Characteristics and Management of Burns in Older Adults

Dr Lincoln Tracy1, Ms Yvonne Singer2, Ms Rebecca Schrale3, Ms Jennifer Gong1, Professor Fiona Wood4, Ms Anne Darton5, A/Prof Dale Edgar6,7, Rochelle Kurmis8, Miss Heather Cleland2, Professor Belinda Gabbe1,9

1School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia, 2Victorian Adult Burns Service, The Alfred, Melbourne, Australia, 3Tasmanian Burns Unit, Royal Hobart Hospital, Hobart, Australia, 4Burn Injury Research Unit, University of Western Australia, Perth, Australia, 5NSW Agency for Clinical Innovation Statewide Burn Injury Service Network, St Leonards, Australia, 6State Adult Burn Unit, Fiona Stanley Hospital, Murdoch, Australia, 7Burn Injury Research Node, The University of Notre Dame, Fremantle, Australia, 8Adult Burns Service, Royal Adelaide Hospital, Adelaide, Australia, 9Heath Data Research UK Institute, Swansea University Medical School, Swansea, Wales

Abstract:

Introduction: Burn injuries affect people of all ages, but less research has focused on burns in older adults. This is an important area given the projected increases in the proportion of older adults in our region over the next 30 years. This study aimed to provide information about the characteristics and surgical management of older adult burns patients in Australian and New Zealand.

Methods: Data from adult admissions (≥ 18 years) collected from burn centres across Australia and New Zealand between July 2009 and December 2018 were extracted from the Burns Registry of Australia and New Zealand. Admissions were stratified based on their age: young adult (18-34 years), middle age (35-64 years), and older adult (65+ years).

Results: There were 17,829 admissions over the study period, with 2,398 (13%) aged ≥ 65 years. Compared to young/middle aged adults, a larger portion of older adults were female (38%), and received a scald (41%). Median total body surface area (%TBSA) did not differ between age groups (3% for all groups), but a larger proportion of older adults had deeper burns (63%). A larger proportion of older adults (26%) underwent multiple debridement procedures compared to young/middle aged adults (24%).

Discussion & Conclusion: Older adults with a burn injury sustained their burn in different ways and settings compared to young/middle aged adults and received different surgical management. The findings from this study can be used to improve planning and care processes in older burn injured patients.


Biography:

Dr Lincoln Tracy is a Research Fellow in the School of Public Health and Preventive Medicine at Monash University, working on the Burns Registry of Australia and New Zealand.

Does chemoprophylaxis prevent venous thromboembolism in burns patients? Findings from the Burns Registry of Australia and New Zealand

Dr Lincoln Tracy1, Professor Peter Cameron1,2, Ms Yvonne Singer3, Associate Professor Arul Earnest1, Miss Heather Cleland2, Professor Belinda Gabbe1,4

1School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia, 2Emergency and Trauma Centre, The Alfred , Melbourne, Australia, 3Victorian Adult Burns Service, The Alfred , Melbourne, Australia, 4Heath Data Research UK Institute, Swansea University , Swansea, Wales

Abstract:

Introduction: While venous thromboembolism (VTE) events are a significant risk for all hospitalised patients, patients with burn injuries are considered to be at a particularly high risk of VTE. This study aimed to quantify the variation in prevalence of VTE prophylaxis use in patients in Australian and New Zealand burns units and whether variation impacts on in-hospital mortality following burn injury.

Methods: Data from adult (≥ 16 years) admissions collected from 12 adult burn centres across Australia and New Zealand between July 2016 and December 2018 were extracted from the Burns Registry of Australia and New Zealand. Admissions were stratified based on whether or not they received VTE prophylaxis.

Results: There were 5,848 admissions over the study period. Ninety-one percent of admissions had a valid response to the VTE prophylaxis data item; 64% of which received some form of VTE prophylaxis. Use of VTE chemoprophylaxis varied between specialist burns units, ranging from 5 to 90%. Mortality following burn injury was low (< 1%), but there was no difference in the proportion of deaths in patients that did and did not receive VTE prophylaxis.

Discussion & Conclusion: Despite widespread variation in the use of VTE prophylaxis in Australian and New Zealand burns units, the in-hospital death rate was similar between VTE prophylaxis groups. Further investigation and analysis, including examining non-fatal VTE events, is required.


Biography:

Dr Lincoln Tracy is a Research Fellow from the School of Public Health and Preventive Medicine at Monash University. Dr Tracy researches a range of burn-related topics using data from the Burns Registry of Australia and New Zealand (BRANZ).

An Update on BQIP: Driving Improved Burn Care Through Registry Data

Dr Lincoln Tracy1, Ms Yvonne Singer2, Ms Jennifer Gong1, Miss Heather Cleland2, Professor Peter Cameron1,3, Professor Fiona Wood4, Ms Tracey Perrett5, Professor Belinda Gabbe1,6

1School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia, 2Victorian Adult Burns Service, The Alfred, Melbourne, Australia, 3Emergency and Trauma Centre, The Alfred, Melbourne, Australia, 4Burn Injury Research Unit, University of Western Australia, Crawley, Australia, 5New Zealand National Burns Centre, Auckland, New Zealand, 6Health Data Research UK Institute, Swansea, Wales

Abstract:

In recent decades, research and advances in treatment have contributed to significant improvements to burn care, and the quality of life following injury. Nevertheless, significant evidence gaps and high variations in clinical practice remain; the effects of which are largely unknown. The Burn Registry of Australia and New Zealand (BRANZ) collects data on patients admitted to all 17 Australian and New Zealand specialist burns units regarding burn injury, pre-existing conditions, clinical quality indicators, and in-hospital outcomes. As such, the BRANZ is an ideal platform to close knowledge gaps and inform best practices.

A successful grant from the HCF Research Foundation in late 2017 has allowed for a detailed analysis of BRANZ data to quantify practice variation and establish if, and how this variation impacts patient outcomes. This is an important piece of work as it sets the standard for the future, and will drive quality improvement initiatives and the development of best practice guidelines with great potential to improve the quality of burn care and patient outcomes in the region.

This presentation will summarise key findings from the final stage of data analysis. The implications of the final data analysis will be discussed, and we will present the necessary next steps to use BRANZ data and the binational Burn Quality Improvement Program as quantitative bases to drive improvements in burn care and patient outcomes.


Biography:

Dr Lincoln Tracy is a Research Fellow from the School of Public Health and Preventive Medicine at Monash University. Dr Tracy researches a range of burn-related topics using data from the Burns Registry of Australia and New Zealand (BRANZ).

Exposing the Secret World of Paediatric Burn Wound Exosomes

Dr Tony Parker1,2, Mr Yong Qinkoh3, Ms Erika Weinefors4, Ms Kanchan Vaswani2,3, Dr Tuo Zang1,2, Dr Daniel  Broszczak1,2, Professor Murray Mitchell1,2,3, Associate Professor Leila Cuttle1,2,3

1Tissue Repair and Translational Physiology Program, Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia, 2School of Biomedical Science, Faculty of Health, Queensland University of Technology, Brisbane, Australia, 3Centre for Children’s Burns and Trauma Research, Centre for Children’s Health Research, Brisbane, Australia, 4Chalmers University, Gothenburg , Sweden

Abstract:

Burn wounds in children result in significant and long lasting physical and emotional impacts which require repeated surgeries and rehabilitation efforts well into adulthood. Burn wound treatment involves de-roofing of burn blisters, however, little attention has been paid to the composition of the blister fluid and if the constituents are beneficial to burn wound healing or not. We recently found significant differences in the protein composition of burn blister fluid from burns of different depths. Importantly, some of the most significantly over-represented proteins in burn blister fluid suggest a high abundance of small extracellular vesicles (EVs) such as exosomes. Exosomes from other body fluids are known to facilitate intercellular communication and modulate cellular function though the transfer of biomolecules between cells. Despite this knowledge, burn blister fluid exosomes and their biomolecular cargo have not been previously described or characterised.

Therefore, our aim was to isolate and to perform a basic characterisation of burn wound blister fluid exosomes.

Blister fluid exosomes were isolated by a combined ultracentrifugation and size exclusion chromatography approach. They were characterized by the expression of known exosomal markers (immunoblotting), morphology (transmission electron microscopy), and size distribution (Nanoparticle tracking analysis).

We were able to successfully isolate burn wound blister fluid exosomes and perform basic characterisation studies. This is the first time exosomes have been isolated from paediatric burn wound blister fluid. Further characterisation and functional studies will determine the effect of these exosomes on the cellular microenvironment of burn wounds.

Burn blister fluid exosomes and their biomolecular cargo have not been previously described nor their function on skin cells examined. This study represents the first examination of burn wound exosomes. Further examination will determine if these extracellular elements represent a new therapeutic opportunity for children’s burns as they have in other diseases and conditions.


Biography:

Dr Parker has over 15 years of experience in tissue injury, wounds and tissue engineering research. During his bachelor degree he majored in biotechnology and biochemistry, and holds an Honours degree in Life Sciences and PhD in cell biology from Queensland University of Technology (QUT). Dr Parker is currently the deputy program leader of the Tissue Repair and Translational Physiology (TRTP) Program at the Institute of Health and Biomedical Innovation (IHBI) at QUT. He also helped establish and is Chief Scientific Officer of Surgical BioFix Ltd, a Brisbane based biotechnology company involved in the manufacture of dehydrated amniotic membrane allografts for wound and surgical application. In addition, Dr Parker is a Senior Lecturer within the School of Biomedical Sciences at QUT where he teaches anatomy, physiology, proteomics and wound science. Dr Parker’s research is focused on the biochemical implications of musculoskeletal and skin tissue injury and recovery processes. In particular, his team is internationally recognized for their wound fluid analysis expertise. To achieve this he played a key role in the establishment of the world class proteomics and metabolomics capability at QUTs Central Analytical Research Facility (CARF). His team also specializes in the utilization of 2D and 3D in vitro experimental skin wound models and has an interest in the role of exercise in the systemic release of the neuroprotective / neurorepairative protein known as the LG3 peptide which may have implications for stroke prevention and rehabilitation. He has published 28 peer reviewed journal articles in the international scientific literature, attracted over $3 million in research funding and has trained over 29 research and higher degree students.

Does electrical stimulation improve healing in acute burns, as measured by bioimpedance?

Mr Dale Edwick1,2,3,4, Dr Dana Hince5, Dr  Tiffany Grisbrook6, Ms Robyn Murphy7, Mr  Jeremy Rawlins2,8, Professor Fiona  Wood1,2,9, Associate Professor Dale Edgar1,2,3,4,9

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, 6School of Physiotherapy and Exercise Science – Curtin University of Technology, Bentley, Australia, 7ActivLife Technologies Pty Ltd, Niddrie, Australia, 8Department of Plastic and Maxillofacial Surgery – Royal Perth Hospital, Perth, Australia, 9Burn Injury Research Unit – The University of Western Australia, Crawley, Australia

Abstract:

Background: Electrical stimulation (E-stim) has been shown to improve wound healing in chronic wounds. It is yet to be demonstrated to assist in acute burn wounds.

Aim: The aim of this study was to determine if E-stim improves acute burn wound healing. The hypothesis tested was: in patients with acute burn wounds, applying E-stim will increase phase angle (PA) compared to routine care.

Methods: A within patient randomised control study of patients presenting to the State Adult Burns Unit with burns to multiple limbs. One affected limb was randomised by coin toss to receive E-stim and routine dressings. The other wound received routine care only. Wounds were planned to receive stimulation for 10-14 days for more than 20 hours/day (30V, 6-12 Hz, 200µs pulse width). Serial localised bioimpedance spectroscopy (BIS) PA measures were recorded for both wounds. The results were analysed using multi-level mixed effects regressions.

Results: Analysis on 27 patients (21 males) demonstrated PA at 50kHz increased at a faster rate in the stimulated wound (stimulation x time interaction, p=0.0083). Stimulated wound PA increase was 0.052°/day (10.42% increase from baseline) (95% CI -0.005 to 0.11, p=0.078) compared to control PA increase of 0.022°/day (2.69% increase) (95% CI -0.038 to 0.082, p=0.476). Stimulated wound impedance at zero frequency (R0, impedance of extracellular fluid) increased at a faster rate (stimulation x time interaction, p=0.015), indicating an increased oedema reduction rate.

Conclusion: E-stim may provide an adjunct therapy to acute burn wound healing. BIS demonstrates potential to measure acute burn wound healing.


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.

Establishing Disability Weights and the Burden of Burn Injuries in Australia, New Zealand and the Netherlands

Miss Inge Spronk1,2,3, Assoc prof Dale Edgar4,5,6, Dr Margriet van Baar1,2, Prof Suzanne Rea4, Dr Helen Douglas4, Dr Nancy van Loey7,8, Prof Esther Middelkoop3,9, Prof Babette Renneberg10, Dr Caisa Oster12, Dr Lotti Orwelius11, Dr Asgjerd Moi13

1Association Of Dutch Burn Centres, Rotterdam, Netherlands, 2Erasmus MC, University Medical Center Rotterdam, Department of Public Health, Rotterdam, Netherlands, 3Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Plastic, Reconstructive and Hand Surgery, Amsterdam Movement Sciences, Amsterdam, Netherlands, 4State Adult Burn Unit, Fiona Stanley Hospital, Murdoch, Australia, 5Burn Injury Research Node, The University of Notre Dame Australia, , Australia, 6Fiona Wood Foundation, Murdoch, Australia, 7Association of Dutch Burn Centres, Department Behavioural Research, Beverwijk, Netherlands, 8Utrecht University, Department Clinical Psychology, Utrecht, Netherlands, 9Association of Dutch Burn Centres, Red Cross Hospital, Beverwijk, Netherlands, 10Department of Clinical Psychology and Psychotherapy, Freie Universität Berlin, Berlin, Germany, 11Department of Anaesthesiology and Intensive Care, and Department of Clinical and Experimental Medicine, Linkoping University, Linkoping, Sweden, 12Department of Neuroscience, Psychiatry, Uppsala, Sweden, 13Department of Nursing, Faculty of Health and Social Sciences, Bergen University College, Bergen, Norway

Abstract:

Background

Burden of disease calculations are an important resource allocation tool in public health. An essential factor for these calculations is the disability weight, which reflects the magnitude of health loss associated with outcome. Currently, robust estimates are not available for the burden of burns due to the lack of disability weights for homogenous burn injury groups.

Objectives

Our objective is to elaborate on a refined methodology to derive disability weights for homogenous burn injury groups, and to use this methodology to derive disability weights and calculate the burden of burns of Australia, New Zealand and the Netherlands.

Methods

Australian and European health-related quality of life data were used to derive disability weights for three homogenous burn injury groups based on %TBSA burned. Subsequently, incidence data from Australia and New Zealand (BRANZ data) and the Netherlands were used to compute years lived with disability which expresses the non-fatal burden of burns.

Results

Data of 2600 patients were included. Disability weights ranged from 0.05 (subgroup <5% TBSA burned; >24 months post-burn) to 0.58 (subgroup >20% TBSA burned; 0-1 months post-burn). Incidence data from Australia, New Zealand and the Netherlands will be used to estimate the non-fatal burden of burns of these countries. This project is ongoing. Final results will be presented at the ANZBA ASM 2019.

Conclusion

This project will establish a method for more precise estimates of the burden of burns. This information can be used as input for health decision making at both the national and international level.


Biography:

Dale is Head of the Burn Injury Research Node within the School of Physiotherapy and IHR at Notre Dame. In addition to this half-time role, Dale is also Senior Physiotherapist in the Adult Burns Unit at Fiona Stanley Hospital and Director of Clinical Research for the Fiona Wood Foundation.

For more than 20 years, Dale has been devoted to the provision and improvement of burn survivor and acute trauma rehabilitation.

Yarning Up About Out of Pocket Healthcare Expenditure in Burns with Aboriginal Families

Ms Courtney Ryder1,2, Dr Tamara Mackean1,2, Dr  Kate Hunter1, Ms Julieann Coombes1,3, Professor Andrew Holland4, Professor Rebecca  Ivers1,2,5

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

Abstract:

Background

Burn injuries are expensive to treat, and are a significant cost for families through out-of-pocket healthcare expenditure (OOPHE). OOPHE are additional health related costs not covered by universal taxpayer funded health insurance, and can include medication, transport, wage or educational loss. This study sought to understand the impact of OOPHE on Aboriginal families affected by burn injuries.

Methods

Families of Aboriginal children ≤ 16 years who had sustained a severe burn injury from 5 hospital sites were invited to participate. Severe burn injury was defined as ≥1 night hospital stay with follow-up care and TBSA%≥10. Yarning sessions with participants explored OOPHE for burns care that families may have encountered during their child’s treatment. Yarning is an Indigenous research method, encompassing a conversational technique to gather information from participants. Indigenous research methods were applied to identify main themes from transcripts; data were organised using NViVO (Version 12).

Results

Five yarning sessions were undertaken. Ten themes were identified, including costs (i.e. transport, pharmacy), loss (i.e. financial, employment capacity), sibling impacts (i.e. psychological), family support (i.e. financial) and financial stress. Inequities were present, such as lack of support, where participants were ineligible in accessing government support initiatives (i.e. carer pension). The need to cover OOPHE significantly impacted families, from restricting social interactions to paying household utilities.

Conclusion

This study has provided new understandings of OOPHE from the perspective of Aboriginal families. These results will inform the development of the first OOPHE tool to assess cost impacts of burn injury on Aboriginal families.


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.

Study of negative pressure wound therapy as an adjunct treatment for acute burns in children (SONATA in C): a randomised controlled trial

Mr Cody C. Frear1,2,3, Dr. Bronwyn Griffin1,2,3, Associate Professor Leila Cuttle4, Professor  Steven McPhail5,6, Professor Roy Kimble1,2,3

1Centre For Children’s Burns And Trauma Research Children’s Health Research Centre, The University of Queensland, The University Of Queensland, South Brisbane, Australia, 2The Pegg Leditschke Children’s Burns Centre, Queensland Children’s Hospital, Level 5, South Brisbane, Australia, 3The University of Queensland Faculty of Medicine, Herston, Australia, 4Institute of Health and Biomedical Innovation, Centre for Children’s Burns and Trauma Research, Children’s Health Research Centre, Queensland University of Technology, South Brisbane, Australia, 5Centre for Functioning and Health Research, Metro South Health, Queensland Health, Brisbane, Australia, 6School of Public Health & Social Work and Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia

Abstract:

Background: In the setting of burns, negative pressure wound therapy (NPWT) has been widely adopted as a means of wound bed preparation prior to skin grafting and graft immobilisation. Its role in the treatment of acute burns is less well studied, although there is limited evidence to suggest that it might facilitate physiological healing. This study aimed to assess its efficacy in the management of acute burns in children with small-to-medium-sized thermal injuries.

Methods: A pragmatic randomised controlled trial was conducted in children under 17 years of age with acute thermal burns that covered <5% of their total body surface area (TBSA). Children were excluded if they presented >7 days post-injury, or if their wound was located facially or deemed trivial by clinical staff. Participants were randomised to either an active control consisting of Acticoat and Mepitel or an intervention comprised of Acticoat, Mepitel, and NPWT. Dressings were changed every 3-5 days until ≥95% re-epithelialisation of the wound. The time required to reach this endpoint served as the primary outcome. Secondary outcomes included grafting, pain, ease of management, and scarring at 3 and 6 months post-burn.

Results: A total of 114 children were recruited, of which 57.7% were male. Participants had a median (IQR) age of 3 years (1-8) and TBSA percentage of 1.0% (0.5-3.0%). Results will be presented for time to re-epithelialisation, grafting, and pain.

Discussion: This trial provides evidence-based recommendations for the use of NPWT as an adjunct to standard care in the treatment of acute paediatric burns.


Biography:

Cody C. Frear is an MD/PhD candidate at the University of Queensland. Prior to starting medical school, he conducted immunology and virology research at the National Institutes of Health in Washington, D.C., and the Biodesign Institute in Tempe, Arizona, inspired by his experiences volunteering at an HIV/AIDS clinic in The Gambia. Following his undergraduate studies, he worked as a medical scribe in an Emergency Department, where he developed an interest in trauma research. This interest led him to the Centre for Children’s Burns and Trauma Research in Brisbane. He is currently completing his PhD, which focuses on the efficacy of negative pressure wound therapy in the management of acute paediatric thermal injuries. His other areas of study include burns first aid and the proteomics of burn wound exudate.

A Composite Cultured Skin- Bench to Bedside

Ms Bronwyn Dearman1,2, Professor John Greenwood1

1Skin Engineering Laboratory, Adult Burns Unit, Royal Adelaide Hospital, Adelaide, Australia, 2The University of Adelaide, Faculty of Health Sciences, School of Medicine, Adelaide, 5000

Abstract:

The biodegradable temporising matrix (BTM) is our standard of care for patients with >30% TBSA deep burns. A 95% TBSA burn presented in December 2018. After total eschar excision on arrival, BTM was applied to 90% of the body 2 days later. With no meaningful donor site, we obtained TGA Special Access Scheme B approval to use Composite Cultured Skin (CCS). We have been developing this technology, alongside the BTM, since 2004. Twenty six CCSs were grown in an ISO 7 cleanroom environment in a semi-automated bioreactor. Two small split thickness skin grafts were obtained to provide the fibroblasts and keratinocytes, which were isolated and mass cultured in Cell Factories to obtain relevant cell numbers. The matrix (1mm thick polyurethane foam) was pre-soaked in plasma. In the bioreactor cassette (25cm x 25cm), fibroblasts were seeded onto the matrix with thrombin until the keratinocytes were seeded. The total co-culture period was 14 days. The CCSs were applied after BTM delamination and dermabrasion, and dressed with Mepitel and Acticoat. Punch biopsies, VapoMeter readings (TEWL) and Vivascope confocal imaging were performed to indicate wound healing and skin barrier function. Clinically, robust epithelium was visible with CCS ‘take’ by at least day 18 post-application. Early CCS batch take was irregular and additional CCSs produced. Some widely meshed split skin, and Meek, grafting were used to cover difficult areas, yielding poorer cosmetic results. At 5 months post burn, this 95% TBSA deep burn patient is alive, healed and will soon be discharged to rehabilitation.


Biography:

Bronwyn Dearman, a Medical Scientist at the Adult Burns Unit, Royal Adelaide Hospital has been instrumental in establishing the first Skin Laboratory for SA providing both a clinical service and the development of the Biodegradable Temporising Matrix (BTM) (a product now in fledgling global use in burn communities). To complement this first stage and assist in abolishing the need for a skin graft, the development of the Composite Cultured Skin substitute (CCS) encompasses her current research interests.

Effectiveness of topical silicone gel and pressure garment therapy for burn scar prevention and management in children: a randomised controlled trial

Ms Jodie Wiseman1, Dr Robert Ware2, Dr Megan Simons3, Professor  Steven McPhail4, Professor Roy Kimble5, Dr Zephanie Tyack1

1Centre For Children’s Burns And Trauma Research, South Brisbane, Australia, 2Menzies Health Institute Queensland, Griffith University, Nathan, Australia, 3Occupational Therapy Department, Queensland Children’s Hospital, South Brisbane, Australia, 4Centre for Functioning and Health Research, Metro South Health, Buranda, Australia, 5Pegg Leditschke Children’s Burns Centre, Queensland Children’s Hospital, South Brisbane, Australia

Abstract:

Background

This study aimed to determine the effectiveness of topical silicone gel and pressure garment therapy, alone or combined, for the prevention and management of burn scarring in children.

 

Methods

A randomised trial was conducted with children with burns that healed spontaneously after 17 days or more, required grafting, or received reconstruction surgery for a pre-existing burn scar. Participants were randomised into: (1) topical silicone gel only, (2) pressure garment only, or (3) combined therapies. Primary outcomes included scar thickness and itch intensity (primary end-point, 6-months post-burn injury). Secondary outcomes included health-related quality of life, scar severity, treatment satisfaction, adherence and adverse effects. Data were analysed using descriptive statistics and mixed models regression.

Results

Participants (N=153; silicone n=51, pressure garment n=49, combined n=53) had a median (IQR) age of 4.9 (1.6, 10.2) years, median percent total body surface area burn of 1% (0.5%, 3%), and were 65% male. At 6-months post-burn injury, intention to treat analysis identified thinner scars in the silicone (n=51 scar sites) compared to the combined group (n=48 scar sites) (MD (95%CI)=-0.04cm (-0.07, -0.00), p=0.05). No other between group differences were identified for outcomes at the 6-months post-burn primary endpoint. Results for the 12-months post-burn secondary endpoint will be discussed.

Discussion

No benefit was identified for a combined silicone and pressure intervention for the prevention and management of scarring in children at 6-months post-burn injury. Other considerations include the risk of adverse effects and treatment adherence which may underpin treatment selection decisions in paediatric burn-care settings.


Biography:

Jodie is an Occupational Therapist who has submitted her PhD with the Centre for Children’s Burns and Trauma Research at the University of Queensland and Pegg Leditschke Children’s Burns Centre. Jodie’s PhD research was focused on the effectiveness of silicone and pressure garment therapy for the prevention and management of burn scarring in children.

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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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