Rebecca Coffey

Burn wound photographs have become essential to multidisciplinary burn teams and improve patient care overall. This retrospective single-center chart review was conducted at an American Burn Association-verified burn center to evaluate the quality of burn wound photographs obtained by burn nurses who had received 1-hour basic clinical photography instruction. The quality of 15 burn wound photographs taken by burn nurses was judged by 3 skilled photographers using a 5-point Likert scale (1 = very poor, 2 = poor, 3 = average, 4 = good, and 5 = excellent) to evaluate key components of high-quality burn photography, including appropriate orientation, decent leveling, lack of a disruptive background, proper framing, and quality lighting. The proportions of photographs meeting at least average quality standards (a Likert score of ≥3) for the five evaluated components were 93.2%, 82.1%, 82.3%, 82.2%, and 86.7%, respectively. This suggests that when formal clinical photography instruction is given to burn nurses, standardized techniques are applied during image capture, resulting in high-quality, reproducible burn wound photographs used to augment clinical care, communication, and documentation.

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.

Background: Over 357 500 structure fires occur in the United States annually, resulting in 2 710 civilian deaths. Combustion of plastic, vinyl, wood, silk, and petroleum can release toxic hydrogen cyanide gas. Empiric treatment with hydroxocobalamin has been advocated for cyanide toxicity without clear guidelines, and overuse can occur. Our study objective was to evaluate protocol compliance for the use of hydroxocobalamin for inhaled cyanide toxicity pre- and post-implementation of criteria and a smart order set. Methods: We performed a retrospective review of compliance for the use of hydroxocobalamin, pre- (2022) versus post-implementation (2023-2024) of protocol criteria in patients with inhalation injury. Patients would receive hydroxocobalamin if they were exposed to smoke in an enclosed space, had the injury within 2 hours, experienced a cardiac arrest at the scene or prior to hospital arrival, had a Glasgow Coma Score < 10 at the scene or admission, or had lactate >10 and carboxyhemoglobin >10. Patients without an inhalation injury were excluded. Baseline demographics, laboratory values, and medication administration data were collected. Results: Overall, 127 patients met inclusion criteria, 62 in the pre-protocol group and 65 in the post-protocol group. Appropriate utilization of the antidote based on the protocol criteria was 29% in the pre-group vs. 48% in the post-group. Administration of the antidote 2 hours after exposure was the most common reason for protocol deviation in both groups. There were no differences in mortality rates, hospital or ICU length of stay, or duration of mechanical ventilation between groups. Conclusion: Identification of patients with risk factors for inhalation injury with cyanide toxicity is key. Development of criteria for use ensures judicious stewardship of this antidote.

Fires and burn injuries incurred from home oxygen therapy continue to pose a significant and escalating public health risk, particularly as the population of older adults ≥ 65 years exponentially grows during the next decades. In these oxygen-rich environments, common household ignition sources can trigger spontaneous fires that burn hotter and spread more rapidly. This endangers the patient, family members, neighbors, home healthcare workers, and first responders, potentially leading to property loss, injury, and/or death. A call to action was stimulated by a national review revealing a 14% per year increase in oxygen therapy injuries during a 10-year period. Similarly, the Veterans Health Administration issued a “Patient Safety Alert” due to the observed significant increase in oxygen therapy-related fires and injuries. To address this critical issue, professionals nationwide are seeking novel solutions to define the problem, raise awareness, and implement community-based risk reduction strategies. Hence, this article bridges an identified literature gap by providing a needed foundational overview of oxygen therapy-related fires and burn injuries, examining incidence data, illustrating current knowledge and data limitations, highlighting unique challenges, exploring opportunities for change, outlining ongoing national risk reduction efforts, and recommending specific evidence-informed strategic approaches for comprehensive prevention and mitigation interventions.

The incidence of admissions for burn and inhalation injuries related to home oxygen therapy remains poorly defined in the U.S. We analyzed the American Burn Association’s Burn Care Quality Platform (BCQP) database (2013-2022) to generate national estimates of supplemental home oxygen therapy-related injuries and outcomes. Text string extraction identified cases using multiple search permutations related to home oxygen use. Patient demographics, injury characteristics, and inpatient outcomes were described. Logistic regression assessed predictors of oxygen therapy injuries, and Poisson regression estimated adjusted incidence rates. Of 207 364 burn admissions, 79 114 (28%) contained injury descriptions, with 3.0% (2360 cases) attributed to home oxygen therapy. These patients had a median age of 65 years (IQR: 59-71), mean total body surface area (TBSA) of 4.1%, were predominantly male (62.6%) and white (79.0%). Medicare was the most common payer (57.7%). Inhalation injury was present in 11.4%, mean length of stay was 8 days, and inpatient mortality was 6.1%. Smoking was the leading ignition source (63%), followed by cooking/stove (4%), while 22% had no identified cause. The adjusted incidence rate of supplemental home oxygen injuries was 3.6% (95% CI, 2.7%-2.9%; P < 0.001), with a significant annual increase (incidence rate ratio: 1.03; 95% CI, 1.02-1.04). Oxygen therapy-related injuries account for 1088 (95% CI, 1065-1113) burn admissions per year in the U.S. Despite smaller TBSA burns, mortality was twice the national average for burn patients, and for survivors, the odds of discharge home were 15% less likely. Targeted prevention strategies are needed to mitigate this growing public health problem.

Research is one of the American Burn Association’s (ABA) strategic priorities. Advocacy is required not only to promote burn research, but also, the ABA’s other strategic priorities (Prevention, Quality, and Education). The ABA convened a two-day Research and Advocacy (R&A) Summit in September 2023, to develop a roadmap for the organization’s research and advocacy efforts. The in-person summit identified fourteen key R&A initiatives. A multidisciplinary workgroup then developed strategies to achieve each initiative. The initiatives and strategies were then approved by the ABA’s Board of Trustees as our organization’s roadmap for research and advocacy. The next task will be to implement the initiatives. This will require not only oversight from the ABA’s Board of Trustees, but also, effort from and collaboration between several of the ABA’s committees and panels, including the Burn Science Advisory panel (BSAP), the Research Committee, the Prevention Committee, The Governmental Affairs Committee, The Organization and Delivery of Burn care Committee, the Quality and Burn Registry Committee, the ad hoc Coding Committee, and the ABA’s Central Office.

Introduction: Fluid resuscitation in the first 48 hours post burn is crucial in the management of burn shock. Hourly titration of fluids is needed to avoid complications of over or under resuscitation which can increase morbidity and mortality. Historically these titrations have been driven by the burn physician; we hypothesized that given protocols with specific resuscitation parameters the burn nurse can accurately resuscitate the burn patient without complications. Methods: This quality improvement project at our ABA verified adult Burn Center tracked performance of a nurse-driven protocol for all inpatients with burns who underwent formal fluid resuscitation. Education regarding the nursing-driven protocol was provided to 90 surgical intensive care nurses. Badge buddies with both the Parkland formula and the Modified Albumin formula were made for the staff. Burn order sets were updated to reflect burn resuscitation guidelines with fluid adjustment parameters. A 48-hour data resuscitation data collection tool was developed by the burn physicians and nurses and all resuscitations were reviewed in real-time and in burn leadership meeting to identify opportunities for improvement. Follow up and education reinforcement was done in real time by the clinical nurse specialist following each burn resuscitation. Results: Over a one-year period, 23 patients’ resuscitations were tracked and reviewed by the burn quality team. One patient was excluded because of early transition to comfort care. After the initial three tracked resuscitations, the data collection tool was evaluated and modifications made to more effectively capture relevant findings. Mean age of patients was 45.1 (18–82) with a mean TBSA burn injury of 32.5 (15–42.5) In the first 24 hours patients (n=22) received a mean volume of 3.47 ml/kg/%TBSA (0.66 – 8.39) with a mean urine output of 0.95 mL/kg/hr (0.30 – 2.16 ml/kg/hr). For patients who remained on resuscitation during the second 24 hours (n = 16), they received a mean volume of 2.68ml/kg/%TBSA (0.56- 8.44) and had a mean urine output of 1.31 mL/kg/hr (0 .30–2.16). There were no complications related to fluid administration. Appropriate hourly fluid adjustments were made in 21 of the 22 patients. The one patient who did not have fluids titrated appropriately was attributed to resident physician education because the resident failed to provide the burn order set that includes the fluid resuscitation protocol. Conclusions: Using a multidisciplinary approach and preparatory and real time education processes, burn nurses can successfully guide burn resuscitation. Providing education and follow up in real time can improve the process. Applicability of Research to Practice: The use of nurse-driven protocols can improve outcomes for burn patients.

This is the first study to characterize U.S. adult burn readmissions using a nationally representative hospital inpatient sample (22 U.S. States). The objectives of the study are (1) to estimate the national 30-day unplanned hospital readmission rate for US adult burn patients, (2) to describe reasons for readmission, and (3) to identify patient and hospitalization risk factors for readmission. We queried the 2013 and 2014 Nationwide Readmission Database (NRD) for adult burn patients who were readmitted within 30 days of discharge. The data were weighted to estimate national readmission rates. Principal readmission diagnoses were sorted into burn-specific or other readmissions categories. We used multivariable logistic regression to assess the effects of patient and hospital stay traits on readmissions. An estimated 42,957 U.S. adult burn patients were discharged between January and November of 2013 and 2014. Of these patients, an estimated 3,203 had unscheduled readmissions within 30 days [All-cause readmission rate: 7.5%, 95% CI: 6.7 - 8.2]. The top three most frequent principal readmission diagnoses were burns (37.0%), septicemia (5.8%), and complications of devices/implants/grafts (4.2%). An estimated 55.4% of unplanned readmissions were for burn-specific principal readmission diagnoses. Burn-specific readmissions increased with both patient age and number of Elixhauser comorbidities. Patients whose length of stay was less than 1 day per 1% burn total body surface area (TBSA) were more likely to be readmitted [Adjusted odds ratio (AOR) = 2.10, 95% CI = 1.48 - 2.99]. The results of logistic regression models were similar for burn-specific readmissions and all-cause readmissions. Our analysis shows that about 1 in 13 U.S. adult burn patients suffered an unplanned readmission within 30 days of hospital discharge. We have described specific risk factors associated with readmission, including length of stay shorter than 1 day per 1% TBSA. Healthcare providers can use this information to identify patients at risk for unplanned readmission and perhaps modify their treatment plans accordingly.