Clinical application of functional near-infrared spectroscopy for burn assessment

Significance: Early assessment of local tissue oxygen saturation is essential for clinicians to determine the burn wound severity.Background: We assessed the burn extent and depth in the skin of the extremities using a custom-built 36-channel functional near-infrared spectroscopy system in patients with burns.Methods: A total of nine patients with burns were analyzed in this study. All second-degree burns were categorized as superficial, intermediate, and deep burns; non-burned skin on the burned side; and healthy skin on the contralateral non-burned side. Hemodynamic tissue signals from functional near-infrared spectroscopy attached to the burn site were measured during fNIRS using a blood pressure cuff. A nerve conduction study was conducted to check for nerve damage.Results: All second-degree burns were categorized into superficial, intermediate, and deep burns; non-burned skin on the burned side and healthy skin on the contralateral non-burned side showed a significant difference distinguishable using functional near-infrared spectroscopy. Hemodynamic measurements using functional near-infrared spectroscopy were more consistent with the diagnosis of burns 1 week later than that of the degree of burns diagnosed visually at the time of admission.Conclusion: Functional near-infrared spectroscopy may help with the early judgment of burn extent and depth by reflecting differences in the oxygen saturation levels in the skin

A pilot study to compare the efficacy and safety of Betafoam® and Allevyn® Ag in the management of acute partial thickness burns

Betafoam® is a new polyurethane foam dressing containing 3% povidone-iodine. This pilot study aimed to assess the performance of Betafoam® for the management of acute partial thickness burn wounds, by comparing its efficacy and safety with those of a silver foam dressing, Allevyn® Ag Gentle. This randomized, two-arm, pilot study was conducted between June 2016 and February 2017 at 2 sites in the Republic of Korea. A total of 32 patients (aged ≥19 years) with acute partial thickness burn wounds and burn total body surface area ≤15% were randomized to treatment with Betafoam® or Allevyn® Ag Gentle dressings for 28 days. Endpoints included target lesion re-epithelialization, infection, pain, and adverse events. Mean time to complete re-epithelialization was similar in the Betafoam® and Allevyn® Ag Gentle groups (12.53 ± 1.13 vs 9.88 ± 1.02 days, P = 0.1556). All patients had complete re-epithelialization by day 28, and none had a burn wound infection during the study period. Analgesic use and patient-reported pain scores during dressing changes were not significantly different between dressing groups. No adverse events were associated with application of the dressings. The results of this first-in-human study suggest that Betafoam® has comparable wound healing efficacy to Allevyn® Ag Gentle, with no notable safety concerns. Keywords: Wound healing, Partial thickness burns, Betafoam, Allevyn, Povidone-iodine, Burns, Pilot project

Deciphering AKI in Burn Patients: Correlations between Clinical Clusters and Biomarkers

Acute kidney injury (AKI) is a significant complication in burn patients, impacting outcomes substantially. This study explores the heterogeneity of AKI in burn patients by analyzing creatinine time-series data to identify distinct AKI clusters and evaluating routine biomarkers’ predictive values. A retrospective cohort analysis was performed on 2608 adult burn patients admitted to Hangang Sacred Heart Hospital’s Burn Intensive Care Unit (BICU) from July 2010 to December 2022. Patients were divided into four clusters based on creatinine trajectories, ranging from high-risk, severe cases to lower-risk, short-term care cases. Cluster A, characterized by high-risk, severe cases, showed the highest mortality and severity, with significant predictors being PT and TB. Cluster B, representing intermediate recovery cases, highlighted PT and albumin as useful predictors. Cluster C, a low-risk, high-resilience group, demonstrated predictive values for cystatin C and eGFR cys. Cluster D, comprising lower-risk, short-term care patients, indicated the importance of PT and lactate. Key biomarkers, including albumin, prothrombin time (PT), cystatin C, eGFR cys, and total bilirubin (TB), were identified as significant predictors of AKI development, varying across clusters. Diagnostic accuracy was assessed using area under the curve (AUC) metrics, reclassification metrics (NRI and IDI), and decision curve analysis. Cystatin C and eGFR cys consistently provided significant predictive value over creatinine, with AUC values significantly higher (p < 0.05) in each cluster. This study highlights the need for a tailored, biomarker-driven approach to AKI management in burn patients, advocating for the integration of diverse biomarkers in clinical practice to facilitate personalized treatment strategies. Future research should validate these biomarkers prospectively to confirm their clinical utility

Soil Evaluators by Last Name (2012-08)

BACKGROUND:Diagnosing acute kidney injury quickly is imperative since it is known as an independent risk factor for mortality in burn patients. We evaluated the diagnostic power of creatinine, cystatin, serum and urine neutrophil gelatinase-associated lipocalin at different time periods and observed the changes from baseline for each biomarker. METHODS:This was a prospective observation study from January 2015 to February 2016. A total of 84 patients were enrolled consecutively. Serum creatinine, serum cystatin C, and serum and urine neutrophil gelatinase-associated lipocalin were measured at admission, 7th, 14th, 21st, and 28th days after admission. All samples were collected until acute kidney injury developed. RESULTS:Acute kidney injury developed in 35 patients. The mean age was 49.6 years with a male predominance. The median urine neutrophil gelatinase-associated lipocalin was the lowest (11.6 ng/dL) at admission, and the highest at 85.5 ng/dL on day 7. Mean creatinine level was the highest (0.88 mg/dL) at admission and the median creatinine level was the lowest (0.56 mg/dL) on the 14th day. The area under the curve of creatinine levels was the highest with 0.857 during the 1st week. The area under the curve of urine neutrophil gelatinase-associated lipocalin was the highest with 0.803 during the 5th week. CONCLUSIONS:Within 1 week of acute kidney injury, creatinine level was the optimal biomarker for diagnosis while urine neutrophil gelatinase-associated lipocalin showed better diagnostic performance following the 4- week period

Development of a risk prediction model (Hangang) and comparison with clinical severity scores in burn patients.

PURPOSE:The purpose of this study was to develop a new prediction model to reflect the risk of mortality and severity of disease and to evaluate the ability of the developed model to predict mortality among adult burn patients. METHODS:This study included 2009 patients aged more than 18 years who were admitted to the intensive care unit (ICU) within 24 hours after a burn. We divided the patients into two groups; those admitted from January 2007 to December 2013 were included in the derivation group and those admitted from January 2014 to September 2017 were included in the validation group. Shrinkage methods with 10-folds cross-validation were performed to identify variables and limit overfitting of the model. The discrimination was analyzed using the area under the curve (AUC) of the receiver operating characteristic curve. The Brier score, integrated discrimination improvement (IDI), and net reclassification improvement (NRI) were also calculated. The calibration was analyzed using the Hosmer-Lemeshow goodness-of-fit test (HL test). The clinical usefulness was evaluated using a decision-curve analysis. RESULTS:The Hangang model showed good calibration with the HL test (χ2 = 8.785, p = 0.361); the highest AUC and the lowest Brier score were 0.943 and 0.068, respectively. The NRI and IDI were 0.124 (p-value = 0.003) and 0.079 (p-value <0.001) when compared with FLAMES, respectively. CONCLUSIONS:This model reflects the current risk factors of mortality among adult burn patients. Furthermore, it was a highly discriminatory and well-calibrated model for the prediction of mortality in this cohort

Demographic and infection sources according to 60-day mortality.

Demographic and infection sources according to 60-day mortality.</p

Supplementary and further details.

(DOCX)</p

Survival curves (Kaplan-Meier) and unadjusted/adjusted HR of each sepsis criterion related to the 60-day mortality in burned patients with suspected infection.

(A) Sepsis-3. (B) Sepsis-3q. (C) Sepsis-1. (D) Burn Sepsis.</p

Demographics and infection sources according to sepsis categories.

Demographics and infection sources according to sepsis categories.</p

Boxplot of onset days for the four categories of sepsis (gray dots = sample data points, black dots = outlier, blue dots = mean, red dots = 95% confidence interval).

Boxplot of onset days for the four categories of sepsis (gray dots = sample data points, black dots = outlier, blue dots = mean, red dots = 95% confidence interval).</p