J Burn Care Res [JOURNAL]
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200 papers
Serial Casting as a Conservative Treatment for Adults with Upper Extremity Burn Contractures: A Prospective Longitudinal Study with a Criterion for Change.
Edger-Lacoursière Z, Calva V, Labonté V … +6 more , Leclerc IM, Schneider G, Vaillancourt A, Jean S, Marois-Pagé E, Nedelec B
J Burn Care Res · 2026 Jul · PMID 42400564 · Publisher ↗
Joint contractures and hypertrophic scars (HSc) are common complications following burn injuries, significantly impairing range of motion (ROM) and quality of life. While conservative interventions target either contract...
Joint contractures and hypertrophic scars (HSc) are common complications following burn injuries, significantly impairing range of motion (ROM) and quality of life. While conservative interventions target either contractures or HSc, serial casting (SC) is typically reserved for patients who fail traditional therapy or are nonadherent. The purpose of this study was to estimate the extent to which ROM (regular and revised passive and active), scar characteristics (objective and subjective), and patient-reported UE function changes following an individually tailored SC treatment program after switching from a minimum of 3 days of usual care. This study employed a prospective longitudinal intervention design with a criterion for change. Participants with upper extremity (UE) joint passive ROM (PROM) loss of >15% were included. Measures were taken at baseline, pre-SC, every Monday and Friday thereafter, and 3 weeks post-casting. The QuickDASH and Patient Scar Assessment Scale were evaluated at baseline and 3 weeks post-casting. Eleven individuals (13 joints) were included in this study. Regular PROM, revised PROM and AROM and scar thickness improvements were statistically significant. Participants reported improvements in UE function for 11/13 joints (median 16%, range 9-21%) and scar impression for all scars (median 6, 4-10). Participants also perceived that SC reduces their rehabilitation burden. In conclusion, when possible, SC should be prioritised to increase PROM, reduce HSc thickness, and enhance patient-perceived UE function and scar outcome.
White Phosphorus Burns: A Comprehensive Review over a Century of Evidence from "Willie Peter" to Modern Clinical Management.
Marchica P, Mangiameli L, Lombardo GAG
J Burn Care Res · 2026 Jul · PMID 42400563 · Publisher ↗
White phosphorus (WP) is a highly reactive incendiary agent capable of causing severe injuries through combined thermal combustion and chemical tissue damage, with potential systemic toxicity disproportionate to burn siz...
White phosphorus (WP) is a highly reactive incendiary agent capable of causing severe injuries through combined thermal combustion and chemical tissue damage, with potential systemic toxicity disproportionate to burn size. Although traditionally associated with warfare, accidental civilian exposures continue to occur, including in coastal environments where historical military residues may persist. This narrative review synthesizes over a century of evidence on WP burns, integrating findings from experimental studies, clinical reports, military experiences, environmental investigations, and toxicological analyses. A contemporary civilian case of accidental coastal exposure is included to illustrate ongoing non-combat relevance. Available evidence consistently identifies hypocalcemia, hyperphosphatemia, cardiac arrhythmias, renal injury, and hepatocellular damage as major systemic complications of WP exposure. Clinical reports show that retained particles may continue to oxidize and reignite upon oxygen exposure, requiring prompt decontamination, mechanical removal, metabolic monitoring, and repeated evaluation for residual material. Current evidence supports copious irrigation, oxygen exclusion with moist dressings, careful debridement, and avoidance of copper sulfate because of its systemic toxicity. The presented case highlights that even limited exposure may result in full-thickness burns requiring close observation despite minimal TBSA involvement. Despite over a century of reported experience, evidence guiding WP burn management remains fragmented and largely based on case reports and observational studies. The findings underscore the need for standardized clinical protocols, improved preventive strategies, and collaborative civilian-military approaches to advance recognition and management of this uncommon but potentially life-threatening injury.
The Politics of Pores: How Scarcity of Petrolatum Identifies Supply Chain Vulnerabilities in Burn Care.
Coward A
J Burn Care Res · 2026 Jul · PMID 42400559 · Publisher ↗
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Ultra-Early Mobilization After Split-Thickness Skin Grafting in Burn Patients Is Not Associated with Graft Loss.
Singson ME, Pinto DN, Wallace KF … +9 more , Woolhiser E, Marzo K, Le TD, Carney BC, Moffatt LT, Oh JG, Travis TE, Shupp JW, Tejiram S
J Burn Care Res · 2026 Jul · PMID 42391448 · Publisher ↗
Timing of mobilization following split-thickness skin grafting (STSG) in burn patients varies amongst burn centers, due to concerns for graft loss with earlier post-operative mobilization. Existing literature supports th...
Timing of mobilization following split-thickness skin grafting (STSG) in burn patients varies amongst burn centers, due to concerns for graft loss with earlier post-operative mobilization. Existing literature supports the feasibility of earlier mobilization after STSG but is limited in scope. This study aimed to explore the association between time to mobilization after STSG and graft loss, hypothesizing that ultra-early mobilization within 24 hours of STSG does not increase the risk of graft loss. Adult patients who underwent STSG for treatment of thermal burn injuries at an ABA-verified burn center from 2021-2024 were included. Each incident of STSG was categorized as ultra-early (≤24 hours) or late (>24 hours) mobilization. Mobilization cohorts were then compared by graft loss using an institutional grading scale, defined as graft loss >50% of the area grafted, requiring prolonged wound care, or requiring re-operation. Mobilization was defined as either passive or active movement. Of the 240 patients included, there were a total of 431 STSG. Of these, 69 patients were critically ill with a total of 193 STSG. Rates of graft loss were similar between groups (9% vs 9.2%; P =0.93). Neither ultra-early mobilization (OR, 0.59; 95% CI, 0.20-1.73; P = 0.33) or ambulation compared to in-bed exercises (OR, 1.41; 95% CI, 0.36-5.50; P = 0.62) increased the odds of graft loss. The findings suggest that ultra-early mobilization within 24 hours after STSG does not increase the risk of graft loss in burn patients, and out-of-bed ambulation does not increase the risk of graft loss compared to in-bed therapy.
Classification Systems & Clinical Outcomes of Axillary Burn Contracture: A Systematic Review & Meta Analysis.
Frigic GM, Yeh AJ, Kaulakis MG … +7 more , Fedor CJ, Tepe SM, Kim JS, Friedstat J, Odobescu A, Gillenwater J, Egro FM
J Burn Care Res · 2026 Jul · PMID 42384946 · Publisher ↗
Axillary burn contracture is a common and debilitating complication of burn injuries, impairing mobility and quality of life. Multiple classification systems and reconstructive techniques exist, but optimal management re...
Axillary burn contracture is a common and debilitating complication of burn injuries, impairing mobility and quality of life. Multiple classification systems and reconstructive techniques exist, but optimal management remains unclear due to limited systematic data comparing outcomes across techniques and classifications. A systematic review was performed. PubMed, Embase, and Web of Science were searched for full-text studies reporting surgical treatment of axillary contractures. Data extraction and quality assessment were performed independently by two reviewers. Outcomes were synthesized qualitatively, and recurrence rates were meta-analyzed using a random-effects model. Planned subgroup analyses by contracture type were not feasible due to inconsistent reporting. Of 1196 articles screened, 62 met inclusion criteria, encompassing 1602 patients. Most studies were observational. Formal classification systems were inconsistently applied; Kurtzman and Stern classification was the most common one (16.1%). Commonly reported surgical techniques included trapeze flap plasties (n = 277), skin grafting (n = 239), skin grafting with local flaps (n = 85), and Z-plasties (n = 85). Meta-analysis of 78 studies (855 reconstructions) demonstrated a pooled recurrence rate of 13.0% (95% CI:10.7;15.8), with no heterogeneity (I2 = 0%). Meta-regression suggested higher recurrence rates with longer follow-up. Functional outcomes improved across studies, with flap-based reconstructions demonstrating greater gains in abduction (≈82°) than skin grafting (≈52°). In conclusion, flap-based techniques appear to provide lower recurrence and superior postoperative range of motion compared to skin grafting. However, inconsistent classification, predominance of observational studies, and variable outcome reporting limit direct comparisons. Standardized classification, quantitative range of motion metrics, and minimum follow up durations are needed to guide evidence-based surgical selection.
Synthesis of Protocols for Frostbite Care from the FROST Study Sites.
Nygaard RM, Colonna E, Poole A … +11 more , Faucher LD, Paine RE, Sangji N, Lacey A, Bhavsar D, Colling K, Armour A, Fleming I, Wiktor A, Wibbenmeyer L, FROST multicenter study team
J Burn Care Res · 2026 Jul · PMID 42384943 · Publisher ↗
Frostbite injuries can have lasting sequelae including amputations, intolerance to cold, chronic pain, paresthesia, and inability to return to work. Despite this morbidity, the treatment of frostbite remains understudied...
Frostbite injuries can have lasting sequelae including amputations, intolerance to cold, chronic pain, paresthesia, and inability to return to work. Despite this morbidity, the treatment of frostbite remains understudied. The FRostbite ObServational Trial (FROST) aims to address this gap through a multicenter evaluation of treatment practices and outcomes. As part of FROST, we reviewed institutional frostbite care protocols from 16 participating sites across North America. Practices were categorized as demonstrating uniform agreement $\Big(\ge$90% mentioned the practice), consensus ($\ge$75%), or majority if ($\ge$50%). Uniform agreement was limited to use of rapid rewarming and thrombolytics, the latter being influenced by site selection criteria for FROST participation. Consensus was achieved in multiple areas (such as urgency of treatment, perfusion assessment, the therapeutic windows for pharmaceutical interventions, and the therapeutic dosing of IV thrombolytics). Protocols varied on grades for thrombolytic treatment initiation, prostacyclin analogue use, post-thrombolytic anticoagulation treatment and duration, the role of physical or occupational therapy, splinting, and appropriate wound care. This manuscript provides a synthesis of protocols and expert opinion for the acute management of frostbite injury. This synthesized protocol may serve as a tool for centers to develop their own standard protocol to facilitate care for frostbite patients. Additionally, current opportunities for frostbite research and improving care are detailed in the manuscript. Education regarding prevention of injury and the need for emergent treatment is needed for both the public and the medical community.
Identifying Risk Factors for Readmission amongst Unhoused Burn Patients.
Hammond VR, Yerramreddy S, Egger ME … +2 more , Smith JW, Bozeman MC
J Burn Care Res · 2026 Jun · PMID 42364174 · Publisher ↗
Previous studies have used national data to assess readmission risk factors for patients with burn injury. This study sought to identify risk factors for readmission amongst unhoused burn patients. The 2022 Nationwide Re...
Previous studies have used national data to assess readmission risk factors for patients with burn injury. This study sought to identify risk factors for readmission amongst unhoused burn patients. The 2022 Nationwide Readmissions Database, Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality, was used for this study. Patients with International Classification of Diseases Version 10 codes for burn or corrosive injury between January 1, 2022, to November 30, 2022, were included in analysis. Readmission was defined as a subsequent encounter within 30 days with a diagnosis of burn. 18,607 encounters were identified as index admissions, 1,130 (6.1%) were unhoused. 8.6% of unhoused patients (n=97) were readmitted with a diagnosis of burn injury compared to 5.2% (n=908) of housed patients (p<0.001). Risk factors for readmission for unhoused patients included a third-degree burn (OR 2.4, [1.4-4.2], p<0.001), leaving against medical advice (OR 4.1, [2.6-6.6], p<0.001), burn of the trunk (OR 1.9, [1.2-3.0], p<0.001), burn of the upper extremity (OR 1.9, [1.2-3.0], p<0.001), and burn of the lower extremity (OR 1.6, [1.0-2.6], p=0.004). Despite higher rates of diagnoses such as schizophrenia, bipolar disorder, alcohol abuse, and/or substance abuse in the unhoused population, these factors did not increase risk for readmission. Unhoused burn patients were at higher risk of readmission than housed patients, even when adjusting for other risk factors for readmission. Severity of injury, location of injury, and leaving against medical advice were associated with readmission amongst unhoused patients. Leaving against medical advice was a potentially modifiable risk factor identified for readmission risk mitigation in this study.
Family Income and Recovery Outcomes in Pediatric Burn Survivors: A Burn Model System National Database Study Assessing Functional and Psychosocial Differences.
Wang S, Pickering TA, Wiechman S … +4 more , Roaten K, Ryan CM, McMullen K, Yenikomshian HA
J Burn Care Res · 2026 Jun · PMID 42348733 · Publisher ↗
Children from lower income families are often disproportionately affected by burns, potentially experiencing greater psychosocial challenges. This study examines whether family income influences the ability of pediatric...
Children from lower income families are often disproportionately affected by burns, potentially experiencing greater psychosocial challenges. This study examines whether family income influences the ability of pediatric burn patients to return to baseline function. A retrospective study of pediatric patients (<18 years) from a multi-center longitudinal database between 2015 and 2024 was conducted. There were three cohorts of patients based on income level: <$50 k, $50 k - $100 k, and > $100 k. Return to school and psychosocial outcomes (PROMIS Depression, PROMIS Anger, PROMIS Peer Relationships, PROMIS Anxiety, PROMIS Pain Interference, PROMIS Family Relationships, Post-Traumatic Growth, Body Image, and Pain Intensity) were collected at 12 months after injury by individuals ages 8-17. The final sample consisted of 204 individuals: 115 with income <$50 k, 55 with income $50 k - $100 k, and 34 with income >$100 k. On average, the %TBSA burned was significantly higher (p < .001) and there was a greater incidence of inhalation injury (p = .03) in children with a family income of <50 k. There were no significant differences in any psychosocial outcomes or return to school (p = .40) after adjusting for %TBSA burned. These findings show that lower socioeconomic status does not necessarily impede recovery in pediatric burn survivors, and other factors such as social support may have greater impact on recovery. However, there is a need to address systemic inequalities that contribute to the disproportionate injury burden faced by children from lower income families.
LIBRE GO!: A Mobile Application for Longitudinal Social Participation Assessment and Resources Connection after Burn Injury.
Deng H, Frasco GL, Morris JT … +6 more , Acton A, Tenney-Laperriere D, Slavin MD, Kazis LE, Ryan CM, Schneider JC
J Burn Care Res · 2026 Jun · PMID 42348721 · Publisher ↗
Social participation is a long-term goal for individuals recovering from burns. However, individuals often face various challenges in this domain. The Life Impact Burn Recovery Evaluation (LIBRE) Profile is a validated p...
Social participation is a long-term goal for individuals recovering from burns. However, individuals often face various challenges in this domain. The Life Impact Burn Recovery Evaluation (LIBRE) Profile is a validated patient-reported outcome measure of social participation developed specifically for adults with burn injury. Measures are typically administered during clinic visits and using paper-based questionnaires, which limit access and timely connection with resources. This study describes the design, development, and pilot testing of LIBRE GO!, a mobile application that digitizes the LIBRE Profile to assess social participation and connects survivors with community-based resources. The design and development process employed an iterative and user-centered approach involving burn survivors, clinicians, technology experts, and researchers. The developed application comprises four primary functions: "Start a new LIBRE Survey", "My Scores", "Resources", and "About". Pilot testing was conducted with eight burn survivors, who rated the Acceptability of Intervention Measure (AIM), Intervention Appropriateness Measure (IAM), and Feasibility of Intervention Measure (FIM) and subsequently participated in focus groups to share feedback. Average scores for the AIM, IAM, and FIM were 4.13, 4.28, and 4.31 out of 5, respectively. Participants reported that the application was easy to use as a valuable tool for tracking social engagement and connecting with resources. Broad dissemination and use of LIBRE GO! will empower burn survivors and provide clinicians and researchers with an accessible and validated outcome assessment tool to support evidence-based approaches for improving social participation after burn injury.
Dorsal turnover adipo-fascial homo-digital flap, a versatile coverage solution for exposed fingers' dorsum.
Saad AS, Mousa MI, Moiemen NS … +7 more , Elhadidy M, Elready AAA, Gouda ME, Abdelgawad BA, Hemidan AG, Abdel-Wahed M, Saad AS
J Burn Care Res · 2026 Jun · PMID 42340341 · Publisher ↗
A cohort of eleven patients, presenting with fifteen fingers exhibiting soft tissue loss subsequent to trauma or burns, was included in this study. The defects ranged from 20 to 45 mm in length and appeared at various an...
A cohort of eleven patients, presenting with fifteen fingers exhibiting soft tissue loss subsequent to trauma or burns, was included in this study. The defects ranged from 20 to 45 mm in length and appeared at various anatomical sites on the dorsal aspect of the fingers. Coverage of exposed structures was achieved utilizing a local dorsal turnover adipo-fascial flap. Soft-tissue coverage was successfully obtained in all cases (n=15). Minor distal partial flap necrosis developed in 20% of procedures (n=3), which was managed effectively with conservative treatment. Partial split-thickness skin graft (STSG) loss occurred in cases with minor flap necrosis and in one additional instance, resulting in an overall incidence of 27% (n=4). All affected areas resolved without requiring secondary grafting. In summary, the dorsal turnover adipo-fascial flap serves as a technically straightforward reconstructive option, yielding satisfactory soft-tissue coverage and aesthetic results within this series. Although some distal flap-related complications occurred, they were limited and managed with conservative measures.
Artificial Intelligence and Algorithmic Bias in Burn Care: A Literature Review of Ethical Challenges.
Khorsandi J, Ahmed AB, Mirharooni J … +4 more , Kahen M, Ahdout J, Franzoni D, MacDavid J
J Burn Care Res · 2026 Jun · PMID 42340329 · Publisher ↗
Artificial intelligence (AI) is increasingly integrated into burn care for triage, burn-depth assessment, prognostic scoring, pain management, and telemedicine-enabled resource allocation. These tools promise greater eff...
Artificial intelligence (AI) is increasingly integrated into burn care for triage, burn-depth assessment, prognostic scoring, pain management, and telemedicine-enabled resource allocation. These tools promise greater efficiency and precision, yet raise substantial ethical concerns regarding transparency, accountability, and bias. This narrative review synthesizes literature from 2010 to 2025 on AI, predictive modeling, and digital tools in burn care, supplemented by evidence from critical care, emergency medicine, radiology, dermatology, and oncology. Systematic searches of PubMed, Embase, and Scopus identified studies that reported algorithm development or deployment and discussed or allowed inference about equity, fairness, or interpretability. Across medical domains, algorithms frequently misclassified outcomes for racial and ethnic minorities, socioeconomically disadvantaged patients, women, older adults, and individuals with complex comorbidities, while burn-specific models rarely evaluated subgroup performance or reported demographic composition. Common problems included unrepresentative datasets, opaque modeling pipelines, and the absence of formal bias audits. Ethical analyses were fragmented and seldom grounded in established frameworks of biomedical ethics or AI governance. This review argues that current trajectories risk embedding and amplifying inequities in an already vulnerable burn population. It proposes concrete strategies for fairness-oriented design, reporting, validation, and post-deployment monitoring, emphasizing justice, nonmaleficence, transparency, accountability, and stakeholder engagement. Responsible adoption of AI in burn care will require moving beyond technical performance alone toward explicit attention to equity and ethical safeguards throughout the model life cycle.
Verification Status, Rehabilitation Staffing, and Care Practices in U.S Outpatient Burn Clinics.
O'Neil AM, Parry IS, Murray DO … +5 more , Muraru RI, Holler E, Foster K, Spera L, Sen S
J Burn Care Res · 2026 Jun · PMID 42319065 · Publisher ↗
Skilled occupational and physical therapists (OT/PT) provide essential services during outpatient (OP) burn follow-up to support comprehensive long-term recovery. Although ABA verification promotes burn therapist (OT/PT)...
Skilled occupational and physical therapists (OT/PT) provide essential services during outpatient (OP) burn follow-up to support comprehensive long-term recovery. Although ABA verification promotes burn therapist (OT/PT) integration in OP burn clinics, barriers related to staffing, time, and space remain, and little is known about burn therapist integration post-discharge. This study examined the relationship between both verification status and use of burn therapy services in OP burn clinics with three aspects of follow-up care: clinic structure and staffing; rehabilitation access and care delivery models; and patient access, barriers, and continuity of care. A 20-question electronic survey was distributed to 125 U.S. burn centers. Fisher's exact and chi-square tests were used for bivariate analyses, and Firth penalized logistic regression for multivariable analyses. Responses were received from 54 centers (43%). Most centers were ABA-verified (61%), and 65% reported dedicated burn therapists in the OP clinic. In multivariable analysis, therapist presence was not independently associated with verification status but was significantly associated with burn surgeon-led reconstruction programs (OR = 4.19, p = .043) and presence of garment programs (OR = 8.58, p = .043). Holding verification status constant, presence of dedicated OP burn therapy staff was significantly associated with increased outpatient rehabilitation utilization, including higher odds of clinic-based burn therapy referrals (OR = 9.20, p = .002) and post- reconstruction burn therapy follow-up (OR = 3.66, p = .042). These findings suggest that verification supports the integration of therapists, but that therapist presence itself is a critical factor driving comprehensive long-term rehabilitation.
Therapy Driven Protocol: Early Ambulation for Lower Extremity Grafts.
O'Neil AM, Rush C, Griffard L … +4 more , Hartman B, Muraru RI, Holler E, Spera L
J Burn Care Res · 2026 Jun · PMID 42319025 · Publisher ↗
Early post-op ambulation benefits burn survivors by expediting return to functional independence, preventing bedrest complications, and shortening hospital admissions. Despite published practice guidelines supporting ear...
Early post-op ambulation benefits burn survivors by expediting return to functional independence, preventing bedrest complications, and shortening hospital admissions. Despite published practice guidelines supporting early ambulation, significant variability in practice continues among burn centers, ranging between 0-14 days post-op. A 3-year retrospective review was completed of this 15 bed, adult verified burn center, to identify 149 patients who underwent split thickness skin graft (STSG) placement and/or Autologous Skin Cell Suspension (ASCS) application to their lower extremities (LE). Patients unable to ambulate at baseline or died during admission were excluded. LE involvement ranged from 1-28% TBSA (Median: 5%). Autograft placement included 83% meshed (1:1-3:1) STSG (n=125), 14.8% ASCS (n=22), and 1.3% sheet STSG (n=2). Grafts crossed joints on 119 patients including the knee (n=58), ankle (n=57), and foot (n=41). Initial ambulation occurred between POD 1-3 (Avg 1.05) with gait distance ranging from 2 to 1,500 ft (Avg 125.4 ft). Twelve patients experienced minor graft loss, which healed conservatively. Additional analysis compared patients with and without graft loss. There was no significance associated between initial POD ambulation and graft loss. However, graft loss was significantly association with history of stroke (p=0.006), renal disorder (p =0.012), and previous amputation (p = 0.006). These findings suggest that, within a structured protocol, early ambulation as soon as POD 1 may be safely implemented without increased graft loss risk. Incorporating standardized mobility protocols, including use of compression and individualized clinical assessment, may help reduce practice variability and support earlier functional recovery in burn survivors.
Mental and Social Health Recovery after Major Burn Injuries: A Burn Model System Study.
Kaur S, DeGrauw X, Grobowski J … +14 more , Marincasiu C, Orton CM, Hodapp J, Kazis LE, Johnson MB, Kowalske K, Wiechman SA, Jason D, Sabel J, Hukil M, Wilkinson R, Carrougher GJ, Pham T, Stewart BT
J Burn Care Res · 2026 Jun · PMID 42308409 · Publisher ↗
Although survival after major burn injury is increasingly common, persistent psychosocial morbidity often remains prevalent, and the relationship between burn severity and long-term psychosocial recovery is less understo...
Although survival after major burn injury is increasingly common, persistent psychosocial morbidity often remains prevalent, and the relationship between burn severity and long-term psychosocial recovery is less understood. We aimed to evaluate longitudinal trajectories of mental health and social recovery across large burn-size strata to examine whether injury severity differentially influences internal psychological outcomes versus external social participation. We conducted a retrospective, multicenter longitudinal analysis of adults with ≥20% total body surface area burns enrolled in the Burn Model System National Longitudinal Database, using outcome measures available across their respective collection periods. Participants were stratified by total body surface area groups of large (20-49.9%), very large (50-69.9%), or massive (≥70%). Outcomes included Patient-Reported Outcomes Measurement Information System domains of Depression, Anxiety, and Ability to Participate in Social Roles; Community Integration Questionnaire-Social Integration; and employment status assessed at 6-, 12-, and 24-months post-injury. Mixed-effects linear regression models adjusted for demographic and clinical covariables. Among 815 participants, depression and anxiety remained elevated relative to population norms, while social participation improved across all burn sizes longitudinally. Survivors with massive burns demonstrated the greatest improvement in mental health over 24-months, with changes reaching clinically meaningful magnitude, and their community integration at 24-months was comparatively preserved, coming closest to pre-injury burn levels despite lower perceived social role ability and employment. These findings demonstrate that psychosocial recovery over the first 24-months does not worsen in proportion to injury severity, indicating that injury severity alone should not define prognosis. Rather, survival and rehabilitation after massive burn injury can translate into meaningful psychological adaptation and social integration that benefits from sustained, multidisciplinary follow-up across all burn severities.
Association Between Cutaneous Functional Units and Impairment Ratings After Burn Injury.
Andrade MF, Kelly J, Mukherjee R … +2 more , Mittal R, Kahn SA
J Burn Care Res · 2026 Jun · PMID 42308400 · Publisher ↗
Burn injuries can cause lasting functional impairment, often requiring formal impairment ratings for workers' compensation cases. Cutaneous functional units (CFUs), which represent skin areas involved in single-joint mot...
Burn injuries can cause lasting functional impairment, often requiring formal impairment ratings for workers' compensation cases. Cutaneous functional units (CFUs), which represent skin areas involved in single-joint motion, may better capture functional impact than total body surface area (TBSA), yet they are not included in current impairment rating guidelines. This study evaluated relationships between initial TBSA, initial CFUs, final scar CFUs, and impairment ratings, hypothesizing that scar burden measured by CFUs would be strongly associated with impairment. A retrospective review was conducted of 78 burn patients with photographically documented TBSA and whole-body impairment ratings at maximum medical improvement at The South Carolina Burn Center at the Medical University of South Carolina. Initial CFUs were calculated from injury photographs using a previously established CFU map, and scar CFUs were calculated from scar photographs obtained at the time of impairment rating. Associations between TBSA, CFUs, and impairment ratings were assessed using Spearman's rho. Initial TBSA was significantly correlated with initial CFUs (rho = 0.471, p < 0.001) and more strongly correlated with scar CFUs (rho = 0.541, p < 0.001). Initial TBSA was also significantly correlated with impairment ratings (rho = 0.418, p = 0.002). Both initial CFUs (rho = 0.307, p = 0.006) and scar CFUs (rho = 0.569, p < 0.001) were significantly associated with impairment, with scar CFUs demonstrating the strongest relationship. These findings suggest that scar CFUs may represent a clinically relevant correlate of impairment ratings and warrant further prospective evaluation.
A Gap in Knowledge: Patient Perspectives and Barriers to Sunscreen Use after Burn Injury.
Wang S, Johnson D, Flores E … +5 more , Celie KB, Lee KH, Gillenwater J, Johnson MB, Yenikomshian HA
J Burn Care Res · 2026 Jun · PMID 42308397 · Publisher ↗
Burned skin remains highly sensitive to ultraviolet (UV) radiation for years after injury, increasing the risk of damage, pigmentary changes, and carcinogenesis. Although sun protection is crucial, many burn survivors ar...
Burned skin remains highly sensitive to ultraviolet (UV) radiation for years after injury, increasing the risk of damage, pigmentary changes, and carcinogenesis. Although sun protection is crucial, many burn survivors are unsure of necessary measures or how to incorporate them into daily life. This study evaluated survivors' knowledge and use of sun protection to inform future educational efforts. A cross-sectional survey was conducted at a Level 1 ABA-verified burn center from June-September 2025. Adult burn patients attending outpatient clinic visits completed a seven-item survey assessing sunscreen use on burn scars, type of sunscreen used, and barriers to adherence. A total of 50 patients were surveyed. The majority of patients were English-speaking (n = 35, 70%). On a scale of 0-10, with 10 being the most important, 68% (n = 34) of patients rated their perceived importance of sunscreen use on burn scars between 7 and 10, but only 28% (n = 14) applied it to healed burn wounds. Sunscreen use on scars was significantly lower among Spanish-speaking patients (6.7%) compared to English-speaking patients (37.1%) (p = .04). The most common reasons for not applying sunscreen were a lack of awareness (n = 13, 36%) and the belief that it was not necessary (n = 9, 25%). Over half of the participants (n = 29, 58%) reported that their healthcare team had not informed them of sunscreen use at prior appointments. Despite recognizing its importance, many burn survivors do not consistently practice sun protection, suggesting a need for reinforced education strategies to improve long-term skin protection.
Teen Perspectives in Burn Recovery: Coproduction for a New Outcome Tool Measuring Interpersonal Relationships and Social Interactions.
McLaughlin SJ, Slavin MD, McGwin MB … +8 more , Farahvash Y, Patel KF, Romanowski KS, Schneider JC, Murphy JM, Stoddard FJ, Kazis LE, Ryan CM
J Burn Care Res · 2026 Jun · PMID 42296008 · Publisher ↗
Adolescence is a period of major developmental and social change, and when coupled with the challenges of burn injuries, it can significantly affect social interactions and relationships. To develop a burn-specific outco...
Adolescence is a period of major developmental and social change, and when coupled with the challenges of burn injuries, it can significantly affect social interactions and relationships. To develop a burn-specific outcome measure for teens, the Teen-Aged Life Impact Burn Recovery Evaluation (TA-LIBRE12-19) was created. This study details the qualitative analysis of transcripts from teen burn survivors used to co-produce an item pool related to Interpersonal Interactions and Relationships. Stakeholder focus groups involving teens were conducted to identify key outcomes relevant for assessing burn recovery. Participants shared their perspectives on how burns impact their lives, with discussions continuing until thematic saturation was reached. Identified themes were assigned to pre-established domains, and new items were generated from recurring concepts not captured in existing instruments. Two focus groups were conducted with seven teen burn survivors. The median age was 13.8 years (IQR 12.1-16.3), and 71% were female. Half of the burns were fire/flame-related, with a median time since injury of 5.5 years (IQR 0.5-12.1) and a median burn size of 20% total body surface area (IQR 0.3-60). Novel concepts from teen burn survivors produced 28 new items. The final Interpersonal Interactions and Relationships subdomain is comprised of 51 items, 45.1% (n=23) from legacy instruments and 54.9% (n=28) newly developed from teen input. Including burn survivors' voices in developing the TA-LIBRE12-19 highlights the importance of co-production. Over half of the items originated from qualitative input, ensuring the instrument reflects relevant, patient-centered outcomes for teen burn recovery.
Development of Short Forms of the Preschool Life Impact Burn Recovery Evaluation 1 to 5 years.
McGwin M, Ni P, McLaughlin S … +8 more , Murphy JM, Stoddard FJ, Palmieri T, Branski L, Slavin MD, Schneider JC, Kazis LE, Ryan CM
J Burn Care Res · 2026 Jun · PMID 42296002 · Publisher ↗
The Preschool Life Impact Burn Recovery Evaluation Computer Adaptive Test was developed using Rasch methods and computer adaptive testing technologies to assess burn recovery among children aged 1-5 years. To enhance acc...
The Preschool Life Impact Burn Recovery Evaluation Computer Adaptive Test was developed using Rasch methods and computer adaptive testing technologies to assess burn recovery among children aged 1-5 years. To enhance accessibility in settings without advanced computer technology, this study developed Short Forms. Calibration data from the Preschool Life Impact Burn Recovery Evaluation item bank were used for short-form item selection. Items were iteratively added to maximize test information function, with reliability constrained to ≥0.8. Differential item functioning was evaluated, and Cronbach's alpha and score correlations were used to assess internal consistency and validity. Data were obtained from 500 parents of burn survivors (mean ± SD age = 3.0 ± 1.4 years; 55.2% male; mean total body surface area burned = 4.2%; mean time since burn = 1.1 years). Three 10-item short forms were developed for Communication and Language, Physical Functioning, and Emotional Well-being. Differential item functioning analyses indicated the need for age-specific Communication and Language forms (>3 years and ≤3 years). Across all short forms, ceiling effects were ≤15% and floor effects <1%. Marginal reliability ranged from 0.74 to 0.90, Cronbach's alpha from 0.86 to 0.90, and correlations with the full item bank from 0.97 to 0.98. The short forms demonstrated strong psychometric properties and minimal measurement bias. The short forms approximate the computer adaptive test score for each scale and are a part of the Preschool Life Impact Burn Recovery Evaluation Profile, offering a practical and valid assessment of recovery outcomes in preschool-aged children with burn injuries.
Data After Death: Post-Mortem Ethics of Burn Patient Records and Images.
Khorsandi J, Mansoury B, Blank L … +4 more , Ahmed AB, Alkhouri S, Cataldo K, MacDavid J
J Burn Care Res · 2026 Jun · PMID 42286915 · Publisher ↗
Burn care frequently relies on extensive documentation, including graphic photographic images and detailed clinical records. While these materials are essential for diagnosis, treatment planning, and research, their use...
Burn care frequently relies on extensive documentation, including graphic photographic images and detailed clinical records. While these materials are essential for diagnosis, treatment planning, and research, their use after a patient's death raises complex ethical questions. The emergence of new technologies such as artificial intelligence training, alongside the increased visibility of burn images in education and public health campaigns, challenges traditional notions of confidentiality and consent. This narrative review examines the ethical boundaries of using burn patient records and images post-mortem, with a focus on emerging concerns around digital remains and posthumous consent. A narrative review of peer-reviewed literature, professional guidelines, and position statements published between 2000 and 2025 was conducted. Sources included PubMed, Scopus, and Google Scholar, using search terms such as "burn injuries," "medical photography," "post-mortem consent," "digital remains," and "medical ethics." Relevant publications addressing clinical practice, teaching, research, and social media use in burn care were synthesized to identify key ethical themes and gaps. The literature reveals that while ethical frameworks for consent, privacy, and confidentiality are well established during life, guidance becomes inconsistent once the patient has died. A small but growing body of scholarship identifies posthumous privacy as an emerging domain of bioethics. Across studies, concerns included dignity after death, risks of re-identification on digital platforms, and the absence of explicit patient directives regarding posthumous use of images and data. Current medical guidelines provide minimal direction, leaving ambiguity for clinicians and researchers. The ethical use of burn patient images and records after death remains underexplored, particularly in the context of AI training datasets and social media awareness campaigns. The absence of consensus underscores the need for professional societies to establish clearer policies and protocols that honor patient dignity beyond life. Establishing standards for posthumous consent will help clinicians, educators, and researchers navigate the evolving landscape of digital medicine responsibly.
Serum Albumin on Admission: A Prognostic Marker of Morbidity and Mortality in Burns? A Systematic Review and Meta-Analysis.
Ye TTS, Sajeenth Vishnu K, Dahil A … +2 more , Stewart G, Bache SE
J Burn Care Res · 2026 Jun · PMID 42275083 · Publisher ↗
Albumin is essential for maintaining oncotic pressure and vascular integrity. In burn injuries, increased capillary permeability leads to hypoalbuminaemia, which is a recognised marker of poor outcomes in critical illnes...
Albumin is essential for maintaining oncotic pressure and vascular integrity. In burn injuries, increased capillary permeability leads to hypoalbuminaemia, which is a recognised marker of poor outcomes in critical illness. However, its prognostic value in acute burn care remains underexplored. This study evaluated the prognostic value of admission serum albumin in predicting mortality, acute kidney injury (AKI), hospital and intensive care unit (ICU) length of stay, ventilatory requirements, sepsis, and pulmonary infection in burn patients. A systematic search of PubMed, Scopus, Cochrane Library, Web of Science, MEDLINE, and Embase was conducted. Of 5,587 studies screened, 19 were included in the systematic review and 9 in the meta-analysis. Statistical analysis was performed using RStudio, with pooled outcomes reported as odds ratios (OR), standardised mean differences (SMD), and hierarchical summary receiver operating characteristic (HSROC) curves. Heterogeneity was assessed using Cochran's Q, I2, and Tau.2 Hypoalbuminaemia on admission was significantly associated with increased mortality during admission (OR 9.51; 95%CI 3.04-29.78; I2 49.3%). Admission hypoalbuminaemia was also associated with an increased risk of AKI (OR 2.83; 95%CI 2.49-3.22; I2 0%). Evidence for other outcomes was limited and heterogeneous. Admission serum albumin appears to be a valuable prognostic marker in burn patients, particularly for mortality and AKI. Further research is required to support its integration into burn-specific risk models, characterise albumin trends within the first 24 hours post-injury, and establish optimal cut-off values.
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