Journal of Burn Care & Research最新文献

{"title":"Clinical Application of Metagenomic Next-Generation Sequencing of Microbial Cell-free DNA in Ruling Out Invasive Fungal Infection in a Patient with Thermal Burn Wounds: A Case Report.","authors":"Koree Begovic, Lucas Bryant, Keith Glenn, Sean Gamble","doi":"10.1093/jbcr/iraf094","DOIUrl":"https://doi.org/10.1093/jbcr/iraf094","url":null,"abstract":"<p><p>Patients with severe thermal burns are highly susceptible to invasive fungal infections due to compromised skin integrity, prolonged hospitalization, and immunosuppression. Traditional diagnostic methods, such as cultures and tissue biopsies with histopathology, have limitations. Metagenomic next-generation sequencing (mNGS) of microbial cell-free DNA in plasma is a rapid, non-invasive diagnostic tool for detecting fungal elements in the bloodstream. The aim of this report is to present the utility of this method to aid in ruling out an invasive fungal infection in a patient with burns. This case involves a middle-aged male with extensive thermal burns who developed sepsis, with concerns of invasive fungal infection after fungal elements were detected in wound cultures of skin grafts. However, β-D-glucan and galactomannan assays were negative, and metagenomic next-generation sequencing did not detect fungal DNA in plasma. Histopathological examination of tissue biopsies later confirmed the absence of angioinvasion, and blood cultures showed no evidence of fungemia. As a result, antifungal therapy was safely discontinued without clinical deterioration. While metagenomic next-generation sequencing has shown potential for negative predictive value in immunocompromised patients, its role in patients with burns warrants further investigation. Integrating metagenomic next-generation sequencing with conventional diagnostic methods may improve clinical decision-making, reduce unnecessary empirical antifungal treatment, and enhance patient outcomes.</p>","PeriodicalId":15205,"journal":{"name":"Journal of Burn Care & Research","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144142711","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":"Neutrophil Prealbumin Ratio as a Potential Predictive Marker for Severe Burn Patients' Prognosis.","authors":"Ozan Namdaroglu, Hilmi Yazıcı, Ahmet Cem Esmer, Mehmet Alperen Ugur, Ahmet Erim Erdogan, Ahmet Mucteba Ozturk, Ahmet Deniz Ucar, Mehmet Yildirim","doi":"10.1093/jbcr/iraf096","DOIUrl":"https://doi.org/10.1093/jbcr/iraf096","url":null,"abstract":"<p><p>Severe burn injuries are associated with high morbidity and mortality, necessitating reliable prognostic markers for effective patient management. The Neutrophil-to-Prealbumin Ratio (NPR), which combines inflammatory and nutritional status, has emerged as a potential prognostic tool. This study aimed to evaluate the prognostic value of NPR in predicting mortality among severe burn patients. Severe burn patients admitted to the Burn Treatment Center between January 2020 and December 2023 were retrospectively analyzed. Patients were categorized into survivor and non-survivor groups. Inflammatory markers, including NPR, Neutrophil-to-Lymphocyte Ratio (NLR), Systemic Inflammatory Response Index (SIRI), and Platelet-to-Lymphocyte Ratio (PLR), were evaluated for their association with mortality using Receiver Operating Characteristic (ROC) curve analysis and multivariate logistic regression. A total number of 357 patients were included in the study. Of the 357 patients, 101 (28.3%) were non-survivors. The non-survivor group had significantly higher TBSA, full-thickness burns, inhalation injuries, and blood transfusion requirements (p<0.001). ROC curve analysis demonstrated that NPR had the highest area under the curve (AUC=0.760). A cut-off value of 0.75 for NPR was associated with a significant increase in mortality risk. Multivariate logistic-regression identified NPR as an independent predictor of mortality alongside TBSA, full-thickness burns, and inhalation injuries. NPR is a promising prognostic marker for mortality in severe burn patients, outperforming traditional inflammatory markers. Its integration of inflammatory and nutritional status provides a comprehensive assessment of patient risk. Further prospective studies are needed to validate these findings and explore the broader applications of NPR in burn care and other critical settings.</p>","PeriodicalId":15205,"journal":{"name":"Journal of Burn Care & Research","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144136298","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":"Hypothyroidism in Severe Burn Patients Associated with Increased Risk of Musculoskeletal Complications and Decreased Risk of Mortality.","authors":"Isabel Obias, Dalton Amador, Sudhanvan Iyer, Amina El Ayadi, Georgiy Golovko, Steven E Wolf, Juquan Song","doi":"10.1093/jbcr/iraf090","DOIUrl":"https://doi.org/10.1093/jbcr/iraf090","url":null,"abstract":"<p><p>Severe burn patients are prone to developing various musculoskeletal, dermatological, and cardiovascular complications, and hypothyroidism is associated with derangements of these same systems. This study aims to explore the association between hypothyroidism and the emergence of these complications in severe burn patients. Patients with severe burns, defined as those encompassing ≥ 20% total body surface area, were identified in the TriNetX United States Collaborative Network and were categorized into two groups based on a history of hypothyroidism. Risk ratios and differences of contractures, undergoing graft procedures, graft complications, amputations, and various infections and cardiovascular complications were generated using the database's measure of association analysis. The hypothyroidism cohort showed a greater risk of developing contractures (risk ratio [RR], 1.667; 95% confidence interval [CI], [1.207, 2.302]; p = 0.002), skin infections (RR, 1.885; CI, [1.192, 2.980]; p = 0.006), and urinary tract infections (RR, 1.950; CI, [1.155, 3.292]; p = 0.011) within six months of insult. The hypothyroidism cohort showed a decreased risk of mortality (RR, 0.688; CI, [0.516, 0.915]; p < 0.010), undergoing graft procedures (RR, 0.647; CI, [0.518, 0.807]; p < 0.001), and vasopressor use (RR, 0.806; CI, [0.667, 0.974]; p = 0.025) in this same time period. In conclusion, hypothyroidism in severe burn patients is associated with an increased risk of developing contractures and skin and urinary tract infections and a decreased risk of mortality, undergoing graft procedures, and vasopressor use.</p>","PeriodicalId":15205,"journal":{"name":"Journal of Burn Care & Research","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144119766","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":"Characterization of the Endothelial, Coagulofibrinolytic and Inflammatory Profile in Burn Patients after Resuscitation with Fresh Frozen Plasma.","authors":"Amanda M Soo Ping Chow, Anthony E Pusateri, Tuan D Le, Thomas Orfeo, Matthew Gissel, Maria Cristina Bravo, Melissa McLawhorn, Lauren T Moffatt, Jeffrey W Shupp","doi":"10.1093/jbcr/iraf092","DOIUrl":"https://doi.org/10.1093/jbcr/iraf092","url":null,"abstract":"<p><p>Severe burn injuries are associated with endothelial, coagulopathic, and inflammatory dysfunction, requiring resuscitation; this is most often performed with intravenous crystalloids. Colloids, like fresh frozen plasma (FFP), can be used as adjuncts. This prospective observational cohort study investigated whether the varying factor and protein concentrations in a unit of FFP, as well as its allogenic nature, affected the preexisting prothrombotic, fibrinolytic and hyperinflammatory state in burn shock in a group of patients with ≥20% total body surface area (TBSA) who receive transfused plasma as part of the standard of care for resuscitation at a regional burn center. Blood samples were collected immediately prior to administration of the first unit of FFP (Pre-Unit) and immediately after administration of the first unit of FFP (Post-Unit). Concentrations of 31 plasma biomarkers were quantified and compared using paired t-test or a Wilcoxon signed-rank test. Data presented as median (interquartile range). Of the 33 patients included, the median TBSA burn of 34.0% (27.3-45.5). Post-Unit plasma concentrations were decreased compared to Pre-Unit concentrations in factor VIII [329 (201.9-474.1) vs 277 (189.5-438.1) %], fibrinogen [322 (295.3-412.8) vs 305 (285.3-388.5) mg/dL], protein C [105 (96.0-111.5) vs 102 (91.5-112.0) %], total tissue factor pathway inhibitor (TFPI) [69.7 (51.1-96.3) vs 67.7 (50.9-84.5) ng/mL], free TFPI [18.2 (14.2-21.8) vs 16.8 (12.9-21.1) ng/mL], activated/inactivated thrombin-activatable fibrinolysis inhibitor [55.1 (40.7-80.4) vs 48.7 (38.4-64.4) ng/mL], C1 esterase inhibitor [149.6 (132.3-222.1) vs 119.6 (110.4-151.6) %], and TNF-α receptor 1 [2010 (1451-3535) vs 1815 (1418-3189) pg/mL] (p≤0.05). The 23 other biomarkers did not change. While there were small but statistically significant reductions in 8 markers of coagulation, antifibrinolysis and inflammation, the Post-Unit concentrations either remained within or moved closer to the expected reference ranges. After initial transfusion of FFP, there were no clinically significant changes in the preexisting prothrombotic, fibrinolytic, endothelial or inflammatory biological profile.</p>","PeriodicalId":15205,"journal":{"name":"Journal of Burn Care & Research","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144119720","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":"Distinct Transcriptome Signatures Associated With Mortality and Prolonged Recovery Following Burn Injury.","authors":"Burook Misganaw, Desiree N Pinto, Tuan D Le, Anthony Pusateri, Aarti Gautam, Bonnie C Carney, Lauren T Moffatt, Jeffrey W Shupp, Rasha Hammamieh","doi":"10.1093/jbcr/iraf012","DOIUrl":"https://doi.org/10.1093/jbcr/iraf012","url":null,"abstract":"<p><p>A dysregulated immune response after severe burn injury is associated with detrimental short and long-term clinical outcomes. Key changes to gene expression within the first 24 h after burn injury have been identified, but longitudinal data is lacking. Therefore, this study aims to characterize gene expression during the first 3 weeks after burn injury and identify specific genes and pathways associated with distinct clinical outcomes. Patients presenting within 4 h of injury had blood RNA isolated for microarray gene expression at admission and set timepoints to 21 days. Inter- and intra-group comparisons were performed between 4 groups (G1 died within 7 days; G2 died after 7 days; G3 discharged after 7 days; and G4 discharged within 7 days). A total of 17 289 transcripts were quantified from 116 patients. At admission, there were 110, 80, and 31 differentially expressed genes in G1, G2, and G3, respectively, compared to G4, and were largely nonoverlapping. Longitudinal intra-group analyses also showed distinct group- and time-dependent patterns. Upregulation of genes and pathways related to the innate immune response and unfolded protein response predominated during early time points, while persistent upregulation of coagulation pathways and downregulation of immune-related pathways were identified days to weeks following injury. Overall, burn injury induces widespread transcriptomic responses, with larger and more sustained changes observed in patients with worse clinical outcomes. These gene expression signatures reveal underlying molecular mechanisms that occur immediately following injury and may have prognostic and diagnostic utility in the care of burn-injured patients.</p>","PeriodicalId":15205,"journal":{"name":"Journal of Burn Care & Research","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144119722","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":"National Estimates and Outcomes for Supplemental Home Oxygen Therapy Injuries-a Burn Care Quality Platform Analysis.","authors":"Clifford Sheckter, Eloise Stanton, Karla Klas, Bart Phillips, Rebecca Coffey, Alisa Savetamal, Lucy Wibbenmeyer","doi":"10.1093/jbcr/iraf087","DOIUrl":"https://doi.org/10.1093/jbcr/iraf087","url":null,"abstract":"<p><p>The incidence of admissions for burn and inhalation injuries related to home oxygen therapy remains poorly defined in the U.S. We analyzed the American Burn Association's Burn Care Quality Platform (BCQP) database (2013-2022) to generate national estimates of supplemental home oxygen therapy-related injuries and outcomes. Text string extraction identified cases using multiple search permutations related to home oxygen use. Patient demographics, injury characteristics, and inpatient outcomes were described. Logistic regression assessed predictors of oxygen therapy injuries, and Poisson regression estimated adjusted incidence rates. Of 207,364 burn admissions, 79,114 (28%) contained injury descriptions, with 3.0% (2,360 cases) attributed to home oxygen therapy. These patients had a median age of 65 years (IQR: 59-71), mean total body surface area (TBSA) of 4.1%, were predominantly male (62.6%) and white (79.0%). Medicare was the most common payer (57.7%). Inhalation injury was present in 11.4%, mean length of stay (LOS) was 8 days, and inpatient mortality was 6.1%. Smoking was the leading ignition source (63%), followed by cooking/stove (4%), while 22% had no identified cause. The adjusted incidence rate of supplemental home oxygen injuries was 3.6% (95% CI: 2.7-2.9%, p < 0.001), with a significant annual increase (incidence rate ratio: 1.03, 95% CI: 1.02-1.04). Oxygen therapy-related injuries account for 1,088 (95% CI: 1,065-1,113) burn admissions per year in the U.S. Despite smaller TBSA burns, mortality was twice the national average for burn patients, and for survivors, the odds of discharge home were 15% less likely. Targeted prevention strategies are needed to mitigate this growing public health problem.</p>","PeriodicalId":15205,"journal":{"name":"Journal of Burn Care & Research","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144110525","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 retrospective, non-inferiority study of a Treat-at-Home strategy utilizing a surfactant-based dressing for partial-thickness burn wounds.","authors":"Lorraine A Todor, Matthew Sanders, Elysha Lyle, Denise Knight, Maria Tucci, Jacob Jarreau, Mahmoud Hassouba, David M Hill","doi":"10.1093/jbcr/iraf088","DOIUrl":"https://doi.org/10.1093/jbcr/iraf088","url":null,"abstract":"<p><p>Partial thickness (PT) burns are the most common depth of burn seen in emergency departments. This study aimed to evaluate the outcomes of patients managed with a treatment-at-home (TAH) strategy using water-soluble surfactant dressing (WSD) compared to any other dressing (non-WSD). This single-center, retrospective study included all patients with thermal burns treated in the burn center-specific emergency department between May 2019 and May 2023. Patients were excluded if admission was deemed necessary during the initial emergency department assessment. Additionally, patients were excluded for having first degree burns, full-thickness burns, electrical burns, being less than 18 years old, pregnant or incarcerated, or not expected to survive. The planned enrollment was designed to fulfill non-inferiority and potential superiority of surfactant-based dressing versus any another TAH strategy. Two-thousand seven-hundred forty-seven patients were screened over the four-year study. After applying exclusion criteria, 1,001 patients remained in the study group. There were no differences in demographics and injury mechanism, except the non-WSD group contained more patients that were cocaine positive (p = 0.009)and had burns to the head/neck (p < 0.0001). Few in the WSD or non-WSD group required subsequent admission for burn wound excision [5 (1.0%) vs. 2 (0.4%)] although the non-WSD had significantly fewer return for follow up [336 (68.71%) vs 273 (53.32%), p < 0.001]. This is the largest study to evaluate the use of WSD for immediate treatment of PT burns to avoid admission. WSD was found to be non-inferior to other non-WSD TAH strategies. But no matter the choice of home wound treatment, few required subsequent admission for surgery. Given the success of both groups, a TAH model, when feasible, could allow patients to recover at home and result in cost and resource savings associated with admission.</p>","PeriodicalId":15205,"journal":{"name":"Journal of Burn Care & Research","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144110521","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":"Burnout in Burn Surgeons: A Survey of Burn Surgeon Wellness.","authors":"Anastasiya Ivanko, M Victoria P Miles, Jonathan E Schoen, Herb A Phelan, Nathan H Brown, Kathleen Romanowski, Steven Kahn, Alisa Savetamal, Arpana Jain, Anju Bakhshi Saraswat, James Hill Holmes Iv, Richard J Kagan, Jeffrey E Carter","doi":"10.1093/jbcr/iraf089","DOIUrl":"https://doi.org/10.1093/jbcr/iraf089","url":null,"abstract":"<p><p>The U.S. faces a surgeon shortage, threatening a decline in burn care specialists as surgeons shift to other fields. With only 0.3% of the workforce in burn surgery, attrition could severely impact burn care availability. Addressing recruitment and retention challenges requires identifying stressors and workload factors contributing to the strain of operative burn care. In May 2024, a de-identified survey was conducted with Institutional Review Board approval to assess burn surgeons' self-reported well-being. A diverse surgeon panel reviewed the survey, and the American Burn Association distributed it via email and Survey Monkey™. Statistical analysis included Chi-square and t-tests. Seventy-seven burn surgeons (62% male) participated, representing a 20% response rate. Most took burn call (95%) and worked in an academic setting (80%). While 73% were satisfied with their careers and 91% valued the complexities of burn care, 54% lacked time for personal activities, and 62% felt maternity/paternity leave was insufficient. Forty percent experienced burnout, and 26% considered leaving the field. Over half (54%) felt they lacked time to recover after demanding cases, and 65% believed burn surgery negatively impacted their health. Using a Likert scale (10 = high performance), they rated their ability to meet job demands at 7 (±1), with a projected decline to 4.2 (±0.5) in two years. Despite overall career satisfaction, burn surgeons face challenges that threaten their health and the quality and sustainability of burn care. Our findings highlight the need for interventions to mitigate burnout and enhance well-being, ensuring the long-term viability of burn surgery and patient care.</p>","PeriodicalId":15205,"journal":{"name":"Journal of Burn Care & Research","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144093687","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":"Correction to: Synthetic Electrospun Fiber Matrix Utilized in Conjunction with Homograft Wound Dressings in the Management of Post Excisional Massive Necrotizing Fasciitis: A Case Report.","authors":"","doi":"10.1093/jbcr/iraf055","DOIUrl":"https://doi.org/10.1093/jbcr/iraf055","url":null,"abstract":"","PeriodicalId":15205,"journal":{"name":"Journal of Burn Care & Research","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144078245","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":"Letter to the Editor: Prophylactic Antibiotics are Unnecessary for Routine CO2 Laser Burn Scar Treatments.","authors":"Rami Paul Dibbs, Ludmila Rodrigues Ribeiro Da Silva, Ludwik Branski, Ramon L Zapata-Sirvent","doi":"10.1093/jbcr/iraf085","DOIUrl":"https://doi.org/10.1093/jbcr/iraf085","url":null,"abstract":"","PeriodicalId":15205,"journal":{"name":"Journal of Burn Care & Research","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144078247","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}