Arpana Jain

Severe burn injury results in a profound hypermetabolic state that complicates management and recovery. Oxandrolone has historically been used to help attenuate this response, but its withdrawal from the United States (US) market has led to increased use of alternative anabolic agents such as testosterone and human growth hormone (HGH). However, studies comparing the efficacy and safety between these alternative anabolic agents in adult burn patients remain limited. In this multicenter study, patients were stratified based on if they received testosterone, oxandrolone, HGH, or no anabolic supplementation. Baseline characteristics and clinical outcomes were analyzed with analysis of variance and Chi-square testing as appropriate. Propensity score matching was used to adjust for baseline differences in injury severity and patient characteristics. 813 patients who sustained major burn injuries between June 2022 and June 2025 across 12 verified US burn centers were analyzed. Anabolic supplementation was not associated with improved inpatient weight maintenance when compared with no anabolic supplementation (P = .064), nor with differences in median weight change. Patients receiving anabolic therapy experienced longer hospital and intensive care unit stays (P = .026). Overall mortality did not differ between treated and untreated patients (P = .885); however, mortality was higher among patients treated with oxandrolone compared with testosterone (P = .001). Anabolic therapy was associated with higher rates of venous thromboembolic events (P = .019). These findings underscore that optimizing anabolic therapy will require balancing efficacy, safety, and economic considerations, with a focus on long-term functional outcomes beyond initial hospital stay.

In the USA, traumatic injury results in a significant financial burden, which is unevenly distributed in our society. In this paper, we will highlight some of the data around the costs of injury associated with a focus on socially vulnerable and historically resilient groups at risk for disparate outcomes. We delve into the concept of economic return on investment from multiple perspectives: the patient perspective, the community perspective and from a national and policy perspective. Targeted policy changes and dedicated efforts towards minimizing gaps in trauma care and enhancing survivorship can yield substantial economic benefits. This paper also describes several national funding agencies and their current priorities related to funding in equity and trauma research. This manuscript will demonstrate that reducing disparities in trauma care not only serves a moral imperative but also a necessary and financially sound strategy with a good economic return on investment.

On August 2–3, 2023, the Summit on the Advancement of Focused Equity Research in Trauma (SAFER-Trauma) convened to discuss strategies to support research to eliminate disparities in trauma care. An ongoing challenge for performing high-quality equity-based research is the uncomfortable recognition that implicit bias and structural racism are deeply ingrained in our society and culture and are therefore often unrecognized in medicine and research practices. Throughout SAFER-Trauma, several examples of strategies to overcome these challenges were presented. In this article, we will relate a diverse array of examples through three distinct angles. The first focuses on innovations that harness existing data in novel and groundbreaking ways, uncovering fresh insights and applications from information already at our disposal. The second examines innovations that arise from traditional healthcare systems and research methods, showing how research in the healthcare sphere can adapt to meet modern needs. The third will explore projects that emerged from communities, driven by the pressing needs and aspirations of the people they serve.

The U.S. faces a surgeon shortage, threatening a decline in burn care specialists as surgeons shift to other fields. With only 0.3% of the workforce in burn surgery, attrition could severely impact burn care availability. Addressing recruitment and retention challenges requires identifying stressors and workload factors contributing to the strain of operative burn care. In May 2024, a de-identified survey was conducted with Institutional Review Board approval to assess burn surgeons’ self-reported well-being. A diverse surgeon panel reviewed the survey, and the American Burn Association distributed it via email and Survey Monkey. Statistical analysis included Chi-square and t-tests. Seventy-seven burn surgeons (62% male) participated, representing a 20% response rate. Most took burn call (95%) and worked in an academic setting (80%). While 73% were satisfied with their careers and 91% valued the complexities of burn care, 54% lacked time for personal activities, and 62% felt maternity/paternity leave was insufficient. Forty percent experienced burnout, and 26% considered leaving the field. Over half (54%) felt they lacked time to recover after demanding cases, and 65% believed burn surgery negatively impacted their health. Using a Likert scale (10 = high performance), they rated their ability to meet job demands at 7 (±1), with a projected decline to 4.2 (±0.5) in two years. Despite overall career satisfaction, burn surgeons face challenges that threaten their health and the quality and sustainability of burn care. Our findings highlight the need for interventions to mitigate burnout and enhance well-being, ensuring the long-term viability of burn surgery and patient care.

The goal of this study was to inform standards of best practice in the use of cultured epidermal autograft (CEA), manufactured in the United States, for the treatment of patients with severe burns. The study was designed using the modified Delphi technique, a method for structuring group communication among experts to promote the development of consensus-based recommendations. Known areas of variability related to the stages of CEA treatment were identified by literature review prior to the study and were confirmed through qualitative interview with the experts. The areas included Preoperative Planning/Surgical Planning, Immediate Postoperative Care, and Rehabilitation and Long-Term Care. A list of 22 questions was developed based on interviews with the experts, and a 3-round Delphi technique was used to establish consensus (≥80% agreement). Following 3 rounds (quantitative, qualitative, and virtual roundtable meeting) of the Delphi study, important guidance for the use of CEA treatment in severely burned patients gained consensus. Final key recommendations included minimum burn limit for CEA treatment (30%-50% TBSA), ideal biopsy timing (1-2 days), number of grafts (enough to cover; adjust 72 hours before application), use of dermal substrates (recommended) and wide meshed autograft underlay (recommended), optimal CEA drying time per day (open air >6 hours), slings used if CEA placed on extremities (recommended), dressing changes (performed every day, all at once, with all layers removed down to bridal veil), CEA backing removal (10-14 days after placement), heat lamps (can be used to aid the wound in drying, depending on clinical judgment), initial activity restrictions lifted (beginning 10 days after backing removal), compression garments (introduced at approximately 2 months post-CEA surgery), and lasers (CO₂ laser can be introduced between 3 and 6 months post-CEA surgery).