Abstract Introduction Bromelain based Enzymatic Debridement (BBED) for burn injuries has been practiced for more than 10 years in Europe. Exposure to BBED in the US is still relatively small, as it was only recently approved by the US FDA in December of 2022. We reviewed our initial post-FDA approval experience using BBED for deep partial and full thickness burns. Methods An IRB approved, single-center, retrospective study was performed from October 2023 to August 2025. Data included patient demographics, total body surface area (TBSA) burn, enzymatically treated area, mechanism of burn, time post-burn until BBED application, pain management, post-BBED dressings, need for and timing of skin grafting, overall time until complete wound closure, and reconstructive procedures. Wound beds post-BBED were evaluated by experienced burn surgeon and subsequently assessed for the need for surgical closure. Wound beds were also documented by photography. Results In our review, 32 Patients (21 Men, 11 Females), age range 18-95 yrs (mean - 46.25 yrs) underwent BBED for 23 flame burns, and 9 scalds. The mean interval from time of burn injury to BBED was 48 hours. Upper extremity (25) was the most common site followed by lower extremity (9), torso (2) and face (1). Mean TBSA was 9% (range 1%-90%) while mean enzymatic area was 5% (1%- 30%). Nine (28.2%) patients healed without skin grafting. Skin grafting was performed in 23 (71.8%) patients. The most commonly used dressings were allografts and xenografts. Time until 95% wound closure averaged 15 days. Two patients required contracture release and grafting, dorsal hand and elbow flexure contracture. No patients required their procedures to be aborted for pain or other adverse effects. All treatments resulted in >95% eschar removal after 1 treatment. Conclusions At our burn center, BBED was most commonly used for deep partial and full thickness burns to the upper extremities, including the hands. Pain was well controlled and the procedure was well tolerated. Burns expected to heal without grafting were treated with xenografts and silver foam dressings. Applicability of Research to Practice BBED by its virtue of selective eschar removal can help preserve viable dermis and avoid the need for skin grafting in some mixed partial thickness and full thickness burns. In patients who require skin grafting thinner grafts may be harvested. Funding for the study N/A.

Abstract Introduction Laser therapy is an effective treatment at improving outcomes for burn survivors from symptomatic and hypertrophic burn scars. Despite lasers being increasingly adopted by burn centers, we noticed more patients were denied laser treatment coverage by their insurance carriers. With reasonable medical documentation, photographs, literature supporting the rationale for treatment and prior authorizations, we were puzzled why this was happening. In 2024, we began to utilize t codes for laser submissions and our hypothesis was that decreases in laser payment was related to this coding change. Therefore, we performed a retrospective review of the claims data from 2023 and 2024 to evaluate rates of payment for laser therapy over time with use of the t-codes. Methods With IRB approval, insurance claim data was pulled from fiscal year 2023 and 2024 for laser treatment of burn patients. In 2023, the laser codes were 17 106-8. In 2024, they were 17 106-8, 0479 t, and 0480 t. As a negative control, we also compared reconstructive surgical codes for adjacent tissue rearrangements and full thickness skin grafts. Demographic information was collected for both groups (age, sex, TBSA, etiology, and ethnicity). Rates of insurance approval were noted for both groups over time. Laser and reconstructive surgical procedures were compared over time and to one another and for rates of approval. T-tests with unequal variance were performed. Results Comparing laser and surgical reconstructive treatments, the demographics of the two groups were very similar, as patients often were in both, but a few differences were noted. Males had surgery 8% more than females (p=.041), females had laser 15% more than males (p=.035), and patients with a TBSA under 10% had laser 14% more than surgery (p=.006). From 2023 to 2024, laser payment rates decreased from 94.3% to 78.2% (p = < 0.001). In 2024 when t-codes were first used, 13 were paid, 20 were denied and there was no difference between these groups (p=.21). Reconstructive procedures were paid at 94.5% in 2023 and 94.4% in 2024 (p=.98). Laser vs. reconstructive surgery showed no difference in payment rates in 2023 and 2024, both at 94% (p=.94), but in 2024 there was a significant difference in payment of 78.9% vs. 94.4% (p<.001) respectively. Conclusions Based on our analysis from 2023 to 2024, the 16.1% decrease in payment for laser was not explained by demographic differences or the use of t codes, and a similar decrease was not seen in reconstructive surgical procedures. Further research is needed to better explain the decline in payment rates by insurance carriers for laser. Applicability of Research to Practice We plan to analyze fiscal year 2025 for laser and surgical reconstructive surgeries to trend the data over a three-year timeframe, with a full year of t-code utilization. By evaluating laser denial rates, we hope to better understand these insurance challenges so we can improve access to laser therapy for burn survivors. Funding for the study N/A.

Abstract Introduction Axillary burn contracture is a common and debilitating complication of burn injuries, impairing mobility and quality of life. Multiple classification systems and treatments exist, but the optimal choice remains controversial as there is limited systematic data comparing outcomes across techniques and classifications. Methods A systematic review was performed on surgical management of post-burn axillary contractures. PubMed, Embase, and Web of Science were searched for eligible studies that include full-text original articles with >3 human patients. Data were extracted and quality assessed independently by two reviewers with disputes settled by a third. Outcomes were synthesized qualitatively and, where feasible, meta-analyzed with subgroup analyses by contracture type. Results Of 1196 articles screened, 64 met inclusion, encompassing 1823 patients with axillary burn contracture. Most were case series, with few comparative designs. Formal classification systems were rarely applied; when used, Kurtzman and Stern was most common. Reported surgical approaches included skin grafting (n = 327), scapular flaps (n = 117), and square flaps (n = 76), with additional series describing other local, regional, and free flap techniques. Variable reporting and inconsistent classification use limited detailed subgroup analysis. Conclusions Local flap techniques appear to provide favorable outcomes in axillary burn contractures, with lower recurrence and better functional preservation reported in several studies compared to skin grafting. However, inconsistent use of classification systems and variable outcome reporting limit direct comparisons across studies. Standardized reporting of contracture type and surgical outcomes is needed to guide evidence-based selection of reconstructive techniques. These findings suggest that flap-based reconstructions may be advantageous, particularly for more severe contractures, though further high-quality studies are needed. Applicability of Research to Practice This study addresses different surgical approaches for post-burn axillary contractures. The findings help clarify whether current surgical patterns align with best outcomes and inform evidence-based recommendations for managing these cases. Funding for the study No external funding was received for this review. The review is supported by the guarantor/review team’s (non-commercial) institutional affiliations.

This pilot study evaluated the feasibility of treating third-degree, full-thickness burn wounds with both split-thickness skin grafts (STSGs) and micro skin tissue columns (MSTC). Donor sites for both grafting techniques were also assessed. Patients aged ≥18 years with ≤60% TBSA third-degree, full-thickness burns were enrolled. One 2.5 × 2.5 cm2 wound area was treated in each subject, with the remaining portion of the wound used as an internal control. The target wound was treated with MSTCs + STSG while the control site was treated with STSG. Patients were followed for up to 9 months after wound closure. Primary endpoints included re-epithelialization rate, scarring (VSS, Patient and Observer Scar Assessment Scale), and donor site pain (visual analogue scale). Ten patients were enrolled. Overall, MSTC donor sites were less painful, epithelialized faster, and resulted in improved Patient Observer Scar Assessment Scale and Vancouver Scar Scale (VSS) scores than STSG donor sites. For all endpoints, there were no differences in the recipient wounds grafted with or without MSTCs. Intraoperative MSTC grafting is feasible and results in minimal donor site morbidity. This pilot study was unable to demonstrate enhanced wound healing or reduced scar formation when MSTCs were applied simultaneously with STSGs to burn wounds. Larger clinical studies are needed to assess the utility of MSTCs in conjunction with STSGs.

Burn reconstruction outcomes are an area of growing investigation. Although there is evidence of measured physical improvements in scar characteristics after laser treatment, there is little information on patient-reported outcomes. The purpose of this study is to compare patient-reported outcomes between burn survivors with and without laser treatment. The study included participants in the Burn Model System National Database at a single center; participants that received outpatient laser treatment for burn scars were compared to a matched group of burn survivors that did not receive laser. The following outcomes were examined: Satisfaction With Life Scale, Mental and Physical Component Summary of the Veterans Rand Survey, and the Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Intensity Scale. Regression analyses examined the associations between laser treatment and each outcome at 12 and 24 months. The study population included 287 adult burn survivors (65 laser group and 222 control group). The significant differences found between the 2 groups included: burn size (laser: 14.9, 13.5 SD, control: 8.9, 11.1 SD; P < .001), insurance type (P = .036), inhalation injury (laser: 17.2%, control: 2.7%; P < .001), and ventilator requirement (laser: 27.7%, control: 13.5%; P = .013). Laser treatment was not associated with any of the outcomes at both follow-up time points. Further research is needed to develop patient-reported outcome measures that are more sensitive to the clinical changes experienced by burn survivors receiving laser treatment.

Abstract Introduction Many burn injuries result in a prolonged recovery involving extensive therapy and surgical reconstruction. Burn patients experience a broad range of symptoms and acute symptoms can develop into chronic conditions that can significantly impact function and overall quality of life. Hypertrophic scars, a complication from burn injury, can lead to contractures, tightness, pain, pruritis, altered appearance, and impaired psychosocial well-being. The Brisbane Burn Scar Impact Profile (BBSIP) is a patient-reported health-related quality of life survey designed to assess the impact of burn scars in children and adults. In this study, we aimed to assess the reliability and factor structure of the BBSIP in adult patients with hypertrophic burn scars undergoing reconstruction and/or laser treatment. Methods A prospective cohort study enrolled 113 adult patients with hypertrophic burn scars undergoing reconstruction, including skin grafts, and/or laser treatment at a North American major tertiary care center. Patient demographics, percent total body surface area (TBSA) burned, and burn etiologies were obtained. A total of 238 surveys were collected after a reconstructive or laser treatment. An exploratory and confirmatory factor analysis was carried out on the seven sub-domains of the BBSIP to determine the reliability of each. For each sub-domain, we determined the acceptable model fit with a comparative fit index (CFI) >0.9 and a root mean square error of approximation (RMSEA) < 0.1. We considered a sub-domain to have acceptable reliability if the omega reliability or coefficient omega hierarchical was greater than 0.8. Results Of the 113 patients (59 female, 54 male), 61 (54%) completed the survey only once, 20 (17.7%) completed 2 surveys, and 16 (14.2%) completed 3 surveys. For the burn patients, most sub-domains in the BBSIP (sensory symptoms, work/daily activities, relationships/social interactions, appearance, emotional reactions, and physical symptoms) presented with a unidimensional scale (CFI>0.9 and RMSEA < 0.1) and had an acceptable reliability (omega reliability or coefficient omega hierarchical ranged from 0.8 to 0.94) after eliminating select items from the profile that were redundant. The “overall impact” sub-domain presented as a multidimensional scale and was also found to have acceptable reliability. Conclusions This study demonstrates acceptable reliability of the BBSIP in adult patients with hypertrophic burn scars undergoing reconstruction and/or laser treatment. To strengthen BBSIP reliability, within each sub-domain (except “overall impact”), we recommend deleting misfit items and pairing others. This modification would decrease the redundancy of questions and ensure the survey more reliably assesses the impact of burn scars. Applicability of Research to Practice This study provides recommended changes to the BBSIQ that will improve its reliability in the clinical setting.

Cold-induced injuries are a major challenge for burn surgeons, leading to significant sequelae for the patients including amputations, long-term disability, and death. Rapid assessment and diagnosis are essential for optimal outcomes. Various therapies have emerged to improve outcomes. Topical, oral, and intravenous agents have shown to minimize the impact of cold-induced injuries. Thrombolytics have shown the greatest promise in improving tissue perfusion outcomes in cold-induced injuries. This article provides an update on the evidence-based assessment and management of cold-induced injuries, as well as reviews outcomes and future directions of this challenging pathology.

Abstract Introduction Hypertrophic scars can result from burn injury, often leading to a long-term recovery that involves surgical reconstruction and rehabilitation. The Brisbane Burn Scar Impact Profile (BBSIP) is a patient-reported health-related quality of life survey designed to assess the impact of burn scars in children and adults. In this study, we aimed to assess the longitudinal outcomes of changes of BBSIP scores in adult patients with hypertrophic burn scars undergoing reconstruction and/or laser treatment. Methods A prospective study enrolled 113 adult patients with hypertrophic burn scars undergoing reconstruction, including skin grafts, and/or laser treatment at a major North American tertiary care center. Patient demographics, percent total body surface area (TBSA) burned, and burn etiology were obtained. A total of 238 surveys were collected after a reconstructive or laser treatment. Using exploratory and confirmatory factor analysis (FA) on the 7 sub-domains of the BBSIP, we developed an overall impact scale from two subscales: factor 1 and factor 2 were each comprised of 5 items. BBSIP scores were calculated as the average item scores within each scale and standardized to a t-score using scores from respondents who first completed the survey. We assessed the impact of demographics on BBSIP scores over time using a linear mixed model. We used a BIC (Bayesian information criteria) value to determine the optimal model by adding the interactions between time since injury and the independent demographic variables. We calculated regression coefficients (95% confidence interval) and determined statistical significance at p< 0.05. Results Of the 113 patients (59 female, 54 male), 61 (54%) completed the survey only once, 20 (17.7%) completed 2 surveys, and 16 (14.2%) completed 3 surveys. For the factor 2 scores, the three sub-domains (relationships and social interactions, appearance, and emotion) were found to decrease over time since burn injury, with males having about 0.7 standard deviation lower scores than females. Males were found to have lower scores than females for all sub-domains except for factor 1’s work and daily activities scores. Skin grafts resulted in decreasing scores for itch, pain, and other sensations with longer periods of time from burn injury. Skin grafts also resulted in decreasing scores for work and daily activities with increasing time from burn injury for subjects with TBSA>5%. Conclusions This study demonstrates how BBSIP scores may change over time in adult patients with hypertrophic burn scars undergoing reconstruction and/or laser treatment. A deeper understanding of the anticipated trajectory of quality of life measures in these patients can help guide burn care providers in developing long-term management plans. Applicability of Research to Practice This study helps clinicians understand how key health-related quality of life measures may evolve over time in adult burn patients with hypertrophic scars.

Autografting with split-thickness skin grafts (STSG) remains an essential procedure in burn and reconstructive surgery. The process of harvesting STSG, however, leaves behind a donor site, an exposed area of partial-thickness dermis left to heal by secondary intention. There has yet to be a consensus amongst surgeons regarding optimal management of the donor site. The ideal donor site dressing is one that allows for expeditious healing while minimizing pain and infection. Despite numerous studies demonstrating the superiority of moist wound healing, many surgeons continue to treat STSG donor sites dry, with petroleum-based gauze. In this study, two burn centers performed a retrospective review of burn patients whose STSG donor sites were treated with either Xeroform® or Mepilex® Ag dressings. Infections were documented and in a subgroup analysis of patients, postoperative pain scores were noted and total opiate usage during hospitalization was calculated. Analysis revealed an overall infection rate of 1.2% in the Mepilex® Ag group and 11.4% in the Xeroform® group (p<0.0001). Patients with Xeroform® donor site dressings had increased odds of donor site infection (OR=10.8, p=0.002). In subgroup analysis, there were no significant differences in maximum pain scores between Mepilex® Ag and Xeroform® groups, nor were there differences in opiate usage. STSG donor sites dressed with silver foam dressings have a lower rate of donor site infection relative to those dressed with petroleum-based gauze. Moist donor site dressings such as foam dressings (including Mepilex® Ag) should be the standard of care in STSG donor site wound care.

ABSTRACT Introduction: Despite significant advances in pediatric burn care, bloodstream infections (BSIs) remain a compelling challenge during recovery. A personalized medicine approach for accurate prediction of BSIs before they occur would contribute to prevention efforts and improve patient outcomes. Methods: We analyzed the blood transcriptome of severely burned (total burn surface area [TBSA] ≥20%) patients in the multicenter Inflammation and Host Response to Injury (“Glue Grant”) cohort. Our study included 82 pediatric (aged <16 years) patients, with blood samples at least 3 days before the observed BSI episode. We applied the least absolute shrinkage and selection operator (LASSO) machine-learning algorithm to select a panel of biomarkers predictive of BSI outcome. Results: We developed a panel of 10 probe sets corresponding to six annotated genes (ARG2 [arginase 2], CPT1A [carnitine palmitoyltransferase 1A], FYB [FYN binding protein], ITCH [itchy E3 ubiquitin protein ligase], MACF1 [microtubule actin crosslinking factor 1], and SSH2 [slingshot protein phosphatase 2]), two uncharacterized (LOC101928635, LOC101929599), and two unannotated regions. Our multibiomarker panel model yielded highly accurate prediction (area under the receiver operating characteristic curve, 0.938; 95% confidence interval [CI], 0.881–0.981) compared with models with TBSA (0.708; 95% CI, 0.588–0.824) or TBSA and inhalation injury status (0.792; 95% CI, 0.676–0.892). A model combining the multibiomarker panel with TBSA and inhalation injury status further improved prediction (0.978; 95% CI, 0.941–1.000). Conclusions: The multibiomarker panel model yielded a highly accurate prediction of BSIs before their onset. Knowing patients' risk profile early will guide clinicians to take rapid preventive measures for limiting infections, promote antibiotic stewardship that may aid in alleviating the current antibiotic resistance crisis, shorten hospital length of stay and burden on health care resources, reduce health care costs, and significantly improve patients' outcomes. In addition, the biomarkers' identity and molecular functions may contribute to developing novel preventive interventions.

Outside the United States, bromelain-based enzymatic debridement (BBED) has become an effective tool for the removal of burn eschar. A primary concern with BBED is that it is a painful procedure requiring appropriate analgesia. The purpose of this study was to describe our experience using NexoBrid® (NXB), with a particular focus on pain management. We performed a retrospective review on all 32 adult burn patients enrolled at our institution as part of a multicenter phase 3 clinical trial (DETECT) or the expanded access treatment protocol (NEXT). All patients underwent BBED with NXB of acute deep partial- and full-thickness thermal burn wounds at a major burn center between November 2016 and February 2023. Thirty-two patients with an average age of 42.1 years (SD = 17.4, range 18–72) and an average TBSA of 6.3% (SD = 5.9, range 1–24.5) underwent a total of 33 BBED procedures. Only one patient required an additional NXB treatment, and all patients achieved >95% eschar removal. For pain control during debridement, seven patients required a local block (LB), nine a regional block (RB), and thirteen conscious sedation (CS). Three patients were intubated (INTB) for their burn injury prior to the procedure. There was no statistical difference in Numerical Pain Rating Scale (NPRS) scores during vs. before treatment or after vs. before treatment for all patients or when subdivided by BMI, race, TBSA, total area treated, and anesthetic type (LB, RB, and CS). With appropriate analgesia, the pain associated with BBED of acute deep partial- and full-thickness thermal burns is well tolerated.

Background Multiple microsurgical techniques for nasal reconstruction have been described in the literature. Given the gaps in the literature regarding evidence-based reviews for total and subtotal nasal reconstruction using microsurgical techniques, the purpose of this study was to provide a thorough presentation of the most popular microvascular techniques and their outcomes (functional and aesthetic) for total or subtotal nasal defects. Methods A systematic search was performed using PubMed, Google Scholar, and Cochrane Library on free flap techniques for restoration of nasectomy defects. The keywords were “nasal reconstruction,” “nose,” “nasectomy,” “rhinectomy,” and “microvascular.” Inclusion criteria for analysis in the study were the largest clinical case series published in English within the past 15 years with more than 8 patients. Studies were analyzed for patient demographics, etiology of nasal loss, surgical approaches to reconstruction, outcomes, and complications. The current study was registered at the International Prospective Register of Systematic Reviews and conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Results The initial search yielded 302 results. Eleven articles with a total of 232 patients met the inclusion criteria. The radial (n = 85) and ulnar forearm flaps (n = 20), auricular helical rim (n = 87), and anterolateral thigh flap (n = 30) were the most commonly reported free flaps in nasal reconstruction. The main etiologic factors were malignancy and trauma. The most common complication was partial flap necrosis. Conclusions The auricular helical and radial forearm flaps represent the most used free flaps for total and/or subtotal nasal defects with satisfactory patient outcomes.

Summary: Bullous pemphigoid is an autoimmune blistering disease where patients suffer from painful bullae, often covering large portions of the skin and requiring management with immune-suppression. Our case report of recurring bullous pemphigoid illustrates the importance of considering immunosuppressive perioperative management in patients with a history of autoimmune blistering even when the disease has been quiescent for some time. With multidisciplinary care and immune suppressive therapies in the perioperative period, a free flap complicated by recurrent bullous pemphigoid can be salvaged.

Temperature sensitivity is a common problem after burn injury. However, the impact of temperature sensitivity on health-related quality of life (QoL) is unknown. We aimed to describe characteristics associated with temperature sensitivity and determine its association with patient reported QoL. We hypothesized that temperature sensitivity negatively impacts both mental and physical health. We reviewed a multicenter burn database for participants who had been asked about hot or cold temperature sensitivity 6, 12 and 24 months after injury. Outcomes of interest included the Satisfaction with Life Scale (SWLS) score and Veterans RAND 12 (VR-12) physical (PCS) & mental health summary (MCS) scores. Chi square and Kruskal-Wallis tests determined differences in patient and injury characteristics. Generalized linear regression models included burn size (%TBSA), graft size (%TBSA), location of burn, pruritis intensity, amputation status, study site, and review of systems questions at each follow-up visit as covariates to determine the impact of temperature sensitivity on QoL. The cohort was comprised of 637 participants. Prevalence of temperature sensitivity at each follow-up period ranged from 48%-54%. Those who experienced temperature sensitivity had larger burns, required more grafting, and had higher intensity of pruritus at discharge. Temperature sensitivity was associated with lower SWLS scores and lower VR-12 PCS and MCS at each follow-up period. After controlling for confounding variables, temperature sensitivity remained a significant independent predictor of lower SWLS scores (OR -3.2, 95% CI -5.4, -1.1) and VR-12 MCS (OR -4.4, 95% CI -7.4, -1.4) at 6 months follow-up. Temperature sensitivity is a highly prevalent symptom after burn injury and an independent predictor of worse satisfaction with life and worse mental health recovery.

Abstract Introduction Early excision and grafting for deeper hand burns is important for preservation of long-term hand function. Little information exists on long-term reconstructive and revision operations after acute grafting. Limited quantitative data is available on early predictors of this outcome. This study retrospectively examines a cohort of patients who underwent excision and grafting of acute hand burns and details their reconstructive course in the years after injury. Predictors of future reconstructive hand surgery are examined. Methods A retrospective review was conducted using medical records of patients admitted with acute burn injury to a major regional burn center from February 1999 to October 2015 and who subsequently underwent excision and grafting for closure of the acute wound. Information collected included demographics, burn size and etiology, anatomical involvement, grafting, contracture release, local tissue rearrangement, and regional and distant flaps. Regression analysis assessed for demographic and clinical predictors for future contracture release with grafts and/or local tissue rearrangement surgery. Results A total of 704 hands in 532 adults (71% male, median age 40 years, average burn size 14.9% TBSA) met study criteria (Table 1). Ninety-eight patients underwent at least one reconstructive surgery (122 burned hands). Mean length of follow-up was 1000 days. Multivariable logistic regression analysis showed that male gender was negatively associated (p< 0.001; OR 0.369; 90% CI, 0.233–0.584) with contracture release with graft whereas white race (p=0.030; OR 2.060; 90% CI, 1.192–3.560) and burn size ≥21% TBSA (p< 0.001; OR 3.962; 90% CI, 2.224–7.057) were positively associated. Males had a negative association (p=0.023; OR 0.527; 90% CI, 0.332–0.837) and burn size a positive association with local tissue rearrangement (5–10% TBSA - p=0.041; OR 2.149; 90% CI, 1.161–3.975 and >21% TBSA - p< 0.001; OR 4.230; 90% CI, 7.927). Conclusions Approximately 1 in 6 acutely grafted hands underwent at least one reconstructive surgery of clinically significant contractures, primarily in digits and web spaces. Female gender and burn size were positive predictors of both categories of reconstructive surgery while white race was a positive predictor of release and graft.

Background Geography is an important yet underexplored factor that may influence the care and outcomes of burn survivors. This study aims to examine the impact of geography on physical and psychosocial function after burn injury. Methods Data from the Burn Model Systems National Database (1997-2015) were analyzed. Individuals 18 years and older who were alive at discharge were included. Physical and psychosocial functions were assessed at 6, 12, and 24 months postinjury using the following patient-reported outcome measures: Community Integration Questionnaire, Physical Composite Scale and Mental Composite Scale of the 12-Item Short Form Health Survey, Satisfaction with Appearance Scale, and Satisfaction with Life Scale. Descriptive statistics were generated for demographic and medical data, and mixed regression models were used to assess the impact of geography on long-term outcomes. Results The study included 469 burn survivors from the Centers for Medicare and Medicaid Services regions 10, 31 from region 8, 477 from region 6, 267 from region 3, and 41 from region 1. Participants differed significantly by region in terms of race/ethnicity, burn size, burn etiology, and acute care length of stay (P < 0.001). In adjusted mixed model regression analyses, scores of all 5 evaluated outcome measures were found to differ significantly by region (P < 0.05). Conclusions Several long-term physical and psychosocial outcomes of burn survivors vary significantly by region. This variation is not completely explained by differences in population characteristics. Understanding these geographical differences may improve care for burn survivors and inform future policy and resource allocation.

Background: Health-related quality of life is decreased in burn survivors, with scars implicated as a cause. The authors aim to characterize the use of reconstructive surgery following hospitalization and determine whether patient-reported outcomes change over time. The authors hypothesized improvement in health-related quality of life following reconstructive surgery. Methods: Adult burn survivors undergoing reconstructive surgery within 24 months after injury were extracted from a prospective, longitudinal database from 5 U.S. burn centers (Burn Model System). Surgery was classified by problem as follows: scar, contracture, and open wound. The authors evaluated predictors of surgery using logistic regression. Short Form-12/Veterans RAND 12 health survey outcomes at 6, 12, and 24 months were compared at follow-up intervals and matched with nonoperated participants using propensity score matching. Results: Three hundred seventy-two of 1359 participants (27.4 percent) underwent one or more reconstructive operation within 24 months of injury. Factors that increased the likelihood of surgery included number of operations during index hospitalization (p < 0.001), hand (p = 0.001) and perineal involvement (p = 0.042), and range-of-motion limitation at discharge (p < 0.001). Compared to the physical component scores of peers who were not operated on, physical component scores increased for participants undergoing scar operations; however, these gains were only significant for those undergoing surgery more than 6 months after injury (p < 0.05). Matched physical component scores showed nonsignificant differences following contracture operations. Mental component scores were unchanged or lower following scar and contracture surgery. Conclusions: Participants requiring more operations during index admission were more likely to undergo reconstructive surgery. There were improvements in Short Form-12/Veterans RAND 12 scores for those undergoing scar operations more than 6 months after injury, although contracture operations were not associated with significant differences in Short Form-12/Veterans RAND 12 scores.

Abstract Introduction Pediatric burn patients are at high nutritional risk given disease burden and its impact on body reserves. As part of our global mission, we care for children who arrive late after their injury, often with malnutrition. In our experience, these patients have greater susceptibility to infection, poor wound healing, and longer lengths of stay. In accordance, we implemented strategies to improve outcomes in this population including a sustained period of nutritional optimization prior to surgery. The purpose of this study was to describe the frequency of malnutrition in our hospital and to compare clinical outcomes between malnourished (MN) and well-nourished patients (WN) using this approach. Methods An IRB approved retrospective review of pediatric burn patients at our institution from 2010–2018 who received nutritional support (enteral and/or parenteral nutrition) for at least five days was conducted. Data collection included general demographics, anthropometrics, nutritional intake, nutrition related labs, and clinical outcome variables such as length of stay (LOS), and days to wound closure. Using a case-control design, malnourished patients were matched (by age and burn size) to their well-nourished counterparts. Differences in nutritional status and clinical outcome were compared by student’s t test. Results A total of 174 patients, 7.02 ± 5.19 years of age with 39.18 ± 18.31% total body surface area (TBSA) burns were included in the study. Thirty percent of all patients classified as malnourished based upon body mass index (BMI) or weight/length z-scores, visual assessment and/or reported weight loss. On admission, malnourished patients had significantly lower BMI z scores (MN -2.5 vs. WN 0.8, p< 0.0001). Despite significant differences in days post burn admission (MN 97.9 days, WN 17.7 days, p=0.028); there was no statistical difference in days to 95% wound closure (MN 39.4, WN 38.2 days, p=0.85) or LOS (MN 56.5, WN 52.5 days p=0.63) between the two groups. Average intake of malnourished patients over the first four weeks of admission ranged between 92–116% of calorie goal and 96–109% protein goal.Nutrition related lab value averages for MN patients improved over the four week time frame, Prealbumin (mg/dl) (week one 9.6, week four 17.75), C-reactive protein (mg/L) (week one 92.3, week four 71.91), and Albumin (g/dl) (week one 2.64, week four 3.32). Conclusions Despite arriving significantly malnourished, our pediatric burn patients had similar outcomes to their well-nourished counterparts in terms of LOS and 95% wound closure. This can be attributed to prompt identification of those patients at risk, and use of refeeding and nutritional rehabilitation protocols prior to surgical intervention. Applicability of Research to Practice Effective protocols for the management of malnourished pediatric burn patients can negate the impact of malnutrition on clinical outcomes.