Rehabilitation of the Burn Patient

2019 ◽  
Author(s):  
Barclay T Stewart ◽  
Samuel P Mandell ◽  
Nicole Gibran
Keyword(s):  
Injury Severity ◽  
Community Integration ◽  
Total Body Surface Area ◽  
Rehabilitation Medicine ◽  
Rehabilitation Program ◽  
Loved One ◽  
Total Body ◽  
The Moment ◽  
Burn Depth ◽  
Need For Rehabilitation

Burn rehabilitation begins the moment the patient contacts the healthcare system and, for many patients, it never truly ends. Returning severely burned patients to their pre-injury level of function has become more challenging, as more severely burned patients survive their injury. The need for rehabilitation does not simply correspond with burn depth, total body surface area involved, or injury severity. Other factors also impact need for rehabilitation, such as anatomic location of injury (eg, across finger joints, face), additional psychosocial strain from a house fire or having an injured loved one, or body image concerns related to visible scarring. To meet these and other challenges posed by burn injuries, rehabilitation requires a multidisciplinary team including, but not limited to, nursing, surgery, burn therapy, rehabilitation medicine, vocational counseling, rehabilitation psychology, psychiatry, and nutrition. Accord­ingly, verification as a burn center by the American Burn Association requires a goal-oriented, multidisciplinary rehabilitation program. This chapter broadly discusses the spectrum and integral components of burn rehabilitation. This review contains 13 figures, 8 tables, and 71 references.  Key Words: burn, community integration, function, mental health, multidisciplinary, outcome, pain, quality of life, reconstruction, rehabilitation, therapy.

Rehabilitation of the Burn Patient

2019 ◽  
Author(s):  
Barclay T Stewart ◽  
Samuel P Mandell ◽  
Nicole Gibran
Keyword(s):  
Injury Severity ◽  
Community Integration ◽  
Total Body Surface Area ◽  
Rehabilitation Medicine ◽  
Rehabilitation Program ◽  
Loved One ◽  
Total Body ◽  
The Moment ◽  
Burn Depth ◽  
Need For Rehabilitation

Burn rehabilitation begins the moment the patient contacts the healthcare system and, for many patients, it never truly ends. Returning severely burned patients to their pre-injury level of function has become more challenging, as more severely burned patients survive their injury. The need for rehabilitation does not simply correspond with burn depth, total body surface area involved, or injury severity. Other factors also impact need for rehabilitation, such as anatomic location of injury (eg, across finger joints, face), additional psychosocial strain from a house fire or having an injured loved one, or body image concerns related to visible scarring. To meet these and other challenges posed by burn injuries, rehabilitation requires a multidisciplinary team including, but not limited to, nursing, surgery, burn therapy, rehabilitation medicine, vocational counseling, rehabilitation psychology, psychiatry, and nutrition. Accord­ingly, verification as a burn center by the American Burn Association requires a goal-oriented, multidisciplinary rehabilitation program. This chapter broadly discusses the spectrum and integral components of burn rehabilitation. This review contains 13 figures, 8 tables, and 71 references.  Key Words: burn, community integration, function, mental health, multidisciplinary, outcome, pain, quality of life, reconstruction, rehabilitation, therapy.

scholarly journals A Framework for Automatic Burn Image Segmentation and Burn Depth Diagnosis Using Deep Learning

2021 ◽  
Vol 2021 ◽  
pp. 1-12
Author(s):  
Hao Liu ◽  
Keqiang Yue ◽  
Siyi Cheng ◽  
Wenjun Li ◽  
Zhihui Fu
Keyword(s):  
Deep Learning ◽  
Total Body Surface Area ◽  
High Morbidity ◽  
Learning Technology ◽  
Human Errors ◽  
Burn Wounds ◽  
Output Structure ◽  
Network Output ◽  
Total Body ◽  
Burn Depth

Burn is a common traumatic disease with high morbidity and mortality. The treatment of burns requires accurate and reliable diagnosis of burn wounds and burn depth, which can save lives in some cases. However, due to the complexity of burn wounds, the early diagnosis of burns lacks accuracy and difference. Therefore, we use deep learning technology to automate and standardize burn diagnosis to reduce human errors and improve burn diagnosis. First, the burn dataset with detailed burn area segmentation and burn depth labelling is created. Then, an end-to-end framework based on deep learning method for advanced burn area segmentation and burn depth diagnosis is proposed. The framework is firstly used to segment the burn area in the burn images. On this basis, the calculation of the percentage of the burn area in the total body surface area (TBSA) can be realized by extending the network output structure and the labels of the burn dataset. Then, the framework is used to segment multiple burn depth areas. Finally, the network achieves the best result with IOU of 0.8467 for the segmentation of burn and no burn area. And for multiple burn depth areas segmentation, the best average IOU is 0.5144.

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.

25 Social Integration in the First 2 Years After Moderate to Severe Burn Injury: A Burn Model System National Database Study

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S19-S20
Author(s):  
Kara McMullen ◽  
Alyssa M Bamer ◽  
Nicole S Gibran ◽  
Radha K Holavanahalli ◽  
Jeffrey C Schneider ◽  
...  
Keyword(s):  
Mental Health ◽  
Social Integration ◽  
Psychiatric Treatment ◽  
Community Integration ◽  
Total Body Surface Area ◽  
Factors Associated ◽  
Burn Survivors ◽  
Race Ethnicity ◽  
Total Body

Abstract Introduction Feeling a part of community and participating in social life are important aspects of overall quality of life. Burn survivors consider community reintegration one of the most important issues affecting their recovery. Integration, including social integration, has been studied in this population, but longitudinal analyses to examine factors associated with successful integration are lacking. The current study aims to assess variables associated with social integration during the first two years post-burn. Methods Adult (18+ years) burn survivors enrolled in the Burn Model System national longitudinal database responded to questionnaires at hospital discharge and 6-, 12-, and 24-months postburn. Social integration was assessed at all follow-up timepoints using the Community Integration Questionnaire Social Integration Component Scale, which has a possible range of scores from 0 (no community integration) to 12 (excellent community integration). To examine variables associated with social integration over time, linear mixed effect models utilizing generalized least squares with maximum likelihood and robust standard errors were used. Independent variables in the model included age, sex, % total body surface area (TBSA) burned, race/ethnicity, living status at time of injury, facial burn, history of psychiatric treatment preburn, employment at follow-up assessment, and SF-12 or VR-12 mental health component scores at the time of each follow-up assessment. Results Data from 1,848 adult burn survivors were included in the analyses. Average age of the survivors was 42.9 years, 74.0% were male, 77.7% were white, 47.0% were married or living common-law with a partner, and mean total body surface area burned was 18.2%. Factors associated with better social integration over time included younger age, female sex, lower TBSA (< 40%) burn size, white/non-Hispanic race, no preburn psychiatric treatment, postburn employment, and better mental health. Time was not a significant predictor, indicating that social integration scores remain relatively stable over the 24-month follow-up period. Conclusions We identified several factors that contribute to greater social integration including age, gender, burn size, race/ethnicity, employment, and mental health, with the association between age, gender, and employment status and community integration a novel finding in this population. Applicability of Research to Practice This study suggests that while most factors associated with social integration are not modifiable, interventions aimed at improving mental health and helping burn survivors return to work could also improve self-reported social integration.

720 Scalds and Contact Burns: Are They Really Different?

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S191-S191
Author(s):  
Adam Singer ◽  
Evyatar Baer ◽  
Henry Thode
Keyword(s):  
Total Body Surface Area ◽  
Retrospective Chart Review ◽  
Stepwise Logistic Regression ◽  
Full Thickness ◽  
Chi Square ◽  
Included Patient ◽  
Body Location ◽  
Total Body ◽  
Fire Flame ◽  
Burn Depth

Abstract Introduction Prior studies comparing scalds and contact burns rarely address the affect of burn etiology on burn depth. However, it is commonly believed that scalds tend to heal faster than similarly sized contact and flame burns. As a result, expectant therapy is often preferred after scald injuries. We compared the percentages of full-thickness burns based on burn etiology controlling for burn size, location and patient age. We hypothesized that the percentage of full thickness burns would be lower after scalds compared with contact and flame burns. Methods We performed a retrospective chart review of a prospectively collected burn registry of all patients admitted to a regional burn center between 2000–2010. Data collection included patient and burn characteristics including age, gender, body location, and burn etiology. We compared the percentages of full thickness burns among scald, contact and flame burns using Chi-square tests. Stepwise logistic regression was used to adjust for age, location, and burn size. Results There were 1038 patients in the study with either scald (n=537, 52%), fire/flame (n=434, 42%) or contact (n=67, 6%) burn. Mean (SD) age was 29 (25); 75% were male. Mean (SD) total body surface area (TBSA) was 11 (13)%. Mean (SD) length of stay was 10 (18) days. The percentages of full thickness burns by etiology were scalds 13.1%, fire/flame 34%, and contact burns 45% (P< 0.001). Patients with scalds were younger (22+/-24) than patients with contacts (32+/-28) and fire/flame (38+/-22) burns. Multivariate analysis for predicting full thickness burns found that compared with contact burns, scalds were less likely full thickness (OR 0.23, 95%CI 0.11–0.48) while fire/flame burns were as likely to be full thickness (OR 0.54, 95%CI 0.26–1.15). TBSA and age were also associated with full thickness burns (OR 1.06, 95%CI 1.04–1.09 and OR 1.015, 95%CI 1.007–1.024, respectively). Burns on the head and neck were less likely to be full thickness (OR 0.30, 95%CI, 0.11–0.82). Conclusions Scald burns are significantly less likely to be full thickness than contact or fire/flame burns. Applicability of Research to Practice Based on these results, expectant therapy may be more appropriate for scalds than contact or fire/flame burns.

scholarly journals Epidemiology of Scars and Their Consequences: Burn Scars

2020 ◽  
pp. 37-43
Author(s):  
Margriet E. van Baar
Keyword(s):  
Risk Factors ◽  
Burn Injury ◽  
Healing Process ◽  
Total Body Surface Area ◽  
Female Gender ◽  
Burn Injuries ◽  
Post Injury ◽  
The People ◽  
Total Body ◽  
Burn Depth

AbstractPathological scarring in burn wounds can result in hypertrophic scars and/or contractures. Prevalences of hypertrophic scarring after burn injuries between 8% and 67% are reported. A recent prospective study revealed a prevalence of 8%. Data on prevalence of burn scar contractures are limited; reported prevalence at discharge varied between 38 and 54% and decreased with an increasing time post burn. About 5–20% of the people who suffered from burn injuries received reconstructive surgery after burns, up to 10 years post injury.Factors predicting pathological scar formation after burn injuries include patient, injury and treatment characteristics. Injury- and treatment-related characteristics are the main predictors of scar outcomes after burn injury. These characteristics are related to burn size (total body surface area burned) and burn depth (number or type of surgery) or the overall healing process in general (length of stay, wound healing complications). Intrinsic patient-related risk factors seem to play a role as well but are less consistent predictors of scar outcome. This includes the risk factors like the female gender and also a younger age and darker skin.Knowledge on risk factors for poor scar outcome can be used to tailor treatment, aftercare and scar prevention to these patients with a high-risk profile.

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.

scholarly journals A case report of toxic epidermal necrolysis (TEN) in a patient with COVID-19 treated with hydroxychloroquine: are these two partners in crime?

2020 ◽  
Vol 18 (1) ◽  
Author(s):  
Carlo Maria Rossi ◽  
Flavio Niccolò Beretta ◽  
Grazia Traverso ◽  
Sandro Mancarella ◽  
Davide Zenoni
Keyword(s):  
Toxic Epidermal Necrolysis ◽  
Fatal Outcome ◽  
Total Body Surface Area ◽  
Stevens Johnson Syndrome ◽  
First Case ◽  
Cutaneous Adverse Reaction ◽  
Johnson Syndrome ◽  
Mucous Membranes ◽  
Total Body ◽  
The Moment

Abstract Background Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis (SJS/TEN) is the most Serious Cutaneous Adverse Reaction (SCAR) often with a fatal outcome. Coronavirus Disease (COVID-19) is caused by Severe Acute Respiratory Syndrome–Coronavirus—2 (SARS-COV2) and is an emergent pandemic for which no cure exist at the moment. Several drugs have been tried often with scant clinical evidence and safety. Case presentation Here we report the case of 78-years-old woman with cardiometabolic syndrome and COVID-19. A multidrug regimen including others hydroxychloroquine, antibiotics, dexamethasone and paracetamol, low-molecular-weight-heparin and potassium canrenoate was started. After almost 3 weeks, the patient started to display a violaceous rash initially involving the flexural folds atypical targetoid lesions and showing a very fast extension, blister formation and skin detachments of approximately 70% of the total body surface area and mucous membranes involvement consistent with toxic epidermal necrolysis (TEN). The ALDEN algorithm was calculated inserting all drugs given to the patient in the 28 days preceding the onset of the skin manifestations. The highest score retrieved was for hydroxychloroquine. Other less suspicious drugs were piperacillin/tazobactam, ceftriaxone and levofloxacin. Conclusions To our knowledge, this is the first case of TEN in a patient suffering from COVID-19 probably associated with hydroxychloroquine. Given the activation of the immune system syndrome induced by the virus and the widespread off-label use of this drug, we suggest a careful monitoring of skin and mucous membranes in all COVID-19 positive patients treated with hydroxychloroquine in order to early detect early signs of toxicities.

865 Assessing Opioid Administration in Pediatric Burn Patients with Nonsurgical Management

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S271-S271
Author(s):  
Holden Richards ◽  
Junxin Shi ◽  
Rajan Thakkar ◽  
Sheila Giles ◽  
Krista K Wheeler ◽  
...  
Keyword(s):  
Temporal Trend ◽  
Total Body Surface Area ◽  
Burn Patients ◽  
Simple Linear Regression ◽  
Nonsurgical Management ◽  
Pain Scores ◽  
Opioid Administration ◽  
Vast Literature ◽  
Total Body ◽  
Burn Depth

Abstract Introduction Despite the vast literature studying the opioid crisis, there is sparse data in the pediatric burn population. This study sought to assess patient-level characteristics and their potential effects on opioid administration in nonsurgical pediatric burn inpatients. Methods Admitted burn patients from 2013–2018 with nonsurgical management at an American Burn Association (ABA) verified pediatric burn center were retrospectively identified. Morphine milligram equivalents by weight (MME/kg) per admission were evaluated through a multiple loglinear regression with race, sex, age, total body surface area burned (TBSA), and burn depth as predictors. Simple linear regression was used to evaluate the temporal trend of median opioid utilization. Results A total of 806 patients (55% White, 35% Black, 5% Hispanic, 5% Other) were included. In an adjusted analysis, no differences in opioid administration were seen by sex, burn degree, or for Blacks and Hispanics when compared with Whites. Increased MME/kg was associated with older age (10–18 years; p< 0.0001) and larger burns (>5% TBSA burned; p< 0.0001). From 2013 to 2018, median MME/kg per admission declined significantly (2013:0.21, 2018:0.09; p=0.0103). Conclusions Nonsurgical burn patients who were older and presented with larger TBSA experienced marked increases in opioid utilization. Overall, opioid administration decreased over time. Applicability of Research to Practice Future pediatric burn research should evaluate disparities in opioid administration based on injury location and surgical management. Further, the accuracy of pain scores for non-verbal pediatric burn patients should be studied as discrepancies in opioid utilization exist.

Sign in / Sign up

Export Citation Format

Share Document