The health impact and economic cost of residential fires: protocol for a population-based cohort study using linked data

Dr Lara Harvey1,2, Ms Nargess Ghassempour3, Dr Kathy Tannous3,4

1Neurocience Research Australia, Sydney, Australia, 2School of Public Health and Community Medicine, UNSW, Sydney, Australia, 3Western Sydney University, Parramatta, Australia, 4Digital Health CRC, Sydney, Australia

Abstract:

Introduction

Australia has implemented best-practice fire prevention programs- including legislation requiring smoke alarms in every home. Despite this, residential fires remain a significant problem. In NSW (2010-2015) there were 23,700 reported residential fires, with an estimated 3,300 injuries and 115 deaths.[1] There is an urgent need for accurate data to identify high risk populations and to inform targeted prevention efforts.

Objectives

This study will address three main research questions: 1) What is the injury profile, service utilisation and outcomes for people exposed to a residential fire?; 2) Do these differ by type of fire, nature of injury, demographics, geographic location, or over time?; and  3) What are the total economic costs?

Methods and analysis

The study cohort includes all persons residing at an NSW residential address which experienced a fire between 1 January 2005-31 March 2015. Using linked person-level data from eight data sources, this study will provide a comprehensive picture of fire characteristics (nature of fire, functioning smoke alarm, alcohol consumption), first responder use (fire and ambulance services), health service utilisation (emergency department, hospital and specialist burns outpatient clinic use), outcomes (length of stay, re-admissions and mortality) and economic costs of residential fires.

Descriptive statistics will assess between group differences in incidence and outcomes, and negative binomial regression will analyse temporal trends. Costs will be calculated using financial codes for emergency department and hospital visits.

Ethics and dissemination

Ethics approval has been obtained and data linked. Dissemination mechanisms include engagement with policy stakeholders, production of policy relevant summary reports and scientific papers.

Reference:

[1] Fire and Rescue New South Wales. Submission to Commonwealth Senate Inquiry into Smoke Alarms. Submission 20. FRNSW; 2015.


Biography:

Lara is an injury epidemiologist with expertise in the analysis of large population-based administrative datasets. Her research areas of interest include population-based trends in injury and the evaluation of health care policies and safety-related regulations/legislation.

The efficacy of CUTICERIN® with or without a Regenerative Epithelial Suspension (RES™), on donor site pigmentation in children: The DRESSing Trial Protocol

Dr Anjana Bairagi1, Dr Bronwyn  Griffin1,2,3, Dr Zephanie Tyack1,4,5, Prof Steven McPhail4,5, Dr Dimitrios Vagenas6, Dr  Craig  McBride1,2,7, Prof  Roy  Kimble1,2,3,7

1Cenre For Children’s Burns & Trauma Research, South Brisbane, Brisbane, Australia, 2Pegg Leditschke Children’s Burns Centre, Queensland Children’s Hospital, Brisbane, Australia, 3School of Nursing & Institute of Health and Biomedical Innovation (IHBI), Queensland University of Technology, Brisbane, Australia, 4School of Public Health and Social Work & Institute of Health and  Biomedical Innovation, Queensland University of Technology, Brisbane, Australia, 5Centre for Functioning and Health Research, Metro South Health, Brisbane, Australia, 6Research Methods Group & Institute of Health and Biomedical Innovation IHBI, Queensland University of Technology, Brisbane, Australia, 7Faculty of Medicine, University of Queensland, Brisbane, Australia

Abstract:

Introduction:

Paediatric donor site wound (DSW) dyspigmentation is a common complication of a split thickness skin graft (SSG).  The constant visible reminder of the preceding traumatic injury is responsible for a child’s continued distress and remains a challenge for clinicians to treat.  The Regenerative Epithelial Suspension (RES™) prepared with the RECELL® Autologous Cell Harvesting Device, contains the fundamental cell components for human melanogenesis.  Whilst, RES™ has demonstrated improved pigmentation for patients with post burn leukoderma and vitiligo, the effectiveness of RES™ in paediatric DSW is poorly understood. The DRESSing trial aims to evaluate the efficacy of RES™ for managing pigmentation of childhood DSW.

Method:

A two-arm, parallel group, and single-centre randomised trial will be conducted. Eligible children (age < 16 years, n=40) requiring a SSG after an acute partial thickness burn will be randomised to either CUTICERIN® with or without RES™. Using DSW pigmentation at 12 months post-date of injury, a 5% significance level and power of 80%, a sample size of 20 patients per group will be required. Secondary outcomes (donor site re-epithelialisation time, pain, itch, scar severity, health-related quality of life, treatment satisfaction, dressing application ease and healthcare resource utilisation) will be assessed at 3, 6 and 12 months post- date of injury . There are no results, as this is a protocol.

Conclusion:

Paediatric DSW dyspigmentation affects the quality of life for burn survivors, especially children. This trial will add to the body of evidence regarding the efficacy of cell-based therapies in acute burns for managing pigmentation


Biography:

Dr Anjana Bairagi is a paediatric surgeon undertaking a PhD with the  Centre of Children’s Burns & Trauma Research Group. Her research is evaluating non-cultured autologous skin cell suspensions in the management of partial thickness burn injuries in children.

Comparison of different methods of compression for managing oedema following hand burn injury

Mr Dale Edwick1,2,3,4, Dr Dana Hince5, Mr Jeremy  Rawlins2,6, Professor Fiona  Wood1,2,7, Associate Professor Dale  Edgar1,2,3,4,7

1Fiona Wood Foundation, Murdoch, Australia, 2State Adult Burns Unit – Fiona Stanley Hospital, Murdoch, Australia, 3School of Physiotherapy – The University of Notre Dame Australia, Fremantle, Australia, 4Burn Injury Research Node – The University of Notre Dame Australia, Fremantle , Australia, 5Institute of Health Research – The University of Notre Dame Australia, Fremantle, Australia, 6Department of Plastic and Maxillofacial Surgery – Royal Perth Hospital, Perth, Australia, 7Burn Injury Research Unit – The University of Western Australia, Crawley, Australia

Abstract:

Background: Compression, a common treatment of choice for the management of oedema, is one intervention which is applied with little objective understanding of the optimal parameters of application or efficacy in a patient with an acute burn wound.

Aim: The aim of this study was to determine the effectiveness of different methods of compression for the management of hand oedema following burn injury. The hypothesis tested was: in acute hand burn injury, application of Coban will reduce oedema faster than an off the shelf compression glove.

Methods: A randomised control study of patients in the State Adult Burn Unit presenting with hand burn injury. Compression was randomised to one of two methods of application of Coban customised glove, or a third group receiving an off-the-shelf compression glove (control condition). Repeated volume measures of the hand were recorded using both water displacement volumetry, and a novel application of bioimpedance spectroscopy (BIS). The results were analysed using multi-level mixed effects regressions.

Results: Interim analysis on 79 patients (57 males) demonstrated significant reductions in hand volumes, using all compression methods. Both Coban applications resulted in increased rate of oedema reduction compared to the control glove (method x time interaction, p<0.0001 (BIS) and p=0.0099 (volumetry)).

Spiral application of Coban increased Rzero (impedance of extracellular fluid) by 11.9Ω (13.43%) (95% CI 10.14 to 13.66, p<0.0001). Pinch application of Coban decreased volume by 14.18mL (2.63%) (95% CI -15.71 to -12.64, p<0.0001).

Conclusion: Coban offers greater oedema reduction than off the shelf compression in acute burn wounds.


Biography:

Dale has been a Senior Physiotherapist in the State Adult Burns Unit at Fiona Stanley Hospital in Western Australia for the last 5 years. As part of his role as Clinical Research Fellow with the Fiona Wood Foundation, he is undertaking a PhD through the School of Physiotherapy at The University of Notre Dame Australia. His research is investigating proactive management of oedema following hand and minor burn injury, including the use of bioimpedance spectroscopy as an outcome measure.

Inequities in Burns Injuries for Aboriginal and Torres Strait Islander Children

Ms Courtney Ryder1,2, Dr Tamara Mackean1,2, Dr  Kate Hunter1, Associate Professor Kris Rogers1,3, Professor Belinda Gabbe4, Professor Andrew Holland5, Professor Rebecca Ivers1,2,6

1The George Institute, Newtown, Australia, 2Southgate Institute for Health, Society and Equity, Flinders University, Adelaide, Australia, 3The University of Technology Sydney, Broadway, Australia, 4School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia, 5School of Medicine, The University of Sydney, Westmead, Australia, 6School of Public Health and Community Medicine, UNSW, Sydney, Australia

Abstract:

Background

Health equity is the absence of avoidable health disparities. Equity variables as defined by PROGRESS-Plus (residence, ethnicity, gender and socioeconomic status (SES)), have been associated with burn incidence and severity in Australian children. We evaluated equity variables associated with burn characteristics and severity in Aboriginal and Torres Strait Islander children as compared to other Australian children.

Methods

Using Australian data from the Burns Registry of Australian and New Zealand (October 2009 – June 2018), retrospective analyses were conducted on, children aged <16 years with an acute burn presentation. Equity variables, burn characteristics and severity were examined through descriptive statistics. Significance was explored through X2 tests. Missing data were supplemented through multivariate imputation chained equations. All data were analysed through Stata 15.1. Indigenous research methods were used throughout.

Results

A total of 6980 patients were included. Male gender (61.0%), 1-4 years of age (52.9%), very low SES (57.2%) and primary cause from scalds (49.8%) were common in all Australian children. Aboriginal and Torres Strait Islander children made up 10.4% of the study group (compared to 6.0% of the total population) and were more likely to come from outer regional areas (29.0%), have full thickness burns (15.7%), with a hospital length of stay 4.8 days longer than other Australian children (4.59 days).

Conclusion

Equity differences exist between Aboriginal and Torres Strait Islander and other Australian children for burn characteristics and severity. This suggests inequities in both prevention programs and access to health services, which may benefit from targeted intervention.


Biography:

Courtney Ryder is a PhD student in the Injury Division at The George Institute. Her studies are part of the Coolamon study, understanding burn injuries in Aboriginal and Torres Strait Islander children: treatment, access to services and outcomes. For which she has a NHMRC postgraduate scholarship to investigate the trajectory of recovery, quality of life, parental resilience and economic impacts of Aboriginal and Torres Strait Islander families whose children are recovering from a burns injury. She is also a CI for on the NHMRC funded study, preventing falls in older Aboriginal people: the Ironbark trial. Ryder is seen as an emerging research leader in Aboriginal injury and rehabilitation, with a keen interest on equitable health outcomes for communities.

A pilot study on post-burn healing: Optimising scar outcome through the use of a silicone-based film-forming wound dressing

Fiona Poelchow1,2,  Rosemary Kendell2, Associate Professor Dale Edgar1,2,4,5, Winthrop Professor Fiona Wood1,2,3, Professor Jim Codde3

1Fiona Wood Foundation, Murdoch, Australia, 2State Adult Burns Unit, Fiona Stanley Hospital, Perth, Australia, 3Institute for Health Research, The University of Notre Dame Australia, Fremantle, Australia, 4Burn Injury Research Node, The University of Notre Dame Australia, Fremantle, Australia, 5School of Physiotherapy, The University of Notre Dame Australia, Fremantle, Australia

Abstract:

Introduction: Traditionally, silicone has been contra-indicated for application to unhealed wounds, however, in recent years, a new form of silicone has been developed that is suitable for application on non-epithelialised wounds, and claims to minimise patient symptoms.  Stratamed and StrataXRT are semi-occlusive, self-drying, transparent, bacteriostatic and inert silicone gels which form an invisible dressing layer that provides a moist wound healing environment which, in turn, may enable faster re-epithelialisation.

Objectives: To determine if early application of film-forming silicone products, a) reduces healing times; b) reduces patient pain associated with donor site and burns dressings; and, c) positively impacts the scar outcome.

Methods: Utilising a prospective, randomised, single-centre, double-blinded design, this pilot study will assess the efficacy of topical film-forming silicone in early wound care of acute burn wounds of non-surgical faces/neck burn and donor site wounds, compared with standard care.

Results: Patient recruitment commenced in November 2018.  To date, 34 participants have been recruited. This study is being completed as part of a Masters thesis by publication and will conclude mid 2021.

Discussion: The outcomes from this research could present a new opportunity for the earlier commencement of scar management in healing wounds and allow the continued use of silicone-based scar management in the event of wound breakdown.  For patients, this has the potential of a faster return to activities of daily living and improved quality of life.


Biography:

Fiona Poelchow is a Senior Occupational Therapist with over 20 years of clinical experience.  She has worked in the State Adult Burns Unit of Western Australia for the last 13 years and has recently undertaken a research project on the use of topical silicone in wound care.

Burn Wound Progression: A Histological Analysis of the Mechanisms Responsible

Mr Raymond Quan1,2,3, Prof Damien Harkin3, Dr Christine Andrews4, A/Prof Leila Cuttle1,2,3

1Centre for Children’s Burns & Trauma Research, Centre for Children’s Health Research, South Brisbane, Australia, 2Tissue Repair and Translational Physiology Program, Institute of Health and Biomedical Innovation, Kelvin Grove, Australia, 3School of Biomedical Sciences, Faculty of Health, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia, 4Mater Research Institute – The University of Queensland, South Brisbane, Australia

Abstract:

The classification of burn depth when assessing burn wounds is critical to determine the subsequent treatment and healing potential of the injury. Burns are known to be a dynamic environment where progression of damage may occur after the initial thermal insult to the skin, referred to as burn wound progression (BWP). To effectively assess burn depth and assign depth classification, the occurrence of wound progression must be considered. As the gold standard in burn depth assessment, histological staining is widely beneficial in identifying numerous pathological mechanisms present in burn wounds. To observe BWP, tissue was collected from scald and contact porcine burn wound models at 0, 1, 3, 5 hours and day 1, 3 and 7. Burn wounds which progressed in depth over time were chosen, varying from superficial-partial thickness to full thickness. These sections will be stained with H&E, Gomori Trichrome, Verheoff’s Van Gieson (VVG) stains to identify collagen denaturation, in addition to immunohistochemical stains; Lactate dehydrogenase (LDH), Caspase 3a and high mobility group box 1 (HMGB1) to identify cell necrosis and apoptosis. Through observing the various stains at differing time points, an accurate timeline of the mechanisms occurring in burn wounds, which may or may not contribute to conversion, can be constructed. Analysis of these stains will determine what processes can be identified to predict and influence BWP. By further understanding the processes that contribute to and cause BWP, we can explore treatments to limit progression and ultimately halt further injury to burn wounds


Biography:

Raymond graduated from a Bachelor of Biomedical Science and is currently a Biomedical Science Masters of Philosophy student at the Queensland University of Technology. Commencing in December 2018, Raymond’s research aims to further the understanding of the pathological mechanisms that occur in burn wounds and lead to progression.

Can we eliminate donor sites using dermal replacement matrices?

Miss Olivia McGifford1,2,3, Mr Jason Brown4, Mr  Peter Gillies4, Ms Rebecca Dawson4, Mr Damien  Harkin3, Ms Mia Woodruff5, Ms Leila Cuttle1,2,3

1Centre for Children’s Burns & Trauma Research, Centre for Children’s Health Research, South Brisbane, Australia, 2Tissue Repair and Translational Physiology Program, Institute of Health and Biomedical Innovation, Kelvin Grove, Australia, 3School of Biomedical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Australia, 4Professor Stuart Pegg Adult Burns Centre, Royal Brisbane Women’s Hospital, Herston, Australia, 5School of Chemistry, Physics, Mechanical Engineering, Biomedical Engineering and Medical Physics, Science and Engineering Faculty, Queensland University of Technology, Brisbane, Australia

Abstract:

In Australia, approximately 2,000 children per year are hospitalized due to burn injuries. In Queensland alone, more than 500 adult patients are treated for burns each year at the Royal Brisbane Women’s Hospital. Split-thickness skin grafts (STSG) are the main surgical treatment for deep partial or full thickness burn wounds, however this involves transplanting normal skin from a donor site elsewhere on the patient. Cultured epithelial autografts (CEA), which are grown from patient cells, can be used to cover the donor site, however they are fragile, have low shear resistance and can have a poor take rate. We propose that there may be a way to reduce, if not eliminate, the need for a donor site by using CEA combined with dermal replacement matrices (DRM). In this study, we will optimize the properties of the DRM to support the growth of CEA, patient cells, or a combination of CEA and patient seeded cells. Different cell seeding techniques will be trialled for optimal cell attachment and growth. The localization and migration of the seeded cells will be visualised using different antibodies (Keratin 6 or 14 for keratinocytes and Vimentin for fibroblasts) on both the DRM and on de-epidermised human skin as a control. This project aims to develop a graft substitute that mimics and is as effective as a traditional STSG. This will provide the surgeon with an extensive supply of replacement skin to autograft and save the patient from painful donor sites.


Biography:

Studied Biomedical Science, majoring in anatomy and minoring in human physiology and cell and molecular bioinfomatics, graduated with distinction. Graduated with first class honours last year.

Effectiveness of a Hydrogel Dressing as an Analgesic Adjunct to First Aid for the Treatment of Acute Paediatric Burn Injuries

Ms Maleea D Holbert1,2,3, Dr Bronwyn R Griffin1,3,4, Professor Steven M McPhail5,6, Professor Roy M Kimble1,2,3

1Centre for Children’s Burns and Trauma Research, Child Health Research Centre, South Brisbane,, 4101, 2Faculty of Medicine, The University of Queensland, St Lucia,, 4067, 3Pegg Leditschke Paediatric Burns Centre, The Queensland Children’s Hospital, South Brisbane,, 4101, 4Faculty of Health, School of Nursing, Queensland University of Technology, Kelvin Grove,, 4059, 5Centre for Functioning and Health Research, Metro South Health, Brisbane,, 4102, 6School of Public Health and Social Work, and Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane,, 4059

Abstract:

Hydrogel dressings have gained widespread use in the prehospital setting for acute burn injuries, with anecdotes to suggest these dressings provide analgesia via an evaporative cooling effect (Fein et al. 2014). A prospective randomised controlled trial was undertaken comparing Burnaid® hydrogel dressing to plasticised polyvinylchloride film. Paediatric patients (≤16 years) presenting to the Emergency Department at the Queensland Children’s Hospital, Brisbane, Australia, with an acute thermal burn (<20% total body surface area) were approached for participation in the trial from September 2017 – September 2018. Patients were randomised to receive either (1) Burnaid® hydrogel dressing (Intervention) or (2) Plasticised polyvinylchloride film (Control) as an acute burn dressing following appropriate first aid. Repeated measures of pain, stress, and re-epithelisation were collected at burn dressing changes until 95% wound re-epithelialisation occurred. Seventy-two children were randomised and included for analysis (n = 37 Intervention; n = 35 Control). No significant differences in pain scores were found between children who received Burnaid® and those who received plasticised polyvinylchloride film. Mann-Whitney U tests revealed no significant group differences in nursing or caregiver observational pain scores (p = 0.44 and p = 0.96, respectively). Child self-report pain scores showed no significant group differences for pre- and post- acute dressing application (p = 0.95). Moreover, no significant differences in heart rate (p = 0.41), temperature, (p = 0.31) or re-epithelialisation rates (p = 0.26) were found between the two groups. A clear benefit of Burnaid® hydrogel dressing as an analgesic adjunct to first aid was not identified in this analysis.

References

Fein, M, Quinn, J, Watt, K, Nichols, T, Kimble, R & Cuttle, L 2014, ‘Prehospital paediatric burn care: New priorities in paramedic reporting’, Emergency Medicine Australasia, vol. 26, no. 6, pp. 609-615.


Biography:

Maleea Holbert is a PhD Candidate at the Centre for Children’s Burns and Trauma Research, at The University of Queensland, Australia. Her current research focuses on reducing acute pain in children that have sustained a thermal burn injury. More specifically, she is examining the effectiveness of a hydrogel burn dressing as an analgesic adjunct to first aid for the treatment of acute paediatric burn injuries, in comparison to the current recommended acute wound covering (plasticised polyvinylchloride film).

About ANZBA

ANZBA is a not for profit organisation and the peak body for health professionals responsible for the care of the burn injured in Australia and New Zealand. ANZBA encourages higher standards of care through education, performance monitoring and research.

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