Background Early urinary myoglobin may indicate extensive tissue injury after burns, but its prognostic value remains uncertain. We evaluated its association with in-hospital mortality and time to hospital discharge. Methods This single-centre retrospective cohort included 721 burn patients with an available urinary myoglobin result among 1,005 potentially eligible admissions from 2020 to 2024. Myoglobinuria was assessed during the initial hospital evaluation using a qualitative ammonium sulphate precipitation test. Multivariable logistic regression evaluated in-hospital mortality. Time to hospital discharge was analyzed using cause-specific proportional hazards regression, with in-hospital death treated as a competing event. Results Early qualitative myoglobinuria was present in 141 patients (19.6%). Positive patients had more extensive and deeper burns, more inhalation injury, and more associated injuries. Mortality was higher with positive than negative myoglobinuria (53.9% vs. 25.0%; p<0.001). After adjustment for age, sex, total body surface area, burn depth, and inhalation injury, myoglobinuria remained associated with mortality (adjusted OR 2.27, 95% CI 1.37–3.78; p=0.002). Positive myoglobinuria was associated with a lower unadjusted discharge rate (cause-specific HR 0.67, 95% CI 0.52–0.87; p=0.003), but not after adjustment (adjusted HR 0.82, 95% CI 0.62–1.10; p=0.185). Conclusions Early qualitative myoglobinuria was associated with greater burn severity and increased inhospital mortality. Its association with time to discharge was attenuated after adjustment. These findings require prospective multicentre validation using standardized quantitative myoglobin measurements.
Objective Frostbite injuries remain a significant clinical problem, particularly in populations exposed to harsh environmental conditions and limited access to healthcare. This study aimed to evaluate the clinical characteristics, risk factors, and outcomes of frostbite cases managed at a tertiary care center. Materials and Methods This retrospective study included 159 patients diagnosed with frostbite over five years. Demographic, clinical, and laboratory data were recorded for all patients. Cases were classified according to frostbite severity. Statistical analyses were performed using SPSS software, with a significance threshold set at p < 0.05. Results The majority of patients were young males (97.5%), and a large proportion consisted of refugees. Most cases were classified as fourth-degree frostbite (77.4%). The overall amputation rate was 76.1%.The strongest predictors of amputation were higher frostbite grade (p < 0.001), hypotension at admission (p < 0.001), elevated white blood cell count (p = 0.006), and greater TBSA involvement (p = 0.040). Refugee status was also associated with increased amputation risk (p = 0.035).The mean hospital length of stay was 14.3 ± 7.3 days, which was higher than values reported in the literature, largely due to delayed hospital presentation. Conclusion Frostbite injuries in this cohort were associated with high amputation rates. Delayed presentation and advanced-stage injuries appear to be the main drivers of poor clinical outcomes. Early presentation, prompt diagnosis, and timely initiation of appropriate treatment remain critical in reducing morbidity and improving overall outcomes.
Introduction In Western Australia, ablative fractional CO2 laser therapy (AFCO2L) was introduced to treat hypertrophic burn scars (HBS) in 2012. The purpose of this study was to: review the outcomes of the burn patient cohort who received AFCO2L over the first 12 years of the service; and, compare outcomes of those treated with peers not treated with laser. Methods This retrospective cohort study included all patients who received AFCO2L at the Western Australian State Adult Burn Unit between 2012 and 2024. Multidimensional scar outcomes of laser-treated adult burn patients were described and compared with: a timebound cohort including all inpatients and a random selection of 1000 outpatients; and, secondly a group of closely matched peers. Scar and quality of life (QoL) outcomes were analysed for patients who completed a survey package including the Patient and Observer Scar Assessment Scale (POSAS), SF-36, and customised itch questions. Results During the study period, a total of 4005 laser sessions involving 837 individuals were completed. Patients receiving AFCO2L had poorer quality scars at baseline, compared to their peers. From three to six months after burn, the 95% confidence intervals for various and multiple scar, QoL and symptom outcomes of the laser treated patient group overlapped, or converged, with those of the routine care groups. A subset analysis found POSAS scores after only one laser treatment had significant positive changes in itch (p=0.018) and color (p=0.027). Conclusions This study showed that AFCO2L treated patient scar and quality of life outcomes were improved, and converged over time across multiple domains and measures, with those from patients with lower scar burden who were not treated with laser.
Background Acute respiratory distress syndrome (ARDS) is a major complication in severely burn-injured patients and is associated with high mortality. In refractory respiratory failure, veno-venous extracorporeal membrane oxygenation (V-V ECMO) may serve as rescue therapy. However, evidence in burn-injured patients remains limited, and burn-specific predictors of outcome are poorly defined. Methods This retrospective single-center cohort study included all severely burn-injured patients with ARDS treated with V-V ECMO between January 2022 and October 2025. Survivors and non-survivors were compared regarding burn characteristics, clinical course, ECMO-related parameters, and complications. Longitudinal physiological and ECMO-specific parameters, including blood flow, sweep gas flow, lactate, and gas exchange variables, were analyzed. Results Sixteen patients were included. Successful ECMO weaning was achieved in 56.3%. Survival at 30 and 60 days after ECMO initiation was 50%, while one-year survival was 33.3%. Non-survivors showed greater burn severity, reflected by higher total body surface area (TBSA), more full-thickness burns, and higher abbreviated burn severity index (ABSI) and revised Baux scores. At ECMO initiation, they exhibited greater physiological derangement, including higher sequential organ failure assessment scores (SOFA), lactate levels, and coagulation abnormalities. The respiratory ECMO survival prediction score (RESP) showed limited discriminatory value. Blood flow and sweep gas flow were comparable between groups, whereas non-survivors demonstrated persistently elevated lactate levels, higher PaCO₂, and lower pH despite maintained oxygenation. Conclusions V-V ECMO is a feasible rescue strategy in selected severely burn-injured patients with ARDS, but mortality remains high and appears to be driven predominantly by burn-specific and systemic factors rather than respiratory failure alone. Burn severity markers and early physiological trajectories may provide valuable prognostic information.
Introduction large burns are associated with a massive inflammatory response and catecholamine release leading to complex cardiovascular disorders. Our aim was to describe the early hemodynamic trajectories following severe burns and to identify distinct hemodynamic trajectory patterns. Method We retrospectively collected data from patients admitted to our burn center for severe burn injuries between January 2017 and April 2025. Hemodynamic data were obtained by transpulmonary thermodilution coupled with pulse wave analysis. Time series for cardiac index (CI), systemic vascular resistance index (SVRI) and heart rate (HR) were analyzed for the first 96hours. Hemodynamic profiles were compared using dynamic time warping (DTW). Clusters were identified through hierarchical clustering. Results A total of 107 patients were included (median age 52 years [IQR: 36-65], median total burn surface area 40% [IQR: 30-54]), 22 patients died during their ICU stay. In the entire cohort, the hemodynamic profile progressively shifted from a low-cardiac output, vasoconstrictive state to a hyperkinetic, vasoplegic state (CI 2.6 ± 0.8 to 4.8 ± 1.3L/min/m2; SVRI 3362[2659-4489] to 1382[1118-1698] dyn.s.cm-5.m2, p < 0.05). Cluster analysis identified two hemodynamic trajectory patterns, one with CI stabilization after an initial rise and another with a continuous increase in CI. SVRI decreased similarly in both clusters. ICU mortality differed between clusters in univariate analysis. Conclusion This study confirms a two-phase hemodynamic response to severe burns under active fluid resuscitation. It provides evidence for distinct hemodynamic trajectories patterns. These profiles could help optimize individual resuscitation strategies.
Purpose Substance use disorders (SUD) are common among burn patients and may influence recovery, pain management, and postoperative complications. While prior studies have examined general predictors of burn outcomes, limited research has focused on SUD and region-specific injuries. This study evaluated the association between preexisting cannabis, tobacco, and alcohol use disorders and prolonged opioid use, wound infection, and postoperative pain in patients with head, neck, and facial burns. Methods A retrospective cohort study was conducted using the TriNetX Research Network, comprising data from 109 healthcare organizations. Adult patients (≥18 years) with head, neck, or facial burns were included. Cohorts were stratified based on documented diagnoses of cannabis, tobacco, or alcohol use disorders prior to injury. Outcomes were assessed at one, three, and six months post-burn. Multivariable regression models were used to evaluate associations between SUD and prolonged opioid use, wound infection, and postoperative pain. Risk ratios (RRs), 95% confidence intervals (CIs), and p-values were reported, with statistical significance set at p < 0.05. Results At all timepoints, cannabis (RR: 1.685–2.108), tobacco (RR: 1.722–2.51), and alcohol use disorders (RR: 1.878–2.239) were significantly associated with prolonged opioid use (p < 0.0001). Tobacco use disorder was the only SUD consistently associated with increased wound infection risk across all timepoints (RR: 2.043–2.51, p < 0.01). Cannabis and alcohol use disorders were not significantly associated with wound infection. Postoperative pain was significantly increased among patients with cannabis (RR: 1.973–2.108), alcohol (RR: 1.878–2.083), and tobacco use disorders (RR: 1.722–1.850). Conclusion Preexisting SUDs are associated with prolonged opioid use and increased postoperative pain following head, neck, and facial burns, while tobacco use disorder is additionally associated with higher wound infection risk. These findings highlight the need for tailored perioperative and pain management strategies in burn patients with SUD.
Purpose This study examines regional differences in community reintegration outcomes among burn survivors treated at three major U.S. burn centers and asks whether those differences are associated with where patients live. Methods We used data from 531 adult burn survivors in the Burn Model System (BMS) National Database, treated at centers in Seattle, Dallas, and Boston between 2015 and 2023. We linked individual-level clinical and demographic data with county-level structural variables from the Urban Institute and compared Community Integration Questionnaire (CIQ) change scores across centers, alongside patient characteristics and residential community conditions. Results Dallas patients experienced a significantly greater decline in CIQ scores at six months post-injury than Seattle patients (∆ = -0.71, p =.004), while Boston patients showed outcomes comparable to Seattle (∆ = -0.27, p =.276). Clinical characteristics did not differ significantly between Dallas and Seattle. Dallas patients lived in counties with substantially worse economic conditions than Seattle patients, including lower household income at the 20th percentile, higher debt burden, lower economic connectedness, and higher crime rates. Boston patients lived in counties that did not show this pattern of disadvantage, remaining comparable to or more favorable than Seattle's on the same indicators. Conclusions Community reintegration after burn injury varies systematically across burn centers in ways that correspond to differences in the structural conditions of communities patients return to. These findings highlight the need to incorporate residential community conditions into burn rehabilitation planning and discharge support.
Background Burn injury is a common traumatic event that can lead to long-term neurological sequelae, yet the underlying mechanisms remain poorly understood. We aimed to investigate the associations between burn injury and long-term neurological outcomes, and to examine the potential mediating roles of plasma metabolite profiles and brain structural alterations. Methods We conducted a prospective cohort study using data from UK Biobank. Neurological outcomes—including stroke, limb weakness, hearing loss, cognitive decline, depression, anxiety, and insomnia—were assessed. Plasma metabolomics were profiled using NMR spectroscopy, and brain structural metrics were derived from MRI in a subset of participants. Mediation analyses evaluated whether metabolite or brain structural changes explained the associations between burn injury and neurological outcomes. An updated review was performed to contextualize our findings based on our previous study. Results Burn injury was associated with significantly increased risks of stroke (Hazard Ratio [HR]: 1.67; 95% confidence interval [CI]: 1.42-1.97), limb weakness (HR: 1.45; 95% CI: 1.16-1.81), hearing loss (HR: 1.48; 95% CI: 1.20-1.83), cognitive decline (HR: 1.42; 95% CI: 1.11-1.80), anxiety (HR: 1.33; 95% CI: 1.10-1.59), and insomnia (HR: 3.60; 95% CI: 2.69-4.80). Plasma metabolite profiling revealed persistent alterations in lipoprotein subclasses, fatty acid composition, and amino acid metabolites, several of which partially mediated associations with stroke and limb weakness. Burn injury was also linked to widespread white matter microstructural abnormalities and reduced cortical gray matter volume; however, brain structural changes did not mediate the neurological risks. Conclusions Burn injury is associated with elevated long-term neurological risks, accompanied by persistent metabolic and neurobiological alterations. Metabolic dysregulation partially mediates neurovascular outcomes, while structural brain changes may reflect parallel or secondary processes.
Introduction Burn injuries remain a leading cause of morbidity and mortality worldwide, with survivors often requiring prolonged hospitalization, complex wound care, and intensive rehabilitation. Concurrently, cannabis use has risen substantially in North America and Europe, with recent data showing cannabis use in approximately 16–18% of burn admissions by 2025. Cannabinoids influence pain, immunity, and cardiopulmonary physiology, making their role in burn recovery clinically relevant but poorly defined. Methods A systematic review was conducted evaluating cannabis exposure and outcomes in burn patients. MEDLINE, Embase, CINAHL, and Cochrane databases were searched from inception to August 2025. Eligible studies included hospitalized burn patients of any age, with cannabis exposure identified via toxicology, history, or coding, and reported outcomes stratified by cannabis exposure. Outcomes of interest included mortality, infection, graft success, thromboembolism, ventilation, ICU and hospital length of stay, opioid use, discharge disposition, and readmission. Results Of 1009 studies, eight met inclusion criteria, with sample sizes ranging from 64 to over 300,000 patients. Cannabis exposure was identified via toxicology, history, or coding. Across studies, cannabis was not consistently associated with inpatient mortality. Some single-center analyses reported increased opioid and anxiolytic requirements, higher wound infection rates, longer ICU stays, and more reoperations. National database studies found lower adjusted mortality among cannabis-using patients but higher rates of ventilator-associated pneumonia, venous thromboembolism, and prolonged ICU stays. Heterogeneity was pronounced, with polysubstance use, burn severity, and demographic differences influencing outcomes. Conclusion Overall, cannabis exposure does not appear to worsen survival in burn patients but may predispose to infectious, respiratory, and thromboembolic complications. The evidence base is limited by retrospective design, inconsistent exposure definitions, and confounding from polysubstance use. Cannabis positivity at admission should prompt heightened monitoring for complications and tailored pain management. Future prospective, multicenter studies with detailed exposure characterization and long-term follow-up are needed to clarify cannabis’ role in burn recovery and to inform evidence-based analgesic strategies.
Acute kidney injury (AKI) is a severe complication of burn trauma and is associated with significantly increased mortality. Resveratrol (RES) has shown therapeutic potential in AKI, yet its role in burn-induced AKI, particularly through the modulation of succinylation, remains unclear. This study aimed to investigate the protective effects of RES and the underlying molecular mechanisms in a burn-related AKI model. In vivo, AKI was induced in Sprague–Dawley rats by exposing the dorsal skin to boiling water, while in vitro, human kidney proximal tubular (HK2) cells were stimulated with lipopolysaccharide (LPS) to mimic inflammatory injury. The therapeutic efficacy of RES was assessed by measuring renal function parameters, inflammatory cytokine levels, and kidney injury biomarkers, supported by histopathological and ultrastructural examinations. In vitro, the effects of RES were evaluated through cell viability, apoptosis, and mitophagy assays. Mechanistic insights were obtained using molecular docking, surface plasmon resonance (SPR), western blotting, immunoprecipitation (IP), and co-immunoprecipitation (Co-IP). RES treatment significantly reduced blood urea nitrogen (BUN), serum creatinine (SCr), pro-inflammatory cytokines, and kidney injury molecule-1 (KIM-1) levels, attenuated renal tubular damage, and improved mitochondrial and autophagosomal ultrastructure in burned rats. In LPS-stimulated HK2 cells, RES inhibited apoptosis and promoted mitophagy. Mechanistically, RES upregulated SIRT5 expression, which decreased global succinylation levels and enhanced ATG3 protein stability via K9 desuccinylation. Notably, ATG3 knockdown abrogated the renoprotective effects of RES in both in vivo and in vitro models. Collectively, these findings demonstrate that RES upregulates SIRT5 and inhibits ATG3 succinylation, thereby stabilizing ATG3 and promoting mitophagy, which collectively ameliorate burn-induced AKI.
