Eur. Burn J., Volume 5, Issue 4 (December 2024) – 9 articles

Burn injuries can have long-lasting effects not only on a person’s bodily integrity but also on their psychosocial well-being. Since medical advancements have increased survival from burn injuries, improving psychosocial health has become a pivotal goal for burn rehabilitation. Besides health-related quality of life, life satisfaction has become an important parameter for evaluating long-term outcomes after burns. We reviewed life satisfaction after burns among adult burn patients to evaluate the current assessment methods and gain insight into recovery patterns. PubMed, EMBASE, Medline, and Cochrane Library were searched systematically for studies in the English language covering life satisfaction after burns, resulting in the inclusion of 18 studies. The Satisfaction With Life Scale (SWLS) was the most commonly used assessment tool. Others included the Life Satisfaction Index-A (LSI-A) and a non-standardized tool. Most studies’ recovery patterns showed a decreased life satisfaction post-burn injury. There was strong agreement that inhalation injury, body dysfunction, an extended hospital stay, and psychological illness before the injury are possible determinants of post-burn life satisfaction and have shown a negative correlation. There seems to be a consistent use of assessment tools, which opens up the possibility of a further comparative investigation to better understand factors that influence life satisfaction after a burn so that this knowledge can be used to improve patients’ recovery. Full article

Background: The primary aim of this study was to evaluate the performance of four burn prognostic scores—Abbreviated Burn Severity Index (ABSI), Ryan, Belgium Outcome Burn Injury (BOBI), and revised Baux score (rBaux) in a Croatian burn center. A secondary aim was to compare patient outcomes before and after the organizational and protocol changes. Methods: A retrospective study and comparison of four prediction scores was conducted over a nine-year period in burn patients with ≥20% total body surface area (TBSA) burned. Additionally, outcomes before and after organizational changes were compared. Results: A total of 149 patients were included, with the mean patient age of 54.62 ± 19.38 years, the mean of TBSA of 42.98 ± 19.90, and an overall mortality rate of 48.99%. The area under the ROC curve (AUROC) was 0.79 for the rBaux and ABSI score, 0.77 for the BOBI score, and 0.76 for the Ryan score. The duration of mechanical ventilation and length of stay (LOS) in burn intensive care units (BICU) decreased after the organizational changes, though survival rates remained similar. Conclusions: Prognostic scores are good predictors of mortality but with moderate predictive accuracy. Continuity of care in intensive care could be important for better outcomes. Full article

Background: Diabetic patients often present with complex limb pathology, resulting in impaired sensation in the distal extremities making tactile injuries such as burns difficult to notice. We posit that poorly controlled diabetes mellitus, evidenced by increasing elevations in hemoglobin A1c, is associated with delayed wound healing and increased complications in burn patients. Methods: The TriNetX Network, a database of 89 million patients across the U.S., was queried for diabetic patients with foot and ankle burns. Patients were divided into four groups based on A1c: properly controlled (<7%), moderately controlled (7–9%), poorly controlled (>9%), and propensity-matched non-diabetic controls. Evaluated outcomes included split-thickness skin grafting, infections, amputations, acute kidney failure (AKF), and mortality within one month of the burn. Results: When comparing the poorly controlled A1c cohort with the properly controlled and moderately controlled A1c cohorts, we found a significant increase in amputations (p = 0.042) and cutaneous infections (p = 0.0438), respectively. When evaluating non-diabetics to diabetic patients, significantly increased rates of amputations (p < 0.0001), cutaneous infections (p = 0.0485), systemic infections (p = 0.0066), and AKF (p = 0.0005) were noted in the latter. Conclusions: Poorly controlled diabetes shows a significant correlation with increased complications following foot and ankle burns, including amputations, infections, and AKF. Full article

In this study, we aimed to integrate a genetic repository with an existing longitudinal national burn database. We set out two primary objectives, namely (1) to develop standard operating procedures for genetic sample collection and storage, DNA isolation, and data integration into an existing multicenter database; and (2) to demonstrate the feasibility of correlating genetic variation to functional outcomes in a pilot study, using the catechol-O-methyltransferase (COMT) gene. Dubbed the worrier/warrior gene, COMT variants have been associated with varying phenotypes of post-traumatic stress, wellbeing, and resilience. Between August 2018 and July 2020, COMT variants were identified for 111 participants from three sites and correlated with their outcome data. We found no association between COMT variants and functional outcomes, likely due to the inadequate sample size. We also asked all potential participants why they consented to or refused genetic analysis. A thematic analysis of responses revealed altruism and personal interest/enthusiasm in the study as top reasons for consenting. Privacy concerns were the most common reason for refusal. In conclusion, we successfully developed standard operating procedures for genetic sample collection and storage, DNA isolation, and data integration into an existing database, and we demonstrated the feasibility of conducting a multicenter collaborative study using a centralized lab location. Full article

Identifying outcomes that matter most is key in driving specialized paediatric burn care. The aim of this study was to discover the most important outcomes for paediatric burns. Parents of children (0–3 year and 4–11 years old) and adolescents (12–17 yearss old) completed surveys to identify outcomes that matter most in the short-term (<6 months postburn) and long-term (6–24 months postburn). The percentage of patients scoring an outcome as ‘very important’ was used to rank the outcomes. Fifty-four parents/adolescents participated (response rate: 27%). Children had a median TBSA burned of 5.0% (IQR: 2.0–7.0%). In the short-term, ‘good wound healing’ and ‘no wound infection’ (both at 71.4–100%) were very important for all children. ‘Not having pain’ (90.3–93.8%) was ranked highest for children ≤11 years old, whereas ‘walking or moving around’ (85.7%) was most important for older children. In the long-term, more variation was seen in outcome priorities; however, both ‘not having pain’ (53.6–85.7%) and ‘flexibility of scar(s)’ (60.7–71.4%) were considered very important by all three groups. Patient- and parent-derived priorities are important for developing consumer-centric, highest-value care pathways. The priority of the outcomes identified is a starting point to discuss treatment options and recovery priorities in a family-centric approach to guide high-value, individualized care. Full article

(1) Background: Effective wound management aims for expedited healing, improved functional and scar outcomes, and reduced complications including infection. Delayed wound healing remains a prevalent problem in the elderly. Suprathel is a synthetic absorbable skin substitute and an attractive option in partial thickness wounds. The objective of this randomised controlled study was to assess the effect of skin substitute dressings on elderly split-skin graft (STSG) donor sites, evaluating time to heal, pain, itch and scar outcome. (2) Methods: 40 patients over 65 undergoing split-thickness skin grafting for non-melanoma skin cancer excision were randomised to STSG donor site dressings with either Suprathel or Hypafix. Patients were followed up weekly until healed and at 13 weeks post-procedure. (3) Results: There was no significant difference in time to healing, pain, itch, or scar outcome at 13 weeks between the two groups. The mean time to healing was 31.7 days for the skin substitute group and 27.3 days for the adhesive tape control group (p = 0.182). (4) Conclusions: Both dressings are appropriate for STSG donor sites. Hypafix remains a cost-effective dressing of choice for donor sites. Benefits demonstrated in other studies using skin substitutes have not translated into the elderly population. There remains scope in developing dressings that reduce elderly donor site morbidity. Full article

Patient-reported outcome measures (PROMs) are crucial within person-centered care. The use of electronic PROMs (ePROMs) is increasing and multiple advantages have been described. The Patient and Observer Scar Assessment Scale (POSAS) is a validated paper questionnaire to assess patient-reported scar quality in the burn and scar population. In burn and scar rehabilitation, quality of life questionnaires such as the Euroqol 5 Dimensions 5 level (EQ-5D-5L) and the Dermatology Life Quality Index (DLQI) allow us to measure physical and psychosocial impact. The goal of this research was to compare the equivalence of the electronic versions of the POSAS, the EQ-5D-5L, and the DLQI with their original paper counterparts. To ensure the psychometric properties of the electronic versions, we assessed the equivalence of scores, the differences in completion time, and patients’ preferred mode and ease of use. We used a randomized crossover design using a within-subject comparison of the formats of the questionnaires. Participants aged over 18 with a scar were recruited from an outpatient after-care and research center for burns and scars in Antwerp, Belgium. The equivalence of the electronic questionnaires POSAS, EQ-5D-5L, and DLQI is assumed based on the findings of this study. Completion times were faster for all the electronic versions but only statistically different (p = 0.002) for the electronic version of the EQ-5D-5L. The number of missing answers could be reduced to 0. The electronic assessment was preferred in >75% of the cases and subjects found it easy to use, and a tool that could improve the quality of care. Our findings support the electronic delivery of POSAS, EQ-5D, and DLQI, within the burn and scar population. Full article

Background: The work and life of a resident (or “junior”) doctor has changed dramatically over the past 50 years. Descriptions of historic working conditions are usually anecdotal and tinted with nostalgia, but do today’s burns and plastic surgery doctors feel working conditions have improved or declined over the last 50 years, and does this have an impact on recruitment and retention? Methods: An interview was conducted with a retired surgeon who, in 1970, worked as a house surgeon (Year 2 doctor equivalent) in a burns unit for the pioneering burn surgeon Mr. Douglas MacGregor Jackson. This was coupled with a literature review to objectively assess working conditions in that period for doctors. The information generated from this produced a poster summarizing the key differences between these periods. This was presented to the current medical work force, and a survey was conducted to determine their preferences for working conditions. Results: The questionnaire was completed by 68 doctors of mixed grades and backgrounds. The majority of respondents (60%) would choose to work in today’s burns centres. There was a significant difference between the mean age of respondents’ preference of working conditions in 1970 (37 years) and those preferring today (31 years) (p = 0.035). Conclusions: Multiple changes in the working conditions and the management of burns patients were identified. The majority of those who were asked consider today’s working conditions to be better than those of the past. However, more senior clinicians tended to prefer the conditions of 1970 over the present day, suggesting a generational shift in opinion. Full article