Burns最新文献

{"title":"The resilience of burn survivors, reborn in ashes.","authors":"Hui-Ying Chu, Mei-Chuan Huang, Hui-Shan Chan","doi":"10.1016/j.burns.2025.107510","DOIUrl":"https://doi.org/10.1016/j.burns.2025.107510","url":null,"abstract":"<p><p>This study examined the resilience process of burn survivors by analyzing the factors influencing resilience, operational mechanisms, and the contexts in which resilience is demonstrated. Using a qualitative research grounded theory approach and purposive sampling, 20 participants were recruited, including 16 burn survivors, two close relatives (a husband and a friend), a psychologist, and a nurse. The average age of the burn survivor participants was 44.5 years and they were well-adapted according to the Life Adaptation Scale. In-depth semi-structure interviews were conducted for data collection. The findings indicate that the resilience process of burn survivors comprises five stages: grief and loss, pain and recovery, energy storage, growth and adaptation, and mutual help and feedback. Each stage involves specific tasks and challenges. Resilience is influenced by personal traits, as well as family and social environments. Protective factors include optimism and hope, positive thinking, frustration tolerance, self-identity, a sense of responsibility, warm companionship and care from family members, religion, and engagement in group activities or work. The outcome of resilience is growth and the ability to provide support to others. Despite facing life inconveniences, changes in appearance, and challenges after recovery, the participants demonstrated the ability to reflect positively, reaffirm their responsibilities, and recognize the value of their lives.</p>","PeriodicalId":50717,"journal":{"name":"Burns","volume":" ","pages":"107510"},"PeriodicalIF":3.2,"publicationDate":"2025-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144039808","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Single center experience of the first 300 patients treated with bromelain-based enzymatic debridement","authors":"Antonio Bulla ,&nbsp;Danilo Antonio Rivas Nicolls ,&nbsp;José Antonio Lopez Martinez ,&nbsp;Jon Ander Aguirrezabala ,&nbsp;Maria Bayona Visiedo ,&nbsp;Jacinto Baena ,&nbsp;Juan Pedro Barret Nerin ,&nbsp;Jordi Serracanta Domenech","doi":"10.1016/j.burns.2025.107508","DOIUrl":"10.1016/j.burns.2025.107508","url":null,"abstract":"<div><h3>Background</h3><div>This retrospective cohort study evaluates the clinical outcomes of enzymatic debridement (ED) with Nexobrid® in burn patients treated at our hospital’s Burn Unit from 2015 to 2020. The primary aim was to determine whether Nexobrid® effectively reduces unnecessary surgeries and improves patient outcomes.</div></div><div><h3>Methods</h3><div>The study included 300 patients over 18 years old with deep dermal and full-thickness burns, excluding cases with chemical/electrical burns, pregnancy, and allergies to Nexobrid®. Burn depth was assessed upon admission and re-evaluated post-ED. The primary endpoint was the reliability of ED in determining surgical indications compared to traditional clinical assessments. Secondary endpoints included factors influencing healing time, complication rates, and scar hypertrophy.</div></div><div><h3>Results</h3><div>Among the 300 patients (76 % male, median age 41), flame burns were most common (46.7 %). Median total body surface area (TBSA) burned was 8 %, and TBSA treated with Nexobrid® was 5 %. Sequential ED was performed in 26 patients with larger burns.</div><div>Post-treatment data indicated that ED improved burn depth diagnosis compared to initial assessments, often downstaging dermal burns. The “step sign” emerged as a useful predictor for graft surgery necessity in dermal burns. No significant differences were observed between scald and flame burns in ED effectiveness. ED was associated with blood loss, emphasizing caution in cases with high TBSA, and early fever was noted as a factor requiring vigilant monitoring. While scar hypertrophy was associated with surgery, this study design could not directly evaluate ED's impact on hypertrophy.</div></div><div><h3>Conclusion</h3><div>We found ED to be a reliable method for rapid eschar removal and accurate burn depth evaluation, which often helped us avoid unnecessary surgeries—particularly important in delicate, functional areas like the upper limbs. Interestingly, the effectiveness of ED was not influenced by the burn’s etiology when treating intermediate-depth injuries. While ED does not appear to rise the risk of infection, early fever should still be carefully monitored. Over time, ED has become a central tool in our burn treatment protocols. Future studies are needed to explore its impact on treating patients with extensive burns.</div></div>","PeriodicalId":50717,"journal":{"name":"Burns","volume":"51 5","pages":"Article 107508"},"PeriodicalIF":3.2,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143869992","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"First aid knowledge for burn injuries among healthcare workers and the general population in Saudi Arabia: A cross-sectional study","authors":"Safinaz M. Alshiakh ,&nbsp;Abdullah S. Algarni ,&nbsp;Ghadeer Doman ,&nbsp;Ahmad Aalam ,&nbsp;Roaa H. Alabbadi","doi":"10.1016/j.burns.2025.107507","DOIUrl":"10.1016/j.burns.2025.107507","url":null,"abstract":"<div><div>Burns are among the leading causes of disability-adjusted life years (DALYs) lost, predominantly in low- and middle-income countries. Prompt and effective first aid is crucial in mitigating the severity of burn injuries. This study assessed the current burn first aid knowledge level among healthcare workers and non-healthcare individuals in Saudi Arabia.</div></div><div><h3>Methods</h3><div>A cross-sectional study was conducted among a sample of healthcare workers and the general population in Jeddah City, Saudi Arabia. Data were collected through an online questionnaire-based survey composed of two main parts: demographic characteristics of the participants and five case-scenario-based multiple-choice questions (scald burns, flame burns, contact burns, chemical burns, and liquid petroleum gas cylinder burns).</div></div><div><h3>Results</h3><div>A total of 748 participants were included in the study (355 healthcare workers with a response rate of 92.2 % and 393 general population). More than one-third (36.6 %) of the participants reported receiving formal training in first aid. However, this training covered first aid in burn injuries in 26.3 % of cases. Healthcare workers were more knowledgeable than the general population as regards scald burns (p &lt; 0.001), flame burns (p = 0.028), contact burns (p &lt; 0.001), and liquid petroleum gas cylinder burns (p &lt; 0.001). Results of multivariate logistic regression analysis showed that only job category and history of receiving any training in first aid were significantly associated with insufficient knowledge about the management of burns among both groups.</div></div><div><h3>Conclusion</h3><div>Although healthcare workers demonstrated better knowledge than the general population regarding the 1st aid management for different burn scenarios, both groups’ knowledge levels require improvement. Thus, comprehensive health and safety education, with a specific focus on burn safety, is highly recommended for all healthcare workers and the general population.</div></div>","PeriodicalId":50717,"journal":{"name":"Burns","volume":"51 5","pages":"Article 107507"},"PeriodicalIF":3.2,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143854473","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hypoxia impairs autophagy of cardiomyocytes via p38/MAPK/MAP4 pathway","authors":"Nuo Chen ,&nbsp;Qiongfang Ruan ,&nbsp;Siyu Zhang ,&nbsp;Zhigang Chu ,&nbsp;Weiguo Xie","doi":"10.1016/j.burns.2025.107511","DOIUrl":"10.1016/j.burns.2025.107511","url":null,"abstract":"<div><h3>Background</h3><div>Myocardial hypoxia occurs in severe burns and may cause severe cardiac dysfunction, in which the blockage of the autophagy flux plays an important role. Previous studies indicates that the p38/MAPK pathway is involved in regulating the microtubule structure by regulating MAP4 phosphorylation, and the microtubule structure affects the autophagy. However, as a complex degradation process, how autophagy is specifically affected by microtubules remains unknown. An in-depth understanding of hypoxia-related autophagy disorders is critical for the treatment of myocardial injury.</div></div><div><h3>Methods</h3><div>Cardiomyocytes (CMs) were isolated from the ventricles of neonatal Sprague–Dawley rats and cultured in an incubator filled with 1 % O₂, 5 % CO₂, and 94 % N₂. SB203580 and MKK6 (Glu) recombinant adenovirus were used to specifically inhibit and activate the p38/MAPK pathway, respectively. The adeno-associated viruses (AAVs) encoding MAP4 gene and MAP4 siRNA were used to up-regulate and down-regulate the expression of MAP4, respectively. After infection of cells with AAV encoding GFP-LC3 fusion proteins, the number of green spots under fluorescence microscopy shows the quantity of autophagosomes. Western blots access the expression of LC3-II, LC3-I and p62. The ratio of LC3-II to LC3-I (LC3-II/I) tells the quantity of autophagosomes, and the expression of p62 indicates the extent of autophagosome degradation. Cell Counting Kit 8 was used to detect cell viability. Rapamycin was used to recover the autophagy.</div></div><div><h3>Results</h3><div>Hypoxia reduced the viability of cardiomyocytes, in which the quantity of autophagosomes is increased, while the degradation is reduced, and the p38/MAPK pathway is activated. Activation of the p38/MAPK pathway could block the autophagy pathway. The phosphorylation of MAP4 did not affect the quantity of autophagosomes, but hindered its degradation. The p38/MAPK pathway could regulate the phosphorylation of MAP4. Finally, when the autophagy pathway was restored, cell viability has partially recovered.</div></div><div><h3>Conclusions</h3><div>Hypoxia regulates the phosphorylation of MAP4 through the p38/MAPK pathway, thereby hindering the degradation of autophagosomes, rather than the quantity, blocking autophagic flux and ultimately affecting cell viability.</div></div>","PeriodicalId":50717,"journal":{"name":"Burns","volume":"51 5","pages":"Article 107511"},"PeriodicalIF":3.2,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143899653","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ferroptosis and necroptosis may be involved in the formation and progression of hydrofluoric acid burn wounds: Results from an RNA-Seq analysis","authors":"Fuying Li ,&nbsp;Jianda Zhou ,&nbsp;Ke Shi ,&nbsp;Quanyong He ,&nbsp;Wuliang Diao ,&nbsp;Hao Peng ,&nbsp;Geao Liang ,&nbsp;Chi Zhong ,&nbsp;Wengjuan Li ,&nbsp;Dan Xu","doi":"10.1016/j.burns.2025.107513","DOIUrl":"10.1016/j.burns.2025.107513","url":null,"abstract":"<div><h3>Background</h3><div>Hydrofluoric acid (HF) burns have potentially serious consequences. The molecular mechanism of wound development is still unclear. This study aims to preliminarily explore the programmed cell death mode that may be involved in hydrofluoric acid burns by using transcriptome sequencing technology and to provide a theoretical basis for a new treatment approach for hydrofluoric acid burns.</div></div><div><h3>Methods</h3><div>The rat model of hydrofluoric acid burn skin was constructed, and the differentially expressed genes after HF burn were screened by transcriptome sequencing technology. HE staining, TUNEL staining, immunohistochemistry, biochemical detection, and qRT-PCR were used to preliminarily verify the mode of cell death involved in hydrofluoric acid burn wounds.</div></div><div><h3>Results</h3><div>The sequencing results suggest that the differential genes after HF burn were enriched in ferroptosis, apoptosis, and necroptosis pathways in cell growth and death aspects. HE staining confirmed HF burn wounds were progressively aggravated. The positive cells of TUNEL staining in the wound gradually increased. Compared with the normal group, the content of MDA in serum and skin tissue increased and the content of GSH decreased at 4, 8, 12, 24, and 48 hours after HF burn (P &lt; 0.05). The level of serum Fe^2 + in the HF burn group was higher than that in the normal group at 4 h, 8 h, and 12 h postburn (P &lt; 0.05). The level of serum Fe²⁺ at 24 h and 48 h postburn was higher than that of the normal group, but the difference was not statistically significant. The content of Fe²⁺ in skin tissue increased and reached its peak at 12 h (P &lt; 0.05). The serum calcium level decreased to its lowest level at 24 hours postburn (P &lt; 0.05). Immunohistochemistry showed that the expressions of GPX4, FTH1, and Bcl-2 proteins in hydrofluoric acid burn wounds were down-regulated, while the expression of HO-1, Bax, RIPK1, and MLKL was increased (P &lt; 0.05). RIPK3 expression was not significantly different. qRT-PCR showed that the expression of HO-1, FTH1, SLC39A14, SLC39A8, CYBB, ACSL4, Bax, RIPK1, MLKL, IL-1β, and IL-6 increased, while the expression of ACSL1, ACSL6, GPX4, and Bcl-2 decreased after hydrofluoric acid burn compared with the normal group (P &lt; 0.05). The RIPK3 gene expression did not change significantly.</div></div><div><h3>Conclusions</h3><div>Ferroptosis and necroptosis are involved in the formation and progression of HF burn wounds. Early blocking of ferroptosis may be a potential therapeutic for blocking the progress of hydrofluoric acid burn wounds. Necroptosis involvment in the occurrence and development of hydrofluoric acid burn wounds may be a non-classical pathway.</div></div>","PeriodicalId":50717,"journal":{"name":"Burns","volume":"51 5","pages":"Article 107513"},"PeriodicalIF":3.2,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143906739","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Geospatial analysis of community-level social and environmental barriers for adult burn injury survivors in North Texas","authors":"Pyung Kim ,&nbsp;Dohyeong Kim ,&nbsp;Richard Scotch ,&nbsp;Dohyo Jeong ,&nbsp;Karen Kowalske","doi":"10.1016/j.burns.2025.107512","DOIUrl":"10.1016/j.burns.2025.107512","url":null,"abstract":"<div><h3>Purpose</h3><div>This study investigates geographic variations in community integration among burn injury survivors in North Texas and identifies community-level social and environmental factors that influence their post-injury community reintegration.</div></div><div><h3>Methods</h3><div>We utilized data from the Burn Model System (BMS) National Database, focusing on 153 adult burn injury survivors in North Texas who sustained injuries between 2015 and 2022. We conducted county-level mapping to visualize temporal changes in Community Integration Questionnaire (CIQ) scores by comparing pre-injury scores to post-injury scores at 6 and 12 months. Next, we categorized counties into two groups: (1) counties with consistent declines in CIQ scores over the 12-month post-injury period, and (2) all other counties with burn injury survivors. We then compared county-level community characteristics between these two groups, focusing on four factors: socioeconomic conditions, access to healthcare, public safety, and the built environment.</div></div><div><h3>Results</h3><div>There were geographic disparities in CIQ score changes among counties after burn injury. Counties with consistent decreases in CIQ scores had significantly higher levels of poverty, higher unemployment rates, increased crime rates, and lower access to healthy food options compared to other counties.</div></div><div><h3>Conclusions</h3><div>The findings suggest that rural counties may lack a supportive environment for burn injury survivors, highlighting the need for targeted interventions to promote community integration. Implementing strategies to reduce socioeconomic disparities, enhance public safety, and improve access to nutritious food could help facilitate better community reintegration outcomes for burn injury survivors. Furthermore, clinicians can leverage these insights by offering patient-level supports—such as localized telehealth services, peer support group referrals at discharge, and guidance on local resources—to help individuals navigate environmental barriers and maintain community engagement after returning home.</div></div>","PeriodicalId":50717,"journal":{"name":"Burns","volume":"51 5","pages":"Article 107512"},"PeriodicalIF":3.2,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143869991","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The significance of completing burn excision within one week after injury","authors":"Yasuhiko Kaita,&nbsp;Takeaki Matsuda,&nbsp;Yoshihiro Yamaguchi","doi":"10.1016/j.burns.2025.107506","DOIUrl":"10.1016/j.burns.2025.107506","url":null,"abstract":"<div><h3>Background</h3><div>Burn wound excision is crucial for infection control in burn patients. Based on previous studies, the Japanese Society of Burn Injuries recommended that the surgical debridement be completed within one week after injury for patients with a burned area of 30 % or more. However, there have been no reports examining the significance of completing resection of the burn wound within one week. This study was aimed to clarify the importance of completing burn excision within one week after injury for 30 % or more in flame burn patients.</div></div><div><h3>Methods</h3><div>Data from 66 flame burn patients who underwent surgical excision from January 2005 to December 2024 were analyzed retrospectively.</div></div><div><h3>Results</h3><div>There were no significant differences between the completed and uncompleted groups in terms of age, sex, severity of burn, the presence of inhalation injury, the use of cadaver skin, and the ICU length of stay. The presence of bacteremia within two weeks after injury was significantly lower in the completed group compared to the uncompleted group, and the mortality rate in the completed group was lower than that of the uncompleted group. In the logistic regression analysis, the completion of burn excision within one week was independently associated with the incidence of bacteremia but not mortality.</div></div><div><h3>Conclusions</h3><div>Completing burn excision within one week is important for infection control in flame burn patients with the total burn surface area of 30 % or more.</div></div>","PeriodicalId":50717,"journal":{"name":"Burns","volume":"51 5","pages":"Article 107506"},"PeriodicalIF":3.2,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143902257","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Component analysis of polyherbal repair recipe and its pharmacological mechanisms in burn wound healing","authors":"Xiangwei Qu ,&nbsp;Shanqin You ,&nbsp;Zhaoxiang Zeng ,&nbsp;Xueyuan Zhao ,&nbsp;Lijun Zhang ,&nbsp;Wan Li ,&nbsp;Rongzeng Huang ,&nbsp;Chengwu Song ,&nbsp;Jiangcheng He ,&nbsp;Xugui Li ,&nbsp;Xingliang Xiang ,&nbsp;Shuna Jin","doi":"10.1016/j.burns.2025.107514","DOIUrl":"10.1016/j.burns.2025.107514","url":null,"abstract":"<div><h3>Background</h3><div>The Jiusheng Wound Repair Recipe (JSWR), a folk prescription of traditional Chinese medicine, has been used clinically for treating burns and scalds with notable efficacy. However, its chemical components and pharmacological mechanisms remain unclear.</div></div><div><h3>Methods</h3><div>Ultra-performance liquid chromatography coupled to quadrupole time-of-flight mass spectrometry (UPLC-QTOF-MS) was utilized to analyze JSWR's chemical composition. A wound healing model in Kunming mice assessed the effects of JSWR on healing rates, collagen synthesis, angiogenesis, and inflammation through histological and immunohistochemical techniques. Potential pharmacological mechanisms were explored by metabolomic analysis.</div></div><div><h3>Results</h3><div>All 530 components were identified or characterized in JSWR. It significantly accelerated wound healing and reduced TNF-α and IL-6 levels. The expression of CD31 and collagen I and III were enhanced, while COX-2 expression was reduced. 19 critical metabolites and key metabolic pathways were explored by metabolomics.</div></div><div><h3>Conclusions</h3><div>JSWR effectively promoted wound healing through enhancing collagen deposition and angiogenesis, and by inhibiting inflammation. Further exploration of mechanisms would be valuable to the application and development of JSWR.</div></div>","PeriodicalId":50717,"journal":{"name":"Burns","volume":"51 5","pages":"Article 107514"},"PeriodicalIF":3.2,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143854647","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early Laser for Burn Scars (ELABS) - Randomised controlled trial of pulsed dye laser treatment and standard care versus standard care alone for the treatment of hypertrophic burn scars","authors":"Mark P. Brewin ,&nbsp;Sharon Docherty ,&nbsp;Vanessa Heaslip ,&nbsp;Shelley Rhodes ,&nbsp;Obioha C. Ukoumunne ,&nbsp;Naomi C. Burnett-Fry ,&nbsp;Katie Breheny ,&nbsp;Jonathon M. Pleat ,&nbsp;Kate M. Attrill ,&nbsp;Kayvan Shokrollahi ,&nbsp;Quentin Frew ,&nbsp;Christopher J. Lewis","doi":"10.1016/j.burns.2025.107500","DOIUrl":"10.1016/j.burns.2025.107500","url":null,"abstract":"<div><h3>Background</h3><div>Hypertrophic burn scarring (HBS) is described as “the greatest unmet challenge after burn injury”. This ELABS trial hypothesised that early pulsed dye laser (PDL) treatment of HBS improves both scar quality and quality of life (QoL).</div></div><div><h3>Methods</h3><div>A parallel arm randomised controlled trial to assess the effectiveness and cost-effectiveness of PDL was undertaken at seven centres in the UK. Patients were eligible if their burn injury was within three months of wound healing, and ineligible either with history of keloid scarring or aged &lt; 16 years. A total of 153 (77 male, 76 female) participants were recruited between Nov 17, 2021, and Jun 30, 2023, and were randomised using software in a 1:1 ratio stratified by study centre; 138 (69 each arm) were included in the final complete-case analysis. Both study arms received standard care, and the intervention arm received three PDL treatments. The primary outcome was patient-rated scar quality (POSAS) at six months. The trial was registered with International Standard Randomised Controlled Trial Number registry (ISRCTN14392301).</div></div><div><h3>Findings</h3><div>Early PDL showed a statistically significant improvement in patient-rated scar quality (p = 0·041) and the secondary outcome, participant’s perception of change in scar quality (p = 0·01), at six months. There were no statistically significant differences for Quality-of-Life, observer-rated POSAS scar quality, or colour measurement. Early PDL was not cost-effective at 6 months follow-up for the willingness-to-pay threshold of £20,000 per Quality-Adjusted-Life-Year (QALY). There were no unexpected adverse events related to the intervention.</div></div><div><h3>Interpretation</h3><div>Early PDL treatment of HBS is safe and shows improvement for patient-rated scar quality but not QoL at six months. As scar maturation is prolonged and dynamic, longer-term follow-up of upwards of two years is required both to understand the eventual clinical effect on scar outcome and to make any definitive conclusion concerning cost-effectiveness.</div></div>","PeriodicalId":50717,"journal":{"name":"Burns","volume":"51 5","pages":"Article 107500"},"PeriodicalIF":3.2,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143899223","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementation of a multimodal pain protocol in adult burn patients","authors":"Alyssa Garelli ,&nbsp;Allison N. Boyd ,&nbsp;Michelle Brown ,&nbsp;Taylor Rhew ,&nbsp;Molly Tieman ,&nbsp;Brett C. Hartman ,&nbsp;Todd A. Walroth","doi":"10.1016/j.burns.2025.107515","DOIUrl":"10.1016/j.burns.2025.107515","url":null,"abstract":"<div><div>The 2020 American Burn Association guidelines recommend a multimodal approach to pain management comprised of both opioids and non-opioids. The purpose of this study was to compare outcomes before and after implementation of a multimodal pain order set in the burn admission order set within the electronic medical record. This single center, retrospective, cohort study was conducted at an American Burn Association-verified burn center. The pre-group (n = 64) and post-group (n = 63) were well-matched with respect to all baseline demographics, such as total body surface area, length of stay, mechanical ventilation, and number of procedures. The primary outcome was daily morphine milligram equivalents received cumulatively through admission day seven. There was a significant reduction in cumulative median morphine milligram equivalents received in the post-group compared to the pre-group (172 versus 97, p = 0.042) without worsening evidence of pain. Doses of scheduled acetaminophen (62.5 % versus 95.2 %, p &lt; 0.001), ibuprofen (31.3 % versus 42.9 %, p = 0.017), and ketamine (14.1 % versus 28.6 %, p = 0.043) were significantly increased in the post-group. Multimodal order set integration significantly improved guideline recommended multimodal analgesic use and is one effective method to increase non-opioid analgesic use for acute pain following a burn injury.</div></div>","PeriodicalId":50717,"journal":{"name":"Burns","volume":"51 5","pages":"Article 107515"},"PeriodicalIF":3.2,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143874470","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}