Journal Description

European Burn Journal

European Burn Journal (formerly European Journal of Burn Care) is an international, peer-reviewed, open access journal on burn care and burn prevention published quarterly online by MDPI. It is a journal of the EBA (European Burns Association).

Open Access— free for readers, with article processing charges (APC) paid by authors or their institutions.
Rapid Publication: manuscripts are peer-reviewed and a first decision provided to authors approximately 28.3 days after submission; acceptance to publication is undertaken in 4.5 days (median values for papers published in this journal in the first half of 2022).
Recognition of Reviewers: APC discount vouchers, optional signed peer review, and reviewer names published annually in the journal.

Imprint Information Journal Flyer Open Access ISSN: 2673-1991

Latest Articles

Open AccessArticle

A 10-Year Review of Sunburn Injuries Presenting to the Manchester Adult and Paediatric Specialist Burn Services

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Eur. Burn J. 2022, 3(4), 472-485; https://doi.org/10.3390/ebj3040041 - 29 Sep 2022

Abstract

Background: The incidence of sunburn injuries continues to rise despite increased awareness of the risks of sun exposure and availability of sun protection. Whilst not a significant burden on burns care services, patients remain exposed to associated risks for future development of skin malignancies. The aims of this study were to determine the burden and severity of sunburn injury presentations to the Manchester adult and children’s burns services. Methods: A 10-year retrospective review was performed of patients with sunburn injuries, presenting to the Manchester burn services between 2010 and 2019 (inclusive). Data were collected from the International Burn Injury Database (iBID), electronic patient record (EPR) and local data collection systems. The data extracted included patient demographics, sunburn characteristics and management of the burn injury including need for admission and any documented surgical interventions. Temporal correlation was determined by linear regression analysis. Results: In total, 131 paediatric and 228 adult patients with sunburn injuries were managed by the Manchester burns services over the 10-year period. Mean % total body surface area burned was low (2.00% and 2.12% in adult and paediatric patients, respectively), with the majority of injuries either superficial or superficial partial thickness. Thirty percent (30.2%) of adult and 40.5% of paediatric patients were admitted with a mean length of stay of 3.51 and 1.11 days, respectively. The presentation of sunburn injuries progressively increased over the study period with a peak in 2017 (n = 58). Similar trends in patient demographics, burn size and depth and temporal trends were observed in national data from the same period for both adult and paediatric patients. Conclusion: This 10-year retrospective cohort study demonstrates an increasing trend of sunburn injury presentations to the Manchester specialist burns services; a pattern replicated in national data from England and Wales. The majority of sunburn injuries do not present to specialist burn services; therefore, these reported injuries reflect only a fraction of the true burden of sunburn nationwide. Despite increased awareness, an obvious need for enhanced public awareness campaigns regarding sun protection is therefore needed to address this trend. The educational and preventative role of burns care services is a key component in tackling both consequences of burn injuries themselves and associated risks such as future skin cancer development. Full article

Open AccessArticle

An Evaluation of the Treatment of Full-Thickness Wounds Using Adipose Micro-Fragments within a Liquid Dermal Scaffold

Ruhangiz Taghi Kilani

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Aziz Ghahary

Eur. Burn J. 2022, 3(3), 457-471; https://doi.org/10.3390/ebj3030040 - 17 Sep 2022

Abstract

In full-thickness wounds, inflammation, lack of matrix deposition, and paucity of progenitor cells delay healing. As commercially available solid (sheet) scaffolds are unable to conform to wounds of varying shapes and sizes, we previously generated a nutritious, injectable, liquid skin substitute that can conform to wound topography. In combination with adipose micro-fragments as a viable source of progenitor cells, a composite, in situ forming skin substitute was tested for the treatment of silicon ring splinted full-thickness wounds in rats. The in vitro survivability and migratory capacity of adipocytes derived from rat micro-fragmented fat cultured in our scaffold was examined with a Live/Dead assay, showing viability and migration after 7 and 14 days. In vivo, the efficacy of our scaffold alone (LDS) or with adipose micro-fragments (LDS+A) was compared to a standard dressing protocol (NT). LDS and LDS+A showed ameliorated wound healing, including complete epithelialization and less immune cell infiltration, compared to the NT control. Our findings demonstrate that a 3D liquid skin scaffold is a rich environment for adipocyte viability and migration, and that the addition of adipose micro-fragments to this scaffold can be used as a rich source of cells for treating full-thickness wounds. Full article

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Open AccessFeature PaperArticle

Early Impact of COVID-19 Pandemic on Burn Injuries, Admissions, and Care in a Statewide Burn Service

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Eur. Burn J. 2022, 3(3), 447-456; https://doi.org/10.3390/ebj3030039 - 12 Sep 2022

Abstract

Anecdotal evidence from specialist burn clinicians suggested patient numbers and workloads increased during lockdown periods. This study aimed to describe the impact of the early COVID-19-related public health control measures (i.e., lockdowns) on burn injuries, hospital admissions, and care in a statewide burn service. We examined admissions data from The Victorian Adult Burns Service (located at the Alfred Hospital) and the Royal Children’s Hospital Burns Service—both of which contribute to the Burns Registry of Australia and New Zealand—during lockdown periods between March and October 2020, compared to the same periods in previous years. There were 714 patients admitted during the control period and 186 during the COVID-19 period. Burns sustained during COVID-19 lockdowns were larger in size. During COVID-19 lockdowns a greater proportion of patients were admitted to intensive care. Although the number of burn-related admissions did not increase during lockdowns, burn injuries that did occur were more severe (i.e., affected a greater percentage of body surface area). These more severe injuries placed an additional and significant burden on an already strained healthcare system. Future public health messaging should include prevention information to minimize the number of injuries occurring during lockdowns and other responses. Full article

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Open AccessFeature PaperReview

The Use of Infrared Thermography (IRT) in Burns Depth Assessment: A Diagnostic Accuracy Meta-Analysis

Aqua Asif

Constantinos Poyiatzis

Firas J. Raheman

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Djamila M. Rojoa

Eur. Burn J. 2022, 3(3), 432-446; https://doi.org/10.3390/ebj3030038 - 01 Sep 2022

Abstract

Background: The timely diagnosis of burns depth is crucial to avoid unnecessary surgery and delays in adequate management of patients with burn injuries. Whilst it is mostly a clinical diagnosis, indocyanine green, laser Doppler imaging and infrared thermography have been used alongside clinical findings to support the diagnosis. Infrared thermography is a noninvasive technique which uses temperature differences to diagnose tissue burn depth. Our study aims to assess its use in differentiating between superficial and deep burns. Methods: We conducted a systematic literature review and meta-analysis using electronic databases. We used a mixed-effects logistic regression bivariate model to estimate summary sensitivity and specificity and developed hierarchical summary receiver operating characteristic (HSROC) curves. Results: We identified 6 studies reporting a total of 197 burns, of which 92 were proven to be deep burns. The reference standard was clinical assessment at the time of injury and burn healing time. The pooled estimates for sensitivity and specificity were 0.84 (95% CI 0.71–0.92) and 0.76 (95% CI 0.56–0.89), respectively. Conclusions: IRT is a promising burns assessment modality which may allow surgeons to correctly classify burn injuries at the time of presentation. This will allow a more efficient management of burns and timely surgical intervention. Full article

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Open AccessArticle

The Impact of Body Mass Index in Patients with Severe Burn Injury

Aline C. V. Walger

Lucienne T. Q. Cardoso

Marcos T. Tanita

Tiemi Matsuo

Alexandre J. F. Carrilho

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Cintia M. C. Grion

Eur. Burn J. 2022, 3(3), 425-431; https://doi.org/10.3390/ebj3030037 - 22 Aug 2022

Abstract

This study evaluated the association of body mass index (BMI) with mortality, length of stay in the intensive care unit (ICU), and length of hospital stay in major burn patients. It was a retrospective cohort study that was originally conducted from January 2017 to January 2020 and that used data from patients admitted to the intensive care unit for burns at a university hospital. The patients were divided into groups for the purposes of comparing relevant variables according to their BMI. We evaluated 288 patients: 52.8% were classified as eutrophic, 33.7% were classified as overweight, and 13.5% were classified as obese. The median length of stay in the ICU was 11 days for all patients, 9 days for eutrophic patients, 13 days for overweight patients, and 16 days for obese patients (p = 0.004). In the multivariate analysis, age (HR = 1.026; p < 0.001), total body surface area (HR = 1.047; p < 0.001), and the presence of inhalation injury (HR = 1.658; p = 0.026) were associated with mortality. Obesity was not associated with higher hospital mortality in this sample of burn patients. The length of stay in the ICU was longer among obese patients. Age, burned body surface, and the presence of inhalation injury were the major determinants of death in these patients. Full article

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Open AccessReview

Toxic Epidermal Necrolysis: A Clinical and Therapeutic Review

Gonçalo Canhão

Susana Pinheiro

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Luís Cabral

Eur. Burn J. 2022, 3(3), 407-424; https://doi.org/10.3390/ebj3030036 - 08 Aug 2022

Abstract

Toxic Epidermal Necrolysis is a rare dermatological condition with high mortality and serious consequences on its survivors. Despite having been first described in 1956, its pathophysiology remains uncertain, mainly regarding its mechanisms, although it seems that certain apoptosis pathways are pivotal in starting keratinocytes’ apoptosis and in activating T cells, especially those mediated by tumour necrosis factor, Fas-FasL and granulysin. In general, its aetiology and presentation are consensual, being defined as a generalized necrolysis of the epidermis that occurs as an uncontrolled immune response to a specific drug or one of its metabolites, highlighting cotrimoxazole and allopurinol as the most important. This necrolysis leads to a massive shedding of the epidermal layer of the skin, with stronger incidences in the torso, upper limbs and face. Its complications tend to be severe, noting that septic ones are responsible for over half of the disease’s mortality. Nearly all survivors develop long-term sequelae, namely hypertrophic scarring and skin pigmentation anomalies. Regarding treatment, many different opinions arise, including contradictory ones, regarding more importantly immunomodulation therapies that have been the focus of several studies through the years. It is safe to state that supportive therapy is the only modality that has significantly strong evidence backing its efficacy in reducing mortality and improving prognosis, which have improved in the past years as general health care quality increased. In conclusion, it is imperative to say that more research is needed for new potential therapies with large study populations and more scientific rigor. Likewise, investigation towards its basic pathophysiology should also be promoted, mainly at a biomolecular level, allowing for an improved prevention of this illness. Full article

Open AccessCase Report

How Did This Happen? Xenograft Conversion to Dermal Scaffolding after Scalding Grease Burn

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Eur. Burn J. 2022, 3(3), 401-406; https://doi.org/10.3390/ebj3030035 - 05 Aug 2022

Abstract

Xenograft and other biologic dressings have been an integral part of burn care for many years. Porcine graft is both inexpensive and, for partial thickness burns, provides the additional benefit of avoiding painful dressing changes when compared with topical agents. In this case, we discuss a patient suffering from deep partial thickness burns for whom xenograft was used for initial wound coverage. This porcine graft became unexpectedly incorporated, and the patient ultimately underwent operative debridement and autologous re-grafting. The case demonstrates a gap in the understanding of wound-healing mechanisms around porcine xenografts and raises the potential for future innovation in expedited wound healing using xenografting. Full article

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Open AccessArticle

Burden and Costs of Severe Burn Injury in Victoria, Australia

Heather Cleland

Ieva Sriubaite

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Belinda Gabbe

Eur. Burn J. 2022, 3(3), 391-400; https://doi.org/10.3390/ebj3030034 - 13 Jul 2022

Abstract

This study examines the costs of severe burn injury in Victoria, Australia. It quantifies the funding generated through an activity-based case-mix system for hospital treatment of acute injury and presentations in the subsequent two years and costs of the longer-term burden of burn injury due to premature burn-related deaths and disability. Severe adult burns cases in Victoria from 2007–2016 were identified using the Victorian State Trauma Registry (VSTR). Cases were linked with the Victorian Admitted Episodes Dataset (VAED), Victoria Emergency Minimum Dataset (VEMD), and the National Coronial Information System (NCIS). Hospital re-imbursements and costs of Disability-Adjusted Life Years (DALYs) were calculated using disability weights derived from the EQ-5D-3L questionnaire responses at 24 months post injury. There were 331 patients hospitalised with a burn ≥20% total body surface area (TBSA) from 2007–2016. Total mean re-imbursement (SD) for the acute treatment episode per patient in Australian dollars (AUD) was $87,570 ($97,913). There was significant variation in the number of cases by year and re-imbursement per patient, with high outliers common. Excluding 2009, when 173 people died in bushfires, there were 7749 DALYs which cost $991,872,000. Severe burns are uncommon and variable. Economic treatment costs of severe burns are high, and among survivors there is high incidence of long-term disability and overall burden of injury. Full article

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Open AccessReview

What Fuels the Fire: A Narrative Review of the Role Social Determinants of Health Play in Burn Injuries

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Charles Scott Hultman

Eur. Burn J. 2022, 3(2), 377-390; https://doi.org/10.3390/ebj3020033 - 16 Jun 2022

Cited by 1

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 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

(This article belongs to the Special Issue Psychosocial Aspects of Burn Care, from Etiology to Treatment to Recovery)

Open AccessReview

“Out of Touch”—Recovering Sensibility after Burn Injury: A Review of the Literature

Savas Tsolakidis

Ziyad Alharbi

Hans Oliver Rennekampff

Markus Robert Schmidhammer

Robert Schmidhammer

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Rudolf Rosenauer

Eur. Burn J. 2022, 3(2), 370-376; https://doi.org/10.3390/ebj3020032 - 14 Jun 2022

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 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)

Open AccessArticle

Preventable Burns from Domestic Tap Water

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Eur. Burn J. 2022, 3(2), 362-369; https://doi.org/10.3390/ebj3020031 - 09 May 2022

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 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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Open AccessEditorial

Is Post-Burn Scarring a Research Priority?

Amber E. Young

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Robert M. T. Staruch

Eur. Burn J. 2022, 3(2), 355-361; https://doi.org/10.3390/ebj3020030 - 03 May 2022

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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Open AccessReview

Role, Development, and Value of Enzymatic Debridement as Integral Component in Initial Treatment of Burn Injuries Exemplified by NexoBrid^®

Maximilian M. Mattern

Paul C. Fuchs

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Jennifer L. Schiefer

Eur. Burn J. 2022, 3(2), 340-354; https://doi.org/10.3390/ebj3020029 - 21 Apr 2022

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, 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)

Open AccessReview

Techniques to Assess Long-Term Outcomes after Burn Injuries

Rae Spiwak

Shaan Sareen

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Sarvesh Logsetty

Eur. Burn J. 2022, 3(2), 328-339; https://doi.org/10.3390/ebj3020028 - 20 Apr 2022

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, 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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Open AccessArticle

Aspects of Clinical Utility of the Distress Thermometer and Problem List after Burns

Helma W. C. Hofland

Anneke van de Steenoven

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Nancy E. E. Van Loey

Eur. Burn J. 2022, 3(2), 320-327; https://doi.org/10.3390/ebj3020027 - 08 Apr 2022

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, 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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Open AccessReview

Treatment Adherence Interventions for Burn Patients: What Works and What Role Can Motivational Interviewing Play?

Christian R. R. Goans

Karen J. Meltzer

Blake Martin

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Kimberly Roaten

Eur. Burn J. 2022, 3(2), 309-319; https://doi.org/10.3390/ebj3020026 - 06 Apr 2022

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 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

(This article belongs to the Special Issue Psychosocial Aspects of Burn Care, from Etiology to Treatment to Recovery)

Open AccessArticle

Electronic Patient-Reported Outcome Measures in Burn Scar Rehabilitation: A Guide to Implementation and Evaluation

Jill Meirte

and

Zephanie Tyack

Eur. Burn J. 2022, 3(2), 290-308; https://doi.org/10.3390/ebj3020025 - 05 Apr 2022

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 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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Open AccessReview

Damage Control Surgery after Burn Injury: A Narrative Review

Hans-Oliver Rennekampff

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Mayer Tenenhaus

Eur. Burn J. 2022, 3(2), 278-289; https://doi.org/10.3390/ebj3020024 - 01 Apr 2022

Cited by 1

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 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)

Open AccessArticle

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

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

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 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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Open AccessCommentary

Matching Qualitative Inquiry Design and Practice to Contemporary Burns Research Questions: Are We Getting It Right?

Megan Simons

and

Jodie A. Copley

Eur. Burn J. 2022, 3(2), 256-263; https://doi.org/10.3390/ebj3020022 - 28 Mar 2022

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 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)