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Computational and Mathematical Methods... 2021Burn is a common traumatic disease with high morbidity and mortality. The treatment of burns requires accurate and reliable diagnosis of burn wounds and burn depth,...
Burn is a common traumatic disease with high morbidity and mortality. The treatment of burns requires accurate and reliable diagnosis of burn wounds and burn depth, which can save lives in some cases. However, due to the complexity of burn wounds, the early diagnosis of burns lacks accuracy and difference. Therefore, we use deep learning technology to automate and standardize burn diagnosis to reduce human errors and improve burn diagnosis. First, the burn dataset with detailed burn area segmentation and burn depth labelling is created. Then, an end-to-end framework based on deep learning method for advanced burn area segmentation and burn depth diagnosis is proposed. The framework is firstly used to segment the burn area in the burn images. On this basis, the calculation of the percentage of the burn area in the total body surface area (TBSA) can be realized by extending the network output structure and the labels of the burn dataset. Then, the framework is used to segment multiple burn depth areas. Finally, the network achieves the best result with IOU of 0.8467 for the segmentation of burn and no burn area. And for multiple burn depth areas segmentation, the best average IOU is 0.5144.
Topics: Burns; Computational Biology; Databases, Factual; Deep Learning; Humans; Image Interpretation, Computer-Assisted; Photography
PubMed: 33880130
DOI: 10.1155/2021/5514224 -
Burns : Journal of the International... Feb 2023Burn injuries are to this day a major cause of morbidity and mortality, especially within low- and middle-income countries. Understanding the etiology of burn injury and... (Review)
Review
PURPOSE
Burn injuries are to this day a major cause of morbidity and mortality, especially within low- and middle-income countries. Understanding the etiology of burn injury and epidemiologic- and hospital-specific factors associated with burns is vital for allotting resources for prevention and treatment. Therefore, the purpose of this study was to develop a profile of epidemiological differences in burn care and the ideal burn dressing among the different continents based on a global online survey.
OBJECTIVES
This analysis evaluated trends in demographics, epidemiology of burn care, burn incidence, infection, related mortality and burn treatment (e.g., dressing changes and materials). The objective of this study was to investigate and compare the epidemiological profile of burn injury/care amongst the continents and a global control group to determine their utility for guiding evidence-based burn care and identify differences and/or similarities in their clinical practice.
METHODS
A retrospective analysis of data was performed that was acquired during a previous study investigating the ideal burn dressing on a global perspective. The data was analyzed depending on the continent, on which the respondent indicated their hospital to be (Africa, Australia & New Zealand, Asia, Europe, Middle and South America, North America). Statistical analysis was performed to evaluate patient and hospital demographics and variables associated with burn injuries and their treatment. Outcomes of interest also included infections, mortality, length of stay on the ICU and important burn dressing characteristics.
RESULTS
Healthcare providers in different areas of the world share similar views and needs regarding burn care management and on what constitutes an ideal burn dressing. We found significant differences in the various continents regarding hospitalization and length of stay on the ICU, with Australia taking the lead. Africa, with a high proportion of low-income-countries, reported the highest rate of burn infections, mortality, and a disproportionally high number of burn incidences amongst children. In general, men were mostly obtaining burn injuries amongst all continents. We found no significant differences regarding the most important characteristics of an ideal burn dressing.
CONCLUSION
Our results suggest significant epidemiological differences regarding burn injuries and care amongst the continents, possibly resulting from the different infrastructure and/or circumstances on the various continents. Future scientific studies need to focus on adequate pain management and designing longer lasting materials that contain the "ideal" properties, by also taking individual regional needs/desires and the patient's perspective and economic boundaries into account. This analysis has delivered valuable insights into the epidemiological differences and/or similarities amongst the various continents.
Topics: Male; Child; Humans; Burns; Retrospective Studies; Hospitalization; Health Personnel; Bandages; Length of Stay
PubMed: 35843806
DOI: 10.1016/j.burns.2022.06.018 -
Burns : Journal of the International... Aug 2021Race and socioeconomic status influence outcomes for adult and pediatric burn patients, yet the impact of these factors on elderly patients (Medicare eligible, 65 years...
BACKGROUND
Race and socioeconomic status influence outcomes for adult and pediatric burn patients, yet the impact of these factors on elderly patients (Medicare eligible, 65 years of age) remains unknown.
METHODS
Data pooled from three verified burn centers from 2004 to 2014 were reviewed retrospectively. Age, race, gender, percent total body surface area (%TBSA) burn, mortality, length of stay (LOS), LOS per %TBSA burn, and zip code which provided Census data on race, poverty, and education levels within a community were collected. Data were analyzed using logistic and generalized linear models in SAS version 9.4 (SAS Institute, Cary, NC, USA).
RESULTS
Our population was mainly Caucasian (63%), African American (18%), Hispanic (7.6%), and Asian (3.5%). Mean age was 76.3 ± 8.3 years, 52.5% were male. Mean %TBSA was 9 ± 13.8%; 15% of the patients sustained an inhalation injury. The mortality rate was 14.4%. Inhalation injury was significantly associated with mortality and discharge to a skilled nursing facility (SNF) (p < 0.05). Race was significantly associated with socioeconomic disparities and affected LOS/TBSA, but not discharge to SNF or mortality on univariate analysis. Poverty level, education level, and insurance status (others vs. public) independently predicted SNF discharge, while median income and insurance type independently predicted LOS/TBSA.
CONCLUSION
In this elderly cohort, race did not predict standard markers of burn outcome (mortality and discharge to SNF). Socioeconomic status independently predicted LOS and discharge to SNF, suggesting a relationship between socioeconomic status and recovery from a burn injury. Better understanding of racial and socioeconomic disparities is necessary to provide equitable treatment of all patients.
Topics: Aged; Aged, 80 and over; Burns; Female; Humans; Length of Stay; Male; Medicare; Racial Groups; Retrospective Studies; Social Class; Socioeconomic Factors; United States
PubMed: 33933303
DOI: 10.1016/j.burns.2020.10.025 -
Advanced Drug Delivery Reviews Jan 2018This review gives an updated overview on keratinocyte transplantation in burn wounds concentrating on application methods and future therapeutic cell delivery options... (Review)
Review
This review gives an updated overview on keratinocyte transplantation in burn wounds concentrating on application methods and future therapeutic cell delivery options with a special interest in hydrogels and spray devices for cell delivery. To achieve faster re-epithelialisation of burn wounds, the original autologous keratinocyte culture and transplantation technique was introduced over 3 decades ago. Application types of keratinocytes transplantation have improved from cell sheets to single-cell solutions delivered with a spray system. However, further enhancement of cell culture, cell viability and function in vivo, cell carrier and cell delivery systems remain themes of interest. Hydrogels such as chitosan, alginate, fibrin and collagen are frequently used in burn wound care and have advantageous characteristics as cell carriers. Future approaches of keratinocyte transplantation involve spray devices, but optimisation of application technique and carrier type is necessary.
Topics: Burns; Humans; Keratinocytes; Wound Healing
PubMed: 28668483
DOI: 10.1016/j.addr.2017.06.012 -
Burns : Journal of the International... Sep 2008The depth of a burn wound and/or its healing potential are the most important determinants of the therapeutic management and of the residual morbidity or scarring.... (Review)
Review
The depth of a burn wound and/or its healing potential are the most important determinants of the therapeutic management and of the residual morbidity or scarring. Traditionally, burn surgeons divide burns into superficial which heal by rapid re-epithelialization with minimal scarring and deep burns requiring surgical therapy. Clinical assessment remains the most frequent technique to measure the depth of a burn wound although this has been shown to be accurate in only 60-75% of the cases, even when carried out by an experienced burn surgeon. In this article we review all current modalities useful to provide an objective assessment of the burn wound depth, from simple clinical evaluation to biopsy and histology and to various perfusion measurement techniques such as thermography, vital dyes, video angiography, video microscopy, and laser Doppler techniques. The different needs according to the different diagnostic situations are considered. It is concluded that for the initial emergency assessment, the use of telemetry and simple burn photographs are the best option, that for research purposes a wide range of different techniques can be used but that, most importantly, for the actual treatment decisions, laser Doppler imaging is the only technique that has been shown to accurately predict wound outcome with a large weight of evidence. Moreover this technique has been approved for burn depth assessment by regulatory bodies including the FDA.
Topics: Burns; Cicatrix; Female; Humans; Laser-Doppler Flowmetry; Male; Prognosis; Skin; Skin Transplantation; Tomography, Optical Coherence; Trauma Severity Indices; Ultrasonography; Wound Healing
PubMed: 18511202
DOI: 10.1016/j.burns.2008.01.009 -
Burns : Journal of the International... Feb 2015The burn wound exudate represents the burn tissue microenvironment. Extracting information from the exudate relating to cellular components, signaling mediators and... (Review)
Review
INTRODUCTION
The burn wound exudate represents the burn tissue microenvironment. Extracting information from the exudate relating to cellular components, signaling mediators and protein content can provide much needed data relating to the local tissue damage, depth of the wound and probable systemic complications. This review examines the scientific data extracted from burn wound exudates over the years and proposes new investigations that will provide useful information from this underutilized resource.
METHOD
A literature review was conducted using the electronic database PubMed to search for literature pertaining to burn wound or blister fluid analysis. Key words included burn exudate, blister fluid, wound exudate, cytokine burn fluid, subeschar fluid, cytokine burns, serum cytokines. 32 relevant articles were examined and 29 selected as relevant to the review. 3 papers were discarded due to questionable methodology or conclusions. The reports were assessed for their affect on management decisions and diagnostics. Furthermore, traditional blood level analysis of these mediators was made to compare the accuracy of blood versus exudate in burn wound management. Extrapolations are made for new possibilities of burn wound exudate analysis.
RESULTS
Studies pertaining to burn wound exudate, subeschar fluid and blister fluid analyses may have contributed to burn wound management decisions particularly related to escharectomies and early burn wound excision. In addition, information from these studies has the potential to impact on areas such as healing, scarring, burn wound conversion and burn wound depth analysis.
CONCLUSION
Burn wound exudate analysis has proven useful in burn wound management decisions. It appears to offer a far more accurate reflection of the burn wound pathophysiology than the traditional blood/serum investigations undertaken in the past. New approaches to diagnostics and treatment efficacy assessment are possible utilizing data from this fluid. Burn wound exudate is a useful, currently under-utilized resource that is likely to take a more prominent role in burn wound management.
Topics: Bandages; Burns; Cicatrix; Cytokines; Exudates and Transudates; Humans; Wound Healing
PubMed: 24986597
DOI: 10.1016/j.burns.2014.06.002 -
Clinics in Plastic Surgery Jul 2017The classic determinants of mortality from severe burn injury are age, size of injury, delays of resuscitation, and the presence of inhalation injury. Of the major... (Review)
Review
The classic determinants of mortality from severe burn injury are age, size of injury, delays of resuscitation, and the presence of inhalation injury. Of the major determinants of mortality, inhalation injury remains one of the most challenging injuries for burn care providers. Patients with inhalation injury are at increased risk for pneumonia (the leading cause of death) and multisystem organ failure. There is no consensus among leading burn care centers in the management of inhalation injury. This article outlines the current treatment algorithms and the evidence of their efficacy.
Topics: Burns, Inhalation; Extracorporeal Membrane Oxygenation; Humans; Respiration, Artificial
PubMed: 28576239
DOI: 10.1016/j.cps.2017.02.009 -
Biochimica Et Biophysica Acta.... Oct 2017A severe burn can trigger a hypermetabolic state which lasts for years following the injury, to the detriment of the patient. The drastic increase in metabolic demands... (Review)
Review
A severe burn can trigger a hypermetabolic state which lasts for years following the injury, to the detriment of the patient. The drastic increase in metabolic demands during this phase renders it difficult to meet the body's nutritional requirements, thus increasing muscle, bone and adipose catabolism and predisposing the patient to a host of disorders such as multi-organ dysfunction and sepsis, or even death. Despite advances in burn care over the last 50 years, due to the multifactorial nature of the hypermetabolic phenomenon it is difficult if not impossible to precisely identify and pharmacologically modulate the biological mediators contributing to this substantial metabolic derangement. Here, we discuss biomarkers and molecules which play a role in the induction and mediation of the hypercatabolic condition post-thermal injury. Furthermore, this thorough review covers the development of the factors released after burns, how they induce cellular and metabolic dysfunction, and how these factors can be targeted for therapeutic interventions to restore a more physiological metabolic phenotype after severe thermal injuries. This article is part of a Special Issue entitled: Immune and Metabolic Alterations in Trauma and Sepsis edited by Dr. Raghavan Raju.
Topics: Animals; Burns; Humans; Multiple Organ Failure; Sepsis
PubMed: 28219767
DOI: 10.1016/j.bbadis.2017.02.019 -
International Journal of Molecular... Jan 2016Severe burn profoundly affects organs both proximal and distal to the actual burn site. Cardiovascular dysfunction is a well-documented phenomenon that increases... (Review)
Review
Severe burn profoundly affects organs both proximal and distal to the actual burn site. Cardiovascular dysfunction is a well-documented phenomenon that increases morbidity and mortality following a massive thermal trauma. Beginning immediately post-burn, during the ebb phase, cardiac function is severely depressed. By 48 h post-injury, cardiac function rebounds and the post-burn myocardium becomes tachycardic and hyperinflammatory. While current clinical trials are investigating a variety of drugs targeted at reducing aspects of the post-burn hypermetabolic response such as heart rate and cardiac work, there is still a paucity of knowledge regarding the underlying mechanisms that induce cardiac dysfunction in the severely burned. There are many animal models of burn injury, from rodents, to sheep or swine, but the majority of burn related cardiovascular investigations have occurred in rat and mouse models. This literature review consolidates the data supporting the prevalent role that β-adrenergic receptors play in mediating post-burn cardiac dysfunction and the idea that pharmacological modulation of this receptor family is a viable therapeutic target for resolving burn-induced cardiac deficits.
Topics: Animals; Burns; Cardiovascular Diseases; Cardiovascular System; Disease Models, Animal; Humans; Mice; Molecular Targeted Therapy; Rats; Receptors, Adrenergic, beta
PubMed: 26729111
DOI: 10.3390/ijms17010053 -
International Wound Journal Aug 2022The aim of this study was to identify the epidemiology, aetiology as well as the knowledge, attitudes, and practices relating to burn injuries in Palestine. A...
The aim of this study was to identify the epidemiology, aetiology as well as the knowledge, attitudes, and practices relating to burn injuries in Palestine. A mixed-method approach was used. A survey was distributed to a total of 1500 households selected by randomised approach. The survey was standardised based on World Health Organisation's guidelines for conducting community surveys on injury. Additionally, there were 12 focus group discussions and 10 key informant interviews to collect rich qualitative data. In the West Bank and Gaza, 1.5% of Palestinians had experienced serious burn injuries in the 12 months. The total sample of 1500 yields a margin of error (plus/minus) = 2.5% at a 95% level of confidence and a response distribution (P = 50%) with 3% non-response rate. Of the 1500 households approached, 184 reported a total of 196 burn injuries, with 87.2% occurring inside the home: 69.4% were females and 39.3% were children. The main source of reported cause of burn was heat and flame (36%), electric current (31.6%), hot liquid (28.6%), and chemicals (2.7%). The most common first aid for burns was pouring water (74.7%). People in rural, refugee, and Bedouin settings had the highest incidence of burns. This study provides the burn prevalence rate, explanatory factors that contribute to the frequency of burns in Palestine. Making burn prevention a higher priority within the national policy is crucial.
Topics: Arabs; Burns; Child; Female; First Aid; Focus Groups; Health Knowledge, Attitudes, Practice; Humans; Infant; Male
PubMed: 34761542
DOI: 10.1111/iwj.13716