Impact of Facial Burn Injury on Self Esteem of Burn Patients: A Hospital Based Study From Karachi

This article describes the first reported psychotherapeutic group for hospitalized burn patients. The rationale for the group is based upon an adaptive coping model. Issues typically dealt with in groups include feelings toward hospital staff, emotional reactions to treatments, and feelings concerning their burn injury. Body image and resultant self-esteem issues are a major theme. The importance of clinical services for burn injured patients and the involvement of mental health professionals in service delivery is emphasized.

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853 Microblading in Patients with Facial Burn Injuries

Journal of Burn Care & Research ◽

10.1093/jbcr/iraa024.421 ◽

2020 ◽

Vol 41 (Supplement_1) ◽

pp. S264-S265

Author(s):

Melissa Brown ◽

Lori Turgeon ◽

Branko Bojovic

Keyword(s):

Body Image ◽

Burn Injury ◽

Scar Tissue ◽

Self Esteem ◽

Post Treatment ◽

Non Invasive ◽

Patient Reported ◽

The Impact ◽

Over Time ◽

Facial Burn

Abstract Introduction The experience of a burn injury is devastating. Physical and emotional recovery can be lengthy and often difficult. Many patients tire of constant surgical interventions required to achieve optimal functional and cosmetic outcomes. Identifying non-invasive interventions for patients with extensive facial burns that positively affect quality of life is appealing. Microblading, semi-permanent eyebrow tattooing, is one such option. Little research exists on the durability and longevity of microblading in burns, or its impact on body-image and self-esteem. The purpose of this case review is to identify possible benefits microblading may have physically and psychologically. Methods Case report looking at the impact of microblading on a young adult female over 18 years, who sustained a facial burn injury at age one year. Following consultation with her plastic surgeon, she was referred to a licensed body art facility to assess the viability of microblading over scar tissue. First treatment occurred at the facility in March of 2019 with a second session in May, as is standard practice. Patient photos obtained before and after procedures assessed longevity of microblading over scar tissue. Self-reported patient outcomes obtained following the procedure addressed the impact on perceived self-esteem and body-image. Results Photos were taken pre-treatment, directly post-treatment, 2 months, and 6 months post-treatment. Comparisons of photos immediately post treatment to those 6 months out showed appearance of tattooing remains the same. Eyebrows did not fade with time and continue to hold the same color and shape. Assessment of psychological impact was conducted through patient interview and self-report. Patient reported satisfaction with the procedure and cosmetic appearance following initial treatment. Over time, patient noted feeling more positive about body image and improvement in self-esteem. Conclusions Eyebrows are a critically important part of facial expression, which can be lost following a devastating facial burn. Initial data demonstrate the effectiveness of tattooing in recreating the appearance and function of eyebrows over scar tissue. Over time, the eyebrows maintained color without fading and shape did not change, demonstrating durability and longevity in this patient population. Early reports of improved self-image also remained unchanged over time. Microblading presents a possible low risk, inexpensive, effective alternative to expensive or potentially ineffective cosmetic surgery. This case establishes a need for further research on efficacy of microblading over scar tissue, with the hope of incorporating it into burn reconstruction as an alternative therapy and advocate for insurance coverage for qualifying patients. Applicability of Research to Practice Research supports microblading as a potential non-invasive, inexpensive treatment modality for loss of eyebrows.

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11 Vitamin D Deficiency on Admission and the Association with Length of Stay in Patients with Thermal Injury: A Multi-center Analysis

Journal of Burn Care & Research ◽

10.1093/jbcr/irab032.016 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

pp. S13-S14

Author(s):

Sarah Zavala ◽

Kate Pape ◽

Todd A Walroth ◽

Melissa A Reger ◽

Katelyn Garner ◽

...

Keyword(s):

Vitamin D ◽

Length Of Stay ◽

Vitamin D Deficiency ◽

Burn Injury ◽

Total Body Surface Area ◽

Inhalation Injury ◽

Hospital Length Of Stay ◽

Burn Patients ◽

Comfort Care ◽

The Impact

Abstract Introduction In burn patients, vitamin D deficiency has been associated with increased incidence of sepsis. The objective of this study was to assess the impact of vitamin D deficiency in adult burn patients on hospital length of stay (LOS). Methods This was a multi-center retrospective study of adult patients at 7 burn centers admitted between January 1, 2016 and July 25, 2019 who had a 25-hydroxyvitamin D (25OHD) concentration drawn within the first 7 days of injury. Patients were excluded if admitted for a non-burn injury, total body surface area (TBSA) burn less than 5%, pregnant, incarcerated, or made comfort care or expired within 48 hours of admission. The primary endpoint was to compare hospital LOS between burn patients with vitamin D deficiency (defined as 25OHD < 20 ng/mL) and sufficiency (25OHD ≥ 20 ng/mL). Secondary endpoints include in-hospital mortality, ventilator-free days of the first 28, renal replacement therapy (RRT), length of ICU stay, and days requiring vasopressors. Additional data collected included demographics, Charlson Comorbidity Index, injury characteristics, form of vitamin D received (ergocalciferol or cholecalciferol) and dosing during admission, timing of vitamin D initiation, and form of nutrition provided. Dichotomous variables were compared via Chi-square test. Continuous data were compared via student t-test or Mann-Whitney U test. Univariable linear regression was utilized to identify variables associated with LOS (p < 0.05) to analyze further. Cox Proportional Hazard Model was utilized to analyze association with LOS, while censoring for death, and controlling for TBSA, age, presence of inhalation injury, and potential for a center effect. Results Of 1,147 patients screened, 412 were included. Fifty-seven percent were vitamin D deficient. Patients with vitamin D deficiency had longer LOS (18.0 vs 12.0 days, p < 0.001), acute kidney injury (AKI) requiring RRT (7.3 vs 1.7%, p = 0.009), more days requiring vasopressors (mean 1.24 vs 0.58 days, p = 0.008), and fewer ventilator free days of the first 28 days (mean 22.9 vs 25.1, p < 0.001). Univariable analysis identified burn center, AKI, TBSA, inhalation injury, admission concentration, days until concentration drawn, days until initiating supplementation, and dose as significantly associated with LOS. After controlling for center, TBSA, age, and inhalation injury, the best fit model included only deficiency and days until vitamin D initiation. Conclusions Patients with thermal injuries and vitamin D deficiency on admission have increased length of stay and worsened clinical outcomes as compared to patients with sufficient vitamin D concentrations.

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Surviving Burn Injury: Drivers of Length of Hospital Stay

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18020761 ◽

2021 ◽

Vol 18 (2) ◽

pp. 761

Author(s):

Chimdimma Noelyn Onah ◽

Richard Allmendinger ◽

Julia Handl ◽

Ken W. Dunn

Keyword(s):

Mental Status ◽

Burn Injury ◽

Length Of Hospital Stay ◽

Care Plan ◽

Burn Patients ◽

Emotional Needs ◽

Effective Care ◽

Significant Difference ◽

Unitary Model ◽

Hospital Resources

With a reduction in the mortality rate of burn patients, length of stay (LOS) has been increasingly adopted as an outcome measure. Some studies have attempted to identify factors that explain a burn patient’s LOS. However, few have investigated the association between LOS and a patient’s mental and socioeconomic status. There is anecdotal evidence for links between these factors; uncovering these will aid in better addressing the specific physical and emotional needs of burn patients and facilitate the planning of scarce hospital resources. Here, we employ machine learning (clustering) and statistical models (regression) to investigate whether segmentation by socioeconomic/mental status can improve the performance and interpretability of an upstream predictive model, relative to a unitary model. Although we found no significant difference in the unitary model’s performance and the segment-specific models, the interpretation of the segment-specific models reveals a reduced impact of burn severity in LOS prediction with increasing adverse socioeconomic and mental status. Furthermore, the socioeconomic segments’ models highlight an increased influence of living circumstances and source of injury on LOS. These findings suggest that in addition to ensuring that patients’ physical needs are met, management of their mental status is crucial for delivering an effective care plan.

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502 Adapting to COVID19: Can Virtual Burn Camp be as Impactful as Last Year’s In-person Camp?

Journal of Burn Care & Research ◽

10.1093/jbcr/irab032.153 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

pp. S98-S98

Author(s):

Jessica Banks ◽

Matt Ferdock ◽

Jennifer Nagle

Keyword(s):

Burn Injury ◽

Summer Camp ◽

Sense Of Self ◽

Age Groups ◽

Self Esteem ◽

Summer Program ◽

Critical Question ◽

Camp Counselors ◽

Positive Effects ◽

Burn Survivors

Abstract Introduction Skin is not the only casualty following a burn accident. Many children suffer long term, debilitating emotional effects from their burn injury (Abdullah et al. 1994; Kornhaber et al. 2018). Armstrong-James et al. (2018) and Maslow and Lobato (2010) found that summer camps explicitly designed for burn survivor children can positively impact children’s adaptability to stares and comments and improve their sense of self-esteem. Camp Susquehanna has been a summer camp for burn survivors for the past 25+ years. When the COVID19 pandemic closed many businesses, we decided to transition our in-person camp to 100% online. Researchers demonstrated the positive effects of summer camp for burn survivors (Maslow & Lobato, 2010; Bakker et al. 2011). However, the effects of a 100% online camp are not known. Our concern was, are we able to transition and be as impactful as it is face to face at camp? What will the schedule and activities look like in this new format? How will we ensure all children participating will have access to online and the supplies necessary? Methods We opted to select a three-week format with two sessions a day divided into two age groups. We ensured every child had internet access then mailed out a “camp in the box.” It contained all the things needed for each planned activity. The critical question remained, however, will we be as impactful? The current research looks at quantitative and qualitative measures of self-esteem, happiness, and satisfaction following participation in a three-week summer program held in July 2020. We make comparisons to previous years’ results. The authors expected that self-esteem, happiness, and satisfaction levels matched or exceeded last years’ levels. Results We collected data from 42 campers and 22 volunteer camp counselors. Results show that campers were able to receive the support they needed, not only from the staff but also from their peers. Conclusions The delivery method was indeed different this year, but the positive effect on our campers remained the same.

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Follow up after burn injury is disturbingly low and linked with social factors

Journal of Burn Care & Research ◽

10.1093/jbcr/irab065 ◽

2021 ◽

Author(s):

Irina P Karashchuk ◽

Eve A Solomon ◽

David G Greenhalgh ◽

Soman Sen ◽

Tina L Palmieri ◽

...

Keyword(s):

Social History ◽

Drug Dependence ◽

Burn Injury ◽

Retrospective Chart Review ◽

Burn Patients ◽

Chi Square ◽

Factors Associated ◽

Ed Visits ◽

Zip Code

Abstract For medical and social reasons, it is important that burn patients attend follow up appointments (FUAs). Our goal was to examine the factors leading to missed FUAs in burn patients. A retrospective chart review was conducted of adult patients admitted to the burn center from 2016-2018. Data collected included burn characteristics, social history, and zip code. Data analysis was conducted using chi-square, Wilcox Rank Sum tests, and multivariate regression models. A total of 878 patients were analyzed, with 224 (25.5%) failing to attend any FUAs and 492 (56.0%) missing at least one appointment (MA). Patients who did not attend any FUAs had smaller burns (4.5 (8)% vs. 6.5 (11)% median (inter quartile range)), traveled farther (70.2 (111.8) vs. 52.5 (76.7) miles), and were more likely to be homeless (22.8% vs. 6.9%) and have drug dependence (47.3% vs. 27.2%). Patients who had at least one MA were younger (42 (26) vs. 46 (28) years) and more likely to be homeless (17.5% vs. 2.6%) and have drug dependence (42.5% vs. 19.4%). On multivariate analysis, factors associated with never attending a FUA were: distance from hospital (odds ratio (OR) 1.004), burn size (OR 0.96), and homelessness (OR 0.33). Factors associated with missing at least one FUA : age (OR 0.99), drug dependence (OR 0.46), homelessness (OR 0.22), and ED visits (OR 0.56). A high percentage of patients fail to make any appointment following their injury and/or have at least one MA. Both FUAs and MAs are influenced by social determinants of health.

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Once-Daily Amikacin Dosing in Burn Patients Treated with Continuous Venovenous Hemofiltration

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.00374-11 ◽

2011 ◽

Vol 55 (10) ◽

pp. 4639-4642 ◽

Cited By ~ 19

Author(s):

Kevin S. Akers ◽

Jason M. Cota ◽

Christopher R. Frei ◽

Kevin K. Chung ◽

Katrin Mende ◽

...

Keyword(s):

Burn Injury ◽

Continuous Venovenous Hemofiltration ◽

Burn Patients ◽

Small Reduction ◽

Target Attainment ◽

Clinical Pharmacokinetics ◽

Once Daily ◽

Renal Replacement Therapies ◽

Rapid Clearance ◽

The Impact

ABSTRACTAmikacin clearance can be increased in burn injury, which is often complicated by renal insufficiency. Little is known about the impact of renal replacement therapies, such as continuous venovenous hemofiltration (CVVH), on amikacin pharmacokinetics. We retrospectively examined the clinical pharmacokinetics, bacteriology, and clinical outcomes of 60 burn patients given 15 mg/kg of body weight of amikacin in single daily doses. Twelve were treated with concurrent CVVH therapy, and 48 were not. The pharmacodynamic target of ≥10 for the maximum concentration of drug in serum divided by the MIC (Cmax/MIC) was achieved in only 8.5% of patients, with a small reduction ofCmaxin patients receiving CVVH and no difference in amikacin clearance. Mortality and burn size were greater in patients who received CVVH. Overall, 172 Gram-negative isolates were recovered from the blood cultures of 39 patients, with amikacin MIC data available for 82 isolates from 24 patients. A 10,000-patient Monte Carlo simulation was conducted incorporating pharmacokinetic and MIC data from these patients. The cumulative fraction of response (CFR) was similar in CVVH and non-CVVH patients. The CFR rates were not significantly improved by a theoretical 20 mg/kg amikacin dose. Overall, CVVH did not appear to have a major impact on amikacin serum concentrations. The low pharmacodynamic target attainment appears to be primarily due to higher amikacin MICs rather than more rapid clearance of amikacin related to CVVH therapy.

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Malnutrition in Burns: A prospective, single center study

Journal of Burn Care & Research ◽

10.1093/jbcr/irab186 ◽

2021 ◽

Author(s):

Nancy Coutris ◽

Justin Peter Gawaziuk ◽

Saul Magnusson ◽

Sarvesh Logsetty

Keyword(s):

Burn Injury ◽

Nutrition Intervention ◽

Critically Ill Patient ◽

Burn Patients ◽

Significant Independent Predictor ◽

Single Center Study ◽

Multivariable Regression Model ◽

Resource Requirements ◽

Hospital Resources ◽

Multivariable Regression

Abstract The hypermetabolic response from burn injury is the highest of the critically ill patient population. When coupled with the hypermetabolic response, preexisting malnutrition may increase the hospital resources used. The goal of this study was to evaluate the rate of malnutrition in burn patients and the associated hospital resource utilization.We collected prospective data on burn patients ≥ 18 years with a burn ≥ 10% TBSA admitted to a regional burn center. Demographics, %TBSA, co-morbidities, length of stay (LOS) and standardized LOS (LOS/%TBSA) were evaluated on 49 patients. A multivariable regression model was constructed. Nutrition assessment was completed within 24-48 hours of admission including an SGA (Subjective Global Assessment) classification. SGA A (well-nourished) was compared to SGA B and C (malnourished). Fourteen patients (28.6%) in this study were malnourished. Malnourished patients were not statistically different with respect to median age (50 versus 39; p = 0.08] and BMI (22.9 versus 26.5; p = 0.08) compared to the well-nourished group. However, malnourished patients had significantly longer median LOS (21.0 versus 11.0 days, p = 0.01) and LOS/%TBSA (1.69 versus 0.83, p = 0.001) than the well-nourished group. Being malnourished was a significant independent predictor of above median LOS/%TBSA (p=0.027) with an odds ratio (OR) of 5.61 (95% C.I. 1.215-25.890).The rate of malnutrition is important given the high metabolic demands of these patients. Malnutrition increased the resource requirements via higher standardized LOS. This underscores the importance of completing SGA on admission to identify malnutrition early on to optimize nutrition intervention during the patients’ hospital stay.

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Epidemiology of injuries, treatment (costs) and outcome in burn patients admitted to a hospital with or without dedicated burn centre (Burn-Pro): protocol for a multicentre prospective observational study

BMJ Open ◽

10.1136/bmjopen-2018-023709 ◽

2018 ◽

Vol 8 (11) ◽

pp. e023709 ◽

Cited By ~ 1

Author(s):

Esther MM Van Lieshout ◽

Daan T Van Yperen ◽

Margriet E Van Baar ◽

Suzanne Polinder ◽

Doeke Boersma ◽

...

Keyword(s):

Quality Of Life ◽

Observational Study ◽

Prospective Observational Study ◽

Burn Injury ◽

Treatment Costs ◽

Burn Patients ◽

Severe Burns ◽

Referral Criteria ◽

Age Limit

IntroductionThe Emergency Management of Severe Burns (EMSB) referral criteria have been implemented for optimal triaging of burn patients. Admission to a burn centre is indicated for patients with severe burns or with specific characteristics like older age or comorbidities. Patients not meeting these criteria can also be treated in a hospital without burn centre. Limited information is available about the organisation of care and referral of these patients. The aims of this study are to determine the burn injury characteristics, treatment (costs), quality of life and scar quality of burn patients admitted to a hospital without dedicated burn centre. These data will subsequently be compared with data from patients with<10% total bodysurface area (TBSA) burned who are admitted (or secondarily referred) to a burn centre. If admissions were in agreement with the EMSB, referral criteria will also be determined.Methods and analysisIn this multicentre, prospective, observational study (cohort study), the following two groups of patients will be followed: 1) all patients (no age limit) admitted with burn-related injuries to a hospital without a dedicated burn centre in the Southwest Netherlands or Brabant Trauma Region and 2) all patients (no age limit) with<10% TBSA burned who are primarily admitted (or secondarily referred) to the burn centre of Maasstad Hospital. Data on the burn injury characteristics (primary outcome), EMSB compliance, treatment, treatment costs and outcome will be collected from the patients’ medical files. At 3 weeks and at 3, 6 and 12 months after trauma, patients will be asked to complete the quality of life questionnaire (EuroQoL-5D), and the patient-reported part of the Patient and Observer Scar Assessment Scale (POSAS). At those time visits, the coordinating investigator or research assistant will complete the observer-reported part of the POSAS.Ethics and disseminationThis study has been exempted by the medical research ethics committee Erasmus MC (Rotterdam, The Netherlands). Each participant will provide written consent to participate and remain encoded during the study. The results of the study are planned to be published in an international, peer-reviewed journal.Trial registration numberNTR6565.

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Positive Signs on Physical Examination Are Not Always Indications for Endotracheal Tube Intubation in Patients with Facial Burn

10.21203/rs.3.rs-128508/v1 ◽

2020 ◽

Author(s):

Ruo-Yi Huang ◽

Szu-Jen Chen ◽

Yen-Chang Hsiao ◽

Ling-Wei Kuo ◽

Chien-Hung Liao ◽

...

Keyword(s):

Risk Factors ◽

Endotracheal Tube ◽

Odds Ratio ◽

Inhalation Injury ◽

Burn Patients ◽

Shortness Of Breath ◽

Airway Protection ◽

Increased Risk ◽

Independent Risk Factors ◽

Facial Burn

Abstract BackgroundAfter clinical evaluation in the emergency department (ED), facial burn patients are usually intubated to protect their airways. However, the possibility of unnecessary intubation or delayed intubation after admission exists. Objective criteria for the evaluation of inhalation injury and the need for airway protection in facial burn patients are needed.MethodsFacial burn patients between January 2013 and May 2016 were reviewed. Patients who were and were not intubated in the ED were compared. All intubated patients received routine bronchoscopy to evaluate whether they had inhalation injuries. Patients with and without confirmed inhalation injuries were compared. Multivariate logistic regression analysis was used to identify the independent risk factors for inhalation injuries in facial burn patients. The reasons for intubation in patients without inhalation injuries were also investigated.ResultsDuring the study period, 121 patients were intubated in the ED among a total of 335 facial burn patients. Only 73 (60.3%) patients were later confirmed to have inhalation injuries on bronchoscopy. The comparison between patients with and without inhalation injuries showed that shortness of breath (odds ratio=3.376, p=0.027) and high total body surface area (TBSA) (odds ratio=1.038, p=0.001) were independent risk factors for inhalation injury. Other physical signs (e.g., hoarseness, burned nostril hair, etc.), laboratory examinations and chest X-ray findings were not predictive of inhalation injury in facial burn patients. All patients with a TBSA over 60% were intubated in the ED even if they did not have inhalation injuries.ConclusionIn the management of facial burn patients, positive signs on conventional physical examinations may not always be predictive of inhalation injury and the need for endotracheal tube intubation in the ED. More attention should be paid to facial burn patients with shortness of breath and a high TBSA because they have an increased risk of inhalation injuries. Airway protection is needed in facial burn patients without inhalation injuries because of their associated injuries and treatment.

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