The efficacy of hydrogel dressings as a first aid measure for burn wound management in the pre-hospital setting: a systematic review of the literature

Incorporation of natural and synthetic polymers into honey hydrogel for wound healing: A review

Background and Aims

The difficulty in treating chronic wounds due to the prolonged inflammation stage has affected a staggering 6.5 million people, accompanied by 25 billion USD annually in the United States alone. A 1.9% rise in chronic wound prevalence among Medicare beneficiaries was reported from 2014 to 2019. Besides, the global wound care market values were anticipated to increase from USD 20.18 billion in 2022 to USD 30.52 billion in 2030, suggesting an expected rise in chronic wounds financial burdens. The lack of feasibility in using traditional dry wound dressings sparks hydrogel development as an alternative approach to tackling chronic wounds. Since ancient times, honey has been used to treat wounds, including burns, and ongoing studies have also demonstrated its wound-healing capabilities on cellular and animal models. However, the fluidity and low mechanical strength in honey hydrogel necessitate the incorporation of other polymers. Therefore, this review aims to unravel the characteristics and feasibility of natural (chitosan and gelatin) and synthetic (polyvinyl alcohol and polyethylene glycol) polymers to be incorporated in the honey hydrogel.

Methods

Relevant articles were identified from databases (PubMed, Google Scholar, and Science Direct) using keywords related to honey, hydrogel, and polymers. Relevant data from selected studies were synthesized narratively and reported following a structured narrative format.

Results

The importance of honey's roles and mechanisms of action in wound dressings were discussed. Notable studies concerning honey hydrogels with diverse polymers were also included in this article to provide a better perspective on fabricating customized hydrogel wound dressings for various types of wounds in the future.

Conclusion

Honey's incapability to stand alone in hydrogel requires the incorporation of natural and synthetic polymers into the hydrogel. With this review, it is hoped that the fabrication and commercialization of the desired honey composite hydrogel for wound treatment could be brought forth.

l-Carnosine loaded on carboxymethyl cellulose hydrogels for promoting wound healing

Wound management remains a challenge in clinical practice. Nowadays, patients have an increasing demand for wound repair with enhanced speed and quality; therefore, there is a great need to seek therapeutic strategies that can promote rapid and effective wound healing. In this study, we developed a carboxymethyl cellulose hydrogel loaded with l-carnosine (CRN@hydrogel) for potential application as a wound dressing. In vitro experiments confirmed that CRN@hydrogel can release over 80% of the drug within 48 h and demonstrated its favorable cytocompatibility and blood compatibility, thus establishing its applicability for safe utilization in clinical practice. Using a rat model, we found that this hydrogel could promote and accelerate wound healing more effectively. These results indicate that the novel hydrogel can serve as an efficient therapeutic strategy for wound treatment.

An Overview of Recent Developments in the Management of Burn Injuries

According to the World Health Organization (WHO), around 11 million people suffer from burns every year, and 180,000 die from them. A burn is a condition in which heat, chemical substances, an electrical current or other factors cause tissue damage. Burns mainly affect the skin, but can also affect deeper tissues such as bones or muscles. When burned, the skin loses its main functions, such as protection from the external environment, pathogens, evaporation and heat loss. Depending on the stage of the burn, the patient's condition and the cause of the burn, we need to choose the most appropriate treatment. Personalization and multidisciplinary collaboration are key to the successful management of burn patients. In this comprehensive review, we have collected and discussed the available treatment options, focusing on recent advances in topical treatments, wound cleansing, dressings, skin grafting, nutrition, pain and scar tissue management.

Metallic elements combine with herbal compounds upload in microneedles to promote wound healing: a review

Wound healing is a dynamic and complex restorative process, and traditional dressings reduce their therapeutic effectiveness due to the accumulation of drugs in the cuticle. As a novel drug delivery system, microneedles (MNs) can overcome the defect and deliver drugs to the deeper layers of the skin. As the core of the microneedle system, loaded drugs exert a significant influence on the therapeutic efficacy of MNs. Metallic elements and herbal compounds have been widely used in wound treatment for their ability to accelerate the healing process. Metallic elements primarily serve as antimicrobial agents and facilitate the enhancement of cell proliferation. Whereas various herbal compounds act on different targets in the inflammatory, proliferative, and remodeling phases of wound healing. The interaction between the two drugs forms nanoparticles (NPs) and metal-organic frameworks (MOFs), reducing the toxicity of the metallic elements and increasing the therapeutic effect. This article summarizes recent trends in the development of MNs made of metallic elements and herbal compounds for wound healing, describes their advantages in wound treatment, and provides a reference for the development of future MNs.

Converting lysozyme to hydrogel: A multifunctional wound dressing that is more than antibacterial

Wounds are usually irregular in shapes, and accompanied with a series of disorders such as hemorrhage and bacteria contamination. Here, we report a multifunctional hydrogel prepared by phase-transited lysozyme (PTL), which presents antimicrobial, injectable, self-healing, tissue adhesive, hemostatic and biodegradable properties that fit the requirements of wound treatment. The lysozyme was unfolded under the action of tris(2-carboxyethyl)phosphine (TCEP), and then self-assembled into a hydrogel (PTLG). The phase transition expanded the antibacterial spectrum of lysozyme, PTLG effectively killed both Gram-positive bacteria (Staphylococcus aureus, Staphylococcus epidermidis) and Gram-negative bacteria (Escherichia coli, Acinetobacter baumannii) on contact. This dynamically cross-linked hydrogel exhibited injectable and self-healing abilities, and was capable of adapting to various wound morphologies. The tissue-adhesive nature derived from phase-transition, endowed PTLG with hemostatic effect. Meanwhile, PTLG exhibited biocompatibility towards mammalian cells. Furthermore, its anti-infective ability in vivo was verified in a mouse subcutaneous infection model, more than 98 % of S. epidermidis was reduced under PTLG injection. And PTLG could be biodegraded within four weeks in mice body. Overall, the proposed PTLG is a promising multifunctional dressing material that could accommodate the various demands of complex and deep wounds.

Poloxam Thermosensitive Hydrogels Loaded with hFGF2-Linked Camelina Lipid Droplets Accelerate Skin Regeneration in Deep Second-Degree Burns

Burn injuries are difficult to manage due to the defect of large skin tissues, leading to major disability or even death. Human fibroblast growth factor 2 (hFGF2) is known to promote burn wound healing. However, direct administration of hFGF2 to the wound area would affect the bioactivity. To provide a supportive environment for hFGF2 and control its release in a steady fashion, in this research, we developed novel thermosensitive poloxam hydrogels delivered with hFGF2-linked Camelina lipid droplets (CLD-hFGF2 hydrogels). Cryopreserved scanning electron microscopy (SEM) results indicated that the incorporation of CLD-hFGF2 does not significantly affect the inner structure of hydrogels. The rheological properties showed that CLD-hFGF2 hydrogels gelated in response to temperature, thus optimizing the delivery method. In vitro, CLD-hFGF2 could be released from hydrogels for 3 days after drug delivery (the release rate was 72%), and the release solution could still promote the proliferation and migration of NIH3T3 cells. In vivo, compared with hydrogels alone or with direct CLD-hFGF2 administration, CLD-hFGF2 hydrogels had the most obvious effect on deep second-degree burn wound healing. This work indicates that CLD-hFGF2 hydrogels have potential application value in burn wound healing.

Improved Cooling Performance of Hydrogel Wound Dressings via Integrating Thermal Conductivity and Heat Storage Capacity for Burn Therapy

Burn injury has become a crucial public health issue worldwide. It is necessary to explore new methods to reduce heat damage and improve healing efficiency during burn injury treatment. In this study, a kind of hydrogel combining heat storage capacity and thermal conductivity was fabricated via a one-pot method for burn therapy. The novel hydrogel was easily prepared by in situ cross-linking polymerization, using poly(ethylene glycol) (PEG) derivatives, oligo(ethylene glycol) methacrylate and 2-(2-methoxyethoxy) ethyl methacrylate, as thermally responsive base materials and hydroxylated multiwall carbon nanotubes (CNT-OH) as thermally conductive fillers. By dispersing CNT-OH, a thermally conductive network was formed in the hydrogel, leading to an increase in the thermal conductivity. The cooling performance, thermal conductivity, heat storage property, swelling performance, rheological and mechanical properties, biocompatibility, in vivo cooling effect, and wound healing properties of the prepared hydrogel were systematically investigated. The hydrogel consisted of thermally responsive PEG derivatives, and CNT-OH performed a function of rapid heat absorption, further reduced thermal damage, and promoted wound healing. The improved cooling performance of the hydrogel was ascribed to the improved thermal conductivity, enhanced heat storage capacity, and good adhesive ability. Thus, the hydrogel has great potential to be practically applied in burn therapy, laser treatment, cooling fabrics, heat-protective clothing, and other emergency scenarios.

Development and Evaluation of Hydrogel Wound Dressings Loaded with Herbal Extracts

The current study aimed to develop carbomer based hydrogel dressings, incorporating ethanolic extracts of Rosmarinus officinalis aerial parts, Achillea millefolium and Calendula officinalis flowers. The pharmaceutical properties of the obtained hydrogels, as well as their texture and antimicrobial activity, were further evaluated. Five wound dressing formulations based on carbopol were prepared. The addition of the ethanolic extracts to the formulation slightly lowered the pH of the hydrogels, as expected. The Rosmarinus officinalis aerial parts extract loaded hydrogel proved to be the firmest one. In terms of consistency and viscosity, the behavior of the five hydrogels was relatively similar. Based on the texture analysis, the texture of the hydrogels has been affected to some extent by the addition of the ethanolic extracts, decreasing their consistency, firmness, and adhesiveness. The hydrogel loaded with Rosmarinus officinalis aerial parts extract and the one incorporating the blend of extracts (mixture of the three above-mentioned extracts) proved to have a good antimicrobial activity. The studied hydrogel formulations could serve as a basis for the development of novel wound dressing materials, although more extended in vivo studies would be needed in order to support current results.

Burn Wound Healing: Clinical Complications, Medical Care, Treatment, and Dressing Types: The Current State of Knowledge for Clinical Practice

According to the World Health Organization (WHO), it is estimated that each year approximately 11 million people suffer from burn wounds, 180,000 of whom die because of such injuries. Regardless of the factors causing burns, these are complicated wounds that are difficult to heal and are associated with high mortality rates. Medical care of a burn patient requires a lot of commitment, experience, and multidirectional management, including surgical activities and widely understood pharmacological approaches. This paper aims to comprehensively review the current literature concerning burn wounds, including classification of burns, complications, medical care, and pharmacological treatment. We also overviewed the dressings (with an emphasis on the newest innovations in this field) that are currently used in medical practice to heal wounds.

Pre-Hospital Pain Management in Children with Injuries: A Retrospective Cohort Study

Background: The all-too-frequent failure to rate pain intensity, resulting in the lack of or inadequacy of pain management, has long ceased to be an exclusive problem of the young patient, becoming a major public health concern. This study aimed to evaluate the methods used for reducing post-traumatic pain in children and the frequency of use of such methods. Additionally, the methods of pain assessment and the frequency of their application in this age group were analysed. Methods: A retrospective analysis of 2452 medical records of emergency medical teams dispatched to injured children aged 0–18 years in the area around Warsaw (Poland). Results: Of all injured children, 1% (20 out of 2432) had their pain intensity rated, and the only tool used for this assessment was the numeric rating scale (NRS). Children with burns most frequently received a single analgesic drug or cooling (56.2%), whereas the least frequently used method was multimodal treatment combining pharmacotherapy and cooling (13.5%). Toddlers constituted the largest percentage of patients who were provided with cooling (12%). Immobilisation was most commonly used in adolescents (29%) and school-age children (n = 186; 24%). Conclusions: Low frequency of pain assessment emphasises the need to provide better training in the use of various pain rating scales and protocols. What is more, non-pharmacological methods (cooling and immobilisation) used for reducing pain in injured children still remain underutilized.

Antimicrobial Peptides: A New Hope in Biomedical and Pharmaceutical Fields

Antibiotics are essential drugs used to treat pathogenic bacteria, but their prolonged use contributes to the development and spread of drug-resistant microorganisms. Antibiotic resistance is a serious challenge and has led to the need for new alternative molecules less prone to bacterial resistance. Antimicrobial peptides (AMPs) have aroused great interest as potential next-generation antibiotics, since they are bioactive small proteins, naturally produced by all living organisms, and representing the first line of defense against fungi, viruses and bacteria. AMPs are commonly classified according to their sources, which are represented by microorganisms, plants and animals, as well as to their secondary structure, their biosynthesis and their mechanism of action. They find application in different fields such as agriculture, food industry and medicine, on which we focused our attention in this review. Particularly, we examined AMP potential applicability in wound healing, skin infections and metabolic syndrome, considering their ability to act as potential Angiotensin-Converting Enzyme I and pancreatic lipase inhibitory peptides as well as antioxidant peptides. Moreover, we argued about the pharmacokinetic and pharmacodynamic approaches to develop new antibiotics, the drug development strategies and the formulation approaches which need to be taken into account in developing clinically suitable AMP applications.

A Rapid Review of Burns First Aid Guidelines: Is There Consistency Across International Guidelines?

We conducted a rapid review of current international and Australian/New Zealand guidelines on first aid for burns to identify any critical variation and any recent major changes in the literature that would warrant a significant change to current recommendations. A search was conducted to identify Australian/New Zealand and international first aid guidelines for burn care using guideline databases, and we compared key recommendations from each guideline relating to burns first aid. A literature search of relevant databases (Medline, Embase, Cochrane Database of Systematic Reviews, PROSPERO international register of systematic reviews, and ClinicalTrials.gov databases) was conducted to identify existing and in-progress research published on the topic of first aid for burn injuries. Seven guidelines were identified from the Australia/New Zealand region, and 11 international guidelines were identified from the United States of America and Europe. All Australian and New Zealand guidelines recommended a cooling duration of 20 minutes and made some mention of when to refer a burn for medical evaluation, while international guidelines saw cooling duration variation, a number of guidelines failed to mention referral criteria. The review of published systematic reviews and clinical trials revealed a lack of new evidence in the last six years. Our rapid review identified key variation between first aid guidelines for burns that would benefit from the development of an international consensus on management. We identified no new significant evidence that would alter guideline recommendations and did not identify any upcoming reviews or clinical trials on this subject.

Recent trends on burn wound care: hydrogel dressings and scaffolds

Acute and chronic wounds can cause severe physical trauma to patients and also result in an immense socio-economic burden. Thus, wound management has attracted increasing attention in recent years. However, burn wound management is still a major challenge in wound management. Autografts are often considered the gold-standard for burn care, but their application is limited by many factors. Hence, ideal burn dressings and skin substitute dressings are desirable. With the development of biomaterials and progress of tissue engineering technology, some innovative dressings and tissue engineering scaffolds, such as nanofibers, films, foams and hydrogels, have been widely used in the field of biomedicine, especially in wound management. Among them, hydrogels have attracted tremendous attention with their unique advantages. In this review, we discuss the challenges in burn wound management, several crucial design considerations with respect to hydrogels for burn wound healing, and available polymers for hydrogels in burn wound care. In addition, the potential application and plausible prospect of hydrogels are also highlighted.

Recent advances on polymeric hydrogels as wound dressings

Severe hemorrhage is a leading cause of high mortality in critical situations like disaster, accidents, and warfare. The resulting wounds could induce severe physical and psychological trauma to patients and also bring an immense socio-economic burden. Hence, rapid hemostasis and wound healing techniques have become critical initiatives for life-saving treatment. Although traditional methods relying on bandages and gauzes are effective in controlling hemorrhage, they suffer from several limitations: nonbiodegradability, being susceptible to infection, being unsuitable for the irregular wound, secondary tissue damage, and being almost ineffective for wound healing. Owing to the merits of high porosity, good biocompatibility, tunable physicochemical properties, and being beneficial for wound healing, hydrogels with excellent performance have drawn intensive attention and numerous novel effective hydrogel dressings have been widely developed. In this Review, after introducing some commonly used strategies for the synthesis of hydrogels, the most recent progress on polymer-based hydrogels as wound dressings is discussed. Particularly, their hemostasis, antibacterial, and biodegradation properties are introduced. Finally, challenges and future perspectives about the development of hydrogels for wound dressings are outlined.

Clinical Performance of Hydrogel-based Dressing in Facial Burn Wounds: A Retrospective Observational Study

ABSTRACT

Preserving both esthetic and functional outcome remains challenging in facial burn injuries. The major issue is the initial treatment of injury. In this study, we focused on patients with partial-thickness facial burns admitted to the burn unit of Tri-Service General Hospital, Taipei, from November 2016 to November 2018. In 21 included patients, customized mask-style, transparent hydrogel-based dressing was applied to the burns. The mean age of included patients was 37.4 years. The mean area of burn injury was 11.9% of total body surface area, and the mean area of second-degree facial burns was 162.3 cm2. Full reepithelialization took, on average, 10.86 days. Scarring was acceptable in terms of texture and color, and no hypertrophic or keloidal scarring was noted. The mean Vancouver Scar Scale score was 2.07. Use of the hydrogel-based dressing masks seems to be a promising means of reducing pain, providing uninterrupted wound healing, facilitating observation, and positively affecting scarring in patients with second-degree facial burns.

The assessment and management of thermal burn injuries in a UK ambulance service: a clinical audit

Background:

Although burn emergencies are infrequently encountered, the ambulance service is often the first point of contact for patients in these situations. It is therefore important that these potentially devastating injuries are managed in accordance with the evidence base. Appropriate assessment and management of these patients in the pre-hospital phase will have a significant impact upon their long-term outcomes, such as scarring cosmesis and functionality.

Aim and objectives:

This audit was conducted to determine if patients presenting to one UK ambulance service with thermal burn injuries were managed safely, effectively and in a timely manner. Areas highlighted for improvement will assist in directing future pre-hospital research and educational requirements. Epidemiological data will also be provided.

Results:

278 thermal burn incidents occurring from June 2017 to May 2018 (inclusive) were included in this audit. A larger proportion of burn patients were paediatrics who fell into the 0–10 age category, most burn patients were injured at a home address and only nine of the overall sample were major burns. Only 35% of patients received adequate cooling of their burns, an essential first aid intervention. The assessment of pain (87%) and provision of analgesia (75%) showed a higher compliance rate. However, only 54% had pain reassessed after analgesia. There was a near 100% compliance rate for patients being managed without hydrogel dressings and topical medicines.

Conclusion:

The results indicate several areas for improvement within the ambulance trust. Of importance is the application of basic first aid, such as cooling. It is important not only to improve education among staff but also to understand non-compliance. It should be acknowledged that assessment of pain and provision of analgesia demonstrated far higher compliance compared to current pre-hospital evidence. Several points for education and research have been identified.

Injectable supramolecular gelatin hydrogel loading of resveratrol and histatin-1 for burn wound therapy

Prolonged inflammatory response and insufficient vascularization cause delayed and poor wound healing. In this study, we fabricated a supramolecular host-guest gelatin (HGM) hydrogel loaded with resveratrol (Res) and histatin-1 (His-1) to suppress inflammation and promote vascularization at skin burn wound sites. The HGM hydrogel showed good properties of shear-thinning and injectability, thereby allowing easy in situ injection and fast adaption to irregular wounds. Res and His-1 were demonstrated to enhance angiogenesis in vitro using cell migration and tube formation assays based on human umbilical vein endothelial cells (HUVECs). In an established rat burn wound model, HGM/Res/His-1 hydrogel treatment promoted wound healing by inhibiting expression of the pro-inflammatory factors of interleukin 6 (IL-6), interleukin 1β (IL-1β) and tumor necrosis factor α (TNF-α) and increasing the expression of transforming growth factor β1 (TGF-β1) and platelet endothelial cell adhesion molecule-1 (CD31). HGM/Res/His-1 hydrogel treatment showed comparable efficacy with that of the commercial dressing, Tegaderm™, and therefore shows promising potential for clinical translation.

Selection of Appropriate Wound Dressing for Various Wounds

There are many factors involved in wound healing, and the healing process is not static. The therapeutic effect of modern wound dressings in the clinical management of wounds is documented. However, there are few reports regarding the reasonable selection of dressings for certain types of wounds in the clinic. In this article, we retrospect the history of wound dressing development and the classification of modern wound dressings. In addition, the pros and cons of mainstream modern wound dressings for the healing of different wounds, such as diabetic foot ulcers, pressure ulcers, burns and scalds, and chronic leg ulcers, as well as the physiological mechanisms involved in wound healing are summarized. This article provides a clinical guideline for selecting suitable wound dressings according to the types of wounds.

Prehospital care of burn injuries in Africa: A review, 1990-2018

PURPOSE

Administration of appropriate first aid immediately after a burn injury is crucial to averting further harm to the victim, physically and psychologically. The aim of this review is to enable the design of better interventions by describing what is known about prehospital care of burn victims in Africa.

RESULTS

This review is based on 17 articles from 5 countries. For the purposes of the review, first responders are defined as those nearest the victim when a burn occurs. First responders include nonclinicians, most typically the mother of a young burn victim. Forty-five different substances, sometimes used in combination, are reported to have been applied to burn injuries: water, 15 food items (especially oils and egg), 14 pharmaceutical products, 9 traditional treatments, 5 minerals (petroleum products being the most common), and charcoal. Appropriate treatment, defined as the application of cool water for 10 min, was achieved about 0.5% of the time, most frequently in Cape Town, South Africa. Most victims do not have their wounds covered while they are transported to a health-care facility. Treatment delays are common. Pain management is hardly addressed.

CONCLUSIONS

Appropriate prehospital care for burn injury generally is not practiced in Africa. Yet best practices for prehospital care are affordable, available, and easily understood. The greatest risk factor for poor care is first responders' lack of knowledge. Awareness and education campaigns focusing on the lay public, as well as educational institutions for health workers, are urgently needed throughout the continent.

Catechol cross-linked antimicrobial peptide hydrogels prevent multidrug-resistant Acinetobacter baumannii infection in burn wounds

Hospital-acquired infections are common in burn patients and are the major contributors of morbidity and mortality. Bacterial infections such as Staphylococcus aureus (S. aureus) and Acinetobacter baumannii (A. baumannii) are difficult to treat due to their biofilm formation and rapidly acquiring resistance to antibiotics. This work presents a newly developed hydrogel that has the potential for treating bacterial wound infections. The hydrogel formulation is based on an antimicrobial peptide (AMP), epsilon-poly-l-lysine (EPL) and catechol, which was cross-linked via mussel-inspired chemistry between the amine and phenol groups. In vitro studies showed that EPL-catechol hydrogels possess impressive antimicrobial and antibiofilm properties toward multidrug-resistant A. baumannii (MRAB). In addition, cytotoxicity study with the clonal mouse myoblast cell line (C2C12) revealed the good biocompatibility of this hydrogel. Furthermore, we created a second-degree burn wound on the mice dorsal skin surface followed by contamination with MRAB. Our results showed that the hydrogel significantly reduced the bacterial burden by more than four orders of magnitude in infected burn wounds. Additionally, there was no significant histological alteration with hydrogel application on mice skin. Based on these results, we concluded that EPL-catechol hydrogel is a promising future biomaterial to fight against multidrug-resistant bacterial infections.

Effectiveness of a hydrogel dressing as an analgesic adjunct to first aid for the treatment of acute paediatric thermal burn injuries: study protocol for a randomised controlled trial

Background

Burns are a painful and traumatic experience, particularly in children. Reduced pain and anxiety positively influences re-epithelialisation rates in paediatric burn patients, however current literature fails to fully explain the effects of pain and anxiety and their links with wound healing. This study will determine if Burnaid® hydrogel dressing is an effective treatment for reducing pain in the acute period of a burn injury. It is hypothesised that a reduction in pain will then improve re-epithelialisation time in comparison to plastic wrap, which is standard practice at our institution — a metropolitan tertiary paediatric hospital located in Brisbane, Australia.

Methods/design

A randomised controlled trial will be conducted to assess the effectiveness of Burnaid® as an analgesic adjunct to cold running water first aid for the treatment of paediatric burns. Participants will include children aged between 0 and 16 years with an acute thermal burn injury (total burn surface area < 20%) presenting to the Department of Emergency within 24 h of the burn occurring. Participants will be randomised into one of two groups: (1) Burnaid® hydrogel (intervention arm) or (2) plastic wrap (control arm). Participants will also be stratified into one of two groups based on factors that influence pain intensity: (1) high pain risk or (2) low pain risk. High pain risk factors include foot burns, hot coal/ash/fire pit burns, burn area greater than 5%, and circumferential burns. The primary outcome is the intervention’s effect on reducing acute pain. Secondary outcomes include days to re-epithelialisation, pulse rate, temperature, salivary cortisol and α-amylase, anxiety, and cost-effectiveness. Sample size calculations have shown that 36 participants will be recruited into each group.

Discussion

This study will provide comprehensive data on the analgesic properties of Burnaid® as an adjunct to first aid for the treatment of acute paediatric thermal burns. If the intervention is effective in reducing pain, Burnaid® will be integrated as standard practice within the hospital’s Department of Emergency. This study replicates a real-world scenario in order to identify clinically significant analgesic and wound-healing effects.

Trial registration

Australian New Zealand Clinical Trials Registry, ACTRN12617001274369. Prospectively registered on 5 Sept 2017.

Electronic supplementary material

The online version of this article (10.1186/s13063-018-3057-x) contains supplementary material, which is available to authorized users.

Poor methodological quality and reporting standards of systematic reviews in burn care management

The methodological and reporting quality of burn-specific systematic reviews has not been established. The aim of this study was to evaluate the methodological quality of systematic reviews in burn care management. Computerised searches were performed in Ovid MEDLINE, Ovid EMBASE and The Cochrane Library through to February 2016 for systematic reviews relevant to burn care using medical subject and free-text terms such as 'burn', 'systematic review' or 'meta-analysis'. Additional studies were identified by hand-searching five discipline-specific journals. Two authors independently screened papers, extracted and evaluated methodological quality using the 11-item A Measurement Tool to Assess Systematic Reviews (AMSTAR) tool and reporting quality using the 27-item Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. Characteristics of systematic reviews associated with methodological and reporting quality were identified. Descriptive statistics and linear regression identified features associated with improved methodological quality. A total of 60 systematic reviews met the inclusion criteria. Six of the 11 AMSTAR items reporting on 'a priori' design, duplicate study selection, grey literature, included/excluded studies, publication bias and conflict of interest were reported in less than 50% of the systematic reviews. Of the 27 items listed for PRISMA, 13 items reporting on introduction, methods, results and the discussion were addressed in less than 50% of systematic reviews. Multivariable analyses showed that systematic reviews associated with higher methodological or reporting quality incorporated a meta-analysis (AMSTAR regression coefficient 2.1; 95% CI: 1.1, 3.1; PRISMA regression coefficient 6·3; 95% CI: 3·8, 8·7) were published in the Cochrane library (AMSTAR regression coefficient 2·9; 95% CI: 1·6, 4·2; PRISMA regression coefficient 6·1; 95% CI: 3·1, 9·2) and included a randomised control trial (AMSTAR regression coefficient 1·4; 95%CI: 0·4, 2·4; PRISMA regression coefficient 3·4; 95% CI: 0·9, 5·8). The methodological and reporting quality of systematic reviews in burn care requires further improvement with stricter adherence by authors to the PRISMA checklist and AMSTAR tool.

Inaccurate, inadequate and inconsistent: A content analysis of burn first aid information online

OBJECTIVE

With the popularity of the Internet as a primary source of health-related information, the aim of this website content analysis was to assess the accuracy and quality of burn first aid information available on the Internet.

METHODS

Using the search term 'burn first aid' in four popular search engines, the first 10 websites from each search engine were recorded. From a total of 40 websites recorded, 14 websites were evaluated after removing duplicates. Websites were assessed on content accuracy by four independent reviewers with checks conducted on inter-rater reliability. Website quality was recorded based on Health on the Net Code of Conduct (HONcode) principles.

RESULTS

Country of origin for the 14 websites was the US (7), Australia (6), and New Zealand (1). The mean content accuracy score was 5.6 out of 10. The mean website quality score was 6.6 out of 12. Australasian websites scored lower for quality but higher for accuracy. The US websites scored higher for quality than accuracy. Website usability and accuracy in a crisis situation were also assessed. The median crisis usability score was 3 out of five, and the median crisis accuracy score was 3.5 out of five.

CONCLUSIONS

The inaccurate and inconsistent burn first aid treatments that appear online are reflected in the often-incorrect burn first aid treatments seen in patients attending emergency departments. Global consistency in burn first aid information is needed to avoid confusion by members of the public.