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Patients who are admitted to the hospital after sustaining a large burn injury are at high risk for developing hospital-associated infections. If patients survive the initial 72 hours after a burn injury, infections are the most common cause of death. Ventilator-associated pneumonia is the most important infection in this patient population. The risk of infections caused by multidrug-resistant bacterial pathogens increases with hospital length of stay in burn patients. In the first days of the postburn hospitalization, more susceptible, Gram-positive organisms predominate, whereas later more resistant Gram-negative organisms are found. These findings impact the choice of empiric antibiotics in critically ill burn patients. A proactive infection control approach is essential in burn units. Furthermore, a multidisciplinary approach to burn patients with a team that includes an infectious disease specialist and a pharmacist in addition to the burn surgeon is highly recommended.

Measurement of health-related quality of life (HRQL) is essential to qualify the subjective burden of burns in survivors. We performed a systematic review of HRQL studies in adult burn patients to evaluate study design, instruments used, methodological quality, and recovery patterns. A systematic review was performed. Relevant databases were searched from the earliest record until October 2016. Studies examining HRQL in adults after burn injuries were included. Risk of bias was scored using the Quality in Prognostic Studies tool. Twenty different HRQL instruments were used among the 94 included studies. The Burn Specific Health Scale-Brief (BSHS-B) (46%), the Short Form-36 (SF-36) (42%) and the EuroQol questionnaire (EQ-5D) (9%) were most often applied. Most domains, both mentally and physically orientated, were affected shortly after burns but improved over time. The lowest scores were reported for the domains 'work' and 'heat sensitivity' (BSHS-B), 'bodily pain', 'physical role limitations' (SF-36), and 'pain/discomfort' (EQ-5D) in the short-term and for 'work' and 'heat sensitivity', 'emotional functioning' (SF-36), 'physical functioning' and 'pain/discomfort' in the long-term. Risk of bias was generally low in outcome measurement and high in study attrition. Consensus on preferred validated methodologies of HRQL measurement in burn patients would facilitate comparability across studies, resulting in improved insights in recovery patterns and better estimates of HRQL after burns. We recommend to develop a guideline on the measurement of HRQL in burns. Five domains representing a variety of topics had low scores in the long-term and require special attention in the aftermath of burns.

We aimed to describe the gender-based disparities in burn injury patterns, care received, and mortality across national income levels. In the WHO Global Burn Registry (GBR), we compared patient demographics, injury characteristics, care and outcomes by sex using Chi-square statistics. Logistic regression was used to identify the associations of patient sex with surgical treatment and in-hospital mortality. Among 6431 burn patients (38 % female; 62 % male), females less frequently received surgical treatment during index hospitalization (49 % vs 56 %, p < 0.001), and more frequently died in-hospital (26 % vs 16 %, p < 0.001) than males. Odds of in in-hospital death was 2.16 (95 % CI: 1.73–2.71) times higher among females compared to males in middle-income countries. Across national income levels, there appears to be important gender-based disparities among burn injury epidemiology, treatment received and outcomes that require redress. Multinational registries can be utilized to track and to evaluate initiatives to reduce gender disparities at national, regional and global levels. •Females may sustain more severe burn injuries than males globally.•Disparities may exist in burn injury surgical care and outcomes by sex.•Gender disparities are more apparent in low- and middle-income country scenarios.•WHO Global Burn Registry can demonstrate epidemiological patterns and disparities.•Identified patterns and disparities can inform quality improvement initiatives.

Main contributors to adverse outcomes in severely burned pediatric patients are profound and complex metabolic changes in response to the initial injury. It is currently unknown how long these conditions persist beyond the acute phase post-injury. The aim of the present study was to examine the persistence of abnormalities of various clinical parameters commonly utilized to assess the degree hypermetabolic and inflammatory alterations in severely burned children for up to three years post-burn to identify patient specific therapeutic needs and interventions. Nine-hundred seventy-seven severely burned pediatric patients with burns over 30% of the total body surface admitted to our institution between 1998 and 2008 were enrolled in this study and compared to a cohort non-burned, non-injured children. Demographics and clinical outcomes, hypermetabolism, body composition, organ function, inflammatory and acute phase responses were determined at admission and subsequent regular intervals for up to 36 months post-burn. Statistical analysis was performed using One-way ANOVA, Student's t-test with Bonferroni correction where appropriate with significance accepted at p<0.05. Resting energy expenditure, body composition, metabolic markers, cardiac and organ function clearly demonstrated that burn caused profound alterations for up to three years post-burn demonstrating marked and prolonged hypermetabolism, p<0.05. Along with increased hypermetabolism, significant elevation of cortisol, catecholamines, cytokines, and acute phase proteins indicate that burn patients are in a hyperinflammatory state for up to three years post-burn p<0.05. Severe burn injury leads to a much more profound and prolonged hypermetabolic and hyperinflammatory response than previously shown. Given the tremendous adverse events associated with the hypermetabolic and hyperinflamamtory responses, we now identified treatment needs for severely burned patients for a much more prolonged time.

Burn patients experience severe pain when undergoing rehabilitation after skin grafting, which negatively affects their recovery. Traditional analgesic methods (such as opioids) have the risk of addictiveness and side effects. Nitrous oxide, which has rapid analgesic and sedative effects, is commonly used for conscious analgesia. The purpose of this study was to determine whether diluted nitrous oxide reduces pain compared to Placebo(oxygen) during rehabilitation after burn surgery. This single-center, randomized, double-blind, and controlled trial will enroll 80 patients. Patients ≥ 18 years of age who underwent rehabilitation 1 month after burn surgery with acute pain (VAS ≥ 4) were included. The main exclusion criteria included: pulmonary disease (pulmonary embolism, pneumothorax), intestinal obstruction, etc. Patients were randomly assigned in a 1: 1 ratio to intervention (A) and control (B) groups. Doctors, therapists, patients, and data collectors were unaware of the assignment outcomes. Rehabilitation will be performed by a therapist. The nurse performing the intervention handed the envelope with the patient code and the A or B assignment to the physician. Group A will receive diluted nitrous oxide inhalation plus conventional therapy (without analgesics) 30 minutes once daily for 4 weeks, and Group B will receive oxygen plus conventional therapy (without analgesics) under the same conditions. Assessments will be performed before the intervention (T0), 2 minutes (T1) and 5 minutes (T2) after the start of the intervention, and 5 minutes (T3) after the start of the intervention. The primary outcome was pain score. Secondary outcomes included vital signs, side effects, quality of life score, scar score, need for adjuvant analgesia, therapist and patient satisfaction, and willingness to receive the same gas again. If the experimental results show that diluted nitrous oxide can bring good analgesic effects without serious side effects, it can improve patients' compliance with rehabilitation treatment and quality of life, and it is even widely implemented in hospitals and rehabilitation institutions.

The Quality Cost Indicator (QCI) model supports value-based health care at the institutional level, by calculating disease-specific health outcomes per unit cost over time. The aim of this study was to adapt the QCI model for specialized burn care (the BC-QCI model) and explore its utilization using real-world data. Burn care outcome indicators were selected through an iterative process with multiple stakeholders. Threshold values were established per outcome indicator and average total healthcare costs were calculated. A cohort of adult burn patients (n = 1449) admitted for at least one day and/or had undergone surgery in Dutch burn centers between 2020 and 2023 was used, with a follow-up period of 12 months. The proportion of patients who achieved textbook outcome (i.e., having achieved all the outcome indicators), the average total costs per patient, and QCI values were calculated. Of all patients, 54% achieved all five outcome indicators (i.e., length of stay, wound infections, other complications, discharge destination, and predicted mortality). The most successful outcome indicator was ‘predicted mortality’ (passed by 99% of the population), the least successful outcome indicator was ‘length of stay’ (62%). The patients who failed to achieve one or more outcome indicators (46%) had significantly higher average total costs compared to the patients who achieved textbook outcome (54%) (€50,134 [€47,810-€52,850] vs. €11,721 [€11,096-€12,429]). The BC-QCI model is a solid foundation to provide insights into the outcomes and costs for specialized burn care at the institutional level.

Sepsis remains one of the leading causes of death in burn patients who survive the initial insult of injury. Disruption of the intestinal epithelial barrier has been shown after burn injury; this can lead to the translocation of bacteria or their products (e.g., endotoxin) from the intestinal lumen to the circulation, thereby increasing the risk for sepsis in immunocompromised individuals. Since the maintenance of the epithelial barrier is largely dependent on the intestinal microbiota, we examined the diversity of the intestinal microbiome of severely burned patients and a controlled mouse model of burn injury. We show that burn injury induces a dramatic dysbiosis of the intestinal microbiome of both humans and mice and allows for similar overgrowths of Gram-negative aerobic bacteria. Furthermore, we show that the bacteria increasing in abundance have the potential to translocate to extra-intestinal sites. This study provides an insight into how the diversity of the intestinal microbiome changes after burn injury and some of the consequences these gut bacteria can have in the host.

Reports on treatment characteristics and long term outcomes for severe burns are scarce, while the need to compare outcomes of novel treatment modalities to standard of care is increasing. Our national database on burn treatment enabled analysis of patient as well as treatment characteristics during acute treatment and following reconstructive procedures. Furthermore, outcome data of longitudinal scar assessments were analysed from a single burn centre database. Acute and reconstructive data were analysed for patients admitted to the three Dutch burn centres with total body surface area burned of ≥ 20% TBSA. Long term outcome was analysed from a single centre scar database, both for a period of 2009–2019. Treatment characteristics from 396 surviving acute burn patients were analysed. Surgical treatment was required in 89.6% of these patients and 110 patients (27.8%) needed reconstructive surgery in the years after the burn incident, with a mean of 4.4 reconstructive procedures per patient. Main indications were contractures (70.5%) and arms (45.0%) and head and neck region (41.2%) were most frequently affected. Techniques used for reconstructive corrections were predominantly excision, release and flaps (54.7%), followed by skin transplants (32.4%). Scar quality was significantly worse in patients with more severe burns compared to those with TBSA < 20% during prolonged times. These data provide insight into health care utilization, treatment characteristics and outcomes in severely burned patients. These real-world data can guide future development of improved treatment strategies for at risk patients as well as anatomical locations.

Burns are a major cause of injury worldwide. We investigated the epidemiology and outcomes of burn patients in a major burn center in southwest China between 2011 and 2015 to provide guidance for burn prevention. Of the 6,325 included burn patients, 66.8% were male and 34.7% were 0 ~ 6 years old. The incidence of burns peaked in autumn. Scald was the most common cause of burns, which was predominant in patients aged 0 ~ 6 years. The mean total body surface area (TBSA) of burns was 13.4%, and patients with burns ≤10% TBSA comprised 64.1% of all cases. Patients with full-thickness burns accounted for 40.1% of all patients and 81.0% of operated patients; these burns were primarily caused by flame (34.8%), scald (21.0%), and electricity (20.4%). Fifty-six deaths occurred (mortality 0.9%), and risk factors included full-thickness burns, larger TBSA and older age. The median length of stay was 17 days, and major risk factors included more operations, better outcomes and larger TBSA. Our data showed that closer attention should be paid to children under 6 years old, males, incidents in autumn and scald burns to prevent burn injuries. Furthermore, individualized burn prevention and treatment measures based on related risk factors should be adopted.

Burn injuries are prevalent and have a significant effect on patients' quality of life and healthcare costs. Current treatment modalities, such as wound care and surgical interventions, often face challenges due to complications like infection and inadequate healing. This study adopted single-cell RNA sequencing (scRNA-seq) to investigate the cellular landscape of the burn microenvironment. After rigorous quality control filtering, 9,248 cells were retained for analysis. Using UMAP dimensionality reduction, these cells were annotated into 14 subpopulations, including Neutrophils, Macrophages, and T cells. Differential gene analysis and machine learning techniques, such as LASSO regression and random forest selection, were employed to identify marker genes. Macrophages exhibited significant interactions with other cell types, indicating their pivotal role in immune signaling within the burn microenvironment. A total of 155 genes were identified as markers for Macrophages, with AP2A2, CCL7, and TF emerging as key features. Immune infiltration analysis also revealed notable differences in the proportions of immune cells, particularly Mast cells and Neutrophils, highlighting on their involvement in disease progression. This study provides novel insights into the immunological microenvironment of burn injuries. Despite limitations including a modest sample size and lack of experimental validation, our findings establish a foundation for future investigations into targeted immunotherapeutic strategies, potentially improving clinical outcomes and advancing personalized treatment approaches for burn patients.