Burns : journal of the International Society for Burn Injuries
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'Fluid creep' or excessive fluid delivered to burn patients during early resuscitation has been suggested by several studies from individual burn centers. ⋯ Higher resuscitation volumes compared to Parkland estimates were reported, but the trend of increasing resuscitation volumes over the last 30 years is not supported by regression of total fluid infused versus year of study. Mean 24h fluid infused for all studies was 5.2±1.1mL/kg per %TBSA. The mean 24h urinary output reported in 30 studies was 1.2±0.5mL/kg per hr. Burns with inhalation injuries (5 studies) received significantly more fluid than non-inhalation injured burn patients (5.0±1.3 versus 3.9±0.9mL/kg per %TBSA). Fluid infused and urinary outputs were similar for adults and pediatric patients. The most striking finding of our analyses was the great ranges of the means and high standard deviations of volumes infused compared to the original Baxter publication that introduced the Parkland formula CONCLUSIONS: These analyses suggest that burn units currently administer volumes larger than Parkland formula with great patient variability. Individual patient hourly data is needed to better understand the record of burn resuscitation and Fluid Creep.
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Hypertrophic scars in burn survivors are a major cause of morbidity but the development of evidence based treatments is hampered by the lack of objective measurements of these scars. The objective of our study is to investigate the most accurate parameters for objective scar assessment and to create a combination score to facilitate the use of a panel of objective scar measurement tools. ⋯ The objective parameters for the DSM II Colormeter, Cutometer and Dermascan high frequency ultrasound were all found to have moderate to strong ROC AUC values and combination of the Cutometer R0 and Dermascan scar thickness and intensity values can be used to create an objective global scar scale that can accurately differentiate patients with hypertrophic burn scarring from non-hypertrophic scars or normal skin.
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Influenza is a serious disease which can be life threatening. Patients with significant burns have reduced physiological reserve and are at risk both of incurring dangerous respiratory complications. In other susceptible patient groups the flu vaccine is used to reduce the risk of flu and lessen its effects. We aim to investigate whether there were any existing local and national trends in the use of flu vaccination in burns patients. Our second objective was to review any current evidence in the literature. ⋯ Through review of the literature on flu vaccination in immunocompromised patients we show how this could be extrapolated to patients with significant burns. We propose a guideline to aid in the decision to prescribe flu vaccine to patients with significant burns taking into account age, % TBSA burn and comorbidity. The decision to recommend the flu vaccine in this group should be considered on an individual basis. However, flu vaccination represents a simple, low-risk measure which could prevent the dangerous complications of influenza in an at risk group.