Epidemiology of work-related burn injuries: A ten-year retrospective study of 429 patients at a referral burn centre in the north of Iran

Understanding drivers of fire risk with people experiencing homelessness

Fire hazards affecting people who are unhoused span natural and built environments, social circumstances, and human behavior. Identifying key drivers of fire risk and burn injury can inform injury prevention and control initiatives. We conducted 12 key informant interviews with burn patients who were unhoused. Deductive and inductive strategies were used to code transcripts. Corcoran's conceptual model of fire risk was applied in order to group factors into environmental, social, and behavioral categories. The most frequently used fire sources were propane, hand sanitizer, and other alcohol-based liquids. Unsafely contained open flames and improper propane tank storage were frequently identified hazards. Participants described the interplay of environmental, social, and behavioral factors that need to be accounted for when addressing fire hazards. For example, the use of propane heaters inside tents is common because it is effective in warming living spaces and limits the risk of having equipment stolen. This project identified specific environmental risks, socioeconomic risks, and their interplay with identified fire hazards as foundational to injury control for people experiencing homelessness. Injury prevention strategies need to be evaluated within the complex environments of homelessness (e.g., exposure to severe weather, unsafe and potentially violent living conditions, substance use, social marginalization, and limited access to injury prevention media).

Understanding Epidemiological Trends in Geriatric Burn Injuries: A National Multicenter Analysis from NEISS 2004-2022

Burn injuries pose a significant source of patient morbidity/mortality and reconstructive challenges for burn surgeons, especially in vulnerable populations such as geriatric patients. Our study aims to provide new insights into burn epidemiology by analyzing the largest national, multicenter sample of geriatric patients to date. Using the National Electronic Injury and Surveillance System (NEISS) database (2004-2022), individuals with a "burn" diagnosis were extracted and divided into 2 comparison age groups of 18-64 and 65+. Variables including sex, race, affected body part, incident location, burn etiology, and clinical outcomes were assessed between the 2 groups using 2 proportion z-tests. About 60,581 adult patients who sustained burns were identified from the NEISS database with 6630 of those patients categorized as geriatric (65+). Geriatric patients had a significantly greater frequency of scald burns (36.9% vs 35.4%; P < .01), and third-degree/full-thickness burns (10.4% vs 5.5%, P < .01) relative to nongeriatric adult patients with most of these burns occurring at home (75.9% vs 67.4%; P < .01). The top 5 burn sites for geriatric patients were the hand, face, foot, lower arm, and lower leg and the top 5 burn injury sources were hot water, cookware, oven/ranges, home fires, and gasoline. Geriatric patients had over 2 times greater risk of hospital admission (odds ratio [OR]: 2.32, 95% CI: 2.17-2.49, P < .01) and over 5 times greater risk of emergency department mortality (OR: 6.22, 95% CI: 4.00-9.66, P < .01) after incurring burn injuries. These results highlight the need for stronger awareness of preventative measures for geriatric burn injuries.

Association Between Serum Albumin Levels and Clinical Outcomes in Burn Patients: A Single-center Retrospective Analysis

Objectives

Severe burns often result in significant intravascular albumin loss, leading to hypoalbuminemia. This study aimed to evaluate the association between serum albumin levels and clinical outcomes in burn patients.

Methods

A retrospective, single-center study was conducted at Velayat Hospital (Rasht, Iran), including burn patients aged ≥16 years, who were admitted between April 2019 and March 2020. Serum albumin levels were recorded on day 1, day 7, and at discharge. The main variables analyzed included albumin levels, length of hospital stay, skin graft rate, need for mechanical ventilation, and mortality.

Results

Among the 74 patients included in the study, 14 (18.9%) died, while 60 (81.1%) survived. The mean serum albumin levels on days 1, 7, and at discharge were significantly higher in survivors (3.09±0.22, 3.12±0.23, and 3.18±0.28 g/dL, respectively) than non-survivors (2.22±0.29, 2.74±0.29, and 2.07±0.69 g/dL, respectively) at all time points (p<0.001). The serum albumin level measured on day 1 was significantly lower in patients who required mechanical ventilation than in those who did not (2.86±0.47 vs.3.09±0.13, p=0.03). Additionally, a significant inverse relationship was observed between serum albumin levels and both total body surface area burned (TBSA) and graft extent (day 1: rs=-0.76, day 7: rs=-0.74, discharge: rs=-0.62; p<0.001 for TBSA; and day 1: rs=-0.59, day 7: rs=-0.58, discharge: rs=-0.50; p<0.001 for graft extent).

Conclusion

Hypoalbuminemia was associated with poor clinical outcomes in patients with severe burns. Serum albumin levels might serve as a specific marker of burn severity and a predictor of mortality.

The impact of inhalation injury on fluid resuscitation in major burn patients: a 10-year multicenter retrospective study

BACKGROUND

It remains unclear whether additional fluid supplementation is necessary during the acute resuscitation period for patients with combined inhalational injury (INHI) under the guidance of the Third Military Medical University (TMMU) protocol.

METHODS

A 10-year multicenter, retrospective cohort study, involved patients with burns ≥ 50% total burn surface area (TBSA) was conducted. The effect of INHI, INHI severity, and tracheotomy on the fluid management in burn patients was assessed. Cumulative fluid administration, cumulative urine output, and cumulative fluid retention within 72 h were collected and systematically analyzed.

RESULTS

A total of 108 patients were included in the analysis, 85 with concomitant INHI and 23 with thermal burn alone. There was no significant difference in total fluid administration during the 72-h post-burn between the INHI and non-INHI groups. Although no difference in the urine output and fluid retention was shown in the first 24 h, the INHI group had a significantly lower cumulative urine output and a higher cumulative fluid retention in the 48-h and 72-h post-burn (all p < 0.05). In addition, patients with severe INHI exhibited a significantly elevated incidence of complications (Pneumonia, 47.0% vs. 11.8%, p = 0.012), (AKI, 23.5% vs. 2.9%, p = 0.037). For patients with combined INHI, neither the severity of INHI nor the presence of a tracheotomy had any significant influence on fluid management during the acute resuscitation period.

CONCLUSIONS

Additional fluid administration may be unnecessary in major burn patients with INHI under the guidance of the TMMU protocol.

Beyond the burn: An observational study of cardiovascular risk in burn survivors in the north of Iran

Burn survivors experience profound physiological changes following injury, which may have lasting implications for cardiovascular health. This study aims to investigate the cardiovascular risk profile among burn survivors treated at a burn center in northern Iran. This observational study was conducted from 2022 to 2023 at the burn centre affiliated with Guilan University of Medical Sciences, Rasht, Iran. This study assessed a cohort study of 210 burn survivors, focusing on individuals with ≥20% TBSA burn injuries who had recovered and returned to their daily lives. This study assessed patients' lipid profiles, Framingham General Cardiovascular Risk Score (FGCRS) and risk factors, including demographics, clinical variables and physical activity. Statistical analysis employed descriptive and inferential statistics. The mean age was 49.23 years, and the mean TBSA burned was 37.06%. The risk of cardiovascular disease in 66% of the study population was less than 10%, and in 13%, it was more than 20%. Significant associations were identified between CVD risk and sex, diabetes, hypertension, BMI, TBSA burned, years after burn, physical activity level and LDL. Of the lipid profile measures, LDL, triglycerides and TC/HDL exceeded the desirable levels. This research highlights the heightened cardiovascular risk in burn survivors, emphasizing the necessity for targeted interventions and regular monitoring. Identifying modifiable risk factors enables healthcare practitioners to develop tailored strategies, enhancing cardiovascular health in this vulnerable population and improving overall outcomes and quality of life.

Effect of vitamin D on clinical outcomes in patients with thermal injury

Evaluating complications and mortality risks in burn patients is crucial for effective treatment planning and improving survival rates. This study investigated the relationship between the serum vitamin D level and the clinical outcomes of adult burns patients. This was a prospective cohort of adult patients hospitalized due to thermal burns at a burn centre in the north of Iran. Based on the level of 25 hydroxyvitamin D measured upon admission, patients were divided into two groups of patients with sufficient 25 hydroxyvitamin D level and insufficient 25 hydroxyvitamin D level. Descriptive statistics were used for baseline demographics. Univariate analysis was conducted using Mann-Whitney U, Chi-square, independent samples, and Fisher's exact tests. A multivariate logistic regression was performed to adjust for the effects of confounding variables. Statistical analyses were conducted using SPSS 28.0 software. A total of 220 patients were included in the study. The average total body surface area burned was 30.52 ± 9.34. Patients with insufficient vitamin D levels had longer hospital stays (12.53 vs. 11.45) and longer stays in the intensive care unit (ICU) (3.32 vs. 2.40) than those with appropriate vitamin D levels. Participants with insufficient vitamin D levels exhibited a numerically higher incidence of infections than those with adequate levels (p < 0.05). The multivariate regression found that vitamin D deficiency levels were associated with increased infection rates and prolonged hospital stay. This study suggests that vitamin D deficiency is a significant risk factor for adverse clinical outcomes in burn patients. Further research is needed to confirm these associations and to explore potential interventions to optimize vitamin D status in this patient population.