Developing a burn injury severity score (BISS): Adding age and total body surface area burned to the injury severity score (ISS) improves mortality concordance

Outcome after burn injury, as also paralleled by other trauma, has been improving steadily over the years. In this aspect a significant improvement was seen especially in the 1970-ties when the 50% survival chance from a burn injury increased from 45% total body surface area burned (TBSA%) in a 21 year old patient up to almost 80% (TBSA%). Although this improvement may be claimed to have many reasons, a significant one that needs to be stressed is the introduction of more thorough use of protocolized fluid treatment strategies

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Assessment of burn surface area

Burns (OSH Surgery) ◽

10.1093/med/9780199699537.003.0009 ◽

2019 ◽

pp. 67-76

Author(s):

Rowan Pritchard-Jones ◽

Kayvan Shokrollahi

Keyword(s):

Surface Area ◽

Body Surface Area ◽

Body Surface ◽

Gold Standard ◽

Burn Injury ◽

Total Body Surface Area ◽

Injured Patient ◽

Crucial Step ◽

Total Body

Assessment of total body surface area of a burn injured patient is a crucial step in managing burn injury. The chapter describes a number of techniques from using the size of the patient’s palm as an estimate of 1% to the gold standard Lund and Browder Chart. Key caveats are explained, copies of the charts included as well as the use of the CE certified app Mersey Burns.

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Multimodal Analgesia and Discharge Opioid Requirements in Burn Patients

Journal of Burn Care & Research ◽

10.1093/jbcr/iraa088 ◽

2020 ◽

Vol 41 (5) ◽

pp. 963-966

Author(s):

Michael Wright ◽

Jin A Lee

Keyword(s):

Surface Area ◽

Body Surface Area ◽

Body Surface ◽

Total Body Surface Area ◽

Multimodal Analgesia ◽

Burn Patients ◽

Area Burned ◽

Total Body ◽

The Impact

Abstract Analgesia in burn patients is challenging given the complexity of burn pain and prolonged need beyond hospital admission. Given the risks of opioids, the impact of multimodal analgesia postdischarge needs to be further elucidated in this population. This retrospective, single-center cohort study evaluated adult burn patients who were consecutively admitted to the burn service with at least 10% total body surface area burned and subsequently followed in the burn clinic between February 2015 and September 2018. Subjects were separated into two cohorts based on discharge pain regimens: multimodal and nonmultimodal. The primary outcome was the change in opioid requirements (measured in oral morphine equivalents) between discharge and first follow-up interval. Secondary outcomes included the classes of multimodal agents utilized and a comparison of opioid requirements between the last 24 hours of admission and discharge. A total of 152 patients were included for analysis, 76 in the multimodal cohort and 76 in the nonmultimodal cohort. The multimodal cohort was noted to have increased total body surface area burned and prolonged number of days spent in the intensive care unit at baseline; however, the multimodal cohort exhibited a more significant decrease in opioid requirements from discharge to first follow-up interval when compared with the nonmultimodal cohort (106.6 vs 75.4 mg, P = .039).

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Prevalence and associated predictors for patients developing chronic neuropathic pain following burns

Burns & Trauma ◽

10.1093/burnst/tkaa011 ◽

2020 ◽

Vol 8 ◽

Cited By ~ 1

Author(s):

Kevin M Klifto ◽

A Lee Dellon ◽

C Scott Hultman

Keyword(s):

Mechanical Ventilation ◽

Neuropathic Pain ◽

Surface Area ◽

Body Surface Area ◽

Body Surface ◽

Burn Injury ◽

Total Body Surface Area ◽

Chronic Neuropathic Pain ◽

Burn Center ◽

Total Body

Abstract Background Chronic pain, unrelated to the burn itself, can manifest as a long-term complication in patients sustaining burn injuries. The purpose of this study was to determine the prevalence of chronic neuropathic pain (CNP) and compare burn characteristics between patients who developed CNP and patients without CNP who were treated at a burn center. Methods A single-center, retrospective analysis of 1880 patients admitted to the adult burn center was performed from 1 January 2014 to 1 January 2019. Patients included were over the age of 15 years, sustained a burn injury and were admitted to the burn center. CNP was diagnosed clinically following burn injury. Patients were excluded from the definition of CNP if their pain was due to an underlying illness or medication. Comparisons between patients admitted to the burn center with no pain and patients admitted to the burn center who developed CNP were performed. Results One hundred and thirteen of the 1880 burn patients developed CNP as a direct result of burn injury over 5 years with a prevalence of 6.01%. Patients who developed CNP were a significantly older median age (54 years vs. 46 years, p = 0.002), abused alcohol (29% vs. 8%, p < 0.001), abused substances (31% vs. 9%, p < 0.001), were current daily smokers (73% vs. 33%, p < 0.001), suffered more full-thickness burns (58% vs. 43%, p < 0.001), greater median percent of total body surface area (%TBSA) burns (6 vs. 3.5, p < 0.001), were more often intubated on mechanical ventilation (33% vs. 14%, p < 0.001), greater median number of surgeries (2 vs. 0, p < 0.001) and longer median hospital length of stay (LOS) (10 days vs. 3 days, p < 0.001), compared to those who did not develop CNP, respectively. Median patient follow-up was 27 months. Conclusions The prevalence of CNP over 5 years was 6.01% in the burn center. Older ages, alcohol abuse, substance abuse, current daily smoking, greater percent of total body surface area (%TBSA) burns, third degree burns, being intubated on mechanical ventilation, having more surgeries and longer hospital LOS were associated with developing CNP following burn injury, compared to patients who did not develop CNP following burn injury.

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Recovery from an Eighty-Percent Total Body Surface Area Burn Injury Sustained at Work

Archives of Industrial Hygiene and Toxicology ◽

10.2478/10004-1254-63-2012-2169 ◽

2012 ◽

Vol 63 (2) ◽

pp. 223-226

Author(s):

Helga Hahn

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Surface Area ◽

Body Surface Area ◽

Body Surface ◽

Initial Treatment ◽

Burn Injury ◽

Total Body Surface Area ◽

Hot Water ◽

Total Body

Recovery from an Eighty-Percent Total Body Surface Area Burn Injury Sustained at WorkThis article presents a case of severe burn injury at work involving 80 % of body surface area and patient treatment and rehabilitation, which resulted in preserved working ability. The worker was injured by hot water and steam. After initial treatment in the intensive care unit, he underwent comprehensive clinical and outpatient rehabilitation that took 92 weeks, after which he returned to work. His working disability was 100 % after the initial treatment in the intensive care unit, but rehabilitation improved it to 50 %. It should always be kept in mind that even patients with serious or life-threatening injuries can be reintegrated into the workforce if patients, physicians, occupational physicians, and employers all work together.

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Comparison between the Lund-Browder chart and the BurnCase 3D® for consistency in estimating total body surface area burned

WikiJournal of Medicine ◽

10.15347/wjm/2020.002 ◽

2020 ◽

Vol 7 (1) ◽

pp. 2

Author(s):

Kyung-tak Yoo ◽

Gowoon Woo ◽

Tae Young Jang ◽

Jae Seok Song

Keyword(s):

Surface Area ◽

Body Surface Area ◽

Body Surface ◽

Total Body Surface Area ◽

Area Burned ◽

Total Body

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511 Point-of-care 3-dimensional Body Mapping for Determining Total Body Surface Area in Severely Burned Patients

Journal of Burn Care & Research ◽

10.1093/jbcr/iraa024.143 ◽

2020 ◽

Vol 41 (Supplement_1) ◽

pp. S92-S93

Author(s):

Julia Loegering ◽

Kevin Webb ◽

Jesse Ahlquist ◽

Kevin Krause ◽

Karen Xu ◽

...

Keyword(s):

Surface Area ◽

Body Surface Area ◽

Body Surface ◽

Gold Standard ◽

Burn Injury ◽

Point Of Care ◽

Total Body Surface Area ◽

Body Mapping ◽

Burn Care ◽

Total Body

Abstract Introduction With severe burn injury, there is systemic fluid loss due to inflammatory responses in damaged tissue, leading to disruption of cellular processes. Patient fluid levels are restored with the calculation of total body surface area (TBSA). Clinically used TBSA equations are often outdated and inaccurate with error up to 20%, resulting in misinformed treatment and subsequent sequelae including prolonged hospital length of stay and increased mortality. Our objective, therefore, was to create a point-of-care (POC) system employing 3D imaging technology to accurately calculate TBSA for all patient population varieties. Methods Our team employed an iPad attachable, infrared scanner to create 3D models of the human body. From these models, TBSA can be extrapolated using scan processing software. Subject scans were collected on our device and on a gold standard scanner for comparison of TBSA output. Clinical testing on burn patients is occurring at present to establish scanning precision of TBSA in the burn care environment. Results Non-clinical verification tests of the 3D scanned TBSA revealed a 4.05% error when compared to the gold standard, and precision error of 3.8%. Additionally, we introduced the device into the burn unit for preliminary testing with a physician user and non-patient subjects. The subjects were scanned in a prone position to mimic burn care workflow. Clinician scanning error was 1.41% when compared to the gold standard scan of the same subject. Clinical precision study results are on-going in collection. Conclusions Our device introduces an improved method of TBSA estimation to assist clinicians in making accurate burn care decisions and further precision medicine with greater anthropomteric data, notably for children. This device is one of the first POC-3D scanning technologies to be used in a burn setting and may also be employed at outlying medical facilities. Destructive wildfires and combat burn injuries highlight the need for such a device to standardize the triage of burn victims with and away from experienced medical staff. Applicability of Research to Practice 3D body mapping points to an enhanced method of TBSA calculation and minimally disruptive to the burn workflow. Future developments of 3D scanning include deep learning algorithms to identify and better assess burned surface area. Additionally, further automation of TBSA scan processing to reduce user error in calculation and improve burn injury outcomes.

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Referral Patterns of Burn Injury in Rural Kenya

Journal of Burn Care & Research ◽

10.1093/jbcr/iraa187 ◽

2020 ◽

Author(s):

Mary A Hunter ◽

Kimutai Sylvester ◽

Russell E White ◽

David T Harrington ◽

Patrick M Vivier ◽

...

Keyword(s):

Travel Time ◽

Surface Area ◽

Body Surface Area ◽

Body Surface ◽

Burn Injury ◽

Trauma System ◽

Total Body Surface Area ◽

Bivariate Analysis ◽

Rural Kenya ◽

Total Body

Abstract Burn injury represents a substantial burden of disease in resource-limited settings. Kenya has no formal trauma system and referral practices for burn injuries are not well understood. The purpose of this study was to determine the factors associated with burn injury referrals in rural Kenya. A retrospective chart review was conducted for patients with burn injury from January 1, 2014 to December 31, 2017 at a 300-bed faith-based, teaching hospital in southwest Kenya. Bivariate analysis compared referred and non-referred patients. Multivariable logistic regression was used to assess the association between burn severity and odds of referral adjusting for age, sex, insurance, time from injury to arrival, and estimated travel time from home to hospital. The study included 171 patients with burn injury; 11 patients were excluded due to missing referral data. Of the 160 patients, 31.9% (n = 51) were referred. Referral patients had higher average total body surface area burn (23.1 ± 2.4% vs 11.1 ± 1.2%, P < .001), were more likely to have full-thickness burns (41.3% vs 25.5%, P = .05), and less likely to present to the referral hospital within 24 hours after injury (47.8% vs 73.0%, P = .005). Referral patients had longer travel time to hospital (90+ min: 52.9% vs 22.0%, P < .001). Odds of referral increased 1.62 times (95% confidence interval: 1.19–2.22) for every 10% increase in total body surface area burn. Without a coordinated trauma system, referrals represent a substantial portion of burn injury patients at a hospital in rural Kenya. Referred patients present with more severe burns and experience delays to presentation.

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