Fuciños LC, Rotaeche AA, Cabezas EF
… +3 more, Montiel BE, Estañ PM, Sánchez MS
J Burn Care Res
· 2026 Jun · PMID 42275046
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Inhalation injury remains a major contributor to morbidity and mortality in critically ill burn patients, although its hemodynamic impact during early resuscitation is incompletely understood. Patients with inhalation in...Inhalation injury remains a major contributor to morbidity and mortality in critically ill burn patients, although its hemodynamic impact during early resuscitation is incompletely understood. Patients with inhalation injury could exhibit distinct hemodynamic alterations compared with those without inhalation injury, potentially contributing to worse outcomes. We conducted a prospective, single-center observational study over four years including adult patients with major burns. Hemodynamic variables, fluid administration, and analytical biomarkers during initial resuscitation were analyzed according to inhalation injury. A total of 180 patients were included: 96 with ≥20% total body surface area (TBSA) burned without inhalation injury and 84 with inhalation injury irrespective of TBSA, with similar severity scores. Patients with inhalation injury were older and had lower %TBSA burned. They exhibited reduced initial cardiac index, higher lactate, increased stroke volume variation, greater late extravascular lung water index, and elevated NT-proBNP. Mechanical ventilation was more frequent (88% vs. 59%), with a non-significant trend toward higher mortality (28% vs. 18%, p=0.10). Fluid requirements were comparable between groups. In a predefined 25-75% TBSA subgroup, hemodynamic patterns were consistent with the overall cohort. Among patients with inhalation injury, non-survivors showed lower initial cardiac index and higher lactate, troponin, extravascular lung water, and NT-proBNP, despite similar intrathoracic blood volume. These findings demonstrated that inhalation injury was associated with early reductions in cardiac index, lower preload, and a delayed increase in extravascular lung water without higher fluid requirements; mortality correlated with greater cardiac dysfunction and elevated myocardial injury biomarkers during resuscitation.
Manasyan A, Choi KJ, Eisner Z
… +9 more, Gupta N, Kim MI, Pham CH, Kurakazu D, Collier ZJ, Wong S, Johnson MB, Yenikomshian HA, Gillenwater TJ
J Burn Care Res
· 2026 Jun · PMID 42275040
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The hand is the most commonly burned region and often leads to unique functional limitations. Here we review the associations of long-term outpatient hand therapy on hand joint range of motion, activities of daily living...The hand is the most commonly burned region and often leads to unique functional limitations. Here we review the associations of long-term outpatient hand therapy on hand joint range of motion, activities of daily living (ADL) status, pain, and ability to return to work after burn injury. Adult patients with hand burns admitted to a single American Burn Association verified burn center from January 2015 to June 2024 with properly documented outpatient hand therapy follow-up were included. 86 patients were identified who consistently presented for outpatient OT. 75.6% (n = 65) demonstrated improvement of ADL function, and 72.1% (n = 62) had improvement of ROM. At OT intake, 50% (n = 43) reported pain as a major limitation, but by the end of therapy, only 23% (n = 20) were limited by pain. Those with pre-existing hand pathology and older age were more likely to complete therapy to completion (OR = 1.52 and 1.01, CI 1.1-2.2 and 1.1-1.7, p = 0.02 for both), and those who did not require surgery and had good compliance as rated by therapists had significantly increased likelihood of ROM improvement (OR = 1.26 and 1.27, CI 1.0-1.6 and 1.0-1.6, p = 0.03 and 0.04). Most patients referred for hand therapy after burn injury return to functional independence and have functional ROM. Further research should take a prospective approach to evaluate the efficacy of hand occupational therapy after burns, focusing on a wider range of functional and psychosocial outcomes.
Culnan DM, Gudeman A, Coates J
… +4 more, Blears E, Culnan GB, Foncerrada G, Herndon DN
J Burn Care Res
· 2026 Jun · PMID 42261663
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Spray Cell Suspension (SCS) represents a commonplace tool to augment skin grafting; however, the kit required to make the suspension is costly. We hypothesize that repeated use of SCS will result in similar cell counts a...Spray Cell Suspension (SCS) represents a commonplace tool to augment skin grafting; however, the kit required to make the suspension is costly. We hypothesize that repeated use of SCS will result in similar cell counts and graft results while decreasing hospital charges. Our institution used the enzyme from one ReCell kit repeatedly while counting cell dosage and tracking clinical outcomes. Six patients ages 8-86 years, with TBSA 8-50% and Baux scores of 18-144 had 9 surgeries with SCS. All survived to discharge with 95% wound closure from 7-21 days after the first grafting (mode 7 days). Cell dosing was 20 716 +/- 2346 cells/cm2. This is 1/3829th the dose of cultured epidermal autograft (CEA). Linear regression demonstrated no decrease in cell density when preparing up to 14 biopsies of SCS with a positive slope, indicating further samples are feasible. Analysis of variance and Student's T-test of the first and last enzyme use per surgery found no significant differences. The only factor affecting cell counts was live feedback to surgical technologists preparing samples. Motivation of those performing the isolation had more effect than enzyme reuse, age, or number of surgeries. This modification prevented the hospital from purchasing 19 ReCell kits, saving approximately $130 625 in 1 month. Our results show one enzyme can be used at least 7 times without a decrease in cell yield or compromise of clinical outcome, demonstrating repeated use of SCS is a cost effective, safe and feasible option to augment skin grafting.
Slavinsky V, Ching L, Carney BC
… +6 more, Huang J, Lee DT, Allely R, Shupp JW, Tejiram S, Travis TE
J Burn Care Res
· 2026 Jun · PMID 42261654
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Evaluate the influence of patient age on laser therapy outcomes for burn hypertrophic scars (HTS), with a specific focus on assessing differences in scar quality, pain, and itch across stratified age groups. A single-ins...Evaluate the influence of patient age on laser therapy outcomes for burn hypertrophic scars (HTS), with a specific focus on assessing differences in scar quality, pain, and itch across stratified age groups. A single-institution, retrospective cohort study analyzing outcomes of fractional ablative CO2 laser treatments among patients grouped into younger, middle-aged, and older cohorts using k-means clustering. Patients (n = 119) receiving three or more fractional ablative CO2 laser treatments were included. Scar metrics were evaluated pre-treatment and after each laser session using the Patient and Observer Scar Assessment Scale (POSAS), Vancouver Scar Scale (VSS), and durometer measurements. Statistical analyses were performed to compare within- and between-group outcomes using ANOVA with corrections for multiple comparisons. The study cohort included 119 patients, with 49.58% female participants and an average age of 44.86 years (±16.4). The patients were predominantly African American (38.7%), followed by White (28.6%), Hispanic (10.9%), Asian (5.9%), Native American (1.7%), and 14.3% unspecified. Fitzpatrick skin type classifications were most common in Type V (32.8%) and Type II (20.2%), with lower representation in Types VI (4.2%) and I (1.7%). Laser treatment led to significant improvements across all age groups in POSAS metrics, though the timing and extent varied. The older cohort showed significant improvement in POSAS observer pliability after just one session (p < 0.05), while the younger and middle-aged groups required two or more sessions (p < 0.001). Middle-aged patients reported the highest baseline pain and itch levels, with mean scores of 6.17/10 and 6.64/10, respectively, compared to younger (4.26 and 4.97) and older (4.26 and 4.74) groups (p < 0.05). Pain and itch significantly decreased across all groups, with the middle-aged cohort showing the most consistent improvements (p < 0.05). VSS scores improved significantly for all groups, while durometer measurements showed significant changes only in the middle-aged cohort (p < 0.05). Age significantly influences laser therapy outcomes for burn HTS, with older patients experiencing earlier and more pronounced improvements in POSAS observer scales. Different age groups also reported varying levels of pain and itch throughout their laser treatment sessions. Importantly, considerable improvements were noted post-laser treatment across all age groups. These findings emphasize the importance of personalizing laser therapy to address age-specific physiological changes to optimize treatment timelines and outcomes for burn HTS patients.
J Burn Care Res
· 2026 Jun · PMID 42252703
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Discharge against medical advice (AMA) leads to worse outcomes in burn patients including higher readmission rates, wound complications, and elevated costs, although protective and risk factors remain incompletely charac...Discharge against medical advice (AMA) leads to worse outcomes in burn patients including higher readmission rates, wound complications, and elevated costs, although protective and risk factors remain incompletely characterized. Burn encounters were identified in two national databases, the Nationwide Inpatient Sample (NIS), 2016-2021, and the Burn Care Quality Platform (BCQP), 2016-2022. Encounters were stratified by AMA discharge. The primary outcomes were the overall incidence of AMA discharge and the effects of inpatient psychosocial or behavioral interventions and burn center status on AMA discharge, evaluated with 1:1 nearest neighbor propensity-score matching of AMA and non-AMA encounters on demographics, burn characteristics, and established risk factors for AMA discharge, without replacement and with maximum caliper distance of 0.1. In the NIS and BCQP, respectively, 5,950 (2.8%) of 214,390 and 2,923 (1.4%) of 205,993 burn encounters were discharged AMA. Significant predictors of AMA discharge included male sex, Medicaid or self-pay, smaller burns, and more recent year (p<0.01). The incidence of AMA discharges increased over the study period in both the NIS (IRR 1.2; 95% CI: 1.1-1.2; p<0.01) and the BCQP (IRR 1.2; 95% CI: 1.2-1.2; p<0.01). Within a propensity-score matched model, burn center care was associated with a 1.2% decrease in AMA discharge (ATE -0.01; 95% CI: -0.02- -0.00; p=0.01); psychosocial behavioral interventions did not impact the likelihood of AMA discharge (p=0.85). Existing interventions to alleviate AMA discharge are insufficient to significantly alter patterns of AMA discharge. Treatment at burn centers may result in lower likelihood of AMA discharge in burn patients.
Abdulla H, Tan P, Bache SE
… +4 more, Murray A, Sheikh Z, Wearn C, Lewis CJ
J Burn Care Res
· 2026 Jun · PMID 42252144
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Accurate burn depth assessment remains difficult. AI-enhanced multispectral imaging (AI-MSI) offers objective, image-based predictions, but evidence on day-to-day usability is limited. The aim of this study is to evaluat...Accurate burn depth assessment remains difficult. AI-enhanced multispectral imaging (AI-MSI) offers objective, image-based predictions, but evidence on day-to-day usability is limited. The aim of this study is to evaluate the usability of an AI-MSI device in routine practice using a multicentre, modified Nielsen heuristic framework. A retrospective, mixed-methods study was conducted across five UK burn services (September 2024 to August 2025). Doctors and nurses who used the device completed a 12-item Likert survey mapped to six domains and free-text. Outcomes include domain means±SD, medians (IQR), and proportions of positive responses (scores ≥ 4). Mann-Whitney U compared professions; Kruskal-Wallis tested site variability; Dunn pairwise tests with Bonferroni correction were used where indicated. JASP 0.95.1 was used for analysis with statistical significance set at p < 0.05. Forty-nine burn-team members (21 doctors, 28 nurses) participated. Domain means ranged 3.93 to 4.35; medians were ≥ 4.0; positive responses 65.3% to 87.8%. There were no significant differences between professions or centres. Effect sizes were small to moderate; Match & Standards showed the largest effect (ε2 = 0.15) with no pairwise differences after correction. Free-text highlighted speed, clarity of outputs, portability, and workflow fit, and suggested clearer on-screen cues, a lighter imaging head, longer battery life, and streamlined data entry. AI-MSI showed high usability across roles and centres, supporting routine use in clinics, wards, and theatres. As the first multicentre heuristic usability evaluation of AI-MSI in burns, the study provides implementation-focused evidence to guide training, pathway design, and targeted software and hardware refinements.
Khorsandi J, Mirharooni J, Kahen J
… +4 more, Tariq E, Harouni M, Franzoni D, MacDavid J
J Burn Care Res
· 2026 Jun · PMID 42251750
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Burn injuries and chronic wounds impose a substantial and growing global health and economic burden, particularly in low- and middle-income countries and among aging populations with diabetes, vascular disease, and immob...Burn injuries and chronic wounds impose a substantial and growing global health and economic burden, particularly in low- and middle-income countries and among aging populations with diabetes, vascular disease, and immobility. Conventional wound assessment depends heavily on visual inspection, manual measurements, and clinician experience, leading to variability in burn-depth estimation, wound sizing, and prognostication. Artificial intelligence, especially deep learning-based computer vision, has emerged as a promising approach to provide objective, reproducible, and scalable evaluation of burns and complex wounds. In this narrative review, we synthesize studies published between 2015 and 2025 focused on three domains: image-based wound recognition and segmentation, predictive modeling of outcomes such as healing, graft success, infection, and amputation, and integration of artificial intelligence into telemedicine platforms and smart technologies for remote monitoring. Across multiple datasets, convolutional neural networks achieve segmentation Dice coefficients frequently exceeding 0.85 and burn-depth or tissue-type classification sensitivities above 0.90, while multimodal prediction models reach accuracies and areas under the receiver operating characteristic curve of approximately 0.80-0.95. Early clinical pilots demonstrate the feasibility of embedding artificial intelligence tools into smartphone applications, telehealth workflows, and sensor-enabled dressings. Nonetheless, persistent challenges related to algorithmic bias across skin tones, limited dataset diversity, opaque model behavior, workflow integration, and evolving regulatory frameworks must be addressed before artificial intelligence-enabled wound care systems can be safely and equitably deployed at scale.
Illg C, Zoldina A, Fontana J
… +4 more, Thiel JT, Rachunek-Medved K, Daigeler A, Krauss S
J Burn Care Res
· 2026 Jun · PMID 42223471
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Specialized burn centers address the special needs of burn victims. Despite accounting for a small proportion of overall trauma cases, twenty-four-hour specialist availability is required. Identifying periods of increase...Specialized burn centers address the special needs of burn victims. Despite accounting for a small proportion of overall trauma cases, twenty-four-hour specialist availability is required. Identifying periods of increased patient flow may support better allocation of beds and staff. This study examined the influence of temporal and meteorological factors on burn injury consultations. Data of all patients treated for burn injuries in our burn unit within 1 year were analyzed. Temporal variables as well as weather data were correlated with burn injury consultation counts. A total of 466 burn trauma patients (mean age 37.2 ± 18.7 years, 57.9% male, 34.3% occupational injuries) were included. The highest number of daily consultations was observed in June (2.0 ± 1.3) and July (1.55 ± 1.18). The highest number of burn patients presented at the beginning of the week, particularly on Tuesdays (1.9 ± 1.6). Only 50.9% of patients consulted the clinic during regular working hours. Patient presentation numbers did not correlate significantly with temperature, sunshine duration, precipitation, humidity, and wind speed. The proportion of female patients correlated negatively with daily sunshine duration (r = -0.13, p = 0.037) and daily mean temperature (r = -0.15, p = 0.019). Unlike general trauma, the number of burn injury consultations did not correlate with any studied meteorological factor. However, the proportion of female patients showed a negative correlation with favorable weather conditions. Increased patient counts were observed on weekdays in the beginning of the week, notably in June and July. These findings may help improve resource management.
Kays M, Elftmann A, Larson N
… +5 more, Hill DM, Ozhathil DK, Galet C, Romanowski K, Lacey A
J Burn Care Res
· 2026 May · PMID 42213092
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Older adult patients often present with malnutrition, which is associated with increased morbidity and mortality after burn injury. This multicenter retrospective cohort study assessed outcomes in older adult burn patien...Older adult patients often present with malnutrition, which is associated with increased morbidity and mortality after burn injury. This multicenter retrospective cohort study assessed outcomes in older adult burn patients (≥60 years) presenting to twelve burn centers in the US and Canada. Patients were stratified by nutritional status (nourished: admission albumin ≥3.0 g/dL; malnourished: admission albumin <3 g/dL) with further subgrouping by albumin level (1-1.9, 2-2.9, 3-3.9, 4+). A mixed effect generalized linear model controlling for admitting center was fit to assess the adjusted odds of in-hospital mortality and complications. 712 patients met inclusion criteria, 442 in the nourished cohort and 270 in the malnourished cohort. On multivariable analysis, the binary classification of albumin was not significantly associated with morbidity or mortality. However, when treating albumin as continuous, levels were highly associated with mortality and select complications, with every one point increase in admission albumin lowering the odds of death by 54% (aOR 0.46, 95% CI 0.26, 0.81), the odds of multiple organ failure by 59% (aOR 0.41, 95% CI 0.20, 0.85) and the odds of ICU delirium by 54% (aOR 0.46, 95% CI 0.23, 0.95). Admission albumin levels are highly associated with morbidity and mortality in older adult burn patients and appear to be a readily available useful indicator of outcomes.
Imani G, Louie E, Young S
… +3 more, VanAcker S, Heard J, Duby J
J Burn Care Res
· 2026 May · PMID 42207149
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BACKGROUND: Hypercalcemia after a burn injury is attributed to bone resorption secondary to muscle inactivity and prolonged immobilization. Evidence to guide treatment is extremely limited. The purpose of this study was...BACKGROUND: Hypercalcemia after a burn injury is attributed to bone resorption secondary to muscle inactivity and prolonged immobilization. Evidence to guide treatment is extremely limited. The purpose of this study was to assess the effect of pamidronate on hypercalcemia in burn-injured patients. METHODS: This retrospective, observational study was conducted at a regional burn center. Adult patients admitted to the burn surgery service who received IV pamidronate for hypercalcemia during hospitalization were included. The primary outcome was the change in ionized calcium (iCa) at day 7 and 14 after pamidronate treatment. Secondary outcomes included hypocalcemia and the requirement for calcium replacement. Descriptive statistics were used to evaluate the outcomes. Mixed-effects regression analyses were performed to estimate the direction and magnitude of clinical factors on change in iCa. RESULTS: Twenty-seven patients and thirty-seven courses of therapy were included for analysis. The mean age was 44.4 ± 16.0 years; 85% were male, and the mean total body surface area (TBSA) burned was 60.2 ± 22.2%. The majority of IV pamidronate doses were 30 mg (96.2%). The mean peak iCa was 1.45 ± 0.11 mmol/L. The absolute decrease in iCa was -0.26 ± 0.12 mmol/L (-17.1± 7.3%) and -0.26 ± 0.13 mmol/L (-17.0 ± 7.5%) at day 7 and day 14, respectively. Hypocalcemia occurred after 5 pamidronate administrations (13.5%). CONCLUSION: The use of IV pamidronate for the management of hypercalcemia post-burn injury appeared effective in decreasing ionized calcium levels. Future studies are needed to further evaluate the clinical implications of these findings.
Matheny M, Ross E, Humbert A
… +5 more, Parker KA, Flores E, Kowalske K, Schneider JC, Yenikomshian HA
J Burn Care Res
· 2026 May · PMID 42207146
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Burn injuries are functionally limiting, and premorbid mobility impairments may further complicate recovery. Premorbid mobility impairments are associated with worse outcomes in other populations; however, their role in...Burn injuries are functionally limiting, and premorbid mobility impairments may further complicate recovery. Premorbid mobility impairments are associated with worse outcomes in other populations; however, their role in burn recovery remains unclear. This retrospective cohort study included adult burn survivors injured from 2014 to 2025, from the Burn Model System National Burn Database. Premorbid mobility impairment was defined as self-reported pre-burn physical problems or impairments affecting mobility (difficulty moving your arms, legs, or body). Outcomes included length of stay, discharge disposition, and PROMIS Global Mental Health scores at 6- and 12-month follow-up post injury. All regression models were adjusted for age, total body surface area (TBSA), and inhalation injury. The model for Global Mental Health scores additionally adjusted for discharge location, Global Physical Health, pre-injury Global Mental Health, and follow-up time. A total of 1,372 adult burn survivors were included, with a mean age of 46.2. Premorbid mobility impairments was associated with longer hospital stay (IRR 1.15, 95% CI [1.04 - 1.27], P = 0.006,) and discharge to shelter (OR 1.75, 95% CI [1.41- 2.19], P < 0.001). There was also a trend toward lower PROMIS Mental Health scores among survivors with premorbid mobility impairments (β = -1.92, P = 0.091). Premorbid mobility impairment is associated with poorer burn outcomes, including longer hospital stay and discharge to unstable settings such as shelters, and may also be linked to poorer mental health outcomes. It remains unclear whether shelter discharge reflects premorbid housing instability or a new post-burn disposition.
Bull A, Tejiram S, Nosanov LB
… +15 more, Savetamal A, Bhavsar D, Miotke S, Hill DM, Higginson S, Chin T, Long A, Lacey A, Paine R, Johnston M, Ozhathil DK, Jeschke MG, Wibbenmeyer L, Galet C, Romanowski K
J Burn Care Res
· 2026 May · PMID 42176234
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Older adults make up a growing population of burn patients but pose unique physiological challenges that require specialized care. Comprehensive multicenter data are limited, and single-center studies lack the power to a...Older adults make up a growing population of burn patients but pose unique physiological challenges that require specialized care. Comprehensive multicenter data are limited, and single-center studies lack the power to answer key questions for this group. This study assessed the feasibility of forming an unfunded multicenter trial group to study older burn patients and piloted a retrospective study to explore trends in their care and their clinical outcomes. After Institutional Review Board approval and executing data use agreements, twelve North American burn centers collected standardized data on patients aged 60 and older treated from 2017-2019. Demographics, burn characteristics, interventions, and outcomes were gathered from each site's Burn Care Quality Platform (BCQP) submissions or Electronic Medical Record (EMR) and entered in a centralized REDCap database. Among the 1,632 patients included in the database, median age was 68 years; most were male (67%) and White (73%) with a median BMI of 27.5. Median burn size was 3.5% total surface area, and patients arrived a median of 4.7 hours post-injury. The median modified Baux score was 76.2. Patients typically underwent one operation within three days of arrival, leading to a median hospital stay of 6 days and ICU stay of 1 day. In-hospital mortality was 10.4%, and median time to wound healing was 40 days. This pilot demonstrates that an unfunded multicenter collaboration is feasible and can generate meaningful data to guide care for older burn patients. Strong inter-institutional collaboration and communication and standardized data definitions were key to success.
Carrarini MJ, Fedor CJ, Zein O
… +7 more, Liu HY, Arellano JA, Elias G, Corcos AC, Ziembicki JA, Yassin MH, Egro FM
J Burn Care Res
· 2026 May · PMID 42176191
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Infection is a leading cause of mortality in patients with third-degree burns, contributing to over 75% of burn-related deaths. Despite the widespread use of hypochlorous acid and mafenide acetate as wet dressings in bur...Infection is a leading cause of mortality in patients with third-degree burns, contributing to over 75% of burn-related deaths. Despite the widespread use of hypochlorous acid and mafenide acetate as wet dressings in burn care, direct comparisons of their effectiveness are limited. Thus, this study evaluates the relative efficacy of hypochlorous acid and mafenide acetate in managing infections and improving survival outcomes in postoperative burn patients. This retrospective study included adults with second and third-degree burns who underwent excision and grafting between January 2012 - February 2024 at an American Burn Association-verified burn center. Infection, mortality, length of stay, number of operations, and complications were compared across initial antiseptic treatment using chi-square and Mann-Whitney tests. The study cohort comprised 274 patients, the majority of whom sustained flame burns (63.1%), with an average total body surface area burned of 11.2±13.7%. Within the cohort, 88.7% received mafenide acetate and 11.3% hypochlorous acid. Thirteen patients (41.9%) who received hypochlorous acid developed an infection requiring antibiotics, which on average, took 6.85±5.71 days to develop. This was not statistically different from those in the mafenide acetate group, of which 90 patients (37.0%) developed an infection (p=0.5840) which took 6.50±8.47 days to develop (p=0.4436). Mortality was also not significantly different between groups. No significant differences were found between hypochlorous acid and mafenide acetate in infection, mortality, or morbidity outcomes. Both treatments are viable antiseptic options for postoperative burn care, and clinicians can be flexible in choosing either treatment based on patient needs, cost, or availability without compromising care quality.
Buchholz AE, Carter JE, Rivera-Barbosa MA
… +2 more, Schoen JE, Miles VP
J Burn Care Res
· 2026 May · PMID 42171667
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History is frequently recorded through statistics, in burn care, often as mortality rates and graft take percentages, yet the history of burn care is equally a narrative of human resilience and professional evolution. Th...History is frequently recorded through statistics, in burn care, often as mortality rates and graft take percentages, yet the history of burn care is equally a narrative of human resilience and professional evolution. This manuscript presents findings from the Burn Nursing Oral History Archive Project, which sought to preserve the historical identity of the specialty through the voices of its pioneers. By weaving together extensive interview transcripts with foundational historical texts, this project reconstructs the trajectory of burn nursing from the mid-twentieth century to the present. It identifies key historical inflection points, including pivotal mass casualty events and the formal recognition of burn nursing as a distinct specialty by the American Nurses Association in 2020. Qualitative analysis of interviews with sixteen accomplished burn nursing professionals reveals an evolution from bedside clinicians to leaders of interdisciplinary care and champions of prevention. The results are categorized into three distinct eras: the foundation period defined by compassion and moral dilemma, the modernization period focused on establishing protocols and survivorship, and the current era of professional validation through national certification. The findings argue that while clinical protocols and technologies have shifted dramatically, the foundational philosophy of humanistic, patient-centered care remains a constant thread. This archive serves as an impactful tool and call to action for future generations, anchoring current practice in the historical advocacy and compassion that define the specialty.
J Burn Care Res
· 2026 May · PMID 42166184
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Low- and middle-income countries (LMICs) bear a disproportionate burden of burn injuries compared to high-income countries (HICs), making LMIC representation and leadership in burn-related literature critical. This study...Low- and middle-income countries (LMICs) bear a disproportionate burden of burn injuries compared to high-income countries (HICs), making LMIC representation and leadership in burn-related literature critical. This study analyzed authorship patterns and temporal trends in LMIC participation across burn-specific journals. We analyzed 18,275 burn journal publications from 1982 to 2025 using the PubMed Entrez API, with metadata enriched using OpenAlex country affiliations. Country income classification followed World Bank 2025 definitions. LMIC involvement was defined as the presence of at least one LMIC-affiliated author on a publication. We assessed LMIC representation overall, by authorship position, collaboration type, and temporal period. Chi-square tests were used for temporal comparisons. Country affiliation data were identifiable for 8,348 publications (45.7%) representing 75 countries. Among publications, 26.2% (n=2,185; 95% CI: 25.2-27.1%) included at least one LMIC-affiliated author. LMIC researchers held first authorship in 25.7% and last authorship in 25.3% of publications, with identifiable country affiliation. However, this likely reflects LMIC-only publications rather than parity in HIC-LMIC collaborations. Notably, mixed HIC-LMIC collaborations comprised 3.5% of publications, with the majority being either HIC-only (73.8%) or LMIC-only (22.7%). LMIC representation increased significantly over time, from 13.5% pre-2000 to 31.7% between 2020-2025 (p<0.001). China (n=527), Iran (n=370), and India (n=247) were the leading LMIC contributors, representing 54% of LMIC publications. Representation from the African continent remained low at 3%. LMIC participation in burns research has increased over four decades, though HIC-LMIC collaboration remains limited. Initiatives to foster HIC-LMIC partnerships and empower LMIC authors to lead burns research may maximize collaborative efforts.
Kahn SA, Schulz J, Pham T
… +5 more, Bright AC, Bhavsar D, Bernal N, Sandoval S, Bertellotti R
J Burn Care Res
· 2026 May · PMID 42153543
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Following global Phase III trials, a single-arm expanded access program at 23 burn centers in the United States (2019-2024) provided centers with additional experience treating adult and pediatric burn patients with Nexo...Following global Phase III trials, a single-arm expanded access program at 23 burn centers in the United States (2019-2024) provided centers with additional experience treating adult and pediatric burn patients with NexoBrid and maintaining burn care preparedness for mass casualty incidents. Eligible patients included children (<18 years old) and adults (≥18 years old) with deep thermal burns covering up to 30% total body surface area. NexoBrid application was followed by standard care. Patients were monitored weekly until wound closure, and again after 3 and 12 months. Outcomes included incidence and time to eschar removal, need for surgical excision or escharotomy, length of hospital stay, wound closure, and Modified Vancouver Scar Scale. A total of 239 patients (215 adult, 24 pediatric) received NexoBrid, with 142 (131 adult, 11 pediatric) completing the 12-month follow-up. Mean ages were 41 and 11 years, respectively. Mean treated target wound area was approximately 6% of total body surface area, with 38 circumferential burns. Eschar removal was achieved in 95% of adults and 100% of pediatric patients within 4 hours. Surgical excision was performed in 4% of adults, but not in pediatric cases. No escharotomies were needed. Median length of stay was 10 days. Wound closure occurred by 22 days (adults) and 28 days (pediatric). Safety data were consistent with previous trials. NexoBrid demonstrated comparable outcomes versus previous Phase III trials and potential efficacy in preventing burn-induced compartment syndrome.
Grobowski J, Morumganti A, DeGrauw X
… +16 more, Qiu Q, Kaur S, Marincasiu C, Orton CM, Hodapp J, Kazis LE, Johnson MB, Kowalske K, Wiechman SA, Jason D, Sabel J, Hukill M, Wilkinson R, Carrougher GJ, Pham T, Stewart BT
J Burn Care Res
· 2026 May · PMID 42102185
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Advances in burn care have markedly improved survival after major injuries. However, survivors often experience significant physical and psychosocial sequelae. We aimed to characterize long-term health-related quality of...Advances in burn care have markedly improved survival after major injuries. However, survivors often experience significant physical and psychosocial sequelae. We aimed to characterize long-term health-related quality of life (HRQoL) among burn survivors to inform expected trajectories, rehabilitation needs, and common impairments. Adult burn survivors from a multicenter, longitudinal cohort study were stratified into 20-49.9%, 50-69.9%, and ≥70% total body surface area burn size groups. Patient-reported physical and mental HRQoL and life satisfaction were assessed using validated outcome measures at discharge (pre-injury recall), 6, 12, 24 months, and 5 years post-injury. Standardized summary scores were derived using validated bridges. Mixed-effects linear regression models evaluated longitudinal changes and between-group differences. A total of 1,113 participants were analyzed. All outcomes declined early after injury but improved progressively thereafter. Notably, by 24 months, mental health and life satisfaction approached pre-injury levels across all burn size groups. Physical health deficits were greater with increasing burn size, with significant net differences relative to the 20-49.9% reference group (p<.0001). Mental health and life satisfaction outcomes showed minimal between-group differences overall, though individuals with the largest burns exhibited significantly better relative mental health at 24 months (p<.05). Although outcomes improve over time following major burn injury, persistent physical deficits support the classification of major burns as a chronic condition. These findings characterize burn size-specific recovery trajectories and demonstrate that, despite persistent physical deficits, mental health and life satisfaction can return to near pre-injury levels even after the most extensive injuries.