Clinical distinction between superficial and deep burns is problematic. The authors determined whether an infrared thermal imaging (IRTI) camera could predict burn depth. Burn depth was assessed by an experienced surgeon, and the burns were imaged with a portable, lightweight IRTI camera that measures heat emission from the skin using long infrared wavelengths (7.5-13 μm). Burns were considered "deep" if they were surgically excised and confirmed to be of full thickness on microscopic evaluation or if they did not heal spontaneously within 21 days of injury. All other burns were considered "nondeep." There were 39 burns that had both days 1 and 2 IRTI measurements and available outcome. Of these, 16 were "deep" burns and 23 were "nondeep." The mean temperatures of "nondeep" burns between days 1 and 2 increased from 30.6 ± 2.7 to 32.1 ± 3.0°C (difference of 1.5 ± 2.3°C). The mean temperatures of "deep" burns decreased from 32.3 ± 2.0 to 30.8 ± 1.3°C (difference of -1.5 ± 2.0°C) between days 1 and 2. Any decrease in temperatures between days 1 and 2 was predictive of a deep wound, and any increase between days 1 and 2 was predictive of a nondeep burn. Using the ultimate burn depth as the criterion standard, the overall accuracy of IRTI was considerably higher than that of clinical assessment; 87.2% (95% CI: 71.8-95.2) vs 54.1% (95% CI: 37.1-70.2). Any decrease in temperatures between days 1 and 2 was predictive of a deep wound. Our results suggest that thermography using IRTI is more accurate than clinical examination in predicting burn depth and could potentially reduce unnecessary surgery as well as reduce delays to surgery when necessary.

Objectives: Progression of cell death after burn injury may occur by one of three mechanisms: passive necrosis, apoptosis, and programmed necroptosis that requires the receptor-interacting protein kinase-3 (RIP-3). The hypothesis was that RIP-3 is present in normal and burned skin; that necroptosis plays a role in burn injury progression; and that treatment with necrostatin-1, an inhibitor of necroptosis, would reduce burn progression.Methods: Skin specimens from rats were examined for the presence of RIP-3. Using a 150-g brass comb preheated to 100°C, we created two comb burns (one on each side) consisting of four rectangular burns, separated by three unburned interspaces, on both sides of the backs of anesthetized male SpragueDawley rats (240 to 300 g). The interspaces represent the ischemic zones surrounding the central necrotic core. Left untreated, these areas undergo necrosis. In the first experiment, 10 rats each were randomized to 1.65 mg/kg necrostatin-1 or control given by intraperitoneal injection 1 hour after injury. In the second experiment, 10 rats each were randomized to two intravenous injections of 1.65 mg/kg necrostatin-1 or its vehicle at 1 and 4 hours after injury. The primary outcome was the percentage of interspaces undergoing necrosis within 7 days of injury. Binary data were compared with chi-square or Fishers' exact tests.Results: All normal and burned skin specimens from rats stained positive for RIP-3. In the first experiment, nearly all unburned interspaces in both the experimental and the control rats underwent necrosis (47 of 48, 97.9% vs. 48 of 48, 100%; p = not significant [NS]). Similarly, in the second experiment, there was no difference in the percentage of unburned interspaces undergoing necrosis within 7 days of injury in rats treated with two doses of necrostatin-1 or the control vehicle (46 of 48, 95.8% vs. 48 of 48, 100%; p = NS). There were no wound infections noted in rats injected with necrostatin-1. Conclusions:The skin of rats contains RIP-3 necessary for necroptosis. Injection of rats with either a single intraperitoneal dose or two intravenous doses of necrostatin-1 failed to reduce burn injury progression in a rat comb burn model. This may be due to inactivity of necrostatin-1 or the lack of a role of necroptosis in burn injury progression in the rat comb burn model.

Several techniques (such as cooling and covering) are recommended in the first aid management of burn injured patients, both for lay persons and for EMS. Few studies have examined the rates of compliance with these recommendations. This study is a burn registry query performed in a suburban academic medical center with a regional burn unit. Patients seen by the burn service between January 2008 and February 2009 were included. Demographics, injury characteristics, rates of implementation of first aid, and method of transport to medical care (self vs ambulance) were recorded. Rates of implementation are reported as proportions with confidence intervals (CIs) and rates of implementation in those transported by self vs ambulance and work-related vs nonwork-related burns are compared using chi tests. Two hundred eleven burn patients were entered in the registry during the study period. Mean age was 27.0 (SD, 22.1) years, 44.3% were female, 95.2% were thermal burns, and 29.9% were transported by ambulance; 72.7% (95% CI, 66-78%) reported cooling their burn before presentation for medical care. Of those, 39.9% reported using tap water to cool their burn (95% CI, 33.4-46.8%), whereas 25.2% used ice (95% CI, 18.4-33.5%), and 8.9% used a cooling blanket (95% CI, 5-15%). Only 22.2% reported having applied a dressing before arrival in the hospital (95% CI, 16.9-28.5%). There were no significant differences between the groups who transported themselves to care in comparison with those who were brought in by ambulance in terms of cooling with water (P = .516), cooling with ice (P = .063), or application of dressing (P = .506). Further, no differences existed between those reporting cooling of the burn and those who did not in terms of patient characteristics. Rates of first aid administered for burn injury by lay persons before arrival at a burn center are high. A substantial percentage of people continue to use ice to cool their burns despite evidence of its potential detrimental nature. There is no difference in the rates of first aid implementation in those who did and did not contact EMS. The initial call to EMS might be used to instruct lay persons in appropriate burn first aid while awaiting the ambulance.

Intravenous infusion pump safety software improves clinical outcomes through consistent application of evidence-based standards of dose rates for IV drugs.

No abstract