Burns open : an international open access journal for burn injuries最新文献

{"title":"Our experience of treatment of purulent arthritis in lower extremities after burn injury","authors":"B.M. Shakirov ,&nbsp;D.Sh. Karabaev ,&nbsp;S.X. Zoxidova ,&nbsp;Sh. Ziyadullaev","doi":"10.1016/j.burnso.2024.100383","DOIUrl":"10.1016/j.burnso.2024.100383","url":null,"abstract":"<div><h3>Background</h3><div>The burn wound is directly affected by the general condition of the patient and also has a direct impact on the same leading to conditions pathology of the musculoskeletal system. Purulent arthritis is a pathological condition in which the joints of the body get inflamed as a result of bacterial infection.</div><div><strong>The aim</strong> of the present study was identification of purulent arthritis patients and to evaluate different surgical treatment in burn patients’ low extremities.</div></div><div><h3>Material and methods</h3><div>During a 11-year period, 39 patients with burn injuries complicated by purulent arthritis of the joints of the lower extremities treated in the burn department of the Samarkand Center of Emergency Medical Care, Samarkand, Uzbekistan between 2010 and 2020 were enrolled in the present study. The diagnosis is made on the basis of a characteristic anamnesis. Blood tests confirming the presence of acute inflammation. The main diagnostic method purulent arthritis is puncture of the joint with subsequent examination of the punctate. All patients received comprehensive general and local treatment included necrotomy, necrectomy and 1 to 3 operations were performed to plastically close deep and large burn wounds. We performed an arthrotomy in 31 patients. In all cases, arthrotomy was performed as a planned surgical intervention. Unfortunately we performed amputation in 8 patients.</div></div><div><h3>Results</h3><div>In the postoperative period, drainage of the joint cavity through the opening and wound, the application of paraphene to the surrounding tissues of the joints, massage, physical therapy, treatment physical physiotherapy exercises, laser application made it possible to achieve satisfactory results.</div></div><div><h3>Conclusions</h3><div>The described herein method of treatment of purulent arthritis of the lower extremities has improved treatment results, expanded survival rates, reduced probability of complications and disabilities.</div></div>","PeriodicalId":72486,"journal":{"name":"Burns open : an international open access journal for burn injuries","volume":"9 ","pages":"Article 100383"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143155442","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Microbial profile of burn wound injuries in the Northern West Bank − A retrospective cohort study","authors":"Sameh Natsha ,&nbsp;Hester Lacey ,&nbsp;Souad Belkebir ,&nbsp;Ann Attili ,&nbsp;Aya Atatra ,&nbsp;Rawand Daragmeh ,&nbsp;Anas Abu-Safa ,&nbsp;Baljit Dheansa ,&nbsp;Rasha Khayyat","doi":"10.1016/j.burnso.2024.100379","DOIUrl":"10.1016/j.burnso.2024.100379","url":null,"abstract":"<div><h3>Background</h3><div>Determining frequently colonizing microorganisms and typical demographics affected by burns in the West Bank is essential to aid timely and effective injury management.</div></div><div><h3>Methods</h3><div>This study included n = 435 patients with burn injuries between January 2018-December 2021 at a tertiary center in Nablus. Eligible medical records were reviewed, and relevant data extracted.</div></div><div><h3>Results</h3><div>n = 244 males and n = 191 females, average age 14.5 years were included. n = 227 had wound swab cultures, n = 80 which were positive. Scald injuries were the most common mechanism of injury (n = 314, n = 162 in males (p &lt; 0.001), average age of 10.5 years). The most common organisms isolated were <em>Pseudomonas aeruginosa</em> (n = 17) and <em>Staphylococcus aureus</em> (n = 18). n = 17 multidrug resistant (MDR) organisms were cultured, MRSA most commonly (n = 9), followed by <em>K. pneumoniae</em> (ESBL) (n = 5). Overall length of stay (LOS) was 17.27 days in all patients and 28.2 days in those with MDR, with increasing LOS significantly associated with positive culture and MDR development of MDR (p &lt; 0.001).</div></div><div><h3>Conclusions</h3><div>Younger male demographics and longer hospital admission increase the risk of burn wound colonization and MDR development in the Northern West Bank. <em>Pseudomonas aeruginosa</em> and <em>Staphylococcus aureus</em> were prevalent organisms isolated. MDR development represents a significant challenge in the effective management of injuries in an immunologically vulnerable cohort.</div></div>","PeriodicalId":72486,"journal":{"name":"Burns open : an international open access journal for burn injuries","volume":"9 ","pages":"Article 100379"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142655858","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How can mathematics be used to improve burn care?","authors":"Ginger Egberts ,&nbsp;Fred Vermolen ,&nbsp;Qiyao Peng ,&nbsp;H.Ibrahim Korkmaz ,&nbsp;Paul van Zuijlen","doi":"10.1016/j.burnso.2024.100390","DOIUrl":"10.1016/j.burnso.2024.100390","url":null,"abstract":"<div><div>Severe second-degree ‘partial thickness’ and third-degree ‘full thickness’ burns are characterized by damage to the dermal layer of the skin. In the dermis, specialized cells called fibroblasts play a crucial role in wound healing. These cells produce collagen, a protein that provides strength and structure to the skin. After burn injury, fibroblasts migrate to the injured area and start producing and depositing collagen to help repair the damaged tissue. While contraction is essential for closing the wound, it can also result in scar contraction (contractures), especially in more severe burns. This contraction creates stresses on the skin, which can deteriorate the mobility of joints near the burn.</div><div>This article overviews the most recent research results in computer simulations of scar contraction after burns.</div></div>","PeriodicalId":72486,"journal":{"name":"Burns open : an international open access journal for burn injuries","volume":"9 ","pages":"Article 100390"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143155438","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence and characteristics of paediatric burns at the National Reconstructive Plastic Surgery and Burns Centre, Korle Bu Teaching Hospital, Ghana","authors":"Alberta Amissah Rockson ,&nbsp;Natalie Benjamin-Damons ,&nbsp;Sonti Imogene Pilusa","doi":"10.1016/j.burnso.2024.100358","DOIUrl":"https://doi.org/10.1016/j.burnso.2024.100358","url":null,"abstract":"<div><h3>Introduction</h3><p>Burn injuries among children have emerged as a significant global public health concern, accounting for substantial morbidity and mortality worldwide. Low and Middle-Income Countries bear a significant burden of paediatric burn injuries. In Ghana, limited data exists on the prevalence, characteristics and outcomes of paediatric burns. This study provides vital data on the local burden and epidemiology of paediatric burns at Ghana’s main burns treatment center. The findings have significant value in informing prevention strategies, allocating resources, and improving quality of paediatric burn care.</p></div><div><h3>Study objective</h3><p>To establish the prevalence and characteristics of paediatric burns injuries in Ghana’s leading burn center.</p></div><div><h3>Methodology</h3><p>A retrospective cohort study analyzed data from 662 adult and paediatric patients who presented with burns from all over Ghana between 2020 and 2022. The study encompassed medical records of paediatric burn cases (aged 0–14 years) admitted to the center from January 2020 to December 2022. A purposive sampling technique was used to select cases based on the inclusion criteria and elimination of cases with 20 % missing data. A total of 335 paediatric records were reviewed.</p></div><div><h3>Data analytical methods</h3><p>Descriptive statistics, such as frequencies, mean, percentages were used to establish period prevalence and demographic characteristics of paediatric burns. Chi-square analysis and univariate logistic regression was utilized to explore associations between categorical variables, and predictors of burn outcome.</p></div><div><h3>Results</h3><p>The period prevalence of paediatric burns was found to be 50.6 %. Paediatric burn cases predominantly affected males (57.6 %). Majority of cases fell within the age range of 1 to 5 years (70.1 %). Hot water emerged as the leading cause (58.4 %), whiles superficial partial thickness burns (51.9 %) was the predominant type of burn. Most cases involved burns affecting less than 20 % Total Body Surface Area (59.0 %). Multi-part body injuries were common (87.2 %), with the lower limb being the most affected (25.36 %). The mortality rate was calculated to be 21.0 %. Higher TBSA was a significant predictor of mortality (p &lt; 0.001).</p></div><div><h3>Conclusion</h3><p>This study found a high prevalence of paediatric burns with hot water and foods being the predominant causes. Higher TBSA predicted lower chances of survival. The findings have scientific value in informing prevention strategies, allocating resources, and improving the quality of care.</p></div>","PeriodicalId":72486,"journal":{"name":"Burns open : an international open access journal for burn injuries","volume":"8 4","pages":"Article 100358"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2468912224000464/pdfft?md5=738e7741addc028c0101f1d772465df3&pid=1-s2.0-S2468912224000464-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141541241","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes of burn patients presenting with hypotension within 48 hrs of admission to a level 1 Burn Centre","authors":"C.M. Burns ,&nbsp;K.D. Boffard ,&nbsp;M.S. Moeng","doi":"10.1016/j.burnso.2024.100377","DOIUrl":"10.1016/j.burnso.2024.100377","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Introduction&lt;/h3&gt;&lt;div&gt;Burns is one of the important presentations in trauma surgery in both first and third-world countries. Hypotension is often seen in the clinical presentation of a burn injury. Hypotension is the strongest independent predictor of an adverse outcome, according to a study done on emergency departments’ hospital outcomes; the lower the systolic, the worse the outcome. No direct study shows that presenting with or developing hypotension within 48hrs of admission and burn injury will have a worse outcome in our low-middle income setting.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Objectives&lt;/h3&gt;&lt;div&gt;To determine the outcomes of burn patients who developed hypotension within 48hrs of arrival at a Burn Centre in Johannesburg. In a singled time event.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;A retrospective descriptive study was conducted at a Level 1 Trauma Centre Burn unit in Johannesburg from 01 Jan 2019 to 31 Dec 2020. Patients who had a hypotensive episode at any point during the 48 h period were recruited. Hypotension was defined as a systolic blood pressure of less than 90mmhg. The patients were then divided into two groups: those who presented with or developed hypotension within 48hrs and those who did not. After that, the in-hospital mortality of both groups was to be determined. The study included all the patients who presented to the Burn Centre. Those younger than 18, or requiring readmission in the same study or delayed admissions of more than 24 h were excluded. Demographics, burn information, resuscitation data, outcomes and disposition status were evaluated. The STATA Statistics/Data Analysis version 16.0 was used to analyse the data. The level of significance was set at a p-value &lt; 0.05. Ethical approval was obtained from the Human Research Ethics Committee (HREC) (medical) of the University of the Witwatersrand with the clearance number: M220132.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Of the 132 patients seen, only 105 met the study inclusion criteria. Most patients were male: 91/105 (86.6 %). Flame burns accounted for the majority of the burns, 64/105 (60.95 %), followed by electrical burns, 26/105 (24.76 %). Hot water and chemical burns only accounted for 11/105 (10.48 %) and 4 (3.81 %) cases. Hypotension within 48hrs was noted in 37/105(35 %) of the cases. Hypotensive patients had an increased burn depth (p = 0.03), higher inhalation rate component (p = &lt;0.001), greater lactate levels(p = 0.00001), higher baux score(p = 0.00001) and more likelihood of being placed on the ventilator (p = &lt;0.00001) or dialysis (p = 0.008). Mortality was noted in 16 (43 %) of the patients who developed hypotension compared to 5 (7.4 %) patients of non-hypotensive patients (p &lt; 0.001). The mortality of patients who presented with or developed hypotension was 9.59 times (95 % CI 3.1–29.4; p = 0.00001) higher than those who did not develop hypotension. Age and TBSA affected by burn, were found to have significant predictive value for mortali","PeriodicalId":72486,"journal":{"name":"Burns open : an international open access journal for burn injuries","volume":"8 4","pages":"Article 100377"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142560583","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Too hot to handle − Microwaved drinkware: An emerging cause of contact burn injuries?","authors":"Tamara Mertz,&nbsp;Amr Elassy,&nbsp;Christopher Wearn","doi":"10.1016/j.burnso.2024.100359","DOIUrl":"https://doi.org/10.1016/j.burnso.2024.100359","url":null,"abstract":"<div><h3>Purpose of the study</h3><p>To investigate the local and national incidence of contact burns secondary to microwave-heated drinkware and specifically those with a metallic coating.</p></div><div><h3>Methods</h3><p>This retrospective analysis from November 2018 to December 2022 includes UK-wide data on burn mechanism, demographics, TBSA (total body surface area), depth and additionally, local data on injury details, management, complications, healing duration, return-to-work time, and follow-up duration within our service.</p></div><div><h3>Results</h3><p><em>National:</em> In the UK, 87 patients sustained burns related to microwave heating of drinkware. Median (IQR) burn size was 0.21% (+/−0.15) TBSA. Most burn injuries were superficial dermal (SD) (88.7%). All cases were treated conservatively.</p><p><em>Regional:</em> Contact burns from microwave-heated metallic coated drinkware were identified in 28 patients. The median (IQR) TBSA was 0.12% (+/−0). Most injuries were assessed as SD (90%, 45/50), however, 4/5 (80%) of the deeper burns were caused by metallic-coated drinkware. The median (IQR) follow-up was 6.04 days (+/−4.5). Median (IQR) healing time was 14.17 (+/−0) days and mean time to return to work was 7.57 (+/−3.5) days.</p></div><div><h3>Conclusions</h3><p>Microwave-heated drinkware burns, while constituting a small portion of referrals to UK burns services, may have a larger true population incidence. Due to their size, these injuries are probably treated locally without referral to a burns service. Regional data analysis highlighted that metallic coated drinkware related injuries were associated with longer healing times.</p></div>","PeriodicalId":72486,"journal":{"name":"Burns open : an international open access journal for burn injuries","volume":"8 4","pages":"Article 100359"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2468912224000476/pdfft?md5=d77c48aea66bb87a41a84dc43abdc9d3&pid=1-s2.0-S2468912224000476-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141594571","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Oral/enteral fluid resuscitation in the initial management of major burns: A systematic review and meta-analysis of human and animal studies","authors":"Kai Hsun Hsiao ,&nbsp;Joseph Kalanzi ,&nbsp;Stuart B. Watson ,&nbsp;Srinivas Murthy ,&nbsp;Ani Movsisyan ,&nbsp;Kavita Kothari ,&nbsp;Flavio Salio ,&nbsp;Pryanka Relan","doi":"10.1016/j.burnso.2024.100364","DOIUrl":"10.1016/j.burnso.2024.100364","url":null,"abstract":"<div><h3>Background</h3><p>Timely and safe intravenous (IV) fluid resuscitation for major burns may be difficult or impossible during mass casualty burn incidents. Oral/enteral fluid resuscitation may be an alternative.</p></div><div><h3>Objectives</h3><p>To synthesize and assess certainty of evidence on oral/enteral fluid resuscitation as compared to IV or no fluid resuscitation for major burns.</p></div><div><h3>Methods</h3><p>PubMed, EMBASE, CINAHL, and Cochrane Library were searched on 8 September 2023. Primary quantitative studies meeting criteria as assessed by two reviewers were included. Meta-analyses for outcome effects of oral/enteral versus IV and of oral/enteral versus no fluid resuscitation were conducted. Evidence certainty was assessed using GRADE.</p></div><div><h3>Results</h3><p>Seven human and eight animal studies were included. Three human RCTs totalling 100 participants contributed to estimates. Compared to IV fluid resuscitation, oral/enteral fluid resuscitation is associated with a statistically insignificant increased risk of mortality (OR 1.33, 95% CI 0.33–5.36) but the evidence is very uncertain, and no difference in urine output (SMD −0.17, 95% CI −0.65–0.31) with moderate certainty of evidence. Eight controlled animal studies totalling 212 participants contributed to estimates. From these animal studies, enteral fluid resuscitation may increase mortality (OR 36.00, 95% CI 2.72–476.28), worsen creatinine levels (MD 22 mmol/L, 95% CI 15.8–28.2), and increase urine output (MD 1 ml/kg/h, 95% CI 0.55–1.45) compared to IV, but all with very low certainty of evidence. Again, from animal studies, all the evidence is very uncertain, but compared to no fluid resuscitation, enteral resuscitation is associated with a statistically insignificant reduction in mortality (OR 0.29, 95% CI 0.08–1.09), improved creatinine levels (SMD −3.48, 95% CI −4.69 to −2.28), and increased urine output (MD 0.55 ml/kg/h, 95% CI 0.38–0.72).</p></div><div><h3>Conclusions</h3><p>Current evidence comparing oral/enteral and IV fluid resuscitation for major burns is limited and uncertain. However, where IV fluid resuscitation is unavailable or delayed, oral fluid resuscitation could be considered.</p></div>","PeriodicalId":72486,"journal":{"name":"Burns open : an international open access journal for burn injuries","volume":"8 4","pages":"Article 100364"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S246891222400052X/pdfft?md5=cb9faeea0777563e90825b3d5295256d&pid=1-s2.0-S246891222400052X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141849379","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Can viscoelastic haemostatic tests in burn patients help to predict outcome? – A case report and narrative review of the literature","authors":"Joeri Slob ,&nbsp;Stephan A. Loer ,&nbsp;Seppe S.H.A. Koopman ,&nbsp;Cornelis H. van der Vlies","doi":"10.1016/j.burnso.2024.06.005","DOIUrl":"10.1016/j.burnso.2024.06.005","url":null,"abstract":"<div><h3>Background</h3><p>Burn injuries can cause multiple burn-induced coagulopathies. Viscoelastic haemostatic tests received increasing attention in coagulation monitoring as a tool to evaluate the haemostatic function of whole blood. Their exact role in burn patients remains unclear. We wondered whether the results of viscoelastic haemostatic tests are correlated with patient outcome. We present a case report as well as the results of a literature review of studies addressing the relationship of viscoelastic haemostatic tests and patient outcome.</p></div><div><h3>Case</h3><p>We report the case of a 77 year old patient who had suffered flame burns to the chest, abdomen, neck and upper arms accounting for 16 % of the body surface area. One week after burn the patient underwent extensive burn surgery. Repeated perioperative viscoelastic coagulation testing with rotational thromboelastometry showed rapidly changing haemostatic states ranging from hyper- to hypocoagulability. Despite prophylactic use of anticoagulation, the patient developed pulmonary embolism on the second postoperative day. This case highlights the importance of close haemostatic monitoring of patients with burn-induced coagulopathies.</p></div><div><h3>Principal results</h3><p>We identified four studies addressing the relationship between viscoelastic tests and outcome in burn patients, two prospective observational studies and two retrospective cohort studies. Two studies generated prediction models identifying predictors of mortality or complications. Maximum amplitude during viscoelastic testing was found to be an independent outcome predictor in both prediction models. Two other studies suggest that fibrinolysis at 30 min during viscoelastic testing was associated with mortality.</p></div><div><h3>Conclusions</h3><p>Haemostatic management of patients with burn-induced coagulopathies remains challenging. We suggest that viscoelastic haemostatic tests can help to guide clinical decisions. Specific markers, such as maximal strength of the clot and lysis at 30 min after the time of maximal clot strength have been associated with increased mortality. Future research should explore the exact role of viscoelastic haemostatic testing in burn patients.</p></div>","PeriodicalId":72486,"journal":{"name":"Burns open : an international open access journal for burn injuries","volume":"8 4","pages":"Article 100354"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2468912224000397/pdfft?md5=e0e2bf92a14167933483fef54f1dbf1e&pid=1-s2.0-S2468912224000397-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141401312","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adapted approaches to initial fluid management of patients with major burns in resource-limited settings: A systematic review","authors":"Kai Hsun Hsiao ,&nbsp;Joseph Kalanzi ,&nbsp;Stuart B Watson ,&nbsp;Srinivas Murthy ,&nbsp;Ani Movsisyan ,&nbsp;Kavita Kothari ,&nbsp;Flavio Salio ,&nbsp;Pryanka Relan","doi":"10.1016/j.burnso.2024.100365","DOIUrl":"10.1016/j.burnso.2024.100365","url":null,"abstract":"<div><h3>Background</h3><p>Resource limitations in settings such as burn mass casualty incidents (MCIs) present challenges to the judicious fluid resuscitation required for major burns. Previous recommendations for burns care in MCIs have suggested certain adaptations from routine care, such as delaying intravenous (IV) fluid resuscitation until arrival at facility; using a fluid calculation formula that is independent of percentage of total body surface area (%TBSA) burned; or using fluid calculation formula based on time of arrival to first receiving facility rather than from time of injury, thus omitting ‘catch-up’ fluid.</p></div><div><h3>Objectives</h3><p>To synthesize and assess certainty of evidence from resource-limited settings on the three adaptations to fluid resuscitation for patients with major burns in MCIs.</p></div><div><h3>Methods</h3><p>PubMed, EMBASE, CINAHL, and Cochrane Library were searched on 8 September 2023 with an update search on 8 July 2024. Primary quantitative studies in resource-limited settings meeting eligibility criteria as assessed by two reviewers were included. Where available, outcome effects for these adaptations compared to routine burns care were calculated. Evidence certainty was determined by GRADE.</p></div><div><h3>Results</h3><p>Two eligible studies were identified from 544 search results. One study with 48 participants provided very uncertain evidence that delayed IV fluid resuscitation may increase acute kidney injury compared to prehospital resuscitation (OR 2.48, 95% CI 0.58–10.62). The other study with a cohort of 10 children provided very uncertain evidence that calculating fluid requirements based on time of arrival to first receiving facility, i.e. omitting ‘catch-up’ fluids, may maintain adequate urine output and be associated with no complications of fluid over- or under-resuscitation. There were no studies on use of a simplified %TBSA-independent fluid calculation formula.</p></div><div><h3>Conclusions</h3><p>There is very limited and uncertain evidence to inform on delayed IV fluid resuscitation, simplified %TBSA-independent formula, and omission of ‘catch up’ fluids for burns care in MCIs. Contextual factors, local values, preferences and feasibility also need to be considered.</p></div>","PeriodicalId":72486,"journal":{"name":"Burns open : an international open access journal for burn injuries","volume":"8 4","pages":"Article 100365"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2468912224000531/pdfft?md5=503b28a1d46468b83036d3c4961eb5b4&pid=1-s2.0-S2468912224000531-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141843090","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing a tertiary surgical units readiness to offer a fellowship in burn care in Africa","authors":"T. Netshiongolwe ,&nbsp;S. Znamerovskyi ,&nbsp;A. Muganza","doi":"10.1016/j.burnso.2024.100374","DOIUrl":"10.1016/j.burnso.2024.100374","url":null,"abstract":"<div><div>The number of patients presenting with burn injuries in Africa is increasing [1,2], and these injuries can have devastating outcomes [3,4]. One contributing factor to these outcomes is the lack of adequately trained staff in providing expert burn wound care. There is little emphasis on training staff in caring for burn patients in Africa. Our goal was to assess the services offered at a specialized burn unit in South Africa and compare them to the recommendations of the American Burn Association for providing fellowship training in burn care. Establishing such a fellowship program will help train experts who can improve burn care services across Africa.</div></div>","PeriodicalId":72486,"journal":{"name":"Burns open : an international open access journal for burn injuries","volume":"8 4","pages":"Article 100374"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142444565","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}