Scald burn, a preventable injury: Analysis of 4306 patients from a major tertiary care center

Effect of a Childhood Burn Prevention Program on Knowledge Level of Caregivers and Burn Risk Factors

BACKGROUND

Prevention activities are very important in paediatric burns. More than 73% of burns occur at home. This study aimed to develop a Childhood Burn Prevention Program for caregivers of children with burns and to evaluate the effectiveness of the program for reducing burn risk factors for children at home as well as increasing the relevant knowledge of caregivers on burn prevention.

METHODS

"Childhood Burn Prevention Program" was developed in the study. Within the scope of the program, caregivers were interviewed twice at home visits. At the first home visit, caregivers were trained in burn prevention and a poster including burn risk factors was put in their homes. In addition, the knowledge levels of caregivers about burns and risk factors in home settings were evaluated in the first and second home visits.

RESULTS

We found the total risk factor for burns in home settings was 28.94 ± 6.24 before the training and 14.68 ± 3.74 after the training (p < 0.05). In addition, the total number of correct answers given by the caregivers to the questions about burns before the training was 8.60 ± 2.62 and 11.71 ± 1.70 after the training (p < 0.05).

CONCLUSION

This Childhood Burn Prevention Program can be used to reduce risk factors for burns at home and to increase the relevant knowledge of caregivers of children.

Using the NEISS database to understand pressure cooker related injuries in the USA

OBJECTIVE

To determine the incidence of pressure cooker related injuries in US hospital emergency departments. To quantify injury patterns associated with pressure cookers and inform prevention recommendation messaging.

METHODS

The National Electronic Injury Surveillance System (NEISS) was queried to identify injuries associated with pressure cookers between 1 January 2003 and 31 December 2019. Case narratives were reviewed to identify precipitating or contributing factors of pressure cooker related injuries. Negative binomial regression was employed to test for trends over time.

RESULTS

The NEISS query identified 759 actual pressure cooker injuries between 2003 and 2019, yielding a national estimate of 28 337 (95% CI 24 588 to 32,086) injuries treated in US emergency departments, 1667 cases annually. Analysis of case narratives resulted in the identification of four predominant precipitating or contributing factors to injury: burning agent, struck by product, injured while opening and other.

CONCLUSION

NEISS is a valuable tool for determining injury incidence and understanding common injury patterns associated with specific products. Consumers and manufacturers of pressure cookers can develop safety strategies targeted at preventing the product's main injury risks.

Fire burns matter: A case-control study of severe accidental burns in pediatric patients

<b>Objective: </b>We aimed to identify factors associated with severe accidental burns in patients ≤12 years old.<br /> <b>Materials and methods: </b>We conducted a matched case-control study, in which we retrospectively reviewed the medical records of children treated in a single institution from 2014-2016. We classified the cases (patients with severe burns) and controls (patients with non-severe burns) according to the criteria of the American Burn Association. We used multivariate conditional logistic regression analysis to identify the relationship between the etiology of burns and their severity.<br /> <b>Results: </b>We reviewed 180 cases and 90 controls. The most common etiology of burns was boiling water in both cases (65.6%) and controls (83.3%). Most burns occurred inside the home (84.1%) and in the afternoon (37.4%). Multivariate analysis identified that severe burns were mainly due to exposure to fire (odds ratio [OR]: 3.22, 95% confidence interval [CI]: 1.53-6.81). Similarly, these patients were more likely to live in a rural area (OR: 2.96, 95% CI: 1.17-6.19).<br /> <b>Conclusions: </b>In pediatric patients ≤12 years of age severe accidental burns are more likely to be caused by fire compared to boiling water. Public health interventions should focus on populations located in rural areas.

Luteolin is an Effective Component of Platycodon grandiflorus in Promoting Wound Healing in Rats with Cutaneous Scald Injury

Background

Platycodon grandiflorus could significantly improve the pathological results of cutaneous scald injury, reduce the release of inflammatory factors and promote angiogenesis. This study investigated the wound healing effect of luteolin, an active component of P. grandiflorus, on induced cutaneous scald injury in Sprague-Dawley (SD) rats.

Methods

The protein expression levels of TNF-α and IL-6 were detected by ELISA. QRT-PCR was adopted to detect the expression of TGF-β1 and VEGF. Histopathological changes of scald wounds were analyzed by hematoxylin-eosin staining. Cell viability and migration ability were detected by CCK-8 assay and scratch assay.

Results

Both in vivo and in vitro experiments showed that luteolin promoted wound healing of cutaneous scald injury. Gene Oncology (GO) functional analysis and rescue experiments showed that endothelial nitric oxide synthase 3 (NOS3) was the critical target of luteolin in treating cutaneous scald.

Conclusion

This study demonstrated that luteolin is an effective component of P. grandiflorus and is effective in the treatment of cutaneous scald injury.

Serum-derived exosomes accelerate scald wound healing in mice by optimizing cellular functions and promoting Akt phosphorylation

Wound exudate holds great clinical and research potential in wound repair via paracrine signaling. In essence, exudate is modified serum that contains a high concentration of exosomes. The aim of this study was to investigate the role of serum-derived exosomes in scald wound healing of NIH mice skin and to explore the underlying mechanisms. Hence, we constructed a deep second-degree scald model in NIH mice, testing the benefits of exosomes in the scald wound healing. The scratch wound assay, apoptosis assay and MTT assay were conducted to assess the effects of serum-derived exosomes on migration, apoptosis and proliferation of HaCaT cells and fibroblasts. Our results showed that serum-derived exosomes injected subcutaneously entered cells and effectively accelerated wound healing processes in mice. Additionally, serum-derived exosomes optimized functions of cells related to skin injury repair by stimulating fibroblast proliferation, promoting HaCaT cell migration, and suppressing apoptosis of HaCaT cells induced by heat stress. Further study revealed that serum-derived exosomes enhanced phosphorylation of the serine-threonine kinase Akt in scalded skin tissue. These results suggest a potential clinical use of serum-derived exosomes for treating skin scald.

Burn Prevention in the Elderly: Identifying Age and Gender Differences in Consumer Products Associated With Burn Injuries

Elderly suffer worse outcomes from burns; thus, it is important to identify the causes of burns in the elderly to develop burn prevention campaigns. We performed a 10-year review of burns that were registered in the NEISS database. We included patients at least 65 years old and analyzed the top five products that caused burn injury. In adults 65 to 74 years old, hot water was the most common cause of burns. Women suffered more burns by candles and cookware. Heaters/heating systems and gasoline were among the top five causes of burns in only men. For the age group 75 to 84 years old, the most common burn was from hot water in women and gasoline in men. For women, the top five included candles, nightwear, and cookware. Only men suffered gasoline burns. The majority of daywear, home/room fire, and ranges/ovens caused burns occurred in men. The majority of burns from hot water, ranges/ovens, electric heating pads, and bathtubs/showers occurred in women. For men, burns from gasoline, structural fires, and heaters are more prevalent. This data can be used to develop age- and gender-specific prevention campaigns to reduce the risk of burn injury.

Making Microwave Oven Doors Child Resistant to Protect Young Children From Severe Scalds

Most severe child scalds in the United States involve food and beverages. The wide variety of burn mechanisms, however, makes prevention challenging. Over the past 15 years, we have worked toward protecting young children from 1 specific mechanism: children opening microwave oven doors themselves and spilling the heated contents, resulting in often severe scalds. In our published research, we documented the frequency and severity of these cases and the vulnerability of young toddlers to be burned in this way. We have presented our findings and ideas for prevention at multiple national meetings and enlisted college engineering students to design microwave doors that would thwart a young child from opening them. In 2017, we became active members of a national task group convened by Underwriters Laboratories to address this issue, and two authors became voting members on the Underwriters Laboratories Standards Technical Panel for microwave ovens. We worked with microwave manufacturers and others for >1 year to address concerns of the industry, including those related to potential impacts on older adults. This effort resulted in the task group proposing a change in the standard, requiring "two distinct actions" to open the door of a microwave oven. On September 17, 2018, the panel voted to pass the measure, which will require child-resistant doors for all new microwave ovens in 2023. This report highlights how research can inform and support child injury prevention advocacy. Children will now be protected from this type of scald as microwaves with child-resistant doors replace current models.

Downregulation of miR-27b promotes skin wound healing in a rat model of scald burn by promoting fibroblast proliferation

The aim of the present study was to investigate the effect and mechanism of action of microRNA (miR)-27b on skin wound healing in rats with deep second-degree scald burns and in BJ human skin fibroblast cells. Rat models with deep second-degree scald burns were constructed and injected with miR-27b mimics and inhibitors at the wound site daily for 21 days. Healing of burned skin tissues was observed at 0, 3, 7, 14 and 21 days following modeling. H&E and Masson staining were used to observe the pathological structure and degree of collagen fibers in the burned skin tissues. The effects of miR-27b on BJ cell proliferation and migration were determined by MTT and scratch assays. Matrix metalloproteinase-1 (MMP-1), α-smooth muscle actin (α-SMA), collagen I and collagen III expression in rat skin tissues and BJ cells were measured via reverse transcription-quantitative PCR and western blot analysis. The results of the in vivo experiments demonstrated that miR-27b inhibition accelerated scalded skin healing and induced fibroblast growth. Furthermore, the in vitro experiments revealed that miR-27b inhibition increased BJ cell proliferation and migration. Furthermore, miR-27b inhibition upregulated MMP-1, α-SMA, collagen I and collagen III expression in the skin tissues and cells, while the overexpression of miR-27b demonstrated the opposite effect. In conclusion, the results of the present study revealed that miR-27b inhibition increased fibroblast proliferation, thereby accelerating scald wound healing in rats.

Chitosan-Gentamicin Conjugate Hydrogel Promoting Skin Scald Repair

Our earlier research indicated that chitosan-gentamicin conjugate (CS-GT) possesses superior antimicrobial activity and good water solubility. To develop CS-GT-based scald dressings, the antibacterial properties of CS-GT were further studied, and the biosafety of CS-GT and the healing mechanism of CS-GT hydrogel was systematically explored in this article. It was found that cell viability shows a declined inclination with the prolonged culture time and the increased concentration of CS-GT. After three day’s culture, the cell viability could still remain at 79.72% when CS-GT concentration was as high as 1000 μg/mL. On the other hand, the hemolysis rate of CS-GT was lower than 5% when its concentration is 800 μg/mL. Therefore CS-GT has good cytocompatibility and hemocompatibility. A wound-healing experiment has shown that the skin healing rate of CS-GT hydrogel was the highest at 99.61%, followed by the positive control (wet burn ointment) 94.98%, GT hydrogel 87.50%, and matrix 77.39%. The blank control group, however, possessed the lowest healing rate of 75.45%. Further analysis indicated that CS-GT hydrogel could promote the synthesis of total protein (TP) in skin granulation tissue, resulting in the enhanced hydroxyproline (HYP) content, which facilitated collagen fibrogenesis, reduced cytokine expression in an inflammatory response, and, ultimately, accelerated wound healing. To sum up, CS-GT hydrogel is a promising scald dressing.

miR-27b promotes angiogenesis and skin repair in scalded rats through regulating VEGF-C expression

In this study, the effects of miR-27b on angiogenesis in skin repair procedure in rats with deep II degree scald were explored. The rat model of deep II scald was established. miR-27b mimics and inhibitor were injected daily at the wound site for 3 weeks. The healing of scald was observed at 0, 3, 7, 14, and 21 days after the model was established, and the pathological changes of skin were observed by HE and Masson's trichrome stains. Skin tissues were taken 14 days after the operation; CD31 and Ki-67 immunohistochemistry was exerted to evaluate neovascularization and proliferation. Human microvascular endothelial cells (HMEC-1) cells were cultured in vitro. miR-27b mimics or inhibitor was transfected to construct over-expression or inhibition cell lines. MTT assay, scratch test, and angiogenesis test were used to evaluate cell proliferation, migration, and vascular regeneration. Finally, RT-PCR and Western blot were exerted to determine the expression of vascular endothelial growth factor C (VEGF-C), epidermal growth factor (EGF) mRNAs, and protein, respectively. Control, inhibitor, mi-NC, VEGF-C, inhibitor + si-NC, and inhibitor + VEGF-C siRNA groups were used to further analyze the mechanism of miR-27b on VEGF-C; the above experiments were repeated. In contrast to model group, miR-27b inhibitor could significantly promote the healing of scalded skin, alleviate the pathological status of scalded, and promote the angiogenesis and proliferation (p < 0.05). In vitro, miR-27b inhibitor evidently promoted cell proliferation, migration, and angiogenesis and increased the expression of VEGF-C, EGF genes, and protein, while miR-27b mimics significantly reversed the above trends. Further studies shown that downregulation of miR-27b expression can promote the proliferation, migration, and angiogenesis of HMEC-1 cells by promoting the expression of VEGF-C. miR-27b promotes angiogenesis and skin repair in scalded rats through regulating VEGF-C expression.

Non-pharmacological interventions for anxiety in burn patients: A systematic review and meta-analysis of randomized controlled trials

AIM

Present review aimed to conduct a comprehensive review of the effectiveness of non-pharmacological interventions (NPIs) on reducing anxiety in adult burn patients.

METHOD

We searched PubMed, Web of Science, Scopus, Cochrane Library, and Google Scholar databases through September 2019 for randomized clinical trials comparing NPIs to a control group. The primary outcomes were general anxiety and pain anxiety. The Cochrane Risk of Bias Tool was used to assess the risk of bias. All data was pooled with Revman 5.3.

RESULTS

20 studies were eligible for quantitative synthesis. Compared to routine care, Music (4 Randomized Clinical Trials (RCTs), Standardized Mean Difference (SMD) = -2.00, 95 % Confidence Interval (CI) = -3.21 to -0.79), massage (4 RCTs, SMD= -1.84, 95 % CI= -2.77 to -0.91), hypnosis (2 RCTs, SMD= -1.06, 95 % CI= -2.90 to 0.78), relaxation (2 RCTs, SMD= -0.77, 95 %CI= -1.52 to -0.02), transcranial direct current stimulation (1 RCT, SMD= -1.92, 95 %CI= -2.54 to -1.30), and therapeutic touch practices (1 RCT, SMD=-0.45 95 %CI= -0.86 to -0.04), were associated with a significant effect on the anxiety of burn patients. Aromatherapy interventions and virtual reality showed no evidence of a reduction in the anxiety. A large amount of heterogeneity exist among trials. Risk of bias varied across studies. Only one study reported on safety issues.

CONCLUSION

Due to weak evidence, we are unable to make strong recommendations in favor of NPIs for burn anxiety. Further well-designed large sample size randomized clinical trials are warranted.

Emergency Care of Pediatric Burns

Although the overall incidence of and mortality rate associated with burn injury have decreased in recent decades, burns remain a significant source of morbidity and mortality in children. Children with major burns require emergent resuscitation. Resuscitation is similar to that for adults, including pain control, airway management, and administration of intravenous fluid. However, in pediatrics, fluid resuscitation is needed for burns greater than or equal to 15% of total body surface area (TBSA) compared with burns greater than or equal to 20% TBSA for adults. Unique to pediatrics is the additional assessment for non-accidental injury and accurate calculation of the percentage of total burned surface area (TBSA) in children with changing body proportions are crucial to determine resuscitation parameters, prognosis, and disposition.

A prospective analysis of risk factors for pediatric burn mortality at a tertiary burn center in North India

BACKGROUND

None of the available mortality predicting models in pediatric burns precisely predicts outcomes in every population. Mortality rates as well as their risk factors vary with regions and among different centers within the regions. The aim of this study was to identify socio-demographic and clinical risk factors for mortality in pediatric burns in an effort to decrease the mortality in these patients.

METHODS

A prospective analytical study was conducted in patients up to the age of 18 years admitted for burn injuries in a tertiary care burn center in India from January to December 2014. Clinical and demographic data was collected through questionnaire-interview and patient follow-up during their stay in the hospital. Univariate and multivariate firth logistic regression was used to identify various risk factors for mortality in pediatric burns.

RESULTS

A total of 475 patients were admitted during the study period. Overall mortality was 31.3% (n = 149) in this study. Mean age of the patients who died was 8.68 years. Of the 149 deaths, 74 were males and 75 were females (male to female ratio = 0.98). Mean total body surface area (TBSA) involved of the patients who expired was 62%. Inhalational injury was seen in 15.5% (n = 74) of pediatric burn admissions. Mortality was significantly higher (74.3%) in patients with inhalation injury. Mortality was highest in patients with isolates of Acinetobacter + Klebsiella (58.3%), followed by Pseudomonas + Klebsiella (53.3%), Acinetobacter (31.5%), and Pseudomonas (26.3%) (p < 0.0005). Factors found to be significant on univariate firth analysis were older age, female gender, suicidal burns, higher TBSA, presence of inhalation injury, increased depth of burn, and positive microbial cultures. On multivariate analysis, higher TBSA was identified as an independent risk factor for mortality. The adjusted odds ratios for TBSA involvement was 21.706 (25.1-50%), 136.195 (50.1-75%), and 1019.436 (75.1-100%), respectively.

CONCLUSION

TBSA is the most important factor predicting mortality in pediatric burns. The higher the TBSA, the higher is the risk of mortality. Other significant risk factors for mortality are female gender, deeper burns, positive wound cultures, and inhalation injury. Risk of mortality was significantly lower in children who belonged to urban areas, nuclear family, who sustained burn injury in the last quarter of the year, and who stayed in the hospital for longer period.

Impact of First Aid on Treatment Outcomes for Non-Fatal Injuries in Rural Bangladesh: Findings from an Injury and Demographic Census

Non-fatal injuries have a significant impact on disability, productivity, and economic cost, and first-aid can play an important role in improving non-fatal injury outcomes. Data collected from a census conducted as part of a drowning prevention project in Bangladesh was used to quantify the impact of first-aid provided by trained and untrained providers on non-fatal injuries. The census covered approximately 1.2 million people from 7 sub-districts of Bangladesh. Around 10% individuals reported an injury event in the six-month recall period. The most common injuries were falls (39%) and cuts injuries (23.4%). Overall, 81.7% of those with non-fatal injuries received first aid from a provider of whom 79.9% were non-medically trained. Individuals who received first-aid from a medically trained provider had more severe injuries and were 1.28 times more likely to show improvement or recover compared to those who received first-aid from an untrained provider. In Bangladesh, first-aid for non-fatal injuries are primarily provided by untrained providers. Given the large number of untrained providers and the known benefits of first aid to overcome morbidities associated with non-fatal injuries, public health interventions should be designed and implemented to train and improve skills of untrained providers.

Modeling the Distribution of Scald Type Burns in a Child

Splash or spill scald burns may be seen by medical examiners in the setting of intentional trauma or accidental injury. In order to model various scald burn scenarios, an 8-year-old subject dressed in white had colored water spilled or dropped onto her. The results were recorded by video and still photography. Five trials were performed and included: liquid in a cup thrown towards the anterior body surfaces; liquid in a cup thrown towards the posterior body surfaces; a cup of liquid spilled across a table into the lap of a seated subject; a saucepan pulled down onto the anterior torso; and a cup of liquid spilled onto the top of the head. In each of the spill and splash models described above, a large often confluent zone of staining at the site of initial liquid contact with the body was often accompanied by elongate runoff patterns following gravity; droplet staining was often noted on adjacent areas. When seated, an inverted U-shaped staining pattern was on the buttocks. Anticipation of the splash event in one trial resulted in the subject instinctively turning the anterior body away from the oncoming liquid. When presented with a scalded victim, modeling of the reported history may provide a pattern of staining that supports or refutes the explanation offered for the burn. A mobile and neurologically intact subject who can anticipate an incipient scald injury may move prior to and during contact with the liquid resulting in unique staining patterns on multiple surfaces of the body.