Journal of Burn Care & Research最新文献

{"title":"Pilot Validation of a Standardized In- and Outpatient Data Collection Tool for Burn Injury Surveillance.","authors":"Sophia Attwells, Sara Faour, Chae Young Kim, Angeline Correia, Kariym Joachim, Eduardo Gus","doi":"10.1093/jbcr/irag073","DOIUrl":"https://doi.org/10.1093/jbcr/irag073","url":null,"abstract":"<p><p>Burn registries are critical in understanding, managing, and addressing the complexities of burn injuries and care by providing comprehensive data on injury patterns, treatment modalities, and outcomes. Current registries focus on the acute phase of inpatient burn care and lack data on outpatient and long-term treatment outcomes. This study aimed to validate the Burn Injury Surveillance Tool (BIST); a pilot electronic data collection tool designed to standardize burn data collection that includes both inpatient and outpatient data. Developed based on data dictionaries from established international registries, the tool includes six key sections capturing patient information, injury etiology, injury severity, acute treatment, quality-of-care indicators, and long-term outcomes. Validation involved two non-burn specialized participants and one burn specialized participant using the tool to extract data from 45 retrospective burn cases at the Hospital for Sick Children, Toronto, Canada. Inter-rater reliability was assessed through percent agreement and Kappa statistics. Our results indicate high percent agreement and strong inter-rater reliability for most variables, particularly patient demographics and burn characteristics. Challenges included discrepancies in subjective measures such as injury circumstances and specific total burn surface area values, which highlighted areas for tool refinement. The creation and validation of the Burn Injury Surveillance Tool provided valuable insights as of how to incorporate outpatient data into new and existing burn registries. Beyond its immediate findings, this study offers a methodological framework for validating integrated in- and outpatient datasets that can be adapted for other clinical registries, supporting more complete and interoperable burn registry designs.</p>","PeriodicalId":15205,"journal":{"name":"Journal of Burn Care & Research","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147856427","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Longitudinal Trajectories of Health-Related Quality of Life and Life Satisfaction After Major Burn Injury: A Multicenter Cohort Study.","authors":"Joseph Grobowski, Aditi Morumganti, Xinyao DeGrauw, Qian Qiu, Simrat Kaur, Carly Marincasiu, Caitlin M Orton, Julie Hodapp, Lewis E Kazis, Maxwell B Johnson, Karen Kowalske, Shelley A Wiechman, Dylan Jason, Jody Sabel, Max Hukill, Robyn Wilkinson, Gretchen J Carrougher, Tam Pham, Barclay T Stewart","doi":"10.1093/jbcr/irag072","DOIUrl":"https://doi.org/10.1093/jbcr/irag072","url":null,"abstract":"<p><p>Advances in burn care have markedly improved survival after major injuries. However, survivors often experience significant physical and psychosocial sequelae. We aimed to characterize long-term health-related quality of life (HRQoL) among burn survivors to inform expected trajectories, rehabilitation needs, and common impairments. Adult burn survivors from a multicenter, longitudinal cohort study were stratified into 20-49.9%, 50-69.9%, and ≥70% total body surface area burn size groups. Patient-reported physical and mental HRQoL and life satisfaction were assessed using validated outcome measures at discharge (pre-injury recall), 6, 12, 24 months, and 5 years post-injury. Standardized summary scores were derived using validated bridges. Mixed-effects linear regression models evaluated longitudinal changes and between-group differences. A total of 1,113 participants were analyzed. All outcomes declined early after injury but improved progressively thereafter. Notably, by 24 months, mental health and life satisfaction approached pre-injury levels across all burn size groups. Physical health deficits were greater with increasing burn size, with significant net differences relative to the 20-49.9% reference group (p<.0001). Mental health and life satisfaction outcomes showed minimal between-group differences overall, though individuals with the largest burns exhibited significantly better relative mental health at 24 months (p<.05). Although outcomes improve over time following major burn injury, persistent physical deficits support the classification of major burns as a chronic condition. These findings characterize burn size-specific recovery trajectories and demonstrate that, despite persistent physical deficits, mental health and life satisfaction can return to near pre-injury levels even after the most extensive injuries.</p>","PeriodicalId":15205,"journal":{"name":"Journal of Burn Care & Research","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147856441","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Machine Learning-Based Predictive Model for Fever and Adverse Clinical Events in Hospitalized Pediatric Burn Patients.","authors":"Lior Har-Shai, Sapir Gershov, Tomer Lagziel, Noa Manasseh, Alon Keller, Garry Gali Tzarfati, Daniel Hilewitz, Dean Ad-El, Eyal Kalish, Asaf Olshinka","doi":"10.1093/jbcr/irag074","DOIUrl":"https://doi.org/10.1093/jbcr/irag074","url":null,"abstract":"<p><p>Systemic inflammation after pediatric burn injury frequently causes fever, complicating early recognition of infectious complications. Improved risk-stratification may help identify patients at risk for adverse clinical events during hospitalization. This study aimed to develop and validate a machine learning (ML)-based model using a Random Forest (RF) algorithm to predict fever and related adverse outcomes in hospitalized pediatric burn patients. We conducted a retrospective analysis of 595 pediatric burn patients admitted to a tertiary center between 2012 and 2022. Extracted data included demographics, burn characteristics, clinical interventions, laboratory values, and outcomes. RF models were trained to predict three key endpoints: fever (>38.5°C), transfer to pediatric intensive care unit (PICU), and need for surgical intervention. To address missing data and class imbalance, we employed multiple imputation techniques and generated synthetic data through bootstrap sampling to improve model robustness. The patient cohort had a mean age of 4.27 (range: 0.2-18.1) years and an average total body surface area (TBSA) of 5.49 (range: 0.3-45.0). The RF models demonstrated high predictive accuracy, with F1-scores of 0.81±0.037 (fever), 0.88±0.091 (PICU transfer), and 0.81±0.027 (surgery). Area Under the Curve (AUC) values were 0.96, 0.97, and 0.95, respectively. Feature importance analysis identified younger age, lower body weight, female sex, and head and neck burn location as key predictors. These ML-based RF models demonstrate strong potential for early risk-stratification of fever and high-risk trajectories in hospitalized pediatric burn patients, guiding monitoring intensity, diagnostic vigilance, and resource planning. Prospective evaluation is needed to determine whether model-informed workflows improve outcomes.</p>","PeriodicalId":15205,"journal":{"name":"Journal of Burn Care & Research","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147856482","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Utility of hair toxicology in detecting child abuse or neglect in the burn unit: A quality improvement project.","authors":"Shady Al Hayek, Jack Bullis, Tessa A Davis-Walz, Colette Galet","doi":"10.1093/jbcr/irag071","DOIUrl":"https://doi.org/10.1093/jbcr/irag071","url":null,"abstract":"<p><p>Children represent 20% of all burn admissions annually; 20-30% are related to abuse or neglect. Our institution Child Protective Services (CPS) recently decided to stop following and interpreting hair toxicology results for pediatric burn patients. Drug use/exposure is an important risk factor for child abuse/neglect. The goal of this study was to evaluate the value of hair toxicology testing to identify child abuse or neglect. Medical records of pediatric patients ≤14 years admitted between 1/1/2019 and 2/29/2024 were reviewed. Demographics, burn injury information, suspicion of child abuse/neglect on admission, routine urine drug screening tests, hair toxicology results, and reporting to the State Health and Human Services (HHS) were collected. Descriptive statistics were obtained. Univariate analyses were performed to assess the utility of hair toxicology with p < 0.05 considered significant. Two hundred ninety-eight patients were included; child abuse was suspected in 31.5%; hair toxicology performed for 75.2% and positive for 35.7%. Hair toxicology was more likely to be performed when child abuse was suspected on admission (81.9% vs. 72.1%, p = 0.044), and to be positive (40.4% vs. 20.6%, p < 0.001). Suspicion on admission was associated with higher HHS involvement (95.7% vs. 24%, p < 0.001). HHS was more likely to be involved when hair toxicology was performed (54% vs. 24.3%, p < 0.004) and positive (96.3% vs. 28.4%, p < 0.001). Hair toxicology screening for pediatric burn patients is still a valuable tool to help clinicians report suspected abuse/neglect not otherwise detected on admission using other tools.</p>","PeriodicalId":15205,"journal":{"name":"Journal of Burn Care & Research","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147856509","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Caring for Caregivers: System-Level Solutions to Moral Injury in Burn Teams.","authors":"Joshua Khorsandi, Jason Mirharooni, Joshua Ahdout, Justin Kahen, Eli Nazarian, Demitri Franzoni, Joshua MacDavid","doi":"10.1093/jbcr/irag069","DOIUrl":"https://doi.org/10.1093/jbcr/irag069","url":null,"abstract":"","PeriodicalId":15205,"journal":{"name":"Journal of Burn Care & Research","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147838282","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Implementation of the Medical Trauma and Resilience Management (MED TRiM) Model in a Regional Burns Centre: A Thematic Analysis of the experiences of staff members trained as MED TRiM Practitioners.","authors":"Nicola Murphy, Rebekah Baugh, Helen Watkins, Janine Evans","doi":"10.1093/jbcr/irag070","DOIUrl":"https://doi.org/10.1093/jbcr/irag070","url":null,"abstract":"","PeriodicalId":15205,"journal":{"name":"Journal of Burn Care & Research","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147838290","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treatment of Friction Injury Using Enzymatic Debridement and Autologous Skin Cell Suspension.","authors":"W Preston Hewgley, Jonathan Black, Jan O Jansen, Stuart Hurst, Erin White, Stevan C Fairburn, Alayna Holderfield, Jared Morrison, Matthew Lovorn, James Hwang","doi":"10.1093/jbcr/irag015","DOIUrl":"10.1093/jbcr/irag015","url":null,"abstract":"<p><p>Friction injury occurs when a patient slides across a surface at high velocity, resulting in mechanical abrasion, laceration, and thermal burn. Mechanical abrasion removes tissue to a variable depth depending on surface texture in contact, and thermal burn devitalizes tissue to a variable depth based on contact pressure and transfer of kinetic energy. In these heterogenous wounds, tangential excision can excise healthy tissue alongside devitalized tissue, and other debridement techniques like hydrosurgery or dermabrasion may not reach deeper crevices created by abrasion and laceration. In addition, traditional skin grafts create significant donor site morbidity. This case series presents an early experience with a novel approach using bromelain-based enzymatic debridement combined with autologous skin cell suspension. Bromelain-based enzymatic debridement acts uniformly on a wound surface despite its topography, optimizing removal of devitalized tissue while preserving healthy tissue. Autologous skin cell suspension reduces donor site morbidity. This combined strategy minimizes dressing changes, optimizing pain control and enabling outpatient management. We observe rapid healing and outstanding cosmetic outcomes, and no patients experienced wound infection or other complications or required secondary procedures for nonhealing.</p>","PeriodicalId":15205,"journal":{"name":"Journal of Burn Care & Research","volume":" ","pages":"863-867"},"PeriodicalIF":1.8,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146063580","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Epidural Anesthesia for Pain Relief in Patients With Severe Burns.","authors":"Max L Silverstein, Ujalashah Dhanani, Pandora Chua, Clifford C Sheckter, Yvonne Karanas","doi":"10.1093/jbcr/irag023","DOIUrl":"10.1093/jbcr/irag023","url":null,"abstract":"<p><p>Patients with severe burn injuries endure intense pain, which is amplified by serial operations, daily dressing changes, and regular physical therapy. While peripheral nerve blocks have become increasingly popular in the management of isolated burns to the extremities, there have been few reports on the use of neuraxial anesthesia to treat burn pain. Here, we describe the inclusion of epidural anesthesia in our algorithm for management of burns to the lower trunk, bilateral lower extremities, buttocks, and perineum. We hypothesized that epidural anesthesia would be associated with reduced opioid use and improved pain scores. We performed a retrospective review of all patients admitted to a verified burn center who underwent epidural catheter placement between 2018 and 2024. Visual analog scale pain scores and opioid consumption (standardized in morphine milligram equivalents [MMEs]) were extracted for several days before and after placement of each patient's first epidural catheter. During the study period, 11 patients underwent epidural catheterization in our burn unit. An average of 1.8 (SD 1.3) catheters were placed per patient, for a total of 20 catheters. All patients experienced significant reductions in daily opioid consumption (92.5 MMEs/day pre-epidural to 58.1 MMEs/day postepidural, P = .008) and average pain scores (6.25 pre-epidural to 2.45 postepidural; P = .008). Minor complications including nausea/vomiting and pruritus occurred in 4 patients. There were no major complications or infections. We conclude that epidural anesthesia is safe and effective for relieving pain and decreasing opioid consumption in patients with burn injuries.</p>","PeriodicalId":15205,"journal":{"name":"Journal of Burn Care & Research","volume":" ","pages":"899-908"},"PeriodicalIF":1.8,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146165854","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Outcomes of SJS/TEN: A Nationwide Analysis.","authors":"Tyler J Murphy, Arman J Fijany, Emily P Swafford, Jordan T Garcia, Punit Vyas, Robel T Beyene, Stephen P Gondek, Anne L Wagner, Mayur B Patel, Elizabeth Dale Slater","doi":"10.1093/jbcr/irag010","DOIUrl":"10.1093/jbcr/irag010","url":null,"abstract":"<p><p>Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) syndrome are potentially fatal skin conditions frequently cared for in burn units. In a national database study, we studied the demographics and outcomes of this patient population. This retrospective cohort study included patient admissions for SJS/TEN. Patient demographics and outcomes were compared and adjusted for age, sex, inhalation injury, and percent total body surface area (TBSA). Logistical regression was used for binary outcomes, and linear regression was used for continuous outcomes. All outcomes were described in reference to the entire disease continuum (SJS/TEN) and each specific disease subcohort (SJS, SJS-TEN overlap, and TEN). Of 271 971 patients queried within the Noncommercial Burn Research Dataset, 2416 patients had a diagnosis of SJS/TEN. These patients were statistically more likely to be older (48 ± 22 years vs 36 ± 22 years), housed (1% vs 2%), females (57% vs 34%), and have a higher mean TBSA (8 ± 13% vs 7 ± 12%). In multivariable analysis, SJS/TEN was associated with increased risk of unplanned intubations (odds ratio [OR] 1.69) and pneumonia (OR 1.26), but not respiratory failure (OR 0.36). There was also an increased risk for sepsis (OR 1.43). Patients were significantly more likely to have a shorter hospital LOS (OR -3.7). There was no significant difference in mortality. In subcohort analysis, a stepwise increase in morbidity and mortality was observed when comparing SJS, SJS-TEN overlap, and TEN. Stevens-Johnson syndrome/TEN is a rare but extremely morbid disease continuum that frequently affects female patients and results in increased respiratory and alternative complications.</p>","PeriodicalId":15205,"journal":{"name":"Journal of Burn Care & Research","volume":" ","pages":"723-729"},"PeriodicalIF":1.8,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13140644/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146085725","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hyperbaric Oxygen Therapy in Burn Care: A Systematic Review of Current Evidence.","authors":"Julissa Molina-Vega, Rachel E Pferdehirt, Andrew J Vardanian","doi":"10.1093/jbcr/irag026","DOIUrl":"10.1093/jbcr/irag026","url":null,"abstract":"<p><p>Hyperbaric oxygen therapy (HBOT) involves inhaling 100% oxygen at pressures exceeding one atmosphere within a chamber. It is used across several specialties and has been proposed as an adjunct in burn management to enhance healing and improve outcomes. Despite increasing interest, evidence supporting its efficacy in burn care remains inconsistent, with no clear consensus in practice. A literature search was conducted in September 2025 across PubMed, Cochrane Library, and Embase without date restrictions to identify studies evaluating HBOT for burn treatment. Inclusion criteria were human studies, English-language articles, and full-text availability. Study selection followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Two reviewers screened titles and abstracts, and a third resolved discrepancies. Eligible studies described HBOT as a burn treatment and reported clinical outcomes. Thirteen studies met inclusion criteria: 5 randomized controlled trials, 7 cohort studies, and 1 case-control study, evaluating 566 burn patients. Burn severity, HBOT protocols, and outcomes varied substantially. Several studies reported reduced need for surgery and shorter hospital stays with HBOT. Trends toward improved healing and lower infection risk were noted, while mortality benefits were inconsistent. Heterogeneity in design and treatment regimens limited synthesis via meta-analysis. Hyperbaric oxygen therapy shows promise as an adjunct in burn care, improving healing and reducing complications. However, variability and inconsistent outcomes limit definitive conclusions. Well-designed randomized trials are needed to establish standardized protocols and clarify their clinical role in burn management. Until then, burn centers may consider HBOT for acute injuries and threatened grafts.</p>","PeriodicalId":15205,"journal":{"name":"Journal of Burn Care & Research","volume":" ","pages":"917-922"},"PeriodicalIF":1.8,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13140597/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146213188","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}