A Case of Argyria and Acute Leukopenia Associated with the Use of an Antimicrobial Soft Silicone Foam Dressing
Silver has had an important role in preventing burn-related infections for decades. Relatively few side effects is one factor that has led to its wide spread use. Here, the authors present the first case of argyria, acute leukopenia, and possibly acute kidney injury associated with the use of a silver-containing soft silicone foam dressing. A 56-year-old female was transferred to the burn center with an exfoliating skin condition involving 70% TBSA diagnosed as toxic epidermal necrolysis associated with trimethoprim/sulfamethoxazole. On presentation she appeared to have clinical sepsis and was started on vancomycin and pip...
Source: Journal of Burn Care and Research - September 1, 2016 Category: Rehabilitation Tags: Case Reports Source Type: research
Pediatric Frostbite Treated by Negative Pressure Wound Therapy
Frostbite injury in children can lead to abnormal growth and premature fusion of the epiphyseal cartilage with long-term sequela including, but not limited to, arthroses, deformity, and amputation of the phalanges. This was a retrospective chart review of pediatric frostbite identified in an in-house burn center registry from March 1999 to March 2014. Therapeutic management included negative pressure wound therapy (NPWT). Three patients (age 16–31 months) had frostbitten hands because they were outside in cold weather without gloves. They presented within 24 hours after injury, underwent 5–6 days of NPWT after excision...
Source: Journal of Burn Care and Research - September 1, 2016 Category: Rehabilitation Tags: Case Reports Source Type: research
Pediatric Burns from Glass-Fronted Fireplaces in Canada: A Growing Issue Over the Past 20 Years
There is an alarming lack of public awareness surrounding the safety of glass-fronted fireplaces. This has resulted in an active campaign from the American Burn Association Prevention Committee. One issue encountered while advocating for prevention among manufacturers is the lack of corroborating and accurate data. The purpose of this study was to examine the annual trends and epidemiology of glass-fronted fireplace-related burn injuries to children less than 15 years old, who presented to Canadian emergency departments between 1990 and 2010. Records of pediatric burn injuries related to glass-fronted fireplaces were extra...
Source: Journal of Burn Care and Research - September 1, 2016 Category: Rehabilitation Tags: Original Articles Source Type: research
Real-Time Prediction for Burn Length of Stay Via Median Residual Hospital Length of Stay Methodology
Hospital length of stay (LOS) after burn injury is commonly estimated as 1 day per percent burn, but LOS often exceeds that estimate. The purpose of this study is to develop a novel method for estimating burn hospital LOS at any time during hospitalization. The authors used the American Burn Association National Burn Repository from 2000 to 2009 to directly estimate the median residual LOS (MRLOS) of patients hospitalized for burn injuries and who survived to discharge. The MRLOS is the median of how many more days a burn patient will be hospitalized given that the person has been in hospital for a specified time period. T...
Source: Journal of Burn Care and Research - September 1, 2016 Category: Rehabilitation Tags: Original Articles Source Type: research
Bacterial Contamination of Burn Unit Employee Identity Cards
The purpose of this study was to identify the presence or absence of pathogenic bacteria on burn intensive care unit employees’ common access cards (CACs) and identity badges (IDs) and to identify possible variables that may increase risk for the presence of those bacteria. A prospective, cross-sectional study was conducted in our regional Burn Center in which bacterial swab specimens were collected from both the CAC and ID of 10 burn intensive care unit employees in each of five cohorts (nurses, respiratory therapists, physical therapists, physicians, and ancillary staff). Ten additional paired samples, collected from d...
Source: Journal of Burn Care and Research - September 1, 2016 Category: Rehabilitation Tags: Original Articles Source Type: research
Acute Respiratory Distress Syndrome in Burn Patients: A Comparison of the Berlin and American-European Definitions
The purpose of this study was to compare the Berlin definition to the American-European Consensus Conference (AECC) definition in determining the prevalence of acute respiratory distress syndrome (ARDS) and associated mortality in the critically ill burn population. Consecutive patients admitted to our institution with burn injury that required mechanical ventilation for more than 24 hours were included for analysis. Included patients (N = 891) were classified by both definitions. The median age, % TBSA burn, and injury severity score (interquartile ranges) were 35 (24–51), 25 (11–45), and 18 (9–26), respectively. In...
Source: Journal of Burn Care and Research - September 1, 2016 Category: Rehabilitation Tags: Original Articles Source Type: research
Use of Air Transport for Minor Burns: Is There Room for Improvement?
Since 1981, the number of US burn centers has decreased by 29%, resulting in more long distance referrals to remaining facilities. Air transport is often the only feasible method for remote patients to reach few remaining burn centers. A significant proportion of flown-in patients have minor burns and are discharged within 24 hours, representing potential over-utilization of resources with increased cost to the healthcare system for no perceptible benefit. We explored factors associated with air transport of burns and opportunities for system improvement. Retrospective review of burn patients transferred by air to regional...
Source: Journal of Burn Care and Research - September 1, 2016 Category: Rehabilitation Tags: Original Articles Source Type: research
Applying Quality Function Deployment Model in Burn Unit Service Improvement
This study applies QFD technique to improve the quality of the burn unit services in Ghotbedin Hospital in Shiraz, Iran. First, the patients’ expectations of burn unit services and their priorities were determined through Delphi method. Thereafter, burn unit service specifications were determined through Delphi method. Further, the relationships between the patients’ expectations and service specifications and also the relationships between service specifications were determined through an expert group’s opinion. Last, the final importance scores of service specifications were calculated through simple additive weigh...
Source: Journal of Burn Care and Research - September 1, 2016 Category: Rehabilitation Tags: Original Articles Source Type: research
Measuring Depression in Adults With Burn Injury: A Systematic Review
We conducted a systematic review of the literature to identify evidence to support the use of measures of depression for adults with burn injuries. Our goal was to be able to identify the most reliable, valid, and efficient means of identifying adults with symptoms of depression including major depressive disorder. We modified established guidelines for conducting systematic reviews by excluding measures that focused on distress or anxiety or only used depression as a predictor of interest. We also excluded studies that did not report psychometric data in their results. We identified a total of 213 articles that broadly ad...
Source: Journal of Burn Care and Research - September 1, 2016 Category: Rehabilitation Tags: Original Articles Source Type: research
More Than One Third of Intubations in Patients Transferred to Burn Centers are Unnecessary: Proposed Guidelines for Appropriate Intubation of the Burn Patient
Advanced Burn Life Support emphasizes endotracheal intubation for patients with facial burns before transfer to a burn center to prevent airway obstruction. Many patients are intubated before transport and are often extubated shortly after burn center arrival. We hypothesize that many intubations performed before burn center transport are unnecessary. We conducted a retrospective review of all adults who were intubated before burn transfer and survived to discharge from August 2003 to June 2013. Intubations that had 2 or fewer ventilator days (i.e., potentially unnecessary intubations) were compared with those lasting long...
Source: Journal of Burn Care and Research - September 1, 2016 Category: Rehabilitation Tags: Original Articles Source Type: research
Coronary Flow Velocity Reserve in Burn Injury: A Prospective Clinical Cohort Study
In this study, 32 adult burn patients with partial or full-thickness scald burns that were hospitalized and treated were included. The control group was matched for age and sex and was composed of otherwise healthy volunteers. Transthoracic Doppler echocardiography examinations and simultaneous laboratory tests for cardiac evaluation were performed on the sixth month after burn injury as well as with the control group. High-sensitivity C-reactive protein levels were significantly higher in the burn patients than in controls (5.17 ± 3.86 vs 2.42 ± 1.78; P = .001). Lateral isovolumic relaxation time was significant...
Source: Journal of Burn Care and Research - September 1, 2016 Category: Rehabilitation Tags: Original Articles Source Type: research
Effects of Estrogen on Bacterial Clearance and Neutrophil Response After Combined Burn Injury and Wound Infection
Females have a higher rate of mortality following burn injury, largely due to differences in sepsis-related mortality. The present study seeks to understand the underpinnings of the estrogen’s immunomodulatory effects in a murine model of burn injury and infection. Gonad-intact and ovariectomized female mice were subjected to a 15% total BSA scald injury and then inoculated with 3000 CFU of Pseudomonas aeruginosa by topical application to the wound. Animals were killed at 1, 2, or 7 days after injury. Tissue and whole blood were collected. Cultures were performed of all tissues to assess for bacteria content. Lungs were ...
Source: Journal of Burn Care and Research - September 1, 2016 Category: Rehabilitation Tags: Original Articles Source Type: research
Remote Burn Injury Increases Pulmonary Histone Deacetylase 1 and Reduces Histone Acetylation
Dermal burn injury causes profound physiological derangements. Respiratory failure is a primary cause of morbidity and mortality after burn injury, in part, because of excessive and prolonged release of local and systemic proinflammatory mediators. Clinical and preclinical evidence suggests histone deacetylases (HDACs) are key mediators of inflammatory responses. The study objective was to explore the effects of dermal burn injury on pulmonary HDAC activity, identify specific lung HDAC(s) altered by burn, and characterize histone lysine acetylation status. Mice were subjected to a 15% total body surface area scald burn or ...
Source: Journal of Burn Care and Research - September 1, 2016 Category: Rehabilitation Tags: Original Articles Source Type: research
Does Payer Type Influence Pediatric Burn Outcomes? A National Study Using the Healthcare Cost and Utilization Project Kids’ Inpatient Database
Pediatric burns are a considerable source of injury in the United States. Socioeconomic status has been demonstrated to influence other disease outcomes. The goal of this study was to analyze national pediatric burn outcomes based on payer type. A retrospective study was designed using the Kids’ Inpatient Database (KID), years 2000 to 2009. Patients 18 years of age and under with Major Diagnostic code number 22 for burn were included. A total of 22,965 patients were identified, estimating 37,856 discharges. Descriptive and bivariate statistics were performed. Multiple regression analysis was used to assess correlation of...
Source: Journal of Burn Care and Research - September 1, 2016 Category: Rehabilitation Tags: Original Articles Source Type: research
Modified Meek Micrografting Technique for Wound Coverage in Extensive Burn Injuries
The modified Meek micrografting technique constitutes a rapid and efficient surgical approach for the skin coverage of extensive full-thickness burn injuries. A total of 10 burn patients (mean 68 ± 9.2% TBSA) admitted to our burn unit required one or more Meek micrografting procedures (mean 2.2 ± 0.5) to cover in average 43.4 ± 11.6% TBSA (range between 10 and 75% TBSA). This goal was achieved using a donor site area ranging between 2.5 and 18% TBSA. All patients developed local infection to Pseudomona aeruginosa (75%), Stenotrophomona maltophilia (25%), methicillin-resistant Staphylococcus aureus (12.5%), a...
Source: Journal of Burn Care and Research - September 1, 2016 Category: Rehabilitation Tags: Original Articles Source Type: research
