Burns : journal of the International Society for Burn Injuries
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Randomized Controlled Trial
An analysis of deep vein thrombosis in burn patients (part II): A randomized and controlled study of thrombo-prophylaxis with low molecular weight heparin.
Morbidity and mortality from venous thrombo-embolism (VTE) remains a significant problem for trauma and medical patients and there are established guidelines for prophylaxis in these patients. However, the efficacy and safety of VTE prophylaxis in thermally injured patients continue to be elusive as it has never been studied in a prospective, randomized fashion. Selective use of VTE prophylaxis, for high risk patients, is practiced by some burn units even if objective evidence is lacking for majority of risk factors enunciated in burn patients. Differing demographics and wound management techniques are other confounding factors mandating more prospective studies to evaluate the need and role of chemoprophylaxis for deep vein thrombosis (DVT) prevention in burn patients. Ours is the first prospective, randomized, controlled study which seeks to identify risk factors for DVT in our patients, and evaluate the role of routine chemoprophylaxis and its complications. ⋯ With a moderate risk of developing DVT (8%) and a complication rate of only 2% with chemoprophylaxis, we feel that routine prophylaxis has the potential to decrease the incidence of VTE, without associated complications, in the moderate to high risk category.
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Review Meta Analysis
Systematic review and meta-analysis of complications and outcomes of obese patients with burns.
Obesity has been described as a factor that contributes to poorer outcomes and more severe complications in burned patients. We thus aimed to meta-analyse the literature present regarding the extent to which obesity contributes to the prevalence of various complications in burns. We searched MEDLINE, Science Direct and Web of Science for 363 articles. ⋯ Number of wound infections, number of burn operations and length of ICU stay were not found to be statistically different. We postulate that our significant findings are due to the proinflammatory state and poorer glycemic control in obese patients. As our review was limited by the few articles currently available in the literature, it is suggested that more studies of high quality be performed to better understand the implications of obesity in burns.
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Fatigue has been identified as an outcome of concern following burn but is rarely captured in outcomes studies. We aimed to: (i) describe the prevalence, and predictors, of moderate to severe fatigue in the first 12 months following burn, and (ii) establish the association between fatigue and health-related quality of life and work outcomes. ⋯ More than a quarter of participants reported moderate to severe fatigue on the BFI at 12-months and fatigue was strongly associated with poorer health-related quality of life and greater work-related disability.
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Negative pressure has been employed in various aspects of burn care and the aim of this study was to evaluate the evidence for each of those uses. ⋯ Negative pressure can improve autograft take when used as a bolster dressing. There is limited data to suggest that it may also improve the rate of revascularization of dermal substitutes and promote re-epithelialization of skin graft donor sites. Other uses suggested by studies that did not meet our inclusion criteria include improving vascularity in acute partial-thickness burns and as an integrated dressing for the management of large burns. Further studies are warranted for most clinical applications to establish negative pressure as an effective adjunct in burn wound care.