To compare the comprehensive efficacy of a triple therapy combining silver sulfadiazine cream, recombinant human epidermal growth factor (rhEGF), and Compound Huangbai Liquid (Combined Group) versus a nano-silver dressing regimen (Traditional Group) for small-area (<1% TBSA), low-temperature burns that progressed to deep burns due to delayed presentation. A retrospective cohort study was conducted, enrolling 309 patients admitted between January 2023 and December 2024 who were diagnosed with deep second- to third-degree burns following delayed presentation after initial neglect of blisters. The Combined Group (n = 165) received the triple therapy, and the Traditional Group (n = 144) received the nano-silver dressing regimen. Wound healing time, frequency of dressing changes, VAS pain score, wound infection rate, and economic burden were evaluated. The wound healing time in the Combined Group was significantly shorter than in the Traditional Group (28 ± 4 days vs. 41 ± 5 days, P < 0.001), with fewer dressing changes (14 ± 3 times vs. 21 ± 4 times, P < 0.001). The pain scores were significantly lower in the Combined Group from the second dressing change onward (P < 0.05). There was no statistical difference in wound infection rates between the two groups (2.4% vs. 3.5%, P > 0.05). Further precise accounting showed that both the total cost and out-of-pocket expenses for patients in the Combined Group were significantly lower than those in the Traditional Group (Total cost: 1508 ± 360 CNY vs. 3735 ± 480 CNY; Out-of-pocket: 302 ± 72 CNY vs. 1904 ± 96 CNY, P < 0.001). For small-area, low-temperature deep burns that have worsened due to delayed presentation, the combined regimen demonstrates significant superiority over the traditional regimen in accelerating healing, reducing pain, and, most notably, drastically lowering the economic burden on patients through synergistic drug actions. It represents an ideal choice for addressing this clinical challenge.
Telehealth models have the potential to help overcome challenges associated with the provision of in-person adult occupational therapy (OT) burn care. This study aimed to examine clinician and consumer perceptions of in-person adult burn care within a large adult burns service and explore the key features required to develop and implement an adult OT burns telehealth (OT TeleBurns) model of care. Interviews were conducted with adults after burn injury (n=23), and occupational therapists providing burn care to patients at their local facilities (n=18). Data were analysed first qualitatively to identify challenges with current in-person services, then coded using the Consolidated Framework for Implementation Research (CFIR) 2.0, to identify barriers and facilitators for implementing an adult OT TeleBurns service. Patient travel, local clinical expertise, communication across facilities, and patient attendance were key challenges of in-person services. CFIR constructs identified as strong facilitators for an OT TeleBurns service were the tension to change from in-person services, the relative advantage of telehealth services, and the proposed service's adaptability to the local context and ability to meet participants' needs. Perceived implementation facilitators were ensuring choice of appointment type, building local clinician capability, optimising communication methods, and establishing service governance and clear operational processes. Findings highlight strong support for developing an OT TeleBurns service given significant challenges with in-person care. Existing facilitators indicate high feasibility for implementation with clear clinical pathways and service procedures critical to ensuring an effective and sustainable model. Findings will be used to guide telehealth service development.
The Patient and Observer Scar Assessment Scale (POSAS) is an internationally used tool to assess scar quality. The current patient scale, however, is not designed for use in children. This study aimed to develop the Dutch and English pediatric patient scale of the POSAS to assess burn scar quality in children. This qualitative study, conducted in 2023-2024, involved semi-structured interviews with children aged 8-17 with burn scars and focus groups with parents, in the Netherlands and the United States. The goal was to identify key scar quality characteristics and appropriate response options. Interviews and focus groups were audio-recorded, transcribed and thematically analyzed by two independent researchers using MAXQDA. The relevant characteristics were formulated into items for the Dutch and English version of the patient scale, supported by a multidisciplinary, international research team. The draft version was pretested with children and parents to evaluate face validity. Twenty-one interviews with children and five focus groups with a total of 20 parents were conducted. The items satisfaction with the scar, color, bumpiness, pain, thickness, tightness, itch, hardness, lines, numbness, hair growth, and burning sensation are included in the scale. A 5-point emoticon response scale is used. The scale can also be completed by a proxy, instructed to report from the child's perspective (proxy-patient). Pretesting led to minor refinements. The Dutch and English pediatric patient scale of the POSAS are created based on input from children, parents, and burn care professionals. Validation studies will be performed to establish the measurement properties of the scale, including reliability of proxy-reported scores.
There is considerable variability in the management of acute burns globally, including differences between low- and middle-income countries (LMICs) and high-income countries (HICs). This study aimed to describe global surgical burn care practices through an international survey, providing insight into diagnostic, debridement, and coverage techniques and their timing. An online survey was developed and distributed to burn surgeons worldwide, focusing on the management of four patient cases and standard practices. The survey was developed and tested in collaboration with burn care experts, and distributed via email. One respondent per hospital performing burn surgery was permitted to prevent duplication. Data were analysed using descriptive statistics, Fisher's exact tests and Chi-square tests, with responses categorised by country and regional economic status. Burn surgeons from 106 burn units across 50 countries completed the survey, achieving a 44% response rate. Early surgical debridement (<48 h) was most commonly referred to as standard care, although definitions of early grafting differed. LMICs and HICs differed in the availability of diagnostic tools, enzymatic debridement, and wound coverage techniques. Further regional differences were observed among HICs in Europe, North America, and Oceania, highlighting diverse approaches to burn care worldwide. This study offers a global overview of acute surgical burn management, showing both universally common practices and significant regional variations between LMICs, HICs, and continents. The broad heterogeneity in surgical timing and techniques highlights the need for further research.
We present a review of a pro bono legal service provided to patients treated at a regional burns centre in the United Kingdom for the period between October 2012 and October 2019. A solicitor, supported by a paralegal, was available to give pro bono advice to any patient attending the burns service. The legal team provided assistance to patients and their relatives with advice pertaining to their personal and financial affairs as impacted by the injury. This was provided independently from, but in addition to, existing support from the hospital legal and ethical departments. The pro bono legal service has advised on 108 patient cases since this service began in October 2012 and has provided more than 2100 h of solicitors' time. 777 h were spent on non-compensation advice given on welfare benefits and insurance. Advice on welfare and/or financial matters was requested by all patients, and although potential claims for compensation against a third party were found in 83 cases, of these, the law firm operating the legal service was known to have been instructed to pursue recourse in only 16 cases. However, of the 16 cases instructed to make a compensation claim so far, 6 cases have settled, recovering a total of over £ 3.7 million. This review shows a likely benefit to patients from pro bono legal advice available in a burns unit setting. It also showed the significant financial gain to the government and potentially the NHS when a compensation claim was made by a patient.
With the Russian invasion of Ukraine in February 2022, clinicians in Ukraine were urgently faced with expanding burn capabilities to hospitals that were not designated burn centers. In response, international humanitarian groups and non-governmental organizations (NGOs), including national agencies, international burn societies, and many authors of this manuscript, hailed the call for help. One of the biggest concerns identified was the increasing risk of damage to nuclear reactors and powerplants during military operations, and the possible use of tactical nuclear weapons by Russian forces, triggering requests for actionable national medical response planning for nuclear emergencies. This concern led to the creation of the Burn Blast Injury Working Group (BBIWG) in February 2023 by the US Agency for International Development-a multidisciplinary group of civilian and military medical specialists in burns, trauma, and radiation injury; disaster management; public health; and policy. The group evaluated historical data from the 1945 Hiroshima and Nagasaki bombings, as these were on scale with modern "moderate-yield" tactical nuclear weapons (1-20 kilotons). This was supplemented with population impact models to derive a hypothetical cohort of survivors requiring medical care. Based on our collective efforts, this manuscript reports a strategic summary of an actionable civilian readiness plan for the potential survivors of a local nuclear event requiring a large-scale medical response. Although created specifically for contingencies resulting from the current hostilities in Ukraine, the concepts and precedents from this manuscript represent a starting point for anywhere on the globe at heightened risk of a catastrophic nuclear detonation.
Burns are one of the most devastating traumatic injuries, and in cases of advanced burns, patients require urgent and specialized care to minimize mortality. Studies have shown that a variety of herbal medicines and nanoparticles can be used to treat burn wounds. Among them mixture of Eisenia fetida oil, valerian, and zinc oxide (ZnO) nanoparticles can be a good choice due to their healing properties. This study aimed to synthesize an ointment based on Eisenia fetida oil, Valeriana officinalis, and zinc oxide to investigate its effect on skin wound healing. The hemocompatibility and biocompatibility of the designed ointment were evaluated using blood clotting index (BCI), hemolysis test, and 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide (MTT) test. The antibacterial effects of the designed ointment were evaluated using minimum inhibitory concentration (MIC), minimum bactericidal concentration (MBC), and time-kill tests. Finally, the healing ability of the designed ointment was evaluated in a rat model by creating a 3 × 3 cm burn wound. Wound healing was evaluated after 14 days by hematoxylin-eosin (H&E) and Verhoeff-Van Gieson (VVG) staining. The results showed that the addition of Valeriana officinalis and zinc oxide to Eisenia fetida oil improved hemocompatibility, biocompatibility, improved cell migration, and improved antibacterial properties. Additionally, the results of H&E and VVG staining demonstrated the good efficacy of the designed ointment in increasing epidermal thickness, promoting angiogenesis, and enhancing collagen and elastin fibers. These results indicate the potential of the designed ointment as a promising tool for skin wound healing and clinical trials.
To explore risk factors associated with mortality in burn patients, construct a mortality prediction model for burn patients, and expect this model to quantitatively assess the mortality risk of newly admitted burn patients, providing objective decision support for clinicians to help formulate individualized treatment strategies. The clinical data of 400 burn patients admitted to Fujian Burn Medical Center from January 2020 to December 2022 were retrospectively analysed and divided into the survival group (n = 383) and the death group (n = 17). Univariate and multivariate logistic regression analyses were used to investigate the risk factors associated with poor prognosis, and constructing the nomogram models. In addition, model performance was evaluated using calibration curves, receiver operating characteristic (ROC) curves, and decision curve analysis (DCA). The results of the stepwise binary logistic regression analysis for constructing a predictive model showed that when the model included triglyceride-glucose index (TyG), absolute lymphocyte count, hemoglobin, calcium, and platelet-lymphocyte ratio (PLR), the model had the smallest Akaike Information Criterion (AIC) of 97.757. The model's C-index was 0.856. The ROC curve analysis of the model on the training set data yielded an AUC of 0.856 (95% confidence interval: 0.739-0.973), indicating high discriminative ability. The Hosmer-Lemeshow goodness-of-fit test results showed a good fit (χ²=10.905, P = 0.207). Nomograms can predict the risk of death in burn patients, providing personalized clinical decision-making for future clinical practice.
Annually over 30,000 children require outpatient treatment for burn accidents. Attending clinic appointments has a negative psychological and social impact on families. Many burns centres offer families the option to administer dressing changes at home without standardised supporting guidance. Families administering dressing changes at home reported a lack of support. This study developed service guidance to support parent-administered paediatric home dressing changes. Experience-based co-design of service guidance and resources was conducted to address the priorities of service users. Data were collected through clinic observations and interviews with practitioners and parents at three paediatric burns services. Findings were shared with practitioners and parents at co-design events to facilitate agreement on the priorities for service improvements. Two working groups were formed to co-design outputs. The service guidance and resources were piloted across the three sites. Clinic observations and interviews with practitioners and parents were conducted. The findings were shared with a working group who co-designed amendments to the service guidance and resources. The co-designed service guidance included checklists to assess suitability for parent administered dressing changes, how to offer and perform dressing changes, and post-clinic support, and a parent leaflet and video on administering dressing changes. Contents were designed to support the practical, psychological, and social elements of dressing changes. The service guidance was implemented across the three sites. In clinic observations, practitioners appeared more confident and informative when offering and supporting families to administer dressings. Using experience-based co-design to develop service improvements across three paediatric burns services was effective in reaching consensus on best practice. While each burns service was different, they experienced commonalties making the co-designed service guidance suitable to apply across different paediatric burns services. The service guidance offers a competency framework for paediatric burns nursing practice standards to support parent administer home dressings.
Burn scars are the lasting marks left on the skin following a burn injury, which can arise from exposure to heat, chemicals, electricity, or radiation. Burn scars can have both physical and psychological impacts, affecting mobility, sensitivity, and self-esteem. To explore and compare the efficacy of shock wave therapy (SWT) vs. conventional physical therapy in the treatment of partial-thickness forearm burn scars. Double-blind, randomized controlled trial (RCT). Seventy patients aged 20-55 with partial-thickness forearm burns were allocated into two groups: Group A (35 participants) got SWT, whereas Group B (35 participants) had traditional physical therapy with a deactivated applicator. Ultrasonography assessment, the Vancouver Scar Scale, and the Burn Specific Health Scale-Brief (BSHS-B) were evaluated at baseline, after 8 weeks (post intervention), and following an additional 8-week period of follow-up. Treatments Consisted of 24 sessions, each lasting 45 min, and conducted three times per week. No notable changes were detected between groups at baseline assessment. Both groups exhibited statistically significant enhancements across all outcome measures (VAS, thickness, VSS, and BSHS) from pre to post and pre to follow-up, as evidenced by the 95% confidence intervals (CIs) that do not intersect zero in any comparison. Group A consistently had shorter and elevated confidence intervals (CIs); for instance, the VAS pre-post CI was (4.70, 6.36) in Group A compared to (4.19, 6.86) in Group B, and the BSHS pre-post CI was (26.23, 106.66) in Group A vs (28.07, 105.23) in Group B. Furthermore, Group A exhibited significant enhancement in VAS (η²p = 0.82 and 0.80), VSS (η²p = 0.80 and 0.79), and BSHS (η²p = 0.85 for both pre-post and pre-follow-up), signifying a considerable intervention impact. SWT has been demonstrated to be effective in improving the properties of scar tissue, particularly by alleviating pain and enhancing the appearance of hypertrophic scars.
Quorum-sensing (QS) molecules produced by Gram-negative bacteria regulate virulence and host-pathogen interactions, but their systemic role in human septic shock remains largely unexplored. We hypothesized that QS molecules are detectable in the circulation of burn patients with septic-shock-associated acute kidney injury (SA-AKI), are associated with disease severity, and are amenable to removal by extracorporeal treatment. In this observational pilot study, plasma concentrations of eight Gram-negative-derived QS molecules were quantified by HPLC-MS/MS in 12 burn patients with refractory septic shock and SA-AKI on continuous kidney replacement therapy (CKRT) and CytoSorb hemoadsorption. Serial blood samples (0, 0.5, 6, 12, and 24 h) were collected during the 24-hour sessions of the 23 studied cartridges. QS molecule removal by the sorbent cartridge and hemofilter was assessed, and associations between baseline QS molecule levels and systemic lactate concentrations were explored. Out of 8 QS molecules tested, C6-homoserine lactone, 3-hydroxy-C12-HSL, C7-PQS, HQNO, HHQ, and C9-PQS were detectable in systemic plasma, whereas 3-oxo-acyl-homoserine lactones (3-oxo-C10/3-oxo-C12) were below the limit of quantification. Cytosorb induced a significant early reduction in plasma QS molecule concentrations of C6-HSH, 3-OH-C12-HSL, and C7-PQS, whereas hemofilter clearance of QS molecules was negligible (< 4 ml/min). Adsorption was followed by partial rebound at later time points, consistent with sorbent saturation and desorption after 12 h. Baseline lactate levels showed a significant positive correlation with the relative plasma concentrations of QS molecules 3-OH-C12-HSL (r = 0.76818, p < 0.002) and C7-PQS (r = 0.64961, p < 0.03), an association that remained significantly robust for both QS molecules in selected patients with Pseudomonas aeruginosa bloodstream infection (r = 0.87698, p < 0.02 and r = 0.55547, p < 0.03, respectively). Gram-negative QS molecules are detectable in the systemic circulation of burn patients with SA-AKI, are associated with systemic lactate concentrations, and can be removed by hemoadsorption but not by the hemofilter. These findings support a potential pathophysiological role of bacterial communication signals in critical illness, and a potential therapeutic target of hemoadsorption in critical illness.
Burn surface area is an essential factor in determining the need for specialized burn center treatments. Herein, the accuracy of burn surface areas estimated by ambulance crews and referral hospitals was evaluated, providing insight into the effectiveness of patient selection for specialized care. The study was conducted from April 1, 2018 to March 31, 2024. The participants were patients with burns admitted to the Advanced Critical Care and Emergency Center of Yokohama City University Medical Center, Kanagawa Prefecture, Japan. The study population was divided into two groups: direct transport group (patients transported from the scene to our center by ambulance crews) and inter-hospital transfer group (patients transferred from other hospitals). Pre- and post-transfer burn surface area estimates were evaluated in qualitative and quantitative frameworks. During the study period, 176 inpatients were evaluated with respect to the burn surface area at our center, including 134 (76.1%) and 42 (23.9%) in the direct transport and inter-hospital transfer groups, respectively. A comparison of the burn surface area estimates by ambulance crews or referring hospital physicians and those at our center showed that pre-transfer estimates exceeded post-transfer specialist assessments; however, this overestimation was not clinically important. In Japan, the decision to treat patients with burns at an advanced critical care and emergency center depends on evaluations performed by ambulance crews and physicians at the referring hospitals. The results of this study suggest that the burn surface area was properly estimated before transfer, supporting this approach. However, our findings should be generalized with caution.
This study aimed to assess the effects of first aid methods, including early burn wound cooling with running tap water and/or Burnshield® hydrogel, versus no treatment or inappropriate first aid on clinical outcomes in patients with scald burns. In this single-center retrospective analysis, we compared cooling first aid (defined as cooling with running tap water and/or hydrogel within 8 h after injury) with inappropriate or no first aid in 2566 patients with scald burns. Outcomes included time to complete epithelialization, surgical debridement, split-thickness skin grafting, systemic antibiotic use, hospitalization, age-stratified effects (pediatric/adult/geriatric), the effect of combining water with hydrogel, and timing of hospital admission. Overall, 73.4% of patients received cooling first aid. Median healing time was significantly shorter in the cooling first aid group 11 (8-14) days compared with the inappropriate first aid group 16 (12-23) days and the no first aid group 16 (12.25-23) days (p < 0.001). Cooling first aid was also associated with lower rates of debridement (17.05%), grafting (5.20%), systemic antibiotic use (11.84%), and hospitalization (17.26%) compared with inappropriate or no first aid (all p < 0.001). Median healing time differed by age group, with values of 12 (8-15) days in pediatric patients, 12 (8-15) days in adults, and 17 (12-23) days in geriatric patients (p < 0.001). The combination of tap water plus hydrogel yielded the shortest median healing time 10 (7-13) days and the lowest intervention rates. Admission within 24 h was associated with significantly better outcomes than later admission. Early cooling first aid substantially improves clinical outcomes in patients with scald burns. These findings support the effectiveness of hydrogel-based cooling as an adjunct to water irrigation and highlight the need for widespread public education on evidence-based first aid practices.
This review aimed to describe self-management interventions for burn survivors and assess their effectiveness, while also examining interventions for comparable acute onset chronic conditions - myocardial infarction (MI) and lower extremity trauma (LET) - to gain broader insights. Following PRISMA guidelines, a systematic search was conducted across five databases for studies published between January 2010 and October 2025. Eligible studies evaluated self-management interventions in burn survivors, patients with MI or patients with LET. Study quality was assessed using the Downs & Black checklist. In total, 18 studies on 1606 patients met the inclusion criteria; only two focused on burn survivors, providing limited data to draw conclusions about the effectiveness of self-management interventions for this population. Eight MI and eight LET studies were included; seven of these were also of low quality. Interventions varied substantially in design, terminology, outcomes, and rigor. Despite this heterogeneity, self-management interventions generally showed positive effects up to six months post-intervention, with statistically significant improvements particularly in MI patients (sign test, p = 0.008). This review highlights a critical gap in burn care research, emphasizing the scarcity of rigorous studies on self-management for burn survivors and demonstrates the potential benefits for this population by drawing on evidence from other patient groups.
Hyperpyrexia is a complication of burn injury, likely caused by systemic inflammation and infection, the pathophysiology of which is poorly understood. This study aimed to describe the patient cohort who developed hyperpyrexia (≥39.5°C) and evaluate the effectiveness of the Thermogard XP Icy®, an intravascular temperature management device, in restoring normothermia. This was a retrospective cohort study of adult patients admitted to Glasgow Royal Infirmary's intensive care unit with major burns (TBSA ≥20%) between January 2016 and October 2024. A central database and electronic medical records were used to collect data on demographics, burn severity, interventions and outcomes. Episodes of hyperpyrexia and Thermogard XP® use were also recorded. A multilevel interrupted time series analysis was used to assess the effectiveness of the Thermogard XP® device in reducing body temperature in comparison to historic controls. Fifty-six patients were analysed, of which 30 (56.3%) developed hyperpyrexia. This cohort were more likely to have sustained a flame burn (p = 0.003), have a greater burn TBSA (p = 0.006) and longer hospital stay (p = 0.005) when compared to non-hyperpyrexic patients; however, mortality rates did not differ significantly. Eight patients were managed with a Thermogard XP®; this appeared to achieve normothermia quicker than standard interventions. Hyperpyrexia was associated with more severe burn injuries and greater intervention requirements but not increased mortality. The Thermogard XP® seemed effective at controlling temperatures ≥ 39.5°C in this small single-centre observational study; future studies are needed to further explore its effectiveness and impact on outcomes such as survival.
Accurate assessment of burn depth and area are required to guide treatment and inform prognosis. Currently this assessment relies on subjective visual analysis by clinicians. A sub-field of artificial intelligence (AI), computer vision, has been identified as a tool that could bring objectivity to this analysis. This has resulted in a fast-growing area of interdisciplinary research. Given that the regulation of AI research in healthcare is in its infancy, this scoping review aimed to identify current practice and if further guidance for researchers is required. A scoping review of computer vision studies in burn care was conducted using PubMed, arXiv and IEE Xplore databases to ascertain current standards of practice of AI research involving burn image datasets. A quantitative and qualitative analysis and synthesis of papers was undertaken and themes were identified. The database searches identified 1562 papers, of which 75 met the review inclusion criteria. There was variation in the standards of reporting in the reviewed papers. Key common ethical issues identified included: unavailable code and data, missing statements about consent and ethical review, and paucity of information about the datasets. Omissions in the reporting of many studies may raise ethical questions or reflect the need for standardised reporting. A preliminary checklist tailored to the reporting of burn image datasets that are used in AI research is suggested to support researchers working in this important interdisciplinary field.
Acute kidney injury (AKI) is a frequent and severe complication in patients with major burns. AKI diagnosis relies on urine output (UO) and serum creatinine (sCr); however, despite being a central therapeutic target during burn resuscitation, the prognostic value of UO remains uncertain. This study evaluated the prognostic performance of early renal biomarkers for renal outcomes in severe burn patients. We conducted a retrospective single-center cohort study including adult patients admitted within 24 h after severe burn injury between 2018 and 2022. AKI was defined according to KDIGO criteria. Early renal parameters sCr, UO, urinary creatinine (uCr), and creatinine clearance (CrCl) were assessed for their predictive performance and association with the primary outcome, Major Adverse Kidney Events at 30 days (MAKE30). Among 106 patients, 47.2% developed AKI within 48 h, and 29.2% experienced MAKE30. AKI was predominantly diagnosed based on UO criteria. During the first 48 h, patients with MAKE30 had lower minimum CrCl (median 54 vs. 136 mL/min, p < 0.001) and higher maximum sCr (97 vs. 68 µmol/L, p < 0.001), while minimum UO did not differ significantly (0.54 vs. 0.92 mL/kg/h, p = 0.11). CrCl was the strongest predictor of MAKE30 (AUC = 0.80), outperforming sCr (AUC = 0.72), UO (AUC = 0.68), and uCr (AUC = 0.63), with an optimal threshold of 42 mL/min. Renal parameters showed weak or no correlation with each other or with hemodynamic variables. A stricter UO threshold (< 0.3 mL/kg/h) was independently associated with MAKE30, whereas the recommended < 0.5 mL/kg/h cutoff was not. Similar findings were observed at 5 days. In severe burn patients, early UO demonstrated limited prognostic value for renal outcomes. CrCl showed superior predictive performance and may improve early renal risk stratification.
Incendiary weapons (IW) have been used in 21st-century armed conflicts, causing severe burn injuries with lifelong physical and psychological consequences. Existing international law has shortcomings that have undermined its ability to adequately address the human cost of IW. While the harm from IW has been reported, limited standardized clinical data on their medical effects, in addition to high-quality evidence on treatment protocols, exist. No structured assessment of existing literature on this topic exists. This review seeks to address this gap. A scoping review was conducted to evaluate existing literature and identify evidence gaps regarding the medical effects and management of IW injuries in 21st-century armed conflict. A systematic search strategy was performed using standardized inclusion criteria. A standardized extraction form was used to capture data elements for description in both peer-reviewed and grey literature. Our search identified 14,050 records for screening across peer-reviewed and grey literature that were narrowed to 56 included reports. A total of 5565 patients were specifically reported to be affected by IW across 26 countries; however, there was a lack of homogeneous reporting across all categories of interest. Available reports described severe and multidimensional injuries with lack of consensus regarding both diagnosis and treatment of IW injuries. Available data regarding IW use, injury, and treatment are heterogeneous, limiting epidemiological analysis to inform care and practice guidelines. The described injuries raise the need for standardized data collection and focused training on IW care in conflict settings. Global databases to strengthen the evidence base on IW casualties are needed to enhance policy efforts, diagnosis and treatment standards, and trainings, which will in turn improve clinical performance.
Methamphetamine intoxication can lead to medical complications in burn patients, including longer intensive care unit (ICU) stays, sepsis, and more burn debridement procedures. However, its impact on graft durability remains unexplored. We hypothesize that methamphetamine-positive burn patients have higher rates of graft loss. A single center retrospective cohort study of patients admitted to the burn service from 2021 to 2024 was performed at an American Burn Association (ABA)-verified burn center. Patients were age 18 years or over, had toxicology screening, and were excluded if not screened for methamphetamine. The primary outcome measured was graft loss requiring return to operating room for re-graft or flap repair. Patient demographics, burn etiology, and use of autograft, along with ICU days, ventilator days, and length of stay were recorded. 746 patients were included in this study with median age 48 years and median total burn surface area burned for the full cohort of 8.35%. 112 patients were methamphetamine-positive. Methamphetamine users had higher rates of autograft loss (p < 0.001), even on logistic regression analysis. Methamphetamine users had increased TBSA (p = 0.01), longer hospital stays (p = 0.03), and increased likelihood of undergoing endotracheal intubation (p = 0.01). Methamphetamine-positive patients presented primarily with flame burns (p < 0.001), while non-users presented primarily with scald burns (p < 0.001). Methamphetamine-positive burn patients were more likely to sustain flame burns, undergo autografting, and experience graft loss as a complication. Methamphetamine is a unique risk factor for burn patients that increases risk of failing graft management. Routine toxicology testing can promptly identify these patients and notify providers earlier to plan for more intensive burn management.
High mortality in older burn patients results from the combination of acute injury and physiological decline. While total body surface area burned (TBSA) and age are established prognostic factors, the interplay between acute metabolic derangement and chronic comorbidity burden remains poorly characterized. This study evaluated the prognostic value of the lactate/albumin Ratio (LAR) and the Charlson Comorbidity Index (CCI). Secondary endpoints included identifying independent mortality predictors and establishing the lethal area 50 percent (LA50) thresholds. A retrospective study at a National Burn Center (location blinded) included all patients aged > 65 years with burns > 10% TBSA (2012-2025). The LAR assessed the coupling of tissue hypoxia and nutritional status. Chronic disease burden was quantified using the weighted CCI. Multivariate logistic regression identified risk factors for in-hospital mortality. Among 243 patients (mean age 75.8 years, TBSA 26.9%), mortality was 35.0%. In the complete-case analysis for biomarkers (n = 178), LAR discrimination was strong (AUC=0.84), comparable to lactate alone (mmol/L) (AUC=0.81, p = 0.09), but significantly superior to albumin (g/dL) (AUC=0.74, p = 0.014). A cut-off of LAR > 1.0 was identified as a critical threshold for mortality. In multivariate analysis, while binary comorbidities showed no significance, the CCI emerged as a robust independent predictor (OR 1.71, p < 0.001). Other independent predictors included TBSA, inhalation injury, and the LAR (OR 2.15, p = 0.006). The LA50 threshold was established at 34% TBSA. Mortality in older adults can be interpreted through a conceptual "double hit" model: acute metabolic shock (LAR) and chronic comorbidities (CCI). The LAR offers comparable predictive value to isolated markers while integrating nutritional status, suggesting an exploratory and cohort-specific "LAR Unity Threshold" for risk stratification.