Quality improvement (QI) is essential to advancing burn care, yet most locally successful QI initiatives are not disseminated beyond individual centres. Although QI activity is common in burn care, only a small proportion of projects progress to peer-reviewed publication. This restricts shared learning and slows the spread of evidence-based, context-adaptable practices. We highlight persistent barriers to QI publication, including unclear reporting expectations and limited reviewer familiarity with improvement methodology. To address this gap, we propose three practical strategies for burn centres: intentionally developing 1-2 publishable QI projects annually, adopting SQUIRE 2.0 as a reporting scaffold, and expanding QI-trained peer reviewer capacity. We also present a 10-Point QII Scoring Framework to guide project planning and scholarly dissemination.

Cell suspension autograft (CSA) is a non-cultured, autologous cellular suspension used in partial-thickness burns or as an adjunct to widely meshed split-thickness skin grafts (STSG). While CSA has been shown to improve patient outcomes in burn care, literature is limited in highlighting its impact on mortality when used in combination with STSG. This retrospective, matched, case-control study investigates the clinical efficacy of CSA in adult burn patients admitted to a regional burn center from 2015 to 2023. Patients treated with CSA and STSG (n = 63, "CSA-treated") were compared against patients treated with STSG alone (n = 126, "non-CSA-treated"). Non-CSA-treated patients were matched in a 2:1 fashion to CSA-treated patients based on third-degree total body surface area burned (TBSA) and age. Outcomes included mortality, length of stay (LOS), intensive care unit LOS (ICU LOS), and number of procedures. Multivariate analyses revealed that CSA-treated patients had a significant reduction in mortality (p=.0445) and a 78.9% reduction in odds of death (OR: 0.211) compared to non-CSA-treated patients. CSA-treated patients displayed non-significant increases in LOS (p=.0670), ICU LOS (p=.0851), and number of procedures (p=.9084). Selection and chronology bias may partially account for the improved mortality in the CSA-treated group. The non-significant increases in LOS, ICU LOS, and number of procedures may be reflective of increased survivorship. These findings demonstrate that CSA enhances survival in burn patients when used with STSG, warranting further research to confirm these results.

Enzymatic debridement with anacaulase-bcdb was approved by the US Food and Drug Administration in 2023. The purpose of this study is to compare outcomes from our first cohort of patients treated with this novel enzymatic agent. We compared patients treated with anacaulase-bcdb at our burn center from November 2023 to August 2024 to a 1:1 matched control group. Demographic, clinical, and photographic data were collected to ensure appropriate matching. Outcomes included: hospital length of stay, number of surgeries, time to first surgery, autograft size, total opioid and benzodiazepines received for wound care over the first 5 days, pain/sedation scores during wound care, time to wound closure, and readmission data. Descriptive statistics were used to assess anacaulase-bcdb treatment practices, while non-parametric tests were used for all comparisons. 13 patients treated with anacaulase-bcdb were identified. Median (interquartile range) cohort age, total body surface area, and mechanism of injury were 46 years (33.5, 59.5), 4.5% (2, 10.2), and flame (46.2%). No baseline differences were identified between groups. Anacaulase-bcdb was used before day 3 with regional anesthesia in all but 2 cases and successful eschar removal in 12 patients (92%). Patients treated with anacaulase-bcdb had a shorter time to first surgery from admission (4 days [3, 5] vs 6 [5, 7], P = .017) and higher average maximum wound care pain scores during the first 5 days (7 [6, 8] vs 5 [3, 7], P = .047). There was no difference in length of stay, area grafted, number of surgeries, total opioids/benzodiazepines received, or sedation scores.

This study aims to evaluate the accuracy and quality of responses generated by ChatGPT-4o® to frequently asked questions (FAQs) posed by practicing physicians regarding the initial assessment of pediatric burn injuries, with assessment of pediatric burn specialists.

Burn injuries affect over half a million people in the United States (U.S.) annually, with 40,000 requiring hospitalization. Burn patients often experience significant psychological distress, with high rates of PTSD and depression. Undetected or untreated psychiatric symptoms can complicate recovery, prolong hospital stays, and increase risk of long-term problems and readmissions. Although burn centers are well-positioned to provide mental health services on both an inpatient and outpatient basis, few U.S. burn centers have robust programs to meet these needs - despite psychological screening and intervention being a requirement for American Burn Association verification. This study describes the development and early data from the Burn Behavioral Health (BBH) program, a burn center-based, technology-enhanced stepped-care model of delivering mental health services across the inpatient to outpatient continuum. BBH includes four steps: (1) initial screening, education, and early intervention; (2) symptom self-monitoring and self-help resources; (3) 30-day follow-up screening; and (4) provision of best-practice treatment via in-person or telehealth care, including individual and group therapy. Between February 2021 and October 2024, 1,203 eligible patients were identified (Mage=46.08, SDage=18.04; 67% male; 53% White; 38% Black); 919 (84%) completed initial screening. Nearly half (44%) screened positive for PTSD/depression risk and 95% of them received early intervention. The program reached 62% of patients for the 30-day follow-up, with 21% screening positive for PTSD/depression and 23% being interested in mental health services. These findings provide preliminary support for the BBH program, demonstrating its sustainability and capacity to engage a high proportion of burn patients across care settings, ultimately improving both access to and the quality of mental health care.

Burn centers are vital for managing burn injuries, with timely referral being crucial for optimal care. The American Burn Association (ABA) provides referral criteria to help healthcare providers identify patients needing specialized treatment. However, adherence to these guidelines varies, leading to inefficiencies in resource use. This study assesses consultation patterns and hospital size on referral practices and outcomes at a state burn center. A retrospective review of 588 telephone inquiries between January 1 and December 31, 2024, was conducted. Data on hospital size, adherence to ABA guidelines, and patient disposition (admission, referral to ED, or outpatient follow-up) were analyzed using chi-square tests (p < 0.05). Of the 588 inquiries, 29% came from larger hospitals (≥300 beds), with 34% resulting in-patient admissions. In contrast, 36% of calls were from smaller hospitals (<100 beds), with only 20% leading to admissions. Larger hospitals adhered to ABA guidelines more often (72%) compared to smaller hospitals (25%), with a p-value of 0.02. Larger hospitals were 1.21 times more likely to have referrals admitted than medium-sized hospitals and 1.7 times more likely than smaller hospitals (p < 0.005). Overall, 35% of referrals led to admissions. Hospital size significantly influences adherence of guidelines and referral outcomes. Larger hospitals are more likely to follow guidelines and admit patients. Combining structured telehealth programs with enhanced educational initiatives and outreach for referring hospitals may improve efficiency, optimize resource use, and strengthen burn care delivery.

Cellular, Acellular and Matrix-like Products (CAMPs), also known as skin, dermal, or tissue substitutes, have been used to manage thermal injuries for over 20 years with over 75 commercially available products today. Despite demonstrating long term safety and efficacy, the use of CAMPs remains controversial in the burn community in terms of clinical benefit, economics, clinical algorithm, and lack of standardization in coding or categorization of specific products. Most clinical studies regarding CAMP use are product-specific prospective or retrospective studies comparing against split thickness skin grafts alone, but very few have investigated the impact of product-agnostic CAMP use in burn care using the National Burn Repository. The goal of this study was to document CAMP use in burn management from 2016-2021 and provide a preliminary analysis of how CAMP use, including non-autologous and synthetic "tissue substitutes" categorization, may impact patient care compared to not using a CAMP at all.

Healthcare professionals who care for burn survivors are frequently exposed to patient pain, trauma, and distress, placing them at high risk for burnout, compassion fatigue, and secondary traumatic stress. These occupational stressors threaten both the health and career longevity of providers and the quality of patient care. Perceived support-an individual's belief that organizational and social supports are present and reliable-may mitigate these risks and promote professional well-being. This secondary analysis examined the relationship between perceived support and professional quality of life outcomes in burn therapists. Data (n=140) were drawn from a 2023 survey utilizing the Professional Quality of Life Scale; additional items assessed perceptions of workplace and peer support. Findings from Spearman rank-sum analyses demonstrated significant positive associations between compassion satisfaction and perceived support. Specifically, feeling connected to others and having trusted colleagues to discuss struggles were strongly protective, while feeling "bogged down by the system" was linked to higher stress and lower satisfaction. Both feelings of connection and support correlated with lower levels of workplace burnout. Results highlight the critical role of interpersonal and organizational supports in sustaining resilience and compassion among burn therapists. Interventions that foster team connectedness, reduce systemic barriers, and enhance perceptions of organizational concern may reduce occupational stress, strengthen professional fulfillment, and decrease turnover. Promoting perceived support is an actionable strategy to protect the well-being of burn rehabilitation providers and, ultimately, improve patient outcomes.

Burn injuries significantly impact morbidity and mortality, with early surgical intervention crucial for improving outcomes. However, concomitant traumatic brain injury frequently complicates burn management, potentially delaying timely surgical treatment due to neurological concerns. Optimal timing of burn surgery in patients with concurrent traumatic brain injury remains uncertain, necessitating clearer insights into their clinical outcomes. This retrospective study reviewed burned adults admitted to a Swiss Burn Center between 2014 and 2023. Patients were grouped as burns with traumatic brain injury, burns alone, burns with other trauma, or electrical burns. Demographics, injury characteristics, timing of surgery, complications, and outcomes were analyzed. Generalized linear models and logistic regression were applied. Among 602 patients, 27 (4.5 %) had a traumatic brain injury. Mortality was highest in this group (22.2 %) compared to isolated burns (3.7 %), burns with other trauma (7.4 %), and electrical burns (4.8 %). Surgical delays (>72 h) occurred only in burn patients with traumatic brain injury (22.2 %), mainly due to hemodynamic instability, intracranial pressure monitoring, or additional trauma. Delayed surgery correlated with more surgical interventions (p=.018) and longer operative times (p=.048). Complications were more frequent: wound infections (48.1 %) and graft loss (22.2 %) were significantly higher in the traumatic brain injury group. In conclusion, burns with concomitant traumatic brain injury define a distinct, high-risk subgroup with increased surgical delays, complications, and mortality. Management requires an interdisciplinary approach, balancing early surgical intervention with neuroprotective strategies to optimize patient outcomes.

Burns are associated with significant morbidity and mortality. Palliative care (PC) has been shown to improve patients' comfort, clinical decision-making, and overall satisfaction in the burn unit. The purpose of this paper is to describe the frequency of PC utilization after burn injury and to understand the patient characteristics that affect whether they are seen by PC. We conducted a retrospective study by querying the HCUP National Inpatient Sample, identifying patients admitted with a primary burn diagnosis from 2016-2021. Patient characteristic differences were assessed between patients who did and did not receive PC using chi-square analyses and multi-variable regression, weighted to represent the national population. Revised Baux (rBaux) scores were calculated. Of 146,455 patients admitted with a primary burn diagnosis, 3,535 (2.4%) received PC consultation. Of 5,205 patients who died prior to discharge (3.6% of total), 2,370 (45.5% of deaths) had a PC encounter. Older patients, patients with larger burns, and patients with higher rBaux scores were most likely to receive PC. White patients were more likely to receive PC than Black and Hispanic patients. Patients in teaching hospitals were more likely to receive PC than those in rural, nonteaching hospitals. Patients in northern regions received PC more often than those in other regions. More than half of patients with burn injuries who died prior to discharge did not receive PC. Older patients and those with higher rBaux scores received PC most often. Further research is necessary to identify burn patients most likely to benefit from and receive PC.

Burn pain is among the most distressing and complex aspects of burn injuries, significantly impeding the treatment process and overall patient care. Despite advancements in pain management, many burn patients continue to experience inadequate relief. Investigating the experiences of both patients and healthcare providers offers valuable insights into the challenges of pain management. This qualitative study was conducted in Iran between 2024 and 2025. Eighteen hospitalized burn patients and twenty-one healthcare providers-including physicians, nurses, psychologists, and physiotherapists-were selected through purposive sampling. Data were gathered via semi-structured individual interviews until saturation and analyzed using Graneheim and Lundman's content analysis method, supported by MAXQDA 2020 software. Four main categories and thirteen subcategories emerged: "Endless suffering accompanied by a sense of collapse," "The cycle of suffering and restlessness," "Barriers to pain relief," and "A holistic approach to pain management." Findings showed that patients endured severe physical pain along with psychological distress such as anxiety, despair, and sleep disturbances, while healthcare providers emphasized systemic barriers, resource limitations, and the restricted effectiveness of current approaches. These results highlight the multifaceted and enduring nature of burn pain and underscore the importance of addressing both patient experiences and provider challenges. In conclusion (shortened), burn pain represents one of the most intense and debilitating forms of suffering, with consequences extending beyond the physical dimension. Targeted strategies informed by these insights may improve the quality of care and patient outcomes.

Traumatic tattoos, resulting from the accidental impregnation of foreign particles are common consequences of road traffic accidents and explosions. Unlike conventional tattoos, these occur when high-impact events embed foreign materials into the skin, causing persistent discoloration and cosmetic disfigurement. Preventing the permanent inclusion of these particles through immediate removal is widely considered as the best strategy. Nowadays, the preventing procedures by the means of scrubbing remain insufficient and the need for delayed additional methods is of the main causes of concern. Consequently, we aim to propose a new therapeutic protocol with enzymatic debridement to prevent and treat traumatic tattoos. In this prospective study, we included patients diagnosed with traumatic tattoos referred to our National Burn Center during 9 months (from June 2024 to March 2025). All were treated with enzymatic debridement (Nexobrid®) to remove necrotic tissues after initial cleaning of the wound. Pigmented surface was evaluated before and after enzymatic debridement. 15 consecutive patients were successfully treated with enzymatic debridement (Nexobrid®) under sedation within the 24 first hours after the initial incident. 92.5% of the surface of pigmented dermis was cleared from pigments after treatment, thus preventing the occurrence of traumatic tattoos. No adverse events were reported during the treatment. Enzymatic debridement presents a comprehensive approach to wound care in cases of traumatic tattoos, offering precision, tissue preservation, and user-friendly application, to optimize functional and cosmetic outcomes. These advantages position it as an effective alternative to more traditional methods, particularly in settings that require minimal invasiveness and maximal tissue conservation.

Pyogenic granuloma (PG) is a benign vascular proliferation that commonly arises following trauma. Its occurrence in healing burn wounds, particularly in infants, is rare and poses diagnostic challenges. We present the case of an 11-month-old male who developed multiple rapidly growing, angiomatous nodules on the right cheek and scalp two weeks after sustaining a second-degree scald burn from boiling milk. The lesions exhibited typical bleeding and friability, prompting surgical excision and coverage with split-thickness skin grafts. Histopathological examination confirmed the diagnosis of PG. Postoperative recovery was uneventful, and follow-up at 2.5 years showed complete resolution without recurrence and minimal scarring. This case illustrates a rare but distinct manifestation of post-burn PG (PGB), emphasizing the importance of recognizing this reactive vascular phenomenon. A comprehensive review of the 38 cases reported in the literature so far underscores the variable clinical presentations and management strategies, reinforcing surgical excision as a reliable and curative intervention.

Timely closure of acute, full-thickness wounds is critical in minimizing complications such as infection, fluid loss, and impaired healing, all of which can adversely affect long-term patient outcomes. Although meshed autografting is the current standard of care, its effectiveness is limited by the need for donor skin and the re-epithelialization of expanded interstices. Prior research has shown that combining meshed autografts with skin cell suspension autograft (SCSA) enhances epidermal regeneration. In this study, we further investigate the mechanisms by which SCSA promotes re-epithelialization when applied with a widely expanded (3:1) meshed autograft in a full-thickness porcine wound model. Histological analyses demonstrate complete closure of graft interstices as early as three days post-surgery. A dual mechanism of re-epithelialization was observed, with keratinocytes migrating both from the edge of healthy skin from the interstice and within the center of interstices to form a continuous epithelial monolayer. The presence of a high number of proliferating cells in the wound bed further supports the regenerative activity of SCSA. These findings offer valuable mechanistic insight into the role of SCSA in accelerating wound closure and provide additional evidence for its use in improving outcomes for patients with acute full-thickness wounds.

The September 11th attacks were a unique disaster with numerous patients and extensive injury burden. The aim of this study was to provide an update on the long-term functional and psychological recovery of victims treated at a burn center following the September 11th attacks. A mixed methods approach using a quantitative survey and a qualitative interview was completed for each patient. All patients were treated at the burn center for injuries sustained during the September 11th attacks. Interviews were reviewed for trends in recovery and psychological impacts. The survey focused on psychological well-being, functional well-being, and comfort in trauma-related environments. Our study included four patients: three males and one female. The average age was 63 years (range:57-73) and average total body surface area burned was 33.1% (range:3%-80%). Two patients were burned in the North Tower following impact. Two patients were burned outside by debris. Following initial recovery, three patients required additional surgeries. All patients returned to work and hobbies after their injuries. Patients experienced psychological outcomes such as general anxiety, flashbacks, and survivor's guilt. All patients scored high on psychological well-being, while three patients with higher injury burden scored lower on functional well-being and comfort in trauma-related environments. Burn patients from the September 11th attacks with higher injury burden recovered psychologically but continued to struggle with functional well-being and comfort in trauma-related environments. Despite functional and psychological challenges, patients were able to return to work and continue their previous hobbies.

Postoperative pain management is a significant challenge in patients undergoing burn excision. Pharmacologic pain management strategies include both opioid and non-opioid medications. Given the national overuse of opioids and the associated negative effects, it is prudent we find ways to manage pain with fewer or no opioids. We hypothesize that intraoperative administration of intravenous methadone reduces total morphine milligram equivalents per weight used in the 36 hours following surgery. This is a retrospective, single-center cohort study of adult burn patients who underwent a first excision of full thickness burn between January 2019 and January 2021. One group received intraoperative intravenous methadone while the non-exposure group did not. The primary outcome was total morphine milligram equivalents per weight utilized in the 36 hours following surgery. Secondary outcomes included average pain scores in the PACU and for 36 hours postoperatively, as well as discharge opioid prescriptions. The methadone group contained 104 subjects, and the non-exposure group contained 119 subjects. Poisson regression, with adjustment for covariates, showed that the methadone group required fewer 36-hour postoperative opioids (IRR = 0.89, p=.447) and were discharged with fewer opioid prescriptions (IRR = 0.86, p=.363) independent of the age and %TBSA differences. PACU pain scores were lower in the methadone group (IRR = 0.91, p=.350), as were 36-hour postoperative pain scores (IRR = 0.92, p=.310). These trends towards improved pain control and reduced opioid requirements in patients receiving intraoperative, intravenous methadone did not reach statistical significance. Prospective, adequately powered randomized studies are needed to advance these findings.

There is growing awareness of the indirect trauma exposure experienced by health care providers and the resulting development of secondary traumatic stress (STS). However, STS in burn care clinicians has not been examined thoroughly. The current study aimed to examine feasibility of study procedures in this population, estimate the prevalence of STS, and examine the relationship between STS and additional factors. Cross-sectional data were collected from 103 burn clinicians from 15 different occupations working in a large civilian burn center in the U.S. Participants completed measures of STS, burnout, demographics, and occupation-related information. Study procedures were feasible. Over forty percent (42.16%) of participants met criteria for moderate to severe STS. STS was significantly correlated with younger age and burnout subscales. Binomial logistic regression analyses showed that the overall model containing burnout subscales was statistically significant and able to distinguish between respondents who endorsed symptoms consistent with PTSD due to STS and those that did not. Results on STS and time spent with burn patients varied. Non-significant results were found regarding STS and the remaining demographic and occupational variables. Results support the feasibility of studying STS in this population, and the prevalence of STS among burn care clinicians warrants attention. Important information was added to the extant literature on related risk and protective factors. Increased knowledge about STS in this population will help to inform prevention efforts and interventions at both the individual and organizational level to prioritize staff well-being and improve patient care.

Chronic pain is a common and debilitating outcome for many burn patients, necessitating effective and equitable pain management. Although opioids are routinely prescribed for severe and chronic pain, prior studies have shown that Black patients are less likely to receive opioid prescriptions than White patients, raising concerns about racial disparities in pain treatment. This study aimed to investigate whether such disparities in opioid prescribing extend to other racial and ethnic groups following burn injury. Using the TriNetX database, we identified adult patients (≥18 years) diagnosed with both burn injuries and chronic pain between January 1, 2016, and January 1, 2023. To reduce confounding, cohorts were propensity score matched for age, burn severity, and comorbidities. We then examined differences in opioid prescription rates at six- and twelve-months post-injury using univariate regression models, calculating odds ratios (ORs) with statistical significance set at p < 0.05. Among 32,167 burn patients with chronic pain, 63.66% (n=20,478) were White, 17.80% (n=5,726) Black or African American, 2.57% (n=827) Asian, 1.09% (n=351) Native Hawaiian, and 0.60% (n=193) American Indian. Compared to White patients, the odds of receiving an opioid prescription were significantly lower for Black (OR: 0.693, p < 0.0001), Asian (OR: 0.576, p = 0.0135), Native Hawaiian (OR: 0.313, p = 0.0074), and Other Race patients (OR: 0.641, p = 0.0081). No significant difference was observed for American Indian patients (OR: 0.809, p = 0.6689). While racial differences in the prevalence of chronic pain were observed, our analysis specifically focused on treatment disparities within those already diagnosed with chronic pain. These findings reveal inequities in opioid prescribing practices for chronic pain management after burn injuries and underscore the need for policy-level changes to promote equitable care across all racial and ethnic groups.

We present a case of a severe thermal injury leading to vasogenic edema that appears indistinguishable on CT scan from infectious cerebritis. Despite extensive damage seen on imaging, the patient did not exhibit neurological deficits expected for the injured brain region throughout the entire hospital stay. Long-term antibiotic therapy ultimately ruled out infection as the cause of extensive vasogenic edema on imaging, making thermal injury the etiology of exclusion. This case emphasizes the impact that severe burns can have on the central nervous system.