Background Hemophagocytic lymphohistiocytosis is a rare but potentially fatal hyperinflammatory syndrome caused by uncontrolled immune activation. Although severe burn injury induces profound immune dysregulation and systemic inflammation, burn-associated hemophagocytic lymphohistiocytosis remains underrecognized because its clinical manifestations often overlap with those of sepsis and critical illness. Case presentation A 50-year-old man sustained flame burns involving 35% of the total body surface area. On day 4, he developed septic shock due to burn wound infection and underwent surgical debridement and skin grafting. On day 9, the platelet count decreased to 14,000/μL and subsequently progressed to transfusion-refractory thrombocytopenia with persistent inflammation. Disseminated intravascular coagulation, drug-induced thrombocytopenia, and heparin-induced thrombocytopenia were considered unlikely. Because hemophagocytic lymphohistiocytosis was suspected, bone marrow aspiration was performed on day 15 and revealed hemophagocytosis. Although the patient did not strictly fulfill the diagnostic criteria, hemophagocytic lymphohistiocytosis was clinically diagnosed based on persistent fever, multilineage cytopenia, hypertriglyceridemia and bone marrow hemophagocytosis. Corticosteroid-based therapy for suspected hemophagocytic lymphohistiocytosis was initiated on day 16, followed by an increase in platelet counts and improvement in inflammatory markers. An additional skin grafting procedure was subsequently performed without recurrence of thrombocytopenia. After recovery from the acute phase of burn injury and satisfactory wound healing, he was transferred to a rehabilitation hospital on day 55. Conclusions Hemophagocytic lymphohistiocytosis may be considered as a differential diagnosis in patients with severe burns who develop progressive or transfusion-refractory thrombocytopenia. When hemophagocytic lymphohistiocytosis is suspected, early bone marrow aspiration may support the clinical diagnosis and facilitate timely therapeutic intervention.
Burn injuries in children can lead to long-term consequences. Patient-Reported Outcome Measures (PROMs) are essential for monitoring recovery and improving patient-centered care. However, collecting PROMs in children presents challenges. The aim of this study is to describe response rates in a nationwide Dutch outcome registry of pediatric burn patients and to identify predictors of participation and complete follow-up.A retrospective observational cohort study was conducted using routinely collected data from the Dutch Burn Repository including Burn Centers Outcomes Registry the Netherlands (BORN) Kids. All pediatric burn patients hospitalized for ≥1 night or undergoing surgery in a Dutch burn center between November 2020 and December 2023 were eligible. PROMs were administered online at 1 week, 3-, 6-, and 12-months post-discharge. Predictors were analyzed using logistic regression.Of 513 eligible patients, 144 (28.1%) participated in BORN Kids. Among participants, 48 (33.3%) completed all PROMs during the first year. Participation was less likely among children from low socioeconomic status(SES) areas (OR 0.52, 95%CI: 0.33–0.80), more likely among those who underwent surgery (OR 3.28, 95% CI 2.12–5.09), and depending on treatment center (max OR 3.57, 95%CI: 2.11–6.05). No significant predictors of complete follow-up were identified.PROM participation in pediatric burn care is lower than in other populations and influenced by SES, surgery, and treatment center. Completion over time show no clear predictors. The observed challenges in engaging patients for PROMs underscore the need for targeted strategies, such as integration of PROM into routine care, to improve data quality and generalizability.
Background Prognostic scoring systems for elderly burn patients may differ from those used in the general burn population because of age-related comorbidities. This study aimed to evaluate the prognostic scoring system in elderly burn patients treated at the Vietnam National Burn Hospital. Methods A retrospective descriptive study was conducted involving 648 burn patients aged ≥65 years who were treated at the Department of Emergency and Intensive Care, Vietnam National Burn Hospital. Results The mortality rate was 7.62%. Increasing age, hypertension, deep TBSA, and inhalation injury were independent factors associated with mortality in elderly burn patients (p < 0.05). The VNB score for prognostic assessment in elderly burn patients was calculated as follows: VNB score = Age + 2 × Deep Burn Area (%TBSA) + 15 × Inhalation Injury +10 × Hypertension. The VNB score showed excellent prognostic performance for mortality, with an AUC of 0.95 (95% CI: 0.91–0.98). At a cut-off of 99 points, sensitivity and specificity were 86.96% and 88.89%, respectively. The model demonstrated good calibration, with a Hosmer-Lemeshow χ2 = 3.40 (p = 0.907), a low Brier score (0.03), an observed-to-expected (O: E) ratio of 1.000, and a calibration-in-the-large (CITL) of 0. Kaplan–Meier survival analysis showed a significant difference in survival probability between patients with a VNB score < 99 and those with a VNB score ≥ 99. Patients with a VNB score ≥ 99 showed a significantly lower survival probability, particularly within the first 20 days after burn injury (p < 0.001). Conclusion Increasing age, hypertension, deep TBSA, and inhalation injury were independent factors associated with mortality in elderly burn patients (p < 0.05). The VNB score demonstrated excellent performance in predicting mortality among elderly burn patients (AUC = 0.95).
Dermatofibrosarcoma protuberans (DFSP) is a rare, low-grade cutaneous sarcoma characterized by locally aggressive growth and a high risk of local recurrence, whereas distant metastasis is uncommon. Although DFSP has been reported at sites of prior trauma, a causal relationship has not been established. DFSP arising in a frostbite scar has not previously been reported.We describe a 63-year-old man who developed DFSP within a frostbite scar on the anterior chest wall approximately 20 years after the initial injury. The tumor was surgically excised with negative margins, and no recurrence has been observed during four years of follow-up.This case demonstrates that DFSP can occur within a long-standing frostbite scar decades after the initial injury. Clinicians should remain alert to possible malignancy in long-standing frostbite scars that show progressive changes.
Background Deep dermal burns remain a therapeutic challenge, requiring treatment strategies that promote healing while minimizing surgical burden and scarring. Synthetic dermal substitutes based on polylactide terpolymers may offer a promising option for managing deep dermal burns. This study evaluated the clinical value of a polylactic acid (PLA)-based matrix (SupraSDRM®, PolyMedics Innovations GmbH) in deep dermal burns using objective perfusion assessment with Laser Doppler Imaging (LDI). Methods An analysis was performed in 10 consecutive patients with acute thermal burns treated with PLA. Burn depth was assessed preoperatively using LDI. Demographic and burn-related data, timing of matrix application, pain intensity (Numeric Rating Scale, NRS), need for secondary split-thickness skin grafting, length of stay, and scar quality (Vancouver Scar Scale, VSS) were analyzed. Results Mean patient age was 42.3 years (range 16–66) and mean TBSA was 7.5% (range 0.3–18%). The matrix was applied on mean post-burn day 4. Pain intensity decreased significantly from a mean NRS of 5.8 before intervention to 1.8 at 24 h after application (p = 0.002). Mean hospital stay after matrix application was 6 days. Definitive wound healing without grafting was achieved in 8/10 patients. Two patients (6 and 7) required secondary grafting after wound infection that developed following matrix application. At follow-up, scar quality was favorable (mean VSS: 3.3). Scar quality was assessed at the latest available follow-up visit, with a mean follow-up of 12 months (range 8–18). Conclusion Within a perfusion-guided treatment algorithm, lactide-based terpolymer dermal matrices may enable early pain reduction and graft-free wound healing in selected deep dermal burns. When grafting is required, they may still be applied as part of wound bed preparation prior to grafting, supporting their role as a bridge-to-healing strategy.
Background Burn mass casualty poses substantial strain on tertiary care units due to need of highly complex surgical care, long-term intensive care, and rigorous infection control protocols. The plane crash at a school in Dhaka on 21 July 2025, resulting in serious burns cases with respiratory complications strained the local treatment capacity. Addressing the need, the Singapore Medical Team conducted a comprehensive operational analysis, including pre-triage guidelines, ICU support infrastructure, and the systematic implementation of essential burn management protocols, to support an evidence-based model for efficient mass casualty burn management. Methods This was a retrospective descriptive cohort study of verified data sources including operational logs, daily clinical summaries, intensive care unit reports, surgical reports, and infection control data between 21 and 31 July 2025. The dataset was analysed to define patient demographic, clinical intervention and the systemic operational responses of the incident. Results Fifty-five casualties aged 9–18 years arrived at hospitals within hours of the incident, with significant burns and inhalational injuries. The Singapore team conducted 28 surgical procedures, managed 8 intubated patients, treated 13 severe burn cases, established central venous and arterial access, and implemented prone ventilation for acute respiratory distress syndrome (ARDS). An Infection Control Task Force was created to prevent sepsis and ventilator-associated pneumonia. By the end of mission, no patients remained in intensive care. Conclusion Early needs assessment, structured triage, integrated command systems, and rapid international collaboration were critical in achieving favorable outcomes. The Dhaka experience underscores the importance of established burn disaster frameworks, ICU surge capacity, and robust infection prevention strategies, particularly in low- and middle-income settings.
Introduction Age, total body surface area (TBSA), and inhalation injury are well-established predictors of mortality following burn injury. However, contemporary institutional data are needed to evaluate additional determinants of mortality and assess temporal trends in modern burn care systems. This study examined mortality predictors and longitudinal trends among adult burn patients admitted to a regional burn center over a fifteen-year period, specifically to determine whether the mortality rate changed significantly over the study period. Methods A retrospective review was conducted of 4117 adult burn patient records from an institutional burn registry, admitted between 2007 and 2021. Patients younger than 18 years and those with missing essential data were excluded. Demographic variables, burn characteristics, TBSA, inhalation injury, injury mechanism, comorbidities, length of stay, ICU days, and ventilator days were analyzed. Statistical tests included chi-square, Wilcoxon rank-sum, Cochran–Armitage trend test, Jonckheere–Terpstra test, and logistic regression. Results Among 4117 patients, 161 (3.9%) died. Non-survivors were significantly older than survivors (61.25 ± 17.99 vs. 44.47 ± 17.29 years; p < 0.0001) and sustained larger burns (mean TBSA 39.51 ± 30.27% vs. 6.36 ± 9.23%; p < 0.0001). Flash/flame injuries accounted for the majority of deaths (72.67%; p < 0.0001). Inhalation injury was substantially more frequent among non-survivors than survivors (39.1% vs. 6.7%; p < 0.0001). Non-survivors required significantly more ICU days (6.92 ± 14.79 vs. 3.20 ± 9.44; p < 0.0001) and ventilator days (5.89 ± 12.88 vs. 1.86 ± 7.66; p < 0.0001). They also experienced more complications (1.54 ± 1.10 vs. 0.42 ± 0.92; p < 0.0001) and had a greater comorbidity burden (1.41 ± 1.03 vs. 1.21 ± 0.99; p = 0.0079). Overall mortality did not significantly change over time (p = 0.0523). Conclusion Age, TBSA, inhalation injury, and comorbidity burden were associated with mortality in adult burn patients, corroborating determinants established in prior literature. Over the fifteen-year period, institutional mortality did not change significantly, while patient age, comorbidity burden, and injury severity among non-survivors increased over time.
Purpose Comprehensive and accurate burn documentation is essential for safe patient care, as errors may lead to preventable risks. This study evaluated documentation at a tertiary burn centre, comparing Emergency Department (ED) assessments with Plastic Surgery (PS) consultant evaluations. We hypothesized that ED records would be inaccurate and incomplete, resulting in discrepancies in burn size and severity. Methods A retrospective review of the provincial burn registry from 2016 to 2021 was conducted. Patients admitted for burns requiring PS consultation were included; isolated first-degree, ocular, and inhalational burns, or those not requiring admission, were excluded. Data on etiology, injury details, treatment, and follow-up were compared between ED and PS records. Incomplete entries lacked at least one burn-specific variable. Statistical tests included Mann-Whitney, Pearson's Chi-Square, Fisher exact, and Wilcoxon Signed-Rank, with PS considered the gold standard. Results A total of 358 patients were analyzed; 76% were male, with most burns occurring at home and involving the head and neck. Etiology and location were consistently documented across ED and PS records. Significant discrepancies were observed in TBSA estimates: ED mean 22.9% ± 16.6 versus PS mean 18.2% ± 15.2 (p = 0.0019). Differences were most pronounced for burns <25% TBSA (p < 0.0001). ED assessments also overestimated burn depth. Overall, 67.0% of ED charts were incomplete; 54.2% lacked TBSA, 38.3% omitted depth, and 10.6% had missing anatomic location. Conclusions ED documentation frequently overestimated TBSA and depth, with more than 67% of records incomplete. These findings highlight the urgent need for improved awareness, training, and standardized documentation practices in burn care.
Background and Objective Burns create serious injuries which currently exist as widespread problems across the globe because they result in high death rates and permanent disabilities and economic burdens, especially in developing nations. The researchers investigated how burn wounds healed through two different methods which used continuous sutures and staplers to create wound closures that would reduce post-burn scarring and deformities. Materials and Methods The clinical trial recruited 60 patients who received wound edge closure treatment through either staplers or simple continuous sutures. The study measured variables across a 10 cm graft edge. The Vancouver Scar Scale (VSS) assessment took place at one month and three month post-surgery by a physician who did not participate in the research and a plastic surgery professor. Results The average age of the study participants calculated to 44.63 years with a standard deviation of 18.67 years. The study found no significant age weight height BMI itching infection or graft loss differences between the two groups (p > 0.05). VSS scores showed significant differences between the two groups at one and three months because the stapler group achieved higher scores (p < 0.05). The paired t-tests showed that study participants experienced significant changes in their scar scores between month one and month three. The stapler group needed less time for graft closure (p < 0.05) while they also required less time to remove staplers than to take out sutures. Conclusion The Generalized Estimating Equation (GEE) regression analysis found that group type stapler/suture and graft location together with measurement time constituted important factors that determined scar score outcomes. The suture group achieved a mean scar score that measured 2.04 units lower than the stapler group. The scar scores experienced a decline of 0.83 units at the end of three months. The trunk graft patients showed scar scores that measured 1.45 units less than the head/face graft patients.
Background Burn wound infection (BWI) is a leading cause of morbidity in paediatric burns. Distinguishing infection from post-burn systemic inflammatory response syndrome (SIRS) is challenging in minor burns where biomarker patterns are poorly characterised. C-reactive protein (CRP) is widely used clinically, yet its temporal behaviour in this setting remains unclear. Aim This study aimed to characterise CRP trajectories over seven days post-burn in children with minor scalds, comparing patterns between those treated with systemic antibiotics for clinically suspected BWI and those not treated. A secondary aim was to explore whether CRP elevations associate more strongly with suspected infection than burn size alone. Methods This retrospective single-centre study included 344 children treated for scald injuries between 2015 and 2020. Serial CRP values from day 0–7 were extracted from medical records. Trajectories were compared using mixed-effects modelling, epidemiological differences with non-parametric tests, and antibiotic prescription factors with logistic regression. Results Antibiotics were prescribed in 26% of children. CRP trajectories diverged significantly from day 2 to day 6 post-burn (all p < 0.05), with antibiotic-treated children showing a mean difference of 13 mg/L in the first week (p = 0.008). Burn size contributed modestly to CRP variation (2 mg/L per 1% TBSA). Children treated for infection had larger burns and longer hospital stays. Conclusion CRP trajectories differed substantially between children treated and not treated with antibiotics for suspected infection, while burn size explained only a small proportion of variation. CRP kinetics may serve as a clinical adjunct when infection is suspected, though cautious interpretation is warranted given the interaction between biomarker levels and treatment decisions.
Background Burn injuries are a significant public health concern, especially in low and middle-income countries (LMICs), with a majority occurring in and around homes. Household-related burns are caused by activities involving cooking, heating, and lighting. Open flames from traditional stoves, three stone fires, hot liquids, and unstable set stoves increase the risk. Overcrowding, poor housing, and unsafe kitchen setups further heighten exposure. Objective This study aimed to assess the occurrence, causes and the outcomes of household energy-related burns among patients treated at Moi Teaching and Referral hospital, Kenya. Methods A hospital-based prospective study was conducted between June 2024 and December 2025. A total of 289 participants were interviewed using the WHO Burn Registry form. Descriptive statistics and the Kaplan Meier analysis were used. Key Findings Out of 289 participants, children aged 0–5 years old were predominant, accounting for 177(61%). The proportion of burn injuries attributable to household energy was 273(94%), with 226 (78%) occurring during cooking. Most participants (55%) sustained burns involving 1–10% TBSA, while 17% had extensive burns affecting ≥30% TBSA, indicating a substantial burden of severe burn injuries. The arms were the most affected body part with 66% of the participants sustaining injuries on this area. Charcoal (36%) and wood (34%) accounted for a majority of the cases however, electricity and LPG contributed to the worst burn outcomes compared to wood and charcoal. Household energy-related burns were common among children and females. The median length of hospital stay was 30 days, IQR of 49 days. There was 26(9%) mortality, and 32(11%) permanent disability. Conclusion: From our findings, a large proportion of burn injuries were household energy-related and mostly caused by polluting fuels. Policies geared towards transitioning to safer household energy options and health education on burn injury prevention should be put in place.
Advances in acute burn care have improved survival following major burn injury, resulting in a growing population of patients living with long-term morbidity. Visual loss is a devastating complication usually attributed to direct ocular burns; however, indirect mechanisms related to systemic illness and critical care may be underrecognized. We present a case series of three patients with major burns (>55% total body surface area [TBSA]) who developed partial or complete permanent visual loss in the absence of direct ocular injury. All patients had normal initial ophthalmological examinations, including intact corneas and normal anterior segments. Visual impairment was identified only after prolonged intensive care unit (ICU) admission and weaning of sedation, highlighting the diagnostic challenges in critically ill and delirious patients. Two patients were diagnosed with ischemic optic neuropathy, likely secondary to systemic hypotension, large-volume fluid resuscitation, sepsis, and repeated prone positioning during intensive care and operative management. One developed irreversible unilateral blindness and the other developed profound bilateral visual loss, with minimal recovery in both cases. The third patient developed complete bilateral blindness attributed to toxic optic neuropathy following ingestion of gasoline prior to self-immolation, supported by orbital magnetic resonance imaging (MRI) and multidisciplinary review. This represents a rare and, to our knowledge, previously unreported mechanism of visual loss in burn patients. Indirect visual loss without direct ocular injury is a rare but catastrophic complication of major burn injury and may be overlooked during the acute phase of care. Awareness is essential, as early ophthalmological findings may be normal and treatment options remain limited once injury is established. Burn clinicians should maintain a high index of suspicion in patients with large TBSA burns, hemodynamic instability, prolonged ICU admission, prone positioning, or exposure to ignition fluids.
Background Long-term psychosocial consequences of burn trauma remain unexplored despite increasing numbers of burn survivors. Evidence suggests that up to 10% of adult burn survivors (mean age of 41.4 years) develop depression, while a substantial proportion report moderate to mild symptoms [1]. Objective To synthesize evidence on interventions for depression in burn patients, evaluate their therapeutic implications, and identify literature gaps to guide future clinical practice, system policy, and trial design. Methods Studies were identified from PubMed, Embase, Web of Science, MEDLINE, and PsycINFO using PRISMA guidelines. Grey literature and manual hand-searches were extracted using the snowball method. Eligible studies were published in English between 1980 and 2025, evaluating depression interventions in burn patients. Title/abstract, full-text screening, extraction, and quality assessment (GRADE criteria) were conducted independently in duplicate, with conflicts resolved by a blinded third author. Heterogeneity precluded meta-analyses, and findings were synthesized qualitatively. Results Our search strategy pulled 1176 articles, of which 13 studies met the study criteria and were categorized into psychosocial (n = 8), pharmacologic (n = 2), and multidisciplinary (n = 3) interventions. Most studies reported reductions in depressive symptoms among participants post-intervention. Conclusion Psychosocial, pharmacologic, and multidisciplinary interventions have the potential to treat depression in burn survivors. Future research needs to prioritize randomized controlled trials, standardized outcome measures, and long-term follow-up to establish robust, evidence-based interventions.
Introduction High-voltage electrical burns produce extensive soft-tissue destruction and vascular compromise, frequently requiring complex reconstructive procedures. Reconstruction of anterior chest wall defects is particularly challenging when preservation of upper-limb function is essential, especially in patients with contralateral limb loss. Careful selection of the reconstructive technique is therefore critical to achieve durable coverage while minimizing donor-site morbidity. Case presentation A 54-year-old man sustained a high-voltage electrical injury involving the anterior chest wall and right upper limb. Progressive ischemia resulted in right transradial amputation despite emergency fasciotomies and vascular assessment. Following serial debridements and partial failure of a skin graft, a 16 × 11 cm full-thickness precordial defect persisted. Because harvesting a latissimus dorsi muscle flap from the patient's only functional upper limb could compromise postoperative shoulder function and rehabilitation, reconstruction was performed using an ipsilateral adapted Arrow-type neurocutaneous advancement flap. The flap achieved complete tension-free coverage with uneventful postoperative healing, complete flap survival, and primary donor-site closure while avoiding sacrifice of the shoulder musculature. Conclusions This case highlights the importance of individualized reconstructive planning in patients with complex electrical burns. In selected patients, the neurocutaneous Arrow flap may represent a reliable alternative for anterior chest wall reconstruction, providing stable soft-tissue coverage while preserving upper-limb function and minimizing donor-site morbidity.
Aim To evaluate the physical and psychosocial consequences, and risk-taking behavior in children after firework-related burns up to 5 years post injury. Methods A single-center, cross-sectional study was conducted at the burn center of the Red Cross Hospital in Beverwijk, the Netherlands. Children under 18 years of age who sustained burns from fireworks and were treated between 2019 and 2024 were eligible. Children and their parents were invited to participate in semi-structured interviews, held face-to-face or online, in which questionnaires were completed. This was based on items from validated instruments, and addressed scar quality (POSAS), psychosocial well-being, treatment experiences and current firework use. Results Of 108 children treated for firework-related burns, 35 were included. A scar remained in 65.7% of the children, with 56.5% of these children expressing high satisfaction with their scar. The majority experienced no to minimal physical complaints, and most scars (69.6%) showed only minimal reduction in overall quality compared to unaffected skin. Most children reported low psychosocial impact of burns and scars. Furthermore, 85.7% rated the overall hospital care as good. Overall, 94.3% continued to use fireworks, with 42.9% not altering their behavior. Conclusion Firework-related burns and scarring have minimal physical and psychosocial impact, however some children reported persistent complaints. Most children continue to use fireworks, with a notable portion not adjusting their behavior. Given the continuous use and strong appeal of fireworks, and the fact that most injuries result from improper use, prevention campaigns are likely most effective when focused on safe handling and (parental) supervision.
Burn dressing changes in the pediatric population can be painful. Distracting the patient is a useful non-pharmacologic tool to reduce pain severity, but further research is needed to optimize its impact on pain in children. In this randomized controlled study, traditional distraction provided by a certified child life specialist (CCLS) was compared to distraction provided by a deluxe mobile sensory station (DMSS) to determine if one method provided better pain relief for pediatric patients during burn dressing changes. Pain levels were measured before, during, and after wound care using three pain scales. The pediatric patients rated their pain using the Wong Baker FACES scale. Their caregiver rated the patient's pain using the numeric pain scale, and a nurse rated the patient's pain using the FLACC scale. Descriptive and inferential statistics which included Friedman, Mann-Whitney U tests and regression analysis, were completed to compare the two distraction approaches for their effect of pain severity and to control for burn injury size as a percentage of body surface area and for the duration of the procedure. Our analyses revealed no statistically significant differences in the pain scores of patients who received the DMSS or traditional distraction. Further research is needed to determine alternative non-pharmacological ways to help reduce pain in the pediatric population during burn dressing changes.
Firework-related injuries in children are typically associated with high-energy consumer fireworks, while major injuries caused by fireworks classified as low risk are less frequently described. We present a case of a three-year-old girl who sustained a severe penetrating neck burn after an ignited ground spinner (F1 firework) became trapped inside the collar of her jacket. Despite its classification as child-appropriate firework, the confined ignition resulted in airway-related symptoms, gunpowder particles in the mediastinum, deep soft tissue injury, and delayed wound necrosis. The clinical course required multiple surgical interventions and prolonged follow-up. Firework-related injuries in children more frequently occur in bystanders than active users, highlighting their vulnerability even without direct involvement. This case highlights that (child friendly) fireworks perceived as low risk can cause complex and potentially life-threatening injuries in young children. Paediatric burn injuries should be considered as multisystem events with possible long-term physical and psychosocial consequences. Prevention-focused awareness therefore remains essential, particularly as F1 fireworks will remain legally available despite upcoming regulatory changes.
Cricothyrotomy is generally considered a temporary emergency airway, with conversion to tracheostomy recommended when prolonged airway management is required. However, tracheostomy may be technically difficult or high risk in patients with extensive cervical burns.We report the case of a 58-year-old woman with severe burns involving 85% of the total body surface area, including the face and neck, following a residential fire. She developed stridor, hypoxemia, and impaired consciousness. Endotracheal intubation was unsuccessful because of carbonized cervical tissue and inability to extend the neck. Emergency cricothyrotomy was therefore performed in the ambulance.During hospitalization, she underwent repeated debridement and four split-thickness skin graft procedures. Conversion to tracheostomy was avoided because of the invasiveness of additional surgery, severe limitation of neck extension caused by grafted and contracted cervical skin, and concern regarding persistent dual stomas. Airway management was continued through the original cricothyrotomy site. A speech cannula initially failed because of edema and high cannula positioning near the vocal cords, but successful phonation was achieved after improvement of fluid overload. Decannulation was performed on day 260 with preserved phonation. She was transferred for rehabilitation on day 362 without airway complications requiring surgical intervention.This case suggests that prolonged cricothyrotomy may be considered in carefully selected burn patients when tracheostomy is technically difficult or carries substantial risk and when serial airway assessment is available.
Background: General-purpose multimodal AI systems are now accessible to clinicians and patients. While they can process medical images and extract visual features, it remains unclear whether they can translate these into appropriate clinical decisions in burn care. Methods: Sixty burn wound images were assessed by four multimodal AI models (GPT-5.4 Pro, Grok 4.1, Gemini 3.1 Pro, Claude Opus 4.6), each queried five times. Performance was evaluated across multiple variables along a clinical decision pathway from burn depth classification to surgical indication and management (1200 evaluations per variable; 7200 total assessments). The dataset reflected specialist referral patterns, with 95% of cases requiring surgery. Results: Model performance deteriorated along the clinical pathway. Burn depth classification exceeded the majority-class baseline (50.0–62.7% vs. 41.7%). In contrast, surgical decision accuracy (55.0–76.0%) and management accuracy (11.0–54.7%) fell below baseline in every model. Surgical errors were predominantly false negatives, with sensitivity of 52.6–75.8%. A recommendation against surgery was correct in fewer than 15% of cases. For management, models systematically avoided the intermediate category (debridement), instead oscillating between conservative treatment and skin grafting. These errors were structured and reproducible; the most consistent models often performed below baseline accuracy. Conclusions: Current multimodal AI systems can recognize burn characteristics but fail to translate into reliable clinical decisions. Errors were systematic and clinically consequential, predominantly reflecting undertreatment. General-purpose AI tools are not yet suitable for independent use in burn care and will require dedicated models or targeted adaptation of existing systems to achieve clinically reliable decision-making.
