Journal of burn care & research : official publication of the American Burn Association
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Recent evidence indicates that increased frailty is associated with increased mortality in patients with burn over the age of 65 years. However, the effect of frailty may not be restricted to those over the age of 65 years. We hypothesize that admission frailty is associated with mortality in patients with burn ≥50 years of age. ⋯ Multivariate logistic regression revealed that increased admission FS is associated with increased mortality to a greater extent in the 50- to 65-year-old group (age 50-65 years: OR, 2.5; 95% CI, 1.4 to 4.6; age ≥ 65 years: OR, 1.63; 95% CI, 1.003 to 2.7). FS on admission allow for an improved assessment of preinjury physiological condition in patients with burn aged ≥50 years. Poor preinjury physiological fitness is associated with increased risk of death in patients with burn aged ≥50 years.
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When treating burn injuries, to date, there still remains significant disagreement whether presence of hypothermia (HT) on burn centers' intensive care unit (BICU) admission improves or worsens outcomes. The presented single burn center experiences set out to further evaluate the incidence, cause, and potential effects of HT on outcomes in severely burned patients. Between January 2015 and February 2017, 142 severely burned patients were admitted to a BICU. ⋯ HT at admission remains a common problem following burn injury. Main risk factors include inappropriate temperature management after injury and during transport, extent of TBSA burn, and quantity of resuscitation. Given the high incidence, the involved health care and, especially, also prehospital providers should be further educated about existing recommendations and guidelines to prevent HT.
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Severe thermal injury induces metabolic and physiological stress, prompting a disruption in the hypothalamic-pituitary-adrenal axis. The objective of this study was to evaluate potential confounding effects of Lactated Ringer's (LR) resuscitation on adrenal damage and cortisol production following burn. Anesthetized swine were instrumented with jugular catheters and sustained 40% TBSA burns from brass probes heated to 100°C. ⋯ Adrenal hemorrhaging was also greatest in MB animals, with no differences in tissue volume or wet-to-dry ratio. However, tissue levels of cytokines IL-1β, IL-10, and IL-12 were greatest in LV. Burn injury elevates urinary cortisol and compromises adrenal gland integrity, which is affected by IV fluid volume.
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Access to care for pediatric burns remsains a major public health problem in the United States. Telemedicine has an opportunity to improve access to care, but current models are expensive and inefficient. They have developed and pilot-tested the TeleBurn App, a novel smartphone application, to treat partial thickness burns while outpatient. ⋯ Adherence with completion of therapy in patients using the app was 80 vs 64 per cent with standard therapy. They describe a functional, scalable mobile health application in clinical use in a pediatric burn program. Further prospective, randomized studies may validate this mobile health platform, improving access to expert burn care for a vulnerable population.