Split-thickness autografts (STAG) are the current standard of care for the permanent coverage of deep partial-thickness (DPT) burns. However, grafting is often complicated by hypertrophic scarring and dyspigmentation. Non-cultured, autologous, cell suspension systems are potential alternatives to autografting appropriately selected burn wounds. ReCell® is a device for the rapid, point-of-care preparation and application of non-cultured, autologous skin cells that provides an expansion ratio of 80:1 but is currently limited by US law to investigational use only. We present the results of the initial FDA approval trial for ReCell®. This was a prospective, randomized, within-patient controlled, GCP-compliant, FDA IDE trial comparing ReCell® to STAG for the treatment of acute, DPT burns in adults suffering 1–20% TBSA thermal burns. Comparable burn wounds measuring 100–320 cm2 were randomized to treatment with ReCell® vs. 2:1 meshed STAG. The co-primary effectiveness endpoints were donor site healing at 1 week (superiority) and recipient site healing at 4 weeks (non-inferiority) between the ReCell®-treated and autografted wounds. Secondary effectiveness endpoints included percent epithelialization over time, pain, and patient satisfaction. Safety endpoints included graft loss, infection, scarring, and adverse events. Data were analysed by intention-to-treat (ITT) and modified per-protocol (MPP) populations, as appropriate. A total of 101 subjects across 12 US Burn Centers were enrolled (n=101 ITT, n=83 MPP). The superiority effectiveness endpoint was met for ReCell® donor site healing in the ITT population (p=0.004), and the non-inferiority effectiveness endpoint was met at -2.4% [-8.4 to 2.3%] in the MPP population for ReCell® recipient site healing vs. STAG healing. Secondary effectiveness endpoints demonstrated similar rates of epithelialization and patient satisfaction with respect to the recipient wounds, while there was significantly reduced pain and significantly higher patient satisfaction with respect to the ReCell® donor site wounds. No demonstrable safety signal was generated. ReCell® can be used to safely treat acute, DPT, thermal burns in adults with comparable wound closure and scarring outcomes, but with significantly smaller and less painful donor sites that patients clearly prefer, when compared to conventional STAG. Using ReCell® allows the burn surgeon to “graft” a DPT burn with ~98% less skin than with conventional STAG, resulting in comparable healing, reduced pain, improved aesthetics, and increased overall patient satisfaction.

The relationship of death rates due to injury with the dissolution of the Soviet empire deserves special focus because of the impact of injury deaths on the productive working population between the ages of 15 and 65 years. A retrospective review was performed of annual mortality rates due to intentional and unintentional injuries, using WHO data from 1980 to 2003. Using data from a comparison group in Western Europe, the nations of the former Union of Soviet Socialist Republics (USSR) were studied. Annual death rates were examined using polynomial regression after 3-year moving averages smoothed the plots. The majority of trends in injury-related death noted in the comparison group decreased constantly over time. In contrast, many nations of the former USSR experienced an initial decrease, reaching a nadir in 1985 – 1987, followed by an increase in injury-related deaths. Moreover, many of these nations experienced a subsequent decrease following the dissolution of the USSR in 1991. The monitoring of trends in injury mortality in countries experiencing social and political upheavals is warranted.

Journal Article Throwing Fuel–Firefighters Injured by Live Fire Practices Get access M. D. Peck, MD, ScD, M. D. Peck, MD, ScD 1North Carolina Jaycee Burn Center, Chapel Hill, NC; Chapel Hill Fire Department, Chapel Hill, NC Search for other works by this author on: Oxford Academic Google Scholar C Calvert, PhD, C Calvert, PhD 1North Carolina Jaycee Burn Center, Chapel Hill, NC; Chapel Hill Fire Department, Chapel Hill, NC Search for other works by this author on: Oxford Academic Google Scholar D Jones, BA, D Jones, BA 1North Carolina Jaycee Burn Center, Chapel Hill, NC; Chapel Hill Fire Department, Chapel Hill, NC Search for other works by this author on: Oxford Academic Google Scholar E Grant, RN, MSN, E Grant, RN, MSN 1North Carolina Jaycee Burn Center, Chapel Hill, NC; Chapel Hill Fire Department, Chapel Hill, NC Search for other works by this author on: Oxford Academic Google Scholar B. A. Cairns, MD, FACS B. A. Cairns, MD, FACS 1North Carolina Jaycee Burn Center, Chapel Hill, NC; Chapel Hill Fire Department, Chapel Hill, NC Search for other works by this author on: Oxford Academic Google Scholar Journal of Burn Care & Research, Volume 27, Issue suppl_2, March 2006, Page S99, https://doi.org/10.1097/01253092-200603001-00101 Published: 01 March 2006

The financial stability of burn centers must be secured to (1) sustain optimal patient care, and (2) maintain a state of readiness for disaster preparedness. This report examines the economic burden of caring for uninsured burn patients in our burn center. Hospital financial reports for in-patients (IP) and out-patients (OP) treated at a verified burn center were reviewed for the period FY2002–2004. Included in the review were charges and payments, as well as categorization of self-pay cases into US resident and non-US resident status. The data summarized are from Medicare, Medicaid and self-pay patients with primary and secondary diagnoses ICD-9 940–949.50. The designation, “Commercial”, identifies indemnity, Blue Cross/Blue Shield, and workers compensation cases. For all patients, reimbursement totaled 56% of charges, and was identical for both IP and OP. The proportion of IP charges due to self-pay patients was 8%, however self-pay patients averaged only 0.2% reimbursement for IP charges, representing over $5 million. Of the self-pay patients, only eight were non-US residents; however unpaid bills from these eight patients accounted for 48% of un-reimbursed self-pay charges. The top two most expensive self-pay patients, whose combined unpaid charges were nearly $1.3 million, were both non-US residents. Nearly 50% of the hospital charges for these two patients were from daily bed charges, reflecting not only severity of injury but also the difficulty in establishing discharge plans due to a lack of resources. Although a much smaller dollar amount, 75% of OP losses were also due to a lack of reimbursement by self-pay patients.

Journal Article The Burn Center as a Model for Critical Care Education Get access F. L. Byerly, MD, F. L. Byerly, MD 1North Carolina Jaycee Burn Center, Chapel Hill, NC; University of North Carolina at Chapel Hill, Chapel Hill, NC Search for other works by this author on: Oxford Academic Google Scholar I. B. Buchanan, MD, I. B. Buchanan, MD 1North Carolina Jaycee Burn Center, Chapel Hill, NC; University of North Carolina at Chapel Hill, Chapel Hill, NC Search for other works by this author on: Oxford Academic Google Scholar C. S. Hultman, MD, C. S. Hultman, MD 1North Carolina Jaycee Burn Center, Chapel Hill, NC; University of North Carolina at Chapel Hill, Chapel Hill, NC Search for other works by this author on: Oxford Academic Google Scholar M. D. Peck, MD, ScD, M. D. Peck, MD, ScD 1North Carolina Jaycee Burn Center, Chapel Hill, NC; University of North Carolina at Chapel Hill, Chapel Hill, NC Search for other works by this author on: Oxford Academic Google Scholar M Kidd, MD, M Kidd, MD 1North Carolina Jaycee Burn Center, Chapel Hill, NC; University of North Carolina at Chapel Hill, Chapel Hill, NC Search for other works by this author on: Oxford Academic Google Scholar A. A. Meyer, MD, PhD, A. A. Meyer, MD, PhD 1North Carolina Jaycee Burn Center, Chapel Hill, NC; University of North Carolina at Chapel Hill, Chapel Hill, NC Search for other works by this author on: Oxford Academic Google Scholar B. A. Cairns, MD, FACS B. A. Cairns, MD, FACS 1North Carolina Jaycee Burn Center, Chapel Hill, NC; University of North Carolina at Chapel Hill, Chapel Hill, NC Search for other works by this author on: Oxford Academic Google Scholar Journal of Burn Care & Research, Volume 27, Issue suppl_2, March 2006, Page S177, https://doi.org/10.1097/01253092-200603001-00258 Published: 01 March 2006

The U.S. burn care community has a long history of providing humanitarian aid overseas. Within the last decade there has been a shift from providing direct patient care to providing indigenous health care workers with education and training. We present the next step in this transition, namely the provision of assistance to developing burn prevention programs. We reviewed our experience with international burn prevention programs in which we have participated over the last 10 years. These programs has been successful using a variety of approaches. In one case, we facilitated statistical analysis of an existing database in the Republic of China, resulting in the first publication of a national hospital-based survey of burns in Taiwan. In Africa, the efforts have included participation as expert consultants to work group conferences hosted by community groups in South Africa and by the sole burn center in Ethiopia. We have worked within the following...

Objective:To delineate blood transfusion practices and outcomes in patients with major burn injury. Context:Patients with major burn injury frequently require multiple blood transfusions; however, the effect of blood transfusion after major burn injury has had limited study. Design:Multicenter retrospective cohort analysis. Setting:Regional burn centers throughout the United States and Canada. Patient Population:Patients admitted to a participating burn center from January 1 through December 31, 2002, with acute burn injuries of ≥20% total body surface area. Outcomes Measured:Outcome measurements included mortality, number of infections, length of stay, units of blood transfused in and out of the operating room, number of operations, and anticoagulant use. Results:A total of 21 burn centers contributed data on 666 patients; 79% of patients survived and received a mean of 14 units of packed red blood cells during their hospitalization. Mortality was related to patient age, total body surface area burn, inhalation injury, number of units of blood transfused outside the operating room, and total number of transfusions. The number of infections per patient increased with each unit of blood transfused (odds ratio, 1.13; p < .001). Patients on anticoagulation during hospitalization received more blood than patients not on anticoagulation (16.3 ± 1.5 vs. 12.3 ± 1.5, p < .001). Conclusions:The number of transfusions received was associated with mortality and infectious episodes in patients with major burns even after factoring for indices of burn severity. The utilization of blood products in the treatment of major burn injury should be reserved for patients with a demonstrated physiologic need.

Subtle but perceptible variations in the incidence of burns in the US can be noted. Although much of the variation may be due to randomness, there may also be relationships to sociocultural phenomena. To test this theory we examined the pattern of burn deaths in former nations of the USSR, following whose dissolution in 1991 there were dramatic economic and societal changes. Mortality data for deaths due to fire and burns were obtained from the World Health Organization Statistical Information System for the years 1980 to 1998. Participating nations used the International Classification of Disease injury codes, primarily version ICD-9. Records were stratified by country, gender, and age group. Regression analysis was used to assess the strength of correlation between time and incidence of burn deaths, specifically for linear, quadratic and cubic relationships. Correlations > 0.9 (r2 >0.81) were considered significant. The former nations of the USSR were compared...

At 1:37 pm on January 29, 2003, an explosion occurred at the West Pharmaceutical chemical plant in Kinston, North Carolina. The explosion killed three people at the scene and resulted in more than 30 admissions to area hospitals. The disaster resulted in 10 critically ill burn patients, who were all intubated with inhalation injuries, many with combined burn and trauma injuries. All 10 critically injured patients were admitted to a tertiary care facility 100 miles away with both a Level I trauma center and a verified burn center. Ultimately, 7 of 10 patients survived (a mortality rate of 30%), and none were transferred to another trauma or burn center. This article analyzes the unique challenges that combined burn and trauma patients present during a disaster, critically examines the response to this disaster, describes lessons learned, and presents recommendations that may improve the response to such disasters in the future.

Many skin conditions can mimic child abuse by burning. Multidisciplinary evaluation of suspicious burns helps prevent both the underreporting and the misdiagnosis of child abuse by burning. We report a case of pediatric eczema mimicking an abusive burn.

Toxic epidermal necrolysis (TEN) is a potentially fatal disorder that involves large areas of skin desquamation. Patients with TEN are often referred to burn centers for expert wound management and comprehensive care. The purpose of this study was to define the presenting characteristics and treatment of TEN before and after admission to regional burn centers and to evaluate the efficacy of burn center treatment for this disorder. A retrospective multicenter chart review was completed for patients admitted with TEN to 15 burn centers from 1995 to 2000. Charts were reviewed for patient characteristics, nonburn hospital and burn center treatment, and outcome. A total of 199 patients were admitted. Patients had a mean age of 47 years, mean 67.7% total body surface area skin slough, and mean Acute Physiology and Chronic Health Evaluation (APACHE II) score of 10. Sixty-four patients died, for a mortality rate of 32%. Mortality increased to 51% for patients transferred to a burn center more than one week after onset of disease. Burn centers and nonburn hospitals differed in their use of enteral nutrition (70 vs 12%, respectively, P < 0.05), prophylactic antibiotics (22 vs 37.9%, P < 0.05), corticosteroid use (22 vs 51%, P < 0.05), and wound management. Age, body surface area involvement, APACHE II score, complications, and parenteral nutrition before transfer correlated with increased mortality. The treatment of TEN differs markedly between burn centers and nonburn centers. Early transport to a burn unit is warranted to improve patient outcome.

BACKGROUND:Investigations of suspected child abuse must be conducted thoroughly to protect the abused child and to bring the abuser to trial. We have reviewed the literature on child abuse by burning and have synthesized, from the experience of ourselves and others, an algorithm that can be used by physicians, social workers, and nurses involved in the investigation of alleged child abuse by burning. METHODS:A MEDLINE search was conducted for the years 1966 through 2000 for human studies written in the English language using the key terms "child abuse" and "burns." RESULTS:Information from these articles was reviewed and included in this article. On the basis of our own experience and that cited in the literature, an algorithm was constructed to guide hospital-based personnel in their management of child abuse by burning. CONCLUSION:Medical investigation of suspected child abuse by burning can be performed systematically using an algorithm, thereby minimizing the chance of either false-positive or false-negative reporting.

Unlike household burn injuries, the characteristics of burn injuries in the workplace have not been well described. In an effort to understand the causes and effects of occupation-related burn injuries and to aid in prevention, we sought to describe work-related burn injuries by frequency, burn type, age of the patients, body parts burned, and occupation of the patients. This was a statewide, cross-sectional study of all burns that occurred in the workplace during 1994. Data on fatal injuries were obtained from the National Census of Fatal Occupational Injuries. Survey data from the North Carolina Department of Labor were used for nonfatal injuries. Burns caused 34 deaths (15.3%) and 1720 injuries in the workplace in 1994. Of the nonfatal injuries, 1363 (79.2%) were caused by exposure to caustic substances or hot objects or substances. The head and upper extremities were the most frequently injured body parts (936 injuries; 57.6%). The average age of those burned was 30.7 years; most of the patients ranged from 25 to 35 years old. High-risk occupations included vehicle and equipment cleaners, food service personnel, and millwrights (11.3%, 5.3%, and 5.2% of burn injuries, respectively). Unlike the flame burns that occur in homes, exposure to caustics and hot objects and substances caused the majority of on-the-job burn injuries. Protective gear for the head and upper extremities may prevent a significant number of burns. Education and prevention programs may best be directed at workers with high-risk occupations and workers in the 25- to 35-year age range.