The hand is the most commonly burned region and often leads to unique functional limitations. Here, we review the associations of long-term outpatient hand therapy (HT) on hand joint range of motion (ROM), activities of daily living (ADL) status, pain, and ability to return to work after burn injury. Adult patients with hand burns admitted to a single American Burn Association-verified burn center from January 2015 to June 2024, with properly documented outpatient HT follow-up, were included. 86 patients were identified who consistently presented for outpatient OT. 75.6% (n = 65) demonstrated improvement of ADL function, and 72.1% (n = 62) had improvement of ROM. At OT intake, 50% (n = 43) reported pain as a major limitation, but by the end of therapy, only 23% (n = 20) were limited by pain. Those with pre-existing hand pathology and older age were more likely to complete therapy to completion (OR = 1.52 and 1.01, CI, 1.1-2.2 and 1.1-1.7, P = .02 for both), and those who did not require surgery and had good compliance as rated by therapists had significantly increased likelihood of ROM improvement (OR = 1.26 and 1.27, CI, 1.0-1.6 and 1.0-1.6, P = .03 and .04). Most patients referred for HT after burn injury return to functional independence and have functional ROM. Further research should take a prospective approach to evaluate the efficacy of hand occupational therapy after burns, focusing on a wider range of functional and psychosocial outcomes.
Hypercalcemia after a burn injury is attributed to bone resorption secondary to muscle inactivity and prolonged immobilization. Evidence to guide treatment is extremely limited. The purpose of this study was to assess the effect of pamidronate on hypercalcemia in patients with burn injuries. This retrospective, observational study was conducted at a regional burn center. Adult patients admitted to the burn surgery service who received IV pamidronate for hypercalcemia during hospitalization were included. The primary outcome was the change in ionized calcium (iCa) at days 7 and 14 after pamidronate treatment. Secondary outcomes included hypocalcemia and the requirement for calcium replacement. Descriptive statistics were used to evaluate the outcomes. Mixed-effects regression analyses were performed to estimate the direction and magnitude of the effects of clinical factors on changes in iCa. Twenty-seven patients and 37 courses of therapy were included for analysis. The mean age was 44.4 ± 16.0 years, 85% were male, and the mean total body surface area (TBSA) burned was 60.2 ± 22.2%. The majority of IV pamidronate doses were 30 mg (96.2%). The mean peak iCa was 1.45 ± 0.11 mmol/L. The absolute decrease in iCa was -0.26 ± 0.12 mmol/L (-17.1 ± 7.3%) and -0.26 ± 0.13 mmol/L (-17.0 ± 7.5%) at day 7 and day 14, respectively. Hypocalcemia occurred after 5 pamidronate administrations (13.5%). The use of IV pamidronate for the management of hypercalcemia postburn injury appeared effective in decreasing iCa levels. Future studies are needed to further evaluate the clinical implications of these findings.
Burn injuries are functionally limiting, and premorbid mobility impairments may further complicate recovery. Premorbid mobility impairments are associated with worse outcomes in other populations; however, their role in burn recovery remains unclear. This retrospective cohort study included adult burn survivors injured from 2014 to 2025 extracted from the Burn Model System National Burn Database. Premorbid mobility impairment was defined as self-reported preburn physical problems or impairments affecting mobility (difficulty moving the arms, legs, or body). Outcomes included length of stay, discharge disposition, and PROMIS Global Mental Health scores at 6- and 12-month follow-ups postinjury. All regression models were adjusted for age, TBSA, and inhalation injury. The model for Global Mental Health scores additionally adjusted for discharge location, Global Physical Health, preinjury Global Mental Health, and follow-up time. A total of 1372 adult burn survivors were included, with a mean age of 46.2 years. Premorbid mobility impairment was associated with longer hospital stay (incidence rate ratio 1.15; 95% CI, 1.04-1.27; P = .006) and discharge to a shelter (odds ratio 1.75; 95% CI, 1.41-2.19; P < .001). There was also a trend toward lower PROMIS Mental Health scores among survivors with premorbid mobility impairments (β = -1.92, P = .091). Premorbid mobility impairment is associated with poorer burn outcomes, including longer hospital stay and discharge to unstable settings such as shelters, and may also be linked to poorer mental health outcomes. It remains unclear whether shelter discharge reflects premorbid housing instability or a new postburn disposition.
Older adults make up a growing population of burn patients but pose unique physiological challenges that require specialized care. Comprehensive multicenter data are limited, and single-center studies lack the power to answer key questions for this group. This study assessed the feasibility of forming an unfunded multicenter trial group to study older burn patients and piloted a retrospective study to explore trends in their care and their clinical outcomes. After Institutional Review Board approval and executing data use agreements, 12 North American burn centers collected standardized data on patients aged 60 and older treated from 2017-2019. Demographics, burn characteristics, interventions, and outcomes were gathered from each site's burn care quality platform submissions or electronic medical record and entered in a centralized REDCap database. Among the 1632 patients included in the database, median age was 68 years; most were male (67%) and White (73%) with a median BMI of 27.5. Median burn size was 3.5% total surface area, and patients arrived a median of 4.7 hours post-injury. The median modified Baux score was 76.2. Patients typically underwent one operation within 3 days of arrival, leading to a median hospital stay of 6 days and ICU stay of 1 day. In-hospital mortality was 10.4%, and median time to wound healing was 40 days. This pilot demonstrates that an unfunded multicenter collaboration is feasible and can generate meaningful data to guide care for older burn patients. Strong inter-institutional collaboration and communication and standardized data definitions were key to success.
Infection is a leading cause of mortality in patients with third-degree burns, contributing to over 75% of burn-related deaths. Despite the widespread use of hypochlorous acid (HOCl) and mafenide acetate (MA) as wet dressings in burn care, direct comparisons of their effectiveness are limited. Thus, this study evaluates the relative efficacy of HOCl and MA in managing infections and improving survival outcomes in postoperative burn patients. This retrospective study included adults with second and third-degree burns who underwent excision and grafting between January 2012 and February 2024 at an American Burn Association-verified burn center. Infection, mortality, length of stay, number of operations, and complications were compared across initial antiseptic treatment using chi-square and Mann-Whitney tests. The study cohort comprised 274 patients, the majority of whom sustained flame burns (63.1%), with an average total body surface area burned of 11.2 ± 13.7%. Within the cohort, 88.7% received MA and 11.3% HOCl. Thirteen patients (41.9%) who received HOCl developed an infection requiring antibiotics, which on average, took 6.85 ± 5.71 days to develop. This was not statistically different from those in the MA group, of which 90 patients (37.0%) developed an infection (P = .5840) which took 6.50 ± 8.47 days to develop (P = .4436). Mortality was also not significantly different between groups. No significant differences were found between HOCl and MA in infection, mortality, or morbidity outcomes. Both treatments are viable antiseptic options for postoperative burn care, and clinicians can be flexible in choosing either treatment based on patient needs, cost, or availability without compromising care quality.
Malignant hyperthermia (MH) is a rare, lifethreatening condition typically characterized by a rapid increase in body temperature and muscle rigidity in response to anesthetics. However, patients with extensive burn injuries have impaired thermoregulation and intraoperative heat loss, which can mask this classic hyperthermic response. We present the case of a 38-year-old female with a 23% total body surface area flame burn who developed a severe MH crisis during tangential excision following exposure to sevoflurane. Despite profound hypercapnia, acidosis, hyperkalemia, and extremity rigidity, the patient remained entirely afebrile throughout the event. Prompt recognition of the crisis by the surgical and anesthesia teams, followed by immediate administration of dantrolene, led to a rapid reversal of her metabolic derangements and a successful recovery.
Low- and middle-income countries (LMICs) bear a disproportionate burden of burn injuries compared to high-income countries (HICs), making LMIC representation and leadership in burn-related literature critical. This study analyzed authorship patterns and temporal trends in LMIC participation across burn-specific journals. We analyzed 18 275 burn journal publications from 1982 to 2025 using the PubMed Entrez API, with metadata enriched using OpenAlex country affiliations. Country income classification followed World Bank 2025 definitions. Low- and middle-income country involvement was defined as the presence of at least one LMIC-affiliated author on a publication. We assessed LMIC representation overall, by authorship position, collaboration type, and temporal period. Chi-square tests were used for temporal comparisons. Country affiliation data were identifiable for 8348 publications (45.7%) representing 75 countries. Among publications, 26.2% (n = 2185; 95% CI, 25.2%-27.1%) included at least 1 LMIC-affiliated author. Low- and middle-income country researchers held first authorship in 25.7% and last authorship in 25.3% of publications with identifiable country affiliations. However, this likely reflects LMIC-only publications rather than parity in HIC-LMIC collaborations. Notably, mixed HIC-LMIC collaborations comprised 3.5% of publications, with the majority being either HIC-only (73.8%) or LMIC-only (22.7%). Low- and middle-income country representation increased significantly over time, from 13.5% pre-2000 to 31.7% between 2020 and 2025 (P < .001). China (n = 527), Iran (n = 370), and India (n = 247) were the leading LMIC contributors, representing 54% of LMIC publications. Representation from the African continent remained low at 3%. LMIC participation in burns research has increased over 4 decades, though HIC-LMIC collaboration remains limited. Initiatives to foster HIC-LMIC partnerships and empower LMIC authors to lead burns research may maximize collaborative efforts.
Following global Phase III trials, a single-arm expanded access program at 23 burn centers in the United States (2019-2024) provided centers with additional experience in treating adult and pediatric burn patients with NexoBrid, and maintaining burn care preparedness for mass casualty incidents. Eligible patients included children (<18-years-old) and adults (≥18-years-old) with deep thermal burns covering up to 30% of the total body surface area. NexoBrid application was followed by standard care. Patients were monitored weekly until wound closure, and again after 3 and 12 months. Outcomes included incidence and time to eschar removal, need for surgical excision or escharotomy, length of hospital stay, wound closure, and Modified Vancouver Scar Scale. A total of 239 patients (215 adult, 24 pediatric) received NexoBrid, with 142 (131 adult, 11 pediatric) completing the 12-month follow-up. Mean ages were 41 and 11 years, respectively. The mean treated target wound area was approximately 6% of the total body surface area, with 38 circumferential burns. Eschar removal was achieved in 95% of adults and 100% of pediatric patients within 4 hours. Surgical excision was performed in 4% of adults, but not in pediatric cases. No escharotomies were needed. The median length of stay was 10 days. Wound closure occurred by 22 days (adults) and 28 days (pediatric). Safety data were consistent with previous trials. NexoBrid demonstrated comparable outcomes vs previous Phase III trials and potential efficacy in preventing burn-induced compartment syndrome.
Burn registries are critical in understanding, managing, and addressing the complexities of burn injuries and care by providing comprehensive data on injury patterns, treatment modalities, and outcomes. Current registries focus on the acute phase of inpatient burn care and lack data on outpatient and long-term treatment outcomes. This study aimed to validate the Burn Injury Surveillance Tool (BIST), a pilot electronic data collection tool designed to standardize burn data collection that includes both inpatient and outpatient data. Developed based on data dictionaries from established international registries, the tool includes 6 key sections capturing patient information, injury etiology, injury severity, acute treatment, quality-of-care indicators, and long-term outcomes. Validation involved 2 non-burn-specialized participants and 1 burn-specialized participant using the tool to extract data from 45 retrospective burn cases at the Hospital for Sick Children, Toronto, Canada. Inter-rater reliability was assessed through percent agreement and kappa statistics. Our results indicate high percent agreement and strong inter-rater reliability for most variables, particularly patient demographics and burn characteristics. Challenges included discrepancies in subjective measures such as injury circumstances and specific total burn surface area values, which highlighted areas for tool refinement. The creation and validation of the BIST provided valuable insights into how to incorporate outpatient data into new and existing burn registries. Beyond its immediate findings, this study offers a methodological framework for validating integrated in- and outpatient datasets that can be adapted for other clinical registries, supporting more complete and interoperable burn registry designs.
Children represent 20% of all burn admissions annually; 20%-30% are related to abuse or neglect. Our institution's Child Protective Services recently decided to stop following and interpreting hair toxicology results for pediatric patients with burn injuries. Drug use/exposure is an important risk factor for child abuse/neglect. The goal of this study was to evaluate the value of hair toxicology testing to identify child abuse or neglect. Medical records of pediatric patients ≤14 years admitted between January 1, 2019 and February 29, 2024 were reviewed. Demographics, burn injury information, suspicion of child abuse/neglect on admission, routine urine drug screening tests, hair toxicology results, and reporting to the State Health and Human Services (HHS) were collected. Descriptive statistics were obtained. Univariate analyses were performed to assess the utility of hair toxicology with P < .05 considered significant. Two hundred ninety-eight patients were included; child abuse was suspected in 31.5%; hair toxicology was performed for 75.2% of patients and was positive for 35.7%. Hair toxicology was more likely to be performed when child abuse was suspected on admission (81.9% vs 72.1%, P = .044), and to be positive (40.4% vs 20.6%, P < .001). Suspicion on admission was associated with higher HHS involvement (95.7% vs 24%, P < .001). Health and Human Services was more likely to be involved when hair toxicology was performed (54% vs 24.3%, P < .004) and positive (96.3% vs 28.4%, P < .001). Hair toxicology screening for pediatric patients with burn injuries is still a valuable tool to help clinicians report suspected abuse/neglect not otherwise detected on admission using other tools.
Systemic inflammation after pediatric burn injury frequently causes fever, complicating early recognition of infectious complications. Improved risk-stratification may help identify patients at risk for adverse clinical events during hospitalization. This study aimed to develop and validate a machine learning (ML)-based model using a Random Forest (RF) algorithm to predict fever and related adverse outcomes in hospitalized pediatric burn patients. We conducted a retrospective analysis of 595 pediatric burn patients admitted to a tertiary center between 2012 and 2022. Extracted data included demographics, burn characteristics, clinical interventions, laboratory values, and outcomes. RF models were trained to predict three key endpoints: fever (>38.5°C), transfer to pediatric intensive care unit (PICU), and need for surgical intervention. To address missing data and class imbalance, we employed multiple imputation techniques and generated synthetic data through bootstrap sampling to improve model robustness. The patient cohort had a mean age of 4.27 (range: 0.2-18.1) years and an average total body surface area of 5.49 (range: 0.3-45.0). The RF models demonstrated high predictive accuracy, with F1-scores of 0.81 ± 0.037 (fever), 0.88 ± 0.091 (PICU transfer), and 0.81 ± 0.027 (surgery). Area Under the Curve values were 0.96, 0.97, and 0.95, respectively. Feature importance analysis identified younger age, lower body weight, female sex, and head and neck burn location as key predictors. These ML-based RF models demonstrate strong potential for early risk-stratification of fever and high-risk trajectories in hospitalized pediatric burn patients, guiding monitoring intensity, diagnostic vigilance, and resource planning. Prospective evaluation is needed to determine whether model-informed workflows improve outcomes.
Advances in burn care have markedly improved survival after major injuries. However, survivors often experience significant physical and psychosocial sequelae. We aimed to characterize long-term health-related quality of life (HRQoL) among burn survivors to inform expected trajectories, rehabilitation needs, and common impairments. Adult burn survivors from a multicenter, longitudinal cohort study were stratified into 20.0%-49.9%, 50.0%-69.9%, and ≥70.0% total body surface area burn size groups. Patient-reported HRQoL and life satisfaction were assessed using validated outcome measures at discharge (pre-injury recall), 6, 12, 24 months, and 5 years post-injury. Standardized summary scores were derived using validated bridges. Mixed-effects linear regression models evaluated longitudinal changes and between-group differences. A total of 1113 participants were analyzed. All outcomes declined early after injury but improved progressively thereafter. Notably, by 24 months, mental-HRQoL and life satisfaction approached pre-injury levels across all burn size groups. Physical-HRQoL deficits were greater with increasing burn size, with significant net differences relative to the 20.0%-49.9% reference group (P < .0001). Mental-HRQoL and life satisfaction outcomes showed minimal between-group differences overall, though individuals with the largest burns exhibited significantly better relative mental-HRQoL at 24 months (P < .05). Although outcomes improve over time following major burn injury, persistent physical deficits support the classification of major burns as a chronic condition. These findings characterize burn size-specific recovery trajectories and demonstrate that, despite persistent physical deficits, mental health and life satisfaction can return to near pre-injury levels even after the most extensive injuries.
Burn care teams-nurses, physicians, rehabilitation therapists, respiratory therapists, and unlicensed care providers such as burn technicians or patient care assistants-work amid catastrophic injury, disfigurement, severe pain, and complex end-of-life decisions, creating high risk for moral distress, moral injury, and compassion fatigue. This structured, PRISMA-informed narrative review synthesized burn-specific evidence and literature from analogous high-acuity settings. PubMed, CINAHL, PsycINFO, and Google Scholar were searched (English, 2010-2025; foundational earlier works retained). Eligible publications addressed ethically mediated workforce outcomes and organizational, systemic, or team-level drivers and responses; resilience-only studies were excluded unless conceptually informative. Burn-focused studies were sparse but aligned with ICU findings: antecedents included resource scarcity and staffing mismatch, perceived futility and contested goals of care, hierarchical role conflict and constrained voice, and ethically unsafe climates. Consequences clustered around emotional exhaustion, secondary traumatic stress, moral residue, turnover intention, and downstream risks to safety and quality. Across settings, the most promising protections were organizational: accessible leadership, safe staffing and predictable workload, psychologically safe communication, structured peer support and debriefings, reflective forums (eg, Schwartz Rounds), and proactive ethics consultation and moral distress consultation services that surface remediable policy and culture gaps. Moral suffering in burn units should be treated as an organizational ethics problem; embedding moral protection into governance, quality metrics, and ethics infrastructure is essential. Such system-level approaches can reduce preventable moral harm, sustain workforce retention, and protect patient and family experience in burn centers.
This study aimed to explore the experiences of staff members trained as medical trauma and resilience management (MED TRiM) practitioners at the Welsh Centre for Burns. There is limited evidence available from organizations outside of the military regarding the effectiveness of the MED TRiM model. This study is the first to our knowledge to examine the implementation of the model within a burns service, making it a significant contribution to the understanding of the importance of psychological support in a high-trauma healthcare setting. The study used semi-structured interviews. Six professionals trained as MED TRiM practitioners at the Welsh Centre for Burns were recruited. Data were analysed using thematic analysis. Three main themes were identified: practical aspects of the MED TRiM model, challenges of implementing the MED TRiM model in a busy work environment, and the wider impact of the MED TRiM model across the burns centre. Findings suggest that the implementation of the MED TRiM model within the burns centre has been beneficial. Participants discussed the ways in which the model helped to support the psychological well-being of staff, promoted practitioners' skills in supporting the well-being of staff, and complemented psychologically informed team working. Challenges reported included staff availability to attend sessions within a busy clinical environment, and the requirement to adapt the model to best meet the needs of staff in a burn care setting. This study demonstrates the potential for the MED TRiM model to be used successfully within other burns services, and in healthcare settings more generally. Future research should explore experiences of the model from the perspective of staff who are recipients of it, and in other healthcare settings, to determine whether findings are consistent across services.
Burn injuries often lead to hypertrophic scars (HTS), which negatively affect quality of life and skin function. Hypertrophic scars result from abnormal wound healing characterized by excess, disorganized collagen confined to the original wound. Fractional ablative CO₂ laser revision (FLSR) has shown promise in improving burn scar symptoms by inducing micro-wound healing, but its specific mechanism remains unclear. Progress is limited by a lack of standardized, objective metrics to evaluate treatment response. We hypothesized that FLSR would shift HTS collagen structure toward that of normal skin (NS) and reduce galectin-1, a wound-healing molecule elevated in HTS, and that these changes could be quantified. Red Duroc pigs, whose wounds heal similarly to humans, were used to create HTS and NS sites. Each pig had 4 HTS and 2 NS sites. Punch biopsies were collected at postoperative days 49 and 70, corresponding to pre- and post-FLSR timepoints. Fractional ablative CO₂ laser revision was administered on days 49, 56, and 63. Biopsies were paraffin-embedded, sectioned, stained with Picrosirius Red, imaged at 40× (n = 3/tissue), and analyzed using CT-FIRE and CurveAlign software. Metrics included collagen fiber width, length, straightness, angle, number, and overall alignment. Data were compared using 2-way analysis of variance. Before treatment, NS and HTS differed significantly in collagen alignment and width. After treatment, HTS collagen alignment shifted toward NS values, while width differences persisted. Galectin-1 levels decreased in HTS after FLSR. Other parameters showed no significant changes. These findings indicate that FLSR alters collagen alignment and length in HTS and that quantitative collagen metrics provide a valuable, objective method for assessing HTS treatment effectiveness.
Severe burns provoke a systemic "genomic storm," yet cell states associated with divergent outcomes remain unclear. We profiled blood cells by single-cell RNA-Sequencing (73 014 cells) from adult patients with burn injuries within postburn day 17 (n = 4) and healthy donors (n = 5), integrated data with bulk signatures of burn size, inhalation injury, and mortality, and evaluated clinical associations in the American Burn Association National Burn Repository. Burn was associated with emergency hematopoiesis marked by expansion of hematopoietic stem/progenitor-like cells, immature neutrophils, and plasmablast/plasma cell states, alongside depletion of naïve CD4+/CD8+ T cells and dendritic cells. Larger burns (>20% TBSA) showed enrichment of humoral transcriptional programs, including plasmablast/plasma cell activation and suppression of cytotoxic CD8+ T-cell states. In multivariable models, inhalation injury was a stronger predictor of death (adjusted odds ratio [OR] 1.9) than burn size (adjusted OR 1.1) and shared greater overlap with the most perturbed single cells in non-survivors; 55% of co-perturbed cells were neutrophils, implicating granulocyte dysregulation as a common lethal axis. We identified a neutrophil-specific 5-gene panel (OLFM4, RETN, LCN2, ARG1, and BTNL3) that discriminated survivors vs non-survivors after burns (area under the curve [AUC] > 0.9) and generalized to trauma (n = 158; AUC 0.81) and intensive care unit COVID-19 (n = 103; AUC 0.75), providing information orthogonal to conventional biomarkers and severity scores. Cytomorphology corroborated transcriptomic immaturity, with ~2-fold higher band neutrophils and larger neutrophil size in a fatal case. Computational drug-reversal analysis highlighted galectin-1 inhibition as a candidate modulator of mortality-associated neutrophil programs. Together, our findings suggest that immature neutrophils represent a shared immune feature across severe burns and other forms of critical illness.
The Burn-Specific Health Scale Brief (BSHS-B) is the only specific, standardized, multidimensional tool designed precisely to measure health-related quality of life (HRQoL) after burns. It is translated into many different languages and is used worldwide. To date, an Arabic version has not been available. The current study aimed to translate, culturally adapt, and validate the BSHS-B into Arabic (BSHS-B-AR). A total of 188 patients with burn injuries completed the final Arabic version of BSHS-B to assess the psychometric properties of BSHS-B-AR. Reliability was tested by internal consistency (Cronbach's alpha) and test-retest reliability (interclass correlation coefficients [ICCs]). Validity was investigated through floor and ceiling effect and confirmatory factor analysis (CFA). Also, convergent validity was assessed using the World Health Organization Quality of Life Scale abbreviated version (WHOQOL-BREF) questionnaire and construct validity was verified through the known-groups technique. The scale showed excellent reliability. Cronbach's alpha was > 0.90 (total scale and for each subdomain) and ICC was > 0.80 for the total scale and for the 9 domains. Validity of the scale was satisfactory through CFA (82.7% of the total variance) and it showed a good fit with the original scale (comparative fit index = 0.933). Also, a significant positive correlation was found between the BSHS-B-AR and the WHOQOL-BREF (P < .001). The scale was able to discriminate between patient groups according to site of burns and length of hospitalization (P < .05). The BSHS-B-AR is a reliable and valid scale that can be used both in Arabic and international communities.
A major burn injury triggers systemic inflammation and metabolic responses beyond the skin. Early intestinal barrier failure can amplify postburn inflammation and organ dysfunction, yet the dynamic epithelial lesions that generate focal leakage in vivo remain unclear. We characterized villus-tip epithelial shedding, epithelial gap formation, and tracer leak sites early after burn injuries using intravital multiphoton fluorescence microscopy. Male C57BL/6 mice were assigned to control or burn groups (30%-35% total body surface area full-thickness burn; n = 6/group). Intestinal permeability was assessed at 2, 4, and 6 h postinjury using luminal fluorescein isothiocyanate-dextran (4 kilodaltons) with portal venous sampling. Distal-ileum intravital imaging was performed 330-420 min postinjury (at 1-min intervals). Ten villi per mouse were quantified for shedding duration and prevalence, a condensation-first vs extrusion-first sequence, epithelial gap density, goblet-cell proportion, and focal luminal tracer leak sites. A major burn shortened shedding duration and increased shedding prevalence during the 90-min observation (P < .05), with a shift toward a condensation-first pattern and fewer extrusion-first events (P < .05). Burn increased epithelial gap density and goblet-cell proportion (P < .05). Portal serum fluorescein isothiocyanate-dextran concentrations were elevated at 6 h (P < .05), and imaging localized tracer penetration to discrete postshedding epithelial defects, consistent with incomplete sealing. Major burn rapidly disrupts intestinal barrier integrity through accelerated stress-associated shedding, increased gap formation, and focal leak sites. These time-resolved structural lesions provide an in vivo substrate for early hyperpermeability and suggest a time-critical window for gut-directed interventions to mitigate downstream postburn complications.
Alterations in both the innate and adaptive immune systems can induce a significant immunocompromised state among those hospitalized after burn injury. These changes can devolve into the clinical entity known as persistent inflammation, immunosuppression, and catabolism syndrome (PIICS), characterized by profound and chronic immune dysregulation. Persistent inflammation, immunosuppression, and catabolism syndrome is defined by the presence of lymphopenia, elevated C-reactive protein levels, and evidence of catabolism through weight loss or hypoalbuminemia in the context of a prolonged hospitalization. Though PIICS has previously been described in patients with burn injuries, this immunophenotype in the setting of serious bacterial and fungal infections is poorly characterized. We performed a detailed retrospective analysis of burn-injured adults (aged 19-64 years) in a de-identified institutional database of patient medical records from 1997 to 2023. Of the 960 patients admitted for a primary burn injury, the overall prevalences of serious infections and PIICS was 38% and 25%, respectively. Both the presence of an inhalation injury and the total body surface area (TBSA) burn size correlated with the development of serious infections and PIICS. Patients with PIICS had more pathogens isolated and a higher prevalence of Acinetobacter and Stenotrophomonas infections. The immunophenotype of PIICS was strongly associated with recurrent infections during hospitalization. Detailed assessments of PIICS criteria, including trends in lymphocyte counts, may help identify the development of serious bacterial and fungal infections in burn-injured adults.
Extracorporeal membrane oxygenation (ECMO) has been used to successfully minimize, replace, or avoid the use of mechanical ventilation in burned and nonburned populations. Further research on ECMO in the burned population is warranted, particularly given the insufficient patient numbers reported in the literature. A panel composed of national leaders in ECMO and/or burn injury discussed the use of ECMO in patients with burn injuries as part of the MedStar Washington Hospital Center Burn Center Multidisciplinary Lecture Series. Panelists examined current methods, institutional practices, and clinical controversies around the use of ECMO in burns. While institutional capacity and protocols vary widely, the discussion highlighted the need for both retrospective and prospective data to establish guidelines to maximize the clinical benefits of ECMO in patients with burn injuries. Further multicenter investigation is needed to define patient selection criteria, timing, and perioperative management strategies such as anticoagulation in this patient population.
