Journal of burn care & research : official publication of the American Burn Association, Jan 5, 2016
Small burns are common and can cause disproportionate levels of disability. The ability to measur... more Small burns are common and can cause disproportionate levels of disability. The ability to measure muscle impairment and consequent functional disability is a necessity during rehabilitation of patients. This study aimed to determine the reliability and validity of grip and muscle strength dynamometry in patients with unhealed, minor burn wounds. Grip and muscle strength were assessed three times on each side. Assessment occurred at presentation for the initial injury and again every other day (or every 5 days beyond 10 days post injury) until discharge from the service. Reliability was assessed using intraclass correlation. Minimum detectable differences were calculated for each muscle group. Validity was assessed using regression analysis, incorporating appropriate burn severity measures and patient demographics. Thirty patients with TBSA ≤15% were assessed. Both grip and muscle strength demonstrated very good reliability (intraclass correlation coefficient: 0.85-0.96). Minimum de...
We conducted a rapid review of current international and Australian/New Zealand guidelines on fir... more 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.
Water displacement volumetry (WDV) is a reliable method for measurement of wrist and hand volume ... more Water displacement volumetry (WDV) is a reliable method for measurement of wrist and hand volume in lymphedema patients. However, within session WDV reliability for the whole upper limb (UL) lacks comprehensive investigation, particularly in acute edema populations. This study aimed to confirm the reliability and investigate the impact of time between repeated trials on the sensitivity of WDV as a measure of whole UL volume change in an uninjured cohort and a burn injured pilot group. Within session, duplicate measures of whole UL WDV were recorded in two groups of noninjured volunteers and a group of burn patients. Each noninjured group differed only in the time between WDV repeats. The reliability trials were performed <10 minutes apart (T10) and 20 to 30 minutes apart (T20). The time between repetitions for burn patients was 20 to 30 minutes, based on the results of the noninjured participant trials. All trial groups demonstrated excellent correlation between trials (ICCT10 = 0.999, ICCT20 = 0.997). The minimum detectable difference calculated for WDV when measuring whole UL volume change of >50 ml for noninjured and >100 ml for burn patients. Despite this, a systematic bias was demonstrated between the T10 group means. The T20 group trials did not indicate such error on statistical testing (P = .297). The study confirms that WDV measurement of whole ULs is reliable and sensitive, if used at least 20 minutes apart. However, a significant and clinically relevant subject-by-method interaction was demonstrated. Researchers and clinicians are reminded to be aware of the performance of the technique when designing investigations in patient populations.
Burns : journal of the International Society for Burn Injuries, Jan 29, 2016
There is a growing volume of data that indicates that serious injury suppresses immune function, ... more There is a growing volume of data that indicates that serious injury suppresses immune function, predisposing individuals to infectious complications. With recent evidence showing long-term immune dysfunction after less severe burn, this study aimed to investigate post-burn infectious disease morbidity and assess if burn patients have increased long-term hospital use for infectious diseases. A population-based longitudinal study using linked hospital morbidity and death data from Western Australia for all persons hospitalised for a first burn (n=30,997) in 1980-2012. A frequency matched non-injury comparison cohort was randomly selected from Western Australia's birth registrations and electoral roll (n=123,399). Direct standardisation was used to assess temporal trends in infectious disease admissions. Crude annual admission rates and length of stay for infectious diseases were calculated. Multivariate negative binomial and Cox proportional hazards regression modeling were used ...
Burn injuries are traumatic experiences that can detrimentally impact an individual’s psychologic... more Burn injuries are traumatic experiences that can detrimentally impact an individual’s psychological and emotional wellbeing. Despite this, some survivors adapt to psychosocial challenges better than others despite similar characteristics relating to the burn. Positive adaptation is known as resilience or posttraumatic growth, depending on the trajectory and process. This review aimed to describe the constructs of resiliency and growth within the burn injury context, examine the risk factors that inhibit resilience or growth after burn (barriers), the factors that promote resilience or growth after burn (enablers), and finally to assess the impact of interventions that have been tested that may facilitate resilience or growth after burn. This review was performed according to the recently updated Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Guidelines. An electronic search was conducted in November 2021 on the databases PubMed, Medline (1966-present), E...
Background: Burn patients often receive their initial care by non-burn specialist clinicians, wit... more Background: Burn patients often receive their initial care by non-burn specialist clinicians, with increasingly collaborative burn models of care. The provision of relevant and accessible education for these clinicians is therefore vital for optimal patient care. Design/methods: A two phase design was used. A statewide survey of multidisciplinary nonburn specialist clinicians throughout Western Australia identified learning needs related to paediatric burn care. A targeted education programme was developed and delivered live via videoconference. Pre-post-test analysis evaluated changes in knowledge as a result of attendance at each education session. Results: Non-burn specialist clinicians identified numerous areas of burn care relevant to their practice. Statistically significant differences between perceived relevance of care and confidence in care provision were reported for aspects of acute burn care. Following attendance at the education sessions, statistically significant increases in knowledge were noted for most areas of acute burn care. Conclusions: Identification of learning needs facilitated the development of a targeted education programme for non-burn specialist clinicians. Increased non-burn specialist clinician knowledge following attendance at most education sessions supports the use of videoconferencing as an acceptable and effective method of delivering burns education in Western Australia.
We acknowledge the help of Michael Buck from the UB next-generation sequencing facility for the m... more We acknowledge the help of Michael Buck from the UB next-generation sequencing facility for the mouse skin RNA-seq studies. AUTHOR CONTRIBUTIONS JMR, RAR, and SS designed the study; RAR isolated the RNA from the skin samples; JMR and JB analyzed the data and performed bioinformatics studies; and JMR, RAR, and SS together wrote the manuscript.
Limited data are available to assess the long-term effects of burns to the trunk sustained during... more Limited data are available to assess the long-term effects of burns to the trunk sustained during early childhood on subsequent pregnancies. This population-based retrospective longitudinal study uses linked Western Australia hospital morbidity and midwives notification data for the period 1983-2008. During the study period, 824 girls younger than 15 years with non-erythema burns (partial thickness, full thickness, or unspecified burn depth) to the trunk were hospitalized in Western Australia. During the follow-up, 134 subjects with burns to the trunk during childhood were identified as having later pregnancies. The mean age at admission for burn injury was 5.7 ± 4.0 years, and the majority of burns were caused by scalds (51.5%) and flame (37.3%). For these subjects (N 134), there were a total of 213 subsequent pregnancies. All pregnancies resulted in full-term live births. There were 142 (64.3%) vaginal deliveries, 26 (12.2%) breech or instrument, and 45 (21.2%) deliveries were by cesarean section. No admissions for scar conditions or revisions of burn scar or contracture were identified during any pregnancy (first to fourth) for subjects with burns to the trunk. Mode of delivery was not statistically significantly different from that experienced by subjects with burns sustained during childhood to other anatomical sites. For subjects in this study with less severe burns to the trunk, no specific detrimental impacts during pregnancy or delivery or to the fetus were identified. Further surveillance is required to gauge an accurate assessment of complications associated with severe trunk burns sustained during childhood. (J Burn Care Res 2011;33:654-659)
The aim of the study was to use statewide health administrative data to assess the incidence, tem... more The aim of the study was to use statewide health administrative data to assess the incidence, temporal trends, and external cause of burn injury-related hospital admissions and mortality in Western Australia from 1983 to 2008. Linked hospital morbidity and death data for all persons hospitalized with an index burn injury in Western Australia for the period 1983-2008 were identified. Annual age-specific incidence and age standardized rates were estimated. Poisson regression analyses were used to estimate temporal trends in hospital admissions and mortality. Zero-truncated negative binomial regression analysis was used to identify factors associated with hospital length of stay. From 1983 to 2008, there were 23,450 hospitalizations for an index burn injury. Hospital admission rates declined by an average annual rate of 2% (incidence rate ratio [IRR], 95% confidence interval [CI] ؍ 0.983, 0.981-0.984), and burn-related mortality declined by an average annual rate of 2% (IRR, 95% CI ؍ 0.98, 0.96-1.01). Aboriginal people while having significantly higher hospitalization rates than non-Aboriginal people experienced a greater 26-year decline in hospitalizations of 58% (IRR, 95% CI ؍ 0.42, 0.37-0.48) compared with 32% (IRR, 95% CI ؍ 0.68, 0.65-0.71) for non-Aboriginal people. Children younger than 5 years, 20-to 24-year-old men, and adults older than 65 years remain at high risk for burn injury, and males continue to be hospitalized twice as frequently as females. The results demonstrate declines in burn injury hospitalizations and mortality in both Aboriginal and non-Aboriginal populations. Continued research is required of the impacts of medical interventions and the burn pathway of identified high-risk populations.
Melanocyte restoration is critical in reconstituting skin color. We developed a spotted (piebald)... more Melanocyte restoration is critical in reconstituting skin color. We developed a spotted (piebald) pig wound model to study methods of restoring melanocytes to the epidermis. Paired, full-thickness, porcine wounds were covered with nonpigmented, fully expanded, 3:1 meshed, split-thickness skin grafts and were sprayed with an epidermal cell suspension. The suspensions were highly pigmented skin (HPS) cell isolates for half of the wounds (n = 16) and nonpigmented skin (NPS) cell isolates for the remaining wounds (n = 16). Histologic sections showed 6.0 +/- 3.0 and 15 +/- 4.0 pigmented melanocytes per high-power field on days 8 and 20 in HPS-treated wounds and no pigmented melanocytes in NPS-treated wounds. Melanin pigment was dispersed in all layers of the epithelium for the HPS group on day 20 compared with a lack of melanin pigment observed in the NPS group. Cell spraying may provide a clinical method to restore color to skin; further work is needed to control the expression of melanin.
Like many other Western burn services, the proportion of major to minor burns managed at Royal Pe... more Like many other Western burn services, the proportion of major to minor burns managed at Royal Perth Hospital (RPH) is in the order of 1:10. The Burn Specific Health Scale-Brief (BSHS-B) is an established measure of recovery after major burn, however its performance and validity in a population with a high volume of minor burns is uncertain. Utilizing the tool across burns of all sizes would be useful in service wide clinical practice. This study was designed to examine the reliability and validity of the BSHS-B across a sample of mostly minor burn patients. BSHS-B scores of patients, obtained between January 2006 and February 2013 and stored on a secure hospital database were collated and analyzed Cronbach's alpha, factor analysis, logistic regression and longitudinal regression were used to examine reliability and validity of the BSHS-B. Data from 927 burn patients (2031 surveys) with a mean % total burn surface area (TBSA) of 6.7 (SD 10.0) were available for analysis. The BSHS-B demonstrated excellent reliability with a Cronbach's alpha of 0.95. First and second order factor analyses reduced the 40 item scale to four domains: Work; Affect and Relations; Physical Function; Skin Involvement, as per the established construct. TBSA, length of stay and burn surgery all predicted burn specific health in the first three months of injury (p<0.001, p<0.001, p=0.03). BSHS-B whole scale and domain scores showed significant improvement over 24 months from burn (p<0.001). The results from this study show that the structure and performance of the BSHS-B in a burn population consisting of 90% minor burns is consistent with that demonstrated in major burns. The BSHS-B can be employed to track and predict recovery after burns of all sizes to assist the provision of targeted burn care.
Background: Upper limb (UL) burns can result in significant loss of strength and physical functio... more Background: Upper limb (UL) burns can result in significant loss of strength and physical function. The aim of this study was to establish the reliability and validity of grip strength dynamometry (GSD) for measuring burn-affected UL strength over time. Methods: A retrospective sample of adult participants (n = 89) with UL burns was obtained from Royal Perth Hospital. Data were compiled from assessments conducted at discharge, one, three, six and 12 months afer burn. Within-session reliability and validity was examined through multivariable analyses. Results: GSD demonstrated within-session reliability for all investigated timepoints (ICC's ! 0.87, p < 0.0005.) Criterion validity was confirmed with GSD and QuickDASH being significantly associated in both right (b = 0.17, p = 0.002) and left (b = 0.14, p = 0.002) hands. Construct validity was demonstrated through significant association of GSD values with location of burn (p < 0.35); time after burn (p < 0.012); surgical intervention (p = 0.003) and burn size (p < 0.05). Conclusion: This study demonstrates that grip strength dynamometry is a reliable and valid outcome measure for measuring burn-affected UL strength from one month to one year after burn.
Background: Upper limb (UL) burns can result in significant loss of strength and physical functio... more Background: Upper limb (UL) burns can result in significant loss of strength and physical function. The aim of this study was to establish the reliability and validity of grip strength dynamometry (GSD) for measuring burn-affected UL strength over time. Methods: A retrospective sample of adult participants (n = 89) with UL burns was obtained from Royal Perth Hospital. Data were compiled from assessments conducted at discharge, one, three, six and 12 months afer burn. Within-session reliability and validity was examined through multivariable analyses. Results: GSD demonstrated within-session reliability for all investigated timepoints (ICC's ! 0.87, p < 0.0005.) Criterion validity was confirmed with GSD and QuickDASH being significantly associated in both right (b = 0.17, p = 0.002) and left (b = 0.14, p = 0.002) hands. Construct validity was demonstrated through significant association of GSD values with location of burn (p < 0.35); time after burn (p < 0.012); surgical intervention (p = 0.003) and burn size (p < 0.05). Conclusion: This study demonstrates that grip strength dynamometry is a reliable and valid outcome measure for measuring burn-affected UL strength from one month to one year after burn.
Keloid scars are difficult to manage and remain a therapeutic challenge. Corticosteroid therapy a... more Keloid scars are difficult to manage and remain a therapeutic challenge. Corticosteroid therapy alone or ionising radiation (radiotherapy) alone or combined with surgery are first-line treatments, but the scientific justification for these treatments is unclear. The aim of this systematic review and meta-analysis of randomised controlled trials (RCTs) is to assess the effects of intralesional corticosteroid injection in treating keloids or preventing their recurrence after surgical removal. Searches for RCTs were conducted through the MEDLINE, EMBASE, EBSCO and Cochrane databases from January 1974 to September 2017. Two authors independently reviewed study eligibility, extracted data, analysed the results, and assessed methodological quality. Sixteen RCTs that included more than 814 patients were scrutinised. The quality of evidence for most outcomes was moderate to high. In 10 RCTs, corticosteroid intralesional injections were compared with 5-fluorouracil, etanercept, cryosurgery, ...
Journal of burn care & research : official publication of the American Burn Association, Jan 5, 2016
Small burns are common and can cause disproportionate levels of disability. The ability to measur... more Small burns are common and can cause disproportionate levels of disability. The ability to measure muscle impairment and consequent functional disability is a necessity during rehabilitation of patients. This study aimed to determine the reliability and validity of grip and muscle strength dynamometry in patients with unhealed, minor burn wounds. Grip and muscle strength were assessed three times on each side. Assessment occurred at presentation for the initial injury and again every other day (or every 5 days beyond 10 days post injury) until discharge from the service. Reliability was assessed using intraclass correlation. Minimum detectable differences were calculated for each muscle group. Validity was assessed using regression analysis, incorporating appropriate burn severity measures and patient demographics. Thirty patients with TBSA ≤15% were assessed. Both grip and muscle strength demonstrated very good reliability (intraclass correlation coefficient: 0.85-0.96). Minimum de...
We conducted a rapid review of current international and Australian/New Zealand guidelines on fir... more 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.
Water displacement volumetry (WDV) is a reliable method for measurement of wrist and hand volume ... more Water displacement volumetry (WDV) is a reliable method for measurement of wrist and hand volume in lymphedema patients. However, within session WDV reliability for the whole upper limb (UL) lacks comprehensive investigation, particularly in acute edema populations. This study aimed to confirm the reliability and investigate the impact of time between repeated trials on the sensitivity of WDV as a measure of whole UL volume change in an uninjured cohort and a burn injured pilot group. Within session, duplicate measures of whole UL WDV were recorded in two groups of noninjured volunteers and a group of burn patients. Each noninjured group differed only in the time between WDV repeats. The reliability trials were performed &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;10 minutes apart (T10) and 20 to 30 minutes apart (T20). The time between repetitions for burn patients was 20 to 30 minutes, based on the results of the noninjured participant trials. All trial groups demonstrated excellent correlation between trials (ICCT10 = 0.999, ICCT20 = 0.997). The minimum detectable difference calculated for WDV when measuring whole UL volume change of &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;50 ml for noninjured and &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;100 ml for burn patients. Despite this, a systematic bias was demonstrated between the T10 group means. The T20 group trials did not indicate such error on statistical testing (P = .297). The study confirms that WDV measurement of whole ULs is reliable and sensitive, if used at least 20 minutes apart. However, a significant and clinically relevant subject-by-method interaction was demonstrated. Researchers and clinicians are reminded to be aware of the performance of the technique when designing investigations in patient populations.
Burns : journal of the International Society for Burn Injuries, Jan 29, 2016
There is a growing volume of data that indicates that serious injury suppresses immune function, ... more There is a growing volume of data that indicates that serious injury suppresses immune function, predisposing individuals to infectious complications. With recent evidence showing long-term immune dysfunction after less severe burn, this study aimed to investigate post-burn infectious disease morbidity and assess if burn patients have increased long-term hospital use for infectious diseases. A population-based longitudinal study using linked hospital morbidity and death data from Western Australia for all persons hospitalised for a first burn (n=30,997) in 1980-2012. A frequency matched non-injury comparison cohort was randomly selected from Western Australia's birth registrations and electoral roll (n=123,399). Direct standardisation was used to assess temporal trends in infectious disease admissions. Crude annual admission rates and length of stay for infectious diseases were calculated. Multivariate negative binomial and Cox proportional hazards regression modeling were used ...
Burn injuries are traumatic experiences that can detrimentally impact an individual’s psychologic... more Burn injuries are traumatic experiences that can detrimentally impact an individual’s psychological and emotional wellbeing. Despite this, some survivors adapt to psychosocial challenges better than others despite similar characteristics relating to the burn. Positive adaptation is known as resilience or posttraumatic growth, depending on the trajectory and process. This review aimed to describe the constructs of resiliency and growth within the burn injury context, examine the risk factors that inhibit resilience or growth after burn (barriers), the factors that promote resilience or growth after burn (enablers), and finally to assess the impact of interventions that have been tested that may facilitate resilience or growth after burn. This review was performed according to the recently updated Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Guidelines. An electronic search was conducted in November 2021 on the databases PubMed, Medline (1966-present), E...
Background: Burn patients often receive their initial care by non-burn specialist clinicians, wit... more Background: Burn patients often receive their initial care by non-burn specialist clinicians, with increasingly collaborative burn models of care. The provision of relevant and accessible education for these clinicians is therefore vital for optimal patient care. Design/methods: A two phase design was used. A statewide survey of multidisciplinary nonburn specialist clinicians throughout Western Australia identified learning needs related to paediatric burn care. A targeted education programme was developed and delivered live via videoconference. Pre-post-test analysis evaluated changes in knowledge as a result of attendance at each education session. Results: Non-burn specialist clinicians identified numerous areas of burn care relevant to their practice. Statistically significant differences between perceived relevance of care and confidence in care provision were reported for aspects of acute burn care. Following attendance at the education sessions, statistically significant increases in knowledge were noted for most areas of acute burn care. Conclusions: Identification of learning needs facilitated the development of a targeted education programme for non-burn specialist clinicians. Increased non-burn specialist clinician knowledge following attendance at most education sessions supports the use of videoconferencing as an acceptable and effective method of delivering burns education in Western Australia.
We acknowledge the help of Michael Buck from the UB next-generation sequencing facility for the m... more We acknowledge the help of Michael Buck from the UB next-generation sequencing facility for the mouse skin RNA-seq studies. AUTHOR CONTRIBUTIONS JMR, RAR, and SS designed the study; RAR isolated the RNA from the skin samples; JMR and JB analyzed the data and performed bioinformatics studies; and JMR, RAR, and SS together wrote the manuscript.
Limited data are available to assess the long-term effects of burns to the trunk sustained during... more Limited data are available to assess the long-term effects of burns to the trunk sustained during early childhood on subsequent pregnancies. This population-based retrospective longitudinal study uses linked Western Australia hospital morbidity and midwives notification data for the period 1983-2008. During the study period, 824 girls younger than 15 years with non-erythema burns (partial thickness, full thickness, or unspecified burn depth) to the trunk were hospitalized in Western Australia. During the follow-up, 134 subjects with burns to the trunk during childhood were identified as having later pregnancies. The mean age at admission for burn injury was 5.7 ± 4.0 years, and the majority of burns were caused by scalds (51.5%) and flame (37.3%). For these subjects (N 134), there were a total of 213 subsequent pregnancies. All pregnancies resulted in full-term live births. There were 142 (64.3%) vaginal deliveries, 26 (12.2%) breech or instrument, and 45 (21.2%) deliveries were by cesarean section. No admissions for scar conditions or revisions of burn scar or contracture were identified during any pregnancy (first to fourth) for subjects with burns to the trunk. Mode of delivery was not statistically significantly different from that experienced by subjects with burns sustained during childhood to other anatomical sites. For subjects in this study with less severe burns to the trunk, no specific detrimental impacts during pregnancy or delivery or to the fetus were identified. Further surveillance is required to gauge an accurate assessment of complications associated with severe trunk burns sustained during childhood. (J Burn Care Res 2011;33:654-659)
The aim of the study was to use statewide health administrative data to assess the incidence, tem... more The aim of the study was to use statewide health administrative data to assess the incidence, temporal trends, and external cause of burn injury-related hospital admissions and mortality in Western Australia from 1983 to 2008. Linked hospital morbidity and death data for all persons hospitalized with an index burn injury in Western Australia for the period 1983-2008 were identified. Annual age-specific incidence and age standardized rates were estimated. Poisson regression analyses were used to estimate temporal trends in hospital admissions and mortality. Zero-truncated negative binomial regression analysis was used to identify factors associated with hospital length of stay. From 1983 to 2008, there were 23,450 hospitalizations for an index burn injury. Hospital admission rates declined by an average annual rate of 2% (incidence rate ratio [IRR], 95% confidence interval [CI] ؍ 0.983, 0.981-0.984), and burn-related mortality declined by an average annual rate of 2% (IRR, 95% CI ؍ 0.98, 0.96-1.01). Aboriginal people while having significantly higher hospitalization rates than non-Aboriginal people experienced a greater 26-year decline in hospitalizations of 58% (IRR, 95% CI ؍ 0.42, 0.37-0.48) compared with 32% (IRR, 95% CI ؍ 0.68, 0.65-0.71) for non-Aboriginal people. Children younger than 5 years, 20-to 24-year-old men, and adults older than 65 years remain at high risk for burn injury, and males continue to be hospitalized twice as frequently as females. The results demonstrate declines in burn injury hospitalizations and mortality in both Aboriginal and non-Aboriginal populations. Continued research is required of the impacts of medical interventions and the burn pathway of identified high-risk populations.
Melanocyte restoration is critical in reconstituting skin color. We developed a spotted (piebald)... more Melanocyte restoration is critical in reconstituting skin color. We developed a spotted (piebald) pig wound model to study methods of restoring melanocytes to the epidermis. Paired, full-thickness, porcine wounds were covered with nonpigmented, fully expanded, 3:1 meshed, split-thickness skin grafts and were sprayed with an epidermal cell suspension. The suspensions were highly pigmented skin (HPS) cell isolates for half of the wounds (n = 16) and nonpigmented skin (NPS) cell isolates for the remaining wounds (n = 16). Histologic sections showed 6.0 +/- 3.0 and 15 +/- 4.0 pigmented melanocytes per high-power field on days 8 and 20 in HPS-treated wounds and no pigmented melanocytes in NPS-treated wounds. Melanin pigment was dispersed in all layers of the epithelium for the HPS group on day 20 compared with a lack of melanin pigment observed in the NPS group. Cell spraying may provide a clinical method to restore color to skin; further work is needed to control the expression of melanin.
Like many other Western burn services, the proportion of major to minor burns managed at Royal Pe... more Like many other Western burn services, the proportion of major to minor burns managed at Royal Perth Hospital (RPH) is in the order of 1:10. The Burn Specific Health Scale-Brief (BSHS-B) is an established measure of recovery after major burn, however its performance and validity in a population with a high volume of minor burns is uncertain. Utilizing the tool across burns of all sizes would be useful in service wide clinical practice. This study was designed to examine the reliability and validity of the BSHS-B across a sample of mostly minor burn patients. BSHS-B scores of patients, obtained between January 2006 and February 2013 and stored on a secure hospital database were collated and analyzed Cronbach&amp;amp;amp;amp;#39;s alpha, factor analysis, logistic regression and longitudinal regression were used to examine reliability and validity of the BSHS-B. Data from 927 burn patients (2031 surveys) with a mean % total burn surface area (TBSA) of 6.7 (SD 10.0) were available for analysis. The BSHS-B demonstrated excellent reliability with a Cronbach&amp;amp;amp;amp;#39;s alpha of 0.95. First and second order factor analyses reduced the 40 item scale to four domains: Work; Affect and Relations; Physical Function; Skin Involvement, as per the established construct. TBSA, length of stay and burn surgery all predicted burn specific health in the first three months of injury (p&amp;amp;amp;amp;lt;0.001, p&amp;amp;amp;amp;lt;0.001, p=0.03). BSHS-B whole scale and domain scores showed significant improvement over 24 months from burn (p&amp;amp;amp;amp;lt;0.001). The results from this study show that the structure and performance of the BSHS-B in a burn population consisting of 90% minor burns is consistent with that demonstrated in major burns. The BSHS-B can be employed to track and predict recovery after burns of all sizes to assist the provision of targeted burn care.
Background: Upper limb (UL) burns can result in significant loss of strength and physical functio... more Background: Upper limb (UL) burns can result in significant loss of strength and physical function. The aim of this study was to establish the reliability and validity of grip strength dynamometry (GSD) for measuring burn-affected UL strength over time. Methods: A retrospective sample of adult participants (n = 89) with UL burns was obtained from Royal Perth Hospital. Data were compiled from assessments conducted at discharge, one, three, six and 12 months afer burn. Within-session reliability and validity was examined through multivariable analyses. Results: GSD demonstrated within-session reliability for all investigated timepoints (ICC's ! 0.87, p < 0.0005.) Criterion validity was confirmed with GSD and QuickDASH being significantly associated in both right (b = 0.17, p = 0.002) and left (b = 0.14, p = 0.002) hands. Construct validity was demonstrated through significant association of GSD values with location of burn (p < 0.35); time after burn (p < 0.012); surgical intervention (p = 0.003) and burn size (p < 0.05). Conclusion: This study demonstrates that grip strength dynamometry is a reliable and valid outcome measure for measuring burn-affected UL strength from one month to one year after burn.
Background: Upper limb (UL) burns can result in significant loss of strength and physical functio... more Background: Upper limb (UL) burns can result in significant loss of strength and physical function. The aim of this study was to establish the reliability and validity of grip strength dynamometry (GSD) for measuring burn-affected UL strength over time. Methods: A retrospective sample of adult participants (n = 89) with UL burns was obtained from Royal Perth Hospital. Data were compiled from assessments conducted at discharge, one, three, six and 12 months afer burn. Within-session reliability and validity was examined through multivariable analyses. Results: GSD demonstrated within-session reliability for all investigated timepoints (ICC's ! 0.87, p < 0.0005.) Criterion validity was confirmed with GSD and QuickDASH being significantly associated in both right (b = 0.17, p = 0.002) and left (b = 0.14, p = 0.002) hands. Construct validity was demonstrated through significant association of GSD values with location of burn (p < 0.35); time after burn (p < 0.012); surgical intervention (p = 0.003) and burn size (p < 0.05). Conclusion: This study demonstrates that grip strength dynamometry is a reliable and valid outcome measure for measuring burn-affected UL strength from one month to one year after burn.
Keloid scars are difficult to manage and remain a therapeutic challenge. Corticosteroid therapy a... more Keloid scars are difficult to manage and remain a therapeutic challenge. Corticosteroid therapy alone or ionising radiation (radiotherapy) alone or combined with surgery are first-line treatments, but the scientific justification for these treatments is unclear. The aim of this systematic review and meta-analysis of randomised controlled trials (RCTs) is to assess the effects of intralesional corticosteroid injection in treating keloids or preventing their recurrence after surgical removal. Searches for RCTs were conducted through the MEDLINE, EMBASE, EBSCO and Cochrane databases from January 1974 to September 2017. Two authors independently reviewed study eligibility, extracted data, analysed the results, and assessed methodological quality. Sixteen RCTs that included more than 814 patients were scrutinised. The quality of evidence for most outcomes was moderate to high. In 10 RCTs, corticosteroid intralesional injections were compared with 5-fluorouracil, etanercept, cryosurgery, ...
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