Search Results (54)

Burn injuries are increasingly recognized as chronic conditions with enduring physical, psychological and social consequences that extend beyond acute survival. This narrative review synthesizes and interpretatively discusses recent evidence on health-related quality of life (HRQoL) in adult burn survivors, focusing on recovery patterns following discharge. Persistent physical sequelae—particularly chronic pain, pruritus, contractures and scarring—remain major determinants of reduced HRQoL, mainly mediated by functional limitation and self-perception. Psychological morbidity is common, with high rates of depression, anxiety and post-traumatic stress disorder, particularly early after injury, although post-traumatic growth may also emerge. Social reintegration, including return to work, is often delayed or incomplete and is influenced by injury severity, mental health status and social support. Recovery trajectories are nonlinear: the greatest improvements occur within the first six months, followed by slower gains up to 18–24 months, after which many patients fail to reach population norms. Pain and psychological symptoms may persist for years. Overall, these findings support a multidisciplinary, longitudinal approach to burn care, emphasizing early risk stratification and rehabilitation to optimize individualized recovery. In this narrative review, we aim to outline the main dimensions of long-term quality of life, with a particular focus on the temporal dynamics of recovery patterns. Full article

Background: Burn injuries are increasingly being recognized as chronic conditions with long-term physical, emotional, and social consequences. As survival after acute burn trauma improves, greater attention has shifted toward health-related quality of life (QoL) in survivors, particularly in regions where data remain limited. Methods: This study included burn survivors treated between January 2022 and December 2023 in the Department of Plastic Surgery and Reconstructive Microsurgery of the Emergency Clinical Hospital “Bagdasar-Arseni,” Bucharest, Romania. Patients who survived hospitalization and follow-up were invited to complete a Romanian-adapted version of the Burn Specific Health Scale-Brief (BSHS-B). Demographic and clinical data were collected from medical records, including burn type, total body surface area (TBSA), burn depth, burn localization, and access to rehabilitation services. Statistical analysis included descriptive methods, chi-square tests, t-tests, Kendall’s tau-b, Cramer’s V, Cronbach’s alpha, and exploratory factor analysis. Results: Thirty-eight patients were included. Most burns were thermal (94.74%), while burns involving <10% TBSA were most frequent (60.53%). Functional outcomes were generally favorable, with most patients reporting no difficulty in basic daily activities such as bathing, dressing, and writing. However, fine motor activities and return to previous work were more frequently affected. Emotional recovery appeared less complete, with persistent mild-to-moderate loneliness, sadness, and emotional distress reported by many participants. Women reported higher levels of loneliness (p = 0.015), while third-degree burns were associated with more frequent depressive symptoms (p = 0.008). Depressive symptoms were also significantly associated with functional limitations (such as getting dressed, p = 0.002) and work impairment (p < 0.001). The adapted functional and emotional subscales showed excellent internal consistency. Conclusions: Post-burn recovery extends beyond physical healing. Although most patients regained functional independence, emotional distress and occupational difficulties often persisted. These findings support the need for multidisciplinary long-term burn care integrating physical rehabilitation, psychological screening, and psychosocial support. Full article

Background: Burn injuries profoundly impact the survivors’ physical, psychological and social well-being, with sexuality, intimacy and body image remaining among the most disrupted yet least addressed areas of rehabilitation. Limited professional training, social discomfort, and a lack of clinical guidance contribute to these unmet needs. Recognizing sexuality as an essential part of health, this interdisciplinary project developed evidence-informed recommendations and communication tools to support both burn survivors and healthcare professionals in discussing intimacy, sexuality, and body image after burn injury. Methods: An interdisciplinary expert group conducted a narrative literature review, supplemented with grey literature and lived experience resources. These insights informed two practical tools: a poster for healthcare professionals and burn centers, and a patient-focused brochure. Both underwent iterative refinement through multicultural feedback from patients and professionals across Europe, Asia and Africa, followed by final validation during an interdisciplinary workshop at the 2025 European Burns Association (EBA) Conference. Results: The literature indicated that burn injuries affect sexuality and body image through interacting physiological, psychological, sensory, relational, and sociocultural factors. Common challenges included reduced desire, anxiety, fear of rejection, altered self-perception, and discomfort initiating conversations about intimacy. Professionals reported limited training, insufficient privacy and cultural barriers. Conclusions: The developed tools and these recommendations aim to normalize dialog, support proactive screening, and promote culturally sensitive patient-centered burn rehabilitation. Embedding sexuality and intimacy within burn care requires ongoing professional training and the identification of dedicated resource persons within each team. Full article

Over the past years, burn care has evolved from a discipline focused on survival to one centered on restoring long-term health, function, and quality of life. Significant advances in critical care, early excision and grafting, infection control, and metabolic support have transformed survival outcomes for even the most severe injuries. As a result, the field now faces a new frontier: understanding and managing the long-term physical, psychological, and systemic sequelae of survival. This review traces the evolution of burn care over the last century and outlines the challenges and priorities for the next 25 years. The first era of progress, defined by innovations in resuscitation, surgery, and critical care, has given rise to a growing cohort of long-term survivors. Research over the past decade has revealed that major burns induce chronic multisystem alterations, including metabolic, cardiovascular, neurocognitive, and immunological dysfunctions. Emerging concepts such as burn-associated heart failure exemplify this shift from acute to chronic disease understanding. Looking ahead, the future of burn medicine lies in personalized and lifelong care, supported by translational research, digital health, regenerative therapies, and interdisciplinary collaboration. Overall, burn care stands at a pivotal crossroads. By integrating precision medicine, rehabilitation science, and psychosocial care, we aim to move the field from survival toward sustained, holistic recovery over the next 25 years. Full article

Introduction: Various scoring systems are applied to burn patients to assess the perioperative and mortality risks as well as comorbidities. Objective: The purpose of this study was to compare the predictive accuracies for mortality of different scoring systems: the Abbreviated Burn Severity Index (ABSI), Bogenhausen ABSI (BABSI), American Society of Anesthesiologists (ASA) classification, Charlson Comorbidity Index (CCI) and modified Frailty Index-5 (mFI-5). Materials and Methods: We retrospectively analyzed 644 burn patients treated at one burn center between September 2018 and May 2022. Results: Median scores were 5 (range: 1–16), 5 (range: 2–17.5), 2 (range: 1–5), 0 (range: 0–14) and 0 (range: 0–5) for the ABSI, BABSI, ASA, CCI and mFI-5, respectively. Significantly different median score results were observed between survivors and non-survivors: ABSI: 5 vs. 10; BABSI: 5 vs. 10.5; ASA: 2 vs. 4; CCI: 0 vs. 5; and mFI-5: 0 vs. 2 (p < 0.001 for all scores). Predictive accuracies were excellent for the BABSI (AUC = 0.963), ABSI (AUC = 0.952), and ASA (AUC = 0.916), whereas fair predictive accuracies were found for the CCI (AUC = 0.851) and mFI-5 (AUC = 0.760). Good calibration was observed for the BABSI, ABSI, CCI, and mFI-5, whereas calibration was poor for the ASA. Conclusion: All five scores significantly differentiate between survivors and non-survivors. However, the strongest discriminatory power and best calibration for mortality prediction were observed for the BABSI and ABSI scores. Therefore, the application of both scores is recommended in daily routine. Full article

Background: Electrical injuries occur when an electric current comes into contact with or passes through the body. Electrical injuries can result from contact with faulty electrical appliances and machinery or from contact with open household wiring or electrical power lines. Aim: The aim of this study was to evaluate the psychosocial difficulties experienced by individuals who suffered electrical burns due to work accidents, using a phenomenological approach. Study Design: This phenomenological study was conducted with semi-structured in-depth interviews with 15 electrical burn survivors living in different regions of Turkey via the WhatsApp mobile application. The snowball sampling method was used to reach the sample group. Interviews continued until data saturation was achieved. All interviews were audio recorded and then transcribed. The data were analyzed using Colaizzi’s phenomenological analysis method. The study was conducted and reported according to the COREQ checklist. Results: In the analysis of the data, two categories and five themes were identified: the effects of electrical burn at the time of occurrence and during the hospital process (psychological, social and physical), and adaptation to life after electrical burn treatment (emotions experienced, difficulties experienced and coping). Conclusions: This study revealed the life experiences, psychosocial difficulties and coping experiences of individuals with electrical burns. According to the results of the research, it is understood that individuals experienced negative emotions such as depression, helplessness and hopelessness as a result of electrical burns, could not cope with the psychosocial difficulties experienced and received psychological support. It was determined that social appearance anxiety due to deterioration in body image was very important in individuals. Full article

Objective: To identify key predictors of clinical outcomes in burn survivors and clarify the role of mixed-depth burns and confounding by indication in observational rehabilitation research. Design: Retrospective cohort study using data from a burn rehabilitation registry (January 2024 to July 2025). Setting: Burn rehabilitation center. Participants: 120 adult patients (age ≥ 18 years) with burns affecting ≥1% total body surface area (TBSA) and complete baseline data. Interventions: Not applicable. Main Outcome Measures: Primary outcome was functional improvement (ΔFIM). Secondary outcomes included pain reduction (ΔPain), scar severity (Vancouver Scar Scale; VSS), Activities of Daily Living (ADL) improvement, and Range of Motion (ROM) recovery. Multivariable linear and logistic regression models were used to identify predictors. Results: Patients achieved significant improvements in function (mean ΔFIM = 11.3 ± 8.9 points) and pain (mean ΔPain = 1.28 ± 0.81). Having a mixed-depth burn was the strongest predictor of worse scar outcomes (β = 2.52, 95% CI: 0.93 to 4.12, p = 0.002) and failure to achieve full ROM (OR = 0.089, 95% CI: 0.008 to 0.930, p = 0.043). An apparent association between inpatient ward care and better scar outcomes (β = −1.30, p = 0.020) was determined to be an artifact of confounding by indication, as the outpatient group had a higher proportion of high-risk mixed-depth burns (6.2% vs. 3.5%). Longer therapy duration was the only significant predictor of achieving ADL goals (OR = 1.014, 95% CI: 1.002 to 1.026, p = 0.025). Conclusions: Injury characteristics, particularly the presence of a mixed-depth burn, emerged as the dominant predictors of long-term scar and functional outcomes. This study identifies mixed-depth burns as a potentially high-risk clinical phenotype requiring targeted therapeutic strategies and demonstrates the critical importance of accounting for confounding by indication when evaluating rehabilitation outcomes in observational burn research. Full article

Background: Enzymatic debridement with Nexobrid (NXB) is established for burn care, but specific outcomes in the elderly remain poorly characterized. This study evaluates the safety, efficacy, and clinical outcomes of NXB in patients aged ≥65 years. Methods: A retrospective case-series of 43 consecutive elderly patients (mean age 74.5 years) with deep partial- to full-thickness burns treated with NXB at a single burn center. Data on demographics, burn characteristics, treatment chronology, and complications were analyzed. Results: The median total burn surface area (TBSA) was 11%. NXB was applied selectively, with a mean debrided area of 7.41% TBSA, primarily on limbs and hands. While 76.7% of patients ultimately required surgical autografting, no patient required an escharotomy in NXB-treated areas. The mortality rate was 25.6%, which was lower than expected for a median revised Baux score of 90, which is expected to be more than 50%. Hypertrophic scarring occurred in 28.1% of survivors, associated with a prolonged median healing time of 63 days. Conclusions: In elderly burn patients, NXB facilitates precise eschar removal and reliably prevents compartment syndrome, demonstrating a strong safety profile even in high-risk individuals. Its primary benefit shifts from reducing surgical incidence to optimizing the wound bed for grafting. These findings support the use of NXB in the elderly, with the understanding that subsequent grafting is often still required due to age-related delayed healing. Full article

Background: Burn patients with severe inhalation injury and refractory hypoxemia are at high risk for cardiorespiratory failure and mortality. Extracorporeal membrane oxygenation (ECMO) has emerged as a potential rescue therapy, but its survival benefits in this population remain uncertain. This study aimed to evaluate the impact of ECMO on mortality in burn patients with severe lung injury, to identify risk factors associated with death, and to analyze causes of rehospitalization among survivors. Methods: We conducted a population-based, retrospective cohort study using the Taiwan National Health Insurance Research Database (NHIRD). Burn patients with severe hypoxia requiring mechanical ventilation between 2000 and 2015 were identified. A 0.25-fold propensity score matching was applied based on age, gender, and burn severity. Mortality rates, survival risk factors, and rehospitalization causes were analyzed between ECMO and non-ECMO groups. Results: Among 6493 eligible patients, ECMO-treated patients had a hospital mortality rate of 47.09%, compared to 38.71% in the non-ECMO group. Early-phase mortality was higher among ECMO patients (adjusted 1-year mortality HR: 3.19), but survivors demonstrated stable long-term outcomes. Pulmonary complications, cardiac dysfunction, and sepsis were the leading causes of death. Kidney failure and infections were the most common reasons for rehospitalization among survivors. Conclusions: This research offers a comprehensive real-world analysis of the effectiveness of ECMO in burn patients. While ECMO does not eliminate early mortality risk, it may provide critical support during acute phase in carefully selected burn patients with severe hypoxemia. Multidisciplinary care and early rehabilitation planning are essential to improve long-term outcomes. Further research is needed to refine patient selection and optimize ECMO strategies in this high-risk population. Full article

Background and Objectives: Despite the advances in the treatment, severe burns with total burn surface area ≥ 20% are still a major cause of mortality worldwide. Pan-immune inflammation value (PIV) is a novel and promising biomarker to predict prognosis and mortality in various diseases. The aim of this study was to evaluate the utility of PIV to predict in-hospital mortality of patients with severe burn. Materials and Methods: This retrospective cross-sectional study included ≥18 years old patients with severe burn who were admitted to hospital within 12–24 h after the burn injury between January 2007 and August 2024. The demographics, clinical and laboratory characteristics of patients were recorded from electronic hospital records. Pan-immune inflammation value was calculated as neutrophil counts x monocyte count x platelet counts divided by lymphocyte counts. The receiver operating characteristic (ROC) analysis was conducted to determine the predictive value of PIV for mortality. Results: A total of 100 patients (median age 41 (26.3–55) years; 79% male) were included in the study of whom 23 were non-survivors. The PIV was significantly higher in non-survivors when compared to survivors (p = 0.009). The ideal cut-off of PIV was 1185, with a sensitivity of 69.6% and a specificity of 66.2%. The multivariate analysis showed that high PIV along with inhalation injury, and the need for surgery were predictors of in-hospital mortality. Conclusions: This study is the first to demonstrate that the novel, comprehensive index, PIV, is a reliable immuno-inflammatory marker predicting in-hospital mortality in patients with severe burn. Full article

Background: Severe burn injuries often lead to lasting physical and psychological consequences. Post-traumatic stress disorder (PTSD) is common among burn survivors and may be influenced by persistent somatic complaints. This study examined whether PTSD is associated with a higher burden of physical symptoms during and after inpatient rehabilitation. Methods: We conducted a subgroup analysis of a multicenter prospective cohort study involving 103 adult burn patients in inpatient rehabilitation. Based on Impact of Event Scale—Revised (IES-R) scores and clinical evaluation, patients were grouped as PTSD (n = 43) or No PTSD (n = 60). Physical symptoms assessed included skin dryness (xerosis), temperature sensitivity (cold/heat), numbness, skin tightness, and increased sweating. Results: Patients with PTSD reported significantly more physical symptoms at follow-up than those without PTSD: xerosis (74% vs. 50%, p = 0.03), cold sensitivity (61% vs. 35%, p = 0.02), heat sensitivity (63% vs. 39%, p = 0.03), numbness (63% vs. 33%, p = 0.006), skin tightness (82% vs. 52%, p = 0.004), and sweating (45% vs. 19%, p = 0.01). PTSD patients also had more severe burns, reflected in higher full-thickness TBSA (2% vs. 0%, p = 0.03) and elevated ABSI scores (median 6 vs. 5, p = 0.04). Conclusion: PTSD is associated with a higher and more persistent burden of physical skin symptoms after severe burns. These findings underscore the importance of early PTSD screening and integrated psychological-somatic rehabilitation to improve long-term recovery and quality of life. Full article

Burn injuries result in complex physiological and psychological sequelae, including hypermetabolism, muscle wasting, mobility impairment, scarring, and disrupted body image. While advances in acute care have improved survival, comprehensive rehabilitation strategies are critical for restoring function, appearance, and psychosocial well-being. Structured physical activity, including resistance and aerobic training, plays a central role in counteracting muscle atrophy, improving cardiovascular function, enhancing scar quality, and promoting psychological resilience and body image restoration. This narrative review synthesizes the current evidence on the effects of exercise-based interventions on post-burn recovery, highlighting their therapeutic mechanisms, clinical applications, and implementation challenges. In addition to physical training, emerging technologies such as virtual reality, aquatic therapy, and compression garments offer promising adjunctive benefits. Notably, artificial intelligence (AI) is gaining traction in burn rehabilitation through its integration into wearable biosensors and telehealth platforms that enable real-time monitoring, individualized feedback, and predictive modeling of recovery outcomes. These AI-driven tools have the potential to personalize exercise regimens, support remote care, and enhance scar assessment and wound tracking. Overall, the integration of exercise-based interventions with digital technologies represents a promising, multimodal approach to burn recovery. Future research should focus on optimizing exercise prescriptions, improving access to personalized rehabilitation tools, and advancing AI-enabled systems to support long-term recovery, functional independence, and positive self-perception among burn survivors. Full article

Background: Coagulopathy in severe burn injury is associated with complications and mortality. Methods: We compared 3 tests (EXTEM, INTEM, FIBTEM) of rotational thromboelastometry (ROTEM), a viscoelastic coagulation assay (VCA), with conventional coagulation assays (CCAs), fibrinogen, d-dimers and coagulation factors during the five post-burn days in survivors and non-survivors with severe burn injury, in order to correlate the results with burn coagulopathy and prognosis. Results: Seventeen survivors and ten non-survivors, with mean total burn surface area of 33.78% were included. CCAs measurements were abnormal, but unable to detect coagulopathy. At day 2, D-dimers and fibrinogen levels were statistically augmented for non-survivors. Regarding VCAs, FIBTEM MCF increased for non-survivors at day 2 and remained increased for the whole post-burn period. Furthermore, FIBTEM A10 and A20 at day 2 and EXTEM A10, EXTEM A20, EXTEM MCF, and EXTEM CFT at day 5 took abnormal values for the same group (p < 0.05). These changes were underlined through abnormal measurements of coagulation factors. Conclusions:CCAs are poor indicators of coagulation status in burn injury, whereas VCAs are more sensitive markers, demonstrating coagulopathy and patients at greater risk of mortality. 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

Burn injuries lead to significant physical and psychological consequences, including chronic pain, post-traumatic stress, depression, and social isolation. Mindfulness-based interventions (MBIs) have been proposed as a holistic approach to address these challenges in burn rehabilitation. This systematic review evaluates the efficacy of dispositional mindfulness and MBIs, including mindfulness meditation, yoga, and self-compassion training, in managing pain, emotional distress, and psychosocial adaptation in burn survivors. A comprehensive literature search was conducted through MEDLINE and Web of Science, covering studies up to February 2025, with additional papers retrieved from Google Scholar and Semantic Scholar. Studies were included if they reported quantitative data on the effects of MBIs in burn patients and/or their families, excluding opinion pieces, editorials, reviews, and qualitative studies. After screening 91 studies retrieved from the databases and adding a compelling paper retrieved from the other sources explored, 12 studies were included in the final pool, categorized into cross-sectional studies (n = 6), and intervention studies (n = 6). The extracted data included publication year, research design, sample characteristics, intervention details, main findings, and data for quality assessment. The synthesis of the results suggests that mindfulness is associated with reduced psychological symptoms, improved emotional regulation, and enhanced self-compassion, leading to better coping strategies and social reintegration. However, the long-term efficacy of MBIs remains inconclusive, and further research is needed to differentiate mindfulness-specific effects from those of general physical exercise. Evidence also suggests that mindfulness interventions may reduce anxiety and secondary trauma in children with burns and their caregivers. This review highlights the potential of MBIs as adjuncts to conventional burn rehabilitation programs, but further high-quality trials are needed to establish their sustained efficacy and to understand the specific benefits of mindfulness. Full article