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Gus E, Wang SM, Malic C, Zuccaro J. Routinely collected burn clinical data in Canada: Determining the knowledge gap. Burns 2024; 50:1101-1115. [PMID: 38429127 DOI: 10.1016/j.burns.2024.02.009] [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: 10/26/2023] [Revised: 01/17/2024] [Accepted: 02/08/2024] [Indexed: 03/03/2024]
Abstract
Unlike other developed countries that hold national burn registries to monitor burn injury and care, Canada relies on single-centre secondary datasets and administrative databases as surveillance mechanisms. The objective of this study was to determine the knowledge gap faced in Canada for not having a dedicated burn registry. A comprehensive scoping review was conducted to identify the burn literature that has arisen from secondary datasets in Canada. Literature of all study designs was included with the exception of case reports and cases series. Once data extraction was concluded, a thematic framework was constructed based on the information that arose from nations that hold national burn registries. Eighty-eight studies were included. Twelve studies arose from national datasets, and 18 from provincial databases, most of which were from Ontario and British Columbia. Only seven studies were conducted using a combination of Canadian units' single-centre datasets. The majority of included studies (58%) resulted from non-collaborative use of single-centre secondary datasets. Research efforts were predominantly conducted by burn units in Ontario, British Columbia, Manitoba and Alberta. A significant number of the included studies were outdated and several provinces/territories had no published burn data whatsoever. Efforts should be made towards the development of systems to surveil burn injury and care in Canada. This study supports the development of a nation-wide burn registry to bridge this knowledge gap.
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Affiliation(s)
- Eduardo Gus
- Division of Plastic, Reconstructive & Aesthetic Surgery, The Hospital for Sick Children, Toronto, Canada; Department of Surgery, Temerty Faculty of Medicine, University of Toronto, Canada.
| | - Sabrina M Wang
- Temerty Faculty of Medicine, University of Toronto, Canada
| | - Claudia Malic
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Ottawa, Ontario, Canada; Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Jennifer Zuccaro
- Division of Plastic, Reconstructive & Aesthetic Surgery, The Hospital for Sick Children, Toronto, Canada
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Stanton E, McMullen K, Won P, Schneider JC, Ryan C, Carrougher G, Kowalske K, Yenikomshian HA. Neuropathic Pain After Burn Injury: A Severe and Common Problem in Recovery. Ann Surg 2024; 279:874-879. [PMID: 37916448 PMCID: PMC10997473 DOI: 10.1097/sla.0000000000006146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Abstract
OBJECTIVE The aim of this study was to address the limited understanding of neuropathic pain (NP) among burn survivors by comprehensively examining its prevalence and related factors on a national scale using the Burn Model System (BMS) National Database. BACKGROUND NP is a common but underexplored complaint among burn survivors, greatly affecting their quality of life and functionality well beyond the initial injury. Existing data on NP and its consequences in burn survivors are limited to select single-institution studies, lacking a comprehensive national perspective. METHODS The BMS National Database was queried to identify burn patients responding to NP-related questions at enrollment, 6 months, 12 months, 2 years, and 5 years postinjury. Descriptive statistics and regression analyses were used to explore associations between demographic/clinical characteristics and self-reported NP at different time points. RESULTS There were 915 patients included for analysis. At discharge, 66.5% of patients experienced NP in their burn scars. Those with NP had significantly higher Patient-Reported Outcomes Measurement Information System 29 (PROMIS-29) pain inference, itch, anxiety, depression, and sleep disturbance scores and were less able to partake in social roles. Multiple logistic regression revealed male sex, % total body surface area, and moderate-to-severe pain as predictors of NP at 6 months. At 12 months, % total body surface area and moderate-to-severe pain remained significant predictors, while ethnicity and employment status emerged as significant predictors at 24 months. CONCLUSIONS This study highlights the significant prevalence of NP in burn patients and its adverse impacts on their physical, psychological, and social well-being. The findings underscore the necessity of a comprehensive approach to NP treatment, addressing both physical symptoms and psychosocial factors.
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Affiliation(s)
- Eloise Stanton
- Division of Plastic and Reconstructive Surgery, Keck Medicine of USC, Los Angeles, CA
| | - Kara McMullen
- Burn Model Systems National Data and Statistical Center, University of Washington, Seattle, WA
| | - Paul Won
- Division of Plastic and Reconstructive Surgery, Keck Medicine of USC, Los Angeles, CA
| | - Jeffrey C Schneider
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA
| | - Colleen Ryan
- Department of Surgery, Massachusetts General Hospital, Shriners Hospitals for Children®-Boston, Harvard Medical School, Boston, MA
| | - Gretchen Carrougher
- Department of Surgery, UW Medicine Regional Burn Center, University of Washington, Seattle, WA
| | - Karen Kowalske
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, TX
| | - Haig A Yenikomshian
- Division of Plastic and Reconstructive Surgery, Keck Medicine of USC, Los Angeles, CA
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Burry E, Collins J, Devey-Burry R. E-learning course for burn care: A proposal. Nursing 2024; 54:18-20. [PMID: 38386445 DOI: 10.1097/01.nurse.0001008484.30360.8d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
Affiliation(s)
- Elizabeth Burry
- Elizabeth Burry is an RN on the Medical Surgical Intensive Care Unit at Health Sciences Centre in St. John's, Newfoundland and Labrador, Canada, and both Jennifer Collins and Robin Devey-Burry are assistant professors at Memorial University in Newfoundland and Labrador, Canada
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Costa PCP, Barbosa CS, Ribeiro CDO, Silva LAAD, Nogueira LDA, Kalinke LP. Nursing care directed to burned patients: a scoping review. Rev Bras Enferm 2023; 76:e20220205. [PMID: 37377314 DOI: 10.1590/0034-7167-2022-0205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 12/12/2022] [Indexed: 06/29/2023] Open
Abstract
OBJECTIVES to identify in the literature and summarize nursing care in a hospital environment directed to patients who suffered burns. METHODS a scoping review, according to the JBI Reviewers' Manual recommendations, with a search in the MEDLINE, CINAHL, Web of Science, Scopus databases and in the Virtual Health Library portal, through articles published between 2016 and December 2021. RESULTS of the total 419 articles found, nine were selected for analysis. The main care measures identified were changing dressings and types of coverage, vital sign control, non-pharmacological techniques for pain relief and opioid reduction. CONCLUSIONS the complexity of burn care requires constant updating by the nursing team. Keeping it prepared to carry out the best nursing care practices for burn patients will promote adequate care, patient recovery and reduction of possible harm.
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Polychronopoulou E, Kuo YF, Wilkes D, Raji MA. Prescribing of Gabapentinoids with or without opioids after burn injury in the US, 2012-2018. Burns 2022; 48:293-302. [PMID: 34991930 PMCID: PMC9007844 DOI: 10.1016/j.burns.2021.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 12/14/2021] [Accepted: 12/17/2021] [Indexed: 12/14/2022]
Abstract
Burn injury pain manifests as a combination of inflammatory, nociceptive, and neuropathic features. While opioids are the mainstay of burn pain management, non-opioid medications, such as gabapentinoids, have also been considered as they target the central nervous system. Increased opioid adverse events and overdose deaths in the United States led to the 2014 and 2016 guidelines to reduce opioid prescribing and consider alternatives, such as gabapentinoids. In the context of burn, the rate of gabapentinoid prescribing at the national level is unknown and it is unclear whether any shift has occurred in prescribing practices over time. We conducted a population level cohort study of adult burn patients from 2012 to 2018 to evaluate the rates and determinants of gabapentinoid prescribing, with and without opioids. Of 98,001 patients with burn, 22,521 (22.98%) received opioids and/or gabapentinoids (GABA). GABA represented 2.4% of prescriptions in 2012, but increased to 7.2% by 2018, while GABA-opioid co-prescriptions increased from 2.3% to 5.1%. The rate of increase in GABA prescriptions was higher for those aged 50-65 years or residing in the South. After adjustment, GABA was 44% more likely to be prescribed in 2017 and 2018 compared to 2012 and 2013, opioids were 38% less likely, while co-prescribing did not show a statistically significant change. Our study showed a modest increase in gabapentinoids' outpatient prescribing for burn patients after the 2014 and 2016 guidelines, indicating more opportunities for prescribers to expand non-opioid pain management in this population.
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Affiliation(s)
- Efstathia Polychronopoulou
- Department of Preventive Medicine and Population Health, University of Texas Medical Branch,Division of Rehabilitation Sciences, University of Texas Medical Branch
| | - Yong-Fang Kuo
- Department of Preventive Medicine and Population Health, University of Texas Medical Branch,Department of Internal Medicine, Division of Geriatrics and Palliative Medicine, University of Texas Medical Branch,Sealy Center on Aging, University of Texas Medical Branch,Institute for Translational Sciences, University of Texas Medical Branch
| | - Denise Wilkes
- Department of Anesthesiology, The University of Texas Medical Branch
| | - Mukaila A. Raji
- Department of Preventive Medicine and Population Health, University of Texas Medical Branch,Department of Internal Medicine, Division of Geriatrics and Palliative Medicine, University of Texas Medical Branch,Sealy Center on Aging, University of Texas Medical Branch
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Romanowski KS, Carson J, Pape K, Bernal E, Sharar S, Wiechman S, Carter D, Liu YM, Nitzschke S, Bhalla P, Litt J, Przkora R, Friedman B, Popiak S, Jeng J, Ryan CM, Joe V. American Burn Association Guidelines on the Management of Acute Pain in the Adult Burn Patient: A Review of the Literature, a Compilation of Expert Opinion, and Next Steps. J Burn Care Res 2020; 41:1129-1151. [PMID: 32885244 PMCID: PMC7703676 DOI: 10.1093/jbcr/iraa119] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The ABA pain guidelines were developed 14 years ago and have not been revised despite evolution in the practice of burn care. A sub-committee of the American Burn Association's Committee on the Organization and Delivery of Burn Care was created to revise the adult pain guidelines. A MEDLINE search of English-language publications from 1968 to 2018 was conducted using the keywords "burn pain," "treatment," and "assessment." Selected references were also used from the greater pain literature. Studies were graded by two members of the committee using Oxford Centre for Evidence-based Medicine-Levels of Evidence. We then met as a group to determine expert consensus on a variety of topics related to treating pain in burn patients. Finally, we assessed gaps in the current knowledge and determined research questions that would aid in providing better recommendations for optimal pain management of the burn patient. The literature search produced 189 papers, 95 were found to be relevant to the assessment and treatment of burn pain. From the greater pain literature 151 references were included, totaling 246 papers being analyzed. Following this literature review, a meeting to establish expert consensus was held and 20 guidelines established in the areas of pain assessment, opioid medications, nonopioid medications, regional anesthesia, and nonpharmacologic treatments. There is increasing research on pain management modalities, but available studies are inadequate to create a true standard of care. We call for more burn specific research into modalities for burn pain control as well as research on multimodal pain control.
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Affiliation(s)
- Kathleen S Romanowski
- University of California, Davis and Shriners Hospitals for Children Northern California, Sacramento, California
| | - Joshua Carson
- University of Florida Health Shands Burn Center, Gainesville, Florida
| | - Kate Pape
- University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | | | - Sam Sharar
- University of Washington School of Medicine, Harborview Medical Center, Seattle Washington
| | - Shelley Wiechman
- University of Washington School of Medicine, Harborview Medical Center, Seattle Washington
| | | | - Yuk Ming Liu
- Loyola University Medical Center, Maywood, Illinois
| | | | - Paul Bhalla
- University of Washington School of Medicine, Harborview Medical Center, Seattle Washington
| | - Jeffrey Litt
- University of Missouri School of Medicine, Columbia, Missouri
| | - Rene Przkora
- University of Florida Health, Anesthesiology and Pain Medicine, Gainesville, Florida
| | | | | | - James Jeng
- Nathan Speare Regional Burn Treatment Center Crozer Chester Medical Center, Upland, Pennsylvania
| | - Colleen M Ryan
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, and Shriners Hospitals for Children-Boston®, Boston, Massachusetts
| | - Victor Joe
- University of California Irvine Regional Burn Center, Orange, California
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Jones LM, Uribe AA, Coffey R, Puente EG, Abdel-Rasoul M, Murphy CV, Bergese SD. Pregabalin in the reduction of pain and opioid consumption after burn injuries: A preliminary, randomized, double-blind, placebo-controlled study. Medicine (Baltimore) 2019; 98:e15343. [PMID: 31045775 PMCID: PMC6504294 DOI: 10.1097/md.0000000000015343] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The primary objective of the study was to evaluate the efficacy of 300 milligrams (mg) and 600 mg of pregabalin compared to placebo in the reduction of pain in patients with noncritical partial and full thickness burn injuries. METHODS A prospective, randomized, double-blinded, single center, placebo-controlled trial was conducted. Simple randomization method was used in this trial. After subjects met all the inclusion and none of the exclusion criteria, they were randomized and assigned to 1 of the 3 18-day treatments groups: Pregabalin 300 group, Pregabalin 600 group, or Placebo group. Demographics and clinical characteristics were recorded. The severity of pain was assessed by using the visual analog scale for pain intensity at baseline on day 3, day 9 ± 3, day 25 ± 7, day 90 ± 6, and day 180 ± 12. RESULTS A total of 54 subjects were randomly assigned, and 51 were included in the data analysis. Demographics and clinical characteristics did not differ significantly between the 3 groups. There was a statistically significant difference in pain between the Pregabalin 300 and Pregabalin 600 groups (P-value = .0260). The Pregabalin 300 group had 17.93 units (95% confidence interval: 1.83-34.04) higher pain scores on average than the Pregabalin 600 group, regardless of time. The adjusted P-value comparing 0 to 300 was .1618, while the adjusted P-value for 0 versus 600 was .5304. There was an overall difference in pain across time regardless of study group (P-value = <.0001). An overall difference in opioid consumption (P-value = .0003) and BSHS (P-value = .0013) across time regardless of study group was noted. CONCLUSIONS Pregabalin could be part of a promising multimodal analgesic regimen in noncritical burn population. Future placebo-controlled studies assessing the use of pregabalin in burn victim patients may further endorse our findings.
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Affiliation(s)
- Larry M Jones
- The Ohio State University Wexner Medical Center, Department of Surgery, Division of Trauma, Critical Care and Burn
| | - Alberto A Uribe
- The Ohio State University Medical Center, Department of Anesthesiology
| | - Rebecca Coffey
- The Ohio State University Wexner Medical Center, Department of Surgery, Division of Trauma, Critical Care and Burn
| | - Erika G Puente
- The Ohio State University Medical Center, Department of Anesthesiology
| | - Mahmoud Abdel-Rasoul
- The Ohio State University Medical Center, Center of Biostatistics, Department of Biomedical Informatics
| | - Claire V Murphy
- The Ohio State University Medical Center, Department of Pharmacy
| | - Sergio D Bergese
- The Ohio State University Medical Center, Department of Anesthesiology
- The Ohio State University Medical Center, Department of Neurological Surgery, Columbus, OH
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