Exploring the similarities and differences of burn registers globally: Results from a data dictionary comparison study.

INTRODUCTION: Pooling and comparing data from the existing global network of burn registers represents a powerful, yet untapped, opportunity to improve burn prevention and care. There have been no studies investigating whether registers are sufficiently similar to allow data comparisons. It is also not known what differences exist that could bias analyses. Understanding this information is essential prior to any future data sharing. The aim of this project was to compare the variables collected in countrywide and intercountry burn registers to understand their similarities and differences. METHODS: Register custodians were invited to participate and share their data dictionaries. Inclusion and exclusion criteria were compared to understand each register population. Descriptive statistics were calculated for the number of unique variables. Variables were classified into themes. Definition, method, timing of measurement, and response options were compared for a sample of register concepts. RESULTS: 13 burn registries participated in the study. Inclusion criteria varied between registers. Median number of variables per register was 94 (range 28 - 890), of which 24% (range 4.8 - 100%) were required to be collected. Six themes (patient information, admission details, injury, inpatient, outpatient, other) and 41 subthemes were identified. Register concepts of age and timing of injury show similarities in data collection. Intent, mechanism, inhalational injury, infection, and patient death show greater variation in measurement. CONCLUSIONS: We found some commonalities between registers and some differences. Commonalities would assist in any future efforts to pool and compare data between registers. Differences between registers could introduce selection and measurement bias, which needs to be addressed in any strategy aiming to facilitate burn register data sharing. We recommend the development of common data elements used in an international minimum data set for burn injuries, including standard definitions and methods of measurement, as the next step in achieving burn register data sharing.

Evaluation of a thermoregulatory intravascular catheter in critically ill burns patients.

Patients with severe burns are at high risk of thermoregulatory failure. Yet, there is a lack of consensus regarding the optimum approach to temperature dysregulation in patients with severe burns. Intravascular temperature management catheters may offer a superior method of temperature control, but robust data is lacking. In this article we describe our experience in using a thermoregulatory catheter for temperature management in a tertiary referral burns centre. We conducted a single-centre, prospective evaluation of the use of a thermoregulatory intravenous catheter system (Thermogard XP®) in critically injured burns patients admitted to our Intensive Care Unit over an 18-month period. 10 patients had a total of 12 catheters inserted. Patient temperatures were maintained between a median low of 36.9°C and median high of 38.4°C whilst in the Intensive Care Unit. If patients were transferred to theatre, the median temperature change was -0.15°C (IQR -0.3, 0) if Total Body Surface Area (TBSA) was ≤50% and -1.45°C (IQR -2.05, -0.975) if >50%. No surgical procedures were terminated due to intra-operative hypothermia. On return from theatre, 72.2% of patients were normothermic with a median temperature of 36.8°C. 30% of patients developed a thrombotic complication. Overall, the device appeared reliable in achieving and maintaining normothermia for critically ill burns patients manifesting temperature dysregulation. It may also be of benefit to patients expected to show temperature fluctuations during operative procedures. Further research is needed to define whether this represents an improvement over current practice and to investigate the thrombus risk associated with such devices.

Neuropathic agents in the management of pruritus in burn injuries: a systematic review and meta-analysis.

OBJECTIVES: Pruritus is a common and often distressing complication after a burn injury. The purpose of this review is to explore the efficacy of drugs classically used to treat neuropathic pain in the management of pruritus after burn injury. METHODS: A systematic literature search of medical databases was conducted to find studies investigating drugs listed in the National Institute for Health and Care Excellence (NICE) guideline (CG173, "neuropathic pain in adults") for the management of pruritus after burn injury in patients of any age. Controlled studies were stratified by the drug class studied and their risk of bias before conducting meta-analysis. A narrative review of case series or observational studies was presented. Severity of pruritus at any time point, with all quantitative and qualitative measures, was included. RESULTS: Fifteen studies were included in the final analysis, 10 investigated the use of gabapentinoids, 4 studied doxepin, and 1 local anesthetic agents. Meta-analysis of three randomized controlled trials (RCTs) demonstrated that the use of gabapentinoids was associated with an improvement in mean VAS (Visual Analog Scale) 0-10 scores of 2.96 (95% confidence interval (95% CI) 1.20 to 4.73, p<0.001) when compared with placebo or antihistamine. A meta-analysis of four RCTs investigating topical doxepin showed an improvement in mean VAS scores of 1.82 (95% CI 0.55 to 3.09, p<0.001). However, when excluding two studies found to be at high risk of bias, no such improvement was found (-0.32, 95% CI -1.64 to -0.99, p=0.83). CONCLUSION: This study suggests that gabapentinoids are beneficial in the management of burn-related pruritus. There is a lack of evidence to suggest that doxepin is an effective treatment. Topical local anesthetic agents may be safe and beneficial, but studies are scarce. LEVEL OF EVIDENCE: Systematic review, level II.

Utility of the PRE-DELIRIC delirium prediction model in a Scottish ICU cohort.

The PREdiction of DELIRium for Intensive Care (PRE-DELIRIC) model reliably predicts at 24 h the development of delirium during intensive care admission. However, the model does not take account of alcohol misuse, which has a high prevalence in Scottish intensive care patients. We used the PRE-DELIRIC model to calculate the risk of delirium for patients in our ICU from May to July 2013. These patients were screened for delirium on each day of their ICU stay using the Confusion Assessment Method for ICU (CAM-ICU). Outcomes were ascertained from the national ICU database. In the 39 patients screened daily, the risk of delirium given by the PRE-DELIRIC model was positively associated with prevalence of delirium, length of ICU stay and mortality. The PRE-DELIRIC model can therefore be usefully applied to a Scottish cohort with a high prevalence of substance misuse, allowing preventive measures to be targeted.

Rescue therapy using an endobronchial valve and digital air leak monitoring in Invasive Pulmonary Aspergillosis.

In this case report, we describe the utilisation of two recently developed technologies for the successful management of a persistent air leak (PAL) in a critically ill patient in whom cardiothoracic surgical intervention was not possible. We report the case of a young leukaemic woman with a PAL complicating Invasive Pulmonary Aspergillosis (IPA), who was effectively managed using an Endobronchial Valve, supplemented by objective, digital air leak data provided by a Thopaz(®) device (Medela, Switzerland).