531 The Effect of Burn Wound Size on Caloric Requirements: A Correlation of Nutritional Changes to the Clinical State

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S113-S114
Author(s):  
Marc R Matthews ◽  
Sara Calder ◽  
Areta Kowal-Vern ◽  
Philomene Spadafore ◽  
Karen J Richey ◽  
...  
Keyword(s):  
Injury Severity ◽  
Burn Injury ◽  
Recovery Period ◽  
Total Body Surface Area ◽  
Caloric Intake ◽  
Retrospective Chart Review ◽  
Clinical State ◽  
Apache Score ◽  
Burn Wound ◽  
Caloric Requirements

Abstract Introduction Caloric intake has been a vital component for burn wound healing and recovery. The hypothesis was that caloric requirements are based on injury severity & post-burn week as predicated by indirect calorimetry (IC)/predictive equations. Methods This was a retrospective chart review of 115 burn patients (2012–2017). Caloric requirements were determined by the Curreri equation [which includes % total body surface area (TBSA)] and IC for a 5-week period provided mainly by enteral nutrition. Patients received supplements and total parenteral nutrition as needed. Results The mean ±sd age was 43±18 years, 41±18 % TBSA, Body Mass Index of 28±7 kg/m2, and mortality of 26 (23%). The major mechanisms of injury were flame/flash/explosions. There were 59 (51%) of patients with < 40 % TBSA burns, [median Injury Severity Score (ISS) 9; Apache score 14], and 56 (49%) with ≥40 % TBSA (median ISS 25; Apache score 21), p < .0001. The Respiratory Quotient (RQ) had a median of 0.94 (range 0.79 to 1.02). The median number of surgeries for the < 40 % TBSA group was 5 versus 12 for the ≥40 % TBSA, p < .0001. The Injury Factor did not differ from weeks 1–5 (1.8 for < 40 % TBSA and 2.0 for the ≥ 40 % TBSA). The Curreri equation calculation for this study was a median 3640 (range 2161–5950) calories. The Curreri equation resulted in significantly increased caloric recommendations for the ≥ 40 %TBSA compared to the < 40 %TBSA patients, p < .0001. The < 40 %TBSA group had caloric requirements ranging between 1500- 2700 calories compared to the ≥ 40 %TBSA group, whose calories ranged between 2000–3700. The total daily caloric recommendations were also significantly increased in the ≥40 %TBSA compared to the < 40 %TBSA patients. The maximum levels of resting energy expenditure (REE) from IC, total daily calories recommended by the dietitian and average calories ranged between 3000–4500 in the < 40 %TBSA group and 3600–6700 in the ≥ 40 %TBSA group. The caloric recommendations increased for all patients from week 1 to week 3 and leveled off during weeks 4–5. Conclusions Patient caloric requirements were dependent not only on the severity of the burn injury but also the post-burn hospitalization during which surgeries, debridement/grafting, and infectious complications occurred. They increased until the third week post-burn and leveled off in the recovery period. The study caloric recommendations and requirements were consistent with the REE and Curreri equation assessments.

666 The Effect of Burn Wound Size on Caloric Requirements: A Correlation of Nutritional Changes to the Clinical State

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S178-S178
Author(s):  
Marc Matthews ◽  
Sara Calder ◽  
Areta Kowal-Vern ◽  
Philomene Spadafore ◽  
Hunter McCollum ◽  
...  
Keyword(s):  
Injury Severity ◽  
Burn Injury ◽  
Recovery Period ◽  
Total Body Surface Area ◽  
Caloric Intake ◽  
Retrospective Chart Review ◽  
Clinical State ◽  
Apache Score ◽  
Burn Wound ◽  
Caloric Requirements

Abstract Introduction Caloric intake has been a vital component for burn wound healing and recovery. The hypothesis was that caloric requirements are based on injury severity & post-burn week as predicated by indirect calorimetry (IC)/predictive equations. Methods This was a retrospective chart review of 115 burn patients (2012–2017). Caloric requirements were determined by the Curreri equation [which includes % total body surface area (TBSA)] and IC for a 5-week period provided mainly by enteral nutrition. Patients received supplements and total parenteral nutrition as needed. Results The mean±sd age was 43±18 years, 41±18 % TBSA, Body Mass Index of 28±7 kg/m2, and mortality of 26 (23%). The major mechanisms of injury were flame/flash/explosions. There were 59 (51%) of patients with < 40 % TBSA burns, [median Injury Severity Score (ISS) 9; Apache score 14], and 56 (49%) with ≥40 % TBSA (median ISS 25; Apache score 21), p < .0001. The Respiratory Quotient (RQ) had a median of 0.94 (range 0.79 to 1.02). The median number of surgeries for the < 40 % TBSA group was 5 versus 12 for the ≥40 % TBSA, p < .0001. The Injury Factor did not differ from weeks 1–5 (1.8 for < 40 % TBSA and 2.0 for the ≥ 40 % TBSA). The Curreri equation calculation for this study was a median 3640 (range 2161–5950) calories. The Curreri equation resulted in significantly increased caloric recommendations for the ≥ 40 %TBSA compared to the < 40 %TBSA patients, p < .0001. The < 40 %TBSA group had caloric requirements ranging between 1500- 2700 calories compared to the ≥ 40 %TBSA group, whose calories ranged between 2000–3700. The total daily caloric recommendations were also significantly increased in the ≥40 %TBSA compared to the < 40 %TBSA patients. The maximum levels of resting energy expenditure (REE) from IC, total daily calories recommended by the dietitian and average calories ranged between 3000–4500 in the < 40 %TBSA group and 3600–6700 in the ≥ 40 %TBSA group. The caloric recommendations increased for all patients from week 1 to week 3 and leveled off during weeks 4–5. Conclusions Patient caloric requirements were dependent not only on the severity of the burn injury but also the post-burn hospitalization during which surgeries, debridement/grafting, and infectious complications occurred. They increased until the third week post-burn and leveled off in the recovery period. The study caloric recommendations and requirements were consistent with the REE and Curreri equation assessments. Applicability of Research to Practice There is no constant number of calories for all patients. Caloric requirements are modified by the severity of Burn %TBSA and phases of resuscitation through recovery.

521 Incidence of Bone Fracture Rate Post-Burn and Trauma in Role 2 and 3 Treatment Centers

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S107-S108
Author(s):  
Linda E Sousse ◽  
Amanda Staudt ◽  
Christopher VanFosson
Keyword(s):  
Bone Fracture ◽  
Injury Severity ◽  
Burn Injury ◽  
Bone Fractures ◽  
Total Body Surface Area ◽  
Anatomical Location ◽  
Fracture Rate ◽  
Initial Correlation ◽  
Total Body ◽  
Markers Of Bone Resorption

Abstract Introduction One of the hallmarks of critical illness and trauma is that it triggers resorptive bone loss, as well as an increase in bone fractures and a reduction in bone density. Sustained markers of bone resorption, bone formation, and regulators of bone signaling pathways are linked to prolonged inflammatory activities and the prolonged deterioration of bone microstructure. The objective of this study is to evaluate the bone fracture rate of the U.S Military, non-U.S. Military, North Atlantic Treaty Organization (NATO) Military, local civilian, and Coalition Forces population in Operation Enduring Freedom and Operation Freedom’s Sentinel with burns from 2005 to 2018 using the Department of Defense Trauma Registry (DoDTR; n=28,707). Our hypothesis is that there is a direct relationship between burn injury severity and bone fracture rates. Methods Pearson’s correlation coefficient and scatterplots were used in this retrospective, observational study to demonstrate the correlation between total body surface area (TBSA) burn and number of fractures by anatomical location. Results Approximately 15,195 patients (age: 26 ± 10 years) in Role 2 and Role 3 treatment centers reported fractures. Of those patients, 351 suffered from burns with 632 anatomical fracture locations. Facial fractures were most prominent (16%), followed by foot (12%), skull (12%), tibia/fibula (11%), hand (11%), and ulna/radius (10%). There was no initial correlation between n increasing severity of TBSA burn and count of fracture locations (ρ=-0.03, p=0.8572). Conclusions There was no acute correlation between burn severity and bone fracture rates; however, further analyses are required to assess chronic post-burn fracture rates.

726 The Use of Xeroform Dressings for Partial Thickness Scald Burn Injuries in a Verified Pediatric Burn Center

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S194-S195
Author(s):  
Lisa C Vitale ◽  
Jennifer Livingston ◽  
Erica Curtis ◽  
Katherine Oag ◽  
Christina M Shanti ◽  
...  
Keyword(s):  
Burn Injury ◽  
Wound Care ◽  
Total Body Surface Area ◽  
Burn Injuries ◽  
Wound Complications ◽  
Burn Wound ◽  
Burn Center ◽  
Partial Thickness ◽  
Partial Thickness Burn ◽  
At Home

Abstract Introduction For children who have suffered a burn injury one of the greatest challenges is managing pain with an adequate yet practical burn wound dressing that will ultimately be managed at home. Medical product companies have created a variety of wound care products available on the market. These products are advertised to be more superior over one another in categories such as decrease in wound infections, minimization of pain, ease of dressing application, increased dressing wear time, and better wound healing. With all the options for burn wound care there are many factors to consider when choosing a burn dressing such as cost, ease of dressing for families at home, comfort, and efficacy. At our ten year verified pediatric burn center we have tried many different burn wound care products, however we have found Xeroform and bacitracin to be the most practical and easy to use for our patient population. Methods A retrospective chart review was performed from 2016–2018 of all cascading scald injuries to children 0–5 years of age treated at our verified pediatric burn center. 179 patients were included in this review. Of those patients a total of 52 patients were excluded, 28 patients had no follow up, 21 patients received alternate dressings, and 3 patients had full thickness injuries requiring a split thickness skin graft (STSG). Charts were reviewed for total body surface area (TBSA), length of stay (LOS), discharge dressing type, complications, and time to healing. All patients included routinely received consistent application of the Xeroform and bacitracin. Results 127 patients discharged with Xeroform dressings were included in this study with an average age of 1.4 years old (range 0–5 years) and average TBSA of 2.5% (range 0.25–13%). The average LOS was 1.6 days (range 1–10 days). In this sample 32 (25%) patients were healed within 7 days. 77 (61%) patients were healed within 7–14 days. 11 (9%) patients were healed within 14–21 days. 7 (5%) patients were healed in greater than 21 days. There were no wound complications identified within this study group. Conclusions Using Xeroform as our standard of practice has streamlined the care provided to our patients. We have demonstrated consistent effective re-epithelization, protection from infection, and ease of dressings for families and burn providers. In our experience Xeroform has provided a versatile way to care for partial thickness burn injuries. Applicability of Research to Practice We suggest Xeroform and bacitracin dressings be used for partial thickness burn injuries in patients under 5 years of age. This dressing may be superior to other products because it allows for bathing while providing good wound epithelization and is easy to use.

Presentation and Management of Staphylococcal Scalded Skin Syndrome in a Child After a Burn Injury: A Case Report

2019 ◽  
Author(s):  
Thomas Edward Pidgeon ◽  
Federica D’Asta ◽  
Malobi Ogboli ◽  
Yvonne Wilson
Keyword(s):  
Case Report ◽  
Burn Injury ◽  
Wound Care ◽  
Total Body Surface Area ◽  
Granular Cell ◽  
Burn Wound ◽  
Staphylococcal Scalded Skin Syndrome ◽  
The Face ◽  
Total Body ◽  
Learning Points

Abstract This case report describes the clinical course of a child who developed staphylococcal scalded skin syndrome (SSSS) after a burn injury. The intent is to aid other units in recognizing the presentation of SSSS after a pediatric burn and to optimize subsequent management. The main clinical finding was of rapid, progressive, superficial epidermal loss at sites separate from the original burn, involving 55% of the total body surface area, 13 days after a 6% scald burn to the face, neck, and chest. Diagnosis was confirmed by multidisciplinary team clinical assessment and histopathology of an intraoperative skin biopsy. This confirmed epidermal cleavage at the granular cell layer. These findings were later supported by Staphylococcus aureus cultured from the burn wound, and a positive epidermolytic toxin A assay. Management was with general medical supportive care, clindamycin and flucloxacillin intravenous antibiotic therapy, and cleansing and dressing of the areas of epidermal loss. Key learning points from this case were that SSSS presented after a burn injury and that 13 days elapsed between the burn and SSSS. Factors differentiating it from toxic epidermal necrolysis are described, including the value of histopathology in confirming the diagnosis. The prompt use of antibiotics and attentive wound care are advocated as an effective management strategy.

scholarly journals A comparison of burn related injuries following the natural disaster Super Storm Hurricane Sandy to the National Burn Repository of the American Burn Association

2016 ◽  
Vol 4 ◽  
pp. 1-4 ◽  
Author(s):  
Michael Kalina ◽  
Grigoriy Malyutin ◽  
Michael L. Cooper
Keyword(s):  
Natural Disasters ◽  
Natural Disaster ◽  
Burn Injury ◽  
Total Body Surface Area ◽  
Retrospective Chart Review ◽  
Hospital Length ◽  
Outcome Data ◽  
Hurricane Sandy ◽  
University Hospital ◽  
Hospital Length Of Stay

Abstract Background Burn related injuries from natural disasters are not well described and natural disasters are not identified as an etiology of burn injury in the National Burn Repository (NBR) of the American Burn Association. The natural disaster Super Storm Hurricane Sandy had devastating effects. Our goal was to detail the burn related injuries following this natural disaster and to compare the data to the NBR. Methods This was a retrospective chart review of thirty four patients who sustained burn related injuries following Super Storm Hurricane Sandy (SSHS) and were managed at Staten Island University Hospital Burn Center. Institutional Review Board approval was obtained. Data variables included age, gender, race, past medical history (PMHx), burn type, percentage total body surface area (%TBSA), hospital length of stay (HLOS), and mortality. We compared data from SSHS to the 2003-2013 NBR. Categorical data were summarized using frequency counts, percentages and Clopper-Pearson 95 % confidence interval for proportion. Continuous outcome data were summarized by descriptive statistics. Data analyses performed with SAS® System Version 9.3 (SAS Institute Inc., Cary, NC) and p < 0.05 was significant. Results In the SSHS group, average age was 36 + 24 years, range 1-80 years, and 44.1 % were males (15/34, 95 % CI: 27.2 - 62.1). Caucasians comprised 58.8 %, (20/34, 95 % CI: 40.7, 75.4) and 73.5 % had no PMHx (25/34, 95 % CI: 55.6, 87.1). The most common burn type was scald, 55.9 %, (19/34, 95 % CI: 37.9, 72.8) and %TBSA ranged 1 %–47 %, average of 7 % + 12 %. The average HLOS was 13 + 26 days, range of 1–113 days. Mortality was 2.9 % (1/34, 95 % CI: 0.07–15). In comparison, the NBR reported an average age of 32 years and 69 % were males. Caucasians comprised 59.1 %. The most common burn type was flame, 43.2 % and the %TBSA ranged 1 %–9.9 %. HLOS ranged 8.4–10.2 days and mortality was 3.4 %. Conclusion We conclude that burn related injuries following a natural disaster differ as compared to those most commonly reported in the NBR.

scholarly journals The Effect of Educated Platelets on the Healing Process of Burn Wounds in Rats: Educated Platelets in Rat Burn Wound Healing

2021 ◽  
Vol 8 ◽  
Author(s):  
Orkun Ilgen ◽  
Sefa Kurt ◽  
Osman Yilmaz ◽  
Murat Celiloglu
Keyword(s):  
Wound Healing ◽  
Burn Injury ◽  
Healing Process ◽  
Recovery Period ◽  
Control Group ◽  
Study Group ◽  
Second Line ◽  
Burn Wound ◽  
Wound Area ◽  
Burn Wound Healing

Burns are serious life-threatening health problems. This study was performed to determine the effect of educated platelets on burn wound healing process. 28 female wistar albino 200-220 gr rats were randomly divided into four groups. Group A1 rats(n:7) were the first-line burnt group from which blood samples are extracted to develop platelet-rich plasma(PRP) with the educated platelets that have a response to burn injury. Group B1 rats(n:7) were the unburnt group with ordinary platelets. Group A2 rats(n:8) were the second-line burnt group which was given PRP with educated platelets. Group B2 rats(n:6), as control group, were the second-line burnt group which was given PRP with ordinary platelets. Photos of rats' dorsum were taken by digital camera on the first day and 21st day of the study. Wound healing was determined by scar surface area. In the study group (Group A2) mean wound area was  53±37 mm², in the control group (Group B2) mean wound area was 114±55 mm² on the last day of the experiment. The sizes of the wounded areas were significantly lower in the study group compared with the control group (p: 0.039). Educated platelets seem to facilitate the recovery period of burn wound healing in rats.

725 Escharotomy Incisions in the Burn Foot and Toe with Compartment Syndrome

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S194-S194
Author(s):  
Gregory Lifferth ◽  
Bryan Roth ◽  
Marisse Lardizabal ◽  
Areta Kowal-Vern ◽  
Kevin N Foster ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Compartment Syndrome ◽  
Burn Injury ◽  
Total Body Surface Area ◽  
Retrospective Chart Review ◽  
Burn Injuries ◽  
Metatarsal Bones ◽  
Fat Level ◽  
Total Body ◽  
Effective Site

Abstract Introduction Patients with burn injuries are at risk for lower extremity compartment syndrome, especially if the injury is circumferential. The hypothesis was that two dorsal escharotomy incisions to release foot and toe compartment syndrome would be most efficacious in the prevention of lower extremity amputations. Methods This was a retrospective chart review of foot compartment syndrome in burn patients between January 2001 and May 2019. Results The study consisted of 59 feet from 32 patients who had been admitted to the Burn Center for thermal injury. The patient age was a mean±sd of 29±30 years, and 41±29 as the % total body surface area (%TBSA); there were 19 males and 13 females. All patients had received fluid resuscitation on admission. Twenty-one (66%) of the patients did not require amputations after undergoing a median of two incisions (range 1–5); 6 of 59 (11%) required fasciotomies. Compared to medial or dorsal or multiple echarotomies, the majority of patients who underwent two dorsal foot escharotomies did not require amputations, p = .0001. Significantly more patients were alive with no amputation 15 (50%) compared to 4 (13%) (dead with amputations), p = .02. Survivors were significantly younger than the non-survivors (median 20 and range1-69) compared to the non-survivors (48, 12–59), p =.04. The survivors also had significantly less severe %TBSA median 22 (range 2–75) versus 83 (35–95) %TBSA, p < .0002. Dorsal/Lateral incisions had the highest number of amputations. Conclusions Foot dorsal compartment release is the most effective site for escharotomies in the treatment of burn-induced compartment syndrome. It does not require more than two incisions at the skin/fat level and over the second and fourth metatarsal bones on the dorsal part of the foot to decrease the lower extremity amputation rate in the majority of cases. Applicability of Research to Practice This research was a critical appraisal of the safest escharotomy foot incisions for compartment syndrome to avoid possible amputations in burn injury.

scholarly journals Exploding power: a statewide review of lithium battery related burns

2021 ◽  
Vol 4 (2) ◽  
Author(s):  
Jason Diab ◽  
Justine O’Hara ◽  
Andrea-Issler Fisher ◽  
Erik La Hei ◽  
Robert Gates ◽  
...  
Keyword(s):  
Lithium Battery ◽  
Injury Severity ◽  
Burn Injury ◽  
Electronic Cigarettes ◽  
Total Body Surface Area ◽  
Ethics Committees ◽  
Home Setting ◽  
Royal North Shore Hospital ◽  
South Wales ◽  
Severity Of Injury

Introduction: With the increase of lithium battery devices, including electronic cigarettes and battery power banks, there has been a steady rise in burn injuries secondary to device malfunction. These devices may cause chemical or flame burns. Our aim was to identify and classify epidemiological trends of explosions from lithium battery devices across the state of New South Wales (NSW), Australia. Methods: A review of the NSW Burn Injury Service (SBIS) database from January 2005–December2019, together with medical records from the burns units at the Children’s Hospital at Westmead (CHW), the Concord Repatriation General Hospital (CRGH) and the Royal North Shore Hospital (RNSH) was conducted. All patients who suffered a burn secondary from a lithium battery device were included and data was extracted on mechanism of injury, severity of injury and management. This study was approved by the ethics committees of CHW, RNSH and CRGH [2020/PID00179]. Results: Of the 24 patients identified, six were paediatric and 18 were adults. The majority were male (7:1) with a mean age of 29.0 (+/- 16.6 years). The mean total body surface area burnt was 2.5% (+/- 0.9) [range 0.1–21.0%]. The majority occurred after 2014 and involved spontaneous explosions. Their injuries ranged from partial to full thickness burns with flame being the most common type (n=15). Three quarters of the cases (n=18) occurred in a home setting. Conclusions: Lithium battery device explosions can result in a mix of burn depth injuries from flame, contact and electrical, or chemical burns. Consumers need to be made more aware of the potential risks associated with use of lithium battery powered devices.

scholarly journals Collocated burn and fracture injuries in major trauma: a 10 year experience

2020 ◽  
Vol 102 (4) ◽  
pp. 256-262
Author(s):  
D Bui ◽  
BS Sivakumar ◽  
A Ellis
Keyword(s):  
Chart Review ◽  
Major Trauma ◽  
Injury Severity ◽  
Total Body Surface Area ◽  
Retrospective Chart Review ◽  
Operative Management ◽  
Complication Rates ◽  
Cast Doubt ◽  
Operative Fixation ◽  
Total Body

Introduction Collocated burn and fracture injuries, defined as a burn overlying the site of a fracture, represent a serious subset of major burns and trauma. The literature pertaining to these rare injuries is inconclusive. Recent studies cast doubt on the safety of operative fixation in this population. No study to date has examined outcomes of collocated burn and fracture injuries compared with control. The aim of this study was to compare characteristics, injury patterns and complication rates in major burns and fracture patients with a collocated injury to those without. Methods A retrospective chart review of all consecutive patients with dermal burns and major fractures were undertaken between January 2005 and December 2015 at a tertiary referral trauma hospital. Outcomes assessed included demographics, injury characteristics and complications, including infection. Orthopaedic infection was defined as orthopaedic surgical site infection or osteomyelitis. Results Of the 40 patients identified, 21 subjects sustained collocated injuries. Patients with collocated injuries demonstrated a trend towards higher injury severity, higher percentage of total body surface area affected, longer length of stay and greater overall and orthopaedic complication rate. Significant predictors of orthopaedic infection were related to injury severity rather than collocation or operative management. Conclusion There are differences in the characteristics and complication rates between collocated and non-collocated burn and fracture injuries. Collocated injuries tend to result from greater energy mechanisms, undergo longer inpatient stays and demonstrate increased morbidity. Injury severity appears to be the most important factor in determining postoperative orthopaedic infection. These characteristics must be considered when managing these rare but significant injuries.

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