Journal of burn care & research : official publication of the American Burn Association
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Isokinetic dynamometry is used during exercise testing and rehabilitation to obtain a quantitative strength measurement on which progressive strength training programs can be based. This study assesses the test-retest reliability of isokinetic leg function in the knee flexors and extensors at 150 degrees/second in children and young adults with severe burns to be used for rehabilitation exercise program prescription. In 39 severely burned patients (49 ± 14% total body surface area burn [TBSA], mean ± SD; 34 ± 21% TBSA 3 rd degree; 14 ± 5 years, 153.3 ± 16.5 cm height; 53.8 ± 17.9 kg) knee flexion/extension isokinetic dynamometry at 150 degrees/second was performed on each patient's dominant leg in two sessions. ⋯ Sessions did not differ significantly in knee extension or flexion for any muscle function outcome or the hamstrings to quadriceps ratio. All intraclass correlation coefficients were >0.89 and r2 >0.79. Test-retest isokinetic dynamometry functional measurements in the knee flexors and extensors at 150 degrees/second are reliable in the burn population and may aid resistance rehabilitation program prescriptions.
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Acute kidney injury (AKI) is a common and morbid complication in patients with severe burn. The reported incidence of AKI and mortality in this population varies widely due to inconsistent and changing definitions. They aimed to examine the incidence, severity, and hospital mortality of patients with AKI after burn using consensus criteria. ⋯ Presence of and increasing severity of AKI are associated with increased hospital mortality. AKI appears to be independently and strongly associated with mortality in patients with TBSA ≤ 40%. Further investigation to develop risk-stratification tools tailoring this susceptible population is direly needed.
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Observational Study
Evaluation of Procalcitonin Accuracy for the Distinction Between Gram-Negative and Gram-Positive Bacterial Sepsis in Burn Patients.
Sepsis is the main cause of death in burns. Early institution of antimicrobial therapy is crucial to optimize outcomes but superfluous therapy increases adverse events, microbial resistance, and costs. Blood cultures are the gold standard for diagnosis but can take 48 to 72 hours. ⋯ Most elevated levels were related to nonfermentative Gram-negative bacteria and by Klebsiella pneumoniae and other Enterobacteriaceae. PCT levels were significantly higher in burn patients with Gram-negative sepsis comparing to patients with Gram-positive sepsis and controls. The determination of PCT levels may help the choice of empirical antimicrobial therapy while microbiological culture results are not available, despite not fully ensuring the desirable degree of precision.
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Burn size estimation is a crucial component of acute burn management that guides referral to burn centers, fluid resuscitation parameters, hospital resource distribution, and mortality-based interventions. Referring providers often misestimate the total BSA (TBSA) of burn injury, which contributes to unnecessary healthcare costs, misappropriation of limited resources, and delay in provision of appropriate patient care. A systematic literature review of articles available on PubMed, Scopus, Google Scholar, OvidSP Medline, and Web of Science was performed. ⋯ TBSA misestimation is associated with an increased incidence of inappropriate transfers to burn centers and the associated costs. The data remains lacking, however, and larger studies are required to further elucidate the clinical impact of such errors. A systematic approach with telemedicine-facilitated computer-based burn assessments is required.
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Amputations following a burn injury, although infrequent, may affect community reintegration and create a barrier to returning to work. The objective of this study was to compare patient and injury characteristics, quality of life, and employment status for those with and without amputation using a national longitudinal database of people with burn injuries. In this retrospective review of prospectively collected data, group differences were examined using descriptive statistics. ⋯ Amputation was a statistically significant predictor of SF-12 scores at 6 months for both PCS (β = .10, P = .003) and MCS (β = -.07, P = .04) scores. Amputations are relatively rare following burn injury and are more often associated with electrical and contact injuries. Whereas, people with amputations were less likely to be employed at 12 months postburn, those who were employed before the injury were more likely to return to work regardless of amputation status.