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Management of burn injuries--recent developments in resuscitation, infection control and outcomes research.

Dries DJ - Scand J Trauma Resusc Emerg Med (2009)

Bottom Line: Burn injury and its subsequent multisystem effects are commonly encountered by acute care practitioners.While new medical therapies have been proposed for patients sustaining inhalation injury, a new standard of medical therapy has not emerged.No new medical therapy for inhalation injury exists but new standards for description of burn-related infections have been presented.

View Article: PubMed Central - HTML - PubMed

Affiliation: Regions Hospital, Department of Surgery, St. Paul, MN 55101, USA. david.j.dries@healthpartners.com

ABSTRACT

Introduction: Burn injury and its subsequent multisystem effects are commonly encountered by acute care practitioners. Resuscitation is the major component of initial burn care and must be managed to restore and preserve remote organ function. Later complications of burn injury are dominated by infection. Burn centers are often called to manage soft tissue problems outside thermal injury including soft tissue infection and Toxic Epidermal Necrolysis.

Methods: A selected review of recent reports published by the American Burn Association is provided.

Results: The burn-injured patient is easily and frequently over resuscitated with complications including delayed wound healing and respiratory compromise. A feedback protocol is designed to limit the occurrence of excessive resuscitation has been proposed but no new "gold standard" for resuscitation has replaced the Parkland formula. Significant additional work has been included in recent guidelines identifying specific infectious complications and criteria for these diagnoses in the burn-injured patient. While new medical therapies have been proposed for patients sustaining inhalation injury, a new standard of medical therapy has not emerged. Renal failure as a contributor to adverse outcome in burns has been reinforced by recent data generated in Scandinavia. Of special problems addressed in burn centers, soft tissue infections and Toxic Epidermal Necrolysis have been reviewed but new treatment strategies have not been identified. The value of burn centers in management of burns and other soft tissue problems is supported in several recent reports.

Conclusion: Recent reports emphasize the dangers of over resuscitation in the setting of burn injury. No new medical therapy for inhalation injury exists but new standards for description of burn-related infections have been presented. The value of the burn center in care of soft tissue problems including Toxic Epidermal Necrolysis and soft tissue infections is supported in recent papers.

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Related in: MedlinePlus

SCORTEN Mortality and Risk Variables.
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Related In: Results  -  Collection

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Figure 3: SCORTEN Mortality and Risk Variables.

Mentions: Outcome is predicted by the SCORTEN system which uses variables present during the first 24 hours after admission to estimate the severity of TEN and predict mortality.[70,71] Originally described in a series of patients with cutaneous disorders ranging from SJS to TEN, SCORTEN gives each risk factor a score of 1 and utilizes the sum of these values so that a higher score is associated with greater mortality. SCORTEN is based on a logistic regression study deriving a predictive death equation. The figure and table below indicate the SCORTEN risk variables and outcomes. Each variable is one SCORTEN point. (Figure 3 and Additional file 3)


Management of burn injuries--recent developments in resuscitation, infection control and outcomes research.

Dries DJ - Scand J Trauma Resusc Emerg Med (2009)

SCORTEN Mortality and Risk Variables.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2666628&req=5

Figure 3: SCORTEN Mortality and Risk Variables.
Mentions: Outcome is predicted by the SCORTEN system which uses variables present during the first 24 hours after admission to estimate the severity of TEN and predict mortality.[70,71] Originally described in a series of patients with cutaneous disorders ranging from SJS to TEN, SCORTEN gives each risk factor a score of 1 and utilizes the sum of these values so that a higher score is associated with greater mortality. SCORTEN is based on a logistic regression study deriving a predictive death equation. The figure and table below indicate the SCORTEN risk variables and outcomes. Each variable is one SCORTEN point. (Figure 3 and Additional file 3)

Bottom Line: Burn injury and its subsequent multisystem effects are commonly encountered by acute care practitioners.While new medical therapies have been proposed for patients sustaining inhalation injury, a new standard of medical therapy has not emerged.No new medical therapy for inhalation injury exists but new standards for description of burn-related infections have been presented.

View Article: PubMed Central - HTML - PubMed

Affiliation: Regions Hospital, Department of Surgery, St. Paul, MN 55101, USA. david.j.dries@healthpartners.com

ABSTRACT

Introduction: Burn injury and its subsequent multisystem effects are commonly encountered by acute care practitioners. Resuscitation is the major component of initial burn care and must be managed to restore and preserve remote organ function. Later complications of burn injury are dominated by infection. Burn centers are often called to manage soft tissue problems outside thermal injury including soft tissue infection and Toxic Epidermal Necrolysis.

Methods: A selected review of recent reports published by the American Burn Association is provided.

Results: The burn-injured patient is easily and frequently over resuscitated with complications including delayed wound healing and respiratory compromise. A feedback protocol is designed to limit the occurrence of excessive resuscitation has been proposed but no new "gold standard" for resuscitation has replaced the Parkland formula. Significant additional work has been included in recent guidelines identifying specific infectious complications and criteria for these diagnoses in the burn-injured patient. While new medical therapies have been proposed for patients sustaining inhalation injury, a new standard of medical therapy has not emerged. Renal failure as a contributor to adverse outcome in burns has been reinforced by recent data generated in Scandinavia. Of special problems addressed in burn centers, soft tissue infections and Toxic Epidermal Necrolysis have been reviewed but new treatment strategies have not been identified. The value of burn centers in management of burns and other soft tissue problems is supported in several recent reports.

Conclusion: Recent reports emphasize the dangers of over resuscitation in the setting of burn injury. No new medical therapy for inhalation injury exists but new standards for description of burn-related infections have been presented. The value of the burn center in care of soft tissue problems including Toxic Epidermal Necrolysis and soft tissue infections is supported in recent papers.

Show MeSH
Related in: MedlinePlus