European burn journal最新文献

Background: Weight extremes are linked to morbidity, yet their impact on burn outcomes remains underinvestigated. Prior studies suggest an 'obesity paradox', showing survival benefits and better functional outcomes in obese patients.

Methods: This study used the global real-world database TriNetX to assess the association between body mass index (BMI) and clinical outcomes in adult burn patients, categorized using WHO definitions. After 1:1 propensity score matching for demographics, burn severity, and smoke inhalation injury, clinical outcomes were analyzed over a six-month period following burn injury. Outcomes included mortality, sepsis, pneumonia, acute kidney injury (AKI), cardiovascular events, graft complications, skin infections, and psychological impairment.

Results: After matching, 9736 patients were included in the underweight versus normal weight comparison, 72,274 in overweight versus normal weight, 71,195 in obesity versus normal weight, and 9732 in underweight versus obesity. Underweight patients were associated with higher mortality and increased risks of sepsis, pneumonia, cardiovascular events, and psychological impairment. Overweight and obese patients showed higher survival rates and overall better clinical outcome associations.

Conclusions: These findings are consistent with the previously described 'obesity paradox' in burn care and identify underweight burn patients as a distinct high-risk subgroup.

Introduction: Patients with major burn injuries are highly susceptible to hypothermia due to extensive skin loss, aggressive fluid resuscitation, repeated surgical procedures, and exposure during wound care. Hypothermia is associated with coagulation disorders, increased blood loss, impaired immune response, prolonged hospitalization, and increased mortality. When conventional warming strategies fail, intravascular temperature management systems may be employed, although they carry risks inherent to central venous catheters. Case Report: We report the case of a 26-year-old male with 66% total body surface area flame burns and inhalational injury, admitted to the Burns Intensive Care Unit with persistent hypothermia despite standard warming measures. An intravascular temperature management catheter was inserted via the femoral vein and successfully restored normothermia. Due to clinical instability, the catheter remained in situ beyond the recommended duration. During attempted catheter removal, significant resistance was encountered, raising concern for mechanical malfunction. Imaging confirmed catheter entrapment without fracture. Multidisciplinary management involving vascular surgery and interventional radiology enabled successful removal using endovascular snare techniques. A detached balloon fragment was identified and secured with venous stenting. Conclusions: This report describes the first documented case of complicated removal of an intravascular warming catheter due to balloon detachment in burn patients. Physicians using these devices should be aware of this possible complication and be prepared for its management.

Background: Pathological scarring (PS) following surgical procedures, burns, or trauma poses significant clinical, psychological, and socio-economic challenges. Despite the high prevalence of PS, reliable information resources are limited, often leading individuals to depend on unvalidated online sources. To address this gap, we developed MyScarSpecialist.com, an evidence-based website providing comprehensive information on scar types, characteristics, and treatment options. This study aimed to optimize the website through co-creation with patients and clinicians.

Methods: Semi-structured focus group meetings were conducted with patients and carers; sessions were recorded, transcribed, and analyzed using thematic analysis.

Results: From the 3 focus group meetings with 15 patients with scars and 3 carers, four key themes emerged: (1) Information Sources: The Role of Professionals, Peers, and Digital Media in information sharing; (2) Desired information: From scar typing to treatment outcomes to psychosocial impact; (3) Website design: Audience preferences on content layering, information load, and image positioning; (4) Readability: Optimizing content for comprehension. Participants highlighted the need for enhanced peer support and resources addressing the psychological impact of scarring.

Conclusions: These findings provide comprehensive insights for optimizing medical educational websites, ensuring inclusivity, accessibility, and empowerment for patients through co-designed strategies.

Background: Pediatric burns cause considerable morbidity and hospital resource use. Advanced dressings on moderate-degree pediatric burns that accelerate healing may offset acquisition costs by shortening length of stay (LOS).

Objective: The aim of this study was to assess the budget impact of introducing an oxygen-enriched olive-oil dressing for pediatric burns (grade I-IIG; total body surface area < 20%) at a tertiary children's hospital.

Methods: A hospital-perspective budget impact analysis was conducted according to ISPOR guidance over a 4-year horizon (2022-2025). The study population included 32 inpatients (<18 years) with non-extensive, moderate-degree burns treated between 2022 and 2023. Two scenarios were modeled: (i) standard of care (SoC) and (ii) SoC plus the oxygen-enriched olive-oil dressing (OEoD), with annual caseload projections to 2025. Costs combined treatment (dressings, drugs, and devices) and hospitalization data provided by the hospital's Control & Management Unit. The average daily hospitalization cost was €1438.99.

Results: Compared with SoC, the OEoD scenario increased per-patient dressing costs (mean €271.4 vs. €121.9) but reduced LOS (mean 7.3 vs. 16.6 days), leading to lower overall hospitalization expenditure. Total annual costs decreased by 7%, 13%, 16%, and 18% across 2022-2025, respectively (for example, 2025: €612,516 vs. €751,445; Δ -€138,929). Cumulative 4-year savings reached €337,399. Deterministic sensitivity analysis confirmed the robustness of these findings, with savings persisting under variable assumptions.

Conclusions: Despite higher acquisition costs, oxygen-enriched olive-oil dressings were associated with shorter LOS and meaningful budget savings in pediatric burn care. These results support their integration into multidisciplinary burn management pathways and call for further prospective multicenter validation.

Accurate documentation of burn wounds is essential for evaluating treatment outcomes and monitoring healing progression. Traditional two-dimensional (2D) photography remains the clinical standard but lacks depth and volumetric accuracy. Three-dimensional (3D) scanning offers enhanced visualization of wound morphology and tissue vitality, potentially improving objectivity in burn assessment. This study compares two handheld 3D scanning systems-Artec Eva and Revopoint Miraco-in documenting acute and healing burn wounds, using standard clinical photography as the reference. Fifteen patients with second-degree and third-degree burns were prospectively examined at the Burn Unit of AGEL Hospital Košice-Šaca, with five representative cases selected for detailed analysis. For each patient, clinical photographs and paired 3D scans were obtained under standardized conditions and evaluated for color fidelity, wound margin clarity, representation of epithelialisation islands, necrotic tissue, and correlation with clinical findings. Across all cases, Artec Eva demonstrated superior color accuracy, clearer wound delineation, and more realistic visualization of tissue vitality and re-epithelialisation. Revopoint Miraco reliably captured wound shape but produced darker tones and exaggerated surface relief, occasionally distorting depth perception. Overall, both systems successfully identified key healing features; however, Artec Eva provided more clinically accurate and visually consistent results. Three-dimensional scanning represents a valuable adjunct to conventional burn documentation.

Background: A childhood burn presents new and unfamiliar challenges to patients and their parents during recovery. These injuries can negatively impact activities such as independence in self-care, participation in physical activity, and social interaction. As such, pediatric burn patients are at risk of poorer quality of life (QoL) outcomes after their burn. In this longitudinal, observational cohort study, we examined the social, demographic, and clinical factors that were associated with a poor QoL at 12 months postburn for pediatric patients aged > 2 years with non-severe burns in Western Australia. Methods: Inpatients were recruited from the pediatric burn unit at Perth Children's Hospital in Western Australia between February 2021 and September 2022. Demographic and family information (age, sex, postcode, parental education, languages spoken at home) and clinical data (burn cause, TBSA%, location, surgical interventions, length of stay) were collected at baseline. At 6 and 12 months, caregivers completed the Brisbane Burn Scar Impact Profile (BBSIP). Results: A total of 37 caregivers completed the Brisbane Burn Scar Impact Profile (BBSIP). For the child's QoL, 57% of caregivers reported that some impact remained for overall QoL, 32% for sensory intensity, 46% for sensitivity, 22% for daily living (22%), and 19% for emotional reactions. Parent worry was impacted in 46% of caregivers. Being female was associated with greater long-term impacts, particularly in overall functioning and parental worry. The burn location also influenced outcomes, with injuries to the upper limbs linked to higher sensory intensity and emotional impact. Children from culturally and linguistically diverse (CaLD) backgrounds, indicated by those speaking a language other than English at home (LOTE), demonstrated significantly greater effects across several domains, including overall impact, daily living, appearance, and parent worry. Conclusions: A substantial proportion of children continued to experience impacts from non-severe burns across multiple domains, indicating that even small-area burns can have lasting effects. The factors associated with worse scores were the child being female, the families being linguistically diverse, and upper body burns.

Objective: To identify key predictors of clinical outcomes in burn survivors and clarify the role of mixed-depth burns and confounding by indication in observational rehabilitation research.

Design: Retrospective cohort study using data from a burn rehabilitation registry (January 2024 to July 2025).

Setting: Burn rehabilitation center.

Participants: 120 adult patients (age ≥ 18 years) with burns affecting ≥1% total body surface area (TBSA) and complete baseline data.

Interventions: Not applicable.

Main outcome measures: Primary outcome was functional improvement (ΔFIM). Secondary outcomes included pain reduction (ΔPain), scar severity (Vancouver Scar Scale; VSS), Activities of Daily Living (ADL) improvement, and Range of Motion (ROM) recovery. Multivariable linear and logistic regression models were used to identify predictors.

Results: Patients achieved significant improvements in function (mean ΔFIM = 11.3 ± 8.9 points) and pain (mean ΔPain = 1.28 ± 0.81). Having a mixed-depth burn was the strongest predictor of worse scar outcomes (β = 2.52, 95% CI: 0.93 to 4.12, p = 0.002) and failure to achieve full ROM (OR = 0.089, 95% CI: 0.008 to 0.930, p = 0.043). An apparent association between inpatient ward care and better scar outcomes (β = -1.30, p = 0.020) was determined to be an artifact of confounding by indication, as the outpatient group had a higher proportion of high-risk mixed-depth burns (6.2% vs. 3.5%). Longer therapy duration was the only significant predictor of achieving ADL goals (OR = 1.014, 95% CI: 1.002 to 1.026, p = 0.025).

Conclusions: Injury characteristics, particularly the presence of a mixed-depth burn, emerged as the dominant predictors of long-term scar and functional outcomes. This study identifies mixed-depth burns as a potentially high-risk clinical phenotype requiring targeted therapeutic strategies and demonstrates the critical importance of accounting for confounding by indication when evaluating rehabilitation outcomes in observational burn research.

Background: Burns cause about 180,000 deaths annually and lead to substantial morbidity, especially in low- and middle-income countries. Clinical assessment of burn depth and TBSA relies on visual and bedside examination and remains subjective. Convolutional neural networks (CNNs) have been proposed to improve objectivity in image-based burn assessment, but clinical generalizability and acceptance remain uncertain. Aims: To map current evidence on CNN performance for burn TBSA, burn depth and treatment-related tasks and to explore whether a large language model (LLM) can organize extracted findings into a transparent, literature-derived orientation decision tree. Methods: We performed a scoping review following PRISMA-ScR. PubMed, Web of Science and Cochrane were searched on 5 April 2025. Eligible studies reported CNN analysis of 2D burn images and quantitative performance metrics. We summarized reported values descriptively. We then provided a structured summary of extracted findings to ChatGPT to draft a one-page orientation decision tree. Two consultant burn surgeons reviewed the figure for clarity and plausibility. Results: Of 659 records, 24 studies were included. Across studies, reported performance for TBSA and depth assessment was often high, but study designs, datasets, labels, imaging modalities and validation strategies varied substantially. High reported performance does not necessarily imply clinical robustness or real-world accuracy. A single study reported high test-set accuracy for graft versus non-graft using heavily expanded data. This value should not be generalized. Conclusions: CNNs show promise for image-based burn TBSA and depth assessment, but heterogeneity, dataset limitations and limited external validation restrict interpretation and clinical transfer. The LLM-derived decision tree is a literature-synthesis orientation figure, not a clinical decision-support tool.

Background: Burns result in approximately 180,000 deaths annually, with the majority occurring in rural regions of Africa and Southeast Asia. This study aimed to assess the available resources, key challenges, and potential solutions in burn care from the perspective of healthcare providers in India.

Methods: An online survey was conducted among burn care professionals across India. The survey was disseminated via social media platforms, burn care networks, and hospital representatives.

Results: A total of 105 respondents, primarily from tertiary care centers, participated in the survey. Of these, 64.2% were affiliated with government hospitals, and 40.1% served catchment areas extending beyond 300 km. Dedicated burn units were present in 88.0% of government hospitals, compared to 66.9% in non-government facilities. Treatment costs were significantly lower in government hospitals, with 88.8% offering care either free of charge or at minimal cost (p ≤ 0.00001).

Conclusions: The findings reveal significant gaps in staff training, intensive care monitoring, and infection prevention. Many patients initially seek help from traditional healers, often delaying appropriate treatment and worsening outcomes. Enhancing education, implementing standard monitoring practices, and ensuring adherence to clinical protocols are critical steps toward improving burn care outcomes in India.

(1) Background: Inhalation injury significantly worsens burn outcomes but lacks a standardized definition and diagnostic consensus, complicating prognosis. Existing diagnostic tools often show limited sensitivity and specificity, reducing clinical utility. This study aimed to identify potential clinical markers, recorded at or shortly after admission, for inhalation injury prognostication. (2) Methods: A retrospective cohort study of 59 burn patients admitted to Tygerberg Hospital's Burn Centre (South Africa) between 23 April 2016 and 15 August 2017 was conducted. Descriptive statistics were reported based on data type and distribution. Fisher's exact test, Spearman's rank correlation (rho), and partial least squares regression (VIP scores) assessed associations, correlations, and predictive value. p < 0.05 (two-tailed) denoted significance. (3) Results: Severe inhalation injury accounted for 61% of admissions (mean 11.2; CI = 9.5-12.9), with a 38.9% mortality rate. Significant associations (p ≤ 0.008) and positive correlations (p ≤ 0.06) were noted for total body surface area (rho = 0.357), complications (rho = 0.690), and burns intensive care unit length of stay (BICU LOS, rho = 0.908). Complications and BICU LOS showed the strongest predictive contributions (VIP = 1.229 and 1.372). Lactate (rho = 0.331, p < 0.011) and hoarseness (rho = -0.314, p < 0.015) correlated significantly but lacked association. (4) Conclusions: Findings suggest elevated lactate may serve as a prognostic marker, while BICU LOS and complications may reflect disease progression. A multi-marker approach is recommended.