1
|
Rousseau AF, Fadeur M, Fauville JP, Hans N, Martin F, Misset B. Determination of energy requirements after minor burns using indirect calorimetry: A descriptive cohort study. JPEN J Parenter Enteral Nutr 2024; 48:284-290. [PMID: 38400637 DOI: 10.1002/jpen.2614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 02/02/2024] [Accepted: 02/02/2024] [Indexed: 02/25/2024]
Abstract
BACKGROUND Minor burns could be associated with moderate hypermetabolism. In this study, the primary outcome was measured energy expenditure (mEE) determined by indirect calorimetry in patients with minor burns. We also compared mEE with predictive values and actual energy intakes. METHODS Adults with minor burns exclusively treated on an outpatient basis were included. During the week following injury, a dietitian performed indirect calorimetry (Q-NRG in canopy mode), calculated the estimated energy expenditure (eEE) based on the Harris-Benedict (HB) and Henry formulas, and evaluated daily energy intakes using a food anamnesis. RESULTS Forty-nine patients (59.2% male; median age: 35 [interquartile range: 29-46.5] years; body mass index [BMI]: 26.2 [22.3-29.6] kg/m2; burn surface area [BSA]: 1.5% [1%-2%]) were included 4 (2-6) days after injury. The mEE was 1863 (1568-2199) kcal or 25 (22.4-28.5) kcal/kg and 1838 (1686-2026) kcal or 26.1 (23.7-27.7) kcal/kg in patients who were respectively fasting for >10 h or not (P = 0.991 or P = 0.805). The total mEE was 104% (95%-116%) and 108% (99%-122%) of the total eEE using the HB and Henry formulas, respectively, with diet-induced thermogenesis and physical activity level. Hypermetabolism (ie, oxygen consumption at rest ≥3.5 ml/kg/min) was observed in 21/49 (42.9%) patients. Energy intakes corresponded to 71% (60%-86%) of the total mEE. CONCLUSION Performing indirect calorimetry in adults with minor burns revealed that ≥40% of the tested adults presented a hypermetabolism and that their mEE was not covered by their energy intakes.
Collapse
Affiliation(s)
- Anne-Françoise Rousseau
- Department of Intensive Care and Burn Centre, University Hospital, University of Liège, Liège, Belgium
- GIGA-Research, GIGA-I3 Thematic Unit, Inflammation and Enhanced Rehabilitation Laboratory (Intensive Care), University of Liège, Liège, Belgium
| | - Marjorie Fadeur
- Multidisciplinary Nutrition Team, University Hospital, University of Liège, Liège, Belgium
| | - Jean-Philippe Fauville
- Department of Intensive Care and Burn Centre, University Hospital, University of Liège, Liège, Belgium
| | - Nadine Hans
- Department of Plastic Surgery and Burn Centre, University Hospital, University of Liège, Liège, Belgium
| | - François Martin
- Department of Plastic Surgery and Burn Centre, University Hospital, University of Liège, Liège, Belgium
| | - Benoit Misset
- Department of Intensive Care and Burn Centre, University Hospital, University of Liège, Liège, Belgium
| |
Collapse
|
2
|
Whife CJ, Vallence AM, Edgar DW, Wood FM. Decreased neuroplasticity in minor burn injury survivors compared to non-injured adults: A pilot study in burn injury survivors aged 45 years and older. Burns 2020; 47:327-337. [PMID: 33288329 DOI: 10.1016/j.burns.2020.10.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 10/22/2020] [Accepted: 10/29/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Neuroplasticity is the capacity of the brain to change or adapt with experience: brain changes occur with use, disuse, and injury. Repetitive transcranial magnetic stimulation (rTMS) can be used to induce neuroplasticity in the human brain. Here, we examined rTMS-induced neuroplasticity in the primary motor cortex in burns survivors and controls without injury, and whether neuroplasticity is associated with functional recovery in burns survivors. METHODS Sixteen burn injury survivors (total body surface area of burn injury <15%) and 13 non-injured control participants were tested. Repetitive TMS (specifically, spaced continuous theta-burst stimulation[cTBS]) was applied to induce neuroplasticity 6 and 12 weeks after injury in burn survivors and in two sessions separated by 6 weeks in controls. Motor evoked potentials (MEPs) elicited by single-pulse TMS were measured before and after rTMS to measure neuroplasticity. Burns survivors completed a functional assessment 12 weeks after injury. RESULTS Non-injured controls showed decreased MEP amplitude 15-30 min after spaced cTBS in both experimental sessions. Burn survivors showed a smaller change in MEP amplitude after spaced cTBS compared to controls 6 weeks after burn injury but no difference compared to controls 12 weeks after burn injury. In burn survivors, there was a significant positive association between general health outcome (Short-Form Health Survey) and the change in MEP amplitude after spaced cTBS 12 weeks after injury (r=.73, p = .01). CONCLUSIONS The current findings suggest that burn survivors have a reduced capacity for neuroplasticity early in the recovery period (6 weeks after injury), which normalizes later in the recovery period (12 weeks after injury). Furthermore, the results provide preliminary evidence to suggest that burn survivors with normalized neuroplasticity 12 weeks after injury recover faster after burn injury.
Collapse
Affiliation(s)
- Casey J Whife
- Burn Injury Research Unit, School of Surgery, University of Western Australia, Crawley, Western Australia, Australia
| | - Ann-Maree Vallence
- Psychology, Murdoch University, Western Australia, Australia; Centre for Healthy Ageing, Health Futures Institute, Murdoch University, Western Australia, Australia; Centre for Molecular Medicine and Innovative Therapeutics, Murdoch University, Western Australia, Australia.
| | - Dale W Edgar
- Burn Injury Research Unit, School of Surgery, University of Western Australia, Crawley, Western Australia, Australia; Burn Injury Research Node, The University of Notre Dame Australia, Fremantle, Western Australia, Australia; Burns Service of Western Australia, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Fiona M Wood
- Burn Injury Research Unit, School of Surgery, University of Western Australia, Crawley, Western Australia, Australia; Burns Service of Western Australia, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| |
Collapse
|
3
|
Whife CJ, Vallence AM, Edgar DW, Wood FM. No difference observed in short-interval intracortical inhibition in older burn-injury survivors compared to non-injured older adults: A pilot study. Burns 2019; 45:1131-1138. [DOI: 10.1016/j.burns.2019.02.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 02/20/2019] [Accepted: 02/27/2019] [Indexed: 11/25/2022]
|
4
|
Burn injury models of care: A review of quality and cultural safety for care of Indigenous children. Burns 2018; 44:665-677. [DOI: 10.1016/j.burns.2017.10.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 08/31/2017] [Accepted: 10/14/2017] [Indexed: 11/23/2022]
|
5
|
Modified Vancouver Scar Scale score is linked with quality of life after burn. Burns 2017; 43:741-746. [DOI: 10.1016/j.burns.2016.11.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 11/03/2016] [Accepted: 11/07/2016] [Indexed: 11/24/2022]
|
6
|
A Systematic Review of Patient-Reported Outcome Measures Used in Adult Burn Research. J Burn Care Res 2017; 38:e521-e545. [DOI: 10.1097/bcr.0000000000000474] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
|
7
|
Ryland ME, Grisbrook TL, Wood FM, Phillips M, Edgar DW. Demonstration of the test-retest reliability and sensitivity of the Lower Limb Functional Index-10 as a measure of functional recovery post burn injury: a cross-sectional repeated measures study design. BURNS & TRAUMA 2016; 4:16. [PMID: 27574686 PMCID: PMC4964082 DOI: 10.1186/s41038-016-0043-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Accepted: 04/24/2016] [Indexed: 11/29/2022]
Abstract
Background Lower limb burns can significantly delay recovery of function. Measuring lower limb functional outcomes is challenging in the unique burn patient population and necessitates the use of reliable and valid tools. The aims of this study were to examine the test-retest reliability, sensitivity, and internal consistency of Sections 1 and 3 of the Lower Limb Functional Index-10 (LLFI-10) questionnaire for measuring functional ability in patients with lower limb burns over time. Methods Twenty-nine adult patients who had sustained a lower limb burn injury in the previous 12 months completed the test-retest procedure of the study. In addition, the minimal detectable change (MDC) was calculated for Section 1 and 3 of the LLFI-10. Section 1 is focused on the activity limitations experienced by patients with a lower limb disorder whereas Section 3 involves patients indicating their current percentage of pre-injury duties. Results Section 1 of the LLFI-10 demonstrated excellent test-retest reliability (intra-class correlation coefficient (ICC) 0.98, 95 % CI 0.96–0.99) whilst Section 3 demonstrated high test-retest reliability (ICC 0.88, 95 % CI 0.79–0.94). MDC scores for Sections 1 and 3 were 1.27 points and 30.22 %, respectively. Internal consistency was demonstrated with a significant negative association (rs = −0.83) between Sections 1 and 3 of the LLFI-10 (p < 0.001). Conclusions This study demonstrates that Section 1 and 3 of the LLFI-10 are reliable for measuring functional ability in patients who have sustained lower limb burns in the previous 12 months, and furthermore, Section 1 is sensitive to changes in patient function over time.
Collapse
Affiliation(s)
- Margaret E Ryland
- School of Physiotherapy and Exercise Science, Curtin University, Bentley, 6102 WA Australia
| | - Tiffany L Grisbrook
- School of Physiotherapy and Exercise Science, Curtin University, Bentley, 6102 WA Australia ; Fiona Wood Foundation of Western Australia, Fiona Stanley Hospital, 11 Warren Drive, Murdoch, 6150 WA Australia
| | - Fiona M Wood
- Fiona Wood Foundation of Western Australia, Fiona Stanley Hospital, 11 Warren Drive, Murdoch, 6150 WA Australia ; State Adult Burn Unit, Fiona Stanley Hospital, Level 4, 11 Warren Smith Drive, Murdoch, 6150 WA Australia ; Burn Injury Research Unit, The University of Western Australia, Crawley, 6009 WA Australia
| | - Michael Phillips
- Harry Perkins Institute of Medical Research, The University of Western Australia, Crawley, 6009 WA Australia
| | - Dale W Edgar
- Fiona Wood Foundation of Western Australia, Fiona Stanley Hospital, 11 Warren Drive, Murdoch, 6150 WA Australia ; State Adult Burn Unit, Fiona Stanley Hospital, Level 4, 11 Warren Smith Drive, Murdoch, 6150 WA Australia ; Burn Injury Research Unit, The University of Western Australia, Crawley, 6009 WA Australia ; Burn Injury Research Node, The University of Notre Dame Australia, 19 Mouat St, Fremantle, 6160 WA Australia
| |
Collapse
|
8
|
Finlay V, Phillips M, Allison GT, Wood FM, Ching D, Wicaksono D, Plowman S, Hendrie D, Edgar DW. Towards more efficient burn care: Identifying factors associated with good quality of life post-burn. Burns 2015; 41:1397-404. [PMID: 26233899 DOI: 10.1016/j.burns.2015.06.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Revised: 06/04/2015] [Accepted: 06/26/2015] [Indexed: 11/18/2022]
Abstract
BACKGROUND As minor burn patients constitute the vast majority of a developed nation case-mix, streamlining care for this group can promote efficiency from a service-wide perspective. This study tested the hypothesis that a predictive nomogram model that estimates likelihood of good long-term quality of life (QoL) post-burn is a valid way to optimise patient selection and risk management when applying a streamlined model of care. METHOD A sample of 224 burn patients managed by the Burn Service of Western Australia who provided both short and long-term outcomes was used to estimate the probability of achieving a good QoL defined as 150 out of a possible 160 points on the Burn Specific Health Scale-Brief (BSHS-B) at least six months from injury. A multivariate logistic regression analysis produced a predictive model provisioned as a nomogram for clinical application. A second, independent cohort of consecutive patients (n=106) was used to validate the predictive merit of the nomogram. RESULTS AND DISCUSSION Male gender (p=0.02), conservative management (p=0.03), upper limb burn (p=0.04) and high BSHS-B score within one month of burn (p<0.001) were significant predictors of good outcome at six months and beyond. A Receiver Operating Curve (ROC) analysis demonstrated excellent (90%) accuracy overall. At 80% probability of good outcome, the false positive risk was 14%. The nomogram was validated by running a second ROC analysis of the model in an independent cohort. The analysis confirmed high (86%) overall accuracy of the model, the risk of false positive was reduced to 10% at a lower (70%) probability. This affirms the stability of the nomogram model in different patient groups over time. An investigation of the effect of missing data on sample selection determined that a greater proportion of younger patients with smaller TBSA burns were excluded due to loss to follow up. CONCLUSION For clinicians managing comparable burn populations, the BSWA burns nomogram is an effective tool to assist the selection of patients to a streamlined care pathway with the aim of improving efficiency of service delivery.
Collapse
Affiliation(s)
- V Finlay
- Burn Service of Western Australia at Fiona Stanley Hospital, Australia.
| | - M Phillips
- Burn Service of Western Australia at Fiona Stanley Hospital, Australia
| | - G T Allison
- Burn Service of Western Australia at Fiona Stanley Hospital, Australia
| | - F M Wood
- Burn Service of Western Australia at Fiona Stanley Hospital, Australia
| | - D Ching
- Burn Service of Western Australia at Fiona Stanley Hospital, Australia
| | - D Wicaksono
- Burn Service of Western Australia at Fiona Stanley Hospital, Australia
| | - S Plowman
- Burn Service of Western Australia at Fiona Stanley Hospital, Australia; Fiona Wood Foundation, Perth, Western Australia, Australia
| | - D Hendrie
- Burn Service of Western Australia at Fiona Stanley Hospital, Australia
| | - D W Edgar
- Burn Service of Western Australia at Fiona Stanley Hospital, Australia; Fiona Wood Foundation, Perth, Western Australia, Australia; State Adult Burn Unit, Fiona Stanley Hospital, Murdoch, Western Australia, Australia; Burn Injury Research Node, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
| |
Collapse
|