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Eur. Burn J., Volume 3, Issue 2 (June 2022) – 13 articles

Cover Story (view full-size image): Scalds from domestic tap water can cause significant burn injuries through immersion in hot water. They are preventable and predominantly affect the most vulnerable in society: patients at the extremes of age, and those with physical or mental disabilities. There has been unacceptable stagnation in the prevention of these injuries despite their recognition as a problem since the 1970s and the availability of simple preventative measures, such as the control of water temperature at domestic outlets with thermostatic mixing valves. This retrospective observational study carried out at a regional burns unit in the UK investigates the incidence, aetiology, and outcome of these injuries and highlights a need for simple safety measures to reduce the burden of domestic tap water scalds. View this paper
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14 pages, 317 KiB  
Review
What Fuels the Fire: A Narrative Review of the Role Social Determinants of Health Play in Burn Injuries
by Kimberly H. Khoo, Emily S. Ross, Joshua S. Yoon, Tomer Lagziel, Feras Shamoun, Joseph S. Puthumana, Julie A. Caffrey, Sheera F. Lerman and Charles Scott Hultman
Eur. Burn J. 2022, 3(2), 377-390; https://doi.org/10.3390/ebj3020033 - 16 Jun 2022
Cited by 5 | Viewed by 2461
Abstract
Social determinants of health (SDOH) are the conditions where people live, learn, work, and play that affect their health and quality of life. There has been an increasing focus on the SDOH in the field of medicine to both explain and address health [...] Read more.
Social determinants of health (SDOH) are the conditions where people live, learn, work, and play that affect their health and quality of life. There has been an increasing focus on the SDOH in the field of medicine to both explain and address health outcomes. Both the risk of burn injuries and outcomes after burns have been found to be associated with multiple aspects of the SDOH. This narrative review seeks to explore the main domains of the social determinants of health, reiterate their importance to the general and burn injury population, examine each’s association with risks of burn injuries and burn-related outcomes, and provide an overview of the current burn research landscape that describes the social determinants of health. Full article
7 pages, 251 KiB  
Review
“Out of Touch”—Recovering Sensibility after Burn Injury: A Review of the Literature
by Savas Tsolakidis, Ziyad Alharbi, Hans Oliver Rennekampff, Markus Robert Schmidhammer, Robert Schmidhammer and Rudolf Rosenauer
Eur. Burn J. 2022, 3(2), 370-376; https://doi.org/10.3390/ebj3020032 - 14 Jun 2022
Cited by 3 | Viewed by 3357
Abstract
Background: Full-thickness burn injuries (FTBI) not only lead to a significant burden in multiple ways, including social life and self-esteem, but have also a tremendous impact on environmental interaction by reducing sensibility in manifold ways. On these grounds, possible ways and solutions to [...] Read more.
Background: Full-thickness burn injuries (FTBI) not only lead to a significant burden in multiple ways, including social life and self-esteem, but have also a tremendous impact on environmental interaction by reducing sensibility in manifold ways. On these grounds, possible ways and solutions to recover sensibility in burn wounds are essentials and should not be overlooked. Methods: A review of experimental, clinical studies and the related literature was performed with the aim to highlight post-burn nerve regeneration and discover ways for sensory re-integration to complement the therapeutic concept. Results: In human burn injuries, it has been hypothesized that grafted cells, partly multipotent stem cells, could be additionally responsible for nerve regeneration in burn wound areas. In addition, burn eschar excision, performed within a short post-burn time frame, can reduce or even avoid long-term nerve damage by reducing post-burn toxic mediator release. Various animal studies could demonstrate sensory reinnervation of different qualities in burn wounds. Post-burn scar tissue prevents, or at least decelerates, nerve reinnervation, but could be reduced by targeted mediators. Conclusion: Sensory loss is present in skin grafted areas following full-thickness burn-wound excision, thereby leading to a reduction in quality of life. In addition, various mediators might reduce or avoid nerve damage and should be considered at an early stage as part of a holistic burn-patient therapeutic approach. In addition, supportive multifaceted physical therapy strategies are essential. Full article
(This article belongs to the Special Issue Burn Wound Assessment and Initial Surgical Management)
8 pages, 385 KiB  
Article
Preventable Burns from Domestic Tap Water
by Max Prokopenko, Alistair J. M. Reed, Maria Chicco and Fadi Issa
Eur. Burn J. 2022, 3(2), 362-369; https://doi.org/10.3390/ebj3020031 - 9 May 2022
Cited by 2 | Viewed by 2314
Abstract
Tap water scalds from domestic outlets can afflict large body surface areas. Such injuries are preventable and carry significant associated morbidity, mortality, and economic burden. Previously identified risk factors include age (<5 or >65 years old) and the presence of physical or mental [...] Read more.
Tap water scalds from domestic outlets can afflict large body surface areas. Such injuries are preventable and carry significant associated morbidity, mortality, and economic burden. Previously identified risk factors include age (<5 or >65 years old) and the presence of physical or mental disabilities. Education campaigns and advances in legislation mandating the restriction of tap water temperature at user outlets have been employed in an attempt to prevent such injuries. Nonetheless, the incidence of these injuries persists, and further mitigating measures must be implemented to minimize their occurrence. The purpose of this study was to determine the groups at risk for such injuries and whether this has recently changed. A retrospective observational study was carried out to include patients admitted with tap water scalds to a regional burn’s unit from October 2016 to September 2020. Twenty-three patients were included, and their incidence was 5.75 cases per year, equating to 5.1% of all scalds requiring inpatient treatment. The very young (<5 years old) and elderly (>65 years old) accounted for the majority of admissions (65.2%), 26.1% had a mental disability, and 30.4% had a physical disability. Tap water scalds continue to cause preventable injuries affecting all ages, and in particular, the elderly and patients with pre-existing disabilities. Full article
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7 pages, 1013 KiB  
Editorial
Is Post-Burn Scarring a Research Priority?
by Amber E. Young and Robert M. T. Staruch
Eur. Burn J. 2022, 3(2), 355-361; https://doi.org/10.3390/ebj3020030 - 3 May 2022
Viewed by 1770
Abstract
National and international research budgets are insufficient to approve all requests for funding, even if a methodology is of high quality and the outputs are likely to have an impact on improving patient outcomes [...] Full article
(This article belongs to the Special Issue Innovation in Burn Scar Prevention and Management)
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15 pages, 343 KiB  
Review
Role, Development, and Value of Enzymatic Debridement as Integral Component in Initial Treatment of Burn Injuries Exemplified by NexoBrid®
by Maximilian M. Mattern, Paul C. Fuchs and Jennifer L. Schiefer
Eur. Burn J. 2022, 3(2), 340-354; https://doi.org/10.3390/ebj3020029 - 21 Apr 2022
Cited by 5 | Viewed by 2602
Abstract
Despite intensive research and increased knowledge over the past decades, the handling of severe burn injuries remains complex and is mainly based on clinical experience. High demands in terms of the diagnosis and choice of therapy often confront clinicians with challenging circumstances. Thus, [...] Read more.
Despite intensive research and increased knowledge over the past decades, the handling of severe burn injuries remains complex and is mainly based on clinical experience. High demands in terms of the diagnosis and choice of therapy often confront clinicians with challenging circumstances. Thus, the treatment of burn injuries has predominantly remained under the responsibility of specialised centres. As a new approach in addition to conventional surgery, enzymatically controlled debridement has come into focus for the treatment of burn injuries over the past years. The efficacy and safety of enzymatic debridement has already been implemented by numerous reputable studies. Promising results from the literature are enhanced by feedback from various conference contributions, intradisciplinary exchanges, and international collaborations. The implementation of enzymatic debridement in initial care management was found to be capable of reforming Standards of Care in numerous burn centres by facilitating treatment determinations and reducing the number of classical surgical interventions. Nevertheless, its use is also subject to certain restrictions as usage has shown limitations concerning efficacy when applied to scalds or pre-treated wounds. Enzymatic debridement shows high efficacy in terms of tissue debridement by combining this feature with the minimisation of collateral damage and a broad field of application in burn injuries. Due to their impressive performance in the treatment of burn injuries, enzyme-based techniques have also attracted attention for the treatment of other pathologies such as chronic wounds and are objects of ongoing research in this field. In this article, we illustrate the significance of enzyme-based treatment in initial burn care and shed some light on the potential value of enzymatic approaches in future burn surgery. Full article
(This article belongs to the Special Issue Burn Wound Assessment and Initial Surgical Management)
12 pages, 639 KiB  
Review
Techniques to Assess Long-Term Outcomes after Burn Injuries
by Rae Spiwak, Shaan Sareen and Sarvesh Logsetty
Eur. Burn J. 2022, 3(2), 328-339; https://doi.org/10.3390/ebj3020028 - 20 Apr 2022
Cited by 4 | Viewed by 2516
Abstract
Burn injuries have a tremendous impact on not only the physical health of the burn survivor, but also mental health and social outcomes of the individual and their support systems. While much effect occurs at the point of injury, post-injury pain, infection, scarring, [...] Read more.
Burn injuries have a tremendous impact on not only the physical health of the burn survivor, but also mental health and social outcomes of the individual and their support systems. While much effect occurs at the point of injury, post-injury pain, infection, scarring, inflammatory response and metabolic changes all impact the long-term health of the burn survivor. The goal of the following article is to explore how to examine long term outcomes associated with burn injury, including mental disorders, suicide, loss of work and quality of life in the context of risk factors for burn injury, including social determinants of health. We then discuss ways to examine post-burn outcomes, including the important role of administrative data, the advantages of mixed methodology research studies including qualitative research, and the importance of considering sex, gender and vulnerable populations, not only in study design, but in prevention and intervention programs. Full article
(This article belongs to the Special Issue Critical Care in Burns)
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8 pages, 483 KiB  
Article
Aspects of Clinical Utility of the Distress Thermometer and Problem List after Burns
by Helma W. C. Hofland, Anneke van de Steenoven and Nancy E. E. Van Loey
Eur. Burn J. 2022, 3(2), 320-327; https://doi.org/10.3390/ebj3020027 - 8 Apr 2022
Cited by 1 | Viewed by 1983
Abstract
Burn survivors may benefit from screening for a broad area of problems to improve communication and inform referral needs. Therefore, the aim of this study was to investigate clinical utility aspects such as appropriateness and acceptability to clinicians and completers of an existing, [...] Read more.
Burn survivors may benefit from screening for a broad area of problems to improve communication and inform referral needs. Therefore, the aim of this study was to investigate clinical utility aspects such as appropriateness and acceptability to clinicians and completers of an existing, frequently used screening instrument in oncological populations, the Distress Thermometer and Problem List (DT and PL). Methods: Paediatric and adult patients visiting the outpatient clinic after admission to the burn centre were invited to complete the instrument. The DT and (problem domains of) the PL were related and compared to the need to discuss the reported problems. Results: A total of 160 patients were invited to complete the DT and PL, of which 139 agreed. The study shows evidence for appropriateness and high acceptability to clinicians and completers, although the effectiveness of the PL may be lower compared to the DT and needs adaptation to better meet the burn survivors’ situation. Discussion: The use of a screening instrument in the outpatient clinic environment has shown to be appropriate and acceptable and informs clinical practice to identify supportive needs in patients with burns. However, the PL needs to be adapted to the situation of the burn survivors. Full article
(This article belongs to the Special Issue Innovation in Burn Scar Prevention and Management)
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11 pages, 298 KiB  
Review
Treatment Adherence Interventions for Burn Patients: What Works and What Role Can Motivational Interviewing Play?
by Christian R. R. Goans, Karen J. Meltzer, Blake Martin and Kimberly Roaten
Eur. Burn J. 2022, 3(2), 309-319; https://doi.org/10.3390/ebj3020026 - 6 Apr 2022
Cited by 1 | Viewed by 3230
Abstract
The unique challenges burn patients face along the trajectory of recovery necessitate an interdisciplinary team approach to care. As much as providers rely on care-team members for delivery of optimal treatment, the patient must be an active collaborator in their care. Optimal burn [...] Read more.
The unique challenges burn patients face along the trajectory of recovery necessitate an interdisciplinary team approach to care. As much as providers rely on care-team members for delivery of optimal treatment, the patient must be an active collaborator in their care. Optimal burn recovery outcomes hinge on treatment adherence. In addition to general challenges faced in ubiquity by burn patients, there are specific patient populations for whom treatment adherence is particularly challenging. Although psychological interventions have been used successfully with burn patients, very few are appropriate for both inpatient and outpatient care environments and most do not focus on treatment adherence. This paper reviews unique facets of Motivational Interviewing (MI) that may be applicable in interdisciplinary burn treatment teams across inpatient and outpatient settings to optimize treatment adherence. Full article
19 pages, 6089 KiB  
Article
Electronic Patient-Reported Outcome Measures in Burn Scar Rehabilitation: A Guide to Implementation and Evaluation
by Jill Meirte and Zephanie Tyack
Eur. Burn J. 2022, 3(2), 290-308; https://doi.org/10.3390/ebj3020025 - 5 Apr 2022
Cited by 4 | Viewed by 2877
Abstract
In burn scar rehabilitation, electronic patient-reported outcome measures (ePROMs) are increasingly being used in research and clinical settings as part of patient- and family-centred care. These measures can identify patients’ needs and monitor the therapeutic progress of both adults and children. The feedback [...] Read more.
In burn scar rehabilitation, electronic patient-reported outcome measures (ePROMs) are increasingly being used in research and clinical settings as part of patient- and family-centred care. These measures can identify patients’ needs and monitor the therapeutic progress of both adults and children. The feedback of information from ePROMs to clinicians treating patients with scarring and psychosocial issues may have therapeutic benefits. However, testing the effectiveness of ePROMs used in the routine clinical care of patients with burn scarring is in its infancy, and one of the greatest challenges remains the implementation of ePROMs in real-world clinical settings. The aim of this paper is to provide a guide for clinicians and researchers involved in burn scar rehabilitation to assist in implementing ePROMs in clinical settings. The guide outlines strategies, processes, and considerations for ePROM implementation and the accompanying resources. Two real-world case studies of ePROM implementation are presented in burn scar clinics in Belgium and Australia. Additionally, ten recommendations for the implementation of ePROMs are provided based on research evidence and the lessons learned by the authors. The information provided should pave the way forward for using and testing these ePROMs in research and practice. Full article
(This article belongs to the Special Issue Innovation in Burn Scar Prevention and Management)
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12 pages, 293 KiB  
Review
Damage Control Surgery after Burn Injury: A Narrative Review
by Hans-Oliver Rennekampff and Mayer Tenenhaus
Eur. Burn J. 2022, 3(2), 278-289; https://doi.org/10.3390/ebj3020024 - 1 Apr 2022
Cited by 5 | Viewed by 3231
Abstract
Burn injuries with cutaneous loss result in a severe systemic response when profound injuries exceed 20% of the total body surface area. The management of severely burned patients is a complex and dynamic process. Timely and safe operative interventions are critical components of [...] Read more.
Burn injuries with cutaneous loss result in a severe systemic response when profound injuries exceed 20% of the total body surface area. The management of severely burned patients is a complex and dynamic process. Timely and safe operative interventions are critical components of multidisciplinary care. Effective management of severely burned patients, their cutaneous injuries, and the associated systemic disease requires a comprehensive understanding of the pathophysiologic response to trauma, objective indicators of patient status, and an appreciation for the dynamic nature of these parameters. Progress in both clinical and basic science research has advanced our understanding of these concepts and our approach to the management of burn patients. Incorporating concepts such as early total care, damage control surgery (DCS), and safe definitive surgery (SDS) in the polytraumatized patient may further aid in optimizing outcomes and quality of care for burn patients. This article connects current knowledge of the lethal triad, inflammation, immunosuppression, and eschar-derived toxins, with surgical burn care, especially burn wound debridement. The concepts of DCS and SDS for the care and management of burn patients are strongly advocated. Experimental and clinical studies are encouraged to validate these concepts in an effort to optimize patient outcomes. Full article
(This article belongs to the Special Issue Burn Wound Assessment and Initial Surgical Management)
14 pages, 409 KiB  
Article
Assessing Health-Related Quality of Life of Adult Patients with Intermediate Burns: The Added Value of an Itching and Cognition Item for the EQ-5D: A Retrospective Observational Study
by J. Nicolaas Dijkshoorn, Juanita A. Haagsma, Cornelis H. van der Vlies, M. Jenda Hop, Margriet E. van Baar and Inge Spronk
Eur. Burn J. 2022, 3(2), 264-277; https://doi.org/10.3390/ebj3020023 - 30 Mar 2022
Cited by 2 | Viewed by 1937
Abstract
The EQ-5D is increasingly used to assess the health-related quality of life (HRQL) of adult patients with intermediate burns. However, this generic instrument may lack sensitivity, as important problems for burn patients, such as itching and cognition problems are not included in this [...] Read more.
The EQ-5D is increasingly used to assess the health-related quality of life (HRQL) of adult patients with intermediate burns. However, this generic instrument may lack sensitivity, as important problems for burn patients, such as itching and cognition problems are not included in this instrument. This retrospective observational study investigates the value of adding an itching and cognition item to the EQ-5D-3L. Patients completed the EQ-5D-3L, and the Patient and Observer Scar Assessment Scale (POSAS), including an itching item and an extra cognition item three months postburn. The potential added value of an itching and cognition item was studied by distribution, informativity, convergent validity, dimension dependency, and explanatory analyses. In total, 120 patients were included of whom 65% reported itching and 23% reported cognition problems. Adding an itching item to the EQ-5D improved the discriminatory power and informativity of the EQ-5D-3L, but barely increased the explanatory power (0.4%) and decreased the convergent validity (r = −0.529 vs. r = −0.612). In contrast, adding a cognition item slightly improved the informativity and discriminatory power. Moreover, convergent validity (r = −0.617 vs. r = −0.612) and explanatory power increased (4.0%). In conclusion, adding an itching item to the EQ-5D-3L provides some additional information, however, the added value is small, whereas adding a cognition item improved the measurement properties of the EQ-5D-3L in our sample and should be considered when assessing HRQL in adult patients with intermediate burns. Full article
(This article belongs to the Special Issue The Global Burden of Burns, Burn Care Management and Outcome)
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8 pages, 243 KiB  
Commentary
Matching Qualitative Inquiry Design and Practice to Contemporary Burns Research Questions: Are We Getting It Right?
by Megan Simons and Jodie A. Copley
Eur. Burn J. 2022, 3(2), 256-263; https://doi.org/10.3390/ebj3020022 - 28 Mar 2022
Viewed by 1950
Abstract
Qualitative methodology has continued to develop through scholarly inquiry, with its application to burn scar research progressed substantially since early use. Concerns were raised in 2015 that qualitative inquiry in burn care and rehabilitation used a limited range of qualitative research approaches. The [...] Read more.
Qualitative methodology has continued to develop through scholarly inquiry, with its application to burn scar research progressed substantially since early use. Concerns were raised in 2015 that qualitative inquiry in burn care and rehabilitation used a limited range of qualitative research approaches. The aim of this commentary paper is to consider how broadly the suite of methodologies available within the qualitative research paradigm have been applied to burn scar research since that call. Observations from a scan of qualitative burn scar papers published since 2015 to March 2022 (n = 36) are presented. Less commonly used qualitative methodologies (such as interpretive design, interpretive phenomenological analysis, narrative inquiry, grounded theory, explanatory case study) and their contribution to burn scar research is discussed. Examples are presented to consider how the application of qualitative methodological approaches (including post-qualitative research methodologies) can be ultimately used to inform meaningful outcomes. Full article
(This article belongs to the Special Issue Innovation in Burn Scar Prevention and Management)
15 pages, 2072 KiB  
Perspective
Mechanomodulation: Physical Treatment Modalities Employ Mechanotransduction to Improve Scarring
by Ulrike Van Daele, Jill Meirte, Mieke Anthonissen, Tine Vanhullebusch, Koen Maertens, Lot Demuynck and Peter Moortgat
Eur. Burn J. 2022, 3(2), 241-255; https://doi.org/10.3390/ebj3020021 - 26 Mar 2022
Cited by 3 | Viewed by 4093
Abstract
Every year, surgical interventions, traumatic wounds, and burn injuries lead to over 80 million scars. These scars often lead to compromised skin function and can result in devastating disfigurement, permanent functional loss, psychosocial problems, and growth retardation. Today, a wide variety of nonsurgical [...] Read more.
Every year, surgical interventions, traumatic wounds, and burn injuries lead to over 80 million scars. These scars often lead to compromised skin function and can result in devastating disfigurement, permanent functional loss, psychosocial problems, and growth retardation. Today, a wide variety of nonsurgical scar management options exist, with only few of them being substantiated by evidence. The working mechanisms of physical anti-scarring modalities remained unclear for many years. Recent evidence underpinned the important role of mechanical forces in scar remodeling, especially the balance between matrix stiffness and cytoskeleton pre-stress. This perspective article aims to translate research findings at the cellular and molecular levels into working mechanisms of physical anti-scarring interventions. Mechanomodulation of scars applied with the right amplitude, frequency, and duration induces ECM remodeling and restores the ‘tensile’ homeostasis. Depending on the scar characteristics, specific (combinations of) non-invasive physical scar treatments are possible. Future studies should be aimed at investigating the dose-dependent effects of physical scar management to define proper guidelines for these interventions. Full article
(This article belongs to the Special Issue Innovation in Burn Scar Prevention and Management)
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