Search Results (86)

Fluid resuscitation after thermal injury is paramount to avoid burn shock and restore organ perfusion. Both over- and under-resuscitation can lead to unintended consequences affecting patient outcomes. While many studies have examined systemic effects, limited data exist on how fluid resuscitation impacts burn wound progression in the acute period. Furthermore, the mechanisms underlying burn wound progression remain not fully understood. This study used a swine model to investigate how varying resuscitation levels affect peri-burn wound dynamics. Twenty-seven female Yorkshire pigs were anesthetized, subjected to 40% total body surface area burn and 15% hemorrhage, then randomized (n = 9) to receive decision-support-driven (adequate, 2–4 mL/kg/%TBSA), fluid-withholding (under, <1 mL/kg/%TBSA), or high-constant-rate (over, >>4 mL/kg/%TBSA) resuscitation. Pigs were monitored for 24 h in an intensive care setting prior to necropsy. Laser Doppler Imaging (LDI) was conducted pre-burn and at 2, 6, 12, and 24 h post burn to assess perfusion. Biopsies were taken from burn, peri-burn (within 2 cm), and normal skin. RNA was isolated at 24 h for the qRT-PCR analysis of IL-6, CXCL8, and IFN-γ. At hour 2, LDI revealed increased peri-burn perfusion in over-resuscitated animals vs. under-resuscitated animals (p = 0.0499). At hour 24, IL-6 (p = 0.0220) and IFN-γ (p = 0.0253) were elevated in over-resuscitated peri-burn skin. CXCL8 showed no significant change. TUNEL staining revealed increased apoptosis in over- and under-resuscitated peri-burn skin. Differences in perfusion and cytokine expression based on resuscitation strategy suggest that fluid levels may influence burn wound progression. Full article

Background/Objectives: Enzymatic debridement with NexoBrid^® is an effective alternative to surgical debridement in burn care, but its potential systemic effects remain unclear. In the context of personalized burn care, understanding individual patient responses to topical agents is essential to optimize outcomes and minimize risks. This study aimed to characterize laboratory and clinical parameter changes following NexoBrid^® application in patients with small burn injuries (≤10% TBSA). Methods: We retrospectively analyzed 75 burn patients treated with NexoBrid^® to evaluate changes in systemic inflammatory markers, coagulation parameters, and clinical parameters before and after enzymatic debridement. Results: Statistically significant increases in body temperature (p = 0.018), decreases in hemoglobin (p < 0.001), and increases in C-reactive protein (CRP) levels (p < 0.001) were observed, suggesting mild systemic inflammatory changes. However, leukocyte counts did not change significantly (p = 0.927), and body temperature remained within the normothermic range, indicating that these changes were not clinically significant. A significant decrease in the prothrombin time ratio (% of normal; p = 0.002) was also observed, suggesting potential impacts on coagulation. Importantly, while body temperature was slightly higher in patients with a higher degree of BSA exposure within the ≤10% TBSA cohort (p = 0.036), the extent of NexoBrid^® application did not correlate with other inflammatory markers. Conclusions: These findings suggest that measurable systemic changes can occur following NexoBrid^® application in small burns, particularly affecting inflammatory and coagulation parameters. These observations contribute to the understanding of treatment-related responses and may help inform clinical decision-making. Full article

Background: High-voltage electrical injuries (HVEIs) represent a complex and life-threatening entity, frequently involving multi-organ damage. While traditionally linked to occupational hazards, train surfing—riding on moving trains—and train climbing—scaling stationary carriages—have emerged as increasingly common causes among adolescents. Popularized via social media, these behaviors expose individuals to the invisible danger of electric arcs from 15,000-volt railway lines, often resulting in extensive burns, cardiac complications, and severe trauma. This study presents a 30-year retrospective analysis comparing cardiac biomarkers and clinical outcomes in train-surfing injuries versus work-related HVEIs. Methods: All patients with confirmed high-voltage injury (≥1000 volts) admitted to a Level 1 burn center between 1994 and 2024 were retrospectively analyzed. Exclusion criteria comprised low-voltage trauma, suicide, incomplete records, and external treatment. Clinical and laboratory parameters—including total body surface area (TBSA), Abbreviated Burn Severity Index (ABSI), electrocardiogram (ECG) findings, intensive care unit (ICU) and hospital stay, mortality, and cardiac biomarkers (creatine kinase [CK], CK-MB, lactate dehydrogenase [LDH], aspartate transaminase [AST], troponin, and myoglobin)—were compared between the two cohorts. Results: Of 81 patients, 24 sustained train-surfing injuries and 57 were injured in occupational settings. Train surfers were significantly younger (mean 16.7 vs. 35.2 years, p = 0.008), presented with greater TBSA (49.9% vs. 17.9%, p = 0.008), higher ABSI scores (7.3 vs. 5.1, p = 0.008), longer ICU stays (53 vs. 17 days, p = 0.008), and higher mortality (20.8% vs. 3.5%). ECG abnormalities were observed in 51% of all cases, without significant group differences. However, all cardiac biomarkers were significantly elevated in train-surfing injuries at both 72 h and 10 days post-injury (p < 0.05), suggesting more pronounced cardiac and muscular damage. Conclusions: Train-surfing-related high-voltage injuries are associated with markedly more severe systemic and cardiac complications than occupational HVEIs. The significant biomarker elevation and critical care demands highlight the urgent need for targeted prevention, public awareness, and early cardiac monitoring in this high-risk adolescent population. Full article

Introduction: Superficial partial thickness burns generally do not require surgical intervention and are managed with specialized wound dressings. Mepilex Ag^® is commonly used and often represents the standard of care. This study evaluated the clinical performance of pure silk compared to Mepilex Ag^®. Methods: A prospective, single-center intraindividual study was conducted on adult patients with superficial partial thickness burns. Each burn wound was divided, treating one half with pure silk and the other with Mepilex Ag^®. Clinical parameters including wound closure time, pain levels, and scar quality at 3-month follow-up were analyzed. Results: Twenty-four patients were included (mean TBSA: 5.8%). Mepilex Ag^® showed a trend towards a shorter wound closure time (10.5 vs. 11.5 days; p = 0.223). Pain scores remained below 4/10 for both dressings throughout treatment. However, Mepilex Ag^® demonstrated significantly lower pain on day one (3.5 vs. 2.77; p = 0.039) and day two (2.91 vs. 2.27; p = 0.041). Scar quality after 3 months was similar. Conclusion: Both dressings proved to be effective treatment options. Pure silk required fewer resources, showed high clinical practicality, and demonstrated a similar performance to Mepilex Ag^® in key clinical parameters, making it an interesting option for other clinics and our standard of care. Full article

Fluid management is a critical component in the treatment of patients suffering with major burns. Clinicians must carefully balance judicious resuscitation with the risks of over- or under-resuscitation. We aimed to identify factors associated with survival in burns patients and determine the importance of resuscitation practices. Patients requiring admission to Burns Services in the United Kingdom between 1 April 2022 and 31 March 2023 were included in the National Burns Audit project on fluid resuscitation practices, to evaluate factors associated with survival and Critical Care Length of Stay (CCLoS). A total of 198 patients were included in the analyses, with median age of 51 years (interquartile range, (IQR) 35–62 years), median Total Burn Surface Area (TBSA%) of 27.5% (IQR 20–40%), and median Baux score 82.5 (IQR 66–105). The following were found to be significant for survival: younger age, smaller TBSA%, lower Baux score and independence from renal replacement therapy. Neither the mechanism of burns nor the fluid resuscitation volumes appeared to influence survival. Although interventions such as tracheostomy or the number of surgical procedures did not appear to affect survival, fluid replacement of more than 6 mL/kg/%TBSA independently predicted longer CCLoS. Volume of fluid resuscitation, within the limits examined in this cohort, did not impact likelihood of survival. Full article

In some regions, extreme heat can result in pavement temperatures that are high enough to cause severe burn injuries within seconds of skin contact. This risk is elevated for unhoused individuals who may lack adequate clothing and shelter and have susceptibility to other risk factors, including substance use and in turn loss of consciousness. While prior studies have shown worse outcomes for unhoused individuals due to delays in care and higher susceptibility, there is a lack of data on the impact of pavement burns specifically within this population. This single-institution retrospective cohort study aims to explore burn severity and hospital outcomes in housed vs. unhoused patients with pavement burns. The data were analyzed using independent samples t-tests and logistic regression when appropriate, with p < 0.05 considered statistically significant. A total of 305 individuals met the inclusion/exclusion criteria and comprised the final study cohort, 17.7% of which were unhoused. There was no significant difference in TBSA, survival to discharge, or hospital length of stay between housed and unhoused patients. While unhoused individuals may still be at heightened risk for pavement burns due to exposure to extreme heat and a lack of protective measures, these results may additionally suggest consistent emergency care for patients regardless of housing status. Furthermore, these results highlight the importance of developing targeted outreach and prevention programs and equitable emergency care protocols for vulnerable populations. Full article

Background: Finding the optimal amount of fluid is a major challenge in burn shock. Although there is evidence that a restrictive fluid regime is beneficial, current practice shows fluid resuscitation still well above recommendations. The extent of trauma, pre-hospital care and the patient’s pre-existing conditions influence requirements. Methods: We analysed outcomes and influencing factors of fluid regimes in a retrospective cohort study including 90 severely burnt patients resuscitated with the same protocol. Results: The mean amount of fluids in the first 24 h was 6.5 mL/kg bodyweight (BW)/% total burn surface area (TBSA). A total of 14% received restrictive (<4), 34% received liberal (4–6) and 51% received excessive (>6) mL/kgBW/%TBSA fluids. There was no difference regarding mortality, age, complications, organ failure, inhalation injury or full-thickness burns in the groups. Patients with excessive fluid therapy had a significantly lower ABSI score (9 vs. 11, p = 0.05) and TBSA (35 vs. 51%, p < 0.001), while patients with a restrictive fluid therapy needed fewer incidences of surgery to cover burn wounds (3.5 vs. 9.0 vs. 7.0, p = 0.008). History of liver disease or alcohol abuse tended to indicate excessive fluid administration. Patients with pre-existing heart failure received restrictive fluid therapy (23 vs. 3 vs. 4%, p = 0.03). Conclusions: Individualised, timely therapy monitoring is as essential as identifying patients with a higher or lower fluid requirement. Excessive fluid resuscitation had fewer deleterious consequences in complications than expected but seems to influence wound healing. Awareness of circumstances that prompt deviations from recommended fluid rates remains elementary. Full article

Background/Objectives: Accurate prehospital assessment of total body surface area burned (TBSA-B) is crucial for pediatric burn management, guiding resuscitation, fluid therapy, and transfer decisions. This study evaluates the accuracy of prehospital TBSA-B estimations compared to in-hospital expert assessment and examines their impact on prehospital management. Methods: This retrospective study analyzed 104 pediatric burn cases (median 17 months; 5 days–14 years) from 2017 to 2021. The primary endpoint was the difference between prehospital TBSA-B estimation and clinical measurement, with a clinically significant discrepancy defined as >5%. Secondary endpoints included the relationship between TBSA-B estimation and fluid therapy, analgesia, and hospital stay duration. Results: Prehospital TBSA-B estimations ranged from 2% to 40% (mean: 13.9%, SD = 4.4%) with scalds being the most common burn type (90.4%). Bland–Altman analysis showed a mean TBSA-B overestimation (bias) of 6.35%, with limits of agreement ranging from −6.97% (CI: −9.42 to −4.51) to 19.67% (CI: 17.21 to 22.12). No significant patterns in overestimation were associated with age, gender, or burn location. Fluid therapy volumes were independent of prehospital TBSA-B estimates, and analgesic administration varied by gender, with girls receiving less analgesia than boys, but showed no association with burn extent or severity. Hospital stay duration correlated proportionally with in-hospital assessed TBSA-B. Conclusions: Prehospital TBSA-B estimation was systematically overestimated, yet it did not influence fluid therapy decisions. Gender differences were observed in analgesic administration, while hospital stay duration was directly related to burn extent. These findings highlight the need for improved training and standardized tools to enhance prehospital burn assessment in pediatric patients. Full article

Firework-related injuries remain a serious public health issue in Germany, especially during New Year’s Eve. While many injuries are minor, the misuse of illegal or homemade fireworks can cause severe trauma resembling military combat injuries and can heavily burden emergency services. Notably, injury rates declined during the COVID-19 firework bans, underscoring the impact of preventive measures. We report two cases of young males with severe injuries from illicit fireworks. The first is a case of a 16-year-old that detonated an illegal Polish firework ball bomb, sustaining 9% total body surface area (TBSA) burns (second- to third-degree), hand fractures, compartment syndrome of the hand, and soft-tissue trauma. He underwent multiple surgeries, including fasciotomy, osteosynthesis, and skin grafting. The other case presented is a 19-year-old man who was injured by a homemade device made of bundled firecrackers, suffering deep facial and bilateral hand burns. He required prolonged ventilation, surgical debridement, and treatment with Kerecis^® fish skin and Epicite^® dressings. Both required intensive ICU care, interdisciplinary management, and lengthy rehabilitation. Total hospital costs amounted to €58,459.52 and €94,230.23, respectively, as calculated according to the standardized German DRG. These cases illustrate the devastating impact of illegal fireworks. The devastating consequences of explosive trauma are often difficult to treat and may lead to long-term functional and psychological impairments. Prevention through public education, stricter regulations, and preparedness is essential. Pandemic-era injury reductions support sustained policy efforts. Full article

Background: Cell-free DNA (cfDNA) released during tissue damage has attracted interest as a marker of patient outcomes. However, limited research has examined its predictive utility in thermally injured patients. Methods: This study measured cfDNA concentrations across days 1, 3, 7, 14, and 28 post-burn in a total cohort of 98 adult patients with total body surface area (TBSA) burns ≥ 15% and healthy controls (HC). CfDNA concentrations in survivors (n = 79) versus non-survivors (n = 16) were compared and area under the receiver operating curve (AUROC) models generated to evaluate cfDNA as a predictor of mortality. Results: Patient cfDNA levels were significantly elevated at all time points compared to HC. Positive correlations were identified between day 1 cfDNA concentrations (n = 95) and %TBSA (r = 0.413, p < 0.0005), rBAUX (r = 0.365, p = 0.0005) and SOFA (r = 0.391, p = 0.0002). On day one, cfDNA levels showed good discriminatory ability for distinguishing between survivors and non-survivors (AUROC 0.778), with an optimal cut-off value of 446.37 pg/mL exhibiting a sensitivity of 0.80 and specificity of 0.70. Predictive models built on rBAUX, SOFA, interleukin(IL)-6 and IL-10 generated AUROC values of 0.733, 0.743, 0.472, and 0.688 respectively. Conclusions: Major burns result in immediate and persistent cfDNA elevation, with concentrations on day one higher in non-survivors. Plasma cfDNA concentrations on day one post-burn showed good performance as a prognostic marker for mortality. CfDNA therefore represents a rapid objective measure that may be useful during acute burn assessments to aid mortality predictions. Full article

Face and neck burns present significant clinical challenges due to their proximity to the airway, predisposing patients to inhalation injuries and subsequent respiratory complications. In our cohort of 206 patients, facial and neck burns were associated with a markedly higher incidence of inhalation injury (34.8% vs. 2.8%), necessitating more frequent endotracheal intubation (51.9% vs. 14.1%). Furthermore, respiratory infections were significantly more common in patients with facial and neck burns (26.7% vs. 7%, p < 0.001), with respiratory secretion cultures revealing a predominance of Pseudomonas aeruginosa (39.58%), Acinetobacter baumanii (18.75%), and Klebsiella pneumoniae (6.25%). In contrast, patients without facial and neck burns primarily exhibited Pseudomonas aeruginosa (50%) in their cultures. These complications translated into a significantly increased mortality rate in patients with facial and neck burns (31.1% vs. 12.7%), with a reduced mean survival period (66.7 days vs. 84.3 days) and a 2.8-fold increase in the hazard of mortality. Additionally, older age emerged as a significant determinant for the development of respiratory infections. Multivariable model regression analysis revealed that only TBSA remained a consistent and independent predictor for adverse respiratory outcomes and increased mortality, while face and neck burns are more causally associated with TBSA. Full article

Mesh grafting and Meek micrografting are split-thickness skin graft expansion techniques. This study aimed to compare the effectiveness of Meek and Mesh expansion ratios 1:2 and 1:3 in smaller wounds. An intra-patient randomized controlled trial was conducted at two burn centers (the Netherlands and Belgium). Wound outcomes, e.g., take rate, re-epithelialization rate, and donor site size, were measured. At 3 months post-surgery, patient preference and scar quality were evaluated with the Patient and Observer Scar Assessment Scale (POSAS), cutometer and dermaspectrometer. Seventy patients with a TBSA of 10 ± 10% (mean ± SD) were included. The take rate was 79 ± 25% vs. 87 ± 19% (p = 0.003), Meek vs. Mesh, respectively. At follow-up, a majority of observer and patient POSAS items were statistically significantly lower, corresponding with better scar quality for Mesh grafting compared to Meek micrografting. The scar elasticity was 0.37 ± 0.20 vs. 0.42 ± 0.21 (p = 0.013) and mean melanin 13.3 ± 8.3 vs. 12.1 ± 7.7 (p = 0.019) for Meek vs. Mesh, respectively, and the patient preference was 32%, 49%, and 19% for Meek, Mesh, and no preference. Other outcomes showed no statistically significant difference. In patients with smaller wounds, Mesh showed superiority on most wound and short-term scar results. Nevertheless, patient preference within the 1:3 expansion ratio group and donor site size were in favor of Meek. Full article

Background: High-voltage injuries associated with train surfing are a distinct subset of electrical injuries, yet detailed analyses remain limited. This study retrospectively reviewed train-surfing injuries admitted between 1994 and 2024, comparing their characteristics and outcomes to work-related high-voltage injuries. Methods: Medical records of 102 patients admitted for high-voltage injuries were analyzed, including 32 train-surfing and 70 work-related cases. Demographics, injury patterns, and clinical outcomes were assessed. Results: Train surfers were predominantly young males (median age 19 years), while work-related injuries involved slightly older males (median age 34 years). Train surfers sustained more severe burns (%TBSA: 47.6% vs. 25.4%, p < 0.0001) and higher ABSI scores (6.7 vs. 5.3, p < 0.01). Vertical electrical flow was predominant in train surfing (65.6%), reflecting contact with overhead lines, while work-related injuries showed varied flow patterns, with diagonal flow being most frequent (58.6%). Train surfers had longer ICU stays (38.7 vs. 17.9 days, p < 0.001) and underwent more surgeries per patient (5.3 vs. 2.8, p < 0.01). Fasciotomy rates were significantly higher among train surfers (84.4% vs. 55.7%, p < 0.01), as were amputations (53.1% vs. 25.7%, p < 0.001). Mortality rates were similar in both groups (25%). Conclusions: Train-surfing injuries represent a distinct and highly severe subgroup of high-voltage trauma, marked by greater burn extent, predominantly vertical electrical flow due to contact with overhead lines, and significantly higher surgical complexity—including increased rates of fasciotomies and amputations. Despite comparable mortality, the clinical burden for train-surfing victims is substantially higher, reflected in longer ICU stays and more operations per patient. These findings underscore the urgent need for targeted prevention strategies addressing youth engagement in train surfing. Public health campaigns, railway infrastructure modifications (e.g., deterrent systems or physical barriers), and early educational interventions could play a critical role in reducing these preventable injuries. Furthermore, trauma centers should be prepared for the specific reconstructive and critical care demands posed by this high-risk group, emphasizing the importance of specialized multidisciplinary management protocols. Full article

Background: High-voltage injuries pose severe risks, particularly among train surfers and occupational workers. This study compares current flow mechanisms and their association with cardiac failure and kidney function problems in these groups. Methods: A retrospective analysis of 102 patients treated for high-voltage injuries between 1994 and 2024 was conducted, including 32 train-surfing and 70 work-related cases. Demographics, current flow patterns, and complications were analyzed. Results: Train surfers, mostly young males (median age: 19 years), sustained more severe burns compared to older males with work-related injuries (median age: 34 years), with a %TBSA of 47.6% vs. 25.4% (p < 0.0001). Vertical electrical flow was predominant among train surfers (65.62%) and led to cardiac failure in 37.5% of cases. In contrast, diagonal flow was most common in work-related injuries (58.57%). Cardiac failure occurred in 21.57% of all patients, with vertical flow posing the highest risk (38.46%). Kidney failure affected 43.75% of train surfers and 21.43% of work-related cases, with dialysis required in 21.57% overall. Train surfers were more likely to require resuscitation (43.75% vs. 15.71%, p = 0.005), while ECG findings showed no significant differences (p = 0.325). Biomarker levels, such as CK, myoglobin, and troponin, were significantly higher in train surfers, reflecting greater muscle damage. Conclusions: Current flow mechanisms significantly influence cardiac and renal complications. Vertical flow, common in train surfers, is strongly associated with cardiac failure, while work-related injuries exhibit varied flow patterns. These findings highlight the need for targeted prevention strategies and public awareness. Full article

Background: Burns represent one of the most severe injuries encountered in the pre-hospital and ED environment, with essential features and an often negatively powerful impact on patients’ quality of life. Preventive measures can significantly reduce the number of cases presenting to medical facilities; knowledge and the correct application of first aid measures in the pre-hospital stage have a significant role in reducing the risk of complications and in obtaining optimal outcomes. Methods: This retrospective one-year single-center study analyzed 399 adult burn patients treated at the Clinical Emergency Hospital of Bucharest (CEHB) in 2023. Information concerning the main characteristics of the patients (age, sex, and residence), etiology and severity of burns, and pre-hospital management of patients was analyzed. Results: Most patients (63.41%) resided in urban areas, with a higher prevalence of males (55.89%). Thermal burns accounted for 77.69% of cases, primarily caused by water, food, oil, or flames. Burns covered ≤10% TBSA in 77.19% of cases, while 6.52% extended beyond 50% TBSA. First aid was provided to 52.63% of patients at the accident site, often by non-specialized individuals. The mean time to presentation was 34.90 h, with significant correlations between time, age, burned body surface area, and burn depth. Conclusions: There is a real need for improvements in first-aid training and health initiatives to enhance pre-hospital burn care. Better documentation of the care provided to patients before being admitted to specialized centers, as well as further studies in this field, are absolutely necessary for improving prevention programs and burn management in the acute stage. Full article