Journal of Burn Care & Research最新文献

{"title":"Bacteriological profile and antimicrobial resistance patterns in clinical isolates from a tertiary burns ICU: A retrospective comparative analysis of carbapenem resistance and invasion.","authors":"Neha Nityadarshini, Jaya Biswas, Maneesh Singhal, Shivangi Saha, Tanu Sagar, Kshitija Singh, Sarita Mohapatra, Seema Sood, Bimal Kumar Das, Mukesh Kumar, Ranjna Basyal, Mamta, Benu Dhawan","doi":"10.1093/jbcr/iraf191","DOIUrl":"https://doi.org/10.1093/jbcr/iraf191","url":null,"abstract":"<p><p>Burn injuries are a major cause of morbidity and mortality in low- and middle-income countries, with infections and antimicrobial resistance posing significant challenges. Carbapenem-resistant Gram-negative bacteria are particularly concerning in burn intensive care units. Aim of the study was to evaluate bacteriological profile, and antimicrobial susceptibility patterns of burn ICU patients, and identify risk factors associated with carbapenem resistance, invasive infections, and in-hospital mortality. This retrospective, single-centre study included all patients admitted to a 30-bed burns ICU in north India between January and December 2024, whose clinical sample was received for microbiological investigations. Data on demographics, clinical parameters, and microbiological findings were extracted from hospital records and analysed using chi-square, Fisher's exact, Mann-Whitney U tests, and multivariable logistic regression. Out of 246 patients included, the mean age was 29.1 ± 20.4 years and mean total body surface area (TBSA)% was 39.0 ± 19.9%. Overall mortality was 42.3%. A total of 1586 samples yielded 1057 pathogens, predominantly Gram-negative bacteria (Pseudomonas aeruginosa 36.1%, Acinetobacter baumannii 22.3%, Klebsiella pneumoniae 18.8%). Carbapenem resistance was observed in 85.3% of patients and was significantly associated with higher TBSA% (p<.001), longer hospital stays (p=.022), and mortality (p<.001). Invasion was present in 27.6% and was significantly associated with both carbapenem resistance and mortality. Multivariable logistic regression identified TBSA% (OR: 1.07, p<.001) and invasion (OR: 4.14, p=.001) as independent predictors of mortality. Carbapenem resistance and invasive infections are highly prevalent in burn ICU patients, underscoring the urgent need for robust infection control, regular antibiogram surveillance, and targeted antimicrobial stewardship in burn care settings.</p>","PeriodicalId":15205,"journal":{"name":"Journal of Burn Care & Research","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145232584","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":"Is Burn Center Admission Necessary After Home Oxygen Ignition Injury?","authors":"Hope E Werenski, Anju Saraswat, James H Holmes, John K Bailey","doi":"10.1093/jbcr/iraf189","DOIUrl":"https://doi.org/10.1093/jbcr/iraf189","url":null,"abstract":"<p><p>Accidental ignition of home oxygen does not mandate emergent intubation, but due to the thermal component of the injury, patients are initially directed toward burn units. To identify potential benefit associated with admission to an American Burn Association (ABA) verified burn center, the local registry was queried from January 2016 through May 2022. Charts were inspected for additional data related to the pattern of the patient's injuries, comorbidities, and hospital course. We compared patients admitted to the burn service with those primarily cared for by non-burn services. A total of 48 adult patients admitted with burn injuries associated with home oxygen use. Of the 28 patients intubated on admission, 19 were managed by the burn service, and 9 by non-burn services. There were no differences in ventilator days, ICU days, total length of stay, or mortality. Of the 20 patients admitted without intubation, the burn service managed 7, and non-burn services managed 13. These two groups had no identified differences in ICU days, total length of stay, or mortality. This single-center review found no outcome differences between patients cared for in an ABA-verified burn center and those managed by non-burn services following home oxygen-related burn injury. Versus non-burn services for home oxygen ignition injury. Additionally, most intubated patient required only short-term ventilation, suggesting intubation may often be avoidable in this population.</p>","PeriodicalId":15205,"journal":{"name":"Journal of Burn Care & Research","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145232550","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 Effect of COVID-19 on Length of Stay in Hospital and Patient Population Following Burn Injury.","authors":"Sara Sheikh-Oleslami, Bettina Papp, Anthony Papp","doi":"10.1093/jbcr/iraf192","DOIUrl":"https://doi.org/10.1093/jbcr/iraf192","url":null,"abstract":"<p><p>Acute burn care is heavily resource-dependent and thus was significantly impacted by the COVID-19 pandemic. This study sought to examine the relationship between COVID-19 and the length of stay (LOS) in hospital following burn injury as prolonged admissions have implications on both individuals and healthcare systems. Additionally, this study explored how COVID-19 affected the homeless burn population, as homelessness has been associated with longer hospital admissions due to limited post-discharge resources. Single-centre, retrospective cohort study using data from the Burn Registry and medical chart review with inclusion of all adult burn patients admitted to a quaternary provincial burn unit from April 1, 2016, to March 31, 2023. Patients admitted prior to April 1, 2020, were considered the pre-COVID cohort. Key variables included demographic characteristics and LOS, with homelessness defined as a lack of a fixed address. Of 498 included patients, 301 and 197 were in the pre-COVID and COVID cohorts, respectively. While both cohorts had similar age and gender distributions, a significant difference was noted in LOS between cohorts, with COVID cohort patients staying in hospital for 22 (24) days compared to 20 (29) days in the pre-COVID cohort. More notably, a 58% increase in homeless patients was seen during COVID, with 17% (50/301) of admitted patients being homeless pre-COVID compared to 26% (52/197) during COVID (p < 0.05). The COVID-19 pandemic resulted in a slightly increased LOS in burn patients, with homeless patients disproportionately affected. This has important implications for both patient outcomes and healthcare resource allocation.</p>","PeriodicalId":15205,"journal":{"name":"Journal of Burn Care & Research","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145232566","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":"Regional differences in inpatient adult burn Etiology across the United States.","authors":"E S Blake, A E Kurth, J M Dougherty, C J Rittle, Z Fan Mph, Hemmila, N F Sangji","doi":"10.1093/jbcr/iraf193","DOIUrl":"https://doi.org/10.1093/jbcr/iraf193","url":null,"abstract":"<p><p>Despite known regional variation in access to specialized burn centers, the differences in burn injury patterns across the United States have not been well described. We investigated the geographic variation in burn injury etiology across the United States. A retrospective cohort study of burn injury was conducted with Healthcare Cost and Utilization Project-National Inpatient Sample (HCUP-NIS) data from 2017-2020. ICD 10-CM codes were used to identify burn patients and etiology of injury. Demographics, including median household income quartile across regions, were also identified. The proportion of patients who sustained chemical burns (29.9 people per million population) and electrical burns (29.8 people per million population) was significantly higher in the South compared to other regions in the US (at 4.7% and 4.8% of all inpatient burn admissions, respectively), despite the region's relative scarcity of burn centers. The South also had the highest proportion of self-pay patients, at 15.8%, compared to other regions, while also having the highest proportion of lower income patients. These differences have implications for policy decisions concerning resource allocation.</p>","PeriodicalId":15205,"journal":{"name":"Journal of Burn Care & Research","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145232599","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":"A 12-Year Analysis of Thermal and Chemical Ocular Burns: Insights into Management and Outcomes from a Single Burn Center.","authors":"Hilary Y Liu, Benjamin B Scott, José Antonio Arellano, Christopher J Fedor, Mare G Kaulakis, Garth Elias, Alain C Corcos, Jenny A Ziembicki, Francesco M Egro","doi":"10.1093/jbcr/iraf188","DOIUrl":"https://doi.org/10.1093/jbcr/iraf188","url":null,"abstract":"<p><p>Acute ocular burns can lead to severe complications such as vision loss or eyelid contractures. While management strategies vary, no standardized algorithm exists. This study examines the etiology, management, and outcomes of ocular burns at a single burn center, with a focus on the differences between thermal and chemical burns. A retrospective cohort study was conducted on patients admitted with ocular burns to a burn center from 2012 to 2023. Data on demographics, injury characteristics, treatments, and outcomes were analyzed to identify differences in clinical presentation and management by burn type. Among 50 patients (84% male, mean age 39.4 ± 20.4 years) with 81 eyes affected, 78% of burns were thermal, 20% chemical, and 2% electrical. Visual acuity was worse in chemical burns (103.3 ± 111.3 vs. 67.0 ± 58.6), though not statistically significant. Chemical burns consistently received immediate irrigation (100% vs. 20.5%, p<.001) and more frequent anti-inflammatory treatment (70% vs. 23.1%, p=.009). Hospital stays were longer for thermal burns (24.1 ± 15.0 days vs. 3.7 ± 4.3 days, p=.037). Complications included two cases of significant vision loss and one case of entropion requiring multiple two surgeries. In summary, ocular burns differ significantly in management and outcomes depending on burn etiology. However, these differences in early management may reflect variations in clinical presentation and triage priorities, rather than differences in treatment importance. Standardized protocols that emphasize early ocular care for all burn types may help reduce variability in practice, particularly in thermal burns where systemic injuries often take priority.</p>","PeriodicalId":15205,"journal":{"name":"Journal of Burn Care & Research","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145199626","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":"Autologous Skin Cell Suspension Provides Comparable Healing in Both Burn and Non-Burn Wounds.","authors":"Riley Shegos, Sarah Miller, Carrie Ann McGroarty, Corianne Rogers, C Scott Hultman","doi":"10.1093/jbcr/iraf187","DOIUrl":"https://doi.org/10.1093/jbcr/iraf187","url":null,"abstract":"<p><p>Burn injuries often require advanced treatments to optimize healing, yet the comparative effectiveness of autologous skin cell suspension (ASCS) across wound types remains unclear. While ASCS shows promise in enhancing wound healing, its relative efficacy in burn versus non-burn wounds is not well understood. This study evaluates ASCS outcomes in burn and non-burn patients, hypothesizing that ASCS is equally effective in promoting healing across both wound types. This retrospective cohort study analyzed 100 patients with full-thickness injuries treated with ASCS, comparing burn (n=28) and non-burn (n=72) groups. Outcomes included wound closure at 4 and 8 weeks, complication rates, age, length of stay, time from ASCS application to discharge, American Society of Anesthesiologists score, Mangled Extremity Severity Score, wound size, estimated blood loss, case time, operating room time, and follow-up duration. Statistical significance was set at p < 0.05, using T tests and Chi-square analysis. At 4 weeks, wound closure was comparable at 78.6% (22/28) for burns and 75% (54/72) for non-burns. By 8 weeks, closure reached 100% (28/28) for burns and 93% (67/72) for non-burns. Complication rates were 25% in both groups. Follow-up averaged 64.24 days for burns and 89.54 days for non-burns. No significant differences were found in wound closure or complications, supporting the hypothesis. These findings suggest that ASCS is a versatile and valuable addition to burn treatment protocols, offering promising results irrespective of injury etiology. The results can inform clinical guidelines and protocols, enabling confident application of ASCS beyond burns to optimize patient outcomes.</p>","PeriodicalId":15205,"journal":{"name":"Journal of Burn Care & Research","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145191807","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":"A CHARACTERIZATION OF PEDIATRIC BURN INJURY PATIENTS PRESENTING TO A ZONAL REFERRAL HOSPITAL IN NORTHERN TANZANIA.","authors":"Kajsa Vlasic, Theresia Mwakyembe, Francis Sakita, Irma Fleming, Giavonni Lewis, Getrude Nkini, Nancy Mmary, Deus Marandu, Nora Fino, Jonah Holiday, Melissa H Watt, Catherine A Staton, Elizabeth M Keating, Blandina M Mmbaga","doi":"10.1093/jbcr/iraf184","DOIUrl":"https://doi.org/10.1093/jbcr/iraf184","url":null,"abstract":"<p><p>Burn injuries disproportionately impact children in low- and middle-income countries (LMICs), with Sub-Saharan Africa bearing the highest burden. While pediatric injury research in LMICs is growing, data on pediatric burn injuries and associated mortality in LMICs remains limited. The objective of this study was to describe a cohort of pediatric burn injury patients from a pediatric injury registry in Northern Tanzania including the epidemiology, clinical presentation, pre-hospital factors, and clinical outcomes. We conducted a retrospective observational study of burn injury patients from a pediatric injury registry at a tertiary zonal referral hospital in Northern Tanzania. We evaluated patient demographics, emergency department presentation, and inpatient data. Study outcomes included ICU admission, in-hospital mortality, and morbidity at discharge. Differences in statistics were evaluated with ANOVA/t-test, chi-square tests, or Fisher's exact tests. We assessed associations with ICU stay, in-hospital mortality, and morbidity by reporting adjusted odds ratios and 95% confidence intervals from multivariable logistic regression models. 133 pediatric burn patients were enrolled between November 2020 and August 2024. Sixty-eight patients were female (51%) and most were aged five years or younger (81.9%). Scalds were the most common injury. The in-hospital mortality rate was 22.6%. Burn severity was independently associated with all three study outcomes. Pediatric burn mortality was high with burn severity predicting poor outcomes. This study highlights the urgent need to address gaps in burn injury prevention, community education on timely burn care, and pre-hospital and referral systems for pediatric burn patients in Northern Tanzania.</p>","PeriodicalId":15205,"journal":{"name":"Journal of Burn Care & Research","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145191860","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":"Revascularize or Amputate? Underrated Arterial Damage in High-Voltage Electrocution: A Literature-Informed Clinical Perspective.","authors":"Paolo Marchica, Isidoro Musmarra, Francesco Ciancio, Dario Melita, Adelina Vena, Rosario Ranno, Giuseppe A G Lombardo","doi":"10.1093/jbcr/iraf182","DOIUrl":"https://doi.org/10.1093/jbcr/iraf182","url":null,"abstract":"<p><p>High-voltage electrocution injuries can result in extensive, multisystem tissue damage, including vascular injuries. The decision between revascularization and early amputation remains challenging, especially given the risks of hemorrhage, infection, and repair failure. A comprehensive literature review was performed using PubMed, Scopus, and Cochrane databases with predefined MeSH terms and keywords related to electrocution and arterial injury. Nineteen relevant human studies were selected after screening. Additionally, we present a case of high-voltage upper limb injury in which an arterial interposition graft using the deep inferior epigastric artery (DIEA) was performed in an attempt to maintain hand perfusion. Most published reports describe venous grafts-most commonly used-or flow-through flaps as reconstructive options. To date, no previous cases have reported the use of arterial grafts in this context. Arterial injuries may present acutely or subacutely, and a variety of repair techniques have been described, without clear evidence favoring one approach over another. In our case, despite technically successful placement of a DIEA arterial graft following radial artery rupture, early thrombosis and distal ischemia occurred, ultimately resulting in limb loss. Vascular injury from electrocution is often more extensive than macroscopically evident. Reconstructive attempts should be considered only in stable patients, especially when preserving the dominant limb in young individuals. Although arterial grafts offer structural advantages, they may not overcome the systemic and local damage induced by electrocution. Further research is needed to define clearer guidelines for vascular repair versus amputation in these complex scenarios.</p>","PeriodicalId":15205,"journal":{"name":"Journal of Burn Care & Research","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145185839","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":"Small burns need attention too: evaluating the 15% burn resuscitation threshold in adults.","authors":"Ashleigh Bull, Mala Sharma, Alexander Kurjatko, Sarah Wellsandt, Brooke Dwars, Colette Galet, Lucy Wibbenmeyer","doi":"10.1093/jbcr/iraf185","DOIUrl":"https://doi.org/10.1093/jbcr/iraf185","url":null,"abstract":"<p><p>The American Burn Life Support (ABLS) course recommends fluid resuscitation of patients with total burned surface area (TBSA) ≥20% to prevent burn shock. Our center resuscitates patients with burns greater than 15% TBSA. Herein, we characterize that population. Patients with burns 15 to 19.9% TBSA admitted from 1/1/2019 to 3/31/2023 who received protocolized fluid resuscitation were included. Demographics, hospital course, and fluids received were reviewed. Fluid resuscitation was categorized as \"below range\" (Parkland formula [PF] < 3 mL/kg/%TBSA), \"within range\" (PF = 3-5 mL/kg/%TBSA or \"above range\" (PF > 5 mL/kg/%TBSA). Similarly, urine output (UOP) was expressed as \"below range\" (<30 mL/h), \"within range\" (31-50 mL/h) or \"above range\" (>50 mL/h). The resuscitation groups were compared. p<.05 was considered significant. Thirty-three patients received resuscitation via Brooke (9.1%), PF (63.6%), or other formula (27.3%). Most were male (81.8%) with a median TBSA of 17%; median age was 57 years. Almost 20% of patients required vasopressors during resuscitation. Fifteen patients were within the predicated range of PF, 15 were under, and 3 were over. There was no difference between the groups with respect to demographics, burn injury variables, or complications. Notably, the average creatinine and lactate 24 h post-admission were 0.9 mg/dL and 2 mg/dL, respectively. Half of the study patients received greater than maintenance; all were in either the within burn resuscitation range or above range groups. This retrospective study suggests that patients with smaller burns may benefit from resuscitation as 50% received more than maintenance. Resuscitation of smaller burns requires more study.</p>","PeriodicalId":15205,"journal":{"name":"Journal of Burn Care & Research","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145185842","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":"An Integrated Deep Learning and LLM Model for Burn Wound Depth Recognition.","authors":"Haitao Ren, Yongan Xu, Hang Hu","doi":"10.1093/jbcr/iraf170","DOIUrl":"https://doi.org/10.1093/jbcr/iraf170","url":null,"abstract":"<p><p>Accurate burn depth assessment remains a challenge, especially in emergency settings. This study aimed to develop a low-cost AI-based system for burn wound classification using deep learning and large language models (LLMs). A total of 397 burn wound images from public databases were augmented to 7156 images and categorized by depth. A classification model was trained using PaddlePaddle, and a burn-specific LLM was developed based on clinical guidelines. Model performance was evaluated using accuracy, recall, and F1 score and compared against 10 medical students and six general LLMs on 80 out-of-sample images. Our model achieved an overall accuracy of 96.82% and F1 score of 96.70%, outperforming medical students (F1:76.63%) and general LLMs (F1:68.75-73.75%). In a separate test using ten guideline-based true/false questions, all AI models answered correctly, whereas students had only 64% accuracy. This integrated model offers accurate burn depth recognition and guideline-based treatment suggestions, addressing the shortage of burn care specialists, and supporting medical education.</p>","PeriodicalId":15205,"journal":{"name":"Journal of Burn Care & Research","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145175664","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}