Survivability in Major Paediatric Burn Injuries: A Single Centre Experience

HP Chong1, E Gibson1, L Quinn1R Cooksey1,D Molony1,A Jeeves1, M Lodge1,B Carney1

1Women’s And Children’s Hospital, North Adelaide, Australia

Abstract:

Survival rates in burn injuries are inversely proportional to burn size. With advancement in technology, multidisciplinary approach comprising of knowledgeable and dedicated specialist with particular interest in treating this unique surgical population, and multiple medical innovations, mortality rates have decreased significantly. However, no large analysis on outcomes in pediatric burn patients with current treatment regimen exists. This study was designed to identify the burn size presently associated with significant increases in morbidity and mortality in pediatric burn patients. We perform a single center retroprospective observational cohort study utilizing the clinical data of severely burned pediatric patients admitted between 1975 and 2017. This study included severely burned pediatric patients with burns over at least 30% of their total body surface area (TBSA). We analyse the epidemiology, trends in presentations and treatment approaches that have lead to the implementation of our approach to this date.


Biography:

HP Chong is the Burns Fellow at WCH and previous unaccredited Plastics and Reconstructive Surgery Registrar at Flinders Medical Centre.

Scar Management: Academic-Clinician Collaborations in Identifying and Mapping Evidence

Dr Sandeep Moola1, Dr Matthew Stephenson1 Ms  Rochelle  Kurmis2, Assoc Prof  Dale Edgar3, Ms  Kathryn  Heath4

1Research Fellow, University Of Adelaide, North Adelaide, Australia, 2Allied Health Project Manager, Adult Burns Service, Royal Adelaide Hospital, Adelaide, Australia, 3Head, Burn Injury Research Node, The University of Notre Dame, Fremantle, Australia, 4Allied Health Project Manager, Adult Burns Service, Royal Adelaide Hospital, Adelaide, Australia

Abstract:

Background: The Burns Care Node of the Joanna Briggs Institute’s COnNECT+ database provides access to reliable, high quality burns specific evidence-based resources. The Expert Reference Group aligned to the node assists with the development and review, ensuring that the quality and relevancy of the resources is maintained. Evidence tools such as point-of-care resources, rapid reviews and evidence maps are developed to aid decision-makers in understanding the evidence base and leveraging it to improve clinical practice and policy.

Aim: To present the current state of evidence in burns scar management, and demonstrate the value of academic-clinician collaborations, and evidence tools such as rapid reviews and evidence maps.

Methods: A rapid review method was utilised, and a comprehensive search was conducted in the COnNECT+ database for evidence summaries (ESs) related to various aspects of burns scar management and in other major databases. Further, an evidence map aided by tables was used to visually represent the data.

Results: Twenty ESs were identified and the quality of included evidence, and best practice recommendations were reviewed. An evidence map was generated identifying effective interventions for burns scar management and highlighting the evidence gaps in this field.

Conclusion: The process of rapid reviews and evidence mapping in collaboration with clinical experts is a useful tool for assisting clinicians with identifying evidence-based strategies for implementation into practice and for identifying future research priorities. The project further demonstrated the value of robust academic processes in close collaboration with clinical topic experts to develop and promote evidence-based burns practice.


Biography:

I am currently working as a Research Fellow within the Implementation Science Team at the Joanna Briggs Institute, University of Adelaide. My role at JBI involves undertaking systematic reviews and writing evidence summaries, recommended practices, review summaries and Best Practice Information Sheets. I am an Academic Lead of ‘Burns Care’, and ‘Infection Control’ Nodes of JBI COnNECT+ database. I also assist in developing short course online modules and have contributed to various external consultancy research projects.
I have a clinical background in oral health, and I have obtained a Master’s degree in Health Services Management and a Master of Philosophy degree in Evidence-Based Health care. I recently completed my PhD.

Interim Pressure Garment Therapy: An investigation into the use of low level pressure therapy for burns donor site support and scar reduction

Ms Michelle Donovan1, Dr Zephanie Tyack2, Dr  Claire Simpson3, Professor Michael Muller4, A/Professor Jenny Paratz5

1Occupational Therapy Royal Brisbane And Women’s Hospital, Herston, Brisbane , Australia, 2Burns, Trauma & Critical Care Research Centre, School of Medicine, University of Queensland,  Herston, Brisbane, Australia, 3Centre for Children’s Burns and Trauma Research, UQ-Child Health Research Centre Level 6, CCHR   Building, The University of Queensland, St Lucia, Brisbane, Australia, 4Professor Stuart Pegg Adult Burns Centre, Royal Brisbane & Women’s Hospital, Level 4, Dr James Mayne Building, Herston, Brisbane, Australia, 5School of Allied Health Sciences, Griffith University, Gold Coast Campus,, Southport, Australia


Abstract:

Background: Pressure garment therapy (PGT) is commonly used in the treatment of burns scars and has been the focus of many studies. However, there has been little investigation of PGT to treat burn donor sites. Two studies were undertaken to determine the effectiveness of PGT for early donor site support and scar reduction.

Method: A cross sectional single centre design of 47 healthy volunteers was undertaken to firstly establish size and pressure ranges of an Interim PGT (IPGT) for donor sites. The pressure at the skin/garment interface was determined using the thin sensor pad of the Pico Press®.  A subsequent pilot study (n=8) was conducted to test the effectiveness of IPGT for donor site scar reduction using a single centre, single (assessor) blinded, randomised, controlled trial of burn patients who had thigh donor sites following skin grafting.  The IPGT was administered post-operatively, and worn for 23 hours per day for a period of 12 weeks. Donor scar thickness was measured using the Dermascan C® high frequency ultrasound.  Descriptive statistics and multiple regression were used to analyse the findings.

Results: The mid-thigh measurement was a significant predictor of the IPGT sizes small, medium and large (p < 0.001, p = 0.64 and p = 0.13) and provided a pressure range of 3 to 7 mmHg at the donor site thigh location. The results of the IPGT pilot study indicated a trend towards a decrease in donor site scar thickness over time for the IPGT group (p = 0.07), compared to the control group. Results also indicated that there were a number of parameters such as pain and itch severity that appeared to reduce over time, however no significant differences (p = 0.48 and p = 0.29 respectively) between the groups over time were found possibly due to such low participant numbers.

Conclusion: Preliminary data demonstrates IPGTs may be a feasible, safe and practical early scar reduction technique for donor sites. Directions for further research will be described.


Biography:

Michelle Donovan is a senior Occupational Therapist at the Royal Brisbane and Women’s Hospital with a special interest in burn scar management. She graduated from the University of Queensland with a Bachelor of Occupational Therapy and has recently completed a Master of Philosophy in burn donor site management. Michelle has 14 years’ experience across vascular, plastics and burn care rehabilitation. She provides professional guidance to occupational therapists, students and patients in metropolitan, rural and remote areas of Australia, and aboard in Nepal. Michelle holds a clinical academic title at the University of Queensland (School of Health and Rehabilitation Sciences) as an associate lecturer and is an active member of the Australia and New Zealand Burn Association. Michelle is a published novice researcher with research funding totaling $50 000.

Burn Injury as a Result of Interpersonal Violence in the Northern Territory Top End

Dr Lisa Murphy1, Mr David Read1,2, Ms Margaret Brennan1, Mrs Linda Ward2,3, Mrs Kathleen  McDermott2

1Royal Darwin Hospital, Tiwi, Australia, 2National Critical Care and Trauma Response Centre, Tiwi, Australia, 3Menzies School of Health Research, Tiwi, Australia

Abstract:

Background: Rates of interpersonal violence (IPV) in the Northern Territory are high. Burns due to IPV constitute 7.4% of admissions to the Royal Darwin Hospital (RDH) Burns Service. This study aims to describe demographics, circumstances and burn wound characteristics of IPV burn victims admitted to RDH and assess the adequacy of their care.

Methods: Identification of IPV burns through retrospective Burns Registry analysis of all RDH patients meeting BRANZ criteria from 2010-2015, with intent recorded as ‘assault’; supplemented by medical case note review; children (<16yo) excluded. Characteristics of the IPV cohort were compared against those of non-IPV burns in the Registry during the same timeframe.

Results:  Fifty-three patients met IPV criteria. IPV burn victims were 2.3 times more likely to be female than non-IPV victims (95% CI: 1.2-4.3), and 16.7 times more likely to be Indigenous (95% CI: 7.9-35.3). Alcohol or drug use was involved in almost 60% of IPV cases. Approximately half (53%) of IPV burns were classified as family or domestic violence. Scalding was the most common mechanism in family and domestic violence. Scald to the back was nine times more likely to be due to IPV (95% CI: 3.4-25.4). A total of 10 patients (19%) had incomplete burn care through self-discharge, all of whom identified as Indigenous. Twenty percent of patients had no documented inpatient psychosocial support.

Conclusions: Women and Indigenous persons are at increased risk of IPV burn. Burns from IPV have a high rate of incomplete burn wound treatment in Indigenous persons. This study explores the challenges of providing care to the IPV burn population, which extend beyond burn wound closure.


Biography:

Lisa is a current Medical/Surgical Intern at the Royal Darwin Hospital, where she has previously worked from 2010 to 2017 as a theatre nurse, with a special interest in burns.
She has been formally involved in the delivery of EMSB at RDH since 2013 and deployed with the National Critical Care and Trauma Response Centre to Tacloban following typhoon Haiyan in 2013.

The experiences of wearing Compression Garments post Burn Injury

Ms Nicole Coghlan1,2, Associate Professor  Jodie Copley2, Dr Tammy Aplin2, Professor  Jenny  Strong1,2

1Royal Brisbane And Women’s Hospital, Herston, Australia, 2The University of Queensland, St Lucia, Australia

Abstract:

Burn injuries result from mostly catastrophic events leaving injuries that require extensive medical treatment and rehabilitation (Silwa, Heinemann & Semik, 2005). As burn injuries heal, thick, raised hypertrophic scar can form, with these scars impacting on the patient’s ability to engage in occupational roles including daily hygiene, work and leisure activities. An important role of the multidisciplinary team is to assist in managing scar formation through the provision of compression garments. There is limited evidence however, discussing the patient experience of wearing compression garments, what experiences limit wearing ability or how to improve the patient experience (Martin et al., 2016).
A qualitative research design was utilised to gain patient and therapist perspectives regarding compression garment wear. Key themes include what it is like to wear compression garments, experiences of being a patient, the impact of wearing compression garments, strategies used to make wearing easier, and recommendations to improve the garment experience. In the constant war against scar, knowing patient’s experiences of wearing compression garments, their strategies and recommendations to improve the wearing experience may lead to enhanced outcomes for burn patients.

References:
Martin, C., Bonas, S., Shepherd, L. and Hedges, E., 2016. The experience of scar management for adults with burns: an interpretative phenomenological analysis. Burns, 42(6), pp.1311-1322.
Sliwa, J.A., Heinemann, A. and Semik, P., 2005. Inpatient rehabilitation following burn injury: patient demographics and functional outcomes. Archives of physical medicine and rehabilitation, 86(10), pp.1920-1923.


Biography:

Nikki is an occupational therapist currently working in the burns team at the Lady Client Children’s Hospital. She will be presenting findings from her research masters completed whilst working at the Royal Brisbane and Women’s Hospital.

The Effect of Smart Scar Care Pad (SSCP) on the Elasticity of Post Burn Hypertrophic Scar (HS)

Ms Walei Zhang1, Prof  Cecilia  Li-Tsang1

1The Hong Kong Polytechnic University , Hung Hom, Kln, Hong Kong

Abstract:

Hypertrophic scars (HS) developed after burn injuries would cause discomfort, joint contracture, deformities resulting disfigurement for burn survivors. Scar elasticity is directly associated with complications leading to dysfunction. Our research team has invented a new padding material, the Smart Scar Care Pad (SSCP), aiming at enhancing the hydration and occlusion effect of HS, at the same time, providing pressure intervention to reduce vascularity of the HS. This pilot study was to investigate the clinical effectiveness of ‘Smart Scar-care pad (SCCP)’.

The study adopted a self-control cohort study design. 30 adults with post burn hypertrophic scar (HS) on limbs were recruited upon their consents. For each subject, two scar sites were selected. One scar site was treated by “Smart Scar-care pad (SCCP)” together with pressure garment as experimental group. Another scar site was prescribed with a form of padding and pressure garment as control group. Assessments were performed before treatment and after 45-day treatment on various parameters, including VSS, Hydration level, Melanin score, Erythema score, Elasticity, Retraction time and thickness, and end-users’ feedbacks.

Our preliminary result has demonstrated its clinical efficacy to improve HS elasticity. The SSCP appeared to show positive effect in management of HS through the occlusion and compression effect, particularly for those scars which are still very active and hypertrophic. Subjects reflected satisfaction towards the maintenance and the quality of ‘SCCP’, especially on its conformability, durability and adhesiveness. A large scale of RCT study would be conducted to verify its clinical efficacy.


Biography:

Prof. Cecilia W.P. Li-Tsang is specialized in the field of burns and scar management, developmental disabilities and hand rehabilitation. She is an active researcher as well as an expert clinician to manage complex hand, burns and paediatric cases. She is the Executive member of International Federation of Societies of Hand Therapy and the Member of Scar Academy of British Burns Association. She was successfully in bidding more than HK40 million of research funding support and has also published over 100 journal articles.

Advancement in 3D Printing Technology in the Management of Facial Hypertrophic Scar

Ms Yating Wei1,2, Ms  Walei Zhang1, Mr Sidney  Wong3, Mr  Stanley  Ngai3, Prof  HC Man3, Prof  Cecilia  Li-Tsang1

1Department of Burn Surgery,the Second Affiliated Hospital of Kunming Medical University, Kunming, China , 2Department of Rehabilitation Sciences, The Hong Kong Polytechnic University , , Hong Kong, 3University 3D Printing Center, the Hong Kong Polytechnic University, , Hong Kong

Abstract:

Facial hypertrophic scars caused by burn injuries usually result in disfigurement, discomfort, dysfunction as well as deprived quality of life (QoL). Children with facial hypertrophic scars are no stranger to developmental delay and disrupted family dynamics, and even abandonment. Transparent facemask was introduced as one method to treat facial scar based on compression therapy concept. By integrating 3D printing, 3D scanning technologies as well as computer assisted design (CAD), an innovative transparent 3D-printed facemask with silicone gel lining can be produced with increased efficiency and accuracy to provide the optimal pressure on the complex contour of the face, when compared to the traditional method of fabrication.

The method of production of the 3D printed facemask and its clinical effectiveness would be presented in this paper. The facial contours of the patients with facial burns were scanned with a portable 3D scanner. The scanned 3D file was processed and modified with CAD software before 3D-printed. Subsequently, medical grade silicone gel was lined on the inside surface of the mask. The facemasks were fitted on the patients’ faces with elastic straps. The biomechanical principles governing the fabrication of the face mask together with the choice of printing materials would also be presented. Based on two case studies, the clinical results showed positive changes of scar thickness and the overall conditions of the scar after one month of intervention. To conclude, the innovative 3D-printed transparent facemask appeared to demonstrate its efficacy on management of facial scars.


Biography:

Ms Eve Walei Zhang is a PhD student from the Hong Kong Polytechnic University.

Flat Out Dangerous: Household Iron Burns in Children

Dr Teagan Fink1, Dr Courtney Hall1, Ms Alenka Paddle1, A/Prof Warwick Teague2

1Plastic and Maxillofacial Surgery, Royal Children’s Hospital, Parkville, Australia, 2Burns Unit, Royal Children’s Hospital , Parkville, Australia

Abstract:

To date, few studies have been conducted regarding household irons as an important cause of paediatric burns. We performed a retrospective review of iron burns at a large tertiary paediatric hospital from July 2015 to May 2018. We examined patient demographics, location of burn, total body surface area (TBSA), burn depth, level of supervision, first aid measures, surgical management and complications.

In the three-year study period 30 children sustained iron burns; and all were managed in the outpatient or day surgery setting. The majority of children were male (67%), toddler (1-2 years old, 83%) and sustained burns to the hand only (80%). Despite all burns involving a small surface area (<2% TBSA), 17% of children required surgical intervention, with one lost to follow up. 17% of iron burns had complications. Alarmingly, 45% were unsupervised at the time of the burn. Only 37% of children received the recommended first aid for burns in Australia.

Paediatric iron burns have significant morbidity and an economic impact upon hospital resources. Inadequate supervision was common amongst patients with iron burns in our population. It follows that prevention and education programs aimed at caregivers could reduce the incidence and sequelae of iron burns in this age group, given their common place in many households.


Biography:

Dr Teagan Fink is a Plastic and Maxillofacial Surgical Resident at the Royal Children’s Hospital.  During her six month rotation with the unit, she undertook research into paedatric burns.  She is also employed as a Surgical Resident at St Vincent’s Hospital Melbourne.

Scar management protocol at RNSH Burns Unit: Intra-lesional steroid injections in the management of hypertrophic burns scars

Dr Harriet Semple1, Akane Katsu1, Dr Aruna Wijewardana1, Dr Robert Gates1, Dr John Vandervord1

1Royal North Shore Hospital, St Leonards, Australia

Abstract:

Intra-lesional steroid injection is a widely accepted treatment for hypertrophic scarring secondary to burns and is often used in refractory cases where non-invasive methods have already failed. However, despite decades of use in multiple centres, the literature is surprisingly scant when it comes to high level trials on the use of steroid injections in burns hypertrophic scars specifically, or when these are most effective in relation to scar maturation. At the Royal North Shore Hospital Burns Unit, doctors are injecting hypertrophic burns scars with triamcinolone acetonide 10mg/ml to 40mg /ml between 6 and 18 months post injury. However, even within this unit consensus has not been reached on the most appropriate time to commence intra-lesional steroid therapy. In this presentation we intend to detail the current protocol used at RNSH Burns Unit for the management of burns scars in general, and particularly the determinants for the use of intra-lesional steroid injections for hypertrophic scars such as patient suitability, pre-treatment scar evaluation and timing of injections in relation to scar maturation. This will be compared with the available literature to evaluate where further studies are necessary to provide an evidence based guide on the most effective use of intra-lesional steroid therapy when treating hypertrophic burns scars.


Biography:

Harriet is a resident at RNSH with a keen interest in burns surgery.

A mixed method design to examine the use of padding inserts in pressure garments for burns scar management.

Mrs Kate Sands1, Mrs Tamsin Mahoney1, Dr. Megan Simons1,2

1Pegg Leditschke Children’s Burns Centre – Lady Cilento Children’s Hospital, Brisbane, Australia, 2Centre for Children’s Burns and Trauma Research – Centre for Children’s Health Research, Brisbane, Australia

Abstract:

Background:Pressure garments are routinely used for burns scar management, with higher pressures considered more effective. The use of padding inserts in pressure garments to increase localized pressure is practiced clinically, however there are currently no published guidelines. The aim of this study was to examine current practice and state of the evidence regarding the use of padding inserts in pressure garments.

Method:A Rapid Evidence Assessment (REA) was conducted. A number of databases were searched using inclusion criteria featuring scar outcomes on hypertrophic scarring from using padding inserts. Combined treatments involving silicone were excluded. Additionally, burns therapists across Australia and New Zealand were surveyed about their experience and understanding of padding inserts in pressure garments for scar management.

Results:There were 2087 studies sourced. Following screening, 35 full texts were reviewed. The appraisal highlighted a lack of translatable, quality evidence supporting or comparing inserts in pressure garments.
Of the 25 respondents, 96% used padding inserts (including foam, silicone, otoform, mineral oil sheets etc). The majority (84%) were not aware of evidence supporting the use for such treatment. Reasons for use, benefits, contraindications and prescription details were wide-ranging.

Conclusion:There is a lack of translatable, quality evidence regarding the use of padding inserts in pressure garments, along with significant variability in use, understanding and prescription amongst Australian and New Zealand burns therapists. These results indicate that further research about the efficacy and properties of padding inserts is needed. A reference guide featuring available insert materials for therapists will be discussed.


Biography:

Kate is an Occupational Therapist at the Lady Cilento Children’s Hospital, currently working in the Pegg Leditschke Children’s Burns Centre.

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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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