Neuropathic Pain After Burn Injury: A Severe and Common Problem in Recovery.

OBJECTIVE: The aim of this study was to address the limited understanding of neuropathic pain (NP) among burn survivors by comprehensively examining its prevalence and related factors on a national scale using the Burn Model System (BMS) National Database. BACKGROUND: NP is a common but underexplored complaint among burn survivors, greatly affecting their quality of life and functionality well beyond the initial injury. Existing data on NP and its consequences in burn survivors are limited to select single-institution studies, lacking a comprehensive national perspective. METHODS: The BMS National Database was queried to identify burn patients responding to NP-related questions at enrollment, 6 months, 12 months, 2 years, and 5 years postinjury. Descriptive statistics and regression analyses were used to explore associations between demographic/clinical characteristics and self-reported NP at different time points. RESULTS: There were 915 patients included for analysis. At discharge, 66.5% of patients experienced NP in their burn scars. Those with NP had significantly higher Patient-Reported Outcomes Measurement Information System 29 (PROMIS-29) pain inference, itch, anxiety, depression, and sleep disturbance scores and were less able to partake in social roles. Multiple logistic regression revealed male sex, % total body surface area, and moderate-to-severe pain as predictors of NP at 6 months. At 12 months, % total body surface area and moderate-to-severe pain remained significant predictors, while ethnicity and employment status emerged as significant predictors at 24 months. CONCLUSIONS: This study highlights the significant prevalence of NP in burn patients and its adverse impacts on their physical, psychological, and social well-being. The findings underscore the necessity of a comprehensive approach to NP treatment, addressing both physical symptoms and psychosocial factors.

Treatment of Hypertrophic Burn Scars With Laser Therapy: A Review of Adverse Events.

ABSTRACT: Hypertrophic scarring, characterized by excessive scar tissue formation, is a debilitating outcome that significantly impairs physical and psychosocial recovery after burn injury. Hypertrophic scarring affects a substantial proportion of burn survivors, with reported prevalence as high as 70%. Fractional CO 2 laser (FCL) therapy, a therapy commonly used in acne scar treatment or skin rejuvenation, has become popular in treating hypertrophic scars. Little is known regarding FCL's adverse events for burn scar treatment. We hypothesize that FCL is a safe treatment modality with minimal adverse events in the management of hypertrophic burn scars. This is a retrospective chart review of adverse events after FCL at 2 centers within a single institution. Burn patients undergoing FCL between May 1, 2019, and June 1, 2021 were included. Demographics, injury etiology, laser treatment details, and adverse events were collected. A total of 170 patients, 77 (45.3%) males and 93 (54.7%) females, underwent 544 FCL therapies for burn scars. The average number of treatments per patient was 3 ± 2.23, with a range of 1 to 17 sessions. From the total 544 laser therapy sessions, 13 adverse events (2.4%) were reported. There were 5 reports (0.9%) of increased postprocedural pain and 1 report (0.2%) of increased paresthesia/numbness to laser site. Three instances (0.6%) of increased erythema and 4 reports (0.7%) of epidermal sloughing or blistering were reported. All but 5 patients (2.9%) reported improvements to scar symptoms. This study demonstrates minimal adverse events associated with FCL for hypertrophic burn scar treatment.

Disruption of the SucT acyltransferase in Mycobacterium smegmatis abrogates succinylation of cell envelope polysaccharides.

Similar to other prokaryotes, mycobacteria decorate their major cell envelope glycans with minor covalent substituents whose biological significance remains largely unknown. We report on the discovery of a mycobacterial enzyme, named here SucT, that adds succinyl groups to the arabinan domains of both arabinogalactan (AG) and lipoarabinomannan (LAM). Disruption of the SucT-encoding gene in Mycobacterium smegmatis abolished AG and LAM succinylation and altered the hydrophobicity and rigidity of the cell envelope of the bacilli without significantly altering AG and LAM biosynthesis. The changes in the cell surface properties of the mutant were consistent with earlier reports of transposon mutants of the closely related species Mycobacterium marinum and Mycobacterium avium harboring insertions in the orthologous gene whose ability to microaggregate and form biofilms were altered. Our findings point to an important role of SucT-mediated AG and LAM succinylation in modulating the cell surface properties of mycobacteria.

Increased drug permeability of a stiffened mycobacterial outer membrane in cells lacking MFS transporter Rv1410 and lipoprotein LprG.

The major facilitator superfamily transporter Rv1410 and the lipoprotein LprG (Rv1411) are encoded by a conserved two-gene operon and contribute to virulence in Mycobacterium tuberculosis. Rv1410 was originally postulated to function as a drug efflux pump, but recent studies suggested that Rv1410 and LprG work in concert to insert triacylglycerides and lipoarabinomannans into the outer membrane. Here, we conducted microscopic analyses of Mycobacterium smegmatis lacking the operon and observed a cell separation defect, while surface rigidity measured by atomic force microscopy was found to be increased. Whereas Rv1410 expressed in Lactococcus lactis did not confer drug resistance, deletion of the operon in Mycobacterium abscessus and M. smegmatis resulted in increased susceptibility toward vancomycin, novobiocin and rifampicin. A homology model of Rv1410 revealed a periplasmic loop as well as a highly conserved aspartate, which were found to be essential for the operon's function. Interestingly, influx of the fluorescent dyes BCECF-AM and calcein-AM in de-energized M. smegmatis cells was faster in the deletion mutant. Our results unambiguously show that elevated drug susceptibility in the deletion mutant is caused by increased drug influx through a defective mycobacterial cell envelope and not by drug efflux mediated by Rv1410.

Techniques for Patient Positioning During Burn Surgery: A Systematic Review.

INTRODUCTION: Patient positioning in the operating room remains a challenge for burn surgeons; burn surgery involves critically ill patients who require close monitoring, difficult exposures, and careful handling of grafted areas. Various techniques to optimize intraoperative positioning during burn surgery have been described in the literature. The aim of this review was to outline these positioning techniques and report on their complications. METHODS: A systematic review was performed by 2 independent reviewers using PubMed, Scopus, and OvidSP MEDLINE databases. Articles were included if they described intraoperative techniques to position patients undergoing burn surgery. The primary variable of interest was complications related to positioning during surgery. RESULTS: The search identified 1855 nonduplicate citations, of which 29 underwent full-text review, and 10 met inclusion criteria. Three studies described overhead suspension techniques, including a hook-and-pulley system, ceiling chains, weighted IV poles, and mounted crossbars; no complications were reported. Six studies described limb fixation techniques, including Steinmann pins, finger traps, wrist/ankle wraps, towel clips through eschar or distal phalanges, and external fixators. Complications included one case of hardware failure of external fixation and several pin site infections. Four studies described table modification techniques, including a modified Stryker frame, a fracture table, the Mayfield headrest, and the recliner position; no complications were reported. DISCUSSION: Numerous techniques have been described to improve patient positioning during burn surgery. No major complications were identified in this systematic review. Most techniques use standard operating room equipment and can aid in safe and easier operations.

The State of Burn Care Training During Plastic Surgery Residency.

INTRODUCTION: There is an ongoing shortage of burn specialists, and workforce reports suggest possible hurdles attracting plastic surgeons into burn care. The purpose of this study was to (1) determine the state of burn care in plastic surgery residency and (2) identify what barriers might exist for plastic surgeons pursuing a practice that involves burn care. METHODS: Surveys were distributed to North American plastic surgery program directors and residents, respectively, during the 2018-2019 academic year. RESULTS: Fifty-eight program directors (response, 54%) and 320 plastic surgery residents (response, 30%) participated. Burn care was felt to be an important component in training by most program directors (USA, 88%; Canada, 100%) and residents (USA, 87%; Canada, 99%). The majority of program directors included a burn unit rotation (USA, 88%; Canada, 90%). Rotations for integrated residents averaged 2.5 months and most commonly occurred during second year; independent residents spent 1.2 months on rotation, usually in first year. Three-quarters of American residents were interested in a career that involves burn care in some capacity, primarily burn reconstruction (40%). Factors that would discourage a trainee from practicing burn care in the future included the nature of burn care (60%) and burn operations (45%), the on-call commitment (39%), and a narrow scope of practice (38%). DISCUSSION: This study challenges the belief that plastic surgery trainees are disinterested in burn care. Burn surgery remains an important component of training programs, and we propose several steps to encourage greater interest and participation in the burn surgery workforce.

Evaluation of Burn Rounds Using Telemedicine: Perspectives from Patients, Families, and Burn Center Staff.

INTRODUCTION: Burn care requires multiple disciplines to collaborate to achieve best patient care. Because of this, rounds involve a very large burn team to assess patients' wounds and formulate plans. To decrease the amount of team members on rounds, our burn center implemented a new budding technology: telemedicine. We created "Zoom Rounds," a Health Insurance Portability and Accountability Act (HIPAA)-compliant, secure videoconferencing system to relay patient wound evaluations to a remote conference room where team members can participate digitally. We sought to evaluate this new rounding process by querying the burn team, patients, and families regarding their experience. METHODS: Surveys were developed for each group and were distributed over a 2-month period. Respondents were asked to rate the videoconferencing rounding experience and comment on the educational experience (staff/providers) and one's personal experience (patient/family). We analyzed both the quantitative data with the qualitative responses. Qualitative data analysis for content was used to independently code and analyze responses to the open-ended survey questions by two authors and verified by adjudication review. RESULTS: Thirty-three patients/families and 69 burn staff members completed the confidential survey (response rate of 90% and 83%, respectively). Coded responses identified several themes: inconsistent technology, improved visualization and communication regarding the wounds, better learning experience, and improved patient experience by decreased crowds in the room. CONCLUSIONS: There was strong support for the use of videoconferencing for patient wound rounds among providers, burn center staff, and patients/families. Telemedicine is a promising technology to improve inpatient burn rounds.

Photothermal Off-Resonance Tapping for Rapid and Gentle Atomic Force Imaging of Live Cells.

Imaging living cells by atomic force microscopy (AFM) promises not only high-resolution topographical data, but additionally, mechanical contrast, both of which are not obtainable with other microscopy techniques. Such imaging is however challenging, as cells need to be measured with low interaction forces to prevent either deformation or detachment from the surface. Off-resonance modes which periodically probe the surface have been shown to be advantageous, as they provide excellent force control combined with large amplitudes, which help reduce lateral force interactions. However, the low actuation frequency in traditional off-resonance techniques limits the imaging speed significantly. Using photothermal actuation, we probe the surface by directly actuating the cantilever. Due to the much smaller mass that needs to be actuated, the achievable measurement frequency is increased by two orders of magnitude. Additionally, photothermal off-resonance tapping (PORT) retains the precise force control of conventional off-resonance modes and is therefore well suited to gentle imaging. Here, we show how photothermal off-resonance tapping can be used to study live cells by AFM. As an example of imaging mammalian cells, the initial attachment, as well as long-term detachment, of human thrombocytes is presented. The membrane disrupting effect of the antimicrobial peptide CM-15 is shown on the cell wall of Escherichia coli. Finally, the dissolution of the cell wall of Bacillus subtilis by lysozyme is shown. Taken together, these evolutionarily disparate forms of life exemplify the usefulness of PORT for live cell imaging in a multitude of biological disciplines.

Hydrogen Sulfide Protects Renal Grafts Against Prolonged Cold Ischemia-Reperfusion Injury via Specific Mitochondrial Actions.

Ischemia-reperfusion injury is unavoidably caused by loss and subsequent restoration of blood flow during organ procurement, and prolonged ischemia-reperfusion injury IRI results in increased rates of delayed graft function and early graft loss. The endogenously produced gasotransmitter, hydrogen sulfide (H2 S), is a novel molecule that mitigates hypoxic tissue injury. The current study investigates the protective mitochondrial effects of H2 S during in vivo cold storage and subsequent renal transplantation (RTx) and in vitro cold hypoxic renal injury. Donor allografts from Brown Norway rats treated with University of Wisconsin (UW) solution + H2 S (150 µM NaSH) during prolonged (24-h) cold (4°C) storage exhibited significantly (p < 0.05) decreased acute necrotic/apoptotic injury and significantly (p < 0.05) improved function and recipient Lewis rat survival compared to UW solution alone. Treatment of rat kidney epithelial cells (NRK-52E) with the mitochondrial-targeted H2 S donor, AP39, during in vitro cold hypoxic injury improved the protective capacity of H2 S >1000-fold compared to similar levels of the nonspecific H2 S donor, GYY4137 and also improved syngraft function and survival following prolonged cold storage compared to UW solution. H2 S treatment mitigates cold IRI-associated renal injury via mitochondrial actions and could represent a novel therapeutic strategy to minimize the detrimental clinical outcomes of prolonged cold IRI during RTx.

RIPK3-mediated necroptosis regulates cardiac allograft rejection.

Cell death results in tissue damage and ultimately donor graft rejection and can occur as an active molecular process through apoptotic, necrotic and newly identified receptor interacting protein 1 and 3 kinase (RIPK1/3)-mediated necroptotic pathways. Necroptosis leads to the release of inflammatory molecules which can activate host immune cells. This pathway has yet to be studied in heart transplantation. We have found that necroptosis was induced in murine cardiac microvascular endothelial cell (MVEC) under anti-apoptotic condition following tumor necrosis factor alpha treatment. Necroptotic cell death and release of the danger molecule high mobility group box 1 (HMGB1) were inhibited by the RIPK1 inhibiting molecule necrostatin-1 and by genetic deletion of RIPK3. In addition, tissue necrosis, release of HMGB1 and graft cell infiltrate were attenuated in RIPK3 null heart allografts following transplantation. Finally, a brief sirolimus treatment markedly prolonged RIPK3 null cardiac allograft survival in allogeneic BALB/c recipients as compared to WT C57BL/6 donor grafts (95 ± 5.8 vs. 24 ± 2.6 days, p < 0.05). This study has demonstrated that RIPK1/3 contributes to MVEC death and cardiac allograft survival through necroptotic death and the release of danger molecules. Our results suggest that targeting RIPK-mediated necroptosis may be an important therapeutic strategy in transplantation.

Integrated high quality factor lithium niobate microdisk resonators.

Lithium Niobate (LN) is an important nonlinear optical material. Here we demonstrate LN microdisk resonators that feature optical quality factor ~10(5), realized using robust and scalable fabrication techniques, that operate over a wide wavelength range spanning visible and near infrared. Using our resonators, and leveraging LN's large second order optical nonlinearity, we demonstrate on-chip second harmonic generation with a conversion efficiency of 0.109 W(-1).

Grill-Related Burn Injuries: A Matched Cohort Study.

Barbequing can result in devastating burn injuries with unsafe practices. This study aims to characterize the demographics, injury characteristics, and outcomes of grill-related burns and identify ways of burn prevention. A retrospective review of patients admitted to a single-institution, metropolitan burn center from January 1, 2017, to July 1, 2023. Data included demographics, burn injury characteristics, and outcomes. Each Grill Cohort patient was matched to 3 nongrill controls by mBaux score and burn location. Of 2355 patients, 69 (2.9%) met Grill Cohort inclusion criteria. The Grill Cohort had 55 (79.7%) males and an average age of 41.7 ± 17.5 years old. In the Grill Cohort, 25 (36.2%) patients had positive blood alcohol, 8 (11.6%) tested positive for amphetamines, and 5 (7.2%) for cocaine at the time of admission. A total of 61 (88.4%) Grill Cohort burns involved the upper extremity, 43 (62.3%) the head/neck, 34 (49.3%) the lower extremity, and 30 (43.5%) the trunk. Compared with the Control Cohort, the Grill Cohort had smaller proportions of patients who were undomiciled (P < .01) or had a history of mental illness (P < .001). Grill-related burns had a greater proportion of flash/flame burns (P < .001). This study suggests that middle-aged, domiciled males without psychiatric comorbidities are more likely to make preventable grilling errors resulting in burn injuries. Prevention strategies targeting this demographic group should emphasize the risks of grilling while intoxicated, proper handling of propane tanks and lighter fluid, and the use of flash/flame-resistant gear protecting the upper extremities and head/neck.

Injury Pattern Analysis to Optimize Burn Injury Prevention in the Unhoused Community.

Unhoused patients are an overrepresented group in burn injury, and are a uniquely vulnerable population. Current research focuses on the consequences of homelessness on burn outcomes, with little known about the specific circumstances and behaviors leading to burn injury that may represent specific targets for injury prevention efforts. The burn registry at an urban regional burn center was queried for burn admissions in unhoused adults from 2019 to 2022. Registry data pulled included demographics, urine toxicology, mechanism of injury, and injury subjective history. Subjective injury history was reviewed to determine more specific injury circumstances and activities during which accidental burns occurred. Demographic and mechanistic trends in burn admissions were explored via descriptive statistics. Among 254 admissions for burns from the unhoused community, 58.1% of patients were positive for stimulants on admission. Among accidental injuries (69.7%), common circumstances included preparing food or beverages, cooking or using methamphetamine, smoking cannabis or tobacco, bonfires, and candles. A specific common circumstance was lighting a cigarette while handling accelerants (6.7%). Interventions for stimulant abuse, as well as outreach efforts to educate unhoused patients about situational awareness, safe handling of accelerants, safe smoking practices, and safe cooking practices, may be effective tools in reducing burn admissions in this vulnerable population.

Minority pediatric burn survivors undergo more burn operations: A single center's five-year experience.

Burn injuries remain a significant source of trauma in the United States and disproportionately affect racial and ethnic minorities. Although disparities are well documented in adults, less is known regarding those in pediatric populations. To address this gap in literature, we aim to better characterize burn injuries, inpatient treatments, and post-discharge outcomes in minority pediatric burn patients. We hypothesize minority patients undergo more surgery and re-admissions than non-minority patients for burn care. This is a single institution retrospective chart review of pediatric patient admissions with burn injuries from July 1st, 2016 to July 1st, 2021. Demographics, details of injury, inpatient surgical and non-surgical care, and post-discharge outcomes were collected. Patients identifying as Hispanic/Latino, Black, and Asian were coded as minority patients. Univariate analysis was utilized. A total of 332 patients with average age of 4.9 years (SD: 4.4) and average total burn surface area (TBSA) of 8.5% (SD: 10.0) were collected. Minority patients were significantly more likely to experience accidental burn injury (p < 0.01), inhalational injury (p < 0.01), surgical management (p < 0.01), and to undergo skin graft (p < 0.01) than White patients. Minority patients were significantly more likely to undergo laser treatment after discharge (p < 0.01) than White patients. Our study shows minority pediatric patients are at risk for non-intentional burn injuries that undergo surgical management such as skin grafting and longitudinal reconstructive procedures including laser therapy more often. Short-term goals should include facilitating improved physical and psychosocial outcomes in this often-underserved patient population.

Neuropathic pain in burn patients - A common problem with little literature: A systematic review.

BACKGROUND: The prevalence of neuropathic pain (NP) in burn patients is reported in the literature to be as high as 80%1. Given the complexity of NP in burn patients and the wide range of treatments available, a systematic review of the literature is warranted to summarize our current understanding of management and treatment of NP in this population. METHODS: This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. The following databases were queried to identify relevant articles: PubMed, Cochrane, Embase, Scopus, Ovid, and Web of Science. The main outcome measures were incidence and management of NP. Secondary outcomes included risk factors for NP. RESULTS: Included articles presented findings from 11 different countries, capturing outcomes for 4366 patients. Risk factors for neuropathic pain in burn patients were identified, including older age, alcohol and substance abuse, current daily smoking, greater % total body surface area burns (TBSA), and longer hospitalizations. Pharmacologic treatments included gabapentin/pregabalin (n = 7), ascorbic acid (n = 1), and lidocaine (n = 1). Overall, the studies showed varied results regarding the efficacy of pharmacological treatments. While certain studies demonstrated gabapentanoids to be effective in reducing neuropathic symptoms, others found conflicting results. With regards to non-pharmacologic treatments, electroconvulsive therapy (n = 1), electropuncture (n = 1), nerve release/reconstruction (n = 2), and somatosensory feedback rehabilitation (n = 1) were used and demonstrated promise in reducing pain intensity and improving functionality. CONCLUSIONS: Despite NP afflicting the majority of burn patients long after their injury, this systematic review demonstrates insufficient evidence on the pathophysiology, outcomes, and risk factors in NP, as well as the efficacy of various therapies. Future prospective and randomized studies evaluating the etiology of these factors can substantially improve our treatment strategies. This can allow for the development of well-delineated and evidence-based protocols in NP management in hopes of improving quality of life and both psychological and physical function in burn patients.

Surgical Management of Diabetic Foot Burns is Associated with Poor Outcomes: A Systematic Review and Meta-Analysis.

There is no consensus for the optimal management of diabetic foot burn injuries. Here, we systematically identify studies reporting on diabetic foot burns and evaluate outcomes among patients managed operatively versus non-operatively. PubMed, Embase, and Web of Science were searched. Screening was performed by independent reviewers. Primary research studies with English full texts published between 1980 to 2023 that discussed outcomes of foot burns in adults with diabetes were included and critically appraised using validated tools. Results are presented using descriptive statistics of aggregated data. The search yielded 2,402 non-duplicate papers, of which 35 met inclusion criteria. Nine papers were included for meta-analysis, including seven retrospective comparative analyses, one cross-sectional study, and one retrospective chart review. There were 1798 diabetic foot burn patients. Mean age was 58.2 years (SD 4.12) and 73.1% (n = 1,314) were male. A total of 15.7% (n = 283) of patients were surgically managed, including debridement (3.7%, n = 66), grafting (8.2%, n = 147), flap (0.2%, n = 3), and primary amputation (7.1%, n = 127). Secondary amputation rate, defined as amputation following initial surgery, was 4.9%, (n = 14). The overall amputation rate was 7.8% (n = 141). Other complications included infection (4.0%, n = 72), osteomyelitis (1.9%, n = 34), and graft failure (8.2%, n = 12). One study reported functional status at last visit. Diabetic foot burns are highly morbid. The surgical management of these complex injuries is high risk, as amputation results in poorer quality of life and functional outcomes.

Assessing Scar Outcomes Using Objective Scar Measurement Tools: An Adjunct to Validated Scar Evaluation Scales.

INTRO: The assessment of scar outcomes is important to both patient care and research focused on understanding the results of medical and surgical interventions. The Vancouver Scar Scale and Patient and Observer Scar Assessment Scale are validated and simple instruments to assess scars. However, these subjective scales have shortcomings. The VSS fails to capture patient perception and has indeterminate validity and reliability. The POSAS captures patient perception, but the observer scale has been shown to have moderate amounts of inter-rater variability. Studies highlighting the ability of objective scar assessment tools to produce reliable and reproducible results are needed. In this study, we aimed to validate the use of the Fibrometer ®, Elastimeter ®, and SkinColorCatch ® as an objective adjunct in the assessment of hypertrophic scar and keloid outcomes. METHODS: This was a prospective single-center study which assessed patient scars using the Vancouver Scar Scale, the Patient and Observer Scar Assessment scale, and the aforementioned objective study tools. Correlations between the different methods of scar assessment were measured. RESULTS: The Fibrometer ® and SkinColorCatch ® showed significant correlations with the VSS total and the Observer POSAS total. The Elastimeter ® showed significant correlations with both the Patient and Observer POSAS totals. Unexpected correlations between Elastimeter ® measurements and the vascularity/pigmentation of scars indicate that scoring of these categories may be influenced by how severe the scar looks to the observer subjectively, further necessitating the need for reliable objective scar assessment tools. CONCLUSION: These results highlight the ability of these devices to assess scars and demonstrate their potential in serving as an important adjunct to previously validated scar assessment scales.

Food Security: An Unmet Need in Outpatient Burn Care.

Nutrition is paramount for wound healing after burn injury. With rising food prices and time off work due to burn injuries, access to adequate nutrition may be a significant financial stressor. We asked patients at an outpatient burn clinic to complete the Household Food Security Module, which queries about food security over the preceding 12 months. Demographics and burn characteristics were abstracted from the medical record. We assessed the overall prevalence of food insecurity, risk factors for food insecurity, and potential effects of food insecurity on nutritional status and wound healing time. Wound healing time was assessed via Cox regression while adjusting for burn depth, total body surface area burned, and diabetes. Over 40% of participants reported experiencing food insecurity; it was more common in patients who preferred Spanish language (p=0.014) or were unemployed (p=0.049). Just over half of participants experiencing food insecurity were using any food assistance resources. Among patients more than 30 days from burn injury, patients who were food insecure had larger burns (p=0.01). Experience of food insecurity was not associated presence of malnutrition on nutrition-focused physical exam (p=0.47). Wound healing time for burns managed in the outpatient setting was associated with burn depth (p<0.001), but not food insecurity (p=0.95), burn size (p=0.17), or diabetes (p=0.14). Although food insecurity did not result in malnutrition or negatively impact wound healing time, it is important for providers to routinely screen for food insecurity due to increased nutritional requirements and loss of wages after burn injury.

Lower Admission Prealbumin and Albumin Levels in Unhoused Burn Patients is a Marker for Poorer Outcomes.

Unhoused (UH) individuals experience burn injuries at a higher rate than domiciled individuals, and have poorer outcomes following injuries. One such mechanism proposed for worsened outcomes is secondary to poor nutrition. Access to proper nutrition and food insecurity are major barriers. Malnutrition has been shown to decrease wound tensile strength, increase infection rates, and prolong healing. The purpose of this study was to understand if albumin and prealbumin could help determine outcomes in UH patients and identify at-risk patients earlier in their hospital course A retrospective chart review was conducted of UH patients from 2015 through 2023 at a large urban safety net hospital. Data collected included admission laboratory values including albumin and prealbumin. Outcomes studied included length of stay, ICU days, ventilator days, and mortality. Data analysis for the effect of albumin and prealbumin included a zero-truncated negative binomial model for length of stay, a negative binomial hurdle model for ICU length of stay and ventilator days, and logistic regression for mortality. 385 patients met inclusion criteria and of these, 366 had albumin and 361 had prealbumin information. Adjusting for age, gender, and TBSA, the fewest days in the hospital and lowest odds of admission to the ICU occurred for those with admission albumin values of approximately 3.4-3.5 g/dL. Each unit (g/dL) decrease in albumin was associated with 3.19 times the odds of death (95% CI 1.42, 7.69). Each unit (mg/dL) decrease in prealbumin was associated with 1.19 times the odds of death (95% CI 1.06, 1.35). Decreased admission albumin and prealbumin levels are associated with worse burn outcomes in UH patients. These nutritional biomarkers may aid in determining which UH patients are suffering from food insecurity at injury onset. Obtaining these values on admission may help burn providers target nutritional goals in their most vulnerable patients.

A Scoping Review of PTSD and Depression in Adult Burn Patients: A Call for Standardized Screening and Intervention Research.

Despite the growing incidence of burn injuries globally and the advancements in physical recovery, the psychological aspect of burn trauma recovery remains inadequately addressed. This review aims to consolidate existing literature posttraumatic stress disorder (PTSD) and depression in adult burn survivors, recognizing the need for a holistic approach to burn recovery that encompasses both physical and mental health. The comprehensive analysis of 156 studies revealed significant variations in methodological approaches, leading to challenges in creating standardized protocols for mental health assessment in burn care. Key findings include the identification of a wide range of psychological assessment tools and a substantial research gap in low and middle-income countries, where the majority of burn injuries occur. Only 7.0% of the studies assessed interventions for PTSD or depression, indicating a lack of focus on treatment modalities. The studies identified demographic factors, patient history, psychosocial factors, burn injury characteristics, and treatment course as risk factors for PTSD and depression post-burn injury. The review highlights the need for early screening, intervention, and attention to subjective experiences related to burn injury, as these are strong predictors of long-term psychological distress. It also emphasizes the complexity of addressing psychological distress in burn survivors and the need for more standardized practices in assessing PTSD and depression specific to this population.