Journal of burn care & research : official publication of the American Burn Association
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Increasingly, patients are being evaluated for burns related to home oxygen use. Although the majority of burns are minor, referral to a burn unit regardless of depth or size is still common. The care of this population was reviewed to determine the feasibility and potential saving if such patients could be managed by nonburn-trained surgeons. ⋯ Average distance by helicopter transport was 57 miles, and cost $12,500.00. Large savings could be realized if patients cared for by local physicians were educated in basic burn care. This would be more palatable with good communication between the community hospital and burn center, with consultation on an as-needed basis.
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Home oxygen therapy use has steadily increased for the past 30 years. A majority of these patients suffer from chronic obstructive pulmonary disease secondary to smoking. Although warned of the danger of smoking while on oxygen, patients continue to do so, potentially resulting in cutaneous burns and suspected inhalation injury. ⋯ Between the subgroups, no difference was found in %TBSA, ventilator days, or LOS. One patient admitted for airway observation required intubation and one patient failed extubation, postoperatively. Patients on home oxygen therapy suspected of inhalation injury should ideally be observed for signs of airway compromise before intubation is performed.
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Studies have shown that monocytes are hyporesponsive and that dendritic cells (DCs) are depleted in burn patients. We have recently shown in a mouse model that burn injury alters the transcriptional regulation in bone marrow progenitors and inhibits myeloid-derived DC (mDC) production. In the present study, using human burn patient peripheral blood mononuclear cells, we have shown an overexpression of MafB with a corresponding reduction in peripheral blood mononuclear cell-derived mDCs. ⋯ Furthermore, GATA-1+ and HLA-DR+ mDCs were increased following MafB silencing. Although burn injury augments the number of peripheral blood monocytes, the frequency of mDC is reduced. This impairment is likely secondary to the down-regulation of mDC differentiation by high MafB-expressing monocytes following burn injury.
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The American Burn Association publishes a list of defined criteria for patients who require admission or transfer to a burn center. This study examines the extent to which those criteria are observed within a regional burn network. Hospital discharge data for 2008 were obtained for all hospitals within the South Florida regional burn network. ⋯ Inappropriate burn patient triage may be occurring to more than half of the burn patients within our regional burn network despite better functional outcomes at the burn center. This may be because of a lack of knowledge regarding triage criteria, patient insurance status, or other factors. Further studies are necessary to fully characterize the problem and implement education or incentives to encourage appropriate burn patient triage.