Satisfaction with life after burn: A Burn Model System National Database Study.

Objectives: While mortality rates after burn are low, physical and psychosocial impairments are common. Clinical research is focusing on reducing morbidity and optimizing quality of life. This study examines self-reported Satisfaction With Life Scale scores in a longitudinal, multicenter cohort of survivors of major burns.

Early Enteral Nutrition for Burn Injury.

Nutrition has been recognized as a critical component of acute burn care and ultimate wound healing. Debate remains over the appropriate timing of enteral nutrition and the benefit of supplemental trace elements, antioxidants, and immunonutrition for critically ill burn patients. Pharmacotherapy to blunt the metabolic response to burn injury plays a critical role in effective nutritional support.

Repeat hospitalization and mortality in older adult burn patients.

The aim of this study was to examine 2-year postdischarge outcomes-including hospital readmissions, complications, and mortality-for a cohort of older adults with burn injury. In a statewide hospital discharge database, we identified all patients ≥ 45 years of age admitted for acute burn injury from 1996 to 2005 and followed each patient for any hospital admissions 2 years following discharge. We then linked the state database to the National Death Index to identify patients who died within the 2-year period.

Verified centers, nonverified centers, or other facilities: a national analysis of burn patient treatment location.

Background: Although comprehensive burn care requires significant resources, patients may be treated at verified burn centers, nonverified burn centers, or other facilities due to a variety of factors. The purpose of this study was to evaluate the association between patient and injury characteristics and treatment location using a national database.

Study Design: We performed an analysis of all burn patients admitted to United States hospitals participating in the Healthcare Cost and Utilization Project over 2 years.

Risk factors for the development of pneumonia in older adults with burn injury.

Older adults with burns are at risk for worse outcomes because of factors related to age, comorbidities, and response to treatment. Although the impact of pneumonia has been previously described in burn patients, less is known in the older adult population. In this study, we used the National Burn Repository to characterize patient and injury factors associated with pneumonia development in older adults with burns.

Early acute kidney injury predicts progressive renal dysfunction and higher mortality in severely burned adults.

The incidence and prognosis of acute kidney injury (AKI) developing during acute resuscitation have not been well characterized in burn patients. The recently developed Risk, Injury, Failure, Loss, and End-stage (RIFLE) classification provides a stringent stratification of AKI severity and can allow for the study of AKI after burn injury. We hypothesized that AKI frequently develops early during resuscitation and is associated with poor outcomes in severely burned patients.

American Burn Association Practice guidelines for prevention, diagnosis, and treatment of ventilator-associated pneumonia (VAP) in burn patients.

The purpose of this guideline is to review the available published literature on ventilator-associated pneumonia (VAP) as it pertains to the burn patient. It provides an evidence-based recommendation for the prevention, diagnosis, and treatment of VAP in adult burn patients. This guideline is designed to assist all healthcare providers caring for adult burn patients with suspected VAP.

Rehabilitation of the burned hand.

Successful outcomes following hand burn injury require an understanding of the rehabilitation needs of the patient. Rehabilitation of hand burns begins on admission, and each patient requires a specific plan for range of motion and/or immobilization, functional activities, and modalities. The rehabilitation care plan typically evolves during the acute care period and during the months following injury.

The beneficial effects of plasma exchange after severe burn injury.

Severe burn injury results in a systemic inflammatory response that leads to increased capillary permeability and fluid leak into the interstitium. This global systemic capillary leak can be attributed, at least in part, to inflammatory mediators produced as a result of cellular injury. Plasma exchange has been used in the management of a number of illnesses with a significant inflammatory component, and, therefore, may have a role in the early management of burn injury.

Influence of comorbidities and age on outcome following burn injury in older adults.

Despite advances in medical and surgical techniques, older adults tend to be at high risk for adverse outcomes following burn injury. The purpose of this study was to examine the relative impacts of age and medical comorbidities on outcome following injury in a cohort of older adults. This was a retrospective study of all patients age 55 and over admitted to the University of Washington Burn Center from 1999 to 2003.

Impact of oxandrolone treatment on acute outcomes after severe burn injury.

Pharmacologic modulation of hypermetabolism clearly benefits children with major burns, however, its role in adult burns remains to be defined. Oxandrolone appears to be a promising anabolic agent although few outcome data are as yet available. We examined whether early oxandrolone treatment in severely burned adults was associated with improved outcomes during acute hospitalization.

Delivery of critical care in North American burn centers.

The management of severely ill patients is an essential component of burn management. As critical care practices become more specialized, and payers such as the Leapfrog group insist on organizational structure for critical care delivery, we sought to determine how critical care is delivered in North American burn centers. Many surgical and medical intensive care units (ICUs) follow an intensivist model with the following features: 1) ICU physician-director is board-certified in critical care, 2) more than 50% of the ICU physicians are board-certified in critical care, and 3) an intensive care team has authority to write patient orders.

Pediatric palm contact burns: a ten-year review.

Management and proper approach to pediatric palm burns remains unclear. Our burn center's approach includes early, aggressive range of motion therapy, combined with a period of watchful waiting, reserving grafting only for those palms that do not heal in a timely manner. We reviewed our experience using this approach over a 10-year period.

Influence of injury characteristics and payer status on burn treatment location in Washington state.

The provision of optimal burn care is a resource-intensive endeavor. The American Burn Association has developed criteria to help guide the decision to refer a patient to a burn center for definitive injury care. The purpose of this study was to compare the patient and injury characteristics of patients admitted to the single verified burn center in Washington State with those treated at other facilities in the state.

Extended time to wound closure is associated with increased risk of heterotopic ossification of the elbow.

Heterotopic ossification (HO) is a well-recognized complication of burn injury that can result in significantly compromised limb function. The etiology and optimal treatment strategy for HO remain elusive. The purpose of this study was to examine the relationship between delay in elbow wound closure and the development of HO.

Comparison of fibrin sealant and staples for attaching split-thickness autologous sheet grafts in patients with deep partial- or full-thickness burn wounds: a phase 1/2 clinical study.

We undertook a multicenter, randomized, controlled, phase 1/2 clinical study to investigate the safety and efficacy of a fibrin sealant containing 4 IU/ml thrombin (FS 4IU) for the attachment of autologous sheet grafts in patients with deep partial-thickness or full-thickness burn wounds. Fibrin sealant (FS 4IU) was compared with staples for adherence of sheet grafts in 40 patients. Patients had to have burn wounds measuring 40% TBSA or less with two comparable test sites measuring between 1% and 4% TBSA each.

The association between fluid administration and outcome following major burn: a multicenter study.

Objective: To determine patient and injury variables that influence fluid requirements following burn injury and examine the association between fluid volume received and outcome.

Background: Fluid resuscitation remains the cornerstone of acute burn management. Recent studies suggest that patients today are receiving more fluid per percent total body surface area (TBSA) than in the past.