Sleep Apnea: A Risk Factor for Obese Burned Children During the Rehabilitative Phase of Injury:

Sleep Quality Among Burn Survivors And The Importance Of Intervention: A Systematic Review And Meta-Analysis

Burn survivors undergo a plethora of physiologic disturbances which can greatly affect quality of life (QOL) and healing processes. This review aimed to systematically examine sleep quality among individuals with burns and to explore the effectiveness of interventions using a meta-analytic approach. A systematic review of the literature was conducted by searching for articles using various databases. Titles and abstracts were screened and full texts of retained articles were assessed based on eligibility criteria. Methodological quality was ascertained in all articles using various scales. Overall, 5,323 articles were screened according to titles and abstracts and 25 articles were retained following full-text screening. Of the twenty-five articles, 17 were assessed qualitatively while 8 were included in the meta-analysis. Based on the qualitative analysis, sleep was found to be negatively affected in burn patients. The subsample of 8 articles included in the meta-analysis showed an overall weighted mean effect size (Hedges's g) of 1.04 (SE = 0.4, 95% CI, z = 3.0; p < 0.01), indicating a large, positive effect of intervention on sleep quality for burn patients. This review was able to demonstrate the detrimental effects of burn injury on sleep quality. Several interventions have been examined throughout the literature and have shown to be beneficial for sleep quality. However, there is great heterogeneity between existing interventions. The results from this review suggest that further research is needed before recommendations can be made as to which intervention is most effective at improving sleep in patients suffering from burn injuries.

Influence of body mass index on skin grafting in pediatric burns

BACKGROUND

There is heterogeneous literature on the association of obese and underweight body habitus on burn outcomes in adult and pediatric literature. We examine the effect of standardized pediatric body mass index (BMI) categories skin graft utilisation.

METHODS

A retrospective chart review was performed on children who underwent burn treatment from January 1995 to November 2011. BMI was categorized by standard definitions: underweight (<5%), normal (5-85%), overweight (85-95%), obese (>95%).

RESULTS

There were 1164 patients: 77 underweight, 604 normal, 215 overweight, and 268 obese patients. No differences existed between group demographics. Grafts were performed in 39% of underweight, 27% of normal, 22% of overweight, and 27% of obese patients. Underweight children had nearly a 2 fold increase in their risk of full thickness burns and were 1.8 times more likely to undergo skin grafting than normal BMI children. Overweight children had a significant decrease in the incidence skin grafting by 23% then compared to normal weight children. There were no differences in percent TBSA burned or percent TBSA grafted using ANOVA.

CONCLUSIONS

Underweight pediatric burn victims have an increased risk for skin grafting while mildly overweight children are slightly protected from skin grafting.

Obesity and burns

The population of overweight patients presenting to burn facilities is expected to increase significantly over the next decades due to the global epidemic of obesity. Excess adiposity mediates alterations to key physiological responses and poses challenges to the optimal management of burns. The purpose of this study is to document the general epidemiological aspects of thermal injuries in the obese population, outline relevant physiological aspects associated with obesity, and draw attention to topics relating to the management, rehabilitation, and prognosis of burns in this emerging subpopulation of patients.