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Langley D, Zimmermann K, Krenske E, Stefanutti G, Kimble RM, Holland AJA, Fear MW, Wood FM, Kenna T, Cuttle L. Unremitting pro-inflammatory T-cell phenotypes, and macrophage activity, following paediatric burn injury. Clin Transl Immunology 2024; 13:e1496. [PMID: 38463658 PMCID: PMC10921233 DOI: 10.1002/cti2.1496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 02/20/2024] [Accepted: 02/23/2024] [Indexed: 03/12/2024] Open
Abstract
Objectives The aim of this study was to characterise the dynamic immune profile of paediatric burn patients for up to 18 months post-burn. Methods Flow cytometry was used to measure 25 cell markers, chemokines and cytokines which reflected both pro-inflammatory and anti-inflammatory immune profiles. Peripheral blood mononuclear cells from 6 paediatric burn patients who had returned for repeated burn and scar treatments for > 4 timepoints within 12 months post-burn were compared to four age-matched healthy controls. Results While overall proportions of T cells, NK cells and macrophages remained relatively constant, over time percentages of these immune cells differentiated into effector and proinflammatory cell phenotypes including Th17 and activated γδ T cells. Circulating proportions of γδ T cells increased their expression of pro-inflammatory mediators throughout the burn recovery, with a 3-6 fold increase of IL-17 at 1-3 weeks, and NFκβ 9-18 months post-burn. T-regulatory cell plasticity was also observed, and Treg phenotype proportions changed from systemically reduced skin-homing T-regs (CCR4+) and increased inflammatory (CCR6+) at 1-month post-burn, to double-positive cell types (CCR4+CCR6+) elevated in circulation for 18 months post-burn. Furthermore, Tregs were observed to proportionally express less IL-10 but increased TNF-α over 18 months. Conclusion Overall, these results indicate the circulating percentages of immune cells do not increase or decrease over time post-burn, instead they become highly specialised, inflammatory and skin-homing. In this patient population, these changes persisted for at least 18 months post-burn, this 'immune distraction' may limit the ability of immune cells to prioritise other threats post-burn, such as respiratory infections.
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Affiliation(s)
- Donna Langley
- School of Biomedical Sciences, Faculty of HealthQueensland University of Technology (QUT)South BrisbaneQLDAustralia
- Centre for Immunology and Infection Control (CIIC)QIMR Berghofer Medical Research Institute, Queensland University of Technology (QUT)BrisbaneQLDAustralia
- Centre for Biomedical Technology (CBT)Queensland University of Technology (QUT)Kelvin GroveQLDAustralia
| | - Kate Zimmermann
- School of Biomedical Sciences, Faculty of HealthQueensland University of Technology (QUT)South BrisbaneQLDAustralia
- Centre for Immunology and Infection Control (CIIC)QIMR Berghofer Medical Research Institute, Queensland University of Technology (QUT)BrisbaneQLDAustralia
| | - Emma Krenske
- School of Biomedical Sciences, Faculty of HealthQueensland University of Technology (QUT)South BrisbaneQLDAustralia
- Centre for Immunology and Infection Control (CIIC)QIMR Berghofer Medical Research Institute, Queensland University of Technology (QUT)BrisbaneQLDAustralia
| | - Giorgio Stefanutti
- Department of Paediatric Surgery, Urology, Burns and TraumaChildren's Health Queensland, Queensland Children's HospitalSouth BrisbaneQLDAustralia
| | - Roy M Kimble
- Department of Paediatric Surgery, Urology, Burns and TraumaChildren's Health Queensland, Queensland Children's HospitalSouth BrisbaneQLDAustralia
| | - Andrew JA Holland
- The Children's Hospital at Westmead Burns Unit, Department of Paediatrics and Child Health, Kids Research InstituteSydney Medical School, The University of SydneySydneyNSWAustralia
| | - Mark W Fear
- Burn Injury Research Unit, School of Biomedical SciencesThe University of Western AustraliaPerthWAAustralia
| | - Fiona M Wood
- Burn Injury Research Unit, School of Biomedical SciencesThe University of Western AustraliaPerthWAAustralia
- Burns Service of Western AustraliaPerth Children's Hospital and Fiona Stanley HospitalPerthWAAustralia
| | - Tony Kenna
- School of Biomedical Sciences, Faculty of HealthQueensland University of Technology (QUT)South BrisbaneQLDAustralia
- Centre for Immunology and Infection Control (CIIC)QIMR Berghofer Medical Research Institute, Queensland University of Technology (QUT)BrisbaneQLDAustralia
| | - Leila Cuttle
- School of Biomedical Sciences, Faculty of HealthQueensland University of Technology (QUT)South BrisbaneQLDAustralia
- Centre for Biomedical Technology (CBT)Queensland University of Technology (QUT)Kelvin GroveQLDAustralia
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Zang T, Fear MW, Parker TJ, Holland AJA, Martin L, Langley D, Kimble R, Wood FM, Cuttle L. Inflammatory proteins and neutrophil extracellular traps increase in burn blister fluid 24h after burn. Burns 2024:S0305-4179(24)00064-0. [PMID: 38490838 DOI: 10.1016/j.burns.2024.02.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 02/15/2024] [Accepted: 02/27/2024] [Indexed: 03/17/2024]
Abstract
Burn wound blister fluid is a valuable matrix for understanding the biological pathways associated with burn injury. In this study, 152 blister fluid samples collected from paediatric burn wounds at three different hospitals were analysed using mass spectrometry proteomic techniques. The protein abundance profile at different days after burn indicated more proteins were associated with cellular damage/repair in the first 24 h, whereas after this point more proteins were associated with antimicrobial defence. The inflammatory proteins persisted at a high level in the blister fluid for more than 7 days. This may indicate that removal of burn blisters prior to two days after burn is optimal to prevent excessive or prolonged inflammation in the wound environment. Additionally, many proteins associated with the neutrophil extracellular trap (NET) pathway were increased after burn, further implicating NETs in the post-burn inflammatory response. NET inhibitors may therefore be a potential treatment to reduce post-burn inflammation and coagulation pathology and enhance burn wound healing outcomes.
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Affiliation(s)
- Tuo Zang
- Queensland University of Technology (QUT), Faculty of Health, School of Biomedical Sciences, Centre for Children's Health Research, South Brisbane, Queensland, Australia
| | - Mark W Fear
- Burn Injury Research Unit, School of Biomedical Sciences, The University of Western Australia, Perth, WA, Australia
| | - Tony J Parker
- Queensland University of Technology (QUT), School of Biomedical Sciences, Faculty of Health, Kelvin Grove, Queensland, Australia
| | - Andrew J A Holland
- The Children's Hospital at Westmead Burns Unit, Kids Research Institute, Department of Paediatrics and Child Health, Sydney Medical School, The University of Sydney, New South Wales, Australia
| | - Lisa Martin
- Burn Injury Research Unit, School of Biomedical Sciences, The University of Western Australia, Perth, WA, Australia
| | - Donna Langley
- Queensland University of Technology (QUT), Faculty of Health, School of Biomedical Sciences, Centre for Children's Health Research, South Brisbane, Queensland, Australia
| | - Roy Kimble
- Children's Health Queensland, Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Fiona M Wood
- Burn Injury Research Unit, School of Biomedical Sciences, The University of Western Australia, Perth, WA, Australia; Burns Service of Western Australia, Perth Children's Hospital and Fiona Stanley Hospital, Perth, WA, Australia
| | - Leila Cuttle
- Queensland University of Technology (QUT), Faculty of Health, School of Biomedical Sciences, Centre for Children's Health Research, South Brisbane, Queensland, Australia.
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3
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Siu MC, Voisey J, Zang T, Cuttle L. MicroRNAs involved in human skin burns, wound healing and scarring. Wound Repair Regen 2023; 31:439-453. [PMID: 37268303 DOI: 10.1111/wrr.13100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 05/09/2023] [Accepted: 05/18/2023] [Indexed: 06/04/2023]
Abstract
MicroRNAs are small, non-coding RNAs that regulate gene expression, and consequently protein synthesis. Downregulation and upregulation of miRNAs and their corresponding genes can alter cell apoptosis, proliferation, migration and fibroproliferative responses following a thermal injury. This review summarises the evidence for altered human miRNA expression post-burn, and during wound healing and scarring. In addition, the most relevant miRNA targets and their roles in potential pathways are described. Previous studies using molecular techniques have identified 197 miRNAs associated with human wound healing, burn wound healing and scarring. Five miRNAs alter the expression of fibroproliferative markers, proliferation and migration of fibroblasts and keratinocytes post-burn: hsa-miR-21 and hsa-miR-31 are increased after wounding, and hsa-miR-23b, hsa-miR-200b and hsa-let-7c are decreased. Four of these five miRNAs are associated with the TGF-β pathway. In the future, large scale, in vivo, longitudinal human studies utilising a range of cell types, ethnicity and clinical healing outcomes are fundamental to identify burn wound healing and scarring specific markers. A comprehensive understanding of the underlying pathways will facilitate the development of clinical diagnostic or prognostic tools for better scar management and the identification of novel treatment targets for improved healing outcomes in burn patients.
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Affiliation(s)
- Man Ching Siu
- Faculty of Health, School of Biomedical Sciences, Centre for Children's Health Research, Queensland University of Technology (QUT), Brisbane, Queensland, Australia
- Centre for Genomics and Personalised Health Research, QUT, Brisbane, Queensland, Australia
| | - Joanne Voisey
- Centre for Genomics and Personalised Health Research, QUT, Brisbane, Queensland, Australia
| | - Tuo Zang
- Faculty of Health, School of Biomedical Sciences, Centre for Children's Health Research, Queensland University of Technology (QUT), Brisbane, Queensland, Australia
| | - Leila Cuttle
- Faculty of Health, School of Biomedical Sciences, Centre for Children's Health Research, Queensland University of Technology (QUT), Brisbane, Queensland, Australia
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4
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Begum S, Johnson BZ, Morillon AC, Yang R, Bong SH, Whiley L, Gray N, Fear VS, Cuttle L, Holland AJA, Nicholson JK, Wood FM, Fear MW, Holmes E. Systemic long-term metabolic effects of acute non-severe paediatric burn injury. Sci Rep 2022; 12:13043. [PMID: 35906249 PMCID: PMC9338081 DOI: 10.1038/s41598-022-16886-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Accepted: 07/18/2022] [Indexed: 11/10/2022] Open
Abstract
A growing body of evidence supports the concept of a systemic response to non-severe thermal trauma. This provokes an immunosuppressed state that predisposes paediatric patients to poor recovery and increased risk of secondary morbidity. In this study, to understand the long-term systemic effects of non-severe burns in children, targeted mass spectrometry assays for biogenic amines and tryptophan metabolites were performed on plasma collected from child burn patients at least three years post injury and compared to age and sex matched non-burn (healthy) controls. A panel of 12 metabolites, including urea cycle intermediates, aromatic amino acids and quinolinic acid were present in significantly higher concentrations in children with previous burn injury. Correlation analysis of metabolite levels to previously measured cytokine levels indicated the presence of multiple cytokine-metabolite associations in the burn injury participants that were absent from the healthy controls. These data suggest that there is a sustained immunometabolic imprint of non-severe burn trauma, potentially linked to long-term immune changes that may contribute to the poor long-term health outcomes observed in children after burn injury.
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Affiliation(s)
- Sofina Begum
- Harvard Medical School, Harvard University, 25 Shattuck Street, Boston, MA, 02115, USA.,Channing Division of Network Medicine, Brigham and Women's Hospital, 181 Longwood Avenue, Boston, MA, 02115, USA.,Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, Sir Alexander Fleming Building, South Kensington, London, SW7 2AZ, UK.,Australian National Phenome Centre, Health Futures Institute, Murdoch University, Harry Perkins Institute, Perth, WA, 6150, Australia
| | - Blair Z Johnson
- School of Biomedical Sciences, The University of Western Australia, Perth, WA, Australia
| | - Aude-Claire Morillon
- Australian National Phenome Centre, Health Futures Institute, Murdoch University, Harry Perkins Institute, Perth, WA, 6150, Australia
| | - Rongchang Yang
- Australian National Phenome Centre, Health Futures Institute, Murdoch University, Harry Perkins Institute, Perth, WA, 6150, Australia
| | - Sze How Bong
- Australian National Phenome Centre, Health Futures Institute, Murdoch University, Harry Perkins Institute, Perth, WA, 6150, Australia
| | - Luke Whiley
- Australian National Phenome Centre, Health Futures Institute, Murdoch University, Harry Perkins Institute, Perth, WA, 6150, Australia.,Perron Institute for Neurological and Translational Science, Nedlands, WA, Australia.,Centre for Computational and Systems Medicine, Health Futures Institute, Murdoch University, Harry Perkins Institute, Perth, WA, 6150, Australia
| | - Nicola Gray
- Australian National Phenome Centre, Health Futures Institute, Murdoch University, Harry Perkins Institute, Perth, WA, 6150, Australia.,Centre for Computational and Systems Medicine, Health Futures Institute, Murdoch University, Harry Perkins Institute, Perth, WA, 6150, Australia
| | - Vanessa S Fear
- Translational Genetics, Telethon Kids Institute, Perth, WA, Australia
| | - Leila Cuttle
- Faculty of Health, Centre for Children's Health Research, School of Biomedical Sciences, Queensland University of Technology (QUT), South Brisbane, QLD, Australia
| | - Andrew J A Holland
- The Children's Hospital at Westmead Burns Unit, Department of Paediatrics and Child Health, Sydney Medical School, Kids Research Institute, The University of Sydney, Sydney, NSW, Australia
| | - Jeremy K Nicholson
- Australian National Phenome Centre, Health Futures Institute, Murdoch University, Harry Perkins Institute, Perth, WA, 6150, Australia.,Centre for Computational and Systems Medicine, Health Futures Institute, Murdoch University, Harry Perkins Institute, Perth, WA, 6150, Australia.,Medical School, University of Western Australia, Harry Perkins Institute, Murdoch, Perth, WA, 6150, Australia.,Faculty of Medicine, Institute of Global Health Innovation, Imperial College London, Level 1, Faculty Building South Kensington Campus, London, SW7 2AZ, UK
| | - Fiona M Wood
- School of Biomedical Sciences, The University of Western Australia, Perth, WA, Australia.,WA Department of Health, Burns Service of Western Australia, Perth, WA, 6150, Australia
| | - Mark W Fear
- School of Biomedical Sciences, The University of Western Australia, Perth, WA, Australia.
| | - Elaine Holmes
- Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, Sir Alexander Fleming Building, South Kensington, London, SW7 2AZ, UK. .,Australian National Phenome Centre, Health Futures Institute, Murdoch University, Harry Perkins Institute, Perth, WA, 6150, Australia. .,Centre for Computational and Systems Medicine, Health Futures Institute, Murdoch University, Harry Perkins Institute, Perth, WA, 6150, Australia.
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5
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Chai H, Chaudhari N, Kornhaber R, Cuttle L, Fear M, Wood F, Martin L. Chemical burn to the skin: A systematic review of first aid impacts on clinical outcomes. Burns 2022; 48:1527-1543. [DOI: 10.1016/j.burns.2022.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 05/09/2022] [Indexed: 11/02/2022]
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6
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Cuttle L, Fear M, Wood FM, Kimble RM, Holland AJA. Management of non-severe burn wounds in children and adolescents: optimising outcomes through all stages of the patient journey. Lancet Child Adolesc Health 2022; 6:269-278. [PMID: 35051408 DOI: 10.1016/s2352-4642(21)00350-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 10/28/2021] [Accepted: 11/01/2021] [Indexed: 12/11/2022]
Abstract
Paediatric burn injuries are common, especially in children younger than 5 years, and can lead to poor physical and psychosocial outcomes in the long term. In this Review, we aim to summarise the key factors and interventions before hospital admission and following discharge that can improve the long-term outcomes of paediatric burns. Care can be optimised through first aid treatment, correct initial assessment of burn severity, and appropriate patient referral to a burns centre. Scar prevention or treatment and patient follow-up after discharge are also essential. As most burn injuries in children are comparatively small and readily survivable, this Review does not cover the perioperative management associated with severe burns that require fluid resuscitation, or inhalational injury. Burns disproportionately affect children from low socioeconomic backgrounds and those living in low-income and middle-income countries, with ample evidence to suggest that there remains scope for low-cost interventions to improve care for those patients with the greatest burden of burn injury. Current knowledge gaps and future research directions are discussed.
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Affiliation(s)
- Leila Cuttle
- Centre for Children's Health Research, Faculty of Health, School of Biomedical Sciences, Queensland University of Technology, Brisbane, QLD, Australia.
| | - Mark Fear
- Burn Injury Research Unit, School of Biomedical Sciences, The University of Western Australia, Perth, WA, Australia
| | - Fiona M Wood
- Burn Injury Research Unit, School of Biomedical Sciences, The University of Western Australia, Perth, WA, Australia; Burns Service of Western Australia, Perth Children's Hospital and Fiona Stanley Hospital, Perth, WA, Australia
| | - Roy M Kimble
- Centre for Children's Burns and Trauma Research, The University of Queensland, South Brisbane, QLD, Australia; Queensland Children's Hospital, South Brisbane, QLD, Australia
| | - Andrew J A Holland
- The Children's Hospital Burns Research Institute, The Children's Hospital at Westmead, The University of Sydney, NSW, Westmead, Australia
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7
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Zang T, Heath K, Etican J, Chen L, Langley D, Holland AJA, Martin L, Fear M, Parker TJ, Kimble R, Wood F, Cuttle L. Local burn wound environment versus systemic response: Comparison of proteins and metabolites. Wound Repair Regen 2022; 30:560-572. [PMID: 36638157 PMCID: PMC9544301 DOI: 10.1111/wrr.13042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 07/08/2022] [Accepted: 07/22/2022] [Indexed: 01/27/2023]
Abstract
In this study, paired blood plasma (BP) and blister fluid (BF) samples from five paediatric burn patients were analysed using mass spectrometry to compare their protein and metabolite composition. The relative quantification of proteins was achieved through a label-free data independent acquisition mode. The relative quantification of metabolites was achieved using a Shimadzu Smart Metabolite Database gas chromatography mass spectrometry (GCMS) targeted assay. In total, 562 proteins and 141 individual metabolites were identified in the samples. There was 81% similarity in the proteins present in the BP and BF, with 50 and 54 unique proteins found in each sample type respectively. BF contained keratinocyte proliferation-related proteins and blood plasma contained abundant blood clotting proteins and apolipoproteins. BF contained more carbohydrates and less alpha-hydroxy acid metabolites than the BP. In this study, there were unique proteins and metabolites in BF and BP which were reflective of the local wound environment and systemic environments respectively. The results from this study demonstrate that the biomolecule content of BF is mostly the same as blood, but it also contains information specific to the local wound environment.
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Affiliation(s)
- Tuo Zang
- Queensland University of Technology (QUT), School of Biomedical SciencesFaculty of Health, Centre for Children's Health ResearchSouth BrisbaneQueenslandAustralia
| | - Kiana Heath
- Queensland University of Technology (QUT), School of Biomedical SciencesFaculty of Health, Centre for Children's Health ResearchSouth BrisbaneQueenslandAustralia
| | - Joseph Etican
- Queensland University of Technology (QUT), School of Biomedical SciencesFaculty of Health, Centre for Children's Health ResearchSouth BrisbaneQueenslandAustralia
| | - Lan Chen
- Queensland University of Technology (QUT), Central Analytical Research FacilityBrisbaneQueenslandAustralia
| | - Donna Langley
- Queensland University of Technology (QUT), School of Biomedical SciencesFaculty of Health, Centre for Children's Health ResearchSouth BrisbaneQueenslandAustralia
| | - Andrew J. A. Holland
- The Children's Hospital at Westmead Burns Unit, Kids Research Institute, Department of Paediatrics and Child Health, Sydney Medical SchoolThe University of SydneySydneyNew South WalesAustralia
| | - Lisa Martin
- Burn Injury Research Unit, School of Biomedical SciencesThe University of Western AustraliaPerthWestern AustraliaAustralia
| | - Mark Fear
- Burn Injury Research Unit, School of Biomedical SciencesThe University of Western AustraliaPerthWestern AustraliaAustralia
| | - Tony J. Parker
- Queensland University of Technology (QUT), School of Biomedical SciencesFaculty of HealthKelvin GroveQueenslandAustralia
| | - Roy Kimble
- Children's Health QueenslandQueensland Children's HospitalSouth BrisbaneQueenslandAustralia
| | - Fiona Wood
- Burn Injury Research Unit, School of Biomedical SciencesThe University of Western AustraliaPerthWestern AustraliaAustralia,Burns Service of Western AustraliaPerth Children's Hospital and Fiona Stanley HospitalPerthWestern AustraliaAustralia
| | - Leila Cuttle
- Queensland University of Technology (QUT), School of Biomedical SciencesFaculty of Health, Centre for Children's Health ResearchSouth BrisbaneQueenslandAustralia
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Davies P, Cuttle L, Young A. A Scoping Review of the Methodology Used in Studies of Genetic Influences on the Development of Keloid or Hypertrophic Scarring in Adults and Children After Acute Wounding. Adv Wound Care (New Rochelle) 2021; 10:557-570. [PMID: 33975469 PMCID: PMC8312015 DOI: 10.1089/wound.2020.1386] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Significance: Keloid and hypertrophic scarring are common following acute wounds. However, the variability in scarring outcomes between individuals and in particular, the association between genetic factors and scarring, is not well understood. This scoping review aims to summarize the methodology used in studies of genetic influences on the development of keloid or hypertrophic scarring in adults and children after acute wounding. The objectives were to determine the study designs used, the characteristics of participants included, the tools used to assess scarring and the length of follow-up after wounding. Recent Advances: The review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Medline, Excerpta Medica Database (EMBASE), Web of Science, Biosciences Information Service (BIOSIS), Prospective Register of Systematic Reviews (PROSPERO), The Human Genetic Epidemiology (HuGE) Navigator (database of genetic association studies), and the genome-wide association study Catalog were searched from January 2008 to April 2020. Cohort studies and case–control studies that examined the association between one or more genetic variations and the development of keloid or hypertrophic scarring were eligible for inclusion. A narrative synthesis that grouped studies by wound type was conducted. Critical Issues: Nine studies met the inclusion criteria (five in burns, four surgical wounds, and none in other types of acute wounds). Seven assessed hypertrophic scarring, one keloid scarring, and one both scar types. Seven studies used a prospective cohort design. All studies used subjective methods (clinician or patient observation) to assess scarring. There was considerable variation in how scar scales were operationalized. Future Directions: This review identified a small body of evidence on genetic susceptibility to scarring after acute wounding. Further studies are needed, and in a wide range of populations, including patients with wounds caused by trauma.
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Affiliation(s)
- Philippa Davies
- Bristol Center for Surgical Research and Bristol Biomedical Research Center, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Leila Cuttle
- Faculty of Health, School of Biomedical Sciences, Queensland University of Technology, Brisbane, Australia
| | - Amber Young
- Bristol Center for Surgical Research and Bristol Biomedical Research Center, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- Children's Burn Research Center, University Hospital Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom
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9
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Davenport LM, Cuttle L, McBride CA, Kimble R. The morbidity associated with paediatric burn wound escharotomies. ANZ J Surg 2021; 91:2139-2144. [PMID: 34427042 DOI: 10.1111/ans.17153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 07/22/2021] [Accepted: 08/08/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION An escharotomy is an effective surgical procedure for the rapid decompression of a constricting and unyielding eschar, to permit restoration of blood flow. However, an escharotomy is also a full-thickness incision, which adds additional scarring to the burn injury area. The cosmetic and functional morbidity of escharotomy scarring in children is poorly characterised. METHODS Children who required a burn wound escharotomy at the Queensland Children's Hospital (QCH) between May 2011 and May 2020 were included. Demographics of these children were described. In addition, the number of operations for revision of escharotomy scars was recorded as an indicator of functional or cosmetic concern. RESULTS A total of 19 patients required an escharotomy after a burn injury. Children with 1% to 96% TBSA burns required an escharotomy, with a median of 28% (IQR 10-39%) TBSA. Two patients (81% and 96% TBSA) died. Seventy-one percent (12/17) of survivors had operative revisions of their escharotomy scars. The median time from burn to first scar intervention was 35 weeks (IQR 19-70 weeks). CONCLUSION There is substantial morbidity associated with escharotomies in children. Further investigation of the current methods of decompression after burn injury, and the long-term morbidity of escharotomy, is required.
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Affiliation(s)
- Lisa M Davenport
- Surgical Services Group, Townsville University Hospital, Townsville, Queensland, Australia
| | - Leila Cuttle
- School of Biomedical Sciences, Faculty of Health, Queensland University of Technology (QUT), Brisbane, Queensland, Australia
| | - Craig A McBride
- Centre for Children's Health Research, The University of Queensland, South Brisbane, Queensland, Australia.,Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Roy Kimble
- School of Biomedical Sciences, Faculty of Health, Queensland University of Technology (QUT), Brisbane, Queensland, Australia.,Centre for Children's Health Research, The University of Queensland, South Brisbane, Queensland, Australia.,Queensland Children's Hospital, South Brisbane, Queensland, Australia
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10
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McGifford OJ, Harkin DG, Cuttle L. Effect of Rho-Associated Protein Kinase Inhibitors on Epidermal Keratinocytes: A Proposed Application for Burn Wound Healing. Tissue Eng Part B Rev 2021; 28:555-568. [PMID: 34039046 DOI: 10.1089/ten.teb.2021.0034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Rho-associated protein kinases (ROCKs) affect a variety of cellular functions, including cell attachment, migration, and proliferation. ROCK inhibitors therefore have potential as tools for optimizing cell behavior in tissue engineering applications, including the manufacturing of cultivated epithelial autografts (CEAs) used in the treatment of burn patients. For example, ROCK inhibitors may facilitate earlier engraftment of CEA sheets by increasing the proliferation of skin keratinocytes ex vivo. Nevertheless, the current understanding of ROCK inhibitor action on epidermal keratinocytes is unclear owing to multiple drug formulations, drug concentrations, and cellular function assays having been used. The aim of this review article therefore is to identify consistent patterns of ROCK inhibitor action on human keratinocytes, as well as revealing key knowledge gaps. In doing so, we propose a clearer course of action for pursuing the potential benefits of ROCK inhibitors for the future treatment of burn patients. Impact statement The properties of Rho-associated protein kinase (ROCK) inhibitors are already used clinically within the fields of cardiology, neurology, and ophthalmology. These results encourage the broadening of ROCK inhibitor uses for other clinical applications. With respect to burn patients, ROCK inhibitors may facilitate improvements in patient survival and healing by reducing the time required for generating cultivated epithelial autograft (CEA) sheets from patient biopsies. Nevertheless, varying approaches to studying the effects of ROCK inhibitors on skin cells in vitro have complicated the development of improved protocols. Our review aims to clarify a diverse and growing body of literature as to the potential benefits for burn patients.
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Affiliation(s)
- Olivia J McGifford
- Faculty of Health, School of Biomedical Sciences, Centre for Children's Health Research, Queensland University of Technology, South Brisbane, Australia
| | - Damien G Harkin
- Faculty of Health, School of Biomedical Sciences, Centre for Children's Health Research, Queensland University of Technology, South Brisbane, Australia
| | - Leila Cuttle
- Faculty of Health, School of Biomedical Sciences, Centre for Children's Health Research, Queensland University of Technology, South Brisbane, Australia
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11
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Carlton M, Voisey J, Jones L, Parker TJ, Punyadeera C, Cuttle L. An exploratory study demonstrating that salivary cytokine profiles are altered in children with small area thermal injury. J Burn Care Res 2021; 43:613-624. [PMID: 34323997 DOI: 10.1093/jbcr/irab147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Serum can be used to investigate changes in cytokine concentration following burn injury in children, however for children receiving treatment in an outpatient setting, blood is not routinely collected and therefore cannot be used for monitoring. The aim of this study was to investigate the use of saliva as a non-invasive tool for predicting burn outcomes by measuring the concentration of salivary cytokines in children with small area burns. A multiplex cytokine assay was used to measure 17 cytokines in the saliva of paediatric patients with burns (n = 20) and healthy controls (n = 20). After the removal of cytokines that had >30% of samples below the assay lower detection limit, six cytokines including IL-1β, IL-4, IL-7, IL-8, MCP-1 and TNFα were analysed for association with burns. IL-1β and IL-4 were found to be significantly elevated in the paediatric burn patients compared to healthy controls. Interestingly, IL-1β was also significantly elevated in scald burns, compared to contact burns. In addition, biologically meaningful differences in cytokine concentration were identified in patients with different burn characteristics, which warrant further investigation. This exploratory study provides evidence that cytokines can be detected in the saliva of children and that salivary cytokine profiles differ between healthy controls and children with burns. Overall, this study demonstrates the value of saliva for the investigation of cytokines and its potential application in paediatric diagnostics, specifically in situations where blood collection is not appropriate.
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Affiliation(s)
- Morgan Carlton
- School of Biomedical Science, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia.,Centre for Children's Burn and Trauma Research, Centre for Children's Health Research, Queensland University of Technology, South Brisbane, Queensland, Australia
| | - Joanne Voisey
- Centre for Genomics and Personalised Health, School of Biomedical Science, Faculty of Health, Queensland University of Technology
| | - Lee Jones
- Research Methods Group & Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - Tony J Parker
- School of Biomedical Science, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Chamindie Punyadeera
- Saliva and Liquid Biopsy Translational Research Team, School of Biomedical Sciences, Queensland University of Technology, Kelvin Grove, Queensland, Australia.,Translational Research Institute, Woolloongabba, Queensland, Australia
| | - Leila Cuttle
- School of Biomedical Science, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia.,Centre for Children's Burn and Trauma Research, Centre for Children's Health Research, Queensland University of Technology, South Brisbane, Queensland, Australia
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12
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McLure M, Macneil F, Wood FM, Cuttle L, Eastwood K, Bray J, Tracy LM. A Rapid Review of Burns First Aid Guidelines: Is There Consistency Across International Guidelines? Cureus 2021; 13:e15779. [PMID: 34295589 PMCID: PMC8291991 DOI: 10.7759/cureus.15779] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2021] [Indexed: 12/02/2022] Open
Abstract
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.
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Affiliation(s)
- Michael McLure
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, AUS
| | - Finlay Macneil
- Department of Urology, Gosford District Hospital and Gosford Private Hospital, Gosford, AUS
- Faculty of Medicine, University of Newcastle, Newcastle, AUS
| | - Fiona M Wood
- State Adult Burn Unit, Fiona Stanley Hospital, Murdoch, AUS
- Burn Injury Research Unit, University of Western Australia, Perth, AUS
| | - Leila Cuttle
- School of Biomedical Science, Queensland University of Technology, South Brisbane, AUS
- Institute of Health and Biomedical Innovation, Queensland University of Technology, South Brisbane, AUS
- Children's Health Research Centre, Queensland University of Technology, South Brisbane, AUS
| | - Kathryn Eastwood
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, AUS
| | - Janet Bray
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, AUS
- Prehospital, Resuscitation and Emergency Care Research Unit, Curtin University, Bentley, AUS
| | - Lincoln M Tracy
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, AUS
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13
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Frear CC, Cuttle L, McPhail SM, Chatfield MD, Kimble R, Griffin BR. Author response to: Comment on: "Randomized clinical trial of negative pressure wound therapy as an adjunctive treatment for small-area thermal burns in children" by Frear et al. Br J Surg 2021; 108:e87. [PMID: 33711134 DOI: 10.1093/bjs/znaa078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 10/12/2020] [Indexed: 11/13/2022]
Affiliation(s)
- Cody C Frear
- Centre for Children's Burns and Trauma Research, Centre for Children's Health Research, South Brisbane, Australia.,Faculty of Medicine, University of Queensland, Herston, Australia
| | - Leila Cuttle
- Centre for Children's Burns and Trauma Research, Centre for Children's Health Research, South Brisbane, Australia.,School of Biomedical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Steven M McPhail
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Brisbane, Australia.,Clinical Informatics Directorate, Metro South Health, Brisbane, Australia
| | - Mark D Chatfield
- Faculty of Medicine, University of Queensland, Herston, Australia
| | - Roy Kimble
- Centre for Children's Burns and Trauma Research, Centre for Children's Health Research, South Brisbane, Australia.,Faculty of Medicine, University of Queensland, Herston, Australia.,Queensland Children's Hospital, South Brisbane, Australia
| | - Bronwyn R Griffin
- Centre for Children's Burns and Trauma Research, Centre for Children's Health Research, South Brisbane, Australia.,School of Nursing, Faculty of Health, Queensland University of Technology, Brisbane, Australia
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14
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Carlton M, Voisey J, Parker TJ, Punyadeera C, Cuttle L. A review of potential biomarkers for assessing physical and psychological trauma in paediatric burns. Burns Trauma 2021; 9:tkaa049. [PMID: 33654699 PMCID: PMC7901707 DOI: 10.1093/burnst/tkaa049] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 09/09/2020] [Accepted: 01/03/2021] [Indexed: 01/08/2023]
Abstract
Biological markers that evaluate physical healing as well as psychological impact of a burn are essential for effective treatment of paediatric burns. The objective of this review is to summarize the evidence supporting the use of biomarkers in children with burns. An extensive review of the literature was performed using PubMed. A total of 59 biomarkers were identified relating to burn presence, specifically relating to processes involved in inflammation, wound healing, growth and metabolism. In addition, biomarkers involved in the stress response cascade following a burn trauma were also identified. Although many biomarkers have been identified that are potentially associated with burn-related physical and psychological trauma, an understanding of burn biology is still lacking in children. We propose that future research in the field of children’s burns should be conducted using broad screening methods for identifying potential biomarkers, examine the biological interactions of different biomarkers, utilize child-appropriate biological fluids such as urine or saliva, and include a range of different severity burns. Through further research, the biological response to burn injury may be fully realized and clinically relevant diagnostic tests and treatment therapies utilizing these biomarkers could be developed, for the improvement of healing outcomes in paediatric burn patients.
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Affiliation(s)
- Morgan Carlton
- Queensland University of Technology (QUT), Centre for Children's Burn and Trauma Research, Centre for Children's Health Research, South Brisbane, Queensland, Australia
| | - Joanne Voisey
- Queensland University of Technology (QUT), Faculty of Health, School of Biomedical Sciences, Brisbane, Queensland, Australia
| | - Tony J Parker
- Queensland University of Technology (QUT), Faculty of Health, School of Biomedical Sciences, Brisbane, Queensland, Australia
| | - Chamindie Punyadeera
- Queensland University of Technology (QUT), Faculty of Health, School of Biomedical Sciences, Saliva and Liquid Biopsy Translational Laboratory, Brisbane, Queensland, Australia
| | - Leila Cuttle
- Queensland University of Technology (QUT), Centre for Children's Burn and Trauma Research, Centre for Children's Health Research, South Brisbane, Queensland, Australia
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15
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Frear CC, Zang T, Griffin BR, McPhail SM, Parker TJ, Kimble RM, Cuttle L. The modulation of the burn wound environment by negative pressure wound therapy: Insights from the proteome. Wound Repair Regen 2020; 29:288-297. [PMID: 33374033 DOI: 10.1111/wrr.12887] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 12/02/2020] [Indexed: 12/24/2022]
Abstract
Negative pressure wound therapy has been used to promote wound healing in a variety of settings, including as an adjunct to silver-impregnated dressings in the acute management of paediatric burns. Fluid aspirated by the negative pressure wound therapy system represents a potentially insightful research matrix for understanding the burn wound microenvironment and the intervention's biochemical mechanisms of action. The aim of this study was to characterize the proteome of wound fluid collected using negative pressure wound therapy from children with small-area thermal burns. Samples were obtained as part of a randomized controlled trial investigating the clinical efficacy of adjunctive negative pressure wound therapy. They were compared with blister fluid specimens from paediatric burn patients matched according to demographic and injury characteristics. Protein identification and quantification were performed via liquid chromatography tandem mass spectrometry and sequential window acquisition of all theoretical mass spectra data-independent acquisition. Proteins and biological pathways that were unique to or enriched in negative pressure wound therapy fluid samples were evaluated using principal components, partial least squares-discriminant, and gene ontology enrichment analyses. Eight viable samples of negative pressure wound therapy fluid were collected and analyzed with eight matched blister fluid samples. A total of 502 proteins were quantitatively profiled in the negative pressure wound therapy fluid, of which 444 (88.4%) were shared with blister fluid. Several proteins exhibited significant abundance differences between fluid types, with negative pressure wound therapy fluid showing a higher abundance of matrix metalloproteinase-9, arginase-1, low affinity immunoglobulin gamma Fc region receptor III-A, filamin-A, alpha-2-macroglobulin, and hemoglobin subunit alpha. The results lend support to the hypothesis that negative pressure wound therapy augments wound healing through the modulation of factors involved in the inflammatory response, granulation tissue synthesis, and extracellular matrix maintenance. Data are available via ProteomeXchange with identifier PXD023168.
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Affiliation(s)
- Cody C Frear
- Centre for Children's Burns and Trauma Research, South Brisbane, Queensland, Australia.,Faculty of Medicine, University of Queensland, Herston, Queensland, Australia
| | - Tuo Zang
- Centre for Children's Burns and Trauma Research, South Brisbane, Queensland, Australia.,Faculty of Health, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - Bronwyn R Griffin
- Centre for Children's Burns and Trauma Research, South Brisbane, Queensland, Australia.,Faculty of Health, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - Steven M McPhail
- Faculty of Health, Queensland University of Technology, Kelvin Grove, Queensland, Australia.,Clinical Informatics Directorate, Metro South Health, Brisbane, Queensland, Australia
| | - Tony J Parker
- Faculty of Health, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - Roy M Kimble
- Centre for Children's Burns and Trauma Research, South Brisbane, Queensland, Australia.,Faculty of Medicine, University of Queensland, Herston, Queensland, Australia.,Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Leila Cuttle
- Centre for Children's Burns and Trauma Research, South Brisbane, Queensland, Australia.,Faculty of Health, Queensland University of Technology, Kelvin Grove, Queensland, Australia
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16
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Frear CC, Cuttle L, McPhail SM, Chatfield MD, Kimble RM, Griffin BR. Randomized clinical trial of negative pressure wound therapy as an adjunctive treatment for small-area thermal burns in children. Br J Surg 2020; 107:1741-1750. [PMID: 32926410 PMCID: PMC7692881 DOI: 10.1002/bjs.11993] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Revised: 04/17/2020] [Accepted: 07/21/2020] [Indexed: 12/03/2022]
Abstract
Background The efficacy of negative pressure wound therapy (NPWT) in the acute management of burns remains unclear. The purpose of this trial was to compare standard Acticoat™ and Mepitel™ dressings with combined Acticoat™, Mepitel™ and continuous NPWT to determine the effect of adjunctive NPWT on re‐epithelialization in paediatric burns. Methods This two‐arm, single‐centre RCT recruited children with acute thermal burns covering less than 5 per cent of their total body surface area. The primary outcome was time to re‐epithelialization. Blinded assessments were performed using photographs captured every 3–5 days until discharge. Secondary measures included pain, itch, grafting, perfusion and scar management referrals. Results Some 114 patients were randomized. Median time to re‐epithelialization was 8 (i.q.r. 7–11) days in the NPWT group and 10 (8–14) days in the control group. In a multivariable model, NPWT decreased the expected time to wound closure by 22 (95 per cent c.i. 7 to 34) per cent (P = 0·005). The risk of referral to scar management was reduced by 60 (18 to 81) per cent (P = 0·013). Four participants in the control group and one in the NPWT group underwent grafting. There were no statistically significant differences between groups in pain, itch or laser Doppler measures of perfusion. Adverse events were rare and minor, although NPWT carried a moderate treatment burden, with ten patients discontinuing early. Conclusion Adjunctive NPWT hastened re‐epithelialization in small‐area burn injuries in children, but had a greater treatment burden than standard dressings alone. Registration number: ACTRN12618000256279 (
http://ANZCTR.org.au).
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Affiliation(s)
- C C Frear
- Centre for Children's Burns and Trauma Research, South Brisbane, Australia.,Faculty of Medicine, University of Queensland, Herston, Australia
| | - L Cuttle
- Centre for Children's Burns and Trauma Research, South Brisbane, Australia.,School of Biomedical Sciences, Brisbane, Queensland, Australia
| | - S M McPhail
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Brisbane, Queensland, Australia.,Clinical Informatics Directorate, Metro South Health, Brisbane, Queensland, Australia
| | - M D Chatfield
- Faculty of Medicine, University of Queensland, Herston, Australia
| | - R M Kimble
- Centre for Children's Burns and Trauma Research, South Brisbane, Australia.,Queensland Children's Hospital, South Brisbane, Australia.,Faculty of Medicine, University of Queensland, Herston, Australia
| | - B R Griffin
- Centre for Children's Burns and Trauma Research, South Brisbane, Australia.,School of Nursing, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
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17
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Gibson ALF, Carney BC, Cuttle L, Andrews CJ, Kowalczewski CJ, Liu A, Powell HM, Stone R, Supp DM, Singer AJ, Shupp JW, Stalter L, Moffatt LT. Coming to Consensus: What Defines Deep Partial Thickness Burn Injuries in Porcine Models? J Burn Care Res 2020; 42:98-109. [PMID: 32835360 PMCID: PMC7856457 DOI: 10.1093/jbcr/iraa132] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Deep partial thickness burns are clinically prevalent and difficult to diagnose. In order to develop methods to assess burn depth and therapies to treat deep partial thickness burns, reliable, accurate animal models are needed. The variety of animal models in the literature and the lack of precise details reported for the experimental procedures make comparison of research between investigators challenging and ultimately affect translation to patients. They sought to compare deep partial thickness porcine burn models from five well-established laboratories. In doing so, they uncovered a lack of consistency in approaches to the evaluation of burn injury depth that was present within and among various models. They then used an iterative process to develop a scoring rubric with an educational component to facilitate burn injury depth evaluation that improved reliability of the scoring. Using the developed rubric to re-score the five burn models, they found that all models created a deep partial thickness injury and that agreement about specific characteristics identified on histological staining was improved. Finally, they present consensus statements on the evaluation and interpretation of the microanatomy of deep partial thickness burns in pigs.
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Affiliation(s)
- Angela L F Gibson
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Bonnie C Carney
- Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, DC.,Department of Biochemistry and Molecular and Cellular Biology, Georgetown University School of Medicine, Washington, DC
| | - Leila Cuttle
- School of Biomedical Science and Institute of Health and Biomedical Innovation, Queensland University of Technology, Children's Health Research Centre, South Brisbane, Queensland, Australia
| | - Christine J Andrews
- Mater Research Institute, The University of Queensland, Brisbane, Queensland, Australia
| | - Christine J Kowalczewski
- Burn and Soft Tissue Research, United States Army Institute of Surgical Research, JBSA Fort Sam Houston, Texas
| | - Aiping Liu
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Heather M Powell
- Department of Materials Science and Engineering, The Ohio State University, Columbus, Ohio.,Department of Biomedical Engineering, The Ohio State University, Columbus, Ohio.,Research Department, Shriners Hospitals for Children, Cincinnati, Ohio
| | - Randolph Stone
- Burn and Soft Tissue Research, United States Army Institute of Surgical Research, JBSA Fort Sam Houston, Texas
| | - Dorothy M Supp
- Research Department, Shriners Hospitals for Children, Cincinnati, Ohio.,Department of Surgery, University of Cincinnati, College of Medicine, Ohio.,Center for Stem Cell and Organoid Medicine, Cincinnati Children's Hospital Medical Center, Ohio
| | - Adam J Singer
- Department of Emergency Medicine, Stony Brook University, New York
| | - Jeffrey W Shupp
- Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, DC.,Department of Biochemistry and Molecular and Cellular Biology, Georgetown University School of Medicine, Washington, DC.,Department of Surgery, Georgetown University School of Medicine, Washington DC
| | - Lily Stalter
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Lauren T Moffatt
- Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, DC.,Department of Biochemistry and Molecular and Cellular Biology, Georgetown University School of Medicine, Washington, DC.,Department of Surgery, Georgetown University School of Medicine, Washington DC
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18
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Frear CC, Griffin B, Cuttle L, McPhail SM, Kimble R. Study of negative pressure wound therapy as an adjunct treatment for acute burns in children (SONATA in C): protocol for a randomised controlled trial. Trials 2019; 20:130. [PMID: 30760332 PMCID: PMC6374905 DOI: 10.1186/s13063-019-3223-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 01/28/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Although negative pressure wound therapy (NPWT) is widely used in the management of several wound types, its efficacy as a primary therapy for acute burns has not yet been adequately investigated, with research in the paediatric population particularly lacking. There is limited evidence, however, that NPWT might benefit children with burns, amongst whom scar formation, wound progression and pain continue to present major management challenges. The purpose of this trial is to determine whether NPWT in conjunction with standard therapy accelerates healing, reduces wound progression and decreases pain more effectively than standard treatment alone. METHODS/DESIGN A total of 104 children will be recruited for this trial. To be eligible, candidates must be under 17 years of age and present to the participating children's hospital within 7 days of their injury with a thermal burn covering <5% of their total body surface area. Facial and trivial burns will be excluded. Following a randomised controlled parallel design, participants will be allocated to either an active control or intervention group. The former will receive standard therapy consisting of Acticoat™ and Mepitel™. The intervention arm will be treated with silver-impregnated dressings in addition to NPWT via the RENASYS TOUCH™ vacuum pump. Participants' dressings will be changed every 3 to 5 days until their wounds are fully re-epithelialised. Time to re-epithelialisation will be studied as the primary outcome. Secondary outcomes will include pain, pruritus, wound progression, health-care-resource use (and costs), ease of management, treatment satisfaction and adverse events. Wound fluid collected during NPWT will also be analysed to generate a proteomic profile of the burn microenvironment. DISCUSSION The study will be the first randomised controlled trial to explore the clinical effects of NPWT on paediatric burns, with the aim of determining whether the therapy warrants implementation as an adjunct to standard burns management. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry, ACTRN12618000256279 . Registered on 16 February 2018.
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Affiliation(s)
- Cody C Frear
- Centre for Children's Burns and Trauma Research, Level 7, Children's Health Research Center, The University of Queensland, 62 Graham St., South Brisbane, QLD, 4101, Australia. .,The Pegg Leditschke Children's Burns Centre, Queensland Children's Hospital, Lvl. 5, 501 Stanley St., South Brisbane, QLD, 4101, Australia. .,The University of Queensland Faculty of Medicine, 288 Herston Rd., Brisbane, QLD, 4006, Australia.
| | - Bronwyn Griffin
- Centre for Children's Burns and Trauma Research, Level 7, Children's Health Research Center, The University of Queensland, 62 Graham St., South Brisbane, QLD, 4101, Australia.,The Pegg Leditschke Children's Burns Centre, Queensland Children's Hospital, Lvl. 5, 501 Stanley St., South Brisbane, QLD, 4101, Australia.,The University of Queensland Faculty of Medicine, 288 Herston Rd., Brisbane, QLD, 4006, Australia
| | - Leila Cuttle
- Institute of Health and Biomedical Innovation, Centre for Children's Burns and Trauma Research, Lvl 8, Children's Health Research Centre, Queensland University of Technology, South Brisbane, QLD, 4101, Australia
| | - Steven M McPhail
- Centre for Functioning and Health Research, Metro South Health, Queensland Health, Brisbane, QLD, 4102, Australia.,School of Public Health & Social Work and Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, 4059, Australia
| | - Roy Kimble
- Centre for Children's Burns and Trauma Research, Level 7, Children's Health Research Center, The University of Queensland, 62 Graham St., South Brisbane, QLD, 4101, Australia.,The Pegg Leditschke Children's Burns Centre, Queensland Children's Hospital, Lvl. 5, 501 Stanley St., South Brisbane, QLD, 4101, Australia.,The University of Queensland Faculty of Medicine, 288 Herston Rd., Brisbane, QLD, 4006, Australia
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19
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Zang T, Cuttle L, Broszczak DA, Broadbent JA, Tanzer C, Parker TJ. Characterization of the Blister Fluid Proteome for Pediatric Burn Classification. J Proteome Res 2019; 18:69-85. [PMID: 30520305 DOI: 10.1021/acs.jproteome.8b00355] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Blister fluid (BF) is a novel and viable research matrix for burn injury study, which can reflect both systemic and local microenvironmental responses. The protein abundance in BF from different burn severities were initially observed using a 2D SDS-PAGE approach. Subsequently, a quantitative data independent acquisition (DIA) method, SWATH, was employed to characterize the proteome of pediatric burn blister fluid. More than 600 proteins were quantitatively profiled in 87 BF samples from different pediatric burn patients. These data were correlated with clinically assessed burn depth and time until complete wound re-epithelialization through several different statistical analyses. Several proteins from these analyses exhibited significant abundance change between different burn depth or re-epithelialization groups, and can be considered as potential biomarker candidates. Further gene ontology (GO) enrichment analysis of the significant proteins revealed the most significant burn related biological processes (BP) that are altered with burn depth, including homeostasis and oxygen transport. However, for wounds with re-epithelialization times more or less than 21 days, the significant GO annotations were related to enzyme activity. This quantitative proteomics investigation of burn BF may enable objective classification of burn wound severity and assist with clinical decision-making. Data are available via ProteomeXchange with identifier PXD011102.
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Affiliation(s)
- Tuo Zang
- Tissue Repair and Translational Physiology Program , Institute of Health and Biomedical Innovation, Queensland University of Technology , Kelvin Grove , Queensland 4059 , Australia.,School of Biomedical Sciences, Faculty of Health , Queensland University of Technology , Brisbane , Queensland 4000 , Australia.,Wound Management Innovation Co-operative Research Centre , Brisbane , Queensland 4000 , Australia
| | - Leila Cuttle
- Tissue Repair and Translational Physiology Program , Institute of Health and Biomedical Innovation, Queensland University of Technology , Kelvin Grove , Queensland 4059 , Australia.,School of Biomedical Sciences, Faculty of Health , Queensland University of Technology , Brisbane , Queensland 4000 , Australia.,Centre for Children's Burns and Trauma Research, Queensland University of Technology , Institute of Health and Biomedical Innovation at the Centre for Children's Health Research , South Brisbane , Queensland 4101 , Australia
| | - Daniel A Broszczak
- Tissue Repair and Translational Physiology Program , Institute of Health and Biomedical Innovation, Queensland University of Technology , Kelvin Grove , Queensland 4059 , Australia.,School of Biomedical Sciences, Faculty of Health , Queensland University of Technology , Brisbane , Queensland 4000 , Australia.,School of Science, Faculty of Health Sciences , Australian Catholic University , Brisbane , Queensland 4014 , Australia
| | - James A Broadbent
- Tissue Repair and Translational Physiology Program , Institute of Health and Biomedical Innovation, Queensland University of Technology , Kelvin Grove , Queensland 4059 , Australia.,School of Biomedical Sciences, Faculty of Health , Queensland University of Technology , Brisbane , Queensland 4000 , Australia
| | - Catherine Tanzer
- Tissue Repair and Translational Physiology Program , Institute of Health and Biomedical Innovation, Queensland University of Technology , Kelvin Grove , Queensland 4059 , Australia.,Wound Management Innovation Co-operative Research Centre , Brisbane , Queensland 4000 , Australia.,Centre for Children's Burns and Trauma Research, Queensland University of Technology , Institute of Health and Biomedical Innovation at the Centre for Children's Health Research , South Brisbane , Queensland 4101 , Australia
| | - Tony J Parker
- Tissue Repair and Translational Physiology Program , Institute of Health and Biomedical Innovation, Queensland University of Technology , Kelvin Grove , Queensland 4059 , Australia.,School of Biomedical Sciences, Faculty of Health , Queensland University of Technology , Brisbane , Queensland 4000 , Australia
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20
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Evans J, Infusini G, Mcgovern J, Cuttle L, Webb A, Nebl T, Milla L, Kimble R, Kempf M, Andrews CJ, Leavesley D, Salamonsen LA. Menstrual fluid factors facilitate tissue repair: identification and functional action in endometrial and skin repair. FASEB J 2018; 33:584-605. [DOI: 10.1096/fj.201800086r] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Jemma Evans
- The Hudson Institute of Medical Research Clayton Victoria Australia
- Department of Molecular and Translational MedicineMonash University Clayton Victoria Australia
| | | | - Jacqui Mcgovern
- Institute of Health and Biomedical Innovation Brisbane Queensland Australia
| | - Leila Cuttle
- Centre for Children's Burns and Trauma ResearchSchool of Biomedical SciencesInstitute of Health and Biomedical InnovationCentre for Children's Health ResearchQueensland University of Technology Brisbane Queensland Australia
| | - Andrew Webb
- Walter and Eliza Hall Institute Parkville Victoria Australia
| | - Thomas Nebl
- Walter and Eliza Hall Institute Parkville Victoria Australia
| | - Liz Milla
- Walter and Eliza Hall Institute Parkville Victoria Australia
| | - Roy Kimble
- Centre for Children's Burns and Trauma ResearchCentre for Children's Health ResearchThe University of Queensland South Brisbane Queensland Australia
| | - Margit Kempf
- Centre for Children's Burns and Trauma ResearchCentre for Children's Health ResearchThe University of Queensland South Brisbane Queensland Australia
| | - Christine J. Andrews
- Centre for Children's Burns and Trauma ResearchCentre for Children's Health ResearchThe University of Queensland South Brisbane Queensland Australia
| | - David Leavesley
- Institute of Health and Biomedical Innovation Brisbane Queensland Australia
- Skin Research Institute of Singapore Singapore
| | - Lois A. Salamonsen
- The Hudson Institute of Medical Research Clayton Victoria Australia
- Department of Molecular and Translational MedicineMonash University Clayton Victoria Australia
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21
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Andrews CJ, Cuttle L. Comparing the reported burn conditions for different severity burns in porcine models: a systematic review. Int Wound J 2017; 14:1199-1212. [PMID: 28736990 PMCID: PMC7949960 DOI: 10.1111/iwj.12786] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 05/31/2017] [Indexed: 12/25/2022] Open
Abstract
There are many porcine burn models that create burns using different materials (e.g. metal, water) and different burn conditions (e.g. temperature and duration of exposure). This review aims to determine whether a pooled analysis of these studies can provide insight into the burn materials and conditions required to create burns of a specific severity. A systematic review of 42 porcine burn studies describing the depth of burn injury with histological evaluation is presented. Inclusion criteria included thermal burns, burns created with a novel method or material, histological evaluation within 7 days post-burn and method for depth of injury assessment specified. Conditions causing deep dermal scald burns compared to contact burns of equivalent severity were disparate, with lower temperatures and shorter durations reported for scald burns (83°C for 14 seconds) compared to contact burns (111°C for 23 seconds). A valuable archive of the different mechanisms and materials used for porcine burn models is presented to aid design and optimisation of future models. Significantly, this review demonstrates the effect of the mechanism of injury on burn severity and that caution is recommended when burn conditions established by porcine contact burn models are used by regulators to guide scald burn prevention strategies.
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Affiliation(s)
- Christine J Andrews
- Centre for Children's Burns and Trauma ResearchThe University of Queensland, Centre for Children's Health ResearchSouth BrisbaneQLDAustralia
| | - Leila Cuttle
- Centre for Children's Burns and Trauma ResearchQueensland University of Technology, Institute of Health and Biomedical Innovation and Centre for Children's Health ResearchSouth BrisbaneQLDAustralia
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Andrews CJ, Kimble RM, Kempf M, Cuttle L. Evidence-based injury prediction data for the water temperature and duration of exposure for clinically relevant deep dermal scald injuries. Wound Repair Regen 2017; 25:792-804. [DOI: 10.1111/wrr.12577] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 08/27/2017] [Indexed: 12/13/2022]
Affiliation(s)
- Christine J. Andrews
- Faculty of Medicine; Child Health Research Centre, Centre for Children's Burns and Trauma Research, The University of Queensland; South Brisbane QLD Australia
| | - Roy M. Kimble
- Children's Health Queensland, Pegg Leditschke Paediatric Burns Centre, Lady Cilento Children's Hospital; Centre for Children's Burns and Trauma Research, The University of Queensland; South Brisbane QLD Australia
| | - Margit Kempf
- Faculty of Medicine; Child Health Research Centre, Centre for Children's Burns and Trauma Research, The University of Queensland; South Brisbane QLD Australia
| | - Leila Cuttle
- Institute of Health and Biomedical Innovation and Child Health Research Centre; Centre for Children's Burns and Trauma Research, Queensland University of Technology; South Brisbane QLD Australia
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Simpson MJ, McInerney S, Carr EJ, Cuttle L. Quantifying the efficacy of first aid treatments for burn injuries using mathematical modelling and in vivo porcine experiments. Sci Rep 2017; 7:10925. [PMID: 28883527 PMCID: PMC5589934 DOI: 10.1038/s41598-017-11390-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 08/23/2017] [Indexed: 01/19/2023] Open
Abstract
First aid treatment of burns reduces scarring and improves healing. We quantify the efficacy of first aid treatments using a mathematical model to describe data from a series of in vivo porcine experiments. We study burn injuries that are subject to various first aid treatments. The treatments vary in the temperature and duration. Calibrating the mathematical model to the experimental data provides estimates of the thermal diffusivity, the rate at which thermal energy is lost to the blood, and the heat transfer coefficient controlling the loss of thermal energy at the interface of the fat and muscle. A limitation of working with in vivo experiments is the difficulty of measuring variations in temperature across the tissue layers. This limitation motivates us to use a simple, single layer mathematical model. Using the solution of the calibrated mathematical model we visualise the temperature distribution across the thickness of the tissue. With this information we propose a novel measure of the potential for tissue damage. This measure quantifies two important factors: (i) the volume of tissue that rises above the threshold temperature associated with the accumulation of tissue damage; and (ii) the duration of time that the tissue remains above this threshold temperature.
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Affiliation(s)
- Matthew J Simpson
- School of Mathematical Sciences, Queensland University of Technology (QUT), Brisbane, Australia.
| | - Sean McInerney
- School of Mathematical Sciences, Queensland University of Technology (QUT), Brisbane, Australia
| | - Elliot J Carr
- School of Mathematical Sciences, Queensland University of Technology (QUT), Brisbane, Australia
| | - Leila Cuttle
- Centre for Children's Burns and Trauma Research, QUT, Institute of Health and Biomedical Innovation at the Centre for Children's Health Research, South Brisbane, Australia
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Gee Kee E, Stockton K, Kimble RM, Cuttle L, McPhail SM. Cost-effectiveness of silver dressings for paediatric partial thickness burns: An economic evaluation from a randomized controlled trial. Burns 2017; 43:724-732. [PMID: 28408145 DOI: 10.1016/j.burns.2016.09.018] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 08/16/2016] [Accepted: 09/15/2016] [Indexed: 01/09/2023]
Abstract
BACKGROUND Partial thickness burns of up to 10% total body surface area (TBSA) in children are common injuries primarily treated in the outpatient setting using expensive silver-containing dressings. However, economic evaluations in the paediatric burns population are lacking to assist healthcare providers when choosing which dressing to use. The aim of this study was to conduct a cost-effectiveness analysis of three silver dressings for partial thickness burns ≤10% TBSA in children aged 0-15 years using days to full wound re-epithelialization as the health outcome. METHOD This study was a trial based economic evaluation (incremental cost effectiveness) conducted from a healthcare provider perspective. Ninety-six children participated in the trial investigating Acticoat™, Acticoat™ with Mepitel™ or Mepilex Ag™. Costs directly related to the management of partial thickness burns ≤10% TBSA were collected during the trial from March 2013 to July 2014 and for a one year after re-epithelialization time horizon. Incremental cost effectiveness ratios were estimated and dominance probabilities calculated from bootstrap resampling trial data. Sensitivity analyses were conducted to examine the potential effect of accounting for infrequent, but high cost, skin grafting surgical procedures. RESULTS Costs (dressing, labour, analgesics, scar management) were considerably lower in the Mepilex Ag™ group (median AUD$94.45) compared to the Acticoat™ (median $244.90) and Acticoat™ with Mepitel™ (median $196.66) interventions. There was a 99% and 97% probability that Mepilex Ag™ dominated (cheaper and more effective than) Acticoat™ and Acticoat™ with Mepitel™, respectively. This pattern of dominance was consistent across raw cost and effects, after a priori adjustments, and sensitivity analyses. There was an 82% probability that Acticoat™ with Mepitel dominated Acticoat™ in the primary analysis, although this probability was sensitive to the effect of skin graft procedures. CONCLUSION This economic evaluation has demonstrated that Mepilex Ag™ was the dominant dressing choice over both Acticoat™ and Acticoat™ with Mepitel™ in this trial-based economic evaluation and is recommended for treatment of paediatric partial thickness burns ≤10% TBSA.
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Affiliation(s)
- E Gee Kee
- Centre for Children's Burns and Trauma Research, Child Health Research Centre, The University of Queensland, Australia.
| | - K Stockton
- Centre for Children's Burns and Trauma Research, Child Health Research Centre, The University of Queensland, Australia
| | - R M Kimble
- Centre for Children's Burns and Trauma Research, Child Health Research Centre, The University of Queensland, Australia; Pegg Leditschke Children's Burns Centre, Lady Cilento Children's Hospital, Brisbane, Australia
| | - L Cuttle
- Centre for Children's Burns and Trauma Research, Child Health Research Centre, The University of Queensland, Australia; Tissue Repair and Regeneration Program, Institute of Health and Biomedical Innovation, Queensland University of Technology, Australia
| | - S M McPhail
- Institute of Health and Biomedical Innovation and School of Public Health & Social Work, Queensland University of Technology, Australia; Centre for Functioning and Health Research, Metro South Health, Australia
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Andrews CJ, Kempf M, Kimble R, Cuttle L. Skin thickness measurements increase with excision and biopsy processing procedures. Wound Repair Regen 2017; 25:338-340. [PMID: 28370706 DOI: 10.1111/wrr.12525] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 02/01/2017] [Accepted: 02/05/2017] [Indexed: 11/27/2022]
Affiliation(s)
- Christine J Andrews
- Centre for Children's Burns and Trauma Research, The University of Queensland, Centre for Children's Health Research, South Brisbane, Queensland, 4101, Australia
| | - Margit Kempf
- Centre for Children's Burns and Trauma Research, The University of Queensland, Centre for Children's Health Research, South Brisbane, Queensland, 4101, Australia
| | - Roy Kimble
- Centre for Children's Burns and Trauma Research, The University of Queensland, Children's Health Queensland, Lady Cilento Children's Hospital, South Brisbane, Queensland, 4101, Australia
| | - Leila Cuttle
- Centre for Children's Burns and Trauma Research, Queensland University of Technology, Institute of Health and Biomedical Innovation and Centre for Children's Health Research, South Brisbane, Queensland, 4101, Australia
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Abstract
There are very few porcine burn models that replicate scald injuries similar to those encountered by children. We have developed a robust porcine burn model capable of creating reproducible scald burns for a wide range of burn conditions. The study was conducted with juvenile Large White pigs, creating replicates of burn combinations; 50°C for 1, 2, 5 and 10 minutes and 60°C, 70°C, 80°C and 90°C for 5 seconds. Visual wound examination, biopsies and Laser Doppler Imaging were performed at 1, 24 hours and at 3 and 7 days post-burn. A consistent water temperature was maintained within the scald device for long durations (49.8 ± 0.1°C when set at 50°C). The macroscopic and histologic appearance was consistent between replicates of burn conditions. For 50°C water, 10 minute duration burns showed significantly deeper tissue injury than all shorter durations at 24 hours post-burn (p ≤ 0.0001), with damage seen to increase until day 3 post-burn. For 5 second duration burns, by day 7 post-burn the 80°C and 90°C scalds had damage detected significantly deeper in the tissue than the 70°C scalds (p ≤ 0.001). A reliable and safe model of porcine scald burn injury has been successfully developed. The novel apparatus with continually refreshed water improves consistency of scald creation for long exposure times. This model allows the pathophysiology of scald burn wound creation and progression to be examined.
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Affiliation(s)
- Christine J. Andrews
- Centre for Children’s Burns and Trauma Research, The University of Queensland, Centre for Children’s Health Research, South Brisbane, Queensland, Australia
| | - Margit Kempf
- Centre for Children’s Burns and Trauma Research, The University of Queensland, Centre for Children’s Health Research, South Brisbane, Queensland, Australia
| | - Roy Kimble
- Centre for Children’s Burns and Trauma Research, The University of Queensland, Centre for Children’s Health Research, South Brisbane, Queensland, Australia
| | - Leila Cuttle
- Centre for Children’s Burns and Trauma Research, Queensland University of Technology, School of Biomedical Sciences, Institute of Health and Biomedical Innovation at Centre for Children's Health Research, South Brisbane, Queensland, Australia
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Zang T, Broszczak DA, Cuttle L, Broadbent JA, Tanzer C, Parker TJ. The blister fluid proteome of paediatric burns. J Proteomics 2016; 146:122-32. [PMID: 27345418 DOI: 10.1016/j.jprot.2016.06.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2016] [Revised: 05/28/2016] [Accepted: 06/17/2016] [Indexed: 01/03/2023]
Abstract
UNLABELLED Burn injury is highly traumatic for paediatric patients, with the severity of the burn often dictating the extent of scar formation. The diagnosis of burn wound severity is largely determined by the attending clinician's experience. Thus, a greater understanding of the biochemistry at burn wound site environment and the biology of burns of different severities at an earlier stage may reduce the reliance on subjective diagnoses. In this study, blister fluid was collected from superficial thickness, deep-partial thickness, and full-thickness paediatric burn wounds. Samples were combined together based on burn depth classification and then subjected to four different fractionation methods followed by trypsin digestion. Peptides were analysed by liquid chromatography tandem mass spectrometry in order to measure the proteome of each fraction. In total, 811 individual proteins were identified, including 107, 84, and 146 proteins unique to superficial, deep-partial thickness and full-thickness burn wounds, respectively. The differences in the protein inventory and the associated gene ontologies represented within each burn depth category demonstrated that there are subtle, yet significant, variations in the biochemistry of burn wounds according to severity. Importantly, this study has produced the most comprehensive catalogue of proteins from the paediatric burn wound microenvironment to date. SIGNIFICANCE To our knowledge, this study has been the first to comprehensively measure the paediatric burn blister fluid proteome and has provided insight into the proteomic response to burn injury. The study contributes to the knowledge of blister fluid biochemistry of burn injury and provides clinically relevant knowledge through the qualitative evaluation of biochemical differences between burns of different depths. A better understanding of the burn wound environment will ultimately assist with more accurate clinical decision making and improved wound healing and scar reduction procedures.
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Affiliation(s)
- Tuo Zang
- Tissue Repair and Regeneration Program, Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia; School of Biomedical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Australia; Wound Management Innovation Co-operative Research Centre, Brisbane, Australia
| | - Daniel A Broszczak
- Tissue Repair and Regeneration Program, Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia; School of Biomedical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Australia; Wound Management Innovation Co-operative Research Centre, Brisbane, Australia
| | - Leila Cuttle
- Tissue Repair and Regeneration Program, Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia; School of Biomedical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Australia; Centre for Children's Burns and Trauma Research, Queensland University of Technology, Institute of Health and Biomedical Innovation at the Centre for Children's Health Research, South Brisbane, Australia
| | - James A Broadbent
- Tissue Repair and Regeneration Program, Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia; School of Biomedical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Australia; Wound Management Innovation Co-operative Research Centre, Brisbane, Australia
| | - Catherine Tanzer
- Tissue Repair and Regeneration Program, Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia; Wound Management Innovation Co-operative Research Centre, Brisbane, Australia; Centre for Children's Burns and Trauma Research, Queensland University of Technology, Institute of Health and Biomedical Innovation at the Centre for Children's Health Research, South Brisbane, Australia
| | - Tony J Parker
- Tissue Repair and Regeneration Program, Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia; School of Biomedical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Australia.
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28
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Zang T, Broszczak DA, Broadbent JA, Cuttle L, Lu H, Parker TJ. The biochemistry of blister fluid from pediatric burn injuries: proteomics and metabolomics aspects. Expert Rev Proteomics 2015; 13:35-53. [PMID: 26581649 DOI: 10.1586/14789450.2016.1122528] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Burn injury is a prevalent and traumatic event for pediatric patients. At present, the diagnosis of burn injury severity is subjective and lacks a clinically relevant quantitative measure. This is due in part to a lack of knowledge surrounding the biochemistry of burn injuries and that of blister fluid. A more complete understanding of the blister fluid biochemistry may open new avenues for diagnostic and prognostic development. Burn insult induces a highly complex network of signaling processes and numerous changes within various biochemical systems, which can ultimately be examined using proteome and metabolome measurements. This review reports on the current understanding of burn wound biochemistry and outlines a technical approach for 'omics' profiling of blister fluid from burn wounds of differing severity.
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Affiliation(s)
- Tuo Zang
- a Tissue Repair and Regeneration Program , Institute of Health and Biomedical Innovation , Kelvin Grove , Australia.,b School of Biomedical Sciences , Queensland University of Technology , Brisbane , Australia.,c Wound Management Innovation Co-operative Research Centre , West End , Australia
| | - Daniel A Broszczak
- a Tissue Repair and Regeneration Program , Institute of Health and Biomedical Innovation , Kelvin Grove , Australia.,b School of Biomedical Sciences , Queensland University of Technology , Brisbane , Australia.,c Wound Management Innovation Co-operative Research Centre , West End , Australia
| | - James A Broadbent
- a Tissue Repair and Regeneration Program , Institute of Health and Biomedical Innovation , Kelvin Grove , Australia.,b School of Biomedical Sciences , Queensland University of Technology , Brisbane , Australia.,c Wound Management Innovation Co-operative Research Centre , West End , Australia
| | - Leila Cuttle
- a Tissue Repair and Regeneration Program , Institute of Health and Biomedical Innovation , Kelvin Grove , Australia.,b School of Biomedical Sciences , Queensland University of Technology , Brisbane , Australia.,d Centre for Children's Burns and Trauma Research , Queensland University of Technology, Institute of Health and Biomedical Innovation at the Centre for Children's Health Research , South Brisbane , Australia
| | - Haitao Lu
- a Tissue Repair and Regeneration Program , Institute of Health and Biomedical Innovation , Kelvin Grove , Australia.,b School of Biomedical Sciences , Queensland University of Technology , Brisbane , Australia
| | - Tony J Parker
- a Tissue Repair and Regeneration Program , Institute of Health and Biomedical Innovation , Kelvin Grove , Australia.,b School of Biomedical Sciences , Queensland University of Technology , Brisbane , Australia
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29
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Tyack Z, Ziviani J, Kimble R, Plaza A, Jones A, Cuttle L, Simons M. Measuring the impact of burn scarring on health-related quality of life: Development and preliminary content validation of the Brisbane Burn Scar Impact Profile (BBSIP) for children and adults. Burns 2015; 41:1405-19. [PMID: 26421693 DOI: 10.1016/j.burns.2015.05.021] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Revised: 05/29/2015] [Accepted: 05/29/2015] [Indexed: 12/26/2022]
Abstract
INTRODUCTION No burn-scar specific, health-related quality of life (HRQOL) measure exists. This study aimed to develop a patient-reported, evaluative HRQOL measure to assess the impact of burn scarring in children and adults. METHOD Semi-structured interviews, content validation surveys, and cognitive interviews were used to develop and test content validity of a new measure - the Brisbane Burn Scar Impact Profile (BBSIP). RESULTS Participants comprised Australian adults (n=23) and children (n=19) with burn scarring; caregivers of children with burn scarring (n=28); and international scar management experts (n=14). Items distinct from other burn scar measures emerged. Four versions of the BBSIP were developed; one for children aged 8-18 years, one for adults, one for caregivers (as proxies for children aged less than 8-years), and one for caregivers of children aged 8-18 years. Preliminary content validity of the BBSIP was supported. Final items covered physical and sensory symptoms; emotional reactions; impact on social functioning and daily activities; impact of treatment; and environmental factors. CONCLUSION The BBSIP was developed to assess burn-scar specific HRQOL and will be available at http://www.coolburns.com.au under a creative commons license. Further testing is underway.
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Affiliation(s)
- Zephanie Tyack
- Centre for Children's Burns and Trauma Research, Child Health Research Centre, Level 4, Foundation Building, Royal Children's Hospital, Herston Rd, Herston, Brisbane, Queensland 4006, Australia; Central Queensland Hospital and Health Service, East St, Rockhampton, Queensland 4700, Australia.
| | - Jenny Ziviani
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Brisbane, Queensland 4067, Australia.
| | - Roy Kimble
- Centre for Children's Burns and Trauma Research, Child Health Research Centre, Level 4, Foundation Building, Royal Children's Hospital, Herston Rd, Herston, Brisbane, Queensland 4006, Australia; Department of Paediatric Surgery, Urology, Neonatal Surgery, Burns and Trauma, Lady Cilento Children's Hospital, Brisbane, Queensland 4101, Australia; School of Medicine, The University of Queensland, St Lucia, Brisbane, Queensland 4067, Australia.
| | - Anita Plaza
- Physiotherapy Department, Royal Brisbane and Women's Hospital, Butterfield St, Herston, Brisbane, Queensland 4006, Australia.
| | - Amber Jones
- Occupational Therapy Department, Royal Brisbane and Women's Hospital, Butterfield St, Herston, Brisbane, Queensland 4006, Australia.
| | - Leila Cuttle
- Centre for Children's Burns and Trauma Research, Child Health Research Centre, Level 4, Foundation Building, Royal Children's Hospital, Herston Rd, Herston, Brisbane, Queensland 4006, Australia.
| | - Megan Simons
- Centre for Children's Burns and Trauma Research, Child Health Research Centre, Level 4, Foundation Building, Royal Children's Hospital, Herston Rd, Herston, Brisbane, Queensland 4006, Australia; Department of Occupational Therapy, Lady Cilento Children's Hospital, 501 Stanley St, South Brisbane, Queensland 4101, Australia.
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Brown NJ, David M, Cuttle L, Kimble RM, Rodger S, Higashi H. Cost-Effectiveness of a Nonpharmacological Intervention in Pediatric Burn Care. Value Health 2015; 18:631-637. [PMID: 26297091 DOI: 10.1016/j.jval.2015.04.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2013] [Revised: 02/28/2015] [Accepted: 04/03/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To report the cost-effectiveness of a tailored handheld computerized procedural preparation and distraction intervention (Ditto) used during pediatric burn wound care in comparison to standard practice. METHODS An economic evaluation was performed alongside a randomized controlled trial of 75 children aged 4 to 13 years who presented with a burn to the Royal Children's Hospital, Brisbane, Australia. Participants were randomized to either the Ditto intervention (n = 35) or standard practice (n = 40) to measure the effect of the intervention on days taken for burns to re-epithelialize. Direct medical, direct nonmedical, and indirect cost data during burn re-epithelialization were extracted from the randomized controlled trial data and combined with scar management cost data obtained retrospectively from medical charts. Nonparametric bootstrapping was used to estimate statistical uncertainty in cost and effect differences and cost-effectiveness ratios. RESULTS On average, the Ditto intervention reduced the time to re-epithelialize by 3 days at AU$194 less cost for each patient compared with standard practice. The incremental cost-effectiveness plane showed that 78% of the simulated results were within the more effective and less costly quadrant and 22% were in the more effective and more costly quadrant, suggesting a 78% probability that the Ditto intervention dominates standard practice (i.e., cost-saving). At a willingness-to-pay threshold of AU$120, there is a 95% probability that the Ditto intervention is cost-effective (or cost-saving) against standard care. CONCLUSIONS This economic evaluation showed the Ditto intervention to be highly cost-effective against standard practice at a minimal cost for the significant benefits gained, supporting the implementation of the Ditto intervention during burn wound care.
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Affiliation(s)
- Nadia J Brown
- Centre for Children's Burns and Trauma Research, Queensland Children's Medical Research Institute, The University of Queensland, Royal Children's Hospital, Brisbane, Australia.
| | - Michael David
- Queensland Children's Medical Research Institute, The University of Queensland, Royal Children's Hospital, Brisbane, Australia; School of Population Health, The University of Queensland, Brisbane, Australia
| | - Leila Cuttle
- Centre for Children's Burns and Trauma Research, Queensland Children's Medical Research Institute, The University of Queensland, Royal Children's Hospital, Brisbane, Australia; Tissue Repair and Regeneration Program, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - Roy M Kimble
- Centre for Children's Burns and Trauma Research, Queensland Children's Medical Research Institute, The University of Queensland, Royal Children's Hospital, Brisbane, Australia
| | - Sylvia Rodger
- Division of Occupational Therapy, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Hideki Higashi
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA
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31
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Gee Kee EL, Kimble RM, Cuttle L, Khan A, Stockton KA. Randomized controlled trial of three burns dressings for partial thickness burns in children. Burns 2015; 41:946-55. [PMID: 25687836 DOI: 10.1016/j.burns.2014.11.005] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Revised: 11/04/2014] [Accepted: 11/05/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND This study compared the effects of three silver dressing combinations on small to medium size acute partial thickness burns in children, focusing on re-epithelialization time, pain and distress during dressing changes. METHOD Children (0-15 years) with clean, ≤ 10% total body surface area (TBSA) partial thickness burns who met the inclusion criteria were included in the study. Children received either (1) Acticoat™; (2) Acticoat™ with Mepitel™; or (3) Mepilex Ag™ dressings. Measures of burn re-epithelialization, pain, and distress were recorded at dressing changes every 3-5 days until full re-epithelialization occurred. RESULTS One hundred and three children were recruited with 96 children included for analysis. No infections were detected for the course of the study. When adjusted for burn depth, Acticoat™ significantly increased the expected days to full re-epithelialization by 40% (IRR = 1.40; 95% CI: 1.14-1.73, p < 0.01) and Acticoat™ with Mepitel™ significantly increased the expected days to full re-epithelialization by 33% (IRR = 1.33; 95% CI: 1.08-1.63, p ≤ 0.01) when compared to Mepilex Ag™. Expected FLACC scores in the Mepilex Ag™ group were 32% lower at dressing removal (p = 0.01) and 37% lower at new dressing application (p = 0.04); and scores in the Acticoat™ with Mepitel™ group were 23% lower at dressing removal (p = 0.04) and 40% lower at new dressing application (p < 0.01), in comparison to the Acticoat™ group. Expected Visual Analog Scale-Pain (VAS-P) scores were 25% lower in the Mepilex Ag™ group at dressing removal (p = 0.04) and 34% lower in the Acticoat™ with Mepitel™ group (p = 0.02) at new dressing application in comparison to the Acticoat™ group. There was no significant difference between the Mepilex Ag™ and the Acticoat™ with Mepitel™ groups at all timepoints and with any pain measure. CONCLUSION Mepilex Ag™ is an effective silver dressing, in terms of accelerated wound re-epithelialization time (compared to Acticoat™ and Acticoat™ with Mepitel™) and decreased pain during dressing changes (compared to Acticoat™), for clean, < 10% TBSA partial thickness burns in children.
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Affiliation(s)
- E L Gee Kee
- Centre for Children's Burns and Trauma Research, Queensland Children's Medical Research Institute, University of Queensland, Australia.
| | - R M Kimble
- Centre for Children's Burns and Trauma Research, Queensland Children's Medical Research Institute, University of Queensland, Australia; Stuart Pegg Paediatric Burns Centre, Royal Children's Hospital, Brisbane, Australia
| | - L Cuttle
- Centre for Children's Burns and Trauma Research, Queensland Children's Medical Research Institute, University of Queensland, Australia; Tissue Repair and Regeneration Program, Institute of Health and Biomedical Innovation, Queensland University of Technology, Australia
| | - A Khan
- School of Health and Rehabilitation Sciences, University of Queensland, Australia
| | - K A Stockton
- Centre for Children's Burns and Trauma Research, Queensland Children's Medical Research Institute, University of Queensland, Australia
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32
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Tanzer C, Sampson DL, Broadbent JA, Cuttle L, Kempf M, Kimble RM, Upton Z, Parker TJ. Evaluation of haemoglobin in blister fluid as an indicator of paediatric burn wound depth. Burns 2015; 41:1114-21. [PMID: 25637955 DOI: 10.1016/j.burns.2014.12.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Revised: 12/21/2014] [Accepted: 12/25/2014] [Indexed: 01/13/2023]
Abstract
The early and accurate assessment of burns is essential to inform patient treatment regimens; however, this first critical step in clinical practice remains a challenge for specialist burns clinicians worldwide. In this regard, protein biomarkers are a potential adjunct diagnostic tool to assist experienced clinical judgement. Free circulating haemoglobin has previously shown some promise as an indicator of burn depth in a murine animal model. Using blister fluid collected from paediatric burn patients, haemoglobin abundance was measured using semi-quantitative Western blot and immunoassays. Although a trend was observed in which haemoglobin abundance increased with burn wound severity, several patient samples deviated significantly from this trend. Further, it was found that haemoglobin concentration decreased significantly when whole cells, cell debris and fibrinous matrix was removed from the blister fluid by centrifugation; although the relationship to depth was still present. Statistical analyses showed that haemoglobin abundance in the fluid was more strongly related to the time between injury and sample collection and the time taken for spontaneous re-epithelialisation. We hypothesise that prolonged exposure to the blister fluid microenvironment may result in an increased haemoglobin abundance due to erythrocyte lysis, and delayed wound healing.
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Affiliation(s)
- Catherine Tanzer
- Tissue Repair and Regeneration Program, Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Brisbane, QLD, Australia; School of Biomedical Science, Faculty of Health, Queensland University of Technology, Kelvin Grove, Brisbane, QLD, Australia; Centre for Children's Burns and Trauma Research, Queensland Children's Medical Research Institute, Royal Children's Hospital, Herston, Brisbane, QLD, Australia; Wound Management Innovation Co-operative Research Centre, Kelvin Grove, Brisbane, QLD, Australia.
| | - Dayle L Sampson
- Tissue Repair and Regeneration Program, Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Brisbane, QLD, Australia; School of Biomedical Science, Faculty of Health, Queensland University of Technology, Kelvin Grove, Brisbane, QLD, Australia; Wound Management Innovation Co-operative Research Centre, Kelvin Grove, Brisbane, QLD, Australia.
| | - James A Broadbent
- Tissue Repair and Regeneration Program, Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Brisbane, QLD, Australia; School of Biomedical Science, Faculty of Health, Queensland University of Technology, Kelvin Grove, Brisbane, QLD, Australia; Wound Management Innovation Co-operative Research Centre, Kelvin Grove, Brisbane, QLD, Australia.
| | - Leila Cuttle
- Tissue Repair and Regeneration Program, Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Brisbane, QLD, Australia; School of Biomedical Science, Faculty of Health, Queensland University of Technology, Kelvin Grove, Brisbane, QLD, Australia; Centre for Children's Burns and Trauma Research, Queensland Children's Medical Research Institute, Royal Children's Hospital, Herston, Brisbane, QLD, Australia.
| | - Margit Kempf
- Centre for Children's Burns and Trauma Research, Queensland Children's Medical Research Institute, Royal Children's Hospital, Herston, Brisbane, QLD, Australia.
| | - Roy M Kimble
- Centre for Children's Burns and Trauma Research, Queensland Children's Medical Research Institute, Royal Children's Hospital, Herston, Brisbane, QLD, Australia.
| | - Zee Upton
- Tissue Repair and Regeneration Program, Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Brisbane, QLD, Australia; School of Biomedical Science, Faculty of Health, Queensland University of Technology, Kelvin Grove, Brisbane, QLD, Australia.
| | - Tony J Parker
- Tissue Repair and Regeneration Program, Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Brisbane, QLD, Australia; School of Biomedical Science, Faculty of Health, Queensland University of Technology, Kelvin Grove, Brisbane, QLD, Australia.
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Fein M, Quinn J, Watt K, Nichols T, Kimble R, Cuttle L. Prehospital paediatric burn care: New priorities in paramedic reporting. Emerg Med Australas 2014; 26:609-15. [PMID: 25348749 DOI: 10.1111/1742-6723.12313] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The present study evaluates the prehospital care of paediatric burn patients in Queensland (QLD). As first aid (FA) treatment has been shown to affect burn progression and outcome, the FA treatment and the risk of associated hypothermia in paediatric patients were specifically examined in the context of paramedic management of burn patients. METHODS Data were retrospectively collected from electronic ambulance response forms (eARFs) for paediatric burn patients (0-5 years) who were attended by Queensland Ambulance Service (QAS) from 2008 to 2010. Data were collected from 117 eARFs of incidents occurring within the Brisbane, Townsville and Cairns regions. RESULTS Initial FA measures were recorded in 77.8% of cases, with cool running water FA administered in 56.4% of cases. The duration of FA was recorded in 29.9% of reports. The duration of FA was significantly shorter for patients in Northern QLD (median = 10 min, n = 10) compared with Brisbane (median = 15 min, n = 18), P = 0.005. Patient temperatures were recorded significantly more often in Brisbane than in other regions (P = 0.041); however, in total, only 24.8% of all patients had documented temperature readings. Of these, six (5%) were recorded as having temperatures ≤ 36.0°C. Burnaid(TM) was the most commonly used dressing and was applied to 55.6% of all patients; however, it was applied with a variety of different outer dressings. Brisbane paramedics applied Burnaid significantly less often (44.3%) compared with paramedics from Northern QLD (72.7%) and Far Northern QLD (60.9%), P = 0.025. CONCLUSIONS Despite FA and patient temperatures being important prognostic factors for burn patients, paramedic documentation of these was often incomplete, and there was no consistent use of burns dressings.
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Affiliation(s)
- Mikaela Fein
- Centre for Children's Burns and Trauma Research, Queensland Children's Medical Research Institute, University of Queensland, Brisbane, Queensland, Australia
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Brown NJ, Kimble RM, Rodger S, Ware RS, McWhinney BC, Ungerer JP, Cuttle L. Biological markers of stress in pediatric acute burn injury. Burns 2014; 40:887-95. [DOI: 10.1016/j.burns.2013.12.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Revised: 12/03/2013] [Accepted: 12/04/2013] [Indexed: 11/26/2022]
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Boonkaew B, Barber PM, Rengpipat S, Supaphol P, Kempf M, He J, John VT, Cuttle L. Development and characterization of a novel, antimicrobial, sterile hydrogel dressing for burn wounds: single-step production with gamma irradiation creates silver nanoparticles and radical polymerization. J Pharm Sci 2014; 103:3244-53. [PMID: 25079080 DOI: 10.1002/jps.24095] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2014] [Revised: 06/16/2014] [Accepted: 06/30/2014] [Indexed: 01/21/2023]
Abstract
Patients with burn wounds are susceptible to wound infection and sepsis. This research introduces a novel burn wound dressing that contains silver nanoparticles (SNPs) to treat infection in a 2-acrylamido-2-methylpropane sulfonic acid sodium salt (AMPS-Na(+) ) hydrogel. Silver nitrate was dissolved in AMPS-Na(+) solution and then exposed to gamma irradiation to form SNP-infused hydrogels. The gamma irradiation results in a cross-linked polymeric network of sterile hydrogel dressing and a reduction of silver ions to form SNPs infused in the hydrogel in a one-step process. About 80% of the total silver was released from the hydrogels after 72 h immersion in simulated body fluid solution; therefore, they could be used on wounds for up to 3 days. All the hydrogels were found to be nontoxic to normal human dermal fibroblast cells. The silver-loaded hydrogels had good inhibitory action against Pseudomonas aeruginosa and methicillin-resistant Staphylococcus aureus. Results from a pilot study on a porcine burn model showed that the 5-mM silver hydrogel was efficient at preventing bacterial colonization of wounds, and the results were comparable to the commercially available silver dressings (Acticoat(TM) , PolyMem Silver(®) ). These results support its use as a potential burn wound dressing.
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Affiliation(s)
- Benjawan Boonkaew
- Department of Chemical and Biomolecular Engineering, Tulane University, New Orleans, Louisiana, 70118
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Boonkaew B, Kempf M, Kimble R, Cuttle L. Cytotoxicity testing of silver-containing burn treatments using primary and immortal skin cells. Burns 2014; 40:1562-9. [PMID: 24767717 DOI: 10.1016/j.burns.2014.02.009] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2013] [Accepted: 02/12/2014] [Indexed: 11/28/2022]
Abstract
A novel burn wound hydrogel dressing has been previously developed which is composed of 2-acrylamido-2-methylpropane sulfonic acid sodium salt with silver nanoparticles (silver AMPS). This study compared the cytotoxicity of this dressing to the commercially available silver products; Acticoat™, PolyMem Silver(®) and Flamazine™ cream. Human keratinocytes (HaCaT and primary HEK) and normal human fibroblasts (NHF) were exposed to dressings incubated on Nunc™ polycarbonate inserts for 24, 48 and 72h. Four different cytotoxicity assays were performed including; Trypan Blue cell count, MTT, Celltiter-Blue™ and Toluidine Blue surface area assays. The results were expressed as relative cell viability compared to an untreated control. The cytotoxic effects of Acticoat™ and Flamazine™ cream were dependent on exposure time and cell type. After 24h exposure, Acticoat™ and Flamazine™ cream were toxic to all tested cell lines. Surprisingly, HaCaTs treated with Acticoat™ and Flamazine™ had an improved ability to survive at 48 and 72h while HEKs and NHFs had no improvement in survival with any treatment. The novel silver hydrogel and PolyMem Silver(®) showed low cytotoxicity to all tested cell lines at every time interval and these results support the possibility of using the novel silver hydrogel as a burn wound dressing. Researchers who rely on HaCaT cells as an accurate keratinocyte model should be aware that they can respond differently to primary skin cells.
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Affiliation(s)
- Benjawan Boonkaew
- Queensland University of Technology, Queensland Children's Medical Research Institute, Royal Children's Hospital, Herston, Queensland 4029, Australia; Department of Chemical and Biomolecular Engineering, Tulane University, New Orleans, Louisiana 70118, United States
| | - Margit Kempf
- Queensland University of Technology, Queensland Children's Medical Research Institute, Royal Children's Hospital, Herston, Queensland 4029, Australia
| | - Roy Kimble
- Queensland University of Technology, Queensland Children's Medical Research Institute, Royal Children's Hospital, Herston, Queensland 4029, Australia
| | - Leila Cuttle
- Queensland University of Technology, Queensland Children's Medical Research Institute, Royal Children's Hospital, Herston, Queensland 4029, Australia; Tissue Repair and Regeneration Program, Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Queensland 4059, Australia.
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Brown NJ, Kimble RM, Rodger S, Ware RS, Cuttle L. Play and heal: Randomized controlled trial of Ditto™ intervention efficacy on improving re-epithelialization in pediatric burns. Burns 2014; 40:204-13. [DOI: 10.1016/j.burns.2013.11.024] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Revised: 11/25/2013] [Accepted: 11/26/2013] [Indexed: 10/25/2022]
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Boonkaew B, Kempf M, Kimble R, Supaphol P, Cuttle L. Antimicrobial efficacy of a novel silver hydrogel dressing compared to two common silver burn wound dressings: Acticoat™ and PolyMem Silver®. Burns 2014; 40:89-96. [DOI: 10.1016/j.burns.2013.05.011] [Citation(s) in RCA: 92] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Revised: 04/12/2013] [Accepted: 05/20/2013] [Indexed: 11/27/2022]
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Boonkaew B, Suwanpreuksa P, Cuttle L, Barber PM, Supaphol P. Hydrogels containing silver nanoparticles for burn wounds show antimicrobial activity without cytotoxicity. J Appl Polym Sci 2013. [DOI: 10.1002/app.40215] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Benjawan Boonkaew
- The Petroleum and Petrochemical College; Chulalongkorn University; Pathumwan Bangkok 10330 Thailand
- Centre for Children's Burns and Trauma Research Queensland Children's Medical Research Institute; The University of Queensland; Herston Brisbane, Queensland 4029 Australia
| | - Pimpa Suwanpreuksa
- The Petroleum and Petrochemical College; Chulalongkorn University; Pathumwan Bangkok 10330 Thailand
| | - Leila Cuttle
- Centre for Children's Burns and Trauma Research Queensland Children's Medical Research Institute; The University of Queensland; Herston Brisbane, Queensland 4029 Australia
- Tissue Repair and Regeneration Program; Institute of Health and Biomedical Innovation, Queensland University of Technology; Kelvin Grove Brisbane, Queensland 4059 Australia
| | - Philip Martin Barber
- School of Medicine; The University of Queensland; Herston Brisbane, Queensland 4006 Australia
| | - Pitt Supaphol
- The Petroleum and Petrochemical College; Chulalongkorn University; Pathumwan Bangkok 10330 Thailand
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Gee Kee E, Kimble RM, Cuttle L, Stockton K. Comparison of three different dressings for partial thickness burns in children: study protocol for a randomised controlled trial. Trials 2013; 14:403. [PMID: 24274190 PMCID: PMC4222277 DOI: 10.1186/1745-6215-14-403] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Accepted: 11/14/2013] [Indexed: 12/03/2022] Open
Abstract
Background In the paediatric population, pain and distress associated with burn injuries during wound care procedures remain a constant challenge. Although silver dressings are the gold standard for burn care in Australasia, very few high-level trials have been conducted that compare silver dressings to determine which will provide the best level of care clinically. Therefore, for paediatric patients in particular, identifying silver dressings that are associated with lower levels of pain and rapid wound re-epithelialisation is imperative. This study will determine whether there is a difference in time to re-epithelialisation and pain and distress experienced during wound care procedures among Acticoat™, Acticoat™ combined with Mepitel™ and Mepilex Ag™ dressings for acute, paediatric partial thickness burns. Methods/Design Children aged 0 to 15 years with an acute partial thickness (superficial partial to deep partial thickness inclusive) burn injury and a burn total body surface area of ≤10% will be eligible for the trial. Patients will be randomised to one of the three dressing groups: (1) Acticoat™ or (2) Acticoat™ combined with Mepitel™ or (3) Mepilex Ag™. A minimum of 28 participants will be recruited for each treatment group. Primary measures of pain, distress and healing will be repeated at each dressing change until complete wound re-epithelialisation occurs or skin grafting is required. Additional data collected will include infection status at each dressing change, physical function, scar outcome and scar management requirements, cost effectiveness of each dressing and staff perspectives of the dressings. Discussion The results of this study will determine the effects of three commonly used silver and silicone burn dressing combinations on the rate of wound re-epithelialisation and pain experienced during dressing procedures in acute, paediatric partial thickness burn injuries. Trial registration Australian New Zealand Clinical Trials Registry ACTRN12613000105741
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Affiliation(s)
- Emma Gee Kee
- Centre for Children's Burns and Trauma Research, Queensland Children's Medical Research Institute, University of Queensland, Royal Children's Hospital, Brisbane, QLD, Australia.
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Brown NJ, Kimble RM, Gramotnev G, Rodger S, Cuttle L. Predictors of re-epithelialization in pediatric burn. Burns 2013; 40:751-8. [PMID: 24184285 DOI: 10.1016/j.burns.2013.09.027] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2013] [Revised: 07/09/2013] [Accepted: 09/29/2013] [Indexed: 12/17/2022]
Abstract
INTRODUCTION An important treatment goal for burn wounds is to promote early wound closure. This study identifies factors associated with delayed re-epithelialization following pediatric burn. METHODS Data were collected from August 2011 to August 2012, at a pediatric tertiary burn center. A total of 106 burn wounds were analyzed from 77 participants aged 4-12 years. Percentage of wound re-epithelialization at each dressing change was calculated using Visitrak™. Mixed effect regression analysis was performed to identify the demographic factors, wound and clinical characteristics associated with delayed re-epithelialization. RESULTS Burn depth determined by laser Doppler imaging, ethnicity, pain scores, total body surface area (TBSA), mechanism of injury and days taken to present to the burn center were significant predictors of delayed re-epithelialization, accounting for 69% of variance. Flame burns delayed re-epithelialization by 39% compared to all other mechanisms (p = 0.003). When initial presentation to the burn center was on day 5, burns took an average of 42% longer to re-epithelialize, compared to those who presented on day 2 post burn (p < 0.000). Re-epithelialization was delayed by 14% when pain scores were reported as 10 (on the FPS-R), compared to 4 on the first dressing change (p = 0.015) for children who did not receive specialized preparation/distraction intervention. A larger TBSA was also a predictor of delayed re-epithelialization (p = 0.030). Darker skin complexion re-epithelialized 25% faster than lighter skin complexion (p = 0.001). CONCLUSIONS Burn depth, mechanism of injury and TBSA are always considered when developing the treatment and surgical management plan for patients with burns. This study identifies other factors influencing re-epithelialization, which can be controlled by the treating team, such as effective pain management and rapid referral to a specialized burn center, to achieve optimal outcomes.
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Affiliation(s)
- Nadia J Brown
- Centre for Children's Burns and Trauma Research, The University of Queensland, Queensland Children's Medical Research Institute, Royal Children's Hospital, Herston Road, Herston, QLD 4029, Australia.
| | - Roy M Kimble
- Centre for Children's Burns and Trauma Research, The University of Queensland, Queensland Children's Medical Research Institute, Royal Children's Hospital, Herston Road, Herston, QLD 4029, Australia
| | - Galina Gramotnev
- Centre for Children's Burns and Trauma Research, The University of Queensland, Queensland Children's Medical Research Institute, Royal Children's Hospital, Herston Road, Herston, QLD 4029, Australia
| | - Sylvia Rodger
- The University of Queensland, School of Health & Rehabilitation Sciences, Division of Occupational Therapy, Brisbane, Australia
| | - Leila Cuttle
- Centre for Children's Burns and Trauma Research, The University of Queensland, Queensland Children's Medical Research Institute, Royal Children's Hospital, Herston Road, Herston, QLD 4029, Australia; Queensland University of Technology, Institute of Health and Biomedical Innovation, Tissue Repair and Regeneration Domain, Brisbane, Australia
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Brown NJ, Rodger S, Ware RS, Kimble RM, Cuttle L. Efficacy of a children's procedural preparation and distraction device on healing in acute burn wound care procedures: study protocol for a randomized controlled trial. Trials 2012; 13:238. [PMID: 23234491 PMCID: PMC3543349 DOI: 10.1186/1745-6215-13-238] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2012] [Accepted: 11/27/2012] [Indexed: 11/17/2022] Open
Abstract
Background The intense pain and anxiety triggered by burns and their associated wound care procedures are well established in the literature. Non-pharmacological intervention is a critical component of total pain management protocols and is used as an adjunct to pharmacological analgesia. An example is virtual reality, which has been used effectively to dampen pain intensity and unpleasantness. Possible links or causal relationships between pain/anxiety/stress and burn wound healing have previously not been investigated. The purpose of this study is to investigate these relationships, specifically by determining if a newly developed multi-modal procedural preparation and distraction device (Ditto™) used during acute burn wound care procedures will reduce the pain and anxiety of a child and increase the rate of re-epithelialization. Methods/design Children (4 to 12 years) with acute burn injuries presenting for their first dressing change will be randomly assigned to either the (1) Control group (standard distraction) or (2) Ditto™ intervention group (receiving Ditto™, procedural preparation and Ditto™ distraction). It is intended that a minimum of 29 participants will be recruited for each treatment group. Repeated measures of pain intensity, anxiety, stress and healing will be taken at every dressing change until complete wound re-epithelialization. Further data collection will aid in determining patient satisfaction and cost effectiveness of the Ditto™ intervention, as well as its effect on speed of wound re-epithelialization. Discussion Results of this study will provide data on whether the disease process can be altered by reducing stress, pain and anxiety in the context of acute burn wounds. Trial registration ACTRN12611000913976
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Affiliation(s)
- Nadia J Brown
- Centre for Children's Burns and Trauma Research, Queensland Children's Medical Research Institute, University of Queensland, Royal Children's Hospital, Brisbane, Queensland, Australia.
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Kempf M, Kimble RM, Cuttle L. Cytotoxicity testing of burn wound dressings, ointments and creams: A method using polycarbonate cell culture inserts on a cell culture system. Burns 2011; 37:994-1000. [DOI: 10.1016/j.burns.2011.03.017] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2011] [Accepted: 03/24/2011] [Indexed: 10/18/2022]
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Cuttle L, Pearn J, McMillan JR, Kimble RM. A review of first aid treatments for burn injuries. Burns 2009; 35:768-75. [DOI: 10.1016/j.burns.2008.10.011] [Citation(s) in RCA: 95] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2008] [Accepted: 10/31/2008] [Indexed: 11/26/2022]
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Liu PY, Phillips GE, Kempf M, Cuttle L, Kimble RM, McMillan JR. Cyanoacrylate glue as an alternative mounting medium for resin-embedded semithin sections. J Electron Microsc (Tokyo) 2009; 59:87-90. [PMID: 19666907 DOI: 10.1093/jmicro/dfp040] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Commercially available generic Superglue (cyanoacrylate glue) can be used as an alternative mounting medium for stained resin-embedded semithin sections. It is colourless and contains a volatile, quick-setting solvent that produces permanent mounts of semithin sections for immediate inspection under the light microscope. Here, we compare the use of cyanoacrylate glue for mounting semithin sections with classical dibutyl phthalate xylene (DPX) in terms of practical usefulness, effectiveness and the quality of the final microscopic image.
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Wang XQ, Chang HE, Francis R, Olszowy H, Liu PY, Kempf M, Cuttle L, Kravchuk O, Phillips GE, Kimble RM. Silver deposits in cutaneous burn scar tissue is a common phenomenon following application of a silver dressing. J Cutan Pathol 2009; 36:788-92. [DOI: 10.1111/j.1600-0560.2008.01141.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Fraser JF, Cuttle L, Kempf M, Phillips GE, Hayes MT, Kimble RM. A randomised controlled trial of amniotic membrane in the treatment of a standardised burn injury in the merino lamb. Burns 2009; 35:998-1003. [PMID: 19447551 DOI: 10.1016/j.burns.2009.01.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2008] [Accepted: 01/15/2009] [Indexed: 02/07/2023]
Abstract
Burn injury is associated with disabling scar formation which impacts on many aspects of the patient's life. Previously we have shown that the fetus heals a deep dermal burn in a scarless fashion. Amniotic membrane (AM) is the outermost fetal tisue and has beeen used as a dressing in thermal injuries, though there is little data to support this use. To assess the efficacy of AM in scar minimisation after deep dermal burn wound, we conducted a randomised controlled study in the 1-month lamb. Lambs were delivered by caesarian section and the amniotic membranes stored after which lambs were returned to their mothers post-operatively. At 1 month, a standardised deep dermal burn was created under general anaesthesia on both flanks of the lamb. One flank was covered with unmatched AM, the other with paraffin gauze. Animals were sequentially euthanased from Day 3-60 after injury and tissue analysed for histopathology and immunohistochemically for alpha-smooth muscle actin (alphaSMA) content. AM resulted in reduced scar tissue as assessed histopathologically and reduced alphaSMA content. This study provides the first laboratory evidence that AM may reduce scar formation after burn injury.
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Affiliation(s)
- John F Fraser
- Department of Paediatrics and Child Health, Royal Children's Hospital Burns Research Group, Royal Children's Hospital, University of Queensland, Australia.
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Wang XQ, Kempf M, Liu PY, Cuttle L, Chang HE, Kravchuk O, Mill J, Phillips GE, Kimble RM. Conservative surgical debridement as a burn treatment: Supporting evidence from a porcine burn model. Wound Repair Regen 2008; 16:774-83. [DOI: 10.1111/j.1524-475x.2008.00428.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Kempf M, Cuttle L, Liu PY, Wang XQ, Kimble RM. Important improvements to porcine skin burn models, in search of the perfect burn. Burns 2008; 35:454-5. [PMID: 18947931 DOI: 10.1016/j.burns.2008.06.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2008] [Accepted: 06/29/2008] [Indexed: 11/27/2022]
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Wang XQ, Liu PY, Kempf M, Cuttle L, Chang AHE, Wong M, Kravchuk O, Mill J, Kimble RM. Burn healing is dependent on burn site: a quantitative analysis from a porcine burn model. Burns 2008; 35:264-9. [PMID: 18845398 DOI: 10.1016/j.burns.2008.05.030] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2008] [Accepted: 05/28/2008] [Indexed: 11/17/2022]
Abstract
This retrospective review examines healing in different sites on a porcine burn model; 24 pairs of burns on 18 pigs from other animal trials were selected for analysis. Each pair of burns was located on the either the cranial or the caudal part of the thoracic ribs region, on the same side of the animal. The burns were 40-50 cm(2) in size and of uniform deep-dermal partial thickness. Caudal burns healed significantly better than cranial burns, demonstrated by earlier closure of wounds, less scar formation and better cosmesis. To our knowledge, this is the first detailed study reporting that burn healing is affected by location on a porcine burn model. We recommend that similar symmetrical burns should be used for future comparative assessments of burn healing.
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Affiliation(s)
- Xue-Qing Wang
- Department of Paediatrics and Child Health, University of Queensland, Royal Children's Hospital, Brisbane 4029, Australia.
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