in the era of COVID-19, however, this format is still new, and the benefits have not been fully explored. Evidence has shown a direct benefit to survivors participating in support services. In an attempt to fill the gap left by the cancelation of in-person events, our facility is hosting a synchronous virtual retreat for adult burn survivors. Retreat evaluation and data comparing the virtual event to prior in-person events will be analyzed and reported.
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Head, William T., Denise Garcia, Rupak Mukherjee, Steven Kahn, and Aaron Lesher. "Virtual Visits for Outpatient Burn Care During the COVID-19 Pandemic." Journal of Burn Care & Research 43, no. 2 (October 23, 2021): 300–305. http://dx.doi.org/10.1093/jbcr/irab202.
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Abstract Burn-injured patients must frequently travel long distances to regional burn centers, creating a burden on families and impairing clinical outcomes. Recent federal policies in response to the coronavirus pandemic have relaxed major barriers to conducting synchronous videoconference visits in the home. However, the efficacy and benefits of virtual visits relative to in-person visits remained unclear for burn patients. Accordingly, a clinical quality assurance database maintained during the coronavirus pandemic (3/3/2020 to 9/8/2020) for virtual and/or in-person visits at a comprehensive adult and pediatric burn center was queried for demographics, burn severity, visit quality, and distance data. A total of 143 patients were included in this study with 317 total outpatient encounters (61 virtual and 256 in-person). The savings associated with the average virtual visit were 130 ± 125 miles (mean ± standard deviation), 164 ± 134 travel minutes, $104 ± 99 driving costs, and $81 ± 66 foregone wage earnings. Virtual visit technical issues were experienced by 23% of patients and were significantly lower in pediatric (5%) than in adult patients (44%; P = .006). This study is the first to assess the efficacy of synchronous videoconference visits in the home setting for outpatient burn care. The findings demonstrate major financial and temporal benefits for burn patients and their families. Technical issues remain an important barrier, particularly for the adult population. A clear understanding of these and other barriers may inform future studies as healthcare systems and payors move toward improving access to burn care through remote healthcare delivery services.
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DiPaolo, Nicola, Ian F. Hulsebos, Jeremy Yu, Justin Gillenwater, and Haig A. Yenikomshian. "561 Ethnicity Influences Outcomes of Adult Burn Patients." Journal of Burn Care & Research 43, Supplement_1 (March 23, 2022): S116—S117. http://dx.doi.org/10.1093/jbcr/irac012.189.
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Abstract Introduction Outcomes of burn survivors is a well-studied field of research for burn providers; however, there has been little data comparing the outcomes of burn survivors by ethnicity. This study seeks to identify any disparities in burn outcomes of broad ethnic groups. Adjustment was made for demographic, social and pre-hospital clinical factors to help isolate ethnic disparities that might not be explainable by other factors. Methods A retrospective chart review of an American Burn Association verified burn center identified adult inpatient admissions from 2015 to 2019 with documented insurance status. A total of 1142 patients were categorized by recorded primary ethnicity: 142 Black (or African American), 72 Asian, 479 Hispanic (or Latinx), 90 white, 215 other, and 144 patients whose race or ethnicity was not indicated. Firth logistic regression was used to study the relationship between ethnicity and each of several binary outcomes. Zero-truncated negative binomial regression was used to examine hospital length of stay (LOS) and intensive care unit LOS. Adjustment was made for several confounders (age, gender, homelessness, primary insurance type, diabetes, inhalation injury, primary burn depth, percentage of total body surface area injured) to clarify the statistical effect of ethnicity. The specific adjustment set used depended on the outcome type or frequency. Results Relative to white patients, surviving Black patients had an estimated 29% higher average hospital LOS (ratio 1.29; 95% CI 1.01-1.64; unadjusted P=.04). Had the average surviving patient in this sample been Black, their hospital stay would be 2.7 days longer (95% CI 0.1-5.4). Relative to white patients, the odds of being discharged home with or without services, or to hospice care, were an estimated 123% higher for Hispanic patients (OR 2.23; 95% CI 1.28-3.88; unadjusted P=.005). Compared with non-Hispanic ethnicity, Hispanic ethnicity was associated with a 44% decrease in the odds of discharge to acute care, inpatient rehabilitation, or a ward outside the burn unit (OR 0.56; 95% CI 0.34-0.92; unadjusted P=.022). Black and Hispanic patients had a higher relative chance of having publicly assisted insurance, versus private insurance, than their white counterparts (P=.041, P=0.011 respectively). Conclusions Even when controlling for burn severity, age, and other factors, Black patients had longer hospital stays. Hispanic patients were more likely to be discharged to home or to hospice care. The causes of these disparities are indeterminate. They may stem from socioeconomic status not entirely accounted for, ethnic differences in comorbidity related to stressors, or inequity in health care delivery or insurance coverage.
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Griffin, Bronwyn R., Cody Frear, Ed Oakley, and Roy M. Kimble. "57 Cool Running Water First Aid Decreases Skin Grafting Requirements in Pediatric Burns: A Cohort Study of 2495 Children." Journal of Burn Care & Research 41, Supplement_1 (March 2020): S38. http://dx.doi.org/10.1093/jbcr/iraa024.061.
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Abstract Introduction First-aid guidelines recommend the administration of cool running water in the early management of thermal injury. Our objective was to analyze the associations between first aid and skin grafting requirements in children with burns. Methods This cohort study utilized a prospectively collected registry of patients managed at a tertiary children’s hospital. Multivariate logistic regression models were used to evaluate the relation ship between first aid and the requirement for skin grafting. Secondary outcomes included time to re-epithelialization, wound depth, hospital admission and length of stay, and theater interventions. Adequate first aid was defined as 20 minutes of cool running water within three hours of injury. Results In our cohort of 2495 children, 2259 (90.6%) received first aid involving running water, but only 1780 (71.3%) were given the adequate duration. A total of 236 (9.5%) children required grafting. The odds of grafting were decreased in the adequate first aid group (OR 0.6, 95% CI 0.4 to 0.8). The provision of adequate running water was further associated with reductions in the full-thickness depth (OR 0.4, 95% CI 0.2 to 0.6), hospital admission (OR 0.7, 95% CI 0.5 to 0.9) and theater operations (OR 0.7, 95% CI 0.5 to 0.9), but not hospital length of stay (HR=0.9, 95% CI 0.7 to 1.2, p=0.48). Conclusions Burn severity and clinical outcomes improved with the administration of cool running water. Adequate first aid must be prioritized by pre-hospital and emergency services in the preliminary management of pediatric burns. Applicability of Research to Practice Although children are at particularly high risk of burn injuries there was a paucity of literature addressing the relationship between burn first aid and clinical outcomes in pediatric populations. Due to differences in volume, surface area and skin thickness it was unknown whether benefits in adults applied to children. This study supports the prioritization of the administration of cool running water for 20 minutes to be adhered to immediately after a pediatric burn to decrease the severity and improve patient outcomes.
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Englefield, Bruce, Melissa Starling, and Paul McGreevy. "A review of roadkill rescue: who cares for the mental, physical and financial welfare of Australian wildlife carers?" Wildlife Research 45, no. 2 (2018): 103. http://dx.doi.org/10.1071/wr17099.
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The non-human animal deaths and injuries that result from collisions with motor vehicles are known colloquially as roadkill, and often lead to individuals from various taxa being orphaned. The complexities of multiple spatial and temporal variables in the available data on Australian roadkill and the scale of orphaning and injury make statistical analysis difficult. However, data that offer proxy measures of the roadkill problem suggest a conservative estimate of 4 million Australian mammalian roadkill per year. Also, Australian native mammals are mainly marsupial, so female casualties can have surviving young in their pouches, producing an estimated 560 000 orphans per year. A conservative estimate is that up to 50 000 of these are rescued, rehabilitated and released by volunteer wildlife carers. These roadkill-associated orphans are in addition to those produced by other anthropogenic and natural events and the injured adult animals in the care of volunteers. In accepting total responsibility for rescued animals, wildlife carers face many demands. Their knowledge base can require days of initial instruction with the need for continual updates, and their physical abilities and personal health can be tested by sleepless nights, demanding manual tasks and zoonoses. This review article explores the impact of this commitment and conservatively estimates carers’ financial input to raise one joey at approximately $2000 a year, and their time input at 1000 h, equating to $31 000 per year, applying a dollar value of $31 per hour. It categorises relevant types of grief associated with hand-rearing orphans and rehabilitating injured animals, and suggests that wildlife carers most likely experience many types of grief but are also susceptible to burn-out through compassion fatigue. A perceived lack of understanding, empathy and appreciation for their work by government can add to the stressors they face. Volunteering is declining in Australia at 1% per year, social capital is eroding and the human population is aging, while the number of injured and orphaned animals is increasing. Wildlife carers are a strategic national asset, and they need to be acknowledged and supported if their health and the public service they provide is not to be compromised.
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Cheung, Y. F., M. Gomez, J. M. Banfield, J. S. Fish, R. Cartotto, and M. Beveridge. "A Public Service Announcement to Promote Burn Prevention among Older Adults." Journal of Burn Care & Rehabilitation 23 (March 2002): S173. http://dx.doi.org/10.1097/00004630-200203002-00258.
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Tiani, Alaina, Desiree N. Williford, Carrie B. Jackson, Kristine Durkin, Ariana Langholz, Gina Hajduk, Ariel Aballay, and Christina Duncan. "810 Routine Psychosocial Screening and Follow-up of Adult Burn Patients in an Outpatient Clinic." Journal of Burn Care & Research 41, Supplement_1 (March 2020): S243—S244. http://dx.doi.org/10.1093/jbcr/iraa024.387.
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Abstract Introduction Sustaining a burn injury is associated with increased risk of mental health issues, and common among these are depression, anxiety, post-traumatic stress disorder (PTSD), and substance use. Unfortunately, less than half of these adult burn survivors receive services related to their mental health concerns. Moreover, few studies have examined the routine implementation of a psychosocial screener in an outpatient burn clinic setting, and there is a paucity of research which examines how to proceed when patients endorse symptomology. The aim of the current study is to report on outcomes of a routine psychosocial screener in a sample of adult burn survivors and patient response to brief psychological consultation at initial screen and 1-month follow-up. Methods A psychosocial screener was developed and implemented (October 2016-August 2019) in an outpatient burn clinic to identify patients who endorse clinically significant psychosocial distress. Comprised of very brief, validated scales (and their clinical cut-off scores), the screener assessed for safety at home, suicidal risk, depression, anxiety, and substance use. Adult burn survivors completed the questionnaire at their first outpatient appointment. Patients who endorsed safety concerns at home and/or suicidal ideation/risk were immediately evaluated by a physician or psychology staff. Those who endorsed significant distress, but no suicidal or safety risk, were contacted by psychology staff within one week of the screener date. Those who did not indicate significant clinically significant distress did not require further action. Results Of the 393 patients who completed the screener, 102 individuals (26%) indicated clinically significant mental/behavioral distress. Psychology staff were able to reach 80 patients (78%) for initial brief consultation (i.e., within one week). Of those contacted, 14 (18%) indicated that they were already receiving psychological services, 25 (31%) reported they were not interested in a psychological referral, 20 (25%) accepted a new referral for psychological services, and 19 (24%) endorsed minimal or decreased symptoms. In February 2019, we began to conduct 1-month follow-up. A total of 19 individuals were eligible (had positive screens) and 8 (42%) were reached. Of those reached, 2 (25%) accepted a new psychological referral, 2 (25%) indicated no interest in a referral, and 3 (37%) reported minimal/no psychological symptoms. Conclusions Implementing a psychosocial screener is a feasible way to screen for distress in outpatients. Applicability of Research to Practice A 1-month follow-up contact helps staff to understand whether referrals are utilized or how symptoms may change over time and yields another opportunity to provide referrals to those previously uninterested.
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Menezes, Hana. "Building a Nurse Practitioner model at Victorian Adult Burns Service (VABS)." Journal for Nurse Practitioners 13, no. 7 (July 2017): e353. http://dx.doi.org/10.1016/j.nurpra.2017.05.087.
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